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Are We Losing the Injury-Prevention Battle?


"Hope deferred makes the heart sick."
-Proverbs 13:12

There are many aspects of medical care that provide hope to patients with injury and illness. Let me tell you what my hope is for sports medicine.

Almost two decades ago, great attention was paid to physical fitness, technique, and equipment design as protective against injury. Hopes then were high that these measures would reduce injuries. Yet according to recent statistics, the incidence of injuries from sports is at an all-time high. According to the US Consumer Product Safety Commission, sports injuries in adults increased by 33% between 1991 and 1998. My read on this is that risk taking, pushing the limits, the desire to win, and athletes' bigger, stronger bodies have preempted advances made in the areas of injury prevention.

There. I've voiced the naked truth, and I challenge you to prove otherwise!

My hope is that common sense will help us to strike a balance more favorable for injury prevention. I hold this hope because of an essential truth in medicine. Exercise has powerful effects on health. For example, just last month, at Medical Grand Rounds at Stanford University, epidemiologist Inger Thune, MD, PhD, from the University of Tromsø, Norway, presented research data showing that cancer rates are substantially reduced in women who exercise regularly.

Sports medicine thus far has been preoccupied with an athletic model of medicine—emphasizing factors that enhance performance, speed recovery, and facilitate rapid return to sport. While sports medicine had its origins in providing care to elite and professional athletes, medical advances in caring for athletes has the potential to profoundly improve the care provided to the broader, noncompetitive community. This most powerful public health contribution from sports medicine has yet to be made.

The field of sports medicine, with years of credibility earned in the trenches of athletic medicine, is poised to provide leadership in this much more important area—helping the broader overcome musculoskeletal impediments that keep them from reaching their health and physical fitness goals. But first, we need to lose the bigger, better, faster, and win-at-all-costs image that now casts a pall on the field.

A recent article in Sports Illustrated (1) profiled seven retired professional football players who are suffering the disabling effects of past sports injuries. Those of us in medicine will be tarred with the same brush unless we clearly identify that we are not just treating elite athletes but are applying sound, time-honored principles of medicine that are transferable to other populations. As my colleague, Stanford bioethicist Ernle Young, PhD, said: "We are up against a deeply entrenched value system in American 'sport': Winning is valued above competing—and above all else, the athletes' well-being included." Looked at from a Kantian perspective, athletes are not treated as ends in themselves, but merely as means to the end of winning—and many of them are complicit in this.

The premise that injury is implicit to sports just doesn't fit the health model. In fact, it's holding back our profession from contributing in this more important area of injury prevention—not just in theory, but in practice. It's time we replaced the old model with a fresher, more hopeful one centered on our patients' contributions to society as human beings, not just on their contributions to the scoreboard.

Gordon O. Matheson, MD, PhD


1. Nack W: The wrecking yard. Sports Illus 2001;94(19):60-75