Sport medical, paramedical and science practitioners provide important contributions to the world of sport. In the high performance arena, it takes a multi-disciplinary approach with each member of the medical team playing an integral role in supporting an athlete’s best performance.

Early recognition of issues through medical and health screening prior to the season as well as early diagnosis and proper treatment of injuries and illnesses when they occur are essential in for a safe and long lasting career for an athlete.

While having a dedicated team behind the team is primarily the domain of high performance sport programs, it is recommended that community sport teams create a comprehensive referral network to fall back on BEFORE an injury or problem arises.

The following is a list of potential members of the team behind the team and how these practitioners work within our current medical system.

Doctors

Typically, a primary care or family physician (MD) manages the continuous medical care of their patients from the initial contact to the resolution of the injury or illness. Quite often, this patient – doctor relationship is one that last for a long time. The physician manages this medical care through routine examinations, prescription of medications as indicated and referrals to therapists and other specialists for conditions that would potentially require surgical or other assessments and treatments. Visits to the family physician are covered under the basic Medical Service Plan (MSP), however, there are service charges that must be paid for by the patient for some services such as conducting a pre-season sport medical.

Specialist physicians including orthopaedic surgeons, neurologists, cardiologists, etc. complete an extensive residency program (usually five years) post medical school. Many orthopaedic surgeons, for example, become highly specialized in the treatment of sport injuries and deal mainly with the surgical intervention of musculoskeletal and joint injuries. A referral from the family or sport physician is required to seek treatment from a physician specialist.

Sport medicine physicians seek out additional training once they have obtained their medical degrees. Qualified sport physicians in Canada complete a postgraduate diploma in sport medicine as offered through the Canadian Academy of Sport Medicine (CASM). Prior to sitting this exam, physicians often enrol in a sport medicine fellowship program. A referral from a primary care physician is needed in order for the visit to a sport medicine physician to be covered by MSP.

Lengthy delays in our current medical system, particularly when seeking consultation and treatment from a specialist are not uncommon. The delays are often even longer should surgery be required. With the extensive changes that have been taking place in our medical system, an entrepreneurial approach to the practice of medicine is beginning to emerge. For example, the Specialist Referral Clinic (SRC) is a Vancouver based medical centre at which selected specialists will offer expedited access for independent assessments and consultations. The SRC limits its services to those that are not covered by MSP (and clients include insurance companies, corporate health providers and occupational and rehabilitation departments of major corporations). The SRC also offers expedited service to law firms and others seeking expert opinions from doctors with sub-specialist expertise. Individuals have the ability to access specialists at the SRC if they wish to acquire a medical or surgical assessment for their own purposes, such as insurance, special licenses (e.g. pilots), independent medical, routine physical and similar reasons. SRC specialists who see medically referred (MSP) patients will do so only through their own private offices. Privately owned surgical centres are also becoming more common, and patients who are willing to pay for the costs of their surgeries and diagnostic procedures (such as MRI and CT scans) will have access to expedited care.

Physiotherapists

Physiotherapists are skilled in the rehabilitation and prevention process of injury. They will manage all aspects of the rehabilitation process from injury recognition to injury management and prevention. They also provide important patient education information, particularly in the area of stretching and strengthening, the provision and administration of therapeutic modalities, and functional assessments to determine readiness to return to sport.

Physiotherapists can opt to specialize in different areas including hand and upper extremities, spine, or in areas related to orthopaedics, neurology and sport. Sport therapists are affiliated with Sport Physiotherapy Canada and move through a three level (I – III) program. Level III therapists (SPC Diploma holders) have developed comprehensive first-aid and on-field skills and typically these therapists are the ones who are called on to service and travel with national team athletes.

A referral is not required to seek treatment from a physiotherapist. A private fee structure is now in place, however, and the patient is required to pay at the time a treatment is rendered. Many extended medical plans partially (or even fully) cover these fees for service, which typically range between $35 and $60 per treatment.

Athletic Therapists

A certified Athletic Therapist (ATC) utilizes contemporary rehabilitative techniques, therapeutic modalities, physical reconditioning and supportive taping procedures to promote an environment conducive to optimal healing. Athletic therapists also provide immediate first aid care of athletic injuries and basic emergency life support. Athletic therapists can be found in a variety of settings including educational institutions, professional and elite sport teams and a variety of clinics. A referral is not necessary to see an athletic therapist and a similar fee for service structure is in place as for the physiotherapist.

Massage Therapists

Registered Massage Therapists (RMT’s) are specifically trained in rehabilitation, assessment and treatment of musculoskeletal injuries, therapeutic exercise, injury prevention and acute and chronic care. Specialized massage therapy techniques have been developed to complement an athlete’s program and the Canadian Sport Massage Therapists Association provides additional credentials to massage therapists working in sport. A referral is not required to see a massage therapist, and a private fee for service structure is in place ($20 – $90 depending on the duration and scope of the treatment).

Chiropractors

Chiropractors are specialists concerned with the locomotor systems of the body and are specifically trained in the diagnosis, treatment and rehabilitation of neuromusculoskeletal injuries and their resultant effects on total body function. Those who specialize in sport complete an extensive postgraduate training program dealing with athletic and peripheral injuries and receive the designation FCCSS(C). Referrals are not required to see a chiropractor and the fee for service (ranging anywhere between $35 – 65) is payable at the time of treatment. Premium assistance MSP will cover a total of ten visits per year of combined service that includes chiropractic, massage or physiotherapy.

Podiatrists

Podiatrists (DPM’s) are doctors who specialize in preventing, diagnosing and treating foot and ankle related pain and disorders both medically and surgically. Podiatrists complete a four-year undergraduate program, followed by a four-year doctorate program and then a 1 to 3 year internship program depending on their speciality. Seeing a podiatrist is often the first step in addressing a sports related condition or injury and a referral is not necessary. Private fee structures are in place to be treated by a podiatrist, and some extended health care plans may partially (or fully) cover treatments.

Psychologists

In order to use the title of psychologist an individual must be registered with the College of Psychologists of BC. There are a number of psychologists who specialize in working with athletes. Psychologists work in private practices and fees vary among professionals ($75 – $200). Some service may be covered under an extended medical plan.

Moving into the performance enhancement stream, additional members of the team behind the team could include:

Exercise Physiologists

Exercise physiology is the study of how the human body functions during exercise and how bodily functions related to exercise can be altered by physical training. The optimal physical preparation of athletes will vary with different sports – all athletes can benefit from well-designed training programs, which address the specific fitness requirements of sport and the specific weaknesses of individual athletes. Exercise physiologists typically have Masters or PhD degrees in sport science and are members of the Canadian Society for Exercise Physiology. Most physiologists can be found working in university settings.

Mental Trainers

Mental trainers work with athletes in a variety of ways, including assisting them with goal setting, developing concentration, dealing with adversity, mental imagery, pre-competition preparation and effective performance evaluation. Mental trainers typically have masters or PhD degrees in related exercise science fields, and are also registered with the Canadian Mental Training Registry.

Nutritionists

Many dietitian/nutritionists have a keen interest in sport and working with athletes. Most sport nutritionists work in private practices and assist athletes in developing optimal eating habits and identifying nutritional strategies to support maximal physical performance capacity. Qualified nutritionists often have sport science and/or nutrition science degrees and are RDN (Registered Dietitian/Nutritionists) with the BC Dietitians’ and Nutritionists’ Association.

Strength and Conditioning Specialists

Certified Strength and Conditioning Specialists receive their designation from the National Strength and Conditioning Association, a US based organization. Currently there is no Canadian equivalent, however, certified fitness appraisers often have been exposed to similar training in the strength and conditioning area.

Summary

The Team behind the team should be a comprehensive one and, when working together, each member of the medical services team respects and values the contribution and skills that the other individuals bring to the group. Well prepared coaches and parents should always know who they can go in their network in order to get the right information and assistance.

One of the most well used services provided by SportMedBC is the online Directory of BC Practitioners that lists individuals who are dedicated to the development and delivery of services for the benefit of the sport, recreation and fitness communities in British Columbia. Each of the listed practitioners have met the standards set by their various professional associations to be involved in the sport medicine / sport science field. The directory is searchable by profession, area of the province, and by name. It is regularly updated and is an excellent resource for coaches and parents of athletes at all levels. To access the Directory, click here.

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