Which Injury Specialist: Sports Doctors

When to go, what to expect

Posted: 5 June 2000
by Rob Watts

Practice Sports doctors treat the musculoskeletal system – ligaments, joints, bones, tendons, muscles and nerves. Some generalists treat the entire human body, others specialise in specific areas of the body or in a specific joint, such as the knee.

Minimum qualification There is no strict definition of a sports doctor, rather this is a catch-all phrase for a variety of medical professionals with a specific interest in sports injuries, which could include orthopaedic surgeons, orthopaedic physicians or rheumatologists. The minimum qualificationwould depend on the position: an orthopaedic surgeon, for example, is required to complete a full 11 years of study culminating with the FRCS Orth; an orthopaedic physician would have completed the minimum five years of medical study plus an additional four to seven years of study for the qualifications MRCP or MRCGP. However, since ‘orthopaedic physician’ is a fairly nebulous term without a strict definition, and hence a strict set of qualifications, an orthopaedic physician could in fact be a GP with an interest in sports injuries.

Injuries treated Knee complaints are the most common injuries treated by sports doctors. They also address problems relating to the joints, muscles and bones of the legs hips and back, severe running injuries such as stress fractures, muscle tears, iliotibial band problems (involving the hip as well as the knee), Achilles tendonitis and plantar fasciitis. Rheumatologists specialise in the diagnosis and treatment of injuries affecting the joints, muscles and connective tissue. That said, not all rheumatologists are sports injury specialists.

When to go A sudden muscle pull or injury involving ligament tears requires immediate treatment. Also, consult an orthopaedic physician when normal home treatment – such as the RICE technique (Rest, Ice, Compression and Elevation) – fails, and the nagging pain continues to slow you down rather than stop you.

What to expect After the mandatory medical history, the doctor will examine the injured area, probably examining the rest of the leg or surrounding area as well. The cause of a knee injury may be somewhere other than the knee. After diagnosis an orthopaedic physician will often refer the patient to another medical specialist, such as a podiatrist or a physiotherapist, for treatment. Alternatively, the doctor may refer you for a consultation with an orthopaedic surgeon.

Case study Dr Patrick Milroy, a GP and orthopaedic physician who operates out of the North Cheshire Sports Injury Clinic, recalls the recent case of an 18-year-old university student of international standard. “This lad came to see me about a year ago suffering from patella-tendinitis. He hadn’t been able to run effectively for about three months. After an examination I decided to give him a steroid injection around the general area, which improved matters so that he was able to return to running and compete up to British Universities standard. The problem, however, started to recur in the middle of the summer, so he came back to see me, asking for another steroid injection. I decided that wasn’t the best course of action, so I’ve sent him off for a consultation with an orthopaedic surgeon, who will scan the injury. Depending on the result of the scan, the treatment options, in no particular order, are to immobilise the injury by putting the leg in plaster for six weeks, give him another steroid injection or operate on the knee to decompress the injury.”

Cost of treatment An initial consultation with an orthopaedic physician at a sports injury clinic starts at about £40, although rates will vary regionally. A referral from your GP to an orthopaedic surgeon or a rheumatologist would be free with the NHS, although it will be subject to the NHS waiting list.

Contact Orthopaedic physicians operate either out of sports injury clinics or hospitals. The National Sports Medicine Institute e-mail enquiry@nsmi.org.uk; www.nsmi.org.uk holds a list of sports injury clinics, although there is no accreditation system at present for such clinics. You could also try your local Yellow Pages for a clinic in your area. Alternatively, you could ask your GP for a referral, which you would have to do to see an orthopaedic surgeon or a rheumatologist.

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Discuss this article

Reading lots about Sports doctors and Specialists but nothing about long term health problems which affect running. I have been diagnosed as having an under active thyroid which requires medication in the form of Thyroxine for the rest of my life. Since diagnosis I have ran like a drain often feeling completely exhausted during races. On Sunday last I ran the Paphos Half Marathon and nearly dropped out at 8K, I continued by running/walking to the end and finished in my worst ever half marathon time and I have been running for over 20 years. I can get no advice on Hypothyroidism in runners.

Nelson's Gate
Posted: 14/03/2006 at 13:18

Do they need to change the dose ? Sorry can't help but my dog has it and she was fine since getting the medication.
Posted: 14/03/2006 at 13:24

I would second popsider and get your dose checked, just because you have been diagnosed it doesn't mean you have the correct doaseage for you yet.

My mum has a very underactive thyroid (as do most of the female members of my mum's side of the family - its something I worry about developing) and I remember it took a long time for things to settle down a bit.

I think they tend to err on the side of caution when initially giving you Thyroxine as too much can cause a lot of problems as well. My mum is now on a really high dose and may need more, you have to keep getting tested (you may need to drive this) especially as you are not a couch potato and want a bit of "performance" from your body.

My mum (or any of the other people I know with thyroid problems) doesn't do any real exercise so I don't have any info on that side of things. Due to my family history I would also be interested in experiences from anyone who have thyroid problems and does significant exercise.
Posted: 14/03/2006 at 16:35

Hi, I'm hypothyroid and ran my first marathon after having been diagnosed so the condition doesn'r exclude exercise at a reasonable level. Nelson - how long have you been on your current dose of thyroxine and have they excluded all other possible causes of your tiredness? I have perniscious anaemia too which was only found about a year after my hypothyroidism cos I kept going back to my doctor saying 'I'm still tired' and he kept checking my thyroid levels and telling me they were ok and that it was just 'stress'. Moved house, changed doctors, got fed-up enough to go and 'waste the time' of the new doc and she said 'ok, if you say you're still tired let's find out why'. My iron levels are often quite low too (enough to get a prescription for iron tablets) and I had to fight to get my tthyroxine increased from what was basically such a low dose as to have no real benefit (but just raised me to the bottom of 'normal'). With the dose doubled I felt much better and am still only in the middle of the 'normal' range. Hope some of this helps. Don't give up, you deserve to feel well enough to run or do whatever else you want - or we could all just sit around, get fat and blame our 'hormones':-)
Posted: 14/03/2006 at 16:56

You will be started on a low dose & build it up depending on blood test results. This will take several months as tests are usually about 3months apart. You will eventually get to an equilibrium & feel back to normal. Do you know what your test result numbers were?
Posted: 14/03/2006 at 19:33

I have also been diagnosed recently and started on thyroxine for Hashimoto's Thyroiditis(symptoms as for hypothyroidism). Have had some bril advice from Shirl, see threads on thyroiditis.
I have only been taking thyroxine for 5days and have noticed an improvement in my energy levels.(Have still got a long way to go though)
It's going to be slow process to get the dosage right.
From what I understand,you basically up the thyroxine dosage until you feel right & your blood levels are within safe limits.(This is done over a 6week period minimum, as it takes that long for your body to stabilise on each dose increment)
It seems to be a complicated business, as everyone is so different. Add to that the T3/T4 debate- depends on which type of thyroid hormone your body is lacking.
Basically if you are on thyroxine and still feel crap, you need to go back to your consultant/GP and talk about a plan for increasing/changing the dosage.
I have found no advice for running specifically, but speaking to professional personal trainers/nutritionist,you have to go steady. If you are used to using a HRM, then that also helps you to keep an eye on what your body's doing.

Posted: 15/03/2006 at 13:55

Thanks to all. I have now upped the dosage slightly and had a complete blood test which showed no abnormalities save the under active thyroid. I will keep running and try to get the dosage correct for me. Have two 10ks coming up so watch this space, I will tell you how I get on.

Posted: 27/03/2006 at 18:50

I was diagnosed with hypothyroid last april lots of people told me it would take about 12 months to get sorted and it has taken that long. My dose was last upped in Feb and finally I feel better, I've got a 6th blood test in about a week but I'm hopeful things should have finally moved on. But up until feb despite treatment i felt rubbish and everytime I had my thyroxin upped I spent a week feeling ill so my running has really suffered. But I did FLM for the first time last year before treatment that training was so hard I hasseled my doc to give me a blood test it turned out that my thyroid was quite depressed. It seems to take time to get things right.
Posted: 28/03/2007 at 14:50

I have been struggling with under active thyroid now for two years.  There have also been periods where I have actually gone over-active due to the dose not being correct, so it is worth monitoring for any unusual symptoms.  I am hopefully now on the correct dose (125 mcg Levothyroxine).  I struggle with running but have now come to the conclusion that I can only go and do my best on the day.  I am hoping to enter a 10 mile run in September and already I am worried about my performance as it seems to be unpredictable.  There must be lots of people out there with this condition and I would love to hear some positive feedback as to whether it is possible to train/run to an acceptable level as I sometimes feel that I will never get back my fitness levels (taking age into consideration!). 
Posted: 19/01/2009 at 09:26

just wanted to add my two penn'orth - I have Addisons disease so underactive thyroid and adrenal gland.

 I have run 3 marathons and several halfs - with the correct dose, these conditions should be no impediment at all. If you have any concerns, go back - bug them, get a second opinion. You should not be feeling this way.

Posted: 19/01/2009 at 13:18

Thanks for the encouragement - will make an appt at GPs to re-check thyroid levels etc.  I have got 2 x 10ks - one in July and one in Aug before the September 10 miler so they will be a test for me. 
Posted: 19/01/2009 at 13:46

Also see if you can find Crash Hamster...look on the triathlon threads, he's got hypothyroidism and has lots of useful advice. Make sure your docs know how active you are, as they seem to err on the cautious side of increasing T4 doses. How often are you getting your bloods tested? and are you keeping a log yourself of your dose/TFT levels and how your running is going?

I've only been on thyroxine for 2 weeks, but have noticed a big difference already.  (following diagnosis of thyroid cancer in October). I'm having my levels checked in March, but my surgeon kept telling right through all my treatment that the worst thing for me would be going hypo. I went from being fully fit and active to having no thyroid overnight, and slept for anything up to 18 hours a day. Once I'd started on T3 it got a bit better, but going hypo for 2 weeks before Christmas was a bad time. Since I've been on T4 I've felt loads better, I'm currently on 175 mcg, but I believe I'm going to be on slightly higher doses than someone with an underactive thyroid would be.

Posted: 19/01/2009 at 16:02

You can do anything you want - but you do need to keep pestering your doc to get your dose right. Do you know what your TSH is? I'm quite unwell if mine is anywhere near 3, let alone above, but in the UK 3 - 5 is still considered 'normal'. Also ensure that other causes are investigated, I kept feeling incredibly tired and my doc kept checking my TSH and telling me it was normal and blaming stress - when I actually had developed perniscious anaemia too. I did a long distance triathlon last year (2.4 mile swim, 112 mile bike and a marathon) in 13.13.22. Hope to get my mara time under 4 hours this year and PB'd at a half marathon yesterday (1.45.05) and I'm 41, been running since 2004 (this time round).

Posted: 19/01/2009 at 20:15

Yup - it took a year to get my levels sorted out.  I didn't even begin to feel better for 6 mths but that may have been the irondepletion.   And yes I was very low on iron too - luckily they tested for both in the beginning.  It took ages to get my iron up.  I too take 125gms levothyroxine.

 I am in my forties, was diagnosed just over 2 years ago (have been running for 5 years now) and last year i did a half marathon PB, knocked 31 minutes off The Launceston half from my time 2 years previously and did my first marathon.

It's all possible - you have to want it.  Yes i am much tireder than I used to be - replacement thyroxine is not as good as your own (quote my doc) but it could be so much worse.

To quote the penquin - waddle on!

Posted: 19/01/2009 at 20:28

Thanks guys - Its been a struggle and there have been times when I've wondered whether I would actually feel "ok" again and if you have previously been fit and healthy, psychologically it can be quite distressing when you are unable to enjoy your fitness regime, especially when its a big part of your life.  I always feel like I am hassling the GP but if I hadn't self-diagnosed two years ago, it might have gone undetected (long story!!) so now I try and keep a check on symptoms (without being obsessive).  TSH has been as low as 0.03 and that's when I have particularly struggled.  Having said that, I've done what I can and now I need to get over the hurdle of worrying if I'm going to be "ok on the day".  Thanks for the encouragement and grateful for your replies. 
Posted: 20/01/2009 at 09:18

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