For the past 20 years, the Clinical Journal of Sport Medicine has been providing information about multidisciplinary topics in sport medicine to its audience. Over that time, there has been growth throughout the field in many areas. Sport medicine has been traditionally considered as the treatment of musculoskeletal injuries in athletes by many. In 2011, the field of sport medicine is considered widely inclusive with a multitude of clinicians and researchers from diverse backgrounds engaged in the field. The issues important to all involved in sport medicine and research have grown over the past 20 years as well. As an example, in the first edition of the Clinical Journal of Sport Medicine in January 1991, the topics highlighted included the benefit of prophylactic knee bracing, safety of exercise testing, criteria for return to play (RTP) after a cervical spine injury, evaluation of lateral elbow pain in athletes, and clinical evaluation of shoulder instability. In this thematic issue, we have tried to capture a variety of issues that are relevant to those involved in sport medicine in 2011. The hope is that these reviews will provide excellent data and a stimulus for continued research and advancement in clinical practice for the topics presented.
In 2011, the leading cause of death of an athlete on the playing field is sudden cardiac death. Cardiovascular screening is almost universally recommended by all sport governing bodies and most sport leagues for athlete participation. This evaluation includes a detailed history and physical examination, but controversy exists regarding the use of the electrocardiogram (ECG) as a required element of this cardiovascular clearance. In the United States, the American Heart Association does not endorse the use of ECG in cardiovascular clearance, whereas other organizations, such as the European Society of Cardiology, do endorse the use of ECG. In separate reviews, 2 groups of experts (Drezner et al and Borjesson et al) have examined and interpreted the best evidence for the use of ECG in cardiovascular clearance for the athlete. These reviews not only note the best medical evidence but also provide insight into many of the issues of ECG use and provide an evidence-based foundation for recommendations.
An area of increasing debate in sport medicine is the risk of concussion in sport and the long-term consequences after multiple concussions in the athlete. This is very prominent in the media with intense scrutiny examining youth to professional athletes and the risk of concussion. McCrory has provided an evidence-based review of data available for the past 50 years examining the risk of concussion and chronic neurological impairment.
Physical activity is widely recognized as beneficial in the prevention and treatment of many diseases and health conditions. The American College of Sports Medicine has endorsed a major initiative regarding this principle titled “Exercise is Medicine.” As Batt and Tanji point out, physicians trained in sport medicine have been recognized as having a major ability to provide input into the management of chronic diseases and musculoskeletal ailments. The role of exercise in areas outside of sport is examined in this review.
Exercise-induced asthma (EIA) and exercise-induced bronchospasm (EIB) are among the most common medical conditions encountered in athletes. The treatment of EIA and EIB often begins with the use of an inhaled beta-2 agonists. Although beta-2-agonists are often standard treatment, McKenzie and Fitch point out the potential for the use of inhaled beta-2 agonists for improved sport performance and as a potential agent of doping. Their review offers a current observation of the use of beta-2 agonists for the treatment of disease versus performance-enhancing agents. Additionally, they examine the current state of therapeutic use exceptions and pharmacologic management as directed by the World Anti-Doping Agency.
Platelet-rich plasma (PRP) is a growing treatment for a multitude of sport injuries. The use of PRP has been applied to various conditions including ligament, tendon, and muscle injuries. Paoloni et al note that although there is some scientific basis for the potential benefit for the use of PRP in these situations, there are little good clinical outcome data for PRP use. These authors provide the current evidence for the use of PRP in ligament and tendon injuries and point out the need for further defining the best clinical protocol for PRP use. Furthermore, Hamilton and Best examine this issue in a systematic review using EMBASE and MEDLINE for the use of PRP as a treatment for muscle injury. As they suggest, although this therapy may be widely used by physicians treating athletes, more research is needed to optimize the use of PRP in muscle injury.
At present, sport medicine continues to examine the role of technology in the specialty and its appropriate uses. Ultrasound has been used by many sport medicine clinicians for the diagnosis of musculoskeletal conditions and with procedures such as joint injections. Coris et al examine the current use of ultrasound by the sport medicine physician and the potential for future use in diagnostics and treatment considering optimizing care, cost containment, and data interpretation.
Sport has evolved to include many international events, and athletes are traveling now more than ever for competition. Pipe has suggested that not only does this travel expose athletes to health risks outside of their native country but the performance of the athlete can also be affected by multiple factors involved in international travel. In this review, preparation for travel, including vaccinations and immunizations, are discussed. Common conditions for the traveling athlete are also reviewed including jet lag, gastrointestinal issues, and altitude sickness. Finally, equipment and supplies along with event planning strategies are presented to help minimize problems with international travel for the elite athlete.
The coordination of large international events can pose certain public health risks to athletes, staff, and those who live in the area hosting the event. In 2010, Vancouver, Canada, was the host site for the Winter Olympic and Paralympic Games. Daly and Gustafson have described the challenges faced from a public health standpoint from hosting these events. Their review provides a guideline for the issues that public health officials face when hosting an international athletic event.
Hip pain is a common complaint for many athletes and femoroacetabular impingement (FAI) has been more recently implicated as a common etiology. The pathomechanics, diagnosis, and treatment (conservative and surgical) for FAI are continuing to be elucidated. Ellis et al have performed a literature review to discuss the best evidence for the diagnosis and treatment of this emerging condition. As they note, there is still more evidence needed to determine the natural history and the results of early treatment for FAI.
When an athlete is injured, many times, the first question raised is when the athlete will RTP. Often, the answer is predicated on the individual situation and the clinician treating the athlete. Many have questioned the best model for making RTP decisions for the athlete and whether standardization is needed when making these RTP decisions. Matheson et al discuss this standardization in medical care when making RTP decisions and examine evidence for a model regarding the standardized RTP. A discussion of who should make the RTP decision is also addressed.
The understanding of study design and their results (statistics, probabilities, etc) is the basis for evidence-based medicine. Although there may be differences in the best type of study design to answer a question and in the interpretations of study results, the authors of the reviews in this thematic issue are to be commended for their efforts to provide the best evidence on these various topics. I would like to thank the authors for their efforts in this thematic issue and for the guidance of the previous thematic issue editor, Thomas M. Best, MD, PhD, in coordinating this thematic issue. I hope you enjoy this thematic issue concerning emerging issues in sport medicine and look forward to your comments and feedback.