1. Sports Medicine Approach to MSK Problems
Bob Kiningham, MD
Associate Professor
University of Michigan Health System

2. Disclosure
I do not have any relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation.

3. Primary Job of the Sports Medicine Physician
To encourage and facilitate safe physical activity

4. Aspects of Sports Medicine
Treatment of musculoskeletal injuries
Optimizing medical conditions to allow for safe physical activity
Promotion of physical activity to prevent and treat medical conditions and optimize health and functioning

5. The Scope of Sports Medicine
Patients who are physically active
Patients who want to become physically active
Patients who should become physically active

7. “Everyone is an athlete
“Everyone is an athlete. The only difference is that some of us are training and some of us are not.”
George Sheehan, MD

8. MSK Problems in Primary Care
Approximately 20% of visits to primary care clinics
Second only to URIs in frequency
One in two American adults have a MSK condition that has required medical care

9. Traditional Medical Approach
Treat pain and “inflammation” with medications/modalities
Activity modification
Rest/immobilization

11. Therapeutic Approaches to Recurrent or Chronic MSK Problems
Change or avoid the job or activity
Change the patient so he she can do the job or activity

12. Most Common MSK Problems in Primary Care
Weight bearing osteoarthritis
Low back pain
Upper back and neck pain
Tendinopathies
Rotator cuff
Lateral and medial epicondylitis

13. Knee Osteoarthritis
Osteoarthritis is characterized by the progressive focal loss of breakdown of hyaline cartilage and underlying bone within a joint, as well as bony overgrowth
Cartilage loss is not uniform

14. Exercise Grade A Recommendation
Low impact aerobic exercise improves functional ability and endurance, and reduces pain
Strength training reduces pain and improves physical function

15. Weight Loss Grade A Recommendation
One pound of weight loss above the knee equals a decrease in 4-5 times less force on the knee when weight-bearing
Reduces pain and improves function
Appears to have additive effect with exercise

17. Computer Sitting Back Pain

18. Computer Sitting Back Pain

20. Tendinosis Hypoechoic, thickened, tendons
Normal Lat Epicondyle
Hypoechoic, thickened, tendons
Small clefts/tears often visualized
Image courtesy of Dr. Troy Henning, MD

21. Eccentric Strengthening

22. Therapeutic Approaches
Muscles are the “shock absorbers” of the joints
Neuromuscular control of movement
Changing tendons from degeneration to reparation with improved strength and function

23. Sports Medicine Approach to MSK Problems
Goals of therapy
Return to activity
Prevent re-injury
Physical therapy
A learning experience
Muscles are the shock absorbers and stabilizers of the joints