Transcript Sports Medicine Approach to MSK Problems

Sports Medicine Approach to
MSK Problems
Bob Kiningham, MD
Associate Professor
University of Michigan Health
System
Disclosure
I do not have any relevant financial
relationships to be discussed, directly or
indirectly, referred to or illustrated with
or without recognition within the
presentation.
Primary Job of the Sports
Medicine Physician
To encourage and facilitate safe
physical activity
Aspects of Sports Medicine
• Treatment of musculoskeletal injuries
• Optimizing medical conditions to allow
for safe physical activity
• Promotion of physical activity to
prevent and treat medical conditions
and optimize health and functioning
The Scope of Sports Medicine
• Patients who are physically active
• Patients who want to become physically
active
• Patients who should become physically
active
“Everyone is an athlete. The only
difference is that some of us are
training and some of us are not.”
George Sheehan, MD
MSK Problems in Primary Care
• Approximately 20% of visits to primary
care clinics
• Second only to URIs in frequency
• One in two American adults have a
MSK condition that has required
medical care
Traditional Medical
Approach
• Treat pain and “inflammation” with
medications/modalities
• Activity modification
• Rest/immobilization
Therapeutic Approaches to
Recurrent or Chronic MSK
Problems
• Change or avoid the job or activity
• Change the patient so he she can do the
job or activity
Most Common MSK
Problems in Primary Care
• Weight bearing osteoarthritis
• Low back pain
• Upper back and neck pain
• Tendinopathies
• Rotator cuff
• Lateral and medial epicondylitis
Knee Osteoarthritis
• Osteoarthritis is
characterized by the
progressive focal
loss of breakdown
of hyaline cartilage
and underlying
bone within a joint,
as well as bony
overgrowth
• Cartilage loss is not
uniform
Exercise
Grade A Recommendation
• Low impact aerobic
exercise improves
functional ability
and endurance, and
reduces pain
• Strength training
reduces pain and
improves physical
function
Weight Loss
Grade A Recommendation
• One pound of weight
loss above the knee
equals a decrease in 45 times less force on
the knee when
weight-bearing
• Reduces pain and
improves function
• Appears to have
additive effect with
exercise
Computer Sitting Back Pain
Computer Sitting Back Pain
Tendinosis
Normal Lat Epicondyle
• Hypoechoic, thickened, tendons
• Small clefts/tears often visualized
Image courtesy of Dr. Troy Henning, MD
Eccentric
Strengthening
Therapeutic Approaches
• Muscles are the “shock absorbers” of
the joints
• Neuromuscular control of movement
• Changing tendons from degeneration to
reparation with improved strength and
function
Sports Medicine Approach to
MSK Problems
• Goals of therapy
• Return to activity
• Prevent re-injury
• Physical therapy
• A learning experience
• Muscles are the shock absorbers and
stabilizers of the joints