Dr. Clarence L. Shields, Jr., specializes in Sports Medicine at the Kerlan-Jobe Orthopaedics Clinic in Los Angeles, one of the world's top facilities for treating orthopaedic and sports injuries. He currently serves as the President of the American Orthopaedic Society for Sports Medicine (AOSSM), and in June 2001, he accepted the organization's Presidential Medallion.
Knee1: You work closely with the Los Angeles Unified School District. What is your motivation?
Dr. Shields: I am involved with the inner city high schools because there is a need for orthopaedic physicians to care for the student athletes. We’ve raised some funds and have hired Athletic Trainers to work at some of the inner city schools. From that we have accumulated quite a bit of knowledge about different types of injury patterns. Some of the coaches would have a lot of hamstring injuries one season because they were causing an imbalance with their weight training with their quads and hamstrings, so we’ve modified some of those things.
Also, we’ve been tracking the injuries and developed some evaluation tools to help us with family histories. This year, there have been several (sports-related) deaths, some of which may be have been genetic, as there are strong family histories. We have been working with the School District to try to get them to expand the family history component of the pre-season physical exam. A conglomerate of the American Pediatric Society, the AOSSM, and the National Athletic Trainers Association has developed a standard physical examination form, which would be used for each high school student athlete. I have been working closely with the School District's Safety Committee to try to get them to implement some of the things, and to help them understand the value of having a trainer at each high school. That is the big focus. At the college level there are trainers; however, there just are not enough at the high school level.
Knee1: Do you find that the more student athletes have access to sports medicine, the more prone they are to push themselves to injury?
Dr. Shields: No, it’s the other way around. Having the knowledge of how to train will cut down on the number of injuries, so you have a much better control over how each student athlete is trained. We give them educational lectures on proper nutrition and instruct them on the proper way to weight train. We've been able to cut down on the number of ankle sprains by having them work on a balance board as part of their conditioning. In football, there's always the issue of concussions. There are cognitive skills tests, which can be used. Essentially, you would do a baseline at the beginning of the season, and that would be your normal reaction time. For example, in the case of a head injury, we would keep the student out until their level on this cognitive test was back up. There aren’t any really good ways to know when the brain is back functioning normal.
Knee1: So this work led to the creation of Team HEAL?
Dr. Shields: I decided what I would like to do is raise some money and to have a couple of schools as the pilot, where we would have an athletic trainer and a fully-equipped training room and a weight room --just as we did at the Rams. (Dr. Shields served as Team Physician to the NFL's Los Angeles Rams before the team moved to St. Louis in 1995). That's how Team HEAL started.
We are up to four schools now. The trainers have been able to teach Sports Medicine classes and to have a "Student Trainer" program at the schools. I've had two students who are actually taking athletic training as their college major, as a result of having been student trainers. This is very rewarding. My goal is that every school has a team doctor and an athletic trainer, but that takes money. The school districts are facing other issues, but we are trying to get them to see that having a healthcare profession at each of their schools would serve more than one goal.
One of the concepts of Team HEAL is that if a student gets injured, the trainer can rehab them at school. This is working very well, and I know the schools are very appreciative. Every time they play other schools, they’re asked, "Well, how come you guys have a trainer?"
Read more about Team HEAL.
Knee1: Tell us about the Shields Patella Stabilizing Brace that you developed.
Dr. Shields: We see a lot of youngsters who play soccer and other sports who have (knee) tracking problems. We did some studies with different types of things to see where you need to put (the patella), and that's how I evolved into designing this brace to hold the patella. Also, I have found, over the years, that you can use it for people on whom you have done an ACL reconstruction when their quadriceps muscles are fairly week, and it does hold, as it should. You could use the brace while you are developing the quad muscle, and you don't need it afterwards. So, it has more uses than just the patella.
Knee1: What are some of your other current focuses and interests?
Dr. Shields: We are working on radio frequency (RF), which are basically like heat probes which you could use on articular cartilage (the cartilage covering the knee joint and lubricating the bones), as well as on capsular shrinkage procedures. Think about it as a heating tool. Perhaps the best understanding would be if you were to put a strip of bacon in a skillet, and as you heat it, it shrinks. There's a safe zone that you can shrink collagen and make it tighter.
We've been working on this for the last three years. As you answer one question, you move on to another one. Right now the questions are related to the articular cartilage where you would have a meniscectomy (surgical remove of the meniscus in the knee joint), and there's a lot of damage to the articular surface. The options are to use a shaver, which is a mechanical tool to try and smooth it down, or to use the heat tool. And what would be the end effects? Those are the kind of things we are working in now. At this point it looks as if it is certainly as good as the shaver, if not better.
Knee1: What type of injuries are candidates for RF treatment?
Dr. Shields: Loose joints would be one. And also, what we call multi-directional instability of the shoulder. Or if you had somebody that has a shoulder that doesn't totally dislocate but comes out only partially – sublux – you could tighten it up. You have to think about it as a repair, so the injury has to be held, as it would if you had sewn, it until it heals. Then, you would start your rehab.
Part of what keeps you stimulated is actually training younger physicians and having them look at your results on things that you've done. There’s certainly a lot to be learned by getting the people back with one particular operation to see does it really work or what you can improve upon. That's really how you push the envelope – by having young bright minds around you.