How to bluff your way in Sport Exercise Medicine

1. 03/06/2012 1 How to bluff your way in Sport & Exercise Medicine Patrick Milroy

2. 03/06/2012 2 Introduction Sport & Exercise Medicine became the 58th Medical Speciality in February 2005 Patients will know this and expect you to show knowledge & competence

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5. 03/06/2012 5 Basic knowledge  Rest Ice Compression Elevation

6. 03/06/2012 6 The myth of REST - affected part only - soft tissues for ?48 hours (beware myositis ossificans, particularly in the thigh)

7. 03/06/2012 7 Rest

8. 03/06/2012 8 Rehabilitation Aim to restore a) Range and flexibility of movement b) Power Joints must have a full and painless range of movement

9. 03/06/2012 9 Hand Movements

10. 03/06/2012 10 How to rehabilitate a) Stretch (to discomfort) b) Massage (with ice cube) c) Controlled stretching movements

11. 03/06/2012 11 Adductor Stretch

12. 03/06/2012 12 Hamstring Stretch

13. 03/06/2012 13 Most Commonly seen sporting conditions seen in GP Practice Muscle and soft tissue tears and strains Epicondylitis Anterior knee pain Calf and Achilles pain Stress Fractures Ankle sprains Foot pain

14. 03/06/2012 14 Epicondylitis Lateral more common than medial Pain often felt elsewhere than over epicondyle

15. 03/06/2012 15 Diagnosis History - lifting kettle or opening door

16. 03/06/2012 16 Treatment of lateral epicondylitis a) Inject with steroid - not more than 2-3 times over 12 months

17. 03/06/2012 17 Tennis Elbow overuse steroids

18. 03/06/2012 18 b) Examine the racket

19. 03/06/2012 19 c) Stretch wrist and use ice massage

20. 03/06/2012 20 d) Epicondylitis Clasp

21. 03/06/2012 21 Anterior knee pain (AKP) a. Osteo- chondritis (Osgood Schlatter's Disease)

22. 03/06/2012 22 Osgood Schlatter's

23. 03/06/2012 23 Treatment of Osgood Schlatter's Disease Do not give NSAID's prior to Play All recover eventually Allow to play within limits of pain (?up to half time) Perform quadriceps exercises without weights Apply ice packs 2-3 times per day

24. 03/06/2012 24 Patello-Femoral pain (used to be called Chondromalacia Patellae) a. Causes up to 50% of AKP b. Sometimes sudden pain, sometimes persistent ache in knee c. Pain stops on ceasing activity d. History of stair pain

25. 03/06/2012 25 Examination of Patello-Femoral pain a) No effusion (may have swelling of infra-patellar fat pads - Hoffa's Syndrome) b) Quadriceps (Vastus Medialis) wasting c) Tight hamstrings (discomfort on hyperextension) d) Sunrise view X-Rays may show cartilage degeneration e) Positive Clarke's Test

26. 03/06/2012 26 Clarke�s Test

27. 03/06/2012 27 Causes of Anterior Knee Pain a) Large Q Angle

28. 03/06/2012 28 Q Angle

29. 03/06/2012 29 b) Abnormal patellar anatomy c) Females d) Genu Valgum e) Pronation

30. 03/06/2012 30 Gross Pronation

31. 03/06/2012 31 Grossly pronated foot f) Occupational (bent knee overuse)

32. 03/06/2012 32 Treatment of Patello-Femoral pain a) STRAIGHT leg quadriceps exercises as Vastus Medialis only reacts in last 10 degrees of extension)

33. 03/06/2012 33 Straight leg quads

34. 03/06/2012 34 b) Stretch Hamstrings c) Obtain orthotics (for pronators) or wear appropriate training shoes. d) Run faster! e) Avoid squats, shuffling and long distance driving.

35. 03/06/2012 35 Stress fractures Most common sites a) Wrist (gymnasts) b) Lumbar area c) Pelvis d) Femur e) Tibia & Fibula (one third of length)

36. 03/06/2012 36 Stress # Tibia f) Metatarsals

37. 03/06/2012 37 Stress # 3rd MT

38. 03/06/2012 38 Symptoms of stress fractures CRESCENDO Pain

39. 03/06/2012 39 Signs a) Deep tenderness b) Positive MRI scan c) X-Rays only positive later d) Positive ultra-sound test e) Osteoporosis?

40. 03/06/2012 40 Treatment a) Active rest b) Stress fractures heal in approximately half the time of a normal fracture c) Avoidance of provoking activities d) Recurrent stress fractures at the same site are uncommon

41. 03/06/2012 41 Achilles Tendon Pain Symptoms a) Take-off pain when walking or running b) Early morning stiffness easing as patient walks around

42. 03/06/2012 42 Signs with Achilles Tendon pain a) Swelling

43. 03/06/2012 43 Swollen TA

44. 03/06/2012 44 b) Crepitus c) Local tenderness of soft and bony tissues d) Pronated feet (causes torsional stresses to Achilles Tendon) e) Trainers with high backs/ rigid heels/excessive rubbing

45. 03/06/2012 45 Heel tabs high

46. 03/06/2012 46 Half cut heels

47. 03/06/2012 47 Conservative treatment of Achilles Tendon pain

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49. 03/06/2012 49 Plantar fasciitis Causes pain under the heel More common in both excessive pronators and those with pes cavus More common in older sportspersons. Teenagers may have Sever's Disease Due to tearing, inflammation and scarring of plantar fascia

50. 03/06/2012 50 Treatment of Plantar Fasciitis a) Ensure shoes have adequate longitudinal arch support (orthotic) b) Wear soft heel pads as by Bauerfiend

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52. 03/06/2012 52 Other hints a) Verrucas respond to banana skin treatment b) Know what you can prescribe. See BNF c) Never wear new clothing or shoes for competition d) Use petroleum jelly or Savlon on all areas which might be rubbed e) Cut toe nails 3-4 days before competition f) Gilmore's Groin (Sportsman's Hernia) is probably underdiagnosed

53. 03/06/2012 53 Never forget sports players are nearly always highly motivated and want to recover

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