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Guest Post by:
Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Sports Medicine

The weather is getting warmer, the days are getting longer, and the smell of fresh cut grass and barbecue is filling the air. This can only mean one thing, the beginning of another lacrosse season.  Lacrosse was started by the Native Americans centuries ago.2  Since then, there have been changes to the equipment used to increase safety such as helmets, mouth guards, shoulder pads, elbow pads, and gloves; however, injuries will always exist.  Some of the more common injuries sustained by lacrosse players involve the ankles, knees, and head.

A lateral ankle sprain is an injury almost every athlete suffers at some point.  The most common of ankle sprains involve injury to one or more of the ligaments on the outside (lateral) of the ankle.  Most athletes report rolling their ankle inwards and experiencing immediate pain over the lateral ankle.  Swelling and bruising may develop as well.  Initial management should include rest, ice, compression, and elevation (RICE).  In addition to RICE, recovery should involve improving strength, flexibility, and balance.  Most athletes with a mild ankle sprain are able to return to lacrosse within ten days of the injury.

Knee ligament sprains in lacrosse often include the anterior cruciate ligament (ACL), or the medial collateral ligament (MCL).  Injury to these ligaments can occur with or without contact.  With contact, the athlete is usually hit from the back or outside of the knee.  Injury without contact usually involves a cutting or twisting motion such as with roll dodges, face dodges, and split dodges where quick fast movements are made.   Athletes will usually notice sudden pain when the injury occurs and may also report a pop or difficulty walking.  Depending on the severity, swelling will occur within hours of the injury.  Immediate care for these injuries should include RICE.  With MCL and ACL injuries, the knee can quickly become very unstable.  While the length of time to return to play varies greatly depending on the severity of the injury, a full tear of the ACL usually means the end of the season for a lacrosse player.

Concussion should be considered the most serious of the common lacrosse injuries since it involves an injury to the brain.  In lacrosse, concussions are commonly suffered as a result of contact from another player, stick, or ball. Unlike more severe traumatic brain injuries, concussions cannot be confirmed with any imaging technologies.  They can be very easy to overlook, misdiagnose, and hide.  Mismanaging even the mildest of concussions can lead to long-term disability or death if there is a second trauma before the injury has completely resolved.  Concussion symptoms can include headache, “pressure in head,” neck pain, nausea/vomiting, dizziness, blurred vision, balance problems, sensitivity to light or noise, feeling slowed down, feeling “in a fog,” “don’t feel right”, difficulty concentrating, difficulty remembering, fatigue/low energy, confusion, drowsiness, trouble falling asleep, more emotional, irritability, sadness, and nervous/anxious.1  Other signs that may be observed include a loss of consciousness, loss of memory, confusion, or abnormal behavior.1  If there is even one mild and short lived concussion symptom after a hit to the head, this athlete should be immediately removed from play and evaluated by a healthcare professional that is well versed in the most recent evaluation and management criteria.  One common phrase used for concussion management is, “when in doubt, sit them out.”

With lacrosse quickly growing in popularity in the United States, safety always needs to be in the front of our minds.  It’s difficult for any lacrosse athlete who suffers an injury that results in lost playing time, but caring for them early and with the help of your Athletic Trainer or Physician will guarantee a return to the field as quickly and safely as possible. 

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1. SCAT3. Br J Sports Med. 2013;47(5):259.
2. Vennum Jr. T.  The History of Lacrosse. http://www.uslacrosse.org/about-the-sport/history.aspx. Accessed April 19, 2015.

‘A day in the life of the MUSC Health Sports Medicine team’

Guest Post by:

Shane K. Woolf, MD
Chief, Sports Medicine
Department of Orthopaedics
Medical University of South Carolina

The crowds have departed, the tents have come down, the world-class tennis athletes have begun competition for their next tournaments, and the MUSC Health Sports Medicine team has settled back into a ‘normal’ workweek.

From April 4th through 12th around 90 international athletes, and a half dozen physiotherapists, massage therapists and other medical staff from the Women’s Tennis Association (WTA) occupied the clubhouse at the Family Circle Cup, which was repurposed as a locker room, lounge, dining hall, physiotherapy center, equipment repair and tuning shop, and medical clinic for these remarkably talented athletes.  It was a wonderful week of great competition, classy sportsmanship, and beautiful spring Charleston days. Much of our time was spent either in the small office we used as our clinic or out near the courts to be immediately available if needed.

I had the good fortune of collaborating on the care of the athletes once again with Alec Decastro, MD (Primary Care Sports Medicine), Jana Upshaw, MD (Emergency Medicine), and Michael Barr, PT (Sports Medicine and Physical Therapy). Our efforts with the WTA for this year’s tournament actually began just after the 2014 event ended, when we all debriefed the medical care provided to the athletes and mapped out the plan for the 2015 event.  Out of that discussion came improvements in our care coordination as well as technologic advances including implementation of a telemedicine connection with our medical subspecialty colleagues at MUSC. The athletes and physiotherapists with the WTA were thrilled to have the ability to virtually ‘meet’ with consulting specialists, themselves world-class, from MUSC without leaving the comfort of the clubhouse.

Throughout the past year, planning the medical coverage, organizing the necessary medical supplies, credentialing and background checks for our team, regular teleconferences with the WTA sports medicine leadership, and on-site coordination with the local Family Circle Cup organizers, Bob Moran and Eleanor Adams were tasks that our group addressed nearly every week to prepare for the 9 days of competition.

Our week actually began on April 3rd, the night prior to the qualifying matches, with a meeting with the WTAs physiotherapists at our medical clinic. We reviewed protocols, emergency action plans, medical record keeping, ‘red alert’ athletes who have unusual or risky medical conditions, and even assessed several athletes who were arriving from tournaments elsewhere in the world. Overall, the three MUSC Health Sports Medicine physicians split our duties covering the tournament from 9 AM until 10 or 11 PM most every night of the week. Each of us also had clinical duties all week, so this meant little sleep, long days, tight schedules, and over 60 hours of time providing medical care at the FCC in addition to our regular practices. Despite the All-Access badges, walkie-talkie, direct interaction with famous athletes, and perceptions of family and friends who see us roaming the FCC grounds all week, this role is rewarding, enjoyable, and fun, but certainly not glamorous.

Dr. Alec DeCastro at the Family Circle Cup
Dr. Alec DeCastro participates in the coin toss at the Family Circle Cup 2015.
 

A typical day might involve a physical exam for a new WTA athlete who won in the qualifier. This is completed with numerous pages of documentation. Then the physiotherapists might ask for a shoulder evaluation on an athlete who complains of pain on motion of the joint after a match. We are each credentialed to evaluate and treat these athletes with rehab protocols, prescription anti-inflammatories, antibiotics and so forth.  So the evaluations are handled like any other clinical visit in practice. Another knock on the clinic door might bring an athlete who needs a contact lens prescription or perhaps renewal of asthma medication.

Then the walkie talkie will awaken with a call from one of the PTs on Court 3 with an athlete who is feeling dizzy in the second set of her match. We gather our medical bag, including stethoscope, blood pressure cuff, and other supplies, and rush out to the court to assess the athlete for cardiac or heat related issues. In this case, dehydration from a gastrointestinal condition might be the problem. She finishes the match, but then comes into the medical office to obtain documentation for a medical withdrawal from her next tournament so that she will have an extra week to rest and recover from the illness. We are responsible for this documentation and any necessary treatment plans as well. Similarly, more complex injuries might warrant consultation with our peers at MUSC, referral for specialty evaluation, or mapping a treatment plan for the player as she travels to the next tournament in Europe or South America.

Each night would end with a check out among the medical personnel on athletes who just finished the evening matches. In many cases, we might examine an athlete or two after 10 PM once the fans have left, the player has checked in with the WTA, urine blood doping screen was completed and she still has a knee or wrist that is aching. Once all of the documentation is finished, we shut down the medical clinic and head home to rest a few hours before the next day’s work begins.

It is a privilege to work with the WTA, Family Circle Cup, and these talented athletes. They trust the care of our MUSC Health Sports Medicine team. We are already beginning to prepare for next year’s Family Circle Cup April 2-10, 2016! Hope to see you there.

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Dr. Harris Slone

Guest Post by:

Harris S. Slone, MD
Assistant Professor
Department of Orthopaedics - Sports Medicine
Medical University of South Carolina

Each year up to 6 million children and adolescents participate in organized youth baseball, and up to 14 million may play some form of recreational or unorganized baseball.1 During this time of year, many of our youngsters here in Charleston will dust off the cleats, pull the glove out of the closet, and hit the baseball diamond.  Youth baseball is a great sport, which helps teach our rising superstars teamwork, discipline, and helps keep them fit and active.  

In general, youth baseball is a very safe sport.   It is estimated that between 2-8% of youth baseball players sustain some sort of injury each year.1  Serious injuries are uncommon however, and generally are acute injuries from direct player-to-player contact, bat-to-player contact, and ball-to-player contact injuries.  Efforts to minimize serious injuries have been employed, including the use of specialized protective equipment, softer and lighter baseballs, rule modifications, elimination of “on-deck” areas, and dugout screening.

In contrast to acute and serious injuries, which are relatively uncommon, overuse injuries of the shoulder and elbow are very common in little leaguers.  Pitchers are most susceptible to overuse injuries of the shoulder an elbow, given the repetitive stress of repeated pitches.  Younger (skeletally immature) patients are at a higher risk of repetitive use injuries, compared to older players.

Experts in orthopaedic surgery have extensively researched youth baseball shoulder and elbow injuries to identify risk factors, and prevent future injuries, and guidelines have been published to minimize risks of injury. Studies have shown that pitch type, pitch count, number of innings pitched, and other positions played may influence a players injury risk. 

Current recommendations include avoiding pitching for two teams during the same season or overlapping seasons, or playing pitcher and catcher in the same game.  Players should avoid overhead throwing for at least 2 months per year, and avoid pitching for at least 4 months per year.  No player should pitch more than 100 innings per year.2 Pitching biomechanics must be established at a young age.  Once players demonstrate good pitching biomechanics, fastballs and change-ups can be introduced.  Curveballs and sliders have been shown to increase the risk of injury in young pitchers.  Most experts agree that curveballs should not be thrown before the age of 14, and sliders should not be thrown before 16. More information and guidelines for pitch counts, and recommended number of rest days between pitching can be found here.  If you or your little leaguer notice any pain in the throwing arm or shoulder, fatigue, or declining pitch velocity, seek professional medical attention from a sports medicine specialist to ensure a long an healthy baseball career.

References:

1.     Matta PA, Myers JB, Sawicki GS. Factors Influencing Ball-Player Impact Probability in Youth Baseball. Sports Health: A Multidisciplinary Approach. 2015;7(2):154–160.

2.     Fleisig GS, Andrews JR. Prevention of elbow injuries in youth baseball pitchers. Sports Health. 2012;4(5):419–424.

3.    http://www.asmi.org/research.php?page=research&section=positionStatement

4.    http://www.asmi.org/research.php?page=research&section=positionStatement

 

Dr. Harris S. Slone is an orthopaedic surgeon specializing in sports-related injuries, such as injuries to the ACL, ankle, knee, and shoulder. He also treats ankle instability, rotator cuff disorders, and shoulder instability. He completed a fellowship in Sports Medicine and Arthroscopy at Emory University following his residency in orthopaedic surgery at the Medical University of South Carolina. During his fellowship, Dr. Slone was a team physician for the Atlanta Falcons and the Georgia Tech Yellow Jackets. He is accepting new patients 10 years of age and older at MUSC Health locations in West Ashley, Mount Pleasant, and North Charleston.

 

Guest Post by:

Michael J. Barr, PT, DPT, MSR
Sports Medicine Program Manager
MUSC Health Sports Medicine

The Family Circle Cup is the largest women’s-only tennis tournament on the WTA circuit; qualifying play is scheduled to begin on Saturday April 4th.  The 2015 tournament will mark MUSC Health Sports Medicine’s 8th consecutive year providing comprehensive Sports Medicine coverage for the participants.  The WTA travels from tournament to tournament with a significant medical staff of Physical Therapists and Athletic Trainers; however they rely on local partners for each event to provide all additional medical coverage.  Most people probably think that just means there is a local physician onsite or on-call through-out the event, which does not even touch the tip of the iceberg for the level of medical coverage needed for a professional event like the Family Circle Cup.

Our onsite responsibilities begin the Friday prior to the event, as a large number of the players will be arriving during the week and training at the Family Circle Tennis Center by Friday the 3rd of April.  The onsite coverage that MUSC Health Sports Medicine will provide the event includes physician coverage from at least an hour prior to the first match until well after the last match concludes.  Our onsite team will be led by Doctors Shane Woolf (Orthopaedics) and Alec Decastro (Primary Care), both of which are fellowship-trained sports medicine physicians in their respective fields, with additional coverage provided by Dr. Jana Upshaw.

Having three different physicians onsite, throughout the 10 day event, seems like a comprehensive medical coverage plan, however this is just the first level of services needed for the Family Circle Cup.  For the majority of the regular adult population, we are home on a daily basis; if we need to see a doctor for a general physical or even see a specialist we make an appointment and move forward with our daily life and responsibilities.  The players on the WTA tour are often away from their homes or training facilities for months at a time, traveling from one tournament to the next.  The majority of the players at the FCC this year will be going from Indian Wells California, to the Miami Open, in the weeks prior to coming to Charleston; so they have very little time and ability to take care of the regular physician appointments that most of us take for granted.  With their extremely busy schedules in mind, MUSC Health has a second level of specialty physicians including women’s health/gynecology, ophthalmology, dermatology, cardiology, dental, and psychology; all of whom are identified months in advance, and will have office availability and on-call access throughout the players stay in Charleston.  This way if there is an emergency situation or just a routine appointment needed, we can provide that level of service to these elite athletes.

MUSC Health is a leader in telehealth deployment and services provided; this year we will be expanding our medical services for the Family Circle Cup to include telemedicine.  Our medical specialists will have access to telemedicine; therefore players will be able to receive teleconsultation services with our specialists, without leaving the comfort and convenience of the Family Circle Tennis Center.  This will be the first time that a telemedicine component will be utilized at a WTA event; it is just another example of how MUSC Health is leading the way in Telehealth and overall Sports Medicine services.

Guest Post by:

Lindsey Clarke, MS, ATC, CMT
Athletic Trainer;  Massage Therapist Charleston Battery
MUSC Sports Medicine

It’s that time of year again…no, not yard work or taxes, but time for the 38th annual Cooper River Bridge Run.  People from all over the world flock to this event to enjoy the beautiful views of Charleston, participate in a world class distance running event, and spend the better part of the day with 40,000 of their closest friends.  There is A LOT going on for this race…many uncontrollable variables that just make shake the most seasoned runner.  Paying attention to your nutrition is the one variable that day you will have complete control of.  Running a race takes preparation, strength, and energy, and how you approach your pre-race eating plan can affect all three. Throughout training, your diet plays a significant role in helping you perform and recover. In the weeks leading up to the race and immediately before the event, a correctly balanced pre-race nutrition plan will contribute towards your best performance.  If you are a professional, world class runner, or just decided to get in on the action and signed up last week, here are a few tips on giving yourself everything your body needs to have a successful and enjoyable race.

WEEK PRIOR: Moderate quantities of carbohydrate-rich foods will fill your glycogen stores throughout the week leading up to the race. Depending on the length of your race, shoot for about 3-5 grams of carbohydrates per pound of body weight per day, with foods like oatmeal, potatoes, carrots, and other vegetables. For example, a 150-pound adult would need at least 450 grams of carbohydrates per day. Many runners focus so much on getting enough carbohydrates that they don't pay enough attention to their protein consumption. Protein is used for some energy, but mostly in repair of tissue damaged during training. Again, depending on your training/length of race, you should consume .5 to .75 grams of protein per pound of body weight.  Good sources of protein are fish, lean meat, poultry, beans, nuts, whole grains, egg whites, low-fat milk, low-fat cheese and some vegetables.  Being a long distance race, you’ll want to aim for the higher amount of carbohydrate and protein per pound body weight.  This is the time to experiment with discovering which foods work best for you, and which foods you want to avoid…experimenting on race day is never a good idea!

DAY BEFORE: Many beginning runners hear that “carbo-loading” before a race is a good idea and mistakenly overindulge on enormous portions of carbohydrate-rich foods. Gone are the days of indulging in stacks of pancakes or sitting down to an all-you-can-eat pasta bowl.  Instead, continue eating as you have in the week leading up to the race, increasing your intake of up to 5.5 grams of carbohydrates per pound of body weight; a 150-pound adult would need up to 825 grams of carbohydrates. Foods with a moderate to high glycemic index are your best choices before a race. Eat foods like whole-wheat pastas, which contain 40 to 50 grams of carbohydrates per dry cup serving, and vegetables.

MORNING OF:   As a 10K(6.2m), this race is considered a long distance race.  For longer races, your body will require more fuel.  With an 8am start, a more substantial meal is warranted approximately 2 hours prior to start, so set that alarm just a little extra early.  In addition to your meal, it is good practice to have a light snack 1 hour prior to the race. While it may be tempting to run into the Duncan Donuts on Coleman Avenue while waiting for your heat’s start time, bring a granola bar, energy chews, GU, etc. as a option for more sustained energy release and a lower possibility for GI distress.

In making food choices, it’s always best to stick with what you know works. No one wants any surprises waiting in cue or during your run!  A well-rounded diet of lean meats, legumes, dairy, fruits, and vegetables is a great way to set your self up for success come race day. Some foods to include in race preparation are:

*Whole grain pastas, brown rice     *Lean proteins; salmon, chicken

*Fresh fruit          *Fruit/Vegetable juice                   *Oatmeal

*Bagels                  *Yoghurt drizzled with honey       *Toast with nut butter

Some foods to avoid in race preparation are:

*Cruciferous vegetables; broccoli, cauliflower     *Sugar-free items/artificial sweeteners

*Bran; cereals, muffins     *Caffeine(unless you regularly consume)

*Fried foods     *fatty meats/high fat cheeses     *alcohol

Another extremely important and often forgotten about component of pre-race preparation is proper hydration practices. Many runners underestimate how much fluid they actually lose during their runs and don't drink enough while they're running as well as post workout/race. The result? Dehydration. This is detrimental to performance and dangerous for your health. In the days leading up to your race, you’ll know you’re properly hydrated if you void a fairly large volume of pale urine at least six times a day. On the day of, drink 8-16oz. of water one to two hours before the race, and then another 4-8oz just before. Consumption will vary depending on the length of your race.

LENGTH OF RACE:

ONE HOUR OR LESS
Three to six ounces every 15 to 20 minutes. Water is usually fine. For a tougher runs over 30 minutes, consider a sports drink to replace electrolytes and glycogen.

ONE TO FOUR HOURS
Three to six ounces every 15 to 20 minutes. A sports drink with carbohydrates and electrolytes will replenish sodium.

OVER FOUR HOURS
Three to six ounces of sports drink every 15 minutes, after which use thirst as your main guide (drinking more if you're thirsty and less if you're not).

POSTRUN
Replace fluids, drinking enough so you have to use the bathroom within 60 to 90 minutes after your run(approximately 8-24oz).

Whether you cruised effortlessly across or stumbled through and promptly found a nice patch of grass to flop down on in Marion Square, you’ve finally made it across the finish line!  So what comes next? Post race practices are very important in regards to recovery. Replacing fluids lost and replenishing glycogen stores are crucial and the window of opportunity is small.  It is best to consume a recovery ‘meal’ within the first 30 minutes after completion of the run. The optimum ratio is 3:1 carbohydrates to protein.  Depending on your preference, this meal can take the form of nutrition bars, recovery sports drinks, or even chocolate milk.   There are numerous sponsors that provide fantastic goodies such as yoghurt, peanut butter crackers, bananas, oranges, and more for all runners, so there is certainly no excuse in consuming your post-race snack and replenishing fluids lost.  For longer runs, you should also take in a full meal within 2 hours of completing your race that contains lean proteins, carbohydrates, and maybe even a post-race treat…you deserve it!  This attention to detail in your meals leading up to your race will definitely take a bit of planning, but getting the proper nutrition for pre and post race will not only help your performance and recovery, but will make the experience over all much more enjoyable and successful!

 

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