BLOG: Joseph S. Torg, MD - profile in character and courage
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The world lost one of the most influential figures in orthopedics on Dec. 15. Joseph S. Torg, MD, regarded by many as the father of modern sports medicine, succumbed to chronic illness with his family present. He was 88 years old.
Torg was simply grit incarnate and he demonstrated what one can achieve in a single lifetime when passion and perseverance prevail. He possessed unusual vision and was truly a monumental positive agent for change in orthopedics. He sparked cataclysmic paradigm shifts in patient care, which still benefit innumerable athletes today.
Torg hailed from a blue-collar Philadelphia neighborhood, where young men often settled disputes with their fists rather than diplomacy. He was a gifted child and enrolled in Central High School, known for its rigid admission criteria. There, he excelled in the classroom, as well as the gridiron as an undersized lineman, Torg’s play was characterized by toughness and the frequent use of bare knuckles. By a stroke of fortune, he was granted an opportunity to transfer to the prestigious William Penn Charter School where his true academic potential was realized. This led to his enrollment in the exclusive Haverford College, where he competed as an undersized offensive tackle. His hard-nosed feats on the gridiron at Haverford earned him mythic status.
Impact of mentors
Torg received both his medical and orthopedic training at Temple University Hospital, where he was blessed to have two colossal mentors, Howard H. Steel, MD, and John W. Lachman, MD, who helped form Torg into a brilliant clinician and surgeon. Torg’s clinical acumen and self-assuredness was so profound that he quickly became the head team physician for Temple Athletics, a position he held with distinction for many years. His unique abilities were noted by then head athletic trainer at Temple, Theodore “Ted” Quedenfeld, who inquired if Torg would be interested in providing free care to athletes in the School District of Philadelphia. Torg agreed and the ensuing partnership was the true genesis of the academic sports medicine model for care.
Torg possessed a keen and inquisitive mind, which prompted him to question existing paradigms. This, coupled with quantum grit and determination, resulted in a tsunami of positive change in sports medicine. For Joe Torg, once he had an idea, nothing, and I mean nothing, would stop him from translating theory into action. His integrity was exceptional. He dedicated his life to simply doing what was right. He became especially passionate about any injustice, whether it was unnecessary injury or surgery.
Here are two examples of seismic shifts in orthopedics this one man affected:
- Torg recognized that early shoe cleat designs afforded dangerously high levels of grip on artificial turf and resulted in many catastrophic knee injuries.
- Torg, along with Quedenfeld, in 1971 published groundbreaking research on the cleat/turf interface, which resulted in the transition to the modern soccer shoe cleat design. Subsequently, countless knees have been spared catastrophic injury.
Cervical spine work
Torg observed that many severe cervical spine injuries were the result of “spearing,” a tackling technique that involves a violent head-first launch. His proof-of-concept work on the effects of axial loading on the spine resulted in material rules changes in football. In 1975, he established the National Football Head and Neck Injury Registry, which proved, without a doubt, that tackling technique mattered. His work has spared innumerable contact athletes from devastating spinal cord injury and paralysis.
Similarly, Torg recognized the relationship of cervical canal stenosis and transient quadriplegia, as well as extension compression “burners,” which are also called stingers. Torg’s recommended use of a Cowboy Collar has protected many “neurons” from trauma.
Furthermore, Torg challenged the existing paradigm for treatment of traumatic unilateral and bilateral facet dislocations. Rather than adopting a wait-and-see attitude about these injuries, Torg passionately advocated for the immediate reduction and stabilization of these dislocations and reported that neurologic recovery was indeed possible.
Torg learned from his mentor Lachman a simple and reproducible method to diagnose an ACL tear. Torg described this test in his landmark article in 1976, and in typical upright fashion, ordained this particular exam the Lachman test to honor his mentor. This is simply the single most cited test in orthopedic literature and has enabled contemporary surgeons to accurately diagnose and treat ACL tears in expedient fashion.
Torg ardently researched stress fractures of the tarsal navicular and recognized that the vast majority of these fractures healed with non-weight-bearing cast immobilization. He crusaded against the zealous use of surgery for this condition and had the data to back up his opinion.
Malpractice crisis, return to play issues
He was especially impassioned about combating the malpractice crisis that beset Philadelphia surgeons in the 1980s and 1990s. His mantra to fight this malady was the adage, “the best defense is a good offense.” He was known to countersue plaintiffs of frivolous lawsuits. This resulted in the dismissal of some claims.
Lastly, Torg questioned the current return to play criteria and recognized that many athletes, with the proper protective devices, could, in fact, safely return to play much earlier than what established standards dictated. Torg treated stress fractures with a graduated activity regimen rather than complying with the contemporary dictum of 3 months of total rest. Hand, and even some forearm fractures, were treated with protective devices, and scores of injured football players successfully completed seasons under his watch. Transient quadriplegia of the cervical spine did not necessarily require abstention from play. Thus, countless athletes were able to return to contact sports under the “Torg Plan.”
Torg’s heart was always with the poor. He would go the extra mile for the undeserved and the uninsured. He spent countless hours devoting charity care to patients at Temple University Hospital, St. Christopher’s Hospital for Children and Shriners Children’s Hospital in Philadelphia. With his wife, Barbara, Torg funded two distinct scholarships to fund undergraduate and graduate medical education. He was noted to spend extra time with patients and did whatever was in his power to restore them to wellness.
These are only some of the material accomplishments of this fearless man.
I have revered Torg. He has served as the ultimate exemplar for me in the power of perseverance. He was the ultimate clear thinker and for years he provided me with wise counsel. He truly was a mentor for the ages.
I hope to pass on to future generations the lessons this warrior for good, Joseph S. Torg, MD, imparted to me:
- Do what is right, period, and let no one stop you.
- Truth and justice trump and override diplomacy.
- Approval of others means nothing, especially when compared to enacting what is right.
- Always question current paradigms.
- Take risks. Fortune does favor the brave.
- Never, ever quit, especially when you are working for a worthy cause.
- And finally, believe in yourself. If you don’t, no one else will.
I have never met anyone like Joe. His confidence, toughness and willingness to do right, regardless of the fallout, is forever imprinted upon my consciousness. He has accomplished more for our beloved vocation of sports medicine than anyone who has graced this earth — all in the name of benevolence and defending the vulnerable.
If anyone has ever donned a football uniform or engaged in a contact sport, they have benefitted from this giant who has very possibly shielded them from potential catastrophic cervical or knee injury.
My hero: Requiescat in pace.
Joe, you served the world with distinction.
Reference:
Torg JS, et al. Am J Sports Med. 1979;doi:10.1177/036354657900700209.