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.
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.
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.
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.
Orthopaedic physicians operate either out of sports injury clinics or hospitals. The National Sports Medicine Institute e-mail firstname.lastname@example.org; 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.