Acupuncture in Sports Medicine.

Acupuncture is gaining popularity and wider acceptance as a treatment modality within the field of sports medicine. Our objective was to provide a comprehensive review of the existing literature pertaining to acupuncture in sports medicine to shed light on approaches utilized in acupuncture while revealing its personalized nature and its impact on athletes' preparation, performance, and recovery. We evaluated acupuncture research in the context of medicine and sports-related injury treatment, assessing its impact on athletic performance across demographics of athletes. Athletes participating in most sports have shown positive outcomes from acupuncture interventions. Acupuncture improves peak oxygen levels, maximum heart rate, delayed-onset muscle soreness, pain, swelling, explosive force production, and joint mobility. Furthermore, the efficacy of acupuncture appears to be similar regardless of age and sex. Lastly, the acceptance of acupuncture is influenced by cultural factors, with Western and traditional East Asian cultures exhibiting distinct perspectives on its rationale and mechanisms of action. Traditional East Asian acupuncturists typically employ qi and meridian theories in their acupuncture practices, with the recent incorporation of Western concepts. Acupuncture shows promise as an effective treatment for musculoskeletal pain and neuropathies in athletes across different age groups and for addressing injuries in various sports. Our comprehensive review will enhance our understanding of acupuncture's potential as a complementary or distinct therapeutic approach compared to conventional therapies. Additionally, our review explores its specific applications within different sports and delves into the cultural dimensions involved in integrating this practice into modern sports medicine.

Physician attitudes toward sports medicine coverage of mixed martial arts.

BACKGROUND: The popularity of modern Mixed Martial Arts (MMA) has been increasing since 2000s. It has drawn the attention of the media due to higher injury rates compared to other sports, and it is possible that this may have led to a generally negative image of MMA among viewers, including but not limited to, physicians. Therefore, our study aimed to understand the attitudes of physicians toward MMA and being asked to cover MMA events. METHODS: A cross-sectional study with an online survey was answered by 410 physicians from four physician organizations throughout the USA. Demographic data, sports event-related, sports coverage experience, athleticism, and familiarity with MMA answers were analyzed. Wilcoxon, Fisher Exact, and χ2 tests were used to compare the data. The main outcomes was the association between characteristics of physicians and attitude toward MMA coverage. RESULTS: Physician characteristics influenced positive attitudes toward MMA coverage. Those who regularly followed MMA felt more strongly that combat sport events required physician coverage, mainly for boxing (92.4% vs. 73.4%; P<0.001), kickboxing (89.9% vs. 54.7%; P<0.001), and taekwondo (50.6% vs. 38.4%; P=0.046). Doctors who considered themselves athletic or who had covered MMA events in the past were more likely to think that all sporting events should be covered by physicians (97.4% vs. 65.9%; P<0.01; 98.4% vs. 72.8%, P<0.001, respectively). Family medicine (72/139 [51.8%]) and physical medicine and rehabilitation (7/11 [63.6%]) were the specialties more inclined to agree with physician coverage for these events. CONCLUSIONS: Physicians familiar with MMA, either as a previous ringside physician or as a spectator, are more inclined to believe these events should have physician coverage as are those more experienced with sports medicine, such as family medicine and physical medicine and rehabilitation specialists. Therefore, specialized sports medicine training should be provided to allow for appropriate MMA physician coverage. With additional training, MMA event organizers should feel comfortable asking physicians in any specialty to provide sports medicine coverage to improve care for MMA athletes.

Complementary and Alternative Medicine Prescribing Practices Among Sports Medicine Providers.

CONTEXT: The drive for a quick return to sport after injury can be great. Athletes look to their sports medicine provider for guidance on a speedy and effective recovery. The sports medicine physician has a number of different treatment options to consider when they turn to their medical armamentarium. One of those treatment choices is complementary and alternative medicine (CAM). Unfortunately, there is limited evidence for many of the CAM modalities. Furthermore, CAM prescribing practices among sports medicine physicians is unknown. The aim of this study is to determine the prescribing practices of CAM among physicians for common sports medicine pathologies. METHODS: An online survey of the prescribing practices of CAM by physician members of the American Medical Society for Sports Medicine. RESULTS: A total of 257 physicians answered the question on prescribing CAM for a response rate of 11%. Of those who responded, 88% prescribed at least one type of CAM in the last one year. The responders identified 23 different CAM modalities they prescribed. Of those modalities prescribed, chiropractic/osteopathic manipulation was the most common followed by acupuncture/electroacupuncture and yoga. Less commonly prescribed CAM included omega-3 fatty acids, riboflavin, and meditation. Providers utilized CAM for common sports medicine pathologies including ligamentous, tendinous and muscle injury, concussion, and low back pain among others. The survey participants believed many of these CAM modalities to be effective. CONCLUSIONS: Among responders, the prescribing prevalence of at least one CAM therapy was high. Sports medicine physicians utilized a number of different CAM modalities to treat common sports medicine pathologies.

A Practical Guide for the Current Use of Biologic Therapies in Sports Medicine.

Over the past decade, there has been an increased interest in the use of biologic therapies in sports medicine. Although these technologies are in relatively early stages of development, there have been substantial increases in marketing, patient demand, and clinical utilization of biologics, including platelet-rich plasma, bone marrow aspirate concentrate, and other cell-derived therapies. Direct-to-consumer marketing of biologics has also proliferated but is largely unregulated, and clinicians must accurately convey the safety and efficacy profiles of these therapies to patients. Because most insurance companies consider biologic treatments to be experimental or investigational for orthopaedic applications given the lack of high-quality evidence to support their efficacy, patients receiving these treatments often make substantial out-of-pocket payments. With a range of treatment costs among centers offering biologics, there is a need for appropriate and sustainable pricing and reimbursement models. Clinicians utilizing biologics must also have a thorough understanding of the recently clarified Food and Drug Administration guidelines that regulate the clinical use of cell and tissue products. There is a lack of consensus on the optimal preparation, source, delivery method, and dosing of biologic therapies, which has been exacerbated by a lack of sufficient experimental detail in most published studies. Future research must better identify the biologic target of treatment, adhere to better standards of reporting, and better integrate researchers, industry, and regulatory bodies to optimize applications.

Vitamin D Practice Patterns in National Collegiate Athletic Association Division I Collegiate Athletics Programs.

CONTEXT: Vitamin D status has been associated with performance, health, and well-being in athletic populations. The measurement of vitamin D status via 25-hydroxyvitamin D [25(OH)D] testing has increased in the general population, as has vitamin D supplement use. It is unclear if similar patterns exist in collegiate athletics programs. OBJECTIVE: To describe the clinical care related to the prevention, evaluation, and treatment of vitamin D deficiency and insufficiency used by sports medicine providers with National Collegiate Athletic Association (NCAA) Division I programs. DESIGN: Cross-sectional study. SETTING: Population-based online survey. PATIENTS OR OTHER PARTICIPANTS: All NCAA Division I head athletic trainers. MAIN OUTCOME MEASURE(S): Information related to 25(OH)D testing, vitamin D supplementation, vitamin D-related protocols and procedures, and characteristics of athletic programs and participants. RESULTS: We received 249 responses (72% response rate). Use of 25(OH)D testing was described by 68% of participants, with the most common indicators being health status/history (78%) and injury status/history (74%). One-fifth of participants stated that vitamin D testing was conducted as screening (without a specific cause or indication). Target blood vitamin D concentrations were highly variable. A range of 8 to 1660 annual vitamin D blood tests was reported at a cost of <$50 (8%), $51 to $100 (51%), $101 to $150 (20%), and >$150 (10%). Forty-two percent of programs covered the cost of vitamin D supplements. More than half of the participants indicated that vitamin D blood testing and supplements were not a good use of program funds. In comparison with Football Championship Subdivision programs, Football Bowl Subdivision programs were more likely to conduct vitamin D testing and pay for vitamin D supplements, and their providers were more likely to believe that testing and supplements were a good use of program funds. CONCLUSIONS: A great deal of variability was present in vitamin D-related clinical practices among NCAA Division I athletics programs, which reflects existing contradictions and uncertainty in research, recommendations, and guidelines. Knowledge of current practice patterns is important in evaluating and establishing best practices, policies, and procedures for sports medicine and sports nutrition professionals in the collegiate setting.

Sport Medicine in the Prevention and Management of Cancer.

Physical inactivity is a major concern in cancer patients despite the established preventative and therapeutic effects of regular physical exercise for this patient group. Sport not only plays an important role in supporting the development and maintenance of a physically active lifestyle but also is increasingly used as a health promotion activity in various populations. Nevertheless, the potential of sport as an effective strategy in the prevention and management of cancer has gained little attention. Based on the scant evidence to date, participation of cancer patients in supervised, well-tailored sport programs appears to be safe and feasible and is associated with an array of physical and psychological benefits. We propose that sport participation may serve as an alternative strategy in the prevention of cancer and sport medicine in the management of cancer. As with the traditional exercise modes, benefits derived from sport participation will be dependent on the sport undertaken and the physical/physiological, motor, and cognitive demands required. To this end, further work is required to develop a solid evidence base in this field so that targeted sport participation can be recommended for cancer patients.

How far have biological therapies come in regenerative sports medicine?

INTRODUCTION: Regular engagement in sports produces many health benefits, but also exposes to increased injury risk. The quality of medical care available is crucial not only for sports trauma but also to avoid overuse syndromes and post-traumatic degenerative conditions. AREAS COVERED: We provide background information on some clinical needs in sport injuries and describe the main families of biological products used in clinical practice. We also discuss limitations of the current clinical experience. EXPERT OPINION: Sport and exercise impairment affects different segments of the population with different needs. The exceptional demands of elite athletes and subsequent media coverage have created hype around regenerative therapies. Statistical evidence, whether weak (cell products) or moderate (PRPs), is not enough to drive medical decisions because of the heterogeneity of the biological products available and their application procedures. Moreover, the specific needs of the different segments of the population along with the available clinical evidence for each musculoskeletal condition should be considered in the decision-making process. There is urgent need to develop regenerative protocols combined with post-intervention rehabilitation, and gather meaningful clinical data on the safety and efficacy of these interventions in the different populations segments.

The assessment of movement health in clinical practice: A multidimensional perspective.

This masterclass takes a multidimensional approach to movement assessment in clinical practice. It seeks to provide innovative views on both emerging and more established methods of assessing movement within the world of movement health, injury prevention and rehabilitation. A historical perspective of the value and complexity of human movement, the role of a physical therapist in function of movement health evaluation across the entire lifespan and a critical appraisal of the current evidence-based approach to identify individual relevant movement patterns is presented. To assist a physical therapist in their role as a movement system specialist, a clinical-oriented overview of current movement-based approaches is proposed within this multidimensional perspective to facilitate the translation of science into practice and vice versa. A Movement Evaluation Model is presented and focuses on the measurable movement outcome of resultants on numerous interactions of individual, environmental and task constraints. The model blends the analysis of preferred movement strategies with a battery of cognitive movement control tests to assist clinical judgement as to how to optimize movement health across an individual lifespan.

Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions.

Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.

RELEVANCE OF WHOLE BODY VIBRATION EXERCISE IN SPORT: A SHORT REVIEW WITH SOCCER, DIVER AND COMBAT SPORT.

BACKGROUND: Whole body vibration exercise (WBVE) has been used as a safe and accessible exercise and important reviews have been published about the use of this exercise to manage diseases and to improve physical conditions of athletes The aim of this paper is to highlight the relevance of WBVE to soccer players, divers and combat athletes. MATERIAL AND METHODS: This study was made through a systematic review of publications involving WBVE and the selected sports in two databases (Pubmed and PEDRo). RESULTS: It were identified 10 studies involving WBVE and sports (6 of soccer, 2 of diving and 2 of sport combat) with 156 subjects (80 soccer players, 32 divers and 44 combat athletes), with age from 17 to 44 years old. CONCLUSION: The use of WBVE has proven to be a safe and useful strategy to improve the physical conditions of players of different sports. These findings may have clinical relevance and should be considered as a strategy to be used to try improve the physical conditions of players.

Orthobiologics in Pediatric Sports Medicine.

Orthobiologics are biological substances that allow injured muscles, tendons, ligaments, and bone to heal more quickly. They are found naturally in the body; at higher concentrations they can aid in the healing process. These substances include autograft bone, allograft bone, demineralized bone matrix, bone morphogenic proteins, growth factors, stem cells, plasma-rich protein, and ceramic grafts. Their use in sports medicine has exploded in efforts to increase graft incorporation, stimulate healing, and get athletes back to sport with problems including anterior cruciate ligament ruptures, tendon ruptures, cartilage injuries, and fractures. This article reviews orthobiologics and their applications in pediatric sports medicine.

Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function.

CONTEXT: Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)-associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI. OBJECTIVE: To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI. DESIGN: Secondary analysis of a randomized controlled clinical trial. SETTING: Sports medicine research laboratories. PATIENTS OR OTHER PARTICIPANTS: Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations. INTERVENTION(S): Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks. MAIN OUTCOME MEASURE(S): Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure-Sport (FAAM-S). RESULTS: Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM-S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM-S improvements from AJM. Patients <22 years old and with ≤9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM-S improvement after PM. Also, those who made ≥2 single-limb-stance errors had a 98% probability of a meaningful FAAM-S improvement from PM. Patients with ≤53.1% on the FAAM-S had an 83% probability of a meaningful FAAM-S improvement after CS. CONCLUSIONS: Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and <5 previous sprains. Age, weight-bearing-dorsiflexion restrictions, and single-limb balance deficits identified patients with CAI who will respond well to PM. Assessing self-reported sport-related function can identify CAI patients who will respond positively to CS.

Potential harmful effects of dietary supplements in sports medicine.

PURPOSE OF REVIEW: The purpose of this article is to collect the most recent data regarding the safety of well-known or emerging dietary supplements used by athletes. RECENT FINDINGS: From January 2014 to April 2016, about 30 articles have been published in the field. New data show that 90% of sports supplements contain trace of estrogenic endocrine disruptors, with 25% of them having a higher estrogenic activity than acceptable. About 50% of the supplements are contaminated by melamine, a source of nonprotein nitrogen. Additional data accumulate toward the safety of nitrate ingestion. In the last 2 years, the safety of emerging supplements such as higenamine, potentially interesting to lose weight, creatine nitrate and guanidinoacetic acid has been evaluated but still needs further investigation. SUMMARY: The consumption of over-the-counter supplements is very popular in athletes. Although most supplements may be considered as safe when taking at the recommended doses, athletes should be aware of the potential risks linked to the consumption of supplements. In addition to the risks linked to overdosage and cross-effects when combining different supplements at the same time, inadvertent or deliberate contamination with stimulants, estrogenic compounds, diuretics or anabolic agents may occur.

[The application of electrolaser myostimulation and laserophoresis of biologically active compounds in sports medicine (a review)].

This scientific review highlights peculiarities of the delivery of laser radiation to the tissues of the athlete's body by means of laser electrophoresis of biologically active substances and the possibilities for electrolaser myostimulation. The main features of electrical myostimulation based on the application of laser-generated radiation are described. The authors emphasize the necessity of taking into account the neurophysiological dependence of active and passive contractile muscular activity during training. They provide the scientifically grounded rationale for the combined use of coherent laser radiation and electrical stimulation. The list of scientific papers that confirm the effectiveness of the method being considered is presented. The authors compare this method with other techniques for the induced ion transfer. The beneficial influence of laserphoresis of succinic and hyaluronic acids on the athlete's body is reported with special reference to alleviating the pain syndrome. A number of phyto-extracts used for the purpose of laser electrophoresis are characterized. The authors demonstrate the application of the optional versions of this technique in various sports during the training and competition periods.

Consenso sobre utilización de las infiltraciones en el deporte. Documento de Consenso de la Sociedad Española de Medicina del Deporte / Consensus on use of infiltration in sport. Document of Consensus of the Spanish Society of Sports Medicine

La infiltración es una opción terapéutica, utilizada para el tratamiento de diversas patologías, que consiste en la administración inyectada en localizaciones precisas de diferentes sustancias. Pueden tener un efecto analgésico y/o antiinflamatorio y curativo. Su uso es frecuente en el tratamiento de muchas lesiones de tejidos blandos como bursitis, sinovitis, fascitis plantar, esguinces, lesiones musculares, tendinopatías y lesiones condrales y deben de ir precedido del correspondiente diagnóstico. Casi todas las infiltraciones tienen efectos secundarios locales, leves y, en algunas ocasiones, sistémicos y pueden presentar algunas contraindicaciones específicas que dependen de la sustancia administrada. La mayor parte de los efectos adversos son debidos a uso inapropiado del medicamento. Los principios activos más utilizados son: Anestésicos locales que producen un alivio inmediato del dolor, como lidocaína y bupivacaína. Se pueden usar solos o en combinación con corticosteroides ejerciendo un efecto combinado analgésico inmediato del dolor local y un efecto terapéutico de mayor duración. Corticoides cuya propiedad fundamental es una acción antiinflamatoria muy potente. Los más utilizados son betametasona, metilprednisolona y triamcinolona. Ácido hialurónico, utilizado en el tratamiento de patologías articulares, especialmente la artrosis de rodilla y las condromalacias. Lubrifica las articulaciones y parece tener efectos directos sobre la función de las células sinoviales y el líquido sinovial. Escleroterapia, que es la introducción de una sustancia química en la luz de los vasos sanguíneos, provocando una obliteración y fibrosis secundaria. Está indicada fundamentalmente en las tendinopatías con proliferación vascular. Biorreguladores: Estimulan la curación al modular o activar diversas sustancias implicadas. Plasma rico en plaquetas: plasma autólogo que contiene más concentración de plaquetas que la sangre normal que segregan una gran cantidad de factores de crecimiento. Proloterapia, que consiste en la infiltración de sustancias que estimulan la regeneración y reparación de los tejidos. Otros: Antiinflamatorios no esteroideos, factores de crecimiento, células madre y terapias relacionadas

Infiltration is a therapeutic option used for the treatment of various diseases, which comprises injected administration into precise locations of different substances. They may have an analgesic and / or anti-inflammatory and healing effect. Its use is common in the treatment of many soft tissue injuries such as bursitis, synovitis, plantar fasciitis, sprains, muscle injuries, tendinopathies and chondral injuries and must be preceded by the appropriate diagnosis. Almost all local infiltrations have mild side effects and, sometimes, these may be systemic and may have some specific contraindications depending on the administered substance. Most of the adverse effects are caused by improper use of the drug. The most used active substances are: local anesthetics that produce immediate pain relief, such as lidocaine and bupivacaine. They can be used alone or in combination with corticosteroids producing an immediate analgesic combined effect on local pain and a therapeutic effect of longer duration. Corticosteroids, whose main property is a very powerful anti-inflammatory action. The most used are betamethasone, methylprednisolone and triamcinolone. Hyaluronic acid, used in the treatment of joint diseases, particularly knee osteoarthritis and chondromalacias/chondropathias . It lubricates joints and appears to have direct effects on the function of synovial cells and synovial fluid. Sclerotherapy, which is the introduction of a chemical substance in the light of the blood vessels, causing obliteration and secondary fibrosis. It is indicated mainly in tendinopathies with vascular proliferation. Biorregulators: They stimulate healing when modulate or activate various involved substances. Platelet-rich plasma: autologous plasma containing more platelet concentration that normal blood, secreting a large amount of growth factors. Prolotherapy, it consists in substances infiltration that stimulate regeneration and tissue repair. Other: Nonsteroidal anti-inflammatory drugs, growth factors, stem cells and related therapies

Selected Issues in Injury and Illness Prevention and the Team Physician: A Consensus Statement.

This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It is not intended as a standard of care, and should not be interpreted as such. This document is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the health care profession. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. This statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues. They have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are the American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine.

Medical Clearance for Desert and Land Sports, Adventure, and Endurance Events.

Endurance events are increasing in popularity in wilderness and remote settings, and participants face a unique set of potential risks for participation. The purpose of this article is to outline these risks and allow the practitioner to better guide the wilderness adventurer who is anticipating traveling to a remote or desert environment.

Alternative Therapeutic Modalities in Sports Medicine.

Bone marrow aspirate, prolotherapy, platelet-rich plasma,and autologous conditioned serum represent alternative treatment options that have emerged to address various musculoskeletal ailments. We have reviewed the basic science, physiology, and clinical evidence of each of these modalities and discovered that each treatment has its individual place in the management of common orthopaedic pathologies. Bone marrow aspirates are successful in treating early arthritis and cartilage defects. Prolotherapy and platelet-rich plasma have demonstrated good efficacy in treating inflammatory processes and early arthritis. Finally, autologous conditioned serum (Orthokine) represents a promising treatment option for chronic joint arthritis. The clinical evidence supporting these alternative treatment modalities is insufficient and further level 1 evidence is needed before we can begin to employ these techniques in our daily orthopaedic practice.