Sports Medicine: The Defensible 'Alternative'
THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 4 - APRIL 99
It is popular among modern scholars in the humanities to describe "myths" or "metaphors" that guide our lives and actions. The corporate literature calls these "paradigms." Whatever the terminology, people more or less consciously use these types of mental structures to interpret events, set priorities, and interact with others. The metaphors that underlie sports medicine emphasize health, functional capacity, and human performance, and our ability to enhance and preserve these throughout life. They appeal to patients in much the same way "complementary and alternative" therapies do; yet sports medicine is supported by the same scientific foundation as other medical disciplines.
In medicine, we distinguish between episodic care and continuing care and between disease-based treatment and preventive medicine. These defining terms have helped bring medical science a long way in the past 100 years—but they have arguably held back medical practice by encouraging overemphasis on episodic and disease-based patient care.
Patients notice this. They have a preconceived notion of what "traditional" medicine is—and many of them don't like it. In 1997, US patients made an estimated 386 million visits to primary care physicians and 629 million to complementary and alternative medicine practitioners (1). According to Kaptchuk and Eisenberg (2), the strong appeal of the various forms of alternative medicine is based on metaphors they share. "The fundamental premises uniting the alternative medicine community involve nature, vitalism, 'science,' and spirituality. Taken together, these principles expand behavioral options, identity, experience, and meaning when illness (or its possibility) threatens a person's intactness and sense of connection to the world."
What is it that patients are seeking? At a minimum, they want to be comfortable, free from pain and disease. Next, they want to preserve their physical function as long as possible. The defining task of sports medicine is improvement of function. With this focus, sports medicine cuts across the episodic/continuous and disease-based/preventive distinctions common in medicine to provide clinical care for patients across the spectrum of age and ability.
This patient-oriented emphasis on function is a departure from disease-oriented treatment, but it is this departure that provides a new measure of hope by empowering patients with the ability to enhance their own physical function and independence. Yet, the focus is simple, straightforward, and objectively verifiable. Kaptchuk and Eisenberg (2) ask the question, "What is the critical distinction between conventional and unconventional medicine? One fundamental difference is that biomedicine has a more rigorous and self-critical scientific method." Any of us who have a sports medicine element in our practice can confidently teach patients that maintaining a physically active lifestyle is a principal determinant of health. Many diseases, disabilities, and even musculoskeletal pain syndromes are not the inevitable result of aging, but rather the result of inactivity. These facts are based on the findings from well-designed research, the same clinical-scientific foundation upon which the rest of medicine is based.
But the full impact of this focus cannot be felt while sports medicine is not fully embraced as a branch of medicine. The maximum potential of sports medicine's contributions will only be seen once the diagnosis, treatment, and performance-enhancement techniques used for elite and professional athletes are widely transferred to the general population. This requires that physicians who practice sports medicine stop changing their mental focus between field and clinic—between their "athletes" and the rest of the patients in their practice.
If you are one of the physicians who shift gears when they leave the training room, think about combining the two paradigms—function-oriented sports medicine and disease-based traditional medicine. In the long run, what's more important: a football player's sprained ankle or his cholesterol level? If your practice doesn't include competitive athletes but you see lots of children, busy young adults, or older patients, on average what will have a greater effect on their long-term health than staying active, or learning to be active?
If you try this change of focus, you'll notice your patients' surprise. Later, you'll find you've helped many of them over mental or physical barriers, but with defensible (and simple and inexpensive) medical management.
PS. This month The Physician and Sportsmedicine presents articles across the range of sports medicine's functional emphasis. Injury management is covered in "Snowboarding Injuries," page 94; maximizing health with chronic illness is discussed in "Hypertension in Athletes and Active Patients," page 35, and "Exercise in Diabetes Management," page 63. And the theme of prevention arises in a number of articles, including "Lyme Disease Vaccination," page 15, and "Swimming Injuries and Illnesses," page 51.