Module 4: Part 1

SPORTS
Module 7 (Part 1): MEDICINE
Sports Medicine
• SPORTS MEDICINE is a branch of
medicine that deals with physical
fitness and the treatment and
prevention of injuries related to
sports and exercise.
• Specialist: Sports physician
• Significant diseases: Trauma;
Muscle strain; Sports injuries
• Significant tests:
Musculoskeletal tests
• System: Musculoskeletal,
Cardiovascular
 Introduction

• Physiatric involvement in the

field of sports medicine has
greatly increased over the past
two decades.
• More and more physical
medicine and rehabilitation
specialists are serving as team
physicians at the high school,
collegiate, Olympic, and
professional levels.
• In addition, there has been
increased involvement in the
American College of Sports
Medicine as participants and
presenters.
The primary purpose of this
module is to:
1) review selected
concepts pertaining to
the treatment of sports
injuries.
2) evaluation and
treatment of some
common injuries are
also presented.

TEAM APPROACH TO THE INJURED
ATHLETE
• The concept of working within a
team approach is inherent in
physiatry.
• Various health care
professionals are involved in
the care of injured athletes.
• Medical specialties traditionally
involved in the care of athletes
include:
• Physiatry
• orthopedic surgery
• internal medicine
• family practice
• emergency medicine, and
• pediatrics.
• A well-trained physiatrist
would appear to be the
most logical choice to
direct the sports medicine
team, addressing the
majority of the
nonoperative injuries in
conjunction with athletic
trainers, therapists, and
others, and referring other
conditions as needed to
the most appropriate
specialist in a timely
manner
• Additional important team members include:
• Podiatrists
• athletic trainers
• Therapists
• nutritionists, and
• strength and conditioning specialists.
 BASIC TISSUE PHYSIOLOGY
&ANATOMY

• The MUSCULOSKELETAL
SYSTEM includes bones,
muscles, tendons, ligaments
and soft tissues. They work
together to support your
body's weight and help you
move. Injuries, disease and
aging can cause pain,
stiffness and other problems
with movement and
function.
 BASIC TISSUE PHYSIOLOGY
&ANATOMY

Skeletal Muscle
• Muscle constitutes the
largest tissue mass in the
body, comprising 40% to
45% of the total body
weight.
• Muscles originate either
from bone or dense Proximal attachment
connective tissue and are
connected to these tissues
by either the muscle itself or
associated tendons. Distal attachment
• The muscle-tendon unit will
cross one or more joints to
its site of insertion, typically
on bone.
• Those muscles that cross one joint are usually located close to bone and are generally
involved in postural activities.
• One-joint muscles possess a slower contraction speed with increased force production.
• Examples of one-joint muscles include:
• vastus medialis/lateralis/intermedius of the quadriceps group
• soleus.
• In contrast to the
one-joint muscles,
those muscles that
cross two or more
joints are located
more superficially
and exhibit faster
contraction speeds
with relatively
reduced force
production.
• Examples of two-
joint muscles
include:
• biceps brachii
• gastrocnemius.
 Muscles can
generate and
attenuate force on a
limb and stabilize a
joint when firing
synergistically with
larger muscles.
 Torn Muscle:
• Muscle that is torn has a limited
ability to regenerate and often
heals by dense scar formation.
 Aging muscle:
• It has been reported that
aging muscle
demonstrates a decrease
in size, number of
muscle fibers (type II),
and the number of
motor units (alpha motor
neuron and the muscle
fibers it innervates).
• There is, however, no
decrease in metabolic
potential for aerobic and
anaerobic activities with
aging.
 Tendon

• A tendon is the structure

that connects muscle to
bone.
• Tendons consist of dense,
regularly arranged collagen
fibers meshed with elastin
and a proteoglycan/
glycosaminoglycan ground
substance.
• The primary function of the
tendon is to transmit the
force generated in muscle to
the bone.
• This process allows for the
generation of movement of
the extremities.
• The tendon is surrounded
by a glistening, synovial-
like membrane called the
epitenon.
• The epitenon is continuous
on its inner surface with
the endotenon, a thin
layer of connective tissue
that contains lymphatics,
blood vessels, and nerves.
• In some tendons, the
epitenon is surrounded by
a loose connective tissue
called the paratenon.
• The paratenon functions
as an elastic sheath that
permits free movement of
the tendon against
surrounding tissue.
• The blood supply of
tendons is variable and
is compromised at sites
of friction, torsion, or Supraspinatus tendon
compression.
• Tendons with a blood
supply that is frequently
compromised include
the supraspinatus,
Achilles, and tibialis
posterior.

Tendon of Achilles
Tendons subjected to
large, repetitive
stresses can tear,
become inflamed, or
degenerate.
 Aging of tendons:
• The aging process is
associated with an
increase in collagen cross-
linkages, causing the
fascia, ligaments, and
tendons to be less
distensible.
• Activity promotes
connective tissue
hypertrophy, whereas
inactivity leads to
atrophy.
• Physical activity also
enhances the rate of
collagen turnover, which
shortens its life span.
• This turnover retards the
effect of maturation of
collagen cross-linkages
and makes collagen more
distensible.
• Activity promotes
connective tissue
hypertrophy, whereas
inactivity leads to atrophy.
• Physical activity also
enhances the rate of
collagen turnover, which
shortens its life span.
• This turnover retards the
effect of maturation of
collagen cross-linkages and
makes collagen more
distensible.
 ARTICULAR CARTILAGE is the smooth, white
tissue that covers the ends of bones where they
come together to form joints.

• Cartilage requires
mechanical loading
and unloading to
remain healthy.
• This helps maintain
nutrition to the
tissues.
• Cartilage rarely has
a direct blood
supply and derives
most of its nutrition
via diffusion.
• If deprived of bearing weight, the cartilage
undergoes degeneration.
• With repetitive overuse, cartilage can break down
over time and lead to symptoms such as pain.
 Ligaments

• Ligaments are
composed of
approximately 70%
collagen, along
with ground
substance and a
larger percentage
of elastin than
tendons.
Ligaments are
attach bone to
bone and are
important
stabilizers of
joints.
• Ligaments contain minimal blood supply, with most supplied
by periarticular arterial plexuses.
• For example, the ACL (ant. cruciate lig.), the main
stabilizer of the knee against anterior translation of the
tibia, has minimal intrasubstance arterial supply.
• The ACL does, however, receive some nutrition from
the synovial fluid as well.
• The poor blood supply to ligaments explains the poor
healing response in complete/partial injuries.
• The principles of collagen
cross-linkages described in
the tendon also apply to
ligaments.
• Ligaments function to
stabilize joints in concert
with normal osseous
alignment and
musculotendinous stability.
• Ligaments also enhance
proprioception via
neurosensory receptors
 Bone

• Bone is a hard
Epithelial, muscle and nervous tissue consisting of
tissues cells in a matrix of
ground substance
and collagen fibers.
• The fibers are
impregnated with
mineral substance,
chiefly calcium
phosphate and
carbonate.

Connective tissue
• Bone is a dynamic tissue that remodels in
response to external stress.
• Bone remodeling/healing represents the
spectrum of bone’s response to stress (Wolff’s
Law).
• Failure of bone
secondary to repetitive
stress (i.e., stress
fractures)
• Bony malalignment will
also predispose the
athlete to injury.
• Examples of malalignment
include:
• valgus alignment of
the knee
predisposing to
patellar maltracking
• cavus foot
predisposing to
Achilles tendinitis.
Module 7 (Part 2):
BASIC PRINCIPLES
OF NONOPERATIVE
FUNCTIONAL
REHABILITATION