The Role of the Primary Care Physician in the Sports Medicine Chain

Transcription

1 The Role of the Primary Care Physician in the Sports Medicine Chain Brian Johnston, ATC Assistant Athletic Director for Sport Medicine East Tennessee State University

2 The sports medicine umbrella has evolved over the years into a very complex system of specialties a26d74d697a00e7ba5c1b784c86c8c015b2/SportsMedUm brella.jpg

3 Today. Sports Medicine (SM) does not fit into one area of expertise. SM does not target one organ, system or disease but rather a broad based area that can encompass many areas simultaneously. (McCrory 2006)

4 This need for a more broad based network of physicians has evolved into an overlapping of disciplines. Athletic Training Physical Therapy Chiropractics Orthopedics Internal Medicine Primary Care Emergency Medicine Internal Medicine and many more.

5 Today, a sports medicine physician must be competent in three levels of care: 1. Sub Optimal Exercise as management of medical problems 2. Optimal Weekend Warrior 3. Supra Optimal Enhancement of performance in athletics (McCrory 2006)

6 The Team Physician in Collegiate Athletics #1 Priority is to provide for the well being of individual athletes enabling each to realize his/her full potential Ultimately responsible for all student athletes as it relates to health and welfare Must utilize resources to have a successful program (Team 2001)

7 Duties and Responsibilities Medical Management Physicals On field injuries Illness Rehab Return to play Nutrition Strength and Conditioning Record Keeping Administrative Role delineation Education of athletes, parents, coaches, etc. EAP Equipment Coverage Environmental (Team, 2001)

8 Who is the right person for a job of this magnitude? What specialty most appropriately can manage such a responsibility?

9 2005 Harvard Study over a 2 year period 73% of initial evals were musculoskeletal 27% of initial evals were general medical 4% of musculoskeletal injuries required surgery (Steiner 2005)

10 The results of the Harvard study very closely reflect the injury data collected at ETSU over the past 10 years.

11 What does this mean? The old model of orthopedic surgeon as the team MD may need to be changed A physician with a more broad scope of knowledge and a specialization in musculoskeletal medicine and exercise would be more appropriate

12 The Inter Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions: Best Practices Recommendations (2010) The right combination of strength, speed, cardiorespiratory fitness, and other components of athletic capacity can complement skill and enhance performance for all athletes.

13 The Facts Since 2000: 21 NCAA D1 student athletes have died during conditioning sessions 75% were football players (16/21) 52% (11/21) occurred on day 1 or day 2 Three most common causes of death Sickle Cell Trait complications Heat issues Cardiac issues

14 From Number of NCAA Division I Football Bowl Subdivision players who died while practicing or playing football 0

15 Sickle Cell Trait Complication Must know the status of every DI student athlete Heat Issues Recognize heat signs/symptoms Manage acclimatization periods Cardiac Issues ACLS EKG/Echo PPE Disqualification?

16 Concussion Epidemic (CDC) ~2 4 million sports concussions/yr in US! (Langlois et al., 2006) RJ Elbin, PhD

17 Constant Media Exposure Sports Illustrated, ESPN, National Geographic, Discovery Channel Madden RJ Elbin, PhD

18 Prevalence & Incidence of Sport Related Concussion 1.6 to 3.0 million sportrelated concussions occur every year in U.S. (CDC, 2006) 5.0% of all collegiate athletic injuries are concussions (Gessel et al. 2007) Occur more often in competition than practice (Gessel et al. 2007)

19 What do we know? Number of Concussions Pro College High School Knowledge/Standard of Care Pro College High School Youth? Youth RJ Elbin, PhD

20 Concussion Resolution Unanimous agreement that the majority (80% 90%) of concussions will resolve in a short (7 10 day) period. *college athletes on average recover within 1 5 days (Field et al. 2003; Macciocchi et al. 1996; Iverson et al. 2006; McCrea et al. 2003) *Young children recover slower than High School *High School recover slower than College *College recover slower than Professional *Senior recover slower than everyone

21 NCAA Return to Play Protocol(McCrory et al. 2009) Rehabilitation Stage Fx Exercise at Each Stage Objective at Each Stage 1. No Activity Physical and cognitive rest Recovery 2. Light Aerobic Exercise Walk, swim, stationary bike, < 70% of max HR, no resistance training 3. Sport Specific Exercise Skating drills (hockey), running (soccer), no head impact activities 4. Non contact drills More complex training drills, may being progressive resistance training 5. Full contact practice Following medial clearance, participate in normal training activities 6. Return to play Normal game play Increase HR Add movement Exercise, coordination, and cognitive load Restore athlete s confidence; coaching staff assess functional skills

22 What medical specialty.. Comfortable managing and assessing labs? Can manage heat related issues? Can interpret and make decisions in cardiac related issues? Is comfortable managing concussions?

23 The answer is clear. The primary care physician with a certificate of added qualification in sports medicine most appropriately fits this new model of a team physician This does not, however diminish the value of other physician specialties

24 Orthopedics Optometrist Internal Medicine Dentist Primary Care Dermatology Cardiology Cardiology

25 Who are the essential members of the Sports Medicine Team? Primary Care Sports Medicine Physician (MD, DO) Athletic Trainer (ATC) Strength Conditioning (CSCS, CSCCa) Sport Science (PhD)

26 Overlapping Roles Team MD Athletic Training Strength Conditioning Sport Science

27 Communication Team MD Athletic Trainer Student Athlete Strength and Conditioning Sport Science

28 What does strength Conditioning have to offer? Negative Trends Decreases in performance Positive Trends Increases in performance Decreases in energy Poor Technique Mental Fatigue Correcting poor technique Mental boost Work ethic

29 What does Sport Science have to offer? Negatives Trends Predictor of injury Positives Trends Baseline testing Root of injury Increases in training Mental injury Training Design Outside the Box predictor Boost Confidence

30 Athlete Monitoring Physician X Rays Labs Manual Muscle Testing Vitals Sport Science Hydration Peak Power Rate of Force Development Asymmetry Labs

31 Will there be Tension? There are going to be problems/concerns that should never be solved If we always agree and get along, someone is not doing their job If there is tension/disagreement Does mean there is a problem? Know what you know not what you ve heard Parent Coach Athlete Sports Medicine Media Strength Staff

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33 So.what IS the role of the Primary Care Physician?...to be a leader

34 To have the right amount of Truth and Grace

35 Not just one or the other Truth Fact You are accountable Dad The tough professor The cold coach Grace It s ok You are forgiven Mom The good professor The player s coach Cannot just be Truth and cannot just be Grace Must be a fluid balance Depends on the situation Depends on the individual Get to know your staff/athletes You will know when the time comes Your actions/attitudes affect everyone

36 To be Resolute Admirable, purposeful, determined, unwavering Determined, firm, decided, resolved, decisive tip of the spear the end of the line webster.com/dictionary/resolute

37 When the world is crashing around you you must stand firm In a crisis or emergency situation you will be the person looked upon to make a decision You will always be the last person to yell not it

38 Without a doubt the most important advice that I can give you can take home about being a team physician is.

39 Have Fun!

40 Thank you. Tom Kwasigroch, PhD Jerry Robertson, ATC Todd Fowler, MD Dough Aukerman, MD Ralph Mills, MD Benjamin England, MD

41 Disclosure Statement of Financial Interest I, Brian Johnston DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

42 McCrory, P. What is sports and exercise medicine? British Journal of Sports Medicine, 2006; 40: Steiner, M., Quigley, D., Wang, F., et al, Team Physicians in College Athletics, The American Journal of Sports Medicine, 33: , 2001 Team Physician Consensus Statement, Reprinted with permission of the projectbased alliance for the advancement of clinical sports medicine, comprised of the American Academy of Family Physicians, the American Academy of Orthopaedic surgeons, the American College of Sports medicine, the American Medical Society for Sports medicine, the American Orthopaedic Society for Sports Medicine, and the American Academy of Sports Medicine 2001 Casa, D. J., Anderson, S. A., Baker, L., et al; The inter association taskforce for preventing sudden death in collegiate conditioning sessions: Best practice recommendations, Journal of Athletic Training, 2012;47(4):

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