Demands and dilemmas in elite sports care

Day one opened with an introduction and welcome by Mr Andrew Wallace, orthopaedic surgeon and chair of the Research and Education Committee of Fortius. Andrew enlarged on the theme of the conference ‘From Start to Finish’, which ranges from identification and treatment of underlying issues to rehabilitation strategies and return to play. Another key message was that, like many sports themselves, sports medicine at its best is a team game, benefitting from a multidisciplinary, co-ordinated approach, involving input from surgeons, radiologists, sports doctors and clinicians, physios and academics.

The general opening session was a well-blended mix of presentations by medical specialists (namely: Conflicting demands on the clinician when treating an elite sports person; The medico-legal perspectives: what you should know; and When should players retire?) as well as an interview and panel debate with the Wales national football team manager Chris Coleman, Shaun Barker and Dean Ashton, all of whom are current or retired footballers. One key message from this session was that today there are many stakeholders involved with an athlete’s injury, including the athlete themselves, the coach/manager, owner, agent, medical team colleagues, team mates, family, media, etc., all of whom create unique and often conflicting demands on the athlete and the clinician regarding return-to-play decisions. A point raised by Chris Coleman was the need for trust and transparency: between the medical team and the manager, but also between the national squad’s medical team and the players’ divisional clubs. From a medico-legal perspective, we are seeing the development of the doctrine of ‘informed consent’ and a greater awareness of long-term medical problems resulting from sport. Areas of medico-legal risk and how to manage this risk were also described. The decision about when a player should retire was shown to be complex and should be made slowly based on a ‘risk–benefit’ analysis. It is crucial as the medic to show that you care.