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, Orthopedists or Sports Medicine physicians practicing allopathic evidence based medicine for a population of amateur or professional athletes.
Manitoba Health covers these insured visits so there is no charge. We only accept appointments but can squeeze in people with urgent problems or injuries as same day appointments. We no longer see patients for Workers Compensation or Autopac injuries but can refer them to other clinics that do.
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's ability to stay active the risk of heart disease, stroke, and osteoporosis decreases 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. Evidence shows that young girls in organized sport are less likely to smoke, less likely to use drugs, have less teenage pregnancies and will often do better academically. Starting with an active lifestyle early sets patterns throughout life and from what we know from cardiac rehabilitation programs -it is never too late to start an exercise program! There are clearly many collateral benefits of athleticism. This should not be confused with institutionalized sport which unfortunately often involves many negative aspects such as aggression (as opposed to assertion), anabolic steroid use, and the "win at any cost mentality"). It is possible of course to combine athleticism with organized sport but when sports become a business and not fun play, many of these benefits go away.

Defining 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 euphemisms for injuries.
Other new or non-traditional activities may not be formally recognized as such by some (i.e. 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. (i.e. 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. Our clinic takes a broad liberalization of what are considered sports where our clients range from Highland Games participants to ballet dancers to yoga practitioners. All of these groups have a central focus around a meaningful activity that may or may not give rise to specific accidents or overuse injuries causing those problems. As Sports Medicine practioners we look for sport specific patterns of injury, which often assist us in making our diagnoses.

Practitioners who treat sports injuries:

Massage Therapy - a licensed profession regulated by a Manitoban body. Licensed therapists are covered under much insurance coverage. Massage therapy is beneficial in the relief of muscular soreness and tension. It is not a substitute for an active exercise program.

Athletic Therapy - Athletic therapists are therapists whose primary focus is rehabilitating athletes back towards competition. They share many features with physiotherapists. Both groups will design a rehabilitation program based on the severity of injury and the progress made in therapy. Many insurance companies will reimburse athletic therapy.

Personal Trainers. Although this term is frequently used by many people, in Manitoba the Manitoba Exercise Professionals Associations publishes a list of personal trainers with their contact numbers and qualifications.

Physical Therapy (Physiotherapy) - is a profession that rehabilitates injured people. It may encompass several other disciplines such as chest physiotherapy (helping people with emphysema) and neurological physiotherapy (helping people with neurological diseases cope and recover). Sports physiotherapy will help assess a problem, design a program, and follow the person during recovery. Often feedback from a physician helps optimize the medication and rehabilitation.
Occupational Therapy - Occupational Therapists assess disabilities and may fashion customized splints for specific injuries (which may be superior to store bought ones). They can also do home assessments to look for how a home is set up for a disabled person and suggest modifications. This is a diverse specialty with many other activities.
For more information contact: http://www.msot.mb.ca/index.html

Podiatrists (Chiropodist, foot doctors) - specialists who deal with foot problems including designing proper Orthotics. In Manitoba, Physiotherapists, Athletic Therapists and Chiropractors also will make Orthotics.

Orthopedic Surgeons - "Orthopods" are surgeons who fix bone and musculoskeletal injuries, especially poorly healing fractures and arthritis related complications. Before being referred to an Orthopod, most people first try several doctors, therapists and medications. Some injuries should be reviewed by an Orthopedic doctor immediately, as they most likely won't heal properly if left on their own. Torn cartilage in the knee and shoulder are good examples of injuries that should be at least reviewed by an orthopedic surgeon since the surgical "fix" is often straightforward and you can often relieve much unnecessary suffering. Usually sports medicine physicians and other doctors act as "gate keepers" who have prompt access to referring to orthopedic doctors when appropriate.

Who are our (players) patients?
Sports medicine involves assessing and treating injuries in "athletes"- who are meant to include regular people doing their jobs or pursuing recreational activities. Through maintaining people's lifestyles 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 positively 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 they will do better academically as well. Starting with active lifestyle early sets patterns for life. We also know with cardiac rehabilitation programs it is never too late to start no matter how old someone is! There are clearly many collateral benefits of athletism. Active living should not be confused with institutionalized sport, which unfortunately has many negative aspects such as 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 many of the benefits go away.

Red flags to appropriate diagnoses
Sports medicine physicians frequently run across many clients with muscular complaints, yet all our patients may not be young healthy adults without any 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 very important.

Mechanism of injury
As in other types of medicine a detailed history will often help establish the correct diagnosis. Although many athletes will state that they do not remember how they hurt themselves, specific questioning such 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. The athlete is often very focuses on their game play so by focusing on what occurred during a game may give some valuable clues to clinician. A soccer player may remember 3 consecutive pops as their MCL, ACL and Medial meniscus are being torn in that terrible triad of injury. A concussion victim who cannot remember the correct score of the game when they were injured is likely to have some antegrade amnesia.
Many "Sports Medicine" injuries occur in people while doing their regular exercises, hobbies, or work. Usually an acute trauma or overuse precipitates an injury accompanied 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 individual's 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).

Clearance and return to play
It 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 requests for earlier return to play 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.

Classic Sports Medicine Injuries
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 could each 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 "the 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.

The PRICE Principle

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 anaesthetic 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 those who have Raynaud'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 to use before 72 hours have elapsed. 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 to "warm up". Cold can be used to decrease swelling and pain after an injury, similar to "cool down".
Alternatively heat may be followed by cold 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 is 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 is often overlooked.

Support - This is similar to protection but also includes fitting people with braces to externally support damaged areas.

Modalities
Modalities are treatments used to facilitate healing. Heat and cold are very simple, effective and inexpensive modalities tat work very well. Other examples include:
1) Therapeutic ultrasound - used to deliver heat to deep tissues. This helps circulation which aids healing. It should not be confused with diagnostic ultrasound, which uses a different frequency in order to examine organs.
2) Muscle stimulation - this stimulation occurs as electrodes are attached to the skin causing muscles to twitch. This can be useful in severe injuries, helping to teach muscles to fire in a coordinated fashion
3) Ionophoresis or phonophoresis are 2 different procedures whereby medication is delivered deep into tissues using either a charged medication via electrical current (Ionophoresis) or medication administered with ultrasound. (phonophosesis). They are both uncommon modalities but can be used effectively in some cases.
4) Ergogenic medication - We do not recommend or endorse any enhancing nutraceutical (drug like foods), vitamins, stimulants, or medication to assist healing. Despite great claims they are still too good to be true. At present the best ergogenic plan is to drink enough water, follow the Canada Food Guide www.hc-sc.gc.ca/hppb/nutrition/pube/foodguid/index.html and get enough sleep.
5) Acupuncture exists in many forms and is used differently by diverse practitioners. A licensed acupuncturist uses acupuncture as a modality for relieving pain or stress.

Cortisone Injections
Cortisone injections are used for specific injuries where there is a lot of inflammation. Cortisone is a potent anti-inflammatory drug but should be used carefully. Some conditions that are benefited by cortisone shots include: Tennis Elbow, Rotator Cuff Tendonitis, and types of bursitis. The precise administration of this anti-inflammatory drug helps resolve these conditions. Sometimes only a cortisone injection is used, but it is more important to use cortisone in conjunction with a complete program that also works towards strengthening the injured part and making sure the injury does not reoccur. 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 to weight bearing joints. Cortisone injections may cause a steroid flare, which will aggravate the joint for a few days. This is actually a reaction to the preservative and does not affect the drugs chance of success.
Cortisone injections are very safe and are sometimes underused as a method of treatment. Patients should be selected so that only those whom would optimally benefit to being injected are given Cortisone. Proper knowledge of anatomy, technique, and placing of the Cortisone in the exact place yields best results.

Exercise
The 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.