Training Center: The sports medicine alphabet soup — where do you find help?

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There are a lot of very good and qualified medical professionals available to us as cyclists and sportsmen (as we are called in Europe). Every community has a practitioner than has some or even a great deal of interest in cyclists and their maladies. Cycling injuries and illnesses typically come in two forms, acute (sudden onset such as a crash or strain) or chronic (over use or over training). Acute issues are easier to deal with as they have a known cause and can be treated as such while chronic issues have evolved over time and require significant detective work on the medical professionals part. So where do you turn?

Navigating the alphabet soup can be time consuming and expensive. Medical Doctors (MD) have always been the gold standard of medical care. Over the past several decades Doctors of Osteopathic Medicine (DO) have achieved equal status to their MD brothers. DO’s have studied manipulative therapies as part of their schooling. Within the realm of MD/DO’s there are many sub-specialties. The sub specialist most well known in sports medicine is the orthopedic surgeon (orthopedist). Within orthopedists there are those who studied an extra two years to become a Fellowship Trained Sports Medicine Specialist. These are the orthopedic surgeons that you want to find in your community if your situation requires surgery.

Another sub-specialist MD/DO that has gained popularity in sports medicine over the past decade is the physiatrist. Traditionally, they have come from pain and physical medicine programs and work in in-patient rehab settings. But like the orthopedist, the physiatrists have developed sports medicine fellowship training programs. They have also gained a strong following as injection therapist for the treatment of chronic pain (i.e. back pain). You can find some excellent physiatrists working with orthopedic surgery groups managing the non-surgical patients for that group.

Internal medicine and family practitioners also have sports medicine fellowship training programs and are an excellent place to begin your search for medical care. They typically have strong orthopedic evaluation skills to accompany their internal medicine toolbox. If illness is the issue these are your experts.

Certified Physician Assistants (PA,C) are becoming more and more popular as primary care givers. These practitioners were originally meant to be just that, assistants, but with the changes in health care many PA’s are developing their own patient populations and specialities. PA’s work with a supervising physician and usually follow their specialty. You might find a PA working as the only medical practitioner in small or rural communities, with their supervisor being miles away but staying in contact via the phone and Internet. Most PA’s have full prescription-writing and referral privileges.

I am an athletic trainer turned PA. I spent 13 years in the college training room, then 11 years in an orthopedic surgery practice and the last 14 years practicing family practice-based sports medicine. I was the Chief Medical Officer for USA Cycling from 1992-96 and was the Medical Officer for Cycling at the Atlanta Olympics. The reason I mention this is to say, don’t over look PA’s as your front line source of sports medical care.

Within the realm of sports medicine, we call upon all of the other sub specialties, i.e. neurology, pulmonary, dentistry and even radiology, but they rarely make sports a big part of their practices.

Physical Therapists (PT/DPT) can be primary sport medicine caregivers. They have excellent physical evaluation skills. Their specialty is of course rehabilitation form injury and or prolonged illness. Many states have direct access to PT’s meaning you don’t have to have a referral to see them even though some insurance companies still require it. For physical medicine PT’s are the gold standard. Many Physical Therapy educations programs have moved toward a longer more in-depth study leading to a Doctor of Physical Therapy Degree. For the patient this change will be seamless but in the long run it should lead to better skills overall for their profession.

Doctors of Chiropractic (DC) are also very popular sports medicine providers and have a sports medicine specialty certification. Chiropractors use spinal and joint manipulation as their primary treatment mode. Many of them use traditional physical therapy techniques as well. Many are well versed in nutrition and exercise. Some states allow chiropractors to provide athletic pre-participation physicals. They are also popular event-day care givers.

Certified Athletic Trainers (AT,C) are the true backbone of sports medicine. They are the only professionals that truly make their entire living from sports injuries. AT,C are well trained post-graduate medical professional that typically work in what is known as the traditional setting, meaning the athletic training room, high schools, colleges and professional sports teams. Their specialty is acute sideline care but they are also superb rehab technicians. You may encounter an AT,C in a sports medicine clinic working along side PTs, CMTs, MDs and PAs.

Certified Massage Therapists (CMT) are a mainstay in cycling maintenance care. Because many of us use a CMT regularly many times they are the first to know of a problem; many times they can feel it before it has become a medical issue. I recommend regular soft tissue work for all serious cyclists. Because their true medical training is limited, be sure you do your due diligence in finding a good CMT experienced with cycling. Within the profession of massage therapy, there are many subspecialties but all could be beneficial as a caregiver if they have the proper experience.

You may have encountered a Certified Strength and Conditioning Specialist (CSCS) in your search for care. This is a credential that rarely stands alone, meaning that it is usually an add on credential. The primary goal of a CSCS is to build on base knowledge of a given professional (i.e., PT, AT,C, PA,C, DC etc)

So as you can see there are many well trained and well meaning medical professionals just waiting to help a cyclist in need, but the real questions are which one is right for you or where do you start. You might start with your primary doctor, especially if they know and respect your athleticism, they can so the initial eval then refer as they see fit. Or if you happen to live in a cycling crazy locale then you can just start asking your friends and fellow riders who has the reputation within the community that might suit your needs. In my many years of experience I would suggest you begin with a mid level medical provider (PA,C, PT/DPT, AT,C) as they probably will spend more time with you working through your injury and how to deal with it, not just tell you not to ride. Part of diagnosising a cycling over-use injury is seeing the rider on their bike. Assuming your chosen provider understands the patho-mechanics of cycling they should be helpful in not only diagnosising your injury but helping fix the problem with equipment adjustments or fit changes. Then refer you as needed for medical care that may be beyond their skill level. Many well trained bike fitters work closely with local sports medicine clinics.

If your local medical talent fails you then you need to search farther. All of the medical professional groups mentioned in this article have national governing bodies, with web sites that can help you find sports medicine certified professionals all over the country and Canada. Beware of self-marketing want to be’s: they may be well intentioned but lack the skill sets you really need.

Here is to healthy cycling!
— Andrew Pruitt, EdD, PA,C

Andrew Pruitt, EdD, PA-C, is the founder of the Boulder Center for Sports Medicine. Pruitt has worked with elite athletes for years and has become the world’s foremost expert in 3D bike fit analysis. His patients include some of the most formidable cyclists in the world including Fabian Cancellara, Andy and Frank Schleck, Jens Voigt, Alberto Contador, and other ProTour riders who either see Pruitt as part of their team, or fly to Boulder from around the world on their own accord. BCSM and VeloNews.com have partnered to produce cycling training and health columns on this site.