Welcome to “Medical Mavericks,” a series from MedPage Today featuring interviews with healthcare professionals working in unconventional fields of health and medicine. We spoke with Timothy McAdams, MD, a clinical professor in the division of sports medicine in the department of orthopedic surgery at Stanford University, about his work as the head physician for the San Francisco 49ers and the president of the NFL Physicians Society. McAdams became interested in orthopedics in medical school, in part due to his athletic background and in part because he appreciated the quicker turnaround of results compared with other specialties. After completing his residency in orthopedics, he pursued two different fellowships: one in hand and upper extremity surgery and another in sports medicine. Today, his practice is limited to sports medicine. This interview has been edited for brevity and clarity.
Q: How did you get involved with the San Francisco 49ers?
McAdams: We all kind of live on the shoulders of our predecessors. Basically, I had a couple of mentors who took me under their wing and helped me along, and got me involved first with Stanford athletics — football and basketball. Then the 49ers came asking if we would help them. That started 16 years ago; in 2007. The rest is history.
Q: I see you’ve also worked with professional baseball and basketball teams. How do those sports compare?
McAdams: I did around 3 years each with the San Francisco Giants [2013-2017] and the Golden State Warriors [2011-2013]. And I currently just work as a consultant for the Giants, no longer as the team physician for those groups. I loved the experience; it was really rewarding to learn about athletes in different sports, to see how they differ in their training, and what their needs are. But it was a challenge, in terms of time, getting from one game to another. So, a great experience, but I think it’s best to focus on football for my situation.
Q: What does the role of head physician for the 49ers entail?
McAdams: I attend every game, home and away. For football, teams really rely on the team physician being there and knowing the athletes because those decisions for return to play are so critical. So, every game, home and away, is attended by the orthopedic surgeon and a medical physician; some teams have two orthopedic surgeons and one or two medical physicians. There’s a real close relationship with the team physician and the head athletic trainer.
Q: What are the most common injuries you see?
McAdams: For me, as an orthopedic surgeon, the most common is going to be ankle sprains or knee sprains. Hopefully not serious ones, because those can mean everything from missing one play only and returning to play, all the way to missing the season and having a surgery.
Q: Have you had to deal with any uncommon medical situations at a game?
McAdams: There was a game where we were in another city, and our running back got tackled awkwardly, and came off the field, said he felt fine, demonstrated that all the functional tests were normal, and passed all of my examinations. He went back into play, ended up having a great game. And he was doing really well, showed no signs of any problems or pain. Then, after the game, he felt a little bit more pain, and this pain was always kind of in his hip and groin area. And, again, he passed every functional test, full strength, full motion. So, I said, let’s get some x-rays. And on the x-rays, there looked to be something unusual. So, I got a special type of x-rays, which we do only in the trauma unit, that looks for hip socket fractures. And sure enough, he had a hip socket fracture.
Q: Do you treat the players separately from care on the field?
McAdams: Yes. Oftentimes, if it requires ongoing treatment, I’ll see them at the training facility for convenience for them, or I’ll do clinic hours, both at Stanford and at the 49ers facility. If it does require a surgical intervention, I will be involved with that in many cases.
Q: Have you ever had a situation where you determined a player was not OK to return to play but they were adamant to do so?
McAdams: Yes, they often do not like what they hear. And if it’s something clear, that they can’t go back, the first thing is we have the athletic trainer take their helmet and go somewhere else with it. Because otherwise they will grab their helmet and go right back on the field as you turn your head to do something else or look at the video — they’re out there playing.