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.
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.
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.
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. In the case of a potential injury, the athlete is evaluated by both of us. An examination is done. And if I feel it’s safe to go back into play, I’ll let them return right then and there. If it needs more workup, we’ll go into the locker room and do a full exam — we even have x-rays at every stadium.
There’s a couple of things the NFL has instituted that have been incredibly helpful that we didn’t have when I first started. The first and foremost is video replay. Viewers, sitting on the couch at home, can often see an injury better than I can; you have so many angles, there are over 20 HD cameras filming in slow motion. You just can’t appreciate that in real time standing on the sideline. So, the first thing we do after examining a player is go over to the video monitor. And I can call up to the video spotter, and they will cue the play for me in slow motion from different angles. It’s really valuable to help assess what type of injury it was, and whether returning to play is safe, in combination with my physical exam.
The second thing that’s been helpful is this blue tent at NFL games. The players don’t want to be seen on the sideline being examined, with the cameras filming and the fans watching. It’s hard on them, and all of us, and it’s not a very good exam, frankly. But also, they don’t want to go back into the locker room all the time because the game is going on — they don’t want to get cold and stiff, they want to keep their body moving. So, this blue tent is really helpful to just go into, where we have an examination table and can take a breath, get out of the way of the cameras, get out of the way of the fans, and really do a good exam and make a thoughtful decision.