What is Sports Medicine?

Sports Medicine has been a recognized subspecialty by the American Board of Medical Specialties since 1989 ⁽¹⁾. Currently there are more than 70 Sports Medicine fellowships ⁽²⁾ and approximately one thousand certified Sports Medicine Specialists in the United States ⁽¹⁾. Sports Medicine Specialists are physicians with a primary certification in Family Practice, Internal Medicine, Emergency Medicine, Pediatrics, or Physical Medicine and Rehabilitation who obtain 1-2 years additional training in Sports Medicine through recognized fellowship (sub-specialty) programs. Eligible physicians who are board recognized in Family Practice, Internal Medicine, Emergency Medicine and Pediatrics may take a subspecialty qualification examination in Sports Medicine ⁽³⁾. The Sports Medicine certification examination is offered every other year. Sports Medicine Specialists further add to their expertise by participating in continuing medical education activities and must re-certify every 10 years.

This rigorous process was instituted to distinguish certified Sports Medicine specialists from other physicians without specialized training.

Sports Medicine Specialists are uniquely positioned to meet the demands of today’s health care environment.

Expertise in Musculoskeletal Injury

Sports Medicine specialists undergo extensive training in musculoskeletal medicine, and as a result are better equipped than their primary care counterparts in the management of these problems. Sports Medicine Specialists are different than sports orthopedic surgeons.

While sports orthopedic surgeons primarily focus on the operative treatment of musculoskeletal injuries, Sports Medicine Specialists specialize in the non-operative medical treatment of these injuries. This represents the great majority of the active population since approximately 90 percent of all sports injuries are non-surgical.

If surgery is required, Sports Medicine Specialist can expedite referral to an orthopedic surgeon. They can also help guide referrals to appropriate rehabilitative care and ancillary services when necessary. Common examples of musculoskeletal problems include acute injuries such as ankle and knee sprains, muscle strains, and shoulder dislocations, and overuse injuries such as tendonitis and stress fractures.

Expertise in Non-Musculoskeletal Injury

Sports Medicine Specialists have also received additional training in the non-musculoskeletal aspects of sports medicine. These often over-looked medical problems now have a specialist in their corner.

COMMON NON-MUSCULOSKELETAL SPORTS MEDICINE PROBLEMS

• Mild traumatic brain injury and other head injuries
• Athletes with chronic or acute illness (such as infectious mononucleosis, asthma or diabetes)
• Nutrition and performance issues
• Exercise prescription for patients who want to increase their fitness
• Injury prevention
• “Return to play” decisions in the sick or injured athlete
• Strength training and conditioning

Sports Medicine does not just mean the competitive athlete

Sports Medicine Specialists are ideal providers for the non-athlete and are excellent resources for the individual who wishes to become active or begin an exercise program.

For the “weekend warrior” or “industrial athlete” who experiences an injury, the same expertise used for the competitive athlete can be applied to return the individual as quickly as possible to full function.

Getting people moving

Keeping patients healthy is the common goal between medical professionals and the insurance industry. Of the myriad of medical specialties which exist today, only Sports Medicine is centered within a wellness-based (rather than disease-based) model. Beyond the abilities of other clinicians, Sports Medicine physicians, by virtue of their training, have the capability to take a sedentary population and incorporate the health-beneficial effects of exercise into people’s lives. Most adults fail to adequately exercise, and about one-quarter are completely sedentary⁽⁴⁾. Unfortunately, only a small percentage of this sedentary population are appropriately counseled by their doctor to exercise^(5,6). In fact, less than one quarter of all primary care physicians were familiar with the American College of Sports Medicine (ACSM) guidelines related to exercise prescription^(6,7).

Sports Medicine physicians help bridge this gap

Although it remains important for primary care physicians to talk to their patients about the benefits of exercise, research clearly indicates that proper counseling can be effective when delivered by a practitioner with more extensive training^{(7, 8, 9)}. That practitioner is the Sports Medicine Specialist.

THE BENEFICIAL EFFECTS OF EXERCISE

• Reduction in risk of premature death due to all causes
• Reduction in risk of cardiac death
• Reduction in risk of development of diabetes
• Reduction in risk of development of high blood pressure
• Reduction in risk of development of colon cancer
• Reduction of pre-established high blood pressure
• Reduction of subjective depression or anxiety
• Improvement in objective measures of obesity
• Decrease in elderly fall risk by increasing balance and proprioceptive skills ⁽⁴⁾

A word about the American Medical Society for Sports Medicine

The American Medical Society for Sports Medicine (AMSSM) was organized in 1991 by a group of family physicians who recognized the need for an organization within the field of Sports Medicine that addressed overall health and functional capacity as it relates to the whole patient, and the incorporation of an objectively verifiable knowledge base towards enhancement and preservation of function⁽¹⁰⁾. The AMSSM was formed to provide a link between the rapidly expanding core of knowledge related to sports medicine and its application to patients in a clinical setting. The clinician best suited to practically establish that link is the Sports Medicine specialist. For more information about Sports Medicine or about the AMSSM, please call (913) 327-1415 or visit our web site at www.amssm.org. We’re dedicated to keeping patients healthy and active.

Do Sports Medicine Physicians only treat competitive athletes?

No, Sports Medicine Physicians are ideal physicians for the non-athlete as well, and are excellent resources for the individual who wishes to become active or begin an exercise program. For the weekend warrior” or “industrial athlete” who experiences an injury, the same expertise used for the competitive athlete can be applied to return the individual as quickly as possible to full function.

What is a Sports Medicine Physician?

• A physician with specialized training who promotes lifelong fitness and wellness, and encourages prevention of illness and injury. This physician helps the patient maximize function and minimize disability and time away from sports, work, or school.
• He or she is a leader of the sports medicine team, which also includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.
• They are experienced sports medicine physicians with a primary specialty in Family Practice, Internal Medicine, Emergency Medicine, Pediatrics, or Physical Medicine and Rehabilitation, most of whom obtain 1-2 years of additional training in sports medicine through accredited fellowship (subspecialty) programs in Sports Medicine. Physicians, who are board certified in Family Practice, Internal Medicine, Emergency Medicine, or Pediatrics, are then eligible to take a subspecialty qualification examination in Sports Medicine. Additional forums, which add to the expertise of a Sports Medicine Physician, include continuing education in sports medicine, and membership and participation in sports medicine societies.

What is the difference between a Sports Medicine Physician and an Orthopedic Surgeon?

Both are well trained in musculoskeletal medicine. Sports Medicine Physicians specialize in the non-operative medical treatment of musculoskeletal sports conditions. Orthopedic surgeons are also trained in the operative treatment of these conditions. Approximately 90% of all sports injuries are non-surgical, and Sports Medicine Physicians can expedite referral to an orthopedic / sports surgeon when indicated, and can help guide referrals to appropriate rehabilitative care and ancillary services as needed. Common examples of musculoskeletal problems include:

• Acute injuries (such as ankle sprains, muscle strains, knee & shoulder injuries, and fractures)
• Overuse injuries (such as tendonitis, stress fractures)
• Mild traumatic brain injury and other head injuries
• Athletes with chronic or acute illness (such as infectious mononucleosis, asthma or diabetes)
• Nutrition, supplements, ergogenic aids and performance issues
• Exercise prescription for patients who want to increase their fitness
• Injury prevention
• “Return to play” decisions in the sick or injured athlete
• Strength training and conditioning
• Healthy lifestyle promotion

Most Sports Medicine Physicians also serve as Team Physicians for local and/or National teams and clubs. These physicians must fulfill published qualifications with the following responsibilities:

• Pre-participation physical examination
• Injury assessment and management
• Care of sports-related and general medical needs of athletes
• Special populations (elderly, disabled, women, youth, etc)
• Sports psychology issues
• Addressing substance use
• Education and counseling on illness & injury prevention
• Coordinating care with other members of the sports medicine team to include athletic trainers, physical therapists, personal physicians, other medical and surgical specialties, and other ancillary personnel of specialty care and rehabilitation
• Communication with athletic trainers, coaches, school administration, as well as athletes and their families

REFERENCES

1. The ABMS Annual Report and Reference Handbook , The American Board of Medical Specialties, Evanston, IL.
2. The Physician and Sports Medicine Fellowship Listing, www.amssm.org
3. The American Board of Family Practice, Lexington, Kentucky, www.abfp.org/caqs.htm
4. Surgeon General’s Report on Physical Activity and Health, 1996.
5. Friedman C, Brownson RC, Peterson DE, Wilkerson JC. Physician advice to reduce chronic disease risk factors. Am J Prev Med 1994;10:367-71.
6. Williford HN, Ba rfield BR, Laze n by RB, Olson MS. A survey of physicians’ attitudes and practices related to exercise promotion. Prev Med 1992; 21:630-6.
7. Walsh JM, Swangard DM, Davis T, McPhee SJ. Exercise counseling by primary physicians in the era of managed care. Am J Prev Med 1999;16:307-13.
8. Marcus BH, Goldstein MG, Jette A, Simkin Silverman L, Pinto BM, Milan F, Washburn R,
9. Smith K, Rakowski W, Dube CE. Training physicians to conduct physical activity counseling. Prev Med 1997; 26:382-8.
10. Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med 1996; 25:225-33.
11. Matheson G, editorial in Phys Sports Med 1999; 27:5,111. 11639