by Jaron Terry, APR
As active baby boomers age and more children participate in high-impact athletics at younger ages, the discipline of sports medicine, once reserved for elite athletes, is now mainstream. Bridging the medical specialties of family medicine and orthopaedics, sports medicine is a vital element in many care plans and the subject of extensive research designed to prevent injury and prolong active lifestyles for all. Ohio State’s Sports Medicine program is nationally renowned for its exceptional patient care and research, and for training future leaders in the field.
Orthopaedics at Ohio State Grows to Meet Demand
“We recommend to our patients who have not engaged in regular exercise to start off slowly,” says Jason Calhoun, MD, chair of Ohio State’s Department of Orthopaedics and holder of the Frank J. Kloenne Chair in Orthopaedic Surgery. “However, when it comes to the growth of the Department and the growth of Sports Medicine, the pace has been very fast.”
Calhoun, who has been a medical educator for more than 28 years, has been building a team of Sports Medicine specialists who come from diverse backgrounds.
“A year ago we had 12 faculty members,” Calhoun notes. “Within a few months we will have added at least six more, representing sports, hand, trauma, oncology and general orthopaedic surgery, and we’re recruiting for spine and total-joint specialists as well as more experts in knee, hip, shoulder and hand repair.
“We tell all of our patients to remain active, especially the older ones who are beginning to experience some osteoarthritis. If they keep moving they’ll continue to feel good. I’d say that’s advice we’re taking for our department, as well. I predict that within another year we will have doubled our numbers,” Calhoun says.
Central to the mission of the OSU Sports Medicine Center is promoting and enhancing physical activity across the spectrum of life,” says Christopher Kaeding, MD, co-director of the Center and director of the Division of Sports Medicine in Ohio State’s Department of Orthopaedics.
As head team-physician for the Ohio State Buckeyes football team, as well as one of the first orthopaedic surgeons to perform knee-repair surgery on a patient more than 60 years old, Kaeding understands that the spectrum of life includes not only young people who put their bodies on the line in extreme ways, but also older individuals who rely on their bodies to enjoy active lives.
“One of the most common knee injuries is the ACL tear, an injury of the anterior cruciate ligament,” explains Kaeding, who is also the Judson Wilson Professor of Orthopaedics at Ohio State. “When I finished my training in the late 1980s, an ACL repair was only available to people under age 40, unless the patient was also a committed athlete. Now, we realize that helping people stay active throughout life helps them stay healthy.”
Kaeding, a nationally recognized expert in ACL repair, is participating in a National Institutes of Health (NIH) research consortium called the Multicenter Orthopaedics Outcomes Network (MOON), which is investigating ACL injuries in patients aged 10-85 to provide evidence-based answers to practical questions regarding knee ligament injuries, surgeries and long-term outcomes. Kaeding is the largest contributor to the MOON investigation, working with colleagues from institutions such as Vanderbilt, Boston Children’s Hospital, Washington University – St. Louis and the Cleveland Clinic, among others.
Sports Medicine Research: The Body Mechanics of Injury
The Ohio State Sports Biomechanics Laboratory studies the mechanisms behind sports injury, rehabilitation and performance. Ajit Chaudhari, PhD, assistant professor of Orthopaedics, is director of the 3,500-square-foot laboratory that simulates real-life sports environments, such as a pitcher’s mound, golfing tee box, batting cage and running track, to study the motion of an athlete’s body and the forces acting at the joints.
For example, while hidden force plates embedded in the floor record the forces acting on each foot, high-speed motion-capture cameras record split-second movements based on sensors taped to specific muscles. Activations of various muscles during movement are recorded by electromyography equipment at the same time isokinetic strength-testing equipment allows researchers to assess muscle strength.
This ground-breaking research will one day allow sports medicine physicians to practice personalized, evidence-based care and prescribe appropriate exercise for all individuals.
Exercise is the Best Medicine
“In my opinion, physical inactivity is the number one killer in this country,” asserts Thomas Best, MD, PhD, a nationally prominent sports medicine specialist who joined Ohio State in 2005 as co-director of the Sports Medicine Center and team physician for the Ohio State Buckeyes hockey team.
“It is well recognized that life-threatening conditions such as obesity, heart disease, type 2 diabetes, high blood pressure and some cancers, including breast and colon, can be consequences of a sedentary lifestyle,” says Best, who also holds the Pomerene Chair in Primary Care and is co-editor of the most widely used textbook in the field, Evidence-Based Sports Medicine, which is in its second printing.
In addition, he is a national leader of “Exercise is Medicine,” a joint initiative of the American College of Sports Medicine (ACSM) and the American Medical Association. The initiative calls on healthcare providers – regardless of specialty – to review every patient’s physical activity level at every visit as a vital sign in patient assessment.
“We want to treat every patient as if they are one of our star athletes. Even if their only daily exercise is a brisk 30-minute walk, they should be counseled on exercise regimens and injury prevention,” says Best. “Office visits should conclude with exercise clearance and a prescription or referral to a certified health and fitness professional,” he adds.
Best, who will become president of ACSM in June, is a proponent of healthcare reform that recognizes physical inactivity as a major health threat. As the first Ohio State faculty member to be elected to this post, he is working with the Centers for Disease Control and Prevention, the President’s Council on Physical Fitness and Sports, and other government agencies and insurance companies to establish physical activity guidelines to improve public health.
“Next year will also see the first World Congress of ‘Exercise is Medicine,’ which will be held in Baltimore,” he says. “We are already working with 71 countries that have signed on to this platform; this is tremendously exciting, worldwide work.”
Sports Medicine Research:
Ohio State’s Sports Medicine team includes neuropsychologist Robert Bornstein, PhD, who says that all head injuries should be evaluated, including concussion (brain injury resulting from a blow to the head), even when considered mild.
According to Bornstein, who also is professor of Psychiatry, Psychology and Neurology, more than half of all concussions are not reported by those who suffer them. Considering that having one concussion increases the risk of subsequent concussion by four-to-six times and that longer periods of time are required for recovery with successive concussions, he asserts that seeking medical help is imperative.
His colleague, Kelsey Logan, MD, assistant professor of Internal Medicine, recommends that serious athletes undergo a neuropsychological evaluation – a 30-minute computerized battery of tests focusing on reaction time, concentration and memory – to establish a baseline against which physicians can evaluate the seriousness of their injury should they suffer a concussion.
Everyone’s an Athlete
“It doesn’t matter if you’re running a marathon or walking around the block, anyone can sprain an ankle, injure their knee or suffer some other type of musculoskeletal injury,” says Mary Jo Welker, MD, chair of Ohio State’s Department of Family Medicine.
“When most people think of sports medicine, it is these musculoskeletal concerns that usually come to mind. However, the specialty goes beyond that to include other health issues that might impede a patient’s activity level,” adds Welker, who also is executive director of Ohio State’s Primary Care Network.
“Sports Medicine is a multidisciplinary specialty that includes pulmonologists, cardiologists, neurologists, psychiatrists and others,” she explains. Medical problems such as asthma and heart disease, as well as treatment for concussion, are all part of what a sports medicine physician handles.
“Family practice physicians need to have a working knowledge of sports medicine, because all patients are athletes – they just have differing activity levels. That’s why residents who are studying to be family practice specialists at Ohio State’s College of Medicine also study sports medicine as part of their training,” she notes. In addition, the College offers a fellowship in Family Medicine in Sports Medicine.
Sports Medicine Research:
Asthma in Athletes
According to Jonathan Parsons, MD, pulmonologist and associate director of Ohio State’s Asthma Center, athletes often ignore symptoms of exercise-induced bronchospasm (EIB). They attribute the condition to poor performance or simply being out of shape. However, exercise is one of the most common triggers of bronchospasm in patients with chronic asthma. Exercise-induced asthma occurs in approximately 80 to 90 percent of individuals with known asthma.
Parsons recently presented the results of research he conducted in the college football community. His study to see how well asthma is being managed in athletes competing at the National Collegiate Athletic Association (NCAA) level, showed that very few athletic trainers associated with NCAA programs said they were following best-practice standards for managing asthma among their athletes.
Established guidelines support testing athletes for asthma when it’s suspected, having inhalers immediately on hand and including asthma specialists as part of their athletes’ care. The study, funded by the Center for Research Resources, was recently published in the American College of Sports Medicine’s journal, Medicine & Science in Sports & Exercise.
John Mastronarde, MD, director of the Asthma Center in Ohio State’s Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, was among Parsons’ collaborators. Mastronarde recently presented findings at a convention of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports and the National Athletic Trainers Association. His work centered on the main reasons for sudden collapse during summer conditioning sessions and recognizing student-athletes in crisis. He outlined condition-specific recovery strategies and emergency-response protocols. He also reviewed the implications of off-season conditioning as it relates to exercise-induced asthma.
Thomas Ellis, MD, vice chair of the Department of Orthopaedics, agrees that all patients should be active, and points out that for many, participation in high-stress athletics begins in early childhood and continues for 50 years or longer, thus compounding the possibility of sports-related injuries.
Ellis, a noted authority on hip pain in young athletes, is a national expert in performing a minimally invasive arthroscopic surgical technique to treat hip labral tears and hip impingement. Three decades ago X-rays of a young hip-pain patient would appear normal. Because no arthritis was evident, there was no treatment.
“Thanks to better imaging with MRI, a Swiss physician found that hip pain comes from more than just the bony tissue, as was thought up until the early 1980s,” he explains. “Now we know that we have to treat the labral tear (injury to soft tissue) as well.”
Initially, the earlier procedure to treat hip labral tears was done through an open surgery, necessitating a large incision, dislocation of the hip, several days in the hospital and an extended recovery period.
Today’s approach entails a small arthroscopic surgical incision and improved pain management and physical therapy, all of which afford patients only one overnight hospital stay and a shorter recovery time, as well as less scarring
“It is important that we treat athletes of all ages and levels of training, be they collegiate heroes, professional sports superstars or regular mall-walkers,” says Best.
However, he says, one of the greatest challenges to providing evidence-based, personalized health care to sports medicine patients is the lack of research on how injuries happen and which treatments will work best for different people.
“That’s just one of the reasons I’m so excited about being at Ohio State, where research is a cornerstone for everything we do (see sidebar story),” he notes. “At Ohio State, the focus is moving from disease-based treatment to developing personalized healthcare initiatives that are prevention-based. This really ties in with what is happening today in sports medicine.”
- As more people play sports as youths and stay active throughout their lives they stay healthier longer but are also at greater risk for injury.
- Sports medicine bridges the medical specialties of
family medicine and orthopaedics.
- Sports medicine research at Ohio State has led to
better prevention and management of concussion, knee ligament injury, body mechanics control, and exercise-induced asthma.
From left: Jason Calhoun, MD; Christopher Kaeding, MD; Thomas Best, MD, PhD; Mary Jo Welker, MD; Thomas Ellis, MD
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