Sports Medicine Setting Research Articles

Shared Decision-Making About Returning to Sport After Recovery From Pediatric Concussion: Clinician Perspectives.

Describe how sports medicine clinicians support decision making about sport participation after concussion recovery with adolescent patients and their parents. Specific areas of inquiry related to how clinicians framed the decision, what factors they considered in how they approached the decision process, and how they navigated discordance within families. Qualitative study. Tertiary care sports medicine clinics at 4 children's hospitals in the United States. Individual interviews were conducted with 17 clinicians practicing in sports medicine settings. N/A. Semi-structured interviews explored clinician approaches to supporting decision making, with the question guide informed by components of the Ottawa Decision Support Framework. Clinicians routinely incorporated aspects of shared decision making (SDM) into their conversations with families. This included ensuring all parties were informed about risk and aligned behind a shared value of adolescent well-being. Mediation strategies were used to manage discordance between adolescents and their parents, and between parents. These strategies aimed to facilitate a decision that was adolescent centered. When clinicians believed that there was a medical benefit to modifying the adolescent's sport participation practices, or when they did not believe the athlete was psychologically ready to return to the sport in which they were injured, they initiated conversations about alternative activities. In such situations, they used persuasive communication practices to encourage families to strongly consider this option. The strengths and strategies used by sports medicine clinicians in this study provide a foundation for guidance or intervention development aimed at supporting SDM after concussion with adolescents and their families.

Major clinical outcomes of metabolism and sports physiology: a systematic review

Introduction: In the sports medicine setting, many of the established positive health benefits of exercise have been documented by historic discoveries in the field of exercise physiology. Mitochondrial function is critical in regulating all three of the classic physiological factors that limit endurance performance. Objective: It was to carry out a systematic review to present the main information on exercise physiology in the light of mitochondrial redox activities in sports performance, as well as the guidelines of sports medicine in this regard. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from August to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles dated from 2008 to 2023. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 200 articles were found, and of the 77 articles were evaluated in full and 32 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 37 studies with a high risk of bias and 78 studies that did not meet GRADE. It was concluded that sports physicians may seek to use an increasing number of non-invasive techniques to study muscle metabolic functioning, answering how mitochondrial networks interact with O2 kinetics, how to remodel mitochondrial networks to increase performance, and how training affects the interaction between glycogen/lipid storage site and mitochondrial networks. Physiological and psychological demands during training and competition generate fatigue and reduce an athlete's sport-specific performance capacity. The magnitude of this decrease depends on several characteristics of the exercise stimulus, such as type, duration, and intensity, as well as on individual characteristics, such as physical conditioning, profile, and fatigue resistance. Recent evidence suggests that exercise-induced reactive species are essential upstream signals for the activation of redox-sensitive transcription factors and the induction of exercise-associated gene expression. Free radicals and oxidative stress are increasingly included in major reviews of exercise physiology as regulators of responses and adaptations.

Concurrent Force Feedback on Load Symmetry in Total Knee Arthroplasty Patients.

Load asymmetry can be present before and after total knee arthroplasty (TKA), which may affect progress during knee rehabilitation in an outpatient sports medicine setting. Current rehabilitation primarily focuses on strength, pain, and range of motion deficits; however, recent evidence suggests the use of movement retraining strategies such as load feedback to address load asymmetry. Therefore, the purpose of this study was to examine how a single session of concurrent force feedback influences load symmetry during the leg-press and body-weight squat exercises in individuals following TKA. Additionally, a secondary purpose was to examine the retention of any changes over the course of a week. Case-series study. This observational, repeated-measures study design examined the effect of concurrent force feedback training on the mean and standard deviation of load symmetry index during the leg press and squat exercises in 26 patients with TKA in an outpatient sports medicine clinic.The load asymmetry was measured with loadpad sensors placed underneath the each extremity during leg press and squat (baseline), after one training session consisting of concurrent force feedback during these exercises within a single physical therapy session (post feedback), and after seven to ten days of a washout period (post retention). Separate 2 x 3 repeated measures analysis of variance was used to compare the mean and standard deviation of load symmetry across exercise (leg press and squat) and across time (baseline, post feedback and post retention). There was a time effect for the mean load symmetry index (p=0.027) but not for the standard deviation (p=0.441) during these exercises. The leg press showed a greater mean symmetry index compared to the squat regardless of time (p=0.001). A reduction in the mean load symmetry index following concurrent feedback training suggests improved use of the surgical limb during both leg press and squat exercises during the same therapy session but the more symmetric loading pattern was not retained one week later. Overall, the leg press showed greater mean asymmetry than the squat. Standard deviation in the load symmetry index did not change across time or by exercise. 3©The Author(s).

Ultrasonography- and Doppler-Guided Surgical Treatment for Insertional Achilles Tendinopathy: Results From a Case Series in a Southern Sweden County Hospital.

Treatment with ultrasonography (US)- and color Doppler (CD)-guided mini surgery for insertional Achilles tendinopathy has shown good clinical results in a sports medicine setting. The aim in this study was to introduce this new methodology at a county hospital and study the clinical results on a traditional orthopaedic population. Twenty-six consecutive patients (12 men, mean age 61 years; 14 women, mean age 56 years) with a long duration (>12 months) of pain symptoms from insertional Achilles tendinopathy (a combination of bursae, bone, and tendon pathology) were included. US- and CD-guided surgical removal of bursae, bone, and tendon pathology, performed with local anaesthesia, was used. After surgery, there was immediate weightbearing loading without immobilization, followed by a structured rehabilitation protocol for 12 weeks. The VISA-A and SEFAS scores plus a questionnaire evaluating satisfaction with treatment and activity level was used for evaluation. At the 1-year follow-up, there were 3 dropouts. Twenty-one patients were satisfied. Their VISA-A score had increased significantly from 26 to 81 (P < .001), and the SEFAS score from 17 to 38 (P < .001). Two patients were not satisfied. There were 3 complications, 2 superficial skin infections, and 1 wound rupture. For patients with chronic painful insertional Achilles tendinopathy, the US- and CD-guided surgical treatment method followed by immediate weightbearing loading showed a high satisfaction rate and improved functional scores at the 1-year follow-up in a majority of the patients. There are advantages using this method compared to other more tendon invasive surgical methods in use for this condition. Level IV, case series.

Use of Blood Flow Restriction Training Between North American Sports Medicine Practitioners: A Questionnaire-Based Survey

<h3>Research Objectives</h3> To profile current clinical application of blood flow restriction (BFR) training among active sports medicine practitioners in North America using an online questionnaire. To compare responses to position stand recommendations regarding BFR training methodology. <h3>Design</h3> Survey distributed through August and September of 2021. <h3>Setting</h3> Online. <h3>Participants</h3> Convenience sample of 72 clinicians actively practicing in the United States (n=67) and Canada (n=5) were included. Experience applying or prescribing BFR training was required. Individuals unfamiliar with written English were excluded. The survey link was distributed electronically through professional organizations, email list servs, and social media. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Demographics (profession, practice setting, years of experience), type of equipment, treatment parameters, observed side effects, and personal opinions on the efficacy and value of BFR training. <h3>Results</h3> Athletictrainers (48.6%) and physical therapists (41.7%) primarily completed the survey. Automatic inflated cuffs and KAATSU airbands were the most common units employed. Parameters varied between respondents for exercise prescription (e.g. load and volume) and occlusion settings. Populations for BFR implementation ranged from injured (93.1%) and post-surgery cases (88.4%) to healthy individuals for performance enhancement (9.4%). Respondents primarily followed position statement recommendations with individualized pressure selections specific to blood pressure for resistance (80.9%) and aerobic BFR (69.6%) modes. Side effects reported included delayed onset muscle soreness (66.2%), inability to continue treatment due to pain (28%), numbness (22.5%), and cold feeling in the extremity (19.7%). Physical therapists indicated higher confidence in safety (t= -2.291, p=0.026), understanding of practice recommendations (t= -2.615, p=0.011) and theoretical principles (t=-3.056, p=0.004) compared with athletic trainers. <h3>Conclusions</h3> BFR is a common modality in contemporary sports medicine settings. Variations in BFR application is evident in devices, exercise and occlusion parameters selected, and side effects observed. Practitioners appear to be compliant with practice recommendations regarding the adoption of individualized pressure prescription. <h3>Author(s) Disclosures</h3> N/A.

Roles And Responsibilities Of The Physical Therapist In Collegiate Athletics: Results Of A National Survey.

BackgroundOver the past decade, there has been an increased focus on collaboration within collegiate athletics based sports medicine. Specifically, athletic trainers (ATs) and physical therapists (PTs) are working together, often side-by-side, to provide optimal care for the injured athlete. However, the roles and responsibilities of the PT within this model are currently not well described.PurposeThe purpose of this study was to identify educational training, credentials, roles, and responsibilities of the PT working with collegiate athletes.Study DesignCross-sectional surveyMethodsAn anonymous, descriptive online survey focusing on the demographic and occupational characteristics of PTs providing care for collegiate athletes was created and distributed electronically through the American Academy of Sports Physical Therapy (AASPT), a subgroup within the American Physical Therapy Association (APTA).ResultsOne hundred forty eligible responses were included. Sixty-four percent (90/140) of the respondents were male; 86% of the respondents (120/140) reported working in the National Collegiate Athletic Association (NCAA) Division I setting. Half (70/140) of respondents were also ATs, and 60% (83/140) were board-certified sports clinical specialists (SCS). All respondents (140/140) provide rehabilitation exercises; nearly all provide sports performance enhancement and manual therapy (97%, 136/140 and 96%, 135/140, respectively). Other identified roles and responsibilities included communication with the athletic training staff, event coverage, and personnel management.ConclusionsThe role of the PT within collegiate athletics sports medicine is highly varied; years of experience, certification, credentials, and location of patient care are also variable.Clinical RelevancePTs working in a collegiate athletics sports medicine setting have many paths to entry and diverse job duties. PTs interested in working in this setting should prioritize developing relevant experience and communication skills.Level of EvidenceLevel 3b

Anthropometrics, Exercise Duration Associated With Force And Rate Of Force Development During A Suspended Plank

Suspension training is used in rehabilitation and fitness training settings due to its ability to challenge various muscle groups. Suspended planks require an individual to support their body weight and are mostly used as an advanced core endurance exercise. PURPOSE: To determine how force and rate of force development (RFD) during a suspended plank relate to total hold time and participant body size and activity level. METHODS: Forty physically active, asymptomatic individuals (Age: 23.6 ± 4.9 years, Height: 169.7 ± 6.9 cm, Weight: 151.0 ± 22.4lbs, 20 males, 20 females) participated in this study. Prior to exercise, individuals completed the International Physical Activity Questionnaire (IPAQ: 5850.6 ± 3746.6mets). Participants performed a prone plank holding onto the suspension strap system attached to a closed door, with arms in full extension and feet fixed on the floor. A load cell sensor was attached to the suspension strap above the participant’s right hand and measured force (lbs) and RFD (lbs/s). Plank time (s) started when the participant raised into the appropriate plank position and stopped when they could no longer maintain proper form. Mean and standard deviation were calculated for force, RFD, plank time, height, and weight. Pearson’s r correlation was used for force and participant characteristics, and Spearman’s ρ correlation was calculated for all RFD relationships. RESULTS: Participants held the suspended plank for 25.5 ± 14.8 s and exhibited an average force of 110.1 ± 20.4lbs (RFD min -25.2lbs/sec, max 1.96lbs/sec). Plank time revealed a strong positive relationship with RFD (ρ = .81, p < .001). Height (r = .58, p < .001) and weight (weight r = .83, p < .001) showed a significant positive relationship with force. Weight was also indirectly associated with days (ρ = -.37, p = .02) and minutes/week (ρ = -.33, p = .04) spent walking from the IPAQ. CONCLUSIONS: Body size was directly related to force production during the suspended plank exercise. Individuals who walked more frequently may have had less body weight to control, thus reducing the force required to maintain the plank position. Understanding how various body sizes and activity levels impact body weight stabilization exercise is important for clinicians and practitioners in sports medicine and fitness settings who may utilize suspension training.

The Effects on Knee Swelling, Range of Motion and Pain using a Commercially Available Hot/Cold Contrast Device in a Rehabilitation and Sports Medicine Setting.

Background and PurposeContrast therapy consists of alternating thermotherapy and cryotherapy repeatedly to assist in the management of acute, subacute, and chronic musculoskeletal conditions. This has been utilized for several decades with good to excellent subjective and objective results reported for patients with swelling (acute to chronic), pain, and loss of motion. Typically, the intervention is performed by either the use of a hot and cold whirlpool or by applying hot and cold packs which can be very time consuming and labor intensive. The purpose of this study was to determine the efficacy of a single treatment of the Hyperice X system in reducing knee joint pain, swelling and stiffness in active patients and young injured athletes. A secondary purpose was to measure patient satisfaction with the use of the device.SubjectsFifty subjects (34 males and 16 females) with a mean age of 22.2 +/- 4.9 yrs (ranging from 17 to 45 yrs of age) were recruited. Subjects presented with various types of knee pain, both non-operative and operative, secondary to ligamentous, tendinous, cartilage, muscle, and/or meniscus pathology. The subjects were in various stages of rehabilitation with six in the acute stage, 24 in subacute stage, and 20 in the chronic stage. The subjects participated in a variety of different sports at various levels of competition ranging from recreational to professional.MethodsSubjects were recruited from one of two centers: an athletic training room or an outpatient sports medicine rehabilitation center. They were evaluated for baseline pain using the visual analog scale (VAS),verbal patient satisfaction on a scale of 1-10, verbal assessment of knee tightness, knee circumference, and knee flexion range of motion. The Hyperice X was applied to the knee utilizing the contrast setting for a total of 18 minutes with three six-minute cycles, each consisting of three minutes of heat therapy and three minutes of cold therapy. The contrast therapy was applied at the initiation of the physical therapy session and all subjective and objective measures were repeated immediately post contrast treatment.ResultsThe VAS scores significantly improved following the treatment session with the mean score pretreatment of 2.59 and following the treatment of 1.68. Knee circumference improved for mid patella and 5 cm below mid patella, but no significant improvement was noted at the 5 cm above the patella region. Knee flexion improved from 130 degrees pre-treatment to 134 degrees post treatment. Knee extension improved from 2.72 degrees of hyperextension to 3.44 degrees, both of which were statistically significant(p<.001).ConclusionContrast therapy utilizing the Hyperice X device demonstrated effectiveness in affecting pain reduction, swelling, and knee ROM. A commercially available device providing contrast therapy, may enhance outcomes in athletes after even a single treatment. In addition, the device was found to be easy to use, clinically practical, and demonstrated very high subjective patient satisfaction.Level of EvidenceLevel 3

Gender Diversity in Primary Care Sports Medicine Leadership.

Diversity, equity, and inclusion have been recognized as important drivers of excellence and innovation in the physician workforce. Given the historical underrepresentation of women in medicine, gender diversity is of interest. In this cross-sectional study, we sought to quantify leadership representation of female physicians in primary care sports medicine settings, including primary care sports medicine fellowship programs, select sports medicine societies, and select sports medicine-related scientific journals. Data were collected by querying the corresponding web site for each fellowship program, society, and journal and analyzed in a descriptive manner. Results showed that fewer female physicians hold primary care sports medicine leadership roles than men do. This work establishes a baseline for female representation in primary care sports medicine leadership; efforts should continue to increase the presence of women in leadership positions.

Prospective Evaluation of Pain Flares and Time Until Pain Relief Following Musculoskeletal Corticosteroid Injections.

Corticosteroid injections are used ubiquitously within musculoskeletal medicine. One of the most common side effects is a postinjection pain flare, though little is known regarding this phenomenon. Some risk factors are related to postinjection pain flare following an ultrasound-guided corticosteroid injection. Prospective clinical research study. Level 2. Patients undergoing ultrasound-guided corticosteroid injections in an academic orthopaedic and sports medicine clinic were approached to participate. Patients completed a survey immediately following their injection and again 2 weeks later, asking them about their pain and side effects. A postinjection pain flare was defined as an increase in pain, as defined by the patient. A total of 140 patients completed the entirety of the study, with 29 (20.7%) patients reporting a flare of pain. There was a significant effect of younger age on the development of a pain flare after the injection, estimated as 5.5% decreased odds of developing a flare per year of age (P < 0.01). Gender, injection location, body mass index (BMI), preinjection pain, and corticosteroid type had no contributing effect. When patients obtained relief following the corticosteroid injection, 60.4% had improved pain within 3 days, whereas over 93.7% obtained relief within a week. Pain flares seem to affect approximately 1 in 5 patients. With increasing age, the likelihood of postinjection pain flare becomes less likely. Sex, injection location, BMI, preinjection pain, and corticosteroid type do not seem to significantly relate to an increase in pain following injection. Corticosteroid injections are common procedures in the orthopaedic and sports medicine settings. Younger patients can be counseled on the higher likelihood of a pain flare following a corticosteroid injection.

Reliability of Plain Radiographs Versus Magnetic Resonance Imaging to Measure Tibial Slope in Sports Medicine Patients: Can They Be Used Interchangeably?

Background:The slope of the tibial plateau has been proposed as a reason for failure of anterior cruciate ligament reconstruction.Purpose:To evaluate the interobserver reliability of measurements of tibial slope on radiographs versus magnetic resonance imaging (MRI) scans and to assess whether the modalities can be used interchangeably for this purpose.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:This retrospective study included 81 patients aged 18 to 30 years who were evaluated in a sports medicine setting for knee pain and who had lateral knee radiographs as well as knee MRI scans on file. Medial and lateral tibial plateau slope measurements were made by 3 blinded reviewers from the radiographs and MRI scans using graphic overlay software. The paired t test was used to compare measurements of the medial tibial plateau slope (MTPS) and lateral tibial plateau slope (LTPS) from radiographs and MRI scans. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver reliability of measurements within each imaging modality, and Pearson correlation coefficients were calculated to determine the relationship between measurements on radiographs versus MRI scans.Results:Imaging from 81 patients were included. The average MTPS was significantly larger on radiographs compared with MRI scans (8.7° ± 3.6° vs 3.7° ± 3.4°; P < .001), and the average LTPS was also significantly larger on radiographs compared with MRI scans (7.9° ± 3.4° vs 5.7° ± 3.7°; P < .001). ICC values indicated good to excellent intraobserver agreement for all imaging modalities (ICC, 0.81-0.97; P ≤ .009). The ICCs for interobserver reliability of MTPS and LTPS measurements were 0.92 and 0.85 for radiographs, 0.87 and 0.83 for MRI based off the subchondral bone, and 0.86 and 0.71 for MRI based off the cartilage, respectively (P < .001). Medium correlation was noted between radiographic and MRI measurements; Pearson correlation coefficients for radiographic versus subchondral MRI measurements were 0.30 and 0.37 for MTPS and LTPS, respectively.Conclusion:The average MTPS and LTPS were significantly larger on radiographs compared with MRI scans. Although tibial slope measurements using radiography and those using MRI are reliable between individuals, the measurements from radiographs and MRI scans cannot be used interchangeably, and caution should be used when interpreting and comparing studies using measurements of the tibial slope.

Exercise induced Leg Pain due to Vascular Compression Syndrome

Within a sports medicine setting vascular pathologies of the legs represent a rare entity and are often associated with a significant delay of diagnosis and treatment. Nevertheless, timely detection is crucial when it comes to management of athletes. Three types of vascular compression syndromes are going to be summarized within this review. Therefore, adductor’s canal (or Hunter’s canal) represents an external compression of the superficial artery located in the middle third of the thigh causing exercise-induced calf pain and numbness of toes.

Collaborative care model for treatment of persistent symptoms after concussion among youth (CARE4PCS-II): Study protocol for a randomized, controlled trial

BackgroundCurrently, there is limited evidence to guide intervention and service delivery coordination for youth who suffer a concussion and subsequently experience persistent post-concussive symptoms (PCS) (Lumba-Brown et al. JAMA Pediatr 172(11):e182853, 2018; Lumba-Brown A et al. JAMA Pediatr 172(11):e182847, 2018). We have developed a collaborative care intervention with embedded cognitive-behavioral therapy, care management, and stepped-up psychotropic medication consultation to address persistent PCS and related psychological comorbidities. The CARE4PCS-II study was designed to assess whether adolescents with persistent symptoms after sports-related concussion will demonstrate better outcomes when receiving this collaborative care intervention compared to a usual care (control) condition.Methods/designThis investigation is a randomized comparative effectiveness trial to receive intervention (collaborative care) or control (usual care). Two hundred sports-injured male and female adolescents aged 11–18 years with three or more post-concussive symptoms that persist for at least 1 month but less than 9 months after injury will be recruited and randomized into the study. The trial focuses on the effects of the intervention on post-concussive, depressive, and anxiety symptoms measured 3, 6, and 12 months after baseline.DiscussionThe CARE4PCS II study is a large comparative effectiveness trial targeting symptomatic improvements in sports injured adolescents after concussion. The study is unique in its adaptation of the collaborative care model to a broad spectrum of primary care, sports medicine, and school settings. The investigation incorporates novel elements such as the delivery of CBT through HIPAA complaint video conferenceing technology and has excellent widespread dissemination potential should effectiveness be demonstrated.Trial registrationClinicalTrials.gov, NCT03034720. Registered on January 27, 2017.

Platelet-rich plasma in orthopaedic sports medicine: state of the art

Platelet-rich plasma (PRP) is one of the many new developments within the expanding field of regenerative medicine. It aims to improve the process of tissue repair through local delivery of autologous bioactive agents to influence critical physiological mechanisms such as inflammation, angiogenesis or extracellular matrix synthesis. Within orthopaedics and sports medicine, the use of PRP has been rapidly increasing in popularity as patients seek non-surgical approaches to acute and chronic musculoskeletal injury and disease. The popularity of this new treatment option has prompted a rapid increase in research endeavours. Although preclinical studies were encouraging, clinical studies often reported controversial results. The differences in the composition and application techniques of PRP have made comparisons regarding its efficacy difficult and somehow inconclusive. Although PRP appears to be a safe treatment option with potentially beneficial effects to injured musculoskeletal tissues, continuous efforts are needed to identify factors that influence the biological response to PRP treatment. It is likely that in the near future the PRP preparation will be tailored not only to the specific pathology of interest but also to stage of disease. However, the growing emphasis on an evidence-based approach in the sports medicine setting demands additional research efforts before incorporating this technology in routine clinical care. The current review explores the latest findings on PRP efficacy in several musculoskeletal conditions, focusing on results of the highest level of evidence available.

Eccentric Exercise for Achilles Tendinopathy: A Narrative Review and Clinical Decision-Making Considerations.

Background: Achilles tendinopathy is a common health condition encountered in the orthopedic and sports medicine settings. Eccentric exercise is a common intervention in the management of pain and limited function for this patient population, although contemporary evidence suggests additional exercise methods may be effective as well. Study design: Narrative review: Methods: A literature review was performed using the electronic databases Pubmed and PEDRO for articles through February 2019. Randomized clinical trials integrating eccentric exercise, with or without co-interventions, were evaluated. Outcomes related to pain and/or function were considered. A patient case is provided to highlight decision making processes related to clinical prescription of eccentrics for Achilles tendinopathy. Results: After screening titles and abstracts, seven studies were included for full review. Two articles compared eccentric exercise to a control group, four compared eccentrics to the use of modalities, while one used eccentric exercise as part of a multimodal intervention. In each case, eccentric exercise was effective in reducing pain and improving function. In comparison to other forms of exercise or additional interventions, eccentric exercise was frequently not more effective than other options. Discussion: Eccentric exercise has been associated with clinical benefit in improving pain and function for patients with Achilles tendinopathy. Despite the available evidence reporting effectiveness of eccentrics, other options may be equally useful. Appropriate load modification and exercise prescription for patients with Achilles tendinopathy requires systematic clinical reasoning and incorporation of patient values to optimize outcomes.

Contemporary Conflict Management in the Sports Medicine Setting

PURPOSE. Conflict management is an important aspect in the administration and organization of sports medicine teams. Health care professionals attempt to exert personalities, influences, biases that may create points of misunderstanding within everyday team operations. METHODS. This review gathers contemporary information and theories towards conflict and conflict management, including definitions of current terminology and current concepts. This study also identifies opportunities that team members may utilize when dealing with conflict. Four main types of conflict are discussed and are juxtaposed with sports medicine scenarios. These types include: goal related conflict, affective conflict, procedural conflict, and cognitive conflict. A review of recent literature also provides strategies for dealing with conflict and creating commitment within team members. RESULTS. Potential effects and benefits of various conflict management approaches are discussed. Evidence is then presented to further understand and appreciate the elements involved with conflict when intertwining healthcare professionals in a sports medicine setting. CONCLUSION. In conflict management, recognizing that all team members have differing viewpoints can serve as a resolution point which encourages team members to embrace their differences. Finally, a case study summarizes the theories for conflict management.

Elbow examination in the athlete

The elbow is a frequently underestimated and commonly misunderstood joint, leading to a considerable amount of clinical problems. A large part of this due to the largely overlapping and often unspecific symptoms of various diseases and injuries. A better understanding of elbow symptoms and the clinical exam of the elbow is the key to unlocking elbow pathology. This paper reviews a comprehensive and concise exam of the elbow that can easily be employed in a primary care sports medicine setting.

Objective Eye Tracking Deficits Following Concussion for Youth Seen in a Sports Medicine Setting.

Quantification of visual deficits may help to identify dysfunction following concussion. We evaluated eye-tracking measurements among adolescents within 10 days of concussion and healthy control participants. Patients who reported to 2 tertiary care sport concussion clinics within 10 days of concussion completed an objective eye tracking assessment. Seventy-nine participants completed the study, 44 with concussion (mean age = 14.1 ± 2.2 years, 39% female) and 35 controls (mean age = 14.3 ± 2.4 years, 57% female). Right eye skew along the bottom of the screen was significantly higher for the concussion group compared to controls (median = 0.022 [interquartile range = -0.263, 0.482] vs 0.377 [interquartile range = -0.574, -0.031]; P = .002), but not the left eye. Among the variables investigated, right eye skew was altered for adolescents with a concussion. Visual function is an important component in the postconcussion evaluation, and identifying deficits soon after injury may allow for earlier specialist referral and intervention.

Contrast Baths, Intramuscular Hemodynamics, and Oxygenation as Monitored by Near-Infrared Spectroscopy.

Contrast baths (CB) is a thermal treatment modality used in sports medicine, athletic training, and rehabilitation settings. Proposed physiological effects of CB include increasing tissue blood flow and oxygenation and decreasing tissue swelling and edema to promote better healing, improved limb function, and quicker recovery. To investigate the physiological effects of CB on the intramuscular hemodynamics and oxygenation of the lower leg muscles using near-infrared spectroscopy (NIRS), an optical method for monitoring changes in tissue oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) as well as tissue oxygen saturation index (TSI%). Descriptive laboratory study. Ten healthy men and women with a mean age of 29 (range = 17 ± 42) years, mean body mass index of 24.6 ± 3.2, and mean adipose tissue thickness of 6.4 ± 2.2 mm. Conventional CB (10-minute baseline, 4 : 1-minute hot : cold ratio) was applied to the left lower leg. Changes in chromophore concentrations of O2Hb, HHb, tHb, and TSI% of the gastrocnemius muscle were monitored during 10 minutes of baseline measurement, a 30-minute CB protocol, and 10 minutes of recovery using a spatially resolved NIRS. After a 30-minute CB protocol, increases ( P < .05) in tissue O2Hb (7.4 ± 4 μM), tHb (7.6 ± 6.1 μM), and TSI% (3.1% ± 2.3%) were observed as compared with baseline measures. Application of CB induced a transient change in the hemodynamics and oxygenation of the gastrocnemius muscle in healthy individuals. The effect of CB application in improving tissue hemodynamics and oxygenation may, therefore, support the therapeutic benefits of CB in the treatment of muscle injuries.

How to manage patellofemoral pain – Understanding the multifactorial nature and treatment options

Patellofemoral pain (PFP) is one of the most prevalent conditions within sports medicine, orthopaedic and general practice settings. Long-term treatment outcomes are poor, with estimates that more than 50% of people with the condition will report symptoms beyond 5 years following diagnosis. Additionally, emerging evidence indicates that PFP may be on a continuum with patellofemoral osteoarthritis. Consensus of world leading clinicians and academics highlights the potential benefit of delivering tailored interventions, specific to an individual's needs, to improve patient outcome. This clinical masterclass aims to develop the reader's understanding of PFP aetiology, inform clinical assessment and increase knowledge regarding individually tailored treatment approaches. It offers practical application guidance, and additional resources, that can positively impact clinical practice.