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This question is inspired 1st by my natural scepticism and questioning, some might say contrary, nature but also by the recent SCP symposium on sports injuries and the Pod forum question 'what is the most common running injury'.

So what exactly is a sports injury? Isn't any injury caused by mechanical overload of a tissue? If you fracture a metatarsal then how does is it differ if you did it kicking the shins of a football player on the other team or by attempting to kick the dog after he pee'd on the cat and you missed and hit the bed leg instead? How does an achilles tendon tear differ if it comes on when running for the bus instead of sprinting for Gold in under 10 seconds?

The thing is people come into my clinic and ask do you specialise in sports injuries and I tend to think, well yes, I treat injuries using biomechanical principles, I don't discriminate if it occurred while playing badminton or during a particularly rough night at the pub.

Do you need to be a sports person to have a sports injury?

Can you be a keen sports player and have an injury that was not related to your sport but is commonly classified (arbitrarily in my opinion) as a sports injury? e.g. your a footballer but you've got tennis elbow, or your a ballet dancer but you've got runners knee? Do you then need a sports specialist or can anyone who treats injuries treat the condition?

How do you feel about sports injuries? Is it really a special case?

Dave Smith

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Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

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Hi Davis:
Great question.
I think "SPORTS INJURIES" involves competitive, or at least the serious participant.

Many sports participants are predisposed to injuries particular to their sport; for instance, inversion sprains in basketball players.
Of course an inversion sprain is an inversion sprain- but when treating an athlete one must also take into consideration preventive measures since the patient will most likely wish to continue to compete, an understanding of the possible adverse sequelae of continued participation (at various ages) and the weighing of possible further and more severe injury if allowed to.
Also, treatments allowing the athlete to continue to compete including ways to decrease symptoms temporarily while playing would not be considered for the non athlete.

I think, fundamentally, the goals for treatment for the athlete are different from those of the general public. The athlete wants to return to his/her sport - quickly. I have patients in the general population who, at times, do not EVER want to get better (i.e., return to work)

Additionally, the physical demands of the injured area are frequently much higher in the athlete. This often changes the type of treatment and rehabilitation for any given injury.

That's my take.

Steve

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DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

Steve

I agree with all that you say but what you are doing is accounting for medical and social history in your clinical decision making that leads to a suitable and unique treatment programme for your patient.

This is the same for each and every patient / customer and of course one can separate out and categorise the patient demographics, these might be sports, elderly, active, shirkers, learning difficulties, physical disabilities, drunks, workers, non workers, partygoers, male, female etc. You could categorise by social standing, or religion, or culture or race or political view etc. Each has its own considerations as to what clinical decisions are made and what type of treatment program is given.

Certainly, in some cases, it may be useful to separate out a certain demographic particularly for type of disease or risk factor and therefore give priority and additional consideration to those groups.

Do sports persons come in that criteria, are they more at risk, are they due more careful consideration, do they require priority treatment pathways?

Certainly the individual sports person would say they are and do since they want quick effective treatment so as to return to sport quickly and with minimal loss of performance. They are perhaps at greater risk of injury but then that is a lifestyle choice and not a risk imposed by disease and physiology. And then again a man or woman with a family to feed will also have similar requirement for different reasons as will a person due to go on the holiday of a lifetime, maybe they do a risky job, like mining or fishing or maybe the want to try to walk the grand canyon at 80years old, all these things mean non sports people can have the same kind of treatmemt requirements as a sports person.

As we know, the skilled and experienced clinician will give each and every case appropriate consideration and design a treatment program unique to that individual.

Is there therefore a case for separating out sports injuries as a special category other than being a niche product in the injury treatment market?

regards Dave

__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

I think that generally I would agree with you about treating everyone as an individual and tailoring the treatment accordingly however having recently experienced the NHS (admittedly physio) with a teenager with a tarsal coalition which affects her sport (archery) and when asked to stand in her shooting position told 'oh you don't do much then' (and who was suprised when told the teenager has walked 300m (on uneven ground) on the first few dozen arrows!) it is very helpful if the person treating a patient has an understanding of sport....sorry but pent up rant as well there :(

David;
an evaluation is an evaluation. The benefit of a good biomechanical eval is that you can and will identify similar dysfuncitons and deficits in athlete and non-athlete alike.
I agree with you that it is the eval and formation of a treatment plan that makes the difference in most cases when treating patients.
That is not to say that there are not special circumstances involved when treating athletes or that their specific repetitive movements don't need special attention drawn to them in the formulation of the treatment plan.
sincerely;
Bruce Williams

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Bruce E. Williams, D.P.M.
Breakthrough Podiatry

Hi Dave,

I like to treat sports injuries because they are more difficult to treat. The knowledge that one obtains from these treatments are then used to treat the non athletes.
For instance, in my practice the arthritic patients are ones that have tissues that cannot deal with what would be considered normal stresses.
Athletes have normal tissues that have abnormal stresses.
The arthritic patients benefit from the treatment that is used in sports medicine.

Regards,

Stanley

Really?

How it the pathology of a sports injury different to the pathology of an occupational or other injury? How are they 'harder' to treat?

I would concede the psychological issues of elite or professional sportspeople are a can of worms, along with managing the desire to return to competitive sports ASAP. But how is that really any different to a self employed tradesman who needs to get back to a worksite ASAP or lose his contract after sustaining the same traumatic pathology?

I think we need to separate the issues of pathology versus the patient population the pathology occurs in.

It is entirely appropriate to adjust your treatment of an ankle sprain in a professional basketballer in the context of their activity demands, in the same way you would do so for a nurse who sustains the same injury tripping over a stray toy at in the kids' bedroom and spends 8 hours a day as a scrub nurse in an operating theatre.

The pathology of sports injuries is no different to most other injuries, its just that they occur playing sport. So what?

LL

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Remember, it's just a foot.

Yes, my point exactly but what I am curious to find out is, what are the special skills required, if there are any, to treat sports people as opposed to any other patient category or population demographic?

Now, (assuming as podiatrists we are considering sports injuries related to ambulation) there are obvious skills that one can possess that would better enable one to treat a certain sports category successfully. For instance Kevin K has many years of distance running under his belt and so he would understand better the circumstances that lead to injury and what techniques might reduce those injuries while still maintaining maximum performance. However he wouldn't be able to apply that insight to skiing for instance (even if you do ski in Big Bear as much as you run the pacific coast then they are a different set of skills) I think it would be the exceptional case where a podiatrist would possess all the skill sets and insight into all the sports of the sports people they were likely to treat.

Regards DAve Smith

__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

Dave

I get where you are coming from and I do make a differentiation in my approach from the Orthopedic foot and the sports foot.
The sports patient needs more in terms of understanding there psycho social needs e.g. runners seem incapable of stopping running no matter how nicely I ask!
Mechanically I tend to back off on the degree of ORF required but do more rehab/ soft tissue, footwear mods etc.

Phil

It's not too difficult to understand the biomechanics of different sporting events, provided you possess a sound understanding of the principles of biomechanics to begin with. When I have a patient present who takes part in a sport that I don't have first hand experience in, I try to do some background research prior to my assessment and moreover, talk to the patient about the demands of their sport.

I played rugby for many years and now deal with elite players from a couple of professional clubs. I was a back-row forward so I have an excellent appreciation of playing in the back-row, but the only time I ever played prop was in 7's. The demands on the body at front row are different from back-row, but by understanding the game and moreover, talking to the players you can get a pretty good insight into the mechanical demands of their position.

Another challenge with this group of athletes is their shear size and speed and the consequential reaction forces exerted at the foot-orthoses interface. Couple that with wet muddy environment and material selection/ adhesive selection for their foot orthoses becomes more challenging than for your average middle aged office worker patient with plantar-fasciitis.

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Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Simon,

Back-row! I'm pretty sure you're confusing that with the front row again......

Hi Dave:
I stand by my original post concerning differences.
One thing I didn't mention, nor anyone else, is the marketing aspect.

At least in the USA, the following may be the main reason for "sports Medicine"....
There are a lot of young people getting injured in sports.
They (or their parents) usually have private insurance (not medicare) which pays better.
Trying to attract younger patients is important for surgeons, especially orthopedic or Podiatric that
may have a high proportion of medicare patients.

If you're going to perform surgery, would you rather do a few quick knee scopes on a private insurance patient or 2 or 3 total hips on medicare patients? The scopes take 20 minutes and you most likely get paid the same at a TK or hip.

If you want to attract these younger patients what better way than through SPORTS MEDICINE marketing?

Steve

__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

Oi! Pretty pacey in my day with an engine that could run and run, also I'm very annoying in case you hadn't noticed.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Dave:

Unlike others, I don't find sports injuries more difficult to treat than other types of injuries or conditions that show up at my office. However, I think that my being comfortable with treating sports injuries probably comes from my experience of having been an athlete for very many years, understanding the psychology of the athlete and having educated myself on sports injuries since before I even began podiatry school. I enjoy seeing athletes, whereas, others doctors I know don't like seeing these individuals. I understand athletes and I believe that makes my job so much easier with these individuals than for someone who has never been athletic.

The key difference between seeing athletes (i.e. treating sports injuries) and the average individual (who may have the exact same injury but with a different mechanism of injury) is that the athlete will be much more highly motivated to do whatever it takes to get back to the physical activity they love and crave. If you give them a regimen of stretching, icing, massaging and a recommended shoe, they will do all that you ask of you in order to get better. For the average individual, they will be much less motivated and much less likely to do what you ask of them in order to get better.

In addition, the athlete does not want to "get out of shape" while they are being treated and resting from their sport/activity. They do much better being given alternative exercise activity than total rest since they will feel better both physically and mentally when they are working out daily even though it may be another activity from what they are participating in on a regular basis. For example, runners are often told to bike, swim, do elliptical trainer or upper body strengthening exercises if they can't run in order to keep up their cardiovascular endurance levels and to give them an alternative exercise to keep their body relatively fit. You will not likely have as much need to give alternative exercise activities to your non-sports injury patients since their bodies will not crave daily physical exercise activity like the athlete craves daily physical activity.

If you have a poor knowledge of foot and lower extremity biomechanics, then you will be poor at treating sports injuries since these injuries are all biomechanical in origin. However, having a good knowledge in biomechanics but without an empathy and understanding of the specific psychological and physiological makeup of an athlete, will also lead to poor performance as a sports podiatrist. One needs to continually be a student of sport and biomechanics to become a good, or better yet, a great sports podiatrist. However, for those who can become that person for their community, they will garner the respect of many individuals who are actively seeking the expert care and understanding of the sports physician that can allow them continue doing the sport the love for as long as possible.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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Athletes put higher loads on their structures, and as such will require more exacting treatment to get them better.
For instance, a non runner or a slower runner may get by with a forefoot varus post for the medial plantar fasciitis.
If you try that with an elite runner, you may be asking for trouble.
It is precisely because of my elite athletes, that I do not make Schuster style orthoses, even though they were just fine for my non elite athletes.


Regards,
Stanley

I was always wondering about the difference between 'daily life' and sports injuries.

Last year I started my post-bachelor course in Sports Podiatry (which is new in The Netherlands). Whitin 1 month I knew the differences! It's very interesting to see how many aetiological factors can play a role in the development of this kind of injuries.

Therapy differs completely from daily life treatment. Orthoses can be completely different and function concentrates on the painful movements. So, a little correction can do it. Athletes also ask clear advice, and in some cases you have to make your point otherwise they won't follow-up.

I'm expecting the most difficulties with athletes that don't take rest when they need it.