American football and the evolution of modern sports medicine

Journal of Orthopaedic Surgery, Dec 2003 by Cahill, B R

Editorial

Sports have influenced the public image of medicine to the extent that a new branch of medicine has evolved: sports medicine. In this article, I will explain how this development was spurred on by American football-particularly by the number and severity of injuries as the sport grew in popularity. With time, it became imperative that new and better methods of treatment were needed. As modern sports medicine developed, so did the community of medical professionals dedicated to the specialty, culminating, in the United States, in the formation of the American Orthopedic Society for Sports Medicine (AOSSM).

The origin of sports medicine goes back to the beginning of written history, when ancient physicians-people who healed or exerted a healing influence-were known by names, such as medicine man, witch doctor, shaman, quack, quacksalver, and charlatan. In the 7th century BC, these 'physicians' began to study and treat athletes' fractures, deformities, and maladies in infirmaries (asdlepieas) in Greek temples. During the 5th century BC, the Greek historian Herodotus (484-424 BC) treated athletes and gymnasts, and his student, Hippocrates (468-370 BC), developed the discipline of anatomy. Hippocrates also did not believe that gods caused diseases-a revelation that led to the Hippocratic Oath, by which physicians still work. Several centuries later, the Greek surgeon Galen (131-201 AD) developed methods of an operation to remove arrows from the body. Galen, probably the first physical therapy practitioner, also taught trainers and developed techniques to increase the strength of athletes. He was the first to treat injured gladiators and to describe in detail the ligaments of the extremities. Truly, he was the first sports medicine physician.

According to Rang,1 "Sports were a slow activity in the ancient world. The Greeks had no team sports. The men were naked, and women were not allowed to participate or watch. The Romans had become a spectator occupation, with battles to the death between gladiators, men, and wild animals, and then chariot races. In mediaeval times, peasants only worked, prayed, and fought. The nobles had leisure for falconry, the chase, and jousting. These would have been lean times for a sports doctor."

It seems that the ancient sportsmen would kick any object. 2000 years ago, the Spartans and Romans invented a game similar to soccer. And in 1000 AD, when the Danes occupied England, Britons would use heads of dead Danes as a kicking object. When they ran out of heads, they resorted to using an inflated cow bladder. The English developed a contest between two villages: a bladder was placed at the midpoint between the villages, and the winner was the village that kicked the bladder into the opposing town. During the tournament, they also kicked the opposing team and any living animals. This sport was vicious, and many players were maimed or killed. During the reign of King Henry II (1154-1189), the game was named soccer, and the king attempted to stop the game several times, calling the pastime "a combination of soccer, vandalism and mass modified-homicide."1 Royal Proclamations tried to stop the activity-6 times until 1581. Obviously, they failed. In 1823 in Rugby, William Ellis had the nerve to pick up the ball and run with it; hence, rugby football was born in England.

In the United States, however, football began in the early 1800s-then, without rules, padding, helmets, and officials. Consequently, there were many serious injuries and deaths. The first university football match was held on 6 November 1869, between Princeton and Rutgers. Rules were quite different from modern American football: each team had 25 players, the goal posts were 25 yards apart, and the bar was raised at liberty. The ball was moved using methods used in soccer and rugby. When Walter Camp joined Yale University, the rules changed drastically. In 1880, teams had 15 players and the centre 'snap' was created to start the ball. In addition, there were different goal scores for passing the goal line. More referees were added to the game to decrease the penalties and injuries resulting from breaking of rules. Camp also ruled that tackling below the knees was legal, thereby causing another source of injuries. The 'wedge', designed by Camp, was driven into the line of the opponents with the ball carrier in the centre of the wedge. Shortly after the adoption of Camp's wedge, Lorin Deland of Harvard invented the 'flying wedge', which was even more dangerous for the players.2

In 1902, an editorial in the Journal of the American Medical Association3 stated that "The football season is now over and leaves behind it a respectable record of casualties, enough to supply a respectable SpanishAmerican War." It continued, "The reports of casualties give plenty of evidence of this [slugging]; we had the records-'kicked in the head', 'stabbed in the back'-showing that the game is made absolutely murderous at times." The carnage was so severe that in 1902, President Roosevelt vowed to abolish football; however, he was not successful. At this time, rules and officials were introduced to the game. Helmets were required, and most players had padding in their uniforms. These measures minimised injuries. Nevertheless, the game is still violent today and deliberate injuries are sometimes incurred.