Sports

There used to be a simple cure for over-the-hill jocks who suffered aches and pains from playing their favorite sport doctors simply told them to stop playing. But more and more, these weekend athletes are refusing to slink quietly onto their living-room sofas. An increased number of Baby Boomers are exercising well into their 40s and 50s and, when they get hurt, they are seeking the same state-of-the-art treatments they see professional athletes receive. “The population in general has become more active,” said Dr. Ronald Karzel, managing partner at the Southern California Orthopedic Institute in Van Nuys, among the first medical groups to offer the specialty. “Unfortunately, as you get older, you get more injuries.” At the Southern California Orthopedic Institute, the number of sports medicine specialists has gone from six in 1989 to 10 currently, Karzel said. While the practice also handles other problems and conditions, more than half the institute’s work is sports-related. Likewise, about half the patients treated at the Los Angeles Knee and Sports Medicine Clinic in Encino are athletes, weekend or otherwise, said Dr. Michael Shapiro, who 10 years ago put one of UCLA’s star basketball players, Ed O’Bannon, back into the game after an injury that many thought would end his career. Orthopedists like Shapiro and Karzel point out that one important reason for the increased popularity of sports medicine is the advent of arthroscopic surgery. Repairs on knees, shoulders and other joints once meant large incisions and months or even years of rehab, something patients were reluctant to go through unless they absolutely had to. But arthroscopic surgery requires only a pinkie-nail-sized incision and can be done on an outpatient basis. When it is over, patients can go back to their favorite sport. “Now that you can treat through arthroscope, it’s gone a long way to extending the concepts that apply to professional athletes,” said Shapiro. “You can honestly recommend surgeries for people who have to go to work on Monday.” Orthopedists were the first to embrace sports medicine because they were the first line of defense for athletes who suffered breaks and tears. But more recently a wide range of practitioners has begun to specialize in the field, under the theory that the same condition can require different treatment depending on whether it was caused by athletics or another type of activity. If a factory worker develops tendonitis, the reason is likely to be repetitive stress on the joint from the job. If a baseball player develops tendonitis, the reason could be the way he throws the ball, or it could be the way other parts of his body move when he throws the ball. “The ‘itis’ is not the problem,” said Dr. Gunnar Brolinson, a primary-care sports medicine physician and past president of the American Osteopathic Academy of Sports Medicine. “It’s figuring out what caused the ‘itis.’ We’re trying to identify what it is in the athlete’s kinetic chain from foot to shoulder that is breaking down,” Brolinson said. Using that approach, these doctors are able to apply treatments including physical therapy, shoe inserts or other prosthetics that alleviate problems that doctors once treated by telling patients to refrain from the activity. In short, doctors are no longer just focusing on healing the injury, but on getting the patient back into the game be it tennis, running, skiing or weightlifting as quickly as possible. “There’s a huge demand for physicians who understand the athletic person,” said Lewis G. Maharam, a sports medicine physician and editor-in-chief of the American Medical Athletic Association Journal. “That’s why the supply has increased and will continue to increase.” Though there are no statistics on the growth in medical practices that specialize in sports medicine, reports of emergency-room admissions linked to sports injuries shows that demand has skyrocketed in the past 10 years among those over 40. Some physicians with no additional training have seized upon the label as a marketing tool, believing that, as with other goods and services, a sports medicine specialty represents the top-of-the-line care that many Baby Boomers demand. “Sports medicine is really trendy at the moment,” said Sheila Endicott, executive director of the American Osteopathic Academy of Sports Medicine. “When something becomes trendy, it seems like everybody jumps on the bandwagon.” At the same time, advances in technology and medicine have allowed physicians to offer new treatments that actually do quicken recovery times dramatically, prevent injuries from occurring in the first place, or enable patients to exercise despite other conditions like diabetes or pregnancy. Sports medicine as a specialty evolved from the treatment of professional and collegiate athletes who could not afford months on the sidelines. But as reports of remarkable recoveries on the professional playing field reached the general population, more and more weekend athletes began seeking similar treatments. The demand is especially strong with the over-40 set, a group that is exercising more frequently and getting hurt more often. According to the U.S. Consumer Product Safety Commission, in 1996 (the most recent year for which figures are available), more than 47,000 adults over 40 visited emergency rooms for injuries related to bicycling, more than double the number in 1986. Skiing injuries sent more than 43,000 middle-aged athletes to emergency rooms, up from only 3,562 10 years earlier. And injuries from weightlifting sent nearly 6,000 adults over 40 to hospital emergency rooms in 1996, a more than threefold increase from 1986. Despite the increased demand, there are few formal avenues for training physicians who want to specialize in sports medicine. About 40 sports medicine fellowships are offered in orthopedics, each accepting one to five fellows a year. And a joint board of family practice, emergency room and internal medicine groups offering certification in the field reports that less than 20 doctors a year take the test. Most of the sports medicine specialists learned by working with high school teams or other sports teams. Many simply have a personal interest in the field. “I think the term ‘sports medicine’ is very loosely applied,” said Shapiro. “You have all kinds of facilities that advertise for sports medicine. It’s a marketing opportunity.” Those who do take the time to pursue formal study find little additional financial incentive. A sports medicine fellowship requires an additional year of training, over and above the doctor’s residency. “Depending on the area of the country, your salary (during the sports medicine fellowship) is going to be in the $40,000-to-$45,000 range,” said Brolinson. “As a primary care physician, most start out with a salary of $120,000 to $125,000. So you’re looking at an $80,000 a year pay cut.” Once installed in a practice, sports medicine specialists often encounter a number of other financial drawbacks. Besides expensive MRI machines, the practice also requires pricey rehabilitation equipment, like computerized exercise machines that can cost anywhere from $15,000 to $30,000. There are also limitations imposed by insurance company reimbursement policies. A sprained ankle can be cured with rest and ice. But a sports medicine doctor may want to take other steps. Doctors like Karzel report they treat a number of patients without fees because HMOs are unwilling to pay for the procedures. “Sometimes getting a patient back (on the playing field) right away is in conflict with doing it for the least amount of money,” Karzel said. The area where a sports medicine doctor’s expertise is most needed is also the area that offers the least remuneration. High school teams don’t pay their doctors at all. And because of the number of physicians now interested in working with college and professional teams, many of those organizations require the doctors to pay them for the privilege. Despite the drawbacks, these doctors, usually athletes themselves, say they wouldn’t trade their practices for any other. They say working in sports medicine is fun, and it gives them the opportunity to do something many other doctors rarely get a chance to do treat essentially healthy individuals. “It is a field where people get a problem and many times you can figure out what the problem is and the person will get better,” said Karzel. “In some fields, that is not always the case. You might deal with people with heart disease and they never get better.”