Abstract
This is a visual representation of the abstract.
Time
Let’s talk about time. For something that superficially appears so intuitive and obvious—I mean, we literally experience it every moment of our lives, right? Everyone does. However, upon closer examination, time proves to be profoundly mysterious.
Scientists and philosophers have struggled with the concept of time for thousands of years, and this struggle has intensified in the last 100 years, particularly with the advent of Einstein’s general theory of relativity, which has shown that time is not absolute, stable, or the backdrop on which everything occurs. It is not universally uniform; it is not constant. I may see that events A and B occur at the same time; they are simultaneous. Someone over here said, no, no, A occurred before B. A third observer may say, no, no, B occurred before A. Very strange, counterintuitive.
So when you dig a little deeper, what exactly is time? We have struggled with this for a long time. It is not even clear whether time is fundamental to our universe or is emergent. Is time a fundamental backdrop on which all events happen, or does it emerge from something even more fundamental? This mystery of time: what exactly is time? Where does it go? It goes into the past. What is the past? Is the past real? Does it exist? Can you go to the past? Can you change the past? Or is it just a memory that does not exist, meaning you cannot go there and you cannot change it, as it no longer exists? We do not know. Where does time come from? Can you create time? Can you destroy time? Can you stop time? Why does time appear to only go in 1 direction? The mathematics of physics suggests that time should be able to flow in both directions, but we only experience it moving in one direction. Why is that? The past appears fixed. Is the future fixed? Is the future already set? If it is, what are the consequences of what we feel is free will? We have so many questions about time, but we really have no idea.
As humans, we experience time in which the past is fixed, the present is distinct, and the future is open and undefined. “Now” is this perception concept that separates the past from the future. Now represents the flow of time. How the future flows into the present and the present flows into the past. Physics cannot explain Now. They have no idea. In fact, Einstein said, "Now is not real; now doesn’t exist." That this flow of time is a human illusion, it is not a reality. He would say that the past and the future both exist currently, and they are equally real. He would say it is like New York and New Orleans. We all accept that New York and New Orleans are real and exist, but we are in Nashville, and we are not experiencing them. Nonetheless, just because we do not experience them does not mean New York and New Orleans are not real. That is what he would say. The same applies to the past and the future. They are here, they are now, and they exist. We are just not experiencing them.
So, this passage of time that we perceive, they would say, is our brain or our consciousness organizing and trying to make sense of all the events in this space-time block universe that we exist in. Clearly, we are still struggling with what Now really is.
What are some of the theories about the past and future? Well, one theory is called presentism. The past is gone. It does not exist. The future has not yet happened. Only Now is real. Only the present is real. On the other end of the spectrum is eternalism—also known as the block universe. That is where the past and the future are equally real. This is Einstein’s universe. Now, a third theory is between those two. It is called the growing block theory, where the past is real and the future is open and undefined, and the past continues to grow as the present becomes the past.
Hubble has shown us that the universe is expanding, and as it expands, it creates new space. That is pretty widely accepted. The growing block theory posits that as the universe expands, not only does it create new space, but it also creates new time. It is this creation of new time that gives us the perception of the present moment, or the Now. This theory is pretty attractive, right? Because it dovetails with our human experience of what time is, but it is not universally accepted, far from it—it has a lot of critics.
It appears that time is Change. Where you see and perceive time, you will see change, and wherever you see change, you are going to perceive the passage of time. There is a very sensitive instrument that can demonstrate that to us. It is called a mirror.
Every now and then, we come across a media piece that illustrates how things change over time. This is one of those media pieces. This media piece is about Moose Machinsky, a football player. I am going to challenge the group here. We are going to play this video, this media piece, and I want to see if you can pick up on how we know that this piece is from the past and not from the present. What is it about this piece that we know “Oh, yeah, that happens then, but that does not happen now”? All right, so here it is. I am going to ask you if you catch it.
“These highlights are brought to you by Lucky’s cigarettes. Nine out of 10 physicians recommend Lucky’s for a cool, smooth after supper treat. Remember, kids, smoke them if you got them, back to the game. In the third quarter, Ohio State’s 140-pound fullback, Moose Machinsky, is picked up and slammed into the ground by two Michigan defenders. Moose, who was not wearing a helmet on the play, would be carted off the field with severe head trauma. But even while bleeding from the ears, a helmetless Moose is back out on the field without missing a single play.”
Did you guys catch that? Some of you guys played football. You picked up that something on that media piece is not current, right? You get it? I thought you would. Moose, the fullback, only weighed 140 pounds. Nowadays, who has ever heard of a 140-pound fullback? That’s crazy—time and change.
Now, a couple of curious facts about time. A photon, that little packet of light, does not experience time. To the photon, everything is instantaneous. So, we sit here and perceive that this photon is emitted from a galaxy and has to travel thousands or millions of years to reach us. We perceive a million years passing. But to the photon, it happened like this, in an instant. Hard to get your head around that. Einstein said that gravity warps space-time, and we have all seen this type of graphic, right? Intuitively, we think that, oh yeah, objects are kind of moving through space because that space is being warped. But on Earth, what we experience from gravity is that gravity actually warps time more than it warps space. The reason the apple falls from a tree and hits the ground is that objects move through slower time. Time moves infinitesimally slower on the ground than it does up in the tree. So the apple wants to move to the ground. Try to get your head around that.
So what is the definition of time? A dictionary definition is that it is a “non-spatial continuum that’s measured in terms of events.” Now wait a minute. Time's measured by events? I thought events were measured by time. So which is it? It sounds like time and events are part of the same thing or incredibly intimately related. If you define an event as a change, then if something changes, that’s an event. Time and change seem to be interchangeable, and potentially, they are two aspects of the same thing. So, does time allow events to occur, or do events allow time to emerge? Many people believe it is the latter. If there is no change, does time even exist? Many people think it does not. If we are going to discuss change, the concept of change introduces another concept from physics—energy.
Energy
What is energy? It is pretty simple. Energy is the capacity to bring about change. It is the ability to create change. If you make a change, you have created an event. So, changes or events require energy, and they are measured by or allow the emergence of time.
Life is a series of events, and even though time is so poorly understood, everyone seems to realize that it is very precious. A fundamental question is how we want to use this non-renewable, constantly diminishing resource. What changes or events do we want to create? We each have time and energy, right? It is fundamental to our existence, as we just discussed.
People often discuss the importance of their health. I would argue that health serves as a proxy for time and energy. If we have poor health, we perceive we have less time and energy. If we have good health, we perceive we have more time and energy. People who claim to prioritize relationships and legacy, well, that is a result of how they spend their time and energy. As individuals, we perceive ourselves as having free will. We can choose how we want to direct our energy.
How do we want to do that? Well, obviously, we want to be happy. That begs the question: “what does it mean to be happy?” Is that the absence of pain, suffering, and disappointment? Most major religions and great philosophers would argue that we cannot avoid pain and suffering on this earth, and that if we want to pursue some sense of fulfillment in life, we need to have a purpose. It is interesting for those of you who heard Coach Urban Meyer’s talk yesterday; remember, he said that clarifying purpose leads to inspiration.
Purpose
If you are going to have purpose, you need to have defined your goals. If you are going to have goals, you need to have defined your priorities.
In my Kennedy lecture a couple of years ago, I discussed the importance of balancing personal and professional rewards. We discussed a six-step plan. The first thing you have to do is make a hard stop in your life and have a very purposeful and thoughtful process.
So, in summary, identify professional opportunities. Define your personal life opportunities. Make a brutally honest priority list. You cannot do everything. Trim that list. Things will evolve. Stop. Reevaluate. Repeat steps 1 through 4 intermittently and accept and be thankful. It will not be perfect, but it will be thoughtful.
We have discussed how you can personally expend your time and energy, but what about collectively? Individuals can contribute their time and energy to a common purpose. That is known as a team. Fortunately, we have an outstanding team in the American Orthopaedic Society for Sports Medicine (AOSSM), which is incredibly high-performing. What has that team been doing with its time and energy? Well, let me tell you.
On the medical publishing side, we have had a transition in leadership. Brett Owens has assumed the role of Editor in Chief of the American Journal of Sports Medicine, and Bruce Reider remains part of our publishing family as Editor in Chief of the Orthopaedic Journal of Sports Medicine. Of course, he continues his Easy Reider podcast. We also named two new associate editors, Miho Tanaka and Michael Freehill. Also, congratulations to Steve Brockmeier and the entire Medical Publishing Board for the Video Journal of Sports Medicine. After just 4 years in publication, the journal’s been indexed by PubMed, one of the first video journals to be so recognized. We are grateful to Ed Wojtys for his leadership and success at the helm of Sports Health. The Journal continues to receive significant recognition, including a new honor announced just Wednesday at our Leadership Dinner, the new Frank and JoAnne Noyes Award of Excellence. Frank Noyes was a leader in fellowship education, a member of the AOSSM Hall of Fame, and a longtime editorial board member of Sports Health. He has established a new award, a $10,000 annual prize for research that advances the safety and injury prevention of female athletes. We are grateful to Frank and JoAnne for their generosity and support of this important area of research.
We are also busy building collaborations, especially with our global partners, including the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS), and the Latin American Society of Arthroscopy, Knee and Sports Medicine (SLARD). We are advancing thought leadership through consensus statements. We are advancing cultural and scientific exchange through our traveling fellow programs, and we host faculty exchange lectures at our annual meetings. Also, we are exploring the possibility of reciprocal membership.
How about our athletic training colleagues? Well, the National Athletic Trainers’ Association (NATA) had a live podcast here at our meeting. We participated in their artificial intelligence virtual media briefing, and we collaborated on their Inter-Association Collegiate Standard of Care Toolkit. What about our physical therapy colleagues? The American Academy of Sports Physical Therapy co-located their meeting with our meeting here in Nashville.
Of course, we are working to build more collaborations and working with the Arthroscopy Association of North America (AANA). Here you see a picture of both societies’ presidential lines. We co-located our board meetings in Phoenix, Arizona, in April 2025, to facilitate more discussion and sharing. What better way to engage in discussions and share ideas than over co-branded hats and bourbon? A special thank you to Allen Curtis from AANA for providing the co-branded hats, and a very special thank you to Jeff Dugas for providing the co-branded bourbon from the Dread River Distillery.
AOSSM and AANA are both proud to partner with the Society of Military Orthopaedic Surgeons on two important programs. For the past 2 years, AOSSM has partnered with the Military Advanced Surgical Training (MAST) initiative. MAST provides research funding to support the development of return-to-duty interventions focusing on biologics and surgical skills. Applications are open now through August 1. Two grants, of $150,000 and $50,000, were recognized at the Summit this November. This spring, the 3 organizations launched a new research mentorship program, known as the Catalyst Program. It is designed to provide early-career clinician-scholars with education and research mentorship to advance their careers. The first class of mentees was announced just 2 weeks ago. Congratulations to Jonathan Hughes from the University of Pittsburgh, Eric Cotter from the University of Wisconsin, and Major Daniel Cognetti from the Burke Army Medical Center. I would also like to thank Travis Maak, who will serve as a Senior Science mentor for this 18-month program.
The future of collaboration between AOSSM and AANA is bright. We have signed a groundbreaking agreement to co-host Specialty Day for the next 5 years, where we will continue to deliver the best from both organizations. We will start in March 2026 at the Academy Meeting in New Orleans, and we have also invited the Pediatric Orthopaedic Society of North America (POSNA) to join us.
At our November meeting, the AOSSM Board approved a partnership with AANA to co-fund a surgical skills construct validity assessment. In a shining example of agility through collaboration, this assessment took place this April with expert and novice surgeons. Phase 2 will be a Fellows Assessment Correlation Study, which will take place the day after the AOSSM Fellows Course in August. I want to thank everyone who contributed to the combined task force.
Sports skills and sports-specific courses provide the opportunity for a deep dive into specific areas of interest. AOSSM has partnered with numerous societies and sports leagues to develop exceptional didactic and experiential learning. The next event in this series is scheduled for this October, when the American Orthopaedic Foot & Ankle Society will join AOSSM at the Orthopaedic Learning Center (OLC).
In addition to our Society partners, AOSSM is proud to receive generous support from our industry partners, with whom we work closely to deliver innovative programming to our members. Our corporate advisory group comprises representatives from our platinum sponsors, and we meet annually with our board of directors to discuss the latest trends in technology and sports medicine. We could not have hosted this meeting without the support of our industry partners. Whether you are getting bonus education from today’s training center presentations, this evening’s dinner sessions, watching surgical demonstrations in the OLC Mobile lab, or discovering some of the latest innovations from more than 100 exhibitors in our Field House. I encourage you to engage and soak up everything you can.
We are also reaching across borders to develop new opportunities for other societies. Earlier, I mentioned some of our international and allied health partners. I would also like to mention a few additional collaborations. One is the Playmaker Grant Competition, taking place on the turf in the Field House today at 9:30, which is supported by the Aircast Foundation and the Haslam Sports Innovation Center. Incidentally, the Aircast Foundation just extended its support to AOSSM by >$600,000 through 2030.
We have concurrent sessions today with The Forum and the J.R. Gladden Society, and everyone is invited to the Gladden Society’s Annual Meeting and the Shields Lecture this evening. Next year at our annual meeting in Seattle, we are excited about the Biologics Symposium, presented by the Academy in collaboration with the Biologic Association, and this list goes on and on.
In 2024, we partnered with the American Shoulder and Elbow Surgeons (ASES) for the Specialty Day in San Francisco. In 2025, we will host two events with the American Orthopaedic Foot & Ankle Society (AOFAS): in March, we will hold a successful combined specialty day in San Diego, and in October, together we will provide a hands-on skill course at the OLC. As we move forward, it will be crucial for us to ensure that our colleagues in other subspecialties, as well as general orthopaedists, have access to high-quality team physician education and training. Membership in AOSSM includes Safe Sport training and the Collegiate Standard of Care Toolkit, which I have already mentioned. In a minute, I am going to show you how our new virtual Team Physician series is progressing. Quality team education will be a hallmark for AOSSM.
This afternoon, we welcome back representatives from each of the major professional sport team physician groups for the second annual Professional Sport Physician Coalition meeting held here at our annual meeting. We will be joined this year by leadership from the National Collegiate Athletic Association (NCAA), the American Academy of Orthopaedic Surgeons (AAOS), the American Medical Society for Sports Medicine (AMSSM), and the National Federation of State High School Associations (NFHS). They will get together for an in-depth discussion on issues that face team physicians.
What about education? Thanks to the leadership of Tim Miller, an impressive list of faculty, and the hard work of the AOSSM Professional Team, the “Team Physician” series is now here. This is a new virtual series—it is on demand, interactive, and modular. We have just published the third of 5 modules, with the final 2 modules scheduled to be released by the end of this calendar year.
We want to enhance the value and participation in the Sports Medicine Subspecialty Certification. I think this is existential for this society and our field. Working with the American Board of Orthopaedic Surgery (ABOS), surgeons can now take the Orthopaedic Sports Medicine Subspecialty Certification examination immediately after completing their fellowship, rather than waiting 2 or 3 years. We think this removes a hurdle for those candidates who wish to be subspecialty certified. Also, I want to recognize and thank David Martin, the ABOS Executive Director, for helping to make this happen. We are very excited to have over 360 candidates scheduled to take this examination in early August.
To help our candidates prepare for the examination, we have launched a new review course. It will be held on Sunday following the annual meeting. I would also like to thank Mark Miller for organizing and directing this new review course.
Thanks to Dean Taylor, who helped roll out the Boosting Orthopaedic Leaders’ Development (BOLD) program in 2023. Over the last 2 years, 18 early-career playmakers have received executive coaching, mentorship, and education, and they worked in small groups to develop proposals for projects to serve AOSSM members and our patients. These proposals were presented at a concurrent session yesterday. Here in Nashville, we welcome our second BOLD cohort, a new group of 18 surgeons, to kick off their BOLD experience. Congratulations to all the participants, and thank you to all who supported this program. We look forward to seeing what those playmakers will accomplish.
I want to welcome this year’s Resident Scholarship winners to Nashville. They have a curated itinerary of sessions, instructional courses (ICs), and networking opportunities. In 2024, we sent 1 resident. This year, we have 8 recipients thanks to generous donations to AOSSM. In particular, we are grateful to Michael Axe, whose $10,000 gift made it possible to bring 6 residents. The Council of Delegates is committed to raising funds for four additional scholarships in 2026.
However, resident scholarships only scratch the surface. I believe we had over 200 attendees at our third annual Residents and Fellows Forum. We have sold out our fellows course every year at the OLC. We offer free membership to fellows, residents, and medical students, a new benefit introduced this year. We also provide scholarship pricing for our annual meeting and other courses. We have already discussed our surgical skills assessment. We are very proud to be the preeminent provider and leader in early career education.
How about research? Well, if you were in this room yesterday, you heard Ben Ma, the chair of our research committee, present our largest grant to date, a $500,000 award from the Arthritis Foundation. It was a result of the 2024 think tank in Denver. It will support a multicenter trial dedicated to shoulder arthritis. We hope to have similar great news from this past Wednesday’s think tank on hip arthritis in time for next year’s annual meeting in Seattle. Thank you to all who participated and particularly to the Arthritis Foundation for their vision and generosity. Let’s recognize the finalists from this competition and offer congratulations to the grant winners just announced yesterday, Michael Davies, Brian Feeley, and Robert Tashjian.
Research is so integral to the mission and daily work of AOSSM. I have already mentioned so many achievements rooted in our research agenda—including the AOSSM Arthritis Foundation think tanks and multicenter grants, the Catalyst Research Mentorship Program, the MAST Initiative, and the Playmaker Grant Contest. However, we cannot overlook our Return to Play grant, which was awarded at this meeting last year. This is a partnership among AOSSM, The Forum, and the Gladden Society, supported by Arthrex and the Aircast Foundation, exemplifying collaboration that drives innovation and discovery.
Several times a year, our Research Committee grants Bart Mann Awards to our members who serve as National Institutes of Health (NIH) reviewers. Additionally, on Sunday here in Nashville, our Research Committee will hold its third annual research workshop, with this year’s focus on how to jumpstart your research career in various practice settings. Last year, they focused on partnering with industry for research, and the year prior to that, they brought in guests from the NIH and other government agencies to share insight on how to pursue government research funding successfully.
I would like to extend a special thank you to Dr. Ben Ma, who served as our Chair of the Research Committee for the past 3 years. I would like to thank him for his leadership and the service of all the committee members. This is an often invisible but integral, vital part of our society. Thank you.
Not only do we fund grants to support research and educate early-career clinicians in research techniques, but we also like to recognize outstanding research. We have 6 research awards and 12 publication awards, and I would also like to recognize AOSSM’s awards for outstanding efforts in education and community service.
What about the future? Well, I think the future is exceptionally bright for AOSSM. I anticipate that we will continue our efforts to promote inclusive membership, expand our innovative educational initiatives, and explore new research collaborations. We will expand our efforts to be the home for all orthopaedists who care for athletes. We will expand our societal collaborations as a world leader in sports medicine.
Now more than ever, clinician researchers are relying on organizations like AOSSM to drive the future of discovery. Your donation supports research grants, traveling fellowships, resident scholarships, sports medicine fellowship education, the BOLD Program, and many other initiatives. These are just a few of the reasons I choose to support AOSSM with a donation every year; I urge you to consider doing the same.
Gratitude
For those of you who were at the Academy this year. You may have noticed that gratitude was a recurring theme in Paul Tornetta’s presidential address, and I echo his comments. We live in a great time, in a great country, in a great profession, and in an outstanding society. With all the outstanding achievements I have just listed, we clearly have a lot to be thankful for. I would like to begin with our professional team. This is an exceptional group of professionals who take great pride in our society, and they strive to keep themselves, our society, and our members at the top of their game. I could not be prouder to be associated with this team. They perform so well. In fact, they do so much that I am not sure what our Chief Executive Officer (CEO), Greg, has to do. They are doing it all. I am just kidding. Obviously, building a team is a challenge, and building a high-performing team is a significant challenge. So, a big thank you to Greg for building this exceptionally high-performing team. Thank you.
I would like to recognize our Board of Directors, who contribute countless hours to ensure that AOSSM continues its path of innovation, excellence, and leadership. They take their role as stewards of our great society very seriously.
Where would we be without our committee chairs and their commitment to excellence? Thank you. And we are blessed to have a very engaged membership. We have nearly 300 members who serve on committees. I want to recognize our presidential line. I am sure you recognize them from these time-warped photos. You recognize Dean Taylor? How about Mark Miller? Who’s this guy, Eric McCarty? And Rick Wright. I would like to thank them all for their exceptional commitment to AOSSM and for being so generous with their time and insight in supporting both the society and me over the past year.
I want to recognize our program chairs. I am sure you recognize Lutul Farrell and Grant Jones. I would like to thank Lutul, Grant, and the professional staff, especially Jenny, Marisol, Jamie, and Kaitlyn, for the incredible task of organizing both Specialty Day and this annual meeting. Thank you.
Also, I cannot forget my home team, anchored by my wonderful wife, Christine. None of us in this room would be where we are without the support of a spouse or loved one. And I want to thank Christine for being that anchor of support not only for me, but also for our family. Christine, thank you for your unwavering support over the years.
I recommend that everyone in this room find a mentor or be a mentor. I would be remiss in discussing mentorship if I did not recognize my mentor, Dr. John Bergfeld. He has been advising me for over 35 years. I also encourage you to support and mentor others in your professional journey. Join a team or create a team. There is an African proverb, “If you want to go fast, go alone. But if you want to go far, go together.” Working with other people and building a team is not easy. You have conflicting agendas, different levels of commitment, and complex human interactions. Who is going to get the credit? There are different perspectives and different skill sets. You have egos, you have trust issues, logistics, clarity of structure, and different priorities.
However, I encourage you not to be intimidated, but also not to be naive. If you build a team, be thoughtful and seek advice. A team is a high-performing interaction of moving parts that requires careful construction and diligent maintenance. And though challenging, it can be incredibly rewarding. I also encourage you to make that hard stop every now and then in life and go through that thoughtful and purposeful process to prioritize your personal and professional priorities and be grateful.
I want to thank my bride, then and now, one more time for sharing her precious time with me for the last 44 years. Thank you, Christine.
Now, we don’t have much time on this earth, so please enjoy the journey because time waits for no one, and it is later than you think.
Thank you for your time.
Footnotes
This article has been copublished in The American Journal of Sports Medicine.
Presented at the annual meeting of the AOSSM, Nashville, Tennessee, July 2025.