20 May, 11 | by BMJ Group
It seemed like the perfect match: combining my dream job as a new registrar in sports and exercise medicine, with plans to develop my competitive career in international athletics. In August 2010, I’d just competed for GB in the Barcelona European marathon and was commencing a post as a new ST3.
However, six months later, injured, I found myself in the unexpected situation of becoming a doctor and patient simultaneously in the sports medicine field: an experience that, as an athlete, was utterly frustrating, but as a trainee, illuminating, and instructive for my future practice.
Having competed for GB in the preceding year, I was entitled to see a sports doctor through my sport’s governing body, UK Athletics, and therefore received swift and excellent attention and an MRI.
The resultant findings of a stress fracture were devastating as an athlete.
As a physician, it was a swift wake-up call to the perils of exercise, so beneficial in moderation, yet at an extreme level, potentially harmful. Upon reflection, I’d inadvertently ticked all the boxes for pitfalls the textbook tells us of (increasing mileage-guilty; wrong footwear-guilty, missing rest days, inattention to nutrition on busy days…the list went on).
At this point, the thorough assessment, empathic approach, and careful planning from my sports physician were essential to address the complex issues arising from injury; a model of care I hope one day to emulate.
If my specialty’s role is to promote exercise for its well founded benefits to the health of the general public, we as sports physicians will also have a duty of care and increasing role in monitoring the health of the exercising nation, intervening early to correctly diagnose and treat injury and illness, and implementing timely appropriate rehabilitation.
The “sick role” is not one to which your athlete will conform readily. Whether “weekend warriors” with a recreational pastime or elite competitors, athletes have a passion for sport that may be seen as addiction, but it is often a simpler love for a hobby and the escapism it provides, as well as the endorphins.
The endeavour of focused training is often goal oriented, whether striving for an Olympic qualification or aiming to complete a 5km race for charity, though in the attempt, an athlete’s perspective may shift from maintaining health through sport, to sacrificing a healthy model of exercise in the quest for perfection.
Therefore, it is important from the outset to determine the athlete’s goals and health beliefs; to treat with empathy and promote the athlete’s ability to take responsibility for their own health.
Although medicine increasingly involves patients in the decision process, the injured sportsperson presents a unique challenge.
Though the necessity for temporary cessation of injurious activity may seem obvious to the practitioner, for the athlete there are complex practical and psychological issues that may be barriers to accepting this, from the loss of earnings for professionals through to the loss of identity for athletes for whom participating in a sport is a fundamental part of their lifestyle.
From a personal perspective, even despite my awareness of an injury before a scan, the diagnosis cancelled out hundreds of miles of training in the rain and snow and the nights sacrificed from social events to build up the training “deposit.” Yet now I was offered no rebate.
To this point, I’ve experienced the advantage of early diagnosis and initiation of treatment as a privilege of elite competition.
The advantages of attending a sports doctor were encompassed by a holistic approach. The first appointment included thorough musculoskeletal assessment, discussion of an array of issues from the impact of the injury both on competitive scheduling and psychologically to the the initiation of further tests, and symptomatic treatment. My consultant managed my referrals to physiotherapy, sports nutrition, and provided rehabilitation guidance within the first week of consultation.
Despite my initial gloom, it was hard not to envisage with hope the possibilities of offering to the general public comprehensive acute injury treatment, insightful investigation, and crucial steps toward timely rehabilitation, alongside a broader remit of health promotion through sport and exercise medicine as a “one stop shop.”
Beyond the initial treatment, sophisticated rehabilitation models get the elite fit again, sometimes super fast. A multidisciplinary team approach centred around the athlete, to include coach, physiotherapist, nutritionist, physiologist and sports psychologist can help optimise results.
Such methods have produced great results, for example in athletics and British cycling, but are not yet widely available to the thousands of club runners, climbers, boxers, cyclists, gymnasts, and perhaps most importantly schoolchildren, whose potential to be the next Ennis or Adlington is yet untapped, but, crucially, whose potential for lifelong enjoyment of exercise may well be equal.
My own pursuit of rehabilitation to get back to competitive sport translates into arduous reconditioning, cross training, and patience.
However, a voyage of discovery and a lifetime’s worth of empathy for the injured athletes I will one day treat is certainly a solid “personal development plan” for an aspiring sports doctor.
Rebecca Robinson is a specialist registrar in Sports and Exercise Medicine, based in Sheffield. She is interested in the role of sports medicine in supporting athletes in the lead up to 2012 and beyond, as well as the importance of exercise for improving the health of patients with chronic disease. She is also a keen athlete, with a background in International Mountain running, currently training for the marathon and hoping to build on my experience, gaining bronze as part of Team GB in the 2010 European championships in Barcelona.