SPORTS  MEDICINE

The International Federation of Sports Medicine, founded in 1928, adopted the most satisfactory of many definitions of sports medicine:

Sports Medicine embodies theoretical and practical medicine which examines the influence of exercise, training and sports, as well as lack of exercise, on healthy and unhealthy people of all ages to produce results that are conductive to prevention, therapy, and rehabilitation, as well as beneficial for the athlete himself.

Thus the subject is far more comprehensive than suggestions that it is only about injuries. The complex and interrelated aspects of athletic preparation far exceeds the skills of any one group of professionals.  In other words, sports medicine implies a high degree of interdisciplinary cooperation – all centered on the athlete (and perhaps family and school) – not only between doctor, therapist and scientist but with coach, official, manager, sponsors and media.

At the outset, keen children and adolescents reach a moment when their physical characteristics will determine or limit what sport they can practise, especially if they desire a professional career in sports. Around this time in their lives, a number of professionals will intervene in their careers: 
  • clinical doctors caring for sportsmen and women; 
  • sports psychologists, 
  • coaches involved in a single sport, usually leaders or champions in their field in the past;  
  • sports nutritionists;
  • sports scientists, who analyze biomechanics of events and equipment:
    • surface qualities; 
    • traction and its relation to shoe properties;
    • jumping and landing areas;
    • clothing properties and footwear design;
    • action dissection by filming and reviewing;
    • equipment analysis: rackets, bikes, ball, clubs, motors, boats, poles, javelins, etc.
  • sponsors and the media.
The coach is the key influence in guiding the training schedules, as the technical skills require meticulous instruction and endless repetition. The maintenance of stamina and flexibility, plus precision, is boring, and demands a good deal of persuasion and inspiration: both top performance and safety being important issues.   A battery of physiological assessments are routinely undertaken for the professional athlete, guided by the clinician and the sports scientist, and at some point the sports nutritionist plays a very important role, as the biochemical needs for fueling or refueling vary in the different sports.  

A constant need to achieve success is so great that many men and women have been driven into overtraining and to the use of illegal means to enhance their performance. The former, overtraining, has become a limiting factor in sports, and it can affect all locomotor tissues: bone, joints, ligaments and tendons.  Here clinicians trained in sports medicine play a vital role in nursing the athletes back to normal, and carefully supervising with their coaches a gradual return so as to regain their competitive edge. Modern technology in the form of echosonography, computed tomography, magnetic resonance imaging, diagnostic arthroscopy and minimal invasive surgery have played a key part in restoring disabled athletes back to normal.  

The initial steps leading to performance enhancement began with some athletes training at high altitude, as the low oxygen content in the atmosphere leads to increased red cell production, thus a higher content of oxygen can be used back at sea level. Others risked transfusion above the physiological needs of the body, and in the past decades stimulation of the bone marrow to produce excess red blood cells began, with the use of erythropoietin. Used medically in a number of sicknesses, it has been banned from use in sports, though as is common knowledge, it is still widely used, despite an alarming number of unexplained sudden deaths attributed to its use. Many other artificial performance enhancements have been used, though strict controls and routine monitoring for illicit drug use, plus heavy penalties and public dishonor have apparently diminished their employment.

As a lot of us either actively take part in individual or competitive sporting activities, or we accompany and follow our children in theirs, it is wise to remember some of the problems, both physical and psychological, that may arise, both to prevent injuries or to treat them adequately. 

Author: Dr. John Emery


Ref:  Edited by S. Lock, J.M. Last & G. Dunea, “The Oxford Illustrated Companion to Medicine”, Oxford University Press, 3rd. Edition, 2001.