AAFP Helps Craft New Team Physician Consensus Statement

January 11, 2016 02:34 pm Chris Crawford

On Dec. 16, the AAFP, the American College of Sports Medicine (ACSM) and four other medical organizations released a new team physician consensus statement(journals.lww.com) that outlines best practices for injury and illness prevention for athletes at all levels of expertise.

[Happy female doctor checking happy female patient's ankle]

Titled "Selected Issues in Injury and Illness Prevention and the Team Physician," the statement was published concurrently in the January 2016 issue of Medicine & Science in Sports & Exercise and the January/February 2016 issue of Current Sports Medicine Reports. It updates a statement issued in 2007 and provides recommendations on musculoskeletal injuries, head and neck injuries, heat illness, cardiovascular issues, equipment and injury reduction/modification, and skin infections.

The other groups involved in developing the statement were the American Academy of Orthopaedic Surgeons, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine and the American Osteopathic Academy of Sports Medicine.

According to an ACSM news release,(www.acsm.org) key recommendations in the document include the importance of up-to-date treatment information for athletes, the role of sport-specific prevention programs and cautions regarding equipment safety.

Story highlights
  • The AAFP, the American College of Sports Medicine and four other medical organizations recently released a new team physician consensus statement.
  • The consensus statement provides updated recommendations on musculoskeletal injuries, head and neck injuries, heat illness, cardiovascular issues, equipment and injury reduction/modification, and skin infections.
  • The statement is the latest in a series that began in 2000 and that addresses topics such as return-to-play decisions, concussion treatment, sideline preparedness and psychological issues.

"This paper offers guidelines for practice in the areas of injury and illness most commonly seen by team physicians," said Stanley Herring, M.D., chair of the project-based alliance and clinical professor in the departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery at the University of Washington School of Medicine in Seattle, in the release. "It provides a roadmap of common issues facing medical professionals on the sidelines and in their offices."

Consensus Statement Development

The statement is the latest in a series that began in 2000 and that addresses topics such as return-to-play decisions, concussion treatment, sideline preparedness and psychological issues.

Family physician Jason Matuszak, M.D., of Buffalo, N.Y., a sports medicine specialist and member of the AAFP Commission on Health of the Public and Science, participated in the expert panel that developed the consensus statement last year during the annual Team Physician Consensus Conference.

"The statements serve as a guide for physicians who provide sports medicine services in their community but may not have formal training in sports medicine," he told AAFP News. "We try to create a new or revise an existing statement each year."

Matuszak explained that an executive committee develops the structure and outline for the topics that should be covered. Then, each expert researches and writes a portion of the statement. The complete document is pieced together before the in-person meeting, and then the group discusses the concepts presented; reviews and, if necessary, modifies its structure; and edits it in real-time.

Takeaways for Family Physicians

Matuszak pointed to a handful of topics from the consensus statement that he said family physicians should know about as they treat sports-related injuries and illness/medical conditions.

First, he said understanding the particular demands on an athlete based on his or her sport and position can help family physicians determine what the injury is and how soon the athlete might be able to return to play.

"Commonly injured joints include the shoulder, knee and ankle, and common medical problems include heat illness, skin infection and concussion," said Matuszak. "Ideally, we are working toward injury prevention, or at least mitigation."

It's important to consider certain risk factors specific to each athlete, such as muscle weakness, inadequate rehabilitation from previous injury, balance difficulties, level of awareness or concentration, and flexibility (or lack thereof), he noted. Extrinsic factors also should be taken into account, such as field conditions, sport-specific demands, equipment issues and environmental conditions (e.g., heat and humidity).

"Some of these factors are modifiable," Matuszak explained. "Implementing strategies to assess and correct risk factors for injury may reduce the number and severity of injuries. The team physician should understand this concept and assist, where able, with risk factor identification and policy implementation."

Next, he said, there are a number of pieces of sport-specific safety equipment that have been shown to be effective in reducing or modifying injuries; however, there also is sports equipment that is designed to prevent injury but that evidence hasn't supported.

"Mouthguards help reduce dental injuries, but don't prevent concussion, even though they are sometimes marketed as such," Matuszak said. Also, helmets help reduce catastrophic injuries but don't prevent concussion, and chest protectors have not been shown to prevent commotio cordis.

"Given the growing concern and attention to youth sport safety and the potential for vendors to market to that concern, it is important for physicians dealing with athletes to be able to counsel patients and their parents about what equipment may or may not improve safety, or at least refer them to appropriate resources," said Matuszak. Such resources include the consensus statement and the STOP Sports Injuries website.(www.stopsportsinjuries.org)

Finally, he said, although sudden cardiac death is a devastating sport-related outcome for athletes and their families, teams and communities, no large-scale screening programs -- including those that use electrocardiography -- have been shown to prevent the condition and are not recommended at this time.

"This is largely based on the relative rarity of the event combined with the limited sensitivity and specificity of the testing methods, especially for those unfamiliar with normal differences seen in the hearts of athletes that would result in a high number of false-positives and even some false-negatives," Matuszak said.

Family physicians should continue to follow American Heart Association guidelines(circ.ahajournals.org) for cardiovascular preparticipation screening for competitive athletes.

On behalf of the Team Physician Consensus Conference panel, Matuszak invited family physicians to offer feedback on the consensus statement, including recommending topics for coverage in future years.

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