An Introduction to Sports Medicine

Original Editor - User Name

Top Contributors - Wanda van Niekerk, Jess Bell, Kim Jackson and Nupur Smit Shah  

Introduction

Sport and exercise medicine is rapidly growing and evolving as a specialist discipline. It includes various tasks and responsibilities and it is often practiced by a multidisciplinary team of professionals. Each of these professionals have specific specialised skills that is 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 (often orthopaedic surgeons, or 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. While 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?

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

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.

Read more: The Role of the Sports Physiotherapist

History of Sports Medicine

• 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
    • Galen 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".
• Multidisciplinary model was part of sports medicine from the beginning
• Initially, it was a more physician-centered approach, whereas now it is a patient-centered approach

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

• The Origins of Sports Medicine
• History of Sports Medicine/Physiotherapy Timeline
• This lecture presented by Dr Robert Johnson on A History of Sports Medicine: A Sports Physician's Perspective is part of Aspetar's Tuesday Lecture Series.

What Does Sports Medicine Encompass?

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

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

Professions in Sports Medicine

Professions that fall under the sports medicine umbrella:

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. Very often these skills are not related to their primary role as team physiotherapist, but ways to further help out the athletes or management. For example, working with wheelchair basketball, may require the physiotherapist to help out with wheelchair maintenance. Physios 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.

Read more: Sports and Exercise Physiotherapy Roles and Competency Areas

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

Human Performance versus Injury Management

Sports medicine can be divided into two parts: Human performance versus Injury Management. Various professions may overlap and also fall in both categories. When considering these two categories, some professsions are better equipped for a specific category and some professions, like physiotherapy, can easily function in both categories

The Growth of Sports Medicine

There has been a 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 subspeciality
• Increase in literature, research and educational experiences
• Increase in 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 sport such as women's health and gender equality in sport.

• The sports medicine philosophy has also evolved to highlight the importance of exercise to prevent many chronic diseases.
  • Exercise is Medicine

The Growth of Sports Medicine in Women's Health

Earlier much of the research on sports medicine included only male participants or athletes and there was the assumption that the findings could just be applied to women. This is however not the case and consideration should be given to female-specific challenges in sport, such as exercising during pregnancy or post-partum return to sport. Certain injuries are also more common in women than in men, for example anterior cruciate ligament (ACL) injuries. Other complex groups of pathologies to consider in female athletes are the female athlete triad and relative energy deficit syndrome (RED-S). In recent years the effect of the menstrual cycle on performance has also been recognised as a crucial consideration in women's sport and further research is necessary in this area.

Exercise is Medicine

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

• Diabetes
• Cardiovascular disease
• Osteoporosis
• High blood pressure
• Stroke

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 behaviourand WHO Fact Sheet with a summarised version is available here: Physical activity.

The Future of Sports Medicine

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 have progressed and good outcomes are reported.

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.

The Sports Medicine Team

The goal of the sports medicine team is to ensure a safe environment for maximal sports performance. Different areas of athlete health and well-being needs to be addressed to achieve this and collaboration between professionals working with the athlete is essential for successful outcomes.

The primary sports medicine team often includes:

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

Read more: The Sports Medicine Team

The Sports Medicine Model

The sports and exercise medicine model remains an athlete-centered approach. Often athletes prefer to consult with the professional that they have the best relationship with 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 and 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.

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