Andy Thomas' grandmother inspired him to become a physical therapist. She was extremely independent and continued to live out in the country outside Mooresville, N.C., even after his grandfather died.

"When her knees got so bad that she couldn't drive to see friends or shop, she felt marooned and got depressed. Life wasn't enjoyable anymore," said Thomas, PT, lead therapist for the Rehabilitation and Fitness Center at Piedmont Fayette Hospital in Fayetteville.

When Thomas' grandmother was 82, an orthopedic surgeon replaced both of her knees, and a physical therapist came to the house for rehabilitation sessions.

"She was soon driving and having lunch with her friends and back to her old self again," Thomas said. "She gave the credit to the therapist, and I thought if I could do that for just one person, it would be worth it."

While in school, Thomas trained with the sports medicine team at the University of Georgia. Today, his practice is more generalized, with clients ranging from high school athletes to senior citizens recovering from strokes, joint replacement or tennis elbow. It's not sports medicine, per se, and yet it is in theory, Thomas said.

"The concept of various disciplines working together, of an entire team of professionals working toward one goal — to get someone whatever they need to return them to full function as soon as possible — may have started with big-time athletics, but everyone has benefited," Thomas said.

Sports medicine dates back to the ancient Greeks and Romans, when specialist trainer-coaches guided young athletes in sports techniques, diet, exercise and hygiene. In the United States, sports medicine mushroomed with the fitness craze of the 1960s and 1970s. The American Board of Medical Specialties recognized it as a subspecialty in 1989.

Sports medicine is an umbrella term for a multidisciplinary field that includes doctors, physical and occupational therapists, athletic trainers, rehab nurses, physician's assistants, biomechanists, sports nutritionists and sports psychologists. A successful outcome takes a team effort that includes specialists, the athlete, the coach and perhaps the athlete's parents.

"It may be that team approach that attracts so many former athletes to the field of sports medicine," said Dr. Spero G. Karas, an orthopedic surgeon at Emory Sports Medicine Center in Atlanta.

Like many sports medicine specialists, Karas played sports growing up, suffered an injury and had a good experience with a sports medicine team. As a sports fan and a doctor, he remains excited about the field.

After earning his medical degree and completing a shoulder and sports medicine fellowship, he served as training camp physician for the Denver Broncos of the National Football League and the Colorado Rockies baseball team. Now he treats college and professional athletes, including cyclists from the Tour de Georgia.

"Sports medicine isn't just for the [Atlanta] Falcons," Karas said. "The beautiful thing about my specialty is that I may see professional, college or high school athletes, their younger siblings or their parents. The techniques pioneered by sports medicine help people from all walks of life."

In orthopedics, sports medicine is driving research and new protocols, Karas said. "Two things that have revolutionized sports medicine are arthroscopy — the use of a fiber-optic camera inserted in a quarter-inch incision that allows surgeons to find and fix joint damage — and MRI (magnetic resonance imaging), a minimally invasive tool to see changes in soft tissue."

These techniques, which are used to reduce surgical trauma and promote faster healing in athletes, are just as effective for the general public. People can tear the anterior cruciate ligaments in their knees by playing soccer or raking leaves; the injury and treatment are the same, no matter how the tear occurs.

"Rotator-cuff tear repair, an injury found most often in older patients, is markedly improved because of arthro-scopy and MRI," Karas said.

"Arthroscopic procedures are used regularly now on shoulders, hips, knees and ankles, which impacts what we do in physical therapy," said Ted Hanson, a physical therapist at the MCG Sports Medicine Center in Augusta. "There's less cartilage damage and less postoperative pain. Rehabilitation is not so grueling, and we can get people feeling better a lot faster."

Working with active patients

Hanson, PT, chose sports medicine because he enjoyed working with younger, active patients.

"I played soccer, basketball and football myself and had injuries. I know what it feels like when you can't play, and people trust you when they know you've gone through something similar," he said.

Working with athletes, who often master therapy techniques quickly and like a challenge, keeps him on his toes.

"Patients come to a sports clinic expecting to find the latest equipment and best techniques," he said. "We do have sophisticated equipment, but a lot of our job is helping patients figure out ways to duplicate the exercises at home using common household items, like bottles with coins for weights."

At The Sports Rehabilitation Center in Atlanta, owner Brian J. Tovin makes use of innovative equipment, such as an underwater treadmill, which helps speed recovery for patients with knee injuries, and consults athletes who use high-speed motion-analysis software, which scrutinizes how someone swings a bat or throws a ball.

"Surgical advances and technology are constantly changing the field. We know now that immobilization of a joint after surgery can do more harm than good, because a joint needs nutrients to heal," Tovin said. "It's better to have controlled mobilization. But, while it flies in the face of technological advances, some of our best treatments are still hands-on."

Wrapping, massaging, manipulating and applying ice or heat are all part of the therapist's arsenal.

Getting to spend more time with patients is what led Tovin to choose sports medicine and physical therapy.

"I'm a people person, and I knew that becoming a physical therapist and certified athletic trainer would give me opportunities to do a lot of different things," said Tovin, DPT, MMSc, SCS, ATC, FAAOMPT.

Tovin has traveled internationally as a therapist/athletic trainer with the U.S. swimming and diving teams and was the head athletic trainer at the aquatics venue during the 1996 Olympic Games.

"Sports medicine has been around a long time now, but it has come to the forefront in recent years, because so many of our practices benefit the public as a whole," he said. "Injury prevention is a whole area that is growing in sports medicine. It's our duty to educate people about recent findings, risk factors and how to avoid injury.

"Helping patients set and meet reasonable goals is just as important and rewarding whether you're working with a professional football player or a weekend tennis warrior."

Education and prevention

"A lot of what we do as trainers is prevention — educating players and coaches," said Bryan Jones, ATC, MBC, certified athletic trainer with the MCG Sports Medicine Center.

Prevention is paramount in caring for athletes and for people who are physically active: young people playing competitive sports, women exercising more than ever and older people who stay active to fight obesity and disease.

"A big issue we are trying to solve now is why women are four to six times more likely to sustain an ACL tear than males playing the same sport at the same level," Jones said. "Researchers are looking at the biomechanics of female athletes — how women use their leg muscles when landing from a jump. It's different than men.

"Some programs to help volleyball players strengthen and retrain core muscles before their season — teaching them better jumping and landing techniques — have been shown to reduce the risk of injury."

Studies on concussions have brought about not only safer football helmets but also laws that require young bike riders to wear head protection.

"Sports medicine began exploding in the '90s, and so did the research," Jones said. Experts say that the field is less empirical and more evidence-based as a result.

"Where we're headed is more studies in the field of biomechanics and the biochemical aspect of healing," Karas said. "Injury prevention is a burgeoning field, and so are gender differences. We're looking at why women sustain certain kinds of injuries."

In an aging population, "it's critical that we understand how older joints age and respond to injury and rehab — it's different at 60 [years old] than 20 — so that we can treat them better," he said.

Because research and advances in sports medicine have improved treatment methods, Karas said that success stories are common and "full recovery more the rule than not."

"The best part of this job is when a patient comes back after a successful surgery and long rehab to say, 'Thanks, Doc; I'm as good as new and haven't felt this good in years,' " Karas said. "It's rewarding to know that you made a connection, walked with him and allayed his fears along the way. That's why we get into the field."