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[MUSIC PLAYING]

JEFF BRAULT: Welcome to Simply PM&R, a Mayo Clinic Talks production. A simple solution for PM&R healthcare physicians who want to keep up while on the go. I'm your host, Dr. Jeff Brault, physiatrist in PM&R at the Mayo Clinic.

Sports medicine is a dynamic, quickly emerging and expanding subspecialty within physical medicine and rehab. There are many physiatrists, however, who don't truly understand the practice of sports medicine.

Today, we're joined by Dr. Cara Prideaux, a colleague at Mayo Clinic and a physiatrist in physical medicine and rehabilitation and a consultant in sports medicine. Welcome, Cara.

CARA PRIDEAUX: Hello. Thank you. Happy to be here.

JEFF BRAULT: So what is sports medicine? What is sports rehabilitation?

CARA PRIDEAUX: So we are physiatrists, physical medicine rehab specialists, who have the goal of working with our athletes at any age, any activity level, whether that's the professional level or just the weekend warrior. And our goal is to provide non-operative treatment for their musculoskeletal injuries, their pain, including joint, bone, muscle, tendon, ligaments.

And our goal is to help restore their movement and function, optimize their performance in their athletic endeavor, and also to reduce their risk of reinjury. And we work with a team of specialists including athletic trainers and physical therapists. And we do a detailed evaluation diagnosis and treatment intervention just to help them stay active in the sport or activity they want to do.

JEFF BRAULT: So I lift the weights a couple of times a week. Am I considered a sports medicine patient if I would get hurt?

CARA PRIDEAUX: For sure. We are ready to treat any patient who is active or even a patient who is not active and wants to be active. So maybe they're limited by something and they can't do the activities they want to do. So anything that's limiting them, or even if they're not hurting and they just want to enhance their performance, we're happy to see them and help them out as well.

JEFF BRAULT: So what are some of the common conditions seen by a sports medicine specialist?

CARA PRIDEAUX: Great question. We see a lot of different things, but I would say some of the most common things these days include concussion, tendonitis, so whether that be a shoulder tendonitis including the rotator cuff, an elbow tendonitis like tennis elbow.

Sprains, so ankle sprains, knee sprains, or ligament tears, like an ACL tear. Muscle strains like straining your hamstring. Bone stress injuries, like a stress fracture.

Patella femoral pain is a common condition we see in the knee. Plantar fasciitis. So any body part, any problem. But those are the most common ones.

JEFF BRAULT: You know, one of the things that we notice about athletes is they want to get back to doing what they do. Whatever the sport is, they want to get back. Someone coming off an injury, how do you counsel them that maybe it's not the best time to go back, and modify their activity? Working towards the goal of getting back to their sport?

CARA PRIDEAUX: Yeah, that's always a tough discussion. You know, their goal is to get back as soon as possible. But we have discussions about doing a gradual return to their activities and making sure that we don't miss any steps in that gradual return process, because that may put them at risk for reinjury.

So we have that discussion, and it's variable with every specific injury, every specific athlete, and every specific sport that we're returning them to. So it has to be an individualized program.

But some of the things we look for, make sure that we've got adequate control of their pain, and that we restore full, pain-free range of motion, full, pain-free strength, and make sure that they're progressing well through their rehab program.

And then gradually reintroducing their sport-specific or activity-specific activities. For example, running and throwing with good mechanics.

JEFF BRAULT: OK. Concussion has been a big topic in sports right now.

CARA PRIDEAUX: It sure is.

JEFF BRAULT: I read 3.8 million concussions annually in the United States, most of them sports-related. Which sports seem to have the highest occurrence of concussion?

CARA PRIDEAUX: Another great question. So any activity, whether it's sports-related not, you're at risk for potentially having a concussion.

But we think that the higher risk sports and activities are those with contact and high impact. So for example, American football, rugby, ice hockey. Other sports that we commonly see with concussions are soccer, lacrosse, wrestling, basketball.

But we've certainly seen every sport have a concussion. Those are some of the more common that we see.

JEFF BRAULT: What are the long term ramifications of having a concussion, especially repetitive concussions?

CARA PRIDEAUX: So there's certainly a lot that we've learned about that, but certainly a lot we still don't know. But there's a lot of information about Chronic Traumatic Encephalopathy, and that's the main concern. Some people seem to develop symptoms that could be consistent with that, and some people don't.

So there's probably some underlying genetic factors that we don't fully know about at this point. Right now, that Chronic Traumatic Encephalopathy is a post-mortem diagnosis, but it's a good area that we need to keep researching and learning about.

But a discussion that we need to have patients that have recurrent concussions, say, this is what we know, and this is what we don't know.

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JEFF BRAULT: Today's episode was sponsored by Mayo Clinic Online CME, offering on-demand demand medical education in a wide variety of specialties. This includes the Physical Medicine and Rehabilitation Online Board Review course. Enter your Boards with confidence, whether it's your first time through or for recertification.

Learn on your own time and earn credit. Register today at ce.mayo.edu/pmrbronline.

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JEFF BRAULT: You know, as a physiatrist, I used to work the sidelines at some of the high school athletics. And I'm always wondering what the latest test was, or sideline test for concussion was? What is the latest sideline concussion test?

CARA PRIDEAUX: So the best sideline test is going to be one that we can compare to a pre-injury test. So we want to see if there's any differences between how they perform that test before a potential injury and then after a potential injury. And if there's been any decrement in their performance, then that could be suggestive of a concussion.

So the things that we do here at Mayo Clinic-- of course, there's always a clinical evaluation, whether that be by a physician on the sidelines or one of our skilled athletic trainers. There's always a clinical evaluation.

We always go through a graded symptom checklist. So we want to know if they have any of those common symptoms that we associate with concussion. We do a mental status test. The particular one we do is Standardized Assessment of Concussion, and it looks at orientation, memory, concentration, those sorts of things, that can be altered from a concussion.

We also do the King-Devick Test, which is a test that's rapidly performed and can do it on the sideline. It assesses eye movements, ocular motor dysfunctions, saccatic dysfunction, which is-- if those things are abnormal, that can indicate suboptimal brain function as well.

And then we often do some sort of balance test, because, especially early on, the balance can be impacted in a concussion.

JEFF BRAULT: You mentioned pre-injury tests. What type of pre-injury tests are we doing?

CARA PRIDEAUX: These pre-injury tests, or what we call baseline tests, are the same ones. So--

JEFF BRAULT: Oh, OK.

CARA PRIDEAUX: You do the same tests before and after, so that you can see what their performance is like and make sure if they do worse on the test after an injury, that could be indicative of an injury.

JEFF BRAULT: So we have-- this is a true case. You have a high school football player with a concussion that requires him to leave the game. How and when do you return him to play? Because you know, some of these young men, they want to get out there and play. How do you counsel them?

CARA PRIDEAUX: They sure do. They want to get back to play as soon as possible. So one thing that I want to see is that they tell me they feel back to normal. So of course, that's a very subjective thing. But I want them to tell me that they feel 100%.

Sometimes they'll tell me they feel 99% and I say, well, what's that one percent that's keeping you from saying you feel 100? So I like them to tell me they feel back to normal, 100%.

Ideally their symptom checklist will be back to a zero as well. And I want to see that they're tolerating cognitive activity, particularly in this age group. Work at school, see that they're tolerating that activity without accommodations, without any increased symptoms.

I want to see that they're tolerating some degree of physical activity. So non-contact physical activity, light, low-risk physical activity. To see that they're tolerating that without any increased symptoms is really reassuring.

And then, of course, all that concussion testing we want to repeat. Hopefully compare it to a baseline, if that's available. And see that they've returned to their baseline, or even better than their baseline.

So those are the main things that I look at in regard to giving them clearance. And once we clear them, it's not like they can just go right back and play a game. So there's a gradual return to play protocol that we do, where we gradually increase their physical activity.

You know, starting with just some light physical activity and then adding some sport-specific activity, and then having them do a non-contact and then a contact practice. And then being ready to get back to playing in a competitive scene at that point.

CARA PRIDEAUX: How long does that take? What do you usually counsel them how long that process is going to take?

CARA PRIDEAUX: So it's not uncommon-- again, do this with your physician's guidance-- but it's not uncommon for us to start levels 2 and 3, the pre-contact levels, before they're even fully asymptomatic, as long as it's not making their symptoms worse. But the typical protocol that we use is probably a five-step protocol if you're not including the rest that we do for the first couple of days.

JEFF BRAULT: OK. Does it change at all if it's a non-impact sport? Do you clear any differently?

CARA PRIDEAUX: Every situation is individualized, but we still have to go do all the concussion testing, and we still have to have them go through a gradual return to play. So it'll look a little different based on their specific sport, because we can't really have a track and field athlete participate in a contact practice, so it'll look a little different.

We work with our athletic trainers to make it applicable to their specific sport.

JEFF BRAULT: We've been talking about sports medicine with Dr. Cara Prideaux, a colleague at Mayo Clinic and a physiatrist interest in physical medicine and rehabilitation, who also spends a good deal of time in our Sports Medicine Clinic. Thanks for your time, Cara.

CARA PRIDEAUX: Thank you. I appreciate it.

JEFF BRAULT: Are you a physiotherapist preparing for your upcoming PM&R Part II Oral Boards? Do you need to brush up on your examination skills? Through a combination of didactic lecture, case vignettes, optional mock oral examinations, and online modules, the PM&R Board Review Course can help guide your preparation.

This vital course will be held on the historic Mayo Clinic campus in downtown Rochester, Minnesota every spring, just prior to the American Board of Physical Medicine and Rehabilitation oral examinations. For complete course information and to receive an email and registration is open, visit ce.mayo.edu/pmr.

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Sports medicine

Guest: Cara C. Prideaux, M.D.
Host: Jeffrey S. Brault, D.O. (@JeffBrault)

Sports medicine is a distinct medical specialty combining modalities from several other specialties. What exactly is sports medicine and who can be seen in a sports medicine clinic? What testing should be performed at the sideline at the time of injury? Cara C. Prideaux, M.D., answers these questions and discusses when and how to get athletes back into their preferred physical activity after an injury.

Connect with Mayo Clinic's Department of Physical Medicine and Rehabilitation on Twitter @MayoClinicPMR.

Connect with Mayo Clinic School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.


Published

April 21, 2020

Created by

Mayo Clinic