Team Physician

Historical Perspective

Historians note that battle physicians in ancient times were deemed a necessity. Galen (131201 CE), a Roman physician of Greek origin, is considered by many to be the epitome of sports medicine practitioners. His voluminous writings reveal that he performed anatomical research and studied physiology, neurology, and wound care. He was appointed physician to the gladiators and was a teacher and a private surgical practitioner. Galen's qualifications to care for athletes and nobles need to be emulated.

Even though there was a marked increase in basic scientific and biological knowledge over the next centuries, there does not appear to have been a similar increase in athletic care and injury reduction in the United States. One possible exception was Edward Hitchcock, MD, who as a school physician at Amherst College in 1854 introduced [Page 1446]swimming and gymnastics, emphasized baseball and basketball, and penned a book on athletes and medicine. With the increased popularity of sports participation, the injury rate also escalated. Because severe and often career-ending injuries were occurring so numerously, Harvard University appointed an orthopedic team surgeon in 1890. Other large eastern schools soon followed with similar appointments.

In 1904, the Germans were the first to use the term sports physician, and then they proceeded to hold a sports physicians’ congress in 1912. This impetus evolved into the Fédération Internationale de Médecine Sportive (FIMS; International Federation of Sports Medicine) in 1933, with the primary goal being to facilitate clinical and scientific research in cooperation with Olympic federations. In 1938, Augustus Thorndike, MD, published a monograph depicting his experiences and knowledge as a team surgeon. His writings, which included much of the scientific knowledge in sports medicine, served as a primary source of pertinent sports medicine information in the 1960s.

A distinct change in sports medicine care of the high school and college athlete occurred when Dr. Jack Hughston (19172004) developed team coverage in the early 1950s. He and his orthopedic group and trainers began to “cover” high school football games on Friday night and college games on Saturday. During the week, his crew visited colleges and schools, noted injuries, arranged rehabilitation, and helped decide return to practice and refer, if necessary, back to clinic. This entire program was enacted with the cooperation of the local physician, who was a specialist or generalist, to maintain rapport. This program was not readily accepted until approved by the Georgia State High School Coaches Association. Adjacent states quickly followed this system of sideline and midweek team coverage that persists nationwide to this writing.

In the period after World War II in the United States, there was an exuberance expressed in physical activity and the formation of team sports. Physicians returning home from active duty restarting or starting up a practice often were ushered into a position as a team physician. Most had no sports medical experience, but used good medical knowledge quite successfully. Predominately, these physicians were generalists in the high school and junior college settings. In contrast, the larger colleges, universities, and professional teams tended to select an orthopedist as the primary team physician. While this selection arrangement was transpiring, research and teaching organizations came on the scene such as the American College of Sports Medicine (ACSM), American Orthopaedic Society for Sports Medicine (AOSSM), American Medical Society for Sports Medicine (AMSSM), and the National Athletic Trainers’ Association (NATA). Of even greater significance to the practice of sports medicine was the establishment of orthopedic and general sports medicine fellowships. These board-eligible candidates were elected to take an additional year of specialized, sport-centered training under qualified individuals. These mentors used current therapy and ancillary techniques, the most salient of which was the development of the Watanabe arthroscope. This instrument revolutionized the practice of orthopedics and initiated visual understanding of injuries to the knee, shoulder, and elbow.

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