Sports Medicine Issues Research Articles

Effect of a Corrective Exercise Program Based on the National Academy of Sports Medicine’s Protocol on Forward Head Angle and Cervical Joint Position Sense in Females With Forward Head Posture

Background and Aims Nowadays, the musculoskeletal disorders and postural problems due to inappropriate postural habits and uninterrupted repetitive movements are important issues in sports medicine. Recently, the National Academy of Sports Medicine (NASM)’s corrective exercise protocol has received attention from scholars. This study aims to evaluate the effect of a corrective exercise program based on NASM’s protocol on the forward head angle and cervical joint position sense. Methods This is a quasi-experimental study. Participants were 30 female college students, aged 18-25 years with a forward head angle > 46 degrees, who were randomly divided into two groups of control (N=15, age=20±2 years, height=1.59±3.03 m, weight=58.13±5.08 kg, BMI=22.71±1.41 kg/m2) and exercise (N=15, age= 20.53±1.55 years, height=1.60±0.02 m, weight=60.53±4.10 kg, BMI=23.61±1.20 kg/m2). The exercise group performed corrective exercises for eight weeks, three sessions per week, each for 30-70 minutes, while the control group did not receive any intervention. The lateral photography method was used for measuring forward head posture. The cervical joint position sense was assessed using the target angle repositioning error test before and after corrective exercises. Data were analyzed using paired t-test and analysis of covariance. The significance level was set at 0.001. Results Eight weeks of corrective exercises reduced the forward head angle and target angle repositioning error in the exercise group compared to the control group (P≤0.001). Conclusion Corrective exercises based on NASM’s protocol seem to reduce the forward head angle and improve the cervical joint position sense. Therefore, correctional treatment specialists and therapists are recommended to use the program to improve the forward head posture and cervical proprioception in women with this postural deformity.

Clinically Useful Family Medicine Research

What is next for family medicine? After the long, rough road since the beginning of the COVID-19 pandemic, other topics are again receiving renewed attention. Family medicine researchers continue to consider issues important to our patients and practices. There is a collection of clinical research on children's health care. One article outlines practical actions to move medical academia past racism. The need for physician trust in patients is also often overlooked. Other articles address how to improve the practice of family medicine and a framework for thinking about legal and ethical issues in sports medicine. Three in-depth clinical reviews cover lumps and bumps of wrists and hands, spondylosis/spondylolistheses, and vitamin D association with specific disease entities.

A General Framework for Exploring Ethical and Legal Issues in Sports Medicine.

Medicolegal dilemmas faced by Sports Medicine providers differ from those of other primary care physicians in type and frequency. Exotic, high-profile challenges are widely covered in the literature and offer guidance on how to navigate challenging situations. However, there is a gap in the literature on how to approach more mundane, but nevertheless common, medicolegal dilemmas. The purpose of this article is to provide Sports Medicine providers simple tools for determining whether a course of action is legal or ethical and offer Sports Medicine educators a model for teaching these skills. We searched U.S. federal and state law using the LexisNexis® database for laws regulating Sports Medicine practice, and PubMed for articles related to physician approaches to Sports Medicine legal and ethical challenges. Searches started with the term sports medicine, and included winnowing terms of ethics, ethical practice, ethical guidelines, law, and legal guidelines. We used current ethical practice guidelines followed by the American Medical Association and described in detail by Beauchamp and Childress. We offer a framework for how to approach legal challenges in Sports Medicine and apply it to four common scenarios that Sports Medicine physicians often face. We further suggest that the profession formally address this literature gap with a standardized curriculum in Sports Medicine law. A curriculum using this framework and clinical vignettes provides learners and practitioners with familiarity and confidence when legal and ethical challenges arise in Sports Medicine.

Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making?

Background:Personal and professional biases can affect decision-making regarding important issues in pediatric sports medicine. Gaining insight into the opinions of health care professionals who specialize in pediatric sports medicine will provide information that may be useful for directing ongoing research in this field.Hypothesis:It was hypothesized that surgeons would demonstrate bias toward early surgical intervention versus nonsurgeons. In addition, it was hypothesized that youth sports medicine professionals who were parents of a child with a previous major sports injury or concussion would be less likely to allow their child to play American tackle football or return to football after a concussion.Study Design:Cross-sectional study.Methods:An online survey was provided to the active members of the Pediatric Research in Sports Medicine Society. We used both professional background information and responses to questions related to personal experiences with youth sports injuries to determine potential factors associated with underlying biases. Survey responses among subgroups were compared using the Fisher exact test. The Pearson correlation coefficient was used to evaluate years in practice versus opioid use.Results:Of the survey participants, 62.5% were pediatric surgeons, and 37.5% represented different nonsurgical youth sports medicine professions. Surgeons were less likely than nonsurgeons to agree to allow their child to return to football after sustaining a concussion and completing a concussion protocol (48% vs 76%, P = .013). Surgeons were more likely than nonsurgeons to agree to both elective shoulder stabilization after a first-time dislocation and elective drilling of a stable knee osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%, P = .003 and 52% vs 23%, P = .013, respectively). Those who reported having a child with a concussion history were more likely to support him or her returning to football after a concussion (65% vs 33%, P = .026).Conclusion:Surgeons were more likely to favor elective shoulder-stabilization surgery after a first-time dislocation and drilling of a stable knee OCD instead of nonoperative management. Personal experience of having a child who sustained a major sports injury or concussion did not demonstrate a bias against participation in football or return to football after a concussion.

Multidisciplinary Perspective on Controversial Issues in Pediatric Sports Medicine

Multidisciplinary Perspective on Controversial Issues in Pediatric Sports Medicine

Guidelines for community-based injury surveillance in rugby union

ObjectivesThe vast majority of rugby union (‘rugby’) participants are community-based players; however, the majority of injury surveillance studies reported relate to the elite, professional game. A potential reason for this dearth of studies could be the perceived difficulty of using the consensus statement for injury recording at the community level. The aim of this study was to identify areas where the consensus statement could be adapted for easier and more appropriate implementation within the community setting. DesignRound-table discussion. MethodsAll community-based injury surveillance issues were discussed during a 2-day facilitated round-table meeting, by an 11-person working group consisting of researchers currently active in rugby-related injury surveillance, sports medicine and sports science issues. The outcomes from the meeting were summarised in a draft guidance document that was then subjected to an extensive iterative review prior to producing methodological recommendations. ResultsEach aspect of the rugby-specific consensus statement was reviewed to determine whether it was feasible to implement the standards required in the context of non-elite rugby and the resources available within in a community setting. Final recommendations are presented within a community-based injury report form. ConclusionsIt is recommended that whenever possible the rugby-specific consensus statement for injury surveillance studies be used: this paper presents an adapted report form that can be used to record injury surveillance information in community rugby if suitable medical support is not available.

MJA sports medicine issue.

<em>MJA</em> sports medicine issue.

Sports Medicine and Ethics

Physicians working in the world of competitive sports face unique ethical challenges, many of which center around conflicts of interest. Team-employed physicians have obligations to act in the club's best interest while caring for the individual athlete. As such, they must balance issues like protecting versus sharing health information, as well as issues regarding autonomous informed consent versus paternalistic decision making in determining whether an athlete may compete safely. Moreover, the physician has to deal with an athlete's decisions about performance enhancement and return to play, pursuit of which may not be in the athlete's long-term best interests but may benefit the athlete and team in the short term. These difficult tasks are complicated by the lack of evidence-based standards in a field influenced by the lure of financial gains for multiple parties involved. In this article, we review ethical issues in sports medicine with specific attention paid to American professional football.

Revisiting the AAN guidelines on sport-related concussion

Definition, evaluation and management of concussion are contentious issues in sports medicine, and evidence-based guidelines on these issues are urgently needed. An updated practice parameter on sport-related concussion from the AAN is, therefore, timely. However, these new guidelines fail to meet the needs of clinicians in this field.

Characteristics of myogenic response and ankle torque recovery after lengthening contraction-induced rat gastrocnemius injury

BackgroundAlthough muscle dysfunction caused by unfamiliar lengthening contraction is one of most important issues in sports medicine, there is little known about the molecular events on regeneration process. The purpose of this study was to investigate the temporal and spatial expression patterns of myogenin, myoD, pax7, and myostatin after acute lengthening contraction (LC)-induced injury in the rat hindlimb.MethodsWe employed our originally developed device with LC in rat gastrocnemius muscle (n = 24). Male Wistar rats were anesthetized with isoflurane (aspiration rate, 450 ml/min, concentration, 2.0%). The triceps surae muscle of the right hindlimb was then electrically stimulated with forced isokinetic dorsi-flexion (180°/sec and from 0 to 45°). Tissue contents of myoD, myogenin, pax7, myostatin were measured by western blotting and localizations of myoD and pax7 was measured by immunohistochemistry. After measuring isometric tetanic torque, a single bout of LC was performed in vivo.ResultsThe torque was significantly decreased on days 2 and 5 as compared to the pre-treatment value, and recovered by day 7. The content of myoD and pax7 showed significant increases on day 2. Myogenin showed an increase from day 2 to 5. Myostatin on days 5 and 7 were significantly increased. Immunohistochemical analysis showed that myoD-positive/pax7-positive cells increased on day 2, suggesting that activated satellite cells play a role in the destruction and the early recovery phases.ConclusionWe, thus, conclude that myogenic events associate with torque recovery after LC-induced injury.

Ethical Issues in Sports Medicine

Ethical issues present a challenge for health care professionals working with athletes of sports teams. Health care professionals—including the team physician, the physical therapist, and the athletic trainer—are faced with the challenge of returning an athlete to competition as quickly as possible but as safely as possible. Conflicts of interest arise due to conflicting obligations of the team physician to the athlete and other members of the sports organization, including coaches and the team owner. The multiple stakeholders involved in sports teams challenge the traditional notion of confidentiality and autonomy. The aims of this article are to explicate the ethics of sports medicine, highlight the ethical issues, and provide some strategies and suggestions for ethical decision making.

Eminence-Based Medicine Versus Evidence-Based Medicine: Level V Evidence in Sports Medicine

Through extensive survey analysis, we investigated expert opinion in sports medicine. The study had 3 purposes: to provide clinical guidance for cases in which the correct action is not necessarily apparent, to examine expert opinion itself, and to delineate areas of future study. A total of 500 members of the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine evaluated a set of 25 statements on unresolved issues in sports medicine. The following 10 statements were deemed false: “It's okay for 12-year-old pitchers to throw curve balls; it's the pitch count that matters”; “Resistance training (‘weight lifting’) should be avoided until physeal closure”; “Jogging during pregnancy is to be avoided”; “At an athletic event, if sideline coverage is offered by an emergency medical technician and athletic trainer, there is little additional benefit from having a physician present”; “Contact sport athletes who sustain a second concussion should be excluded from contact sports permanently”; “The utility of pre-season medical screening is derived from the history; as such, student-athletes should complete a questionnaire, with physical examination reserved for only those with a positive relevant history”; “Femoroacetabular impingement is a myth—the designation of anatomic variation as disease”; “An AC (acromioclavicular) separation in a contact athlete should not be treated surgically if the athlete won't give up the sport; it will fail”; “Ankle taping induces weakness and atrophy of the dynamic stabilizers of the ankle”; “Only autografts should be used in ACL (anterior cruciate ligament) surgery, as allografts have an unnecessary high failure rate in clinical practice.” One statement was accepted as true: “Surgery to treat anterior (patello-femoral) knee pain in a patient with normal patellar mechanics and stability is contraindicated.” In short, expert opinion may be a helpful adjunct to clinical practice. Expert opinion cannot replace individual judgment and certainly does not trump the primary medical literature. Yet when better evidence is lacking, expert opinion is valuable for even the staunchest practitioner of evidence-based medicine.

Platelet-Rich Plasma in Muscle Healing

The muscle healing process is defined as a complex and dynamic process resulting in the restoration of anatomic continuity and function. This process is characterized by a cascade of events triggered by the tissue injury itself. It is widely accepted that growth factors play a central role in the healing processes by modulating the recruitment, duplication, activation, and differentiation of different cell types. This observation is the basis on which the use of platelet-rich plasma in several circumstances is founded; all of them requiring the activation or the modulation of the tissue repair process. There is an extensive documentation of in vitro and in vivo studies demonstrating the safety and efficacy of growth factors in the muscle healing process. Unfortunately, the precise biological efficacy and the lack of long-term side effects have not been clearly demonstrated. With regard to sports medicine, doping-related issues are still a matter of debate, especially regarding the treatment of muscle injuries. The purpose of this review is to examine the role of growth factors during muscle healing processes and to discuss the implications of platelet-rich plasma in its therapeutic applications. Sports medicine issues are also discussed particularly with regard to antidoping regulations.

Playing Field Issues in Sports Medicine

The use of artificial turf on playing fields has increased in popularity. Advances in technology have allowed for the development of turf that closely mimics the properties of natural grass. Overall injury incidence does not differ between the two surfaces, but unique injury patterns are apparent between the two surfaces. Differences in shoe-surface interface, in-shoe foot loading patterns, and impact attenuation may provide insight into the different injury patterns. Player perceptions of artificial turf vary and may be related to different physiological demands between the two surfaces. Artificial turf has been implicated in skin infections, but concerns about other health consequences related to the synthetic materials have not been proven yet. Understanding the differences between artificial turf and natural grass will help physicians, athletic trainers, and coaches better care for and train their athletes.

Selected Issues for the Master Athlete and the Team Physician

SUMMARY This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It is not intended as a standard of care and should not be interpreted as such. This document is only a guide and, as such, is of a general nature, consistent with the reasonable, objective practice of the health care profession. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. This statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are the American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.

Selected Issues for the Adolescent Athlete and the Team Physician: A Consensus Statement

This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It is not intended as a standard of care and should not be interpreted as such. This document is only a guide and, as such, is of a general nature, consistent with the reasonable, objective practice of the healthcare profession. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. This statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine.

Free Communication/Poster -Sports Medicine Issues

Free Communication/Poster -Sports Medicine Issues

Concussions in Sports and Recreation

In 2004, 475 000 children between 0 and 14 years old sustained a traumatic brain injury, and 90% were treated and released from emergency departments (EDs). Concussions are considered one of the most pressing issues in sports medicine and are challenging to diagnose. The clinician has to rely on gross clinical symptoms and/or the athlete's willingness to admit to clinical symptoms. Computed tomography results are often negative and are therefore not helpful for determining the extent of a child's injury or his or her prognosis. Computerized neuropsychologic assessment programs have made the evaluation of athletes easier and more sensitive and are in fact considered the criterion standard for diagnosing and monitoring sports concussions. All athletes presenting to EDs with suspected concussion should be discharged with careful follow-up. Furthermore, return to play should be guided by a gradual increase in activity as recommended by the Prague conference on concussion. A young athlete should never be allowed to return to his or her sport until asymptomatic.

Injury prevention and rehabilitation for active older adults

With the rise in active participation in sports and exercise by older people, Injury Prevention and Rehabilitation for Active Older is both timely and instructive. It explores the issues involved in working with active older adults, providing a valuable resource to help sports medicine professionals prevent, diagnose, and treat injuries for this growing population.Geared toward those working with active seniors--from competitive and recreational athletes to fitness enthusiasts--Injury Prevention and Rehabilitation for Active Older Adults contains the information to help practitioners -strengthen their understanding of general issues in sports medicine for active seniors;-explore prevention of, and determine treatment for, specific injuries;-apply to their own practice the knowledge of specialists experienced in working with older populations; and-implement and supervise appropriate conservative therapies.Injury Prevention and Rehabilitation for Active Older was written by a team of specialists with extensive experience in treating active seniors. While it emphasizes conservative treatment over surgery, it also guides readers in knowing when to refer a client to a surgeon, how to prepare a client for what might happen when referred, and what type of surgery might be indicated. Therapists and trainers will strengthen their ability to explain their basis for both treatment and referral. Part I focuses on a variety of issues in sports medicine for active seniors, including senescent changes in the musculoskeletal system, exercise testing and prescription, and factoring the kinetic chain into prevention and therapy. Flexibility, stretching, and massage for older people are also covered, as are nutrition, nutritional supplements, and pharmacology.Part II, organized by anatomical areas, delves into specific injuries and conditions in active seniors. This approach helps readers easily locate regional musculoskeletal problems and identify appropriate rehabilitation procedures. These regions include the shoulder, elbow, hand and wrist, spine, hip, knee, and foot and ankle. Common injuries, conditions, and treatments are explored in each area.Accompanying photos and illustrations supplement the text, showing stretches for all parts of the body, exercises for both injury prevention and rehabilitation, diagnostic techniques (including special tests and best X-ray positions) and various treatment options. The result is a reference that facilitates understanding of the issues involved in preventing and treating injuries in active older people and in helping them recover and return to full activity as soon as possible.

Medicolegal Issues in Sports Medicine

This article reviews medicolegal issues in sports medicine. Nonmusculoskeletal medical conditions discussed include cardiac abnormalities, heat illness, and concussion in the athlete. Musculoskeletal injuries with the greatest potential for litigation, knee dislocation, and cervical spine trauma, are also reviewed. We provide legal case examples and discuss evaluation and treatment strategies to assist the medical team in the care of athletes.