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On the field and in the clinic

Stanford Medicine orthopedic surgeon uses his skills to as head physician for the San Francisco 49ers football team

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

McAdams, a Stanford Health Care orthopedic surgeon, doubles as the head team physician for the San Francisco 49ers. So when he walks from the sidelines onto the field -- in full view of television cameras -- that means a player is injured.

In that moment, there's one looming question that sits squarely with McAdams: Can the player return to the game? "The pressure to let someone back onto the field is palpable," said McAdams, MD, whose 22 years of experience as a sports physician sustains his measured demeanor on the field.

"In my head, all I'm thinking about is the health and safety of the player -- I'm mentally running through our medical protocol, taking everything one step at a time. I gather the information, and I rely on my gut, which is usually right," said McAdams, who is also a Stanford School of Medicine clinical professor of orthopedic surgery.

Photo by Hanae Armitage

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

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

Making the cut

Growing up in Saratoga, California, McAdams was attracted to science and technology. "I always grabbed the science section of The Mercury News," he recalled, referring to his local newspaper.

He studied biology in college but didn't initially consider being a doctor, but it wasn't for a 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 in my sophomore year, I had a sort of epiphany and I thought, 'That's a terrible reason to not go for something you want.' And so, from that day on, decided I would switch gears and go for it."

McAdams attended medical school at Georgetown University, 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 extremity surgery. That lent itself to doctoring injured athletes, and after an additional knee surgery fellowship that focused on sports medicine, McAdams pivoted from solely upper limb surgery to sports medicine.

McAdams first started treating football players when his mentor and colleague, Gary Fanton, MD, a Stanford School of Medicine professor of orthopedic surgery, recruited him to join the 49ers as a co-team physician. When Fanton retired from the 49ers in 2014, McAdams took on the head team physician role. Now he's joined by Stanford Medicine colleagues Geoff Abrams, MD, associate professor of orthopedic surgery, and Bill Maloney, MD, professor and chair of orthopedic surgery, both of whom are associate team physicians. McAdams now leads a team of 20 trainers, physicians and physical therapists -- some of whom are also Stanford Health Care colleagues.

Team doctors attend every game, home and away. "There are a lot of in-game decisions that are important in evaluating if someone can return to play," McAdams said. "The injury rates for this game are high -- my skills, and those of my colleagues, are used five to 10 times per game."

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

Addressing ACL tears

McAdams is well versed in the health risks posed by high-contact sports, such as football, one of which is the dreaded ACL tear, a vexing knee injury that is often season-ending. The ACL, or anterior cruciate ligament, is a strip of tissue that connects the thighbone to the shinbone.

"It's been long thought that ACL injuries in football are contact related, which is different from what we see in other sports," McAdams said. But a study conducted by McAdams and others showed that ACL injuries mostly happen during harsh lateral movements, such as quick pivots. "We saw that 70% of ACL tears in football were actually noncontact injuries."

In a weird way, that's good news. It means there's hope that special training can strengthen the muscles around the ACL and, ideally, prevent tears. "There's this idea that football players just need to lift and weight train -- that the goal is to jump higher, go faster and be stronger. But there's a new paradigm shift that focuses on conditioning, and injury prevention, while still enhancing strength," he said. "That includes new methods to monitor performance -- whether through GPS technology or video observation -- and further investigations into how we can decrease the injury risk for football players, from professional players to high-schoolers."

Part of that, McAdams said, is that the NFL is using a longer ramp-up period, in which players slowly become acclimated to high-intensity physical activity. Already, McAdams said, injury rates are down.

Increasing diversity among sports physicians

Outside of research and injury prevention McAdams says he has another focus this year: increasing diversity among sports physicians: "In many sports, including football, we see that the population of players does not closely mirror the race and ethnicity of the physicians that take care of them. Nearly 70% of the players in the NFL are Black, and less than 8% of NFL physicians are Black."

McAdams points to studies showing that patients connect better with physicians who look like them and who can relate to them through common backgrounds. That often translates to improved patient care.

"I remember being in a grand rounds session that focused on diversity, equity and inclusion, and it opened my eyes more to the fact that, to bring the best care to our patients and players, representation and diversity matter," McAdams said. "I'm part of a community that's fairly progressive and forward thinking, but you'd be naive to say that racial discrimination and systematic racism doesn't impact every community."

The talk on racial justice inspired him to figure out ways to encourage young people of color -- many of whom aren't sure where to start or don't have proper mentorship -- to pursue a career in sports medicine. His aim: to amplify diverse student voices and opportunities for mentorship in the National Football League and beyond.

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

"It's terrible to think that there are people -- students -- out there who could be great doctors but never had that opportunity to succeed," McAdams said. "I believe in meritocracy and that you rise to the level of your ability, but I think that if you don't have the opportunity -- or the mentorship -- to show your ability, that talent often doesn't surface. That cycle perpetuates itself, and I hope we can help break it."

Photo by Margarita Gallardo

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