Medical Matters

The 2018 USMST Congress on Health and Sport took place on February 9 and 10, 2018 at the Renaissance Hotel, Long Beach.  This year’s Congress, part of the Physicians Soccer Summit, brought together outstanding speakers attending the PSS along with over 60 physician attendees from around the country.  The Congress, co-sponsored by University of California – San Diego, awarded CME credits and was a great way to start each day prior to the soccer competition.  Dr Suraj Achar, an attending physician at UCSD, was the Congress chairman and put together an outstanding, unique educational program.                                               Congress Agenda and Objectives Day 1:  February 9, 2018 Injury Prevention and Treatment 1)“The Evolution of Soccer/Football Footwear: Strategies to Prevent Soft Tissue Tegumentary Injuries” David Machado, MD 2) Elite athletes in adolescence: unique challenges for the pre-teen and teenager. Chris Grybauskas, MD 3) Balance in the aging athlete Hernan Goldstein MD 4) The effect of Age on Ankle fractures Sam Frankel MD 5) Common core and its connection to injury Jeff Madachy, DO Day 2 8-10 am Saturday, February 10, 2018 Injury: Evaluation and Treatment   1) Turf vs Grass: Cost of Fields Vs. Cost to Athletes Dave Mitzman MD 2)Risk for Acute Kidney Injury in Sports Juan Carlos Velez, MD 3)Adductor Injuries in Soccer JP Valette, MD UCSD family medicine resident 4)Vascular Injuries in Sport Suraj Achar MD 5)Happiness Based Medicine — A Shift in Mindset for Improved Patient and Physician Satisfaction Garrett S. Hyman, MD Faculty and Course Objectives Day 1 David Machado, MD, FACS Assistant Professor of Surgery Co-Director Trauma Burn Intensive Care Unit Division of Acute Care Surgery University of Michigan Health System “The Evolution of Soccer/Football Footwear: Strategies to Prevent Soft Tissue Tegumentary Injuries” 1) We will perform a brief review of the anatomical structures of the foot and ankle and their soft tissue coverage 2) We will review the changes of professional footwear over time and revise their relationship to injury 3) We will review different strategies to prevent injuries to skin and its appendages and other foot soft tissues Chris Grybauskas, MD Pediatric Hospitalist, Johns Hopkins University School of Medicine Department of Pediatrics, Division of Quality and Safety Medical Director, Pediatric Clinical Care and Research Unit (9 North) 1800 Orleans Street, Bloomberg 9411 Baltimore, MD 21287 Cgrybau1@jhmi.edu Elite athletes in adolescence: unique challenges for the pre-teen and teenager. 1. Participants will learn the biological and psychosocial limitations of adolescents, especially in the context of elite athletic competition. 2. Participants will learn from the failures of specific cases. 3. Participants will learn some common features of successful elite athletes under 18yo Hernan Goldstein MD Otology Neurotology Pacific ENT Medical Group Balance in the Aging Athlete At the end of this presentation the attendant will be able to: 1) Describe the changes that occur in balance as the human body ages. 2) Explain the impact that these changes have on the athlete 3) Elaborate at least 3 strategies to decrease chances of injury. Sam Frankel MD Georgetown Medicine 2016, UCSD Emergency Medicine 2020 The effect of Age on Ankle fractures 1) age has a linear effect on the rate of ankle fracture. 2) This effect has a peak at 40 years old 3) Further research will look into other co founders Jeff Madachy DO Clinical Assistant Professor Family Medicine Ohio University Heritage College of Osteopathic Medicine Columbus, Ohio “Common core and its connection to injury” Learning objectives Discuss the abdominal core Core strength and connection to injury Effect of training on injury prevention Day 2 Dave Milzman, MD Associate Dean for Innovation and Student Research Professor of Emergency Medicine Georgetown University School of Medicine Turf VS Grass as playing surface in Soccer: Cost of Fields VS. Cost to Athletes 1. Cost of natural grass fields in most colleges has become prohibitive. Know the basic advantages and disadvantages of turf 2. Understand the mechanism of ankle and knee sprains on turf and grass 3. Understand the differences in injury prevalence with NCAA Soccer compared with other collegiate sports. Juan Carlos Q. Velez, M.D. Associate Professor, Ochsner Clinical School / The University of Queensland Interim Chair, Department of Nephrology, Ochsner Clinic Foundation Adjunct Associate Professor of Physiology, Tulane University School of Medicine @VelezNephHepato / juancarlos.velez@ochsner.org Risk for Acute Kidney Injury in Sports 1. To recognize the potential risk of kidney injury associated with strenuous exercise 2. To identify sport-related scenarios that carry a risk for rhabdomyolysis 3. To familiarize with the mechanisms of nephrotoxicity of drugs consumed by athletes JP Valette MD UCSD school of Medicine 2016, UCSD department of Family Medicine and Public Health 2019 Adductor Injuries in Soccer 1) review anatomy of the adductors 2) Understand diagnosis of adductor injuries 3) understand treatment of adductor injuries Suraj Achar MD, FAAFP, CAQSM Clinical Professor of Family Medicine and Public Health University of California, San Diego, School of Medicine Team Physician San Diego Sockers, UCSD Tritons Hidden Danger: life threatening clots in athletics! How do we miss vascular injuries? Why do athletes get clots? Primary and secondary prevention Garrett S. Hyman, MD, MPH, FACSM, FABPMR, CAQSM Lake Washington Sports & Spine www.lakewass.com www.seattlesoccermedicine.com “Happiness Based Medicine — A Shift in Mindset for Improved Patient and Physician Satisfaction” Learning objective #1: The learner will be able to define happiness in operational terms that allow for measurement and goal setting Learning objective #2: The learner will be able to identify systemic barriers to incorporating happiness into their clinic, and will be able to utilize tactics to overcome them Learning objective #3: The learner will be able to learn three specifics tactics for training their staff in how to incorporate happiness into their clinic on a daily basis

A record four members of the US Medical Soccer Team presented at the 2014 Global Congress on Medicine and Health in Sport in Natal, Brazil this year.  The Congress featured an incredible array of informative talks related to sports and medicine from the participating physician athletes from around the world.  Team USA presented as follows: Brian Blair, MD:  Platelet Rich Plasma – Current Concepts                 Emiliano Chavira, MD:  Exercise in Pregnancy                 Felipe Lobelo, MD:  Football and Population Health:  Is There a Connection?                 Jerry Sterkowicz, MD:  People Like Us – Heart Disease in Athletes                 Every presenter from USMST was outstanding and made the 2014 Global Congress on Medicine and Health in Sport one of the most memorable to-date!

The 19th Global Congress on Medicine and Health in Sport took place at the Ramada Aquaworld Resort in Budapest, Hungary from June 29, 2013 to July 7, 2013. The Congress ran in conjunction with the 19th World Medical Football Championships, with participants from around the world. The speakers chose topics pertaining to medicine and sports, with topics ranging from orthopedics to emergency medicine to nutrition. Highlights included an excellent talk by Dr David Eberhard from Sweden entitled, “Child rearing – what can we learn from a football pitch?” where he examined critical issues in the psychology of child rearing with parallels to soccer. Dr V. Zolnai from Hungary had an excellent presentation on stretching, flexibility and muscle tension that the attendees found incredibly valuable, especially in the closing days of the tournament. Finally, Dr Aleksandr Khaidin discussed first responder medical care for trauma and cardiac arrest on the soccer field which was well-received. From the US Medical Soccer Team, Dr Gautam Nayak gave a talk entitled “Physical Activity in Heart Failure: Is Exercise Medicine?”. He examined the basics behind exercise physiology, the changes occurring in patients with heart failure, and the data behind the benefits of exercise in this sick patient population. By reviewing the data on patients in heart failure, Dr Nayak showed the benefits of exercise in terms of quality of life, cardiovascular mortality and hospitalization, as well as cost. He hoped to use this talk as a springboard to motivate others to give similar talks pertaining to the benefits of exercise in different patient populations at future Congresses. Overall, the 19th Global Congress was a success on many levels. By encouraging a strong professional collaboration between participants of the World Medical Football Championships, the competitiveness on the pitch was enhanced by sharing medical knowledge in an interactive and enjoyable setting.

I know you’ve been wondering…When should I use ice and when I use heat in an injury?  The rule of thumb is:  if an injury is acute (less than 72 hours old), ice it!  Never apply heat to an acute injury, no matter what part of the body is injured.  If the injury is older than 72 hours, but there is still significantly swelling, use ice. Don’t ice an injury before a workout – it diminishes circulation in the affected area and can predispose to further injury.  If there is no swelling or if there is just tightness or soreness from a previous workout, you can use moist heat to the area, before a workout.  You can use ice immediately following a workout on an injury – old or new – for as long as it’s painful or swollen. A little disclaimer – if you have circulatory problems like Raynaud Syndrome, you should cautious where applying ice or cold compresses. So when is it appropriate to use heat?  As mentioned before, you can use heat before a workout in a non-acute injury.  But, you can also use heat on an old injury if it involves an area with muscle spasm or tightness.  Use a moist heating pad or pack, for about 10 to 15 minutes over the affected area. How to apply ice The easiest way to apply ice to an injury is to grab an ice pack and apply it directly to the affected area.  For some people, their skin might be too delicate to handle the cold, so wrap the ice pack in a thin towel.  Apply for 15 to 20 minutes or however long the pack stays cold.  Remember, instant packs are designed for one use only!  Do not refreeze them!  Multiple use gel packs can be refrozen for repeated use. The most effective way of using ice is to ice-massage.  First you need to fill a small paper or Styrofoam cup with water and put it in the freezer.  Once the water is frozen, take the cup and peel down the top to expose the ice.  The leftover cup acts as a grip so you don’t have direct contact with the ice.  Then apply the ice using a circular motion over the affected area for 15 to 20 minutes or until all the ice is melted. In a nutshell, this is the simple way to approach the age old quandary of ice versus heat.  Use it wisely and you’ll recover faster than you thought possible.  If you choose not to follow these recommendations you will spend your days with spare parts taped together.  Hmmm – I think I just got an idea for my next dissertation …  

A new focus for USMST is evolving off the pitch.  From the beginning, the team has drawn closer through its common bond of medicine.  The practice of medicine involves continuing education, and the composition of Team USA allows it to be uniquely positioned to take advantage of its diverse medical backgrounds.  Indeed, one of the founding principles and objectives of the organization was to stay committed to advancing continued medical education for its members.  From internists, to pediatricians, to orthopedic surgeons, the US Medical Soccer Team has a huge range of medical expertise on the field at any given time.  Off the field, the most clear evidence of a commitment to medical education comes with participation in the Global Congress on Medicine and Health in Sport.  This annual conference runs concurrently with the World Medical Football Championships and draws lecturers from all over the world, typically from the participating teams and local experts.  In the first two years,  Team USA sent Gautam Nayak as the representative to the Global Congress.  Last year, Juan Carlos Velez of the Medical University of South Carolina gave a well-received lecture entitled “Sports Drinks are Better than Water:  Truth or Myth?”  The talk was a tour de force of the literature surrounding the use of sports drinks versus alternate therapies in maintaining hydration and intravascular volume in competitive athletics.  Dr Velez’ proved to be an outstanding representative of Team USA as well as the World Medical Football Federation.  The lecture fit in perfectly with the overall theme of the conference and all the attendees walked away with a much better understanding of the pros and cons of sports drinks and a motivation to learn more on their own.  Moving forward, USMST hopes to continue to foster additional participants in the Global Congress and perhaps begin a more expanded CME conference here in the United States on a regular basis, possibly in conjunction with practice sessions.