Young, growing athletes greatly benefit from a multidisciplinary team working in unison

Caring for young athletes can be one of the most rewarding — and most complex — responsibilities in orthopaedic surgery. Young athletes seek care from a wide array of professionals, medical and nonmedical alike, both in real life and virtually. Teenagers research their injuries on social media, and it is often difficult to sort out whether the influencers with large followings are truly qualified experts. Effective injury prevention, treatment, recovery, and return-to-sport planning require clear communication and coordinated care.

A multidisciplinary team led by the musculoskeletal expert, whether housed under one roof or connected digitally, helps growing athletes and their families navigate each step of the process, keeping the patient at the center. When doctors take care of children and teenagers, their parents often require just as much, if not more, attention and reassurance as the actual patient, making family-centered care not just important, but essential.

The orthopaedic surgeon’s role in the patient’s care team is to lead the team. Keeping the patient and their family at the center of the care is imperative. The surgeon determines surgical indications and timing and is part of the team before, during, and after surgery to ensure the surgery is optimized physically and psychologically for the athlete. When surgery is not appropriate or necessary for an athlete, the surgeon is responsible for educating and communicating the reasons for the decision. In fact, athletes who have conditions that will not benefit from surgery may need more communication and explanation than those who require surgery, and the surgeon may need to spend additional time developing a relationship with this patient to enhance trust in the rest of the team.

The athletic trainer (AT) can serve as a bridge from the court or field to the clinic or operating room. The AT community interacts with athletes before, during, and after injury, optimizing transitions and communication. The AT scope of practice ranges from preventing injury and providing acute care to liaising with the medical team and facilitating return to play.

The physical therapist (PT) works with the athlete before and after surgery to regain strength and motion, proprioception, and agility. The PT spends time with the athlete to understand individual strengths and weaknesses and is the surgeon’s trusted partner in determining the return-to-sport timeline.

The primary care sports physician should complement the orthopaedic surgeon in managing concussions, medical conditions, and nonoperative conditions. Primary care sports physicians are the leaders in treating Relative Energy Deficiency in Sport (REDs), a condition caused by chronic low energy availablity that expands on — and includes — the Female Athlete Triad.

Physician assistants and nurse practitioners (advanced practice professionals, or APPs) are the glue of the multidisciplinary team. These professionals are often the first touchpoint for patients, helping to determine initial imaging, initiate therapy, and support young athletes prior to and after surgical evaluation and care.

Care of the young athlete requires expertise in nutrition to prevent injury, optimize performance, and fuel return to play. With the changes in exercise hours, calorie consumption, and strength work that surround injury and surgery, the nutritionist is also a key component of whole-body health.

The psychological component of pain and injury in young athletes cannot be overemphasized. The mind-body connection is integral to understand and treat injuries, and the loop of anxiety amplifying pain and pain amplifying anxiety is imperative to address. The risk of depression when an athlete must take a break or discontinue a sport is often the most important ramification of the pathology.

Adjuncts to traditional western medicine — such as acupuncture, chiropractic care, Gua Sha (a traditional Chinese technique used to relieve muscle tension and inflammation), cupping, and herbal therapies — should be understood by the team. Athletes and their families can sometimes benefit from these interventions, so open dialogue should be welcomed.

In summary, fragmentation of care creates confusion and conflicting messaging. Coordination into one program keeps the athlete and their family at the center, improving quality and enhancing experience.

Jennifer M. Weiss, MD, is a pediatric orthopaedic surgeon specializing in sports medicine. She is the chief of staff at Shriners Children’s Hawaii. She is a past chair of AAOS’ Communications Committee.