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Sports Medicine 2013

Sports Medicine 2013. Jacqui McCord-Uys Sports Physiotherapist. Who am I ?. Practising since 1989 Sports injuries since 1990 Beijing Olympics team Common Wealth teams ( Snr & Jnr) All Africa Games SA Schools Rugby, Women's Rugby Falcons Rugby Team (4 yrs )

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Sports Medicine 2013

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  1. Sports Medicine2013 Jacqui McCord-Uys Sports Physiotherapist

  2. Who am I ? • Practising since 1989 • Sports injuries since 1990 • Beijing Olympics team • Common Wealth teams (Snr & Jnr) • All Africa Games • SA Schools Rugby, Women's Rugby • Falcons Rugby Team (4 yrs) • SuperSport United Football Club Medical Team Leader & Physio (16yrs) • Course presenter in India 2011 & 2012 • Conference Presentations 2008,2010,2011, • ETC…….

  3. Sports Medicine • Why the need for specialization? • GP orthopaedic surgeon not sufficient? • Work opportunities? • Qualifications needed? • MSc Sports Medicine Degree(TUKS, Wits, UCT & Bloemfontein) • College of medicine & HPCSA approved Specialist rating awaiting Government approval.

  4. Sport Injuries • Acute • Bone • Articular Cartilage • Joint • Ligament • Muscle • Tendon • Bursa • Nerve • Skin

  5. Sports Injuries • Chronic ie overuse • Bone stress • Osteitis & Periostitis • Articular cartilage • Joint • Ligament • Muscle • Tendon • Nerve • Bursa • Skin • AND the unknown……

  6. Sports Injury principals • Diagnosis • Treatment • Recovery • Rehabilitation • Return to Play

  7. DiagnosisThere is no more difficult art to acquire than the art of observation. (William Osler) • Clinical assessment: • NB to make an accurate pathological Dx. • Too often broad terms like “swimmers shoulder” or “Runners 'knee” are used • Enables better explanation to sportsman of way forward. • Enables optimum treatment • Enables optimum rehabilitation.

  8. Diagnosis • Special Investigations • Should be a tool confirm or exclude a diagnosis not a replacement of a thorough physical examination. • Old saying by James M Hunter “Treat the patient and not the X-Ray” • Radiological Investigations • X-ray • CT scan • MRI • Ultrasound • Radio isotopic Bone scan

  9. Special Investigations • Neurological Investigations • EMG • Nerve conductivity • Neuropsychological testing (head injuries) • Muscle assessments • Compartment pressure testing • Cardiovascular Investigations • Respiratory Investigations • Pulmonary function tests

  10. Treatment • Randomized controlled trial evidence for all treatments given? • Eg Parachute • We must take note of evidence that is around but never forget our craft remains much an art as science. • Standard principals • Acute management RICE

  11. RICE • Rest: First 48hrs Sportsman • Ice: Reduce tissue metabolism • Reduced hematoma, inflammation & tissue necrosis • Accelerated early regeneration in Muscle tissue • 20min every 2hrs • Compression: • Co-adhesive bandage or Compression sleeves • Elevation • Decrease in hydrostatic pressure Reduces accumulation of interstitial fluid

  12. Immobilization • Earlier better • Too lengthy leads stiffness degeneration, osteopenia, muscle atrophy etc. • Braces, POP, Crutches • CPM (Forms part of in hospital post operative rehabilitation)

  13. Therapeutic drugs • Analgesics : Relieve patients pain immediately post injury • Corticosteroids: Concern regarding the effects on tissue healing • Considered a bridge treatment i.e. providing immediate symptomatic relief but underlying cause of problems must be addressed • NSAID’s : Debatable effects • Avoided in first 48hrs • Long term use (more than 5 days) should be avoided. Reassess & diagnose • Be aware of gastrointestinal problems.

  14. Acute or Chronic Musculoskeletal Injuries Are anti-inflammatory signs & symptoms present ? YES No Previous History adverse effect YES No NSAID’s combined with protective agent Non-NSAID’s Analgesic NSAID’s for max of 7 days NSAID’s not indicated

  15. Additional Treatments • Electrotherapy • Extracorporeal Shock therapy • Manual therapy • Acupuncture/ dry needling • Hyperbaric Oxygen therapy • Surgery

  16. Rehabilitation

  17. Correct Motor control • Poor pelvic control i.e. weak Gluteus medius can cause anterior knee pain • Poor scapular control can be cause of ant shoulder tilting causing impingement • Exercise in open or closed chain (more functional) • Remember agonist and antagonist

  18. Flexibility • Pre Event Active warm-up • Post event Passive cool down stretch • Tight muscles may be associated with injuries • Psoas :Lumbral apophyseal joints and Hamstring • Soleus : Achilles tendinopathy • Vastus Lateralis ITB : Patellofemoral syndrome

  19. Therapy progression Parameters to monitor • Pain & tenderness • ROM • Swelling • Heat & redness • Ability to perform exercises • Number of sets and reps

  20. Psychology • Athlete must understand injury full extend • Long term goal • Short term goal • Listen to Athlete • Give alternate active rest exercise • Refer if needed

  21. Recovery Common methods (Research needed) • Warm Down • Ice baths (5min 10 – 15 degrees) • Massage • Compression garments • Lifestyle factors • Nutrition • Psychology

  22. Most Common Injury summaries

  23. 1. Head - Concussions • Direct blow to head • Rapid onset of short lived impairment of neurological function • Good clinical judgement must prevail over guidelines and coach and player insistence. • When in doubt refer. • Assessment forms: 1.FIFA (SCAT2) www.bjsm.bmj.com (pocket edition) • 2. SA Rugby Bok Smart program: Concussion Management

  24. 2.Shoulder Injuries • Rotator cuff • Instability • Labral injury • Stiffness • AC Joint Pathology • Referred Pain

  25. Rotator cuff Muscles and Tendons • Acute or Chronic • Acute on Chronic ie. An acute tendon tear on a degenerative tendon • Symptoms: Shoulder pain • Overhead activity problems • Investigations: MRI • Treatment: Full thickness tear - repair • Tendons NSAID’s at first • Correct abnormalities: Muscle weakness, Gleno-humeral rhythm etc….

  26. Shoulder instability • On field dislocations Reduce ASAP • Damage to Capsule and Labrum (Ant, Post, Sup) • Periscapular Muscle weakness • Changes to passive structures ielig, capsule or labrum • Ant Dislocations damage the labrum (Bankart lesion) • Symptoms • Pain, unstable, Weakness, Stiffness • Treatment • Non surgical – Rehabilitation and analgesic Rx • Surgical – Post operative rehab program

  27. Labral Injury • Overuse or acute • Intervention: Surgical since Conservative usually unsuccessful • Symptoms: • Impingement or Joint pain • May be unstable • History is NB on mechanism of injury • Common traction on Biceps tendon

  28. Shoulder Stiffness • May be secondary to trauma • Adhesive capsulitis or Frozen Shoulder • Possible injury to cervical nerve roots or brachial plexus • Treatment: • Conservative Rehabilitation • Manipulation

  29. Soft Tissue Acute Injurieseg. Post Thigh • Sudden onset like a puncture! • Return to sport 8 -25 days • High re-occurance rate • Key = correct Dx • Anatomy • History • Strong incident ie sprinting (eccentric) or overstretching (ballet) • None consider referred pain • Special investigations : confirm grade of tearUltrasound, MRI

  30. Management • First 48hrs – RICE, early pain free M contractions • Following: • Stretching: Hamstring & Antagonists (Quads Iliopsoas) • Neural Mobilization • Soft tissue Rx • Strengthening • Sport specific drills esp. Agility and motor control

  31. 3.Anterior Knee conditions 7. ITB 1.OA Knee 6. Lat Lig. 2. Med Lig 3. Pes Anserine bursitis 5.General knee effusion 4. Patellar tendon / Osgood-Schlatters / Runners knee

  32. Knee injuries

  33. Knee Injuries

  34. Acute knee injury pricipals Is the injury significant ie fast intervention History to consider: • Mechanism of injury • Amount of pain • Swelling & timing of onset • Degree of disability • Previous injuries

  35. Diagnosis knee injury Assessment: • ? Damaged structures • Extent of damage • Degree of joint limb disability to provide safe and timely management

  36. Hints • Symptom of ‘give way’ (ACL) • Location of pain – Cruciate poorly localized • Collaterals fairly well localized • Severity of pain not always in corralation with injury severity • Intra articular swelling obvious within 2 hrs damage • - ACL,PCL • - Pateller dislocation • - Osteochondral # • - Medial menisci peripheral tear

  37. Hints • Effusion develops after a few hours • Reactive synovitisie. meniscal or chondral injuries • Little effusion with collateral injuries • Pop or snap or tear : ACL • Locking : Loose body or displaced meniscal tear

  38. Lower leg Injuries • ‘Shin splints’ • Deep compartment muscle strains • Gastrocnemius / Soleus strains / tears • Achilles tendinosis or ruptures • ‘Severs’ disease

  39. Tibialis Anterior Tibialis Posterior FDL

  40. Gastrocnemius /Soleus & Achilles

  41. Sport specific injuries • Always consider the type of sport played • Level of sport ie international, national or local • Is sport the players income? • Surface where injury occurred • Gear involved • Training regime

  42. Rugby injuries

  43. Are you Listening? • Your patient is the answer to your diagnosis • Your Diagnosis is the answer to your successful treatment • So Listen

  44. Sources • Clinical Sports Medicine Fourth edition Brukner& Khan

  45. Jacq1@mweb.co.za 0123466909 Complete Physio Brooklyn Pretoria

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