Dr. James Andrews is the Co-Founder of the Alabama Sports Medicine and Orthopaedic Center, the medical director for numerous sports teams, and a leading pioneer in sports medicine. He is widely recognized for his role in advancing the field of shoulder, knee and elbow surgery. He has mentored over 125 fellows throughout the course of his academic career, and is considered one of the foremost orthopaedic surgeons and sports doctors in the world.
Over the course of his career, he has operated on a remarkable number of prominent athletes, including Troy Aikman, Roger Clemens, and Jack Nicklaus.
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Dr. Andrews shares his thoughts on important aspects of orthopedic care:
The Advent of the Arthroscope - (56K) | (250K) | (QuickTime)
The Advantages of Arthroscopy (56K) | (256K)| (QuickTime)
Prevention of Injuries in Throwing Athletes(56K) | (256K) | (QuickTime)
Treating Professional Athletes (56K) | (256K) | (QuickTime)
How the Treatment of Professional Athletes Benefits Others (56K) | (256K) | (QuickTime)
The Future of Sports Medicine (56K) | (256K) | (QuickTime)
Shoulder1: You've earned a tremendous reputation for your various successes in sports medicine: What drew you to sports medicine originally?
Dr. Andrews: Well, I was an athlete. In medical school, I thought I would continue to participate in track and field as a pole vaulter, and found out that studies required all of my time. So I said, "If I can’t be an athlete, the best thing to do is to go into sports medicine, so I can continue to participate and be involved in what I love: athletic competition."
Shoulder1: You’re credited with advancing the arthroscopic technique of shoulder, knee and elbow surgery, and performing some of the very earliest arthroscopies. Can you explain what arthroscopy is and what advances you’ve seen in this field since the early days?
Dr. Andrews: The advent of the arthroscope has been the major breakthrough in sports medicine in the last thirty years, and certainly I don’t take credit for being the one who invented it. I’ve had some influence, but a number of people that came before and after me have continued to push the use of the arthroscope for minimally invasive surgery. It’s been extremely important, particularly for the athletes, to get well more quickly. Along with it has come rapid rehabilitation. That’s the real major breakthrough in sports medicine in the last thirty years.
Shoulder1: You’ve had a great deal of success treating professional athletes, such as Troy Aikman and Roger Clemens. How have shoulder injuries changed since you first started?
Dr. Andrews: When I first started in orthopaedics, even though I trained as a sports medicine fellow, the knee was king. We knew very little about the shoulder, much less the elbow. I quickly realized that there was more to sports and sports injuries than just the knee. I was fortunate to be in the right place at the right time: in the Southeast United States, very close to where all the baseball spring training was being done. So I was forced into figuring out why the shoulder hurt, for example, in a baseball pitcher. That’s really where it started: the way I began to try to figure out why pitchers had shoulder pain, when we knew very little about it, was to use the arthroscope to start looking in these shoulders. That’s the tool that gave me the edge to work in that field, particularly with baseball players and shoulder problems.
Shoulder1: What is it about the shoulder that makes it so susceptible to injury?
Dr. Andrews: There’s very little stability, other than the dynamics of the rotator cuff and the static stability provided by the ligaments in the capsule. A lot of people describe the shoulder as trying to balance a beach ball on the nose of a seal. It’s a very intricate joint. Particularly in overhead athletics, it’s got to be perfect to function. The most minute injury will cause dysfunction, pain, and inability to perform at a high level. The shoulder is complex, to some degree more complex than the knee.
Shoulder1: What kinds of things can young athletes do to protect their shoulders over the course of their careers?
Dr. Andrews: Prevention of injuries is probably the hardest thing we face in sports medicine. At our American Sports Medicine Institute, during this new decade, we are putting most of our research money into the prevention of injuries. That’s particularly important in the baseball throwing shoulder at the youth level.
There are four risk factors with youth baseball. Number one is year-round baseball: that happens, of course, not only in the sunshine states, but all over the U.S. The second is overuse, for example, playing in more than one league at the same time. The third is the radar gun, where these young kids are trying to throw 92 miles per hour when they’re 13 years of age. The fourth risk factor is the showcases, where they go out and try to throw hard, to show off for a college coach or perhaps a pro-scout, and they’re not in shape to throw.
There’s a lot that can be done, such as preventative exercises, which we’ve worked on and published through our Institute. Even a youth pitcher needs to be involved in strength training and flexibility exercises for his throwing arm, and of course there are core exercises for the body. That message has not gotten out, but hopefully through media like this, parents and coaches will understand that these injuries begin at a young age. They may not show up until later on, but they begin at a young age.
Shoulder1: The list of patients you’ve operated on is huge: from Charles Barkley (retired NBA star) and Emmitt Smith (NFL star formerly of the Dallas Cowboys; now playing for the Arizona Cardinals), to Jack Nicklaus (professional golf star), Chris Webber (NBA player for the Sacramento Kings), and Roger Clemens (MLB pitcher, currently playing for the Houston Astros). When treating a high-profile athlete, how do the treatments and the rehab differ from other patients, given that the athlete is under a lot of pressure to go back to a high-impact sport?
Dr. Andrews: The most important thing in treating a high-level athlete is you don’t treat them any differently than anybody else. You develop a routine and a system that works for you. To change that system because the patient is a high-level athlete just creates problems for you and the patient. There’s always that increased pressure, though. I remember when I operated on Jack Nicklaus’ knee, I had him all set up: I looked down to put the scope in his knee, and, being a big golfing fan, I said to myself, "My goodness, this is Jack Nicklaus." Once I got started, though, it was like doing anybody else’s knee. I had the same feeling when I did my young daughter’s ACL when she was in the eighth grade. I was a little bit nervous until I got started, then it was like anybody else’s knee. You can’t change your system; you can’t change your routine.
To be perfectly honest, the better the athlete, the higher the level they are, sometimes the easier they are to take care of. As a doctor, they can make you look pretty good. They have the ability to focus and get well, they’re motivated, and they’re on a mission to get back to their sport. To some degree, they’re easier to fix.
Shoulder1: Roger Clemens came to you with a nagging shoulder injury that refused to heal, very early in his career. What did you do differently in terms of treating his shoulder that allowed him to resume a hall-of-fame career?
Dr. Andrews: He was struggling with performance. He was the future for that particular team. He was young. Really, we go back to the arthroscope: I scoped his shoulder to try to delineate what was wrong with Roger. It took some courage to come to grips with doing that back in those days. What we found was a partial tear of his rotator cuff, which we cleaned up, and fortunately, he healed. One of the reasons that he’s been so successful, even today, is that he followed all the rehab protocols that we gave him. He still comes in--not every year but quite frequently--for a revamp related to the exercises that he’s continued to do. He’s devoted to longevity in baseball. What I’ve done for him is probably minute compared to what he’s done for himself as an athlete.
Shoulder1: For the typical patient, the weekend warrior, what kind of lessons can one take from a professional like Jack Nicklaus in terms of rehabilitating their injuries?
Dr. Andrews: Everything that we do for a professional athlete, even the newer technologies that we develop and work for the elite--all of that trickles down to the weekend warrior. Not only surgical techniques, but the advances in exercises, including rapid rehabilitation, all go right down to the lowest levels, down through college, down through high school and to junior high. They also go up. They go up to the middle-aged athletes and the aging athletes. I have patients that come to see me that are 65-year-old tennis players. They want the same treatment that we give to a younger elite athlete. And indeed, we may modify what they do to some degree, but we try to give them the same treatment, and they’ve all benefited from that. They enjoy their sports from a recreational standpoint just as much as a Jack Nicklaus enjoys professional golf. So they’ve all benefited from everything we’ve learned from the elite athlete.
Shoulder1: You mentioned discipline in terms of the rehabilitation process. How important is that for the injured weekend warrior?
Dr. Andrews: Well, regardless of what level they’re at, professional or recreational, you’ve got to figure out how devoted they are. Without the devotion for postoperative rehabilitation, they’re probably not going to be successful in their outcomes, and we’re not going to be successful in our surgeries. So there’s a lot of preoperative rehabilitation, so called "prehab," that we put them through to figure out how devoted they are. There’s a lot involved--not only figuring out their personalities, but whether they’re on a mission to get well. There are a lot of exercises we do prior to surgery to make the surgery successful. We have some regular recreational athletes that actually move to Birmingham post-op just to rehab in our rehabilitation department, because they’re devoted to their recreational sport. They’re not professionals, but they’re still devoted, and they want to get well. That’s what it takes: you have to be on a mission if you want to get back to a high level, regardless of whether your sport is recreational or professional.
Shoulder1: There’s been a lot of innovation beyond this in the field of orthopedics, especially in recent years. Where do you see the most interesting areas of research as they apply to the shoulder and the knee joints in particular?
Dr. Andrews: That’s an easy question. We had a symposium at the American Orthopedic Society of Sports Medicine in San Diego about the future of sports medicine: the future is really in tissue engineering and in gene therapy. For example, I’m sure that in the end of this decade, we’ll be able to make anterior cruciate ligaments in the laboratory. We’ll have spare parts that we’ll be able to get off the shelf and put in the body.
The other area that is probably going to revolutionize sports medicine is robotic surgery with global navigation systems, where we actually use the computer to help us to be more accurate with some of our surgical techniques. Those areas--gene therapy, tissue engineering, and robotic surgery--are going to be the next revolution in sports medicine, equally important as the arthroscope in the past.
Shoulder1: Is there anything else you’d like to say specifically to patients, or to the average person trying to stay in shape, and possibly injuring their ankles, knees, or shoulders along the way?
Dr. Andrews: First, I’d like to emphasize to the public how important it is to get behind the prevention of injuries in our youth athletics, not only in baseball but in all of our youth sports. One of the most important things we have to offer to young kids is athletic participation. We have to figure out how to do that healthily and without serious injury. We need all of us along with the media, to help us get the message out so that we can begin to have some breakthrough on preventing these injuries.
The other thing I would say to the weekend athlete is this: Stay in shape, don’t give up your sport, look for athletic fitness wherever you find it. I’ve been through this myself. If you ever give up the recreation in your life, you’ll never get it back. You can’t all of a sudden decide to do it again once you give it up. I also believe tt’s much more beneficial and healthy as you age to be overactive than it is to be underactive.