The spirit of the locker room, we're going to continue the locker room discussions here with some great discussions throughout the day today, general sessions that I would encourage you all to attend. Our first one right here, right now is going to be the Winning Playbook for Elite Athlete Care. That's going to be moderated by our co-chair, Alison Toth, and an excellent panel with Tiki Barber and Ronnie Barnes, who need no introduction. That's going to be followed after the break in the exhibit hall by another game-changing session. That's going for the gold, and in the spirit of the Olympics coming up, if you haven't heard the story about Olympic skier Nina O'Brien and her surgeon, Tom Hackett, please come back, and that's going to be a great discussion with Chief Medical Officer for the Olympic Committee, Jonathan Finoff. And then a little bit later today, we'll have a fireside chat with our general-in-chief, Dean Taylor, as well as a general of the U.S. Army, Bob Brown. And then last but not least, we have an awesome game-changer session on innovation at 3.30 that's going to cover a whole bunch of topics. And last but not least, tonight is probably the culmination of the social events tonight with your families, with everybody that's invited. We're going to be taking shuttles from all three of our hotels at 5.15, and then at 6.30, everyone will meet with our social event at the Wings Over the Rockies Air and Space Museum. So 5.15 in the lobby, and I'll turn it over to Alison. Well, thanks, John. So I want to welcome to the stage our panel. So if you guys can come up and take a seat here. We've got Tiki Barber. Come on up, guys. So Tiki Barber, again, needs no introduction. He's one of those people with a first name that, just like Serena or Pele or something, everybody knows Tiki, but he's a retired running back for the New York Giants, currently an analyst and commentator for CBS Sports. He has his own radio show as well. Ronnie Barnes, to your far right there, is the senior vice president of medical services, head athletic trainer for the New York Giants. Ronnie, how many years have you been doing that? Over four decades. Over four decades. Amazing. And then lastly, Scott Rodeo, who's the head team physician for the New York Giants, attending surgeon at the Hospital for Special Surgery, professor at Weill Cornell. And so we have a great panel here. Again, we're going to discuss elite athlete care. We've got a number of great items to ask the panel. And at the end, we put some mics out. So at the end, if there's some questions that you have, we don't have questions in the app to ask, but if people would come up to the mics, I'll leave some time for that at the end. So if you're thinking about, if something raises a question in your mind, understand you could come up at the end and ask some questions. So without further ado, we're going to get the session started. Okay, so good. So our lavaliers are working. I see. Okay, well, we're going to start with you, Tiki. So we had a really nice session earlier here with Billy McMullen, who was, as you know, like Tiki played football at the University of Virginia, and so did Billy. So he had a big UVA contingent here. And Billy told us a lot about how he developed trust in the medical staff. And I think starting with that topic with you as well is, you know, how do elite athletes view the medical system and what influences how they come to trust that medical system? Yeah. Well, first of all, Allison, before we start, I just want to thank you all at the AOSSM for having me, but I need to give a special thanks to a few people. So last night I had an altitude dehydration event at the Gladden Award Session, and I passed out. And I really want to thank Dr. Bennett, Craig Bennett, Tim Johnson, and Ronnie Barnes, who all went to me to the emergency room and stayed with me for three hours. And I'm fine. There's nothing to worry about. I'm a survivor, I think. So thank you all for taking care of me. It's a good thing I was in a room of doctors. But that gets back to your question, Allison, about trust. And trust to me is always about the relationship. And I think one of the hard things for athletes, especially those that have gotten really good, is trusting other people. They'll trust their family. They'll trust their friends. They'll trust those that have supported them, whose shoulders they stand on as they achieve in college or in the NFL or other sports. But it's really hard to trust someone who they just met or who doesn't look like them. And so the challenge for guys like Ronnie Barnes, for Dr. Rodeo, is developing the relationship that allows those young men and women to trust someone who is not close to them. And so I think it's imperative for organizations, for teams, for colleges to consciously work on that. Right? It has to be intentional. And it's not just going to happen. Because otherwise, athletes will go seek second advice from an uncle. Right? And we know how that goes. And so I think it is paramount to successfully treating athletes as trust in the relationship. And can you comment specifically on Frank McHugh? Like Billy told a nice story about Frank. And then maybe Frank McHugh first, your college team doctor at UVA, and then your relationship with Ronnie Barnes. Right. Russ Warren, who unfortunately couldn't be here, he's in Maine. And Scott Rodeo, who was your assistant team doc at the time you played. I'll start with Frank McHugh. So as crazy as this sounds, I played four years of college football, I played a decade in the NFL. I had one surgery. And I had a lot of injuries, but one surgery. And that one surgery is a Herbert screw in my ulna navicular, like the littlest thing you could possibly have surgery on happen in college. And I broke my wrist, interestingly, punching my twin brother in his stomach. I'm not kidding. I didn't know how to punch. So I punched him the wrong way. It bent the wrong, whatever. And a couple of years later, it just was really hurting me. And Dr. McHugh did an x-ray, and he's like, oh yeah, you got a fractured ulna. We'll do surgery. But the beauty of this surgery, I'm at the University of Virginia. I'm in my second year, living in a dorm. I have this surgery. It's just a local anesthetic in my arm. So I'm kind of awake while it's going on. And I see him tugging on my wrist, and I feel it, and it's kind of cool. He's talking me through it. So I felt like I was a part of it. And then afterwards, he took me to his house, and him and his wife cared for me for three days. And my brother's like, where are you at? I'm like, I'm at Dr. McHugh's house. And so that type of relationship was a relationship that Frank had with everybody. And you just felt connected to him. He treated you like you were one of his kids. And I think in a collegiate atmosphere, you can have those kind of relationships, because they're still kids. I mean, we're literally kids. And it was meaningful. I think I was fortunate when I got drafted by the New York Giants, because as soon as I walked in the room, I'm like, oh, head trainer's black? I like this guy. And so without even knowing him. And it brought a sense of understanding and comfort. But it was also, the relationship was easy to develop because of how trusting he felt, how attuned to whatever the athlete needed we were. And we can get to some of those conversations as we go down, because there was a lot that was new that I think during my era with the Giants, the Giants and Ronnie and Dr. Rodeo and Dr. Warren brought into the organization to help us deal with some of the injuries and issues that we went through. But the thing that I loved most about the Giants and the challenges that you face as an athlete when you get hurt was being able to keep it real with them. And this happened in 2000 when I broke my forearm. We played the Cowboys on week 16, and Filippi Sparks hit me in my forearm and cracked it. I didn't know it was cracked. I thought it was just a bruise. I didn't get an X-ray. The next week we played the Jacksonville Jaguars, which was in the last game of the season. And we had a good game. We won. We got the bye week. I was like, man, this thing is really hurting me. And so Ronnie took me over to the X-ray room, which was right in the stadium. I was like, oh yeah, you got a fractured forearm. And it wasn't like just a little crack. It was compound fracture. So it was displaced. And I'll never forget this conversation I had with Dr. Warren, because he has a pretty stead bedside manner, if you've ever met him. He's just going to tell you exactly what's wrong and what he wants to do. And he came up to me and he said, Teague, you got a fracture. We got to plate this. Your season's over. And this was the level of trust I had with him. I said, Doc, with all due respect, that's not an option. And so we innovated. And we created, he reset it, which hurt. He reset it. And then we brought in, I forget who the doctor was, that we brought in to create a carbon graphite cast. I had a bone stimulator that I wore 24 hours a day like it was going to do something. And I ended up, it made me feel good. But psychologically, they made me feel OK. And physically, I felt protected. And so after the bi-week, we played in the wild card round against the Eagles. And I played. And subsequently, we went to the Super Bowl. And I played three weeks with a fractured forearm. And I mean, talk about high levels of trust. I always told people, I'm either really brave or I'm really stupid. And so they allowed me to be both. That's awesome. Well, thanks for all that, Teague. And it's a great example of kind of this is a team-like decision. And athletes, professionals are now older and making their decisions. I wanted to ask the medical team here, Ronnie, I'll start with you. You remember these injuries quite well. You remember that very well. Of course. The Super Bowl year especially. But like talking about developing trust with the athlete, Teague said he came right in, met you, and really felt that sense of how do you develop trust with athletes, Ronnie, so well? Well, I think athletes are people too. And we're often focused on the pathology or the injury at hand, whether it's a hamstring strain, a fracture, you know, whatever it might be. The players walk into the exam room, and we're looking at the pathology. And I think if you step back a little bit and realize that, yes, they are people, and they have families, and they have lives, and the more that you get to know them and develop a relationship with them and have them understand that you're there for them, the trust starts to accumulate, if you will. But it takes some time. And you have to earn that trust, both as a physician and athletic trainer. I think athletic trainers do an excellent job of helping the physician, the athlete, build trust in the physician. Because long after you've left the exam room, the athlete talks to the athletic trainer. And the first question usually is, what did he say? And it's our job to explain. And oftentimes, you know, they're a bit confused, and we'll get the doc back into the room, or we'll get them on the phone. But I think communication builds trust. And that's so important. And I think as physicians, you should rely on your athletic trainer to help you build trust with the athletes. Now, Tiki brought up the issue of an athletic trainer looking like him. Well, in the National Football League, you know, over 90% of the athletes are African-Americans. But I think we're at a level today where athletes trust well-trained physicians. And people who believe in them and who they believe have their best interests at heart. So I think race is always an issue. But I think that we can overcome that by being very good at what we do and working as a team. Thanks, Ronnie. We'll come back at the end of the session to the pipeline, or how do we develop, you know, different medical people of different backgrounds, and how we could improve that on others' initiatives in the NFL. And so we'll want to come back to that. I wanted to ask you, Scott, about the issue of trust. You're a team physician. You've been working with the Giants for a long time. You've also been very involved in USA Swimming and Olympic efforts in that area. So you've dealt with some really elite athletes. How do you approach this trust issue? I think probably trust is probably the single most important factor you need to think about as a team physician. Actually, Ronnie and Tiki both use the word relationship. So I think it's establishing a relationship with the athlete, with the individual. And it doesn't happen overnight. I think you develop trust day in, day out, week in, week out. Ronnie also said you have to earn the trust. So it's not there day one. Tiki comes in the league. He knows Frank McHugh. He doesn't know us. You earn it over time. I think you do that by treating the patient as your private, just like you would your private patient. It kind of gets on to the points Ronnie made there. You bring them in an exam room. See them in a closed exam room. Don't see the player in the middle of a busy training room where, you know, the coach or the manager or someone's looking over your shoulder. Treat them like your private patient. I think communication is critically important. Ronnie mentioned communication. Same message. So you need to make sure the same message goes to the player, their agent, the coach, manager, family. Jimmy Andrews taught us to always talk to the player's mama. That was one of Jimmy's rules there. So I think communication is critically important. I saw a quote earlier this week from David Sisk, former president of this society, who said, I may be the team doc, but when you're hurt, I'm your doc. And I think that philosophy should guide you, where you are their private doctor. You treat them like your private patient. And trust is earned. Great. So Tiki, you made a great example of your ulna fracture and really coming right into a Super Bowl and decisions about playing hurt. I just wanted to ask you, of course, that was probably an easier one since, you know, what was at stake and it felt like it was safe to play with this cast. But what are some of the other things you mentioned to me when we were preparing for this about, you know, you were really fighting for a position at times. And like, you know, how do we how does the medical staff help athletes who like tell us what you feel like is at stake in the background that maybe not everybody thinks about for you? Yeah. So it's interesting in football. And I say this all the time on my radio show when someone gets hurt or doesn't want to play or it feels like they don't want to play. It's like you're an at will employee, man. They want to fire you. You get fired unless you're signing or your signing bonus is so high that it's so punitive to the to the salary cap. You're an at will employee. And so nowadays, the money has gotten so much bigger that that's less of an issue. But during my era, you honestly felt like you could get cut any week or any year or they're going to bring someone in to replace you. And yeah, you'll get a chance to compete, but the writing is on the wall. And so as it pertained to injuries in that context, it was it was very difficult to say, yeah, I think I'll sit out this week. I tore my PCL, my rookie season. And again, Ronnie comes over, he does the test. He's like, yeah, you got a torn PCL. I'm like, what? What do you mean I got a torn? What does that mean? Right. Because because that's the first thing that bumps into top that goes to the top of your mind. What does that mean? And if it's an ACL, I get it. Sure. My season's done. But what does that mean? PCL? And so it became a like a scramble for me to figure out, did I need surgery? If I did get surgery, how long would I be out? If I don't get surgery, how do I mitigate it? And so all of these conversations are happening as I'm sitting out for a few weeks. Now, I ended up not getting surgery. It created laxity in my joint. I have some bone spurs, which Scott and I talked about, you know, years later as I wanted to run some marathons. But I think having the the the the the reality that getting hurt can cost you your job is important for trainers and doctors to know. Now, it doesn't necessarily come into how they treat us, but it does come into into play when you when you think about the mindset of the athlete, because the athlete is always, at least they used to, is going to default to want to play. I used to say the worst thing about not being on the field is watching someone else do my job, a job that I had earned, a job that I had put blood, sweat and tears into. And now a PCL injury or a broken thumb or whatever it may have been is jeopardizing my job. And it's real. Right. And I and it's part pride. It's part professional. But it's also I want to be there for my guys. I want to be there for my teammates. Accountability in that regard is is one thing I always prided myself in. So if I had a little small injury, a thigh bruise or even a broken thumb, as we did against the Chicago Bears, Ronnie just taped it up and didn't take my glove off. I wanted to always be there. And I think understanding that for each individual player is paramount for trainers, because some guys don't want to do that. Some guys don't have a pain, high pain tolerance. I do. So, Ronnie, I want you to to kind of comment on what Tiki, you know, talked about. And we talked now more about a shared decision making model in health care. And I think it's probably most germane to these really elite athletes. There's so much on the line, as Tiki said, like people think about money, but there's also that I want to be there for my guys. I'm going to lose my job. It's not just about maybe in the contract, the money you get for playing in a game. There's a lot more at stake. How do you handle that, Ronnie? Like like Tiki has the biggest quads in the NFL, probably at the time that he was playing. And so his PCL might have been OK. But how do you handle some of that? Because and Scott, I want you to answer after that the risk, like because Tiki has to be informed of the risks of playing on a PCL. Right. And like so, Ronnie, first, how do you handle that with athletes? The risks? Well, let me just say that, you know, these athletes work very hard at every level, whether it be high school, college or pro, to be the very best at who they are and to participate, get a spot on the team and to lose that and be injured, it can be emotionally affecting to them. I mean, they really are affected by it. And you see players carted off the field who are crying, you know, even with a sprained ankle because they have to come out of the game. They don't know if if this is the injury is going to take them out of the game for for a year or forever. And and I think the way we deliver the message to an injured athlete is so very important because, again, athletes are people, but they're also highly emotional. We have an awful lot invested in doing well on the field, whether it's football, basketball, golf or tennis. And so we need to understand that there are emotions involved. And for the NFL, there's money involved. And there are also agents and and families who are interested in what's really going on with this athlete. And I think we have to be transparent as physicians and athletic trainers and as a medical team in terms of here's what's going on. This is what we think. And and we're going to do our very best to give this to get this athlete back to play. I like to sell hope even in the worst of times, because these athletes invest so much and and it might affect them economically. They may lose money or they may lose a position on the squad. And if we treat them, if we understand those emotions, I think they'll be good. I always say the clock starts ticking the moment an injury occurs. And first of all, we have to get an excellent diagnosis. We have to do all the studies that we need. And we have to be able to then share that diagnosis with the athlete. With the coaches and administrators, with the agent and with the family. And it's great if you can do it when they're all in one room. But clearly, I think the the athlete ought to be present when you're talking to the agent. The athlete ought to be present when you're talking to the family. What it allows him to do is participate in his care. So I'm not sure I answered your question the way you wanted to, but it's that clock starts ticking. And the first thing I start thinking about is what the rehabilitation plan is going to be and which members of my team we're going to bring in. Whether it's a physical therapist, you know, whether it's the dietitian, maybe even behavioral health. OK. And then we start thinking about recovery and all of the resources that we have available. We begin making that plan. Ronnie, I think that's interesting what you're talking about, but that's post-game. Yeah. What about in-game? Because that happens fast. Oh, yeah. The decision happens really quickly. I think it was you, Dr. Rodeo, or whoever it was, looked at my thumb, I'm talking about the Chicago game. It was broken, I could feel it, it was hanging down here. And in the moment. We can tell. It was like, what do we do? I was like, I'm not coming out, so what do we do? And so, how do you make that decision like that? Because that's hard. It goes back, I think, to good medicine. Again, you're treating that patient like you're a player, as your private patient. This brings in the inherent conflict that can always be there. Is this doctor working for the team or is he working for me? So I think it's back to the trust issue. It's back to, I'm making clear that I'm doing, I have your best interest at heart. And then you've got a lot of factors to take into account. So you're trying to get your information rapidly, get your imaging, examine the player. You've got time constraints. That situation in the middle of the game. What has to be your overriding philosophy, though, is what is the right thing for the individual? Now, you're an adult. You can make informed decisions. So it's communication. In fact, Ron's point is more working out post-game where you're involving the trainers or the agent and certainly management and coach, the importance of a consistent message. But yeah, I think you do the best job in-game by having a trust relationship that you've established with the athlete upfront. That, I think, allows you to have the athlete's confidence. And then, again, the athlete, you're working with them. They can be part of the shared decision-making. Well, that's great. Let's build on the, so we've heard, I heard you say, Ronnie, let's make sure an agent's present. And I think engaging them probably really helps because they're also, they've got a lot of the athlete's interests in their mind. And the family, more than anybody, really certainly cares. And I think that's really important. Somebody we haven't talked about as much is the coach. And I wanna bring that up with the panel here about, we haven't really talked about that in the entire AOSSM session. There's kind of an incident that was well-known with Penn State, I believe, earlier this spring, where there was at least some discussion about a coach being involved in medical decisions. And I think, Tiki, from your side, whether the question is, does the medical staff answer to the coach and the organization, or is the medical staff acting for the athlete? Love to hear your perspective, Tiki. I mean, I always knew what the coach wanted. Yeah, of course. Are you hurt or are you injured? What does that actually mean, coach? I'm not sure what you're saying. It hurts, but I don't know if it's detrimental for my long-term health. I think we always assumed, from an athlete's perspective, when we got hurt, that the coach was going to be informed. But I never believed that the coach was telling Ronnie or Scott or whoever was in charge at whatever organization, that you gotta get him out there. The coach might say that, but ultimately, the decision was patient-doctor, right? There was not that outside influence. Do you feel like that happens, though, Tiki, other places? Have you heard colleagues? I mean, obviously, it does. There wouldn't be anecdotal evidence suggesting that it does if it didn't. But that wasn't my experience, either at the University of Virginia or with the New York Giants, the only two places that I played. And so, maybe I was fortunate. Maybe I was lucky that I had three really good coaches, Coach Welsh at UVA, and then Coach Fossil, may he rest in peace, and Tom Coughlin with the New York Giants, who took the advice of their medical professionals. And I think we're talking now about the relationship between team trainers and doctors with the athlete. There's also that same type of trust and relationship that has to be built with the staff, with the organization, with the owner, because the owner's going to come ask. John's going to come down and say, hey, what's up with Eli? What's up with Odell Beckham? They're going to want to know. And so, having that trust relationship is also equally important, I would say, because their expectations need to be met as well. And Ronnie, you've been doing this a long time. We said four decades, and you've dealt with a lot of, you've dealt with coaches, you've dealt, and you've been doing this such a long time. What is your perspective on the role of coach or organization in medical decisions? Well, coaches can be difficult, extremely difficult. I worked with Bill Belichick when he was an assistant coach, and he used to try to butt in to what's going on, you know? So, let me just say that it starts at the top. In my organization, it starts with the owner who wants us to give great care to the athletes, and then passes that down to the general manager, and then, of course, me being responsible for the medical care with the physicians, making sure that we do the right thing all the time. Clearly, coaches try to interfere, and there are conversations with every coach that I've had, exclusive of the doctor and of the athlete, saying, are you really sure that he can't play on Sunday? Yes, I'm sure. Are you sure he needs surgery? Yes, I'm sure. So, it's difficult, but you manage it. When the great Bill Parcells coached for the Giants, we had a running back who had had a concussion the week before and had been cleared. We didn't have all the protocols that we have now, but we had pretty good protocols at our team, but this running back hyperventilated and collapsed on the sidelines. So, having had a concussion the week before, we took him to the bench, and now we're going to be as conservative as we can. We're gonna figure out what's going on. And Parcells called me over and he said, do you see that score? I said, I see it. He said, if you don't put this player back in the game, we're gonna lose this game. I said, well, what do you wanna do, kill him? And he chased me down the sidelines. And this is when the coaches had cords, right? So, he couldn't catch me, but he kept glaring at me through, we're almost at halftime, he kept glaring at me the whole time. So, now it's time to go in at halftime. And he catches up with me and he says, I need to see you in my dressing room. I said, I quit, you can have this damn job. So, now we go to the locker room and he's now trying to make up cause he doesn't want me to quit in the middle of the game. So, it was that important to me that we do the right thing. And I think it's different at every place. And again, coaches can be difficult. I think you need the support of the institution. If it's high school, you need the principal, superintendent, and you certainly in the pros need the owner to have your back. That's an amazing story. Maybe they should still have cords on their headsets. Scott, definitely want to ask you the same question. You've dealt with coaches, I mean, probably even at Olympic level and big, big mistakes. You know, what's your thought about the role coaches should have in medical decisions? I mean, everything from the reporting structure that doctors should have in terms of hired by the organization or not. And like, just comment on a few of those aspects too. Yeah, there are obviously those inherent conflicts. You know, Ronnie mentioned the culture in the institution. We're lucky at the Giants. We have a culture where that doesn't happen. And that comes from ownership and management, but it can certainly happen in other places. I think, go back to why, you know, all of us physicians here went to medical school. You took the Hippocratic Oath. You know, first, do no harm. You do the right thing for the player. Ultimately, I would have and do have a line in the sand. If I'm being forced by a coach to do something I think is not the right thing, I'm out of there. But you need to establish that culture up front. Ronnie said, you know, made some point about it's institutional culture. And how you develop that can be challenging. If you're hired by the owner, you're answered to the owner. Depends on what situation you're in, a college or a junior college, or even a high school. I think the message for all of us in this room, though, is try to establish an environment where medical staff is making the decisions. That has to be your line in the sand. Now, and that's really helpful to, you know, to hear two physicians, or hear your perspective as a team physician. Ronnie is, you know, likes, you know, vice president of medical services, and the head trainer for over 40 years say, you're willing to put a line in the sand if someone wants to tell you you should be making decisions you're not comfortable with. And so I think that's a great message for everyone in the room. Now to the next topic, which is somewhat related. The sort of medical, like, medical legal climate seems like it's changing. And we had a nice discussion yesterday in a session we called Risky Business, where we were talking about, and Tiki, you may be aware of this, I know these other guys are, but the organization that's taking care of the Philadelphia Eagles, the Rothman Clinic, which is extremely well known as one, you know, terrific physicians or team physicians decided to pull out of covering the Eagles. Probably the cost of litigation, can't feel like they can afford that. And, you know, because of lawsuits and this type of thing, you know, I wanted to ask you, like, your thoughts on that, not on the case or something, but your thoughts on, as an elite athlete, what if a climate was developing where some of the best team docs in the country, their organization or their health system, the docs themselves can't afford or don't feel like they can deal with that. How would you feel, you know, if you were playing today about that environment? So I think it depends on the athlete and the, more specifically, the awareness of the athlete. So some athletes are very aware of everything that's going on. So they understand that, oh, the New York Giants are affiliated with the Hospital for Special Surgery. That's the best orthopedic hospital in the world. So of course we wanna be involved with them. Of course we want Dr. Warren or Dr. Rodeo or Dr. Kelly, who's now the president and CEO. Of course we want that organization. But some guys are oblivious to it, to say the least. And they just kind of, they have to trust the athletic trainer. They have to trust the team doctor that's around. But what I think could ultimately happen, if the situation that's happening in Philadelphia continues to occur, athletes might lose trust. They might start looking for their own physicians, their own orthopedics outside of the organization. And I think that's detrimental to the entirety of what teams have built over years and years and years. And so it is dangerous, but you understand where the liability comes from. You understand that if you misdiagnose, let's say a torn labrum, say it's in your hip, because that's probably more damaging than your shoulder, a torn labrum in your hip, you let the athlete continue to play, he does irreparable damage and his career is threatened because you misdiagnosed it as a physician. Now he can, are you liable? And as an athlete, you want your pound of salt, right? You don't want the justice. We have this commercial, I forget, it's called Top Dog Law in New York. And it's like, I don't want justice. I want money. It's a hilarious commercial. I'll never forget it. It's awesome. And so if something like that should happen where a doctor misdiagnosed you, mistreated you, and it ruined your career and thus millions of dollars, what recourse do you have? You have to, you almost have to take illegal action. And as much as that hurts you and it probably hurts the organization, it's where the money has forced athletes to go now. And so the perspectives are unique from whoever's giving this answer. But from an athlete standpoint, you're trying to protect your current wealth situation, but also your future and generational wealth creation. A lot of guys don't have an appreciable skills outside of what they're doing. And it gets really hard if at 26 years old, they're told you're never playing football again or you're never playing baseball again or whatever it may be, good luck. So you have to take every chance or every opportunity you have to correct that misdiagnosed behavior. And it's really helpful, Tiki, because I think we all know there's so much at stake as we've talked about earlier in our conversation and hearing from you and understanding that perspective that's so helpful. But then I'll ask our medical team here. So you just heard what Tiki said and you know what happened with Philadelphia. And I think that most of us, we don't want this to be a depressing conversation because we also on the medical side have the best job in the world and taking care of elite athletes is really fun. It's super rewarding. And there's just many great things about it. And this climate, medical legal climate is making it harder. And so Ronnie first, what would be your message about how do we kind of understand this risk yet respond to that as a medical professional has been doing this a long time? Well, I've been coming to this meeting for nearly 30 years and I've seen the evolution of sports medicine. And we have a country full of very well-trained, fellowship-trained sports medicine physicians. So I have by and large confidence in the abundance of talent in this room and people who are practicing sports medicine. And we all try to do the very best that we can, attend meetings like this and continue to get better. I take a more cynical view and say, follow the money. Athletics is changing. Last night we were speaking about college athletics and how athletes go from one program to the next. So you operate on a kid and for his ACL and in three months he's in the portal and he goes to another university. I think that's problematic. There are athletes in high school who now have agents and it's all about the economics. And so I always say follow the money only because it isn't that someone had malpractice but it's maybe they didn't manage expectations or there were things that occurred that were not within in their ability or scope to manage because the events changed. Athletes changed school or they're getting some advice. I wanna keep it positive and say, I don't think that any of that should discourage you from having a career in sports medicine. I enjoy working with elite athletes and athletes just in general. Volunteer for a high school event or for a wrestling match because I enjoy it and I'm sure you do too. And I don't think we're gonna let a lawsuit get in our way. So Scott, I wanna ask you about as on the position side about how you view this situation and the risk of litigation and whether it's changed anything and specifically can you comment on whether you've changed how you provide informed consent about an injury and then especially surgery. Do you include different people in the room as was discussed yesterday? Do you have more people in the room? Do you have witnesses, quote unquote? Do you spell out more in detail in a note or consent the risks to your future health and things? Have you taken a slightly defensive posture to help with this? Yeah, good question. I start with the point Ronnie made which is don't let this liability environment discourage you from, this is a great field and it's great taking care of these athletes. Now that said, we have to acknowledge these issues are there and you don't wanna get to the point where you all in the room, good physicians are unable or willing to take care of players because of liability concerns. It really almost becomes an access to care issue. If more and more physicians aren't able or willing or their groups can't let them take care of teams, then are we really providing the best doctors for our athletes? So you don't wanna get to the point where just the major medical institutions have big, that have the financial wherewithal that there's only groups that can take care of patients. Again, it's back to the access to care. Your question about consent. Yeah, I think that a lot of this goes back to the things we talked about at the beginning here, trust, communication. So having those relationships with your players hopefully helps ameliorate these issues, but I get it, these issues are real. So yes, documentation, communication is critically important always has been the case and maybe all the more so in right now. So I think that we are all paying more and more attention to that. That said, I've always thought, don't practice defensive medicine. Do the right thing, be a good doctor, take good care of your patient and you can't let the chips fall, quite honestly. You need to have good coverage obviously, but don't run scared. Certainly the sense of defensive medicine may be in the back of our minds and maybe needs to be, but again, it was back to the point we made earlier. Don't let this discourage you from taking care of athletes. I think that moving forward, there are some efforts afoot to start to address this issue. I think associations like the AOSSM can start to address these issues. We should partner with the medical societies like the American Medical Society for Sports Medicine. Actually yesterday, James Voos, the president of the NFL Team Physicians Society organized a meeting of the presidents of the major team physician societies, NHL, NBA, Major League Baseball, Soccer and the NFL to start to talk about this issue. So I think we're better together. So I think collaborative efforts in this area can hopefully start to make some inroads. Excellent. So when an athlete, sometimes Tiki, an athlete will decide to go outside their organization for care. I'm sure you're well aware there's some really some experts out there, whether it's somebody who's known for elbow and baseball or knee. What do you think, we talked about trust earlier, but what influences that decision? I know you're probably aware of many elite athletes that go to places and after you answer, I wanna ask Ronnie and Scott to comment on how they deal with if an athlete's gone to another doctor outside the organization, then how do you guys handle that with the athlete and how do you handle the rehab and all that? I'm actually really interested to hear Dr. Rodeo and Ronnie's answer to this question because let's be real. Athletes are star seeking as well. My agent used a different word for that, started with an F. But athletes also want the best and they wanna be surrounded by the best. And if they have an issue, they wanna go to the best. Now, is this care gonna be as personal and as knowledgeable? Likely not. But there's something in the, I don't know, maybe it's just the social media world that we live in, the media driven expansive world that we live in right now where the stars, so to speak, of your industry get put on pedestals. And do they do wrong? Sure, I'm sure at times. But you never hear about that. You only hear about the successes and he operated on this guy. He did this guy's ACL. He did this guy's Achilles. And so in some people's minds, athletes' minds, that's what they want. If they have a similar issue, I wanna go to that guy because he's the best. He's the star. But to me, that undercuts everything that we've been talking about. If I had, and luckily I didn't, torn an Achilles, I would've been right where I was because I knew Dr. Rodeo knew me well, knew my body well. In fact, many years after I retired, I decided I wanted to start running marathons. And I could've went to my general practitioner in Florham Park at some medical group. But I drove my ass into the city and went and met with Dr. Rodeo. We took some imaging and I have this wear on my knee. And I don't know if he realized he was my doctor for life, but there's a trust there. And so I think ultimately for an athlete, that matters more. But it's hard not to expert. I appreciate that. I don't know what to say to that last comment. I'm sorry. But now we know the term that Tiki was mentioning. Okay, so. I figured you guys could handle it. Yeah, I won't use that term, Ronnie. But how do you as a trainer now, like the athlete has gone to a star physician that's well known, star physician. And then, Ronnie, Scott, you kind of have to deal with that. Ronnie first, how do you deal with that? Meaning just like the athlete's going to go there, perhaps have surgery. And then as the head athletic trainer, you have to manage the, like probably talk with that physician, surgeon, and then manage the after. How does that go for you? Well, first of all, I think star status is equivalent to how much media attention you get. But that being said, I think my doctors are stars, okay? And I think our hospital is a star. And so I do everything I can to convince our athlete to stay with us. However, if they would like to see someone else for a second opinion, I think as Scott often says, you check your ego at the door. But clearly we want to make certain on our end that we have an accurate diagnosis, that we've done all the tests and studies that we need to know to do, and that we know exactly what's going on. And we have complete confidence that the star will come up with the same opinion that we do. And then it's up to the athlete to decide whether he's going to stay with us for care or whether he's going to go someplace else. It is quite common. One in the NFL, the union has given every player the opportunity for a second opinion, and quite frankly, I welcome it. And at our team, I pay for the transportation, I put them up, and I help them. I think oftentimes there are athletes who choose a star physician because they've read about them or because an agent has told them, and often they're my friends. So I say, I know him, he's excellent, but so is Dr. Rodeo. Okay, that's helpful. Scott, let's say the athlete has gone for that opinion and they decide to go with the other physician, like not come to you for various reasons. Talk to us about how you handle that. First, if they agree with the same diagnosis, they're gonna do the surgery, and then how you're gonna work with that. But second, I want you to ask, what if you disagree with what the other physician said? How do you handle that with the athlete? Yeah, open discussion. I think it's all about communication. As Ronnie said, I welcome second opinions. I think in our own practices we do. Certainly at this level, in the NFL, they're allowed to, and I encourage you to get a second opinion. If there's diverging opinions, I think you talk to the consulting physician. Have an informed discussion. Now, I think there's this, Ronnie mentioned, I do use this term, check me with the door. I mean, I think in sports medicine, you're part of a team. At the end of the day, and certainly you like to take care of your own player, but at the end of the day, if the player does well, that's a success. It doesn't matter who gets the credit. That said, there are different challenges, and if the player has surgery elsewhere, it's geographically and just communication. I think it all comes back to communication. Okay, that's very helpful. And I know if they, and Ronnie, you can comment on this, if there's a disagreement, you're the head trainer, you're with the athlete constantly. I think the relationship with the trainer, the head athletic trainer in particular, is so strong, and how the athlete then views that. If there's a difference in opinions, Ronnie, how do you handle that? Well, I'm often the mediator, and many athletic trainers are. One of the things I really like to do is to get everybody talking together in one room. So if I can get the athlete, the second opinion rendering physician, and our own physicians on the phone. I haven't used Zoom yet, but if we could get them on the phone, we can all talk about it. Oftentimes, we're all saying the same thing, just a little bit differently, okay? So generally, we're pretty much all trained the same, think the same, attend the same meetings, treat things pretty much similar, although not always. And we're usually able to come to some resolution. I don't think we're going, I just want the athlete to have the very best care. And what concerns me sometimes, if an athlete chooses a physician who's going to do something out of his specialty, and then I intervene and try to educate the player that yeah, that's great, but he's a cervical spine physician who wants to fix your ACL. Now that's helpful, Ronnie. Okay, so I'm gonna switch gears a little bit, Tiki here, and I wanna have a little discussion about the team behind the team. So the medical team, of course, is not just the trainers and the physicians, it's the physical therapists, massage therapists, nutrition, and you can go on and on. Tiki, I think you've described it as the ecosphere around the athlete, and tell me a little bit about how important that was to you as a player. It was paramount for me in particular, because I'm not a big athlete. I weigh now 185 pounds, it's what I naturally should be. But when I was playing for the Giants, I'd go to training camp at 212, and I'd play at about 208. And so to get that much muscle and weight on my body was a grind, and my body suffered because of it. There'd be certain muscles that would not be activated, and I didn't know why. Like I'd have a weakness in my shoulder, I wouldn't know why. I'd have this persistent groin issue, and I wouldn't know why. And because of how attuned I think Ronnie Barnes was and our team doctors were, they were able to bring in experts that would help us. And so we brought in a chiropractor, and Rob, Dr. Rob, would come in, and he would do this new technique, or not new, but one that I had never experienced, called ART, active release technique. And he'd just pull out my arm, and he'd just start fiddling with something, and I couldn't hold it. And then afterwards, it'd be rock solid. I'd be like, dude, what did you just do? And it made me feel better. It made me feel more confident. Not dissimilar to when they devised a system for my ulna fracture. The psoas muscle, if you ever had your psoas worked on, right, it would kill me. Like I always wanted to punch him, because it hurt so bad. But when I- You didn't want to break your navicular. Yeah, right. But when I got off the table, I would feel amazing. The value of massage and acupuncture, these alternative treatments that don't feel like they're always necessary, but they became necessary for a guy like me and my body. It was always available. We'd go to training camp, and this was before teams built these massive facilities and got sponsors to donate them. Before all of that happened, we would go away for training camp. Like most teams would go away. We'd go to Albany, New York. And trust me, there is nothing in Albany, New York, except for SUNY Albany. And we'd be sleeping in these dorm rooms, and we're in the middle of nowhere. There's no kids there, so we can't even have fun. And so it became like this grind. But during this grind, the giants would bring Jack Jung, who was a massage therapist. He'd come up, and he'd hang out for a week. And if you needed treatment, he'd be right there in the locker room, and you'd get worked on. Dr. Rob, he'd be there. We had other types of assets as well, including a nutritionist. Her name is Heidi Skolnick. And I don't think I realized what my body composition was. I mean, I know I'd taken blood tests and things of that nature, but I never really paid attention to it, because athletes think that we're invincible, that we're fine, like we're gonna be fine no matter what. And then one day she came to me and says, you know, you have high blood pressure and high cholesterol. And I was like, that's just because I eat so much. And she said, no, it's probably not. It's probably genetic. You should ask your mom, you should ask your father, ask other people in your family. And so I started doing this research, and guess what? I have genetic high blood pressure and high cholesterol. And so she actively got me on a different type of diet to help control something that I was not aware of. And I'm young, I'm 26 years old, 25, 26 years old. I'm not thinking about that future management of my life at that point. But because of her, I still manage those. I have a team, a personal doctor. A lot of guys leave the NFL, as Ronnie said last night, when we were in the ER, who's your doctor, they ask. I said, Dr. Robert Tamra, said some of the medical group. Ronnie goes, oh, great, because a lot of these guys still say Ronnie Barnes. You know, they're long retired. And so because of those interactions and interventions, you could say, it put me on a path to lead a healthy life 18, 20 years after I've been retired. And that's what I'm grateful for. The treatment in the real time was fantastic. It kept me on the field. But the fact that I can live a healthy life at almost 50 now is because of the things that these guys did for us. The extra team. So thanks for that, Tiki. And then for Ronnie and Scott, and Ronnie, I'll start with you. But you have to build a team behind the team. And I'm sure that's a challenge, because a lot of people would love to do this, but you have to, I mean, you're trying to deal with evidence-based medicine, you're trying to do the right things, and you really gotta pick the right people. So maybe talk a little bit about that, and then at the end, talk about mental health and that team behind the team, which wasn't as big a deal at Tiki's time, but is now really prominent. Well, I think it takes a team to really take care of these athletes, particularly at the professional ranks. Tiki named a few of the resources which we have, but in selecting them, one of the first criteria for me is that they not be fans, okay? That they're interested in the athlete and not just to come to the football game and see us win. But we have chiropractors, I recall being one of the early teams to adopt chiropractic, and we have had fellows since I've been there with Russ Warren, and one of the fellows came up to me and said, does Dr. Warren know that there's a chiropractor here? Yeah, does he know that he's manipulating spines? Yes, he does, okay, but part of the team. So a well-trained chiropractor, a dietician, and that's been so important to us, Tiki named it. Now, instead of one or two massage therapists, we have 14. Wow. And we have them there on the day after a game, and then we have them there on Friday. I looked at the expenses for it. We can do this in the NFL. You can't do it everywhere. $400,000 for massages last year. Now, I'm glad no one's looking at my budget. The athletes appreciate it, I promise you. Behavioral health, and we have someone who's there, and we ask her to respect the privacy of the athlete. So we not only have an in-house, full-time psychologist, but a network of other folks that athletes can contact on their own and not be involved with the team. We have a red light bed. I think everything we do, I think, has to have some evidence base, but there are a few things that athletes demand and request, and if they'll do no harm, then we have them. I don't know if the saline flotation bed has any real medicinal purpose, but we have it. I don't know that I believe everything that's said about the red light bed, but we have it. The athletes demand it. I'm not sure that, you know, invertebrates hanging upside down isn't necessarily that great. It's like the bone stimulator? Yeah, absolutely, but I guess I'm just saying that we have a lot of resources, and they're so important, but you mentioned one that is extremely important, and that's behavioral health. Athletes deal with all kinds of issues, particularly at the NFL level, from issues at home, domestic violence issues, substance abuse, and everything that people on the street have problems with, and so we're happy to provide that service, and I think nearly all the teams do that now. And Scott, you've probably seen the growth of, I'd say, complementary medicine and behavioral health. Like, in your time, I'm sure it's changed a lot, as it has, like, you know, you've been with the team as long as Tiki has, I think, and so, how do you work with those other types of medical providers? For me, the funnest part of sports medicine is just that, working part of a team. It takes a village, and it's fun, and you've got athletic trainers and therapists and all these specialties mentioned here, nutrition, sports psychology, you know, you've got your performance people. I think it goes back to, first, vetting these new individuals, and as Ronnie said, the new things we do, we want to assess the evidence, have a scientific approach to what you do. At the same time, you have to realize if it's safe, won't hurt, might help, and we're okay to try some of these things, but I think our job as team leaders is to help manage all the different parts of the medical team, and that's a critically important part. All the other parts can really be very additive and very help you, and they help you take better care of the player, and what it really creates is an environment where it's, I'm not just taking care of your clavicle fracture, your ACL. It's more, you know, we care about you as a person, as a player, and that gets back to the various issues we talked at the beginning, trust, developing relationships with the players, Tiki's story about, you know, hypotension and cholesterol. I mean, taking care of the whole player, I think that allows you to provide much better care, which ultimately helps the overall system, helps, it creates the kind of culture that you want to develop in your institution. At the end of the day, it's better medical care and helps your performance. Now, so the ecosphere, like we talked around, having that around the athletes, so that's all very helpful to, you know, think about for everybody out here about what you're, you know, providing all around the athlete, and so just kind of now switching gears a little bit to this idea of a pipeline of, like, having medical staff of all types to be around the athlete, but particularly how we help develop, you know, for more minorities and all that have had, maybe, or have less of a chance or opportunity to get to the levels of, maybe, elite medical care or taking care of elite athletes, I should say, but even any level, how do, like, Tiki, how important is to, you asked a little bit earlier, but how important is it to you to see people, maybe, that look more like you, and, like, you know, what is your view on this, like, how we could maybe increase diversity? Yeah, so I think Ronnie said this best. The athlete ultimately cares about the care they're getting. Ultimately, it's gonna come down to that. Is it an added benefit when you walk into the room, and, like I did in 1997 as a rookie, and I see that my head trainer is black? Of course it does. You just automatically feel comfortable. The comfort can come in other ways. It can come by the relationship building that we've talked about. It can come by, you know, successful outcomes from injuries that you may have sustained, but ultimately, as with anything, when it comes to growing minority populations in certain professions, it's about the examples. It's about championing those examples. It's about being seen in schools and in articles or publications that highlight the work of African American or brown minority physicians and trainers, because if you don't see it, you don't know that you can aspire to be it, and so I always say this because it gets frustrating sometimes when athletes, myself included, get put on this pedestal like we've accomplished these great things. We were given God-given talents that allowed us to excel and with the right training and direction have become star athletes, but there are so many others and other professions that are excellent at what they do, but they're not talked about, and so to me, it's championing the successes as loud as you can, but not to each other. Don't throw it in the echo chamber. I mean, that doesn't matter. Throw it to a generation below you or two generations below you so that a kid who might not be able to be a great athlete but loves sports now sees a path to be in it, all right? So that's what I would say, and I think that's with any profession, but particularly with the medical profession. Oh, that's awesome, and I know the NFL, Ronnie, specifically the NFL has tried to make some inroads here to encouraging young people to get involved. What would you say about the opportunities? Well, I think we're doing an excellent job and we're only beginning. We are now taking medical students for the second year in a row from historically black medical schools in the United States and placing them with teams for a rotation. We've had them at our team facility and at the hospital for special surgery. The experience has been great for them, and many of them have placed well in residency programs, so we're really thrilled about that. I worked with Pete Rozelle. Many of you wouldn't know who he is, but he was the commissioner long before this commissioner in developing an internship program for African-American athletic trainers, so each team would get one athletic trainer from across the country of African-American descent. We've now changed that to minorities, including women, and we've had great success. Each team, all 32 teams, get three internship scholarships, two awards, so that's been extremely wonderful. Our commissioner has met with the medical staffs and the athletic trainers and encouraged us to increase the number of females involved in the NFL and to get women physicians and athletic trainers and to begin to hire them on our staffs. I'm proud to say that I had the very first woman fellow, Dr. Jo Hannafin, and I recall her coming to the training room and an athlete came and said, there's a woman in there. I said, yep, and she's a doctor, so that was great. Of course, I also remember Dr. Toth standing on the sidelines and the owner calls down and goes, who's that very tall blonde-headed lady? I said, she's an orthopedic surgeon. Now, and I really appreciated that opportunity. That was a great deal of fun. Well, we're kind of getting just about out of time, about three minutes left, and our president, Dr. Dean Taylor, who invited Tiki as the presidential guest speaker. We're gonna take one question from Dean as we wrap up. Thanks, Allison, and as president, there's a lot of great things, and I talked about how much fun it's been, and one of the fun things that you get to do as president is to offer the opportunity to bring in a presidential guest speaker, and that was really fun, and I wanted to expand it for a lot of reasons, but certainly, I think everybody's seen today how good it is to do that as a team, and Allison Toth, you're our treasure, and you are showing all of us how we can work as a team, not only as the program chair, but as this moderator, and we all know that at Duke, and so it's great for me to share that with the AOSSM and the world, and Scott, this whole organization knows how great you are, and to have you on the stage as a head team physician and to share your insights is wonderful, and Tiki, I mean, you talked about your physical resiliency and playing with a fracture and taping up a broken thumb. Well, what you've done for us has shown it even more. You came out of the hospital last night, and you're here on the stage now, and it's been a thrill for me to have you as our presidential guest speaker, and nothing against Allison or Scott or Tiki, but the person I most wanted on the stage is Ronnie Barnes, and everyone knows Ronnie Barnes as the most tenured athletic trainer in the NFL, and what an amazing athletic trainer and leader you are, but I know Ronnie Barnes as this most amazing human from Rocky Mountain, North Carolina, who every year would bring his high school team doc to the sidelines of the New York Giants game, Tyson Jeanette, and so I'm gonna ask a question before we wrap this up. What advice, Ronnie, do you have for all of us to emulate Tyson Jeanette and mentor those young athletes that we take care of on the sidelines and embrace that role of being a team physician, not at the NFL, but in high school? Well, Tyson Jeanette took care of high school athletes for 40 years and loved sports medicine, and each, he actually referred to nearly all of his athletes as his children, because he cared for them like they were his children. My advice to you is to take care of these athletes as if they were members of your own family, and you know it requires an awful lot of time. I don't remember Tyson Jeanette ever looking at his watch to see what time it was. It was just bring me the next patient, and who can I help? So keep doing what you're doing, attend these meetings, ask questions like the great Russ Warren used to do from the podium all the time, or as Scott does today, and continue learning, but the most important thing is treat those athletes like they were your own kids. Thank you. Thank you, and thank all of you. This has been the best, thanks. Thank you. Thank you, guys. Thank you. Well, that'll wrap up the session. Thank you. Thank you, man. Thank you. Thank you for attending this morning's general session. The exhibit hall is now open. Please join us here at 1045 for our next game changer, Going for the Gold.

Tiki Barber

Alison Toth, MD

Ronnie Barnes, MS, ATC

Scott Rodeo, MD

sports medicine

Ronnie Barnes

Scott Rodeo

athlete care

trust

communication

diagnostic accuracy

complementary therapies

diversity