In mid-April, Chestnut Hill College celebrated the 25th Anniversary of its Biomedical Distinguished Lecture Series by welcoming Michael Ciccotti. M.D., director and chief of sports medicine at Rothman Institute, to present “Return to Play after Sports Injuries: Ethics, Agents and Principles of a Team Physician.”
“Since 1994, Chestnut Hill College has been enhanced and broadened by the Biomedical Seminar Series sponsored by the biology department,” Sister Carol Jean Vale, Ph.D., college president, said. “This series presents students with an opportunity to meet, interact, listen and learn from some of the most prestigious scientists in the country. Over the years, these encounters have opened the doors of research laboratories to our students to provide them with stellar internships and incomparable mentors. It is no exaggeration to say that through these encounters live have been changed, careers launched, and horizons expanded.”
Ciccotti joined a list that reads like a “Who’s Who” in the scientific community. The series has included three Nobel Laureates, six elected members of the National Academy of Sciences, two Laskar Award winners, awardees of the Benjamin Franklin Medal in Life Sciences, and now, for the first time, a head team physician of a major league baseball team. In addition to being the director and chief of sports medicine at Rothman, Ciccotti is also the team physician for St. Joseph’s University and the Philadelphia Phillies and the President of the Major League Baseball Team Physicians Association. His accolades include the prestigious George D. Rovere Award for Lifetime Contribution to Sports Education and the Dick Vermeil Award for Lifetime Achievement in Sports Medicine.
For all these reasons, Ciccotti was able to provide a unique perspective on the topic on sports injuries and the role a team physician plays in getting players back on the field.
“It comes down to managing expectations, of the player, the team, the fans, the agents — all of whom have something at stake and something to lose when someone gets injured,” Ciccotti said. “We, as team doctors, have to be honest with ourselves and prepared to make the tough calls when the athletes or teams themselves can’t.”
Ciccotti talked about how the media has cultivated a misperception that team physicians are beholden to the owners and teams, impacting their decision-making. According to Ciccotti, this is false. While athletes, coaches, agents and others may put pressure on the team doctors, at the end of the day, the physicians are not going to do anything to jeopardize a player’s health or recovery, even if it may be to detriment of the team in the short-run.
“We don’t treat them as athletes, we treat them as people who just happen to be athletes,” Ciccotti said. “Ethics transcends all professions.”
Tommy John Surgery
Using the example of Tommy John surgery, an operative procedure, which is most common among Major League Baseball (MLB) pitchers, Ciccotti explained the step-by-step process, as well as everything that goes into making sure a player is able to return to the field at the same, pre-surgery performance level.
“There is an important distinction between return to play and return to peak performance,” he said. “The idea is not just to drop athletes back into the sport when they are 50 percent or 90 percent but to slowly progress them back.”
Tommy John played 26 seasons in the major leagues and was a four-time MLB All Star. He ranks seventh highest of all-time in terms of his win total (288) among left-handed pitchers, half of which came after the surgery which bearing his name. John injured his ulnar collateral ligament in 1974, 11 years after his MLB debut. According to Ciccotti, at that time, that injury was considered a career-ender, but the surgery, performed by Dr. Frank Jobe, was revolutionary got John back on the field for another 15 years, allowing him to continue pitching at a high-level.
“We can never stop asking how good an operation is and how we can make it better,” Ciccotti said. “Like Tommy John surgery, techniques continue to evolve.”
As do the perceptions. According to research conducted in 2012, a staggering number of players, coaches and parents at the high school, collegiate and even professional levels, had a misperception of Tommy John surgery, with nearly half of those surveyed believing that the surgery could be used to enhance pitch velocity and improve performance to pre-surgery levels. The respondents also significantly underestimated recovery time. In 2015, a similar study was conducted that showed close to half of media personnel did not know that an injury to the UCL was the pre-requisite for surgery, with about a quarter believing the primary reason to get Tommy John surgery was to enhance performance.
“It’s an alarming percentage of misperceptions,” Ciccotti said, addressing education as a key component in getting fans, agents, players, coaches and everyone involved, to understand why players need a proper timeline for recovery, even if the team doctor has to alter treatment plans based on an athlete’s progress. Even if that means unhappy players or fans.
“Never be intimidated by the circumstances and never let the who, the what or the where alter your recommendations,” Ciccotti said. “Most importantly, always remain true to the physician-patient relationship, the essence of what we do.”
The 25th Annual Fall Distinguished Biomedical Lecture will be held on September 26 at 2 p.m. in the East Parlor when Alexander R. Vaccaro, M.D., Ph.D., MBA will present “Adapting to the Rapid Transformation in Health Care in Caring for Patients with Spinal Cord Injury: Lessons Learned.”
— Marilee Gallagher ’14