Current sports medicine reports
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Sports-related concussion has gained increased prominence, in part due to media coverage of several well-known athletes who have died from consequences of chronic traumatic encephalopathy (CTE). CTE was first described by Martland in 1928 as a syndrome seen in boxers who had experienced significant head trauma from repeated blows. The classic symptoms of impaired cognition, mood, behavior, and motor skills also have been reported in professional football players, and in 2005, the histopathological findings of CTE were first reported in a former National Football League (NFL) player. ⋯ The pathophysiology is still unknown but involves a history of repeated concussive and subconcussive blows and then a lag period before CTE symptoms become evident. The involvement of excitotoxic amino acids and abnormal microglial activation remain speculative. Early identification and prevention of this disease by reducing repeated blows to the head has become a critical focus of current research.
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Back pain is common in athletes and a source of missed time from practice and competition. Pain generators include muscle (strain), ligament (myofascial sprain and strain), intervertebral disc (herniation and degeneration), nerve (radiculopathy), joint (facet and sacroiliac (SI) joint), and bones (pars interarticularis defect). ⋯ The use of interventional spine procedures in athletes with back pain has gained popularity as a nonoperative treatment option. Although there is lack of high-quality evidence of these procedures specifically in athletes, this article will discuss the utility of selective nerve root blocks, epidural steroid injections, intradiscal injections, pars interarticularis injection, facet joint interventions (intraarticular injection, medial branch block, and radiofrequency neurotomy), and SI joint interventions (intraarticular injection and radiofrequency neurotomy).
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Curr Sports Med Rep · Sep 2012
Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction.
Disorders causing lateral hip pain are encountered frequently by physicians. Evaluating these problems can be challenging because of the myriad of potential causes, the complex anatomy of the peritrochanteric structures, and the inconsistently described etiologic factors. Misconceptions about the causes of lateral hip pain and tenderness are common, frequently leading to approaches that only provide temporary solutions rather than address the underlying pathology. ⋯ Treatment options include therapeutic exercise, physical modalities, corticosteroid injections, extracorporeal shock wave therapy, and regenerative injection therapies. For recalcitrant cases, surgery may be appropriate. By understanding the anatomy of the peritrochanteric structures, and the pathologic processes most likely responsible for symptomatology and dysfunction, the physician will be prepared to provide effective long-term solutions for this common problem.
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Although the benefits of regular physical activity are widely acknowledged, recent epidemiological findings indicate that a growing number of youth are not as active as they should be. The impact of a sedentary lifestyle during childhood and adolescence on lifelong pathological processes and associated health care costs has created a need for immediate action to manage, if not prevent, unhealthy behaviors during this vulnerable period of life. The concept of identifying children with exercise deficit disorder early in life and prescribing effective exercise interventions to prevent the cascade of adverse health outcomes later in life is needed to raise public awareness, focus on primary prevention, and impact the collective behaviors of health care providers, government officials, school administrators, public health agencies, and insurance companies.
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Exercise in cold environments exerts a unique physiologic stress on the human body, which, under certain conditions, may result in a cold-related injury. Environmental factors are the most important risk factors for the development of hypothermia in athletes. Frostbite occurs as a result of direct cold injury to peripheral tissues. ⋯ Chilblains are local erythematous or cyanotic skin lesions that develop at ambient air temperatures of 32°F to 60°F after an exposure time of about 1 to 5 h. Cold urticaria is, essentially, an allergic reaction to a cold exposure and can be controlled with avoidance of the cold. There are a number of risk factors and conditions that predispose athletes to cold injury, but exercise in the cold can be done safely with proper education and planning.