If he saw a crowd coming his way, the athletic Dr. Bert Mandelbaum would run in the other direction. Dr. Mandelbaum, President of the Santa Monica Orthopedic and Sports Medicine Research Foundation, explains, “I always wanted to stay away from the mainstream, with a focus on doing things that were particularly impactful.”
Choosing His Path
Growing up on Long Island, New York, a young Bert Mandelbaum was impacted by medical people on the home front and sports people on the field. “We were a typical middle class family; my dad was a pharmacist and my mom was a public health educator nurse. I spent a lot of time in high school playing football and lacrosse, then focused more on lacrosse in college. I was so devoted to this sport that for two years prior to medical school I coached at Johns Hopkins. During that time I tore my meniscus, something that profoundly affected my life direction. At the time, a meniscal tear would keep an athlete out of play for six to eight months, an extremely frustrating situation. I was influenced by the talented, interesting orthopedist who treated me during my rehab process, something which led me to consider a career in sports medicine.”
Even in graduate school, his athletic mentors continued to influence his life path. Dr. Mandelbaum: “From 1976-78 I was enrolled in graduate school at Johns Hopkins University. During this time I coached lacrosse and was blessed to have Bob Scott, the athletic director, as a mentor. He was a consummate gentleman, philosopher and teacher who taught his protégés how to maintain a level mindedness and use one’s emotions for strength. He would always say, ‘The definition of a gentleman is one who uses emotion as a motivator, but is able to keep people calm.’”
“I was just out of school and already the head lacrosse coach, ” states Dr. Mandelbaum. “It was time to decide whether to stay on this path or become a doctor. It was a hard decision as I was closer to being a kid than an adult. In the end, I found the breadth of offerings in medicine to be what I was seeking. I could see a fascinating, varied future of clinical interactions, working with teams, doing research, educating others, and administration.”
You might say that physicians who focus on children have a lot of heart. Then there are the ones who turn away from pediatrics because they just have too much heart.
Dr. Mandelbaum: “I was admitted to the second year of medical school at Washington University in St. Louis. I continued to do research on prostaglandins, as well as on the mechanics of how the heart gets oxygen after birth. That experience turned my attentions away from sports medicine and toward pediatric surgery. Over time, however, I came to see that this world was too intensely emotional for me…too laden with death. I returned to my sports medicine roots.
While he didn’t carry around a tome entitled, “Zen and the Art of Surgery, ” Dr. Mandelbaum did soon learn how to achieve a “oneness” with the OR. “I returned to Johns Hopkins for my orthopedic residency, where I had a cadre of tremendous mentors. There was Dr. Vern Tolo, a pediatric orthopedic surgeon who was a consummate gentleman…truly a combination of an outstanding surgeon and a fantastic human being. Dr. Dave Hungerford, a total joint surgeon, was of a philosophical nature and taught me the Zen of surgery, i.e., how to approach things with completeness of understanding of all aspects of care. Also leaving his imprint on my career was Dr. Chick Silverstein, the team doctor for the Baltimore Orioles. He was instrumental in my understanding how I could be in private practice, be a leader in the field and also have time to be a team doctor.”
For his next career adventure, Dr. Mandelbaum didn’t have to travel to ancient Egypt to learn the secrets of the pyramids. As it turns out, L.A. has its own pyramid. “I did my Sports Medicine Fellowship at the University of California, Los Angeles (UCLA), during which time I was exposed to the legendary coach John Wooden. His pyramid of success, including its focus on self-control and perseverance, remains useful today in many locker rooms and board rooms. The entire experience was invigorating; it was particularly exciting that the first year I was there we won the Rose Bowl.”
Staying on as full time faculty at UCLA, Dr. Mandelbaum and his patients only became more famous. “As the 1988 Olympics approached we went into high gear, and worked with gymnast Tim Daggett, the famous Florence Griffith Joyner, and a number of track athletes. This was the period when the steroid controversy began to rear its head, so we all had to focus more on drug abuse and the control of doping. Even today, it is still hard to control. Whether it’s major league baseball or soccer, you’ve got the same issues. The strategy is to have a program of education and testing with the goal that sports should be a level playing field for all athletes. The expectation should be one that people are going to participate in a drug free environment, that there will be open testing, and that there will be sanctions if athletes cross the line.”
Scoring Major Career Goals
Developing his knee niche, Dr. Mandelbaum went on to create a targeted program that would address ACL issues in athletes. Of the history behind his Performance Enhancement and Injury Prevention Program (PEP), Dr. Mandelbaum says, “In the 90s there was a rash of young girls who were tearing their ACLs. Interestingly, in my practice we went from doing 80% of the ACL operations on males to 80% on females. In 1972 3.2 million boys participated in high school sports as opposed to only 264, 000 girls; by 2006 it was 3.6 million boys to 3.4 million girls. We began to see dramatic increases in the development of new technology, techniques, and protocols for prevention, diagnosis, and treatment. After a number of researchers looked at factors such as hormones, shoes, and anatomy, a consensus was formed that there were deficiencies in muscular and neuromuscular control that resulted in the ACL tears.”
And that they could work with. He continues, “We designed the PEP program to include five steps, including warm-up, flexibility, strength, proprioception and activity. The goals are to improve the functioning of the hamstrings, enhance the connection between the muscles and nerves, and instruct athletes as to the proper alignment of their lower extremity in a landing or planting position.”
Last year we conducted a randomized, controlled study on PEP involving the CDC, the National Collegiate Athletic Association (NCAA) and FIFA and overall found a minimum of a 72% reduction in ACL tears. I’m pleased that we recently won the NCAA award for the best research project.
Emboldened, Dr. Mandelbaum and his colleagues are reaching beyond medicine into program implementation. “Because we have developed and tested this methodology and theory both epidemiologically and biomechanically, we are taking a bold new step. Joining forces with the Amateur Athletic Foundation, The California South Soccer Association, and the Federation International de Football Association (FIFA), we are now putting the focus on implementation. As an orthopedic surgeon this is a totally new frontier for me—one that includes developing a team focused on enhancing the broad based application on the public health and larger athlete population.”
Dr. Mandelbaum, now the Medical Director of the FIFA Medical Center of Excellence, adds, “To date we’ve learned that it’s a challenge to get people to commit to prevention regardless of whether the issue is tooth brushing or taking steps to prevent swine flu. ‘FIFA 11’ is the name of the program; it is a PEP program, but includes enhanced exercises. Thus far it has been implemented in New Zealand and Switzerland with great success. To assess the program we are partnering with a variety of health education entities to conduct surveys.”
He may run from the crowd, but in certain situations, the crowd might follow him. Dr. Mandelbaum, President of the International Cartilage Repair Society (ICRS), states, “Cartilage repair is becoming quite the hot topic in orthopedics. Much of my research time has been devoted to working on articular cartilage repair, as well as new methods, concepts, and technologies of cartilage transplantation. In the early ‘90s we jumped on new concepts of cartilage repair and started using autologous chondrocyte transplantation where you clone cells and put them back into patients.”
At first you had clinicians waiting for innovations and ‘pure’ researchers doing science and technology; then we began to see that it was only through synergy that innovation would progress. Through contact with colleagues and institutions around the world I can see that we are beginning to overcome a number of hurdles. We’re having a difficult time getting certain technologies through the FDA, unfortunately. But we continue to work with them to help elucidate the technologies and their benefits. The reality is that it’s just easier to pursue these things in other countries. For example, in Italy doctors and patients have access to certain stem cells, scaffolding and growth factors that we don’t have access to here in the U.S.
For these and other efforts, Dr. Mandelbaum was recently bestowed with the honor of a “tassel turn.” Dr. Mandelbaum: “One day I received a phone call notifying me that I’d been nominated for Doctorate of Humane Letters from the State University of New York. Imagine my surprise when I found out that I was selected, along with Ann Dunwoody, a four star general. It’s really wonderful to have the things I’ve been working on for years recognized in such a manner.”
The Doctor at Home
There is a particular someone who has always recognized his accomplishments. “My wife, Ruth Sorotzkin, is a family physician. This means that she understands the things I do and why I do them. It is very helpful to have a spouse who comprehends the complexities of one’s work, whether in the clinical, educational, or research arenas. Our 18 year old, Rachel, is taking premed courses with an eye toward a career in public health. She is doing an internship this summer on disease management. Our 11 year old, Ava, is an avid volleyball player and has visions of becoming a fashion designer. Our son Jordan is 15 and spends a great deal of time on the soccer field. His team recently won the Dallas Cup in a major international competition.”
“When I squeeze out a bit of quiet time for myself, ” says Dr. Mandelbaum, I read books like Blink, Freakonomics, and The World is Flat…things that deepen my understanding of the wider world.”
Dr. Bert Mandelbaum…a Zen master of the knee.
