Evidence-based Sports Medicine

Evidence-based Sports MedicineIt is possible for physicians to discuss with athletes and theirrelatives the dangers associated with particular sports. In providingathletes with solutions the physician must incorporate a risk analysis.Solutions should also be suggested as to which sporting activities maybe more suitable. The benefits of sport and exercise are well describedso participation in low risk sports may be advisable. Thus while it maynot be considered appropriate to participate in contact or collisionsports a physician should be able to advise an athlete on a sport whichis suitable. The concept of non-participation in all sporting activitiesis rarely indicated for any illness, injury or deprivation. The traditionof excluding the disabled athlete has now been replaced by theconcept of facilitation and support for the athlete who may bechallenged or “disabled”.Consideration should be given to advising young athletes with onetesticle to store semen prior to taking up or continuing in contact orcollision sport.The viewpoint of the advising physician must be respected.While there is no documented case of a successful lawsuit against aphysician for advice to compete in sport with one kidney or onetesticle there remains a theoretical risk that a physician could besued. In particular, the sometimes suggested “apparent waiver ofentitlement to sue” by an athlete may not stand up to scrutiny in acourt of law.DiscussionGiven the rarity of single kidneys or testicles in participatingathletes it is not surprising that the evidence on which to base one’sadvice about participation is thin. The easy advice for the physicianto offer is not to play sport. Such advice implies that an athlete willnot suffer any injury and that the physician will not incur anymedicolegal consequences in the future. However, the physician hasa duty of care to advise the athlete in consultation with the athleteand to offer advice based on evidence. The focus in encouraging sportshould be to look at the opportunities certain “low risk” sportsprovide rather than defending the at-risk organ.It is clear that physicians do not always follow the evidence whenadvising athletes. Indeed there is some evidence that the advicecurrently offered by physicians remains dichotomous and indeed maybe biased. For instance, Anderson, in a questionnaire sent to the 1994membership of the American Medical Society for Sports Medicine,found 54·1% of respondents indicated they would allow participationin collision and contact sports for an athlete with a single kidney afterdiscussion of the possible risks. However, the percentage allowing126