SPORTS MEDICINE PHYSICIAN SCOPE OF PRACTICE

Introduction

Training

Practice Guidelines

• 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.
• Based on the ACGME Program Requirements for Graduate Medical Education in Sports Medicine, and the Team Physician Consensus Statement, physicians from the medical specialties who have completed an ACGME-accredited sports medicine fellowship, and are board certified in sports medicine, are all qualified to serve as team physicians, head team physicians, and sports medicine medical directors at any level of sport without restrictions.
• Though each sports medicine physician possesses a unique skillset entering sports medicine fellowship, the uniform curriculum of sports medicine training means board-certified sports medicine physicians are trained to serve as team physicians regardless of their primary residency training in emergency medicine, family medicine, internal medicine, internal medicine-pediatrics, pediatrics, or physical medicine and rehabilitation.
• 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

• Injection/aspiration of small, medium and large joints (to include analysis of joint aspirate) as well as tendon sheaths, bursae, etc.
• Trigger point injections
• Dry needling
• Injections of sites of nerve entrapments (e.g., carpal tunnel, tarsal tunnel, etc.)
• Image-guided injections (e.g., ultrasound, CT, 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