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Exercise in the Cold and Cold Injuries

General Principles Physiology of Cold Exposure Mechanisms of Heat Loss Radiation Radiation involves the direct emission or absorption of heat energy from the body (mostly infrared radiation). Radiation is the largest source of heat loss from the body. Clothed, sedentary individuals in a calm, temperate climate lose more body heat (approximately 60%) by radiation than active individuals (approximately 45%) in a thermoneutral environment where heat production…

Exercise in the Heat and Heat Illness

Heat Production Exercise: The Body’s Furnace Caused by the Inefficiency of Work The body utilizes energy in the form of energy-rich chemical compounds to maintain normal function ( Fig. 21.1 ) and is inefficient; most reactions produce heat. Resting Heat Production Sources of nonexercising heat production include involuntary smooth muscle contraction, myocardial contraction, muscle group contraction to maintain posture, shivering, digestion, and cellular metabolism. Heat Production…

Flexibility

General Principles The term flexibility is often used as a synonym for range of motion (ROM) around a joint. Both muscles and ligaments can limit ROM. Mobility refers to a limited ROM because of ligaments; flexibility is usually reserved to refer to limited ROM caused by the muscle–tendon unit. Flexibility depends on both muscle stiffness (force required to stretch a muscle) and the stretch tolerance of…

Resistance Training

General Principles Resistance training is the most potent form of exercise to strengthen tissues and help prevent injury and improve sports performance. Appropriately prescribed and implemented resistance training programs are necessary to achieve these goals. The size principle of motor unit recruitment demonstrates that the recruitment of motor units and their associated muscle fibers occurs in an orderly manner from low- to higher-threshold motor units, and…

Aerobic Training

Introduction In the early days of sporting events, coaches and athletes learned through trial and error that they could not simultaneously develop maximal endurance and maximal power. They found that by first establishing an aerobic endurance base and later adding faster training, they could peak at appropriate times. It was not until the 1960s that the study of exercise as a science became widespread, and gradual…

Exercise Prescription and Physiology

Exercise Physiology Science of processes and mechanisms of skeletal muscle contraction and the corresponding interaction of other body systems that facilitate and respond to skeletal muscle contraction. Skeletal muscle contraction that exceeds physiologic limits, is inappropriate in duration or intensity, or for which the musculoskeletal system has been inadequately prepared can lead to injury or poor performance and adaptation to training. Clinical relevance lies in identification…

The Wilderness Athlete and Adventurer

Introduction Wilderness sports differ from traditional sports in several ways. Participation levels of athletes may vary: professional, sponsored, and paid athletes; athletic individuals and adventurers; and intermittent recreational participants. The setting of wilderness sports is often austere, remote, and not regulated by organized bodies as traditional sports are. Participants range in age from children to older adults and seniors. Typically, there is no distinction in participation…

Care of Athletes at Different Levels: From Pee-Wee to Professional

General Considerations ( Box 15.1 ) Availability Being a team physician requires a tremendous time commitment. BOX 15.1 The Five A’S of Being an Excellent Team Physician Availability Ability Affability Advocacy Affiliation Must have a sincere desire to care for athletes and allow their expedient return to play. Ability Possess the necessary skills to accurately diagnose and appropriately treat the athlete. In addition to the team…

The Athlete With Physical Disability

General Considerations Definitions Physically challenged, physically disabled, and “disabled” athletes are terms often used to collectively refer to all groups of athletes competing in international competitions such as Paralympics and have an impairment that limits their ability to participate in athletic arenas within a manner considered “normal” for regulated sport. The impairment is not a “disability” in their selected sport, as these athletes have tremendous ability…

The Senior Athlete

General Considerations Demographics It is widely accepted that the average life expectancy continues to increase; as it does, the proportion of older adults in the population also increases. In Western industrialized countries, the average life expectancy increased from 47 years in 1900 to 78 years in 2007. The number of individuals older than 85 years has increased by 232% from 1960 to 1990, along with a…

The Female Athlete

History of Women In Sports Throughout history, women have participated in sports at much lower rates than men. Still, Egyptian temple wall illustrations depict women playing ball games in 2000 BCE. The first recorded women’s athletic competition was the Heraean Games in the sixth century BCE held in the original Olympic stadium. The women of indigenous tribes in the Americas participated in multiple sports until European…

The High School Athlete: Setting Up A High School Sports Medicine Program

Acknowledgment We would like to acknowledge Dr. Stephen G. Rice for his contributions to prior versions of this chapter. General Principles Athletic Healthcare in High-Level Collegiate and Professional Sports At the highest levels of sports, organizations are much like corporations; they function to increase success of shareholders by providing a product (i.e., winning team) linked to profitability. Although there are ethical concerns with this model, it…

The Pediatric Athlete

General Principles A pediatric athlete can be any child or adolescent usually under the age of 18 years who participates regularly in sports activities. Understanding physical and physiologic differences between pediatric and adult patients aids in the prompt recognition and management of most medical and orthopedic conditions affecting a pediatric athlete. Activity type, skill level, and motivation for sports participation greatly vary at different ages and…

Sports Pharmacology of Psychiatry and Behavioral Medicine

Introduction Optimal treatment is determined through a collaborative approach, including team physicians, psychologists, psychiatrists, athletic trainers, academic advisors, coaches, teammates, parents, and administrative staff. More institutions are promoting an integrative approach to mental health and well-being using a wide variety of interventions: Self-care: exercise, sleep, nutrition Social connections: informal groups, team activities, interest-based communities Online or self-directed tools: mental health apps, life hacks, relaxation, mindfulness Group…

Sports Pharmacology of Chronic Disease

Introduction Adults are encouraged to engage in 150 minutes of moderate-intensity exercise weekly to maintain overall health and fitness. As the US population ages, many people are actively taking or have previously taken medications that may affect exercise performance. Managing athletes and patients on medications for chronic illnesses is an important skill for sports medicine physicians to master. Lipid-Lowering Agents Statins Statins are some of the…

Sports Pharmacology of Pain And Inflammation Control in Athletes

Overview The pharmacology of pain management in the athletic arena can be a critical component in returning an athlete to play. Several options exist, and choosing an appropriate intervention should involve careful consideration of treatment goals and potential adverse reactions. In addition to selecting the appropriate pharmacologic therapy, it is crucial to determine the etiology of pain and incorporate a multidisciplinary approach to addressing pain in…

Sports Supplements

Product Oversight and Marketing Dietary Supplement Health and Education Act of 1994 (DSHEA) Food and Drug Administration (FDA) Regulates dietary supplements under separate regulations from those that cover “conventional” foods and drug products (prescription and over the counter). Considers “dietary ingredients” a vitamin, mineral, herb, or botanical; amino acid; substance to increase total dietary intake; or a concentrate, metabolite, constituent, or various combinations or derivatives of…

Sports Nutrition

Acknowledgment The authors would like to acknowledge the work of Jacqueline R. Berning, MD, on the previous edition chapter. Role of Nutrition in Athletic Performance Exercise training and genetic makeup are major determinants of athletic performance. A healthy diet will not substitute for either factor, but making wise food choices will allow athletes to maximize their athletic potential by contributing to endurance, speed, and recovery of…

Sideline Preparedness and Emergencies

General Principles Sideline preparedness is the recognition and formation of medical services in order to promote athletic participation, provide exemplary medical care, and reduce risk of injury. It is achieved by having a unified system with qualified medical staff, pre-event planning, game-day preparation, and post-event evaluation. Many factors influence the type of injuries and emergencies that may occur, and it is critical that the director of…

The Preparticipation Physical Evaluation

Preparticipation Physical Evaluation (PPPE) History and physical examination, with additional testing as indicated, that is performed before participation in sport, that meets several objectives, and that is one of the most important functions provided by the sports medicine physician. Often, this is the first interaction between the physician and the athlete; for many young adults, it may be the first exposure to the healthcare system. It…