Opportunity and Responsibility

As sports medicine clinicians, we spend a lot of time around athletes during their daily routines. These daily encounters by athletic trainers, physical therapists, and physicians in the training room and on the field often provide us with an opportunity to improve the experience of athletes entrusted to our care. Along with this opportunity, more importantly, comes the responsibility to intervene when the situation warrants. Well-meaning coaches, athletic directors, and general managers, among others, can influence the physical and mental health of athletes with their attitudes and policies. These powerful influences are geared, understandably, toward producing positive performance and victories. Sports medicine clinicians, however, should monitor these efforts and recognize when the athlete’s welfare may be in jeopardy. Successful sports organizations maintain administrative systems that ensure that clinicians can guide the medical care of athletes without undue pressure and influence. These safeguards are critical to athletes and the sports they play.

The process should begin by placing competent and responsible professionals in the leadership positions. Clinicians who will make the right decision regardless of the pressures put on them. The sideline physician and/or ATC (certified athletic trainer) who can determine when a player needs to go to the emergency room, the locker room, or the bench is an invaluable asset to the athlete’s welfare, especially in competitive situations where clinicians may be asked to cut corners or compromise their best judgment when stakes are high. Picture the star quarterback recovering from a concussion the week before a big game. Is he ready to play? Really ready? Can the decision makers restrict their emotions and allegiance to the team and make the right call for the athlete?

No doubt the primary responsibility of clinicians is to diagnose and treat, but our responsibilities do not have to end there. With good clinical care at the high school, college, or professional level, we can influence the physical, emotional, and the economic costs of injuries. These short- and long-term costs should help guide our recommendations, research, and prevention efforts.

Unfortunately, too often it’s the short-term costs of injury that become the focus for most of those involved: players, coaches, family, and teams. It is the clinician’s responsibility to educate and clarify the implications of injuries and illness, when those are known and the situation is appropriate. An athlete should know the risks for returning to sport 4 months after an anterior cruciate ligament reconstruction if he or she chooses that hazardous course. Athletes and their families should be informed of these realities by clinicians even when all the pressure and “talk” is only about getting back to competition. Athletes deserve to know the likely outcome of their injuries and illnesses, especially the risks and potential complications, and particularly when the prognosis is guarded. How that information is used understandably depends on the athlete and his or her family. Additional concern is certainly warranted with the youngest and most vulnerable athletes.

With time, clinicians are able to assimilate the outcomes of their treatment efforts into valuable experience that can benefit their own and possibly other patients. To be successful at this task, you don’t have to be in an academic/research center to play this vital role in athletic medicine. A good example of a clinical care researcher was one of my professional heroes, the late Dr. Tom Peterson, a private practice orthopaedic surgeon from Ann Arbor, Michigan. Tom was an outstanding high school running back who went on to play at the University of Michigan on its National Championship football teams in the late 1940s. After his stellar career at Michigan, he pursued his goal of orthopaedic surgery but his love for football never died. He wanted to make the game of football safer. After spending many hours on the sidelines and treating knee injuries, Dr. Peterson recognized the danger of the crackback block in football and collected injury data from National Collegiate Athletic Association (NCAA) and National Football League (NFL) films.¹ He is responsible for taking the data to the NFL and the NCAA and credited with the subsequent rule changes that outlawed these blocking techniques, making the game undoubtedly safer. His work was recognized by the AOSSM with one of the first O’Donoghue Research Awards for Injury Prevention. I was fortunate to get to know Tom Peterson well, later in his career. He contributed to my orthopaedic training and was a great role model for sports medicine clinicians. Interestingly, he never had formal research assistance. He did all his clinical research out of his private practice office based on his keen observations and diligent data collection. He was willing to intervene and challenge the system when he recognized that the welfare of athletes was clearly at risk. Tom Peterson saw the opportunity to improve the sport of football and accepted the responsibility by challenging the system. Dr. Peterson documented the danger of the crackback blocks. His film collection from the University of Michigan, Michigan State University, and the Detroit Lions demonstrated the injury mechanism well. Once the mechanism was known, injury prevention was possible through rule changes.

Sports medicine clinicians often have similar opportunities to improve athletic participation if we remain vigilant and engaged in our daily work. Current national interest in concussions, anterior cruciate ligament injuries, and femoral acetabular impingement are but a few of the dilemmas that we witness every day. I think it is our responsibility as sports medicine clinicians to constantly try to determine who is most at risk for injury so that the athlete can be properly counseled about that risk. The preparticipation physical is just one of the many opportunities that we should use fully to determine possible at-risk athletes by obtaining an accurate injury and illness history and providing a proper physical examination. That may be the best time to determine whether additional testing, special preparation, or protective equipment is warranted. The desired outcome of these preseason evaluations should not just be the play/no play decision. This should be an assessment of risk and safety, especially for those athletes participating in the high-risk contact sports.

To sum up, the question we should contemplate as sports medicine clinicians is: Do we accept the responsibility of pursuing athletic safety? Or do we simply view our role as diagnosing and treating illnesses and injuries after they occur? Every so often we have an excellent opportunity to improve sports participation. I think that we can and should do better!

—Edward M. Wojtys, MD
Editor-in-Chief