When elite athletes walk into an orthopedics clinic after a major injury, they sometimes find the road to pain minimization and restored peak performance to be a forked path.
For Prem Ramkumar, MD, medical director of technology and clinical innovation and a hip and knee surgeon at Los Angeles-based Commons Clinic, and Scot Prohaska, a sports performance consultant, that divide has never made sense.
Together, Dr. Ramkumar and Mr. Prohaska have built a tightly integrated model that combines precision surgery, high-performance coaching and advanced rehabilitation, and it’s already reshaping what athletes believe is possible after injury.
A surgeon, a coach and a shared philosophy
The partnership began, unexpectedly, with a bad hip. Mr. Prohaska, a former athlete, had spent years pushing his body through elite competition. Eventually, his hip started to fail him, and he sought an alternative approach to what he found in traditional orthopedics.
“I was looking for the best hip surgeon,” Mr. Prohaska said. “I didn’t just want someone to get me walking out the door pain-free. I wanted a high-performance approach, someone who understood athletes and the biomechanics behind why things break down.”
Dr. Ramkumar’s name surfaced repeatedly.
When the two met, they aligned immediately. Dr. Ramkumar explained how the same anatomy that once served an athlete at the highest level often becomes a liability in adulthood — a concept that clicked for Mr. Prohaska.
“What he described made so much sense,” Mr. Prohaska said. “It wasn’t just ‘fix the joint.’ It was performance surgery with the expectation that I would come back highly functioning, not just functional.”
Dr. Ramkumar performed Mr. Prohaska’s surgery, and just twelve days later, Mr. Prohaska walked into a meeting so fluidly that colleagues assumed the operation hadn’t happened yet.
“They were stunned,” he said. “That’s when I knew this was different.”
An offense-and-defense model for athlete recovery
What emerged from that experience is now the core philosophy behind their partnership: shared expectations, constant communication and a refusal to accept “good enough” recovery.
Mr. Prohaska describes it using a game-day analogy.
“I’m on offense, pushing to get athletes back to the field,” he said. “Prem’s on defense, making sure the repair is protected, that there’s no swelling, no complications. When offense and defense talk constantly, you get a great game plan.”
Expectations, they both emphasize, are set far above the norm. Their aim is not simply restoring activities of daily living — the bar that defines most traditional orthopedic care — but rebuilding the athlete’s entire kinetic chain to prevent reinjury and maximize long-term performance.
“Most athletes aren’t hurt just because a joint failed,” Mr. Prohaska said. “It’s their sequencing, the biomechanics of how everything works together. If we retrain only the hip or only the knee, we miss the actual cause. Addressing the entire movement pattern is where athletes get not just recovery, but transformation.”
Performance never stops
One of the most distinct features of the Ramkumar-Prohaska model is that training in other areas doesn’t pause while one joint is healing.
“If Prem has to fix one joint, why stop training the rest of the body?” Mr. Prohaska said. “Performance doesn’t have to stall because recovery has begun.”
That mindset is especially powerful for elite athletes, who often struggle mentally with periods of inactivity.
“Athletes gain a lot of confidence when they feel like they’re still getting better during rehab,” Mr. Prohaska said. “If we can keep improving performance in other areas while we’re rehabbing one joint, they show up more, push more and keep a positive, growth-minded outlook.”
This performance-oriented approach to surgery, therapy and training creates what Dr. Ramkumar calls a “complete handoff,” eliminating the fragmented journey many athletes face once they leave the operating room.
A surgeon usually has a trusted physical therapist, he noted. Some may even have a trainer. But almost no athlete has a performance coach guiding them toward the finish line from day one.
“With Scot, they see the full pathway early,” Dr. Ramkumar said. “Not just walking pain-free, but catching a 200-mile-per-hour puck, landing a jump, returning to game-speed decision making. And that specificity builds trust.”
A referral center for elite sport — and complex cases
The partnership’s reputation has spread quickly across professional leagues. Their patients now include athletes from the National Hockey League, USA Water Polo and Major League Soccer, among others. Increasingly, they also serve as the second, third or even fourth opinion after poor surgical outcomes elsewhere.
“It makes the handoff back to their regular ecosystem so much smoother and so much easier,” Dr. Ramkumar said. “These athletes have confidence, and their teams have much more confidence, because we’re a dense, small network with rich experience between us.”
The future of performance-driven orthopedics
Dr. Ramkumar believes the field is on the brink of a broader shift — one that unites surgeons, performance coaches and sport-specific metrics to guide patients through recovery.
“They don’t always see that positive connection between a surgeon putting you through a major life event and a performance coach trying to get you back to where you were before,” he said. “Without that connection, the transition is choppy and hard, and it doesn’t give confidence to anyone.”
For Dr. Ramkumar and Mr. Prohaska, the vision is to build the model they wish existed across the industry.
“The expectation,” Mr. Prohaska said, “is that you come back better than you were before.”
