Sports Health: A Multidisciplinary Approach

Low back injuries are the most common injury in golf. Best practice guidelines for rehabilitation and prevention of these injuries are helpful for health care professionals and all golfers.

To establish a best practice clinical model for low back pain in golfers from diagnosis through treatment and rehabilitation to return to golf.

The PubMed database and Google Scholar were searched from 1993 to 2012 with the following keywords: golf and low back injury, low back injury, golf and low back pain, golf injury prevention, golf modern swing, muscles in golf swing, low back rehabilitation, diaphragm, and core stability. All studies addressed in some manner the rehabilitation, prevention, or return to sport from low back injury, preferably in direct relation to golf, as well as muscle firing patterns used during the golf swing.

Best practice for rehabilitation and prevention of low back injury in golf appears to be through a multidisciplinary approach.

Movement patterns, muscle imbalances, and type of swing utilized all have a direct effect on the forces applied to the spine during the golf swing and need to be assessed to prevent or rehabilitate injury. Understanding the golf swing and how the body works during the swing is necessary.

Soccer heading is using the head to directly contact the ball, often to advance the ball down the field or score. It is a skill fundamental to the game, yet it has come under scrutiny. Repeated subclinical effects of heading may compound over time, resulting in neurologic deficits. Greater head accelerations are linked to brain injury. Developing an understanding of how the neck muscles help stabilize and reduce head acceleration during impact may help prevent brain injury.

Neck strength imbalance correlates to increasing head acceleration during impact while heading a soccer ball.

Observational laboratory investigation.

Sixteen Division I and II collegiate soccer players headed a ball in a controlled indoor laboratory setting while player motions were recorded by a 14-camera Vicon MX motion capture system. Neck flexor and extensor strength of each player was measured using a spring-type clinical dynamometer.

Players were served soccer balls by hand at a mean velocity of 4.29 m/s (±0.74 m/s). Players returned the ball to the server using a heading maneuver at a mean velocity of 5.48 m/s (±1.18 m/s). Mean neck strength difference was positively correlated with angular head acceleration (rho = 0.497; P = 0.05), with a trend toward significance for linear head acceleration (rho = 0.485; P = 0.057).

This study suggests that symmetrical strength in neck flexors and extensors reduces head acceleration experienced during low-velocity heading in experienced collegiate players.

Balanced neck strength may reduce head acceleration cumulative subclinical injury. Since neck strength is a measureable and amenable strength training intervention, this may represent a modifiable intrinsic risk factor for injury.

The National Collegiate Athletic Association classifies women’s rugby as an emerging sport. Few studies have examined the injury rates in women’s collegiate rugby or compared injury rates between sexes.

Injury rates will differ between female and male intercollegiate club rugby players.

Descriptive epidemiological study.

Five years of injury data were collected from the men’s and women’s rugby teams at a US service academy using the institution’s injury surveillance system. The primary outcome of interest was the incidence rate of injury during the study period per 10,000 athlete exposures. Incidence rate ratios (IRRs) were calculated using a Poisson distribution to compare the rates by sex.

During the study period, the overall incidence rate for injury was 30% higher (IRR = 1.30, 95% CI: 1.09, 1.54) among men when compared with women; however, the distribution of injuries varied by sex. The incidence rate for ACL injury among women was 5.3 times (IRR = 5.32, 95% CI: 1.33, 30.53) higher compared with that among men. Men were 2.5 times (IRR = 2.54, 95% CI: 1.03, 7.52) more likely to sustain a fracture. The rate of acromioclavicular joint injury was 2.2 times (IRR = 2.19, 95% CI: 1.03, 5.19) higher among men when compared with women. Men were 6.6 times (IRR = 6.55, 95% CI: 2.65, 20.91) more likely to have an open wound than women.

There are differences in injury rates and patterns between female and male American rugby players.

The differences in injury patterns may reflect distinct playing styles, which could be the result of the American football background common among many of the male players.

Research has shown increases in efficiency and productivity by using physician extenders (PEs) in medical practices. Certified athletic trainers (ATCs) that work as PEs in primary care sports medicine and orthopaedic practices improve clinic efficiency.

When compared with a medical assistant (MA), the use of an ATC as a PE in a primary care sports medicine practice will result in an increase in patient volume, charges, and collections.

Cross-sectional study.

For 12 months, patient encounters, charges, and collections were obtained for the practices of 2 primary care sports medicine physicians. Each physician was assisted by an ATC for 6 months and by an MA for 6 months. Eighty full clinic days were examined for each physician.

Statistically significant increases were found in all measured parameters for the ATC compared with the MA. Patient encounters increased 18% to 22% per day, and collections increased by 10% to 60% per day.

ATCs can optimize orthopaedic sports medicine practice by increasing patient encounters, charges, and collections.

Orthopaedic practices can be more efficient by using ATCs or MAs as PEs.

Physicians need to consider medical-legal issues when volunteering their time to assist with community mass-participation and athletic events. This article also reviews medical-legal aspects of the volunteer physician’s out-of-state practice. Seven cases illustrate the importance of expertise and planning to avoid legal issues for the volunteer event physician.

Relevant studies, expert opinion, medical-legal legislation, and medical-legal cases were reviewed.

Physicians typically make 4 common assumptions regarding these types of events: Good Samaritan legislation, event liability insurance, personal liability insurance, and waivers. We discuss the intent of these assumptions and the reality of how, or how not, they provide any protection to the volunteer event physician.

The intent of this article is to make physicians aware of medial-legal issues when volunteering their time for community and athletic events.

Muscle injuries are extremely common in athletes and often produce pain, dysfunction, and the inability to return to practice or competition. Appropriate diagnosis and management can optimize recovery and minimize time to return to play.

Contemporary papers, both basic science and clinical medicine, that investigate muscle healing were reviewed. A Medline/PubMed search inclusive of years 1948 to 2012 was performed.

Diagnosis can usually be made according to history and physical examination for most injuries. Although data are limited, initial conservative management emphasizing the RICE principles and immobilization of the extremity for several days for higher grade injuries are typically all that is required. Injection of corticosteroids may clinically enhance function after an acute muscle strain. Additional adjunctive treatments (nonsteroidal anti-inflammatory drugs, platelet-rich plasma, and others) to enhance muscle healing and limit scar formation show promise but need additional data to better define their roles.

Conservative treatment recommendations will typically lead to successful outcomes after a muscle injury. There is limited evidence to support most adjunctive treatments.

Overhead sports place the greatest strain on the elbow of any of the upper extremity joints. Unfortunately, athlete-specific functional outcome tools do not exist for the elbow.

The Elbow Demand Rating Scale (EDS) will demonstrate strong reliability and validity properties: (1) test-retest reliability with a 2-week EDS administration, (2) internal reliability of the subscales, and (3) construct validity through lower scores for patients with elbow injuries.

Prospective case-control study.

Patients with (n = 19) and without elbow injuries (n = 19) completed the EDS during their routine clinical appointment and 2 weeks later. Clinicians completed the functional portion of the EDS.

The EDS demonstrated strong test-retest reliability and construct validity. Internal reliability was moderate (α = 0.50). Exploratory analyses further supported construct validity using demographic survey questions regarding elbow pain and symptoms.

Overall, the EDS demonstrated moderate to strong psychometric properties in a patient population with elbow injuries, and its use is supported for young athletes.

The EDS provides clinicians working with adolescent and young adult athletes a scale to direct care and determine intervention success or failure.

The ability to return to elite pitching, performance, and clinical outcomes of shoulder surgery in elite baseball pitchers are not definitively established.

To determine (1) the rate of return to sport (RTS) in elite pitchers following shoulder surgery, (2) postoperative clinical outcomes upon RTS, and (3) performance upon RTS and to compare RTS rates in different types of shoulder surgery.

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched.

Levels I-IV evidence were eligible for inclusion if performance-based (eg, RTS) and/or clinical outcome–based reporting of outcomes were reported following surgical treatment of shoulder pathology in elite pitchers (major or minor league or collegiate).

Subject, shoulder, and pre- and postoperative performance-based variables of interest were extracted. All shoulder surgery types were potentially inclusive (eg, open, arthroscopic, rotator cuff, labrum, biceps, acromioclavicular joint, fracture). Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS).

Six studies were analyzed (287 elite male pitchers [mean age, 27 years] who underwent shoulder surgery, with 99% on the dominant, throwing shoulder). MCMS was 38 (poor). Most pitchers were professional, with a mean career length of 6.58 years and postoperative clinical follow-up of 3.62 years. In 5 of 6 studies, multiple diagnoses were addressed concomitantly at surgery. Rate of RTS was 68% at mean 12 months following surgery. Twenty-two percent of Major League Baseball (MLB) pitchers never RTS in MLB. Overall performance did improve following surgery; however, this did not improve to pre-injury levels.

In this systematic review, the rate of return to elite baseball pitching following surgery was established. Performance tended to decrease prior to surgery and gradually improve postoperatively, though not reaching pre-injury levels of pitching.

IV (systematic review of studies level I-IV evidence), therapeutic.