Sports Medicine Team Research Articles

Keeping Them on the Field

Keeping Them on the Field

Extended Abstracts

The soccer athlete has a greater incidence of overuse and acute knee injuries and as a consequence is at most risk for chondropenia and osteoarthritis. Chondropenia conceptually defines the complex nature of the multivariable processes over time including acute and chronic injury, modulators and the aging process. The role of the Sports Medicine team is to prevent injury, restore the joint and ultimately return the athlete to sport while preventing Osteoarthritis. The clinical consequences of full thickness Articular Cartilage defects are pain, swelling, mechanical symptoms athletic and functional disability and osteoarthitis. In the soccer athlete it is articular cartilage that confers the highest levels of performance. It is the fact that any partial or full thickness loss results in loss of day to day resilience and a spectrum of soreness, stiffness, pain and swelling and most importantly. These injuries may be career- endingIn this group of high demand participants any increase in activity and loading beyond the articular cartilage threshold for injury, results in a clinical overuse response with the potential negative adaptive consequences of chondropenia and an increased risk of developing osteoarthritis. Lesions to articular cartilage are common acutely but are associated with ACL injuries and long-term chondropenia and Osteoarthitis. The challenge of ACL injury reduction, articular cartilage repair and regeneration and osteoarthitis prevention in the soccer athlete continues to be significant despite significant recent advances. The purpose of this lecture is to present the current concepts with respect to the Athlete's Articular Cartilage the histological, biochemical and clinical implications and contemporary treatments from a historical and an evolutionary prospective as applied during or after their competitive years.

Heat Illness Symptom Index Scale In Football Players Predictive Of Elevated Gi Temperature In Subsequent Practice

Exertional heat illness is a significant morbidity and mortality risk in individuals exercising in hot, humid environmental conditions. The third leading cause of death in US high school athletes, it is of considerable concern to the sports medicine team. PURPOSE: This study investigated the relationship between subjective symptom scores and gastrointestinal temperature, Tgi, in elite football athletes during two a day practices in the heat and humidity of southern Florida. METHODS: 66 division I collegiate football athletes participated in this study over two years of two a day preseason practices. Athletes ingested Tgi temperature thermistors preceeding each practice and were evaluated by a validated symptom questionnaire, the Heat Illness Symptom Index (HISI), following each practice. RESULTS: 5552 data points were obtained on 66 athletes, covering an average of 4.4 hours per player. The data was collected over 25 early preseason practices, 12 am practices and 13 pm practices. Each player was monitored for an average of four practices. Statistically significant correlation was seen between multiple variables and Tgi. Time elapse (p=<.0001), was obviously a predictor of core temperature elevation, but also player position group (p=0.0003), BMI (p=0.0001), symptom score of same practice (p=<0.0001), symptom score of the preceding practice (p= <0.0001), and rating of perceived exertion (p= <0.0001). CONCLUSION: HISI scores following each practice were predictive of core temperature elevations in the the following practice (p=0.0001). Those at highest risk of elevated core temperature the following practice were those that ranked in the fourth (highest) quartile on HISI score (p=0.0001). The HISI can be a valuable, simple tool in identifying those at risk of elevated core temperature in football athletes exercising in the heat.

In-season rehabilitation of a division III female wrestler after a glenohumeral dislocation

Objective Wrestling is a popular sport in the United States at both the high school and collegiate levels. Traditionally a men's sport, participation by female athletes in wrestling is increasing. There exists a paucity of literature regarding injury incidence in women's wrestling. This lack of information challenges the ability of sports medicine and strength training professionals to design optimal injury prevention programs, training routines, and rehabilitation strategies. The objective of this report is to detail the successful conservative rehabilitation of a female wrestler after an initial glenohumeral dislocation. Design Case report Case description A 20-year-old female wrestling student–athlete presented to the university's sports medicine team after sustaining an anteriorly dislocated right shoulder. The patient had the goal to return back to competition in time for the National Championships. An evidenced-supported, non-traumatic glenohumeral instability rehabilitation protocol combined with weight-bearing exercises simulating functional sport positions was implemented with the goal of returning the injured collegiate female wrestler back to sport. Results At the end of the rehabilitation program the athlete demonstrated full active range of motion, good strength in the right shoulder, and reported her pain rating at a 1/10. The conservative rehabilitation strategy utilized in this case enabled the patient to return to wrestling and successfully compete at the National Championships.

Sports Neuropsychology: Assessment and Management of Traumatic Brain InjuryEdited by Ruben J. Echemendia, Ph.D. State College, PA Published 2006, Guilford Press, New York 324 pages ISBN-10 1-57230-078-7 $49.00

Back to table of contents Previous article Next article BOOK-REVIEWFull AccessSports Neuropsychology: Assessment and Management of Traumatic Brain InjuryGary S. Solomon Ph.D.Gary S. Solomon Ph.D.Search for more papers by this authorPublished Online:1 Oct 2008https://doi.org/10.1176/jnp.2008.20.4.504AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The past 15 years has yielded an explosion of information on the topic of concussive injuries in sports, both in the public press and in the professional literature. In 2005 the Centers for Disease Control concluded that concussion in sports was of “epidemic” proportion and estimated that 1.6 to 3.8 million cases of sports-related concussions occur annually in the United States. At least six major sports neuroscience textbooks have appeared in the past decade, including Sports Neurology by Jordan, Tsairis, and Warren (1998); Sports-Related Concussion by Bailes, Lovell, and Maroon (1998); Neurologic Athletic Head and Spine Injuries by Cantu (2000); Neurologic Sports Medicine by Bailes and Day (2001); Traumatic Brain Injury in Sports by Lovell, Echemendia, Barth, and Collins (2004); and Foundations of Sports-Related Brain Injuries by Slobounov and Sebastianelli (2006). The most recent addition to the armamentarium of sports concussion textbooks is the edited book by Dr. Ruben Echemendia, a founding member of the Penn State Cerebral Concussion Program and a recent past president of the National Academy of Neuropsychology. Sports Neuropsychology is divided into five sections. The contributing authors are primarily neuropsychologists, but also include a neurologist, a certified athletic trainer, and a sports medicine physician. Section one addresses some of the history of sports neuropsychology. Section two is devoted to the epidemiology and pathophysiology of traumatic brain injury in sports, sideline assessment of the concussed athlete, and return to play decisions. Section three discusses the nuts and bolts of neurocognitive testing programs at various levels of competition, including high school, collegiate, and professional programs. Section four is an overview of the four most frequently utilized computerized neurocognitive platforms for assessing the cognitive effects of sports concussion, and includes overviews (written in part by the developers) of CogSport, The HeadMinder Concussion Resolution Index, ImPACT, and Automated Neuropsychological Metrics (ANAM) Sports Medicine Battery. Section five concludes the text with perspectives from an athletic trainer and a sports medicine team physician. The text will likely be of greatest interest to neuropsychologists, since two of the five major sections of the book are devoted to overviews of computerized neurocognitive batteries, as well as information on sports concussion testing programs at various levels of competition. The chapters on computerized neurocognitive tests are superior in depth to the information presented in the text by Lovell et al. (2004). The text by Mark Lovell and colleagues addresses sports concussion testing by sport, whereas Sports Neuropsychology covers the subject matter by age group. Though dated, the texts by Bob Cantu (2000) and Barry Jordan and associates (1998) are likely to be of greater interest to neurologists and neurosurgeons. Sports Neuropsychology will be of interest to other sports medicine clinicians who are interested in obtaining an in-depth appreciation of the history and development of neurocognitive testing in sports, and how various cognitive functions are assessed by the different computerized neurocognitive tests. Athletic trainers and team physicians may find the chapter on sideline assessment particularly useful. Students or neuroscientists needing a review of sports concussion epidemiology and basic concussion pathophysiology will also find the book valuable. Any professional member of a sports medicine team who deals with athletic concussions and their associated issues will find the perspectives presented by Echemendia (neuropsychologist), Putukian (team physician), and Furtado (athletic trainer) particularly useful and informative. Sports Neuropsychology is well-written, does not suffer from the redundancy found in many edited texts, and should be considered a useful and authoritative review of the status of this emerging specialty. FiguresReferencesCited byDetailsCited ByRecurrent neural network-based acute concussion classifier using raw resting state EEG data11 June 2021 | Scientific Reports, Vol. 11, No. 1 Volume 20Issue 4 Fall, 2008Pages 504-504 Metrics PDF download History Published online 1 October 2008 Published in print 1 October 2008

Diagnosing Emotional Disorders in Athletes: A Sport Psychiatrist’s Perspective

Like the sports medicine physician, the sport psychiatrist plays an important role in the sports medicine team (SMT). A specialist in diagnosing emotional disorders can increase the diagnostic and treatment capabilities of the SMT. The goal of this article is to increase awareness of the psychiatric disorders commonly occurring among athletes and highlight the value of accurate psychiatric diagnosis. Using vignettes involving established athletes, the article examines anxiety and mood disorders, eating disorders, substance use disorders, and attention deficit disorder as they occur in athletic settings, as well as other syndromes with particular relevance to athletes, such as overtraining and postconcussion syndrome. Other clinical issues encountered while working with athletes, including learning disabilities and career termination concerns, are also discussed. Finally, the basic concepts of transference and countertransference are reviewed to highlight important relational dynamics between the athlete and the SMT.

CrossRef Listing of Deleted DOIs

Strength training has become an integral part of preparing for and participating in sports. Strength is one of the four components of athleticism, along with power, speed, and agility. Optimal strength training and conditioning workouts are best directed by a coach with formal training in this discipline. Unfortunately, many high school and some college programs do not have access to certified strength and conditioning coaches. This task often falls to the individual sport coaches and medical staff (athletic trainers and physicians). In this article we present a framework for practical strength training knowledge including the concepts of specificity, prioritization, periodization, and progressive overload. We also discuss concepts of the sports medicine team and its approach to training and conditioning. This framework will give physicians and other athletic heath care providers the basic information needed to design and implement a safe and effective strength training program.

Differential Diagnosis of a Sports Hernia in a High-School Athlete

Resident's case problem. Chronic anterior hip and groin pain is a growing concern among high-performance athletes. This manuscript enforces the need for physical therapists to remain current with its complex differential diagnosis, as it can be debilitating for the athlete and equally frustrating for the sports medicine team. This resident's case problem details the account of an 18-year-old high-school wrestler who presented to the high-school sports medicine team without physician referral. His chief complaint was chronic right anterior hip and groin pain, which had been variable in frequency and intensity for 3 years. A screening examination for serious underlying pathology was negative. After physical examination, it was determined that this individual had signs and symptoms consistent with a sports hernia. He was referred to a general surgeon who diagnosed him with a symptomatic inguinal hernia and later performed laparoscopic evaluation and treatment. The patient had a moderate-size indirect inguinal hernia sac, which was carefully dissected away from the remaining contents of the spermatic cord and was repaired with a Parietex mesh. At a 2-week postoperation follow-up, the patient was asymptomatic and cleared to return to wrestling and baseball without limitations. This resident's case problem demonstrates the debilitating and often elusive nature of a sports hernia. It suggests that the diagnosis is not well understood and emphasizes the importance of a robust medical foundation for each member of the sports medicine team conducting athletic evaluations.

Return to Activity Considerations in a Football Player Predisposed to Exertional Heat Illness: A Case Study

Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.

Strength Training

Strength training has become an integral part of preparing for and participating in sports. Strength is one of the four components of athleticism, along with power, speed, and agility. Optimal strength training and conditioning workouts are best directed by a coach with formal training in this discipline. Unfortunately, many high school and some college programs do not have access to certified strength and conditioning coaches. This task often falls to the individual sport coaches and medical staff (athletic trainers and physicians). In this article we present a framework for practical strength training knowledge including the concepts of specificity, prioritization, periodization, and progressive overload. We also discuss concepts of the sports medicine team and its approach to training and conditioning. This framework will give physicians and other athletic heath care providers the basic information needed to design and implement a safe and effective strength training program.

Return to Play After Concussion

The sport medicine team is increasingly being asked to manage concussed athletes and to provide written clearance for return to play postconcussion, making it critical to have a good understanding of concussion recognition, assessment, and management. A handy way to think of concussion management is the four Rs: recognition, response, rehabilitation, and return. Athletes, coaches, parents, therapists, and physicians need a thorough understanding of concussion signs and symptoms. An athlete suspected of having sustained a concussion should be removed from the game or practice and assessed by a member of the sideline medical team. All athletes who sustain a concussion should be evaluated by a medical doctor. Rehabilitation has similarities to but also differs from the traditional orthopedic model in that the first step is rest, both physical and cognitive. Once asymptomatic at rest, a step-wise return to activity is undertaken. This protocol has been adapted for various sports. It may be used for children, although it is prudent to be more conservative and to progress more slowly than in an older age group.

Management and Return to Play of Stress Fractures

The purpose of this article is to provide the clinician an evidence/experience-based algorithm for the management of stress fractures. Medline search of peer reviewed publications regarding stress fracture etiology, classification, treatment, and natural history. The algorithm was developed from a review of retrospective case series, a few evidence-based papers, and the clinical experience of 4 sports medicine team physicians with a combined experience of over 40 years in the care of athletes at the college and professional level. The literature is almost entirely case series without control groups; therefore, clinical consensus is included as the next best guide to treatment. The emphasis of this article is to provide a clear and simple approach to the management of these fractures by classifying them as either high-risk or low-risk. This separation into 2 groups is based on the biomechanical environment and natural history of the fracture. High-risk stress fractures occur in the superolateral femoral neck, anterior tibial shaft, tarsal navicular, proximal fifth metatarsal, and talar neck. Low-risk stress fractures occur in the lateral malleolus, calcaneus, 2nd through 4th metatarsals, and the femoral shaft. The undertreatment of high-risk stress fractures can lead to catastrophic bone failure and/or prolonged loss of playing time. Overtreatment of low-risk stress fractures can result in unnecessary deconditioning and unneeded loss of playing time. We propose that the use of the simple and clinically relevant algorithm will help guide appropriate management and return to play decision-making as well as encourage future prospective research.

The Brugada Syndrome

Brugada syndrome is a recognized cause of sudden cardiac death worldwide. An inherited ion channel abnormality produces abnormal repolarization leading to characteristic ST-segment elevation in precordial leads V1 to V3 and a pseudo right bundle branch block on electrocardiogram. Only recently has medical therapy and management been defined to allow for athletes to lead healthy lifestyles. This article provides a concise review of the clinical manifestations, pathophysiology, and therapeutic options for the sports medicine team.

Dental Injuries in Sports

The expanding arena of sports and vigorous recreational activities is associated with an increased risk for sports-related injuries, including trauma to the teeth. Because dental professionals may not be present on site, in the best interest of athletes, it is suggested that sports medicine professionals who are present be provided with current evaluative, emergent, and referral protocols for proper management of sports-related dental injuries to address the immediate needs of the athlete and to enhance the long-term prognosis of the traumatized tooth. This article provides information related to some of the more common dental injuries encountered in sports, including crown fractures, root fractures, and traumatic tooth displacements. Use of properly fitted, custom-fabricated athletic mouth guards for the prevention of dental injuries is recommended strongly, as is the inclusion of a dentist on the sports medicine team roster.

Heat illness in children.

With an increasing number of children and adolescents involved in competitive athletics throughout the calendar year, the sports medicine team must be familiar with preventing and treating heat-related illness. Heat illness is a spectrum of illnesses from heat cramps to heat stroke. Mortality for heat stroke ranges from 17% to 70%, depending on severity and age of the patient. Children are more susceptible to heat illness than adults for many reasons, including a greater surface area to body mass ratio, lower rate of sweating, and slower rate of acclimatization. The prevention of heat illness is based on recognizing and modifying risk factors, which include environmental conditions, clothing, hydration, and acclimatization. Once heat illness is suspected, treatment should begin immediately with rapid cooling procedures started on the field.

Bull Riding Injuries in Professional Rodeo

ABSTRACTBACKGROUND: Recent tragedies in bull riding have highlighted the need for prospective epidemiologic investigation of injury patterns.OBJECTIVE: To document the frequency, type, severity, anatomic location, and mechanism of injury to bull riders participating in professional rodeo in Canada.DESIGN: Five-year prospective cohort study examining 4,375 competitor exposures during bull riding events at selected rodeos. Certified athletic therapists gathered data at 63 of 323 professional rodeos in Canada from 1995 through 1999. Data were included when a registered bull rider was injured and the Canadian Pro Rodeo Sport Medicine Team was officially present and providing services. The main outcome measures were the frequency, severity, and anatomic location of injuries to bull riders.RESULTS: According to the injury classification system (severe, minor, or other), 36% of injuries to bull riders were severe. Fractures were the most common severe injury. Concussions constituted 10.6% of all injuries; neck injuries and concussion with other head and facial injuries accounted for 28.9%. About half (48%) of injuries were minor. The knee and shoulder were the most commonly injured joints.CONCLUSION: Injuries to the head, neck, and face may deserve more attention by both researchers and those interested in preventing injury to bull riders. Epidemiologic information will give on-site physicians a better foundation in preparing to care for injured rodeo participants.

Bull Riding Injuries in Professional Rodeo

ABSTRACTBACKGROUND: Recent tragedies in bull riding have highlighted the need for prospective epidemiologic investigation of injury patterns.OBJECTIVE: To document the frequency, type, severity, anatomic location, and mechanism of injury to bull riders participating in professional rodeo in Canada.DESIGN: Five-year prospective cohort study examining 4,375 competitor exposures during bull riding events at selected rodeos. Certified athletic therapists gathered data at 63 of 323 professional rodeos in Canada from 1995 through 1999. Data were included when a registered bull rider was injured and the Canadian Pro Rodeo Sport Medicine Team was officially present and providing services. The main outcome measures were the frequency, severity, and anatomic location of injuries to bull riders.RESULTS: According to the injury classification system (severe, minor, or other), 36% of injuries to bull riders were severe. Fractures were the most common severe injury. Concussions constituted 10.6% of all injuries; neck i...

Epidemiologic analysis of injury in five years of Canadian professional rodeo.

Longitudinal studies of rodeo injuries are rare. We prospectively investigated injuries in professional rodeo in Canada over a 5-year period. Our specific interests included injury incidence density in specific rodeo events, risk factors such as past injury, and the incidence of head injury. Of 323 professional rodeos from 1995 through 1999, 63 rodeos provided a convenience sample. These rodeos were selected because the Canadian Professional Rodeo Sport Medicine Team was in attendance at these events, thus providing both competitor health care and data collection. Four hundred fifty-one injuries were reported during 30,564 competitor-exposures. The greatest injury frequency and injury incidence density were in the rough stock events (bull riding, bareback riding, and saddle bronc). Bull riding accounted for the greatest injury frequency (141) and incidence density (32.2 injuries per 1000 competitor-exposures). Bull riding had a relative injury risk of 1.32 when compared with bareback riding; bareback riding had a relative injury risk of 1.39 when compared with saddle bronc riding. Concussions accounted for 8.6% of all reported injuries. Concussions and other head injuries (65) were second only to knee injuries (76) in frequency of injury to specific body parts. This concussion frequency is higher than has previously been reported.

Effect of experience on rodeo injury.

To document injury rates, severity, and relative risk during five competitive seasons of Canadian professional rodeo, between experienced (saddle bronc [SB], bareback [BB], and bull riders [BR]) and inexperienced (novice saddle bronc [NSB], novice bareback [NBB], and boys' steer riders [BSR]) rough stock competitors. Prospective cohort study. Canadian professional rodeo competition. Experienced competitors included professional cowboys from Australia, Brazil, New Zealand, the United States, and Canada. Inexperienced competitors included cowboys from Canada and the United States. Data was gathered prospectively at 63 of 323 professional rodeos in Canada from 1995 to 1999, constituting 30.8% of all professional rodeo performances during this time period. Injury data (severity and body part affected) was included when the injury occurred to a registered contestant, at a Canadian professional rodeo, at which the Canadian Professional Rodeo Sport Medicine Team was officially present and providing services. Data were collected by certified athletic therapists. Inexperienced rough stock competitors had a lower overall rate of injury in comparison to experienced competitors. In addition, inexperienced rough stock competitors had a lower injury rate of severe injuries, and a lower rate of injury to most body parts when compared with experienced competitors. Inexperienced competitors had a high rate of injury to the hand, wrist, and forearm. Most of these injuries to inexperienced contestants occurred to NBB (46%) and BSRs (31%). The relative risk of injury to inexperienced competitors did not differ from experienced competitors in the horse riding events (NSB vs. SB, NBB vs. BB), but the relative risk of injury to BSRs was one-half that of BR (0.49). Inexperienced competitors in rodeo rough stock events do not have increased rates of severe injury, or of injury to specific body parts (in general). Inexperienced competitors do have a greater rate of injury to the arm, hand, and wrist. The relative risk of BSR is one-half the risk of BR.

An operational model to investigate contact sports injuries.

A cyclical operational model is proposed to examine the interrelationship of a number of factors that are involved in sports injury epidemiology. In sports injury research, investigations often attempt to identify a unique risk factor that distinguishes an injured player. However, a wide variety of factors can contribute to a sports injury occurring, and an understanding of the cause of injury is important to advance knowledge. The proposed model identifies a healthy/fit player initially, although the player may exhibit a number of intrinsic risk factors for sports injury. Before exposure to extrinsic risk factors, there is the opportunity for implementation of prevention strategies by coaching personnel and the sports medicine team. These strategies might include, among others, appropriate warm-up, adequate hydration, wearing protective equipment, and prophylactic taping. Additionally, preventative screening could take place to assess the various intrinsic and extrinsic risk factors that could lead to sports injury. Two examples of how the operational model relates to contact sports injury cases are presented. Participating in sport inevitably exposes the player to external risk factors that predispose toward injury. The treatment of the injured player aims to restore the player to preinjury playing status and to prevent the injury from becoming chronic. It is suggested that the application of this proposed cyclical model may lead to greater success in understanding the multifaceted nature of sports injuries and furthermore help minimize injury risk and support the rehabilitation of injured contact sports participants.