Talking Injury Prevention, COVID-19 with Brooklyn Nets Medical Director, Dr. Riley Williams

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Dr. Riley J. Williams III has worked alongside some of the biggest names in professional sports. As recently as this past March, he performed arthroscopic surgery on Brooklyn Nets All-Star Kyrie Irving. And back in 2014, when Paul George suffered a gruesome leg injury in a Team USA exhibition in Las Vegas, Williams acted quickly and performed surgery on the then-Pacers star. For his efforts, George has previously referred to Williams as, “My Hero.”

“It's super, super satisfying to see him playing now like nothing ever happened,” Williams recently told Sports Illustrated.

An orthopedic surgeon and specialist in knee, shoulder and elbow surgery at Hospital for Special Surgery in New York City, Dr. Williams is also the medical director for the Brooklyn Nets and New York Red Bulls, having been with each franchise since 2005. He also serves as the medical director for Iona College’s department of athletics and a team physician for USA Basketball.

As the Red Bulls begin their run of play in the MLS is Back Tournament and the Nets prepare for the completion of the 2019–20 season, Williams spoke with Sports Illustrated about what he’s watching for as sports resume, how he goes about building relationships with the numerous professional athletes he works with, how regular athletes at home can prevent injuries and adjust to new interactions in the COVID-19 era, and much more.

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The following conversation has been edited for length and clarity.

Sports Illustrated: How does your approach to working with professional athletes compare to your approach when working with normal people?

Dr. Riley J. Williams III: I'd say that on the bones of it there's no real essential difference. There's obviously a big, big priority made on diagnostics and getting the root cause of problems accurate the first time. There's a lot of listening, a lot of history taking and physical exam as a means of understanding the mechanism of injury and then obviously making recommendations. The difference with pro athletes is just the urgency of the timing. You know most people would get hurt on the weekend and if they're fortunate, they’ll be able to see their doctor within a week or maybe two. If someone goes down on the pitch or on the court, we're getting hands on them within minutes and imaging usually within the day, within that 12 hours. So it’s just a time crunch that tends to happen with these high level athletes that's just kind of part and parcel, that's kind of part of the deal.

SI: How important is building and fostering the relationships you have made with athletes when working with them?

RW: Obviously very important. It's a multifaceted arrangement, right? Cause you're often times working with a team relies upon you to help manage these athletes through injury. But at the same token, you have to approach it in such a way that inspires confidence in the individual athlete. I'm very fortunate to work with organizations that put a high priority on player health, and just prioritizing player health as a sound kind of long-term strategy with regards to their players.

SI: What has changed about how you go about your work since you took over the Red Bulls and Nets jobs?

RW: People hear about analytics and to me that's just a fancy way of saying we're much more outcomes-driven, data-driven, science-driven now then we were back then. There's been a migration in all sports away from the athletic trainer-centric model, which was effective, it just wasn't data driven. Now you have sports scientists and nutritionists and strength and conditioning, all sort of tied together under this umbrella of performance. It's been amazing, over the past I'd say five to seven years, to see what a high-functioning performance team can do. They can concretely create value in players as well as, in a very significant way, design protocols and approaches that help to prevent injury. It's been fascinating. It's real. It's not made up.

SI: What advice would you provide a non-professional athlete, a normal person, as it pertains to injury prevention measures?

RW: So I’m going to answer that in a little bit of a roundabout way. So you asked me at the beginning, do I treat my regular patients differently. The reality is you have to because most people don't have a medical staff at their disposal, to attend to them daily. But what I try to do is frame goals with patients so that they understand what we’re trying to do.

So as an example, let's just say someone with a torn ACL wants to downhill ski. No one comes to you and says, “Hey, Dr. Williams, can you stabilize my knee?” They say, “Dr. Williams, I hurt my knee and I want to ski.” So I'm like, “Okay, great.” The first part of it, quite frankly, is getting an understanding of what's their time availability to deal with the problem. Do they work or not work? Are they in school? What resources do you have and what drive do you have to engage those resources? Realizing you just have to try and meet people where they are. I try to basically use the pro example to say, “Hey, listen, the surgery is the same, the rehab is the same. The differences are in the resources.” So I'm really involved in ushering them or crafting an experience that is realistic, but that incorporates an interested third-party observer to help keep them on track. Because you need a coach. You need someone to look at you and to observe what you doing and to assert corrective behavior. And that's a big, big, big deal.

SI: In terms of resources, what has it been like these past few months turning to telehealth communication?

RW: It’s a two-fold answer and it made me realize that this is a little bit of a black swan moment. The COVID-19 break left a lot of my patients without access to rehab. So again, crafting scenarios wherein they could get advice and monitoring via telehealth that was new. Listen, it wasn't ideal, but it worked out. For me personally, it really made me realize that a good history and just some visual inspection of patients, along with imaging, really for what we do is fairly thorough. I mean I continued to do surgeries through the break and a few of them I did having never met the patient except when we met at the hospital for surgery for some emergent things. I think there's just going to be a willingness to engage more remotely, just because, the imaging is really outstanding today in 2020. I've been in practice 22 years. I mean, I can typically hone things down to a couple of possible diagnoses, two, maybe three just by listening to you.

Fast forward, now that I've got two teams in the bubble, our plan is to do a Zoom call and basically a remote-based training room encounter with the athletic trainers in the bubble and the PT staff and with the athletes. And I'll be honest with you, it all feels quite natural. We've been re-acculturated and re-focused over these past three months to now accept these remote health encounters much more than we were back in March.

SI: What are you especially mindful of as the Red Bulls take part in their tournament and the Nets are nearing the start of their seeding games?

RW: We seem to learn a lot more every week I'd say just from a pure safety standpoint. I'm fairly confident in the plan, which basically features social distancing and mask wearing off-court and off-pitch and 24/7 mask wearing by all ancillary staff. Then, the only real exposures are during play. It doesn't eliminate risks, but, in both circumstances, I think it satisfactorily ameliorates risk to a point where I can look a player in the face and say, “Hey, you know, as long as you're healthy and you got no predisposing conditions that you should be fine.”

The reality is that the bulk of the athletes are of an age group that is typically not severely affected by COVID. So I think again from a player safety standpoint, we're good. It's really if these are really the asymptomatic carriers, it's really family members, older family members at home that they could potentially affect in an open situation, which is then basically handled by keeping them in a bubble.

The NBA and MLS again, kudos to them. They are very data-driven and it's a minute-to-minute assessments of what's happening on the ground. Day-to-day, I get memos from both leagues, pretty much once, sometimes, twice a day with regards to how they're handling, what they're observing. We're learning, and I think that the experience here will help to frame what we're able to do with sports down the line, collegiate and high school as well.

SI: In terms of particular injuries, are you especially mindful of possible soft tissue injuries right now like you might be at the start of a training camp?

RW: I mean I wouldn't frame what we're doing now as quite the same as a fresh start. But obviously, someone quarantining in Brooklyn apartment is different than someone quarantining at a large house in Los Angeles. You're always worried about soft tissue injuries at a training camp, muscle strains, ankle sprains, hamstring, quad. But I know for a fact that both my teams were very active on an individualized basis, kind of working with players based on their available resources to create some opportunity to try to maintain some fitness.