DOCTOR OF THE MONTH—DAVID A. ABRUTYN, M.D.

David A. Abrutyn, M.D., is the team physician for both Immaculata High School in Somerville, NJ, and Sky Blue FC, New Jersey’s team in Women’s Professional Soccer. He also serves as Medical Director of The Joint Surgery Institute at Somerset Medical Center, ranked among the top 10 percent of hospitals nationwide for joint replacement surgery, as well as Associate Chairman of the Division of Orthopedic Surgery at Somerset Medical Center and Tissue Transplant Service Director at Somerset Ambulatory Surgical Center.
DAVID A. ABRUTYN, M.D.PSH spoke to Dr. Abrutyn about his areas of expertise—shoulder and knee disorders—and about the relationship between his personal sports experience and his profession.

Q: You had a lot of injuries in your own early athletic career. What was that career, and what have you learned from your experience?
A: I was captain of my varsity soccer, basketball and baseball teams at Montville (NJ) High School. In my senior year of high school, I tore my ACL. That was my major orthopedic injury, and my wake up call. At that point I realized that, even at 17, I was mortal. I think certainly that being hurt and understanding the expectations of athletes, even “weekend warriors,” gives you empathy towards your patients. It doesn’t make them heal any faster, but I understand their desires and hopes. My goal is to try to get them back to where they want to be, but give them realistic expectations—such as about the post-operative pain, for example. My patients do better when they are well informed and have realistic expectations. I think having been on the other side of the knife helps me give them that perspective.

Q: You treat amateurs, “weekend warriors” and professionals. What would you say the main difference is between the professionals and the others?
A: The needs and expectations of a professional athlete are much different in the sense that this is their career and their life. Even though for an amateur or a high school athlete it can be their life, they have other interests. On the professional level, the acuity of everything is heighted. We need to get them back on the field as quickly as possible, while also keeping in mind the safety of the athlete. In some ways we treat them differently, in terms of how aggressive we are from a diagnostic point of view—MRI, bracing, etc. They can spend all day rehabbing in physical therapy, getting treatment and icing. The others—the “weekend warrior” or the high school athlete—are in school or at work. They have other things going on.

Q: Is the professional athlete “wired” differently from the others, from a physiological point of view?
A: I don’t think they’re wired differently; what’s different is their commitment to rehabbing themselves, because it’s their job. You and I may spend six hours doing something for our job, whereas the professionals are spending that much time at the therapist—stretching, icing—doing what they need to do to maximize their recovery.

Q: The issue of the shoulder—especially in youth baseball players—is a prominent topic. In which other sports is the shoulder “taking a beating?”
A: Any sport where there is repetitive use of the shoulder—obviously baseball, swimming, tennis. I don’t see many golfers who get hurt playing golf, per se. Once you have shoulder pain, it hurts more when you play golf, obviously. But I don’t think golf is the cause of the shoulder pain, whereas baseball and swimming are the cause.

Q: How can these athletes protect themselves?
A: The major things, at least in baseball, are pitch counts and rest. Unfortunately, the way sports have evolved, even at the Little League level, is that most have become year round. Most kids aren’t taking two months off from a particular sport. When I was growing up, I played soccer in the fall, basketball in the winter, and baseball in the spring, but didn’t do any of them year round. Now, most kids are dedicated to one or two sports. In terms of protection: pitch counts, rest and, specifically, stretching. There are specific stretches that most people are unaware of that can help prevent injuries. It is the repetitive overuse that leads to tightness in the shoulder, which then leads to a downward spiral of abnormal mechanics and eventually pain. So if you can prevent the tightness, that would go a long way in preventing shoulder injuries.

Q: It seems that most athletes don’t include these types of exercises. If that is so, why not?
A: It is lack of education on the parents’ part, and lack of awareness of how common the problem is. It is a lack of understanding by coaches and trainers, and then, fundamentally, it’s a philosophy of life. Our society is a reactionary society, not proactive. In everything we do, most of the time we worry about it once it becomes a problem. We don’t do a lot of prevention. In the last 10 to 15 years, there have been a lot of good studies that show that, specifically with the shoulder, and even more in respect to ACL prevention, there are a lot of simple programs you can implement in both the off-season and during the season. These include stretching, but also core strengthening, flexibility, proper landing techniques—all of which would decrease these injuries. This is not to say they would decrease by 100 percent, but if you can decrease the risk by 40 or 50 percent, that’s fairly significant.

Q: What is the greatest advancement for ACL injury prevention? Is there hope in this area?
A: I think there is a lot of hope. The difficulty is implementing prevention programs on a wide basis. The best prevention is really strengthening your core, trunk stabilizers, hip abductors, quadriceps, and really trying to coordinate neuromuscular activity so that you land properly and your body is unconsciously aware of how you are stopping and starting your movements. A lot of the programs can be implemented on the practice field, by professional trainers. There are some factors that are outside of our control: the way we’re built, the surfaces we play on. But the one thing we can control is our conditioning, our strengthening. But it only works if you do it.

Q: What are the toughest and best parts of your job?
A: I think the toughest part of my job is dealing with complications. Just like in sports, most orthopedists, including myself, expect to win. You expect every patient to do well; you want that. When they do well, that’s the most satisfying part of my job. When people don’t do well, that’s the hardest thing to deal with. Fortunately, most of my patients do well.
The most rewarding thing is making people better—whether that’s non-operatively or operatively—giving them quality of life and getting them back onto the field. When someone thanks me for a successful surgery, it rolls off my back; that’s what I’m supposed to do. It’s the one percent that doesn’t do well that has me up at night staring at my ceiling.

Q: You’ve run the New York City Marathon, and participated in a lot of sports. What has your own sports experience taught you?
A: Running the New York City Marathon was a great personal challenge and accomplishment. I was never a runner, other than what was required for sports. I committed to the marathon and I did it. It was one of the great life experiences in terms of committing to something and doing it. What I took from that, and from sports, has stayed with me throughout my life—in terms of the commitment, discipline and sacrifice. Professionally, a lot of my sports experience—training, winning, losing—has helped shape me as a husband, father, person and an orthopedist.

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