Rheumatology and sports medicine are a perfect and natural fit and, as a specialty, we need to do more to promote sports medicine as a viable option for those who might consider specializing.
Most people don’t understand exactly what a rheumatologist does and may be surprised that some of us do sports medicine. As team physician for the Canadian Football League’s Saskatchewan Roughriders, I know that training in rheumatology is an asset in sports medicine. The understanding of joint disease, myopathies, and neurology in the context of systemic disease and injury – fundamental components of rheumatology – is essential to the practice of sports medicine.
Most rheumatologists would agree that, when it comes to musculoskeletal evaluation, no other specialty does as thorough an examination, which relates to rheumatologic training programs in which clinical assessments take such a priority.
Additionally, rheumatologists are uniquely poised for the challenges of sports medicine because of our joint aspiration and injection skills for diagnostic and therapeutic purposes, which we utilize in daily practice; our familiarity with the commonly used medications for the treatment of musculoskeletal injuries and conditions; our knowledge and practice of musculoskeletal radiology; and the liaisons between occupational therapy, physiotherapy, and orthopedic surgery.
The internal medicine component of our rheumatology training is also invaluable to the practice of sports medicine. As physicians, we are called upon to deal with all aspects of our patients’ health, not just the injuries. This is especially important when treating elite athletes whose primary goal may be to get back to the field, court, or pool as soon as possible, even though doing so could be physically or psychologically damaging in the long run. We are well suited to handle issues that fall outside of the musculoskeletal domain.
Success as a sports medicine physician requires not only knowing your role on the care team, but also understanding the roles of others. This involves being prepared to take the lead role but also letting others, such as the physiotherapist, the orthopedic surgeon, the athletic trainer, do theirs. Communication among the team is essential so that everyone is on the same page or the same field, as the case may be.
Some rheumatologists may balk at embracing sports medicine because of the potential overlap between the medications we use and substances that may be banned in competition. This is really not very overwhelming. The World Anti Doping Agency has a list of banned substances that is updated annually. As rheumatologists, we are skilled and able to consider alternate therapies and do so daily in clinical practice. When an alternative isn’t warranted, it is sometimes possible to get therapeutic use exemptions when justified.
Rheumatology offers sports medicine a rich tradition of balancing empirical treatment and rigorous science. As a specialty, we should be developing and implementing strategies to bring the two realms closer together in training and in practice.
Dr. Robert S. McDougall is a rheumatologist in Regina, Sask., who has worked as the team physician for the Saskatchewan Roughriders since 2000. He has no financial conflicts of interest to disclose.