The next time you’re at a doctor’s office, take a good look at your fellow waiting room denizens. To the left, there could be a 65-year-old man hoping for relief from a sore shoulder. To the right, maybe a 14-year-old soccer player who’s come for a knee examination. Across the room, there may be a 30-year-old mother, there for a back problem.

There may also be a Bengal, a Cyclone or Cincinnati Red thumbing through the magazines, too.

Sports medicine centers, once the sole province of college and professional sports stars, have taken a turn of late to all-encompassing practices that treat teens, middle-aged weekend warriors and older adults for conditions ranging from recent injuries to the results of decades’ worth of wear and tear.

In fact, doctors say those patients out-number the pros these days.

The proliferation is being fueled by two age groups — an aging baby boomer generation and the rise of highly competitive youth leagues in which participants as young as their early teens are already eyeing potential college scholarships.

“The boomers are the biggest reason,” explains Dr. Michael J. Miller, medical director of St. Elizabeth Sports Medicine in Northern Kentucky. “They’re the first generation of the fitness boom. They’re used to being active and they want to remain active, and from them we’re seeing a lot of orthopedic and musculoskeletal conditions like osteoarthritis and degenerative joint disease. Then, there’s young athletes. They’re training harder than ever before, doing year-round sports and, unfortunately, there are consequences — from shin splints and tendonitis, up to stress fractures and acute tendon injuries.”

With doors jammed with an influx of new patients, sports medicine practices have grown to meet the demand. As an illustration, Miller points out, when St. Elizabeth Sports Medicine opened its doors in 1989, it was run out of one office with a staff of five. Twenty years later, it has three locations, and nearly 30 staffers.

Also driving a boom in the specialty, though, has been the evolution of the field itself. Within the last decade, the practice of sports medicine has mushroomed from its traditional roots in orthopedics to include chiropractic care, neurology, physical therapy and a wide range of other specialties.

According to Beacon Orthopaedics and Sports Medicine’s Dr. Timothy Kremcheck, radiologists now routinely roam the halls of sports medicine centers, and doctors also call in specialists in acupuncture and massage therapists.

“It’s evolved into a very, very sophisticated field that includes people it didn’t as little as 10 years ago,” says Kremchek, who also serves as medical director and chief orthopedic surgeon for the Cincinnati Reds.

At Beacon, for example, radiologists have been assuming a larger role in treatment. While striking advancements have been made in the technological side of ultrasound imaging, MRIs and CT scans, it was the application of those imaging technologies that has made the greatest step forward, making an on-site radiologist a necessity, Kremchek says.

At Beacon, “we have a radiologist in the office, and we bring them in with the patient for a consult,” he says. “They can see, for example, the patient’s range of motion and where the pain is, information they use to zero in on problem areas. They correlate that information with the image and have a larger role in determining patient care.”

Despite technological advances in imaging, much still rests with the user, Miller agrees.

“Ultrasound has been around forever, MRIs have been around since the late ‘80s, but it’s their applications to assess and treat conditions that’s outpacing even the technological advancements,” he adds.

That increased diagnostic capacity is also leading to many more options for patients facing surgery.

Ultrasound-guided injection therapies use imagery to zero in on tendon damage that used to require surgery and allow doctors to inject substances designed to speed healing.

Those substances range from platelet-rich plasma to growth factors that stimulate natural body repair, and a category of synthetic substances known as hyaluronan. Known more commonly by the brand name Synvisc, hyaluronan is a gel-like substance that lubricates and cushions damaged joints, delaying more extensive surgical options.

Short of total joint replacement, patients are also being afforded other, less drastic treatments.

Arthroscopy, surgery through small incisions using specialized instruments, has been common on knees and shoulders for years. Now, advances in the instruments have brought on a rise in hip arthroscopy, sparing patients from further pain and more invasive procedures.

For tendon and cartilage damage, newer treatments include transplants from cadaver donors and lab-grown “spare parts.”

Kremchek explains: “One option that’s really taking off is procedures where we take a piece of the articular cartilage, cartilage on the end of the bone, and send it off to a lab. They can now grow new cartilage from that sample, and then we re-implant it to damaged areas.”

Despite the glimmer of these awe-inspiring advances, a less-heralded corner of sports medicine has quietly stolen the show.

Physical therapy has always been a part of sports medicine in the form of rehabilitation after surgery or other treatment. Recently, however, the focus has changed from “rehab” of an acute problem to a new catch phrase: “Prehab” — prevention of injuries before they occur.

Prehab programs focus on the repetitive movements and stresses of the patient, whether they are sports-specific or daily life-based, that leave weaknesses that may lead to injury. A golfer may not be developing leg strength, for example, or a weekend jogger may not be doing enough abdominal work, which may lead to spinal or hip problems.

These discrepancies are natural, doctors say, and are at the root of many injuries.

In prehab, after consulting a physical therapist, patients are given personalized strength and conditioning exercises to amend deficiencies.

“We continue to earn better and more ways to rehab injuries, but with prehab, the key is prevention. We do evaluations, looking at range of motion, strength, flexibility, your gait, feet and lower extremity alignment, core strength — your abdominal strength — and see what might lead to problems,” Miller explains.

“We can tell what role these things played in an injury, or might lead to one, and correct it. That’s where the real gains have been.”

Physical therapists have also been vocal in stressing the need for warming up and stretching before activity, which becomes even more important in preventing injury as people get older.

In all, the specialty looms large in the future of sports medicine.

“I used to tell patients that it’s a 50-50 deal,” Kremchek admits, “50 percent of what I can do for them with surgery, and 50 percent what a physical therapist could do for them. Now, it’s more like 30 to 40 percent what I can do for them. The rest is physical therapy. It’s taken a quantum leap. It’s absolutely essential to what we do now.”

Along the same lines, chiropractic care has also gained importance, says Dr. Stephanie Owens of Owens Chiropractic and Rehabilitation Center in Silverton. Treating spinal and other musculoskeletal conditions, the tenets of prehab, have long been part of chiropractic care, she says.

“We’re a preventative healthcare profession, so we’ve always preached movement, strength and balance to keep the body in its natural position,” Owens adds, pointing out that physical therapy is catching up with those long-held points in chiropractics. “Increased mobility and flexibility is what you obtain through chiropractics, and that’s what patients want and need.”

As more specialties move under the umbrella of sports medicine, doctors have shown they’ll opt to accept a wide range of care.

“As a sports medicine physician, you used to hang your shingle and take care of everything yourself,” Kremchek explains. “Now, you hang a shingle and have a bunch of specialists inside the office and outside that you use to make sure patients get the right care.”



Curbing Over-Use Injuries in Young Atheletes
Though the baby boomers may dominate the influx of new patients for sports medicine, doctors are far more concerned about another group — young athletes who may be over-doing it in the pursuit of excellence.

With youth leagues stretching to year-round seasons, doctors are concerned younger athletes may be setting themselves up for an increased risk of injury.

“We need to be more careful about over-training,” says Dr. Michael Miller, medical director of St. Elizabeth Sports Medicine in Northern Kentucky. “I see a bad trend, mainly because the leagues are so competitive. There’s a willingness on the part of the kids to continue to play while injured, and parents and coaches are willing to let them take those risks.”

While training methods have increased performance, he says, they also need to be balanced with downtime to facilitate healing.

For Dr. Timothy Kremchek of Beacon Orthopaedics and Sports Medicine, the cause has become a crusade.

Kremchek has appeared on HBO, ESPN and in a myriad of national magazines calling for an easing of pressures, especially playing time and pitch counts, for young athletes.

“Now, kids play baseball 12 months a year; they play basketball and soccer 12 months a year with no rest, no downtime, and it’s clearly leading to a problem with over-use injuries,” he says.

“People always ask me about the pressure of working on pro athletes,” Kremchek adds. “There’s no pressure, there. They’ve got their money. The pressure is with the kids. If you mess that up, maybe they don’t get that college scholarship, and that has ramifications throughout the rest of their lives. As a sports medicine physician, I’m not going to cure cancer, but I’m going to prevent these kinds of injuries if I can.”