Sport medicine, Part 2: Treatment (Guest editorial)

This is the second issue of the BC Medical Journal with a focus on sport medicine. The articles in the first issue addressed training topics, while the three articles in this issue focus on treatment. The person on the street would likely envision the sport medicine physician as one of the people assessing an injury at a football or hockey game or some other athletic endeavor, usually involving athletes performing at a highly competitive level. While this is a role for a few sports physicians, most find themselves dealing more with the weekend warrior and the fitness enthusiast. The level of competition may differ, but the injuries are the same. Sport medicine physicians deal with the treatment of acute, chronic, and overuse injuries. We also deal with acute and chronic medical challenges that are caused or exacerbated by exercise or that inhibit or stop the person from exercising. While prevention is the goal, treatment is often the reality.

New treatments are introduced to physicians at an astounding rate. There is a need to be up-to-date, since today’s patients will have read about the latest treatment in the newspaper, seen it on television, or researched it on the Internet. Sport medicine is no stranger to new treatments, tools, protocols, or equipment. Many injury patterns have changed over the past two decades due to such things as ski boots, ski bindings, bike helmets, and changes in running shoes. Arthroscopic surgery, non-steroidal anti-inflammatory medication, and ultrasound are but a few of the innovations employed in sport medicine. The use of MRI, CT scan, bone scan, and ultrasound in investigation has allowed us to see the injury, where before (without surgery) we could only feel it.

In treating injuries it is valuable to have a strong understanding of function, physiology, and anatomy. In the article on the role of the anterior cruciate ligament (ACL) in functional stability of the knee joint, the author discusses the neurophysiology of proprioception, the function of the ACL, some consequences of ACL injuries, surgical reconstruction, and the importance of neuromuscular training on outcome.

Sports that involve a great deal of jumping and running have a high prevalence of patellar tendinopathy (or jumper’s knee), the subject of the second article. This is an overuse injury caused by repeated mechanical stress on the patellar tendon. Patellar tendinopathy has been treated with numerous conservative methods, but none has proven highly successful in allowing full and painless return to activity—and surgical intervention has also had limited success. The use of extracorporeal shock wave therapy (ESWT) to treat calcific shoulder tendonitis, lateral epicondylitis, and calcaneal spurs has been well researched. The Sonorex referral facility in Vancouver gave us the opportunity to test the efficacy of ESWT in the treatment of patellar tendinopathy.

The third article addresses a medical condition that can be challenging to both diagnose and to treat: exertional dyspnea. Three causes, exercise-induced asthma, vocal cord dysfunction, and pulmonary embolism are discussed. Both environmental and pharmaceutical treatments are covered. In elite athletes who undergo drug testing, there are protocols that must be followed since some drugs are banned and others are permitted but must be documented. The authors have provided a table with the current information.

I was honored to be the guest editor for these two editions of the BC Medical Journal.

—Jack Taunton, MD
Director, Allan McGavin
Sports Medicine Centre