Dr. Ryan D. Wilkins was a physical therapist before he became an orthopedic surgeon.
“The two years I was working full time as a physical therapist, I’m getting all these patients either before they had surgery, if they needed surgery, or afterward, and you’re seeing them three times a week for 45 minutes to an hour, whereas a physician might be seeing that patient every six weeks for 10 to 15 minutes,” he said. “So I think you get a much greater understanding as to what they’re going through as they’re recovering from a procedure. At the same time, I think I’m able to better identify patients who might benefit from non-operative management, who won’t need surgery.”
Wilkins, 37, is an Amherst native who stayed close to home – at the University at Buffalo – for his PT and medical degrees. After medical school he served as a fellow at UB Orthopaedics and Sports Medicine, among other things helping Drs. John Marzo and Leslie Bisson with training duties for the Buffalo Bills.
He joined Excelsior Orthopaedics in Amherst in April, specializing in treatment and surgeries of the shoulders, knees and hips.
The former Amherst High School football and basketball team captain married his high school sweetheart; Dr. Diana Wilkins is a family physician at UB Family Medicine in the Town of Tonawanda. The couple live in Amherst with a son and two daughters.
Q. In your experience, what are some of the most common causes of hip, knee and shoulder injuries?
With regard to the shoulder, far and away the most common source of pathology or pain is the rotator cuff, although patients can develop shoulder arthritis just like the knee or hip, and that may require replacement as well. With regard to the knee, the meniscus is probably the most important source of pain that we see. ACL injuries are the second-most common. In the hip, labral tears are fairly common and there’s a diagnosis called femoral acetabular impingement in the hip joint that can be addressed arthroscopicly, as well.
Q. Has it been nice to go on a similar career track with your wife?
It doesn’t make it any easier for her to be married to an orthopedic surgeon but at the very least being in the field gives her an understanding of what I’m doing. I think that’s very helpful. Having children gives you a great perspective on health care, too. I think it makes you a better doctor. It helps you treat the pediatric population much better. Certainly, you can empathize with the parents of a kid who just tore his ACL.
Q. Why physical therapy to start?
I’ve always been interested in musculoskeletal biomechanics. Physical therapy is a huge part of our profession. For a lot of orthopedic surgeons, it’s a big black box when they send patients. I think I have a greater understanding about what goes on and what I want to happen there.
Q. When did you decide you wanted to become involved in the medical side of things?
Toward the end of my time in school as a physical therapist. While I was out doing clinical rotations, I had the opportunity to shadow some surgeons in the operating room. That’s what really piqued my interests. I distinctly remember my first day in the operating room and thinking immediately that this was something I wanted to do. It was a knee arthroscopy. At that time, I was learning how to rehab people and to strengthen them after they have the operation. Then you see what happens during the operation – how the anatomy gets restored - and that was such a powerful thing. To be able to develop the skill set to do that was the next step for me.
Q. Do you have a spouse or child come in and say, “I’ve been wanting my husband or wife or mom or dad to take care of this for years?”
Absolutely. I saw one today, another physician who told me, “I’m here because my wife said I’ve got to come in and get this looked at.”
Another reason not to avoid seeing a physician is that if you’re having shoulder surgery and you do have a small rotator cuff tear, it’s much easier from a surgical standpoint to deal with a small tear than a large, retracted rotator cuff tear that’s been there for 10 or 15 years.
Q. Can you talk about some of the steps that can be taken short of surgery?
Injectables, physical therapy, anti-inflammatory medications. Activity modification: change your exercise routine, change in regular activities throughout the day to avoid exacerbating something. Sometimes it’s a matter of shutting the inflammatory cycle down and all of those things can do that.
Q. Do improving diet and exercise help?
Absolutely. Especially with knee pain, the American Academy of Orthopedic Surgeons commissioned a panel to look at non-operative management of knee arthritis. The pharmaceutical industry invests millions of dollars each year to come up with anti-inflammatory medications and injectables, and hands-down the thing that makes the biggest difference is weight loss. That has to do with the biomechanics of the knee and the way the forces are magnified at the knee joint. That’s the reason extra weight causes so much pain. Through the patella-thermal compartment of the knee, between the kneecap and the femur, the forces are magnified five times your body weight. If you lose 20 pounds, with every step that you take, that’s 100 pounds less through your knee. That’s why it works well.
Q. Physical therapy also helps?
Therapy has become a very hard sell for us for patients because it’s costly and it’s time consuming, and in order to get good results, there’s a lot of effort involved. The therapy that really works is work for patients. The stuff that feels good – the moist heat and the electric stimulation and the ultrasound – there’s not a lot of proven benefit from those things. So patients have to go to a therapist who’s making them work. If they’re willing to put in the time and effort, a lot of surgery can be avoided. Certainly, if surgery is needed, no matter how good a shoulder surgery is in the operating room, if a patient doesn’t adequately rehab it, they’re not going to get a good result.
Q. So there’s no way around the work and rehab part?
No. It’s absolutely critical. I tell patients, “The surgery restores your anatomy. The rehab restores your function.” You don’t get good, strong, powerful motion if you don’t rehab it – and that’s the ultimate result patients are looking for.
Q. A lot of Bills fans seem to have the impression that the team has a greater percentage of injuries than other teams. Is that true?
I don’t think there’s any truth to that. They’ve had an excellent medical and training staff for a long time. When you lose, injuries become magnified and for the last 16 years, they’ve been losing.
Q. In your sports-related cases, what tend to be the most common injuries and common sports activities you see?
ACL ruptures. In this area, soccer is the most common sport where we see that and they tend to be non-contact injuries. It is more common in females playing soccer than males. There are a lot of theories on that but there are no definite answers. Some of it probably has to do with the female anatomy, perhaps some of the neuromuscular control. There’s even some evidence there’s a hormonal influence that may predispose patients to ACL injuries but a lot of that is not fully understood.
Q. What are some of the ways high school and college athletes, and weekend warriors, can protect their bones and joints?
As far as high school athletes, there are training programs where you try to train the musculoskeletal system how to respond to things that are happening on the playing field. We have programs here that help people do that. You’re basically training the neuromuscular skeletal system to react appropriately to sudden changes in position. As far as the weekend warriors, the biggest way to prevent injuries is not to put yourself into a setting where injuries are likely to occur. There’s no question that as time goes on, we’re more at risk to things like Achilles tendon injuries while playing basketball.
When the knee becomes degenerative, everyone knows that the smooth surface cartilage wears out – that’s what they think of as arthritis – but cartilage weakens as well and it can tear with much less energy than is required for a young, healthy person. That’s why meniscus tears are some common with people in their 40s, 50s and 60s.
Twitter: @BNrefresh, @ScottBScanlon