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Advocating Injury Prevention: The Team Physician's Role


Perhaps primary among the gatekeepers of injury prevention stands the team physician. But team physicians typically are more geared toward treating injuries than preventing them, and we need to bolster the prevention arm.

Before we assess the team physician's contribution to prevention, we need to get a handle on injury trends over the past two decades, which can be difficult. The lack of standard definitions prevents good numerator data, and there is a fundamental lack of denominator data as well. However, aside from isolated success stories, it doesn't appear that injury rates have declined appreciably, and, in some cases, they've gone up.

It seems that in the past, we have clung to two approaches to injury prevention. One is the development of better protective equipment and everything associated with that, from artificial turf to footwear. The other is improved physical preparation. But since this dual focus has apparently not led to a significant reduction in injuries, we should explore other avenues.

Team physicians are doing a good job overall with treatment. New medical devices, high-quality rehabilitation, advanced surgical techniques, and state-of-the-art diagnostic imaging all contribute to our ability to make a diagnosis and provide definitive treatment quickly.

But how are we doing on the preventive side? Among the team physician's roles in preventing sports injury is detection, most commonly represented by the preparticipation exam (PPE). We don't know, though, how good the PPE is—there are no data to show that the PPE reduces morbidity and mortality.

Another role is monitoring athletes who have existing problems. This component arises because the athletic model of healthcare is to "clear" or "disqualify" athletes, and this black-and-white approach does not align with reality. We need to have effective mechanisms in place to monitor those who are cleared but have ongoing problems—a substantial percentage of those participating in competitive sports.

A third area is in return-to-play guidelines. Without being too critical here, we have virtually no evidence-based approaches to these difficult problems, and it appears there is as much or more written in the legal literature as in medical journals.

A fourth role for the team physician is pregame treatment, such as injections with local anesthetics to mask pain. Again, no real data.

The final area is advocacy and health policy, a clear role for physicians. But as the values and goals in competitive sports begin to overlap less with those in medicine, physicians' ability to influence health policy will very much depend on the quality of our data to create a solid platform for health policy advocacy. We must embrace this vital role in the coming years.

We can do much to foster prevention, but obstacles exist. We need to strike a balance between an athletic and medical model of healthcare. In addition, quality sports medicine training programs and services need to be less fragmented. And—in case you didn't recognize the repeated theme above—we need more studies to gather better data.

The American College of Sports Medicine sponsors a team physician course and publishes consensus statement on the team physician and on return to play. These efforts constitute a good start but don't go far enough. Virtually every team has a team physician, and this rather large group of physicians needs to champion prevention efforts. Most sports medicine meetings are organized around societies. What about establishing an annual meeting solely designed for team physicians?

It's time to see how a concerted effort from those in the trenches will reduce injuries.

Gordon O. Matheson, MD, PhD