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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
www.puresportsmed.com
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• 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
What is a Sports Physician ?
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What is a Sports Physician?
Sports Physician
1.Clinic workload – Orthopaedic Physician
1.Team Doctor workload
1.Exercise prescription and ‘healthy living’
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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
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Pure Sports Medicine
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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 …………
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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
What is Sports Medicine ?
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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
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Sports Medicine Scenarios
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
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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 ?
Sports Medicine Scenarios
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Impingement
What is it ?
It’s not all Bursitis !
What are the causes ?
Sports Medicine Scenarios
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Impingement
•Scapula movement
•Capsular restriction
•Acromion type (Osteophytes)
•Instability (laxity, labral)
•Rotator cuff (tear or weak)
•Suprascapular nerve palsy
Sports Medicine Scenarios
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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 ????
Sports Medicine Scenarios
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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 ?
Sports Medicine Scenarios
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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 ++
Sports Medicine Scenarios
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1. Shoulder
Frozen shoulder –
Adhesive Capsulitis
What would you do in
General Practice ?
What are your options ?
Sports Medicine Scenarios
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1. Shoulder
Frozen shoulder – Adhesive Capsulitis
• Management
• Injection therapy
• Rehabilitation
Sports Medicine Scenarios
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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 ?
Sports Medicine Scenarios
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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 ?
Sports Medicine Scenarios
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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 ?
Sports Medicine Scenarios
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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)
Sports Medicine Scenarios
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2. Lumbar Spine
Stress fracture R L5 pedicle
Sports Medicine Scenarios
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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 ?
Sports Medicine Scenarios
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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 ?
Sports Medicine Scenarios
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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 ?
Sports Medicine Scenarios
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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
Sports Medicine Scenarios
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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 :
Sports Medicine Scenarios
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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
Sports Medicine Scenarios
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3. Knee
Management ???
Sports Medicine Scenarios
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Any Questions ?