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A Winning Combination:
Elite Athletes and Hopkins’ Sports Medicine Specialists


Chick Silberstein and Orioles pitcher Matt Riley, photographed in the pitchers' tunnel at Camden Yards.


Andy Cosgarea with Hopkins lacrosse star, All-American Kyle Barrie, in the training room at Homewood.



by Mat Edelson
Photography by Keith Weller

Like a finely tuned thoroughbred who trains days for his two-minutes of bone-jarring glory, an elite athlete has but one goal: To compete and beat the best. It is a pursuit that creates an awareness of body unknown to us mere mortals and makes entrusting that body to a physician an extremely delicate proposition when injury occurs.

Several Hopkins faculty are among the top sports medicine specialists chosen to take care of Baltimore’s preeminent competitors. In the rarefied realm of professional and Division I sports, this kind of work translates into serious business. In the first place, these physicians must earn the trust of the athletes. And, their medical decisions must be based on the unique needs of the individual athlete, free and clear of the financial and competitive pressures of the game.

With spring approaching, Hopkins’ sports medicine orthopedists are helping prepare the Orioles and Hopkins’ legendary Division I lacrosse team for the 2004 season. Several years ago, at the request of Orioles owner Peter Angelos, the Department of Orthopedic Surgery took over management of the team’s orthopedic needs. This includes everything from spring training physicals to in-season pre- and postgame evaluations. While many pro teams sell the rights to be an organization’s “official” sports medicine physicians, the Orioles instead pay Hopkins for their physicians’ services.

Orthopedist Charles “Chick” Silberstein, who has been treating Orioles players for nearly 40 years, works regularly with the team throughout the season. “Chick has the advantage of knowing the player as a person,” says long-time head trainer Richie Bancells, who works each day with Silberstein. “He knows the player’s mind, emotions, relations to other team members, and the dynamics of how this team works.”

Silberstein and Director of Sports Medicine Andrew Cosgarea see players for two hours before each game. A bullpen full of orthopedists covers the team during and after the contests. They include sports medicine specialists Ed McFarland, Leigh Ann Curl, Tim Johnson and John Wilkens; foot and ankle specialist John Campbell; hand and wrist expert Mark Deitch; and spinal specialists Lee Riley and David Cohen. “I wanted everyone in the [Orioles] organization to be exposed to all members of Hopkins’ sports medicine team, so if players are referred to someone from one of those specialty regions, they’d be well known,” says Silberstein.

Earning Trust

Hopkins sports medicine physicians know what it’s like to lay one’s body on the line, for they themselves have been competitors. Ravens’ physician Leigh Ann Curl, the Bayview orthopedic surgeon who was the NFL’s first female team doctor, was a college basketball star. Cosgarea, who is also head team physician for the Johns Hopkins Athletic Department, was captain of Penn State’s swim team. Experiences like these create immediate bonds between them and the players they treat.

Pro and top-level amateur athletes count on the physicians to know the answers to their questions, questions upon which careers and millions of dollars often ride. Does my doc understand my injury and how it relates to my sport? Does he see how my hip pointer is taking five miles an hour off my fastball?

Balancing these unique and intense desires of the athlete with those of other financially interested parties, such as insurers, agents, TV networks and sponsors, puts the sports medicine doctor in a potentially precarious position. What’s the right call? Allowing a player to play? Sitting him down? Having season-ending surgery? Or just making sure that he can still walk when his career is over?

Identifying which injuries pose serious risks of permanent damage is key. For some injuries, of course, the protocols are black and white. When a nerve injury creates muscle weakness, for example, athletes can’t play until the ailing muscle is at full strength. Period. Other injuries, however, fall into grey areas. How much pain, for instance, can an athlete play through? “Virtually every pro athlete plays every day with pain. Whether it’s a sore muscle, hip pointer, shin splints—pain is a part of it,” says Cosgarea. “An athlete has, say, a partially torn ligament. You tell him the knee is unstable; going out now will cause further damage. With some you can say: I will not clear you to play. Head docs at a college make that decision all the time.”

Cosgarea and Silberstein concur that they function as advocates for the athlete, not the team that employs them. They give players all the options for possible inventions, then let them make the choice. As for the team’s or coach’s opinion of those options: “I don’t get involved with that. I call it like I see it,” says Silberstein. “If they want to follow my directions, fine. If they want to kick me out, that’s fine too.”

Cutting Alternatives

It’s not enough to “fix” a problem through surgery; what’s important is getting at the root cause. If the underlying cause is biomechanical, the problem can recur or exacerbate and ruin a promising career. A big-toe injury forced famed St. Louis pitcher Dizzy Dean to alter his motion. That, in turn, wrecked his pitching arm and ended his career. Thus, Silberstein frequently inundates players with questions they’d usually hear only from a pro pitching coach. When did you start pitching Little League or high school? How do you throw? Three-quarters motion, over the top, sidearm? Have you ever had a problem with a foot, ankle or knee? “Too often, they don’t realize that a problem in one area can lead to aches and pains in shoulders and elbows,” says Silberstein.

Advances in technology likewise have revolutionized sports medicine. Diagnostic imaging and tools such as arthroscopes have made it easier to spot, treat and recover from what previously were career-threatening knee, shoulder and elbow injuries. Add the digital power of the Internet, and treating serious sports injuries now is an almost instantaneous process, even when the team is out of town.

Last year, an Oriole suffered an arm injury while on the road. “We took a picture of the X-ray with a digital camera, uploaded it on the computer and sent it to Andy and Chick,” recalls Bancells. “In the middle of a road trip we could talk about treatments. It doesn’t mean you’re not working with the other team’s docs, but you like working with your own people. They know you best.”

Private Lives

In addition to working with the Orioles and the Hopkins teams, Silberstein and Cosgarea maintain their regular orthopedic practices. Silberstein is also on the medical advisory committee for Major League Baseball. Cosgarea fits sports medicine into his larger life by making it a family affair. He’ll often bring his three boys to Camden Yards or to Homewood. “How many kids get to go into the training room, or walk in the dugout and chat with the players, or stand on the sidelines at a D-1 game? There are a lot of positives,” says Cosgarea.

No doubt the superstars he treats feel the same way.

SIDEBARS:

Out of His League (and Loving It)
Dean Edward Miller goes to Orioles Fantasy Camp. MORE
Marathon Medicine
A unique Hopkins program is bringing sports medicine and emergency medicine together. MORE
Ironman Solutions
As part of Hopkins’ Sports Medicine team, Brian Krabak, a physiatrist with a dual appointment in Physical Medicine and Rehabilitation and Orthopedic Surgery, often works out subtle biomechanical and rehab solutions that allow athletes to forego surgery. MORE
 

 

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