Sports medicine

Editors-In-Chief: Robert G. Schwartz, M.D. [mailto:RGSHEAL@aol.com], Piedmont Physical Medicine and Rehabilitation, P.A., Paul Tortland, D.O., Assistant clinical professor at the University of Conneticut Health Center, Dept of Internal Medicine

Overview
Sports medicine specializes in preventing, diagnosing and treating injuries related to participating in sports and/or exercise, specifically the rotation or deformation of joints or muscles caused by engaging in such physical activities. The sports medicine "team" includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, as well as the athlete himself/herself. Because of the competitive nature of sports, a primary focus of sports medicine is the rapid recovery of patients, which drives many innovations in the field.

Sports medicine has always been difficult to define because it is not a single specialty, but an area that involves health care professionals, researchers and educators from a wide variety of disciplines. Its function is not only curative and rehabilitative, but especially preventive.

Despite this wide scope, there has been a tendency for many to assume that sport-related problems are by default musculoskeletal and that sports medicine is a physiatry or an orthopaedic specialty. There is much more to sports medicine than just musculoskeletal diagnosis and treatment. Illness or injury in sport can be caused by many factors; from environmental to physiological and psychological.

Consequently, sports medicine can encompass an array of specialties, including cardiology, pulmonology, dermatology, ophthalmology, rehabilitation medicine, orthopaedic surgery, arthroscopy, exercise physiology, biomechanics, and traumatology. For example, heat, cold or altitude during training and competition can alter performance or may even be life threatening. The female triad of disordered eating, menstrual disturbances, and bone density problems, and the problems of pregnant or aging athletes demand knowledge from many diverse fields. In addition, the management of endocrinological diseases and other such problems in the athlete demands both medical expertise and sport-specific knowledge.

The use of supplements, pharmacological or otherwise, and the topics of doping control and gender verification present complex moral, legal and health-related difficulties. Further unique problems are associated with international sporting events, such as the effects of travel and acclimatization, and the attempt to balance an athlete's participation with his or her health. Much of this draws on new fields of study, in which extensive clinical and basic science research is burgeoning.

Sports medicine in the United States
The Sports Medicine specialist, either an Orthopedist or a Primary-care Sports Medicine specialist, is usually the leader of the sports medicine team, which also includes physician and surgeon specialists, physiologists, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.

Doctors wishing to specialize start with a primary residency program in family practice, internal medicine, emergency medicine, pediatrics, or physical medicine and rehabilitation. Then, they generally obtain one to two years of additional training through accredited fellowship (subspecialty) programs in sports medicine. Physicians who are board certified in one of the preceding displines are then eligible to take a subspecialty qualification examination in sports medicine. Additional forums, which add to the expertise of a Sports Medicine Specialist, include continuing education in sports medicine, and membership and participation in sports medicine societies.

Sports medicine has been a recognized subspecialty of the American Board of Medical Specialties since 1989. Currently there are more than 70 sports medicine fellowships and approximately one thousand certified Sports Medicine Specialists in the United States.

History
The origins of sports medicine lie in ancient Greece and ancient Rome where physical education was a needed aspect of youth – training and athletic contests first became a part of everyday life during these times. However, it was not until in 1928 at the Olympics in St. Moritz, when a committee came together to plan the First International Congress of Sports Medicine, that the term itself was coined. In the 5th century, however, the care of athletes was primarily the responsibility of specialists. These were trainer-coaches and were considered to be experts on diet, physical therapy, and hygiene as well as on sport-specific techniques. The first use of therapeutic exercise is credited to Herodicus, who is thought to have been one of Hippocrates' teachers. Until the 2nd century AD, when the first "team doctor", Galen, was appointed to the gladiators, the physician only became involved if there was an injury.

Whether or not there was good communication or rapport between the trainer-coaches and the team physician back then is a matter of speculation. What is clear, however, is that from its beginnings, sports medicine has been multidisciplinary, and charged with the obligation not only to treat injuries but also to help prevent them, and to instruct and prepare athletes for competition. This link with physical education has remained in place throughout its evolution.

First Olympic sports medicine team
While watching his daughter Louise swim at the 1968 Summer Olympics in Mexico City, Dr. J. C. Kennedy, a doctor based in London, Ontario, Canada concluded for a variety of reasons that competing athletic teams from Canada should be accompanied by a qualified and well organized medical team. This belief led him to be a founding father of the Canadian Academy of Sport Medicine. One of the primary mandates of this society was to provide expert care to Canadian athletes, and in 1972 Dr. Kennedy was appointed chief medical officer of the first "true" medical team, at the 1972 Summer Olympics in Munich, Germany. Other countries soon followed this example and assigned medical teams to their own Olympic athletes.

Dr. Kennedy's vision was not limited to traveling Canadian athletes. At a time when sport medicine clinics were unheard of in Canada, he convinced his university's administration to convert a former wrestling room into The Athletic Injuries Clinic that officially opened in 1972. The first Nautilus equipment in Canada was purchased from funds raised to outfit this clinic. Dr. Kennedy inspired and fostered an interest in research in sport medicine, for which the University of Western Ontario (UWO) and London, Ontario have become known.

The future of sports medicine
According to Dr. David Janda, orthopedic surgeon and director of The Institute for Preventative Medicine in Michigan, prevention is sports medicine's final frontier. The risk of injury will never be entirely eliminated, but modifications in training techniques, equipment, sports venues and rules, based on outcomes of meaningful research have shown that it can be lowered.

One rapidly advancing field with great potential for applications in prevention is the study of the body's neuromuscular adaptations. A study of specific preseason neuromuscular training for soccer players demonstrated a significant decrease in the incidence of anterior cruciate ligament tears. In another investigation by Janda et al., serious injuries in recreational softball were reduced by 98% when breakaway bases were used.

Participation in all forms of physical activity at all levels is a huge part of everyday life, and its benefits to health and quality of life are clear. Sports medicine's continued growth and development may help the benefits of physical activity to be fully and safely realized.