Sports Medicine

Sports Medicine      
Prepared by  Prepared by: Christine May, Senior Research Consultant, Clearinghouse, Sport Australia (formerly Australian Sports Commission)
evaluated by  Evaluation by: Dr. Stephan Praet, Sports & Exercise Physician, Australian Institute of Sport (February 2016)
evaluated by  Evaluation by: Nicole Vlahovich PhD, Research Manager, Australian Institute of Sport (February 2016) 
Reviewed by  Reviewed by network: Australian Sport Information Network (AUSPIN)
Last updated  Last updated: 19 March 2018
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Introduction

Sports and exercise medicine (SEM) encompasses a broad range of skills including management of acute or chronic exercise related injuries, the management of medical problems associated with sport and exercise, doping related issues, as well as exercise prescription for both healthy people and for treatment and prevention of chronic disease. Team care, at both an elite and community level, which may involve on-field management, touring with team, and administrative work, is commonly performed by Sport and Exercise Medicine Physicians who are Fellows of the Australasian College of Sports Physicians (ACSP). Research in SEM is particularly concerned with injury prevention, rehabilitation and enhancing physical function.



While there are an almost infinite number of medical conditions and/or potential injuries which may affect individual athletes there are some specific conditions which are consistently of concern in the sport sector.

Concussion and Head Trauma

A concussion is a type of traumatic brain injury  caused by a bump, knock, or jolt to the head that can change how the brain normally works. The long term consequences of repeated concussion and head trauma, particularly in sport, are an issue of increasing concern and research across all levels of the sport sector. Concussions can occur in any sport or recreation activity but may be of specific concern to athletes participating in contact sports.

In May 2016 the Australian Institute of Sport (AIS) and Australian Medical Association (AMA) launched a website on Concussion in Sport which brings together the most contemporary evidence-based information for athletes, parents, teachers, coaches and medical practitioners. Funded by the Australian Government, this site seeks to ensure that all members of the public have rapid access to information to increase their understanding of sport-related concussion and to assist in the delivery of best practice medical care.

Additional information is available in the Clearinghouse Sports Concussion & Head Trauma topic.  

Relative Energy Deficiency in Sport (RED-S)

Traditionally, a range of studies have focused on the Female Athlete Triad, a syndrome of three interrelated conditions that exist on a continuum of severity, including:

  • Energy Deficit/Disordered Eating
  • Menstrual Disturbances/Amenorrhea
  • Bone Loss/Osteoporosis

However, in 2014 the International Olympic Committee (IOC) released a new consensus statement Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S) which notes that male athletes can also be affected by relative energy deficiency. RED-S can impair both male and female physiological functions including (but not limited to): 

  • Metabolic rate
  • Menstrual function
  • Bone health
  • Immunity
  • Protein synthesis
  • Cardiovascular health 

[Source: Margo Mountjoy et.al., (2014) The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S), British Journal of Sports Medicine, Volume 48, p. 491-497] 

Additional information is available in the Clearinghouse Relative Energy Deficiency in Sport topic 

Sudden Cardiac Death 

Although not a universally accepted definition, Sudden Cardiac Death (SCD) can be considered a nontraumatic, nonviolent, unexpected death due to cardiac causes within 1 hour of the onset of symptoms [source: Koester M (2001), A review of sudden cardiac death in young athletes and strategies for pre-participation cardiovascular screening, Journal of Athletic Training, Volume 36, Number 2, p. 197–204]. This is also known as Sudden Arrhythmic Death Syndrome (SADS). The most common cause of this kind of sudden death is hypertrophic cardiomyopathy (HCM). Unexpected death due to cardiac causes is an infrequent occurrence in sport but understanding the risk factors and management practices can help to frame appropriate policies and actions.

Additional information is available in the Clearinghouse topic, Sudden Cardiac Death in Sport.   

An important role for Sports Medicine & Exercise (SEM) professionals is providing medical screening or periodic health evaluations (PHE) for athletes. The International Olympic Committee (IOC) has developed a Consensus Statement on Periodic Health Evaluation of Elite Athletes (2009) which provides further information.

PHEs have several aims, including to:

  • Prevent sudden death
  • Ensure optimal medical health (asthma, diabetes, menstrual, depression)
  • Ensure optimal musculoskeletal health
  • Optimise performance (nutrition, psychology, biomechanics)
  • Prevent injury
  • Review medications and vaccinations
  • Collect baseline data (blood tests, neuropsychological testing in contact sports)
  • Develop professional relationship with athlete
  • Educate

[Source: Brukner et.al., (2004) Screening of Athletes: Australian Experience (PDF PDF document - 78 KB), Clinical Journal of Sports Medicine, Volume 14 (3)]

The main professional bodies for SEM practitioners in Australia are:

  • Australasian College of Sports Physicians (ACSP) is the professional body representing sports physicians in both Australia and New Zealand.
  • Australian Medical Association (AMA) is the most influential membership organisation representing registered medical practitioners and medical students of Australia.
  • Exercise and Sport Science Australia (ESSA) is the peak professional organisation committed to establishing, promoting and representing the career paths of tertiary-trained exercise and sports science practitioners.
  • Sports Medicine Australia (SMA) is a national multidisciplinary organisation committed to enhancing the health of all Australians through safe participation in sport, recreation and physical activity.

International

  • International Federation of Sports Medicine (FIMS). Aims primarily to promote the study and development of sports medicine throughout the world, to protect the physical and mental health and ensure the wellbeing of all who are engaged in sports and exercise, and to assist athletes in achieving optimal performance by maximizing their genetic potential, health, nutrition and (access to) high-quality care and training.
  • American Medical Society for Sports Medicine (AMSSM). Provides a forum to foster professional relationships among sports medicine physicians to advance the discipline of sports medicine through education, research, advocacy and excellence in patient care.

The Australasian College of Sports Physicians provides an overview of SEM training in Australia:

Clinical Sport and Exercise Medicine (SEM) is a discipline that comprises medical specialists who, as part of a multi-disciplinary team, provide:

  • Promotion of health through increased use of exercise and physical activity
  • Advice on the safe use of physical exercise in both prevention and treatment of illness
  • A holistic approach to addressing medical conditions and injuries in individuals who wish to exercise.

SEM Physician Training in Australia requires: 

  1. Completion of initial medical qualification, MBBS or registrable equivalent
  2. Three years approved medical and surgical experience (Foundation Training)
  3. ACSP Part 1 Examination, or equivalent
  4. Four years full time training (or equivalent) with the ACSP, including completion of all training program requirements
  5. ACSP Part 2 Examination
  6. Award of Fellowship of the Australasian College of Sports Physicians (FACSP)

Exercise and Sport Science Australia (ESSA) provides information in its Careers Guide (PDF PDF document - 2.6 MB) that outlines some of the potential careers for medical professionals in the field of sport.

Current Research Projects

  • Injury Study: The genetics of exercise-induced injuries involving tendon and bone . The aim of this research study is to identify genetic polymorphisms that contribute to increased risk of, or protection from tendon and bone injuries sustained through participation in physical activity. This knowledge will be used to develop programs for the prevention of injury in sport and physical activity.
  • Concussion Study. The aim of this research study is to investigate the nature of concussion in Australian sport and the role of balance in concussion assessment.
  • Hamstring Injury Study. A randomised double blinded placebo controlled trial to assess the efficacy of Traumeel S injection vs Placebo (Normal Saline) in acute Hamstring tears.
  • Achilles Study. The aim of this pilot research project is to perform a case control study with a cross-over design to explore the potential clinical benefits of 2 times 12 weeks supplementation of TENDOFORTE™ P (containing 5g of highly bioactive collagen peptides) or PLACEBO in chronic midportion Achilles tendinopathy patients as an add-on therapy to 24 weeks of eccentric exercise therapy.
  • EYECONIS - Eyes on Concussion in Sport Study. In this joint AIS, University of Canberra, and Australian National University study data will be collected on visual integrity using the new instrument, in addition to standard eye and existing concussion tests. State-of-the-art assessment of proprioception, balance, and postural sway will also be examined. The tests we propose are noninvasive. In addition to 30 healthy controls, normal ranges have been established for people in this age group, thereby overcoming the limitations associated with absence of baseline results. 

Stay Healthy Project 

Researchers from the AIS and University of Canberra launched the Stay Healthy Project in 2016 to track athletes' wellbeing with a view to estimate the risk of getting sick and inform prevention practices - particularly around important competitions. Several papers were published in January 2017 based on the research undertaken. These included: 

AIS Best Practice Handbook

  • AIS Best Practice Handbook (restricted access). A collaboration between various disciplines at the AIS including Sports Nutrition, Medicine, Physiology, Physical Therapies, Psychology, and Strength and Conditioning. This handbook is a resource developed for use by sports science and medicine professionals at the AIS and as a Leadership Activity of the AIS for potential sharing within the Australian Sports Network.

AIS Sports Science/Sports Medicine: Best Practice Principles

The SSSM Best Practice Principles have been developed by the AIS as a practical guide to assist boards and senior management of sporting organisations in performing their oversight function in relation to SSSM practices. Download the full guide. (PDF PDF document - 949 KB)

Reports


Where possible, direct links to full-text and online resources are provided. However, where links are not available, you may be able to access documents directly by searching our licenced full-text databases (note: user access restrictions apply). Alternatively, you can ask your institutional, university, or local library for assistance—or purchase documents directly from the publisher. You may also find the information you’re seeking by searching Google Scholar.

Sport Specific Resources

Athletics

Football

  • Fédération Internationale de Football Association (FIFA). The Medical Committee addresses all medical issues relating to football and attempts to discover new ways of protecting the health of players. Resources available include: information for players on injury prevention (“11+”); nutrition; common injuries and first aid; FIFA Medical Centres of Excellence; Football for Health; and an online anti-doping education programme. Booklets, regulations, and teaching material are available for download.
  • FIFA 11+ Injury prevention programme. The dedicated website for the FIFA 11+ injury prevention programme including background and scientific papers, videos of the FIFA 11+ exercises, the FIFA 11+ manual, and much more material available to download.

Mountain Climbing

Rowing

  • Rowing Australia. Rowing Australia’s Chief Medical Officer, Dr Larissa Trease, and Lead Physiotherapist, Kellie Wilkie, have put together these documents for rowers and coaches which may assist in injury prevention and management.

Rugby

  • World Rugby. The Medical Commission of World Rugby has a dedicated website with guidelines, expert papers, research, and online training addressing important medical matters in rugby including: cardiac screening, concussion, gender, hygiene, heat, injury surveillance, pregnancy, medical facilities, and other matters.
  • World Rugby Concussion Management App. This online resource is designed for anyone involved in rugby - players, coaches, parents, teachers, match officials, spectators, and anyone else with a role or interest in the game. It is designed to ensure that players who suffer concussion are managed effectively to protect their long-term health and welfare. (currently only available on iTunes)   

Tennis

  • International Tennis Federation (ITF). A wealth of information on injuries and their prevention; nutrition; conditioning; psychology; anti-doping; and medical care at competitions. Also provides further information on the benefits of exercise for lay people and numerous information sheets for athletes.

Volleyball

  • Fédération Internationale de Volleyball (FIVB). Offers information on both athlete’s and referee’s health including injury prevention and surveillance; heat stress (for both athletes and referees); sun exposure; health certificates; team medical and physical therapists; regulations; medical control; and an extensive anti-doping section.

Position & Consensus Statements

  • IOC consensus statement: dietary supplements and the high-performance athlete, Maughan RJ, Burke LM, Dvorak J, et al., British Journal of Sports Medicine, (published online 14 March 2018). Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition programme. The appropriate use of some supplements can benefit the athlete, but others may harm the athlete’s health, performance, and/or livelihood and reputation (if an antidoping rule violation results). This review summarises the issues faced by high-performance athletes and their support team (coach, trainer, nutritionist, physician) when considering the use of supplements, with the goal of providing information to assist them to make informed decisions.
  • Psychological Issues Related to Illness and Injury in Athletes and the Team Physician: A Consensus Statement—2016 Update. Medicine & Science in Sports & Exercise, Volume 49, Issue 5, pp.1043–1054 (May 2017). This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It addresses select psychological issues including: stress/anxiety, depression, eating disorders, and substance use disorders, as well as issues related to the team physician and their role n recognizing athletes at risk and providing referrals for additional care. 
  • Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. McCrory P, Meeuwisse W, Dvořák J, et.al.,  British Journal of Sports Medicine, Volume 51, pp.838-847 (2017). This consensus document reflects the current state of knowledge and will need to be modified as new knowledge develops. It provides an overview of issues that may be of importance to healthcare providers involved in the management of SRC. This paper should be read in conjunction with the systematic reviews and methodology paper that accompany it. First and foremost, this document is intended to guide clinical practice; however, the authors feel that it can also help form the agenda for future research relevant to SRC by identifying knowledge gaps.
  • Monitoring Athlete Training Loads: Consensus Statement (PDF PDF document  - 1.1 MB). Pitre C. Bourdon, Marco Cardinale, Andrew Murray, et.al., International Journal of Sports Physiology and Performance, Volume 12, S2-161-S2-170, (2017). In February 2016, a conference on “Monitoring Athlete Training Loads—The Hows and the Whys” was convened in Doha, Qatar. This consensus statement brings together the key findings and recommendations from this conference in a shared conceptual framework for use by coaches, sport-science and -medicine staff, and other related professionals who have an interest in monitoring athlete training loads and serves to provide an outline on what athlete-load monitoring is and how it is being applied in research and practice, why load monitoring is important and what the underlying rationale and prospective goals of monitoring are, and where athlete-load monitoring is heading in the future
  • International criteria for electrocardiographic interpretation in athletes: consensus statement. Drezner JA, Sharma S, Baggish A, et.al., British Journal of Sports Medicine, Volume 51, pp.704-731 (2017). This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
  • Ethics of genetic testing and research in sport: a position statement from the Australian Institute of Sport. Nicole Vlahovich, Peter Fricker, Matthew Brown & David Hughes, British Journal of Sports Medicine (November 2016). As Australia's peak high-performance sport agency, the Australian Institute of Sport (AIS) has developed this position statement to address the implications of recent advances in the field of genetics and the ramifications for the health and well-being of athletes. Genetic research is only to be conducted after careful consideration of a range of ethical concerns which include the provision of adequate informed consent. 
  • How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Torbjørn Soligard et.al., British Journal of Sports Medicine, July 2016. This paper summarises the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport.
  • How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. Martin Schwellnus et.al., British Journal of Sports Medicine, July 2016. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. 
  • Australian Institute of Sport and Australian Medical Association Concussion in Sport Position Statement (PDF PDF document - 1.3 MB). Dr. Lisa Elkington & Dr. David Hughes, Australian Institute of Sport, May 2016. Brings together the most contemporary evidence-based information and presents it in a format that is appropriate for all stakeholders.
  • Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. Thornton JS, Frémont P, Khan K, et al., British Journal of Sports Medicine, Volume 50, pp.1109-1114 (2016). The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field.
  • Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes. (British Journal of Sports Medicine, published online April 2015). This position statement represents a set of recommendations intended to provide clinical guidelines for sport and exercise medicine physicians and other healthcare providers for the prevention and treatment of urinary tract infection in spinal cord injured athletes. It has been endorsed by the Australian Institute of Sport (AIS) and the Australian Paralympic Committee (APC).
  • Pre-participation Cardiac Evaluation In Young Athletes (PDF PDF document  - 182 KB). The Australasian College of Sports Physicians (2013). The ACSP re-affirms the well-known position that for the vast majority of young individuals – regular exercise is not only safe but should be encouraged. However, there are a small proportion of the population with pre-existing cardiac pathology where participation in competitive sport may increase their risk of a significant cardiac event.
  • Sports Supplements (PDF PDF document  - 386 KB). The Australasian College of Sports Physicians (2013). The position statement below is designed to provide guidelines for the appropriate use of dietary and nutritional supplements. The purpose of the statement is to ensure that the use of supplements is evidence-based and individuals are not at risk of an inadvertent anti-doping rule violation.
  • IOC concensus statements are published based on the works of the Medical Commission.
  • International Federation of Sports Medicine (FIMS) Position Statements. The Scientific Commission of FIMS prepares the FIMS Position Statements, which are intended to provide practical guidelines to practitioners in areas of Sports Medicine where there is controversy or a lack of clarity.   
  • American College of Sports Medicine Position Stands. Official statements of ACSM on topics related to sports medicine and exercise science. All current ACSM Position Stands and Joint Position Statements are free to the public online. 
  • Recent Position Statements, Consensus Statements, Policy Statements, Guidelines, and Recommendations Related to Sports Medicine. List collated and maintained by Sports Medicine Research: In the Lap & In the Field.    

International Olympic Committee (IOC)

European Federation of Sports Medicine Associations

  • Electrocardiography for Sports Medicine course. The objective of this course is to provide students the expertise to study the cardiovascular system from the point of view of the electrocardiogram (ECG) to diagnose cardiovascular problems that can affect the athlete; know the characteristics of ECG Cardiac adaptations to stress (athlete's heart syndrome); and diagnose by ECG susceptible cardiovascular diseases which may cause sudden death to help prevent its occurrence. 

Cochrane Reviews

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They are published online in The Cochrane Library.  

Electronic journals

Clearinghouse Videos

Please note a number of the resources below (as indicated) are restricted to ‘GOLD' AIS Advantage small AIS Advantage members only.
Please see the Clearinghouse membership categories for further information.


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