Million-dollar heads crash into million-dollar knees. Players limp off the field holding million-dollar hamstrings. It's just another Sunday in the National Football League (NFL).
Almost every NFL player has suffered a remarkable litany of injuries -- enough to make most people look for different careers. But the players still manage to put on their helmets in pursuit of even more injuries. They deserve credit for courage and determination, but courage alone doesn't keep them on the field.
That's why the St. Louis Rams have Robert Shively, M.D., assistant professor of orthopaedic surgery at Washington University, on the sidelines of every game. As the team orthopaedist, Shively and his partners take responsibility for every joint and muscle of the Rams. It's a serious job with some huge fringe benefits. He gets to know the Rams personally and, perhaps most importantly, gets to cheer his favorite team from the sidelines.
"You can catch him being a fan every now and then," said Rams wide receiver Jermaine Ross, a young player who partly owes his career to Shively. In August 1995, Ross tore the anterior cruciate ligament in his left knee. It was the first game of his NFL career. It could have been his last.
Shively and partner Rick Wright, M.D., instructor in orthopaedic surgery at Washington University, reconstructed Ross' knee. Ross now is back in a Rams uniform.
"I take some personal pride in the fact that here's a guy who had a potentially career-ending injury and he's not only out there performing but performing well," Shively said.
Said Ross: "I give the doctors and trainers a lot of credit. I'm very grateful."
Shively said he also feels grateful mainly because his job allows him to pursue one of his passions -- watching sports. As if following the Rams across the country isn't enough, Shively also is the team orthopaedist for a dozen local high schools. He might stand on the sidelines for three games in one weekend -- more sports than most coaches can take.
"I'm one of the lucky people who have the same vocation and avocation," Shively said. "If I weren't on the sidelines, I'd be sitting in the stands."
Shively spent much of his childhood as a fantasy sports hero in his back yard. He played high school football and wrestled as an undergraduate at the University of Illinois, but he thought he would have to leave the sports world for his career. After graduating from the University of Illinois Medical School in 1969, he became a general surgery resident in Charlotte, N.C.
In 1975, Shively joined Saint Louis University as a resident in orthopaedic surgery, and he began a sports-medicine fellowship at Oklahoma University in 1979. He joined Washington University the next year as an instructor in orthopaedic surgery, and it wasn't long before he started taking care of his first high school football team, Vianney High School. Naturally, he soon became the team orthopaedist for the Washington University Bears, and more high schools started asking for his help.
As his list of clients expanded, it became impossible for Shively to work alone. Wright and Matthew Matava, M.D., assistant professor of orthopaedic surgery at Washington University, joined the practice, forming the largest sports-medicine network in the area.
Even a team of three orthopaedic surgeons can't take care of a dozen high schools, a university and an NFL team without some assistance. Shively gets help from the many orthopaedic residents with whom he works. The residents often cover the high school games, making it possible for Shively's team to meet a dozen obligations on a Friday night.
Shively and his partners don't earn anything from the high schools, but taking care of the teams helps them build their reputations and attract patients, including many of the high school athletes. "We tell them, 'If you don't already have an orthopaedist, we'd be happy to see you,'" Shively said.
The extra work paid off when the Rams moved to St. Louis in 1995. Professional sports teams usually don't hire university doctors, but Shively was building a reputation that couldn't be ignored.
"(Shively) is regarded as a premier sports-medicine surgeon in the community," said Richard Gelberman, M.D., the Fred C. Reynolds Professor of Orthopaedic Surgery and head of the Department of Orthopaedic Surgery. "He was a natural for their short list, and I think they've been very pleased with their care."
The Rams hired Shively and his partners the day before training camp started in 1995, giving Shively one of the most prestigious jobs in sports medicine. Shively tries to downplay the glamour -- he doesn't even have any Rams paraphernalia in his office -- but he obviously enjoys being a part of the team.
"There are only 30 of these jobs in the country," he said. "If you do sports medicine, it's the ultimate."
A few ultimate warriors will try anything to get into a game, but Shively sticks with his decisions. As a fan, Shively wants to see the best players take the field. As a doctor, he has to protect the players' health. "It's admirable that these guys are so driven that they want to do that, but you can't let them do crazy things," he said.
During the first half of the game, Shively watches every play, ready to run onto the field if a player goes down. At halftime, Shively and Wright attend to the inevitable turned ankles and pulled hamstrings from the first half. In the second half, Shively treats players at a training table while Wright walks the sidelines.
After the game, Shively and Wright spend a couple hours examining X-rays and making diagnoses. That night, they return home, which often means a long flight.
Add the full day of work on Sunday to checkups before and after practices -- not to mention any surgery that's needed -- and Shively has committed major time to the team.
"It's not a 9-to-5 job or a five-day-a-week job," he said. "You have to do what you have to do, and you have to do it when it needs to be done."
Medically speaking, being an NFL team orthopaedist isn't more challenging than working for a high school team, Shively said. High school players suffer injuries just as often as the pros, and the injuries can be just as severe -- concussions, blown-out knees or worse.
But the NFL provides challenges and pressures that have nothing to do with medicine. Shively works on a national stage, tending to body parts worth millions of dollars. His work is scrutinized by coaches, agents and fans -- not to mention the players themselves. "Their bodies are worth a lot of money to them, and consequently, they're really focused on their bodies," Shively said. "You really have to have their confidence that you're going to do the right thing for them."
"He's got a good rapport with the players," Ross said. "He's on our level, and he talks in a way that we can appreciate what he does."
At the same time, Shively has learned to appreciate the players. "I used to think like a lot of people do -- that they're all making millions of dollars at a cushy job," he said. "But fans don't realize how hard these guys work. It's a rough job."
Shively should be considered an authority on rough jobs. The combination of the Rams, the high school teams and his practice leaves him chronically short of free time. He keeps up the pace, perhaps partly motivated by his two children and two stepchildren, all of whom are in college. But, someday, he'll have to give the Rams' knees and shoulders to someone else.
"I'm 53 years old, and this is not a job for a guy who's 65," Shively said. "I anticipate doing this job for maybe six or eight more years and then passing it on."
When he leaves the Rams, he'll definitely miss the sensation of standing on the sidelines and watching his patients score touchdowns and make interceptions. After all, whether you're a quarterback or an orthopaedic surgeon, nothing's better than a win.
"The most gratifying thing is when we play well and win a game," Shively said. "If you win a game, those bumps and bruises don't seem so important."
-- Chris Woolston
Please send comments and suggestions to: