Off the Field: Caring for the Washington Nationals

Published October 24, 2017

At The Centers for Advanced Orthopaedics, we are proud to help keep local athletes healthy and on the field – from local high school teams to weekend warriors to the athletes we see on television each week. Our expertise is vast – from soccer to gymnastics to dance, our physicians have done it all. As the 2017 World Series begins, we sat down with Dr. Thomas Amalfitano, a team physician for The Washington Nationals, to learn about what goes into caring for professional baseball players.

How long have you been caring for professional athletes?

I have been working with the Nationals for ten years. I previously worked as team physician for Hagerstown Community College prior to the Nationals, where I cared for all of their sports teams.

What do your responsibilities include throughout the baseball season?

The season begins with Spring Training, and I work as a part of a team of physicians under the supervision of Head Team Physician for the Nationals, Dr. Robin West. There are 150 athletes and additional staff, all of whom have to be deemed healthy to start the season. At the beginning of Spring Training, in late February or early March, we evaluate all of the players and staff who work with the players.

Before the season begins in April, the players are assigned to teams. Most of the players go to minor league affiliates and the top players compete on the major league club. The minor league affiliates are in different cities, and Dr. West cannot manage all of the players, so the team includes orthopaedic physicians in those various cities. I have been fortunate to be a part of the team providing care to athletes in Hagerstown who play for the minor league affiliate, the Hagerstown Suns. Washington Nationals players who are younger and less experienced are assigned to Hagerstown, and while they are there, I work with the athletic trainer to manage orthopaedic issues as they come up. As Medical Director for the Hagerstown Suns, I’ve enlisted other specialists, including an internal medicine physician, to care for players in the Hagerstown community.

The minor league season ends in the first week of September. Some players are moved up to the major league club, and others go to instructional leagues in Florida or the Caribbean. At the end of the season, we evaluate the players again to make sure they have ended the season without any medical issues.

Most of these players are in their 20s and are in great physical condition. They do get injuries from time to time, but overall, they are very healthy individuals. For the most part, they do a remarkable job of getting through the season without serious injuries. As the season progresses and injuries do occur, the players are evaluated by the athletic trainer and I am brought in when they require a doctor’s evaluation.

What are some of the more common injuries that you see?

Baseball players are throwing athletes so we see issues with the throwing shoulder and elbow. As running athletes, they also get injuries to their feet, ankles and knees. They get back discomfort and hand injuries, too. There is a wide variety of things that can affect these athletes because they are asking a lot of their bodies on a daily basis. They can get hit by balls. They can collide with other players. For the most part, they are healthy, but we are prepared to intervene if something occurs.

Trainers help with preventative measures through stretching and strengthening, and following pitch counts to keep players from going beyond what is deemed to be appropriate, reducing the risk of overuse injuries. When needed, the physicians step in to determine the cause of the injury and whether or not the player needs rehab, medication or surgical intervention.

What is the treatment process for these athletes?

The athletic trainers are incredibly well trained when it comes to managing the players. The trainers are with the players every day for eight months out of the year, so they are very in tune with the players’ needs and are experienced at managing injuries early on to help avoid a larger issue from developing. When injuries do not improve, or there is immediate severity, I will get involved in the treatment process. One of the most interesting things about working with the team is the trainers’ vast knowledge base and the work they do to keep the athletes functioning at such a high level.

What is your favorite thing about treating professional baseball players?

As a former athlete, the opportunity to be around young professional athletes is fascinating. When I was a kid, I dreamed of getting to the level of athletics that these young men have achieved, and to see these players achieving their dreams is fun. I find it particularly gratifying when I look at the Big League Club to see players I have treated in years past.

It’s also nice to be a part of an organization that is achieving great things. The Nationals went to the playoffs in October, and it is an exciting time to be a small part of the club and its success.

Have you ever cared for professional athletes who play other sports? How does that differ from professional baseball?

With the Nationals, the athletic trainer is responsible for about 30 individuals at a time, whereas the athletic trainer at Hagerstown Community College was responsible for every student athlete at the college. The level of care provided by the trainer is relative to the number of athletes. It’s a different job with a different level of expectations, and the trainer can’t be everywhere. At the university level, the physician sees athletes more often because the trainer can’t provide the same level of preventative care. Overall, though, the treatment process is similar. Regardless of the sport and level of play, the trainer’s goal is to keep athletes on the field, and they require a doctor to step in when things are unclear.

Do you have any recommendations for athletes to prevent injuries?

There have been evolutions in the management and training of the modern athlete. Athletes today are in the best physical condition of any athletes in history. A few generations ago, professional athletes didn’t do off season training and many athletes had other jobs during off season. Spring training sometimes was used to get in shape. Today’s modern athlete is in peak condition year-round and tremendous resources are devoted to keeping them in great physical condition all year round. This training has likely been responsible for the amazing feats athletes are able to perform.

What differences do you see between treating professional athletes and amateur athletes?

When a professional athlete comes to see me, he has been managed and educated by a trainer, so the athlete already understands the issue. People who come to see me directly have not been seen by a trained professional in advance, so I spend more time educating those patients. In professional sports, the trainer has significant time and influence to reinforce things that we have discussed with the patient. The trainers also provide so much of the care with these athletes. I often wish I had trainers to send out with my patients to reinforce the things we talk about, such as stretching and training.

The Nationals has a training room full of equipment to help athletes rehab, and because it is their job, they can train and rehab all day. The athlete’s full-time job is to get well so they can get back on the field, whereas the weekend warrior can’t devote the same time and resources to getting better. The ball club has invested significant resources for these athletes to return to the field as quickly as possible.

Dr. Thomas Amalfitano is a sports medicine surgeon serving the Hagerstown community. His practice includes fracture treatment, hip, knee, foot, ankle and shoulder problems. He is a graduate of the Johns Hopkins University and State University of New York at Stony Brook Medical School, where he remained to complete his orthopaedic residency his last year as Chief Orthopaedic Resident. He is a former college football player and wrestler. He joined The Centers for Advanced Orthopaedics at its Center for Joint Surgery & Sports Medicine care center in spring 2017.