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Sports Medicine to the X-treme!


Am I the only one noticing a rise in X-treme activities? You got your X-treme sports, the X Games, and the X-treme Football League, to name a few. An Australian ex-commando (and, apparently, X-commando) who plans to skydive from the edge of outer space called his attempt "X-treme science." These sports boast three key elements: heightened danger, unusual body piercings, and a language only partly resembling English. Where did all this come from? My guess is that "extreme" was applied by sports marketing people to boost "X" appeal. (But why drop the "e," you ask? X-treme spelling, of course.)

I'm even seeing this wave spread out from sports into areas it has no business being. While visiting the Midwest, for example, I saw an ad for an X-treme herbicide. X-treme herbicide?? Does it kill weeds and rotate crops? Marketing folks have no idea how jarring these monikers are. I still can't shake the image of farmers wearing fatigues and nose rings, applying their X-treme herbicide and saying, "Dude! This pesticide is, like, totally stoked!" And I don't even want to get into udder piercings.

But I digress. The key question is this: How do X-treme sports affect us in sports medicine, a field that seems to follow trends in sports and name syndromes in honor of a sport (swimmer's ear, jumper's knee, skier's thumb)? The way I see it, this new X-treme thing could be good for sports medicine. X-treme sports will cause X-treme injuries that will require X-treme MRIs, X-treme surgery, and X-treme rehabilitation—all of which adds up to X-treme reimbursement. Plus, I like the idea of syndromes that are obvious to diagnose because of their severity: X-treme concussions, X-treme tendinitis, X-treme stress fractures, X-treme ACL ruptures, X-treme jock itch. We could develop a whole new branch of X-treme diagnostics. And think of the line of associated products: X-treme 360° derotational knee braces, X-treme supplements, X-treme jog bras made from a combination of Spandex, Kevlar, and the tiles used on the space shuttle heat shield.

The only thing is, once sports medicine is retooled around X-treme sports, the most X-treme of all will happen. Some New York advertiser will invent the Minimalist Games (the M-Games), and sports medicine will need to swing the other way. Picture the new syndromes this trend will generate: lawn dart leg (underestimating the prevailing wind), croquet hyphema (from bending over too far to appraise your opponent's shot), curler's frozen fat pad syndrome (lingering on the ice), horseshoe hamstring (premature release), bowler's itch (from serial-use shoes), and shuffleboard spine (when the cruise ship lurches). Think of the opportunities for new interventional studies: the Likely Outcomes from Sifting through Every Result (LOSER) study, the M-game Outcomes Not Encountered Yet (MONEY) study, the Anaerobic Bowling Shoe (ABS) study, the Warm Ice Prevention Study (WIPS) for preventing curling injuries to the knee. This research could keep sports medicine going for at least another 10 years!

Now, before I'm accused of X-treme silliness, I must say at least something non-X-istential. For us at The Physician and Sportsmedicine, identifying trends is only one of our activities. Our main purpose is to synthesize information that forms the foundation of clinical practice of physicians providing care to active patients, so that you, our readers, don't have to. It's all part of being an X-treme editor-in-chief!

Gordon O. Matheson, MD, PhD