Sports Medicine Centers in the United States: the ...

13 downloads 0 Views 1MB Size Report
Sports medicine in the United States is a rap- .... Activities of sports medicine center personnel at local high ..... Univ. of Pennsylvania Sports Medical Center.
0196-6011/80/0104-0222$02.00/0 THE JOURNAL OF ORTHOPAED~C AND SPORTS PHYSICAL THERAPY Copyright O 1980 by The Orthopaedic and Sports Medicine Sections of the American Physical Therapy Association

Sports Medicine Centers in the United States: the Personnel, Patients, and Services

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

PERRY S. ESTERSON,*.+ MS, PT, ATC

Sports medicine in the United States is a rapidly expanding field. The movement of the public into organized and informal recreation and sports has stimulated the growth and sophistication of sports medicine. In the last 35 years, sports-related injuries have received unprecedented interest. Numerous sports medicine centers (SMC) have been established to meet the increased demand for a specialized approach to the treatment of sports injuries. Three main functions of SMC's have been reported: 1) research into the causes of and possible prevention of sports injuries; 2) sports medicine education for physicians, medical students, allied medical professionals, coaches, and the public; and 3) care of the injured athlete including the areas of prevention, diagnosis, treatment, and rehabilitat i ~ n .4.~ , In the latter half of 1978, this investigator surveyed SMC's in the United States to identify the status of selected aspects of the operations and approaches to sports medical treatment at these centers and also to provide a profile of sports medicine centers. A listing of SMC's was generated and a specially constructed survey instrument was mailed to 85 centers. Of the centers identified for this study, 71 (83.5%) responded with either a completed survey or a letter of explanation. Of those 71 responding, 56 (79%) met criteria established for inclusion in the study. These criteria were that the SMC: 1) specialized in the care of athletic injuries, and 2) had a patient population presenting primarily participant sports-related injuries.

RESULTS Aspects of SMC's ORGANIZATIONAL STRUCTURE/PRIMARY GOALS The most typical organizational structure of SMC's is a separate center and the least as part of an institution of higher learning. Table 1 represents the frequency of responses for the types of structures. Rehabilitation (37%), acute care (27%), and injury prevention (17%) are most often the primary goals of SMC's. Monetary gain and training sports medical personnel are mentioned least often. STAFFING Of the 56 SMC's included in the study, 34 centers had licensed physical therapists (LPT) and 30 had professionals who were both licensed physical therapists and certified athletic trainers (LPT/ATC). Physicians were the only group more frequently found in SMC's. Although LPT's are reported in all types of SMC settings, the staffing pattern is different in each structure. SMC's that are part of a larger private practice have the widest staffing range (1 -10) with 2-4 LPT's being the most frequent staffing pattern. Hospital departments most often note two LPT's on the staff whereas separate centers usually have one. ATC's are least often employed in hospital-based SMC's (4 of 13). Separate centers usually identify one or two LPT/ATC's on staff whereas all other settings report employing one. SMC PATIENT POPULATION AND REFERRAL SOURCES

* From Case Western Reserve University, Cleveland. OH.

t Present address: Center for Sports Medicine. National Orthopaedic and Rehabilitation Hospital. Arlington. VA 22206.

An average of 75% of the patients seen at SMC's included in the study have sports-related

injuries. Of the 48 SMC's that responded, 56% state that high school athletes comprise the rnajority of their patients. Recreational athletes are the second most frequently listed major group with 31 %. Coaches, team physicians, and family physicians are most often mentioned as referral sources whereas physical therapists are cited least often. Coaches comprise the major referral source. In 40% of the centers (19 of 48), coaches are reported as the major source of referral while physical therapists are never mentioned in this regard. PROFESSIONAL SERVICES AND TYPES OF TREATMENTS Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

223

SPORTS MEDICINE CENTERS

JOSPT Spring 1980

Three activities are ranked most frequently by SMC's: Diagnosing and evaluating injuries, rehabilitating injuries, and treating injuries. Rehabilitation and acute care treatment are also most frequently mentioned as primary goals. Taping

and strapping, fabricating protective pads, and performing preparticipation screening examinations are the least frequently ranked activities. Formulating preventative exercise programs and administrative tasks fall in between these rankings. The complete order of ranking is presented in Table 2. SMC personnel do not appear to be directly involved in activities at high schools. However, when they are involved, it is more often at games than practices. Table 3 shows the activities of SMC personnel at high school practices and games. Nearly 70% of the centers responded that they do not offer acute care and diagnosis of injuries, strapping and taping, or rehabilitation of injuries at high school athletic practices. Only 13% (N = 53) provide acute care of injuries at TABLE 3 Activities of sports medicine center personnel at local high schoolsa Practices

Games Activities

TABLE 1

All

Organizational structures of sports medicine centers SMC's = 56

Percentage

Separate center

21

38

Hospital department

14.5"

26

University/college department

7

Part of a larger private practice

14.5"

12 24

" SMC's listed more than one response.

Acute care of injuries, N = 53 Strapping and taping. N = 53 Diagnosis injuries, N = 53 Rehabilitating injuries, N = 53

Some

28 38

19

68

38

53

7

23

70

30 38

32

9

19

72

17 41.5

41.5

9

23

68

9

"The responses for each activity are expressed as the percentage of the total number of SMC's responding in each activity.

% of Responses

Diagnosing and evaluating injuries Rehabilitating injuries Taping and strapping Fabricating special protective pads Performing preparticipation screening exams Formulating preventative exercise programs Performing administrative tasks Fitness evaluations Education

Rank N " Totals may not equal 100% due to rounding error.

a

Some No

13

TABLE 2

Treating acute injuries

All

34

Ranking of activities performed in sports medicine centers

Activity

No

224

ESTERSON

all practices. Nearly 30% offer acute care and diagnosis of injuries at all games. Very few centers have staff members strap and tape at all games, while 53% do no taping or stripping. Twenty-two centers do no rehabilitation of injuries and 22 do some rehabilitation at games.

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

PREPARTlClPATlON SCREENING PHYSICAL EXAMINATION Of the centers surveyed, 34 conduct preparticipation screening physical examinations. Over 90% of these exams include a medical and orthopaedic history and physician's physical examination. Flexibility testing and blood pressure readings are mentioned by 20 centers. Strength testing is reported in 71% of the responses whereas cardiovascular stress testing is offered in 41 % of the examinations. High school athletes are the most frequently screened group with 61 % of the SMC's reporting this group comprise the bulk of their screening examinations. College athletes are the next most specified group. Children less than 14 years old, recreational and industrial league athletes, and business executives least often receive screening examinations. Staff members of the SMC's treat conditions or deficits discovered in the preparticipation screening examination in 74% of the centers. Family physicians and school athletic trainers also treat these conditions, but less frequently. EDUCATIONAL PROGRAMS Over 80% (49 of 56) of the SMC's offer some type of continuing education program. The data show that the programs are directed primarily toward coaches. Thirty centers (65%) report that coaches comprise the majority of participants attending continuing education programs. All but four centers mention having coaches at their educational programs. Athletic trainers are the second most frequent group for which programs are held. Only 16 centers report presenting educational programs for parents. Various other sports groups, student athletic trainers, physical therapists, and allied health professionals are infrequently mentioned. Once again, rehabilitation, treatment of acute injuries, and recognition of injuries receive high priority as over 88% of the SMC's present these topics. Also, 84% offer taping and strapping as a topic. Basic sciences and various aspects of conditioning are additionally reported, but much less frequently-1 3 responses of 250.

JOSPT Vol. 1 , No. 4

DISCUSSION One of the primary goals of this study is to profile activities of SMC's. An analysis by organizational structure reveals that functions of the SMC's are not generally determined by their structure. Goals and activities are similar in all settings. A patient choosing a SMC in which to receive treatment might reasonably find similar services offered at different centers. How these services are carried out will depend on the staff at a particular center. Many professionals from diverse medical fields provide health care in SMC's. This diversity in staffing reflects a broad multidisciplinary approach to sports medicine. However, the relatively small number of centers that utilizes all or most of the professionals from other disciplines indicates a fragmented approach to the practice of sports medicine. As to patients, high school athletes constitute the major patient population at over half of the SMC's. Several investigators found that a considerable number of injuries occur at the schools.35 The results of this research reveal that most activities of the SMC staff members take place at the center rather than the schools. These professionals serve in a support capacity rather than as primary providers of sports medical care. They do little taping, strapping, or rehabilitation at the schools. When needed, they diagnose and treat acute injuries, although most frequently at games. The majority (nearly 70%) of the SMC staff members does not offer services for any sports practices. Yet, Blyth and Mueller' report 51% of all high school football injuries occur in practices. Garrick3 notes an even higher rate of injury for all high school athletic practices-65-75%. Because the number of SMC professionals is limited, they cannot possibly offer medical coverage to all schools for all practices and contests. Therefore, some action needs to be taken to provide competent sports medical coverage at sports practices and games. Several alternatives are available to respond to the need to have coverage at practices. High school personnel, especially coaches, can be trained to identify and treat injuries. In the absence of trained sports medical professionals, coaches are frequently the first to attend to injuries, assuming the injuries are recognized. However, coaches are primarily concerned with coaching responsibilities, and this potential conflict of interests might well negate their effectiveness as athletic trainers. Therefore, the job of

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

JOSPT Spring 7 980

SPORTS MEDICINE CENTERS

identifying and treating injuries should rest with individuals who are not also coaching. Teachers serving as athletic trainers can be assigned less teaching responsibilities to enable them to devote more time to athletic training. Another solution is for the school to employ nonteaching certified athletic trainers who can direct all their efforts to this task. It may be possible for SMC personnel to be present at more sports practices, but this course of action may be limited by the schools' ability to pay for this additional service or the availability of the SMC personnel. Physical therapists need increased exposure to sports medicine while in training. Physical therapy curricula in the past have lacked courses in acute care of injuries, strapping and taping, or exercise physiology. Additionally, further practic.al field experience will increase the capabilities of physical therapists wanting to offer their services to the sports community, but feel they lack the necessary skills and background for deeper involvement. The high frequency of SMC's conducting continuing education programs (87.5%) illustrates the broad commitment by professionals in sports medicine to upgrade the knowledge base of those dealing with athletes. Several programs have been developed to achieve this goal. One SMC meets with coaches from individual schools. The material presented is based on the coaches' particular needs. Another approach is to train more high school faculty members to become athletic trainers. In this program, the teachers will receive sufficient training to qualify for certification as athletic trainers by the National Athletic Trainers Association. One SMC offers graduate assistantships to physical therapists in an attempt to further specialize their training. Another service that many of the SMC's provide is preparticipation screening examinations, although this is not a high priority. Respondents indicate that rehabilitation and acute care treatment, including diagnosis and evaluating injuries, are considered most important, whereas injury prevention and performing preparticipation screening exams are less so. Apparently, a majority of centers become involved with athletes after they sustain an injury, rather than before. With greater emphasis on detecting deficits and previous injuries through preparticipation screening examinations and formulating programs to correct these problems, injuries can be

225

reduced. In addition, members of SMC's have the opportunity to direct athletes into sports suited to their physical capabilities. By selecting appropriate sports activities, athletes may sustain fewer injuries.

CONCLUSIONS There is a need to increase sports medicine center programs designed at preventing injuries. This action will reduce the enormous number of injuries sustained in sports-related activities and decrease the time lost from these activities. Additionally, more centers need to integrate the contributions of all the medical professionals active in sports medicine. The increased input of podiatrists, osteopaths, nutritionists, and others can only enhance the care the athlete receives. Musculoskeletal problems present in sports medicine are complex and require careful analysis. The full cooperation between professionals will ultimately benefit the patient. Growing numbers of recreational participants will increase the already staggering number of sports-related injuries in the United States. With increased emphasis on educating the medical and nonmedical community in sports medicine, sports participants will seek out practitioners with the expertise to deal with their problems. The emergence of the sports medicine center staffed with professionals skilled in the prevention, diagnosis, and treatment of sports-related injuries will continue as a means to meet this growing need. As a part of this professional nucleus, physical therapists must continue to evolve through further research and education.

REFERENCES 1. Blyth CS, Mueller FO: Football Injuries. Minneapolis, Phys Sportsmed 10:5-12, 1974 2. Description and organization of Rainbow Sports Medicine Center, unpublished data. 1978 3. Garrick JG: Sports medicine. Pediatr Clin North Am 24:737747. 1977 4. Lazorko L: Temple Clinic: Good care for all athletes. Phys Sportsmed 3:75-77, 1975 5. Smith NJ: The pediatrician and sports medicine. Pediatrics 61: 497-499. 1978 6. The Sports Medicine Clinic: Teamwork approach to sports medicine, Seattle, Washington, 1978

APPENDIX Alabama United States Sports Academy Univ. of South Alabama 307 University Blvd. Mobile. AL 36688

ESTERSON Arizona

Colorado

Rehabilitation Medicine P.C. 899 N. Wilmot Road Suite C-2 Tucson. AZ 8571 1

Denver Sports Medicine Clinic Room 51 8 2045 Franklin Street Denver, CO 80205

The Sports Medicine Clinic 31 00 E. Bell Road Phoenix. AZ 85032

Sports Medicine Clinic 1930 S. Federal Blvd. Denver. CO 8021 9

California

Storm Meadows Sports Medicine Rehabilitation 8 Physical Therapy Department P.O. Box 1566 Steam Boat Springs. CO 80477

ATHER Sports lnjury Clinic 20664 Santa Maria Castro Valley, CA 94546 Crowl Sports lnjury Center 5207 J Street Sacramento. CA 9581 9

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

JOSPT Vol. 7, No. 4

East Bay Sports Medicine Program Peralta Hospital 450 Thirtieth Street Oakland, CA 94609 National Athletic Health Institute 575 East Hardy Street Inglewood, CA 90301 Orthopedic € Sports i Physical Therapy. Inc. 10627 Bandley Drive Cupertino, CA 95104 P.A.C.E.R. Clinic 2307 Concord Blvd. Concord, CA 94520

f Physical Therapy and Rehabilitation 1103 Trancas Street Napa. CA 94558 Sports Conditioning 8 Rehabilitation Clinic 871 South Tustin Orange. CA 92666 Sports lnjury Rehabilitation and Research Clinic 3340 Kemper Street San Diego, CA 921 10 California College of Podiatric Medicine 1770 Eddy Street San Francisco, CA 941 15 Dr. Harry Hlavac 36 Tiburon Blvd. Mill Valley, CA 94941 Sports Medicine Clinic of Memorial Medical Center at Long Beach 2801 Atlantic Avenue Long Beach, CA 90801 Sports Medicine Center Orthopaedic Hospital 2400 S. Flower Street Los Angeles. CA 90007 Total Health Medical Center 390 40th Street Oakland, CA 9461 5 Treat Fitness Center 11 19 Industrial Road San Carlos, CA 94070

Connecticut Greenwich Sports Conditioning €i Cardio-Fitness Center 20 Dayton Avenue Greenwich. CT 06830 Florida Life Clinic 407 Beverly Blvd. Brandon, FL 3351 1 Georgia Dr. Fred L. Allman. Jr. 61 5 Peachtree Street. N.E Suite 1100 Atlanta. GA 30308 Sports Medicine Education Inst. Suite 414 20 Linden Avenue. N.E. Atlanta, GA 30308 Sports Medicine Section Rehabilitation Services of Columbus. Inc. Medical Arts Bldg. Columbus. GA 31 901 Idaho

$ ADA Physical Therapy Associates 61 69 Clinton Boise, ID 83704 Illinois Center for Sports Medicine Northwestern Univ. Medical School 31 3 E. Chicago Avenue Room 4-334 Chicago. IL 6061 1 Center for Sports Medicine Illinois Masonic Medical Center 836 West Wellington Avenue Chicago. IL 60657 Great Plains Sports Medicine Foundation 624 N.E. Glen Oak Peoria. IL 61 603 Podiatric Sports Medicine Center Illinois College of Podiatric Medicine 1001 N. Dearborn Street Chicago. IL 6061 0 Suburban Physical Therapy Service Suite 119 2474 Dempster Street Des Plaines. IL 6001 6 Kansas

$ These SMC's were identified after the survey was mailed and not included in the study.

Sports Rehabilitation Assoc.. Inc. 451 0 W. 89 Street Prairie Village. KS 66207

JOSPT Spring 1980

SPORTS MEDICINE CENTERS

Maryland

New Jersey

f The Sports Medicine Center Suite 1555 5454 Wisconsin Avenue Chevy Chase. MD 20015

Morristown Memorial Hospital Mt. Kemble Avenue Morristown. NJ 07960

Massachusetts Berkshire Sports Medicine lnstitute Adams Road Williamstown, MA 01 267 Braintree Hospital Sports Medicine Department 250 Pond Street Braintree, MA 021 84

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

New England Sports Medical Clinic 4 State Road Danvers, MA 01 923 Sports Medicine Clinic Children's Hospital Medical Ct 300 Longwood Avenue Boston, MA 021 15 Sports Medicine Clinic Massachusetts General Hospital Fruit Street Boston, MA 021 14 Sports Medicine Resource 830 Boylston Street Chestnut Hill, MA 021 67 Michigan Physical Therapy & Sports Medicine Clinic 20002 Farmington Road Livonia. MI 481 52 Sports Medicine Clinic 30730 Ford Road Garden City. MI 481 35 Minnesota lnstitute for Athletic Medicine Suite 708 Fairview-St. Mary's Medical Bldg. 606 24th Avenue. South Minneapolis, MN 55454 North Memorial Medical Center-Sports Medicine Center 3220 Lowery Avenue. North Minneapolis, MN 55422 Orthopedic Physical Therapy S e ~ i c e 733 Central Medical Bldg. St. Paul, MN 55104

American Sports Medical Training Center 17 Grand Avenue Englewood. NJ 07631 Rehabilitation Research Sports Medicine 263 Messina Avenue Hammonton. NJ 08037 Sports Medicine Department United Hospital Orthopedic Center 89 Park Avenue " Newark, NJ 07104 Sports Medicine Center Winslow Professional Center State Highway No. 73 Tansboro, NJ 08004 New York Athletic Injury Treatment Center University of Rochester 601 Elmwood Avenue. Box 665 Rochester. NY 14642 Fitness lnstitute 99 Fieldstone Drive Hartsdale, NY 10530 The lnstitute of Sports Medicine and Athletic Trauma Lenox Hill Hospital 130 East 77th Street New York, NY 10021 Preventive and Sports Medicine Center 610 City Island Avenue City Island, NY 10464 Rainbow Sports Medicine Center 566 Broadway Massapequa, NY 11758 Sports Medicine Clinic 535 East 70th Street New York. NY 10021 North Carolina Cleveland County Sports Medicine Center 341 Hudson Street Shelby. NC 281 5 0

$ St. Croix Orthopedics

Department of Sports Medicine Duke University 310 0 Erwin Road Durham, NC 37705

13961 North 60th Street Stillwater. MN 55082

Ohio

Missouri The Athletes' Center 4930 Lindell Blvd. St. Louis, MO 631 08 I.W. Johnson lnstitute of Rehabilitation Dept. of Preventative Medicine 509 South Euclid Avenue St. Louis. MO 631 10 Metropolitan Orthopedics Sports Medicine Center 522 N. New Ballas Road. Rm. 199 St. Louis, MO 63141

Sports Medicine Department Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland, OH 441 0 6 Ohio City Orthopaedics. Inc. Sports Medicine Associates Div 2609 Franklin Blvd. Cleveland. OH 441 13 Rainbow Sports Medicine Center 21 03 Adelbert Road University Cricle Cleveland. OH 441 0 6

ESTERSON

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Sports Medicine Institute University of Cincinnati Rm. South 508 234 Goodman Avenue Cincinnati, OH 45267

Utah Physical Therapy and Sports Medicine, Inc. 301 6 Van Buren Ogden. UT 84403

Tri County Orthopaedics Surgeons. Inc. 3244 Bailey Street, North West Massillon. OH 44646

Sports Mall Physical Therapy Center Sports Mall 5451 So. 9th E. Salt Lake City, UT 841 1 7

Wittenbrook Therapeutics. Inc 31 87 West 21 st Street Lorain, OH 44053

Virginia

Pennsylvania The Milton S. Hershey Medical Centel The Pennsylvania State Univ. Department of Surgery Division of Orthopaedic Surgery Hershey. PA 17033 Sports Medicine 8 Fitness Training Centel 15 Industrial Blvd. Paoli, PA 19301 Sports Medicine Center Braddock General Hospital 400 Holland Avenue Braddock. PA 15104 Temple Univ. Center for Sports Medicine and Science Broad and Tioga Streets Philadelphia. PA 10140 Univ. of Pennsylvania Sports Medical Center Dept. of Orthopaedic Surgery 165 Medical Bldg. 3400 Spruce Street Philadelphia, PA 19104

$ Pittsburgh Physical Therapy Assoc 1191 0 Perry Hwy. Wexford, PA 15090

JOSPT Vol. 1 , No. 4

$ Center for Sports Medicine National Orthopaedic and Rehabilitation Hospital 2455 Army Navy Dr. Arlington, VA 22206 Washington Spokane Sports Medicine Suite 560 South Washington Spokane Sports Medicine Suite 560 South Center Medical Bldg. Spokane,WA99204 The Sports Medicine Clinic 1551 Northwest 54th Suite 200 Seattle, WA 981 07 Division of Sports Medicine Univ. of Washington Department of Orthopaedics Seattle, WA 981 9 5 West Virginia Sports Medicine Clinic 15 Greenbriar Lane Mt. Olivet Wheeling. WV 26003

Texas Wisconsin Sports Medicine 8 Rehabilitation Clinic 7526 Louis Pasteur Drive San Antonio, TX 78229 Sports Medicine Center of Dallas 3622 Fairmont Street Dallas. TX 7521 9

Sports Medicine Section University of Wisconsin Division of Orthopedic Surgery 1300 University Avenue Madison, WI 53706

$ Orthopaedic and Sports Physical Therapy Sports Medicine Clinic of North Texas 9262 Forest Lane Dallas, TX 75221

2501 Shelby Road Lacrose, WI 54601

This article has been cited by:

Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on March 26, 2018. For personal use only. No other uses without permission. Copyright © 1980 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

1. John Cormier, Alice York, Elizabeth Domholdt, Sam Kegerreis. 1993. Athletic Trainer Utilization in Sports Medicine Clinics. Journal of Orthopaedic & Sports Physical Therapy 17:1, 36-43. [Abstract] [PDF] [PDF Plus] 2. Frank J. Cerny, Debra C. Patton, Terry J. Whieldon, Susan Roehrig. 1992. An Organizational Model of Sports Medicine Facilities in the United States. Journal of Orthopaedic & Sports Physical Therapy 15:2, 80-86. [Abstract] [PDF] [PDF Plus] 3. Gary L. Derscheid, David C. Feiring. 1987. A Statistical Analysis to Characterize Treatment Adherence of the 18 Most Common Diagnoses Seen at a Sports Medicine Clinic. Journal of Orthopaedic & Sports Physical Therapy 9:1, 40-46. [Abstract] [PDF] [PDF Plus] 4. Sam Kegerreis, Terry Malone, Louis Greenwald, Dave Knoeppel. 1983. Survey of Scholastic Athletic Health Care and Sports Medicine Clinics. Journal of Orthopaedic & Sports Physical Therapy 5:2, 78-81. [Abstract] [PDF] [PDF Plus]