What’s Hot in Sport and Exercise Medicine

Dr Jon HoughtonMBBS MRCP MFSEM BSc DipSEM PgCert MSK USConsultant Rheumatologist and Sports Physician

Honorary Senior Lecturer University of Wales Institute Cardiff

Sports Orthopaedics UK

Contents

• A Brief Introduction

• How to advise patients about Exercise

• The role of Musculoskeletal Ultrasound

• Summary

•1999 MRCP

•2000 Rheumatology NTN

•2000 Training in MSK Ultrasound

•2003/04 Diploma in Sports Medicine UCL

•2006 CCT in Rheumatology/GIM

•2006 Consultant DMRC Headley Ct

•2010 Joined Sports Orthopaedics UK

Exercise Prescription•Benefits of Exercise

•Reduction of mortality from

•All forms of Cardiovascular Disease

•Diabetes

•Cancer

•Improved Mental Health

•Improved Bone Health

Components of Exercise Prescription

•Type of exercise or activity

•Duration and frequency

•Specific workloads

•Intensity Guidelines

•Precautions

•Goals

Type of Exercise/activity•What does the pt enjoy?

•Access

•Funding

•Commuting/Daily routine

•Housework

•Vary Aerobic with resistance/isotonic

Duration and Frequency

•Generally aim for 20-60 minutes 5/week

• V low capacity aim for multiple short sessions daily

• Moderate capacity 1-2 sessions daily with slightly increased duration

Specific Workloads

•Walking Pace

•Watts

•Calories/hour

Intensity•%Max Heart Rate (220-Age)

•40-60 Fat Burn

•60-85 Aerobic

•85+ High/anaerobic

•Heart rate reserve (max stress test-resting)

•METS - 1 MET is resting O2 consumption

Intensity•Rate of Perceived Exertion (RPE)

•Borg Scale• 6 No effort

• 11 Light

• 12-13 Moderate

• 14-15 Hard

• 16-17 Very Hard

• 18-19 Extremely hard

Precautions/Special groups• Obese/Overweight - Reduce impact exercise

• Respiratory - Regular short duration

• Diabetes - Decreased Insulin requirements

• Osteoporosis - combine impact with resistance

• Pregnancy - maintain pre exercise level and watch for joint laxity and overheating

• Cardiovascular - Often require stress test prior and work to very specific intensities.

Case studies

•48 Year old male office worker with mild hypertension

•14 year old boy with obesity

•68 year old female with osteopenia

Top Tips•Involve the Patient!

•Include enjoyable activities

•Set Goals - SMART

•Warn about pain and stiffness

•Start slow and progress

•Review progress

Musculoskeletal Ultrasound

• Rapidly Growing Field

• High Frequency probes - excellent resolution

• Portable and cheaper

• Extension of the clinical examination

• Diagnostic

• Guided Injections

Tissues visible•Muscle

• Tendon

• Ligament

• Bones

• Bursae

•Nerves

• Synovitis

•Calcification

Muscle

Tendon

Bones

Nerves

Synovitis

Tenosynovitis

Guided Injections

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Guided Therapy for Tendinopathy

•Supraspinatus

•Extensor Origin Elbow

•Patella

•Achilles

•Plantar fascia

Neovascularisation• Hallmark of

tendinopathy

• Power Doppler USS

• Abundant sensory nerves

• No Inflammation

• Substance P and CGRP

High Volume stripping

Ultrasound Summary•Extension of the clinical

examination

•Real time assessment

•Comparable to MRI in many instances

•Exceeds MRI in tendinopathy

•Guide therapeutic intervention

Questions?

• Sports Orthopaedics UK - Delia Sittert - Caterham

• clinic@sportsortho.co.uk 08445 617131

• jon.houghton@sportsortho.co.uk