AN approach to Sports Medicine – “THE SPORTS MEDICINE MODEL” Dr Louis Holtzhausen Program director: Sports Medicine University of the Free State South Africa April 22, 2017

Definition of Sports Medicine Not only the management of injuries The medicine of exercise Total medical care of the exercising individual Brukner and Khan, 2001

The scope of Sports Medicine Prevention of injury Diagnosis of illness and injury Treatment and rehabilitation Performance enhancement Training Nutrition Psychology Management of medical problems caused by exercise The role of exercise in chronic disease Cardiac disease Diabetes Asthma and COPD Arthritis The needs of special exercising populations Children Females Older people Persons with disabilities Medical care of sporting teams and events Medical care in situations of altered physiology Diving and aviation Heat Altitude Ethical issues Drugs in sport

“THE SPORTS MEDICINE MODEL”

The traditional medical model Brukner P, Khan K. Clinical Sports Medicine. 2007

The Sports Medicine model Brukner P, Khan K. Clinical Sports Medicine. 2007

The multi professional team approach “A champion team will always beat a team of champions“ Know your skills and limitations and that of other team members Team may differ in different settings Multi skilling Geographically isolated Travelling Overlap Case manager/ co-ordinator Primary contact is the choice of the athlete – responsibility of the practitioner is to know his/her place in the multi professional team and utilise other members

Challenges of management Diagnosis Clinical (“Victim“): Specific, anatomical, pathological Cause: (“Culprit“) Interaction between body (with its physical properties) with the environment and a training schedule

Causes of chronic injury Intrinsic causes: Biomechanics Body mass Level of fitness and skill Extrinsic causes: Equipment Footwear Playing surface Environmental conditions Training factors: Frequency Intensity Time Type

Challenges of management Treatment Presenting injury/illness Cause Consider all aspects of injury Return to sport issues

Philosophy of injury rehabilitation Understand the healing process Understand the pathomechanics of injury Understand the kinetic chain Psychological aspects The tools of rehabilitation Goal setting

The components of injury rehabilitation Control of swelling and pain Restoring range of motion Restoring muscular strength, endurance and power Restoring neuromuscular control Restoring postural control and stability Maintaining cardio-respiratory fitness Psychological aspects Monitor possible complications Functional progression and testing Return to sport Criteria for full recovery

Meeting individual needs Individual needs of individual athletes determine management plan Contextual variables have to be considered The role of the coach Communication Shared decision making Ultimate responsibility to patient

The Bio-psycho-social model HOLISTIC PATIENT CARE The Bio-psycho-social model

Ashburnpsychologist.com 2012

Systems theory Before injury Effects of injury Engel, 1980 in Mc Whinney IR. A Textbook of Family Medicine. 1989

Systems theory Resolution Engel, 1980 in Mc Whinney IR. A Textbook of Family Medicine. 1989

A biopsychosocial method: The three stage assessment Intrinsic Training Extrinsic Social/contextual: Effect on social systems Personal/PsychologicalThoughts Feelings Fears Expectations

The athlete support system Athlete and agent Clinician Coach Brukner P, Khan K. Clinical Sports Medicine 3rd Ed, 2007

Love thy sport Know thy sport

The sports medicine consultation Subjective assessment History Determine type, severity and cause Objective assessment Clinical evaluation Assessment summary Clinical Personal Contextual Plan Case manager Multi professional Stages of rehabilitation Goal setting Follow-up Return to sport

Thank you! Dr Louis Holtzhausen Sports Medicine University of the Free State HoltzhausenLJ@ufs.ac.za