Your knee has been aching for six weeks. It is not getting worse, but it is not getting better either, and running is off the table. You search for help and immediately hit a fork in the road: a primary care sports medicine physician, or an orthopedic surgeon?
It is a fair question, and the answer is less about which specialty is better and more about what problem is causing the pain. The two roles are designed to work together, and most people benefit from understanding the order rather than picking a side.
Two specialties, one shared goal
Both non-surgical sports medicine physicians and orthopedic surgeons treat the musculoskeletal system: bones, joints, muscles, tendons, and ligaments. They train differently and they use different tools, but they are pointed at the same outcome, which is getting you back to what you want to do.
The simplest way to think about it: a primary care sports medicine physician handles the large majority of musculoskeletal problems that do not need an operation. An orthopedic surgeon handles the ones that do. Neither replaces the other.
What a primary care sports medicine physician does
Primary care sports medicine is a specialty many people have never heard of. These are physicians trained first in a primary care field such as family medicine, then further trained in musculoskeletal and sports medicine. They work with athletes, teams, and schools, as well as everyday people. They do not operate.
Their work usually includes:
- Diagnosis. A detailed history and hands-on exam, often with in-office ultrasound to look at tendons, ligaments, and joints in real time.
- Non-surgical treatment. Activity modification, rehabilitation planning, bracing, medication where appropriate, and injections like steroids, NSAIDs, anesthetic, and ultrasound-guided PRP.
- Load and training management. Working out why the tissue became painful in the first place, which is often about how much, how fast or how differently you were loading it.
- Concussion evaluation and management, including return-to-play decisions. We covered concussion signs for parents separately.
- Knowing when to refer. Recognizing the injuries that belong in a surgeon’s hands, and sending them there promptly.
What an orthopedic surgeon does
Orthopedic surgeons complete a surgical residency and often a further fellowship in a specific area such as the knee, shoulder, spine, hand, or foot and ankle. Many subspecialize narrowly, which is exactly what you want when you need an operation.
They are the right physician for fractures needing fixation, some tendon ruptures, joint replacements, structural problems that have not responded to good non-surgical care, and anything where the anatomy itself needs to be repaired or rebuilt. When an injury needs surgery, an orthopedic surgeon’s expertise is not a second opinion, it is the treatment.
Why starting with sports medicine often makes sense
For a problem that has come on gradually, or an injury that is painful but not clearly structural, a sports medicine evaluation is usually a sensible first step. A few reasons:
- Many musculoskeletal problems are not surgical problems. Tendon pains, muscle strains, overuse injuries, joint pain from arthritis, and mechanical issues generally respond to non-surgical care, and current guidance generally favors trying that first for many of these conditions.
- The diagnosis may not be what you assume. Shoulder pain can come from the rotator cuff, the biceps tendon, the joint itself, or even the neck. Knee pain in runners may trace back to the hip. An unhurried exam sorts that out before anyone plans a procedure.
- You may avoid an unnecessary scan. Imaging is sometimes essential and sometimes just finds red herrings that were never the source of pain. A good exam helps decide which imaging test, if any, helps diagnose the issue.
- If you do need a surgeon, you arrive better prepared. Turning up with a clear history, a considered exam, and a record of what has already been tried makes a surgical consultation far more productive.
When to go straight to a surgeon or the emergency department
Some injuries should not wait for a stepwise approach. Please seek emergency care right away for:
- An obvious deformity of a limb or joint, or a joint that appears dislocated.
- An open wound over a broken bone.I
- Numbness, a cold or pale limb, or loss of pulse below an injury.
- Rapid, severe swelling immediately after trauma.
- A joint that is hot, red and severely painful with fever, which can indicate infection.
- Back pain with loss of bladder or bowel control, or new weakness in the legs.
Outside of those, a knee that locks or gives way repeatedly, a shoulder that has dislocated more than once, or a problem that has genuinely not improved after a reasonable course of non-surgical care may all have surgical options, and a primary care sports medicine physician can help arrange sirgical consultation for you.
What a sports medicine visit at Ridgeview looks like
Expect a conversation before an examination. How the injury started, what you were doing in the weeks before, what makes it better or worse, what you are trying to get back to. Then a hands-on exam, watching how you move, and ultrasound in the room if it helps answer the question.
From there you should leave with a working diagnosis in plain language, a plan you understand, and a clear sense of what should change and by when. Having time for that is much of the point of how longer appointments work. A partial list of common conditions seen is on the sports medicine page.
How referring out actually works
Referral is not a failure of the first visit. It is part of the job. When an injury needs a surgeon, the useful thing a sports medicine physician can do is recognize it, get the right imaging beforehand where appropriate, point you to a surgeon suited to that specific problem, and stay involved afterwards if a surgery is only a part of the treatment of all symptoms.
Dr. Kroner’s sports medicine experience runs from professional and Olympic athletes to high school sidelines, and a good deal of that work is coordination: knowing which problems need an operation, which need patience and a plan, and who to call. A direct primary care membership is not health insurance, so specialist and surgical care will run through your own coverage.
Get the problem looked at properly
Dr. Christopher Kroner, MD MPH, has practiced family and sports medicine since 2013, including twelve years of full-time academic practice training medical students, residents, and fellows. If something has been nagging for weeks and you are not sure who to call, that is a good reason to start with an evaluation rather than another few weeks of waiting. Ridgeview also offers sports physicals for athletes of any age who are Ridgeview Direct Primary Care members or non-members who cannot get their physical done with their regular primary doctors or who have particular medical or injury issues that bring special considerations to sport clearance.
Ridgeview Direct Care is at 4045 Wadsworth Blvd #300 in Wheat Ridge, open Monday through Friday, and serves patients from Arvada, Lakewood, Golden, Edgewater and west Denver.
Book a free 30-minute meet and greet with Dr. Kroner or call 720-807-9961.
This article is for general educational purposes only and is not medical advice. Please see our medical disclaimer.