HOW TO BLUFF YOUR WAY IN SPORTS MEDICINE

  1. Introduction

- Sport and Exercise Medicine became the 58th recognised medical

speciality in February 2005

competence

  1. Basic knowledge Rest, Ice, Compression, Elevation
  2. The myth of REST

    - affected part only

    - soft tissues for ?48 hours (beware myositis ossificans, particularly in the thigh)

  3. Rehabilitation

    Aim to restore a) Range and flexibility of movement

    b) Power

    Joints must have a full and painless range of movement

    5)How to rehabilitate

      1. Stretch (to discomfort)
      2. Massage (with ice cube)
      3. Controlled stretching movements

6)Most commonly seen sporting conditions seen in GP Practice

      1. Muscle and soft tissue tears and strains
      2. Epicondylitis
      3. Anterior knee pain
      4. Calf and Achilles pain
      5. Stress Fractures
      6. Ankle sprains
      7. Foot pain
  1. Epicondylitis

Lateral more common than medial

Pain often felt elsewhere than over epicondyle

8) Diagnosis History – lifting kettle or opening door

9)Treatment of lateral epicondylitis
    1. Inject with steroid – not more than 2-3 times over 12 months
    2. Examine the racket
    3. Stretch wrist and use ice massage
    4. Epicondylitis Clasp
    5. Surgery
  1. Anterior knee pain (AKP)
    1. Osteo- chondritis (Osgood Schlatter’s Disease)

      11) Treatment of Osgood Schlatter’s Disease

      Do not give NSAID’s prior to Play

      All recover eventually

      Allow to play within limits of pain (?up to half time)

      Perform quadriceps exercises without weights

      Apply ice packs 2-3 times per day

      12)Patello-Femoral pain (used to be called Chondromalacia Patellae)

    2. Causes up to 50% of AKP
    3. Sometimes sudden pain, sometimes persistent ache in knee
    4. Pain stops on ceasing activity
    5. History of stair pain

13) Examination of Patello-Femoral pain

    1. No effusion (may have swelling of infra-patellar fat pads - Hoffa’s Syndrome)
    2. Quadriceps (Vastus Medialis) wasting
    3. Tight hamstrings (discomfort on hyperextension)
    4. Sunrise view X-Rays may show cartilage degeneration
    5. Positive Clarke’s Test

14) Causes of Anterior Knee Pain

    1. Large Q Angle
    2. Abnormal patellar anatomy
    3. Females
    4. Genu Valgum
    5. Pronation
    6. Occupational (bent knee overuse)

15) Treatment of Patello-Femoral pain

a) STRAIGHT leg quadriceps exercises

as Vastus Medialis only reacts in last 10 degrees of extension)

    1. Stretch Hamstrings
    2. Obtain orthotics (for pronators) or wear appropriate training shoes.
    3. Run faster!
    4. Avoid squats, shuffling and long distance driving.

16) Stress fractures

Most common sites

    1. Wrist (gymnasts)
    2. Lumbar area
    3. Pelvis
    4. Femur
    5. Tibia & Fibula (one third of length)

17) Symptoms of stress fractures

CRESCENDO Pain

18) Signs

    1. Deep tenderness
    2. Positive MRI scan
    3. X-Rays only positive later
    4. Positive ultra-sound test
    5. Osteoporosis?

19) Treatment

    1. Active rest
    2. Stress fractures heal in approximately half the time of a normal fracture
    3. Avoidance of provoking activities
    4. Recurrent stress fractures at the same site are uncommon

20) Achilles Tendon Pain

Symptoms

    1. Take-off pain when walking or running
    2. Early morning stiffness easing as patient walks around

21) Signs with Achilles Tendon pain

    1. Swelling
    2. Crepitus
    3. Local tenderness of soft and bony tissues
    4. Pronated feet (causes torsional stresses to Achilles Tendon)
    5. Trainers with high backs/ rigid heels/excessive rubbing

22) Conservative treatment of Achilles Tendon pain

    1. Ice and rest from pain-provoking activity
    2. Surgery to shoes (unless demise more appropriate)
    3. Heel raises (to shorten tendon whilst running)
    4. Orthopaedic foam strips inside shoes to prevent rubbing
    5. Orthotics
    6. Stretching at rest (both pre and post surgery)
    7. Steroid injection? (never into tendon but may be effective for bursae or fibrous tissue
    8. Physiotherapy ( take care with electrical modalities and excessive frictional massage)
    9. Surgery

23) Plantar fasciitis

Causes pain under the heel

More common in both excessive pronators and those with pes cavus

More common in older sportspersons. Teenagers may have Sever’s Disease

Due to tearing, inflammation and scarring of plantar fascia

24) Treatment of Plantar Fasciitis

    1. Ensure shoes have adequate longitudinal arch support (orthotic)
    2. Wear soft heel pads as by Bauerfiend

c) Use golf ball massage to heel

d) Steroid injections even with local anaesthetic are very painful

25) Other hints

    1. Verrucas respond to banana skin treatment
    2. Know what you can prescribe See BNF
    3. Never wear new clothing or shoes for competition
    4. Use petroleum jelly or Savlon on all areas which might be rubbed
    5. Cut toe nails 3-4 days before competition
    6. Gilmore’s Groin (Sportsman’s Hernia) is probably underdiagnosed