What Are The 10 Commandments of a Sports Physician?

Located at the core of the sports medicine team is the orthopedist. Orthopedists are medical doctors who perform the surgical miracles that return athletes to competition; in addition, they supervise the activities of allied health personnel. Orthopedists specialize in the health of individuals' bones and joints, related supportive structures, and muscles. Osteopathic (D.O.) and chiropractic (D.C.) specialists likewise can serve as sports physicians concentrating on their specific orientation to providing good health. Other medical specialists—for example, dentists—also may assist athletes. Regardless of the specialty of the physician, the commandments of Theodore Fox, M.D., formerly of the Chicago Bears professional football team, deserve serious attention as guidelines to behavior. These have undergone slight modification to conform to this book.

Team or Sports Physician's 10 Commandments

1. The physician must be trained in all procedures for prevention, recognition, diagnosis, and treatment of injuries; first aid; as well as knowledge of soft tissue and skeletal injuries.
   
2. The physician must personally examine and evaluate all candidates for the sport or team prior to their participation to determine each individual's fitness for the same. This should include a history of all previous illnesses, accidents, and surgical procedures as well as a psychological evaluation and a thorough physical examination. The physical evaluation should include observations of any injury, especially in the collision sports. The physical examination should include determination of the individuals' maturity, balance, coordination, agility, stamina, and strength.
   
   
   
3. The physician must know the fundamentals of the particular sport with which he or she is involved, to better understand the mechanism of the injuries occurring, as well as the injured participant and her or his problem.
   
4. The physician must observe and evaluate the emotional well being of the athlete, especially the young player. Is the candidate being pushed by a frustrated parent to be a superstar or made apprehensive by a parent who is concerned that the athlete might get hurt?
   
5. The physician should select and fit all protective gear and equipment and check it as to type and quality, especially in the collision sports.
   
6. The physician should supervise the trainer or the coach in the proper use of physiotherapeutic techniques in the training room. Also, the physician is responsible for conditioning and rehabilitation exercises (such as weight training). Upon the doctor rests the responsibility for total rehabilitation of the injured athlete (mental and physical); a careful examination must precede the athlete s return to participation.
   
7. The physician must advise the coach not to teach dangerous blocking and checking practices and to avoid mismatches between athletes, especially young players. The doctor should advise the coach or trainer about problems or injuries that may occur because of heat, humidity, overwork, or fatigue.
   
8. The physician (or a designated replacement) must be available at all times to examine the injured players as soon as possible after the injury. This is especially true in collision sports where, if possible, the physician should be on field. Often youngsters will mask an injury so as to continue to play; a physician can make an assessment of the severity of the injury. Also, certain injuries (neck, re injury) require a doctor's examination.
   
9. The physician must prevent an injured player from returning to the game if there exists a reasonable doubt about his or her condition. In doing so, the physician must resist all pressures from coaches, parents, alumni, and the player.
   
10. The doctor must obtain X rays of injuries (and other information as necessary) prior to judging the condition of the injury.
    

The sports medicine staff has a serious obligation to the player's present and future health. Close adherence to Dr. Fox's 10Commandments will curtail many of the serious abuses related to athletics.

While a few teams, mainly at schools, employ general practitioners (CP's) in the capacity of sports physicians, orthopedists by their training best serve in this position. Those involved in sports normally serve on a consulting basis with teams and/or work in sports clinics.

This career is the best paid of all sports medicine personnel. Yearly salaries over $100,000 are common; most earn considerably more. In addition, sports physicians enjoy fine working conditions and, in most cases, great prestige.

Many sports physicians work under the auspices of a sports medicine clinic or center. These facilities work with individual athletes and with sports teams. Often they have contracts to provide their services to local schools and colleges. Some are actually associated with colleges, such as the Temple (Pennsylvania) University Center for Sports Medicine and Science; others are privately owned and operated, such as the Stone Clinic of San Francisco, California.

What Are The Typical Functions of A Sports Clinic?

Typical functions of a sports clinic include:

1. Diagnosis and treatment of acute athletic injuries
   
2. Rehabilitation of athletic injuries
   
3. Referral resource for team and family physicians
   
4. Preventative education
   

A clinic or center's staff is made up of a team of sports medicine professionals: the orthopedists, athletic trainers, physical therapists, and other specialists on a consulting basis as needed, such as dentists or nutritionists. Most centers have the finest equipment, both diagnostic and rehabilitative. These centers frequently serve on athletes who wish to avail themselves of the latest aggressive prevention, diagnostic, and rehabilitation procedures and, if required, surgery. The medical aspects of the center fall under the jurisdiction of the orthopedist.

Orthopedists attend undergraduate college and then enter medical school. After graduation, they concentrate on their chosen field. This involves more coursework, individual study, and practical experience. The internship takes one year and the residency normally four years, so the total education of the orthopedist takes nine years after college! During the residency period, the young doctor works under the supervision of an experienced orthopedic physician, conducting examinations, directing first aid, performing surgery, and designing rehabilitation programs. Not all orthopedists go into sports medicine; some set up private practice and work to correct deformities related mainly to muscle, joint, and bone problems. If a person has a serious accident requiring surgery, such as cartilage damage to a knee or hip replacement, an orthopedist would be involved. Some have very specific subspecialties and will focus upon surgical procedures relative to the ankle or knee joint. With increased attention to sports injury prevention and rehabilitation, opportunities for careers as a doctor with a specialty in orthopedics will continue to be very good.

Osteopathic Physicians (D.O.s), like medical doctors, utilize surgery, drugs, and other acceptable health care practices. In addition, they may use manipulation (treatment using the hands or mechanical means) and emphasize the treatment of the whole athlete in designing a conditioning or rehabilitation program.

While still not totally accepted by medical doctors, osteopathic medicine has made great gains in recent years. In Detroit, all four professional sports teams utilize osteopaths as their team physicians. The educational requirements of osteopathic colleges almost parallel those of medical colleges, and osteopaths wishing to specialize likewise complete a rigorous residency. However, they are not certified medical doctors.

Salaries of osteopaths lag behind those of medical doctors. However, most do well-$50,000 to $100,000 a year or more-and those in sports medicine do even better. Opportunities for employment for osteopaths in the future will continue to remain very good as sports medicine expands and the public comes to further respect the work of doctors of osteopathic medicine.

As with medical doctors, osteopaths undertake residencies upon graduation from osteopathic college; for those interested in sports medicine, the residency will take from three to five years. Regardless of specialty, all D.O.s must obtain licensing in all states.

Chiropractic physicians (D.C.s) emphasize the use of manipulation as their primary treatment. They believe that a person's (in this case the athlete s) health, to a large degree, relates to the welfare of the nervous system. Interference with the system thus impairs normal function and lowers resistance to disease. Chiropractors generally work with the spine to restore proper functioning to the nervous system. In addition to manipulation, they utilize water, light, massage, ultrasound, electric, and heat therapy. Often they prescribe a special diet, nutritional supplements, exercise, and rest to heal the injured athlete. They do not believe in using prescription drugs or surgery as part of their approach, nor are they permitted by the state in which they practice to do this, because they are not medical doctors.

More than 30,000 licensed chiropractors practice their profession in the United States. Most have private offices, while others work at clinics and chiropractic colleges where they engage in teaching and/or research. Those engaged in sports medicine usually makes it known that they emphasize the treatment of athletes. Some teams maintain a chiropractor as a consultant, should they need such services.

A strong interest in sports medicine exists among chiropractors. In addition, some former athletes have entered the profession. For example, Dr. Fred Cox, former place kicker for the Minnesota Vikings professional football team, went on to become a D.C. The Council on Sports Injuries is an organization for chiropractors who are interested in the treatment of athletes.