1. 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

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

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

4. 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

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

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

7. Physiatry
Motivation
Structure
FUNCTION
Fitness level
Comorbidities

8. 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.”

9. 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

10. 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…

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

12. 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

13. 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

14. 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

15. 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

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

17. 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