What is a Sports Medicine Specialist?

A Sports Medicine Specialist is a physician with significant specialized training in both the treatment and prevention of illness and injury. The Sports Medicine Specialist helps patients maximize function and minimize disability and time away from sports, work, or school.

He or she is a physician who:
• Is board certified in Emergency Medicine, Family Medicine, Internal Medicine,
Pediatrics, or Physical Medicine/Rehabilitation.
• Has obtained one to two years of additional training in Sports Medicine through one of the
accredited Fellowship (subspecialty) Programs in Sports Medicine.
• Has passed a national Sports Medicine certification examination allowing them to
hold a Certificate of Added Qualification in Sports Medicine.
• Further adds to their expertise through participation in continuing medical
education activities and recertification via re-examination every ten years. This rigorous
process was instituted to distinguish certified Sports Medicine Specialists from other
physicians without specialized training.
• Is a leader of the Sports Medicine team, which also may include specialty physicians
and surgeons, athletic trainers, physical therapists, coaches, other personnel, and the
athlete.

What is the difference between a Sports Medicine Specialist and an Orthopedic Surgeon?
Both are well trained in musculoskeletal medicine. Sports Medicine Specialists specialize in the non-operative treatment of musculoskeletal conditions. Orthopedic surgeons are also trained in the operative treatment of these conditions. However, approximately 90% of all sports injuries are non-surgical. The Sports Medicine Specialist can maximize non-operative treatment, guide appropriate referrals to physical and occupational therapies, and if necessary expedite referral to an orthopedic/sports surgeon.

Common examples of musculoskeletal problems include:
• Acute injuries (such as ankle sprains, muscle strains, knee & shoulder injuries, and fractures)
• Overuse injuries (such as rotator cuff and other forms of tendonitis, stress fractures)
• Medical and injection therapies for osteoarthritis

Sports Medicine Specialists have received additional training in the non-musculoskeletal aspects of sports medicine. Common examples of these include:
• Concussion (mild traumatic brain injury) and other head injuries
• Athletes with chronic or acute illness (such as infectious mononucleosis, asthma or diabetes)
• Nutrition, supplements, ergogenic aids, and performance issues
• Exercise prescription for patients who want to increase their fitness
• Injury prevention
• “Return to play” decisions in the sick or injured athlete
• Recommendations on safe strength training and conditioning exercises
• Healthy lifestyle promotion

Do Sports Medicine Specialists only treat competitive athletes?
No, Sports Medicine Specialists are ideal physicians for the non-athlete as well, and are excellent resources for the individual who wishes to become active or begin an exercise program.  For the “weekend warrior” or “industrial athlete” who experiences an injury, the same expertise used for the competitive athlete can be applied to return the individual as quickly as possible to full function.

Could you use help from one of our Sports Medicine Specialists?  If so, please call 615-324-1600 to schedule an appointment!

Back to the Basics: Osteoarthritis

Many people are all too familiar with the aches and pains of arthritis, but what exactly is arthritis? One common misconception is that arthritis is the result of something that grows in or on a joint over time. If that were the case, curing arthritis would be as simple as removing the unwanted “growth”.  Unfortunately arthritis is not caused by anything growing on the joint, but rather a wearing away of the joint’s protective coating known as cartilage.

The basic definition of arthritis is inflammation of a joint. There are many different types of arthritis, but the most common and the one treated primarily in sports medicine is osteoarthritis (OA). OA is the gradual wearing away or degeneration of a special cartilage called articular cartilage that covers the ends of bones in a joint. It is most commonly seen in weight-bearing joints including the knee, hip, spine, and feet. It is also common in the hand. Risk factors that contribute to early development and continued proliferation of OA include increasing age, gender (OA is more prevalent in women than men), genetic predisposition, obesity, joint injury, excessive mechanical stress, and structural malalignment and muscle weakness.1

Articular cartilage or hyaline cartilage is a highly specialized connective tissue that provides a smooth, lubricated surface for articulation and facilitates the transmission of loads with little to no friction.2 It is highly resistant to shear and compressive forces making it highly resilient to a harsh biomechanical environment. Also, unlike other tissues, articular cartilage has no blood vessels, nerves, or lymphatics. This allows painless motion even with significant impact activity, but also means it has a limited capacity for healing and repair.

As this articular surface wears away either due to age, injury or other causes, more of the underlying bone is exposed, which has millions and millions of nerve endings. Consequently, the more areas of bone that are exposed, the more symptoms of inflammation such as pain, swelling, stiffness, and loss of motion are possible. Also, as this cartilage wears away, it breaks open and frays which causes the surfaces to become rough and coarse instead of smooth and slick. This translates into symptoms of popping, clicking, and catching. Eventually, loss of function and muscle atrophy can occur.

Even though articular cartilage does not have the ability to repair itself once damaged, there are still several treatment options for OA. The most basic form of treatment is to reduce risk factors. Weight loss, activity modification, and strengthening the musculature around the affected joint are some examples of this. Pharmacological management includes anti-inflammatory medications (both oral and topical), cortisone injections, and viscosupplementation injections. Physical therapy can also be beneficial in maintaining motion and strengthening muscles. The gold standard for surgical management of severe OA is joint replacement, but this is usually only recommended when other more conservative treatments have failed. There are arthroscopic surgical options for articular surface loss or injury. However, candidates for these procedures are usually young adults who have only one or two small areas of articular cartilage damage with little diffuse joint involvement. Newer treatments are also available including use of stem cells and platelet rich plasma (PRP) injections (see Dr. Chad Price’s blog post “What’s the Deal with Stem Cells?” for more information).

Our providers can help diagnose and recommend appropriate treatment options to reduce or eliminate the symptoms caused by OA. Please feel free to schedule an appointment with one of our providers if you have any questions regarding osteoarthritis or would like to pursue treatment.

Jocelyn Rollins, ANP-BC

1. Center for Disease Control and Prevention, Division of Population Health. (2014, April 4). Osteoarthritis: Risk Factors. Retrieved October 16, 2014, from http://www.cdc.gov/arthritis/basics/risk_factors.htm

2. Fox, A. J., Bedi, A., & Rodeo, S. A. (2009). The Basic Science of Articular Cartilage: Structure, Composition, and Function. Sports Health: A Multidisciplinary Approach, 1(6), 461-468. doi: 10.1177/1941738109350438

Overuse In Sports

Youth sports are booming here in Nashville. More and more children are becoming involved in travel and year round athletics. There also seems to be an evolving trend of young athletes specializing in a particular sport at a much earlier age. With the growing childhood obesity epidemic in America, I believe encouraging physical activity in young people is great. In addition to the physical benefits of athletics, there are many valuable lessons that can be learned by our children. However, there are some things that parents, coaches, and athletes need to understand about overuse and repetitive stress type injuries, particularly growth plate injuries, in order to keep our young athletes healthy and on the field or court as much as possible.

Most people have at least heard of the term growth plate. Simply put, growth plates are areas of cartilage at the end of a bone where the bone lengthens. Due to the fact that these areas of growth are not ossified (have not turned to solid bone) in young and early adolescent children, they can be particularly vulnerable to injury. As children are becoming more specialized at an earlier age this often results in more repetitive forces applied to a particular joint/piece of anatomy without adequate rest. These types of injuries can also occur in young people who are simply very active. An example would be a child who doesn’t play an “organized sport” but is always outside running or playing pick up games with friends. First, parents and coaches must understand that these athletes are not simply “little adults.” Their skeletons are different because they are growing and in some ways this makes them more vulnerable especially right before and during “growth spurts.” Injury occurs when the force that is applied through a particular joint/bone exceeds what the vulnerable physis (growth plate) can tolerate. Symptoms can involve various places throughout thebody, but are often seen in the shoulder, elbow, hip, knee, or foot.

One of the more common growth plate injuries occurs at the knee joint. This is commonly referred to as Osgood-Schlatter Disease. The injury occurs where the patellar tendon (tendon that runs from the bottom of the “knee cap” or patella to the top of the shin bone or tibia) pulls on its attachment to the growth plate at the top of the tibia. Pain associated with Osgood-Schlatter is typically located over the front of the knee. Often, athletes will notice localized swelling or a “bump” at this attachment known as the tibial tubercle. This type of injury can be seen in many sports, but is common where lots of jumping, landing, and/or explosive movements occur.

Growth plate injuries to the shoulder (often called Little Leaguer’s Shoulder) are most often seen in overhead type athletics. These sports include baseball and softball, but sports like volleyball and even tennis can apply the same forces to a young athlete’s shoulder. (Click here to read a post by Dr. Glattes on volleyball injuries and the shoulder.) Typically, the athlete will complain of pain on the outside of the arm over the deltoid or shoulder.

Sever’s Disease is a growth plate injury that occurs on the back of the calcaneus or “heel bone.” This area is where the Achilles tendon attaches to the back of the heel. Young athletes typically complain of pain over the heel, and the heel is often tender to touch. Excessive running, hard fields, cleats that have poor padding, and/or tight calf muscles may contribute to Sever’s. This can become painful enough that the child will complain of pain while walking and not just during sports.

Regardless of the location, the young athlete will often complain of pain that increases with activity. Diagnosis can typically be made with a good physical examination and x-rays to evaluate the growth plate and bone. Often the symptoms will resolve with rest, activity modification, anti-inflammatory medication (i.e. ibuprofen or naproxen), and sometimes physical therapy. If the symptoms are not treated, this can result in prolonged time away from activity or, in extreme cases, surgery. It is important to have your child evaluated by a healthcare provider who is familiar with treating these types of injuries in order to return your athlete to pain-fee participation as quickly and as safely as possible. The evaluation will also rule out any other cause of your athlete’s symptoms.

Remember:
Children are not “little adults” and as our own Dr. Burton Elrod often says, “If it gets where the more you do, the more it hurts, you should back off.” When it comes to overuse and growth plate injuries “no pain, no gain” is not always the best strategy. Call us today at 615-342-0200 for evaluation if you have any concerns about your young athlete.

Stephen Hasselbring, PA-C, ATC

What’s the Deal with Stem Cells?

Stem cell therapy is becoming a hot topic in sports medicine.  Professional athletes have been getting this type of treatment for the past several years.  As these treatments have been discussed in the news media, my patients have started to ask, “Could this be right for me?”  The answer is challenging because this treatment is relatively new in orthopaedic surgery.   We don’t have many clinical trials to help guide our patients into this realm of stem cell therapy.  So, right now we are relying on a few studies, patient feedback, and personal experience of our physicians.

As wetry to figure out if this treatment is right for you, let’s start by defining stem cells.  Stem cells are cells within our body that have the ability to become any other cell.  They could turn into cartilage, bone, muscle, tendon or any other cell type when placed in the right environment   Stem cells are found in our bone marrow, adipose tissue, synovial tissue and blood.   This type of stem cell treatment is called autologous or from our own body.  Other ways to get stem cells are from other people called allogenic.  Today, most allogenic therapy is derived from placental tissue.  The idea behind using stem cell therapy is to put cells that haven’t decided what they will be into an area of injury for a patient.  Then, the body will have more of the tools that it needs in the injured area to promote healing.

In orthopaedic surgery, we also use growth factor therapy, most commonly known as PRP (platelet rich plasma).  Growth factor therapy is different from stem cell therapy.  The growth factors in the blood that recruit stem cells and other healing cells are harvested from the patient’s blood, concentrated, and then delivered to the site of injury.  The idea here is to load up the injured area with the factors that call on stem cells and other healing factors in the body to come over and help heal an injured area.

Both stem cell therapy and growth factor therapy are used in orthopaedics to promote muscle and tendon healing, improve pain and function in arthritic joints, and to augment healing at a surgery site.  At Elite Sports Medicine and Orthopaedic Center, we have all of these treatments available to our patients.  These treatments are not for everyone.  Currently, insurance companies view these treatments as experimental and typically do not cover the cost of stem cell or growth factor therapies.   If you would like more information, one of our physicians will be glad to help you figure out if this treatment is right for you.

Chad T. Price, MD