Current sports medicine reports
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Chronic low back pain (LBP) is a common and potentially disabling condition in all adults, including those who are physically active. It currently is challenging for clinicians and patients to choose among the numerous treatment options. This review summarizes recommendations from recent clinical practice guidelines and systematic reviews about common primary care and secondary care approaches to the management of chronic LBP. ⋯ Short-term pain relief may be obtained from spinal manipulative therapy or acupuncture. For patients with psychological comorbidities, adjunctive analgesics, behavioral therapy, or multidisciplinary rehabilitation also may be appropriate. Given the importance of active participation in recovery, patient preference should be sought to help select from among the recommended treatment options.
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The symptoms and findings of a concussion reflect a complex series of events that occur in the brain after a concussive injury. Because sports-related concussions do not cause structural lesions that can be identified with traditional neuroimaging techniques, determining concussion severity and when the brain has recovered sufficiently to permit safe return to play is challenging. Current concussion management using symptom monitoring, physical examination, and neurocognitive testing is limited in its ability to assess the extent of injury and recovery. This article reviews several advanced neuroimaging techniques that have the potential to provide more objective data to assist clinicians in the care of the athlete with concussion.
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Curr Sports Med Rep · Jan 2010
ReviewLumbar epidural steroid injections: indications, contraindications, risks, and benefits.
The clinical use of lumbar epidural steroid injections has increased dramatically. Although there are certainly beneficial effects to using epidural steroid injections in a treatment regimen for lumbar radicular pain, there is a lack of well designed, placebo-controlled studies to define conclusively specific indications and techniques for different spinal diagnoses. This article reviews the pathophysiology of lumbar radiculopathy and the use of epidural steroid injections as one treatment option, as well as describes their risks and benefits. Based on current literature, we offer an evidence-based perspective regarding rational use of lumbar epidural steroid injections for certain indications and treatment goals.
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Concussion is a physiological injury to the extremely complex and dynamic human brain. Individual variability adds to the challenge of concussion management, and sports medicine practitioners recently have begun to realize the need for an individualized approach. ⋯ This article reviews what is known or assumed about how some of these risk factors affect concussion. We conclude by providing several key concepts that we feel are important to keep in mind when managing an athlete with concussion.
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Postconcussion syndrome (PCS) is a constellation of physical, cognitive, and emotional symptoms that persist in a small percentage of patients who suffer from a concussion. There is significant debate regarding the definition and pathophysiology of PCS. This article reviews these controversies, the factors that may predict PCS, potential diagnostic and treatment options, and return-to-activity considerations for the sports medicine physician.