Sports Medicine
Foreword Sports Medicine
Gregory T. Carter, MD, MS Consulting Editor
Sports medicine has always been a little bit difficult to define in my mind. A lot of medical specialties and ancillary health care providers have laid claim to the term. Sports medicine is truly a field that cannot be confined to a singular group. Much like our own parent field of physical medicine and rehabilitation, sports medicine involves health care professionals, researchers, and educators from a wide variety of disciplines, in an interdisciplinary fashion, to help prevent and treat injuries in athletes. Given the importance and broad applicability of this topic, I wanted a really strong issue on sports medicine and I knew just the guy to ask to be guest editor: Dr Brian Krabak. Brian brings so much to the table here. First and foremost, he is a brilliant academic physician, specializing in sports medicine. However, he is also himself an elite athlete, having competed in more than 30 endurance events, including 24-hour and 36-hour adventure races. He not only “talks the talk” but he also “walks the walk” (granted he might be doing sprinting intervals while using the walking part to recover). I knew Brian would recruit the best of the best to be his authors, in a carefully selected list of important topics. Indeed, he came through in spades here. Starting out this issue is a “Concussion Update” by Dr Stan Herring. Stan is medical director of Sports, Spine, and Orthopedic Health at University of Washington (UW) Medicine and co-medical director of the Sports Concussion Program, a partnership between UW Medicine and Seattle Children’s Hospital. Dr Herring was a major contributor to the successful passage of the Zackery Lystedt Law1 in Washington State and helped pass similar legislation in all fifty states and the District of Columbia.
1 The key provisions of the Zackery Lystedt Law include immediate removal of an athlete from the game if concussion is suspected. Youth athletes who have been taken out of a game because of a suspected concussion are not allowed to return to play until after they are evaluated by a health care provider with specific training in the evaluation and management of concussions and receive a written clearance to return to play from that same health care provider.
Phys Med Rehabil Clin N Am 25 (2014) xiii–xv http://dx.doi.org/10.1016/j.pmr.2014.10.001 1047-9651/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
pmr.theclinics.com
xiv
Foreword
His excellent article brings us up-to-date in this critically important area of sports medicine. Leading directly from this is an excellent overview entitled, “Treatment of Cervical Spine Injuries and Return to Play Decisions,” provided by one of Dr Herring’s former mentees, DJ Kennedy, MD. DJ is now faculty in the renowned sports medicine program at Stanford University. Cervical spine injuries are often seen with head injuries and the timely and appropriate management of these injuries is of critical importance. Dr Kennedy’s article provides critical guidelines. “Shoulder Pain in the Throwing Athlete” is provided by Edward McFarland, MD, the Wayne H. Lewis Professor of Orthopedics and Shoulder Surgery at Johns Hopkins School of Medicine. Dr McFarland is world renowned for his work in shoulder surgery and provides a fantastic treatise on the workup and management of shoulder pain in the athlete. Back pain in the adolescent athlete is thoroughly covered and discussed by Dr Arthur Jason De Luigi, the Director of Sports Medicine at Med Star National Rehabilitation Hospital, and Program Director of the Med Star National Rehabilitation Hospital/Georgetown University Hospital Sports Medicine Fellowship. Dr De Luigi is internationally recognized as a leader in Adaptive Sports Medicine through his extensive experience with disabled athletes, holding positions as the Medical Director and Head Team Physician for the US Adaptive Alpine Ski Team. An excellent summary of “Managing Hip Pain in the Athlete” is provided by Dr Heidi Prather, Associate Professor of Orthopedic Surgery and Chief of the Section in Physical Medicine and Rehabilitation at Washington University School of Medicine. Dr Prather is also faculty in the Center for Adolescent and Young Adult Hip Disorders at Washington University. “Prevention of ACL Injuries in the Athlete” is very nicely covered by Dr Judith Peterson from the University of South Dakota. ACL injuries are common in athletes of all ages. As youth sports become increasingly competitive, ACL tears are occurring in athletes at younger ages. Sustaining the injury can mean surgery, months of rehab, thousands of dollars in medical bills, and a higher likelihood of knee problems later in life; so, prevention is critical. Foot and Ankle Injuries in the Dancer are covered in a remarkable article by Nancy Kadel, MD, a dancer herself, who founded the Seattle Dance Medicine Free Clinic at Group Health. Dr Kadel’s idea was to have a multidisciplinary clinic for evaluating common dance-related injuries available for dancers at no cost. Many working dancers are uninsured or underinsured so this guarantees access and allows Dr Kadel and her staff to educate the dancers about their bodies, proper rest, and recovery to their training. Dr Krabak himself takes on the “Evaluation and Treatment of Injuries in the UltraEndurance Running Athlete.” Brain is well suited for this topic because he cares for endurance athletes and has plenty of experience himself in the intense mental and physical preparation needed to take on the relentless challenges faced by ultra-endurance running athletes. A superb overview of “Treatment of Tendonopathies with Platelet-rich Plasma” is provided by Dr Ken Mautner. Dr Mautner is a nationally recognized expert in diagnostic and interventional musculoskeletal ultrasound and regularly performs platelet-rich plasma injections for patients with chronic tendinopathy in his clinics at Emory University. Regenerative medicine is an emerging branch of medicine focused on replacing, engineering, or regenerating human cells, tissues, or organs to restore or establish normal function. This topic is sublimely covered by Dr Gerry Malanga in his article
Foreword
entitled, “Role of Regenerative Medicine.” Dr Malanga is the Director of PM&R Sports Medicine Fellowship at Atlantic Sports and Health Director and Pain Management at Overlook Hospital. He is the head team physician for New Jersey City University and is a consultant to the Rutgers University Athletic Department as well. Following the rise and fall of Lance Armstrong, the role of drugs that athletes might use to gain an edge on the competition is a paramount topic today in sports medicine. Dr Caroline Hatton, former Associate Director of the University of California at Los Angeles Olympic Laboratory, has spent her career helping improve methods of testing athletes for performance-enhancing drugs. Her article on “Performance-enhancing Drugs: Understanding the Risks” is a first-rate overview of this critically important topic. In her spare time, she writes books for children and also about drugs in sports for readers of all ages. Finally, another tremendous article entitled, “Psychosocial Factors Impact on Sports Rehabilitation,” is provided by Dr Leslie Podlog, from the Department of Exercise and Sport Science at the University of Utah School of Medicine. I want to give my sincerest thanks to Dr Krabak and to all of the extraordinary authors he recruited to bring together this timely and very useful issue of the Physical Medicine and Rehabilitation Clinics of North America. I suspect this issue will find its way out of physician offices and into locker rooms and onto training tables and even on to the fields of competition themselves. Gregory T. Carter, MD, MS St Luke’s Rehabilitation Institute 711 South Cowley Street Spokane, WA 99202, USA E-mail address: [email protected]
xv
Foreword Sports Medicine
Gregory T. Carter, MD, MS Consulting Editor
Sports medicine has always been a little bit difficult to define in my mind. A lot of medical specialties and ancillary health care providers have laid claim to the term. Sports medicine is truly a field that cannot be confined to a singular group. Much like our own parent field of physical medicine and rehabilitation, sports medicine involves health care professionals, researchers, and educators from a wide variety of disciplines, in an interdisciplinary fashion, to help prevent and treat injuries in athletes. Given the importance and broad applicability of this topic, I wanted a really strong issue on sports medicine and I knew just the guy to ask to be guest editor: Dr Brian Krabak. Brian brings so much to the table here. First and foremost, he is a brilliant academic physician, specializing in sports medicine. However, he is also himself an elite athlete, having competed in more than 30 endurance events, including 24-hour and 36-hour adventure races. He not only “talks the talk” but he also “walks the walk” (granted he might be doing sprinting intervals while using the walking part to recover). I knew Brian would recruit the best of the best to be his authors, in a carefully selected list of important topics. Indeed, he came through in spades here. Starting out this issue is a “Concussion Update” by Dr Stan Herring. Stan is medical director of Sports, Spine, and Orthopedic Health at University of Washington (UW) Medicine and co-medical director of the Sports Concussion Program, a partnership between UW Medicine and Seattle Children’s Hospital. Dr Herring was a major contributor to the successful passage of the Zackery Lystedt Law1 in Washington State and helped pass similar legislation in all fifty states and the District of Columbia.
1 The key provisions of the Zackery Lystedt Law include immediate removal of an athlete from the game if concussion is suspected. Youth athletes who have been taken out of a game because of a suspected concussion are not allowed to return to play until after they are evaluated by a health care provider with specific training in the evaluation and management of concussions and receive a written clearance to return to play from that same health care provider.
Phys Med Rehabil Clin N Am 25 (2014) xiii–xv http://dx.doi.org/10.1016/j.pmr.2014.10.001 1047-9651/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
pmr.theclinics.com
xiv
Foreword
His excellent article brings us up-to-date in this critically important area of sports medicine. Leading directly from this is an excellent overview entitled, “Treatment of Cervical Spine Injuries and Return to Play Decisions,” provided by one of Dr Herring’s former mentees, DJ Kennedy, MD. DJ is now faculty in the renowned sports medicine program at Stanford University. Cervical spine injuries are often seen with head injuries and the timely and appropriate management of these injuries is of critical importance. Dr Kennedy’s article provides critical guidelines. “Shoulder Pain in the Throwing Athlete” is provided by Edward McFarland, MD, the Wayne H. Lewis Professor of Orthopedics and Shoulder Surgery at Johns Hopkins School of Medicine. Dr McFarland is world renowned for his work in shoulder surgery and provides a fantastic treatise on the workup and management of shoulder pain in the athlete. Back pain in the adolescent athlete is thoroughly covered and discussed by Dr Arthur Jason De Luigi, the Director of Sports Medicine at Med Star National Rehabilitation Hospital, and Program Director of the Med Star National Rehabilitation Hospital/Georgetown University Hospital Sports Medicine Fellowship. Dr De Luigi is internationally recognized as a leader in Adaptive Sports Medicine through his extensive experience with disabled athletes, holding positions as the Medical Director and Head Team Physician for the US Adaptive Alpine Ski Team. An excellent summary of “Managing Hip Pain in the Athlete” is provided by Dr Heidi Prather, Associate Professor of Orthopedic Surgery and Chief of the Section in Physical Medicine and Rehabilitation at Washington University School of Medicine. Dr Prather is also faculty in the Center for Adolescent and Young Adult Hip Disorders at Washington University. “Prevention of ACL Injuries in the Athlete” is very nicely covered by Dr Judith Peterson from the University of South Dakota. ACL injuries are common in athletes of all ages. As youth sports become increasingly competitive, ACL tears are occurring in athletes at younger ages. Sustaining the injury can mean surgery, months of rehab, thousands of dollars in medical bills, and a higher likelihood of knee problems later in life; so, prevention is critical. Foot and Ankle Injuries in the Dancer are covered in a remarkable article by Nancy Kadel, MD, a dancer herself, who founded the Seattle Dance Medicine Free Clinic at Group Health. Dr Kadel’s idea was to have a multidisciplinary clinic for evaluating common dance-related injuries available for dancers at no cost. Many working dancers are uninsured or underinsured so this guarantees access and allows Dr Kadel and her staff to educate the dancers about their bodies, proper rest, and recovery to their training. Dr Krabak himself takes on the “Evaluation and Treatment of Injuries in the UltraEndurance Running Athlete.” Brain is well suited for this topic because he cares for endurance athletes and has plenty of experience himself in the intense mental and physical preparation needed to take on the relentless challenges faced by ultra-endurance running athletes. A superb overview of “Treatment of Tendonopathies with Platelet-rich Plasma” is provided by Dr Ken Mautner. Dr Mautner is a nationally recognized expert in diagnostic and interventional musculoskeletal ultrasound and regularly performs platelet-rich plasma injections for patients with chronic tendinopathy in his clinics at Emory University. Regenerative medicine is an emerging branch of medicine focused on replacing, engineering, or regenerating human cells, tissues, or organs to restore or establish normal function. This topic is sublimely covered by Dr Gerry Malanga in his article
Foreword
entitled, “Role of Regenerative Medicine.” Dr Malanga is the Director of PM&R Sports Medicine Fellowship at Atlantic Sports and Health Director and Pain Management at Overlook Hospital. He is the head team physician for New Jersey City University and is a consultant to the Rutgers University Athletic Department as well. Following the rise and fall of Lance Armstrong, the role of drugs that athletes might use to gain an edge on the competition is a paramount topic today in sports medicine. Dr Caroline Hatton, former Associate Director of the University of California at Los Angeles Olympic Laboratory, has spent her career helping improve methods of testing athletes for performance-enhancing drugs. Her article on “Performance-enhancing Drugs: Understanding the Risks” is a first-rate overview of this critically important topic. In her spare time, she writes books for children and also about drugs in sports for readers of all ages. Finally, another tremendous article entitled, “Psychosocial Factors Impact on Sports Rehabilitation,” is provided by Dr Leslie Podlog, from the Department of Exercise and Sport Science at the University of Utah School of Medicine. I want to give my sincerest thanks to Dr Krabak and to all of the extraordinary authors he recruited to bring together this timely and very useful issue of the Physical Medicine and Rehabilitation Clinics of North America. I suspect this issue will find its way out of physician offices and into locker rooms and onto training tables and even on to the fields of competition themselves. Gregory T. Carter, MD, MS St Luke’s Rehabilitation Institute 711 South Cowley Street Spokane, WA 99202, USA E-mail address: [email protected]
xv
