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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…

The Certified Athletic Trainer and the Athletic Training Room

Definition of an Athletic Trainer Athletic training encompasses the prevention, examination, diagnosis, treatment, and rehabilitation of emergent, acute, or chronic injuries and medical conditions. Athletic training is recognized by the American Medical Association (AMA), Health Resources Services Administration (HRSA), and Department of Health and Human Services (HHS) as an allied healthcare profession (see National Athletic Trainers’ Association [NATA] ) Athletic trainers (ATs) are highly qualified,…

The Team Physician

Being a Team Physician: A Special Privilege, an Awesome Challenge Special Role Team physicians have a unique responsibility of leadership while taking care of athletes. Core skills include leadership; team building; shared decision-making and collaboration; good communication; and a mission guided by selfless service, trust, and integrity. Athletes, their parents, and their team administrators expect team physicians to help guide decisions in terms of clearance to…

Exercise Considerations Before, During, and After Pregnancy

Introduction Over the past decade, there has been an increased interest in the topic of physical activity during pregnancy. This is likely due to the increasing number of studies that have shown what benefits exercise can have during this unique time in a woman's life. Physicians and patients often express uncertainty regarding physical activity during pregnancy out of concern for the safety of both the mother…

The Female Athlete Triad/Relative Energy Deficiency in Sports

Introduction The female athlete triad (triad) is a medical condition often observed in physically active girls and women. The three interrelated components of the triad are energy availability (EA), menstrual status, and bone health. These components each present along a physiologic spectrum: EA ranges from optimal to low EA to eating disorder (ED), menstrual function ranges from eumenorrhea to oligomenorrhea to amenorrhea, and bone health ranges…

Chronic Exertional Compartment Syndrome

Introduction Chronic exertional compartment syndrome (CECS) most commonly affects the young, military, and athletic populations and can be debilitating for active individuals. Typical symptoms include pain, paresthesias, muscle weakness, and discomfort described as squeezing or cramping that occur during exercise and intensify as exertion continues, but disappears when activity stops. Although the specific source of pain in CECS is not entirely understood, the condition is caused…

Stress Fractures

Introduction Stress fractures are relatively common overuse injuries occurring in individuals participating in a variety of physical activities. They have been reported to account for up to 20% of all injuries seen in sports medicine clinics. As an overuse injury, stress fractures occur by the accumulation of repetitive forces, which are lower than the force required to cause a fracture with a single load. Compression, tension,…

Concussions in the Female Athlete

Introduction Female athletes are more likely to sustain sport-related concussion than male athletes when playing equivalent sports. Studies on middle-school to high-school females demonstrate that female athletes are at a higher risk of sustaining a concussion than their male counterparts. A landmark study in 2017 by Schallmo et al. was the first to report both gender differences and sport-specific differences in concussion. Despite significant educational efforts, athletes…

Overuse Injuries in Females

Introduction Overuse injuries result from cumulative trauma or many repetitive minor insults, such that the body does not have adequate time to heal properly. These types of injuries typically occur in low-contact sports that require long training sessions and repetitive loading (e.g., running, jumping, rowing, and swimming) and can lead to loss of playing time, physiologic exhaustion, and pain. Overuse injuries typically present with a gradual…

Epidemiology of Female Versus Male Athletic Injuries

Introduction The world of sports has historically been dominated by males and much of our knowledge surrounding athletic injuries originates from our understanding of the male athlete. Data on injuries sustained by the female athlete is often underrepresented in sports medicine research, and as the number of female athletes participating in sports continues to grow, there is a significant need for an improved overall understanding of…

Osteochondritis Dissecans of the Elbow

Introduction and Epidemiology Osteochondritis dissecans (OCD) was first described by König in 1887 as a possible explanation for the presence of loose bodies within a joint. Initially, he postulated that inflammation led to the atraumatic formation of loose bodies, hence the designation of “osteochondritis.” Although the exact cause of OCD remains elusive, we recognize it to be acquired, focal lesions of subchondral bone with varying degrees…

Elbow Ulnar Collateral Ligament Injuries in the Female Athlete

Introduction While there is abundant literature on ulnar collateral ligament (UCL) injuries in male athletes, predominantly professional baseball players, research remains sparse on the pathoanatomy, epidemiology, treatment, and outcomes of UCL injuries in female athletes. A literature review by Gardner and Bedi demonstrated that only 79 of 1902 (4.15%) patients within UCL studies are female. The majority of elbow UCL studies consist of either small case…

Elbow Anatomy and Biomechanics

Introduction The elbow consists of three joints: the ulnohumeral joint, radiocapitellar joint, and proximal radioulnar joint (PRUJ). Together, these three joints enable the elbow to flex and extend as a hinge joint as well as rotate about a longitudinal axis for pronation-supination. As such, the elbow is classified as a trochoginglymoid joint. The distal humerus has a 30-degree anterior tilt relative to the humeral shaft; therefore…

Rotator Cuff Function and Injury in the Female Athlete

Introduction Shoulder problems in the female athlete occur most commonly in sports that require repetitive or forceful use of the upper extremity. While there is extensive research in male overhead athletes, most notably baseball players and in particular pitchers, there is much less research involving female athletes. There is some research in sports where both male and female athletes compete in the same events or under…

Shoulder Instability in the Female Athlete

Introduction The shoulder is notable for being the most mobile joint in the body. Optimal function requires a delicate balance of stability and flexibility. This balance is achieved by contributions from both static and dynamic stabilizers. It is important to understand that some athletes, such as swimmers and dancers, inherently require greater amounts of flexibility, while others, such as overhead athletes, depend more on stability. Shoulder…

Shoulder Anatomy and Biomechanics

Osteology A variety of bony structures including the scapula, humerus, clavicle, and sternum are connected via soft tissue throughout the shoulder complex. The scapula is a flat, triangular bone that forms the posterior aspect of the pectoral girdle. Numerous muscles originate at and insert on the scapula. The four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), teres major, triceps, deltoid, and several other muscles…