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Comprehensive Athlete and Sports Medicine Care Through Physiatry – An Integrative Approach to Physical Health and Performance Management

July 28, 2025

Physiatrists specializing in sports medicine bring a distinctive perspective to musculoskeletal care, one that is grounded in whole-body assessment, patient-centered education, and nonsurgical care coordination. Ryan Nussbaum, DO, is helping to shape this model of care for patients and trainees alike through his clinical and educational leadership roles in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine and UPMC Rehabilitation Institute.

Dr. Nussbaum directs the department’s Sports Medicine Fellowship program and serves as a team physician for multiple high school, college, and adaptive sports organizations in the Pittsburgh region. His clinical practice includes care of acute and chronic musculoskeletal injuries, peripheral nerve conditions, and performance-related concerns in athletes and physically active individuals across a wide range of ages and activity levels.

Care for Athletes at All Levels, Not Just the Elite

One of the fundamental misunderstandings about sports medicine in the public’s perception is that it is a type of care or specialty reserved for elite or professional athletes. In reality, many patients seen by physiatrists specializing in sports medicine are recreationally active individuals, aging adults managing overuse injuries, or those seeking to maintain functional mobility despite musculoskeletal pain or limitations.

“Not everyone is on a sports team. We often treat individuals who may be active on weekends, or who are trying to stay physically engaged as they age. The population we serve is much broader than the world of competitive athletics,” says Dr. Nussbaum.

The emphasis on comprehensive, nonsurgical musculoskeletal care is central to the physiatry approach.

“We diagnose, educate, and empower patients by laying out their options, helping them make decisions that fit their goals and preferences,” says Dr. Nussbaum. “Often, the most powerful intervention is not a procedure, it’s helping a patient understand their problem, navigate the health care system, and access the right rehabilitative support at the right time.”

The Benefits of a Generalist Musculoskeletal Perspective

Unlike subspecialists who focus narrowly on a single joint or anatomical region, physiatrists are trained to assess and manage musculoskeletal and nerve-related issues across the entire body.

“A patient might present with knee pain, but the underlying contributors could include biomechanics, gait, or even another joint. We’re positioned to address multiple areas within the same visit and take a holistic view of function,” says Dr. Nussbaum.

Physiatrists also play an important clinical role in multidisciplinary networks, serving as connectors between primary care, orthopedic surgery, rehabilitation, and behavioral health providers.

“We know how to get patients to the right place when surgery is indicated, but we also have the time and perspective to guide them through conservative options first.”

The Value of Ultrasound in Musculoskeletal Care

One area where physiatrists have advanced practice in recent years is in study and use of musculoskeletal ultrasound, as a diagnostic imaging modality and for image-guided injections or other procedures.

“Ultrasound allows us to assess how tissues move and respond during motion, which often leads to a diagnosis and treatment plan during the same visit. It provides immediate, real-time feedback that static imaging cannot,” says Dr. Nussbaum.

The approach also facilitates precision in targeted treatments.

“There’s strong evidence that image-guided injections are more accurate and potentially more effective when conducted using ultrasound guidance,” says Dr. Nussbuam. “Use of MSK ultrasound has become a national training standard for sports medicine fellows, and UPMC has been a leader in incorporating that into both education and clinical care.”

Team Coverage and Adaptive Sports Medicine

In addition to his outpatient practice, Dr. Nussbaum serves as a team physician for Duquesne University, Penn Hills High School, Sewickley Academy and adaptive sports organizations, including the Pittsburgh Steelwheelers and the Mighty Penguins sled hockey team.

“Providing care for athletes with disabilities has been a particularly meaningful aspect of our work, and it’s an area where physiatry brings unique expertise and understanding,” says Dr. Nussbaum.

Team-based coverage allows physiatrists to work alongside providers from other disciplines, including family medicine, internal medicine, emergency medicine, and orthopaedic surgery. At the collegiate level, teams typically have both nonoperative and surgical physicians assigned to them. “It’s a collaborative model that centers on the needs of the athlete to aid in injury recovery but also performance.”

Extending Multidimensional Care Beyond the Academic Setting

The comprehensive, team-based model seen in academic and collegiate settings offers significant benefits for athlete health and performance. Yet even outside these systems, many of the same principles can be applied.

“There are real opportunities to extend this level of care through digital tools, remote monitoring, and patient education platforms. For motivated individuals, we can help replicate a multidisciplinary experience even if they’re not part of an organized program,” says Dr. Nussbaum.

By leveraging emerging technologies and individualized guidance, physiatrists can bring key elements of performance medicine to the broader community, namely the large proportion of patients who are recreationally active individuals and may not have access to formal athletic services but are seeking high-quality, function-oriented care.

Collaborative Care Models for Athletic Recovery and Optimization

The importance of multidisciplinary collaboration in athlete care, particularly for collegiate-level and elite amateur athletes is highly valued. At institutions such as Duquesne University, athlete care models are built around coordination among sports medicine physicians, athletic trainers, physical therapists, strength and conditioning coaches, and other specialists involved in performance and recovery.

“As team physicians, we are responsible for directing athlete-centered care. That includes diagnosing injuries and guiding return-to-play decisions, while working closely with athletic trainers, therapists, and others to ensure the care plan supports the athlete’s goals and well-being,” says Dr. Nussbaum.

Athlete recovery often involves managing complex injuries that require communication across disciplines.

“In cases involving complex injuries and illnesses, recovery may require the coordinated input of several professionals,” says Dr. Nussbaum.

Preparing the Next Generation of Sports Medicine Physiatrists

Through his role as fellowship director, Dr. Nussbaum is training future leaders in nonoperative sports medicine. Physiatrists have been steadily expanding their presence in this space, alongside traditional pathways from family medicine. The sports medicine fellowship in the Department of Physical Medicine and Rehabilitation aims to develop clinicians how will make an impact in their community and lead at a national level.

“Physiatrists are trained to think across systems. In sports medicine, that translates into a broad view of function, injury risk, and long-term health. Our ability to educate patients and integrate care really makes a difference,” says Dr. Nussbaum.

Fellows gain experience across diverse athletic populations and care settings, including collegiate level, high school level, recreational sports, and adaptive sport programs. They receive comprehensive training in serving as a team physician and in musculoskeletal ultrasound. This breadth of exposure strengthens their readiness to provide comprehensive, inclusive, and functionally oriented sports medicine care.

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