Today is 17.8.2018
The time is 19:50

Dr. Encho Stoyanov

specialist in sports medicine


Sports medicine

Millions of people throughout the world perform physical exercise and play sport every day. These people have specific medical needs. To cater with for these people a branch of medicine known as Sports Medicine has evolved.

Sports medicine includes:

  • Injury prevention, diagnosis, treatment and rehabilitation
  • Performance enhancement through training, nutrition and psychology
  • Management of medical problems
  • Exercise prescription in health and in chronic disease states
  • The specific needs of exercising in children, females, older people and those with permanent disabilities
  • The medical care of sporting team and events
  • Medical care of situation of altered physiology such as at attitude or at depth
  • Ethical issue such as the problem of drug abuse in sport

Because of the depth of content, sports medicine lend itself to being practiced by a multidisciplinary team of professionals with specialized skills who provide optimal care for the athlete and improve each other’s knowledge and skills. A sporting adage is that a ‘champion team’ would always beat a ‘team of champions’ and this also applies to sports medicine. Individuals who provide specialized skills and who utilize the skills offered by other members of the team provide the best athlete care. This team approach can implemented in a multidisciplinary sports medicine clinic or by individual practitioners of different disciplines collaborating by cross-referral.

The sports medicine team

The most appropriate sports medicine team depends on the setting. In an isolated rural community, the sports medicine team may consist of a family physician or a physiotherapist. In fairly populous city, the team may consist of:

  • Family physician
  • Physiotherapist
  • Sports physician
  • Orthopedic surgeon
  • Massage therapist
  • Radiologist
  • Podiatrist
  • Dietitian/nutritionist
  • Psychologist
  • Sports trainer/athletic trainer
  • Other professional such as osteopaths, chiropractor, exercise physiologist, biomechanists, nurses, occupational therapist, orthotics, optometrist,optometrists
  • Coach
  • Fitness adviser


The practitioners in the team have each developed skills in a particular area of sports medicine. Practitioners should be encouraged to increase their knowledge and skills in area other than the one in which they received their basic training.

The challenges of management

The secret of success in sport medicine is to take a broad view of the patient and his/her problem. The narrow view will provide to short-term amelioration of symptoms but will ultimately lead to failure.

The greatest challenge of sports medicine is to identify and correct the cause of the injury/illness. In sports medicine it is necessary to diagnose both the problem and the cause. Treatment then needs to be focused on both these areas.


Every attempt should be made to diagnose the precise anatomical and pathological cause of the presenting problem. Accurate diagnosis permits precise treatment.


It has two component- treatments of the presenting injury/illnesses and treatment to the correct cause. A combination of different forms of treatment will usually give the best results. To be a successful sports clinician it is essential to know and love sport and to be an advocate for physical activity.


Throughout history, human beings ’ability to survive and take care of their families have dependent of their physical capabilities. Speed, strength, and skills were essential survival tools during early civilization. Progress led to the transformation of these physical attributes to organized contests where highly trained members began competing in a team-like fashion.

Therapeutics exercises have been in existence as far as back as 1000BC. This marked the beginning of strength training using progressive resistance exercises. Herodicus became known as the firs sports physician to treat injuries with therapeutic diet and exercises. In the second centuries AD, Galen became the first appointed team physician. His purpose was to cure injured gladiators so that they could return to battle.

As the number of participating athletes grew during the 1950s, the demand for clinician to care for medical needs and athletic injuries increased.

Women in sport

The acceptance of female athletes both in recreational and professional sport, added a new dimension to both sports medicine and sports in general. During the 1880s’ women were forbidden to engage in any type of physical activity. Frailty and pallor were symbol of women’s status in society, for only poor, working class females showed any signs of physical well-being or strength. Doctors in the late 1800s felt that females were an inherently ill species due to their reproductive cycles and felt that most diseases, regardless of origin were diseases of the womb. It was believed that the stress brought by the studying would cause infertility and uterine atrophy because the brain was in direct competition with the uterus. To prevent this from happening, women were encouraged to engage in noncontact activities such as walking, swimming, tennis and golf. In 1896 the bicycle was invented. Women abandoned all sense of moral and sexual taboos that had been bestowed on them to participate in bicycle riding.

World War I and II forced women to enter the workforce to support the war effort. They worked long hours mostly in factories. To compensate for poor working conditions, recreational and team sport were organized by factory owners to alleviate stress.

Disabled athletes in sports

Until the late 1950s persons with either physical or mental disabilities were unable to become involved in physical activities at all. At present, more than 5millions people with disabilities participate in sport each year all over the world. Disabled athletes now compete in basketball, skiing, swimming and many other sports.

Sports medicine physicians have needed to adapt their practice to treat disabled athletes differently from other groups because they are prone to specific injuries.

Sports and the elderly population

In 1900 the average life expectancy was only 48,2 years for males and 51,1 years for females. By 1987 this numbers had increased to 72,2 years and 78,9 years, respectively. All mature athletes need to be involved in a proper conditioning program to include stretching, warm-up, endurance, and strength training to avoid injuries. Physiologic changes such as osteoporosis, decreased elasticity of articular cartilage, and spinal disc degeneration, need to be addressed when treating an older people but should not be considered factor that necessarily end an individual’s athletes career.

Primary care of the pediatric athletes can be a challenging endeavor. The pediatric population sustains many of the same injuries as adults and in addition, is at risk of other types of injuries.

Team physician

Although the role of the team physician may vary depending on the type of team, the location, the team management, and other factors, the team physician’s first responsibility is the safety and well-being of each athlete.

Duties of the team physician

The team physician must be willing to commit the necessary time and effort to provide care for the team and athletes. In addition, the team physician must develop and maintain a current, appropriate knowledge base of the sports for which he/she is accepting responsibility.

The team physician has the following responsibility:

  • Medical management of the athlete
  • Coordinate pre-participating screening , examination and evaluation
  • Manage injuries on the field
  • Coordinate rehabilitation and return to participation
  • Provide for proper preparation for safe return to participation after an illnesses or injury
  • Integrate medical expertise with other health care providers- medical specialist, athletic trainer, allied health professionals
  • Provide appropriate education and counseling regarding nutrition, strength and conditioning, ergogenic aids, substance abuse
  • Provide for proper documentation and medical record keeping
  • Educate athletes, parents, administrators, coaches of concerns regarding the athletes
  • Provide for proper event coverage
  • Assess environmental concerns and playing conditions