SPORTS MEDICINE This sporting life AMANDA LYONS ‘Sport to many Australians is life, and the rest a shadow’ – Donald Horne, The Lucky Country, 1964 Those words were written more than 50 years ago, but Athletes may be fi erce it can be confi dently said that author Donald’s Horne’s combatants when they characterisation of his nation remains accurate. Indeed, the country’s own Department of Social Services declares that, step onto their fi eld of quite simply, ‘Australia is sports mad’.1 battle, but they remain This sports madness ensures that Australian GPs (many of whom do not escape the condition) will regularly see patients vulnerable human beings experiencing sports-related health issues. who require the same ‘GPs are at the coalface, regularly seeing and managing sporting participants,’ Dr Gill Cowen, a GP and Chair of the healthcare as all patients. RACGP’s Specifi c Interests Sport and Exercise Medicine network, told Good Practice. ‘The GP is without doubt the central person facilitating treatment and providing information related to prevention in sports medicine.’ Dr Peter Baquie, a GP turned sports and exercise physician who served as the doctor for the Australian 2004 Athens Olympics team and for several AFL (Australian Football League) clubs, believes general practice training provides a very good basis for a career in elite sports medicine. ‘A signifi cant number of football clubs will have a primarily general practice-trained doctor,’ he said. ‘They often recognise that a sports physician and a GP with a sports interest is their ideal medical team.’ Dr Cowen has worked as a team doctor within a variety of sports, including soccer, Australian rules football and cricket, and has found great satisfaction in the job. ‘I really love it,’ she said. ‘That team environment almost takes you back to your hospital days. You work with a physiotherapist, sports scientist, podiatrist, trainers, the players and the coach. It makes it very collegial.’ The physical As gladiators in a modern-day arena, the importance of professional athletes maintaining top physical condition is obvious – especially as their livelihood, as well as the fortunes of their team, rely on their ability to perform. From top: Dr Peter Baquie feels primary care training is an excellent base for moving into sports medicine; Dr Gill Cowan has found that a lot of work in this fi eld ‘isn’t sports medicine at all’ and is often more like everyday general practice. Images Shutterstock; Gill Cowan; RACGP 12 Good Practice Issue 8, August 2017 Helping to maintain this peak condition increasing number of players across all sports encephalopathy (CTE) as a result of exposure with injury treatment and prevention is a are being held out of games due to more to concussions. crucial aspect of the team doctor’s role. But strictly enforced concussion protocols. There is no doubt concussion can have a many may be surprised at how much sports This year saw the fi rst legal action taken serious effect on the health and wellbeing medicine involves the ‘bread and butter’ type by a player against a professional sporting of professional and amateur athletes alike.4 of medicine and relationship-building that sits club in Australia when rugby league player It is for this reason that Dr Cowen believes comfortably in the GP’s wheelhouse. James McManus sued his former team, the it is vital for GPs and sports physicians ‘A lot of the medicine, especially in the Newcastle Knights of the National Rugby to keep up to date with concussion club situation, isn’t sports medicine at all,’ League (NRL), over traumatic brain injury from recognition guidelines. Dr Cowen explained. ‘As you get to know repeated concussions.3 The subject is also ‘As GPs, it’s really important that we the players, you hear about their relationship at the centre of a high-profi le debate taking educate community-level sporting teams, breakups, sexual health and other problems, place in the US about the legal liability of trainers, parents, kids, teachers, so that such as mental stress, that have to be the National Football League (NFL) for these men and women are managed well managed. players experiencing chronic traumatic properly when they sustain a potential ‘That holistic approach is important in concussion,’ she said. sports medicine. You don’t just see injuries.’ ‘We’ve got to do our best to try to help A player’s ability to perform during training protect people from damage, and materials may also hinge on things that are less such as the Concussion Recognition Tool are action-oriented than a stretched hamstring. a very simple way to get the information out ‘Probably the fi rst two or three people I’ll there.’ (Refer to breakout on page 15 for see in the morning will be people who are more information.) >> stuffy in the head with a cold or who didn’t quite sleep last night,’ Dr Baquie said. ‘The skill is in trying to determine if it’s an illness that’s going to prevent them from training.’ Of course, issues such as hamstrings and shoulder and knee stability remain core concerns for team doctors, but another vital area of prevention – for all athletes, from elite to social – is concussion. The impacts of sports such as Australian rules football and rugby can be signifi cant and the risk of concussion with signifi cant impact is high. There is increasing recognition and fear about the impacts of concussion in sport,2 with many concerned about the effects on RACGP Specifi c the lives of athletes once they have fi nished their playing careers. Interests Sport AFL players Sean Dempster (St Kilda Saints) and and Exercise Heritier Lumumba (Melbourne Demons) Medicine are two examples of professional athletes network walking away from Whether GPs are involved with their careers early elite athletes or mainstream following the impacts patients, the RACGP Specifi c of concussion, while an Interest’s Sports and Exercise network offers education for simple and complex cases relating to sports and exercise. Visit www.racgp.org. au/yourracgp/faculties or email [email protected] for more information or to join the network. Good Practice Issue 8, August 2017 13 SPORTS MEDICINE Battling the mind Puka Up, now works to help others in similar Athletes can be revered almost as gods – or situations. He is also dedicated to lifting just as equally reviled – and the weight of the stigma that surrounds issues of mental public scrutiny combined with the pressure health and encouraging the sporting industry of competition can become very heavy, to offer more support for athletes to develop indeed. Fame and sporting prowess do strength in places other than the fi eld. not necessarily insulate people from issues ‘It’s my belief that we need to invest similar such as anxiety and depression and many amounts of money, resources, time and Australian athletes, from Olympic swimmer energy to equip, educate and train young Ian Thorpe to basketballer Lauren Jackson, athletes ... to be able to cope with stress in a have hit the headlines over the past few personal sense,’ he said. years due to their own struggles with issues ‘Give them resilience, the ability to talk, of mental health. communicate and ask for help.’ According to Dr Baquie, it is important Encouragingly, Schwass believes that he for the doctors who work with athletes to has seen positive signs of change in these Former AFL player Wayne Schwass believes it is vital for all always be mindful that their patients are areas over recent years. athletes to prioritise their mental health. people who live with the same vulnerabilities ‘I am confi dent that these conversations as anyone else. are becoming more regular, and perhaps ‘We sometimes get a little overawed that’s giving people more confi dence and at the excellence [athletes] have in their belief that they can open up and talk about Athletes on sport and perhaps forget that they are also these issues,’ he said. fragile human beings, such as anyone,’ he Dr Cowen has found that because of mental health said. ‘We’ve got to be cognisant of both the bond GPs and team doctors foster of those sides.’ with athletes, they can play a crucial role in An increasing number of professional Wayne Schwass is a former professional assisting them to get necessary help. athletes, in Australia and around the world, AFL player who experienced depression ‘You develop a close working relationship have spoken publicly about their struggles during his 14 years on the fi eld from with the athletes you look after, because with mental health: 1988–2002. When he was diagnosed as a you’re with them a lot,’ she said. ‘You know • ‘I just focused on becoming an athlete younger person, however, the social stigma if something is not right and can encourage and suppressed all those feelings’ that accompanied the condition prevented them to seek appropriate help.’ – AFL player Jake Edwards on Channel him from openly discussing his issues. Dr Baquie feels that while looking after 7’s ‘The Daily Edition’, 2017 ‘I didn’t ask for help until six years after athletes’ mental health has always been part • ‘I actually think it’s a step forward. I was diagnosed,’ he told Good Practice. ‘I of a team doctor’s remit, there is now greater I mean, we’d love to have Lance didn’t speak to my family, including my father, scope and openness to address it. [Franklin] play this week. He’s a star for 12 years after diagnosis and it took ‘It’s increasingly recognised and accepted,’ player and we are concerned about his me 12-and-a-half years to tell my closest he said.