Leon Creaney responds to Des SpenceBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2572 (Published 03 May 2011) Cite this as: BMJ 2011;342:d2572
- Leon Creaney, consultant in sport and exercise medicine1
Throughout his article entitled “Bad medicine: sports medicine,” Spence criticises global corporations making footwear and sports drinks, sports scientists, athletes and coaches, physiotherapists, podiatrists, and sports surgeons, but nowhere does he consider sports medicine itself.1 To label sports medicine as bad medicine is wildly inaccurate when much of current sports medicine practice has been ignored.
Sport and exercise medicine was established as the newest medical specialty in the UK in 2005 by parliament, has a faculty in the Royal College of Physicians of London, as well as a curriculum approved by the Joint Royal Colleges of Physicians’ Training Board and General Medical Council, with 64 specialist trainees in training across the UK’s deaneries and 40 consultants on the specialist register. Thus sport and exercise medicine clearly has a separate identity from the entities criticised by Spence: his conceptual linkage is incorrect.
Much of the article has resonance. There is indeed little evidence for motion control footwear,2 but the assertion of benefit comes from the billion dollar sport wear industry, not sports medicine. The first pair of modern running shoes was made in the 1970s by Bill Bowerman, a running coach who later formed Nike. Little science was involved in those first shoes made in his garden shed with melted rubber on a waffle maker.3 The move towards barefoot running is, however, based partly on evidence. In 2010 Nature published a study of exceptional quality comparing the foot strike patterns and impact forces of habitually barefoot, forefoot-striking Africans with habitually shod, heel-striking North Americans.4
Spence suggests that we advocate the teachings of global sports drink companies. In fact the opposite is true. I point him to the excellent research and evidence based guidance from Tim Noakes and his colleagues—namely, to drink to quench thirst, rather than over-drink.5 This has been my advice to runners for several years.
Spence criticises massage and ultrasonography. I agree the evidence for effectiveness is minimal, but these techniques are largely sought by athletes rather than pushed by doctors. I have never prescribed either, but they are often asked for and given since they are harmless.
Spence derides biomechanics and orthoses. Does he think that injuries occur for no reason? Is it not reasonable to state that abnormal movement patterns lead to abnormal loading of anatomical structures in turn leading to failure? Many studies have been published correlating biomechanics with the risk of injury.6
There is a sadder story to tell. The NHS and universities are currently not developing sport and exercise medicine services, despite a government pledge to develop sport and exercise medicine as a lasting health legacy of the Olympic Games. Without an NHS sport and exercise medicine service the genuine benefits of health enhancing physical activity are unlikely to be realised. The UK is facing an obesity epidemic, and exercise rightly should form a regular adjunct in managing many chronic diseases. Specialists in sport and exercise medicine are trained to prescribe and supervise therapeutic exercise for patients, as well as manage conservatively the full range of musculoskeletal conditions. However, few NHS trusts have developed these important services. Furthermore, without regular university collaboration the research base for sport and exercise medicine is unlikely to expand.
Cite this as: BMJ 2011;342:d2572
Competing interests: LC is a consultant in sport and exercise medicine.