The importance of primary care sports medicine in the treatment of sports injuries

After 30 years as a primary care sports medicine physician, it is probably time to help my colleagues understand just what is it that we do and how we came to do it. Many people assume that we only take care of athletes on college or professional teams, when, in fact, we care for all active patients who develop primarily musculoskeletal issues.

Of course, we also take care of adolescent, high school, college and professional-level athletes across all sports and positions. While it is not necessary that a sports medicine physician be an athlete, it is imperative that we understand the demands of each sport and the scope of injuries for which each athlete may be vulnerable. Our working environment includes not only the sidelines on Friday nights, but exam rooms, daily training rooms and classrooms throughout a typical week.

After medical school, your typical sports medicine doctor will complete one of the following residencies: family medicine, PM&R, internal medicine, pediatrics and emergency medicine. Subsequently, most of these future sports medicine physicians will become team physicians. They will complete a one-year fellowship concentrating on sports injury, diagnosis, treatment, rehabilitation, prevention and return to play along with conducting physicals, treating medical illness and being prepared for sideline event coverage with a well-rehearsed head, neck and cardiac emergency action plan (EAP).

Team physicians are not only responsible for the well-being of the players but also answer to the parents, coaches, administrators and sometimes team owners and managers. It is imperative that all involved in the care team realize that the parents of high school athletes expect and require the same emergent quality and intensity of care as that provided at the professional level. Ultimately, the care team is led by the sports medicine physician with input from athletic trainers, physical therapists and orthopedic consultants.

What is a sports medicine doctor?

A majority of sports medicine doctors are also team physicians with event coverage responsibilities. These athletic events occur primarily on weekend nights and often promote advertising opportunities for the employer health system. Unfortunately, and often not adequately appreciated, this situation can present risks for major liability exists, most often with football and hockey. These additional relationships create new reporting channels to coaches, administrators and owners.

In-office musculoskeletal injury clinics, concussion care and osteoarthritis evaluations make up a majority of daytime patient encounters. When dealing with in-season athletes, the return to play urgency makes for added challenges, namely pressures for safe and speedy return to performance. Sports injuries are a common occurrence among athletes at all athletic levels, from high school to college, from weekend warriors to professionals. You don’t need to be on a team or play a sport to see a sports medicine doctor.

Traditional approaches to treating sports injuries have primarily focused on surgery and orthopedics, but as the field of sports medicine has grown and evolved, so too has the approach to treating and rehabilitating acute and chronic injuries and illnesses.

Primary care sports medicine doctors are trained to use a variety of treatment options, including medications, osteopathic manual treatments, physical therapy and rehabilitation exercises. They work closely with other members of the healthcare team such as certified athletic trainers, physical therapists and orthopedic consultants when needed. Unfortunately, but frequently, psychologists have become a necessary member of the sports health care team.

In addition to treating athletes and recreational sports enthusiasts, sports medicine doctors also treat individuals of all ages who have injuries or conditions related to their daily activities, such as falls, car accidents and work-related injuries. They also help patients recover from injuries or conditions that may be caused by long-term overuse or repetitive motions.

We are not orthopedic surgeons

In the sports medicine world, surgery is seen as a last resort only to be performed when all other options have failed. Orthopedic surgeons have a great skill set in the operating room and are an integral part of the sports medicine care team. Concussions, COVID concerns, mental fitness, medical illness, heat illness, EKG analysis, injury prevention and Head, Neck and Heart Emergency Action Plans are a few situations that differentiate sports medicine from orthopedic surgery. Fractures and dislocations often require the on-field expertise of an orthopedist; however, no surgeries are performed on the sidelines.

According to the American Medical Society for Sports Medicine, as much as 90% of sports injuries (such as concussions and chronic or acute illnesses) can be treated without surgery. These injuries often respond well to non-surgical treatments such as rest, physical therapy, rehabilitation exercises and manual manipulation.

Sports medicine physicians work closely with physical therapists to develop rehabilitation programs that are tailored to the individual’s specific injury and goals. For example, a 2013 study found that sports medicine doctors have promoted numerous exercise regimens to reduce anterior cruciate ligament injuries (>50%) which could play a role in the reduction of future arthroscopic procedures and knee replacements, both staple surgeries for orthopedics and anesthesia.

Unfortunately, surgeons too often maintain control of the sports medicine care team, not because of expertise but because of financial ramifications, and not because of sideline acuity but system contribution. Whereas historically surgeons were hired for these roles, many of the new Chief Medical Officer appointments for college, professional and Olympic teams are sports medicine physicians. Our ability to manage concussions, heart illness and mental fitness, as well as support musculoskeletal care through manual medicine, allows us to improve the health of the athlete from a holistic perspective.

An osteopathic sports medicine physician with family medicine training offers the best of both worlds. With an extensive musculoskeletal foundation, the DO sports medicine physician will evaluate the patient as a whole, assessing structure and function, and any underlying conditions such as diabetes, hypertension and obesity, which can impact the diagnosis, treatment and outcome of the injury. Exercise, sleep, nutrition and mental health are assessed from an integrative perspective with each and every injury.

Factors to considering when referring to sports medicine physicians

Yes, it is important for referring physicians and other specialists to consider various factors when referring patients to a sports medicine doctor. Training, reputation, communication and collegiality are all important factors that should be taken into account when making a referral.

Referring physicians should refer patients to sports medicine doctors who have completed a fellowship in sports medicine, have passed the sports medicine certification exam or have a special interest in sports medicine and attend yearly meetings.

Overall, referring physicians should aim to refer patients to a sports medicine doctor who has the necessary qualifications, experience and skills to provide the best possible care for the patient’s specific condition.

We are doctors first

It is important for a sports medicine doctor to have a strong foundation in general medicine before specializing in sports medicine. A good sports medicine doctor should have a thorough understanding of the human body and its functions, as well as the common illnesses and injuries that can occur. This knowledge is necessary to accurately diagnose and treat sports-related injuries and illnesses.

Being a good sports medicine doctor, like any doctor, involves having good clinical knowledge and skills, such as taking a patient’s history, performing a physical examination, interpreting diagnostic test results and making accurate diagnoses. It also involves good communication and interpersonal skills, as well as the ability to work well with a team of healthcare professionals, coaches, administrators and parents.

Their training typically includes a fellowship in sports medicine, during which doctors learn about the specific injuries and conditions that are commonly seen in athletes, as well as the best practices for treating them.

Presenting, publishing and participating in annual specialty college meetings is essential. Furthermore, sports medicine doctors should have a good understanding of the specific demands of the sport the athlete is engaged in and the biomechanics of the sport to be able to help the athlete prevent injuries and improve performance.

It has been said that MSK ultrasound has become the stethoscope for the sports medicine doctor to assist in the accurate diagnosis and treatment of injuries. Sports medicine physicians also focus on preventing future injuries by addressing any underlying issues that may have contributed. This may include addressing muscle imbalances, improving flexibility and mobility or addressing any nutritional deficiencies. By addressing these underlying issues, sports medicine physicians can help reduce the risk of re-injury and help ensure a full and successful return to activity.

Frequently, injections are employed and include ultrasound guided injections and proper use of steroids, hyaluronic acid and platelet rich protein and stem cells. These newer emerging modalities often are effective in addressing acute and chronic injuries both in athletes and active adults.

The importance of addressing mental fitness and emotional well-being is paramount in sports medicine.

Athletic injuries can also have an emotional impact on an individual, and the sports medicine physician must understand the importance of addressing the mental and emotional well-being of the athlete. This may include providing guidance on how to cope with an injury, helping to alleviate feelings of depression and working to restore a sense of self-worth and mental fitness.

Performance enhancement often is overemphasized in lieu of an emergency action plan to prevent psychiatric red flag behavior. The American Association of College Health has reported that one of four college athletes have mental fitness issues. It is suggested that all athletes receive a baseline PHQ9 survey during their pre-season physical (AMSSM Consensus Mental Health) to ensure proper mental health assessment and more and more health care teams are developing an EAP for mental health emergencies.

This illustrates the importance of sports medicine physicians who have the specialized training and experience necessary to accurately diagnose and effectively treat sports injuries. They understand the importance of injury prevention, return to play, athletic re-conditioning, lifestyle changes, exercise, sleep, nutrition, mental fitness and other elements that impact recovery.

In conclusion, sports medicine is a vital field in the treatment of sports injuries. We hope that other specialty fields can appreciate the wide range and valuable role the primary care sports medicine physician encompasses. We stay abreast of and incorporate the guidelines from the PIAA, NCAA, AOASM, AMSSM, NBA and regulations from local state and national organizations to allow all teams to conform. We undertake the essential duty of appropriately communicating confidential medical information with discretion. Whether a slip on the ice by a fitness walker or a collapse on a high school football field, the sports medicine doctor can facilitate timely treatment and recovery. With an accurate diagnosis and treatment plan that addresses underlying physical and mental health issues, sports medicine physicians provide an appropriate and comprehensive approach to sports injuries.

Related reading:

What sports medicine fellowship program directors look for in applicants

Is a sports medicine fellowship right for you?