Discovery

by Jaron Terry, APR

As active baby boomers age and more children participate in high-impact athletics at younger ages, the discipline of sports medicine, once reserved for elite athletes, is now mainstream. Bridging the medical specialties of family medicine and orthopaedics, sports medicine is a vital element in many care plans and the subject of extensive research designed to prevent injury and prolong active lifestyles for all. Ohio State’s Sports Medicine program is nationally renowned for its exceptional patient care and research, and for training future leaders in the field.

Central to the mission of the OSU Sports Medicine Center is promoting and enhancing physical activity across the spectrum of life,” says Christopher Kaeding, MD, co-director of the Center and director of the Division of Sports Medicine in Ohio State’s Department of Orthopaedics.

As head team-physician for the Ohio State Buckeyes football team, as well as one of the first orthopaedic surgeons to perform knee-repair surgery on a patient more than 60 years old, Kaeding understands that the spectrum of life includes not only young people who put their bodies on the line in extreme ways, but also older individuals who rely on their bodies to enjoy active lives.

“One of the most common knee injuries is the ACL tear, an injury of the anterior cruciate ligament,” explains Kaeding, who is also the Judson Wilson Professor of Orthopaedics at Ohio State. “When I finished my training in the late 1980s, an ACL repair was only available to people under age 40, unless the patient was also a committed athlete. Now, we realize that helping people stay active throughout life helps them stay healthy.”

Kaeding, a nationally recognized expert in ACL repair, is participating in a National Institutes of Health (NIH) research consortium called the Multicenter Orthopaedics Outcomes Network (MOON), which is investigating ACL injuries in patients aged 10-85 to provide evidence-based answers to practical questions regarding knee ligament injuries, surgeries and long-term outcomes. Kaeding is the largest contributor to the MOON investigation, working with colleagues from institutions such as Vanderbilt, Boston Children’s Hospital, Washington University – St. Louis and the Cleveland Clinic, among others.

Exercise is the Best Medicine

“In my opinion, physical inactivity is the number one killer in this country,” asserts Thomas Best, MD, PhD, a nationally prominent sports medicine specialist who joined Ohio State in 2005 as co-director of the Sports Medicine Center and team physician for the Ohio State Buckeyes hockey team.

“It is well recognized that life-threatening conditions such as obesity, heart disease, type 2 diabetes, high blood pressure and some cancers, including breast and colon, can be consequences of a sedentary lifestyle,” says Best, who also holds the Pomerene Chair in Primary Care and is co-editor of the most widely used textbook in the field, Evidence-Based Sports Medicine, which is in its second printing.

In addition, he is a national leader of “Exercise is Medicine,” a joint initiative of the American College of Sports Medicine (ACSM) and the American Medical Association. The initiative calls on healthcare providers – regardless of specialty – to review every patient’s physical activity level at every visit as a vital sign in patient assessment.

“We want to treat every patient as if they are one of our star athletes. Even if their only daily exercise is a brisk 30-minute walk, they should be counseled on exercise regimens and injury prevention,” says Best. “Office visits should conclude with exercise clearance and a prescription or referral to a certified health and fitness professional,” he adds.

Best, who will become president of ACSM in June, is a proponent of healthcare reform that recognizes physical inactivity as a major health threat. As the first Ohio State faculty member to be elected to this post, he is working with the Centers for Disease Control and Prevention, the President’s Council on Physical Fitness and Sports, and other government agencies and insurance companies to establish physical activity guidelines to improve public health.

“Next year will also see the first World Congress of ‘Exercise is Medicine,’ which will be held in Baltimore,” he says. “We are already working with 71 countries that have signed on to this platform; this is tremendously exciting, worldwide work.”

Everyone’s an Athlete

“It doesn’t matter if you’re running a marathon or walking around the block, anyone can sprain an ankle, injure their knee or suffer some other type of musculoskeletal injury,” says Mary Jo Welker, MD, chair of Ohio State’s Department of Family Medicine.

“When most people think of sports medicine, it is these musculoskeletal concerns that usually come to mind. However, the specialty goes beyond that to include other health issues that might impede a patient’s activity level,” adds Welker, who also is executive director of Ohio State’s Primary Care Network.

“Sports Medicine is a multidisciplinary specialty that includes pulmonologists, cardiologists, neurologists, psychiatrists and others,” she explains. Medical problems such as asthma and heart disease, as well as treatment for concussion, are all part of what a sports medicine physician handles.

“Family practice physicians need to have a working knowledge of sports medicine, because all patients are athletes – they just have differing activity levels. That’s why residents who are studying to be family practice specialists at Ohio State’s College of Medicine also study sports medicine as part of their training,” she notes. In addition, the College offers a fellowship in Family Medicine in Sports Medicine.

Thomas Ellis, MD, vice chair of the Department of Orthopaedics, agrees that all patients should be active, and points out that for many, participation in high-stress athletics begins in early childhood and continues for 50 years or longer, thus compounding the possibility of sports-related injuries.

Ellis, a noted authority on hip pain in young athletes, is a national expert in performing a minimally invasive arthroscopic surgical technique to treat hip labral tears and hip impingement. Three decades ago X-rays of a young hip-pain patient would appear normal. Because no arthritis was evident, there was no treatment.

“Thanks to better imaging with MRI, a Swiss physician found that hip pain comes from more than just the bony tissue, as was thought up until the early 1980s,” he explains. “Now we know that we have to treat the labral tear (injury to soft tissue) as well.”

Initially, the earlier procedure to treat hip labral tears was done through an open surgery, necessitating a large incision, dislocation of the hip, several days in the hospital and an extended recovery period.

Today’s approach entails a small arthroscopic surgical incision and improved pain management and physical therapy, all of which afford patients only one overnight hospital stay and a shorter recovery time, as well as less scarring

Research-Centric

“It is important that we treat athletes of all ages and levels of training, be they collegiate heroes, professional sports superstars or regular mall-walkers,” says Best.

However, he says, one of the greatest challenges to providing evidence-based, personalized health care to sports medicine patients is the lack of research on how injuries happen and which treatments will work best for different people.

“That’s just one of the reasons I’m so excited about being at Ohio State, where research is a cornerstone for everything we do (see sidebar story),” he notes. “At Ohio State, the focus is moving from disease-based treatment to developing personalized healthcare initiatives that are prevention-based. This really ties in with what is happening today in sports medicine.”

From left: Jason Calhoun, MD; Christopher Kaeding, MD; Thomas Best, MD, PhD; Mary Jo Welker, MD; Thomas Ellis, MD