Sport and exercise medicine: the team approach

'You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime' Babe Ruth (1895-1948)

Sport and exercise medicine (SEM) is evolving as a specialist medical discipline including a variety of responsibilities and tasks.

These include:

-Injury and illness prevention -injury diagnosis, treatment and rehabilitation -management of medical problems -performance enhancement through training -nutrition and psychology -exercise prescription in health and in chronic disease states -exercise prescription in specific subpopulations -medical care of sporting teams and events -medical care in situations of altered physiology (e.g. altitude, depth, environmental extremes) -dealing with ethical issues such as the problem of drug abuse in sport.

SEM has been defined as the scope of medical practice that focuses on:

- Prevention, diagnosis treatment and rehabilitation of injuries that occur during or after physical activity

- Prevention, diagnosis and management of medical conditions that occur during or after physical activity

- Promotion and implementation of regular physical activity in the prevention, treatment and rehabilitation of chronic diseases of lifestyle.

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The SEM team

SEM traditionally lends itself to being practised by a multidisciplinary team of professionals. SEM is now an official medical specialty in many countries and this has significantly changed the level of care to athletes as well as patients suffering from chronic disease.

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The challenges of management

The secret of success in SEM is to take a broad view of the patient and his/her problem. For example, a runner with shin pain arising from a stress fracture may have abnormal biomechanics, inappropriate footwear, change in training surface, quantity or quality of training. In SEM it is necessary to diagnose both the problem and the cause, then treatment can be focused on both these areas.

Diagnosis

Every attempt should be made to diagnose the precise anatomical, pathological and functional cause of the problem. This should be followed by a diagnosis of the cause. Ben Kibler, an American orthopaedic surgeon, described the presenting problem as the 'victim' and the cause as the 'culprit'. A combination of factors may cause the problem, so diagnosis requires a good understanding of biomechanics, technique, training, nutrition and psychology.

Treatment

A combination of different forms of treatment will often give the best results. It is important for the clinician to be aware of the variety of treatments available and when their use is appropriate. The effectiveness of treatment needs to be constantly evaluated. If a particular treatment is not effective, the diagnosis should be reconsidered and other treatment options explored.

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'Love thy sport'

A good understanding of sport is paramount for a successful SEM clinician. If they understand the technical aspects and physical demands of a particular sport, this will improve their understanding of the possible causes of injury and help them to facilitate sport-specific rehabilitation programmes. It will also mean the patient will have increased confidence in the clinician.

I hope you found my first official blog post an interesting read!

Injury Ninja x

REFERENCES

Brukner, P., 2012. Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.