Sports Medicine in Medical Tourism

On October 2012, MedicalTourism Magazine published an article by Dr. Alejandro Badia named “Sports Medicine in Medical Tourism.” which we are republishing here for your information, as this continues to be a very relevant topic in sports medicine today.
Sports Medicine in Medical Tourism

Sports medicine by nature embodies the concept of medical tourism

This is mostly used by professional athletes and also amateurs who often research to identify a qualified specialist to take care of their sports-related injury. While the injured athlete is typically willing to travel to our Badia Hand to Shoulder Center (BHSC) for medical evaluation and treatment, these patients require significant after care. The International Society for Sport Traumatology of the Hand (ISSPORTH) embodies the concept of medical tourism, since the organization actually encourages that athletes seek out the appropriate specialist for that particular injury so that they can have the surgery performed in that location and then return to their home country to continue training.

Sports medicine as the branch of medicine

Sports medicine is defined as the branch of medicine concerned with the treatment of injuries or illness resulting from athletic activities. While this has a wide range of connotations, generally sports medicine in the realm of medical tourism usually refers to an injured or impaired athlete traveling to obtain the best surgical treatment in order to allow them to return to their sport.

Sports medicine can also encompass areas of physiologic or metabolic management to optimize athlete’s performance, but generally this is something that only elite athletes would travel for and this type of medical care requires long term management. The branch of orthopedic surgery termed “sports medicine” generally refers to a surgical subspecialist who treats the majority of athletic injuries with the use of arthroscopic or minimally invasive surgery. This requires the use of fiberoptic instrumentation to insert in the joint and identify the injured structure that in this case would be hampering athletic performance, or was directly injured as a result of a traumatic injury during sport. While this may be indicated for the pathology, athletic injuries can fall within the area of spine surgery, foot and ankle or hand/wrist. Due to their specific needs, both elite and weekend warrior athletes will often seek the best practitioner to perform this surgery and really embodies the concept of medical tourism.

That is because the impaired athlete often uses different information resources to identify the most qualified specialist to take care of their sports injury. This is logically the case since most athletes are passionate about their sport and their main goal is the fastest and most optimal recovery possible. To do this they need to seek out the best specialist. While cost may be a factor, athletes at all levels will make great sacrifices in order to be able to return to their athletic endeavor. Therefore, sports medicine often embodies the ideal indication for the practice of medical tourism.

As said before, while the injured athlete is often willing to travel specifically for medical evaluation and treatment. these patients typically require significant after care, which will consist not only of physical or occupational therapy, but also working with an athletic trainer and coach to return them to their pre-morbid level of athletic skill and ability. Ongoing communication between the treating surgeon and the rehabilitation team is critical to an optimal result. This is a procedure specific concept since orthopedic surgery has become extremely specialized and the athlete will need to find not only the appropriate type of orthopedic subspecialist, but perhaps the person who treats this specific type of injury or performs a particular surgical intervention. For example, James Andrews, a renowned sports medicine surgeon in Alabama and Florida, frequently sees athletes who require reconstruction of the critical medial collateral ligament of the elbow allowing them to return to pitching a baseball, throwing a football or hurling a javelin. Dr.Pinczewski from Sydney, Australia is world renowned for mainly performing anterior cruciate ligament reconstruction on athletes. Soccer players from Europe or South American may travel way down under just to have this one specific surgery.

In my specialty, surgery of the hand and upper extremity, the need for sports specific injury management led to the creation of the International Society for Sport Traumatology of the Hand (ISSPORTH). This society was founded in Europe and now has members from more than 50 countries in 6 continents. While the US is actually underrepresented, I am the current worldwide president and my goal is to not only educate other medical colleagues about the importance of hand surgery involvement in those specific sports injuries, but also educating athletes and trainers alike about the importance of having hand surgeons involved in their treatment.

This is such a lofty goal that ISSPORTH created an IPhone app that allows a coach, trainer, or athlete himself to easily find the nearest ISSPORTH member hand surgeon in order to treat their specific problem. For example, I have been treating professional tennis players for upper limb injuries for many years, often seeing them during the Sony Ericsson tournament where their trainers schedule a consultation and players frequently return to have wrist or elbow surgery with me in Miami. A simple click on their smartphone will dial my office number, send an email or bring up a map of our center, as easily as it can be done if they are competing in Latvia, Brazil or South Africa where they will be seeking the closest appropriate hand specialist.

Sports medicine is not only for the elite professional athlete

While sports medicine is often thought of for elite athletes, such as professional or Olympic competitors, sports medicine in its broadest sense actually entails treatment of the everyday competitor who happens to be passionate about golf, tennis, or any multitude of sporting endeavors. When either degenerative problems, overuse syndromes, or even acute injury impair that player’s ability to compete in their sports activity, they will often seek the best practitioner they can find to return them to their sport. In many cases, the everyday athlete possesses the financial means to afford travel, since patients with less financial resources are not typically members of golf clubs or tennis academies in their home country. Because the ability to dedicate time to a sporting activity generally requires the financial means, these are the very same patients that will often travel to great lengths to seek appropriate care. Therefore sports medicine is actually an ideal avenue to promote the overall concept of medical tourism. Once that patient travels to have a wrist arthroscopy, they may decide to travel again in the future to have coronary bypass surgery or an elective hernia operation.

The treatment of high caliber athletes can often inspire less competitive athletes to seek the same quality of care. We all remember the slogan idolizing Michael Jordan, namely “Be Like Mike.” In other words, we not only want to wear the athletes’ chosen sneaker brand, but we also may want to be treated in the same world renowned clinic or by the same famous sports medicine surgeon. Recently, I had the opportunity to evaluate and then perform arthroscopic shoulder surgery on Karen Meakins, a world class female squash player from Barbados who has been Caribbean champion and a silver medalist in world masters championship. The patient was referred to me by another orthopedic surgeon because in her country arthroscopic surgery of the shoulder is still in its infancy. It was clear that this patient needed a rotator cuff repair, but her goal was not only to be able to achieve the optimal result, but to do this in record time since the patient was eyeing the Barbados National Championship within six months of the time of her planned surgery. This athlete not only had an excellentl outcome, but successfully defended her title to win her 13th Barbados national title. This case, as well as operating on the shoulders of a world class MMA fighter, an Olympic swimmer and a rugby player has ultimately led arthroscopic shoulder surgery to even surpass endoscopic carpal tunnel release as the most common procedure I perform in the international patient. I fully attribute this to the stark visibility that sports injuries provide the public in understanding what recovery is possible after an orthopedic ambulatory procedure. It inspires confidence.

Coordinating with the international facilitator

The travelling athlete does require particular attention in facilitating their care abroad. Early discussion of treatment options, often with the coach or trainer, must be done before they make the commitment to travel. This requires evaluation of studies, such as radiographs, MRIs and nerve studies, as well as meticulous review of the current treatment regimen without being critical, as collaboration with local health professionals is vital to achieving the desired result in return to play. An international patient coordinator or facilitator is particularly helpful in assembling this data, scheduling the travel and local stay, even finding athletic or gym facilities so that the athlete can maintain their conditioning level.

In our center, all of the diagnostic equipment, including fluoroscopy, MRI imaging and electrodiagnostic instruments are available onsite to utilize on the very first consultation. Most importantly, the surgical team is safe and experienced, with a cardiac anesthesiologist leading the unit and performing virtually all surgeries under regional block anesthesia, followed by indwelling pain pump catheters, allowing a virtually pain-free post-operative course. The surgical center is onsite as well as the rehab unit, as close communication with the physiotherapist is particularly crucial in guiding the athlete through the recovery process.

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