PM&R Holds Court on Game Day

Sports teams live and thrive on the talents of their star athletes. But when players get injured, the teams rely on another kind of superstar to help return them to their winning ways - the physical medicine and rehabilitation (PM&R) physician. Specific training in exercise and physiology make PM&R physicians well suited to dealing with the day-to-day health challenges that elite athletes face.

"To work effectively with any athletic team, you have to be a jack of all trades," says Robert S. Gotlin, DO, director of orthopedic and sports rehabilitation at Beth Israel Medical Center in New York City. "I support the team doctor and work closely with the trainers to help maximize the athletes' performance as well as prevent injuries."

"Our goal is really to do everything but surgery," says David Stone, MD, a PM&R physician who is also an assistant professor of orthopedics at the University of Pittsburgh and consultant for their football team.

"This is a very hands-on job," adds Gotlin, who has spent 10 years treating the New York Knicks basketball team, four years with the NY Liberty, and two years with the New Jersey Nets. "You're part doctor and part trainer at times. I really enjoy that."

"This is always a team effort. I have tremendous respect for our team doctor and head trainer - we trust each other," says Stone. "That's why the person who sees an athlete's injury is typically the person who will set up a treatment program."

Monitoring the success of that treatment program often falls to the PM&R specialist. The breadth of PM&R training allows these specialists to assume the global role of a general consultant for health and well being.

During the week both Gotlin and Stone are actively involved in developing and monitoring the rehabilitation programs of injured athletes. Typically the head trainer and his staff are involved in the physical aspects of the rehabilitation, such as physical therapy, while the PM&R specialist monitors the progress made.

"I consult with our head trainer to evaluate an injury and how it is progressing," reports Stone. "What we often worry most about is being too passive, because when it comes to the rehabilitation process - you get out what you put in."

"One of our most important roles is helping athletes return to 'play shape' after an injury or surgery," explains Gotlin. "This is where our training in PM&R is particularly well-suited to the needs of the athlete."

And both physicians say they take a more active role in back injuries. "PM&R training lends to this area of treatment because of the modalities we study and the background we have in musculoskeletal anatomy," says Gotlin. "We're often the gatekeepers for this care."

Game Day

While both PM&R specialists are present at their teams' home games, Stone also travels with his team. A typical game day for both physicians starts with evaluating players' injuries and consulting with the team doctor about who is fit to play. To do this, they test injured athletes' range of motion and pain response. If the athlete appears healthy, the PM&R physicians monitor the player's warm-up session.

"You look for lots of things, because some players want to play no matter what," says Stone. "After watching the warm up, you know who is ready to play and who is not."

During the game, the physicians continue to monitor a player's performance. In certain circumstances, a noticeable limp or "favoring" might require recommending that a player sit out the rest of a game before a more serious injury is sustained. If an injury does occur, the PM&R physician is immediately available to consult with the team physician and trainers.

While the actual game is mostly a "wait and see," the period after the game in the locker room is significantly more intense. Injuries are evaluated, and tests like X-rays or MRIs are often ordered. Depending on whether the injury requires surgery, rehabilitation often begins immediately.

"Sometimes players come to you, and other times you have to ask them how they're doing," says Gotlin. "Once again, the rapport and trust you establish with an athlete is key."

"Many of these star athletes are set in their ways, and it can be difficult to get them to correct their training regimen," adds Gotlin. "But they respond when you show how you can help them feel and play better."