Editorials

Preventing Sports Injury and Illness: Key Resources for Family Physicians

 

Am Fam Physician. 2017 Apr 15;95(8):479-482.

In the United States, there are 212.6 million physically active persons older than six years (eFigure A), including 36 million youths and 7.8 million high school sports participants at approximately 36,000 secondary schools.14 Although physical activity clearly improves health outcomes, it also carries inherent risks, including injury, illness, and, rarely, death. Although a small percentage of family physicians currently hold a sports medicine certificate of added qualifications,5 most family physicians treat active patients or athletes, and many serve as team physicians. Given the limited attention paid to the role and importance of physical activity in medical schools6 and the limited exposure to sports medicine and musculoskeletal problems during residency, many physicians would likely benefit from additional knowledge to improve their ability to prevent and treat injuries from sports and physical activity.

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eFigure A.

Participation in various categories of sports by generational divide.

Adapted with permission from the Physical Activity Council 2016 participation report. http://www.physicalactivitycouncil.com/pdfs/current.pdf. Accessed October 25, 2016.


eFigure A.

Participation in various categories of sports by generational divide.

Adapted with permission from the Physical Activity Council 2016 participation report. http://www.physicalactivitycouncil.com/pdfs/current.pdf. Accessed October 25, 2016.

The Team Physician Consensus Conference Statements (http://www.acsm.org/public-information/team-physician-consensus-conference-statements), which represent an ongoing collaboration between six major medical societies concerned with clinical sports medicine issues, is one helpful resource for physicians caring for athletes. The most recent version addresses the team physician's role in preventing illness and injury, and discusses potentially helpful and ineffective or unproven strategies for preventing common or serious conditions and injuries that can result from physical activity (Table 1).7

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Table 1.

Helpful and Ineffective Prevention Strategies for Common or High-Morbidity Sports Medicine Conditions or Injuries

Prevention strategies

Condition or injuryRisk factorsPotentially helpfulLikely ineffective or ineffective

ACL injury

Women have a higher risk

Sport-specific neuromuscular training programs and educational Interventions

Knee bracing

In high school and college sports, there is a higher rate in men's football, women's soccer, and women's basketball players

In persons with a history of ACL injury, men are more likely to retear the same ACL, and women are more likely to tear the contralateral ACL

Commotio cordis

Participation in sports played with projectiles (e.g., baseball, hockey, lacrosse)

Age-specific baseballs and chest protectors

Concussion

Women have a higher risk than men in sports played with the same rules

Neck strengthening, improved playing technique, improved adherence to game rules

Protective equipment, including helmets, helmet add-ons, and mouth guards

Heat illness

High body mass index

Acclimatization, exercising at times of lower heat and humidity, ensuring adequate rest and hydration

Low fitness level

Multiple same-day sessions with inadequate rest and hydration

Previous heat illness

Sickle cell trait

Use of supplements, energy drinks, or alcohol

Inversion (lateral) ankle sprain

History of ankle sprain

Bracing, taping, or proprioceptive training

Participation in sports that involve jumping, cutting, or uneven terrain

Poor balance

Shoulder overuse Injuries

Participation in sports that involve throwing and overhead activity

Monitoring volume of activity, adequate rehabilitation of injuries in other parts of the kinetic chain

Skin or soft tissue infections

Participation in sports with high skin-to-skin contact (e.g., football, wrestling)

Maintaining good personal hygiene and facility cleanliness, avoiding sharing personal items, withholding athletes with contagious skin lesions from practice and game play

Sudden cardiac death

Men have a higher risk Participation in sports with more periods of maximal exertion (e.g., basketball)

Cardiac screening tests, such as electrocardiography or echocardiography


ACL = anterior cruciate ligament.

Information from reference 7.

Table 1.

Helpful and Ineffective Prevention Strategies for Common or High-Morbidity Sports Medicine Conditions or Injuries

Prevention strategies

Condition or injuryRisk factorsPotentially helpfulLikely ineffective or ineffective

ACL injury

Women have a higher risk

Sport-specific neuromuscular training programs and educational Interventions

Knee bracing

In high school and college sports, there is a higher rate in men's football, women's soccer, and women's basketball players

In persons with a history of ACL injury, men are more likely to retear the same ACL, and women are more likely to tear the contralateral ACL

Commotio cordis

Participation in sports played with projectiles (e.g., baseball, hockey, lacrosse)

Age-specific baseballs and chest protectors

Concussion

Women have a higher risk than men in sports played with the same rules

Neck strengthening, improved playing technique, improved adherence to game rules

Protective equipment, including helmets, helmet add-ons, and mouth guards

Heat illness

High body mass index

Acclimatization, exercising at times of lower heat and humidity, ensuring adequate rest and hydration

Low fitness level

Multiple same-day sessions with inadequate rest and hydration

Previous heat illness

Sickle cell trait

Use of supplements, energy drinks, or alcohol

Inversion (lateral) ankle sprain

History of ankle sprain

Bracing, taping, or proprioceptive training

Participation in sports that involve jumping, cutting, or uneven terrain

Poor balance

Shoulder overuse Injuries

Participation in sports that involve throwing and overhead activity

Monitoring volume of activity, adequate rehabilitation of injuries in other parts of the kinetic chain

Skin or soft tissue infections

Participation in sports with high skin-to-skin contact (e.g., football, wrestling)

Maintaining good personal hygiene and facility cleanliness, avoiding sharing personal items, withholding athletes with contagious skin lesions from practice and game play

Sudden cardiac death

Men have a higher risk Participation in sports with more periods of maximal exertion (e.g., basketball)

Cardiac screening tests, such as electrocardiography or echocardiography


ACL = anterior cruciate ligament.

Information from reference 7.

One important area to address is the preparticipation evaluation. Although this evaluation has not been proven to prevent injury or death, most states require them for youth athletes. The fourth edition of the American Academy of Pediatrics' preparticipation physical evaluation recommendations, which was previously reviewed in American Family Physician (http://www.aafp.org/afp/2015/0901/p371.html), provides several practical tools and forms for the team physician, as well as guidance on screening young athletes prior to sports participation.8 The American College of Sports Medicine's (ACSM's) revised criteria on exercise preparticipation health screening offer clearer and more succinct advice for exercise testing in adult patients.9 The criteria state that to help eliminate barriers, excessive referrals, and overuse of medical resources, physicians should perform exercise testing only in persons at high risk of exercise-related complications who are starting a vigorous physical activity program. The Physical Activity Readiness Questionnaire (http://www.csep.ca/cmfiles/publications/parq/par-q.pdf) is a free self-screening tool commonly used to determine whether a patient should see a physician prior to physical activity.

There are several live and online continuing medical education programs. Physicians with limited experience and background knowledge in sports medicine might begin with the ACSM Team Physician Course (http://www.acsm.org/attend-a-meeting/acsm-team-physician-course). The American Academy of Family Physicians (AAFP) offers the Practical Advances in Musculoskeletal and Sports Care course (http://www.aafp.org/cme/cme-topic/all/sports-live.html), which mixes didactic learning with hands-on practical experience, including field-side emergency management training and sessions at the AAFP's Family Medicine Experience (http://www.aafp.org/events/fmx.html).

Highly experienced physicians may find more value in an advanced team physician course. This type of course is offered by the ACSM, American Medical Society for Sports Medicine, and American Orthopedic Society for Sports Medicine (http://www.sportsmed.org/aossmimis/Members/Education/Meeting_Resources/ATPC2016/Advanced-Team-Physician-Course.aspx), and by the International Olympic Committee (http://www.ioc-preventionconference.org/atpc2016/). Online continuing medical education through webinars and stored lectures, such as the AAFP self-study programs (http://www.aafp.org/cme/browse/topics.tag-sports.html), offer a self-paced and potentially more economic alternative.

Family physicians may join national sports medicine organizations to stay current and interact with individuals with similar interests. The ACSM (http://acsm.org/), which is open to physicians, scientists, and allied health professionals, and the American Medical Society for Sports Medicine (http://www.amssm.org/), which is open to physicians only, are broad sports medicine organizations. Those interested in particular topics might join more specialized associations. For instance, the American Medical Athletic Association (http://www.amaasportsmed.org/) focuses primarily on sports medicine related to runners, and sponsors symposia at the Marine Corps and Boston Marathons.

Family physicians can meet the needs of their communities, including those related to sports injuries. Table 2 includes resources that can help physicians fill the knowledge gap needed to provide effective care for athletes.

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Table 2.

Selected Sports Medicine Resources for Family Physicians

Continuing medical education

American Academy of Family Physicians

Concussion webinars: http://www.aafp.org/patient-care/public-health/sports-medicine/webcasts.html

Family Medicine Experience: http://www.aafp.org/events/fmx.html

Live and online sports medicine courses: http://www.aafp.org/cme/browse/topics.tag-sports.html

American College of Sports Medicine

Advanced team physician course: http://www.acsm.org/attend-a-meeting/acsm-team-physician-course

International Olympic Committee

Advanced team physician course: http://www.ioc-preventionconference.org/atpc2016/

Other resources

American Academy of Pediatrics

Preparticipation physical evaluation recommendations: https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Council-on-sports-medicine-and-fitness/Pages/PPE.aspx

American College of Sports Medicine

Revised criteria for preparticipation health screening: http://journals.lww.com/acsm-msse/Fulltext/2015/11000/Updating_ACSM_s_Recommendations_for_Exercise.28.aspx

Team Physician Consensus Conference Statements: http://www.acsm.org/public-information/team-physician-consensus-conference-statements

American Family Physician

Review of the preparticipation sports evaluation: http://www.aafp.org/afp/2015/0901/p371.html

American Medical Society for Sports Medicine

Find-a-Doc (primary care sports medicine physician locator): http://www.amssm.org/Find-a-Doc.html

American Orthopaedic Society for Sports Medicine

Sports- and injury-specific prevention tips and tools: http://stopsportsinjuries.org

University of California, San Diego

Practical guide to clinical medicine: https://meded.ucsd.edu/clinicalmed/joints.htm

Wheeless' Textbook of Orthopaedics (Duke Orthopaedics)

Overview of musculoskeletal injuries: http://www.wheelessonline.com

Table 2.

Selected Sports Medicine Resources for Family Physicians

Continuing medical education

American Academy of Family Physicians

Concussion webinars: http://www.aafp.org/patient-care/public-health/sports-medicine/webcasts.html

Family Medicine Experience: http://www.aafp.org/events/fmx.html

Live and online sports medicine courses: http://www.aafp.org/cme/browse/topics.tag-sports.html

American College of Sports Medicine

Advanced team physician course: http://www.acsm.org/attend-a-meeting/acsm-team-physician-course

International Olympic Committee

Advanced team physician course: http://www.ioc-preventionconference.org/atpc2016/

Other resources

American Academy of Pediatrics

Preparticipation physical evaluation recommendations: https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Council-on-sports-medicine-and-fitness/Pages/PPE.aspx

American College of Sports Medicine

Revised criteria for preparticipation health screening: http://journals.lww.com/acsm-msse/Fulltext/2015/11000/Updating_ACSM_s_Recommendations_for_Exercise.28.aspx

Team Physician Consensus Conference Statements: http://www.acsm.org/public-information/team-physician-consensus-conference-statements

American Family Physician

Review of the preparticipation sports evaluation: http://www.aafp.org/afp/2015/0901/p371.html

American Medical Society for Sports Medicine

Find-a-Doc (primary care sports medicine physician locator): http://www.amssm.org/Find-a-Doc.html

American Orthopaedic Society for Sports Medicine

Sports- and injury-specific prevention tips and tools: http://stopsportsinjuries.org

University of California, San Diego

Practical guide to clinical medicine: https://meded.ucsd.edu/clinicalmed/joints.htm

Wheeless' Textbook of Orthopaedics (Duke Orthopaedics)

Overview of musculoskeletal injuries: http://www.wheelessonline.com

Address correspondence to Jason M. Matuszak, MD, at matuszakjason@gmail.com. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Physical Activity Council 2016 participation report. http://www.physicalactivitycouncil.com/pdfs/current.pdf. Accessed October 25, 2016....

2. Static Brain Research Institute. Youth sports statistics. http://www.statisticbrain.com/youth-sports-statistics/. Accessed January 19, 2017.

3. National Federation of State High School Associations. 2015–2016 high school athletics participation survey. http://www.nfhs.org/ParticipationStatistics/PDF/2015-16_Sports_Participation_Survey.pdf. Accessed January 19, 2017.

4. U.S. Department of Education. High school facts at a glance. https://www2.ed.gov/about/offices/list/ovae/pi/hs/hsfacts.html. Accessed January 19, 2017.

5. DiFiori JP, Kinderknecht J. Family physicians with a sports medicine certificate of added qualification (CAQ): well prepared to meet a significant patient care need. J Am Board Fam Med. 2015;28(6):693–694.

6. Connaughton AV, Weiler RM, Connaughton DP. Graduating medical students' exercise prescription competence as perceived by deans and directors of medical education in the United States: implications for Healthy People 2010. Public Health Rep. 2001;116(3):226–234.

7. Selected issues in injury and illness prevention and the team physician: a consensus statement. Med Sci Sports Exerc. 2016;48(1):159–171.

8. Bernhardt DT, Roberts WO; American Academy of Pediatrics. PPE: Preparticipation Physical Evaluation. 4th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2010.

9. Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM's recommendations for exercise preparticipation health screening [published correction appears in Med Sci Sports Exerc. 2016;48(3):579]. Med Sci Sports Exerc. 2015;47(11):2473–2479.

 

 

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