Trends for the Future as a Team Physician: Herodicus to Hereafter

(1)

Trends for the Future as a

Team Physician:

Herodicus to Hereafter

James R. Andrews, M.D.

Andrews Sports Medicine & Orthopaedic Center Andrews Sports Medicine & Orthopaedic Center

Birmingham, AL Birmingham, AL The Andrews Institute The Andrews Institute

Gulf Breeze, FL Gulf Breeze, FL

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Goals of this Presentation

• To discuss what has transpired in the world of sports _{To discuss what has transpired in the world of sports}

medicine through the centuries

• To define the responsibilities of the team physician_{To define the responsibilities of the team physician} • To discuss the makeup of the Sports Medicine Team_{To discuss the makeup of the Sports Medicine Team} • To present my philosophy of how I approach the care _{To present my philosophy of how I approach the care}

of the athlete

(3)

Let’s look back in time at the

development of Sports Medicine

and the “Team Physician”

(4)

Herodicus was reportedly the 1

stst

team

_team

physician and original

“Father of Sports Medicine”

• _{He was a Thracian physician of the 5}_{He was a Thracian physician of the 5}thth century _century

B.C. who rendered his foundational theories

on the use of therapeutic exercises for the

maintenance of health and treatment of disease

maintenance of health and treatment of disease • _{Reportedly Hippocrates’ father sent him to the}_{Reportedly Hippocrates’ father sent him to the}

Isle of Crete to study sports medicine from

Herodicus

(5)

There has been an abundance of sports

medicine theories and practices since

then – some good, some bad with lots of

inconsistencies

• _{The one fact that has been consistent through}_{The one fact that has been consistent through}

history is that athletic competition does

produce injuries, some of which are severe,

career ending and even deadly

(6)

Modern sports medicine really began in

1890 at Harvard Medical school

• At _AtHarvardHarvard it became apparent that unattended, uncoached, it became apparent that unattended, uncoached, and academically unsupervised team sports activities

and academically unsupervised team sports activities

frequently produced significantly large numbers of

musculoskeletal injuries

• Because of this a program was instituted to educate the players _{Because of this a program was instituted to educate the players}

of the need for personal fitness, the use of proper gear, the

need for treatment of all injuries and the importance of

rehabilitation

• Team _Teamathletic trainers and therapistsathletic trainers and therapists were provided and were provided and escalated in importance

escalated in importance

• _{And the team physician was recognized as the}_{And the team physician was recognized as the}_{HEAD TEAM}_{HEAD TEAM}

SURGEON

SURGEON with full responsibility for the care and health of with full responsibility for the care and health of the athlete

(7)

Other milestones in the development of

the team physician and Sports Medicine

include:

• 1899 – Dr. Darling’s scientific report defined the _{1899 – Dr. Darling’s scientific report defined the}

physiologic effects of strenuous athletic and methods

for decreasing injuries

• 1904 –Dr. Nichols as a team physician changed _{1904 –Dr. Nichols as a team physician changed}

football rules to have protective gear and defined the

basis for a significant decrease in injuries

• _{1905 – President Theodore Roosevelt formed the}_{1905 – President Theodore Roosevelt formed the}

American Football Rules Committee

• _{1910 – The work of that committee under the}_{1910 – The work of that committee under the}

leadership of Henry L. Williams later formed the

N.C.A.A.

(8)

Other milestones in the development of

the team physician and Sports Medicine

include:

• 1914 – In Germany in the year before World War I, _{1914 – In Germany in the year before World War I,}

they were the first to use the term “Sports Physician”

they were the first to use the term “Sports Physician” • 1933 – From their organization work the Federation _{1933 – From their organization work the Federation}

Internationale de Medico-Sportive et Cientifique

“FIMS”

• _{1938 – Dr. Thorndike of Harvard Sports Medicine}_{1938 – Dr. Thorndike of Harvard Sports Medicine}

wrote the first book on Sports Medicine entitled

“Athletic Injuries, Prevention, Diagnosis and

Treatment

(9)

U.S.O.C. Sports Medicine History

• _{The USOC began as a small group, headed by}_{The USOC began as a small group, headed by}

James E. Sullivan, the founder of the Amateur James E. Sullivan, the founder of the Amateur

Athletic Union Athletic Union

• _{Dr. William Milligan Sloane served as the first}_{Dr. William Milligan Sloane served as the first} president of the committee in 1894.

president of the committee in 1894.

• The formal committee, initially named the _{The formal committee, initially named the}

American Olympic Association, was formed at American Olympic Association, was formed at a meeting in November 1921 at the New York a meeting in November 1921 at the New York

Athletic Club. Athletic Club.

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U.S.O.C. Sports Medicine History

• _{In 1940, the AOA changed its name to the}_{In 1940, the AOA changed its name to the}

United States of America Sports Federation United States of America Sports Federation and, in 1945, changed it again to the United and, in 1945, changed it again to the United

States Olympic Association. States Olympic Association.

• _{Public Law 805, which granted the USOA a}_{Public Law 805, which granted the USOA a} federal charter, was enacted in 1950.

federal charter, was enacted in 1950.

• This charter enabled the USOA to solicit tax-_{This charter enabled the USOA to solicit} tax-deductible contributions as a private,

deductible contributions as a private, non-profit corporation.

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U.S.O.C. Sports Medicine History

• _{In 1961, when major constitutional}_{In 1961, when major constitutional}

revisions were made, the name of the

USOA was changed to the United States

Olympic Committee.

• _{The USOC moved its headquarters from}_{The USOC moved its headquarters from}

New York City to its present Colorado

Springs site on July 1, 1978.

(12)

U.S.O.C. Sports Medicine History

• On November 8, 1978, Public Law 95-606 (The _{On November 8, 1978, Public Law 95-606 (The}

Amateur Sports Act) was enacted by Congress. It

specifically named the USOC as the coordinating body

for athletic activity in the United States directly relating

to international Olympic family athletic competition,

including the sports on the programs of the Olympic and

Pan American Games.

• _{The USOC was also given the responsibility of}_{The USOC was also given the responsibility of}

promoting and supporting physical fitness and public

participation in athletic activities by encouraging

developmental programs in its member organizations.

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U.S.O.C. Sports Medicine History

• The Act also included provisions for recognizing _{The Act also included provisions for recognizing}

National Governing Bodies (NGBs) for the sports

on the Olympic (winter and summer) and Pan

American Games programs and gave the USOC the

general authority to review matters related to the

recognition of NGBs in the Act.

• This public law not only protects the emblems of the _{This public law not only protects the emblems of the}

IOC and the USOC, but also gives the USOC

exclusive rights to the words "Olympic,"

"Olympiad" and "Citius, Altius, Fortius," as well as

to Olympic-related symbols in the United States.

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U.S.O.C. Sports Medicine History

• Prior to 1978, individual sports would select _{Prior to 1978, individual sports would select}

their own medical teams their own medical teams

• There was no continuity or consistency in the _{There was no continuity or consistency in the} selection process

selection process

• _{In 1978 Bob Beeten ATC started the U.S.O.C.}_{In 1978 Bob Beeten ATC started the U.S.O.C.} sports medicine volunteer program

sports medicine volunteer program

• _{The review and selection process was refined}_{The review and selection process was refined} and standardized over the next two decades and standardized over the next two decades

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U.S.O.C. Sports Medicine History

• _{Progression of service and “pyramid”}_{Progression of service and “pyramid”}

system with evaluation at each level:

– Application and credential review_{Application and credential review} – _{OTC 2 week service}_{OTC 2 week service}

– Olympic Festival (80’s to 90’s)_{Olympic Festival (80’s to 90’s)} – World University Games_{World University Games}

– World Championships_{World Championships} – Pan American Games_{Pan American Games}

(16)

U.S.O.C. Sports Medicine History

• _{The selection process is still intact, but is}_{The selection process is still intact, but is}

now under the Performance Services

Division

• _{Oversight :}_{Oversight :}

– _{1978-2000: U.S.O.C. Sports Medicine}_{1978-2000: U.S.O.C. Sports Medicine}

Committee

– _{2000-present: staff with U.S.O.C. Sports}_{2000-present: staff with U.S.O.C. Sports}

Medicine Advisory Committee as advisors

(17)

From the early 1940’s and 50’s

many scientific articles were

published in the U.S. which

began the scientific basis for

Sports Medicine in the U.S.

(18)

Another milestone in Sports

Medicine was in 1957 when

Harvard’s Dr. Quigley,

the first

_{the first}

real team physician, produced

the athlete’s

(19)

Other pioneers in sports medicine during

these times included famous names as:

• _Delorme_Delorme • _Dutoit_Dutoit • _Hey_Hey

• _Pendergrass_Pendergrass • _Bosworth_Bosworth

• _{Bennett – noteworthy was his contributions in}_{Bennett – noteworthy was his contributions in}

a study on shoulders and elbows in pitchers,

1947

(20)

After World War II a whole new arena of

sports medicine arose with the coverage

of athletic events on the sidelines.The

leader in this coverage explosion was

one

Jack C. Hughston

_{Jack C. Hughston}

who with his

_{who with his}

group of physicians covered high school

games on Friday night and Auburn

University and other colleges on Satuday

(21)

Also after World War II the N.A.T.A. was

organized and founded

(22)

In the 1950’s

Don O’ Donoghue

the

team physician for the University of

Oklahoma became the father of modern

sports medicine. His book entitled

“Treatment of Injuries to Athletes”

was

considered the

Bible

for sports medicine

physicians

(23)

Also

Through the work of Jack C. Hughston

as Chairman of the American Medical

Association’s “Sports Medicine

Committee” and later Chairman of the

AAOS’s “Sports Medicine Committee”,

post graduate education courses and

research peer review article became the

standard

(24)

From these courses grew the following

two very important establishments:

• _{The American Orthopaedic Society of Sports}_{The American Orthopaedic Society of Sports}

Medicine

• _{American Journal of Sports Medicine}_{American Journal of Sports Medicine}

(25)

Because of this the first Sports Medicine

Fellowship was established in the early

1970’s

(26)

From the 1970’s to present there was an

explosion in the academics of Sports

Medicine to include

• _Arthroscopy_Arthroscopy

• _{Modern ACL surgery and other acute &}_{Modern ACL surgery and other acute &}

chronic ligamentous surgery

• _{Along with minimally invasive procedures for}_{Along with minimally invasive procedures for}

the other joints: Shoulder, elbow, ankle, hip &

wrist

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Noteworthy from the leadership of all the

above groups the modern sports

medicine team was born

(28)

Leadership roles were also taken by the

other sports societies and their leaders to

include:

• _{American College of Sports Medicine}_{American College of Sports Medicine} • _{The NATA and its athletic trainers}_{The NATA and its athletic trainers}

• _{The Sports section of the American Physical}_{The Sports section of the American Physical}

Therapy Association

• _{The American Medical Society of Sports}_{The American Medical Society of Sports}

Medicine

• _{The National Association of Strength and}_{The National Association of Strength and}

Conditioning Coaches

(29)

From there the rest is Modern Sports

Medicine History!!

(30)

Through all of this even today the

hallmarks of a good team physician are:

• _Availability_Availability • _Compassion_Compassion • _Gentleness_Gentleness • _Honesty_Honesty

• _{Communication}_{Communication}

• _{And a true love of being helpful to those whos}_{And a true love of being helpful to those whos}

show good sportsmanship

(31)

Orthopaedic Sports Medicine

What is it?

“

The care of the muscles,

bones,and joints of

athletically active individuals”

(32)

Whatever it is, it’s a “team effort”!

Sports medicine

encompasses a number of

medical disciplines!

Orthopaedic Sports Medicine

(33)

The Modern Sports Medicine Team

Sports doctor Sports doctor Sports orthopedist Sports orthopedist Athletic trainer Athletic trainer Physical therapist Physical therapist

Strength and Conditioning

Specialists Specialists Medical specialist Medical specialist Hand Surgeon Hand Surgeon Neurosurgeon Neurosurgeon Dentist Dentist Nutritionist Nutritionist Psychologist Psychologist Bioengineer Bioengineer Other para-medical personnel

(34)

Responsibilities of

The Sports Medicine Team

#1 To the player

#2 To the parents

Then to the team, to the coaches and

to management / ownership

(35)

Sports Medicine is a hobby –

almost a full-time hobby if

you do it right

(36)

Why do we do it?

• _{Community involvement and interest}_{Community involvement and interest} • _{Because we enjoy it}_{Because we enjoy it}

• _{The right thing to do}_{The right thing to do}

• _{YOU ARE EXPECTED TO DO IT}_{YOU ARE EXPECTED TO DO IT}

(37)

“

Availability

_Availability

is #1”

_{is #1”}

“

Communication

_{Communication}

is the

_{is the}

other key factor”

Dealing With Athletes

(38)

• Lack of _{Lack of}communicationcommunication is the major reason is the major reason

for failures in taking care of the athlete.for failures in taking care of the athlete.

• _{You must effectively communicate with the}_{You must effectively communicate with the}

player, the parents, the trainer/therapist the coach,player, the parents, the trainer/therapist the coach,

and the management / ownershipand the management / ownership

• _{In regards to professional athletes,}_{In regards to professional athletes,}

the agents become a big factorthe agents become a big factor..

• The media and the fans have also made the care of _{The media and the fans have also made the care of}

the athlete much more difficult and complex

(39)

Andrews Patient Philosophy

• Always be open-_{Always be}

open-minded

minded

• Do not be the first _{Do not be the first}

person to make the

BIG statement

• _{The patient is always}_{The patient is always}

right

• _{Make the patient feel}_{Make the patient feel}

he is treated properly he is treated properly by his previous by his previous physician physician

• _{Do not say anything}_{Do not say anything}

bad about another

physician, for that

matter another person

matter another person • _{Listen to the patient}_{Listen to the patient}

• Attitude, responsibility, _{Attitude, responsibility,}

knowledge, desire and

availability are always

necessary to be

successful

• _{One must always be}_{One must always be}

able to read the patient

able to read the patient • _{The physician must be}_{The physician must be}

confident with his skills.

His confidence is

reflected back and

perceived by the patient

perceived by the patient • Try to make every _{Try to make every}

patient feel as though

they are

(40)

Physical Therapy and its role

in my practice

• We work side by side with the P.T. and _{We work side by side with the P.T. and}

A.T.C.

• All f/u are seen together in the P.T. dept._{All f/u are seen together in the P.T. dept.}

• _{Rehabilitation is often more important than}_{Rehabilitation is often more important than}

the surgical procedure in the overall result!!

(41)

Pre-operative and post-operative rehabilitation Pre-operative and post-operative rehabilitation

is frequently more important than the surgical procedure! is frequently more important than the surgical procedure!

(42)

Education and Research

is still

_{is still}

the core ingredient in any

sports medicine practice

(43)

ASMI

“My Pride and Joy”

• _{501(c)3Non-profit public}_{501(c)3Non-profit public}

foundation

• _{Education & Research in}_{Education & Research in}

Sports Medicine

– _{Epidemiology: Primary}_{Epidemiology: Primary}

focus on prevention of

injuries in youth sports

(44)

Sports Medicine

Today and tomorrow

Unfortunately,

it has become a “big business”

(45)

Orthopedics & Sports Medicine

The future

(46)

(47)

The future is just around

the corner and it is also

unbelievable

(48)

So what about the future?

“

Remember if you are still talking

about what you did yesterday you’re

not doing much today”

(49)

The future team physician will have to be

more sophisticated than ever!

• _{Fellowship trained}_{Fellowship trained}

• _{The holder of a certificate of added}_{The holder of a certificate of added}

qualification

• _{He will need to possess administrative}_{He will need to possess administrative}

capabilities to formulate an efficient sports

medicine team that includes all of the medical

disciplines, athletic trainers, sports physical

therapists and others

(50)

He or she will have to learn to balance

their busy lives with priorities to include

faith, family and their passion for sports

medicine!

(51)

Prevention will become more important

than treatment especially with the

epidemic rise in injuries in youth sports

(52)

We are at the genesis of radical advancements in treatments of

orthopedic and sports injuries. I am sure that as the arthroscope

was a “cataclysmic” event in the 70’s and 80’s that

revolutionized sports medicine to the hereafter, there will be

other breakthroughs in this millennium such as:

• _{Gene therapy}_{Gene therapy}

• _{Tissue engineering, Biologics (stem cell}_{Tissue engineering, Biologics (stem cell}

research)

• _{Robotic surgery}_{Robotic surgery}

• _{And other newer technology and}_{And other newer technology and}

instrumentation to make complex, diagnostic

and surgical procedures fast, simple, and

reproducible

(53)

Conclusions

• _{Sports Medicine has evolved since the beginning}_{Sports Medicine has evolved since the beginning}

of Herodicus’ time

• _{Many physicians have passionately molded the}_{Many physicians have passionately molded the}

profession to where it is today

• _{You need a complete & integrated sports team to}_{You need a complete & integrated sports team to}

take care of any athlete

• _{You must develop your own philosophy and}_{You must develop your own philosophy and}

ethical parameters to be successful

(54)

So good luck to our future sports

medicine physicians. They should have a

lot to look forward to!!!!

(55)

Thank You

American Sports Medicine Institute

Andrews

Sports Medicine & Orthopaedic Center