Michael A. Schwartz, M.D., FAAOS, an orthopedic surgeon specializing in sports medicine at White Plains Hospital, says “sports medicine” may be a misnomer. A better term for the kind of medicine he practices might be “activity medicine,” he says, because White Plains Hospital sees patients with a broad range of injuries suffered during a broad range of activities.
Terminology aside, the sports medicine practice at White Plains Hospital is as active as ever as more people undertake active lifestyles. While healthful activity is a sensible part of anyone’s life, young and adolescent athletes, poorly trained athletes, and poorly conditioned athletes all run the risk of a sports injury.
Caring for Athletes of All Ages
Although the national focus is zeroing in on sports injuries among youths and adolescents, Dr. Schwartz says White Plains Hospital sees injured patients of all ages.
“We take all comers here,” says Louis McIntyre, M.D., a sports medicine specialist at White Plains Hospital. “We see lots of preteens, teenagers, college athletes and a large contingent of weekend warriors.”
According to the Centers for Disease Control and Prevention, nearly 30 million American children and adolescents annually participate in youth sports. High school athletes suffer an estimated 2 million sports injuries a year and account for 500,000 doctor visits and 30,000 hospitalizations. Younger athletes are at risk, too, with more than 3.5 million children younger than 14 receiving medical treatment for sports injuries each year.
Dr. Schwartz examines the X-rays of a patient with knee pain.
Then, there are the “weekend warriors,” generally young to middle-aged adults who try to pack a week’s worth of recreational activity into two days and wind up suffering sports injuries of their own. The journal Medicine and Science in Sports and Exercise reports an estimated 1% to 3% of the adult population in the United States can be characterized as weekend warriors.
Dr. Schwartz says his patients tend to suffer different sports injuries at different ages.
Youths typically suffer nondisplaced fractures instead of sprains of the ligament, because their growth plates are weaker than the ligament at that age range. When young athletes become older and their growth plates close, the ligament is the weaker part of the anatomy, and athletes can suffer acute injuries and chronic overuse injuries. Dr. Schwartz’s practice commonly sees anterior cruciate ligament (ACL) tears of the knee, shoulder dislocation and instability problems among patients in their late teens and early 20s and 30s. Progressing into the 40s, 50s and older ages, there are more rotator cuff problems, including tears from injury or from repetitive overuse, and meniscus tears in the knee as the meniscus weakens with age.
However, overuse is not just a problem of the adult population, Dr. Schwartz says.
“Nowadays, kids are very commonly overscheduled,” he says. “They have access not only to school teams but league teams. A lot of their injuries are due to overuse, which is a huge epidemic. It’s concerning because if kids are getting overuse injuries in their sports, they can’t play and end up having to drop out of those sports. Lots of physical activity may not be as good as we thought.”
“Primary physicians have quick access to our whole sports medicine team for comprehensive care of their patients. Their patients will be treated thoroughly and will be part of the decision-making process. If their patients need surgery, they will get the most technologically advanced, state-of-the-art procedures because we are leaders in our field.”
— Michael A. Schwartz, M.D., FAAOS, orthopedic surgeon specializing in sports medicine at White Plains Hospital
Combating the Rash of Concussions
An increasingly common sports injury, concussion has captured the nation’s attention with professional athletes suffering traumatic brain injuries, sometimes with dire consequences. Now, the spotlight has turned to younger athletes and their risk of concussion.
Young athletes are particularly vulnerable to second-impact syndrome. Physicians at White Plains Hospital conduct outreach in area schools to encourage young athletes to have baseline ImPACT cognitive testing — the same measure used by the National Football League — before participating in contact sports. The test can be readministered after a concussion to ensure athletes are returning to their baseline levels of cognitive function.
“ImPACT testing facilitates objective measurement of neurocognitive function, whereas in the past, evaluations and return-to-play criteria were pretty subjective,” Dr. McIntyre says.
White Plains Hospital has established a concussion management protocol in conjunction with White Plains High School, as all high schools in the state are now required to do.
Dr. Schwartz performs a routine follow-up exam on a patient.
Dr. Schwartz says an athlete who suffers symptoms of concussion on the field is asked certain questions to determine his or her cognitive function and whether a concussion has occurred, then a decision is made as to whether the student can return to play. If a concussion is indicated, follow-up evaluation and treatment are required before determining when it is safe to return to play. Dr. McIntyre says the staple of concussion treatment is strict physical and cognitive rest.
“Concussions are certainly something we all know are not to be taken lightly,” Dr. Schwartz says. “We work with coaches and trainers, especially in high school sports, to ensure proper protocols are followed. I can’t stress that enough.”
Help Just a Phone Call Away
When it comes to a sports injury, time is often of the essence. Before scheduling an appointment with a doctor, an athlete may allow days or even weeks to go by without proper medical evaluation, and that interim can make the injury worse as the athlete tries to “play through the pain.”
White Plains Hospital has made accessing timely care easier with its 24-hour sports injury hotline, allowing athletes to be diagnosed quickly and avoid the temptation to play on and potentially aggravate injuries. Failing to receive prompt care can mean the difference between days on the sidelines and sitting out multiple weeks or even an entire season.
Dr. McIntyre consults with Mike Mirabella on a case.
Certified athletic trainer Mike Mirabella fields the calls and refers athletes who require follow-up to Dr. McIntyre. Since the hotline debuted, the number of calls has steadily increased, with complaints ranging from ankle sprains to hip pain that turned out to be caused by a tumor.
The hotline provides direct access to diagnosis, treatment and recovery. As soon as an injury occurs, a patient, parent, coach or an athletic director can call the hotline to arrange for an immediate appointment.
Dr. McIntyre describes the impetus behind the hotline as White Plains Hospital’s commitment to building the sports medicine program.
“We’d been trying to form a more coherent and structured sports medicine program here for the last 10 to 15 years,” Dr. McIntyre says. “It’s sort of a soup-to-nuts program that facilitates people needing access to health care. It has been successful, and it’s something that patients really appreciate.”
Surgery as a Last Resort
With most sports injuries, the White Plains Hospital team aims to help patients heal and regain function without surgery. The hospital provides onsite X-rays, ultrasound diagnostics and proactive physical therapy.
Major knee ligament, cartilage and rotator cuff injuries often require surgery, and Drs. Schwartz and McIntyre are both skilled in arthroscopy to treat patients with the least invasive means possible.
Dr. Schwartz performs arthroscopic knee surgery.
“The minority of patients requires surgical intervention, and only for major ligamentous, cartilaginous or tendon injuries,” Dr. McIntyre says. “We operate on maybe 5% of all patients that present primarily to our office. Most patients are treated with expectant care — rest, ice, elevation and immobilization.”
Patients for whom surgery is required may benefit from minimally invasive procedures, which Dr. McIntyre characterizes as one of the most significant advances in orthopedic surgery in the last decade.
The Benefits of a Specialist
While many pediatricians and other primary care physicians are equipped to treat sports injuries, Dr. McIntyre says patients with activity-related injuries are best treated by a sports medicine specialist who can provide a thorough diagnosis and an efficacious treatment plan that ensures rapid and safe return to athletic activity.
Dr. Schwartz and Larissa Tedesco, physician assistant, review the MRI of a patient’s knee.
Dr. Schwartz agrees, citing the dual goals of a sports medicine specialist — helping to heal and properly managing the injury so the patient can safely return to the sport or activity he or she enjoys.
“I have experience working with athletes at all different levels — high school, college and professional athletes,” says Dr. Schwartz, who has worked as a team physician and assistant team physician with organizations such as Major League Baseball’s Philadelphia Phillies as well as a Division I university. “These athletes have similar but somewhat different goals, and treatment can always be tailored to the individual. We have an extra appreciation for that.”
Dr. McIntyre is the team physician for White Plains High School, which he says likely has the most thorough sports injury protocol in Westchester County.
“It’s important for high school student athletes to have easy access to well-coordinated evaluation and treatment so they benefit from a seamless program of care from evaluation to management to follow-up,” Dr. McIntyre says. “Communication with the coaching and training staffs and parents works really well.”
Seth Golden, physical therapist, helps to restore mobility and quality of life to a patient.
White Plains Hospital’s sports medicine department has the multidisciplinary team in place to maintain a strong program. In addition to the department’s two sports medicine physicians and board-certified athletic trainer, the team includes physician assistants and physical therapists who subspecialize in orthopedic sports medicine.
“Physical therapy is a big component of our efforts to get people back into their sports using nonoperative measures,” Dr. Schwartz says.
Dr. Schwartz wants referring physicians to see White Plains Hospital’s sports medicine program as a quick, accessible, comprehensive resource for their patients. Partnering with patients’ primary physicians, the program can meet patients’ needs with the prompt, specialized attention that many sports injuries require.
“If referring physicians have patients with any type of activity-related condition or injury, they can call us either through our sports injury hotline or directly through our office, or reach us directly and receive quick, expeditious access to our sports medicine team,” Dr. Schwartz says. “Their patients will be treated thoroughly and will be part of the decision-making process.”
The Intangibles of Practicing Medicine
White Plains Hospital’s sports medicine practice is distinguished by experienced sports medicine specialists and a skilled multidisciplinary team. But the physicians bring another skill to their practice — empathy for the patient.
“I practice patient-centered care,” Dr. Schwartz says. “Any patient who comes to see me will undergo a full evaluation and afterward receive a full explanation of what’s going on — in plain English, not in complex medical terms, so it can be understood.”
Dr. Schwartz reviews treatment options with each patient and explains the pros and cons of each before making a recommendation. Ultimately, though, the decision rests with patients.
“They get to choose what their treatment is going to be after being given all the information,” Dr. Schwartz says. “The patient has a sense of control in making well-informed decisions.”
Working with doctors in both the office and the operating room, physician assistants and medical assistants provide help and support when it is needed.
A sense of control is often lacking when a patient is injured and in pain, and Dr. Schwartz places a priority on putting patients in the driver’s seat.
Likewise, Dr. McIntyre understands what it’s like to be on the exam table with an athletic career — be it high school or beyond — in jeopardy.
“We’ve gotten some kids with pretty significant injuries back on the playing field,” he says. “There’s no more grateful patient than someone who has really been dinged up and is down and depressed because of being out of play. Then, to see that patient get back and not only succeed at the high school level but go on to the collegiate level is certainly very gratifying.”
For more information about White Plains Hospital’s sports medicine practice, visit www.wphospital.org.