Sports Medicine

A 30-year-old male presents with a one-year history of worsening lower back pain and alternating buttock pain. He mentions his symptoms are typically worse first thing in the morning, but seem to remit later in the day with NSAIDs and exercise. Physical examination reveals swelling of the proximal interphalangeal joints of several digits, restricted lumbar movement, and tenderness of the sacroiliac joint. An X-ray demonstrates the findings seen here. Which of the following extra-articular clinical manifestations is most commonly associated with this patient’s condition?

A) Blurred vision
B) Right lower quadrant pain
C) Plaques with silver scale
D) Shortness of breath

Click here for answers to this clinical conundrum. 

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The Myths of Dehydration and Heat Illnesses

• The primary cause of hyponatremia in athletes is drinking too much water.
• The incidence of hyponatremia appears to be between 13% and 15% among endurance athletes.
• Gender and the duration of athletic activity appear to be predictors of the incidence of hyponatremia.
• Sodium supplementation has no effect on the occurrence of hyponatremia.
• There seems to not be a single case of death resulting from sports-related dehydration in the medical literature.

• Surgical meniscus repair was not superior to sham surgery in a randomized, controlled trial.
• Non-surgical care of meniscus-injury related pain, such as exercise, was equally or more effective than surgical interventions.
• Approximately 700,000 arthroscopic partial meniscectomies are performed annually in the U.S.
• Annual direct medical costs are estimated at $4 billion.
• Physicians and patients should consider all non-surgical options before undertaking surgical intervention for knee pain related to meniscus injury.

• People who exercised showed cognitive improvement compared with those who didn't exercise.
• Researchers found a time threshold for exercise efficacy in cognitive improvement.
• All study patients showed mental decline caused by mild subcortical ischemic vascular cognitive impairment.

• The hugely popular commercial sports drinks have no effect on performance or muscle cramping.
• The only potential performance benefit of drinks like Powerade or Gatorade may be the sugars they contain.
• There are no scientific data to support the efficacy of low-dose electrolytes in boosting performance.
• No data exist to support the notion that electrolytes (at the dosages in the commercial drinks) prevent muscle cramping.
• Evidence appears to support the “altered neuromuscular control” hypothesis as well as other causes and solutions.

The Myths of Dehydration and Heat Illnesses

• The primary cause of hyponatremia in athletes is drinking too much water.
• The incidence of hyponatremia appears to be between 13% and 15% among endurance athletes.
• Gender and the duration of athletic activity appear to be predictors of the incidence of hyponatremia.
• Sodium supplementation has no effect on the occurrence of hyponatremia.
• There seems to not be a single case of death resulting from sports-related dehydration in the medical literature.

• Anterior cruciate ligament (ACL) injury affects as many as 250,000 individuals in the U.S. annually, resulting in an annual health care cost exceeding $2 billion.
• Women suffer ACL tears at 3x the rate of men.
• Multiple reviews have found minor differences between single-bundle versus double-bundle surgical reconstruction techniques.
• Analysis included 240 full-text articles.

• Runners who strike with greater force, increased vertical impact peaks, and increased vertical load rates have a higher risk for injuries requiring medical attention.
• Higher impact forces at landing increased the risk of bony and soft tissue injuries.
• Runners who have never been injured had the lowest impact loading of all studied groups.
• Vertical average loading rate was the strongest predictor of injury risk.

When a patient asks whether it makes sense to use chondroitin for osteoarthritis, the following are appropriate responses:

1. It may moderately reduce the pain in your knee.
2. Consider the cost.
3. Try a variety of therapies before you settle on one.
4. Over-the-counter analgesics can also be effective, as can physical therapy, weight loss, and exercise.

The Myths of Dehydration and Heat Illnesses

• The primary cause of hyponatremia in athletes is drinking too much water.
• The incidence of hyponatremia appears to be between 13% and 15% among endurance athletes.
• Sodium supplementation has no effect on the occurrence of hyponatremia.
• There seems to not be a single case of death resulting from sports-related dehydration in the medical literature