The Winning Formula: Rationalizing Sports Medicine Preston Cheek

What is Rationalization?

Rationalization, the process of streamlining activities to maximize efficiency and output, is a growing trend sociologist George Ritzer observed in society. He coined the term "McDonaldization" to describe how the fast-food industry's core principles – efficiency, control, predictability, and calculability – are seeping into other sectors like healthcare and education. This McDonaldization offers convenience, but critics worry it homogenizes experiences, reduces human interaction, and prioritizes profit over quality. Ritzer's theory provides a framework to analyze this societal shift towards efficiency and its potential drawbacks.

McDonaldization of Society (Wikipedia 2024)

Sports medicine has boomed since its official recognition in 1992. This rapid growth has even spurred advancements in broader medicine! A key driver is a concept called rationalization. It's the streamlining of processes for efficiency, and it's impacted everything in sports medicine – from how doctors interact with athletes to crafting treatment plans, prioritizing player safety, and even the technology used to enhance performance. To understand these changes and their impact, let's delve into the history of sports medicine.

A Brief History

The seeds of sports medicine were first sown at the 1928 Olympics with the introduction of medical crews, primarily volunteers from the Red Cross, to care for athletes. Recognizing the growing need for dedicated sports medicine expertise, these Olympics led to the formation of the International Congress of Sports Medicine (Minigh, 2007).

This early step was followed by a landmark publication in 1938. Augustus Thorndike, a prominent surgeon at Harvard, authored "Athletic Injuries, Prevention, Diagnosis, and Treatment," a comprehensive guide that established best practices in the field. Despite this progress, sports medicine still lacked a central governing body. This gap was filled in 1954 with the creation of the American College of Sports Medicine.

However, it's important to remember that although significant strides were made, sports medicine remained in its early stages, with many practitioners still relying on volunteer work.

American College of Sports Medicine Emblem

The landscape of sports medicine shifted dramatically thanks to a few key figures. One was Dr. Robert Kerlan, an orthopedic surgeon with a passion for treating athletes. His success in treating star pitcher Sandy Koufax's UCL tear for the Dodgers caught the attention of other teams, sparking a trend of hiring dedicated team doctors.

Another pivotal figure was Dr. J.C. Kennedy. He recognized the importance of a multidisciplinary approach, advocating for teams to have a diverse group of medical professionals on their staff. This included athletic trainers, physical therapists, nutritionists, and physicians, all working together for optimal patient care. Today, this model with various healthcare professionals is the norm in sports medicine clinics, a stark contrast to the past reliance solely on physicians.

The Art of Expertise: Specialization in Sports Medicine

Imagine sports medicine clinics like a pit crew for athletes! In the early days, there were mostly doctors, like Dr. J.C. Kennedy who saw the need for a team approach. This meant bringing in specialists like physical therapists (PTs) and nutritionists, each with their own skills. But doctors can't do everything perfectly, and the same goes for PTs and nutritionists.

To make the most of this "dream team," clinics started using an assembly line approach. Each specialist focused on 1-2 jobs they did really well. Doctors diagnosed injuries, PTs helped athletes regain strength, and athletic trainers managed return-to-play plans. Think of a soccer player with a torn ACL. They'd see a doctor for diagnosis, then walk down the hall to a PT for rehab advice, and finally meet with an athletic trainer to plan their comeback – all in a few hours! This was way faster than the old system with just doctors.

However, clinics needed more than just speed. They needed ways to be predictable, controlled, and efficient (think "McDonalds" for sports medicine!). As clinics grew, a big problem emerged: paper records! Filing cabinets worked when you saw 5 patients a day, but not for 100! The solution? Electronic health records (EMRs), which we'll explore next!

Electronic Health Records

The pre-digital era of healthcare relied heavily on paper-based medical records, posing significant challenges for data management and accessibility. These cumbersome paper charts were not only time-consuming to navigate but also susceptible to loss or misplacement. Recognizing these limitations, the Regenstreif Institute played a pivotal role in pioneering electronic health records (EHRs) in 1972 (Honovar 2020). This groundbreaking system facilitated the electronic storage and retrieval of patient information, including physician notes, diagnostic images, and treatment plans. EHRs revolutionized healthcare delivery by streamlining information exchange between providers, enabling faster retrieval of patient data, and fostering data-driven approaches to improve overall care quality and efficiency. The widespread adoption of EHRs exemplifies the transformative impact of technology on rationalization within the healthcare system.

Treatment of Injuries

The past 30 years have seen a revolution in sports injury treatment. In the 1990s, runners with injuries might simply rest for a week or two. However, new research in the early 2000s highlighted the benefits of icing and elevating injured areas, leading to this becoming the standard treatment. The field kept evolving – a decade later, ASTYM, a technique that breaks down scar tissue to improve blood flow, emerged as a new approach. Today, sports medicine professionals often combine these strategies – rest, icing, elevation, and ASTYM – to create a personalized recovery plan that gets athletes back on the field faster. These advancements not only expedite recovery but also contribute to athletes' overall effectiveness and efficiency.


Sports medicine has become more standardized in recent years, thanks in part to the Accreditation Council for Graduate Medical Education (ACGME). This organization created a comprehensive guide outlining best practices for all aspects of patient care. This standardization has several benefits:

Efficiency: Doctors can communicate more quickly using a shared language for injuries. For example, saying "grade 4 sprain" instantly conveys a lot of information about the severity.

Control: Standardized care ensures all patients receive similar treatment for comparable injuries, reducing potential inconsistencies.

Predictability: Both doctors and patients have a clearer understanding of what to expect during treatment.

This focus on standardization has helped streamline sports medicine, leading to faster communication and more consistent care for athletes.

An irrationality that exists due to this is that each patient is different. They require different treatments and need doctors to adapt to their needs. A common example is a UCL tear in a baseball player and a lawyer. Both have vastly different uses for their elbow, which means they will require different treatments. Baseball players need to be able to throw a ball 100mph while lawyers only need to be able to pick up items and bend their elbow.


Concussions in the NFL

Concussions used to be brushed off as an inevitable part of football. Players were told there were no lasting risks. This all changed with Dr. Bennet Omalu's discovery of Chronic Traumatic Encephalopathy (CTE) in the brain of former NFL star Mike Webster. Dr. Omalu's findings sparked a heated debate. He insisted concussions posed a serious threat, while the NFL downplayed the risks.

The tide began to turn as more and more players were diagnosed with CTE. The NFL could no longer ignore the evidence. They implemented significant safety changes:

Independent sideline doctors: Each team now has a neutral medical professional to conduct concussion evaluations during games.

Standardized testing: New, unbiased concussion tests were introduced to ensure consistent evaluation.

Research funding: The NFL invested millions in research for better helmets and sensors to improve concussion detection.

These steps represent a major shift in the NFL's approach to player safety, all thanks to Dr. Omalu's groundbreaking work.

Concussions in Soccer

Concussions are a serious concern in soccer. A recent study surveying high school sports found that soccer players experience concussions at a higher rate than any other sport (SCIAM 2023). To address this issue, soccer leagues have implemented several new safety measures:

Mandatory concussion checks: Teams are now required to assess players who experience head contact during games, either at halftime or after the final whistle.

Independent medical professionals: Similar to the NFL, soccer leagues now mandate the presence of unbiased medical professionals on the sidelines to solely focus on player safety and evaluate potential concussions.

Protective headgear: Some leagues are even experimenting with forehead protection helmets to lessen the impact of heading the ball or accidental contact.

These proactive steps demonstrate a commitment to reducing the risk of concussions in soccer.

Protective Helmets making their debut in a soccer league

Concussions in the NHL

Concussions are a major concern in the NHL, accounting for a whopping 14% of all injuries and occurring on average 8.3 times per 100 games (Andrews et al., 2022). This has led to significant rationalization, or streamlining of procedures, to improve player safety.

Similar to measures taken in soccer and football leagues, the NHL now mandates a dedicated, neutral medical professional on the sidelines during games to assess potential concussions. They've also added "spotters" – trained observers stationed near the bench – who can identify players showing concussion symptoms or who've been involved in high-risk plays. This multi-layered approach demonstrates the NHL's commitment to player safety through rationalization of concussion protocols.


Gene Therapy

Imagine being able to upgrade your body like a phone! That's the idea behind gene therapy in sports medicine. Normally, gene therapy is used to fix faulty genes that cause diseases. But some researchers are looking at using it to improve athletic performance.

Here's the basic idea: Athletes have genes that control things like muscle growth. Gene therapy could involve replacing "bad" genes that limit muscle mass with "good" ones that help build it. For example, a gene called myostatin acts like a brake on muscle growth. By removing myostatin (like the image shows), athletes might be able to build more muscle.

However, gene therapy in sports is still very new and experimental. There are safety concerns, and it's not clear if it actually works or is even fair in sports. For now, it's more like science fiction than reality.

Image showing a leg with myostatin expressed (left) and myostatin removed (right)


In sports, doping refers to using banned substances or methods to improve performance. These substances can be synthetic or natural and come in various forms, including steroids, hormones, and certain stimulants. Proponents of doping argue that these substances can aid athletes in several ways. Studies suggest some can improve recovery times, increase muscle mass and strength, and enhance focus.

Opponents of doping highlight the significant health risks associated with these substances. Potential side effects can include high blood pressure, hormonal imbalances, and even organ damage. They also argue that doping creates an unfair playing field, undermining the spirit of fair competition.

The debate surrounding doping is complex. While some view it as a way to push the boundaries of human performance, others see it as a serious threat to athlete health and sportsmanship. Regardless of your stance, it's important to understand the potential benefits and risks associated with doping in sports.


Imagine having a cheat sheet for perfect form! That's what biomechanics is like in sports medicine. It's the science of how your body moves and generates power. Think of it like analyzing your throwing motion in baseball or your kicking form in soccer.

Biomechanics helps athletes and rehab patients in two big ways:

Boosting Performance: By filming movements like a golf swing, biomechanics experts can identify inefficiencies. Maybe your swing involves too much twist or not enough leg drive. These small tweaks can make your movements smoother, stronger, and even generate more force, helping you hit the ball farther.

Safer Recovery: After an injury, it's easy to favor your good side during exercises. Biomechanics helps rehab patients move correctly to ensure a full recovery and prevent further injury. It's like having a coach watching your form and making sure you're doing the exercises the right way.

So, biomechanics isn't magic, but it's a cool tool that can help athletes perform better and recover safely!

Growth / Future

The field of sports medicine, though relatively young, boasts significant growth potential. Market analysts predict a doubling in size within the next decade, driven by several factors. A key driver is likely to be rationalization. This concept extends beyond simple streamlining of patient flow. It encompasses the strategic implementation of technology and data analysis to optimize patient care pathways, improve efficiency, and potentially reduce costs. This optimization allows sports medicine professionals to see more patients while maintaining high standards of care. Additionally, rationalization can lead to the development of specialized clinics catering to specific sports or injury types, further expanding the overall reach of the field.

It's important to note that the specific methods and technologies employed for rationalization will likely evolve alongside the field itself. However, the core principle of optimizing care delivery while expanding access is likely to remain a critical driver of growth in sports medicine.

Sports medicine isn't just about treating sports injuries! It also wants to help improve the overall health of people in the US. That's because America's health hasn't been doing so well lately. Less activity, unhealthy eating, and other factors have contributed to a slight decline.

This is where sports medicine comes in. It's like a three-way circle connecting nutrition, exercise (like sports!), and regular medicine. So, sports medicine professionals can give advice on healthy eating, staying active, and preventing injuries. By promoting these healthy habits, they hope to slowly improve the overall health of the US population. Think of it like a team effort to get everyone moving and eating better!

Interested in learning more about the rationalization of sports medicine? Check out my paper where I will flesh out many of the ideas that are presented here as well as many more!

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