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Sports Medicine: Picking up Pace

The unorganised sports medicine segment in India is in the cusp of transformation, but has to overcome many roadblocks to become more structured, says Sonal Shukla

With noticeable performance of the Indian sportsmen at the Olympics last year, the future of sports and sports medicine in India doesn't seem so bleak anymore. Presently, the unorganised sports scenario in India is in the active transformation phase and steadily evolving to become more structured. Likewise, sports medicine and sports science are budding with their importance being felt in various sports. A decade ago, this branch of medicine was non-existing. But, increased exposure of athletes, coaches, team officials to international sporting events has made them appreciate the importance of performance enhancement, injury management and injury prevention using scientific principles. Importance of a travelling sports physician and sports physiotherapist has also increased and more or more teams are employing sports medicine consultants on a full-time basis. However, there is still a long way to go.

Evolving Segment

According to KPMG India report, the current sports medicine market in India is estimated to be about $250 million, and is expected to grow to $1.5 billion by 2015 and $2 billion by 2017. India is also becoming a target country for international sports. Commonwealth Games 2010 will provide greater opportunities to local sports persons, athletes and gymnasts to aspire for medals and prizes. All this will likely arouse greater demand and investment in this segment. Currently, with the growth of sports in India, the Government has also been actively supporting various developments and making progressively higher budgetary spend provisions in the Union budget every year, which will also induce demand for the sports medicine segment. "The Government allocated a budget of Rs 11 billion for the year 2008-09 and in 2009 budget, it increased the allocation for the 2010 Commonwealth Games from Rs 2,112 crore to Rs 3,472 crore," shares Anurag Dubey, Programme Manager, Health IT & Healthcare Delivery Practice - South Asia & Middle East, Frost & Sullivan.

Sporting Nation

As various sports gain greater acceptability and popularity with the Indian masses, there is a constant and growing need for increasing number of sportsmen to maintain fitness regimes to remain competitive. There are many short duration sports for example T-20 cricket, which are gaining popularity and in which sports persons are more injury prone than normal sports due to demanding nature of the sport and the stressful fitness regime. "The growing frequency of the sports tournaments and new versions of sports, enable participation from more and more sports persons, who are the future patients for sports medicine segment," says Pradip Kanakia (Head of Markets and Heathcare- KPMG India). The sub segments within the sports medicine segment that have shown higher potential to develop in India include sport and fitness counseling, rehabilitative training, sports nutrition etc. As awareness of physical fitness grows among the masses in India and not just sportsmen, the sub segment such as nutrition and dietetics are expected to show sharp increase. "As people are increasingly realising the dangers and consequences of obesity, and more people are opting for weight loss and other body contouring procedures. The number of patients seeking a fitness procedures/ programmes will increase manifolds in 2009 and this will help the Indian industry to flourish," shares Prof Dr Jaspal Sandhu, Dean, Faculty of Sports Medicine, Guru Nanak Dev University, Amritsar. Advancement in the medical technology and surgical techniques have also given impetus to this segment.

All Inclusive

Sports medicine is defined by experts as the 'total care of the exercising individual'.

In terms of service offerings, sports medicine involves many aspects such as training, nutrition, psychology, physiotherapy, prevention and/ or early detection of injuries, treatment including surgery and rehabilitation.

Shares Dr Dinshaw Pardiwala, Consultant- Arthroscopy, Sports Orthopaedics and Shoulder Service Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, "When we talk about sports medicine services in the hospital, it has three parts-diagnostic, clinical and rehabilitation. All these three aspects are extremely important which, in India, for a long time has been neglected." Hospitals are today realising the importance of diagnostic and rehabilitation in sports medicine, and we see a gradual trend towards a comprehensive sports medicine centres coming up in the leading corporate hospitals. The surgical part and the treatment constitute a small percentage when we see the sports medicine treatment as a whole. In the preventive aspect of sports medicine, the sportsman would be evaluated and therefore might require high tech evaluation like GATE analysis, or muscle strength testing and other various means of quantising to check how fit he/ she is and therefore is suited for that sports, what his cardiovascular output is going to be and then how can he improve on those aspects by doing those specific rehab and exercises etc. Here the psychotherapist and rehabilitation specialist comes in.

"Sports medicine requires a 'Team Approach' with a team comprising sports physicians, surgeons, physiotherapists, psychologists, exercise physiologists, masseurs, sports nutritionists, and trainers who work directly with the coach and most importantly the athlete," shares Dr Parag Sancheti, Chairman, Sancheti Institute for Orthopaedics and Rehabilitation (SIOR), Pune. Today, the sports medicine specialists serve as consultants, counselors, performance enhancers or educators to provide scientific input to the elite and budding sports persons. Sports scientists are involved in sports psychology, sports nutrition, sports biomechanics, training methods, rehabilitation and research.

Players in the Playground

"Sports medicine services in hospital has three components —diagnostic, clinical and rehabilitation, all of which are important" - Dr Dinshaw Pardiwala Consultant- Arthroscopy and Sports Orthopaedics, KDAH, Mumbai

"Sports medicine team comprises physicians, surgeons, nutritionists physiotherapists, psychologists, masseurs, physiologists & trainers" - Dr Parag Sancheti Chairman SIOR, Pune

"We need research on parameters such as VO-2 max, muscle fibre conduction velocity and effect of exercise on Indian population" - Dr Chandra Siddaiah Consultant Sports and Exercise Medicin, Manipal Hospital

Indian healthcare players are gradually investing in sport medicine specialists and are devising product and service offerings to meet the growing need as this is a high potential and revenue generating speciality. But the challenge is availability of skilled / experienced professionals in this field. National players like Fortis Healthcare are known to have plans of establishing dedicated sport medicine facilities to cater to the growing demand. The selected Indian players involved in the sport medicine segment are Indian Spinal Injuries Centre, Manipal Health Systems, Kokilaben Dhirubhai Ambani Hospital Medical Research Institute, Mumbai, SIOR, Pune to name a few. Asian Heart Institute, Mumbai is planning to set up a metabolic evaluation clinic to test person's aerobic capacity for which it is investing Rs 50-70 lakh in the next few months.

A laboratory for the screening of future athletes by means of psychological testing, speed and skill testing, fitness assessment, people who are starting sporting activity in adolescence or as adults after a long break —proper assessment of their cardio vascular fitness level to avoid injuries or damage to their heart and lungs—these are the areas hospitals are keen on exploring with their sports medicine centres.

"To a large extent sports medicine in India is practiced by individuals—orthopaedic surgeons or physiotherapist. Sports medicine as a speciality does not exist in an institution environment particularly in a multi-speciality hospital. We would like to create a centre for sports medicine within an institution so that besides orthopaedic and physiotherapist any other specialist input which is required to deliver comprehensive treatment is available under one roof: diagnostic, therapeutic and rehabilitation," says Dr Ram Narain, CEO, Kokilaben Dhirubhai Ambani Hospital Medical Research Institute, Mumbai.

"India also has very few sports medicine centres across the country with the state-of-the-art, purpose-designed facility, for analysis of musculoskeletal injuries by a team of specialists in the field of sports medicine," believes Dr Chandra Siddaiah, Consultant Sports and Exercise Medicine, Manipal Hospital, Bangaluru.

Apart from the established national players, there are standalone clinics offering sports medicine as a dedicated speciality and are used by sportsmen and sports authorities due to personalised treatment and trusted relationship based on prior experience or references. In terms of market share almost 85 per cent share is enjoyed by these localised players, who are more readily accessible to local sports persons. "In the sports medicine market, there is a constant threat from new entrants trying to launch technologically advanced and more efficient products as compared to the existing products," says Kanakia. Still sports medicine is at a developmental stage in our country.

Research

Research activities form an important part of the sports unit which includes innovative and sophisticated methods and technologies for quicker and better healing. Qualitative research includes screening of future athletes by means of physiological, psychological testing, speed and skill testing which help determine the athletes with the best potential. "The sports medicine research is devoted to the identification of risk factors and preventing sports related injuries, with emphasis on injuries to the head, knee, shoulder and ankle. Furthermore, it is also dedicated for developing injuries screening and prevention strategies that are clinically applicable. Many companies are nowadays coming forward in this field by opening a separate research and development wing and investing at least 10 per cent shares in this sector," shares Dr Sandhu. Recently, World Anti-Doping Agency (WADA) has opened its laboratory in India to take a step forward in this direction. Research also involves the physical training, science and educational services. In the field of exercise physiology, to increase the physical capacity/ performance/ VO2 max of the athlete, training sessions are given on suitable equipment. In case of orthotics and prosthetics, German company Bionic is collaborating with the Indian trade markets. According to experts, to spread the awareness globally, it is important to publish the research work, which will give impetus to this market in India.

However, they also feel that there is very nominal research done in the clinical aspects of sports medicine in the country. Currently, there are only few research papers on sports drinks, muscle strength, endurance and other anthropometric parameters where studies were done on Indian subjects. "Overall, we have very scarce data on research in sports medicine area. We need research on parameters such as VO-2 max, muscle fibre conduction velocity, human movement analysis and effect of exercise on Indian population with various medical conditions. The findings will definitely help to understand and implement good care to all those in need," says Dr Siddaiah. Research in sports requires highly accurate equipment and objective methods to evaluate the benefit of a given treatment. In, India such equipment are not easily available. According to Dr Ashish Contractor, Head— Preventive Cardiology and Rehabilitation at the Asian Heart Institute, Mumbai, currently research in sports medicine also needs to concentrate on areas like sports performance for athletes and sports injury.

International journals related to sports are not easily available to Indian students to study the current trends in the international sports medicine scenario. According to Dr Sancheti, adequate funds are not available for students to conduct research in sports medicine. Blind application of western ideology and training methods will not help Indian athletes. "Organised research using Indian athletes will help in understanding the Indian body and mindset to achieve better results in international events. The sports bodies/ federations/ associations along with educational institutions will need to take initiative to improve the standard of research and its application," says Dr Sancheti. Lessons need to be learnt from countries like China who through their indigenous research and application of sports medicine and sports science won several medals during the Olympic Games.

Challenging Grounds

Speed testing equipment

The major roadblock for the development of sports medicine segment in India is said to be the unavailability of trained sport medicine physicians in India. Very few medical students tend to show inclination towards choosing sports medicine as a specialisation. "It is hard to blame them, as there is perception of limited employment/ career opportunities, which is making the sector less attractive," shares Kanakia. On the contrary, only short-term certificate or diploma courses are offered without specialist training compared to western countries where they are moving on to super specialisation in sports medicine. Hence, the lack of sports specialists for such a huge country like ours. On the other hand, there is increasing number of sportspersons and people of all age groups involving themselves in physical activities. As Dr Pardiwala puts it, there are not specialised courses offered in India for surgeons who would like to specialise in the clinical aspect of sports medicine, and therefore have to go abroad for course and training thereafter.

There is a pressing need for development of healthcare facilities for treating sports related injuries which are cost effective so that they are easily accessible to vast majority of sportsmen and athletes who are otherwise unable to afford expensive treatment due to lack of funding support by the Government or sports institutions in most cases.

According to Kanakia, to change this situation, the administrative and sports bodies can make a difference by spreading awareness of physical fitness amongst sports enthusiasts and by recognising sports physicians in the same way as prominent medical professionals. There should be separate budget allocations by both central and state Governments towards research in the field of sports medicine, sports science and allied sciences. The administration can publicise the achievement of individual athletes to encourage sports enthusiasts to lift their performance levels. "For example, Haryana athletes (in shooting, boxing and wrestling) have set great examples for Haryana Government to promote the concept of training and fitness amongst masses," adds Kanakia.

Opportunities Galore

Sports medicine segment has brought business opportunities in abundance for suppliers/ dealers of international class sports medicine related equipment for setting up state of the infrastructure to provide all the related facilities. For example, suppliers/ dealers of the equipment like electrotherapy, biomechanical analysis equipment, sports rehabilitation aids - rehab gyms, exercise bands, braces, supports and sports tapes, sports nutrition supplements, sports testing and performance enhancement equipment have tremendous scope. Further, the corporate industry has a great opportunity to sponsor athletes in various sports. Sponsorships at the local and state level will help to lift up the standard of the sport at the grass root level. The insurance sector can also play an important role by providing medical insurance to athletes. Affordable insurance will benefit the athlete to get immediate medical attention and proper treatment from a specialist in sports medicine. Educational institutions can also benefit by training personnel in the field of sports medicine. Ideal courses should be designed for surgeons, physicians, physiotherapist and trainers to educate those regarding sports medicine and sports science. This will also give an opportunity for the students to research in the related fields.

The Road Ahead

Presently, the industry offering in terms of sports medicine has been largely restricted to diagnosis and treatment of injuries, specifically the rotation or deformation of joints or muscles. Going forward, the trend would shift towards preventive sport medicine wherein it is forecasted that the healthcare players would offer fitness regimes and preventive therapies to avert sports-related injuries and help athletes perform better. With concentrated efforts from the Government, research bodies and healthcare players, this yet disorganised field has the potential to slowly but steadily lead India to become a true sporting nation.

sonal.shukla@expressindia.com