Why Sport and Exercise Medicine may be valuable where functional rehabilitation, not performance, is the priority

Keywords: Sport and Exercise Medicine; Rehabilitation; Musculoskeletal health

Introduction

Sport and Exercise Medicine (SEM) is still often associated with athletes, pitch-side care and return to sport. Yet some of the clearest opportunities for SEM to improve outcomes may sit far from traditional sporting environments. In inpatient rehabilitation, musculoskeletal problems frequently limit recovery, but can be under-recognised or difficult to address quickly within existing care models. This blog explores how SEM may naturally fit into this space.

Musculoskeletal problems quietly limit rehabilitation

Rehabilitation patients commonly present following neurological injury, surgery, frailty syndromes, falls, deconditioning or prolonged immobility. Alongside the primary diagnosis, there is often a significant burden of musculoskeletal pathology.

Common examples include:

• Hemiplegic shoulder pain 
• Osteoarthritis flares 
• Acute crystal arthropathy, including gout and calcium pyrophosphate deposition disease 
• Post-operative joint effusions 
• Occult or missed fractures after falls 
• Joint stiffness following prolonged admission or immobility 

These issues matter. Pain, swelling and restricted movement reduce engagement with therapy, delay functional gains and can prolong length of stay. A swollen knee, painful shoulder or undiagnosed fracture may be the difference between progressing with transfers, gait retraining and discharge planning – or losing rehabilitation momentum.

Crystal arthropathy is a particularly relevant example in frail, multimorbid patients, especially around acute illness, admission, renal dysfunction or medication changes. Timely diagnosis and targeted treatment may avoid unnecessary transfers, reduce reliance on systemic therapies where these carry risk and allow rehabilitation to continue.

Why SEM aligns with rehabilitation

SEM is well suited to rehabilitation because the specialty combines broad medical training, MSK diagnostic expertise, use of diagnostic ultrasound, image-guided intervention skills and a functional, movement-focused mindset.

In practice, this means SEM clinicians can support proportionate decision-making at the bedside: is this pain safe to move through? Is there an effusion to aspirate? Is imaging needed? Would a targeted injection improve therapy participation? Does this presentation need escalation to orthopaedics, rheumatology or acute medicine?

The role is not to replace rehabilitation medicine, geriatrics, neurology, orthopaedics, rheumatology, physiotherapy or occupational therapy. It is to add an embedded MSK-functional skillset within the multidisciplinary team.

SEM as a flow-enabling specialty

When SEM input is available within rehabilitation teams, its value may extend beyond individual diagnoses. Timely MSK assessment, bedside ultrasound and targeted intervention can restore engagement with therapy, reduce avoidable transfers or acute referrals, support safer post-falls assessment, clarify weight-bearing and exercise progression and contribute to discharge planning.

In a local 3-month service report in 2025 from St Pancras Rehabilitation Unit, embedded SEM input delivered 18 ultrasound-guided injections, 4 joint aspirations and 11 diagnostic MSK ultrasound assessments. At least 31 external referrals or acute trust reviews were estimated to have been avoided over this period. While these figures require more formal evaluation, they suggest that timely MSK input may have meaningful impact on patient flow, therapy participation and system burden.

In this context, SEM is not simply a referral endpoint. It can act as a flow-enabling specialty, aligned with wider healthcare priorities around rehabilitation, community care, reduced acute burden and functional recovery.

Impact beyond patients: the MDT and workforce

The benefits are not limited to individual patient encounters. Rehabilitation units often include clinicians with variable MSK confidence, including resident doctors rotating through services where MSK presentations are common but formal MSK training may be limited.

Embedded SEM input can provide immediate educational value by supporting:

• Confidence in MSK examination and red flag recognition 
• Better assessment of pain and injuries after falls 
• Practical understanding of aspiration and injection procedures 
• Improved shared decision-making with therapists 
• Early exposure to SEM as a career pathway 

This matters because the educational gain persists after the individual SEM consultation. Improving baseline MSK confidence across resident doctors and the wider MDT can strengthen rehabilitation services more broadly.

What this means for SEM

Rehabilitation challenges the narrow view of SEM as a specialty focused only on athletes or outpatient MSK clinics. At its core, SEM is about restoring movement, reducing pain and enabling participation.

As healthcare systems face ageing populations, multimorbidity and increasing emphasis on recovery and function, SEM’s relevance in rehabilitation is likely to grow. The question is not whether SEM adds value here, but whether service design should evolve to make that value available where it is needed most.

Conclusion: what should the reader take away?

• MSK pathology is a major, under-recognised barrier to rehabilitation. 

• SEM’s integrated skillset aligns closely with rehabilitation needs. 

• Embedded SEM input may improve patient flow, MDT confidence, resident doctor education and system efficiency.

Figure 1: Infographic summary highlighting the advantages of SEM in rehabilitation

Authors
Dr Raj Amarnani, University College London Hospitals NHS Foundation Trust 

Dr Nicola Fitzgerald, Central and North West London NHS Foundation Trust 

Dr Frances Baawuah, Central and North West London NHS Foundation Trust 

Dr Arvind Chandratheva, Central and North West London NHS Foundation Trust 

Dr Sophie Edwards, Central and North West London NHS Foundation Trust 

Dr Will Goodison, Central and North West London NHS Foundation Trust 

Carole Walters, Central and North West London NHS Foundation Trust 

Competing Interests

Nil