An Introduction to Sports Medicine

Original Editor - Wanda van Niekerk based on the course by James Laskin

Top Contributors - Wanda van Niekerk and Jess Bell

Introduction[edit | edit source]

Sport and exercise medicine is rapidly growing and evolving as a specialist discipline. The various tasks and responsibilities are often managed by a multidisciplinary team of professionals. Each professional has specific specialised skills that are necessary for the optimal care of athletes of all levels and those taking part in physical activity and exercise. A physician is commonly involved as part of the sports and exercise medical team (these can be orthopaedic surgeons, emergency medicine physicians, general practitioners and more recently specialist sport and exercise medicine physicians). Physiotherapists have a key role in athlete management as part of the multidisciplinary team and, depending on the specific sports setting, may be the only sports medicine professional working directly with the athlete or team. When working in a professional sports environment, the physiotherapist may be part of a larger network of sports medicine professionals looking after the team and athletes.

What is Sports Medicine?[edit | edit source]

Sports Medicine is "the scientific and clinical testing, manipulation, and care of those who exercise, especially athletes."[1]

There is often a misconception that sports medicine professionals only work with elite and high-level athletes, but these professionals provide services to athletes of all ages and of all levels, as well as to physically active people and those who take part in recreational exercise.

Sports and Exercise Physiotherapists are involved in the prevention and management of injuries resulting from sport and exercise participation at all ages and at all levels of ability. They provide evidence-based advice on safe participation in sport and exercise, as well as promoting a physically active lifestyle to help individuals improve and maintain their quality of life.[2]

Read more: The Role of the Sports Physiotherapist

History of Sports Medicine[edit | edit source]

  • Sports Medicine has its origins in ancient Greece and Rome
    • Physical education was valued and an integral part of an adolescent's life
    • Specialists took care of athletes
    • The first team doctor was Galen - doctor of the gladiators and he recommended: "Take fresh air, get a good sleep, eat and drink properly, control emotions and empty bowels once a day!" He also added: "No activity is exercise unless you become breathless".[3]
  • The multidisciplinary model was part of sports medicine from the beginning
  • Initially, it was a more physician-centred approach, whereas now it is a patient-centred approach

If you are interested in the history of sports medicine and want to find out more, here are some interesting resources to consult:

[5]

What Does Sports Medicine Encompass?[edit | edit source]

Sports Medicine is an umbrella term that includes all professionals concerned with enhancing the performance and healthcare of physically active individuals.[6] It encompasses a broad range of medical areas, such as:

  • Biomechanical
  • Psychological
  • Nutrition
  • Environmental
  • Pathological
  • Physiological

Professions in Sports Medicine[edit | edit source]

Professions that fall under the sports medicine umbrella[6][7]:

Various Professions in the Sports Medicine Team
Kinesiologist

Athletic Trainer

Physician

Psychologist

Nutrionist/Dietician

Coach

Physiotherapist

Dentist

Soft tissue therapist

Rheumatologist

Radiologist

Cardiologist

Biokineticist

Orthopaedic surgeon

Exercise physiologist

Chiropractor

Ophthalmologist

Podiatrist

Emergency medical technician (EMT)

Nurse

Athletic director

Physical educator/ Fitness Advisor

Osteopath

Biomechanisists

Occupational therapist

Orthotist

Professions in Sports Medicine

Physiotherapists often learn new skills when being part of a sports team or association. These skills are often not related to their primary role as team physiotherapists, but are ways to further help the athletes or management. For example, while working with a wheelchair basketball team, the physiotherapist may need to help out with wheelchair maintenance. Physiotherapists are also sometimes involved with setting up practice or warm-up drills or keeping score. However, it is important to remember that the first priority is towards the athlete's health and safety.[6]

Read more: Sports and Exercise Physiotherapy Roles and Competency Areas

You can access the complete document on Sports Physiotherapy: Competencies and Standards[8] available on the website of The International Federation of Sports Physical Therapists (IFSPT).

Human Performance and Injury Management[edit | edit source]

Sports medicine can be divided into two broad categories: human performance and injury management. Various professions may overlap and also fall in both categories. When considering these two categories, some professions are better equipped for a specific area and some professions, like physiotherapy, can easily function in both.[6]

Broad Areas of Sports Medicine and Professions Linked to These Areas
Human Performance Injury Management
Exercise Physiology

Biomechanics

Sports psychology

Sports nutrition

Sports massage

Practice of medicine

Sports physiotherapy

Athletic training

Areas of Sports Medicine: Human Performance and Injury Management

The Growth of Sports Medicine[edit | edit source]

There has been rapid growth in sports medicine in the last 40 years. This is evident from an:

  • Increase in the number of professional associations designating sports medicine as a sub-speciality
  • Increase in literature, research and educational experiences
  • Increase in the number of professional journals (peer-reviewed)
  • Increase in the number of medical clinics specialising in sports medicine
  • Increase in awareness and understanding of specific populations in sports such as women's health and gender equality in sports
  • The sports medicine philosophy has also evolved to highlight the importance of exercise to prevent many chronic diseases
    • Exercise is Medicine![9]

The Growth of Sports Medicine in Women's Health[edit | edit source]

Earlier, much of the research on sports medicine included only male participants or athletes and assumed that the findings could just be applied to women. However, this is not the case and consideration should be given to female-specific challenges in sports, such as exercising during pregnancy[10] or post-partum return to sport.[11] Women are more at risk of certain injuries, for example anterior cruciate ligament (ACL) injuries.[12] Other complex groups of pathologies to consider in female athletes are the female athlete triad[13] and relative energy deficit syndrome (RED-S).[14][15] In recent years, the effect of the menstrual cycle on performance has also been recognised as a crucial consideration in women's sports and further research is necessary in this area.[16][17][18]

Exercise is Medicine[edit | edit source]

Exercise and physical activity has been proven to be efficient in the prevention and management of chronic diseases such as:

The most recent guidelines on physical activity and sedentary behaviour by the World Health Organization (WHO) are available here: WHO Guidelines on physical activity and sedentary behaviour[24] and a WHO Fact Sheet with a summarised version is available here: Physical activity.

The Future of Sports Medicine[edit | edit source]

Through education and research, it is evident that surgical techniques and rehabilitative techniques are improving in the sports medicine field. For example, ACL injuries are no longer career-ending injuries, the management of these injuries has progressed.[25][26]

The future of sports medicine lies in advocating for and promoting "exercise and/or physical activity is medicine". Groundbreaking research is done in stem cell research and the growth of new tissue and surgical techniques has improved with less invasive and damaging procedures leading to better outcomes and shorter recovery times.[27]

The Sports Medicine Team[edit | edit source]

The goal of the sports medicine team is to ensure a safe environment for maximal sports performance.[28] Different areas of athlete health and well-being need to be addressed to achieve this and collaboration between professionals in sport is essential for successful outcomes.

The primary sports medicine team often includes[6]:

  • Team physician
  • Physiotherapist
  • Certified athletic trainer (in countries such as the USA and Canada)
  • Coaching staff

Read more: The Sports Medicine Team

The Sports Medicine Model[edit | edit source]

The sports and exercise medicine model remains an athlete-centred approach. Often athletes prefer to consult with the professional that they have the best relationship or the professional that they are most in contact with. Therefore, it is imperative that all members of the multidisciplinary sports medicine team know their own strengths and limitations. They must also be knowledgeable about the skills and competencies of other members in the team and refer to these professionals to ensure that the athlete receives the best possible care and management.[6]

Physician and Physiotherapist Shared Responsibilities[edit | edit source]

  • Provide for the well-being of the athlete
  • Enable athletes to realise their full potential
  • Pre-participation examination[29]
    • The team physician and/or physiotherapist should possess proficiency in the care of musculoskeletal injuries and medical conditions in sports.
    • Also realise that it may not always be only athletes that need medical care - coaching and support staff, spectators and match officials may also require medical attention at times.
  • On-site coverage of catastrophic sports contests[30]
  • Prescribe and dispense medicine
    • Although physiotherapists do not usually prescribe medicine it is important to be knowledgeable about medications, doping rules and regulations, performance-enhancing drugs, herbal medicine, etc., as athletes often seek the opinion of the physiotherapist on these matters.
  • Facilitate referrals
  • Determine return-to-play guidelines
  • Provide in-service training/Education

Physician and Physiotherapist Competencies[edit | edit source]

Shared Skills of Physician and Physiotherapist[edit | edit source]

Physiotherapists often have to explain the results of tests, or testing procedures to athletes to help them make informed decisions and create a better understanding of the specific pathology/injury.[6] Some of the specific skills of evaluation and medical problems that physicians and physiotherapists share are shown in the table below.

Specific Skills Shared by Physician and Physiotherapist
Evaluation Medical Problems
  • Imaging[32]
    • Understanding reports and imaging as well as implications
  • Electrodiagnostic
    • EEG (electroencephalogram)
    • ECG (electrocardiogram)
    • EMG (electromyogram)
  • Exercise testing
  • Gait analysis
  • Compartment syndrome testing
  • Exercise-induced asthma testing
  • Drug testing
  • Endocrine considerations
  • Haematology
  • Neurology
  • Gastroenterology
  • Pulmonary
  • Allergic disease
  • Overtraining syndrome
  • Environmental issues

Typical Conditions Encountered in Sports Medicine[edit | edit source]

The lists above show just a few of the common sports conditions. You can also have a look at the Sports Injuries Category.

Principles of Rehabilitation[edit | edit source]

Some of the sports-specific foundational skills include[6]:

  • Physical rehabilitation
  • Physical modalities
  • Medications, ergogenic aides, injections
  • Adaptive equipment
  • Footwear
  • Orthotics
  • Taping
  • Bracing
  • Psychological considerations
  • Complementary and alternative medicines

Special Populations in Sports[edit | edit source]

  • Women
  • Paralympics[33]
  • Special Olympics
  • Paediatric
  • Geriatric
  • Cancer[34]
  • Human Immunodeficiency Virus (HIV)
  • Covid-19[35]

References[edit | edit source]

  1. Lamb, D. American College of Sports Medicine.
  2. Sports and Exercise Physiotherapy New Zealand. What is Sports and Exercise Physiotherapy. Available from https://sportsphysiotherapy.org.nz/about-sepnz/ (accessed 20/10/2022).
  3. 3.0 3.1 Ergen, E. The origins of sports medicine. Aspetar Sports Medicine Journal. 2016; Vol 5: Issue 2.
  4. Timetoast.com. History of Sports Medicine/PT. Available from https://www.timetoast.com/timelines/history-of-sports-medicine-pt (last accessed 20 October 2022)
  5. Aspetar. A History of Sports Medicine: A Sports Physician's Perspective. Available from: https://www.youtube.com/watch?v=tcl5-yPCuMs [last accessed 20 October 2022]
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Laskin, J. Introduction to Sports Medicine Course. Plus. 2022.
  7. Brukner P. Clinical sports medicine: Injuries. McGraw-Hill Education (Australia) Pty Limited; 2017.
  8. Bulley C, Donaghy M, Coppoolse R, Bizzini M, van Cingel R, DeCarlo M, Dekker L, Grant M, Meeusen R, Phillips N, & Risberg M.Sports Physiotherapy Competencies and Standards.2004. Sports Physiotherapy For All Project. [online] Available at: www.SportsPhysiotherapyForAll.org/publications/
  9. Thompson WR, Sallis R, Joy E, Jaworski CA, Stuhr RM, Trilk JL. Exercise is medicine. American journal of lifestyle medicine. 2020 Sep;14(5):511-23.
  10. Yang X, Li H, Zhao Q, Han R, Xiang Z, Gao L. Clinical practice guidelines that address physical activity and exercise during pregnancy: a systematic review. Journal of Midwifery & Women's Health. 2022 Jan;67(1):53-68.
  11. Davenport MH, Ray L, Nesdoly A, Thornton J, Khurana R, McHugh TL. We’re not Superhuman, We’re Human: A Qualitative Description of Elite Athletes’ Experiences of Return to Sport After Childbirth. Sports Medicine. 2022 Jul 28:1-1.
  12. Arundale AJ, Silvers‐Granelli HJ, Myklebust G. ACL injury prevention: Where have we come from and where are we going?. Journal of Orthopaedic Research®. 2022 Jan;40(1):43-54.
  13. Maya J, Misra M. The female athlete triad: review of current literature. Current Opinion in Endocrinology & Diabetes and Obesity. 2022 Feb 1;29(1):44-51.
  14. Dave SC, Fisher M. Relative energy deficiency in sport (RED–S). Current Problems in Pediatric and Adolescent Health Care. 2022 Jul 30:101242.
  15. Charlton BT, Forsyth S, Clarke DC. Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know. International Journal of Sports Science & Coaching. 2022 Apr;17(2):445-60.
  16. O’Loughlin E, Reid D, Sims S. Discussing the menstrual cycle in the sports medicine clinic: perspectives of orthopaedic surgeons, physiotherapists, athletes and patients. Qualitative Research in Sport, Exercise and Health. 2022 Aug 18:1-9.
  17. Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The impact of menstrual cycle phase on athletes’ performance: a narrative review. International journal of environmental research and public health. 2021 Feb;18(4):1667.
  18. McNamara A, Harris R, Minahan C. ‘That time of the month’… for the biggest event of your career! Perception of menstrual cycle on performance of Australian athletes training for the 2020 Olympic and Paralympic Games. BMJ open sport & exercise medicine. 2022 Apr 1;8(2):e001300.
  19. Kanaley JA, Colberg SR, Corcoran MH, Malin SK, Rodriguez NR, Crespo CJ, Kirwan JP, Zierath JR. Exercise/physical activity in individuals with type 2 diabetes: A consensus statement from the American College of Sports Medicine. Medicine and Science in Sports and Exercise. 2022.
  20. Sanchis-Gomar F, Lavie CJ, Marín J, Perez-Quilis C, Eijsvogels TM, O’Keefe JH, Perez MV, Blair SN. Exercise effects on cardiovascular disease: from basic aspects to clinical evidence. Cardiovascular Research. 2022 Jun;118(10):2253-66.
  21. Beck BR. Exercise Prescription for Osteoporosis: Back to Basics. Exercise and Sport Sciences Reviews. 2022 Apr 1;50(2):57-64.
  22. Barone Gibbs B, Hivert MF, Jerome GJ, Kraus WE, Rosenkranz SK, Schorr EN, Spartano NL, Lobelo F, American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Physical activity as a critical component of first-line treatment for elevated blood pressure or cholesterol: who, what, and how?: a scientific statement from the American Heart Association. Hypertension. 2021 Aug;78(2):e26-37.
  23. Prior PL, Suskin N. Exercise for stroke prevention. Stroke and Vascular Neurology. 2018 Jun 1;3(2).
  24. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine. 2020 Dec 1;54(24):1451-62.
  25. Gerami MH, Haghi F, Pelarak F, Mousavibaygei SR. Anterior cruciate ligament (ACL) injuries: A review on the newest reconstruction techniques. Journal of Family Medicine and Primary Care. 2022 Mar;11(3):852.
  26. Gokeler A, Dingenen B, Hewett TE. Rehabilitation and Return to Sport Testing After Anterior Cruciate Ligament Reconstruction: Where Are We in 2022?. Arthroscopy, sports medicine, and rehabilitation. 2022 Jan 1;4(1):e77-82.
  27. Shapiro SA, Finnoff JT, Awan TM, Borg-Stein JP, Harmon KG, Herman DC, Malanga G, Master Z, Mautner K. Highlights from the American Medical Society for Sports Medicine position statement on responsible use of regenerative medicine and orthobiologics in sports medicine. British journal of sports medicine. 2022 Feb 1;56(3):121-2.
  28. Mendonça LD, Schuermans J, Wezenbeek E, Witvrouw E. Worldwide sports injury prevention. International journal of sports physical therapy. 2021;16(1):285.
  29. Piedade SR, Ferreira DM, Zogiab RK, Martínez IC, Zayats V, Neyret P. Pre-participation evaluation in sports practice. InThe Sports Medicine Physician 2019 (pp. 13-25). Springer, Cham.
  30. Lemak L, Courson R. Sports medicine team should call “time-out” before start of events. National Federation of State High School Associations Web site. 2019.
  31. Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, Budgett R, Campriani N, Castaldelli-Maia JM, Currie A, Derevensky JL. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British journal of sports medicine. 2019 Jun 1;53(11):667-99.
  32. Heath L. Imaging for Sports Injuries. Imaging. 2021 Aug 12
  33. Fagher K, Badenhorst M, Van de Vliet P. Sports physiotherapy–Actions to optimize the health of Para athletes. International Journal of Sports Physical Therapy. 2021;16(6):1376.
  34. Coletta AM, Basen-Engquist KM, Schmitz KH. Exercise Across the Cancer Care Continuum: Why It Matters, How to Implement It, and Motivating Patients to Move. American Society of Clinical Oncology Educational Book. 2022 Apr 8;42:1-7.
  35. JM S, HG P. Recommendations for Return-to-Sport after COVID-19: Expert Consensus. German Journal of Sports Medicine/Deutsche Zeitschrift fur Sportmedizin. 2022 Apr 1;73(4).