Medicine in Motion

Douglas B. McKeag, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 4 - APRIL 98

When C. Everett Koop exclaimed that exercise is the "most potent modifier of health" in medicine today (1), he was merely echoing what most of us have known for the past 25 years. Exercise is not only recreation and work, it is also therapy, prevention, and treatment. Primary care physicians inherently practice "sports medicine" with each patient they treat because they know the inherent health benefits of physical activity. As a result, society now has a greater consciousness about sports medicine and the benefits of exercise than ever before.

Sports medicine is nothing more nor less than medicine in motion. It is the most complete treatment for disease known. Physical activity may be applied across the entire spectrum of disease and is the most "natural" of interventions. This activity-based medicine promotes, as a central theme, maximum fitness and activity in pursuit of health.

One qualifier: Sports medicine is not as relevant to healthcare if it is defined only as care for the elite athlete, something we may have focused on too much in the past 25 years. We are talking about the "athlete" who is participating in the game of life. Relevant sports medicine is activity-based medicine founded on a belief in the importance of exercise, motion, and activity for everyone.

Practicing "sports medicine" gives us an extra dimension, another option, that can change the way people think about themselves. It is the very essence of personal health. To really be is to exercise?

The sports medicine movement, an infant when this journal debuted 25 years ago, has grown from youth to young adulthood complete with imperfections but still something to be considered with pride. Like any young adult, sports medicine has unrealized potential. Opportunities have been missed that would have made the field much more potent. Self-interest, even greed, continue to taint the motives of some. Yet as a whole, the field has turned out far better than we ever thought it would.

Broad Vision, Personal Approach

Many in medicine may still consider sports medicine to have little relevance to the serious business of taking care of sick people. Every patient, though, is an athlete with needs that flow across specialty boundaries. This multidisciplinary area of medicine represents precisely the type of approach needed to meet the demands of healthcare for the next century.

One of the biggest mistakes in modern healthcare is the attempt to standardize medicine by treating all patients who have similar disease in exactly the same way—as if each person didn't deal with health problems differently. A second major error is the tendency to focus narrowly on a single organ or system in the treatment of disease. The remedy for these two mistakes involves considering the patient as a unique, whole individual, observing all the ramifications of the illness or injury for him or her, and tailoring treatment accordingly.

Sports medicine practitioners are especially well positioned for resolving these problems because their skills must draw on many disciplines (orthopedics, cardiology, psychology, nutrition, neurology, and gynecology, to name a few), and because they combine this interdisciplinary orientation with a keen understanding of the immense benefits of physical activity. Athletes today demand comprehensive care, and physicians properly trained in sports medicine are well equipped to provide it.

Sports Medicine for All Patients

In considering how we can best help sports medicine to grow, we need to consider how this young movement truly fits into medicine. The fit is more congruent than most of us realize.

All of us who treat athletes, no matter what level, have been guilty of tunnel vision to some extent. Why do we fight each other for the privilege of taking care of rich suburban high school sports programs when urban athletes suffer inadequate care, if any? Our close-up lens needs to move to wide angle. When the Centers for Disease Control and Prevention tells us that poor kids are fatter now than ever before, it is not only poor nutrition at fault, but lack of activity as well. Hello? What are we doing about it?

We practitioners of activity-based medicine, then, have a mission. This mission, should we choose to accept it, is to use the expertise that we have garnered to enhance all of medicine. Consider, if you will, these prognostications:

• Recreational athleticism will shift to a preference for individual, alternative-type activities such as tai chi, rowing, and rock climbing.
• The need for interventional surgery will decline as improved rehabilitation continues to show that the "natural" history of most musculoskeletal injuries is complete functional recovery. Surgery will focus on the heretofore "incurable" injury and illness.
• "At-home" rehabilitation for most sports injuries will dominate. Such rehabilitation will be accompanied by sophisticated regimens that change daily as needed.
• Evidence-based physical exams will lend sophistication to on-field clinical care.

Shaping the Specialty

As we strive to apply sports medicine knowledge to 21st-century problems, these are some of the developments the field will likely face:

• To best serve patients, sports medicine will not be "cubbyholed" or controlled by any one discipline but will continue to integrate and appeal to many disciplines.
• Complete healthcare for teams will be the norm, not the exception, as primary care sports medicine grows in influence.
• As third-party payers begin to truly understand the importance of prevention and early appropriate care, primary care physicians who earn a certificate of added qualification in sports medicine will achieve dual listing in healthcare panels. Outcome studies will show that having such physicians involved in a panel results in better care of patients and more efficient use of consultants. The primary care sports medicine physician will essentially become a "broker" of sports medical care.
• Primary care sports medicine fellowship programs will decrease in number and increase in length. Weaker programs will disappear, leaving stronger primary care-based programs to offer fellowships concurrent with work toward an additional advanced degree.

Keeping Our Focus

It has been exciting to be part of the enthusiastic movement of sports medicine. For all that we have done, we must realize that the future of sports medicine depends on maintaining the single commitment upon which this movement was started—improving the complete healthcare of active patients. We must collaborate with others and never forget that the benefactors of our efforts are all our patients. Because all of us—athletic or not—need to perform each day.

Reference

1. US Public Health Service: Healthy People 2000: Public Health Service Action. Washington, DC, Dept of Health and Human Services, 1992

Address correspondence to Douglas B. McKeag, MD, University of Pittsburgh Medical Center, Kaufman Bldg, 3471 5th Ave, Suite 1000, Pittsburgh, PA 15213-3221; e-mail to dmckeag@uoi.upmc.edu.

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