Sports Medicine Approach to MSK Problems Bob Kiningham, MD Associate Professor University of Michigan Health System

Disclosure I do not have any relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation.

Primary Job of the Sports Medicine Physician To encourage and facilitate safe physical activity

Aspects of Sports Medicine Treatment of musculoskeletal injuries Optimizing medical conditions to allow for safe physical activity Promotion of physical activity to prevent and treat medical conditions and optimize health and functioning

The Scope of Sports Medicine Patients who are physically active Patients who want to become physically active Patients who should become physically active

“Everyone is an athlete “Everyone is an athlete. The only difference is that some of us are training and some of us are not.” George Sheehan, MD

MSK Problems in Primary Care Approximately 20% of visits to primary care clinics Second only to URIs in frequency One in two American adults have a MSK condition that has required medical care

Traditional Medical Approach Treat pain and “inflammation” with medications/modalities Activity modification Rest/immobilization

Therapeutic Approaches to Recurrent or Chronic MSK Problems Change or avoid the job or activity Change the patient so he she can do the job or activity

Most Common MSK Problems in Primary Care Weight bearing osteoarthritis Low back pain Upper back and neck pain Tendinopathies Rotator cuff Lateral and medial epicondylitis

Knee Osteoarthritis Osteoarthritis is characterized by the progressive focal loss of breakdown of hyaline cartilage and underlying bone within a joint, as well as bony overgrowth Cartilage loss is not uniform

Exercise Grade A Recommendation Low impact aerobic exercise improves functional ability and endurance, and reduces pain Strength training reduces pain and improves physical function

Weight Loss Grade A Recommendation One pound of weight loss above the knee equals a decrease in 4-5 times less force on the knee when weight-bearing Reduces pain and improves function Appears to have additive effect with exercise

Computer Sitting Back Pain

Computer Sitting Back Pain

Tendinosis Hypoechoic, thickened, tendons Normal Lat Epicondyle Hypoechoic, thickened, tendons Small clefts/tears often visualized Image courtesy of Dr. Troy Henning, MD

Eccentric Strengthening

Therapeutic Approaches Muscles are the “shock absorbers” of the joints Neuromuscular control of movement Changing tendons from degeneration to reparation with improved strength and function

Sports Medicine Approach to MSK Problems Goals of therapy Return to activity Prevent re-injury Physical therapy A learning experience Muscles are the shock absorbers and stabilizers of the joints