How Dr. Andrew Hecht is treating elite athletes' spines

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Andrew Hecht, MD, is a professor of orthopedic surgery and of neurosurgery and the chief of spine surgery of the Mount Sinai Health System. He is also the spine surgical consultant for the NFL's New York Jets and NHL's New York Islanders.

He recently connected with Becker's on the evolution of the treatment of spine injuries of elite professional athletes.

Note: Responses were edited for clarity and length. 

Question: How is the treatment of professional athletes changing and evolving?

Dr. Andrew Hecht: At the elite level — professional, collegiate or even high school — when you're taking care of athletes in contact sports, we understand the risks and how to teach young athletes how to avoid high risk behaviors. Our treatment of these athletes begins before they set foot on the field or on the ice. What we really tried to do many years ago was the concept of keeping your head up in collision sports to try to avoid some of those devastating injuries. With that education, the rate of serious injuries fell off. When it comes to taking care of an athlete's spine, it really takes a whole team. You are working hand in glove with athletic trainers, sports medicine doctors and the spine surgeon. With the Jets, we have an extensive emergency action plan and we rehearse all sorts of scenarios ahead of time, so if something ever happens we are ready. When it comes to how treatment has evolved, it is really this team approach and trying to maximize the return to play through the least invasive way possible. 

Q: What are some lessons that you've learned from treating professional athletes that you can take back to more general patient populations?

AH: It can sometimes be more challenging taking care of the weekend warriors than it is professional athletes. Olympic, collegiate and professional athletes understand that they are a much better performer out of pain than in pain. Weekend warriors tend to be a lot more impatient. The elite athlete, whose whole livelihood depends on performing, really understands how important it is to let the body heal before returning. You often have to take a few extra minutes with the weekend warriors because they tend to have less patience and really want to get back out there. The only difference is that the elite athlete is going to return under the guidance of the athletic training staff to do specific rehabilitation to return to their specific sport. The weekend warriors often find great comfort in knowing that for the first six to 10 weeks they are on the same exact clinical pathway as if they played professionally. 

Q: What are some of the biggest challenges you are facing when it comes to spine injuries and treatment for professional athletes?

AH: We're always looking to get athletes back to their pre-injury level of excellence. As our techniques continue to pioneer less invasive procedures, trying to minimize the size of incisions, all trying to preserve function in athletes. Our return to play rate for elite athletes after the most common procedures, like a lumbar disc herniation, is extraordinarily high. The most important thing and the challenge ahead for all physicians who take care of athletes is never losing sight of the journey ahead for every athlete they are taking care of. What has been rewarding is that all the different groups who are taking care of athletes are really communicating well together. Everyone is all coming in sync with optimizing the safety, return to play and longevity of athletes. 

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