Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the late 20th century that sports medicine has emerged as a distinct field of health care. Sports medicine physicians have completed medical school, specialized in residency training, and then specialize further in sports medicine or 'sports and exercise medicine' (the preferred term). Specialization in sports medicine may be a doctor's first specialty (as in Australia, Netherlands, Norway, Italy). It may also be a sub-specialty or second specialization following a specialization such as physiatry, family medicine, paediatrics or orthopedic surgery. The various approaches reflect the medical culture in different countries. Specializing in the treatment of athletes and other physically active individuals, sports and exercise medicine physicians have extensive education in musculoskeletal medicine. SEM doctors treat injuries such as muscle, ligament, tendon and bone problems, but may also treat chronic illnesses that can affect physical performance, such as asthma and diabetes. SEM doctors also advise on managing and preventing injuries.