In the field and in the clinic

When Tim McAdams appears on TV, it’s not a good thing.

McAdamsa Stanford Healthcare Orthopedic surgeon, as the chief physician for the San Francisco 49ers. So when he walks from the sidelines onto the field — in full view of the television cameras — it means the player is injured.

At that moment, one question loomed large with McAdams: Can the player return to the game? “The pressure to let someone back on the field is palpable,” said McAdams, MD, who with 22 years of experience as a sports physician maintains a measured demeanor on the court.

“In my head, all I think about is player health and safety — I mentally work through our medical protocol, taking everything step by step. I gather information, and I rely on my gut,” said McAdams, who is also a clinical professor of orthopedics at Stanford School of Medicine.

Photographed here by Armitage

McAdams, who specializes in knee and shoulder surgeries, has been with Stanford Medicine for more than two decades and with the 49ers since 2007. In addition to his role with the 49ers, McAdams has served as a physician for the San Francisco Giants, Golden State Warriors and Stanford University’s men’s and women’s soccer teams. Over the past 20 years, he has repaired torn shoulder tissue and rotator cuffs, as well as knee ligament and cartilage injuries (among other injured body parts) in hundreds of elite athletes.

Throughout his career, McAdams, who most recently became president of the NFL Physicians Association, has applied research findings from his work at Stanford Medicine to the players he sees on the field.

making the cut

McAdams grew up in Saratoga, California, and was drawn to science and technology. “I always grabbed the science department at the Mercury Newsreferring to his local newspaper.

He studied biology in college but didn’t initially consider being a doctor, but it wasn’t for lack of interest. “I was intimidated. Doctors are really smart people, and I didn’t know if I was in that league.” McAdams said. “But my sophomore year, I had kind of an epiphany and I thought, ‘This is a terrible reason not to look for something you want.'” And so, from that day on, I decided to switch gears and go for it.”

McAdams attended Georgetown University School of Medicine, where he graduated magna cum laude, and completed his residency at the University of New Mexico before making his way to Stanford Medicine for a fellowship in hand and upper limb surgery. That gave way to treating injured athletes, and after an additional knee surgery fellowship focused on sports medicine, McAdams switched from upper extremity surgery only to sports medicine.

McAdams first began dealing with football players when he was his mentor and teammate, Gary Fanton, MD, professor of orthopedics at Stanford School of Medicine, recruited him to join the 49ers as an associate physician on the team. When Fanton retired from the 49ers in 2014, McAdams assumed the role of the team’s lead physician. Now his colleagues at Stanford Medicine have joined him Jeff AbramsMD, Associate Professor of Orthopedics, W Bill Maloney, MD, professor and chair of the Department of Orthopedics, both associate physicians. McAdams now leads a team of 20 coaches, doctors and physical therapists – some of whom are also fellows at Stanford Healthcare.

Team doctors attend every game, home and away. “There are a lot of decisions within the game that are important in assessing whether someone can return to play,” McAdams said. “The injury rates in this match are high – my skills and those of my teammates are used 5-10 times per match.”

While his medical prowess is valuable on the field, McAdams also tries to make the game safer and reduce the injury rate.

Treatment of anterior cruciate ligament rupture

McAdams is well aware of the health risks posed by high-contact sports, like soccer, one of which is a terrible ACL tear, a nagging knee injury that often ends the season. The anterior cruciate ligament is a band of tissue that connects the femur to the shinbone.

“It has long been believed that ACL injuries in football are contact-related, which is different from what we see in other sports,” McAdams said. But the study conducted by McAdams et al. showed that ACL injuries often occur during harsh lateral movements, such as rapid pivots. “We’ve seen that 70% of ACL tears in football were actually non-contact injuries.”

In a strange way, this is good news. This means that there is hope that the special training will strengthen the muscles around the ACL and prevent tearing optimally. “There’s this idea that soccer players just need to lift and train weights — and that the goal is to jump higher, be faster, and be stronger. But there’s a new paradigm shift that’s focused on conditioning, injury prevention, while still promoting strength,” he said. “This includes new methods of performance monitoring – whether through GPS technology or video monitoring – and further investigation of how to reduce injury risk for football players, from professional players to high school students.”

Part of that, McAdams said, is that the NFL uses a longer intensity period, in which players slowly acclimate to high-intensity physical activity. Indeed, infection rates have come down, McAdams said.

Increasing diversity among sports physicians

Outside of research and injury prevention, McAdams says he has another focus this year: increasing diversity among sports doctors. Of them. Approximately 70% of the players in the NFL are black, and less than 8% of the NFL’s doctors are black.”

McAdams points to studies that show patients communicate better with doctors who are similar to them and with whom they can connect through common backgrounds. This often translates to improved patient care.

“I remember being in the Grand Tours session that focused on diversity, equality and inclusion, and it opened my eyes even more to the fact that to give the best care to our patients and players, representation and diversity are important,” said McAdams. “I am part of a somewhat forward-thinking society, but it would be naive to say that racial discrimination and systemic racism do not affect every society.”

Talking about racial justice inspired him to discover ways to encourage youth of color—many of whom are not sure where to start or do not have proper mentoring—to pursue a career in sports medicine. His goal: to amplify diverse student voices and mentorship opportunities in the National Football League and beyond.

He said the timing was just right. He was starting a new role as president of the NFL Physicians Association, and he and his colleagues were discussing a new program that would help train medical students of color early in their sports medicine careers, giving them an opportunity to work with NFL physicians, McAdams included.

McAdams said, “It’s terrible to think that there are people—students—who could make great doctors but never had that chance to succeed.” “I believe in meritocracy and in living up to your ability, but I believe that if you don’t have the opportunity — or the mentorship — to show your ability, that talent often doesn’t come to the surface. That cycle is self-perpetuating, and I hope we can help break it.”

Photo by Margherita Gallardo

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