What can sports medicine really achieve and just as importantly what should it be aiming to achieve? This may seem like a simple question, but the answer has a myriad of competing influences. Should sports medicine be aimed at merely optimising the sports person’s health? Should it try to improve their performance? Perhaps prevent them from getting problems?

How much to intervene and what to leave to nature is a common dilemma in physiotherapy and medicine. The shades of grey are no less opaque in sports. The history of sport includes many unsavoury events where clinicians have intervened too greatly and lost sight of the true meaning of medical care- take blood doping, EPO use and steroid abuse as the more obvious examples. It is clear in these instances that the medical team involved has transferred their focus from caring to performance enhancement. Trying to help a sports person achieve their goals is one of the most rewarding aspects of sporting physiotherapy- but should our focus really be performance enhancement? Surely the role of physiotherapy in sports is to help the sports person to be as healthy as possible, this includes instances when not competing or training maybe more important than any goals they may have. To care for an athlete is no different from caring for any other individual; ultimately their long term psychological and physical well-being is paramount to the clinician. It may be easy to allow the sports person’s desire and undoubted determination to achieve come at the expense of them as a whole person. Athletes often require a degree of lack of perspective in order to motivate themselves to the level required to achieve. If they viewed football as just a few people kicking a ball on some grass they would struggle to attach a sense of purpose to their training and matches. On the converse if they have such intense focus that the same football game is more important than anything else in their life they may struggle with the pressure of important situations. Should the clinician also lose perspective they may not be fulfilling their role in aiding the sports person in finding a balance on the spectrum of intensity.

If you consider this thought through current pain theories- that pain is correlated to how much protection the body perceives that it needs- you can see how increased intensity of focus on the importance of achievement could intensify pain and disability. If the individuals whole life is attended towards sporting success an injury to a key body part may be devastating. Their brain will amplify the need to protect the area- i.e. increasing the pain. If the clinician then reinforces the belief that nothing is more important than them being able to train and compete this may not be clinically best practice? Are we then risking persistence of problems or over medicalisation of more minor issues?

The need of medical care is exactly that- caring for the individual’s well-being. Even if that means advising them against doing what they instinctively wish to do. We as clinicians need to remember there is more to each person than just the sport they do or what they achieve.