Being a Sports Doctor Is Quite an Operation

Joe Namath’s knees. Tommy John’s elbow. Dave Dravecky’s cancer.

They’ve all been dramatic stories of courage, watched closely by sports fans nationwide. And in no small way, high-profile cases like these have been both the cause and the result of an explosion in the field of sports medicine over the past 25 years.

Last month, 470 team doctors gathered in Scottsdale, Ariz., for the second of three annual sports medicine seminars, with topics ranging from “biomechanics of the throwing athlete’s shoulder” to “special dietary measures for the athlete.”

Twenty-five years ago, you’d have been hard-pressed to find such a seminar, or enough interested doctors to make it worthwhile, says Dr. John A. Bergfeld, team doctor for the Cleveland Browns and co-chairman of the meeting.

“There have been physicians concentrating in sports medicine in Europe since the turn of the century, but not here,” Bergfeld said in a recent interview at his Cleveland Clinic office. “I’m not sure why, because we’re a very sports-minded country.”

Physicians and trainers have been looking after athletes here for decades, of course. But sports doctors in the United States didn’t begin comparing notes regularly until the mid-1960s, when Namath’s gimpy knees focused nationwide attention on Dr. James A. Nicholas, the New York Jets’ team doctor.

“That’s when the term ‘sports medicine’ was really coined here,” Bergfeld said. “There was the day-to-day Joe Namath knees story, and then he went to the Super Bowl. People began to read that there was this man who was a sports medicine specialist, and they started saying, ‘Gee, maybe I need a sports specialist.”’

In December 1971, The New York Times Sunday magazine published a detailed article about Nicholas, giving wide publicity to both the man and his field. In it, Nicholas noted that technical literature about sports medicine was almost non-existent when he became a sports doctor in 1960.

Dr. Don O’Donoghue, a teacher at the University of Oklahoma’s Medical School, had written a textbook on athletic injuries that contained a majority of what was known about the discipline at the time, Nicholas said. He told the Times that O’Donoghue “has done more for sports medicine than anyone else in the world.”

Progress came quickly once doctors began sharing information about sports-related injuries. O’Donoghue’s pioneering work with ligament damage, which Nicholas and others used to revive the careers of scores of professional athletes, was followed by a series of successes by Dr. Frank Jobe, who succeeded sports medicine pioneer Dr. Robert Kerlan as the Los Angeles Dodgers’ team doctor.

Jobe refined surgical techniques for repairing torn rotator cuffs, and he also received attention for his knee surgeries on basketball players such as Wilt Chamberlain, Elgin Baylor and Jerry West.

Perhaps the single most famous success story in sports medicine was Jobe’s reconstruction of pitcher Tommy John’s elbow in 1975. Jobe took a ligament from John’s right forearm and used it to rebuild John’s injured left elbow.

The left-handed John won 90 games over the next five years, including three seasons with 20 or more wins, and he continued pitching throughout the 1980s. His story encouraged other injured athletes to persevere.

“For someone like that to have that operation and win 20 games . . . has done a tremendous amount for sports medicine,” Tom Candiotti, now a pitcher for the Indians, was quoted as saying in 1983. “Someone like me should really be grateful for someone like him.”

Candiotti underwent an operation similar to John’s in 1981.

The perception that sports medicine has produced great advances used in other medical disciplines is not entirely accurate, Bergfeld said. Arthroscopic surgery, for example, is typically thought of as a method used to get athletes back in action more quickly, but it is not at all a sports exclusive. It has been used for years to treat problems totally unrelated to sports.

Still, the living laboratory provided by sports has made significant contributions. Scrutiny of athletes’ injured knees and ankles is helping doctors better understand joint malfunctions such as arthritis, Bergfeld said, and he yearns for the day, maybe 10 years from now, when invention of a functional artificial ligament will aid athletes and non-athletes alike.

“We’ve had a greater recognition of the importance of the ligaments of the knee joints,” he said. “We’ve learned a lot about physical conditioning that has spinoffs for the recreational athlete.”

Also, videotaped replays of injuries that seem gory to the general public have given doctors insight into the way joints react to stresses. Bergfeld frequently watches videos of his patients’ injuries, not as a diagnostic tool but rather to help determine how they occurred and whether they might have been prevented.

“I think we’ve learned a lot by looking at films of injuries, to see exactly what happens to that knee joint when it goes out,” Bergfeld said.

Replays held a surprise for doctors by revealing that a majority of major knee problems occur not because the knee itself is struck, but because the body’s weight lands off center, or the foot locks in the turf, causing the knee to twist.

“We’ve found that 60 percent of major injuries occur without anybody touching the knee,” Bergfeld said, noting recent injuries to Los Angeles Clippers’ forward Ron Harper and Browns’ guard Ted Banker as examples.

Bergfeld doesn’t wince in sympathetic pain when he watches tapes of his patients getting hurt, but he does share the anguish an athlete feels when he learns the severity of his condition. It was Bergfeld who first discovered a cancerous tumor in Dravecky’s arm in 1988.

The San Francisco pitcher finally retired after his surgically repaired arm broke during an inspiring comeback attempt last year.

“You know how hard they worked to get where they are and how devastating an injury can be psychologically,” Bergfeld said. “Dave has great inner strength.”

Nicholas, Jobe and other orthopedists -- surgeons specializing in muscle and joint disorders -- became models for sports medicine in the United States during the past two decades. In Europe, by contrast, general practitioners, rather than surgeons, took the lead in sports medicine.

“If you go to Russia, the sports medicine doctor is a physician, not a surgeon,” Bergfeld said. “Now, the evolution is occurring here, and primary care doctors are getting more and more involved in sports medicine. The Family Practice Association now has a sports medicine committee.”

In many cases, teams today will hire both a generalist and a surgeon. Bergfeld, for instance, is the orthopedist for the Cavaliers, whose team physician is Dr. John A. Lombardo, a primary care doctor. Lombardo co-chaired the Scottsdale seminar with Bergfeld in February.

Bergfeld never envisioned himself as a sports doctor when he was going through med school in the early 1960s. He had played football at Temple, however, so he readily agreed to be the sideline doctor at Wickliffe High School’s football games while he was interning at the Cleveland Clinic.

He went into the Navy in 1970 and was appointed the team doctor at the Naval Academy, and when he returned to the clinic in 1973, he helped set up its sports medicine section.

He became affiliated with the Browns, Indians and Cavaliers in the early 1980s, serving as the Browns’ team doctor and as the other two teams’ orthopedic specialist.

He doesn’t see the discipline of sports medicine as frivolous at all.

“We have to have recreation,” Bergfeld said. “When people go to the football game, they enjoy it, and the players are their entertainment. To be able to support that makes me feel good. Athletics and recreation are important parts of our society.”