Jason Peterson
JOUR 523
Final Paper
Doctors’ duty collides with athletes’ resolve in sports healthcare
Farley Crofts took the snap, dropped back and fired a short pass to Brett Burtenshaw, his favorite target all season long. Burtenshaw suddenly found daylight against South Summit High's secondary and focused on the end zone just ahead of him.
Racing full speed in sub-freezing temperatures, Burtenshaw had hoped to add to San Juan High's lead in the third quarter of the 2A state football championship game in Orem, Utah, in November of 2000.
But he wasn't quite fast enough.
Burtenshaw never saw the hand that clung to the back of his collar, sending his feet running ahead without the rest of his body. For one sickening moment, his body hung in the air, twisting and contorting until he hit the ground in a sprawling heap.
He doesn't recall the yellow flags raining on the field for the horse-collar tackle. All he remembers is the excruciating pain and the unnatural lump in his left knee telling him something was wrong.
Rather than limp to the sidelines and ask to be taken to the locker room, however, Burtenshaw did what so many other young athletes are wont to do when they face the possibility of losing playing time.
"I just took a pain killer and played the fourth quarter," he said, smiling. “Dragged my leg around.”
The following week, Burtenshaw found himself sitting in Dr. Robert Jackson's office outside of Brigham Young University in Provo, Utah, where he works as an orthopedic consultant for BYU athletics. Jackson entered the room and needed all of 10 seconds to make up his mind.
"How long you gonna be in Provo?" he asked Burtenshaw.
"I don't know. Why?"
"Can you do surgery tomorrow?"
Burtenshaw was floored.
Two years earlier in his sophomore year, he had a similar injury on the same knee. Except that time it was on the basketball court and his kneecap ended up on the wrong side of his leg.
Tests revealed there was no structural damage and because Burtenshaw was an active athlete with excellent muscle tone to support the knee, his family doctor saw no need for surgery.
"I was really happy with that decision because surgery requires four months of rehab and I would've missed a lot of time in sports," Burtenshaw said.
Missing just a few weeks of action, he continued to strengthen his knee through weight lifting and jumping exercises. When Burtenshaw returned for track in spring, something still wasn't quite right.
"It never got as strong as my other leg," he said. "I couldn't figure it out because I was working just as hard or even harder on it than my other leg."
Over the next two years and two more dislocations, Burtenshaw began to accept the reality of his limitations.
"I got really apprehensive with my knee because I was scared it would keep popping back out," he said.
Sitting out a year and waiting to see if he could regain full use of his leg was simply not an option. As one of the stars on San Juan's football, basketball and track teams, Burtenshaw's teammates and coaches depended on him. His father ran the football team and winning games in small-town Blanding, Utah, had become a reliable source of inspiration and entertainment.
The issue was made all the more urgent in high school, where redshirting or postponing eligibility doesn’t exist. At least from an emotional standpoint, as Burtenshaw put it, "career-ending injuries can be pretty devastating for a high school kid."
It took two days for Burtenshaw to accept Jackson's proposal and arrange for surgery. In less than two hours, Jackson completed a full knee arthroscopy, scooping out loose bodies of torn cartilage and repairing an MCL that was hanging by a thread. Three weeks later, Burtenshaw was sprinting up and down the hardwood for the Broncos despite doctor's orders to not play for another four to six weeks.
"But it felt so good," Burtenshaw said. "I got faster and stronger than ever."
By the end of his senior year, he had regained full speed for the track team. And by the time he began playing football for Snow College and Weber State University, the brace came off for good, leaving Burtenshaw to wonder "what if?"
"I thought, 'Maybe I should've had the surgery in my sophomore year,'" he said. "Maybe I was a step slower than I could've been."
Helping other athletes make informed decisions while keeping the regrets and second-guessing to a minimum is part of why Burtenshaw chose to study sports medicine. He doesn't want to see others make the same mistakes he did and delay treatments that, perhaps inconvenient in the short term, present greater health for the long haul.
The evolution
The concept of sports medicine is certainly not new. Herodocus trained the legendary physician Hippocrates how to care for Greek wrestlers using exercise and diet. Roman philosopher and physician Galen gained much of his anatomical knowledge as a surgeon to the gladiators.
It wasn’t until the early 1970s, however, that modern sports medicine earned the distinction as a legitimate subspecialty. According to the American Board of Medical Specialties, it is recognized by six different boards, including the boards for emergency, family and orthopedic medicine.
Part of the increased attention to sports medicine might be attributed to the rise of sports as a commercialized industry in the past few decades. In addition to certified primary care doctors and orthopedic surgeons under the umbrella of sports medicine, a wide range of specialists including physical therapists, athletic trainers, chiropractors, podiatrists and psychologists has cropped up to provide more intensive care.
“Sports is big business,” Burtenshaw said. “The No. 1 goal is to get the athlete back on the court or the field as fast as possible.”
In December, Burtenshaw completed his studies at the Caribbean-based Ross University’s School of Medicine. He is now preparing for residency training at Mercy Hospital in Janesville, Wis., where he’ll shadow family medicine doctors for three years and enroll in a one-year fellowship program for sports medicine. He’ll be working alongside team physicians for the University of Wisconsin and University of Wisconsin-Whitewater athletics as well as the Janesville Jets, a minor league hockey team.
Yet the demand for sports medicine programs doesn’t seem to match the supply of roughly 125 available spots in the U.S., according to the Accreditation Council for Graduate Medical Education.
“It’s very competitive,” Burtenshaw said. “Almost every place I looked at, they either had one or two spots for sports medicine. Other concentrations had seven to 15 spots.”
With 79 million baby boomers entering retirement (including a large number of practicing physicians), the medical field is bracing for a severe shortage of doctors over the next decade. The need for sports medicine practitioners is no exception.
Obesity trends climbed to an all-time high in 2010, according to Centers for Disease Control and Prevention (CDC), and numerous health organizations have ramped up awareness for the importance of staying active and fit.
The U.S. Department of Labor estimates that 16 percent of Americans, or roughly 50 million people, are participating in sports or exercising on any given day. – a figure that equates to a large number of potential injuries and accidents. The CDC reports that nearly one million sports-related injuries occur annually in school settings alone.
These facts, among others, are why the American Medical Association foresees a strong outlook for a career in sports medicine.
“I think it’ll continue to grow,” said Burtenshaw, who hopes to design a weight-loss program when he sets up his own practice. “We’re getting more active as Americans. When they’re out jogging for 10 miles, sooner or later, they’re going to have some kind of knee or ankle they’ll want you to look at.
“And that’s a good problem to have.”
The stakes
From the average Joe who plays recreational racquetball on the weekends to the MVP of the NFL, everyone gets injured. No one is immune to twisted ankles, torn rotator cuffs or tennis elbow.
Sports injuries can range from the mundane scratch to the tragic hypertrophic cardiomyopathy – a sudden cardiac arrest that claims the lives of young athletes like former Boston Celtics star Reggie Lewis. While everyone has something to lose, some have more at stake than others.
“Time is money to the athletes,” said Dr. Craig Westin, medical director of Chicago’s Joffrey Ballet and a team physician with the U.S. Figure Skating Team. “Athletes are so well-conditioned, the longer they’re down, the longer it takes to get them back.
“But the average guy who sprains his ankle is not a big deal,” he added. “He can go to work and sit at his computer; he doesn’t need to play basketball.”
For an athlete whose livelihood depends on his or her physical performance in a competitive environment, injuries can be the difference between gainful employment and the streets.
“If they don’t (compete),” Westin said, “they’ve got 10 others that would love to take their spot.”
The fear of losing one’s job, a shot at a record or an accolade, a spot in the starting lineup, or even a few precious minutes of playing time is enough to cause athletes to ask drastic sacrifices of their bodies.
During the 2007 World Junior Championships in Oberstdorf, Germany, one of Westin’s ice dancing champions, Emily Samuelson, stumbled to the ice mid-performance. Before she could roll out of the way, her partner, Evan Bates, skated across the back of her left hand, nearly severing her fingers.
The music stopped and the crowd fell quiet as Samuelson momentarily lay on the ice. She had two minutes to decide whether to continue and finish the routine as she skated over to consult with Westin on the sidelines.
With her right hand concealing the gash on her left, Samuelson asked the doctor, “I can finish that program, can’t I?”
Westin asked her to straighten her fingers. She couldn’t.
“I said, ‘No, you’re not going to finish. Show me your hand,’” Westin recalled. “She laid it open. It’s miraculous the guy picked up his skate quick enough.”
Without his full slate of resources at Weiss Memorial Hospital where he usually works, Westin could only treat the skater with antibiotics, sew up her hand and put it in a splinter. Samuelson had surgery at the nearby Ravensburg Center for Hand Surgery and missed the rest of the competition.
“The next week, she received a standing ovation when she returned for the banquet ceremony,” Westin said.
The resolve
Though Samuelson returned to action without further complications, the possibility of career-ending injuries hang over the minds of countless other athletes.
Jabari Parker has been dominating Chicago’s basketball circuits since he began playing organized hoops in the second grade. The 6-foot-8 small forward’s meteoric rise to the tops of almost every scout’s list began long before his growth spurt kicked in around middle school.
By the age of 12, Parker had five Division I scholarship offers on the table. By the age of 14, he became the first freshman allowed to play varsity at Simeon Career Academy, currently the No. 4 high school team in the nation. And in January, at 16 years of age, he became the first high school player to be named USA Basketball’s Male Athlete of the Year after leading the USA to a gold medal in the 2011 FIBA Americas U16 Championship.
Now ranked the No. 1 junior in the country on ESPNU’s top 60 (though many would argue he’s No. 1 regardless of class), pundits are already declaring him the No. 1 pick in the 2014 NBA Draft.
Parker’s mother, Lola, is proud of her son. But she’d rather talk about his 3.8 GPA. Or his membership in the National Honor Society. Or his two-year role as president of the school’s student body. Or his devout faith as a member of the Church of Jesus Christ of Latter-Day Saints. And the list goes on.
Jabari is the youngest and most athletically gifted of Lola Parker’s four children. When Jabari reached the 6th grade, Lola stared down her husband, Sonny, and told him, “This one’s mine.”
She could see the potential in her son and she’s doing everything in her power to see it fulfilled. Scouts, agents, NCAA coaches – even the mail – must go through her first.
“I run the show,” Lola said. “Everything that has to do with basketball, I handle it.”
Why not Jabari’s father, who played for the NBA’s Golden State Warriors for six years?
“Mother’s wisdom,” she smiled. “I’m more concerned for his entire well-being and my husband trusts that. Nothing else matters to me except Jabari’s happiness. He has a special calling that I always knew of when he was born.”
Jabari’s potential, his apparent sense of destiny, is what drives Lola to monitor her son’s every move. She cooks all his meals and keeps his daily intake of proteins, pastas and vegetables between 4,000 and 5,000 calories. She often attends Jabari’s games and 3-hour practices six days a week. She keeps close tabs on Jabari’s two top physicians – the Chicago Bulls’ Kathleen Weber for lower body treatments and the Chicago Bears’ Armen Kelikian for upper body support. Most of all, Lola is perceptive to every ache, bruise and injury her son sustains.
“My husband jokes around with me that if Jabari had a hangnail, I’d call an expert,” she said. “The reason for that is because his body is not built like normal people. Dr. Weber explained to me his bones were fragile because he was still growing.”
Between the 8th and 9th grades, Jabari shot up five inches and suffered three injuries. For three months, he played on a right shinbone with pain that refused to go away. Lola constantly applied ice after games but when the pain wouldn’t subside, she encouraged her son to seek help. An MRI revealed a stress fracture on the tibia and doctors put him in a cast.
“It was painful for him,” Lola said. “He plays through pain anyway, but I know him so well that I knew there was something wrong.”
The following summer, Jabari slammed his hand awkwardly against a defender and cracked one of the carpal bones of his non-shooting hand. Thanks to fortunate timing and another cast, he recovered before basketball season started.
Jabari wasn’t as lucky with his last injury. The night before his first state championship game against rival Whitney Young High School, he injured himself while sleeping.
“I jerk when I sleep,” he said. “I hit my foot against the desk where the alarm was. I hit it real hard but I was kind of asleep, so I didn’t really get all of the pain. I woke up the next morning and it hurt real bad.”
Jabari neglected to tell his coach on game day. He was going to play and no one would tell him otherwise.
“I try to downplay my injuries because I feel the need to win and I think my team needs me as much as possible,” Jabari said. “I think I can make a change if I'm in there; my presence makes a difference. I can't trust anyone on the bench to fill my role.”
Jabari lasted about six minutes until the pain was too much to bear. He wasn’t much use to his team, which went on to win the IHSA Class 4A state title without him.
“I took myself out,” he said.
For Jabari, that experience was far more painful than the throbbing in his foot. There was the agony of knowing that if he continued playing, he could jeopardize his long term health and an NBA career. There was a constant tug-of-war between his desires to go all out on the basketball court, tempered by fears of becoming Greg Oden 2.0 – a top NBA prospect whose future is sidelined before it really had a chance to take off.
“It’s always on my mind,” he said, “seeing what my future is and what’s going to end up ending my career as far as an injury. I just go all out anyway; I can’t let everything hold me back.
“This is really what I do every do,” he continued, “so just getting used to not being able to play would mess up my mind.”
The controversy
Championships and the will to win are often cited by athletes as their primary objectives, but the fear of losing can be a powerful motive. It’s what drives some athletes to seek a competitive advantage beyond what their own abilities can provide.
Doping, human growth hormone, steroids, and performance enhancements – these are all common terms in today’s sports lexicon because athletes will pay to find the edge. And there are plenty on the outside who will help them.
According to the American Osteopathic Academy of Sports Medicine, anyone can call themselves a “sports medicine specialist” because it isn’t a standard specialty such as internal or emergency medicine. Some of these practitioners open up clinics without the proper training in sports medicine, and many offer services that aren’t backed by proper research.
“Those are the guys I’ve gotta deal with,” Westin said. “They want a piece of the action, so they make an unethical claim or something.
“If you open a clinic saying, 'I can turn lead into gold,' people would come in and try the lead,” he added. “The unethical practitioners take advantage of that.”
It isn’t always as black and white as it seems. Some are well-meaning physicians who honestly believe in the potency of their treatments while others seek out the latest (yet unfounded) treatment methods in an attempt to lure more patients.
One such method that has divided the sports health industry is the use of platelet-rich plasma (PRP) therapy. The process is done by extracting the patient’s blood and spinning it in a centrifuge, dividing the plasma containing the platelets from the rest of the blood cells. The plasma, now loaded with a high concentration of platelets, is then injected back into the affected area.
The Orthohealing Center in Santa Monica, Calif., claims that platelets contain healing agents, or growth factors, that accelerate the recovery of tissue and open wounds. Ideally, it is used on joints and other parts of the body that don’t receive a great deal of blood supply.
Los Angeles Lakers star Kobe Bryant and New York Yankees slugger Alex Rodriguez swear by it. Both of them visited widely-known German orthopedic surgeon Peter Wehling and received a sort of “cocktail” version of PRP, which Wehling produces by “supercharging” the proteins in an incubator for more than 24 hours. Wehling, a former physician to Pope John Paul II, claims he can cure arthritis with this formula.
“There's a lot of crazy people in this world who will try anything,” Westin said. “If that was true, we'd all be doing it. If I'm the Pope's doctor, I'm gonna be pretty good, right? And if you're really good, you'll be more than busy; you won’t need any gimmicks.
But the unethical people use (PRP) on everybody,” he added. “They charge $500, spin it in a machine and it does all this hocus pocus. It's sort of like voodoo.”
That’s not to say Westin doesn’t believe PRP can work. Despite studies thus far that have shown the treatment is statistically inconclusive, Westin thinks PRP has a place in sports health care. Just not in the hands of the “witch doctors.”
“PRP has great potential,” he said. “When you break a bone, there's blood in there. And what we don't understand yet is those compounds are part of what activates the whole system to begin to repair the tissue and make new bone.”
Westin said the purchase of a centrifuge must be approved by the U.S. Food and Drug Administration and can be quite costly – upwards of $1,000. In addition, most insurance companies don’t consider it an accepted form of treatment, so they don’t cover it.
“Unfortunately, a lot of these new things are used by people to make money,” he said. “It gets popular and people are like, 'I've got a PRP,' and they inject everything with it.
“It doesn't work that way,” he added, “but that doesn't keep people from coming in.”
The upside for PRP is that, to date, there aren’t any serious side effects because the patient’s own blood and tissue are used. At best, the athlete recovers and continues on with his or her career. At worst, the athlete is subjected to the placebo effect, which should never be discounted, said Westin.
“That’s huge,” he said. “You’ve gotta have the mind on your side. If you think something is going to fail, it will. If you believe something is likely to work, you'll work a little harder at your rehab and get better.”
“For example, we've started adding more medicine right before they go to surgery, so they wake up with less pain,” Westin continued. “You get moving quicker, you don't lose as much muscle strength, and you don't get as stiff. That's where you get into the more progressive places where you're using all these things to minimize post-operative pain.”
The Reality
One of the more difficult tasks for a sports medicine specialist is breaking the bad news.
Jabari Parker spends hours each week stretching and strengthening his legs and core muscles in order to prevent future injury. But no matter how much effort he expends, odds are he’ll get injured again.
In Westin’s experience, athletes have been extraordinary in their ability to handle and deal with the disappointing news of an injury.
“Athletes can deal with reality,” he said. “The point is at the outset after an injury, you tell the athlete, 'It's gonna take you three months to get better if you do what I tell you. If you don't do what I tell you, it either won't work or it will take you six months.' If you tell them up front what it's going to take, they're usually pretty good about following orders.”
Players, coaches and owners know that injuries are part of the business, Westin said. If a star player goes down and won’t be available for the playoffs, they’ll simply find someone else.
Burtenshaw stressed the importance of trust between an athlete and the team’s physician. Both sides are best served when they’re straight with each other. As an athlete and a physician in training, he speaks from experience.
“They have to understand, if we’re at some D-III college in the middle of nowhere and somebody goes down, we’re going to do whatever we can to get him back in the game or get him to the hospital,” he said. “They’re our No. 1 priority.”
Parker does understand. He’s counting on the training and the treatment of some of the most well-respected physicians in Chicago to enable him to rise to the hype others have placed upon him.
In a refreshing twist, Parker is grateful for the mental obstacles that injuries present.
“Sports medicine will help out my career a lot because of new inventions and the little things that help us lengthen our careers,” he said.
“With the injuries, I think they’re for a reason,” he added. “I’m just thankful for them because I also get patience from them. I’m not as anxious and it’s a waste of time to be mad at the world. Everything works for the best.”
