from fitness centres, athletic therapists (trainers), physiotherapists, chiropractors
and others all practicing "Sport medicine". For our purposes we will restrict
its use to refer to Family Physicians, Orthopedists or Sports Medicine physicians
practicing allopathic evidence based medicine for a population of amateur or
Manitoba Health covers these insured visits so there is no charge. We only accept
appointments but can squeeze in people with urgent problems or injuries as same
day appointments. We no longer see patients for Workers Compensation or Autopac
injuries but can refer them to other clinics that do.
Sports medicine involves assessing and treating injuries in "athletes"- who
are meant to include regular people doing their jobs or pursuing recreational
activities. By maintaining people's ability to stay active the risk of heart
disease, stroke, and osteoporosis decreases and enables people to have more
fulfilment with their lives through socialization. Other conditions like mental
illness and chronic diseases (epilepsy, brain injury, diabetes, and
many others) are also modified or improved through regular exercise. Evidence
shows that young girls in organized sport are less likely to smoke, less likely
to use drugs, have less teenage pregnancies and will often do better academically.
Starting with an active lifestyle early sets patterns throughout life and
from what we know from cardiac rehabilitation programs -it is never too late
to start an exercise program! There are clearly many collateral benefits of
athleticism. This should not be confused with institutionalized sport which
unfortunately often involves many negative aspects such as aggression (as
opposed to assertion), anabolic steroid use, and the "win at any cost mentality").
It is possible of course to combine athleticism with organized sport but when
sports become a business and not fun play, many of these benefits go away.
The definition of Sport also varies widely. Many traditional popular sports
are easy to identify- baseball, football, soccer etc. and even have their
well-known sports specific euphemisms for injuries.
Other new or non-traditional activities may not be formally recognized as
such by some (i.e. Ultimate Frisbee, Highland Dancing, X-treme sport, and
Eco-Racing). Finally some activities practiced by some would not appear to
be very strenuous or complex to outsiders but remain a meaningful activity
for their adherents and occasionally they may require need of a Sports Medicine
doctor. (i.e. Table tennis (which can be strenuous), Gardening (which can
irritate osteoarthritis) and Golf (which has repetitive injuries). This last
category may receive tremendous relief from a sports medicine approach. Our
clinic takes a broad liberalization of what are considered sports where our
clients range from Highland Games participants to ballet dancers to yoga practitioners.
All of these groups have a central focus around a meaningful activity that
may or may not give rise to specific accidents or overuse injuries causing
those problems. As Sports Medicine practioners we look for sport specific
patterns of injury, which often assist us in making our diagnoses.
who treat sports injuries:
Massage Therapy - a licensed profession regulated
by a Manitoban body. Licensed therapists are covered under
much insurance coverage. Massage therapy is beneficial in
the relief of muscular soreness and tension. It is not a substitute
for an active exercise program.
Therapy - Athletic therapists are therapists whose primary
focus is rehabilitating athletes back towards competition.
They share many features with physiotherapists. Both groups
will design a rehabilitation program based on the severity
of injury and the progress made in therapy. Many insurance
companies will reimburse athletic therapy.
Trainers. Although this term is frequently used by
many people, in Manitoba the Manitoba Exercise Professionals
Associations publishes a list
of personal trainers with their contact numbers and qualifications.
Physical Therapy (Physiotherapy) - is a profession
that rehabilitates injured people. It may encompass several
other disciplines such as chest physiotherapy (helping people
with emphysema) and neurological physiotherapy (helping people
with neurological diseases cope and recover). Sports physiotherapy
will help assess a problem, design a program, and follow the
person during recovery. Often feedback from a physician helps
optimize the medication and rehabilitation.
Therapy - Occupational Therapists assess disabilities and
may fashion customized splints for specific injuries (which
may be superior to store bought ones). They can also do home
assessments to look for how a home is set up for a disabled
person and suggest modifications. This is a diverse specialty
with many other activities.
For more information contact: http://www.msot.mb.ca/index.html
Podiatrists (Chiropodist, foot doctors) - specialists
who deal with foot problems including designing proper Orthotics.
In Manitoba, Physiotherapists, Athletic Therapists and Chiropractors
also will make Orthotics.
Surgeons - "Orthopods" are surgeons who fix bone and musculoskeletal
injuries, especially poorly healing fractures and arthritis
related complications. Before being referred to an Orthopod,
most people first try several doctors, therapists and medications.
Some injuries should be reviewed by an Orthopedic doctor immediately,
as they most likely won't heal properly if left on their own.
Torn cartilage in the knee and shoulder are good examples
of injuries that should be at least reviewed by an orthopedic
surgeon since the surgical "fix" is often straightforward
and you can often relieve much unnecessary suffering. Usually
sports medicine physicians and other doctors act as "gate
keepers" who have prompt access to referring to orthopedic
doctors when appropriate.
Who are our (players) patients?
Sports medicine involves assessing and treating injuries in
"athletes"- who are meant to include regular people doing
their jobs or pursuing recreational activities. Through maintaining
people's lifestyles the risk of heart disease, stroke, and
osteoporosis goes down and enables people to have more fulfilment
with their lives through socialization. . Other conditions
like mental illness and chronic diseases (epilepsy, brain
injury, diabetes, and many others) are also positively modified
or improved through regular exercise. There are even studies
that show that young girls in organized sport are less likely
to smoke, use drugs, have teenage pregnancies and they will
do better academically as well. Starting with active lifestyle
early sets patterns for life. We also know with cardiac rehabilitation
programs it is never too late to start no matter how old someone
is! There are clearly many collateral benefits of athletism.
Active living should not be confused with institutionalized
sport, which unfortunately has many negative aspects such
as aggression (as opposed to assertion), anabolic steroid
use, and the "win at any cost mentality". It is possible of
course to combine athletism with organized sport but when
sports become a business and not fun play many of the benefits
Red flags to appropriate diagnoses
Sports medicine physicians frequently run across many clients
with muscular complaints, yet all our patients may not be
young healthy adults without any prior medical problems. A
simple complaint may also be a symptom of a major systemic
illness and the sports medicine physician may be the first
sentinel health care provider to discover the presence of
a major medical problem such as metastatic cancer, inflammatory
illness, or cardiovascular disease among many others. Knowing
what is clearly not a sports medicine complaint and arranging
consultation with the appropriate specialist is very important.
Mechanism of injury
As in other types of medicine a detailed history will often help establish
the correct diagnosis. Although many athletes will state that they do not
remember how they hurt themselves, specific questioning such as to what they
were doing at the time of the injury, where their weight was, and if they
felt or heard any telltale snaps or pops. The athlete is often very focuses
on their game play so by focusing on what occurred during a game may give
some valuable clues to clinician. A soccer player may remember 3 consecutive
pops as their MCL, ACL and Medial meniscus are being torn in that terrible
triad of injury. A concussion victim who cannot remember the correct score
of the game when they were injured is likely to have some antegrade amnesia.
Many "Sports Medicine" injuries occur in people while doing their regular
exercises, hobbies, or work. Usually an acute trauma or overuse precipitates
an injury accompanied with pain and loss of function. Sports medicine doctors
assess the type and the degree of injury and make decisions involving the
best treatment. As with many treatments there is no universal treatment, so
each individual's treatment must be tailored to their degree of injury, demands
of daily activity, and expectancies (return to work or to play in an upcoming
Clearance and return to play
It is important to not return an injury to a stressful environment before
it is healed. "Too much, too soon" can lead to a larger period of disability
by aggravating an injury continually, instead of letting it heal once properly.
Often patients and coaches exert considerable pressure for an early return
to play. Compliance with requests for earlier return to play may also lead
to considerable admiration and reputation within that sport. However, being
in the position of a Team Physician the practitioner must also realize that
their opinion is also vulnerable to medicolegal action if something goes wrong
and an athlete is reinjured badly.
Classic Sports Medicine Injuries
Many sports medicine injuries are grouped into euphemisms that describe them
- "Tennis Elbow", "Rotator Cuff" (Tendonitis), and "Shin Splints". These are
convenient labels but are only descriptive and could each represent a group
of illnesses. A sports medicine physician should first make a specific diagnosis
and then make a specific treatment for that diagnosis.
we must first have a history of what happened "the mechanisms of injury",
as well as events or movements that further affected the injury. A physical
exam then helps narrow the possible diagnoses. Specialized tests like x-rays
will help confirm the diagnosis. After the diagnosis is made (or not made
but possibilities suspected) each patient will be assessed for what is best
for them. Although each injury is different, some general guidelines are nearly
universal in sports medicine. These guidelines can help promote faster healing
and prevent further damage.
The PRICE Principle
Protection - This can mean splinting, removing a player or worker from
further activity, or not walking on something that hurts a lot. Protection
also means using crutches or a cane if you even suspect something is broken
before getting it cleared by an x-ray.
Rest - This includes physical and mental rest. People will heal better
if they eat properly, sleep enough and rest the injured part. Non-smokers
heal faster than smokers so even cutting back a little will definitely aid
in a faster recovery.
Ice - To cool
the skin, muscle and ligaments. The decreased temperature acts locally to
vasoconstrict blood vessels and limit further bleeding and swelling. Ice has
an anaesthetic effect to reduce pain as well. Ice also blocks the formation
of the "mediators of inflammation" which are released by damaged cells. These
mediators are responsible for pain and swelling. By preventing swelling this
will facilitate an earlier start in rehabilitation. Ice is best applied for
the first 48-72 hours and sometimes longer if there is severe swelling.
Ice should not be applied directly to the skin, but through a towel. Most
experts recommend 15-20 minutes at a time to avoid cold damage to the skin.
People with very poor circulation or those who have Raynaud's Phenomenon (an
over developed reflex to cold) should be cautious in applying ice.
Heat should be applied as a moist towel but is not recommended to use
before 72 hours have elapsed. Heat will cause vasodilatation of blood vessels
and lead to increased swelling. After 72 hours as the wound matures, heat
may be considered since it will promote better blood flow (helping to nourish
the damaged area) and relieve muscle aches. After 72 hours neither heat nor
cold need be used exclusively since they are both complementary. Heat can
be used prior to starting an activity to "warm up". Cold can be used to decrease
swelling and pain after an injury, similar to "cool down".
Alternatively heat may be followed by cold then heat again in contrasting
therapy. Contrasting therapy is used later in the phase of healing and is
a useful tool for the rehab therapist. Compression - Mechanically limits expansive
swelling after an injury.
Compression may actively make a fracture more painful
and suspicious injuries should be examined immediately. Fractures
should be treated with splints or casts.
The affected limb should be elevated. This is easily accomplished in an
ankle or hand injury, but is not of any benefit in a hip or back problem.
Elevation is suggested to be at least above the level of the heart. The
force of gravity helps remove swelling. This is a simple and easy thing
to do but is often overlooked.
Support - This is similar to protection but also includes fitting
people with braces to externally support damaged areas.
Modalities are treatments used to facilitate healing. Heat and cold are
very simple, effective and inexpensive modalities tat work very well.
Other examples include:
1) Therapeutic ultrasound - used to deliver heat to deep tissues. This
helps circulation which aids healing. It should not be confused with diagnostic
ultrasound, which uses a different frequency in order to examine organs.
2) Muscle stimulation - this stimulation occurs as electrodes are attached
to the skin causing muscles to twitch. This can be useful in severe injuries,
helping to teach muscles to fire in a coordinated fashion
3) Ionophoresis or phonophoresis are 2 different procedures whereby medication
is delivered deep into tissues using either a charged medication via electrical
current (Ionophoresis) or medication administered with ultrasound. (phonophosesis).
They are both uncommon modalities but can be used effectively in some
4) Ergogenic medication - We do not recommend or endorse any enhancing
nutraceutical (drug like foods), vitamins, stimulants, or medication to
assist healing. Despite great claims they are still too good to be true.
At present the best ergogenic plan is to drink enough water, follow the
Canada Food Guide www.hc-sc.gc.ca/hppb/nutrition/pube/foodguid/index.html
and get enough sleep.
5) Acupuncture exists in many forms and is used differently by diverse
practitioners. A licensed acupuncturist uses acupuncture as a modality
for relieving pain or stress.
Cortisone injections are used for specific injuries where there is a lot
of inflammation. Cortisone is a potent anti-inflammatory drug but should
be used carefully. Some conditions that are benefited by cortisone shots
include: Tennis Elbow, Rotator Cuff Tendonitis, and types of bursitis.
The precise administration of this anti-inflammatory drug helps resolve
these conditions. Sometimes only a cortisone injection is used, but it
is more important to use cortisone in conjunction with a complete program
that also works towards strengthening the injured part and making sure
the injury does not reoccur. Cortisone injections should not be injected
into tendons as this causes them to weaken and rupture. Also it is generally
advised to limit Cortisone injections to weight bearing joints. Cortisone
injections may cause a steroid flare, which will aggravate the joint for
a few days. This is actually a reaction to the preservative and does not
affect the drugs chance of success.
Cortisone injections are very safe and are sometimes underused as a method
of treatment. Patients should be selected so that only those whom would
optimally benefit to being injected are given Cortisone. Proper knowledge
of anatomy, technique, and placing of the Cortisone in the exact place
yields best results.
The most important rehabilitation tool for injuries is exercise. "Exercise
is medicine". It is important to return to activity at a controlled rate
so as not to re-injure again. Try to avoid "too much, too soon" but at
the same time unnecessary immobilization will lead to more muscle atrophy
or loss of cardiovascular fitness. A good therapist can help guide an
injured person towards gradually recovering post injury. Maintaining a
regular level of fitness (flexibility, strength and endurance) is one
of the most powerful (and cheap) preventative measures for good health.