Many sports injuries are treated by orthopaedic surgeons because of their involvement with trauma, but sports medicine is very different from the rest of orthopaedic surgery. For one thing, an athlete who is 100% fit will be unhappy – an athlete needs to be not less than 110% fit, at least in his or her own estimation, and will strive for 120%. This belief, coupled with the athlete’s drive to achieve goals beyond the scope of ordinary people, may loosen their hold on reality and prevent them understanding that their body is made of the same stuff as ordinary mortals.

A further problem is that many athletes have a compulsive–obsessional approach to their sport. A cyclist or a runner who does not put in the allotted number of miles per week will feel uneasy and fear their performance will be permanently impaired. In this regard the behaviour of some athletes is similar to that of other compulsive neuroses such as alcoholism, compulsive gambling and anorexia nervosa. Fortunately, most sportsmen and women have a healthy approach to their sport, but compulsive individuals do exist and must be recognized at an early stage.

For many well-balanced athletes fitness is an integral part of their way of life and self-image. Occasional recreational athletes may feel that their sporting activities distinguish them from their more everyday contemporaries. To find that their sporting prowess has been taken away can make both groups clinically depressed and produce a similar reaction to bereavement or the loss of a limb.

Sports medicine presents practical and ethical problems. In other specialties doctors are in no doubt that they are the patient’s medical attendant, but in the field of sports medicine there may be more concern for the success of the player’s club than for the long-term future of the player.

The welfare of any patient has to be considered not only from the short-term point of view but also from the long-term. Considerable pressure is sometimes applied to the doctor by the team manager or club, as well as by the player, to achieve a good short-term result without regard for the long-term.

Enabling a player to take part in an important match soon after a serious injury or operation, for example, could have harmful long-term effects. To complicate matters, the players themselves are not always in a position to disagree with their club official and may enthusiastically embrace the prospect of osteoarthritis in middle age if only they can play on Saturday.

The need for rapid results and the fast return to sport after injury also means that athletes demand priority over other patients. If health service resources are in short supply, it is hard to justify treating a recreational athlete in preference to a wage-earner who cannot work. Injured sportsmen are seldom ill or disabled in the common sense of the word, yet their powerful motivation will often find a way through the normal channels to be treated in preference to patients with genuine organic illness. This can lead to ill-feeling when resources are scarce.

To avoid this problem, sports clinics treating athletes only are often set up outside hospitals and orthopaedic departments, but this leads to the paradox that in some places the only way to receive prompt treatment for a musculoskeletal disorder is to declare that it was the result of a sporting injury rather than an accident at work.

These observations do not detract from the need for a specialized service for sportsmen or deny the existence of injuries specific to individual sports. Provided that the doctor can come to terms with the psychological aspects of sportsmen and women and the practical problems of establishing a clinic for sports injuries, sports medicine is a rewarding and fascinating specialty.

The conditions described below are commonly seen in athletes but are not unique to them.