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Sports Medicine: A Focus on Health


As part of a detailed survey, we recently asked our physician readers to define sports medicine. No single definition stood out. Words and phrases used included (among many others): art and science of medicine applied to physical activity, care of athletes, disease prevention and treatment, emphasis on function, enhancing fitness, exercise, health, health for all age groups, human performance, medical conditions affected by exercise, medical subspecialty, musculoskeletal medicine, nutrition, orthopedic subspecialty, physiology, prevention, psychology, rehabilitation, sports injuries, sports-related medical conditions, sports science, etc.

Not that the range of descriptions surprised us. Indeed, it provided a welcome endorsement of our philosophy here at The Physician and Sportsmedicine. Sports medicine is practiced in a number of venues by clinicians with overlapping but distinct areas of expertise. In short, sports medicine is multidisciplinary. To a pessimist, "multidisciplinary" means "fragmented." To an optimist, the term connotes varied expertise and points of view that improve patient care.

I'm optimistic. What ties the field together, in my view, is its focus on a health model of medicine. As such, in addition to the care of athletes—their injuries, safety, and general health—sports medicine embraces preventive medicine, the role of exercise in the treatment of disease, and the underlying science of function and performance. In practice, that means that sports medicine takes advantage of some untidiness of organization—such as crossing bounds of traditional disciplines—to deliver comprehensive, problem-based healthcare.

For physicians, the chief sports medicine "practice paradigms" are the team physician, office-based, and operative models. Each model is further subdivided by purpose and practitioners. The team physician model is arguably the most prominent. High-profile physicians with elite teams attract media attention, patients, and prestige. This benefits sports medicine as a whole, because these committed physicians have directed resources attracted by star teams and athletes to understanding and care of "the average patient," and to issues of disease and injury prevention. Similarly, the knowledge and skills learned at the higher levels of sport have filtered down to fill needs of college and high school athletes as well as active patients seen in office-based settings. In what is perhaps the greatest strength of this model, the athlete's unique pattern of needs—such as quick recovery—receives maximum attention.

The team physician model has drawbacks, though. Care is generally episodic (in season only) and fragmented (multiple caregivers). The model also tends, when considered exclusively, to elevate the medical care of athletes to a higher plane than its important (some would argue more important) sister, exercise and health for all patients. And, in fact, the team physician model, by definition, focuses on team athletes from the ages of 12 to 22 (and a few older professionals)—a very narrow population relative to a family physician's or internist's caseload.

In this issue, both the focus on athletes (team physician model) and the extension to everyday patients (office-based or operative model) can be seen in the article "Acute Knee Injuries: On-the-Field and Sideline Evaluation" by Robert F. LaPrade, MD, et al, page 55. Similarly, articles on ACL injury in women, page 15, and functional knee braces, page 117, extend lessons learned in the care of elite athletes into your practice.

Odds are, then, that you practice sports medicine—by our definition. Next month, when I examine the other models (the roles of the great majority), we'll see more about how and why.

Gordon O. Matheson, MD, PhD