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Sports Injuries: To Treat or not to Treat – do you know the answer?

50 years ago, before clot-busting drugs, before angiograms and catheters, before we even knew to give an aspirin for a heart attack, there was not a lot physicians could do to treat acute cardiovascular events, like strokes or heart attacks. In fact, an old medical saying when treating a stroke was “don’t just do something, stand there”.

So there were some people, 50 years ago, that when having a stroke or a heart attack, chose to stay at home and hope for the best. Even though stroke and heart attack treatments were not very effective, no medical professional at the time would have advised a patient to stay at home.

That was why I was surprised recently when I read an article from the New York Times News Service.

Dr. Paul Thompson, a cardiologist and runner, suggested that when people get a sports injury, they should skip going to a doctor.

Other doctors were quoted in the article as well. An orthopedist from University of Pittsburgh and a Sports Medicine Specialist from Ohio State University both echoed Dr. Thompson’s sentiments.

It is my opinion that these physicians were acting irresponsibly.

Not necessarily because they advised against seeking medical attention. No, in fact, the physicians made some valid points: that most doctors — even so-called ‘sports medicine specialists’ — really don’t do a good job at treating non-surgical musculo-skeletal problems like athletic injuries; that the first recommendation is usually rest anyway; and that going to a doctor too soon can actually lead to unnecessary tests and treatment.

No, the reason that I think they are irresponsible is that, rather than suggesting that patients avoid doctors after an sports injury, Dr. Thompson and others should be calling for better teaching of musculoskeletal disorders to medical students and better training of physicians. We need more research on how to effectively enhance the healing process.  We need better application of current data. We need better treatment protocols that are based on the results of good science.

We should be telling patients to demand better care, not suggest self-diagnosis, self-treatment or to simply ignore an injury. Not going to a competent physician for evaluation after a musculoskeletal injury can lead to even greater injury or disability. In addition, while most problems get better with rest and time, there are injuries that need early, aggressive care. Patients cannot be expected to know the difference between a simple strain and something more serious.

This is not a small problem: musculoskeletal diseases and injuries are the leading cause of disability in the US. In fact, according to the National Center for Health Statistics, musculoskeletal diseases are the most common health condition in the United States, with more than 1 in 4 Americans having a musculoskeletal condition requiring medical attention. The Centers for Disease Control notes that arthritis and other musculoskeletal conditions were the most frequently-mentioned conditions casuing disability among working-age adults. Musculoskeletal injuries accounted for more than 57 million health care visits in 2004.  Back pain is the leading cause of disability in Americans under 45 years old.

Although most musculoskeletal injuries are not life-threatening or have the devastating complications of a stroke or heart attack, musculoskeletal injuries can lead to long term chronic pain and disability. Musculoskeletal injuries are a bigger reason for lost productivity than strokes and heart attacks combined.

Imagine how things would be different if, 50 years ago, if physicians ignored the problems of poor care and poor outcomes, and simply advised people not to seek medical attention. Instead physicians and researchers developed better medicines and treatments.

Today, it is inappropriate to suggest avoiding the hospital if you are having symptoms of a stroke or a heart attack. It should be equally inappropriate to suggest avoiding medical care for a musculoskeletal injury.

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