India's medical colleges were built around infectious disease, maternal health, and trauma โ not performance medicine. Sports medicine was treated as a luxury until the National Medical Commission recognised it as a specialty in 2018, yet structured postgraduate training remains thin. As of 2025, fewer than fifteen medical institutions offer a formal postgraduate diploma or degree in sports medicine, and most are concentrated in metro cities. Orthopaedic surgeons focus on fractures and replacements; physiotherapists handle rehab protocols; the physician who integrates load management, imaging decisions, and return-to-sport clearance is rare. Cricket illustrates the gap: the national team has advanced support, but club and district players often see only a team physio. The amateur fitness boom since 2015 increased knee surgeries and shin pain clinics, yet supply of specialists did not follow. Private hospitals in Mumbai and Bengaluru now market sports clinics, but geography and price exclude most Indians. Until residency capacity exists, the bottleneck will remain.