SPORTS MEDICINE PHYSICIAN SCOPE OF PRACTICE


Introduction

 
It is important to define the skills acquired through medical specialty training and establish the parameters within which a specialist may practice medicine. This document has been developed by the American Medical Society for Sports Medicine (AMSSM) to define the practice guidelines for physicians who have completed an Accreditation Council for Graduate Medical Education (ACGME) accredited sports medicine fellowship. The practice guidelines in this document are based upon the ACGME sports medicine fellowship program requirements and the topics included on the sports medicine board certification examination.
 
 

Training

 
Sports medicine physicians have completed an ACGME accredited primary residency in family medicine, internal medicine, pediatrics, emergency medicine or physical medicine and rehabilitation and through their training and practice experience possess the competence and skill from their primary specialty training. In addition, they have completed an ACGME-accredited fellowship in sports medicine. Following successful completion of an accredited sports medicine fellowship and the qualifying examination, sports medicine physicians are board-certified by the American Board of Medical Specialties.
 

Practice Guidelines

 
Sports medicine physicians provide comprehensive medical and musculoskeletal care to athletes, active people, and populations of all ages and abilities. Sports medicine physicians work toward providing equitable care to the patients they serve.
 
Sports medicine physicians:
  • Diagnose and provide medical and minimally-invasive management of medical illness and injuries related to sports and exercise including, but not limited to, musculoskeletal conditions of the spine, trunk, pelvis and extremities (e.g., tendinopathy, tendon/muscle strain, hematoma, ligamentous sprain, acute fracture, stress fracture, joint separation, joint dislocation and chronic exertional compartment syndrome); eye and ear injuries (e.g., corneal abrasion, auricular hematoma), facial injuries (e.g., epistaxis), neurologic conditions (e.g., sports related concussion, brachial plexopathy, nerve entrapment), vascular conditions (e.g., popliteal artery entrapment syndrome), abdominal injuries (e.g., spleen laceration, rectus hematoma), pediatric injuries (e.g., Salter-Harris fracture, apophysitis), cardiovascular conditions (e.g., hypertension, differentiate physiologic from pathologic changes to the athlete's heart), pulmonary conditions (e.g., asthma, vocal cord dysfunction), gastrointestinal conditions (e.g., motility disorders), dermatologic conditions (e.g., impetigo, herpes gladiatorum), hematologic conditions (e.g., iron deficiency anemia, DVT/PE), endocrine disorders (e.g., diabetes mellitus, menstrual dysfunction, female athlete triad), infectious diseases (e.g., febrile illness, mononucleosis, sexually transmitted diseases), gynecologic conditions (e.g., pelvic floor dysfunction), allergy/immunologic conditions (e.g., cholinergic urticaria), environmental illness (e.g., heat illness, cold illness, altitude illness, diving disorders), psychiatric conditions (e.g., depression, anxiety, eating disorders), rheumatologic conditions (e.g., seronegative spondyloarthropathy), and conditions specific to geriatric, pediatric, female, and adapted athletes. Evaluate medical illness and injuries related to sports and exercise by independently interpreting diagnostic imaging including radiographs, computed tomography (CT), radionuclide bone scan, bone density testing, magnetic resonance imaging (MRI) and ultrasound of joints, muscle, bone, tendon, ligament, fascia and nerve.
  • Function as team physicians in a leadership role and oversight role on multi-disciplinary clinical teams to provide comprehensive continuous care to sports teams and active populations/communities. This includes determination of safe strategies for participation in a variety of environmental settings (e.g. heat, cold, pandemic).
  • Possess knowledge and expertise regarding, but not limited to:
    • Anatomy, physiology and biomechanics of exercise
    • Basic nutritional principles and their application to exercise
    • Psychological aspects of exercise, performance and competition
    • Pre-participation physical evaluation for participation in sport or work-related activity
    • Physical conditioning requirements for various exercise-related activities and sports
    • Special considerations in physical activity related to age, gender, physical or mental impairment and special populations (e.g. pregnancy, hypermobility, etc.)
    • Pathology and pathophysiology of illness and injury as they relate to exercise
    • Management of infectious disease in sport
    • Common rheumatologic conditions
    • Effects of disease on exercise and the use of exercise in the care of medical and musculoskeletal problems
    • Prevention, evaluation, management and rehabilitation of sport and work-related injuries and sports-related illnesses
    • Utilization of exercise as a therapeutic modality in the treatment of disease
    • Evaluation, management and return-to-play decisions following sports-related concussion, musculoskeletal injuries and medical issues in the athlete and active individual
    • Clinical pharmacology relevant to sports medicine and the effects of therapeutic, performance-enhancing and mood-altering drugs
    • Doping in athletics and drug testing
    • Promotion of physical fitness and healthy lifestyles
    • Apply ethical principles as applied to exercise and sports
    • Medicolegal aspects of exercise and sports
    • Environmental effects on exercise
    • Growth and development related to exercise
    • The role of exercise in maintaining the health and function of the elderly
  • Educate individuals and groups of all types (to include patients, families, coaches, athletes, legislators, other health professionals to include allied health personnel) regarding issues related to sports and exercise
  • Manage and direct the medical coverage of mass-participation sporting events
  • Work collaboratively with physicians from all specialties to ensure comprehensive and optimal care for patients, including collaboration with orthopedic sports medicine specialists who share a similar scope of practice in some domains
 
Sports medicine physicians will have the training and may be able to perform the following procedures, including, but not limited to:
  • Injection/aspiration of small, medium and large joints (to include analysis of joint aspirate) as well as tendon sheaths, bursa, etc.
  • Trigger point injections
  • Dry needling
  • Injections of sites of nerve entrapments (e.g., carpal tunnel, tarsal tunnel, etc.)
  • Image-guided injections (including ultrasound, CT and fluoroscopy)
  • Diagnostic sports ultrasound of conditions affecting athletes and active individuals
  • Other ultrasound-guided procedures (e.g., tenotomy, barbotage, etc.)
  • Compartment pressure testing
  • Reduction, splinting, and casting of fractures/joint injuries or dislocations
  • Electrocardiogram (ECG) interpretation in athletes and active people
  • Exercise stress testing (graded exercise stress testing)
  • Exercise performance/physiology testing (VO2 max, lactate threshold, etc.)
  • Interpretation of objective tests (e.g., computerized neuropsychological testing, balance testing, oculomotor testing) used for the identification and management of sports-related concussion
  • Perform and interpret pulmonary function testing and spirometry
  • Exercise prescription for all ages, with or without medical or musculoskeletal issues
  • Laceration repair and return to sports activity
  • Prescription, supervision, and performance of therapeutic exercise
  • Evaluation, prescription and design/manufacture of orthotics and prosthetics
  • Establishment and providing patient guidance of home-based rehabilitation protocols
  • Manual therapy
 
 

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


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