This sporting life
Author: Amanda Lyons
Athletes may be fierce combatants when they step onto their field of battle, but they remain vulnerable human beings who require the same healthcare as all patients.
‘Sport to many Australians is life, and the rest a shadow’
– Donald Horne, The Lucky Country, 1964
Those words were written more than 50 years ago, but it can be confidently said that author Donald’s Horne’s characterisation of his nation remains accurate. Indeed, the country’s own Department of Social Services declares that, quite simply, ‘Australia is sports mad’.1
This sports madness ensures that Australian GPs (many of whom do not escape the condition) will regularly see patients experiencing sports-related health issues.
‘GPs are at the coalface, regularly seeing and managing sporting participants,’ Dr Gill Cowen, a GP and Chair of the RACGP’s Specific Interests Sport and Exercise Medicine network, told Good Practice.
‘The GP is without doubt the central person facilitating treatment and providing information related to prevention in sports medicine.’
Dr Peter Baquie, a GP turned sports and exercise physician who served as the doctor for the Australian 2004 Athens Olympics team and for several AFL (Australian Football League) clubs, believes general practice training provides a very good basis for a career in elite sports medicine.
‘A significant number of football clubs will have a primarily general practice-trained doctor,’ he told Good Practice. ‘They often recognise that a sports physician and a GP with a sports interest is their ideal medical team.’
Dr Cowen has worked as a team doctor within a variety of sports, including soccer, Australian rules football and cricket, and has found great satisfaction in the job.
‘I really love it,’ she said. ‘That team environment almost takes you back to your hospital days. You work with a physiotherapist, sports scientist, podiatrist, trainers, the players and the coach. It makes it very collegial.’
As gladiators in a modern-day arena, the importance of professional athletes maintaining top physical condition is obvious – especially as their livelihood, as well as the fortunes of their team, rely on their ability to perform.
Helping to maintain this peak condition with injury treatment and prevention is a crucial aspect of the team doctor’s role. But many may be surprised at how much sports medicine involves the ‘bread and butter’ type of medicine and relationship-building that sits comfortably in the GP’s wheelhouse.
‘A lot of the medicine, especially in the club situation, isn’t sports medicine at all,’ Dr Cowen explained. ‘As you get to know the players, you hear about their relationship breakups, sexual health and other problems, such as mental stress, that have to be well managed.
‘That holistic approach is important in sports medicine. You don’t just see injuries.’
A player’s ability to perform during training may also hinge on things that are less
action-oriented than a stretched hamstring.
‘Probably the first two or three people I’ll see in the morning will be people who are stuffy in the head with a cold or who didn’t quite sleep last night,’ Dr Baquie said. ‘The skill is in trying to determine if it’s an illness that’s going to prevent them from training.’
Of course, issues such as hamstrings and shoulder and knee stability remain core concerns for team doctors, but another vital area of prevention – for all athletes, from elite to social – is concussion. The impacts of sports such as Australian rules football and rugby can be significant and the risk of concussion with significant impact is high.
There is increasing recognition and fear about the impacts of concussion in sport,2 with many concerned about the effects on the lives of athletes once they have finished their playing careers.
AFL players Sean Dempster (St Kilda Saints) and Heritier Lumumba (Melbourne Demons) are two examples of professional athletes walking away from their careers early following the impacts of concussion, while an increasing number of players across all sports are being held out of games due to more strictly enforced concussion protocols.
This year saw the first legal action taken by a player against a professional sporting club in Australia when rugby league player James McManus sued his former team, the Newcastle Knights of the National Rugby League (NRL), over traumatic brain injury from repeated concussions.3 The subject is also at the centre of a high-profile debate taking place in the US about the legal liability of the National Football League (NFL) for players experiencing chronic traumatic encephalopathy (CTE) as a result of exposure to concussions.
There is no doubt concussion can have a serious effect on the health and wellbeing of professional and amateur athletes alike.4 It is for this reason that Dr Cowen believes it is vital for GPs and sports physicians to keep up to date with concussion recognition guidelines.
‘As GPs, it’s really important that we educate community-level sporting teams, trainers, parents, kids, teachers, so that these men and women are managed properly when they sustain a potential concussion,’ she said.
‘We’ve got to do our best to try to help protect people from damage, and materials such as the Concussion Recognition Tool are a very simple way to get the information out there.’
Battling the mind
Athletes can be revered almost as gods – or just as equally reviled – and the weight of public scrutiny combined with the pressure of competition can become very heavy, indeed. Fame and sporting prowess do not necessarily insulate people from issues such as anxiety and depression and many Australian athletes, from Olympic swimmer Ian Thorpe to basketballer Lauren Jackson, have hit the headlines over the past few years due to their own struggles with issues of mental health.
According to Dr Baquie, it is important for the doctors who work with athletes to always be mindful that their patients are people who live with the same vulnerabilities as anyone else.
‘We sometimes get a little overawed at the excellence [athletes] have in their sport and perhaps forget that they are also fragile human beings, such as anyone,’ he said. ‘We’ve got to be cognisant of both of those sides.’
Wayne Schwass is a former professional AFL player who experienced depression during his 14 years on the field from 1988–2002. When he was diagnosed as a younger person, however, the social stigma that accompanied the condition prevented him from openly discussing his issues.
‘I didn’t ask for help until six years after I was diagnosed,’ he told Good Practice. ‘I didn’t speak to my family, including my father, for 12 years after diagnosis and it took me 12-and-a-half years to tell my closest male friends that I was living with mental health conditions.
‘There were only two people during that entire time that knew what I was living with, and that was my wife and my GP.’
Schwass’ fear of negative reaction to the idea that any man – let alone a high-profile warrior who went into competition on the field every weekend – had experienced issues of mental health led him to keep his secret.
‘The reason I chose not to tell anybody through that entire period was that I believed I would lose relationships, friendships, opportunities and respect,’ he said.
In hindsight, Schwass understands the counter-productive nature of this approach.
‘Regrettably, I chose to trade my health and wellbeing away to protect those things that I thought were more important,’ he said.
Schwass managed to get the appropriate help and find his way out of that dark place and, through his social enterprise Puka Up, now works to help others in similar situations. He is also dedicated to lifting the stigma that surrounds issues of mental health and encouraging the sporting industry to offer more support for athletes to develop strength in places other than the field.
‘It’s my belief that we need to invest similar amounts of money, resources, time and energy to equip, educate and train young athletes ... to be able to cope with stress in a personal sense,’ he said.
‘Give them resilience, the ability to talk, communicate and ask for help.’
Encouragingly, Schwass believes that he has seen positive signs of change in these areas over recent years.
‘I am confident that these conversations are becoming more regular, and perhaps that’s giving people more confidence and belief that they can open up and talk about these issues,’ he said.
Dr Cowen has found that because of the bond GPs and team doctors foster with athletes, they can play a crucial role in assisting them to get necessary help.
‘You develop a close working relationship with the athletes you look after, because you’re with them a lot,’ she said. ‘You know if something is not right and can encourage them to seek appropriate help.’
Dr Baquie feels that while looking after athletes’ mental health has always been part of a team doctor’s remit, there is now greater scope and openness to address it.
‘It’s increasingly recognised and accepted,’ he said. ‘I think all footy teams now have a welfare officer, most will have a clinical psychologist, and a strong acceptance among the coaching group and the players’ group that there is fragility that can become raw and exposed.
‘That makes our job easier to assist the athlete in that regard, because a lot of the social mores and tough exteriors have been broken down.’
Dr Baquie observed that it is just as important for an athlete to take time away from the field for an issue of mental illness as it is with physical injury.
‘[When players needed time away for mental health issues in the past], I used to talk about, “He’s still got a stress fracture, just not quite right. He ran last week and it flared, so we’ll take this week off”. It was often ducking and weaving a little bit,’ he said. ‘But now you don’t have to put up those smoke and mirrors to try and achieve a good outcome for the athlete.
‘Fortunately, [the issue of mental health] is out of the closet. For a player to say he or she is taking time off for mental health issues, the coach and the community supports them.’
When AFL club the Western Bulldogs announced one of their players, Tom Boyd, was being provided a leave of absence in order to deal with clinical depression in early July, the club was candid in its remarks and made clear it would provide support through its own systems of healthcare.
‘Tom has managed his illness in conjunction with the Bulldogs’ medical staff for an extended period and will continue to receive the club’s full support,’ the Bulldogs said in a statement. ‘The club will work closely with Tom and the Bulldogs’ medical staff to determine a suitable time for reintegration into the training program.’
Schwass believes that greater openness and education about mental health issues in sports will ultimately benefit everyone, not just the athletes.
‘We all could be impacted by mental health conditions,’ he said. ‘It’s fundamentally important to every one of us, whether it’s elite sports, business, or in our personal lives, to have a much better understanding of some potential signs and symptoms of mental health conditions.
‘When we have a basic understanding of those signs and symptoms, we’re in a better position to start to look after ourselves, start to make decisions to help get those situations under control much quicker.’
- Department of Social Services. Civic participation – Sports and recreation. Canberra: DSS, 2016. Available at www.dss.gov.au/our-responsibilities/settlement-services/sports-and-recreation [Accessed 4 July 2017].
- Australian Sports Commission. Australian Institute of Sport and Australian Medical Association concussion in sport position statement. Canberra: ASC, 2016.
- Ford M, Hall L. Knights should have retired winger James McManus following head knocks, court hears. ABC News. 21 June 2017. Available at www.abc.net.au/news/2017-06-21/james-mcmanus-suing-newcastle-knights-nrl-over-concussions/8638682 [Accessed 4 July 2017].
- Pearce A, Hoy K, Rogers A, Fitzgerald P. The long-term effects of sports concussion on retired Australian football players: A study using transcranial magnetic stimulation. J Neurotrauma, 2014;31(13):1139–45.