Transcript Sports Medicine

Sports Medicine
David W. Hang, M.D.
Assistant Clinical Professor of Orthopedic
Surgery
University of California at Los Angeles
Director
Shin Kong Orthopedic Sports Medicine Institute
Sports Medicine
Sports Medicine Program
2/3 of injury occurs during practice (high school)
Team Physician
Orthopedist or family practice physician
Basic medical knowledge and emergency evaluation
Supportive and cooperation with the team (AT, PT, coach)
Prescribe pre-injury conditioning and post-injury care
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Athletic Trainer
Front-line, on site director
Provide optimal sports healthcare
Direct supervision of physician
Liaison between different parties
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Athletic Trainer
Facility and materials
Injury prevention (conditioning)
Assessment of injury
Appropriate first-aid
Determination of return to sport
Appropriate medical profession referrals
Effective rehabilitation program
Educational and counseling program
Organize physical examination
Role model for future medical professional
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Playing Surfaces
Little research other than grass and synthetic turf
Inconclusive results
Astro turf > grass > Tartan turf ??
More serious sprains and torn ligament on grass ?
Synthetic surface
– Prepatellar bursitis
– Olecranon bursitis
– Heat Stroke
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Screening examination
Legal and insurance requirement
Determine overall health of the individual
Assess physical maturity
Detect conditions that predispose to injury
Identify and treat injuries before participation
Baseline for return to participation
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Documentation
States specific form
Parental / guardian consent
– Examination
– Participation
– Treatment
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Examination
Individual / office based
Group / station based
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Office Based Examination
Privacy, comprehensive, better medical records
High cost, time consuming, increased demand
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Station Based Examination
Reduce cost, time efficient, team staff involvement
Impersonal, great deal of coordination
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Components of Screening Examination
Detailed medical history
PMH, PSH, Allergy, Rx, Immunization, FH
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CV – murmurs, syncopy, CP, SOB
Neurological injuries – concussion
Heat / cold injury
Menstruation
Physical Examination
General
Dental
Genital
Maturation (Tanner stages)
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Recommendation
Clearance without restriction
Clearance with restriction (15%)
Disqualification (1%)
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Disqualifying Conditions
*Always consider alternative activities !!!
Atlantoaxial Instability
Cardiovascular
Visual Impairment
Neurologic
Inguinal Hernia
Dermatologic
Pulmonary
HIV
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Musculoskeletal
Gynecologic
Hepato- / Splenomegaly
Kidney Abnormalities
Sickle Cell Trait
Testicular
Acute Illness
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AA Instability
No contact / collision sports
No repetitive flexion / extension
C-spine radiograph in Down’s (10 - 20%)
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Cardiovascular
HTN (higher than 95 percentile)
10 – 12 years
:
125/80
13 – 15 years
:
135/85
15 years / older :
140/90
Restriction
1) Diastolic > 115 mm Hg
2) End-organ involvement
Controlled HTN
1) No End-organ : Moderate intensity activities
2) LVH /  renal function : Low intensity (golf / bowling)
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Cardiac Murmurs
Mitral Prolapsed (No participation)
Syncopy
Family history of sudden death
Chest pain or arrhythmias (worse with activities)
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Hypertrophic Cardiomyopathy
Most common cause of sudden death in young athletes
Disqualification
1) LVH
2) LV outflow obstruction
3) Arrhythmia
4) Syncopy
5) Sudden death in relative
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Vision Impairment
Best corrected vision : 20/50 (one eye)
Restricted Sports
Boxing, wrestling, full contact karate
Protective eyewear use
Football, racquetball, baseball
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Renal / Liver / Spleen
No contact or collision sports
1) Renal (abnormal solitary kidney)
2) Hepatomegaly (surpassed bony protection)
3) Splenomegaly
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Concussions
Confusion
Amnesia
LOC
Grade I (Mild)
+
-
-
Grade II (Moderate)
+
+
-
Grade III (Severe)
+
+
+
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Concussions
Grade I (Mild)
First Concussion
Second Concussion
Third Concussion
Return to play
(Asymp. for 20 min.)
Stop contest / practice
Return to play
(Asymp. > 1 wk)
Terminate season
Return to play
(Asymp. > 3 mos)
Terminate season
Return to play
(Asymp. > 1 mon)
Terminate season
Return next season
(Asymp.)
Terminate season
Terminate season
(MRI)
Grade II (Moderate) Stop contest / practice
Return to play
(Asymp. > 1 wk)
Grade III (Severe)
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Stop contest / practice
Return to play 1 mon
(Asymp. > 2 wk)
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Neurologic Injury
Neuropraxia (Burner)
Asymtomatic
Recurrent
Participation
Further evaluation
Seizure
Controlled
Poorly controlled
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Participation
1 month after last seizure (on Rx)
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Objectives of Fitness Assessment
Minimize injury
Improve athletic performance
Identify weakness that hinders performance
Assess achievement of personal goal
Motivational
Wellness counseling
Evaluate preseason conditioning
Sports specific profile (risk factors identification)
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Evaluation
Resting heart rate and BP
Body mass index (BMI)
Skin fold measurement
Abilities
– Muscle strength
– Muscle endurance
– Power
– Flexibility
– Speed
– Aerobic endurance
– Anaerobic endurance
– Agility
– Balance
– Reaction time
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Nutrition
Micronutrient (vitamins)
Macronutrients (fat, carbohydrate, protein)
Diet
– Carbohydrate (4 calories / gm) :
– Fat (9 calories / gm) :
– Protein (4 calories / gm) :
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60 - 70% (starch)
15 - 20%
10 - 15%
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Carbohydrate Loading
Glycogen storage for endurance activity
– 100 gm of carbohydrate within 15 - 30 minutes after exercises
– Additional 100 gm of carbohydrate every 2 to 4 hours
(Need 20 hours to replace depleted store)
Complex carbohydrate
– More glycogen storage
– Less insulin response
– Contains basic nutrients
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Protein
Essential amino acids (8 – not produced by body)
1.2 - 2 gram / kg / day (4 cal / gm)
Complete protein (contain essential AA – meat, milk)
Incomplete protein (seeds, nuts, peas, grains, beans)
Branch-chain AA (Leu, IsoLeu, Val)
– Source for muscle repair and muscle energy
– Availability: 50% within 1 hr and 100% at 2 hrs
– Aids glycogen production
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Fat
Most concentrated source of energy (9 cal / gm)
Saturated (animal) or unsaturated (vegetable)
Muscle energy at rest or latent endurance events
Available after 20 - 30 minutes of exercise
Consumes more oxygen (use more oxygen)
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Water
60% of body weight
Cooling effect
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Fluid consumption
2 1/2 cups 2 hrs & 1 1/2 cup 15 minutes before
5 - 8 oz every 15-20 minutes (during)
Sodium and 6-8% glucose
No ETOH or caffeine
2 cups of water for each kg of body weight lost
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Training diet
Avoid feeling hungry or weak
Empty stomach and upper bowels at competition
Sufficient water
Minimize slow digesting food
Carbohydrate 2 to 4 hrs before competition
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Body Fat
Anthropometry (skin folds*)
Men
16 to 18%
Women
22 to 26%
(* subscap., triceps, axilla, chest, biceps,
iliac crest, abdomen, thigh)
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Exercise Program
(Weight Loss)
3 times a week
60 to 70% of maximum heart rate for 30 minutes
Maximum weight loss (60 minutes of continuous aerobic activity)
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Master Athletes
Endurance : maintained with conditioning
Strength : Sports specific strength
Power : loss quickness
Flexibiity : loss with age
Speed : loss with age (upper > lower)
Coordination : nerve degeneration (other elements ?)
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Master Athletes
Injuires
– Chronic “wear-and-tear” with acute tear
– Previous injury / surgery
Illness
– Adaptation to chronic health conditions
(DM, CA, OA, CAD)
Rehabilitation and maintenance
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