Sports Medicine Sports Medicine

Sports Medicine Sports Medicine Sports Medicine Sports Medicine

David W. Hang, M.D.

David W. Hang, M.D.

Assistant Clinical Professor of Orthopedic Assistant Clinical Professor of Orthopedic

Surgery Surgery

University of California at Los Angeles University of California at Los Angeles

Director Director

Shin Kong Orthopedic Sports Medicine Institute

Shin Kong Orthopedic Sports Medicine Institute

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Sports Medicine Sports Medicine

Sports Medicine Program Sports Medicine Program

2/3 of injury occurs during practice (high school)

2/3 of injury occurs during practice (high school)

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Team Physician Team Physician

Orthopedist or family practice physician Orthopedist or family practice physician

Basic medical knowledge and emergency evaluation Basic medical knowledge and emergency evaluation

Supportive and cooperation with the team (AT, PT, coach) Supportive and cooperation with the team (AT, PT, coach) Prescribe pre-injury conditioning and post-injury care

Prescribe pre-injury conditioning and post-injury care

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Athletic Trainer Athletic Trainer

Front-line, on site director Front-line, on site director

Provide optimal sports healthcare

Provide optimal sports healthcare

Direct supervision of physician

Direct supervision of physician

Liaison between different parties

Liaison between different parties

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Athletic Trainer Athletic Trainer

Facility and materials Facility and materials

Injury prevention (conditioning) Injury prevention (conditioning)

Assessment of injury Assessment of injury

Appropriate first-aid Appropriate first-aid

Determination of return to sport Determination of return to sport

Appropriate medical profession referrals Appropriate medical profession referrals

Effective rehabilitation program Effective rehabilitation program

Educational and counseling program Educational and counseling program

Organize physical examination Organize physical examination

Role model for future medical professional

Role model for future medical professional

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Playing Surfaces Playing Surfaces

Little research other than grass and synthetic turf Little research other than grass and synthetic turf Inconclusive results

Inconclusive results

Astro turf > grass > Tartan turf ??

Astro turf > grass > Tartan turf ??

More serious sprains and torn ligament on grass ? More serious sprains and torn ligament on grass ? Synthetic surface

Synthetic surface

– Prepatellar bursitis Prepatellar bursitis

– Olecranon bursitis Olecranon bursitis

– Heat Stroke Heat Stroke

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Screening examination

Legal and insurance requirement Legal and insurance requirement

Determine overall health of the individual Determine overall health of the individual

Assess physical maturity Assess physical maturity

Detect conditions that predispose to injury Detect conditions that predispose to injury

Identify and treat injuries before participation Identify and treat injuries before participation

Baseline for return to participation

Baseline for return to participation

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Documentation Documentation

States specific form States specific form

Parental / guardian consent Parental / guardian consent

– Examination Examination

– Participation Participation

– Treatment Treatment

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Examination Examination

Individual / office based Individual / office based

Group / station based

Group / station based

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Office Based Examination Office Based Examination

Privacy, comprehensive, better medical records Privacy, comprehensive, better medical records

High cost, time consuming, increased demand

High cost, time consuming, increased demand

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Station Based Examination Station Based Examination

Reduce cost, time efficient, team staff involvement Reduce cost, time efficient, team staff involvement

Impersonal, great deal of coordination

Impersonal, great deal of coordination

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Components of Screening Examination Components of Screening Examination

Detailed medical history Detailed medical history

PMH, PSH, Allergy, Rx, Immunization, FH PMH, PSH, Allergy, Rx, Immunization, FH



CV – murmurs, syncopy, CP, SOB CV – murmurs, syncopy, CP, SOB



Neurological injuries – concussion Neurological injuries – concussion



Heat / cold injury Heat / cold injury



Menstruation Menstruation

Physical Examination Physical Examination

General General

Dental Dental Genital Genital

Maturation (Tanner stages)

Maturation (Tanner stages)

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Recommendation Recommendation

Clearance without restriction Clearance without restriction

Clearance with restriction

Clearance with restriction (15%) (15%)

Disqualification

Disqualification (1%) (1%)

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Disqualifying Conditions Disqualifying Conditions

* * Always consider alternative activities !!! Always consider alternative activities !!!

Atlantoaxial Instability

Atlantoaxial Instability Musculoskeletal Musculoskeletal Cardiovascular Gynecologic

Cardiovascular Gynecologic Visual Impairment

Visual Impairment Hepato- / Splenomegaly Hepato- / Splenomegaly Neurologic

Neurologic Kidney Abnormalities Kidney Abnormalities Inguinal Hernia

Inguinal Hernia Sickle Cell Trait Sickle Cell Trait Dermatologic

Dermatologic Testicular Testicular Pulmonary

Pulmonary Acute Illness Acute Illness

HIV HIV

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AA Instability AA Instability

No contact / collision sports No contact / collision sports

No repetitive flexion / extension No repetitive flexion / extension

C-spine radiograph in Down’s (10 - 20%)

C-spine radiograph in Down’s (10 - 20%)

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Cardiovascular Cardiovascular

HTN (higher than 95 percentile) HTN (higher than 95 percentile)

10 – 12 years

10 – 12 years : : 125/80 125/80 13 – 15 years

13 – 15 years : : 135/85 135/85 15 years / older

15 years / older : : 140/90 140/90

Restriction Restriction

1) Diastolic > 115 mm Hg 1) Diastolic > 115 mm Hg 2) End-organ involvement 2) End-organ involvement Controlled HTN

Controlled HTN

1) No End-organ : Moderate intensity activities 1) No End-organ : Moderate intensity activities

2) LVH / 2) LVH /  renal function : Low intensity (golf / bowling) renal function : Low intensity (golf / bowling)

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Cardiac Murmurs Cardiac Murmurs

Mitral Prolapsed (No participation) Mitral Prolapsed (No participation)

Syncopy Syncopy

Family history of sudden death Family history of sudden death

Chest pain or arrhythmias

Chest pain or arrhythmias (worse with activities) (worse with activities)

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Hypertrophic Cardiomyopathy Hypertrophic Cardiomyopathy

Most common cause of sudden death in young athletes Most common cause of sudden death in young athletes

Disqualification Disqualification

1)1)

LVH LVH

2)2)

LV outflow obstruction LV outflow obstruction

3)3)

Arrhythmia Arrhythmia

4)4)

Syncopy Syncopy

5)5)

Sudden death in relative Sudden death in relative

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Vision Impairment Vision Impairment

Best corrected vision : 20/50 (one eye) Best corrected vision : 20/50 (one eye) Restricted Sports

Restricted Sports

Boxing, wrestling, full contact karate Boxing, wrestling, full contact karate Protective eyewear use

Protective eyewear use

Football, racquetball, baseball

Football, racquetball, baseball

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Renal / Liver / Spleen Renal / Liver / Spleen

No contact or collision sports No contact or collision sports

1) Renal (abnormal solitary kidney) 1) Renal (abnormal solitary kidney)

2) Hepatomegaly (surpassed bony protection) 2) Hepatomegaly (surpassed bony protection) 3) Splenomegaly

3) Splenomegaly

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Concussions Concussions

Confusion

Confusion Amnesia Amnesia LOC LOC Grade I (Mild)

Grade I (Mild) + + - - - -

Grade II (Moderate) +

Grade II (Moderate) + + + - - Grade III (Severe)

Grade III (Severe) + + + + + +

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Concussions Concussions

First Concussion

First Concussion Second ConcussionSecond Concussion Third ConcussionThird Concussion Grade I (Mild)

Grade I (Mild) Return to playReturn to play (Asymp. for 20

(Asymp. for 20 min.)min.)

Stop contest / practice Stop contest / practice Return to play

Return to play (Asymp. > 1 wk) (Asymp. > 1 wk)

Terminate season Terminate season Return to play Return to play (Asymp. > 3 mos) (Asymp. > 3 mos)

Grade II Grade II (Moderate) (Moderate)

Stop contest / practice Stop contest / practice Return to play

Return to play (Asymp. > 1 wk) (Asymp. > 1 wk)

Terminate season Terminate season Return to play Return to play (Asymp. > 1 mon) (Asymp. > 1 mon)

Terminate season Terminate season Return next season Return next season (Asymp.)

(Asymp.)

Grade III (Severe)

Grade III (Severe) Stop contest / practiceStop contest / practice Return to play 1 mon Return to play 1 mon (Asymp. > 2 wk) (Asymp. > 2 wk)

Terminate season

Terminate season Terminate seasonTerminate season (MRI)

(MRI)

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Neurologic Injury Neurologic Injury

Neuropraxia (Burner) Neuropraxia (Burner)

Asymtomatic

Asymtomatic Participation Participation

Recurrent Further evaluation Recurrent Further evaluation

Seizure Seizure

Controlled

Controlled Participation Participation Poorly controlled

Poorly controlled 1 month after last seizure (on Rx) 1 month after last seizure (on Rx)

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Objectives of Fitness Assessment Objectives of Fitness Assessment

Minimize injury Minimize injury

Improve athletic performance Improve athletic performance

Identify weakness that hinders performance Identify weakness that hinders performance Assess achievement of personal goal

Assess achievement of personal goal Motivational

Motivational

Wellness counseling Wellness counseling

Evaluate preseason conditioning Evaluate preseason conditioning

Sports specific profile (risk factors identification) Sports specific profile (risk factors identification)

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Evaluation Evaluation

Resting heart rate and BP Resting heart rate and BP Body mass index (BMI) Body mass index (BMI) Skin fold measurement Skin fold measurement Abilities

Abilities

– Muscle strengthMuscle strength – Muscle enduranceMuscle endurance – PowerPower

– FlexibilityFlexibility – SpeedSpeed

– Aerobic enduranceAerobic endurance – Anaerobic enduranceAnaerobic endurance – AgilityAgility

– BalanceBalance

– Reaction timeReaction time

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Nutrition Nutrition

Micronutrient (vitamins) Micronutrient (vitamins)

Macronutrients (fat, carbohydrate, protein) Macronutrients (fat, carbohydrate, protein) Diet Diet

– Carbohydrate Carbohydrate

: 60 - 70% (starch) : 60 - 70% (starch)

– Fat Fat

: : 15 - 20% 15 - 20%

– Protein Protein

: : 10 - 15% 10 - 15%

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Carbohydrate Loading Carbohydrate Loading

Glycogen storage for endurance activity Glycogen storage for endurance activity

–

100 gm of carbohydrate within 15 - 30 minutes after exercises 100 gm of carbohydrate within 15 - 30 minutes after exercises

–

Additional 100 gm of carbohydrate every 2 to 4 hours Additional 100 gm of carbohydrate every 2 to 4 hours

(Need 20 hours to replace depleted store) (Need 20 hours to replace depleted store)

Complex carbohydrate Complex carbohydrate

–

More glycogen storage More glycogen storage

–

Less insulin response Less insulin response

–

Contains basic nutrients Contains basic nutrients

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Protein Protein

Essential amino acids (8

Essential amino acids (8 – not produced by body – not produced by body ) ) 1.2 - 2 gram / kg / day

1.2 - 2 gram / kg / day (4 cal / gm) (4 cal / gm)

Complete protein (contain essential AA

Complete protein (contain essential AA – meat, milk – meat, milk ) ) Incomplete protein (seeds, nuts, peas, grains, beans) Incomplete protein (seeds, nuts, peas, grains, beans) Branch-chain AA (Leu, IsoLeu, Val)

Branch-chain AA (Leu, IsoLeu, Val)

– Source for Source f or muscle repair and muscle energy muscle repair and muscle energy

– Availability: Availability: 50% within 1 hr and 100% at 2 hrs 50% within 1 hr and 100% at 2 hrs

– Aids glycogen production Aids glycogen production

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Fat Fat

Most concentrated source of energy

Most concentrated source of energy (9 cal / gm) (9 cal / gm) Saturated (

Saturated ( animal) animal) or unsaturated or unsaturated (vegetable) (vegetable)

Muscle energy at rest or latent endurance events Muscle energy at rest or latent endurance events Available after 20 - 30 minutes

Available after 20 - 30 minutes of exercise of exercise Consumes more oxygen

Consumes more oxygen (use more oxygen) (use more oxygen)

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Water Water

60% of body weight 60% of body weight

Cooling effect

Cooling effect

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Fluid consumption Fluid consumption

2 1/2 cups 2 hrs & 1 1/2 cup 15 minutes before 2 1/2 cups 2 hrs & 1 1/2 cup 15 minutes before

5 - 8 oz every 15-20 minutes (during) 5 - 8 oz every 15-20 minutes (during)

Sodium and 6-8% glucose Sodium and 6-8% glucose

No ETOH or caffeine No ETOH or caffeine

2 cups of water for each k

2 cups of water for each k g g of body weight lost of body weight lost

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Training diet Training diet

Avoid feeling hungry or weak Avoid feeling hungry or weak

Empty stomach and upper bowels at competition Empty stomach and upper bowels at competition

Sufficient water Sufficient water

Minimize slow digesting food Minimize slow digesting food

Carbohydrate 2 to 4 hrs before competition

Carbohydrate 2 to 4 hrs before competition

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Body Fat Body Fat

Anthropometry (skin folds*) Anthropometry (skin folds*)

Men Men 16 to 18% 16 to 18%

Women

Women 22 to 26% 22 to 26%

(* (* subscap., triceps, axilla, chest, biceps, subscap., triceps, axilla, chest, biceps,

iliac crest, abdomen, thigh) iliac crest, abdomen, thigh)

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Exercise Program Exercise Program

(Weight Loss) (Weight Loss)

3 3 times a week times a week

60 to 70% of maximum heart rate for 30 minutes 60 to 70% of maximum heart rate for 30 minutes

Maximum weight loss

Maximum weight loss

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Master Athletes Master Athletes

Endurance : maintained with conditioning Endurance : maintained with conditioning Strength : Sports specific strength

Strength : Sports specific strength Power : loss quickness

Power : loss quickness Flexibiity : loss with age Flexibiity : loss with age

Speed : loss with age (upper > lower) Speed : loss with age (upper > lower)

Coordination : nerve degeneration (other elements ?)

Coordination : nerve degeneration (other elements ?)

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Master Athletes Master Athletes

Injuires Injuires

– Chronic “wear-and-tear” with acute tear Chronic “wear-and-tear” with acute tear

– Previous injury / surgery Previous injury / surgery Illness

Illness

– Adaptation to chronic health conditions Adaptation to chronic health conditions

(DM, CA, OA, CAD) (DM, CA, OA, CAD)

Rehabilitation and maintenance

Rehabilitation and maintenance

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