What is a Sports Physician?

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Lesley Goodwin
10 years ago
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1 What is a Sports Physician? Dr Mike Bundy MBBS MRCGP Dip Sports Med FFSEM Consultant in Sport and Exercise Medicine Medical Director at Pure Sports Medicine Ex-England Rugby senior team Doctor

2 What is a Sports Physician? 16 years as a GP 4 Years Training as a Sports Physician Orthopaedic Physician Consultant Status Recognition by GMC 50 Recognised Consultants Nationwide Very few NHS posts most in Private medicine

3 What is a Sports Physician? Sports Physician 1.Clinic workload Orthopaedic Physician 1.Team Doctor workload 1.Exercise prescription and healthy living

4 Sports Physician All those musculo-skeletal problems that are not inflammatory and don t require surgery 30 % GP workload is musculoskeletal <5% of our workload is referred to surgery Most is treated in house

5 Pure Sports Medicine

6 What is Sports Medicine? Where do you go / refer if you have : Persistent shoulder pain? Achilles pain? A twisted ankle that doesn t settle? Groin pain? Sports hernia Pain in calves on running? Wear and tear in the knee? Hamstring strains? Low back ache / sciatica? Shoulder painful arc? Inadequate diet for your sport? Tennis elbow? Shin Splints? Neck pain? Facet dysfunction?.. The list goes on

Sports hernia Pain in calves on running? Wear and tear in the knee? Hamstring strains?

7 What is Sports Medicine? Pure Sports Medicine unique, self supported, self directed, multifaceted unit: Sports Physicians Physiotherapists S&C / Performance Coaches Sports Massage Therapists Sports Podiatrists Sports Osteopaths Nutritional Therapists Sports Dietitians / Nutritionalists Support Staff To assess, diagnose and rehabilitate all those injuries that don t need surgery

Physicians Physiotherapists S&C / Performance Coaches Sports Massage Therapists Sports

8 What Sort of Conditions 1. Trauma Acute & Chronic 2. Overuse injuries 3. Referred pain Soft tissue injury Muscle, ligament, fascial injury Tendinopathy Stress fractures PFS, osteitis pubis Not limited to Elite Recreational sporting population DIY Gardening Hobbies

$Tendinopathy Stress fractures PFS, osteitis pubis Not limited to$

10 1. Shoulder 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms

11 1. Shoulder 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms Examination Neck normal Very limited shoulder Rom Flexion to 90*, Abduction to 80*, ER 0* Poor Scapula rhythm Good RC power within range Impingement +++, No instability What does impingement mean?

Very painful, Night pain, no neck or radicular symptoms Examination Neck normal Very limited

12 Impingement What is it? It s not all Bursitis! What are the causes?

13 Impingement Scapula movement Capsular restriction Acromion type (Osteophytes) Instability (laxity, labral) Rotator cuff (tear or weak) Suprascapular nerve palsy

14 1. Shoulder 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms Causes of night pain????

15 1. Shoulder 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms RC tear Frozen Shoulder /Adhesive Capsulitis Calcific tendonopathy Causes of reduced Ext Rotation?

Very painful, Night pain, no neck or radicular symptoms RC tear Frozen

16 1. Shoulder 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms Causes of reduced external rotation Frozen shoulder Posterior dislocation OA Shoulder ++

Very painful, Night pain, no neck or radicular symptoms Causes of

17 1. Shoulder Frozen shoulder Adhesive Capsulitis What would you do in General Practice? What are your options?

18 1. Shoulder Frozen shoulder Adhesive Capsulitis Management Injection therapy Rehabilitation

19 2. Lumbar spine 17 year old schoolgirl, keen swimmer, comes in with mother. Concerned ++ she s very good doctor!! Gradual onset of R LBP for 3 months. Not told anyone. No night pain. Systemically well. Pain most of the day. Worse on carrying books at school. Worse after sport. No radiation, No radicular symptoms. Does she need to see a specialist? What else do you need to know? Is there anything you need to ask? Why should she get back pain now?

Worse on carrying books at school. Worse after sport. No radiation, No radicular symptoms.

20 2. Lumbar Spine 17 year old schoolgirl, keen swimmer, comes in with mother. Concerned ++ she s very good doctor!! Gradual onset of R LBP for 3 months. Not told anyone. No night pain. Systemically well. Pain most of the day. Worse on carrying books at school. Worse after sport. No radiation, No radicular symptoms. Does she need to see a specialist? What else do you need to know? What stroke does she swim? How much swimming and other sport? What is the provocative position? Any family history? Any Cauda symptoms / Red flag symptoms? Periods, diet, weight, FH osteoporosis?

Worse on carrying books at school. Worse after sport. No radiation, No radicular symptoms. Does she need to see a specialist?

21 2. Lumbar Spine Examination : Good posture, Good pelvic control, no HF tightness, Resonable Lx spine flexion but extension poor and painful esp to R, -ve neural tension (Slump, SLR and neurology examination) SI joint normal Hop painful in back Mild tender R L5 Any thoughts? What back pains are worse in Extension?

22 2. Lumbar Spine Examination : Good posture, Good pelvic control, no HF tightness, Resonable Lx spine flexion but extension poor and painful esp to R, -ve neural tension (Slump, SLR and neurology examination) SI joint normal Hop painful in back Mild tender R L5 Diff Diagnosis : Facet joint, SIJ, Stress fracture Extension related disc prolapse (10% only)

23 2. Lumbar Spine Stress fracture R L5 pedicle

24 2. Lumbar Spine Stress fracture R L5 pedicle What is it? Spondylolysis / Spondylolisthesis How would you manage this? If you referred to a Physio and they weren t sure of a diagnosis, where would you go next?

25 3. Knee 16 year old schoolboy, not very sporty, attends with father complaining of anterior knee pain. Gradual onset, very localised to centre of patella, no radiation, no swelling, occ feeling of going to give way but never actually does, no clicking or locking Any other questions you may ask?

26 3. Knee 16 year old schoolboy, not very sporty, attends with father complaining of anterior knee pain. Gradual onset, very localised to centre of patella, no radiation, no swelling, occ feeling of going to give way but never actually does, no clicking or locking Any other questions you may ask? Worse on stairs down more than up Worse on sitting for prolonged periods Grown a lot recently ++ Differential diagnoses?

27 3. Knee 16 year old schoolboy, not very sporty, attends with father complaining of anterior knee pain. Gradual onset, very localised to centre of patella, no radiation, no swelling, occ feeling of going to give way but never actually does, no clicking or locking Differential Diagnoses? Osgood-Sclatters, Sindig-Larson-Johannson, Patella tendonopathy Patello-femoral syndrome Fat pad impingement Referred from back (L3 disc prolapse) Referred from Hip

28 3. Knee Examination: Overweight, valgus knee posture, poor SL squat control, normal hips & Lumbar spine Knees cool dry and stable, no fat pad impingement, no meniscal signs Poor VMO bulk, tight ITB, mobile patella (excessive lateral movement) Tender under medial patella facet No Lower pole or TT tenderness, patella tendon normal Diagnosis :

29 3. Knee Examination: Overweight, valgus knee posture, poor SL squat control, normal hips Knees cool dry and stable, no fat pad impingement, no meniscal signs Poor VMO bulk, tight ITB, mobile patella (excessive lateral movement) Tender under medial patella facet No Lower pole or TT tenderness, patella tendon normal Diagnosis : Patello-Femoral Syndrome secondary to : Overweight, inactivity, growth spurt Poor gluteal and VMO strength, tight lateral structures Mobile patella

30 3. Knee Management???

31 Any Questions?

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