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The Forward Movement: Amplifying Black Voices on Race and Orthopaedics—It’s Time to Talk about Race in Sports Medicine

Owusu-Akyaw, Kwadwo MD

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Clinical Orthopaedics and Related Research: April 2021 - Volume 479 - Issue 4 - p 671-673
doi: 10.1097/CORR.0000000000001722
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Sport has the power to change the world. It has the power to inspire, it has the power to unite people in a way that little else does. It speaks to youth in a language they understand. Sports can create hope, where once there was only despair.

— Nelson Mandela

I gave the young man an elbow bump. Under normal circumstances, cultural etiquette would have dictated a dap, but the current public health crisis precluded the typical exchange. Still, the rhythm of the conversation maintained a pre-COVID-19 level of familiarity. He was a college-level running back with some soreness in his upper extremity. I examined it, determining nothing was needed but some rest and possibly decrease in activity.

“Take the weight down, and have your trainer watch your form,” I advised my patient.

As we parted ways, I looked down at his wrist and saw a “Black Lives Matter” wrist band.

“Nice wrist band, brother!” I said.

He nodded, quietly appreciating my affirmation.

Wearing a “Black Lives Matter” wrist band may seem like a simple gesture, but for a young Black man living in the United States now, it is an act of courage. The phrase, which shouldn’t be controversial, seems to perplex some and anger others. But that’s who we are as a country. A nation divided. We can’t even agree that Black lives matter. 2020 proved that. The events of January 6th etched it in stone.

The very fabric of our national identity is under attack. But an identity, national or otherwise, is largely the product of one’s history. The issues we face are not a “2020 thing” or a “January 6th thing” that can be solved by turning the page on our calendars. This is our history. It’s what this country has been for generations. So, it should come as little surprise that a reassessment of America’s character would bring to the forefront a reckoning with its original sin: Racism.

This reckoning has been a long time coming. But as in any movement, there must be an inciting event, a spark to which the blaze owes its life. This time, the murder of George Floyd was such a tipping point. I can attest to the impact of his murder and others on multiple levels. As a Black man, it was a reminder of my tenuous position in life. As the father of a Black boy, that fear multiplies infinitely. As a sports medicine provider, I have counseled many Black athletes as they grapple with the anxieties of racial injustice. I can’t take that pain away. But I can offer perspective on channeling those frustrations into excellence, and eventually influence.

In the face of these tragedies, we have seen the rise of young and courageous Black leaders, particularly from those in professional sports, who are willing to give voice to a Forward Movement, defined by a commitment to racial equity. This movement continues the historic marriage between sports and social justice. Young tennis phenom Naomi Osaki used her platform to elevate the names of Breonna Taylor, Elijah McClain, Amaud Arbery, Tamir Rice, Trayvon Martin, and Philando Castile. We have seen multigenerational activism in the NBA, from LeBron James and his contemporaries to younger players such as Malcolm Brogdon and Jaylen Brown. Our National Women’s Soccer team took a cue from Colin Kaepernick and took a knee, leveraging their own excellence to demand a higher level of excellence from the nation.

Herein lies the power of sports, which creates opportunities and provides a platform to demand local and national change. By nature of our proximity to athletes, the orthopaedic subspecialty of sports medicine stands adjacent to this enormous potential. We attend games and practices. We interact in the locker room and on the sidelines with our patients. We’re privileged to enjoy a next-level degree of access. We should use our access to educate and empower. But too often, we miss the chance to engage, and we don’t have all the social impact that we might.

The work of Kytwan Heath, a native of Richmond, Virginia, embodies the powerful effect that local sports leadership can have on uplifting Black communities. By way of his nonprofit, 804 Sports Association, Mr. Heath has trained many young kids who have gone on to play in college and even the NFL. Moreover, his organization provides local youth with health education, education on their legal rights, and financial literacy. Mr. Heath knows the power of sports. He knows how our unique circumstances position sports medicine physicians as not only healers, but as role models. And he knows that we can be doing more.

“Throughout my 17 years of training, I have not seen nearly enough personal engagement between sports medicine doctors and my athletes,” Mr. Heath told CORR. “The most I have witnessed it is during game times. I would like to see doctors more engaged throughout the training process overall. These relationships may help athletes, who won’t play professionally, see another career option that allows them to stay connected to the game that they love. This is why the effect of Black medical doctors matters so much, because it helps Black athletes see the possibilities of that career path.”

For that reason, we must also address racial disparities in our own profession. Currently, only 1.5% to 2% of orthopaedic surgeons in the United States are Black [3]. Obviously only a small percentage of those have fellowship training in sports medicine [1]. In contrast, about 13% of Americans are Black [8]. The racial disparity between providers and high-level athletes looms even larger. Black athletes make up over half of the NFL (57.5%) [6], NBA (74.2%) [5], and WNBA (67.4%) [4].

Of course, a white surgeon can provide excellent and compassionate care to Black athletes. But when the demography of providers differs so dramatically from that of the population being cared for [2], disconnection is inevitable. For example, even after controlling for relevant confounding variables, patients who are Black are more likely to be lost to follow-up after ACL reconstruction [7]. Surely this is an indication of a disconnect if ever there was one.

To reach our potential, sports medicine surgeons must do two things. First, we must support the pipeline of budding Black practitioners as well as encourage the leadership aspirations of those currently practicing. For over 20 years, the J. Robert Gladden Society (JRGOS) has continued to set the standard for improving the diversity of orthopaedics as a whole. This support may come in the form of time and resources, but even more powerful would be the initiation of long-term partnerships. CORR has set the standard in terms of tangible support and empowerment. By way of the collaboration between CORR and JRGOS, we are seeing the appointment of Black surgeons to leadership positions on the editorial board and the development of symposia on disparities in orthopaedics. Other organizations in our field should take note and follow suit.

Secondly, sports medicine providers must contribute to the marriage between sports and racial uplift in America. As we see our patients using their platforms to drive change, we need to use our influence as physicians to support their efforts. Speaking personally, my relationship with Coach Heath has resulted in my joining the Board of Directors for the 804 Sports Association. Similar organizations exist across the country, providing ample opportunity for community engagement and contribution. Organizations such as Grid Iron Sports + Performance (Tacoma, WA), SD Intensity Basketball (San Diego, CA), Brooklyn Youth Sports Club (New York, NY), and Ricardo Marsh Training (Chesterfield, VA) are just a few examples of local groups across the United States making a difference in the community. Moreover, those in our field involved in the care of professional athletes can leverage those relationships to contribute to their individual and league-wide efforts to promote racial justice. When surgeons contribute to the national conversation on racism, we enhance our specialty’s ability to engage with patients of all backgrounds.

References

1. Association of American Medical Colleges. Number of active MD residents, by race/ethnicity (alone or in combination) and GME specialty. Available at: https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2020/table-b5-md-residents-race-ethnicity-and-specialty. Accessed February 9, 2021.
2. Brownlee D. Why are black male doctors still so scarce in America? Available at: https://www.forbes.com/sites/danabrownlee/2020/08/11/why-are-black-male-doctors-still-so-scarce-in-america/?sh=738ed9d027c2. Accescsed February 9, 2021.
3. Cherf J. AAOS Now. A snapshot of U.S. orthopaedic surgeons: results from the 2018 opus survey. Available at: https://www.aaos.org/aaosnow/2019/sep/youraaos/youraaos01/. Accessed February 9, 2021.
4. Evans R. Demographics and identity in the new WNBA-WNBPA CBA. Available at: https://onlabor.org/demographics-and-identity-in-the-new-wnba-wnbpa-cba/. Accessed February 9, 2021.
5. Gough C. Share of NBA players 2010-2020, by ethnicity. Available at: https://www.statista.com/statistics/1167867/nba-players-ethnicity/. Accessed February 9, 2021.
6. Granderson LZ. Column: NFL’s Rooney Rule still ineffective and needs enforcement. Available at: https://www.latimes.com/sports/story/2021-01-06/nfl-black-coaches-rooney-rule-enforcement. Accessed February 9, 2021.
7. Ramkumar PN, Tariq MB, Amendola A, et al. Risk factors for loss to follow-up in 3202 patients at 2 years after anterior cruciate ligament reconstruction: implications for identifying health disparities in the MOON prospective cohort study. Am J Sports Med. 2019;47:3173-3180.
8. United States Census Bureau. US census bureau July 1, 2019 estimates. Available at: https://www.census.gov/quickfacts/fact/table/US/PST045219. Accessed February 9, 2021.
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