“Fifty years ago, more or less, if an athlete suffered a torn ACL or the Anterior Cruciate Ligament, an injury that had never been diagnosed then, their career would have been over. They would have gone home to try to recover from what might have been termed a severely sprained knee, or maybe open surgery would have been tried. In either event, competitive athletics on a level more involving than teaching the kids to play catch would have been out of the question. Today, if an athlete suffers a torn ACL and they don’t come back to play, people will ask what went wrong with the surgery,” says Harlan Selesnick, MD.

“It is not just knee ligament injuries that are treatable now. Anatomical knowledge coupled with modern surgical techniques and revved up imaging have revolutionized shoulder, elbow, and ankle injuries too. Today’s athlete, professional or recreational, is in much better hands than ever before. Sports medicine as a subspecialty has come into its own. That isn’t to say the progress is slowing. Practitioners say big changes involving tissue engineering and cell regrowth are under way and will accelerate. Sports medicine is evolving daily,”says Selesnick. “The methods of meniscal repair and ACL reconstruction, PCL reconstruction, shoulder anchors and sutures, and certainly rotator cuff repair have improved dramatically just in the last 5 years.”

Selesnick, a sports medicine orthopedist, is the designated physician for the Miami Heat basketball team among his other roles. He is also chief of orthotic surgery at South Miami Hospital and a frequent consultant to the National Football League and its players on injury treatment and prevention. Selesnick said that the injuries suffered by players have not changed that much in the last few decades. Throwers still get shoulder and elbow injuries. Jumpers still hurt their knees and ankles. Gross contact sports like football still exact their toll in blown knees, fractures, and concussions.

“The injuries aren’t that different,” he says. “It’s the treatments that have changed. In many circumstances, today’s athletes can return to play at the highest level. The emphasis has been on treatments, not on taking the heart out of games with pages of rules to prevent injuries. Of course, there are exceptions where sports have changed in response to injury patterns.”

Selesnick points to tennis where changes in racquet technique and methods of stroking the ball have reduced the incidence of the infamous tennis elbow, but have in turn increased stresses on shoulders and wrists, so that injuries there are more common.

Sports medicine doctors have also directly caused some sports to change rules. Rick Weinstein, MD, director of sports medicine at Bone & Joint Associates in White Plains, NY, points to rule changes in football that outlawed spear tackling, a tackler must now keep his head up as an instance where doctors lobbied coaches and team administrators to better protect athletes and then saw those efforts translated into regulations. Weinstein works with college athletes in a number of sports and he attends to football players at several high schools, but his work with professional athletes is largely with boxers. He was a doctor at ringside at Madison Square Garden last fall when Felix Trinidad, making a comeback, knocked out Ricardo Mayorga in the eighth round.

“It was the greatest fight I ever saw,” he says and he saw it up close from Trinidad’s corner. Weinstein gets a little defensive about boxing because according to him, the AMA is officially opposed to boxing as a sport. Nonetheless, there are fewer injuries in boxing than in cheerleading. He is proud that sports doctors like him have got New York State to mandate that three doctors be at ringside for every fight, one in each fighter’s corner and a third to examine both fighters after a match. He applauds the fact that championship fights have gone from 15 rounds down to 12 and that postfight examinations focus closely on signs of concussion. But he says, “Federal rules are needed to make sure that there are doctors at ringside in every state, and that the doctors in attendance are specialists. In some states, there is no doctor and sometimes a gynecologist is the only doctor at ringside.”

While these are ways and there are more, rules forbidding high school football players to return to action less than 30 minutes after a blow to the head, for instance in which sports medicine doctors and researchers have altered playing conditions, most of the sports medicine advances in the last 50 years, as Selesnick indicates, have had their impact off the field, in the surgical suite or the therapy center.