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Sports physicians treat the injuries and illnesses of both the amateur and elite athlete. They are often referred to as team physicians. Depending upon the level of athlete they are treating, sports physicians are usually either practitioners in family practice as medical doctors (M.D.'s) or orthopedic surgeons. More often than not, the individual who works as the team physician for a professional sports team is too busy tending to the health needs of the team to have time for a private practice as well.
At the scholastic level, the team physician is usually the school physician and is appointed by the school board. Athletic programs at the collegiate level are usually capable of supporting a staff of one or more physicians who cater to the needs of the athletic teams. The size of the school and athletic program also determines the number of full-time physicians; for example, a state university basketball team might have one physician, even an orthopedic surgeon, dedicated wholly to that team's needs.
Professional teams, of course, have the necessary resources to employee both a full-time physician and an orthopedic surgeon. Generally, their presence is required at all practices and games. Often, professional teams have a sports medicine department to handle the various aspects of treatment, from training to nutrition to mental health. If they don't have their own department, they take advantage of the specialists at university hospitals and private care facilities in the area.
To fully understand the nature of a particular sports injury, sports physicians study the athlete as well as the sport. The musculoskeletal system is a complex organization of muscle segments, each related to the function of others through connecting bones and articulations. Pathological states of the musculoskeletal system are reflected in deficits (weaknesses in key muscle segments) that may actually be quite distant from the site of the injury or trauma. The risk factors for any given sport can be assessed by comparing the performance demands that regularly produce characteristic injuries with the risk factors that might predispose an athlete to injury.
Strength and flexibility, for example, are requirements for nearly every sport. Stronger muscles improve an athlete's performance, and deficits in strength can leave him or her prone to injury. Rehabilitation under the supervision of a sports physician focuses on rebuilding lost muscle strength. Likewise, an athlete who lacks flexibility may subject himself or herself to strains or pulls on his or her muscles. For this athlete, rehabilitation would center on warming and stretching the isolated muscles, as well as muscle groups, to reduce or alleviate such muscle strains. In both cases, it is the responsibility of the sports physician to analyze the potential for injury and work with other sports health professionals to prevent it, as well as to treat the injury after it happens. The goal of every sports physician is to keep athletes performing to the best of their ability and to rehabilitate them safely and quickly after they are injured.
To prevent injuries, as well as treat them, sports physicians administer or supervise physical examinations of the athletes under their care to determine the fitness level of each athlete prior to that athlete actively pursuing the sport. During the exams, sports physicians note any physical traits, defects, previous injuries, or weaknesses. They also check the player's maturity, coordination, stamina, balance, strength, and emotional state. The physical examination accomplishes many different goals. To begin with, it quickly establishes the athlete's state of health and allows the sports physician to determine whether that athlete is physically capable of playing his or her sport. On the basis of the physical exam, the sports physician advises the coach on the fitness level of the athlete, which in turn determines a great deal about the athlete's position on the team. Furthermore, the exam alerts the sports physician to signs of injury, both old and new. Old or existing injuries can be noted and put under observation, and weaknesses can be detected early on so that coach and trainers can implement proper conditioning and training patterns.
Depending upon the results of their physical examinations, the sports physician may advise athletes to gain or lose weight, change their eating, drinking, and sleeping habits, or alter their training programs to include more strength or cardiovascular exercises. Routine physical checkups are also a common way of evaluating an athlete's performance level throughout a season, and many sports physicians will administer several exams to gauge the effect of their advice, as well as to ensure that the athlete is making the suggested changes in habits or training.
Preventing injuries is the sports physician's first goal and conditioning is probably the best way to accomplish that goal. Sports physicians are often responsible for developing and supervising the conditioning and training programs that other sports health professionals will implement. The sports physician may work with the coaching staff and athletic trainers to help athletes develop strength, cardiovascular fitness, and flexibility, or the sports physician may advise the coaching and training staff members of the overall safety of a practice program. For example, the sports physician may evaluate the drills and practice exercises that a football coach is using on a given day to make certain that the exercises won't exacerbate old injuries or cause new ones. Sports physicians may even be involved in the selection of protective gear and equipment. The degree of their involvement, again, depends on the size of the team and the nature of the physicians' skills or expertise, as well as on the number of other people on the staff. Large, professional teams tend to have equally large staffs on which one person alone is responsible for ordering and maintaining the protective gear.
Sports physicians are often in attendance at practices (or they are nearby, in case of an injury), but their presence at games is mandatory. If a player shows signs of undue fatigue, exhaustion, or injury, the sports physician needs to be there to remove the athlete from the competition.
After an athlete is injured, the sports physician must be capable of immediately administering first aid or other procedures. He or she first examines the athlete to determine the gravity and extent of the injury. If the damage is extreme enough (or cannot be determined from a manual and visual exam), the sports physician may send the athlete to the hospital for X-rays or other diagnostic examinations. Later, the team physician may perform surgery or recommend that the athlete undergo treatment or surgery by a specialist. Some of the most common types of injuries are stress fractures, knee injuries, back injuries, shoulder injuries, and elbow injuries.
The sports physician oversees the athlete's recuperation and rehabilitation following an injury, including the nature and timing of physical therapy. The athlete's return to practice and competition is determined by the sports physician's analysis of the athlete's progress. Frequent physical examinations allow the physician to judge whether or not the athlete is fit enough to return to full activity. The decision to allow an athlete to compete again following an injury is a responsibility that sports physicians take seriously; whether the athlete is an amateur or an elite professional, the future health and well-being of the athlete is at stake and cannot be risked, even for an important championship game.
A developing area of the sports physician's responsibilities is the diagnosis and treatment of substance-abuse and doping problems. Unfortunately, even as research on the field of sports medicine has produced new methods and medications that mask pain and decrease inflammation—which shortens recovery time and lengthens athletic careers—some also produce unnatural performance enhancement. Most notable of these are anabolic steroids—synthetic modifications of the male hormone, testosterone—which have become widely abused by athletes who use them to better their performances. When taken while on a high-protein diet and an intensive exercise regimen, these drugs can increase muscle bulk, which in turn can produce increased strength, speed, and stamina. The side effects of these drugs, however, include aggression, sterility, liver problems, premature closure of the growth plates of the long bones, and in women, male pattern baldness and facial hair. These side effects are usually irreversible and, as such, pose a significant health risk for young athletes.
Another method also banned from use in competition-level athletics is the withdrawal of an athlete's blood several weeks prior to competition. The blood is stored and then, just before the athlete competes, the blood is transfused back into his or her bloodstream. This process, blood doping, also has serious, even fatal, side effects, including heart failure and death.
Finally, professional athletes sometimes develop substance-abuse problems, such as alcohol or drug abuse. Sports physicians are responsible for detecting all of these problems and helping the athlete return to a healthy lifestyle, which may or may not include competing in their sport.
In addition to the responsibilities and duties outlined above, many sports physicians also perform clinical studies and work with researchers to determine ways of improving sports medicine practices. Often, the results of such studies and research are published in medical journals and popular magazines.