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Active Voice | What Does the Team Physician Need to Know about Initial Management of Musculoskeletal Injuries?

by Greg Margason | Mar 12, 2024

The team physician commonly encounters musculoskeletal injuries resulting from athletic activities, including during practice, training and competition. The most common injuries encountered by a team physician include shoulder dislocation/subluxation, disabled throwing shoulders, elbow ulnar collateral injuries, hamstring injuries, anterior cruciate ligament (ACL) injuries, meniscus (cartilage) tears, ankle sprains, and groin and hip injuries. Discerning what is essential and desirable for the team physician to understand regarding the mechanism of injury and how these injuries present clinically, as well as the initial assessment and management options, are important. This information would be valuable for all members of the athletic care team, including athletic trainers, physical therapists, and strength and conditioning specialists, in addition to team physicians.
The Team Physician Consensus Conference (TPCC) Statements are a series of documents led by the American College of Sports Medicine® (ACSM) Clinical Sports Medicine Leadership Committee, that are resources for team physicians working with athletes at every level of competition. TPCC statements include representation from six major professional medical organizations, including ACSM, the American Academy of Family Physicians, the American Academy of Orthopaedic Surgeons, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine. The TPCC statement “Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Statement,” recently published in ACSM’s Medicine & Science in Sports & Exercise®, is the newest in this series of publications providing team physicians and athletic care team members with a framework for approaching common musculoskeletal injuries, with an emphasis on the sideline and training room. This document provides information about the nonoperative, operative and rehabilitation considerations of the select injuries and illnesses.
Understanding the essentials for evaluating and treating a shoulder, knee or hamstring injury if you are a team physician covering an event can be challenging, and this paper can act as a guide. How these injuries present, what to look for and what to do can be helpful, especially for younger team physicians gaining experience. What are the mechanisms of injury, and how do these injuries typically present? What should you do immediately, and what additional tests and follow-up should be considered? These can be challenging situations, and the TPCC on musculoskeletal trauma provides meaningful guidance based on consensus opinions and an evidence-based approach to common scenarios in sports medicine.
The TPCC on musculoskeletal trauma is one of several ACSM-led statements. These cover a variety of topics important to the team physician, including roles and responsibilities; sideline preparedness; injury and illness prevention; return to play; mass participation events; psychological issues and the response to injury/illness; nutrition; load and overload; and special populations including the female athlete, the adolescent athlete and the master athlete. Furthermore, TPCC statements have been recently published on other critical athlete-related issues, including physician management of various sport-related concussion issues. These papers are necessary resources for team physicians and are included in several sports medicine fellowship curriculums as required reading, given their applicability to clinical training.

Margot Putukian, M.D., FACSM, is the chief medical officer for Major League Soccer, a team physician for the U.S. Women’s National Soccer Team and a volunteer physician for the U.S. Olympic and Paralympic Committee (USOPC). She is the former director of athletic medicine and head team physician for Princeton University and serves on ACSM’s Clinical Sports Medicine Leadership Committee, currently as part of the Executive Leadership Committee for the Team Physician Consensus Statements. She is a past president for the American Medical Society for Sports Medicine.

W. Ben Kibler, MD, FACSM, is emeritus director of the Shoulder Center of Kentucky at the Lexington Clinic. He was a co-founding member of the ACSM TPCC initiative and was a member of the TPCC Executive Committee from 2000 to 2023. He is a member of multiple clinical sports medicine organizations and has published over 200 peer-reviewed papers. He is a past recipient of the ACSM Citation Award and has delivered both an ACSM Presidential Speaker and an ACSM Sutton Clinical Sports Medicine Lecture. He is a member of the AOSSM Hall of Fame.

Viewpoints presented in ACSM Bulletin commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for the ACSM Bulletin.
Continuing Education for Professional Growth

by Greg Margason | Mar 06, 2024
As the associate vice president of certification and credentialing at ACSM, one area I am most passionate about is supporting ACSM’s exercise professionals in navigating their career goals. I have had the distinct pleasure of connecting with numerous stakeholders across the spectrum of the exercise profession: students starting their careers in the exercise sciences, professors connecting scientific theories and exercise prescription, employers offering interns their first real-world experiences, and rising professionals trying to find ways to advance in their careers amid growing responsibilities. Earning a certification, while certainly a significant professional milestone, represents just the first step in a lifelong career.
First Things First
Continuing education (CE) — often referred to as “continuing professional development” — is a key element of professional certifications. Professional certification standards from the National Commission of Certifying Agencies and the International Organization for Standardization (ISO) require organizations like ACSM to have a time-limited process through which its professionals regularly update their knowledge and skills to maintain a certification in good standing. By participating in CE, certified professionals can demonstrate that they are current with updated professional standards and can meet the changing needs of their clients and patients. Certifying organizations can then provide reasonable assurance to the public that their certified exercise professionals are safe/effective throughout their working career.
Continuing education can take a variety of forms, which provides exercise professionals the flexibility in how and when they want their education to be delivered. From workshops and conference sessions to online on-demand classes and peer-reviewed journals, there are endless ways to meet the learning style and schedule of most exercise professionals.
Beyond Minimum Competence
Beyond maintaining up-to-date current professional standards, certified professionals are encouraged to invest in their career advancement. (This is one among many important differences between an academic degree and a professional certification — once you earn a degree, it’s yours, but most professional certifications require you to continually invest in yourself and your education.) As such, the NCCA grants certification organizations the flexibility to distinguish between initial competence and continuing competence, where initial competence means demonstrating competency in foundational knowledge and skills at the time of certification and continuing competence means both maintaining one’s initial knowledge and skills and gaining new competencies over time. In other words, continuing competence allows certified professionals to not only remain current and relevant in their respective fields but also empowers professionals to advance professionally through specialized training or forge new professional roles within health fitness.
Against the backdrop of the seismic changes the health fitness sector experienced from 2020 onward, successful career advancement requires additional effort from both the exercise professional and the certifying organization. The ACSM Board of Trustees (BOT) and the ACSM Committee on Certification and Registry Boards (CCRB) have taken proactive steps to identify stakeholder concerns and prioritize them in short- and long-term action plans. The BOT has undertaken a comprehensive reimagination of its strategic plan, envisioning a future where lives are extended and enriched through the power of movement. At the same time, the CCRB has revised its mission to expand beyond certification exams and include the lifelong development of its certified professionals. The CCRB’s new mission aims to provide exercise professionals with the latest evidence-based education geared toward early, mid-, and late-stage career professionals with the goals of creating a more agile and resilient workforce and making ACSM a home for certified professional to grow and thrive in their careers.
Career Advancement through Specialty Credentials
Successful career planning requires self-reflection and intentional goal-setting. This helps professionals develop a process to guide them toward an aspirational goal and a way to pivot in/around obstacles during a career journey. Start by creating an inventory of one’s unique knowledge, skills, experiences and the types of clients served. Identify areas where additional training or education is needed and develop a short- and long-term plan. And, most importantly, take action. With that said, it’s important to know that plans, not matter how meticulous, are never perfect, so exercise professionals should take time to celebrate their wins and, when they encounter roadblocks, take time to adjust the tactics and/or goals as necessary.
Career-Planning Roadmap
Take Inventory: Reflect on your existing competencies and areas of expertise to identify strengths and weaknesses and pinpoint areas for growth.
Set Goals: Define your career aspirations and develop specific, measurable, achievable, relevant and time-bound (SMART) goals to track your progress.
Plan: Research advanced training courses, specialty credentials and professional conferences that would support your career goals.
Launch: Create a detailed career plan, including timelines, needed resources, and action items to stay on track.
Evaluate: Review your progress, celebrate wins, and adjust your strategies to address any setbacks.
(Click the infographic to the right to see it in full resolution.)
ACSM offers a range of specialty credentials for exercise professionals seeking to deepen their expertise and expand their career opportunities. ACSM designed its specialty certificates to expand certificants’ knowledge and skills in their base certification (i.e., ACSM-GEI, ACSM-CPT, ACSM-EP, ACSM-CEP) to work with clients with special considerations; this includes, but is not limited to, cancer survivors, individuals with autism, and those with special considerations (such as youth athletes). For example, the Autism Exercise Specialist certificate equips professionals with the understanding and strategies needed to implement individual or group exercise programs for individuals with autism. Additionally, the Exercise is Medicine® (EIM) Credential teaches exercise professionals how to help individuals with common chronic diseases lead healthier, more active lives, making those with such a credential trusted referral resources for health care providers. ACSM’s specialty credentials enable exercise professionals to extend and enrich lives of their clients and patients through transformative power of movement.
Bringing It Together
Navigating the landscape of CE and career advancement requires a proactive and strategic approach. At a minimum, it is crucial for exercise professionals to stay current with the ongoing changes to professional standards and industry trends. Career exercise pros must also strategically invest in opportunities for personal and professional growth. Developing a career plan helps keep exercise professionals accountable by providing a framework for setting goals, identifying areas for improvement, and tracking/adjusting progress over time. This proactive approach helps ensure exercise professionals achieve long-term success and fulfilling careers.
Learn more about our specialty certifications and certificates:
Francis Neric, MS, MBA currently serves as the associate vice president of certification and credentialing at the American College of Sports Medicine_® (ACSM). With professional credentialing experience spanning 16 years, Francis has been instrumental in leading strategic initiatives to enhance the certification, advanced certificate and exam preparation programs to meet the needs of the domestic and international stakeholders of ACSM and the National Strength and Conditioning Association (NSCA). Francis holds an MBA in business management from the University of Colorado at Colorado Springs, an M.S. in clinical exercise physiology from California State University, Fullerton, and a B.S. in exercise science from California State University, Long Beach. Francis combines academic and industry knowledge to drive innovation and excellence in the health fitness industry. Francis is a passionate advocate for raising the bar for professionalism in the health fitness industry and expanding opportunities for exercise professionals in health care.
Hot Topic | Creative Strategies to Amplify Your Research and Scientific Voice

by Greg Margason | Feb 21, 2024

For young researchers, the excitement of publishing is often overshadowed by the questions “Will my work reach a wider audience, or will only a handful read it?” and “If my work is read, will the impact of my work be understood by the reader?” Such concerns can propel students and young professionals to seek innovative strategies for communicating their work effectively and explore personal branding possibilities.
The landscape of science communication has evolved significantly over the years. While traditional print journals and magazines once held the main stage, the digital age provides new communication tools to disseminate our findings. The possibilities are endless, from social media to podcasts, blogs to videos. Embracing these mediums allows us to transcend disciplinary boundaries and engage with a diverse audience of professionals and enthusiasts.
In our field, utilizing creative, novel strategies of communicating science can be transformative for the active researcher. Science communication is more than broadcasting our discoveries to the masses; it is also about integrating branding and design to make science relatable and appealing to a general audience and study participants. If done effectively, this can expand your network of professional contacts and colleagues, as well as create unique future professional opportunities.
Consider these specific strategies to amplify your work:
Create personal and study branding. Forge a distinctive brand to position yourself as an expert in your field and build your credentials. Move beyond traditional lab branding by crafting unique identities for your studies. Create logos, choose brand colors and maintain consistent design elements across communication channels. The aim here is to enhance participant and audience engagement, fostering familiarity and approachability. Remember, research can be overwhelming for people looking in from the outside. Well-designed branding transforms complex studies into visually appealing and less intimidating entities.
Develop a centralized website for your research or portfolio. Create a dedicated website as a central hub for your studies or professional portfolio. Incorporate your personal or study brand assets into the site. For research-focused websites, you can provide comprehensive resources such as study details, essential links for participants, a calendar to schedule lab visits, lab location maps and relevant publications. Learning about someone’s research line for the first time may be overwhelming, but a well-organized website streamlines participant engagement and offers a cohesive experience. Alternatively, you may choose to promote your research, case studies and career achievements in portfolio format. A personal website is a potent tool for showcasing expertise, surpassing the limitations of a CV and even professional social media profiles.
Think outside the box using video and audio in new ways. Embrace video and audio to improve outreach efforts. Explore new avenues in social media, vertical-form video content, interviews, podcasting, explainer videos and others. Collaborate with motion designers, video editors and illustrators to infuse creativity and uniqueness into your work, elevating its visibility in the digital sphere. With video emerging as a dominant mode of communication across social platforms, leveraging multimedia content enhances engagement and expands audience reach.
Incorporating creativity and good design into academia isn’t just a novelty; it’s an emerging necessity. In my journey, integrating these aspects has been crucial for crafting engaging narratives and storytelling. As emerging experts in our fields, it is critical to harness that power and amplify our voices by incorporating innovative communication strategies to attract the public and invigorate the scientific community.

Anaissa Ruiz Tejada, Ph.D., is a social media editor for Medicine & Science in Sports & Exercise_® (MSSE) and a multimedia intern for Scientific American. Her digital content work and branding is housed at shethescientist.com and @shethescientist across all social media platforms.
Doing What We Mean to Do: Following Through with Fitness Goals

by Greg Margason | Feb 20, 2024
As February comes to a close, I have to ask — have you kept up with your fitness resolutions? We’re in the period where people tend to fall off, after all.
If you’re reading this, you’re probably not the kind of person who needs to make a New Years’ resolution to get in shape. But maybe you have some additional goals, like hitting a new squat PR or switching up your routine to include more cardio.
And then there are your clients. Are they keeping up with their routines? Are they showing up regularly, or do they miss more days than not? It can get a little frustrating to work with a client over the course of weeks or months only to see them either slowly fade away or, only slightly better, miss so many scheduled classes and sessions that they simply aren’t getting in enough structured exercise to actually progress.
In the latter case especially, they really do intend to make a change in their lives, but something keeps them from following through. Is there anything we can do?
There’s some interesting research to take into account here. In their 2021 ACSM’s Health & Fitness Journal (FIT) article “Closing the Intention–Behavior Gap,” authors Liz Hathaway, Ph.D., MPH, and Mckenzie Gregg, MPH, note that “ … people successfully translate intentions into actions only about 50% of the time.” (The article is an installment in Hathaway and Gregg’s regular FIT column, “Enhancing Your Behavioral Toolkit,” which covers issues of behavior and motivation.)
To help us better explore what’s happening when people don’t follow through with their intentions, Hathaway and Gregg lay out four categories of people: inclined actors, disinclined actors, inclined abstainers and disinclined abstainers.
Inclined actors intend to do something and then do it. Disinclined actors don’t intend to do something but then do it. Inclined abstainers intend to do something but then don’t follow through. Disinclined abstainers didn’t do something, but they never intended to anyway.
Naturally, for our purposes we’re focusing on inclined abstainers. So, how many people is that? Hathaway and Gregg cite a meta-analysis of 10 studies that showed 36% of participants were inclined abstainers (second only to inclined actors, at 42%). This is, potentially, quite a large group.
Things get more troubling when the timescale is shorter. Hathaway and Gregg cite the study “Momentary assessment of physical activity intention–behavior coupling in adults,” which showed that when participants were asked whether they intend to engage in moderate-to-vigorous physical activity within the next three hours, 41% indicated they did. But only 16% of those who reported they intended to exercise within that timeframe actually did so. If your client decides on a day-to-day basis whether they want to exercise or not, they may be less likely to follow through with the decision than if they have a regular schedule to adhere to.
But what else can inclined abstainers do to increase their chances of becoming inclined actors?
The good news is that there are some strategies we can use to close the gap between intention and action. The first, which Hathaway and Gregg gleaned from “Intention–behavior gap is wider for walking and moderate physical activity than for vigorous physical activity in university students,” is based on the fact that people are more likely to follow through with lower-intensity activities. This makes intuitive sense, and a good takeaway might be to have your clients start slow. After all, it’s better to plan on doing something small and getting it done than it is to plan to do something elaborate and fail to do it. So, managing expectations at the beginning of a new client relationship can be important: teaching people that they’re not failures if they don’t go from zero to 60. Rather, encouraging a steady stream of small successes will probably be more beneficial.
Another insight from the same paper is that focusing on how to translate intention into action may be more important than building intention. Meaning, meticulously planning out a workout routine that could help you achieve your goals is great, but meticulously planning when you’ll pack your gym bag, what time you need to leave for the gym in order to get a full workout in, and potentially even how you’ll need to update your laundry schedule to make sure you always have clean gym clothes might be more important. If you exercise before work, how will you ensure you’ll get up in time, and with enough sleep? Do you need to fill up your car’s gas tank after work so you don’t have to do it in the morning before going to the gym? Better yet if you can turn all of these solutions into a series of habits.
By extension, then, talking with your clients about planning the things they need to do around exercise rather than focusing on the exercise itself might be really helpful.
To sum it up, the best ways to translate intention into action will differ between people, but arming yourself with the knowledge that (a) people seem less likely to follow through on short-term commitments, (b) sometimes less (intensity) is more and (c) that focusing on a plan for how to get yourself to the gym is just as if not more important than what you’ll do when you get there could be a serious game changer for you and your clients.
Exploring further
If you’re interested in the relationship between psychology and physiology, consider pursuing these ACSM CEC courses:
- The Mental Health Crisis: The Impact of Exercise and the Environment on Psychobiological Function (1 CEC)
- The Reward for Placebos (1 CEC)
Active Voice | Whole Body Fatigability as a Measure of Mortality Risk

by Greg Margason | Feb 06, 2024

A common definition of fatigue is a “subjective lack of physical and/or mental energy perceived to interfere with usual or desired activities.” Fatigue is a typical response to physical or mental exertion such as exercise, challenging physical tasks, or a long day’s work or dealing with emotionally taxing situations. Yet, everyday fatigue is a common symptom among older adults, which may signal the onset or progression of a pathological condition, often serious. To this end, it is no surprise that a large body of evidence links fatigue with higher mortality risk.
When someone perceives fatigue, their initial response is to adjust their activity to avoid the feeling. In terms of physical fatigue, this adjustment could mean walking slower, carrying less weight during day-to-day activities, or simply not engaging in higher-intensity activities—all of which are also associated with higher mortality risk. This phenomenon is referred to as “self-pacing” or setting a new normal (and slower) pace of activity. As self-pacing occurs, measurement of fatigue becomes complicated as effort is reduced to avoid feelings of fatigue. This issue compounds as perceptions of fatigue become more common and subsequent declines in activity accumulate, often unnoticed by the individual or clinical assessment tools.
Fatigability circumvents the self-pacing issue associated with measuring self-reported fatigue. Though fatigability is primarily associated with muscle contractile capacity and exhaustion, we examined perceived fatigability conceptualized as a whole-body measure after performing a standardized physical task. This facilitates comparing the perception of fatigue across individuals who perform a standardized physical task. Further, when the task is lower intensity (i.e., walking 1.5 mph for five minutes, as in our paper), greater perception of fatigue could signal impending physical decline, even among those who appear healthy and well-functioning. As such, the link between perceived fatigability and mobility decline among well-functioning older adults has been previously demonstrated.
In our prospective observational study of 1,076 men and women, we compared whether measures of fatigue and fatigability were differentially associated with mortality. Among the entire sample, fatigue and fatigability were similarly associated with mortality over an average of 10 years. Yet, when we accounted for the presence of medical conditions, we found that fatigability was only associated with mortality risk among those with little to no morbidity. In contrast, the association between fatigue and mortality appeared to be only present in those living with chronic disease (i.e., diabetes, chronic obstructive pulmonary disease). Our results suggest that perceived fatigability can identify elevated mortality risk in seemingly healthy middle- to older-aged people.
To date, perceived fatigability is rarely used outside of research. Yet, we show that fatigability is an important and early marker of accelerated aging and disease processes. Fatigability has the potential to capture the accumulation of physical function deficits undetectable to current testing. We believe the assessment of perceived fatigability can be highly useful in settings of prevention and rehabilitation (e.g., exercise program tailoring) and may be targeted to improve quality of life and health for older adults.

Amal A. Wanigatunga, Ph.D., M.P.H., FACSM, is an Assistant Professor of Epidemiology at Johns Hopkins School of Public Health and Core Faculty of the Johns Hopkins Center on Aging and Health (COAH). He is a member of ACSM’s Strategic Health Initiative – Aging committee and is the chair-elect for ACSM’s Aging Interest Group.

Jennifer A. Schrack, Ph.D., MS, is a Professor of Epidemiology and Medicine at Johns Hopkins School of Public Health and School of Medicine, director of the Johns Hopkins COAH, and the co-director of the National Health and Aging Trends Study (NHATS). She is a member of the ACSM Aging Interest Group.

For over seven years, they have been working together studying fatigability as a key identifier of declines in physical activity and functional performance. Much of their work utilizes cutting-edge technology and methodology to objectively assess the inter-relationships between physical activity, function, and fatigability.
Viewpoints presented in ACSM Bulletin commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for the ACSM Bulletin.