Sports medicine today, between politics and the quest for a holistic model
A LETTER FROM: Lausanne, Switzerland
– Written by Fabio Pigozzi, Italy
The growth of sports medicine has continued in the last 2 decades thanks mainly to the efforts of various stakeholders, among them the International Federation of Sports Medicine (FIMS) and its member National Sports Medicine Associations. This advance has been brought about by the increasing awareness that sports medicine or sport and exercise medicine, is a scientific discipline that considers sport not only as a competition, a healthy activity or a break from everyday routine, but as a means to improve the quality of life of all individuals. Sports medicine in the modern era transcends the strict interpretation of a ‘medical’ discipline, to which it has been historically assigned. As such, sports medicine has evolved from the narrow medical perspective of providing a ‘cure’ for the athlete to a more holistic scientific approach that considers the complete ‘care’ of an individual, thus enabling the athlete, both recreational or professional, to perform at their very best with minimal health risk. This development is a consequence of sport and physical activity being recognised today as the medium, par excellence, of promoting and maintaining physical and mental health.
The appeal of a more holistic model of sports medicine to different healthcare stakeholders is evidenced not only by the increasing popularity of doctors specialising in sports medicine globally, but also by the growing number of participants in sports medicine congresses, conferences and courses, organised by local, national and international sports medicine associations and organisations. This appeal is also reflected in the increasing number of research grants awarded by governments and international bodies to researchers, to undertake projects related to the promotion of human health through sport and exercise science and medicine. These developments have significantly enhanced the global reputation and prestige of sports medicine, making sports medicine a leading discipline in healthcare.
After a long period in which sports medicine dealt only with anti-doping activities in sports federations, over the last 20 years it has gone on to dedicate itself to injury surveillance. There is now an urgent need for sports medicine and the relevant bodies to expand this narrow focus and implement intervention programmes promoting health and the prevention of injuries and illnesses in athletes within the Olympic Movement and, importantly, also in non-Olympic sports. Ultimately, the purpose of sports and exercise medicine is the promotion of the health of the athlete and the development of well-being and health in communities through sport and physical activity.
It is acknowledged that sports medicine cannot be confined only to dealing with the enhancement and maintenance of health and the prevention and treatment of chronic lifestyle diseases, but should also focus on psychological, social, educational and historical issues. Sport by definition includes all forms of human movement, with the aim of enhancing physical fitness and performance, as well as mental wellbeing. Sport also plays an important role in creating positive social relationships during recreation or competition. In this context, the emphasis of the sports medicine practitioner should clearly be on protecting the health of the athlete, so that they are safe to compete, while at the same time promoting peak performance without drugs.
The field of sports medicine needs to embrace the fact that the responsibilities of the sports physician are constantly changing in both the recreational and competitive sporting arena. With this challenge in mind, FIMS has an important role to play as the umbrella organisation of national and continental sports medicine associations worldwide. The reputation of FIMS has been greatly enhanced in recent years owing to its efforts to disseminate the principles of motivation, performance and health of all people engaged in sport and physical activity.
FIMS has achieved a great deal in the area of sports medicine in recent years. For example, the creation of the FIMS Collaborating Centres of Sports Medicine, intended as an international network to disseminate current and new innovations in sports medicine, these are expected to develop further and grow in number. The centres function as local ambassadors with mandates to disseminate the vision and mission of FIMS in all parts of the world. Individual FIMS members are also actively engaged in editorial and educational initiatives to promote best-practice principles for sports medicine care.
At FIMS conferences and congresses, sports physicians, scientists, physiotherapists and students from around the world exchange the latest ideas in research and debate new advances in technologies and academic news, working continuously to achieve a common vision of injury prevention, management and return to sport after injury in athletes. Other areas of interest include health maintenance, prevention and therapy of chronic lifestyle diseases through physical activity, exercise and sport in the general population.
Sports medicine is a scientific discipline that promotes a healthy balance between sport and physical activity, through continuous dialogue within the different medical specialisations, as well as other disciplines such as sport science, anti-doping science and physiotherapy. This promotes interdisciplinary commitment to the athlete as a person and human being.
As sport physicians, we have to convey not only to the sporting world, but also to the general public, an image of sports medicine which is not only interested in drug-free sport and injury risk and management, but in the prevention of injuries and illnesses and the promotion of the health and well-being – of both athletes and the general public. To this end, it is helpful to return to the roots of our discipline and find inspiration in the words of the father of the modern Olympic Games, Pierre de Coubertin. On 13th of September 1930, as an official member of the French government delegation, de Coubertin addressed the Société des Nations in Geneva, presenting his Charter of Sports Reform.
To counter objections against sport brought forward by a passionate opposition, de Coubertin recommended specific measures that included the development of ‘medicine for sport’ based on the ‘state of the athlete health’ and placed particular emphasis on the examination of the psychological characteristics of the individual. In de Coubertin’s reflections, we find the beginnings of a holistic view of sports medicine that remains relevant today. Sport and health share similar values and are intricately related. Although sport does not directly and inevitably lead to health, sport can enhance physical well-being and enrich our everyday life considerably.
In line with the WHO definition of health as ‘a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity’, sports medicine advocates the use of sport and physical activity to promote the understanding that health is a social experience. A specific benefit of sport as a means to health and well-being is to provide social experiences, contacts and interaction, resulting in the building of social capital. In this regard, sport and all related activities are a bridge to communication and inclusion in the community. They create social cohesion and foster community engagement and leadership. Therefore, we need to promote an image of sports medicine that is in touch with the wider public. This modern image can be achieved by advertising campaigns, workshops, promotion and distribution of information to clubs, federations and schools, targeting a wide audience including athletes, pupils and their parents.
So there is a need to promote a holistic view of the athlete-person as a complex living being. To elevate sport into a source of health, sports medicine needs to be capable of looking at well-being as a holistic experience that is both personally and socially determined. In medicine, it is known that sport conveys well-being, insights and experiences that are unique and cannot be gained elsewhere. Sports medicine can oversee the use of sport as a means for achieving rewarding lifestyles, which are important for a healthy and social life in our contemporary world.
It is my belief that sports medicine will strengthen its position in the context of contemporary sport sciences and within the sports federations only by coupling science with education. It is this coupling that has been the key to the success of many national associations of sports medicine. These associations have managed to promote excellence in sports medicine through highly innovative scientific and educational initiatives for specialists and the public.
Protection, guidance, support, education, ethics, teaching and care of athletes and of communities in close co-operation with international organisations: these are the keywords to success for sports medicine. These keywords have to be put into practice through effective political and educational strategies centred on a model of holistic ‘care’ – and not just mere ‘cure’ – which takes into account the athlete and individual as a person.
In conclusion, it is necessary for sports physicians to continue our scientific, clinical and educational work of promoting sport as a uniquely powerful enhancer of human development and well-being – without forgetting that ‘our work is a mission’. This mission is not only our own professional code of ethics, but the very meaning of our existence as physicians and human beings.
Fabio Pigozzi M.D., Ph.D.
President, International Federation of Sports Medicine (FIMS)
Professor of Internal Medicine and Rector
University of Rome Foro Italico
Image by Kosala Bandara