Handling the Rough Game: The Slow Evolution of Sports Medicine

Development of arthroscopy and recognition of the long-term consequences of concussions have morphed sports medicine into a specialty


In 1980, a torn ACL could end a professional athlete's career. Today, minor surgery and proper rehabilitation can get a player back on his feet before the season's end. In 1980, an on-field brain injury could be overlooked. Today, a hit to the head can sideline a player for weeks as he recovers from a concussion.

The 1985 Chicago Bears, a team known for its hard hits and merciless nature, were welcomed to the White House for the 25th anniversary of their Super Bowl XX victory last week. In the years since the team's glory days, not much has changed in the game or the injuries players suffer, but the treatment of football injuries has evolved considerably.

The development of arthroscopy and the recognition of the long-term consequences of repeated concussions have morphed the field of sports medicine into a well-organized, scientific specialty.

With better technology came enhanced diagnostic capabilities and more attention to detail over time. Physicians and trainers now approach the contact sport with an overly cautious attitude to make sure football remains fair, fun, and safe.

Few athletes will escape a football field without a few sprains and pains. Rips, tears, and breaks can take players out of the game for weeks or months but are generally not career-ending, as they may have been just a couple of decades ago.

Diagnosis and Treatment

One of the biggest breakthroughs in sports medicine over the past 30 years is the development of arthroscopic surgery, according to Dr. Gordon Nuber, an orthopaedic surgeon who has been a team physician for the Chicago Bears since 1992.

"Minimally invasive surgery made a huge difference in our understanding of pathology and our ability to repair things that we would not have been able to imagine 25 or 30 years ago," he said.

Through a small incision, arthroscopy gives surgeons more access to look all around the joints and to fix the torn structure while damaging less soft tissue.

"Back in the '70s and '80s, you'd see these scars that were six inches long across the patient's knee, and now we can do it through basically a few pokeholes and a one-inch incision," said Dr. David Geier, director of sports medicine at the Medical University of South Carolina. "Now they get their motion back typically faster, and they get their strength back because you haven't done as much damage to do the surgery in the first place."

With the advent of magnetic resonance imaging, doctors can look beyond the bone and more quickly and accurately diagnose injuries.

While the University of Cincinnati has the only facility with an MRI machine, it's a requirement that X-ray machines are available at all NFL stadiums. There are two at Soldier Field so physicians can evaluate injuries in the locker room.

"Evaluation of these injuries is always getting better, typically when you talk about brain injuries," Nuber said. "Treatment protocols are getting more and more regimented."

Concussion Detection

Nuber said physicians and trainers at games and practices are much more aware of the severity of concussive injuries.

Repeated hits to the head have been linked to serious health risks including chronic traumatic encephalopathy, a degenerative brain disease with Alzheimer's-like symptoms. The disease begins to appear several years after the trauma, which does not have to be concussive, and it can only be diagnosed when analyzing a brain posthumously.

Presented by

Sara J. Martinez is a reporter for the Medill News Service. She was previously a Pulliam Fellow at The Arizona Republic in Phoenix and a Dow Jones News Fund intern at The Journal News in White Plains, New York.

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