Sports Medicine in Orthopedics vs PM&R How Your Practice Might Differ Lauren Elson, MD Clinical Instructor, Spaulding Rehabilitation Team Physician, Lasell College Director of Dance Medicine Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA

An example: motor sensory MM L4 KE DF shin L5 S1 PF LM

Overview What is sports medicine? What is physiatry? Patient approach

Sports Medicine aka sport and exercise medicine Relatively new field physical fitness,  treatment and prevention of injuries related to sports and exercise Relatively new field Treat muscle, ligament, tendon, bone problems In the context of underlying illness that may affect physical performance

Sports Medicine Mostly musculoskeletal injuries Sports cardiology issues Unexplained underperformance syndrome Exercise-induced asthma Effects of other medical conditions Sports performance

Physiatry Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move

Physiatry Motivation Structure FUNCTION Fitness level Comorbidities

Physiatry: 46th Walter J. Zeiter Lecture, Bruce Becker, MD Exercise Is Rehabilitation Medicine: Our History and future Solid understanding of the role of anatomy and physiology in function Role of our hands and listening skills Exercise has formed the foundation of our treatment regimens “Foremost among medical specialties, we have grasped the critical role of understanding existing medical and physical constraints and limitations and creatively structuring our therapeutic goals to meet the functional requirements of patients, in accordance with their wishes and needs.”

Physiatry TOOLBOX Leader of the team Restore function/ prevent future disability Kinetic chain eval Medication: neuropathic, topical Injections TOOLBOX NCS/EMG Myofascial eval Diagnostic msk ultrasound Unique rehab resources

Commonalities Musculoskeletal medicine experts Can manage acute sideline injuries Interpret physical exam and radiologic findings Perform therapeutic/diagnostic injections Orthopedists that don’t perform surgery…

Patient Approach Ortho PMR Imaging review History Physical Exam* Assessment Treatment options History* Physical Exam* Imaging review Assessment Review of goals Treatment options

Patient Approach Case study 1 33 y/o male +/- imaging PE: Marathoner 12 weeks of R anterior groin pain with running and fast walking ROS negative Improved with 4 weeks rest/stretching, recurred when returned to running +/- imaging R hip xray shows cam lesion Alpha angle 50 degrees PE: Painful scour Decreased internal rotation R hip

Patient Approach Further history Further exam Intrinsic risk factors Recent injuries Extrinsic risk factors Training changes Foot wear changes Further exam R ankle: decreased mobility and proprioception Relative R hip abductor weakness

Patient Approach Case study 2 25 y/o female runner with 4 months progressive dorsal foot pain Initially only with running, then walking In boot for 6 weeks; symptoms worse Now in wheelchair Prior imaging: MRI foot, calf, spine Prior treatment: PT- aimed at treating presumed stress reaction, NSAIDS

Patient Approach Other history: Other exam: Increase in running to cope with stress from breaking up with fiance (7-8 miles/day, 7 days/wk) Other exam: Increased pain with swing phase of gait Profound gluteal myofascial pain

Patient Approach Trigger point injections Sciatic neurogram Functional restoration of pelvic stability

How To Be the Team Doc Communicate with referring and primary care docs Work closely with trainers Stay up to date on all aspects of sports medicine Volunteer for game coverage, PPEs, training room clinics Provide comprehensive services