 |
Sports Medicine Introduction
Who Practices Sports MedicineSports medicine is the branch of medicine dealing with athletic injuries and their remedial therapy to return to sport and daily function.
Studies have shown that it is easier to keep someone healthy than to treat them after they have become sick or injured.
Many different groups have used the term "Sports medicine" for their own niche with groups ranging from fitness centres, athletic therapists (trainers), physiotherapists, chiropractors and others all practicing "Sport medicine". For our purposes we will restrict its use to refer to Family Physicians, Orthopaedists or Sports Medicine physicians practicing allopathic evidence based medicine for a population of amateur or professional athletes.
Who are our patients?Sports medicine involves assessing and treating injuries in "athletes"- who are meant to include regular people doing their jobs or pursuing recreational activities. By maintaining people active the risk of heart disease, stroke, and osteoporosis goes down and enables people to have more fulfilment with their lives through socialization. . Other conditions like mental illness and chronic diseases (epilepsy, brain injury, diabetes, and many others) are also modified or improved through regular exercise. There are even studies that show that young girls in organized sport are less likely to smoke, use drugs, have teenage pregnancies and will do better academically. Starting with an active lifestyle early sets patterns for life although as we also know with cardiac rehabilitation programs it is never too late to start! There are clearly many collateral benefits of athletism, which should not be confused with institutionalised sport, which have unfortunately have many negative aspects like aggression (as opposed to assertion), anabolic steroid use, and the "win at any cost mentality". It is possible of course to combine athletism with organized sport but when sports become a business and not fun play that many of the benefits go away.
What are Sports?The definition of Sport also varies widely. Many traditional popular sports are easy to identify- baseball, football, soccer etc. and even have their well-known sports specific illnesses named after them (eg."tennis elbow").
Other new or non-traditional activities may not be formally recognized as such by some (eg. Ultimate Frisbee, Highland Dancing, X-treme sport, and Eco-Racing).
Finally some activities practiced by some would not appear to be very strenuous or complex to outsiders but remain a meaningful activity for their adherents and occasionally they may require need of a Sports Medicine doctor -eg. Table tennis (which can be strenuous), gardening (which can irritate osteoarthritis) and golf (which has repetitive injuries). This last category may receive tremendous relief from a sports medicine approach.
What are not sports Medicine injuries?Also for the purpose of our discussion we will exclude injuries related to workers compensation and chronic pain. The paradigm of sports medicine may be very appropriate for many injured workers but additional factors such as time away from work and insured benefits may complicate assessments. Some sports medicine practitioners actively exclude compensatory injuries and worker compensation cases from their practices and instead refer them to rehabilitation centres that specialize in this area of musculoskeletal medicine.
Injuries that are not improved swiftly may develop into chronic pain syndromes and become difficult to treat. This can occur after routine sports medicine injuries that are misdiagnosed or mistreated.
As a balance to monitor for complications or red flags, new sports medicine practitioners are advised to schedule appropriately frequent follow-ups with patients that they are unsure of, to monitor improvement.
Red Flags to Appropriate DiagnosesSports medicine physicians frequently run across many clients with muscular complaints yet all our patients may not be young healthy adults without prior medical problems. A simple complaint may also be a symptom of a major systemic illness and the sports medicine physician may be the first sentinel health care provider to discover the presence of a major medical problem such as metastatic cancer, inflammatory illness, or cardiovascular disease among many others. Knowing what is clearly not a sports medicine complaint and arranging consultation with the appropriate specialist is also the responsibility of Sports medicine physicians.
Mechanism of InjuryAs in other types of medicine a detailed history will often help establish the correct diagnosis. Although many athletes will state they do not remember how they hurt themselves specific questioning as to what they were doing at the time of the injury, where their weight was and if they felt or heard any telltale snaps or pops.
A concussion victim who cannot remember the correct score at injury is likely to have some antegrade amnesia.
A soccer player may remember 3 consecutive pops as their MCL, ACL and Medial meniscus are being torn in that terrible triad of O'Donahue.
Many "Sports Medicine" injuries occur in people while doing their exercises, hobbies, or work. Usually an acute trauma or overuse precipitates an injury with pain and loss of function. Sports medicine doctors assess the type and the degree of injury and make decisions involving the best treatment. As with many treatments there is no universal treatment so each individuals treatment must be tailored to their degree of injury, demands of daily activity, and expectancies (return to work or to play in an upcoming game).
Return to PlayIt is important to not return an injury to a stressful environment before it is healed. "Too much, too soon" can lead to a larger period of disability by aggravating an injury continually, instead of letting it heal once properly. Often patients and coaches exert considerable pressure for an early return to play. Compliance with an earlier return may also lead to considerable admiration and reputation within that sport. However being in the position of a Team Physician the practitioner must also realize that their opinion is also vulnerable to medicolegal action if something goes wrong and an athlete is reinjured badly.
Many sports medicine injuries are grouped into euphemisms that describe them - "Tennis Elbow", "Rotator Cuff" (Tendonitis), and "Shin Splints" . These are convenient labels but are only descriptive and each entity could represent a group of illnesses. A sports medicine physician should first make a specific diagnosis and then make a specific treatment for that diagnosis.
As practitioners we must first have a history of what happened "mechanisms of injury" as well as events or movements that further affected the injury.
A physical exam then helps narrow the possible diagnoses.
Specialized tests like x-rays will help confirm the diagnosis. After the diagnosis is made (or not made but possibilities suspected) each patient will be assessed for what is best for them. Although each injury is different, some general guidelines are nearly universal in sports medicine. These guidelines can help promote faster healing and prevent further damage.
These are sometimes memorized by the PRICES pneumonic.
Protection - This can mean splinting, removing a player or worker from further activity, or not walking on something that hurts a lot. Protection also means using crutches or a cane if you even suspect something is broken before getting it cleared by an x-ray.
Rest - This includes physical and mental rest. People will heal better if they eat properly, sleep enough and rest the injured part. Non-smokers heal faster than smokers so even cutting back a little will definitely aid in a faster recovery.
Ice - To cool the skin, muscle and ligaments. The decreased temperature acts locally to vasoconstrict blood vessels and limit further bleeding and swelling. Ice has an aesthetic effect to reduce pain as well. Ice also blocks the formation of the "mediators of inflammation" which are released by damaged cells. These mediators are responsible for pain and swelling. By preventing swelling this will facilitate an earlier start in rehabilitation. Ice is best applied for the first 48-72 hours and sometimes longer if there is severe swelling.
Ice should not be applied directly to the skin, but through a towel. Most experts recommend 15-20 minutes at a time to avoid cold damage to the skin. People with very poor circulation or Raymond's Phenomenon (an over developed reflex to cold) should be cautious in applying ice.
Heat should be applied as a moist towel but is not recommended before 72 hours. Heat will cause vasodilatation of blood vessels and lead to increased swelling. After 72 hours as the wound matures, heat may be considered since it will promote better blood flow (helping to nourish the damaged area) and relieve muscle aches. After 72 hours neither heat nor cold need be used exclusively since they are both complementary. Heat can be used prior to starting an activity (or even the day) to "warm up". Cold can be used to decrease swelling and pain after an injury, similarly to "cool down".
Alternatively heat may be followed by cool then heat again in contrasting therapy . Contrasting therapy is used later in the phase of healing and is a useful tool for the rehab therapist.
Compression - Mechanically limits expansive swelling after an injury. Compression may actively make a fracture more painful and suspicious injuries should be examined immediately. Fractures should be treated with splints or casts.
Elevation - The affected limb should be elevated. This is easily accomplished in an ankle or hand injury, but not of any benefit in a hip or back problem. Elevation is suggested to be at least above the level of the heart. The force of gravity helps remove swelling. This is a simple and easy thing to do but often overlooked.
Support - This is similar to protection but also includes fitting people with braces to externally support damaged areas.
Other Modalities After the Prices TreatmentsModalities are treatments used to facilitate healing. They may be used as a choice of treatment or in combination with other treatments. Although they may be beneficial costs may limit their use.
Brief summaries of common modalities follow:
Acupuncture is not a definite cure for serious illnesses, but is useful as an adjuvant therapy.
ExerciseThe most important rehabilitation tool for injuries is exercise. "Exercise is medicine". It is important to return to activity at a controlled rate so as not to re-injure again. Try to avoid "too much, too soon", but at the same time, unnecessary immobilization will lead to more muscle atrophy or loss of cardiovascular fitness. A good therapist can help guide an injured person towards gradually recovering post injury. Maintaining a regular level of fitness (flexibility, strength and endurance) is one of the most powerful (and cheap) preventative measures for good health. Cortisone InjectionsCortisone injections are commonly used for specific injuries where there is a lot of inflammation. Cortisone is a potent anti-inflammatory drug but should be used carefully. The precise administration of this anti-inflammatory drug helps resolve these conditions. Sometimes a clinician only administrates a cortisone injection alone, but it is more important to include a complete rehabilitation program that will involve strengthening the injured part and making sure the injury does not reoccur. One newer concept in sports medicine is "prehabilitation'-working towards making a person stronger and fitter than they were pre-injury so as to prevent another injury.
Cortisone injections should not be injected into tendons as this causes them to weaken and rupture. Also it is generally advised to limit Cortisone injections into weight bearing joints. Cortisone injections are very safe and are sometimes under-used as a method of treatment. Proper knowledge of anatomy, technique, and placing the Cortisone in the exact place yields excellent results.
Sports and WomenGender issues are relevant for a busy sports medicine clinic. Pregnant women fulfil active lifestyles that include recreational and competitive sports. Other groups of women from premenarche girls to post menopausal women have different medical needs that are affected differently by physical activity.
Sports and ChildrenChildren are not just small athletes but have distinct susceptibilities to injury and environment and must be managed with specific care particularly with respect to trauma in immature bones.
Sports and SeniorsSeniors are growing as a segment of the population. Sports medicine may be a solution to preventing or modifying chronic illnesses.
Sports and the DisabledPeople with disability suffer from difficulties in daily life. Sports may be away to enable them to realize and complete goals, improving satisfaction and quality of life. Sports and SupplementationControversies continue to arise regarding supplementation with prohibited substance that harms athletes. This growing problem faces Sport with a changing challenge as new substances continue to be propagated.
Sports and EnvironmentsAthletes are also now exercising in a variety of new sports in new environments. Extreme sports have increased in popularity. Practitioners may have patients ask more questions about SCUBA diving, High Altitude Illnesses and Tropical Climates
Sports and Infectious DiseasesAwareness has increased on the risk of infectious diseases in Sport. Hepatitis B and HIV are occasionally in the news yet many athletes who may be high risk for infection need to be educated on how to prevent infections.
SummaryA sports medicine conference may encompass more than muscles and bones and can become a full practice as a physician helps establish an active living program for his or her patients.
|
|
|
