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Posters focused on topics like the prevention of illness figure 4 A and the importance of sleep figure 4 B. A Poster emphasising the importance of reducing the risk of untimely illness. B Poster emphasising the importance of quality sleep.


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Photos and design: Anita Mann and Scott Davies. The UKA Medical and Science team to the London Olympics had a very diverse training, skills and experience and included two SEM physicians, four physiotherapists, two soft-tissue therapists, a chiropractor, an osteopath and a sports physiologist. Skills and experience were not the only important aspects—we also prioritised the way we worked together as a professional team figure 5 and all the team members agreed and signed a code of conduct document at the beginning of our pre-Olympic holding camp.

Mo Farah with his coach, physiotherapist and physiologist at the warm-up track, London Olympic Games. For many athletes, coaches, clinicians and managers, the integrated and performance-focused approach to elite athlete health and coaching is still a difficult concept. They then tend to overlook the potential performance and psychological consequences when making decisions in isolation and when athlete preferences are excluded from the consultation.

They might find it difficult to survive in the elite sport setting. Coaches and athletes are sometimes so performance focused that the health consequences of decisions in the heat of the moment are not taken into account. It is therefore important to have a critical look at the organisation of medical support services to elite athletes, the process of decision-making in the elite sport environment and the best way to continuously manage athlete health.

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Athletes cannot do this in isolation and need the support of a well organised and integrated health and coaching team working in harmony towards common goals in a new Integrated Performance Health Management and Coaching model. This study proposes a new Integrated Performance Health and Coaching model for the delivery of sports medicine services to elite athletes.

In this new model, decisions are not taken in isolation and take into account the best medical evidence as well as athlete performance preferences. We illustrate the model describing some of the organisational and implementation strategies used by UK Athletics before and during the successful London Olympic Games. The experienced sports physician in close collaboration with other members of the multidisciplinary support team is ideally positioned as case manager, especially when the athlete needs to train or compete when ill or injured.

The guidelines provided on how coaching and support teams should work together in a performance-driven sport environment are useful to sports medicine physicians, coaches and managers.

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Clubs and sport governing bodies may use the framework for the organisational structure and management of medical teams discussed in this paper. This study discuss novel implementation strategies used in practice by a successful Olympic and Paralympic Team to improve continuous and performance-driven health management of the athlete.

One of the implementation strategies, an electronic medical record keeping system, uses a real-time health and performance risk colour coding system, with continuous health management and effective team communication features. This system may be adopted in sports medicine practice and organisations to facilitate integrated decision-making and communication.

The authors greatly acknowledge the contributions and support, direct or indirect, in writing or in conversation of the UK Athletics Performance teams — RC contributed to the planning, conduct and reporting of the work described in the article and mainly the UKA processes and implementation strategies discussed in the paper as UKA Midlands Medical Officer; contributed to the writing and revision of the manuscript. Competing interests: None. Provenance and peer review: Not commissioned; externally peer reviewed.

National Center for Biotechnology Information , U. British Journal of Sports Medicine. Br J Sports Med. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Elite athletes endeavour to train and compete even when ill or injured. Keywords: Athletics, Elite Performance, Ethics. Introduction While the health benefits of moderate exercise have been well documented, exercise training and competition at elite level may significantly increase the health risk to the athlete.

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Challenge Solution Doctors lacking specialist training employed to manage the health of elite athletes Doctors practising in isolation; decisions made without broader team consultation Physiotherapists managing the total health of elite athletes Employ only well-qualified specialist sports medicine physicians to manage the total health of athletes Doctor should practise and make decisions as part of a comprehensive coaching and medical support team Physiotherapists are qualified to manage musculoskeletal health but not the total health of athletes Doctors are employed by clubs; this fact might influence their objective clinical decision-making Clear role definition with internal and external clinical governance eg, appraisal and revalidation process by the appropriate external bodies such as the Faculty of Sport and Exercise Medicine and General Medical Council in the UK Doctors are clinically line managed by non-medical team members or non-clinicians.

The Performance Director to whom the medical team is accountable may, in conjunction with the athlete and in receipt of the medical opinion, choose an alternative path.


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  • The procedure and documentation around this process should be clear. Open in a separate window. RTP, return-to-play. Step Evidence-based medicine Preference-based medicine 1 Asking focused questions Proper set-up and introduction 2 Finding the evidence Eliciting values and preferences and learning about goals 3 Performing critical appraisal Debiasing strategies and responding to emotions 4 Making a decision Making a recommendation and seeking consensus 5 Evaluating performance Assuring non-abandonment and follow-up.

    The UKA now British athletics experience UKA has adapted the provision of medical and science services to Olympic and Paralympic Track and Field athletes based on some of the core principles of integrated performance health management and coaching. Structure and governance of the medical team In preparation for the London Olympic and Paralympic Games, the comprehensive health management component was governed by the first author of this paper, employed at the time by UKA as the CMO who line managed the other employed UKA Sports Medicine Physicians. Infrastructure development Medical care for elite athletes is continually provided at two distinct levels: the medical or diagnostic environment, sometimes at a hospital or sports medicine institute with regular interaction with other health colleagues, and also the performance environment at the athlete training centres, interacting with athletes, coaches, therapists and scientists on the track and in the weights room.

    The team: relationships, roles and responsibilities The relationship between a doctor and a coach is important for athlete success, especially when travelling to major competitions. Continuous health monitoring and electronic medical record keeping In conjunction with a New Zealand-based software company, the UKA medical team developed a bespoke electronic medical record EMR keeping and health monitoring system, the UKA Medical and Science Profiler. It is your responsibility to consult with a Sports Physician or Physiotherapist immediately if you have any health concerns Low risk of suboptimal performance due to the nature of the conditions stated in column one and the demands of the sport It should be noted that this grading is fluent and might change at any time should the condition s become symptomatic.

    It is your responsibility to consult with a Sports Physician or Physiotherapist immediately if you have any health concerns Mild risk of suboptimal performance due to the nature of the conditions stated in column one and the demands of the sport It should be noted that this grading is fluent and might change at any time should the condition s become more symptomatic. It is your responsibility to consult with a Sports Physician or Physiotherapist immediately if you have any health concerns Moderate risk of suboptimal performance due to the nature of the conditions stated in column one and the demands of the sport It should be noted that this grading is fluent and might change at any time should the condition s become more symptomatic.

    Competition health management: implementing key messages and team selection The UKA Medical and Science team prioritised the implementation of important health messages. Conclusion For many athletes, coaches, clinicians and managers, the integrated and performance-focused approach to elite athlete health and coaching is still a difficult concept.

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    How might it impact on clinical practice in the near future? Acknowledgments The authors greatly acknowledge the contributions and support, direct or indirect, in writing or in conversation of the UK Athletics Performance teams — References 1.

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    Sports injuries and illnesses during the London Summer Olympic Games Injury patterns in Swedish elite athletics: annual incidence, injury types and risk factors. Team clinician variability in return-to-play decisions. Return-to-play in sport: a decision-based model. Williams JGP. Sports medicine. The prevalence and current opinion of treatment of allergic rhinitis in elite athletes. Dijkstra HP, Pollock N. The role of the specialist sports medicine physician in elite sport.

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    Managing athlete health while optimising performance—a track and field perspective. The team physician and the return-to-play decision: a consensus statement update. Evidence, preferences, recommendations—finding the right balance in patient care. Anderson L. Doctoring risk: responding to risk-taking in athletes. Sport Ethics Philos ; 1 —34 [ Google Scholar ].

    Levy D, Delaney JS. Support Center Support Center.

    External link. Please review our privacy policy. Doctors lacking specialist training employed to manage the health of elite athletes Doctors practising in isolation; decisions made without broader team consultation Physiotherapists managing the total health of elite athletes. Employ only well-qualified specialist sports medicine physicians to manage the total health of athletes Doctor should practise and make decisions as part of a comprehensive coaching and medical support team Physiotherapists are qualified to manage musculoskeletal health but not the total health of athletes.