What is a Sports Physician ?

Dr Mike Bundy

MBBS MRCGP Dip Sports Med FFSEM Consultant in Sport and Exercise Medicine Medical Director at Pure Sports Medicine Ex-England Rugby senior team Doctor

www.puresportsmed.com

• 16 years as a GP

• 4 Years Training as a Sports Physician “Orthopaedic Physician”

• Consultant Status Recognition by GMC

• 50 Recognised Consultants Nationwide

• Very few NHS posts – most in Private medicine

What is a Sports Physician ?

What is a Sports Physician?

Sports Physician

1.Clinic workload – Orthopaedic Physician

1.Team Doctor workload

1.Exercise prescription and ‘healthy living’

Sports Physician

• All those musculo-skeletal problems that are not inflammatory and don’t require surgery

• 30 % GP workload is musculoskeletal

• <5% of our workload is referred to surgery

• Most is treated in house

Pure Sports Medicine

What is Sports Medicine ?

Where do you go / refer if you have : •Persistent shoulder pain ? •Achilles pain ? •A twisted ankle that doesn‘t settle ? •Groin pain ? Sports hernia •Pain in calves on running ? •Wear and tear in the knee ? •Hamstring strains ? •Low back ache / sciatica ? •Shoulder painful arc ? •Inadequate diet for your sport ? •Tennis elbow ? •Shin Splints ? •Neck pain ? Facet dysfunction ? ….. The list goes on …………

Pure Sports Medicine – unique, self supported, self directed, multifaceted unit:

•Sports Physicians •Physiotherapists •S&C / Performance Coaches •Sports Massage Therapists •Sports Podiatrists •Sports Osteopaths •Nutritional Therapists •Sports Dietitians / Nutritionalists •Support Staff

To assess, diagnose and rehabilitate all those injuries that don’t need surgery

What is Sports Medicine ?

What Sort of Conditions

1. Trauma – Acute & Chronic

2. Overuse injuries

3. Referred pain

•Soft tissue injury – Muscle, ligament, fascial injury

•Tendinopathy

•Stress fractures

•PFS, osteitis pubis

•Not limited to Elite

•Recreational sporting population

•DIY

•Gardening

•Hobbies

Sports Medicine Scenarios

1. Shoulder

• 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms

1. Shoulder

• 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms

Examination

• Neck normal

• Very limited shoulder Rom – Flexion to 90*,

• Abduction to 80*, ER 0*

• Poor Scapula rhythm

• Good RC power within range

• Impingement +++, No instability

What does impingement mean ?

Sports Medicine Scenarios

Impingement

What is it ?

It’s not all Bursitis !

What are the causes ?

Sports Medicine Scenarios

Impingement

•Scapula movement

•Capsular restriction

•Acromion type (Osteophytes)

•Instability (laxity, labral)

•Rotator cuff (tear or weak)

•Suprascapular nerve palsy

Sports Medicine Scenarios

1. Shoulder

• 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms

Causes of night pain ????

Sports Medicine Scenarios

1. Shoulder

• 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms

RC tear

Frozen Shoulder /Adhesive Capsulitis

Calcific tendonopathy

Causes of reduced Ext Rotation ?

Sports Medicine Scenarios

1. Shoulder

• 58 yr old diabetic and keen recreational swimmer presents with gradual onset of deltoid region shoulder pain. No injury. Very painful, Night pain, no neck or radicular symptoms

Causes of reduced external rotation

Frozen shoulder

Posterior dislocation

OA Shoulder ++

Sports Medicine Scenarios

1. Shoulder

Frozen shoulder –

Adhesive Capsulitis

What would you do in

General Practice ?

What are your options ?

Sports Medicine Scenarios

1. Shoulder

Frozen shoulder – Adhesive Capsulitis

• Management

• Injection therapy

• Rehabilitation

Sports Medicine Scenarios

2. Lumbar spine

17 year old schoolgirl, keen swimmer, comes in with mother.

Concerned ++ “she’s very good doctor “ !! Gradual onset of R LBP

for 3 months. Not told anyone. No night pain. Systemically well. Pain

most of the day. Worse on carrying books at school. Worse after

sport. No radiation, No radicular symptoms. “Does she need to see a

specialist ?”

What else do you need to know ?

Is there anything you need to ask ?

Why should she get back pain now ?

Sports Medicine Scenarios

2. Lumbar Spine

17 year old schoolgirl, keen swimmer, comes in with mother.

Concerned ++ “she’s very good doctor “ !! Gradual onset of R LBP

for 3 months. Not told anyone. No night pain. Systemically well. Pain

most of the day. Worse on carrying books at school. Worse after

sport. No radiation, No radicular symptoms. “Does she need to see a

specialist ?”

What else do you need to know ?

What stroke does she swim?

How much swimming and other sport ?

What is the provocative position?

Any family history ?

Any Cauda symptoms / Red flag symptoms ?

Periods, diet, weight, FH osteoporosis ?

Sports Medicine Scenarios

2. Lumbar Spine

Examination :

Good posture, Good pelvic control, no HF tightness, Resonable

Lx spine flexion but extension poor and painful esp to R,

-ve neural tension (Slump, SLR and neurology examination)

SI joint normal

Hop painful in back

Mild tender R L5

Any thoughts ?

What back pains are worse in Extension ?

Sports Medicine Scenarios

2. Lumbar Spine

Examination :

Good posture, Good pelvic control, no HF tightness, Resonable

Lx spine flexion but extension poor and painful esp to R,

-ve neural tension (Slump, SLR and neurology examination)

SI joint normal

Hop painful in back

Mild tender R L5

Diff Diagnosis :

Facet joint,

SIJ,

Stress fracture

Extension related disc prolapse (10% only)

Sports Medicine Scenarios

2. Lumbar Spine

Stress fracture R L5 pedicle

Sports Medicine Scenarios

2. Lumbar Spine

Stress fracture R L5 pedicle

What is it ?

Spondylolysis / Spondylolisthesis

How would you manage this ?

If you referred to a Physio and they weren’t sure of a

diagnosis, where would you go next ?

Sports Medicine Scenarios

3. Knee

•16 year old schoolboy, not very sporty, attends with father complaining of anterior knee pain. Gradual onset, very localised to centre of patella, no radiation, no swelling, occ feeling of going to give way but never actually does, no clicking or locking

Any other questions you may ask ?

Sports Medicine Scenarios

3. Knee

•16 year old schoolboy, not very sporty, attends with father complaining of anterior knee pain. Gradual onset, very localised to centre of patella, no radiation, no swelling, occ feeling of going to give way but never actually does, no clicking or locking

Any other questions you may ask ?

Worse on stairs – down more than up

Worse on sitting for prolonged periods

Grown a lot recently ++

Differential diagnoses ?

Sports Medicine Scenarios

3. Knee

•16 year old schoolboy, not very sporty, attends with father complaining of anterior knee pain. Gradual onset, very localised to centre of patella, no radiation, no swelling, occ feeling of going to give way but never actually does, no clicking or locking

Differential Diagnoses ?

Osgood-Sclatters, Sindig-Larson-Johannson,

Patella tendonopathy

Patello-femoral syndrome

Fat pad impingement

Referred from back (L3 disc prolapse)

Referred from Hip

Sports Medicine Scenarios

3. Knee

Examination:

Overweight, valgus knee posture, poor SL squat control, normal hips & Lumbar spine

Knees cool dry and stable, no fat pad impingement, no meniscal signs

Poor VMO bulk, tight ITB, mobile patella (excessive lateral movement)

Tender under medial patella facet

No Lower pole or TT tenderness, patella tendon normal

Diagnosis :

Sports Medicine Scenarios

3. Knee

Examination:

Overweight, valgus knee posture, poor SL squat control, normal hips

Knees cool dry and stable, no fat pad impingement, no meniscal signs

Poor VMO bulk, tight ITB, mobile patella (excessive lateral movement)

Tender under medial patella facet

No Lower pole or TT tenderness, patella tendon normal

Diagnosis : Patello-Femoral Syndrome secondary to :

•Overweight, inactivity, growth spurt

•Poor gluteal and VMO strength, tight lateral structures

•Mobile patella

Sports Medicine Scenarios

3. Knee

Management ???

Sports Medicine Scenarios

Any Questions ?