Aside from Coaches, Family, and Friends, Who Else Do You Need Around You?
As few "sports-focused" people as you can get by with. You probably don't need nearly as many people involved in your sports career and training as you might think. Often they only get in the way.
Mark McCormack (founder and CEO of International Management Group) described life on the tennis tour: "Now players are almost like Saddam Hussein and George Bush. They have their entourages -- family, relatives, boyfriends, girlfriends, physical trainers, court psychologists, bodyguards, managers, agents, publicists, that whole group. Plus, a whole bunch of hangers-on who float around telling the [player] how great he is in exchange for being given tennis tickets and being the friend of a celebrity, being invited to dinner and occasionally maybe being invited to the star's home." (1) Two other examples:
Over the past decade, there has been an explosion of people offering services to athletes. Sports doctors, sport psychologists, weight trainers, fitness trainers, and sports nutritionists are all fairly recent creations.
It hasn't always been this way. In the past, athletes didn't have so many specialists to choose from. If they had problems, they went to the same people that non-athletes went to (e.g., general practitioners, school counselors, parents and friends). But in hopes of becoming better competitors, athletes began seeking out professionals who promised to do something special for them.
Nowadays ten-year-olds competing in local events are taking along sport psychologists, physical therapists, and equipment specialists, which suggests that even young athletes (or their parents) will do anything to win.
So, what's wrong with this?
Nothing, as long as you (the athlete) don't get taken in either by people promising too much or by people who begin controlling your life and disrupting your training. If you've gotten to the point where you can't go to a competition without your own private staff, you'd better make sure they are worth the money.
When dealing with this army of sports support people, you should keep these points in mind:
1. Check out credentials, but also keep in mind that these
are no absolute guarantee of expertise.
Credentials are more useful as an indication of training than
a stamp of approval. Someone can be extremely well-trained in
his or her specialty and still not have the expertise to treat
your specific problem.
Consider, for example, sport psychologists. They come from a variety of backgrounds. Some have clinical training and earn Ph.Ds; others have educational training and earn Ed.Ds. There has been continuing discussion as to what kind of training sport psychologists should have. William Morgan (director of the Sports Psychology Laboratory at the University of Wisconsin) noted, "There are physical education and sports science individuals who are very well trained, but not trained as psychologists. And there are very well trained clinical psychologists who are not trained in sports science." (4)
Jerry May (a clinical psychologist and psychiatry professor at the University of Nevada) said, "Some people in physical education feel some sports psychologists don't have enough background in sports science.
"And some clinical psychologists feel those Ph.D.'s in physical education don't have enough background in psychology to know when they're dealing with emotional, not mechanical problems. I personally feel if you're well trained, there's enough work for everybody." (5)
Advised Daniel Gould (then president-elect of the American Association for the Advancement of Applied Sports Psychology), " I think people should try sports psychology, but as informed consumers. Let buyer beware." (6)
Nutritionists also come from several different backgrounds. The term has been applied to medical doctors specializing in diet; registered dietitians (they have at least a four-year degree in nutrition from a accredited college, did an internship, and passed a national exam); and people with perhaps a great deal of practical knowledge about nutrition, but no formal academic training in the field.
As for sports medicine, practitioners include a variety of professionals with different types and levels of training: medical doctors specializing in either sports-related injuries or orthopedics; osteopaths; podiatrists; chiropractors; physical therapists; and sports massage therapists. In addition there are athletic trainers who may be offering advice about physical problems. (Certified trainers must have 1,500 hours of practical work before they can take the National Athletic Trainers Association exam.)
Said Richard Strauss (team doctor and a professor at Ohio State University), "Unlike something like obstetrics or ophthalmology, this is not a well-defined specialty. In fact, any doctor can claim to practice sports medicine." (7)
Some doctors do have additional training. Family physicians can go through a fellowship in sports medicine and pass a test to receive a Certificate of Added Qualifications (CAQ) from the American Board of Family Practice. Orthopedic surgeons who have specialized sports training can join the American Orthopaedic Society for Sports Medicine (AOSSM). Physiatrists (doctors who specialize in skeletal and muscular problems, but don't do surgery) can complete a fellowship in spine and sports medicine.
Doctors who have additional study and practice in sports medicine can become fellows of the American College of Sports Medicine (FACSM). (It is important to note that while only specially trained doctors are eligible to become ACSM fellows, there are no professional requirements to join the American College of Sports Medicine and many members are not doctors.)
"Sports medicine is not a recognized, boarded specialty," said Massachusetts neurosurgeon Robert Cantu (then president-elect of the American College of Sports Medicine). "There are professional organizations, like ACSM, that award certificates of competency in sports medicine. ... But the field is so vast that it crosses too many disciplines to be a specialty itself." (8)
With this many different kinds of sports specialists, you have a wide variety to choose from. Be willing to go to several before you make up your mind. Find the right one for you.
Insurance may also be a consideration. Some procedures will be covered if done by certain specialists, but not by others. Therefore, your choice may be limited to those specialists your insurance company will pay for.
Another guideline is to look for specialists who are honest about their training. Make sure you know the difference between a chiropractor and a medical doctor, between a massage therapist and a certified physical therapist, between a podiatrist and an orthopedic surgeon. Then make sure you are getting what you want.
2. Plan to employ these specialists for only a set amount
of time or until you achieve a set goal.
Don't pay them for the rest of your life. If you can't function
without them, or if they tell you that you can't function without
them, something is wrong. No specialist should make you dependent
on him or her. "Although most doctors will get you in and
out of therapy in a reasonable time frame, certain physicians
who run their own clinics will try to enroll you for all eternity,"
said Dr. Charles Norelli, a physiatrist in Allentown, Pennsylvania.
(9)
Andrew Cusgarea (team physician and assistant professor of orthopedic surgery at Ohio State University) agreed. "Most injuries don't require prolonged, formal therapy. There's no reason why you should be in a physical therapy unit doing an exercise you can do just as well at home." (10)
Said Richard Ferguson (a sport psychologist and assistant professor of physical education at Averett College in Danville, Virginia), ''The best thing in the world is for me to give you something to work on and you can work on it on your own, and you don't have to see me. The worst thing in the world is for someone to feel like they are dependent on the sports psychologist for confidence." (11)
3. Know the extent to which a specialist and your coach
interact with each other.
Some coaches welcome, and even encourage, input and feedback from
outside specialists. Others do not.
Some specialists respect a coach's concerns. Others try to overrule
them.
If your coach and the specialists you hire do not get along, you may get caught in a power struggle. Your coach may tell you to do one thing; your specialist may tell you to do another.
On the other hand, also watch out for specialists who work more for your coach than for you. Some specialists will simply tell you exactly what the coach wants them to. This means you are not getting objective advice. For example, what if your coach wants you to lose weight and sends you to a nutritionist who puts you on a risky diet? Or what if you've been injured and your coach sends you to a doctor who prescribes painkillers instead of recommending rehabilitation?
According to Arthur Caplan (then director of the University of Minnesota's Center for Biomedical Ethics), "No doubt the prime obligation is to the patient and the athlete's well being. But some times doctors themselves get caught up in the pressures exerted by the institutions or the athlete or the athlete's family, to take more risk than the doctor feels is wise." (12) Examples:
Many pro athletes are at least somewhat wary of the advice given by team doctors. Said Aaron Rubin (a doctor and director of the Kaiser Permanente Sport Medicine Fellowship in Fontana, California), "I once heard a player's agent state in an interview, 'The player should just as soon let the team physician care for them as they would allow the team attorney to negotiate their contract.''' (16) (You can find a copy of the article at Physician and Sportsmedicine, July 1998. )
One area where team doctors are said to favor the team over athletes is workman's compensation. When retired athletes say they have lingering disabilities as a result of injuries suffered on the job, the doctors do not support these claims. Said Lou Castle (team doctor for the NFL Cleveland Browns) about the workman's compensation issue, "... this is like the Mafia. You know: 'We're going to shoot you. It's nothing personal. It's business.'" (17)
Said Jim Lachey (then an offensive tackle who had been in the NFL for eleven years), "There are team doctors and there are company doctors. The team doctor looks out for your best interest. The company doctor will do whatever it takes to get you back on the field." (18)
Rob Huizenga (who was team internist for the NFL Raiders from 1983 to 1989) wrote about his experiences in his book, You're Okay, It's Just a Bruise. "There is huge pressure to keep players on the field. Shockingly, almost at all costs -- and to the detriment of a player's own health." (19)
Sometimes it can be very hard for an athlete to know whose advice to take. The best protection against being misled is knowledge. Try to know as much about your situation as you can before you go to a specialist. That way you can better judge whether his or her advice is right for you and whether or not it really addresses your problem.
You might also consider getting a second opinion. This is considered so important to protect athletes against medical malpractice that all professional basketball, baseball, football, and hockey teams are required to pay for second opinions for their athletes if the athletes are dissatisfied with the team doctor's diagnosis.
It is also your responsibility to know if a doctor gives you a banned substance. Many sports organizations have strict guidelines about what drugs you can and cannot take before or during a competition. Even such innocuous substances as over-the-counter cold medicines, herbal teas, and excessive doses of caffeine may result in the disqualification from competition if they are discovered in your body during testing. The United States Olympic Committee maintains a toll-free number (1-800-233-0393) for athletes to call before taking any unfamiliar or questionable medications and also a web page with information on banned substances: ).
It is worth noting here that sometimes doctors give the right
advice and it is not taken. There have been cases where a team
doctor, after administering a physical, has advised an athlete
not to play because there appears to be a problem which might
result in serious injury or even death. The athletes, seeing their
sports careers cut short, have sued for the right to play.
4. Look for specialists who will work with you as a person, not
just as an athlete.
This is important because sometimes what you need as a person
is different from what you need as an athlete. As an athlete,
your focus is usually on winning; as a person, your focus should
be on living a full and meaningful life.
For example, let's say you are having trouble at competitions and you see a sport psychologist. And he or she realizes that what you really want to do is quit, but your coach, friends, and family won't let you. Should the psychologist find a way to motivate you again, even though you are burned out? Or does he or she help you find a way to end your athletic career? And if the psychologist does encourage you to quit, what happens to his or her reputation as a sport psychologist? Most likely your coach will never send any more athletes there.
Aaron Rubin has this observation: "Sometimes we need to take the heat off the athletes. Anyone who has been a team doctor for any length of time has seen the athlete with a minor injury who just doesn't want to play. The reasons are many, and I feel responsible to protect such a player from the coaches', other players', and parents' pressure to return. That's the responsibility to the player. The responsibility to the team is to delve into the motives delaying the player's return and make recommendations." (20)
Conflicts of interest can also arise with employee assistance programs. These are counseling programs provided by employers to help employees coping with personal problems. Athletes are sometimes advised to seek outside help rather than confiding in those who are on the team payroll. But, points out Donald Fehr (executive director and general counsel of the Major League Baseball Players Association), "In the abstract most people would agree with that, but people in general have enough trouble getting help as it is." He thinks that without such programs, baseball players would not get any help at all. "There are no hard and fast rules. There are tradeoffs every step of the way." (21)
The reality of sports specialists is that they have a vested interest in helping athletes perform at their maximum level. "We can get people back in the game sooner," said Joe Ruane (a doctor who serves as medical director of a fitness center in Columbus, Ohio and who also volunteers as a high school team doctor). "You have to know the difference between a kid playing hurt and a kid playing injured. A lot of players get hurt. They get stepped on and bruised. After all, this is football. But an injury is a different story." (22)
If this isn't what you want or need, you may have to be the one to speak up and go somewhere else.
Bill Crothers (who was the Canadian record-holder for the 800 meters) testified, during an investigation of steroid use by Canadian sprinter Ben Johnson, that "the people supported by an athlete's success -- agents, physicians, trainers and promoters -- wield too much influence and are often to blame for corruption.
"They achieve their benefits not by virtue of the enjoyment they get out of the sport but by virtue of the success that the individual athlete achieves." (23)
The trend involving potential conflicts of interest is likely to get worse before it gets better. Now there are even sports doctors who pay teams for the privilege of treating their athletes. These doctors consider it such good business to treat high visibility athletes that they will do it for free. Health-care companies have offered to provide teams free physician time, free trainers and equipment, and monetary payments. In return they get free game tickets, advertising space in programs and at stadiums, and the opportunity to call themselves the team's "official" health-care provider. For example, one hospital submitted to the NFL Jacksonville Jaguars a $ 4.8 million, five-year proposal that included the club receiving $ 200,000 a year in team physician fees, $ 60,000 a year for trainers, and $ 500,000 a year in advertising commitments. As it turned out, another hospital landed the contract. (24) Said Dr. Kurt Spindler (team doctor for Vanderbilt University and director of sports medicine at Vanderbilt Sports Medicine Center), "The question for the players is, 'did the owners pick what they thought was the best medical care for the team, or did they pick a contract to get the most money?' " (25)
Even at the high school level, there are sports medicine professionals
offering their services for free for marketing purposes. "Hospitals
are saying let's go out there and go after as many high schools
and events as we can," said Jerry Whetstone (supervisor of
athletic trainers at the Franciscan Sports Medicine Center in
Dayton, Ohio). According to Dan Rasor (head athletic trainer at
a Dayton-area high school), there is the risk that students will
be encouraged to favor one medical center over another. Trainers
"really can't make (students) go to a particular place...
But how much pressure, how much leverage can you put on the kid?
That's a sticky issue." (26)