Transcript What’s Hot in Sport and Exercise Medicine

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
Contents
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A Brief Introduction
How to advise patients about Exercise
The role of Musculoskeletal Ultrasound
Summary
• 1999
• 2000
• 2000
• 2003/04
MRCP
Rheumatology NTN
Training in MSK Ultrasound
Diploma in Sports Medicine
UCL
• 2006
• 2006
• 2010
UK
CCT in Rheumatology/GIM
Consultant DMRC Headley Ct
Joined Sports Orthopaedics
Exercise
Prescription
• Benefits of Exercise
• Reduction of mortality from
• All forms of Cardiovascular Disease
• Diabetes
• Cancer
• Improved Mental Health
• Improved Bone Health
Components of Exercise Prescription
• Type of exercise or activity
• Duration and frequency
• Specific workloads
• Intensity Guidelines
• Precautions
• Goals
Type of Exercise/activity
• What does the pt enjoy?
• Access
• Funding
• Commuting/Daily routine
• Housework
• Vary Aerobic with resistance/isotonic
Duration and Frequency
• Generally aim for 20-60 minutes 5/week
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V low capacity aim for multiple short
sessions daily
Moderate capacity 1-2 sessions daily with
slightly increased duration
Specific Workloads
• Walking Pace
• Watts
• Calories/hour
Intensity
• %Max Heart Rate (220-Age)
• 40-60 Fat Burn
• 60-85 Aerobic
• 85+ High/anaerobic
• Heart rate reserve (max stress testresting)
• METS - 1 MET is resting O2
consumption
Intensity
• Rate of Perceived Exertion (RPE)
• Borg Scale
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6
No effort
11
Light
12-13 Moderate
14-15 Hard
16-17 Very Hard
18-19 Extremely hard
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
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Cardiovascular - Often require stress test prior
and work to very specific intensities.
Case studies
• 48 Year old male office worker with mild
hypertension
• 14 year old boy with obesity
• 68 year old female with osteopenia
Top Tips
• Involve the Patient!
• Include enjoyable activities
• Set Goals - SMART
• Warn about pain and stiffness
• Start slow and progress
• Review progress
Musculoskeletal Ultrasound
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Rapidly Growing Field
High Frequency probes - excellent resolution
Portable and cheaper
Extension of the clinical examination
Diagnostic
Guided Injections
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Tissues visible
Muscle
Tendon
Ligament
Bones
Bursae
Nerves
Synovitis
Muscle
Tendon
Bones
Nerves
Synovitis
Tenosynovitis
Guided Injections
QuickTime™ and a
Microsof t V ideo 1 decompressor
are needed to see this picture.
Guided Therapy for
Tendinopathy
• Supraspinatus
• Extensor Origin Elbow
• Patella
• Achilles
• Plantar fascia
Neovascularisation
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Hallmark of
tendinopathy
Power Doppler USS
Abundant sensory
nerves
No Inflammation
Substance P and CGRP
High Volume
stripping
Ultrasound Summary
• Extension of the clinical examination
• Real time assessment
• Comparable to MRI in many instances
• Exceeds MRI in tendinopathy
• Guide therapeutic intervention
Questions?
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Sports Orthopaedics UK - Delia Sittert - Caterham
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[email protected]
[email protected]
08445 617131