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Sports Medicine

Sports Medicine. David W. Hang, M.D. Assistant Clinical Professor of Orthopedic Surgery University of California at Los Angeles Director Shin Kong Orthopedic Sports Medicine Institute. Sports Medicine. Sports Medicine Program 2/3 of injury occurs during practice (high school).

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Sports Medicine

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  1. Sports Medicine David W. Hang, M.D. Assistant Clinical Professor of Orthopedic Surgery University of California at Los Angeles Director Shin Kong Orthopedic Sports Medicine Institute

  2. Sports Medicine Sports Medicine Program 2/3 of injury occurs during practice (high school)

  3. Team Physician Orthopedist or family practice physician Basic medical knowledge and emergency evaluation Supportive and cooperation with the team (AT, PT, coach) Prescribe pre-injury conditioning and post-injury care SKOSMI

  4. Athletic Trainer Front-line, on site director Provide optimal sports healthcare Direct supervision of physician Liaison between different parties SKOSMI

  5. Athletic Trainer Facility and materials Injury prevention (conditioning) Assessment of injury Appropriate first-aid Determination of return to sport Appropriate medical profession referrals Effective rehabilitation program Educational and counseling program Organize physical examination Role model for future medical professional SKOSMI

  6. Playing Surfaces Little research other than grass and synthetic turf Inconclusive results Astro turf > grass > Tartan turf ?? More serious sprains and torn ligament on grass ? Synthetic surface • Prepatellar bursitis • Olecranon bursitis • Heat Stroke SKOSMI

  7. Screening examination Legal and insurance requirement Determine overall health of the individual Assess physical maturity Detect conditions that predispose to injury Identify and treat injuries before participation Baseline for return to participation SKOSMI

  8. Documentation States specific form Parental / guardian consent • Examination • Participation • Treatment SKOSMI

  9. Examination Individual / office based Group / station based SKOSMI

  10. Office Based Examination Privacy, comprehensive, better medical records High cost, time consuming, increased demand SKOSMI

  11. Station Based Examination Reduce cost, time efficient, team staff involvement Impersonal, great deal of coordination SKOSMI

  12. Components of Screening Examination Detailed medical history PMH, PSH, Allergy, Rx, Immunization, FH • CV – murmurs, syncopy, CP, SOB • Neurological injuries – concussion • Heat / cold injury • Menstruation Physical Examination General Dental Genital Maturation (Tanner stages) SKOSMI

  13. Recommendation Clearance without restriction Clearance with restriction (15%) Disqualification (1%) SKOSMI

  14. Disqualifying Conditions *Always consider alternative activities !!! Atlantoaxial Instability Musculoskeletal Cardiovascular Gynecologic Visual Impairment Hepato- / Splenomegaly Neurologic Kidney Abnormalities Inguinal Hernia Sickle Cell Trait Dermatologic Testicular Pulmonary Acute Illness HIV SKOSMI

  15. AA Instability No contact / collision sports No repetitive flexion / extension C-spine radiograph in Down’s (10 - 20%) SKOSMI

  16. Cardiovascular HTN (higher than 95 percentile) 10 – 12 years : 125/80 13 – 15 years : 135/85 15 years / older : 140/90 Restriction 1) Diastolic > 115 mm Hg 2) End-organ involvement Controlled HTN 1) No End-organ : Moderate intensity activities 2) LVH /  renal function : Low intensity (golf / bowling) SKOSMI

  17. Cardiac Murmurs Mitral Prolapsed (No participation) Syncopy Family history of sudden death Chest pain or arrhythmias (worse with activities) SKOSMI

  18. Hypertrophic Cardiomyopathy Most common cause of sudden death in young athletes Disqualification • LVH • LV outflow obstruction • Arrhythmia • Syncopy • Sudden death in relative SKOSMI

  19. Vision Impairment Best corrected vision : 20/50 (one eye) Restricted Sports Boxing, wrestling, full contact karate Protective eyewear use Football, racquetball, baseball SKOSMI

  20. Renal / Liver / Spleen No contact or collision sports 1) Renal (abnormal solitary kidney) 2) Hepatomegaly (surpassed bony protection) 3) Splenomegaly SKOSMI

  21. Concussions ConfusionAmnesiaLOC Grade I (Mild) + - - Grade II (Moderate) + + - Grade III (Severe) + + + SKOSMI

  22. Concussions SKOSMI

  23. Neurologic Injury Neuropraxia (Burner)Asymtomatic ParticipationRecurrent Further evaluation Seizure Controlled Participation Poorly controlled 1 month after last seizure (on Rx) SKOSMI

  24. Objectives of Fitness Assessment Minimize injury Improve athletic performance Identify weakness that hinders performance Assess achievement of personal goal Motivational Wellness counseling Evaluate preseason conditioning Sports specific profile (risk factors identification) SKOSMI

  25. Evaluation Resting heart rate and BP Body mass index (BMI) Skin fold measurement Abilities • Muscle strength • Muscle endurance • Power • Flexibility • Speed • Aerobic endurance • Anaerobic endurance • Agility • Balance • Reaction time SKOSMI

  26. Nutrition Micronutrient (vitamins) Macronutrients (fat, carbohydrate, protein) Diet • Carbohydrate (4 calories / gm) : 60 - 70% (starch) • Fat (9 calories / gm) : 15 - 20% • Protein (4 calories / gm) : 10 - 15% SKOSMI

  27. Carbohydrate Loading Glycogen storage for endurance activity • 100 gm of carbohydrate within 15 - 30 minutes after exercises • Additional 100 gm of carbohydrate every 2 to 4 hours (Need 20 hours to replace depleted store) Complex carbohydrate • More glycogen storage • Less insulin response • Contains basic nutrients SKOSMI

  28. Protein Essential amino acids (8– not produced by body) 1.2 - 2 gram / kg / day(4 cal / gm) Complete protein (contain essential AA– meat, milk) Incomplete protein (seeds, nuts, peas, grains, beans) Branch-chain AA (Leu, IsoLeu, Val) • Source for muscle repair and muscle energy • Availability: 50% within 1 hr and 100% at 2 hrs • Aids glycogen production SKOSMI

  29. Fat Most concentrated source of energy(9 cal / gm) Saturated (animal) or unsaturated (vegetable) Muscle energy at rest or latent endurance events Available after 20 - 30 minutesof exercise Consumes more oxygen(use more oxygen) SKOSMI

  30. Water 60% of body weight Cooling effect SKOSMI

  31. Fluid consumption 2 1/2 cups 2 hrs & 1 1/2 cup 15 minutes before 5 - 8 oz every 15-20 minutes (during) Sodium and 6-8% glucose No ETOH or caffeine 2 cups of water for each kg of body weight lost SKOSMI

  32. Training diet Avoid feeling hungry or weak Empty stomach and upper bowels at competition Sufficient water Minimize slow digesting food Carbohydrate 2 to 4 hrs before competition SKOSMI

  33. Body Fat Anthropometry (skin folds*) Men 16 to 18% Women 22 to 26% (* subscap., triceps, axilla, chest, biceps, iliac crest, abdomen, thigh) SKOSMI

  34. Exercise Program (Weight Loss) 3 times a week 60 to 70% of maximum heart rate for 30 minutes Maximum weight loss (60 minutes of continuous aerobic activity) SKOSMI

  35. Master Athletes Endurance : maintained with conditioning Strength : Sports specific strength Power : loss quickness Flexibiity : loss with age Speed : loss with age (upper > lower) Coordination : nerve degeneration (other elements ?) SKOSMI

  36. Master Athletes Injuires • Chronic “wear-and-tear” with acute tear • Previous injury / surgery Illness • Adaptation to chronic health conditions (DM, CA, OA, CAD) Rehabilitation and maintenance SKOSMI

  37. SKOSMI

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