Going The Distance: The Impact of Sports Medicine on Primary Care

On April 13, 2016, Kobe Bryant showcased his signature “Mamba Mentality” one last time on the court.

The longtime Lakers guard—a championed scorer and notorious competitor—was taking his Utah Jazz defenders to task, shouldering into the lane for a contested running on one possession, then crossing into a deep three-pointer on the next.

Bryant’s attack, in what would be his final game in the NBA, accumulated to 50 attempted shots, 60 points, and a standing ovation from his hometown fans as he walked off the court to the embrace of his teammates.

This scene—of a 38-year old star in his twilight, creating magic just one more time—is what fulfills the cliché that sports are theater. Its stadiums akin to stages, and its players to performers.

From the view of Vernon Williams, MD, it’s an entirely different analogy.

Bryant is someone’s patient—having gone through enough rehabilitation for a fractured knee, torn Achilles tendon, and severe ankle sprain within the past couple of years to, once again, dominate professional athletes nearly half his age. And the sports are each their own observational clinics, the laboratories at which Williams and his colleagues monitor the results of healthcare’s most daring innovations.

“We have this natural laboratory in sports,” Williams, director of the center for sports neurology and pain management at Cedars-Sinai Kerlan-Jobe Institute, told MD Magazine®, “where these injuries occur, and we have very tight control and ability to evaluate and test and manage what happens.”

“I think it’s unquestioned how much of a benefit sports have had and continues to have in pushing this science forward,” Williams continued.

The same advances that have changed the very landscape of sports and allowed feats like running back Todd Gurley winning consecutive accolades just years after tearing his anterior cruciate ligament (ACL), could also impacted the care patients receive from their everyday physicians.

In the eyes of Williams—who has also spent time as the team neurologist for the Los Angeles (LA) Rams and sports neurology consultant for the LA Lakers and NFL Players Association (NFLPA)—the impact of sports medicine on primary care is undeniable.

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“Without sports we would be much, much further behind,” Williams said. “A lot of the lessons learned and the processes, procedures, and approaches that stuck in sports clearly have made their way into the general population in other disciplines.”Just a tiny fraction of physicians will ever have the same perspective on advances in sports medicine as Williams.

Among his colleagues is Leigh Ann Curl, MD,. Serving as president of the NFL Physicians Society and head of the orthopedic surgeon team for the Baltimore Ravens through her role as chief of orthopaedics at MedStar Harbor Hospital, Curl spends every day at the forefront of sports medicine in America.

Curl views the relationship between primary care and sports medicine as a give-and-take: both sides benefit from advances in techniques and understanding. While every advance in primary care does not impact sports medicine and every advance in sports medicine does not impact primary care, sports have been the driving force behind advancements in some areas and in treating an array of conditions.

“There are certain injuries that, by and large, we have done the bulk of research in an athletic population that will carry over,” Curl told MD Mag. “So, we’re interested in helping both populations but clearly the sports arena drives the bus, if you want, on a lot of these things.”

Curl—who previously worked as team physician for the New York Mets, USA Women's Basketball, and USA Women's Rugby—sees the impact of sports medicine on primary care in a wide range of areas. It has helped to understand brain function, and even physiologic effects of sleep on the human body. That said, she points to orthopedics as the field has been influenced the most.

A Joint Effort

The Andrews Sports Medicine and Orthopaedic Center in Alabama is renowned for their expertise in treating sports and orthopedic injuries. Founded by James Andrews, MD, who has treated athletes ranging from Drew Brees to Allen Iverson, the center’s list of patients could form impressive all-star teams across a variety of sports.

Benton Emblom, MD, orthopedic surgeon and sports medicine specialist at Andrews, has his own list of high-profile patients that in just recent weeks has included Alabama coach Nick Saban and Auburn freshman guard Tyrell Jones. Yet, the majority of Emblom’s patients aren’t competing in a national spotlight.

In his work, Emblom sees orthopedics and rehabilitation as the best examples of the impact of sports medicine on primary care.

“It does effect primary care in the fact that recognition is better, treatment options are better,” Emblom told MD Mag. “Everybody realizes that these injuries can be corrected. So, in a sense, absolutely it has effected primary care in that regard.”

Once regarded as a death sentence to an athlete’s career or a crippling injury for a layperson, ACL reconstruction is now a fairly routine procedure. These same methods that have allowed professional athletes to regain their ability to cut, jump, and throw at the highest levels also give primary care patients the opportunity to return to work, play with their children, or continue their grind as a weekend warrior.

Emblom pointed to the commitment of athletes to return to competition as a lead factor in advancing rehabilitation techniques, as noncompliance is a common hindrance on recovery for many patients.

“I think there is some definite contributing factors,” Emblom said. “One of the things that typically leads to significant advancement from a rehabilitation standpoint is patient noncompliance. I don’t mean that necessarily in a bad way, but if you take some athletes who are die-hard about recovery and return to sports, sometimes they push the envelope themselves, and what we found is a lot of things we can actually get away with when traditionally we thought we had to protect them.”

Outside of Emblom’s areas of expertise—which specifically include a gamut of knee, shoulder, and hip issues—physicians have seen additional benefits in orthopedics. Charla Fischer, MD, associate professor of orthopedic surgery at NYU Langone Spine Center, believes the impact of sports on orthopedics has been greater when it comes to knee, hip, and other joint injuries, but said she has seen a definite impact in spinal procedures.

Years ago, undergoing spine surgery meant possibly being sidelined from certain physical activities for up to a year. Now, many patients are resuming their everyday lives within weeks. Fischer, who specializes in minimally invasive procedures, contributes most of this to a better understanding of the healing processes of soft tissues, but she often uses sports figures to confront the, sometimes daunting, mental hurdles associated with spine procedures.

Fischer admitted that she will often use examples set by prominent sports figures like Tiger Woods and Peyton Manning—who both underwent spinal procedures and, at advanced ages, managed to return to the peak of their respective sports.

“Having a 2 level ACDF (Anterior Cervical Discectomy and Fusion) and going back to professional football, and having that lumbar fusion and going back to professional golf,” Fischer said. “This definitely helps with messaging that spine surgery isn’t the end.”

Outside the Lines

Save for orthopedics, Williams believes neurology may be the field most impacted by advances in sports medicine. Through his time with organizations like the LA Rams and NFLPA, Williams has dedicated his career to furthering the understanding of brain injuries, performance, and recovery.

Though chronic traumatic encephalopathy (CTE) and concussions in football have often caught the headlines—and even the attention of Hollywood producers—it is the unheralded clinical advances that can offer insight to primary care providers. As professional and college athletes are just a small portion of the population that suffers head injuries, findings can be used when treating a slew of other patients.

Williams feels that knowledge in the area is still in its infancy compared to other neurologic disorders, but the association between CTE, concussions, and brain injuries with other cognitive impairments could still aid primary care physicians in certain populations.

“Even with that caution, it is certainly reasonable to add concussions, sub-concussive blows, and that kind of history as potential contributors to individuals that have either cognitive decline or erratic behavior,” Williams said.

Curl also attested to the influence of sports medicine on our understanding of livelihood-associated factors, including nutrition and sleep science.

“You’re always pushing the envelope. What can we do better, what can we do different?” Curl said. “People are looking at things like diet, nutrition and sleep. Sleep can have as much of a role as anything you do on the field.”

While it may not seem like the subject area professional organizations would pour money into researching, understanding sleep habits and their impact as they pertain to athletic performance have led to tangible advances in primary care. Williams said that possessing greater knowledge of impact on athletic performance has helped primary care doctors understand how much sleep their patients need in their daily lives.

To his knowledge, almost every professional sports organization in the US has a sleep consultation or fatigue management system to optimize player performance.

“These things have an impact of your risk of injury, on your performance,” Williams explained. “So, we’re learning lots and lots of things about how to optimize sleep and reduce fatigue for athletic performance but guess what, there is emerging evidence that shows how sleep effects academic performance.”

While primary care providers may not be concerned with the record of their local sports team or have any interest in attending a national championship event, their colleagues on the sideline have a hand in shaping the care they provide.

“When we think about surgery, primary care and sports medicine, the benefits of studying those things in athletes have been beneficial to the general population,” Williams said, “and I think we will see the same become true for sports neurology.”