What’s Hot in Sport and Exercise Medicine

1. What’s Hot in Sport and Exercise Medicine • Dr Jon Houghton • MBBS MRCP MFSEM BSc DipSEM PgCert MSK US • Consultant Rheumatologist and Sports Physician • Honorary Senior Lecturer University of Wales Institute Cardiff • Sports Orthopaedics UK

2. Contents • A Brief Introduction • How to advise patients about Exercise • The role of Musculoskeletal Ultrasound • Summary

3. 1999 MRCP • 2000 Rheumatology NTN • 2000 Training in MSK Ultrasound • 2003/04 Diploma in Sports Medicine UCL • 2006 CCT in Rheumatology/GIM • 2006 Consultant DMRC Headley Ct • 2010 Joined Sports Orthopaedics UK

4. Exercise Prescription • Benefits of Exercise • Reduction of mortality from • All forms of Cardiovascular Disease • Diabetes • Cancer • Improved Mental Health • Improved Bone Health

5. Components of Exercise Prescription • Type of exercise or activity • Duration and frequency • Specific workloads • Intensity Guidelines • Precautions • Goals

6. Type of Exercise/activity • What does the pt enjoy? • Access • Funding • Commuting/Daily routine • Housework • Vary Aerobic with resistance/isotonic

7. Duration and Frequency • Generally aim for 20-60 minutes 5/week • V low capacity aim for multiple short sessions daily • Moderate capacity 1-2 sessions daily with slightly increased duration

8. Specific Workloads • Walking Pace • Watts • Calories/hour

9. Intensity • %Max Heart Rate (220-Age) • 40-60 Fat Burn • 60-85 Aerobic • 85+ High/anaerobic • Heart rate reserve (max stress test-resting) • METS - 1 MET is resting O2 consumption

10. Intensity • Rate of Perceived Exertion (RPE) • Borg Scale • 6 No effort • 11 Light • 12-13 Moderate • 14-15 Hard • 16-17 Very Hard • 18-19 Extremely hard

11. Precautions/Special groups • Obese/Overweight - Reduce impact exercise • Respiratory - Regular short duration • Diabetes - Decreased Insulin requirements • Osteoporosis - combine impact with resistance • Pregnancy - maintain pre exercise level and watch for joint laxity and overheating • Cardiovascular - Often require stress test prior and work to very specific intensities.

12. Case studies • 48 Year old male office worker with mild hypertension • 14 year old boy with obesity • 68 year old female with osteopenia

13. Top Tips • Involve the Patient! • Include enjoyable activities • Set Goals - SMART • Warn about pain and stiffness • Start slow and progress • Review progress

14. Musculoskeletal Ultrasound • Rapidly Growing Field • High Frequency probes - excellent resolution • Portable and cheaper • Extension of the clinical examination • Diagnostic • Guided Injections

18. Tissues visible • Muscle • Tendon • Ligament • Bones • Bursae • Nerves • Synovitis • Calcification

19. Muscle

20. Tendon

22. Bones

23. Nerves

24. Synovitis

25. Tenosynovitis

26. Guided Injections

27. Guided Therapy forTendinopathy • Supraspinatus • Extensor Origin Elbow • Patella • Achilles • Plantar fascia

28. Neovascularisation • Hallmark of tendinopathy • Power Doppler USS • Abundant sensory nerves • No Inflammation • Substance P and CGRP

29. High Volume stripping

30. Ultrasound Summary • Extension of the clinical examination • Real time assessment • Comparable to MRI in many instances • Exceeds MRI in tendinopathy • Guide therapeutic intervention

31. Questions? • Sports Orthopaedics UK - Delia Sittert - Caterham • clinic@sportsortho.co.uk 08445 617131 • jon.houghton@sportsortho.co.uk