The General Medical Council finally recognised Sports and Exercise Medicine as a medical speciality on 21st February 2005. The Faculty of Sports and Exercise Medicine (here) identifies three roles and accompanying aims. The first role is exercise medicine, intending to enhance physical activity in the UK population. The second is musculoskeletal medicine, intending to improve outcomes for patients with musculoskeletal disorders. The third is team care, providing excellent medical care to sporting teams. It has two links to rehabilitation. The first is that exercise is a vital and effective intervention in almost all rehabilitation. The second focuses on managing musculoskeletal conditions, which are managed by rehabilitation services in many countries. Thus there is undoubtedly some shared areas of interest, and I explore them on this page.
Context – history
Hippocrates recognised the importance of exercise, writing, “in order to remain healthy, the entire day should be devoted exclusively to ways and means of increasing one’s strength and staying healthy, and the best way to do so is through physical exercise.” [This quotation and historical introduction draws on an article here]
Moving on 2000 years, the British Olympic Association first appointed an official medical officer in 1928. It was not until 1953 that a formal organisation was founded, the British Association of Sports Medicine. This Association was renamed the British Association of Sports and Exercise Medicine in 1998. (here)
A government report in 2001 found that the health benefits of sport were not adequately recognised. Over the next four years, many people and organisations established a new medical speciality, Sports and Exercise Medicine. This work culminated in the General Medical Council agreeing that the speciality could be founded on 21st February 2005. The Faculty of Sport and Exercise Medicine was founded in October 2005. The Faculty has approximately 560 members and fellows.
Context – training and rehabilitation
The speciality has a substantial interest in the non-surgical management of musculoskeletal disorders, an area of medical practice that rehabilitation services once undertook. As its name suggests, it also has a significant interest in exercise, and exercise is a vital intervention in rehabilitation. (here) Third, it has a considerable interest in rehabilitating people after sporting injuries, especially but not exclusively sport professionals.
The 2021 curriculum (here) lists the specific speciality capabilities which I will examine here. They are:
- Leading and managing a multidisciplinary team
- this is similar to the Rehabilitation Medicine curriculum, except in rehabilitation we refer to participation in the team
- Ability to develop, lead and deliver a comprehensive musculoskeletal service that …
- there are two similar capability covering different age groups and locations
- Ability to deliver exercise medicine services ….
- there are two similar capability covering different age groups and locations
The last two capabilities concern increasing exercise in the general population and managing acute illness and injuries associated with sporting events.
A search of the curriculum shows that there is only one passing reference to the biopsychosocial model of illness. The curriculum (p 39) states that the ninth and last educational goal of attending medical and musculoskeletal clinics is “to become familiar with all aspects of the biopsychosocial model of illness, using it to ensure that all important factors are considered.“
The word, rehabilitation, occurs 14 times. Sometimes rehabilitation appears as a process the trainee should be learning, and at other times rehabilitation seems to be something the trainee should know about.
I conclude that there are certain areas of common interest. There is a shared interest in musculoskeletal medicine, and trainees in both specialities could learn much from the other speciality. It is also likely that many similar patients are seen in both specialities, but I suspect that the more challenging rehabilitation problems will be seen with expert rehabilitation services.
There is also a shared interest in exercise, and again there would be mutual benefit in sharing expertise and experience.
However, there are also significant differences. Rehabilitation services are not professionally concerned with the health of the general population. Nor are they involved in providing medical cover for sporting events. Some people with sport-related injuries will be seen in rehabilitation services, but not professional or elite athletes.
Last, rehabilitation training does not place so much emphasis on service design and management. All consultants in most areas of medicine have the responsibility, to a greater or lesser extent, for service design and management.
In summary, there are several areas where clinical services will overlap, such as patients with moderate disabilities associated with musculoskeletal disorders. There are other areas where expertise will overlap, such as using exercise as an intervention to improve health and reduce disability. The overlap is about 20%. Nevertheless, both specialities could learn much from the other when discussing the 80% that is not shared.
Contribution to the rehabilitation community
Sports and Exercise Medicine, through the organisations associated with it. It has much to offer the rehabilitation community. The most obvious is its expertise in exercise, adapting exercise to the needs and abilities of an individual and then encouraging the individual to undertake some physical activity. Movement is central to all rehabilitation, whatever the person’s age, problems, or location.
The interest and expertise in managing the mass of disability is a second significant contribution. As emphasised by everyone, musculoskeletal conditions are the commonest cause of disability. Fortunately, many of the individual rehabilitation interventions are relatively straightforward. The focus of this speciality upon population-level exercise service delivery gives it expertise for managing disability at a population level.
Sports and Exercise Medicine overlaps with Rehabilitation Medicine in the UK. A few people see this as competition, but this attitude is inappropriate. All involved in rehabilitation can learn much from Sports and Exercise Medicine and, conversely, there is doubtless much that Sports and Exercise Medicine can learn from others. For example, geriatric medicine knows much about frailty and how to adapt exercise for the frail elderly. Rehabilitation Medicine and other specialities know much about the biopsychosocial model of illness and its application within healthcare.
Several specific organisations represent or focus on aspects of Sports and Exercise Medicine:
- British Association of Sports and Exercise Medicine (BASEM), which was probably the first national organisation focused onthis speciality. (here)
- Faculty of Sports and Exercise Medicine, (here) which is focused on doctors but also has a membership category for “Exercise Rehabilitation Instructors who have completed JSSERI training.” (here) [JSSERI is a military trainingprogramme – Joint Services School of Remedial Instructors]
- British Association of Sports and Exercise Sciences (BASES), (here) which is open to any professional interested in sports and/or exercise sciences.
- National Centre for Sport and Exercise Medicine, (here) which is “is an Olympic legacy project delivering research, education and clinical services in sport, exercise and physical activity from three hubs across England.“
Conclusions
Sports and Exercise Medicine would be an essential member of a National Rehabilitation Community. Although it does not explicitly include rehabilitation among its core activities, its expertise in identifying what exercise might help a patient and adapting it to their lifestyle and needs is invaluable. It also undertakes rehabilitation of people with musculoskeletal disorders who attend all rehabilitation services. Sharing of expertise would help all services.
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