Podcast 016: Sports Medicine With Dr Bob Sallis

Sports is a unique field. It consists of grown adults or small children tossing equipment around according to made-up rules – and somehow having quite a lot of fun doing so.

That’s why sports medicine is a unique specialty. It deals with the afflictions of active people, often involving acute treatment at the moment of injury, not just chronic overuse.

In this episode, Dr Bob talks about sports medicine, his impactful work and the value of exercise.

Podcast

About the guest speaker

Dr Bob Sallis, M.D., FACSM, serves as the chairman for the Exercise is Medicine initiative and previously served as president (2007-08) of the American College of Sports Medicine (ACSM). Dr Bob received his Bachelor of Science degree from the U.S. Air Force Academy and his medical degree from Texas A&M University. He completed his residency in family medicine at Kaiser Permanente Medical Center in Fontana, Calif., where he served as chief resident. He has served as the head team physician at Pomona College since 1988, and holds a Certificate of Added Qualifications in sports medicine.

Dr Bob lectures and publishes extensively in the area of sports medicine and serves as chairman of the Science Advisory Committee to Governor Schwarzenegger’s Council on Physical Fitness and Sports. He received the 2008 Community Leadership Award from the President’s Council on Physical Fitness and Sports, and the 2009 Leonardo da Vinci award for international leadership in sports medicine from the Italian Federation of Sports Medicine. Dr Bob currently serves as editor-in-chief of ACSM’s clinical journal, Current Sports Medicine Reports.

Music credits

Opening and closing themes by Jim Cook’s computer, an Artificial Intelligence project by the Techlab.

Advertisements

Schober Test

Purpose

The Schober test checks the lumbar flexion range of motion.

Suppose the spine is straight. If it bends forward, like in lumbar flexion, the posterior surface of the back should stretch out to accommodate the movement.

For example, if you have a circle drawn with a thick line, the circumference of the outer side of the line is greater than the circumference of the inner side of the line.

If the posterior back doesn’t stretch out all that much, it means the range of lumbar flexion is limited.

Steps

  • Patient has back facing you
  • Find the level of the posterior superior iliac spine
    • PSIS is roughly at L5-S1 level
  • Make a mark 10cm above that and another mark 5cm below it
    • Memory aid: the higher number is higher up
    • The distance between the points is 15cm
  • Tell patient to touch toes
    • Patient bends over, which is lumbar flexion
  • If the distance between the points is <20cm, there is limited lumbar flexion
    • Alternatively, means the increase in distance from the lumbar flexion movement is <5cm

References

  1. Physiopedia. (n.d.). Schober test. [online] Available at: https://www.physio-pedia.com/Schober_test [Accessed 2 Feb. 2018].
  2. General Practice Notebook. (n.d.). Schober’s test. [online] Available at: https://www.gpnotebook.co.uk/simplepage.cfm?ID=1422917656 [Accessed 2 Feb. 2018].

Thomas Test

Purpose

The Thomas test looks for hip pathology, namely of issues with hip flexor tightness. This is called a fixed flexion deformity.

For example, there could be a problem with the iliopsoas muscle.

Steps

  • Patient is supine on bed
  • Tell patient to bring knees to chest
    • Patient flexes both knees and hips
    • But not excessively so, otherwise it could give a false positive result
  • Lower one leg straight onto the bed
    • If the thigh is on the bed, it is a normal result
    • If the thigh is off the bed, the patient has a fixed flexion deformity of that side

References

  1. Patel, M. (2011). Thomas test. [online] OrthopaedicsOne. Available at: https://www.orthopaedicsone.com/display/Main/Thomas+test [Accessed 31 Jan. 2018].
  2. Physical Therapy Haven. (2018). Thomas Test. [online] Available at: http://www.pthaven.com/page/show/157779-thomas-test [Accessed 31 Jan. 2018].
  3. General Practice Notebook. (n.d.). Thomas’ test. [online] Available at: https://www.gpnotebook.co.uk/simplepage.cfm?ID=120913935 [Accessed 31 Jan. 2018].

The Point Of Stretching

Muscles are a grand amalgamation of thin actin, thick myosin, calcium ions binding to troponin, tropomyosin and Z-lines. They require ATP to be relaxed and use ATP when they undergo contraction.

Stretching helps realign and lengthen muscles to prevent them from being tight and easily injured.

How are muscle contractions triggered in the first place?

Motor neurons use the neurotransmitter acetylcholine to send messages to muscles, prodding them into action. This causes the in-flow of sodium ions, propagating the action potential onward through the muscles. In turn, this invokes the release of calcium ions inside the cells.

The calcium binds to troponin and the obstructive bits move out of the way, allowing actin and myosin to meet for a sweet, brief moment. This is cross-bridge cycling

References

  1. Biology Stack Exchange. (2015). How is ATP involved in muscle contraction?. [online] Available at: https://biology.stackexchange.com/questions/31323/how-is-atp-involved-in-muscle-contraction [Accessed 26 Jan. 2018].
  2. Anon, (n.d.). Muscle Fiber Contraction and Relaxation. [online] Available at: http://oerpub.github.io/epubjs-demo-book/content/m46447.xhtml#fig-ch10_03_01 [Accessed 26 Jan. 2018].
  3. The MIT Tae Kwon Do Club. (2008). STRETCHING AND FLEXIBILITY – Physiology of Stretching. [online] Available at: http://web.mit.edu/tkd/stretch/stretching_2.html#SEC13 [Accessed 26 Jan. 2018].
  4. Harvard Health Publishing. (2013). The importance of stretching. [online] Available at: https://www.health.harvard.edu/staying-healthy/the-importance-of-stretching [Accessed 26 Jan. 2018].

American Compact Disc

Colles and Smith fractures are both fractures of the distal radius.

Colles fracture

  • Dorsal angulation of the fractured fragment
  • Memory aid: CD

Smith fracture

  • Volar angulation of the fractured fragment
    • Volar means palmar
  • Memory aid: VS almost looks like US, which is quite American

And that’s how an American CD is made.

References

  1. Luijkx, T. and Desai, P. (2018). Colles fracture. [online] Radiopaedia. Available at: https://radiopaedia.org/articles/colles-fracture [Accessed 15 Jan. 2018].
  2. Luijkx, T. and Gaillard, F. (2018). Smith fracture. [online] Radiopaedia. Available at: https://radiopaedia.org/articles/smith-fracture [Accessed 15 Jan. 2018].

You Can’t Lose Fat In A Specific Place If You’re Fat All Over

Scientific research doesn’t support the idea of losing fat from a particular place. This is also known as spot reduction. It is a lie.

Working out a particular muscle area doesn’t dissolve the fat from that region by priority. Rather, a person’s distribution of fat is determined by the mysterious workings of their body. To reduce fat in a specific spot, overall fat has to be reduced.

This doesn’t render targeted exercises useless; what you can do is build and tone a particular muscle group. It means the muscle grows in that place but the fat doesn’t necessarily disappear from it.

Summary

Muscle is an obedient dog. Muscles respond to directed exercise; bulk and tone happen in the places where you exert yourself.

Fat is a lawless cowboy. It cannot be tamed. In contrast to muscle, fat is wild and runs free; it has a secret agenda and reduces according to an overall body distribution plan.

Recommendations

Your problem then becomes that of losing fat overall.

The solution? It’s the usual: diet and exercise.

Eat less. Use portion control. Be less of a hog. Consume protein, fat and carbohydrates in a healthy ratio. Protein:fat:carbohydrates at 20:20:60 is a simple, approximate guide.

Exercise more. Make sweat. Jump around. Burn energy. Go to a gym.

References

  1. Healthline. (2018). Is It Possible to Target Fat Loss to Specific Body Parts?. [online] Available at: https://www.healthline.com/nutrition/targeted-weight-loss [Accessed 12 Jan. 2018].
  2. Yale Scientific Magazine. (2011). Targeted Fat Loss: Myth or Reality?. [online] Available at: http://www.yalescientific.org/2011/04/targeted-fat-loss-myth-or-reality/ [Accessed 12 Jan. 2018].
  3. Nutrient Reference Values for Australia and New Zealand. (2017). Recommendations to Reduce Chronic Disease Risk. [online] Available at: https://www.nrv.gov.au/chronic-disease/summary [Accessed 12 Jan. 2018].

Sprains Versus Strains

Nobody cares about Marvel versus DC. It’s Marvel, by the way; superheroes who wear their underwear on the outside automatically can’t win.

No, what people care about are confusingly similar medical terms that mean almost the same thing.

Enter the arena: sprains and strains.

Sprain

  • Stretch or tear of a ligament
    • Ligaments connect bone with bone
    • LBB, which is almost LLB, which stands for Bachelor Of Laws if you have any legal-minded friends
  • Memory aid: sprain doesn’t have a t in it, so it refers to the one that’s not about tendons

Strain

  • Stretch or tear of a muscle or tendon
    • Tendons connect muscle with bone
    • TMB, as in too much bother, which is sometimes the case with all this intellectual medicine business
  • Memory aid: strains correlate with tendons, which are related to muscles

Initial treatment

  • RICE for the first 48 hours
    • Rest
    • Ice
    • Compression
    • Elevation
  • Analgesia
    • Paracetamol
    • Then consider NSAIDs if pain persists
  • Movement
    • Early mobilisation and passive movement as soon as pain allows it

References

  1. Mayo Clinic. (2017). Sprains and strains – Symptoms and causes – Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/sprains-and-strains/symptoms-causes/syc-20377938 [Accessed 26 Dec. 2017].
  2. Acute pain: minor trauma [revised 2015 Feb]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.