NBA, Atlanta Hawk's Director Michael Roncarati Gives Thoughts On How to Innovate Sports Medicine

Recently, Lauren Jarmusz -- a Doctor of Physical Therapy (DPT) -- and I interviewed Dr. Michael Roncarati, PT, DPT, CSCS, who is the Director of Rehabilitation for the NBA Atlanta Hawks. Michael oversees all rehabilitative efforts and daily treatment plans for the athletes and assists with programming and coaching for the strength and conditioning programs. Michael graduated with his Doctor of Physical Therapy (DPT) from Northeastern University in 2011. He has spent the past 3 basketball seasons working in the NBA. Before working with the Atlanta Hawks, he worked for the Golden State Warriors. Prior to that, Michael worked as a Physical Therapist (PT) in an outpatient clinic for two years and various gyms as a strength and conditioning coach for 6 ½ years. See our interview below:

Marquis Cabrera: Why did you switch from the Golden State Warriors to the Atlanta Hawks?

Dr. Michael Roncarati: Deciding to leave Golden State was tough; they’re a great team and organization, and I had a fantastic experience there. However, I trusted that this was the right move for me because of the vision outlined by the Hawks organization. The opportunity, in my opinion, provided by the Atlanta Hawks is unprecedented in American professional sports. They chose an Executive Director, my friend and colleague, Keke Lyles, who was given the freedom to build a staff that he knew would coalesce well; provide exceptional athlete medical care and performance opportunities; and could become a model for the rest of pro sports.

Marquis Cabrera: Did you always want to be a PT in a pro sports division?

Dr. Michael Roncarati: No. I have always cared more about being in a good environment with principled and like-minded people who push me, who I can learn from, and put the person they are serving before themselves. The fact that I am in pro sports and am surrounded by likeminded people is wonderful.

Lauren Jarmusz: What is the difference in working in a traditional physical therapy firm versus a sports medicine practice?

Dr. Michael Roncarati: The biggest difference is how often we get to see the patient. In pro sports, we get to see our patients daily. It allows us to really forge a good relationship with the player. We get to know each player’s body by understanding how it reacts to loading and focus on many different objectives in different realms throughout the season.

Marquis Cabrera: How often are you working to prevent injury versus reacting to player injuries?

Dr. Michael Roncarati: Though we are proactive, when players have 4 games in 5 nights, or play 2 overtime games in a row, we may have to be reactive. Any loading significantly over an average is going to predispose our athletes to injury.

Lauren Jarmusz: From your perspective in sports medicine, what do you believe are some persistent problems impeding innovation in the physical therapy field?

Dr. Michael Roncarati: Being part of a team and a large organization raises the stakes, puts it on a bigger stage, and makes it about being something much bigger than any one person. Because of this, it would be nearly impossible to go from pro sports realm back to the clinic. This has much less to do with the types of people or conditions I would see on any given day, and has much more to do with the constructs of insurance, the volume of patients seen on any given day, the business models many private PT clinics need to enact to sustain a business, and other manifestations of a health care system that needs a lot of work.

Just as we, the Physical Therapists, need to be better educated and strive to improve our understanding, we need to have a more knowledgeable population and a society that promotes health and wellness. Without education, consumers within the healthcare system become easy targets for dogmatic claims or sales pitches to those invested in a commercial model, product, or narrow mindset.

People should be able to see a PT if they have had positive experiences with one prior or have a desire to see one. I do not think an MD referral should be required to see somebody one credits in improving their quality of life. Patients need context and they need Physical Therapists to connect dots.

Marquis Cabrera: How do you hold patients/athletes accountable?

Dr. Michael Roncarati: You can have an awesome treatment plan, but if it is not executed outside of the 30 minutes, twice a week that you see them, it will most likely be all for naught. We need to make them understand how this will help them and then show them with results and examples. Each patient has to be the driver of their individual health... they are essentially holding all the power to their care.

Lauren Jarmusz: Do you have recommendations on how to improve the physical therapy profession?

Dr. Michael Roncarati: Physical therapists must get patients to buy into the treatment by paying more attention to patient interaction and clearly addressing underlying factors relating to their impairments by integrating all aspects of physiology. We have to be more principled, more rooted in physiology.

It is important we start to look outside of just musculoskeletal health for expertise. We can use collaborative networks and refer patients to chiropractors, nutritionists, psychologists, etc., to address all aspects of one’s health that may be manifesting in musculoskeletal problems. This will include how nervous, immune, cardiovascular, and respiratory systems fit in, and where psychology, cognition, or the patient’s beliefs and past experience comes into play. We need to better understand how these are all related and should certainly impact how are patients are treated.

Lauren Jarmusz: What do you think of the move towards preventative based care versus reactive care in the Physical Therapy space?

Dr. Michael Roncarati: I’m all for preventative care and this term has various layers to it.

On small scale, I do see benefits in seeing a specialist in orthopedic health regularly to identify potential risks people may be subjecting themselves to with their activities of daily living. On macro level, if people were healthier, we would probably be treating less people for musculoskeletal pain or physical limitations during daily activities. If we moved more, sat less, got better sleep, ate higher quality food, and weren’t overly-stressed from home or work demands, we would have a much more robust society, more impervious to the common maladies we see so frequently in Western societies.

Lauren Jarmusz: PART I: In the future, can you see DPTs acting as primary care providers, specifically for musculoskeletal health. PART II: Do you believe the traditional paradigm of PT care will transition from “treating a patient and hoping to never see him/her again for that specific injury” to a model, similar to athletic training, in which a PT would work with a patient throughout his/her life on all aspects of musculoskeletal care.

Dr. Michael Roncarati: I hope we, Physical Therapists, can become PCPs for musculoskeletal care, but we must improve our standards, expand our education, and further develop our ability to become effective PCPs. I like the idea of a model that allows consumer choice, freedom and options to go to who they want, when they want, and get what they want. Injury is multifactorial so to think you will never have to see the person again because they have achieved whatever discharge criteria you set is definitely short-sighted.

The state of the musculoskeletal system changes whether it is at rest, moving, asleep or anesthetized and it will change from second to second based on the environment or task at hand. It is important to keep in mind that fitness is also task specific so it is imperative that the therapist is addressing all aspects of an individual’s lifestyle.

Marquis Cabrera: It seems as if regular preventative- musculoskeletal care exams are commonplace for elite athletes, and for their optimal athletic performance. Do you think an annual physical exam for muscles and bones designed for the general public (people who are recreationally active) would increase patient education and decrease prevalence of musculoskeletal disorders and diseases?

Dr. Michael Roncarati: If we are allowed to have annual physicals or teeth cleanings every 6 months we should be able to be proactive with our musculoskeletal health and see a PT annually or semi-annually at the cost of our insurance. That being said, cause of injury is too multivariate for me to say with 100 percent confidence that it would decrease the prevalence of musculoskeletal disorders and diseases.

Marquis Cabrera: Since you have worked with both athletes and non-athletes. What aspects of physical therapy/ athletic training/ health & wellness lifestyle techniques/treatments used with athletes more generally can be applied to help prevent musculoskeletal injury for the lay citizen?

Dr. Michael Roncarati: Weekend warriors, non-athletes/lay people need to be more mindful and “learn” about how their bodies work, how to access movements, muscles, and positions and understand that it’s a long process. Lay people should explore and attempt to access new ranges of motion of every joint in their body in all different postures. When competency can be demonstrated in isolation, try to integrate it with other joints, the whole body and eventually subject it to greater forces, speeds, excursions and volumes.

Lauren Jarmusz: What advice would you give to student Physical Therapists looking to work for a pro sports team?

Dr. Michael Roncarati: Learn a lot, push the envelope, find your passion, be humble, and be willing to work for free. Most people get into pro sports through grunt work; internships, and willingness to do a lot of “menial” work with the knowledge it will probably pay off in the end if you go about it the right way. You have to know someone in pro sports- management, colleagues, or players, if you want your way in. While I never did any direct internships in the NBA, I did do many unpaid internships, networked, observed great coaches, studied independently, worked very hard, and developed a systematic approach that best conveyed my talents, knowledge, past experiences and skill set to patients and employers.

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