Book Review

Sports Medicine in Primary Care

N Engl J Med 2001; 344:1025March 29, 2001

Article

Sports Medicine in Primary Care
Edited by Rob Johnson. 363 pp., illustrated. Philadelphia, W.B. Saunders, 2000. $45. ISBN: 0-7216-7871-8

America's obsession with sports is evident just from the salaries of some professional athletes, which rival the entire budgets of many academic medical centers. The increased interest in sports and physical fitness has filled the offices of primary care physicians with patients who have musculoskeletal problems. In his preface, Johnson notes that approximately 25 percent of patients seen in primary care outpatient practices present with such problems. In addition, the primary care physician is called on to advise patients with such medical problems as cardiovascular disease, pulmonary disease, and diabetes about participation in sports.

The 22 excellent chapters of Sports Medicine in Primary Care contain a great deal of information. The topics range from the musculoskeletal examination to the diagnosis and treatment of specific athletic injuries. Also included are chapters regarding the preparticipation evaluation, the principles of athletic training, and advising the athlete on nutrition and supplements.

The book contains contributions from primary care physicians who specialize in the relatively new field of sports medicine. In addition to their medical practices, some of these authors serve as team physicians at the professional, college, and U.S. Olympic Team levels. They have produced an easy-to-read book that provides clear information to the physician who seeks to advise patients about athletic activities.

The book begins with two chapters about the physical examination of the musculoskeletal system and the general evaluation required for participation in sports. Two subsequent chapters, on the prescription of exercise and principles of training, are well written and illustrated, but they could have been enhanced by citations of data. Escher's chapter on advising athletes on nutrition and supplements is very interesting. The topic is controversial and will be the subject of discussion between many athletes and their primary care physicians. There are seven chapters on athletic injuries to various parts of the body — the head, the neck, the upper and lower extremities, the back, the chest, and the abdomen — as well as a chapter on relevant genitourinary problems. These chapters provide excellent information about the evaluation, diagnosis, and treatment of these injuries, and problems including good advice regarding allowing the patient to return to the sport and the appropriate use of referrals to specialists. The chapter on injuries to the legs and feet is extremely well written and complete. It highlights key points for each of the musculoskeletal problems it covers and is well referenced.

The reader should keep in mind that the authors of this book are experts in sports medicine, and their well-developed criteria for referral to specialists should be interpreted with this understanding. For instance, the chapter on injuries to the neck and cervical spine notes that “referral for fractures without neurologic injuries is determined by the degree of instability of the fracture.” Most physicians without expertise in cervical spine fractures could not determine whether a fracture was stable or unstable and would be wise to refer any patient with such a fracture to a specialist immediately. In the chapter on injuries to the lower extremities, the reader is advised that femoral stress fractures without displacement “can be managed by the primary care physician who has the requisite experience and confidence.” Femoral neck stress fracture, however, is one of several high-risk stress fractures that should generally be managed in conjunction with an orthopedic surgeon.

Three chapters provide excellent information regarding adolescent, female, and older athletes. They discuss such topics as sports injuries to the growth plates in young athletes, physiologic and hormonal factors in female athletes, and the effects of aging on athletes. These interesting and helpful discussions provide a wealth of facts and figures for the primary care physician.

The chapter on the athlete with medical problems specifically addresses the problems experienced by athletes with hypertension, pulmonary or cardiac disease, asthma or allergies, diabetes, seizure disorders, and infectious and psychiatric problems. The last chapter is a well-illustrated and useful step-by-step technical manual on joint aspiration and injection.

The editing of the text is somewhat uneven, and there are a few mistakes, such as the description in chapter 1 of the rectus femoris as having two actions, “flexing the knee and extending the hip,” whereas the muscle actually performs the opposite function.

This book covers a comprehensive collection of timely topics relevant to the care of athletes and patients who participate in athletic activities. This information will be extremely helpful not only to primary care physicians but also to any physician or surgeon who takes care of athletes. This book is easily readable and well illustrated and will serve as an excellent reference for physicians who care for both serious athletes and “weekend warriors.”

Randall E. Marcus, M.D.
Case Western Reserve University School of Medicine, Cleveland, OH 44106