physio

Five Things I learned at the Harvard Sports Medicine Conference


I had the privilege of attending the Harvard Sports Medicine Conference in Cambridge, Massachusetes in May 2018 in the interest of hearing from top physicians, physiotherapists and other allied health professionals about the standard of care they currently recommend for their athletes and cutting edge developments in the treatment of sports injuries.

Below are my top five take-aways, from the conference:

*Full disclosure: this blog post may be of greatest interest to physiotherapists, physicians and other healthcare professionals due to the terminology used, however I do welcome any questions to the email listed below. 

  1. Every young male that dislocates his shoulder who is under the age of 19 years old should have immediate referral for orthopaedic surgical consult.

It is now well-known that 95% of young men(as well as women) who dislocate their shoulders and are below the age of 19 years old will go on to become chronic dislocators. Dr. Mark D. Price, medical director for the New England Patriots, compares not referring these individuals to seeing a complete ACL tear and failing to refer them. We would never leave a complete ACL tear without a surgical consult, why do we so frequently fail to refer these patients on for consult knowing the high-risk of continued dislocation and chronic joint and cuff damage that follows?

  1. Gluteus* medius tendinopathy is the most common tendinopathy** in the body.

Dr. Kelly McInnis, team physician for the Boston Red Sox, sited that nearly every female athlete, including elite levels, show deficits in both gluteus medius and minimus strength and activation. Old-school diagnosis by physicians has long been “trochanteric bursitis”, but our thinking must shift to rehabilitation of these inhibited muscles.

Physical therapy focussed on hip control awareness and strength as well as core stability and gait retraining (increasing cadence in running) is recommended as the first line of care with good results following.

Injections of PRP(platelet-rich plasma), not corticosteroids, may be beneficial as well during the course of rehabilitation. (Fitzpatrick J et  al.).

*The gluteus medius is a muscle in the hip/buttock region that plays a major role in stabilizing the hip joint. 

**Tendinopathy is the current term to describe an injury to the tendon which has progressed past the “tendinitis” stage and there exists pathologic changes to the tendon itself. 

  1. Marathon runners present with hamstring tears due to the repetitive eccentric load placed on their hamstrings over the course of the long distance.

Therefore, eccentric strengthening of the hamstrings (with endurance as the focus) should be included in both injury prevention and management of proximal hamstring injuries in long-distance runners, says Dr. Michael Fredricson, Director of Sports Medicine at Stanford University.

  1. Keto diet not recommended by sports dietician, Laura Moretti, athletes still need carbs for immediate fuel.

According to Laura Moretti, Registered Sports Dietician for the Boston Ballet Company and Clinical Nutrition Specialist for the Sports Medicine Division of Boston Children’s Hospital, the body cannot readily access fat or protein as an immediate energy source. Therefore carbohydrates are an essential element to an athlete’s nutritional intake, especially during training and racing.

Make sure you are a critical consumer with the fad diets that are presenting in the media. Laura is not in favour of many popular diets in the media including vegan and Keto diets for athletes and believes they are contributing to the sports injuries that we are seeing in our athletes and potentially negatively affecting performance.

Does the science and educated professional opinion support what is being sold? If not, use caution and do your research before jumping on the bandwagon. A well-balanced diet is still the best option for athletes.

This is similar advice to what Vancouver-based Registered Dietician Carolyn Berry of Berry Nourished taught us at our Nutrition for Runners Workshop at the clinic last February. (If you missed the workshop, we have another one in the works for the fall of 2018).

  1. Female athletes can be screened for risk of bone stress injuries using a Risk Assessment Score and doing so may help to prevent these injuries. 

Says Dr. Adam Tendforde, Director of Sports Medicine at the Spaulding National Running Center and Professor at Harvard Medical School, bone stress injuries are extremely common in cross-country running and gymnastics (Field et al, Changstrom et al, Tenford et al).

Many of these injuries can be avoided upon identification with the Risk Assessment Score of high risk and implementing preventative treatment including:

  • Calcium and Vitamin D deficiencies addressed
  • Physical therapy to address alignment and strength issues as well as retrain gait to a more mid or forefoot strike when hip and intrinsic foot muscle strength is at the level to be able to support this
  • Activity modification-rest from running including water running and cross-training
  • Sleep Normalization and Quality: chronic sleep deficiency has been linked to stress fractures in this population

Final thoughts:

If there is one thing that I wish for our healthcare community, it is more communication between health professionals and a recognition of each professional’s strengths, skillset and area of expertise.  In this way, we can work to provide our patients the best possible care by avoiding unnecessary appointments and referrals and work to streamline our continuum of care to get our patients back to where they want to be faster. 

It was a great privilege to attend a multi-disciplinary conference with collaboration between professionals as such a key focus.

If you have any questions regarding the above, I welcome questions or comments.

Please feel free to email me at: info [at] alaia.ca

 

Katrina Sovio

Registered Physiotherapist and Clinic Owner

BHK, BScPT, MClSc, FCAMPT, Gunn IMS.

 

References:

  • Fitzpatrick J et  al. Effectiveness of PRP Injections with Gluteal Tendinopathy. AJSM 2018.
  • Field et al. Prospective  Study  of  Physical  Activity  and  Stress  Fractures.  Arch AdolMed,  2011.
  • Changstrom et  al.  Epidemiology of Stress Fracture Injuries Among HS Athletes. AJSM,  2015.
  • Tenford et  al. Distribution  of  bone  stress  injuries  in  elite  male  and  female  collegiate  endurance runners. MSSE.  2015; 47(5), Supplement:905.