2018 Alumnus of the Year Award RecipientAn internationally renowned orthopaedic surgeon, Dr. Robert Nirschl's patient-centered approach to care, research contributions to the treatment of sports injuries, and educational fellowship programs in orthopaedics and family practice sports medicine have helped generations of patients worldwide.
Go ahead and call Robert Nirschl, MD, MS a contrarian – he doesn’t mind. In fact, some of his proudest accomplishments resulted from challenging consensus opinion.
Dr. Nirschl (MD, ’58) is the recipient of this year’s Alumnus of the Year award, which is bestowed upon an alumna or alumnus who has achieved success in his or her profession that has led to recognition by their peers.
As an accomplished orthopaedic surgeon, Dr. Nirschl’s wisdom is frequently sought out for consultation and second opinions. His patient-centered approach to care, his research contributions to the understanding and treatment of sports and tendon injuries and his educational fellowship programs in orthopaedics and family practice sports medicine have helped and continue to help generations of patients worldwide.
It all started with his experience with a personal injury and the physician – a fellow contrarian – who inspired him to question the accepted way of doing things.
Robert Nirschl grew up in the suburb of South Milwaukee, where he developed a love of sports. In high school, he was successful in football, basketball and tennis. A knee injury he suffered while playing football, commonly known as “bucket handle tear,” started giving him problems years later during medical school.
Dr. Nirschl knew that the widely-accepted approach to treating his injury was total meniscectomy, or complete removal of the meniscus, which stabilizes knee joint and protects the bones from wear and tear. Luckily for Dr. Nirschl, the orthopaedic surgeon who performed his surgery ignored the then-standard of care and removed only the torn part of the meniscus, resulting in a quicker recovery and less side effects down the road.
Three weeks into his orthopaedic residency at the Mayo Clinic, Dr. Nirschl noticed a total meniscectomy on the schedule. He challenged the physician he was working with, the Mayo orthopaedic department co-chairman with whom he had already developed camaraderie, on the necessity of the procedure.
“I told him, ‘God put the meniscus there for a reason,’” he recalls. “I shared my personal experience and reasoning for only partial removal. And to my surprise, he listened.”
Dr. Nirschl’s ability to think beyond medical dogma and his fascination with mechanics were the perfect recipe for innovation. His father, a dentist, was a major influence in his care philosophy.
“He was always fixing things,” he recalls.
When Dr. Nirschl developed tennis elbow after returning to the game as a young physician, he found that he disagreed with all of the literature he read about his ailment. At the time, failed tendon injury was thought to be an inflammatory process and was inappropriately called tendonitis. Dr. Nirschl conducted his own research, which led to the understanding that the true histopathology was a loss of blood supply and a degenerative failure. He renamed the tissue angio-fibroblastic tendinosis – or heart attack of tendon – terms now used worldwide. This gave birth to the Nirschl operative procedures for elbow tendinosis (tennis and golfer’s elbow) and an elbow rehabilitation book he co-authored with Virginia Sports Medicine Institute Physical Therapist Janet Sobel, in 1981 called Arm Care.
Dr. Nirschl was a pioneer in several other surgical approaches to orthopaedic care. In 1967, he was one of the first in the world to publish the bone patella bone technique for Anterior Cruciate Ligament (ACL) reconstruction of the knee. He was an early innovator in the use of reinforcing patch grafts for the repair of large shoulder rotator cuff tears, cautioned against shoulder acromioplasty (once a standard of care) and he devised a unique repair of bilateral shoulder separations which allowed the first polio paraplegic patient to attempt to swim the English Channel, reaching a distance of 18 miles.
His accomplishments aren’t limited to surgical innovations, however. In fact, his philosophy has always been to use surgery as a last resort.
Dr. Nirschl ‘s approach to care was influenced by his recognition of the role played by inadequate fitness, improper technique and overuse in sports and other types of injuries. Early in his career, Dr. Nirschl noted parallels in the muscular instability imposed by polio and sports technique. Many of his sports medicine concepts, like functional counter-force bracing, were formulated while working with polio patients. During his two years as an orthopaedic surgeon with the U.S. Navy, Dr. Nirschl was part of a project that was focused on treating marines with unstable knees. Marines, as he points out, are essentially “occupational athletes.”
In partnership with teaching tennis pro Ed Eberth, Dr. Nirschl spent a number of years filming the tennis stroke mechanics of world-class tennis players, and compared them to those of recreational players. He recognized injury-producing patterns and recommended improved sport mechanics, exercises and changes in sports equipment as part of his patients’ treatment. It was through this work that he introduced the important concepts and his now-famous quotes, “The goal of sport is not good health, the goal is to win,” and “You don’t play a sport to get in shape. You get in shape to play a sport.”
In 1974, Dr. Nirschl was the second physician in America to incorporate sports fitness equipment into a physical therapy unit, an idea that many of his fellow physicians scoffed at.
“In the late 60s and early 70s, the concept of sports medicine was nonexistent,” Dr. Nirschl says. “Many other physicians at that time didn’t buy into it. In fact, they gave me a great deal of grief about it.”
But as usual, he paid little attention to popular opinion. Instead, he pressed on, becoming a trailblazer in sports medicine.
Dr. Nirschl’s contributions to orthopaedic and sports medicine are numerous. They include founding the Virginia Sportsmedicine Institute in 1974, serving on the President’s Council on Physical Fitness under Ronald Reagan, being a founding member of the Sports Science Committee of the United States Tennis Association in New York and starting two fellowship programs to train young physicians in sports medicine, including one for military doctors. He has written 87 book chapters, published 147 articles in medical journals and magazines and produced 10 videos on surgical techniques. Dr. Nirschl has given approximately 400 presentations, some on television, on orthopaedic and sports medicine topics throughout the United States and in eight foreign countries. He has performed over 10,000 operations, many on serious competitive athletes, including two Wimbledon tennis champions.
The aspect of patient care that Dr. Nirschl enjoys the most is talking with people to better understand their lives.
“It’s important to get to know your patients on a personal level,” he says. “By asking people about things like their hobbies or where they take vacations, I always found bits of information that would prove useful in their treatment.”
It’s an approach to care that he says was instilled in him at the Medical College.
“What the Medical College does exceptionally well is to train doctors to deliver great care,” he says. “It became clear to me during my training in orthopaedic surgery that the Mayo Clinic was very aware of the Medical College’s strong reputation for providing a quality education.”
Although he stopped performing surgeries in 2015, Dr. Nirschl still sees patients 20 hours a week. He married his sweetheart Mary Ann (speech therapy, ’58) two weeks after their graduation, and they now have three children, 11 grandchildren and two great-grandchildren. They live in a Virginia suburb outside of Washington, an ideal location for his passionate work as an advocate for a healthcare system that prioritizes the patient/doctor relationship.
Dr. Nirschl has authored numerous articles on the subject, pointing out that under the current system, instead of being totally accountable to their patients, doctors often have to answer as well to hospitals or insurance companies. He argues that this system makes it difficult for even the best physicians to provide consistent quality care.
The solution, he posits, is to give patients control over their own health benefits coverage. Politically, this would mean changing the tax code to ensure everyone is treated equally under purchase of the health benefit. By putting patients back in control, he says, you have the only chance to restore the true doctor-patient relationship.
As you would imagine, his viewpoint isn’t popular with everyone – especially not insurance companies and some politicians. But he’s used to that.