Treating All Athletes Like the Pros: Q&A with Red Sox Team Physician Eric Berkson, MD

Eric Berkson, MD, is an orthopedic surgeon at Mass General Brigham Sports Medicine specializing in complex knee surgeries, like knee reconstruction and cartilage restorative procedures. And as part of his role, he also oversees the care for high school, college, and professional athletes. In this Q&A, Dr. Berkson discusses being part of the physician team working with the Boston Red Sox, treating athletes of all ages, and how sports medicine research and treatments will transform thanks to the upcoming opening of the Center for Sports Performance and Research.

Q: What is your role with the Red Sox?

Berkson: I've been a team physician for the Red Sox for many years. Peter Asnis, MD, is the head team physician, and my role is really to support him and our team approach to care for the Red Sox team, personnel, and their families. I cover game days, injuries whenever they need to be seen, and work to find the best plan of treatment regardless of condition or injury.

Q: Can you talk more about the team approach to care?

Berkson: The doctors within Mass General Brigham have a long history of caring for professional teams in Boston. My exposure to that began when I was a fellow at Mass General. What I learned from my mentors was an approach that has been persistent in the way that we care for all the teams. Caring for a professional athlete is the same as how we care for anyone else who works through the door.

In the professional team atmosphere, we can take advantage of all the adjuncts that are a part of this. There are specialists in every field whose expertise can help us solve problems. We have an internist covering games with us, and they help make some of the medical decisions. Any sports medicine evaluations are made by whichever doctor is covering that night. If a player gets injured, he will be evaluated by a specialist in the area, and we oftentimes also get opinions from other experts, as well.

There is a level of communication between the care team that allows all the different people to come to together to make decisions. It’s a multidisciplinary approach that allows their care to seem like it’s at a higher level.

Q: What does a typical game day look like with the Red Sox?

Berkson: I arrive several hours before the game begins to take care of anyone in the process of rehabbing from an injury. There are hundreds of people in the organization and in the minor leagues, so there are always lots of people in varying stages of rehab. Luckily, injuries are not very common during baseball games, but when they do happen, it can be very meaningful. Taking care of a player who was hit in the head with a hundred mile per hour fastball can be a challenging situation. But I’m also there to make decisions about whether a player has a serious injury or not, and sometimes just understanding what’s going on from the medical perspective helps the team make better game time decisions.

Q: How do you apply what you learn with professional athletes to your work with amateur athletes or weekend warriors?

Berkson: Caring for the professional athlete is an opportunity to push medicine to its limit. Players are being cared for by trainers 24 hours a day and the rehab process for injury recovery is very regimented and tracked. Because of this we can work with an athlete to push the limits of how quickly he can get back on the field. It also helps us really learn what is a meaningful injury or not.

And then we take that experience back to our everyday patients who don’t have the same level of support, but can potentially achieve the same outcomes. The level of responsiveness I provide for the Red Sox is something I expect of myself and in responding to my other patients.

I think being a team physician also requires you to be at the top of your game. You need to know the latest treatments, and that can be applied to all our patients. Ultimately, the care is the same whether you’re an amateur athlete or a professional, but working with the teams allows us to optimize care for everyone.

Q: What are common injuries you see with the Red Sox or with baseball players more broadly?

Berkson: We see lots of elbow injuries, lots of collateral, ligament injuries, and other injuries like knee pain and arthritis. These are the kinds of things that could happen to anyone playing baseball, no matter what level. But the Red Sox train so much, that they experience these things at a higher level.

Q: As you care for high school or college athletes, is there anything that younger athletes should keep in mind to avoid in injury?

Berkson: I think we all understand that specializing in a sport too early can lead to problems. We see that injury avoidance is not just technique. It's also full-body conditioning. The players who have made it to the professionals certainly understand this. But if we could bring that type of thinking to younger patients, it would help prevent injuries.

But also, everyone is at risk for different problems depending on your age group. As you grow older, there's more wear and tear on your joints, there's more arthritis, and it’s easier to have an overuse injury. So, it’s still important to not over-specialize within your sport and to cross-train. A whole-body approach to strengthening and conditioning helps with these things.

Q: Can you talk about your work in developing the new Center of Sports Performance and Research (CSPaR)?

Berkson: We were given a huge opportunity to create the Center of Sports Performance and Research as an extension of Mass General Brigham Sports Medicine to look at the wellness side of the equation in addition to the injury side. We are using this to ask questions like, how do you stay fit and how do you avoid injury, and how do you use those mechanisms to perform at a higher level no matter what you’re doing? The goal for CSPaR is to take a science-based approach to training and recovery from injury, and to help people avoid future injury so they can take things to that next level in their sport of choice.

We are using what we've learned from being team physicians, and supplementing that with elite strength and conditioning coaches and trainers, to implement a medical approach to rehab and to training to help us then achieve better goals for our patients. It's very exciting.

Q: How do you expect a center like this will impact the way you treat sports patients in the future?

Berkson: Right now when we treat a patient, we tend to try to get them back to sport. This type of center can look at how we recover patients, and not just how to recover from the injury, but also to avoid future injury. We are learning how to keep people on the field doing what they love more than anything else.

The cool thing about the center is that it's a biomechanics research center in as much as it is a training center. Using the technology, we will be able to continue our work in biomechanics of sport and understand injury mechanisms and repetitive injuries.

A lot of my research has been looking at overuse injuries in pitching — for example, how repetitive activities like overhead throwing lead to injuries. We can now take this research and apply it directly to training protocols for people recovering from injury, or those who are just there to train. It’s hands-on research and science developing for the benefit of our patients. What’s great about Mass General Brigham is that I get to do both — patient care and learning about the science of injury avoidance.

The ultimate goal of CSPaR is to take what we learn from our work with professional teams and apply it to the everyday individual athlete. We are providing access to trainers and nutritionists, but also to use our medical expertise to evaluate patients during the process of training and understand the mechanisms of recovery and injury. We’ve had remarkable success with professional team coverage, and Mass General Brigham’s willingness to take that back to patients is admirable and exciting.