Team Physicians for the NY Mets: The HSS Healthcare Team Discusses the Provider-Player Relationship

Adapted from an interview with David W. Altchek, MD and Mickey Levinson, PT, CSCS

Introduction
The “Team” in Team Physicians
Prevention, Maintenance, and Performance
The Rehabilitation Process
Differences Between Professional and Amateur Athletes
The Challenges and Benefits of Working With Professional Athletes

Introduction: Physicians and staff from Hospital for Special Surgery (HSS), led by Dr. David Altchek, have been involved with the Mets professional baseball team for over a decade as team physicians, trainers, and rehabilitation experts. We recently sat down with Dr. Altchek and Mickey Levinson, a physical therapist for the team, to discuss the role HSS plays in the continuing health of some of baseball’s top players. The “Team” in Team Physicians A large team of professional athletes requires its own team of physicians, therapists, and trainers to maximize their performance capability. Each physician or therapist works in tandem to keep the athletes at their peak physical condition. Medical Director: In the 2005 season, Dr. Altchek’s position shifted from being the team physician - managing the day-to-day game coverage for home games - to acting as the Medical Director, overseeing the decision-making process for the players’ course of care throughout the season and off-season. Dr. Altchek notes, “When major decisions have to be made, ones that affect a player’s career, I am directly involved. When making these decisions, I consider the player’s injury profile and assess the risk involved in their treatment against the anticipated benefit.” Physicians: Joining Dr. Altchek are Struan H. Coleman, MD, PhD, Head Team Physician and Andrew D. Pearle, MD, Associate Team Physician. These HSS physicians provide day to day coverage for the Mets. One of these physicians attends every home game as well as spring training, where they diagnose and treat injuries that may arise. Physical Therapists and Trainers: Mickey Levinson, Clinical Supervisor of Physical Therapy for the HSS Sports Rehabilitation and Performance Center, provides therapeutic assistance for injuries on site at Shea Stadium and at HSS. When complex injuries arise, Mickey is part of the decision-making process concerning the athletes’ recovery and rehabilitation by overseeing his team of physical therapists and trainers. Prevention, Maintenance, and Performance Since the Mets team physicians must know the baseline status of each player before he ever sets foot on the diamond, they are aware of previous sports injuries and other factors that can have an effect on their course of treatment for any injury. The team also has a large training staff that directs the athletes’ energies on maintaining the health of each player as well as a conditioning staff that focuses on maintenance, prevention, and performance enhancement. “All these facets work in harmony to produce the fittest players with the best performance and the most efficient management of their injuries,” explains Dr. Altchek. “Without this kind of conditioning, there will most likely be a higher prevalence of preventable injuries such as muscle strains in the groin, hamstring, and calf.” Periodization: On- and off-season training techniques for professional baseball players dovetail in a series of cycles called periodization. During the off-season, Mickey and his team stress a period of rest followed by a period of pure strength training and more functional activities related to baseball. The conditioning team then alters the cycles to coincide with in-season training by decreasing the intensity of the techniques in order to prevent injury. The Rehabilitation Process When players are placed on the DL (disabled list), Mickey and the other physical therapists shepherd them through every part of the rehabilitation and conditioning process until they’re healthy and ready to play. Medical attention isn’t limited to major league players. Whether the players have surgery at HSS or elsewhere, the team physicians, physical therapists, and trainers take care of the whole organization – from the farm teams to the major leagues. Mickey stresses the importance of the constant presence of the team physicians: “Our goal is to have constant physician coverage for all of the players, both major leaguers and minor leaguers. There should always be doctors, physical therapists, and trainers available during every part of the season.” Differences Between Professional and Amateur Athletes By learning the ways in which the professional athlete’s body responds to treatment and rehabilitation, Dr. Altchek and his team can apply these techniques at a lower intensity level for those who play the same sports recreationally. “These professional athletes are trained at a much higher level baseline, and they’re gifted physically - not just in terms of talent, but in their biology,” explains Dr. Altchek. “Their body fiber is simply different. Sports are very Darwinian, and by the time you get to that level of competition, it has selected out other players with enormous talent whose bodies couldn’t withstand the constant trauma.” Mickey agrees: “These professional baseball players are some of the easiest patients that I have, at least physically, because they have such body awareness and a high degree of experience doing these exercises to begin with.” One major difference between professional and amateur athletes is the time they can devote to strength and conditioning training as well as rehabilitation. When combined with their advanced physical condition going into a rehabilitation program, a professional athlete’s rehabilitation efforts generally result in a much quicker rate of recovery. “A lot of people think these athletes bounce back from injury at an astounding rate, and they sometimes expect to see those kinds of results for themselves,” notes Dr. Altchek. “But these athletes are able to spend eight hours a day doing what most people can only afford to do for maybe 45 minutes, two times a week.” The Challenges and Benefits of Working With Professional Athletes Considering the talent and financial pressures that go hand-in-hand with professional sports, it becomes easy to understand the pressures being placed on the team physicians to return the players to top form. “The outcome measurement is very precise,” Dr. Altchek notes. “If these athletes fail to return at or above the same level as they were prior to injury, it’s a disaster, and it’s not acceptable.” Regardless of the athlete’s condition, returning to play after an injury is a very graduated process. Mickey and his team introduce specialized therapy and functional exercises and constantly monitor the athlete’s progress and comfort level. After these steps, they practice at low levels, and eventually, they begin to play at low levels. Pitchers, for example, require extra caution, as they take a longer time to return to pitching at the same level in a game situation. “It’s much different than pitching in the bullpen,” Mickey remarks. “You graduate them over a period of time, and you must rely on the process,” he adds. “Therapists in general, without our experience, may be intimidated by the pressure of getting these athletes off the DL. They might assume that you can’t push them because they might blow up. At the same time, they might think that the team’s management is pushing for the player’s return.” “As it happens,” says Dr. Altchek, “the Mets management and ownership know that we have their interests – as well as those of the players – at heart, and they really do trust us to make the right decisions.” Dr. Altchek describes his relationship with the Mets at length: It’s a constant learning process, and it’s tremendous. Each decision requires you to be cautious and thoughtful – never flippant. Sometimes you have to make decisions in the training room, and it’s very chaotic. But the key is to slow it down, take a deep breath, and perform a thorough physical exam, consider their history, get whatever imaging tests you need, and gather all the information you’ll need to make the best decision. It’s a challenging environment, but when you make the right decision, you gain the player’s trust over time. They learn to trust you as they’d trust their family. When these players get hurt, they notice how interactive and attentive you are to them, and that’s what pays dividends for both the player and the physician as time progresses. The way we look at it, these guys are our patients. We have their best interests in mind - not just the short term interest of the team. But since many teams sign long term contracts with these players, our long term focus on the player ends up benefiting the interests of the team as well. Just today, I had a player from another team contact me to have a procedure done. His team doctor was going to send him to another physician, but the player chose to have it done here. That stems directly from the trust we’ve built.