Category: Sports Medicine

In sports medicine, the most widely accepted method for treating lateral ankle sprains is the PRICE method. In an article by Lucas Bianco, Smokey Fermin, Robert Oates, James May, Scott Cheatham, and Alan Nasypany they assessed the relationship between the Mulligan concept and the Protect Rest Ice Compress Elevate method (PRICE), to determine whether the mulligan method is more useful.

For this study, they searched for people in their community who lead an active healthy lifestyle, sustained a lateral ankle sprain within 3 days of evaluation, and have had an observation, palpation, and orthopedic tests done to determine the severity of the lateral ankle sprain. Any sprain above grade one was unable to participate in the study. The requirements they listed are 18-40 years of age, 150 minutes a week of activity, evaluated within 3 days of onset, and a grade one Lateral Ankle Sprain.

They used the Mulligan concept to test lateral ankle stability by performing joint mobilizations with the use of glides and mobilization with movement (MWM). The specific movements they used were fibular mobilization with movement (FMWM) and modified fibular mobilization with movement (MFMWM). They compared those concepts and methods with the PRICE method.

Some more of the major methods they used were in order to determine the severity of the participant’s ankle sprain, they used the Weight Bearing Lunge Test (WBLT) along with the Y Balance Test (YBT). The WBLT tests the range of the ankle’s dorsiflexion and the YBT tests the limit of reach before ankle interference occurs and the risk of injury.

The results of their test were that the participants who were treated with MWM returned to normal activity levels or returned to play within three days or three treatments, then compared to the 11-20 days that PRICE takes to get you back to normal activity levels. After treatment, the participants maintained the improvement of their test scores at their one week and one-month check-in. They concluded that there is not a large difference in how the participant healed but when using the mulligan concept, they could determine if the participant has a positional fault which could cause future injuries due to functional limitations.

These results can be useful in the field of Athletic Training and Sports Medicine because what they found is that the mulligan concept gets the athletes back to play 8-17 days sooner than when athletic trainers use the widely accepted PRICE method after the athlete sustained a lateral ankle sprain. They also discovered that the participants that used the Mulligan concept in tandem with the PRICE method recovered from their lateral ankle sprain quickly as well, and protecting, resting, icing, compressing and elevating are not bad things so why not use them. They also found that with pain-free early movement that you get with MWM’s there are immediate changes in pain and function. They also recognized that there was a decrease in pain and an increase in function, which makes the athletes life a whole lot easier. After reading this article I have concluded that the best means to treat a grade one lateral ankle sprain is to use the Mulligan Concept along with some elements of PRICE, with that said I think that athletic trainers should not rely as heavily on the PRICE method when there are other ways like the Mulligan Concept that could also help with the rehab of an injured athlete.

The start of sports medicine dates back to the 5th century, where Ancient Greek physicians educated athletes on how important it was to protect their body while exercising. Sports medicine continued to develop, with different scientists and physicians studying how exercise affects the body. In 1928, the first committee was formed to help individuals prevent sports injuries. Then, the American Orthopedic Society for Sports Medicine was established to treat and prevent injuries. The American Medical Society for Sports Medicine was also established to research and educate those about sports injuries. In 1992, sports medicine was approved as a specialty under the American Board of Emergency Medicine. Sports medicine is very relevant in the modern age. From 2011-2016, there were 8.6 million sports injuries. Athletes are benefited by these specialized physicians because they understand the effect of sports on an athlete’s bodies, and they can give deep insight on the most effective ways to prevent injuries. They also use the latest biotechnology products like stem cell therapy to help restore function to the damaged areas. I chose to write about the career of a sports medicine orthopedic surgeon because it is my personal career goal. I believe it is a rewarding career because you are able to help athlete’s return to the game they love.

Sports medicine surgeons treat athletes of all ages. They are by the athlete’s side throughout their whole injury journey. An important aspect of their job is to educate athletes on how to live a healthy life, and how to prevent injuries from occurring again. They also oversee the patient’s rehabilitation process alongside physical therapists. They diagnose injuries by first performing a physical exam and assessing the range and motion of the injured joint. If this is inconclusive, the surgeon will order different tests like X-rays and MRI’s. Once a diagnosis is made, treatment options will be discussed between the patient and the doctor. The surgeon will recommend what they believe to be the best treatment plan, but it is ultimately the patient’s decision about how they wish to treat their injury. If surgery is chosen, the surgeon will inform the patient on how the surgery will be performed. After the patient and the doctor are in agreement about a treatment plan, the surgeon will perform the surgery, and see them through rehabilitation. Sports medicine is a relatively new, yet fast growing specialty. Over the past few years, biotechnology has been a huge part of this exponential growth. For example, stem cells have been used to heal professional athletes’ knees. Bonesport is a biotechnology company that produces an injectable cerament that promotes the healing of broken bones by filling the gaps in it. This biotechnology product has benefited countless athletes who suffer from broken bones. A recent innovation in sports medicine is a newly developed treatment for active adults who have arthritis. Because the pain of the arthritis is severe enough to affect them on a daily basis, but not enough for a total joint transplant, new methods of treatment were needed. Through research, they determined PRP therapy was a good fit. Plasma-rich plasma (PRP) therapy is when PRP’s are injectionected into the affected joint. The blood naturally promotes healing to the damaged area. Some benefits of being a sports medicine surgeon is it pays well ($650,000), there is a positive career outlook, and you can work in many different professional settings, including a private practice, hospital, or sports team. However, some drawbacks are it takes many years of study (around 15) to become this surgeon, there are irregular work hours, and these physicians may be exposed to infectious diseases.

Preparing for this career should start in high school. Your primary goal is to get into medical school first, then specialize in sports medicine. Biology, chemistry, anatomy, physics, calculus, statistics, and physiology are all important classes to take in high school to prepare for the required college pre-med courses. In college, you must complete all of pre-med courses, and take the MCAT before you can apply to medical school. Furthermore, your grades in these classes must be exceptional, because medical school is very competitive to get into. Pre-med courses include one year of biology with lab, one year of chemistry with lab, one year of organic chemistry with lab, one year of english, one year of physics with lab, and one semester of biochemistry. After you obtain your bachelor’s degree, the next step is medical school. After medical school, a 5 year residency in orthopedic surgery is required. Then, to specialize in sports medicine, you must complete a 1-2 year fellowship. 3 colleges or universities where I may study are a BSDO program, University of Arizona, and Duke. A BSDO program is a combined 6-8 year bachelor program and doctor of osteopathic school. Because DO schools focus on therapeutic ways to heal issues to the musculoskeletal system, you will often learn more about bones, tendons, and ligaments, which is what orthopedic surgeons perform surgery on. Also, if you were to attend a regular college and then apply for medical school, it would take a minimum of 8 years, assuming you don’t have setbacks. But, if you attend a combined BSDO program, you would be in school for 6-8 years. UVA will also help prepare me for this career because of their wide range of majors and opportunities. Some opportunities they offer are a pre-health integrated experiential learning course (volunteering at a local health care facility, with mentorship programs), and a preMD ambassadors program (working with the Admissions Office on a wide variety of projects). Because of how competitive medical school is, having these special programs will help you stand out. Duke is another school with a great pre-med program. Their class sizes are very small, and therefore it is easy to get to know your professors, which means they can write you a better recommendation letter, which will really help you get into a good medical school. They also get plugged into a pre-med advising program very early in college, which guides students on how to get accepted into a medical school. To practice medicine as a sports medicine orthopedic surgeon, you must be a board certified sports medicine orthopedic surgeon, and you must be a licensed medical professional in your state.

Gaining employment as a sports medicine surgeon takes many years of hard work and training. After you graduate from your bachelor’s degree and medical school, you are matched into a residency program. There is a chance if your MCAT or medical school grades aren’t high enough that you will not be matched into the residency program of your choice. After 5 years of orthopedic surgery residency, you must take a general exam in order to practice medicine in the state you desire. However, because sports medicine is a specialty, you must complete a sports medicine fellowship. After completing this fellowship, you will become board certified. Many patients and hiring hospitals and practices prefer board certified surgeons because it shows that they have gone through more training than non-board certified surgeons. 3 institutions that employ sports medicine orthopedic surgeons are hospitals, private practices, and sport teams. Hospital for special surgery in New York and Mayo Clinic in Minnesota are the 2 best orthopedic surgery hospitals. If you choose to work at a hospital, you will receive the same amount of money no matter the number of patients you see, you will have an immediate patient base, and you won’t have any administrative duties to complete. However, you have almost no autonomy of your work. Hospital executives control where to perform your surgery, what materials are available for use, and what devices you can use. In private practice, it is almost the opposite. There is no one telling you the limitations of your work. However, money is very unstable. Your salary is determined by how many patients you see, so if you were to not receive as many patients, you wouldn’t make as much money. It is also hard to make a profit from your business if it is new, because there will be external factors like a building mortgage to pay off. Another institution that employs sports medicine surgeons are sports teams. This can range from a high school tennis team, to the team doctor of a NBA team. These jobs are not full time, and most still obtain a job at the hospital or a practice. However, if you do become employed as a professional athletic league’s team doctor, you are required to travel to all games with them. Some of the roles of a team doctor include providing medical documentation and educating the athletes on prevention and healthy lifestyles. The average salary of a sports medicine orthopedic surgeon is $650,000. Some benefits these surgeons receive are malpractice and liability insurance, 401(k) plans, paid vacation, paid sick leave, life and disability insurance, private medical insurance (PMI), and company pension plan.

Preparation to become a successful orthopedic sports medicine surgeon can start in high school. Shadowing these specialized surgeons is essential to determine if this is the correct career choice for you. But, it is also important to shadow other professionals in sports medicine, like nutritionists and physical therapists. There are limited sports medicine internship positions for high school students, but there are countless medical internships that will help you pursue this career in which medical school is required. One sports medicine internship is Sports Medicine South of Atlanta, which allows high school students to shadow the different professions of sports medicine, including surgeons. Some volunteering positions that can prepare you for this career would be volunteering at the hospital, helping out your school’s athletic trainer, and coaching a recreational sports league. All of these can be done as high school, college, or medical school students.

Sports medicine started in the 5th century, and it gradually developed to finally be considered a specialty in medicine. Sports medicine orthopedic surgeons treat athletes of all ages, and they educate them on how to prevent these injuries and live a healthier life. In order to become this surgeon, you must obtain a bachelor’s degree, attend medical school, apply for a 5 year residency of orthopedic surgery, and complete a 1-2 year sports medicine fellowship. However, all this hard work will pay off, because there are an abundance of jobs available in hospitals, private practices, and team doctors. They also get paid very well. Some unique facts about sports medicine orthopedic surgeons are that they get paid the most in New Jersey, they are the 9th most demanded physician, and men make up 91% of the field.

A typical day in the life of sports medicine physician is recording medical information athletes. Coordinate and creating workouts for the athlete. I would also talk with other specialist and coordinate certain activities for the athlete or whoever and supervise the rehabilitation process. I would do a lot of treating and diagnosing injuries relating to the musculoskeletal system.

I would also attend games and evaluate the athlete to see whether I need to set restrictions. When I go to the games, I would also make sure no player is hurt or if there was a hurt player in the game, I would check on him, see what his injury was, and see what the best thing I could do for the athlete. What happens a lot though to would be seeing younger kids that usually have broken bones or something along that line, that happens every day. ​The average annual salary of a sports medicine physician is $227,158. But as far as benefits they are dental, medical, long term and short-term disability, life and vision insurance.

For vacation time, three personal days then 6 national days and sick days. Also, I do get to get to travel with whatever team or company I am employed by. I would work 40 to 60 hours a week and the average age of retirement is 63. ​Well one of the best colleges to go to become a sports medicine physician is University of North Carolina. Then while I’m at college to get more experience I could be assistant for a sports medicine physician at a random company. Then as I get more experience as an assistant and move farther through college I could began to do more and more as an assistant or intern. So, for all the time I was at college I’ll already have had these mini side jobs that would look good on a resume. ​For my college I would go to North Carolina, which is one of the best colleges to go to become a sports medicine physician.

To become a sports medicine physician, you need a bachelor’s degree including a medical degree which usually takes four years to get and eight years all together. I would also need to take pre-med classes such as biology, anatomy, and chemistry. Then depending on my specialty three to seven years in internships and residency programs. My specialty will be in sports medicine so I will be in residency for about seven years getting specialized training to become a sports medicine physician.​Diagnose, treat, and help prevent injuries related to sports or any physical activities including looking for any mental illness. Also create programs to help the athlete recover properly and sometimes restrict players from games. I would also help rehabilitate athletes and work with other doctors such as a physical therapist. Prescribe medical equipment, create medical solutions and determine a patient needs and set treatment goals. So basically, I would be helping and assisting others on pretty much any level, mental and physical.​

Introduction

Many athletes use caffeine as an ergogenic aid to increase performance. There has been lots of research for Caffeine as the ergogenic aid for endurance athlete and the consensus is that it is effective, however, when applied to strength, power and anaerobic activities there seems to be some mixed findings, resulting in inconclusive opinions (1). Caffeine is a substance that accelerates the central nervous system (CNS). It has the effect of reducing the perception of fatigue in individuals. It is one of the most widely used drugs in the world, found in many beverages like coffee, tea, and ‘energy drinks’ (2). Due to its stimulation, it can improve alertness, concentration, reaction time, and energy level.

Physical exercise intense enough to cause lactate to form is called anaerobic exercise. It is used in non-endurance sports. High intensity, short-duration exercises lasting three seconds to a maximum of two minutes are referred to as anaerobic performances. These exercises focus on speed and power. Adenosine triphosphate and phosphocreatine (ATP-PC) is the primary system used during these exercises. ATP-PC utilises anaerobic glycolysis and muscle stores which produces ATP and results in lactic acid (3).

It is hypothesised that ingesting caffeine will increase the average peak power of the wind gates.

Wind gates are a stationary cycle test of anaerobic leg power (4). The wind gate Anaerobic experiment is arguably one of the most known labs fitness tests. It is usually performed on a stationary bike with ergometry and is mainly used to determine the individual’s anaerobic ability and anaerobic state outputs. It requires the participant to cycle in a maximum effort for 30 seconds. After the participant cycles, the 30-sec spurts a few measurements will be taken to see how hard the participant worked. Those are RPE and blood lactate.

To help understand how hard an exercise test or sport is the Borg rating of perceived exertion scale (RPE scale), is a frequently used to give a quantitative measure/score.

The scale is used in a variety of setting from sports coaches during training and competitions to doctor using it to see the patient’s exertion during a test. Exercise intensity is rated on a scale of 6-20; 20 being equivalent to maximum effort and six being equivalent to complete rest.

The by-product of anaerobic glycolysis, lactate, has traditionally been thought to be detrimental to muscle function (5). However, this appears likely only when the lactate level is very high. Elevated lactate levels are only one of many changes that occur during intense exercise that can lead to fatigue. Fatigue, that is muscle failure. Physical exertion or fatigue can lead to elevated muscle and blood lactate concentrations. Lactic acid occurs in the blood when glycogen is broken down in muscle and can be converted back to glycogen in the liver (6).

The purpose of this study was to test the effect of 3-mg·kg -1 body mass of caffeine on average peak power and RPE.

Method

One participant volunteered to participate in this experiment. They were weighed before exercise testing; they were a 21-year-old female that weighed 58kg and had a low level of fitness. 3mg/kg of body mass was used when consuming caffeine. Decaffeinated coffee was consumed as a placebo. Sixty minutes before exercise testing either the coffee or placebo were consumed, varying on two separate occasions and weeks. The subject performed four, thirty-second wind gates on a stationary bike with a five-minute active rest in between each wind gate. Heart Rate, Blood Pressure, Blood lactate and RPE were recorded after each wind gate as well as average max power, peak power, and fatigue index (7).

Results

There was no significant difference between caffeine supplementation and placebo on average peak power (figure 1).

Table 1 shows the physiological effects the wind gates had. There was no significant difference between the two trials when comparing the physiological data. While the first sprints power average with caffeine was slightly higher, the rest of the results are the same. No significant difference was found between heart rate, and blood pressure either.

A slightly higher RPE was found with caffeine supplementation, as compared to the placebo trial as well as Blood lactate, but nothing significant enough that can state that caffeine greatly affected it.

The only out layer in the data is the first wind gate for the placebo. The participant reached a power peak of 1181 (table 1). This can be explained because it was the very first sprint in the experiment, so the participant didn’t know the difficulty of the experiment ahead and went as hard as they could.

Discussion

The purpose of this study was to test the effect of 3-mg·kg -1 body mass of caffeine on multiple sprints cycle performance in a female participant. This study found that caffeine ingestion produced no significant improvement in the sprints as compared to the non-caffeine sprints. Consequently, the hypothesis that caffeine ingestion would significantly increase the average peak power was not supported.

There is conflicting evidence of caffeine’s ergogenic effect when it comes to power-based sports that need short, anaerobic bursts of activity. An increasing number of studies have been published involving HIIT training, resistance training, and force-production activity.

Improvements were observed, in a different study, in absolute strength and peak power (Wingate test) when 5 and 7mg/kg body mass, was consumed. Few studies exist on the effect of low-dose supplementation (6). One study by Lorino, Lloyd, Crixell, and Walker (2006) examined caffeine’s effect on agility performance in the Pro agility run and 30-second Wingate test. Sixteen recreationally active males received a dose of 3mg/kg of body weight an hour before testing (8). Researchers based the dosage on the midpoint of the commonly tested range of 3-9mg/kg body weight (8). There was no significant change in peak power, mean power, per cent power decrease, and pro agility performance (8). The study concluded that caffeine ingested at this dosage did not enhance performance in recreationally active males, but that the results could not be extrapolated to anaerobically trained athletes (8) (3).

The lack of statistical significance on all Wingate’s may have been due to the small sample size. This study only had one participant conducting the test. The participant was also not an anaerobic athlete. More trends could be seen if a larger group of people, who were anaerobic athletes, participated.

Hoffman and colleagues conducted comparable research and had similar findings (9). Caffeine did not increase any of the power performance measures when compared to the placebo, decaffeinated drink.

Earlier research examining the effects of caffeine on performance typically employed untrained subjects with methodologies not specific to high-intensity intermittent sports activities (10). These designs and subject characteristics potentially contributed to the conclusion that caffeine may not be beneficial in this model. However, recent studies have started employing trained subjects accustomed to the intensity of the protocols tested. Therefore, caffeine seems to be the most beneficial for trained subjects, with most studies showing little to no effect on untrained subjects. Its still unclear as to why there is a difference in training status between participants.

Practical Application

The results of this study suggest that consuming caffeine sixty minutes before anaerobic activity does not improve high-intensity exercise performance.

Future research should examine the impact and the extent caffeine has on high-intensity performance, with individual and group data being assessed, with athletes that are anaerobically trained. Studies are also needed to understand whether individuals respond similarly during repeated bouts of exercise (true responders) with caffeine consumption and elucidate the underlying mechanisms between responders and non-responders.

Finally, pinpointing what precise mechanisms caffeine effects as an ergogenic aid is needed.

Admittedly, one co-founder of caffeine research is the dynamic variability in methodology making it problematic to compare findings to identify a definitive, global answer regarding caffeine’s potential impact on exercise bouts dominated by anaerobic metabolic ATP production. Therefore, research should continue to focus on the responder vs. non-responder concept in attempts to identify the parameters that create a responder to caffeine’s ergogenic properties.

Individual testing will be needed to see if caffeine before and/or during training and competitions is ergogenic to that person as caffeine response and amount varies.

References

1. Mouri, Babak. Effects of Caffeine on Anaerobic Performance. [Online] 2018. https://rc.library.uta.edu/uta-ir/bitstream/handle/10106/26742/Mouri%20B.pdf?sequence=1&isAllowed=y.
2. Jordan, J B, Farley, Richard s and Caputo, Jennifer L. Caffeine and Sprint Performance in Habitual and Caffeine Naïve. [Online] 2012. https://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=1320&context=ijes.
3. Andre, Thomas L, et al. Effects of Caffeine on Repeated Upper/Lower Body Wingates and Handgrip Performance. [Online] 2015. https://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=1682&context=ijes.
4. Roberts, Michael, et al. Effects of ingesting JavaFit Energy Extreme functional coffee on aerobic and anaerobic fitness markers in recreationally-active coffee consumers. Springer Link. [Online] December 08, 2007. [Cited: 09 03, 2020.] https://doi.org/10.1186/1550-2783-4-25.
5. Anaerobic capacity determined by maximal accumulated O2 deficit. Medbo JI, Mohn AC, Tabata I, Bahr R, Vaage O, Sejersted OM. 1, s.l. : Journal of applied physiology, 1998, Vol. 64.
6. Muscle Fatigue: Lactic Acid or Inorganic Phosphate the Major Cause? Westerblad, Håkan, Allen, David and Lännergr, Jan . 1, s.l. : Journal of Physiology, 2002, Vol. 17.
7. Britannica. Lactic Acid. Britannica. [Online] 2020. [Cited: 09 04, 2020.] https://www.britannica.com/science/lactic-acid.
8. The effects of caffeine on athletic agility. Lorino, Andrew, et al. 4, s.l. : Strength Cond Res, 2006, Vol. 20.
9. EFFECT OF NUTRITIONALLY ENRICHED COFFEE. Hoffman, Jay, et al. 2, s.l. : Journal of Strength and Conditioning Research, 2007, Vol. 21.
10. Caffeine and Anaerobic Performance. Davis, J and Green, J. s.l. : Sports Medicine, 2009, Vol. 39.
11. Exercise and sport performance with low doses of caffeine. Spriet, Lawrence. 2, s.l. : Sports Medicine, 2014, Vol. 44.