The Physician and Sportsmedicine
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Prevention for All
Applying Our High-Tech Treatment Know-How


Sports medicine, like many other branches of medicine, has always had two sides: treatment and prevention. Treating acute injuries and illnesses that prevent participation in sports and exercise has been front and center in clinical medicine, while prevention is something we spend more time talking about than actually doing.

At least that's the way it seems to me. Initial improvements in physical training and sports preparedness and attention to nutrition, skill, and protective equipment are approaching their limits. The injury rate is not going down; it's going up. Even in colleges with large sports medicine programs that include athletic trainers, physical therapists, nutritionists, strength and conditioning specialists, and physicians, the frequency of injuries and illnesses from contact or overuse are as high as they have ever been.

What's more, determining the frequency and intensity of participation in practice and competition together with rules governing safety are not in the hands of healthcare providers. Instead, prevention seems to be more in the hands of sports governing bodies and associations, health-policy organizations, and lawmakers.

Compare that situation with the development of new medical devices for treating injuries and illnesses, which is growing rapidly on a foundation of new technology. Open MRI, laser-speckled imaging to measure blood flow and oxygenation status in tissues undergoing arthroscopy, advances in rehabilitation, type 1 collagen meniscal scaffolds, and directed energy for modulating connective-tissue remodeling for the treatment of acute and degenerative connective-tissue conditions are but a few examples of high-tech applications. We must continue to move in the direction of new technologies and train physicians to correctly apply them.

The key point is that the development and deployment of these technologies lies within reach of the practicing physician. By contrast, the next step in injury prevention lies just out of reach of the physician—in the hands of the policymakers.

So, rather than beat ourselves up about shortcomings in our approach to prevention through direct patient contact, let's at least consider the plausibility that one reason for limited success is that there is something missing when one relies on the message of prevention to change patient behavior: the laws and policies with sufficient teeth in them to make sports participation safer.

We need to progress in this area but, at the same time, must welcome new technology and not, as some prevention advocates do, bemoan it as a last-ditch solution for a failed prevention program. In fact, much of the new prevention technology is already being used on elite athletes. An example is a comprehensive electronic preparticipation evaluation that provides details on risk factors for participation.

A preventive approach to injuries and illnesses in sports and recreation, one that produces momentum, will be backed by policies that ensure health and safety. (To provide a nonsports analogy: Antibiotics are stopgaps for dysentery if there is no policy to effect clean water supplies and hygiene.) At the same time, technologies that improve diagnosis, treatment, and outcomes in musculoskeletal medicine should continue to be pursued to improve care when injuries do occur.

What is unique about sports medicine is the combination of the potential to treat people to allow them to stay active and the potential for disease and injury prevention—not so much in the elite, competitive population but in the recreational participant. These two worlds should fuse. If we can provide for the mainstream public the same kinds of services available to elite athletes, optimal, high-tech prevention could become a reality.

Gordon O. Matheson, MD, PhD