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Sports medicine

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Sports medicine
An injured player is carried from the field during a football match.
SystemMusculoskeletal, cardiovascular
Focus
Sports
especially athletics
Significant diseases
Significant testsMusculoskeletal tests
SpecialistSports physician
GlossaryGlossary of medicine
Sports medicine physician, Sport and Exercise Medicine (SEM) physician
Occupation
Names
  • Physician
Occupation type
Specialty
Activity sectors
Medicine
Description
CompetenciesExercise prescription, Therapeutic injections
Education required
Fields of
employment
Hospitals, Clinics, Professional sports, College athletics, university

Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the late 20th century that sports medicine emerged as a distinct field of health care. In many countries, now over 50, sports medicine (or sport and exercise medicine) is a recognized medical specialty (with similar training and standards to other medical specialties or sub-specialties). In the majority of countries where sports medicine is recognized and practiced, it is a physician (non-surgical) specialty, but in some (such as the USA), it can equally be a surgical or non-surgical medical specialty, and also a specialty field within primary care. In other contexts, the field of sports medicine encompasses the scope of both medical specialists as well as allied health practitioners who work in the field of sport, such as physiotherapists, athletic trainers, podiatrists and exercise physiologists.[1]

Scope

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Sports medicine can refer to the specific medical specialty or subspecialty of several medical and research disciplines in sports. Sports medicine may be called Sport and Exercise medicine (SEM), which is now well established in many countries. It can broadly also refer to physicians, scientists, trainers, and other paramedical practitioners who work in a broad setting. Sports medicine specialists include a broad range of professions. All sports medicine specialists have one main goal in mind, and that is preventing future injuries and to improve the function of that area to return to everyday life. They work with all different types of people, and not just athletes.[2] The various sports medicine experts often work together as a team to ensure the best recovery plan for the individual. Team members can include orthopedic surgeons, certified athletic trainers, sports physical therapists, physical medicine and rehabilitation specialists, and specialty SEM physicians.[3]

Specializing in the treatment of athletes and other physically active individuals, SEM physicians have extensive education in musculoskeletal medicine. SEM doctors treat injuries such as muscle, ligament, tendon and bone problems, but may also treat chronic illnesses that can affect physical performance, such as asthma and diabetes. SEM doctors also advise on managing and preventing injuries.[4]

European templates for SEM specialization generally recommend four years of experience in:[5]

  • internal medicine with special emphasis on cardiology, emergency medicine and clinical nutrition
  • orthopedics and traumatology
  • physical and rehabilitation medicine
  • fellowship at a recognized sports medicine centre.
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Establishment as a medical specialty

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Historical roots of sports medicine

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Although sports medicine was only established formally as a specialty in the 20th Century, the history of doctors having involvement in treating athletes goes back to ancient times in Greek, Roman and Egyptian societies.[6][7][8][9][10]

Modern establishment of the specialty

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Continental European countries were the first to establish medical groups with a focus on sport in the earliest part of the 20th Century. Possibly the earliest establishment of a society of Sports Medicine was the DGSP in Germany in 1912.[11] The Italian version of this page Medicina dello sport states that Sports Medicine societies were first established in Switzerland (1922) followed by France (1929) and Italy (1929) (Italian Sports Medicine Federation). In Germany in the 1920s, an attempt was made to upskill thousands of doctors and other health professionals in sport and exercise medicine, without establishing it as a distinct specialty at that stage, but it failed due to lack of funding in the Depression.[12] Sports medicine was established as a distinct specialty in Italy, the first country to do so, in 1958. The European Union of Medical Specialists has defined necessary training requirements for the establishment of the specialty of Sports Medicine in a given European country.[3] In May 2024, the EU approved cross recognition of sports medicine qualifications between 11 different countries.[13] It is a goal of the European Federation of Sports Medicine Associations to eventually establish Sports Medicine as a specialty in all European countries.[14]

In Australia and New Zealand, Sport and Exercise Medicine (SEM) is a stand-alone medical specialty, with the Australasian College of Sport and Exercise Physicians being one of Australia's 15 recognized medical specialty Colleges.[15] Australia, New Zealand and the UK have been cited as pioneer countries in the establishment of SEM as a stand-alone specialty.[16]

The USA (and many other countries) follow the model of recognizing Sports Medicine as an official subspecialty of multiple other primary medical specialties. The most common primary specialties prior to a sports medicine subspecialty in the USA are family practice, orthopedics and physiatry.[17]

Country Specialist sports physician association Fully recognized specialty? (Year) Training requirements General sports medicine association
Argentina Yes[18] 2-year training program
Australia Australasian College of Sport and Exercise Physicians Yes (2009) 4-year training program Sports Medicine Australia
Austria Austrian Society of Sports Medicine (OSMV) Subspecialty[19] 3-year Diploma
Belarus Belarus Sports Medicine Association Yes[20]
Belgium The Belgian Federation of Sport and Exercise Medicine Subspecialty[20] 1 year
Bosnia Herzegovina Sports Medicine Association Bosnia Herzegovina Yes[20] 5 years
Brazil Brazilian Society of Exercise and Sports Medicine Yes[21][22] 3 years
Bulgaria Bulgarian Scientific Society of Sports Medicine and Kinesitherapy Yes[20] 4 years
Canada Canadian Academy of Sport and Exercise Medicine Subspecialty
China Chinese Association of Sports Medicine Yes[23][24][25]
Croatia Croatian Sports Medicine Society Yes[26]
Cuba Yes[27]
Czech Republic Czech Society of Sports Medicine Yes[20] 5 years
Denmark No[26] Danish Association of Sports Medicine
Estonia Yes[26]
Finland Finnish Society of Sports Medicine Yes[20] 5 years
France Sport and Exercise Medicine French Association (SFMES) Yes[19]
Georgia Georgian Association of Sports Medicine Yes[20]
Germany German Federation for Sports Medicine (DGSM) Subspecialty[19]
Hungary National Institute for Sports Medicine[28] Subspecialty[20]
India Indian Society of Sports and Exercise Medicine (ISSEM)[29] Yes (1987 for PG Diploma & 2013 for MD)[30] 2[31] & 3 years[32] Indian Association of Sports Medicine & Indian Federation of Sports Medicine
Indonesia Indonesia Sports Medicine Association (PDSKO)[33] Yes[34] 3,5 years[34] Indonesian Sports Health Supervisory Association
Ireland Faculty of Sports and Exercise Medicine Yes[35] (2017)
Israel Israel Society of Sports Medicine Yes[36]
Italy Federazione Medico Sportiva Italiana (FMSI) Yes[19] (1958) 5 years
Japan Japan Medical Association Certified Sports Health Medical System Yes (1994)[37] The Japanese Federation of Physical Fitness & Sports Medicine
Latvia Latvian Sports Medicine Association Yes[20] 4 years
Lithuania Yes
Malaysia College of others (Sports Physician), Academic of Medicine of Malaysia, National Specialist Registrar (NSR)[38] Yes[39] 4 years Malaysian Association of Sports Medicine[40]
Malta Yes
Mexico Yes[27]
Netherlands Netherlands Association of Sports Medicine NASM – VSG Yes[20] (2014) 4 years
New Zealand Australasian College of Sport and Exercise Physicians Yes (1998) 4 years Sports Medicine New Zealand
Norway No Norwegian Sports Medicine Association
Poland Yes[41]
Portugal Sociedade Portuguesa de Medicina Desportiva Yes[20]
Qatar ASPETAR Yes
Romania Yes
Russia Russian Association of Sports Medicine and Rehabilitation of Patients and the Disabled Yes[20] 2 years
Serbia Sport Medicine Association of Serbia Yes 3 years
Singapore Yes (subspecialty)[42] (2011) 3 years (after primary specialty training)[43] Sports Medicine Association Singapore (SMAS)
Slovakia Slovak Society of Sports Medicine Subspecialty (6 years)
Slovenia Slovenian Sports Medicine Association Yes[20]
South Africa College of Sport and Exercise Medicine of South Africa Yes (2022)[44] South Africa Sports Medicine Association (SASMA)
South Korea Subspecialty[45] Korean Society of Sports Medicine (KSSM)
Spain SMD (Sociedad Española de Medicina del Deporte) Yes 3 years
Sri Lanka Sri Lanka Sports Medicine Association Yes[46] 3 years
Sweden No[26] Swedish Society for Physical Activity and Sports Medicine
Switzerland Swiss Society for Sports Medicine (SGSM) Subspecialty[20]
Turkey Turkish Sports Medicine Association Yes[20]
Ukraine Ukrainian Sport Medicine and Physical Exercises Specialists Association (USMPESA) Yes[20]
United Kingdom Faculty of Sport and Exercise Medicine UK Yes (2006)[47] 4 years British Association of Sport and Exercise Medicine
United States of America Subspeciality (1994) of:
  • Emergency Medicine
  • Family Practice
  • Orthopedics
  • Pediatrics
  • Physical Medicine & Rehabilitation
 1–2-year Fellowships American College of Sports Medicine
Uruguay Yes[27]

Public health

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SEM physicians are frequently involved in promoting the therapeutic benefits of physical activity, exercise and sport for the individuals and communities. SEM Physicians in the UK spend a period of their training in public health, and advise public health physicians on matters relating to physical activity promotion.[48]


Common sports injuries

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Main article: Sports injury
An ACL Tear

Common sports injuries that can result in seeing a sports medicine specialist are knee and shoulder injuries, fractures, ankle sprains, concussions, cartilage injuries, and more.[49] A sports medicine specialist can also be seen for advice in other areas of health, like nutrition, exercise, supplements, and how to prevent injuries before they occur. A sports medicine specialist works to help make the performance of the athlete more advanced, as well as ensuring their safety while performing the activity.[50] Sports injuries generally affect soft tissue or bones within the body and are commonly treated without surgery.[51]

Treatment for sports injuries

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Different types of sports injuries require different treatments and major injuries involve surgery, but most do not. Common treatments include medication, such as pain relievers or anti-inflammatory medication, icing, physical therapy, and/or immobilization of the injured area.[52] Physical therapy is used to get the injured area back into regular movements and to reduce the discomfort of the affected area. PRICE is an acronym that is used for the common treatment of these injuries. It stands for protection, rest, ice, compression, and elevation.[51]

Controversies in sports medicine

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Concussion in sport

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Main article: Concussions in sport

The management of concussion in sport has been extremely controversial over the past 20 years due to the discovery and reporting of Chronic traumatic encephalopathy as a disease that is common in ex-athletes, particularly footballers. Sporting codes have been accused of being complicit in understating the long-term damage caused by concussions by allowing too many head impacts to occur and for the players to be able to return to play too quickly after received concussions. A seminal series of consensus papers has been the international guidelines on the management of concussion in sport.[53][54][55] These consensus statements have been seen on the positive side as being sports medicine leaders moving the management of concussion in a more conservative direction over time and encouraging a standard set of tests and assessments. On the negative side, they have been seen as conflicted and allowing return to play too rapidly.[citation needed]

Transgender people in sport

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Main article: Transgender people in sport

Whether male-to-female transgender athletes can safely and fairly participate in women's sport at the elite and community levels is a highly charged and controversial topic. The sports medicine world is not united in its views and although this debate well and truly involves medical input, it is as much a social controversy as it is a medical one.[56][57]

Drugs in sport

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Main article: Doping in sport

Doping in sport has a long history with doctors in the sports medicine world being both heroes and villains on different occasions.[tone] The presence of trained sports medicine professionals at elite sporting events has been critical in the fight against doping, but sometimes doctors become the enablers of doping and are part of the scandal themselves.[58]

Sports scandals involving medicine

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Main article: List of sporting scandals

Major scandals where doctors were prominent include:[59]

Allied health team members

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Different medical professionals for sports injuries require different forms of training, but for sports injuries, they mainly all work with the diagnosis and treatment of these injuries. All sports medicine professionals work with people of all age ranges, professional athletes, or even adolescents playing any sport. The main two allied health professions for sports injuries are athletic trainers (in the USA) and physical therapists (physiotherapists) in most other countries.[2]

Athletic trainer

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Athletic trainers are typically part of a sports medicine team in the US in particular, providing primary care, injury and illness prevention, wellness promotion, emergency care, therapeutic intervention and rehabilitation to injuries.[60] When an athlete is injured, an athletic trainer is key to treatment and rehabilitation working closely with the athlete throughout rehabilitation.[61] Athletic trainers are often the ones who assess the injury first and provide initial care.

Physiotherapist

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Physiotherapists are a primary sports medicine team member in most countries of the world. Physiotherapists can specialize in many areas with sports physiotherapy as a major subspecialty. Physiotherapists are a main factor in the recovery stage of an injury as they set up an individualized recovery plan.[62] Physiotherapy is underfunded within most health systems so that it is generally much more accessible in higher-income countries and, even within these countries, is much more accessible to higher-income earners. In countries like Denmark and Australia there are many more physiotherapists than in lower-income countries.[63]

Podiatrist

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Podiatrists treat issues related to the foot or ankle, which is a common area where athletes get injuries. They specialize in the diagnosis and treatment of foot-related issues by performing tests and referring physical therapists. Podiatrists can also perform surgeries or prescribe medication as forms of treatment.[62]

Other practitioners

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All of Exercise physiologists, Strength and conditioning coaches, personal trainers, Chiropractors, Osteopaths, Sports psychologists and Sports nutritionists/dietitians can be part of the Sport and Exercise Medicine team.

Journals

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Journal Established Scimago Ranking[64] Region/country Publisher
British Journal of Sports Medicine 1964 4.329 United Kingdom BMJ Group
American Journal of Sports Medicine 1972 3.021 United States SAGE Publishing
Knee Surgery, Sports Traumatology, Arthroscopy 1992 1.806 Germany; Europe Springer Science+Business Media
Medicine & Science in Sports & Exercise 1969 1.703 United States Lippincott Williams & Wilkins
Clinical Journal of Sport Medicine 1990 0.990 Canada Lippincott Williams & Wilkins
Journal of Science and Medicine in Sport 1984 1.724 Australia Elsevier
The Physician and Sportsmedicine 1973 0.651 United States Informa Healthcare
Research in Sports Medicine 1988 1.397 Routledge
Sports Health 2009 1.212 United States SAGE Publications
Exercise and Sport Sciences Reviews 2000 1.945 United States Lippincott Williams & Wilkins
The Journal of Strength and Conditioning Research 1987 1.569 United States Lippincott Williams & Wilkins

See also

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Further reading

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