Chapter 1: Sport and exercise medicine: the team approach

INTRODUCTION

Sport and exercise medicine (SEM) is evolving as a specialist medical discipline that includes a variety of tasks and responsibilities.^{1, 2, 3, 4, 5, 6, 7} 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 special subpopulations

• medical care of sporting teams and events

• medical care in situations of altered physiology, such as at altitude, environmental extremes, or at depth

• 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:

1. prevention, diagnosis treatment and rehabilitation of injuries that occur during physical activity

2. prevention, diagnosis, and management of medical conditions that occur during or after physical activity

3. promotion and implementation of regular physical activity in the prevention, treatment and rehabilitation of chronic diseases of lifestyle.⁸

Because of the growing breadth of content, SEM traditionally lends itself to being practised by a multidisciplinary team of professionals with specialised skills who provide optimal care for the athlete and improve each other’s knowledge and skills. The sporting adage that a ‘champion team’ would always beat a ‘team of champions’ applies to sport and exercise medicine. This team approach can be implemented in a multidisciplinary SEM clinic or by individual practitioners of different disciplines collaborating by cross-referral. However, the real-world application of this multiskilled team approach poses significant challenges—some of which are eloquently dealt with by the specialist SEM physician. SEM is now an official medical specialty in many countries and this has significantly changed the level of care to athletes and also patients suffering from chronic disease.

THE SEM TEAM

The most appropriate sports medicine team depends on the setting. Clubs and sporting bodies increasingly employ specialist SEM physicians, with the primary role being the comprehensive health management of the athlete to facilitate optimal performance. This includes the diagnosis and treatment of injuries and illnesses associated with exercise to ultimately improve performance. In an isolated rural community the sports medicine team may consist of a family physician or a physiotherapist/physical therapist alone. In a populous city, the team may consist of a number of clinicians and sports scientists working together and may include:

• specialist SEM physician

• family physician

• physiotherapist/physical therapist

• soft tissue therapist

• exercise specialist for exercise prescription

• other medical specialists with an interest in SEM

• orthopaedic surgeon, rheumatologist, radiologist, cardiologist, etc.

• podiatrist

• dietitian/nutritionist

• psychologist

• sports trainer/athletic trainer

• other professionals such as osteopaths, chiropractors, exercise physiologists, biomechanists, nurses, occupational therapists, orthotists, optometrists

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