Risk Factors, Sports Medicine and the Orthopedic System: An Overview

James A. Nicholas MD

Dr. James A. Nicholas is Director, Institute of Sports Medicine and Athletic Trauma; Director, Department of Orthopedic Surgery. Lenox Hill Hospital. New York City: Associate Clinical Professor of Orthopedic Surgery. Cornell University Medical College: Adjunct Associate Professor, Department of Physical Education. New York University School of Education.

Dr. Jack Hughston, second President of the American Orthopedic Society for Sports Medicine stated that Hippocrates was the Father of Sports Medicine. Dr. Joe W. King, our present and fourth President, stated that Sports Medicine is one of the most popular areas of interest among orthopedic surgeons in this country. Since the time of Hippocrates, Sports Medicine has evolved to encompass such widely diverse areas as social medicine and the biological and physical sciences. Many important contributions from the world over, in such disciplines as physiology, physical education, bioengineering and the medical sciences, have been produced and have not received adequate recognition. In the twentieth century, interest, stimulated by expanding television and communications media, has now produced a marriage between the sciences dealing with recreational activity and medicine. In October 1974 the American Broadcasting company produced a documentary program called "DANGERS IN SPORTS" narrated by Jules Bergman. An astonishing number of requests, flooded the offices of ABC and the Institute of Sports Medicine at Lenox Hill Hospital. Newspaper columnists around the country discussed sports medicine in the context of this program. Requests for information were received from many professionals in widely diverse fields of interest.

This remarkable response was analyzed and tabulated. Thirty basic questions emerged. Eighty percent of the questions dealt with health care. The most frequently asked questions concerned injury prevention, risks of athletic injury, and, available instructional materials in the care of the athlete. This massive public display of interest in sports safety indicates how much Sports Medicine has come of age. It brought attention to the need for increased cooperation between physicians, scientists and other health-care professionals. It also demonstrated a new public awareness of the quality of medical care received by athletes.

In the preparation of this program we learned how important it is to have trained personnel utilizing a teamwork approach when dealing with specialists in the fields of health, fitness, recreational activity, therapeutics and medicine. There is no way at the present time for 8,000 or 10,000 surgeons, well trained in trauma, to treat the huge number of individuals acutely injured in daily athletic performance. Even 200,000 practicing physicians could not, at this time adequately render proper care to the athlete at the site of injury, given the opportunity and available expertise. The continuing interrelated education of all of these diverse groups is what sports medicine is about. New federal and state legislation in conjunction with increased consumer advocacy, have become part of the sports medicine scene. It has been said that there is no need to train more orthopedic surgeons because the country's physician-patient ratio will have reached the saturation point by 1980. We do not agree. Since sports and recreational activities involve injury to the musculoskeletal system, more personnel with special skills in this area are needed. Indeed, the American Academy of Orthopedic Surgeons recognized this, when its report revealed that the knee joint and sports medicine ranked first and fourth respectively in importance to the orthopedic surgeon. The success of the continuing education courses of the AAOS Committee on Sports Medicine; the development of the AOSSM; the ACSM and the numerous sports medicine groups which have been founded in the last few years, are testimony to the urgent need for more information in this area.

Journal of Sports Medicine, Vol. 3, No. 5