Current sports medicine reports
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The role of nonsteroidal antiinflammatory drugs (NSAID) in pain and inflammation has been evaluated in many forms over the last decade. Emerging evidence shows that this class of medications has different effects depending on injury type: bone, ligament, tendon, and muscle. ⋯ It is clear that the side effect profile changes within the subclasses of NSAID, nonspecific cyclo-oxygenase-1 and 2 (COX-1 and COX-2) inhibitors, and more selective COX-2 inhibitors. Safe and effective alternatives may include topical NSAID and acetaminophen.
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The sudden death of a young athlete on the playing field remains the most devastating medical event in sports, with compelling reasons to implement effective preventive strategies. Preparticipation screening is widely practiced, but universal agreement regarding the most appropriate method for cardiovascular screening is lacking. ⋯ However, complex issues regarding feasibility, false positive results, cost-effectiveness, and physician and health system infrastructure still remain regarding large-scale implementation of ECG screening in the United States. When used, ECG interpretations based on modern criteria to distinguish abnormal findings from physiologic alterations in athletes must be applied to ensure acceptable accuracy.
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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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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.