Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Musculoskeletal Injuries in Sports

Acknowledgment The authors would like to acknowledge the contributions of previous edition authors W. Michael Walsh, MD; Ronnie D. Hald, PT, ATC; Laura E. Peter, MD; and Morris B. Mellion, MD . General Classification of Musculoskeletal Sports Injuries Musculoskeletal sports injuries can be classified as traumatic or overuse injuries. Traumatic Injuries Description: Result from specific episode(s) of trauma, whether recent (acute) or in the more distant…

Connective Tissue Diseases and Rheumatologic Problems in Athletes

Connective Tissue Disorders Marfan Syndrome Overview: Inheritable autosomal-dominant genetic condition that affects the processing of fibrillin; it is caused by >1800 mutations in the gene encoding fibrillin-1 (FBN-1), located on chromosome 15 at the q21 loci. Approximately 10% of patients with Marfan phenotype have no identifiable mutation in the FBN1 gene; mutations in TGF-beta receptor 2 and TGF-beta receptor 1 genes have been linked to these…

Skin Problems in the Athlete

General Principles Skin infections account for 21% of illnesses and injuries reported in collegiate sports and 8.5% in high school sports. In collegiate sports, skin infections account for 1%–2% of all time-loss injuries. Twenty percent of National Collegiate Athletic Association (NCAA) wrestlers lose practice or competition time because of skin problems annually. Common dermatologic lesions and examples are listed in Table 40.1 . Table 40.1 Description of…

Headache in the Athlete

General Principles Headache is one of the most common disorders and symptoms reported to primary care, the emergency department, and team physicians. Complaints of headache account for 1%–4% of primary care office and emergency department visits. In the general population, the prevalence of headache in a 1-year period is >90% and the lifetime prevalence is 93%–99%. Headaches are one of the most commonly reported pain complaints…

Neurologic Problems in the Athlete

Epilepsy and Seizure Activity in Athletes Definition Seizure: A transient disruption of brain function from abnormal, excessive, synchronous neuronal activity in the brain; its clinical manifestation depends on the specific region and extent of the brain involved, which may include altered motor function, sensation, alertness, perception, and autonomic function. Epilepsy: An enduring predisposition to generate recurrent, unprovoked epileptic seizures; worldwide prevalence is approximately 8.2 per 1000…

Exercise-Induced Bronchoconstriction, Urticaria, And Anaphylaxis

Exercise-Induced Bronchoconstriction Definitions: Exercise-induced bronchoconstriction (EIB) is defined as a transient narrowing of airways in response to exercise and can be classified as with asthma (EIBa) or without asthma (EIBwa). EIB can present with classic asthma symptoms or with more subtle fatigue or effects on performance. EIB was previously defined as exercise-induced bronchospasm, as opposed to bronchoconstriction, and exercise-induced asthma (EIA) described symptoms brought on by…

The Hypertensive Athlete

General Principles An estimated 108 million Americans over the age of 18 years have hypertension (HTN). HTN is the most common cardiovascular condition observed in competitive athletes. Athletes are usually considered to be free from cardiovascular disease because of their apparent high level of fitness. The overall incidence of HTN in athletes is approximately 50% less than that in the general population. HTN begins in young…

Cardiac Disease in Athletes

The Athlete’s Heart Definition Intense regular physical exercise can induce physiologic and morphologic cardiac changes known as “athlete’s heart.” These adaptations are a normal response to repetitive exercise and training. Physiologic Changes Increased vagal tone Morphologic changes, including left ventricular (LV) enlargement, increases in LV wall thickness, and LV mass Pathologic vs. Physiologic Hypertrophy Physiologic changes that occur in response to training can be difficult to…

Ecg Interpretation in Athletes

Introduction Sudden death related to cardiovascular disorders is the most common cause of death among athletes during sports and exercise. Genetic cardiovascular disorders, such as cardiomyopathies and ion channelopathies, are the primary causes of sudden cardiac death (SCD) in athletes. Acquired cardiac conditions, such as myocarditis, also represent an important cause of SCD in young athletes. Most of these disorders can be identified through characteristic changes…

The Athlete with Diabetes

General Principles Diabetes mellitus (DM) is a chronic group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion leading to an absolute insulin deficiency due to beta-cell destruction (type 1), by defects in insulin action because of progressive insulin secretory loss along with increasing insulin resistance (type 2), or by other causes such as pregnancy (gestational), neonatal diabetes or maturity-onset diabetes of the…

Renal and Genitourinary Problems

Anatomy Genitourinary system: Composed of internal and external organs of the urinary system and genital/reproductive system. Both systems are contained in the abdomen and pelvic region. Urinary system: Composed of kidneys, ureters, bladder, and urethra Reproductive system: Male (penis, testicles), female (ovaries, Fallopian tubes, uterus, vagina, vulva) Female genitourinary system: Situated within the pelvis, except for the vulva, which is external ( Fig. 32.1 ) Male…

Hematologic Problems in the Athlete

Red Blood Cell Disorders And Inherited Hemoglobinopathies Sickle Cell Syndromes Description: Sickle cell warrants special consideration for athletes. Inheritance of a gene from one parent results in sickle cell trait (SCT), and inheritance from both results in sickle cell disease (SCD). Other allele formations that lead to sickling include hemoglobin SC and sickle cell beta-thalassemia. Whereas SCD is a contraindication for competitive sports because of the…

Gastrointestinal Problems

General Principles The gastrointestinal (GI) system and its processes are a secondary priority for the body during exercise. As a result, GI dysfunction and disease can often impede maximal athletic potential. During exercise, blood flow is diverted from the splanchnic circulation and preferentially distributed to demanding peripheral muscles. Additionally, sustained movement created during athletic activity can cause disruption to physiologic GI functioning. These factors are thought…

Infections in Athletes

General Principles Athletes may be immunosuppressed due to a variety of psychological, environmental, and physiologic stressors, especially when combined with inadequate diet and sleep. Infectious outbreaks affect sports participation and performance and can easily spread to team staff, spectators, and other contacts. Appropriate diagnosis may help decrease sports disruption, return the patient to health, foster sports success, and quell a regional epidemic. An athlete’s increased risk…

Overtraining

Introduction Overtraining syndrome (OTS) is among the most challenging medical disorders that confronts the sports medicine provider. OTS, although most commonly associated with endurance athletes (e.g., runners, swimmers), can also be identified in strength athletes. At present, OTS is complicated by multiple diagnostic and therapeutic challenges, as current research in this area is limited by a small number of studies and inconsistent results. Researchers have concluded…

Eating Disorders in Athletes

Overview The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DMS-V), updated in 2013, and the World Health Organization’s (WHO’s) International Statistical Classification of Diseases and Related Health Problems, updated in 2019, identifies and defines the following eating disorders (EDs): anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding or eating disorder (OSFED), unspecified feeding or eating disorder (UFED), and…

Drugs and Doping in Athletes

Definition According to the World Anti-Doping Agency (WADA) Code, doping is defined as the occurrence of one or more of the following antidoping rule violations: The presence of a prohibited substance or its metabolites or markers in an athlete’s bodily specimen. Use or attempted use of a prohibited substance or prohibited method. Refusing, or failing without compelling justification, to submit to sample collection after notification as…

The Role of Sport Psychology and Sports Psychiatry

Introduction Athlete mental health (MH) symptoms and disorders have emerged as a major focus within athletic/sports organizations, international and national sport governing bodies, and the sports medicine environment. This focus has resulted in the development of multiple consensus statements and guidelines regarding MH issues in athletes and articles aimed at increasing awareness and reducing stigma. The sport psychology and sports psychiatry fields have been leaders in…

Travel Considerations for the Athlete and Sports Medical Team

General Principles Modern transportation systems facilitate easy access to most regions of the world. Although this has allowed for the rapid growth of international competition, it also creates unique physiologic and psychological challenges for athletes as well as the sports medicine team. Jet Lag and Chronobiology The American Academy of Sleep Medicine defines jet lag as a syndrome involving insomnia or excessive daytime sleepiness after travel…

Altitude Training and Competition

Acknowledgment The authors would like to acknowledge James Stray-Gundersen, MD, for his major contributions to the previous editions of this chapter. Altitude Environment Barometric pressure is reduced at high altitudes, with a parallel decrease in inspired partial pressure of oxygen (P I O 2 ); thus, hypobaric hypoxia is the most prominent physiologic manifestation at high altitudes. Fig. 23.1 shows the accepted terminology for the range…