Interviewed by Dr Boris Gojanovic, SEMS president
Dear Dr Noack, can you tell us how and why you got interested in becoming a sports and exercise medicine doctor?
PN: Well like most sports medicine doctors, I think everybody has been involved or interested in sports personally. I did athletics myself as a middle distance runner with moderate talent. Later, my first professional interests moved towards becoming a teacher in physical education, but as I went to the military academy in Magglingen, I saw what it meant to do sports every day, and additionally as a hobby on top of the job. That felt like too much sports for me.
I then got interested in medicine and it was always my wish to combine profession and hobby, being sports and medicine. So that’s why I landed as a sports medicine doctor.
What is now your involvement in sports and exercise medicine at the elite level?
My affinity goes really into endurance sports, so that I have been a team doctor for Swiss Triathlon since 2005, quite a long time now. Then I joined Swiss Athletics and Swiss Cycling in 2014. I have been looking after our Swiss cross-country team between 2007 and 2020. I had to hand-over some of those responsibilities, as the time had come to move on and promote some younger colleagues.
I have also been to the Olympics eight times, from Beijing 2008 to Beijing 2022, and I could nicely close that circle, so to speak.
What is your current medical activity (or activities)?
I work at the Medbase Swiss Olympic medical center in Abtwil, St. Gallen. It is a multi-disciplinary medical cabinet, with sports medicine, internal medicine, orthopedics, rheumatology, cardiology, endocrinology, along with physiotherapy, osteopathy and performance diagnostics all in one place.
When I did my formation as an intern in 2005 in Magglingen I witnessed and experienced the benefits of having all the various competencies under one roof. This is of great help to athletes, but also our usual patients.
What percentage of your activity is about sports medicine and athletes, in comparison to medicine in general?
I have always wanted to keep a foot in general medicine, because I think it is good to stay up-to-date, especially if you go on a mission with federations or to some championships, as you need all the tricks from general medicine. So my activity covers about 20 percent of general internal medicine, and the remaining 80 percent are my main sports medicine activity.
Why do you care about SEMS courses and contributing?
During medical studies, I really really disliked “bad lectures”. You know, when you are sitting and listening, whilst thinking: “hmm, this topic sounds interesting…”, but then you have to sit there and suffer sixty minutes of bad lecturing. After that, you have two different ways of going about it. One is to say, well, that this was during education and “that’s it”. Or, you can maybe pledge to try to do it better at some stage. This is was one of my motivations. The second is, as I mentioned before, that I had always been interesting in becoming a physical education teacher and being involved in educating young people. Sharing knowledge has always been appealing to me. Those were the two main motivators. A third motivator is that my work in a multidisciplinary center requires a certain spirit of sharing within the team and with the younger ones, in the sense of the team spirit. It is important to break the hierarchies between professions, so that we don’t position doctors at a certain level and physiotherapists at another level. The teamwork makes the difference when we look after athletes and hope to be successful.
Tell us about your course: what is it about and how have you constructed it?
When we discussed on which center should be running with course content, it was a fast decision, since we have a pediatric sports medicine expert with Dr Daniela Marx-Berger. I always loved this exchange with her and the children’s hospital, because in youth and adolescent sports medicine, one can have a lot of impact. When you look at elite athletes, at some point, they have their mind and set-up well in place and it is more difficult to influence and bring some changes. With the younger ones, you can really establish that habit of working with the sports medicine people. The younger you go down the athlete pool in a federation, the better they can learn at a young age and this makes it easier and more efficient to work with them later on. This was the main motivation to do pediatric and youth sports medicine for the course in our center.
Can you give us a break-down to the topics you are covering in the course in Abtwil?
Of course. We want ideally to do a course as practical as possible, but in pediatric and youth, you cannot get around some theoretical aspects, especially the physiology of growth and the curves. All those things you can easily forget when you are doing a pre-participation examination. We address the collaboration with sports schools and the federation, which have really young athletes, this is one of the main topics.
Then, the 3 workshops are really a centerpiece in our course:
– The spine, very practical/clinical view, which brings very good ratings in our course.
– What to look at on the field, and what you should have ion your emergency bag towards young athlete problems (dosages, medication, etc.).
– How to do an annual sports medicine exam. Focusing also on growing aspects, zones, tendons, etc.
How do you make your course memorable for future SEM doctors?
I think it is worthwhile to do practical examples and present the challenging cases: what went wrong and can one can do better? This is something that is memorable. We learnt that from our professor in physiology: The lectures, which are in the middle – not bad, but also not good –, are not memorable. Contrary to the bad ones and the good ones, which are memorable. One needs to hear about the bad situations and the challenging cases to make it memorable, to do better and not miss something the next times it comes around.
We also integrate a sports activity for the participants, and we choose to expose them to a crossfit session at our nearby center. We make sure everybody can attend, even the person who may have some small injury. There is always something you can do there and good memories to make. After a full day of courses and lectures, we know the benefit of breaking a sweat as a medical practitioner. The sharing of the activity and the social gathering makes it even better for all participants.
Do you manage to do some regular sports yourself?
Yes, Be active yourself! I try to do sports myself 4 to 5 times a week, even if it is just 30 minutes. I have always managed to keep that amount of activity regularly. You cannot only tell people to move, you have to lead by example.
What are the main medical challenges for the SEM field?
One main challenge is the recognition of sports medicine towards other fields, like for example orthopedic surgery. Understanding that the sports medicine doctor has an extensive and complementary knowledge. The second challenge is to find motivated people, who are not only wanting to do sports medicine, but “living” sports medicine in the process. It is not only an 8 to 5 job, it is sometimes in the evening, on the weekends, you can be 10 days away, or even 4 to 5 weeks for the Olympic Games. This is more demanding than some aspirations to work at 80% and “not on the weekends please” that we hear about sometimes, which are not compatible with an active sports medicine career.
Over your time in sports medicine, have you seen an evolution with regard to the recognition aspects you just mentioned?
Recognition from the federations, coaches, athletes: yes. Politically, from the FMH, we are still waiting for some positive signs on the tariffs side to validate our expertise. If you compare with a neighbor specialty like orthopedics, they benefit from specific Tarmed positions for specialty examination, which the general sports medicine doctor does not have access to. This has to change.
How do you see the role of SEMS in education beyond the courses?
That is a really important point. We not only have to do the courses to get our education, but there is a necessity of ongoing further education. Not just the annual congress, but additional events between. For example, local quality circles where sports medicine doctors meet and exchange. This should benefit from education credits as well to support these activities. I like also to see that there some regular presence in the ongoing education space, also on social media, with a strong SEMS voice.
If I had a wish… (what would be your number one wish for the future, can be personal or professional).
The course are full and people are the waiting list, but sometimes when you see people active in the field, there still a “delta”, so to speak. I wish that more people who do the courses later would succeed to have an active role in a club or a federation. I understand this is not always easy as there are other life demands, like family, etc.
If I had more wishes… (other things that would like to do, see happen, facilitate, etc… SEMS-related, or not only).
As I mentioned previously, I would love to see a better recognition of the expertise sports medicine brings in the areas of muscles, joints and tendons, so that general practitioners would not feel they need to send everyone to an orthopedic surgeon. This is especially true in the case of long lasting problems, where we are probably the better suited professionals for this management.
What would you say are the strengths of sports and exercise medicine?
I think that we have this global approach and overview of the athlete, not only focusing on single joints, like the knee, the foot or the shoulder. Our interest is really for the whole body of the athlete. I believe that we should use this strength more and have more self-esteem in our profession and abilities to play that role.
What is your advice to a younger self, entering the SEMS curriculum?
I would say that the “salary” of sports medicine is to be there “live”. You get to see and experience so many things in the worlds of sports at the highest levels. You get to live this with the athletes, all the emotions, and this is unpayable. Keep on going with your courses and your education, and become a SEMS doctor, it is really worth the effort.
Anything else you would like to share with us?
Sometimes you look back and ask: “would I have done something else in my career”? Every time I am on the field or have an athlete in consultation, I feel that this is where I belong and I would not change anything. If you are convinced that this is what you want, look at the obstacles in front and find ways to overcome them to meet your passion. If you have chosen it, then simply do it!