History of Sports Medicine

A sports medicine physician is a medical doctor specializing in the prevention, diagnosis, and treatment of injuries and conditions related to physical activity. Their expertise ranges from managing acute injuries in competitive athletes to optimizing exercise for individuals with chronic illnesses. To become a sports medicine physician, one must first complete residency training and board certification in a primary specialty such as emergency medicine (EM), family medicine, internal medicine, pediatrics, or physical medicine and rehabilitation (PM&R), before pursuing additional fellowship training in sports medicine.

While often perceived as a modern specialty, sports medicine has historical roots dating back to ancient Greece and the original Olympiads. It became officially recognized as a subspecialty in the United States in the 1990s, solidifying its place in medical training and practice.

A Career in Sports Medicine

The role of a sports medicine physician is diverse, spanning clinical, sideline, and leadership responsibilities. These physicians primarily manage non-surgical sports injuries, which institute nearly 90% of all sports-related medical issues. They work in outpatient clinics, on the sidelines of athletic events, and in various advisory and educational capacities.

The versatility of a career in sports medicine allows physicians to tailor their professional paths based on their interests, whether in clinical care, research, sideline coverage, or a combination of these areas.

Common Clinical Responsibilities

• Diagnosing and managing acute injuries (e.g., ankle sprains, ligament tears, concussions, fractures).
• Treating chronic musculoskeletal conditions (e.g., arthritis, tendonopathy).
• Performing procedural interventions (e.g., joint injections, ultrasound-guided therapies, regenerative medicine techniques).
• Managing medical conditions affecting athletes (e.g., heat-related illness, diabetes management, exercise-induced bronchoconstriction).
• Providing injury prevention counseling and guiding rehabilitation plans to facilitate a safe return to activity.

Practice Settings

• Outpatient Clinics: Private practices, hospital-based sports medicine programs, or academic medical centers.
• Sideline and Event Coverage: Local high school teams, collegiate athletics, professional sports organizations, or mass participation events (e.g., marathons).
• Specialized Medical Teams: Consulting for sports organizations, Olympic committees, and tactical/military groups.
• Administrative and Academic Roles: Research, medical education, and leadership positions within hospital systems, academic institutions, and professional sports organizations.

Leadership and Non-Clinical Roles

Many sports medicine physicians extend their impact beyond patient care by:

• Leading multidisciplinary teams in the management of athletic injuries.
• Participating in research to advance best practices in musculoskeletal and exercise medicine.
• Contributing to policy development in sports safety, athlete health, and performance optimization.
• Serving on advisory boards for sports organizations, regulatory bodies, and medical societies.

Why Enter Sports Medicine from an Emergency Medicine Background?

Although the pathway from EM to sports medicine is relatively new, interest in this career trajectory has grown significantly. Traditionally, sports medicine fellowships were geared toward primary care physicians, but the field has expanded to include EM-trained physicians due to their unique and highly-relevant skillset.

• Acute Injury Management: EM physicians are highly-trained in the rapid evaluation and stabilization of musculoskeletal injuries, concussions, and traumatic emergencies - skills that directly translate to sideline and sports event coverage.
• Procedural Expertise: EM residency provides robust training in a wide range of procedural skills, including fracture reductions, joint dislocations, splinting, and ultrasound-guided interventions - all critical in sports medicine practice.
• Ultrasound Proficiency: EM physicians are well-versed in point-of-care ultrasound, which has become an essential tool in diagnosing and treating musculoskeletal injuries both in clinics and on the sidelines.
• Critical Event and Sideline Management: Sports medicine physicians must be prepared to handle life-threatening emergencies such as sudden cardiac arrest, heat stroke, status asthmaticus, and head or spinal trauma in addition to exacerbations of chronic medical conditions such as seizures and type I diabetes - conditions that EM physicians routinely manage.

Emergency department (ED) physicians gravitate towards sports medicine because of the natural crossover mentioned above, in addition to a strong interest in musculoskeletal medicine, event medicine, and athlete care. For emergency physicians, a sports medicine fellowship offers a unique opportunity to broaden their scope of practice while maintaining their acute care expertise. Many sports medicine-trained EM physicians maintain a hybrid career, splitting time between the ED, outpatient sports medicine clinics, and sideline event coverage. The ability to work in both acute and outpatient settings provides more control over clinical schedules, reducing burnout associated with traditional EM shifts. Finally, it allows for expansion of career opportunities. Sports medicine physicians can work in academic medicine, team physician roles, consulting, research, and administrative positions within sports organizations.

The combination of acute care expertise, procedural proficiency, and emergency decision-making makes EM-trained physicians an asset to sports teams, athletic organizations, and large-scale sporting events. Training in sports medicine in turn allows the ED physician increased flexibility of clinical practice, a long-term sustainable career that aligns with interests, and increased marketability in a variety of roles.

Sports Medicine Training

A sports medicine fellowship is designed to enhance a physician's expertise in musculoskeletal medicine, exercise physiology, and the non-operative management of sports-related injuries. It also provides extensive exposure to event coverage, procedural training, and interdisciplinary care. While the core structure varies by program, all ACGME-accredited fellowships share fundamental components that prepare physicians for a career in sports medicine.

Sports Medicine Clinic

• Fellows manage a diverse panel of outpatient patients, treating acute injuries, chronic musculoskeletal conditions, and medical issues affecting athletes.
• Clinics may be hospital-based, academic, or private practice settings, offering hands-on experience in patient evaluation, diagnostic imaging interpretation, and procedural interventions.
• Fellows also work alongside orthopedic surgeons to develop expertise in the diagnosis and non-operative management of fractures, ligament injuries, and degenerative conditions. Exposure to operative cases enhances understanding of when surgical referral is appropriate.
• Continuity of care is emphasized, allowing fellows to track patient progress over time.

Sports Event and Team Coverage

• Fellows gain firsthand experience covering high school, collegiate, or professional sports teams, with responsibilities including sideline management of acute injuries, pre-participation physicals, and return-to-play decision-making.
• Coverage may extend to mass participation events (e.g., marathons, triathlons) and combat sports (e.g., mixed martial arts, boxing).

Procedural Training

Fellows refine their skills in diagnostic and therapeutic interventions, including:

• Ultrasound-Guided Procedures: Joint injections, hydrodissection, percutaneous tenotomy, and regenerative medicine techniques such as platelet-rich plasma (PRP) therapy.
• Fracture Care and Splinting: Advanced immobilization techniques and non-operative management strategies.
• Concussion Management: Baseline neurocognitive testing, return-to-play protocols, and treatment of post-concussion syndrome.

Primary Specialty Integration

• Fellows must maintain clinical competency in their primary specialty. This is typically fulfilled through one half-day per week of continuity clinic or urgent care shifts.
• EM-trained fellows may work ED shifts, urgent care, or designated "emergency care" roles within the sports medicine framework.

Research and Academic Contributions

• Fellows are expected to complete a scholarly project, which may include case reports, clinical studies, or quality improvement initiatives.
• Many programs encourage participation in national conferences.
• Fellows may engage in medical education, teaching residents and medical students during clinical rotations and didactic sessions.

Sports Medicine Didactics and Ultrasound Training

• Programs provide structured educational sessions covering key topics in sports medicine, including biomechanics and injury prevention, sports cardiology and sudden cardiac death in athletes, exercise physiology and athlete performance, and rehabilitation principles and return-to-play guidelines.
• Musculoskeletal ultrasound training is increasingly emphasized, as ultrasound plays a critical role in both diagnosis and treatment.

Exposure to Specialized Areas (Varies by Program)

• Adaptive Sports Medicine: Managing athletes with disabilities or prosthetics.
• Tactical and Military Medicine: Working with police, firefighters, and military personnel.
• Performing Arts Medicine: Treating injuries in dancers, musicians, and other performers.

A sports medicine fellowship provides a well-rounded clinical, procedural, and academic experience designed to prepare physicians for diverse career paths. Whether a physician plans to work in a clinic, on the sidelines, in academic medicine, or in research, fellowship training ensures they develop the necessary expertise to lead in the field of non-operative musculoskeletal and sports medicine care.

Pathways to a Sports Medicine Fellowship

There is no "set path" to entering sports medicine from EM, but there are key steps that can increase the likelihood of matching into a fellowship. Since sports medicine fellowships are highly competitive, early engagement and strategic planning are essential.

Traditional Pathway

Complete an EM Residency

Most applicants apply during their final year of EM residency. While all EM residency programs meet the training requirements for sports medicine, some offer structured sports medicine experiences, making them advantageous for interested residents.

Develop Early Interest and Get Involved

Sports medicine is an experience-driven field and fellowship programs seek applicants with hands-on exposure. There are several ways you can get involved early, including:

• Sideline event coverage (high school, collegiate, or professional teams).
• Sports medicine rotations/electives (either at home institution or away rotations).
• Research or case reports related to sports medicine.
• Professional memberships.

Network and Find Mentors

A mentor can help guide you through event coverage opportunities, research projects, and the fellowship application process. If your institution lacks EM-sports medicine mentors, seek out mentorship through professional societies like SAEM, the American College of Emergency Physicians (ACEP) sports medicine section, or the American Medical Society for Sports Medicine (AMSSM) mentorship program.

Strengthen Your Fellowship Application

Boost your application by attending conferences and presenting research, pursuing leadership roles in EM/sports medicine interest groups, and excelling clinically in both EM and sports medicine settings.

Alternative and Personalized Paths to Sports Medicine

While the traditional route involves applying directly from residency, some physicians choose alternative paths. Again, there is no single "right" path - start early, engage in event coverage, and seek mentorship. A well-rounded application includes clinical excellence, procedural skills, research, and leadership.

Attending Physician to Fellowship Pathway

Some physicians practice EM for several years before deciding to pursue a sports medicine fellowship. The benefits of this approach include stronger clinical experience and procedural skills, financial stability before fellowship training, and the opportunity to moonlight during fellowship. This approach may have a harder adjustment during the transition back to training, and you will need strong mentorship and event coverage experience before applying.

Hybrid EM and Sports Medicine Careers Without Fellowship

Some physicians develop sports medicine skills through additional training (e.g., ultrasound, regenerative medicine, concussion management) and integrate them into their EM or urgent care practice. Opportunities exist to work in orthopedic urgent care, event coverage, or private practice settings.

Sports Medicine Involvement

If your EM residency doesn't have an established sports medicine track or mentorship, you can still build a strong application for fellowship by proactively seeking out opportunities. Many fellowship-trained sports medicine physicians have navigated this challenge by leveraging elective time, networking, and self-directed learning.

Maximizing Elective Time and Clinical Exposure

Use your elective rotations strategically. Request a sports medicine rotation with a primary care sports medicine (PCSM) fellowship program at your institution or nearby programs. If no local options exist, consider an away rotation at a program where you may apply for fellowship. Look for opportunities with orthopedics, PM&R, or primary care sports clinics, as they often welcome EM residents. You should also consider moonlighting in orthopedic urgent care clinics, where many non-operative sports injuries are managed. In addition, seek out sideline and event coverage opportunities and reach out to team physicians or athletic trainers to volunteer as event medical staff.

Networking and Mentorship

Connect with sports medicine faculty in other departments at your institution. Even if they don't typically work with EM residents, many are happy to mentor interested physicians. You can also reach out to EM-sports medicine fellowship programs directly to ask about mentorship and event coverage opportunities. Another good idea is to join national organizations to gain access to mentorship and attend their annual conferences to meet program directors, learn about fellowships, and build connections.

Independent Learning and Research

If structured clinical exposure is limited, build your knowledge base by taking online sports medicine courses, self-study musculoskeletal ultrasound and practice scanning in the ED, and follow sports medicine literature. You can also get involved in research or case reports related to sports medicine by collaborating with sports medicine faculty on a project, publishing a case report on an interesting sports injury or sideline case, or submitting abstracts to local and national conferences.

Challenges

EM physicians bring valuable acute care and procedural skills to sports medicine, but they face unique challenges when entering this primary care-dominated subspecialty.

• Limited EM-Specific Fellowships: Most fellowships are based in family medicine, PM&R, or internal medicine, with limited spots for EM applicants. Some EM physicians must apply outside their home institution to fin a suitable program.
• Fewer Training Opportunities in EM Residency: EM residencies often lack structured musculoskeletal medicine education and dedicated sports medicine rotations. Event coverage is also challenging due to conflicting ED shift schedules.
• Transitioning to a Clinic-Based Practice: Sports medicine involves continuity of care, longer visits, and rehabilitation planning, which differs from the fast-paced, episodic care model of the ED. Physicians may need additional training in advanced musculoskeletal exams and chronic injury management.
• Establishing a Hybrid EM-Sports Medicine Career: Hybrid positions allowing both ED shifts and sports medicine clinic time may be difficult to find or require negotiation. Many institutions lack awareness of the hybrid role, making career planning more complex.
• Navigating a Primary Care-Dominated Field: Most PCSM programs emphasize primary care continuity clinics, which may feel less relevant to EM-trained physicians. Some fellowships prefer primary care applicants, requiring EM applicants to demonstrate strong musculoskeletal knowledge and sideline experience.