Sports medicine doctor Spencer Richards, MD, discusses how sports medicine has changed in the past 30 years and gives a glimpse of what the future might hold:
The Past, Present and Future of Sports Medicine
by Spencer Richards, MD
Most runners and triathletes have dealt with injuries at some point in their career. These injuries can be incredibly frustrating because they often derail training and race plans. As sports medicine physicians, we’re constantly looking for treatment options that can successfully treat these injuries while minimizing time away from sport and preventing recurrence. I’ve been thinking about where we’ve been in the past, where we are now, and where we’ll be in the future in treating these injuries. It’s pretty amazing how fast things change!
Thirty years ago
Most running injuries (doctors weren’t seeing many triathlon injuries back then) were treated with prolonged rest, often exceeding several months. In some cases, cast or prolonged brace immobilization was also used.
Twenty years ago
Prolonged immobilization in casts or braces fell out of favor for early mobilization and movement. Antiinflammatory options were plentiful and were a mainstay of treatment, whether oral or injectable (cortisone). Physical therapy involving stretching, cautious strengthening and tools like electrical stimulation and ultrasound was used extensively. However, long periods of rest from running were still recommended.
Ten years ago
Ten years ago I was a resident physician in Indiana learning the ropes from some of the premier sports medicine physicians in the country. Running as a sport had just gone through a major boom and triathlon was just starting to gain its current levels of popularity. With more runners and triathletes, we were seeing more injuries, such as ITB syndrome, patellar or Achilles tendonitis, knee pain, foot pain, etc. Not only were there more runners and triathletes, they were pushing further, harder, and faster (sometimes despite injuries), so we were seeing more chronic or difficult-to-treat injuries.
At that time, we started treating these injuries with a novel treatment called ASTYM, or Augmented Soft Tissue Mobilization. ASTYM and other similar treatment protocols (Graston, Active Release, etc) introduced a shift in treatment away from “babying” an injury to aggressively inciting tissue repair and regeneration through scraping and strengthening the injured tissue.
Today we treat these same injuries with a mixture of everything we’ve used in the past but with more attention to tissue regeneration—trying to get the tissue to return to normal, not just stop hurting. With advances in diagnostic ultrasound, we’re able to identify abnormal tissues much more effectively (and less expensively since it’s performed in the office). We can also track tissue repair, which helps us return runners and triathletes back to training and competing more quickly, because the decision is based on objective evidence, not guess-work or estimations.
One of the most popular tools we have today to accomplish the goal of tissue regeneration is PRP, or platelet- rich plasma, injections. By now, most of you have heard of PRP—it’s been in the popular media a lot since professional athletes starting using it to recover from injuries more quickly. Evidence suggests that platelets incite tissue repair and regeneration. The platelets are taken from the patient’s blood and injected into the injured tissue during the same visit. On a personal note, PRP was the treatment that finally treated my ITB syndrome and hamstring tendon problems after months of trying and failing other “traditional” treatments and not being able to run. I was grateful to be the first patient in our office to receive PRP treatment several years ago because it worked so well.
Ten years from now
The future of medicine is already happening in labs and some clinics today. One of the most exciting innovations is stem cell therapy. For tendon, ligament and cartilage regeneration, stem cells can be harvested from fat or bone marrow on the same individual and injected, usually with PRP, into the damaged tissue. In the right environment, stem cells can differentiate or change into any type of tissue in the body. This means a damaged tendon, worn out or torn cartilage, or loose ligaments could potentially repair back to normal without the need for surgery or prolonged time off.
Efficacy, safety, and cost are major issues other sports medicine physicians are watching closely, but indications are very promising that in the near future stem cell treatment will be a valuable option for runners and triathletes with frustrating injuries or joint problems.
Beyond 10 years
As fast as medicine changes, it’s hard to predict where we’ll be in the future. However, one area with untapped potential is genomic sequencing for personalized medicine. Basically, this means that doctors take samples of an injured individual’s DNA, figure out what genes that person has and then prescribe specific medications, growth factors, or other biologic agents that will work best for that person’s specific genetic make-up. One of the major downsides of this will be cost and ethical considerations (e.g. could an insurance company deny coverage because of a “pre-existing condition” found in your genes?). It will be fun to watch this field develop and look for applications in sports medicine.
As I have already mentioned, the goal of sports medicine physicians is to successfully treat injuries, minimize time away from sport, and prevent recurrence. We love working with runners and triathletes—most of us doctors participate with you and know the frustration of injuries. We hope to provide the best, most up-todate services possible to keep you rocking and rolling!
Dr. Richards is a Sports Medicine and Exercise Specialist. He practices at the Bountiful Clinic and LDS Hospital campus. Dr. Richards specializes in non-surgical treatment of muscle, joint, and bone issues. He has expertise in treating issues specific to active people and in helping prevent issues through proper movement mechanics, strength training, nutrition and post-injury return-to-play guidance.