Sports Medicine

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Sports Medicine2017-09-07T21:28:51+00:00

Sports Medicine

Whenever people test the physical limits of their bodies, there is a risk of injury. Those injuries can be due to biomechanical derangements of an athlete’s musculoskeletal system or contact related, and:

sport medicine image from New Medical Terms

Flag football, children

• Minimal, due to contact with a forgiving surface–e.g., water in high diving,

• Minor, due to a somewhat forgiving surface–e.g., Astro-Turf or a fellow athlete’s soft parts, or 

• Potentially life-threatening, due to high velocity impact with a completely unforgiving–e.g., the rink wall in ice hockey or a fellow athlete’s not-so-soft parts. 

Obviously, the injuries suffered by a particular group of athletes will be typical for their sport. Partial and complete ACL tears are common in American and league football, basketball, and skiing, but are hen’s tooth rarities in golf. Rotator cuff injuries are common in overhead athletes–e.g., baseball players, especially pitchers, tennis players and archers, but uncommon in track athletes or professional ice hockey players. As with any skill-based–e.g., tennis, golf, or aerobic training-contingent–e.g., running, bicycling, swimming activity, regular practice will reduce the risk of injury.

Worldwide, there are far more amateur athletes–the so-called weekend warriors–than professionals. The subspecialty of sports medicine*, at least in the US, is tailored to meet the needs of part time athletes and requires prior board certification in a field of primary care–e.g., emergency medicine, family medicine, internal medicine or pediatrics, followed by a one year post-primary care fellowship in sport medicine. 

*Also known as sport and exercise medicine

Caring for amateur athletes is the polar opposite of the care needs of professional athletes for whom the stakes are infinitely higher. It’s one thing for the team physician* to bench a high school junior unlikely to get a football scholarship to college for the rest of the season because of a sprained ankle. It’s a completely different ballgame (no pun intended) when one of the team’s orthopedic surgeons decides to sideline the club’s multi-million dollar MVP, on whose skills a championship title—and his own paycheck—could hinge, for the same ankle sprain.  

*Who has a busy family practice in town and serves as the doctor for several teams. 

PET imaging, brain, Image from New Medical Term

PET in chronic traumatic encephalopathy

The stakes are higher in professional ball for the athletes…and the training for the physicians who care for them is much longer. A physician certified in Sport and Exercise Medicine has trained for three years in primary care and had a one-year fellowship in sport medicine, i.e., 4 years post-medical school. In contrast, a physician certified in Orthopaedic Sports Medicine has had a residency of five years in orthopaedic surgery and a one to four-year fellowship in orthopaedic sports medicine, i.e., 6 to 9 years post-medical school. That extra time includes specific training in soft tissue biomechanics, injury healing, and repair; surgical and non-surgical management of sports-specific injuries and competition; rehabilitation methods that enable the athlete to return to competition as quickly and safely as possible; and intimate knowledge of athletic equipment and orthotic devices (braces, foot orthoses, etc.) and their use in preventing and managing athletic injuries.

An unknown factor in the practice of either form of sports medicine will be how the oversight bodies for professional and amateur athletes respond to the scepter of chronic traumatic encephalopathy (CTE), the histopathological changes of which are seen in nearly 100% of the brains of former football players (bottom image is a PET scan of normal person (left), former NFL player with CTE (middle) and a patient with Alzheimer’s disease (right). It appears likely that these changes will be seen other professional athletes exposed to head trauma, either by direct contact with other athletes, as occurs in rugby and ice hockey or with the ball itself, when league football (soccer) players “head” the ball.  Helmets clearly aren’t the answer and banning an entire sport for health and safety reasons would be as likely as Donald Trump becoming President of the United States.