1. Jacqui McCord-Uys Sports Physiotherapist
Sports Medicine 2013
Jacqui McCord-Uys
Sports Physiotherapist

2. Who am I ? Practising since 1989 Sports injuries since 1990
Beijing Olympics team
Common Wealth teams (Snr & Jnr)
All Africa Games
SA Schools Rugby, Women's Rugby
Falcons Rugby Team (4 yrs)
SuperSport United Football Club Medical Team Leader & Physio (16yrs)
Course presenter in India 2011 & 2012
Conference Presentations 2008,2010,2011,
ETC…….

3. Sports Medicine Why the need for specialization?
GP orthopaedic surgeon not sufficient?
Work opportunities?
Qualifications needed?
MSc Sports Medicine Degree(TUKS, Wits, UCT & Bloemfontein)
College of medicine & HPCSA approved Specialist rating awaiting Government approval.

4. Sport Injuries Acute Bone Articular Cartilage Joint Ligament Muscle
Tendon
Bursa
Nerve
Skin

5. Sports Injuries Chronic ie overuse Bone stress Osteitis & Periostitis
Articular cartilage
Joint
Ligament
Muscle
Tendon
Nerve
Bursa
Skin
AND the unknown……

6. Sports Injury principals
Diagnosis
Treatment
Recovery
Rehabilitation
Return to Play

7. Diagnosis There is no more difficult art to acquire than the art of observation. (William Osler)
Clinical assessment:
NB to make an accurate pathological Dx.
Too often broad terms like “swimmers shoulder” or “Runners 'knee” are used
Enables better explanation to sportsman of way forward.
Enables optimum treatment
Enables optimum rehabilitation.

8. Diagnosis Special Investigations
Should be a tool confirm or exclude a diagnosis not a replacement of a thorough physical examination.
Old saying by James M Hunter “Treat the patient and not the X-Ray”
Radiological Investigations
X-ray
CT scan
MRI
Ultrasound
Radio isotopic Bone scan

9. Special Investigations
Neurological Investigations
EMG
Nerve conductivity
Neuropsychological testing (head injuries)
Muscle assessments
Compartment pressure testing
Cardiovascular Investigations
Respiratory Investigations
Pulmonary function tests

10. Treatment
Randomized controlled trial evidence for all treatments given?
Eg Parachute
We must take note of evidence that is around but never forget our craft remains much an art as science.
Standard principals
Acute management RICE

11. RICE Rest: First 48hrs Sportsman Ice: Reduce tissue metabolism
Reduced hematoma, inflammation & tissue necrosis
Accelerated early regeneration in Muscle tissue
20min every 2hrs
Compression:
Co-adhesive bandage or Compression sleeves
Elevation
Decrease in hydrostatic pressure Reduces accumulation of interstitial fluid

12. Immobilization Earlier better
Too lengthy leads stiffness degeneration, osteopenia, muscle atrophy etc.
Braces, POP, Crutches
CPM (Forms part of in hospital post operative rehabilitation)

13. Therapeutic drugs
Analgesics : Relieve patients pain immediately post injury
Corticosteroids: Concern regarding the effects on tissue healing
Considered a bridge treatment i.e. providing immediate symptomatic relief but underlying cause of problems must be addressed
NSAID’s : Debatable effects
Avoided in first 48hrs
Long term use (more than 5 days) should be avoided. Reassess & diagnose
Be aware of gastrointestinal problems.

14. Acute or Chronic Musculoskeletal Injuries
Are anti-inflammatory signs & symptoms present ?
YES No
Previous History adverse effect
YES No
Non-NSAID’s Analgesic
NSAID’s combined with protective agent
NSAID’s for max of 7 days
NSAID’s not indicated

15. Additional Treatments
Electrotherapy
Extracorporeal Shock therapy
Manual therapy
Acupuncture/ dry needling
Hyperbaric Oxygen therapy
Surgery

16. Rehabilitation Proprioception Strength Flexibility RETURN TO SPORT
Skill Acquisition
Proprioception
Strength
Flexibility
Motor re-education &
Muscle activation

17. Correct Motor control
Poor pelvic control i.e. weak Gluteus medius can cause anterior knee pain
Poor scapular control can be cause of ant shoulder tilting causing impingement
Exercise in open or closed chain (more functional)
Remember agonist and antagonist

18. Flexibility Pre Event Active warm-up
Post event Passive cool down stretch
Tight muscles may be associated with injuries
Psoas :Lumbral apophyseal joints and Hamstring
Soleus : Achilles tendinopathy
Vastus Lateralis ITB : Patellofemoral syndrome

19. Therapy progression Parameters to monitor Pain & tenderness ROM
Swelling
Heat & redness
Ability to perform exercises
Number of sets and reps

20. Psychology Athlete must understand injury full extend Long term goal
Short term goal
Listen to Athlete
Give alternate active rest exercise
Refer if needed

21. Recovery Common methods (Research needed) Warm Down
Ice baths (5min 10 – 15 degrees)
Massage
Compression garments
Lifestyle factors
Nutrition
Psychology

22. Most Common Injury summaries

23. 1. Head - Concussions Direct blow to head
Rapid onset of short lived impairment of neurological function
Good clinical judgement must prevail over guidelines and coach and player insistence.
When in doubt refer.
Assessment forms: 1.FIFA (SCAT2) (pocket edition)
2. SA Rugby Bok Smart program: Concussion Management

24. 2.Shoulder Injuries Rotator cuff Instability Labral injury Stiffness
AC Joint Pathology
Referred Pain

25. Rotator cuff Muscles and Tendons
Acute or Chronic
Acute on Chronic ie. An acute tendon tear on a degenerative tendon
Symptoms: Shoulder pain
Overhead activity problems
Investigations: MRI
Treatment: Full thickness tear - repair
Tendons NSAID’s at first
Correct abnormalities: Muscle weakness, Gleno-humeral rhythm etc….

26. Shoulder instability On field dislocations Reduce ASAP
Damage to Capsule and Labrum (Ant, Post, Sup)
Periscapular Muscle weakness
Changes to passive structures ie lig, capsule or labrum
Ant Dislocations damage the labrum (Bankart lesion)
Symptoms
Pain, unstable, Weakness, Stiffness
Treatment
Non surgical – Rehabilitation and analgesic Rx
Surgical – Post operative rehab program

27. Labral Injury Overuse or acute
Intervention: Surgical since Conservative usually unsuccessful
Symptoms:
Impingement or Joint pain
May be unstable
History is NB on mechanism of injury
Common traction on Biceps tendon

28. Shoulder Stiffness May be secondary to trauma
Adhesive capsulitis or Frozen Shoulder
Possible injury to cervical nerve roots or brachial plexus
Treatment:
Conservative Rehabilitation
Manipulation

29. Soft Tissue Acute Injuries eg. Post Thigh
Sudden onset like a puncture!
Return to sport days
High re-occurance rate
Key = correct Dx
Anatomy
History
Strong incident ie sprinting (eccentric) or overstretching (ballet)
None consider referred pain
Special investigations : confirm grade of tear Ultrasound, MRI

31. Management First 48hrs – RICE, early pain free M contractions
Following:
Stretching: Hamstring & Antagonists (Quads Iliopsoas)
Neural Mobilization
Soft tissue Rx
Strengthening
Sport specific drills esp. Agility and motor control

32. 3.Anterior Knee conditions
7. ITB
1.OA Knee
6. Lat Lig.
2. Med Lig
3. Pes Anserine bursitis
5.General knee effusion
4. Patellar tendon / Osgood-Schlatters / Runners knee

33. Knee injuries Medial menisci tear MCL Sprain ACL sprain/rupture
Patellar tendon rupture
# Tibial Plateau
MCL Sprain
Quadriceps tendon tear
Avulsion # tibial spine
ACL sprain/rupture
Acute patella femoral contusion
Osteochondritis dissecans

34. Knee Injuries Lateral Menisci tear PCL Patellar dislocation LCL sprain
Osteochondritis dissecans
PCL
Acute fat pad impingement
Regional Pain Syndrome
Patellar dislocation
Avulsion biceps femoris tendon
Quadriceps rupture

35. Acute knee injury pricipals
Is the injury significant ie fast intervention
History to consider:
Mechanism of injury
Amount of pain
Swelling & timing of onset
Degree of disability
Previous injuries

36. Diagnosis knee injury Assessment: ? Damaged structures
Extent of damage
Degree of joint limb disability to provide safe and timely management

37. Hints Symptom of ‘give way’ (ACL)
Location of pain – Cruciate poorly localized
Collaterals fairly well localized
Severity of pain not always in corralation with injury severity
Intra articular swelling obvious within 2 hrs damage
- ACL,PCL
- Pateller dislocation
- Osteochondral #
- Medial menisci peripheral tear

38. Hints Effusion develops after a few hours
Reactive synovitis ie. meniscal or chondral injuries
Little effusion with collateral injuries
Pop or snap or tear : ACL
Locking : Loose body or displaced meniscal tear

40. Lower leg Injuries ‘Shin splints’ Deep compartment muscle strains
Gastrocnemius / Soleus strains / tears
Achilles tendinosis or ruptures
‘Severs’ disease

42. Tibialis Anterior
Tibialis Posterior
FDL

43. Gastrocnemius /Soleus & Achilles

45. Sport specific injuries
Always consider the type of sport played
Level of sport ie international, national or local
Is sport the players income?
Surface where injury occurred
Gear involved
Training regime

47. Rugby injuries

48. Are you Listening? Your patient is the answer to your diagnosis
Your Diagnosis is the answer to your successful treatment
So Listen

49. Sources
Clinical Sports Medicine Fourth edition Brukner & Khan

50. Complete Physio Brooklyn Pretoria
Complete Physio Brooklyn Pretoria