Team Physicians; comments from two alumni who are…

Originally published in the Mayo Alumnus, October 1967.

Mayo alumni are sometimes asked to serve as physicians to football teams. Many more have sons who play, or yearn to play, this most ‘contact’ of American sports. The following reports are for all of these…..

Editor: Dr. Robert W. Jamplis completed a five-year residency in general and thoracic surgery at Rochester in 1952. He is now executive director of and thoracic surgeon for the Palo Alto Clinic. Two years ago he was one of a select few former college football players to receive Sports Illustrated’s Silver Anniversary All-America Award, given for professional careers “stamped by quality as well as success.” Bob — where did you play your football?

Jamplis: I was a quarterback in the late 1930s at the University of Chicago. I learned to admire excellence at the hands of Michigan’s Forest Evashevski, who seemed to knock me down expertly on every play.

Editor: Dr. Frederick L. Behling completed a 3-year residency in orthopedic surgery at Rochester in 1956. He is now an orthopedic surgeon on the staff of Palo Alto Clinic. Fred — what’s the background to your continuing interest in football and sports generally?

Behling: My interest in football and sports medicine began with my arrival in Palo Alto shortly after finishing my residency in Rochester. Dr. Roth felt a need for an orthopedist “on the bench,” so to speak, and I was nominated.

Jamplis: You see, one of the pioneers of athletic medicine in this country — Dr. Fritz Roth, a Palo Alto Clinic orthopedist — was in charge of the medical care of Stanford teams for many years. (I can’t resist adding here that it was the 1940 Stanford team, under my old coach Clark Shaughnessy, that revolutionized big-time football with the T formation. We used it at Chicago — but not so successfully.)

Doctor Roth was anxious to turn over the reins to a younger man, preferably one with a background in athletics, to insure maintaining a close relationship with Stanford University’s athletic program. That’s how I, and later Fred Behling, got involved. Incidentally, as far as I’m concerned, the best football team physician is an orthopedist.

Editor: What I don’t understand is why a busy physician would waste so much time….

Jamplis/Behling: Waste!

Editor: Sorry. Why does a busy physician get involved as a team physician?

Behling/Jamplis: First, a basic interest in athletics. He gets to observe sports action from close up. There’s no better seat than on the bench with the players; that is, if one is interested in learning physical and emotional responses to injury of athletes in contact sports — as far as viewing the contest, it’s the worst.

A team physician participates, at least administratively and emotionally, in the competitive side of athletics. It’s a service that’s welcomed and appreciated. There is an opportunity to improve public relations, not only for one’s own institution but for the profession as a whole. Finally, it is a gratifying practice, caring for athletes — a high rate of success, rapid and complete rehabilitation, few complications.

Editor: How demanding is being a team physician, in terms of time?

Behling: We’ve found it is necessary to be on the field for 20 to 30 minutes at the end of practice each afternoon, to check current injuries. We spend about one-half to one hour a day during the season in the office, seeing the patient athletes. And, of course, the team physician must be on the field before, during and after each game on Saturday.

This, remember, is at the “big college” level of competition. It would be unusual for high school teams to have this degree of physician availability, although the need is probably no less great. To do a good job, the team physician during practice sessions must be readily available for the coach or trainer or whoever manages athletic injuries on the field. In addition, for a half-day to a day, once a season, there are physical examinations of the athletes — but this can be speeded up by calling on competent colleagues.

Editor: We hear a lot, much of it derogatory, about “professional amateurs” and so on in college sports. What is your experience?

Jamplis: Without any doubt, at the college level the cream of American manhood is involved in the athletic programs. With very few exceptions, only the most motivated and responsible college men are encountered by a team physician and, at least at Stanford, they are all “student-athletes.”

Editor: What sort of injuries are seen?

Jamplis: Whoever coined the phrase, “anything that can happen eventually will,” must have been a team physician. Injuries in contact sports run the gamut of possibilities. A few injuries occur with marked regularity and some with such frequency as to be peculiar to certain sports.

Remember: A team physician will see injuries early, at a stage when often a potentially serious one may appear trivial. So you must be constantly wary.

Head injuries are common; they’re usually limited to concussions, with periods of unconsciousness ranging from a few seconds to 20 to 30 minutes. Close observation of players by the team physician, with early recognition of head injury on the playing field, is necessary to prevent further injury to a stunned and transiently inept player. Fred Behling and I feel that no player with a diagnosed concussion should return to play for 48 to 72 hours, and then only after thorough examination by our neurosurgeons.

Injuries to the eye — ranging from foreign bodies in the eye to “blow out” of the orbit — contribute their share of concern for the team physician these require speedy treatment, usually by an ophthalmologist.

Injuries to the cervical spine, particularly in football, are not uncommon, with a “pinched nerve” being seen with increasing frequency. Why? Because of increased strains on the cervical spine resulting from “protective” equipment, especially face masks; and also because of playing techniques, such as the popular but dangerous “spearing” tackle. These injuries require immediate and accurate assessment to determine the possibility of a potential permanent neurological deficit.

Behling: Shoulder dislocations happen fairly frequently. So do separations of the acromioclavicular joint. Clavicular fractures are occasionally seen. Chest bruises and contusions, as well as cracked ribs of varying degrees of displacement, are also fairly high on the list.

Blows to the abdomen need accurate diagnostic appraisals to determine if the player can safely return to action. Muscle pulls, “charley horses” (muscle contusions to the thigh), and strains of the muscle tendon units are a constant problem, especially in the lower extremities.

Editor: We read a lot about “football knees.” Is this a major problem?

Behling: A team physician must place considerable emphasis on knee injuries. Why? because of frequency, and because of relative urgency, and because of relative urgency of early evaluation and surgical correction if complete ligament tears are felt to be present. Internal derangements of the knee — especially cartilage tears — are the stock in trade of the team physician. But in the absence of complete ligament tear, this need not be evaluated definitively as urgently as ligament tear itself. Sprained ankles are a common problem and must be differentiated from fractures, of course. A great deal of ankle strain is precluded by proper taping, and ni most large athletic programs, a trainer — usually a member of the National Athletic Trainers Association — does an excellent job of protecting players’ ankles.

Jamplis: The physician soon learns to rely greatly on the trainer for many tricks of the trade, particularly if the trainer is included as a part of the athletic injury prevention and treatment team.

Of course, with the variety of problems, many medical specialties many have to be called upon by a team physician for definitive care of various injuries.

Editor: What are the risks involved to players in contact athletics?

Jamplis/Behling: It is our feeling that risk of permanent disability is extremely minimal in any well administered “contact sport” athletic program. But it’s almost 100% certain that,. in three years of competition at the college level, a player will sustain some injury of such a degree that he misses part of a game or practice. One player in 15 or 20 — this is a rough estimate — will probably need surgical treatment for some form of injury, usually related to musculoskeletal system.

But it is unfair to discuss risks without discussing benefits. And, after close observation, it is certainly our feeling that benefits derived from athletic participation far outweigh possible risks of disability, Learning to excel; paying the price to win;l appreciating the benefits of winning and of begin the best, as well as sacrifice and sublimating personal desires for the good of the team — these are the benefits derived from competition in athletics. The changes that occur in a young man as he conquers his fear of physical injury and answers his own questions concerning his ability to outplay an adversary are part and parcel of his maturation from boy to man.

Editor: What sort of person should coach boys and young men tin contact sports?

Behling: I think Bob Jamplis would agree that most coaches in organized athletics today have a really commendable regard for the welfare for their players. The team physician on the field has far less concern in this regard than was the case, apparently, in past years.

Jamplis: Right. But the coach does need, and relies on, information supplied by the team physician on players’ injuries — who should and should not play; and, hardest of all, what is the earliest time that an injured player can safely be back in the lineup?

If there is one suggestion we’d offer a man considering service as a team physician, it would be this. He must have complete cooperation of the school and the coaching staff, and unquestioned authority regarding which player may participate and which injured player must quit for the afternoon — or for the whole season.

It cannot be any other way.