WHAT IS SPORTS MEDICINE?
Sports Medicine, medical specialty concerned with the diagnosis, treatment, rehabilitation, and prevention of athletic injuries and with the effects of exercise on the human body. Sports medicine is also concerned with the evaluation and enhancement of athletic performance. The practice of sports medicine is not restricted to physicians: athletic trainers, coaches, and specialists in exercise physiology, bioengineering, physical therapy, and chiropractic are also involved in the field.














HISTORY OF SPORTS MEDICINE IN JAMAICA
HISTORY OF THE ORGANIZATION

The Jamaica association of sports medicine was founded in June 1979 the following members were instrumental in the formation of the organization:

Dr. Arthur Wint Medical doctor and Olympian and Professor Sir. John Golding orthopaedic surgeon and Miss. Lelia Robinson who worked in conjunction with Dr. Wint and Dr. Golding in the formation of the organization.

The Main purpose for forming this organization was they were visionaries and there was a compressive need fro medical care for athletes in various sports at the various levels all around the island. The Jamaica Association of sports medicine has grown to collaborate with other regional countries for example, Barbados and St.Kits.









THE JAMAICA ASSOCATION OF SPORTS MEDICINE

OBJECTIVES

1.) To promote the scientific approach to the investigation of medical, Physical, mental, social, hygienic, dietetic, physiological, psychological and dental aspect (hereinafter called “health needs”) of sports.

2.) To contribute o the improvement of the health needs and state of those who take part in sport and p[physical education at all levels.

3.) To engage in research and evaluation reward to the health needs of physical education.

4.) To assist in furthering improvement in the health and safety of those who take part in sport and physical education and in the training methods and organization and management procedures in physical education and sport.

5.) To promote and develop improved teaching methods and standards of performance in physical education and sport.

6.) To strive to prevent the improper application of scientific methods and products to physical education and sport and strive to prevent injuries and irregularities to which any individual may be exposed while involved in physical education and sport.

7.) To promote and develop the dissemination of medical information in regard to health needs a so far as it shall relate to the teaching and practice of physical education and sport.

8.) To stimulate, promote and carry on an exchange of information with and among bodies and institutions engaged in the furtherance and practice of physical education and sport.

9.) To promote and encourage the study of sport Medicine and the establishment of sport Medicine programmes in Medical Schools at levels and in Government department with the responsibility for health, physical education and sport.

10.) To further the respect for the scientific approach in all its areas in and among those involved in the teaching, practice, furtherance and development of physical education and sport.

11.) To promote encourage the practice of Sports Medicine by persons engaged in medical or allied or kindred profession and to encourage and assist those engaged in such profession and as aforesaid to acquire Sports Medicine specialization and to engage in such specialization as aforesaid for the benefit of those engaged in the teaching or practice of physical education and sport.

12.) To promote and encourage the holding and conducting of clinics in the scientific aspect and health needs of physical education and sport, and clinics for the treatment and benefits of those who are engaged in sports activities.

13.) To issue, sell and distribute publication, promote conferences and courses of study and keep abreast of development in the health needs for physical education and sports, both clinical and scientific, and take part in and further discussion and conduct seminars and lectures on such subjects.

14.) To promote, encourage and further visits by the members of the aforesaid Association and by those interested in the health needs of physical education and sport to countries overseas and by the peoples of foreign countries to Jamaica for the purpose o study in the health needs of the physical education and sports of the communities concerned and the methods of practice thereof.

15.) To adopt such means of making know the Association and its objects as many seem expedient and in particular by advertising in the press, or radio and television, by circulars, by publication of books and periodicals, and by granting prizes, rewards and donations.








MISSION STATEMENT

The Jamaica Association of sports medicine is a multidisciplinary organization whose missions are to:

 To provide optimal care for the sports person through treatment, rehabilitation, injury prevention and education.
 To maintain Jamaica’s international status as a premier sporting nation.


LINKAGES WITH OTHER ORGANIZATION

The Jamaica association of sports medicine has linkages with other organization both locally and internationally. The international affiliates are the (FIMS) which is the international body for sports medicine which started in 1928 and celebrated its 76th anniversary in 2004. Other international affinities are the Australian sports body and the American Colleges of sports Medicine.

Currently the Jamaica association of sports medicine works in collaboration with the following local affiliates the Jamaica Armature athletic association (JAAA), the Jamaica Cricket association (JCA) the Jamaica netball association (JNA) the Jamaica football federation (JFF) the Jamaica Basketball Association (JABA) and the Jamaica swimming association (JSA).

The Jamaica association of sports medicine also have much local and regional involvement in sports such involvement are: Development track meets, boys and girls championships, Gibson Relays, Club Championships, Manning and Dacasta cup, G.C. Foster Classics, Special Olympics and Carifta games. The association also sends representatives to accompany local teams at international events for example, World Cup and the Olympics.




















BASIC STRUCTURE OF THE ORGANIZATION


The Jamaica association of sports medicine is run by an executive committee which consists of a:

 President
 Vice President
 Security
 Treasurer
 Assistant Security

The association also has eight other executive members. The association two local branches the Kingston branch which is the head office which is located at the SDF conference room and Dr. Winston Dawens is the president of this the Kingston branch. The other branch is the Montego Bay branch which was realunch in 1998 the president of this branch is Mrs. Anglia McIntosh she works at the sava-la-mar hospital. The main objective these two branches are to establish a secretariat.

The associations also have free sub comities these are; education, fun razing, and road racing which pays close attention to 5ks and 10ks and the reggae marathon.





CURRENT STRUCTURE OF THE ORGANIZATION

President Dr. Winston Dawes
 Vice President Primmare Sngh
 Security Mr. Nicolas Ford
 Treasure Miss. Maurine Campbell
 Assistant Security Karline Julius










The International Federation of Sports Medicine (FIMS)
The present International Federation of Sports Medicine (FIMS) is an international organization comprised of national sports medicine associations that span all five continents. The aim of FIMS is to assist athletes in achieving optimal performance by maximizing their genetic potential, health, nutrition, and high-quality medical care and training. An outline of its development is described below.
The first modern Olympic Games took place in Athens, Greece in 1896. Advances in sports training required advances in the medical care of world-class athletes. Among others, the first sports medicine physician, the first laboratory for the evaluation of athletes, the first sports medicine journal, and the first sports medicine association were all established in Dresden, Germany in 1913.
The international sports federations were also founded at the time that the Olympic Games were re-established. The existing sports professionals of the time were being influenced by the organization of the sports and the realization of the importance of promoting the ideas of sports medicine, and at the Winter Olympics held in St Moritiz, Switzerland in February 1920, the Association International Medico-Sportive (AIMS) was founded. The main purpose of this Association was to cooperate with the international sports federations and the International Olympic Committee to provide the best medical care for the athletes competing in the summer and Winter Olympics.
The 1st AIMS International Congress of Sports Medicine was held during the 9th Summer Olympic Games held in Amsterdam, The Netherlands, in August 1928. At least 280 sports physicians from 20 countries attended the meeting, and they had the opportunity to study many of the athletes taking part in the Games through the collection of anthropometric, cardiovascular, physiological and metabolic data.
In 1933, the name AIMS was changed to Federation International Medico-Sportive Cientifique at the 2nd International Congress held in September 1933 in Turin, Italy. During the following International Congress, held in Chamonix, France, the association received its present name. As FIMS was born under the umbrella of the Olympic Games, this strong association with the International Olympic Committee (IOC) is reflected in the five Olympic rings in the FIMS flag and logo. FIMS continues to grow as an international community of sports medicine specialists, researching and practicing the latest techniques in medicine for athletes and others who lead active lives.

What does FIMS do?
• Educates
By supporting national and continental scientific meetings;
Hosting a biennial FIMS Sports Medicine Congress;
Hosting regular Team Physician Development Courses on all continents;
Distributing publications on important sports medicine matters on a regular basis.


• Publishes
FIMS Team Physician Manual
Sports Medicine Position Statements, prepared by sports medicine and related physicians and organisations
The World of Sports Medicine - a quarterly newsletter
International Sport Med Journal (ISMJ) - FIMS' electronic journal, hosted on www.ismj.com
• Communicates
By hosting regional and international sports medicine conferences
fostering and maintaining contacts with sports medicine specialists worldwide

RICE APPROACH

Rest- You may need to rest your ankle, either completely or partly, depending on how serious you sprain is. Use crutches for as long as it hurts to stand on your foot.

Ice- Using ice packs, ice slush baths or ice massage can decrease the swelling, pain bruising and muscle spasms. Keep using ice for up to 3 days after the injury.

Compression- Wrapping you ankle may be the best way to avoid swelling and bruising. You’ll probably need to keep you ankle wrapped for 1 to 2 days after the injury and perhaps for up to a week or ore.

Elevation- Raising you ankle to or above the level if your heart will help to prevent the swelling from getting worse and will help reduce bruising. Try to keep you ankle elevated for about 2 to 3 hours a day if possible.



WHAT IS A STRAIN?


Strains are injuries that involve the stretching or tearing of a musculotendinous (muscles and tendon) structure. An acute (instant or recent) strain of the musculo-tendinous structure occurs at the junction where the muscle is becoming a tendon. These strains take place when a muscle is stretched and suddenly contracts, as with running or jumping. This type of injury if frequently seen in runners who strain their hamstring. Many times the injury will occur suddenly while the runner is in full stride. Symptoms for an acute muscle strain may include pain, muscle spasm, loss of strength, and limited range of motion. Chronic (long-lasting) strains are injuries that gradually build up from overuse or repetitive stress, resulting in tendonitis (inflammation of a tendon). For example, tennis player may get tendonitis in his or her shoulder as the result of constant stress from repeated serves.

Severity of sprains and strains

A physician categorizes sprains and strains according to severity. A grade I (mild) sprain involves some stretching or minor tearing of a ligament or muscle. A grade II (moderate) sprain or strain is a ligament or muscle that is partially torn but still intact. A grade III (severe sprain or strain means that the ligament or muscle is completely torn, resulting in joint instability.




Treatments

Grade (I) injuries usually heal quickly with rest, ice, compression and elevation (RICE). Therapeutic exercise can also help restore strength and flexibility. Grade (II) injuries are treated similarly but may require immobili-zation of the injured area to permit healing. Grade (III) sprains and strains usually require immobilization and possibly surgery to restore function.

The key to recovery is an early evaluation by a medical professional. Once the injury has been determined, a treatment plan can be developed. With proper care, most sprain and strains will heal without long-term side effects.

Will I need to wear a cast?

This will depend on how serious your sprain is, if you have other ankle injures and how your doctor thinks your sprain should be treated. You may need to wear a cast for 10 days to 6 weeks. In some cases, your doctor may suggest a padded plaster. Plastic or fiberglass splint. A cast or splint keeps the bones and injured ligaments from moving, which reduces pain and speeds healing.

How long before I can use my ankle?

This depends on how serious you sprain is. Your doctor man suggest that you start trying to use your ankle again fairly soon- from 1 to 3 days after your injury.

Special exercise is sometimes needed to regain and help reduce the chance of ongoing problems. Your ankle may need to be supported by taping bracing to help protect it from reinjury.

What about medicine for pain?

If you need medicine to case the pain, try acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin, Nuprin)



SPRAINS

Sprains involved over stretching or tearing at the ligaments of the joint.

Classification Mild 1)
Moderate 2)
Severe

Mild – slight pain, tenderness redness, you are able to move

Moderate – obvious pain, tender to touch, red, difficult to move

Severe – The ligament is torn completely, difficult to move.


Mechanism

This includes all the action and the forces. It is inversion and the forces placed on the joint. Treatment 3


Rice Fitness Endurance

Strength

Flexibility


SHIN SPLINTS
Shin splint is a term commonly used to describe lower leg pain. However, shin splints are only one of several conditions that affect the lower leg. The most common causes of lower leg pain are: general shin soreness; shin splints; and stress fractures. For the purpose of this article, I'll only be addressing the first two. I'll save the topic of stress fractures for another issue.
For lower leg pain that goes beyond general shin soreness, a more aggressive approach must be taken. Lets now have a look at shin splints in a little more detail.
What are Shin Splints?
Although the term shin splints are often used to describe a variety of lower leg problems, it actually refers specifically to a condition called Medial Tibial Stress Syndrome (MTSS). To better understand shin splints, or MTSS, let’s have a look at the muscles, tendons and bones involved.
As you can see from the diagram to the right, there are many muscles and tendons that make up the lower leg, or calf region. It's quite a complex formation of inter-weaving and over-crossing muscles and tendons.




The main components of the lower leg that are affected by the pain associated with shin splints are:
• The Tibia and Fibula. These are the two bones in the lower leg. The tibia is situated on the medial, or inside of the lower leg. While the fibula is situated on the lateral, or outside of the lower leg.
• There are also a large number of the muscles that attach to the tibia and fibula. It's these muscles, when overworked, that pull on the tibia and fibula and cause the pain associated with shin splints.
Specifically, the pain associated with shin splints is a result of fatigue and trauma to the muscle's tendons where they attach themselves to the tibia. In an effort to keep the foot, ankle and lower leg stable, the muscles exert a great force on the tibia. This excessive force can result in the tendons being partially torn away from the bone.

What Causes Shin Splints?
While there are many causes of shin splints, they can all be categorized into two main groups. Overload (or training errors), and Biomechanical Inefficiencies.
Overload (or training errors): Shin splints are commonly associated with sports that require a lot of running or weight bearing activity. However, it is not necessarily the added weight or force applied to the muscles and tendons of the lower leg, but rather the impact force associated with running and weight bearing activities.
In other words, it's not the running itself, but the sudden shock force of repeated landings and change of direction that causes the problem. When the muscles and tendons become fatigued and overloaded, they lose their ability to adequately absorb the damaging shock force.
Other overload causes include:
• Exercising on hard surfaces, like concrete;
• Exercising on uneven ground;
• Beginning an exercise program after a long lay-off period;
• Increasing exercise intensity or duration too quickly;
• Exercising in worn out or ill fitting shoes; and
• Excessive uphill or downhill running.
Biomechanical Inefficiencies:
The major biomechanical inefficiency contributing to shin splints is that of flat feet. Flat feet lead to a second biomechanical inefficiency called over-pronation. Pronation occurs just after the heal strikes the ground. The foot flattens out, and then continues to roll inward.
Over-pronation occurs when the foot and ankle continue to roll excessively inward. This excessive inward rolling causes the tibia to twist, which in-turn, over stretches the muscles of the lower leg.
Other biomechanical causes include:
• Poor running mechanics;
• Tight, stiff muscles in the lower leg;
• Running with excessive forward lean;
• Running with excessive backwards lean;
• Landing on the balls of your foot; and
• Running with your toes pointed outwards.
How to Prevent Shin Splints!

Prevention, rather than cure, should always be your first aim. I was very surprised when researching this topic at the number of articles that totally neglected any mention of preventative measures. They all talked of treatment and cure, but only one out of twenty took the time to address the issue of prevention in any detail.
Even before any sign of shin soreness appears there are a number of simple preventative measures that can be easily implemented.
Since about half of all lower leg problems are caused by biomechanics inefficiencies, it makes sense to get the right advice on footwear. Your feet are the one area you should not "skimp" on. The best advice I can give you concerning footwear, is to go and see a qualified podiatrist for a complete foot-strike, or gait analysis. They will be able to tell you if there are any concerns regarding the way your foot-strike or gait is functioning.
After your foot-strike has been analysed, have your podiatrist, or competent sports footwear sales person recommend a number of shoes that suit your requirements. Good quality footwear will go a long way in helping to prevent many lower leg problems.
Apart from good footwear, what else can you do? I believe the following three preventative measures are not only very effective, but crucial.
Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the lower legs, which will result in a lack of oxygen and nutrients for those muscles.
Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.
Secondly, flexible muscles are extremely important in the prevention of lower leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement.
To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine. For a comprehensive reference of over 100 clear photographs of every possible sports related stretch, consider getting a copy of The Stretching Handbook. If you're interested in stretches for the lower legs, The Stretching Handbook has 22 different stretches you can do. Order your copy now!
And thirdly, strengthening and conditioning the muscles of the lower leg will also help to prevent shin splints. There are a number of specific strengthening exercises you can do for these muscles, but instead of me going into the details here, I have simply found another web site that has already done all the hard work. It explains a number of exercises you can do for preventing shin splints.
The above-mentioned article is the only other article I found which included a comprehensive section on shin splint prevention. If you're only interested in the strengthening exercises, you'll find them towards the end of the article. If however, you suffer from shin splints or you're looking for more information on shin splints, I recommend you read the entire article.
How to Treat Shin Splints

Firstly, be sure to remove the cause of the problem. Whether is be a biomechanical problem, or an overload problem, make sure steps are taken to remove the cause.
The basic treatment for shin splints is no different to most other soft tissue injuries. Immediately following the onset of any shin pain, the R.I.C.E.R. regime should be applied. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.
The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for speeding up the healing process of the muscles and tendons.
I have found, both from personal experience and from working with many clients, that this form of treatment is the most effective. The application of heat and deep tissue massage on the effected area seems to bring the best results. If you suffer from shin splints, be sure to spend at least a few minutes massaging the effected area both before and after you exercise.
Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phases it to regain the strength, power, endurance and flexibility of the muscle and tendons that have been injured.








CHONDROMALACIA PATELLAE
What is Chondromalacia patellae?
Chondromalacia literally means "softening of the cartilage", and Patellae mean "the knee-cap". So Chondromalacia patellae means "softening of the articular cartilage of the knee-cap." The articular cartilage is the cartilage lining under the knee-cap that articulates with the knee joint. Under normal circumstances, it is smooth and shiny, so that it glides smoothly along the articular groove of the femur as the knee bends. When it "softens", it may break down, causing irregularities along the undersurface of the patella.
What causes Chondromalacia patellae?
Chondromalacia patellae occurs in two distinct age-groups:
• It can happen in the older age-group (in the 40’s and beyond) when the articular cartilage breaks down as part of the wear-and-tear process that occurs with the rest of the body. The patella cartilage is one of the earliest places where cartilage breakdown occurs, and is slowly progressive, leading to degenerative arthritis (osteoarthritis) in the knee joint.
• It can occur frequently in teenagers (especially girls) when the articular cartilage "softens" in response to excessive and uneven pressure on the cartilage, due to structural changes in the legs with rapid growth, and muscle imbalance around the knee. During periods of rapid growth, especially in girls, any knee valgus (knock-knees) is accentuated, thereby increasing the Q-angle, the angle formed by the thigh and the patellar tendon (see diagram). Any flexion of the knee increases the tendency of the patella to dislocate. Undue pressure is placed on the lateral (outer) facet of the patella. Moreover, in many of these teenagers, the vastus lateralis and vastus medialis components of the Quadriceps muscle are not well-balanced. The vastus lateralis tends to be more powerful than the vastus medialis, thus increasing the tendency for the patella to track or dislocate laterally. This again puts undue pressure on the lateral facet. This uneven and excessive pressure on the lateral facet of the patella leads to cartilage "softening" and breakdown.
• lateral facet of the patella leads to cartilage "softening" and breakdown.
What are the symptoms?
The typical patient is a teenage girl complaining of pain in the front of her knee around the knee-cap. She may also have pain that is deep-seated that may radiate to the back of the knee. The pain comes and goes, but usually with squatting, kneeling, and negotiating steps, especially going down the stairs. She may be engaged in strenuous sports, but experiences pain with repeated bending of the knees. Although girls are more often affected, boys can have this problem too.
At this stage, there is no breakdown of the articular cartilage of the patella yet, and is totally reversible. In fact, many doctors may not use the term "chondromalacia patellae" at this stage, because there is no actual softening or breakdown of the cartilage. A more appropriate diagnosis would be "Anterior knee pain syndrome" or "Patellofemoral stress syndrome". In fact, in the majority of patients, the pain comes and goes for a few years until growth is complete. At that point, the pain goes away permanently. In others, the pain gets increasingly worse during the teenage years, the articular cartilage of the patella may actually break down, and medical or surgical treatment may be necessary.
How do you prevent it?
In a sense, whether a child will develop this problem of anterior knee pain and chondromalacia patellae depends on the morphology of the knee and any muscle imbalance she may have. If she is lanky and knock-kneed, she is more likely to develop the condition. If she has tightness of her lateral muscles, she may be more prone to the problem.
Regardless of the above, the best way to minimize the chances of developing chondromalacia patellae is to warm-up and stretch out before sports, especially your quadriceps and hamstrings. If possible, vary your sports. For example, alternate running with swimming with bicycling. Avoid squatting, kneeling, stairs and hill running if you can. In addition there are some exercises that are helpful in preventing and helping the symptoms of anterior knee pain. These exercises should be done regularly, twice a day. If symptoms are already present, it will take about 6 weeks before you get the benefit of the exercise. So, the key is to be consistent, and persistent.
Short-arc extensions are done sitting up or lying down. Use a rolled-up towel to support your thigh while you keep your leg and foot in the air for 5 seconds. Lower your foot as you bend your knee slowly. Repeat 10 times for each leg, twice a day.

Straight-leg raises are done lying down. Lift your whole lower limb at the hip with the knee extended, and keep it up in the air for 5 seconds. Then lower slowly. Repeat 10 times for each leg, twice a day.
Quadriceps isometric exercises are done sitting up, with your legs extended in front of you. Tighten your quadriceps muscles by pushing the knees down onto the floor. Hold for 5 seconds. Repeat 10 times each leg, twice a day.


Stationary bicycling on low tension setting improves your exercise tolerance without stressing your knee. Adjust your seat high enough so that your leg is straight on the down stroke. Start with 15 minutes a day and work up to 30 minutes a day.


What does your doctor do about it?
After taking a history and performing a physical examination, your doctor may order an X-ray of the knee. In most instances the X-rays are normal, but it is still important to rule out any other significant problems. The patella view or "sunrise" view may show the patella is displaced or tilted laterally, a confirmation that the vastus lateralis muscle is over-powering or too tight.
For the teenager with chondromalacia, the objective of treatment is to restore normal patella alignment with the help of exercises. The only way to alter knee morphology is by performing surgery, and sometimes that is required. However, in most cases, exercises with or without formal physical therapy is all that is needed to correct the problem. The exercises described above concentrates on strengthening the vastus medialis obliquus (VMO), responsible for stabilizing the patella. Once that strengthens, and muscle balance is restored, the pain improves. In some cases, if the pain persists, your physician may prescribe physical therapy. The therapist will work at stretching the vastus lateralis, as well as strengthening the Quadriceps muscle and Hamstring muscles, using manual and electrical techniques. Occasionally the therapist may employ a technique called "patella taping" to keep the patella from tracking laterally.
A non-steroidal anti-inflammatory medication like Motrin is often prescribed by your physician. This is taken regularly, whether you feel pain or not. By decreasing the inflammation, the pain is often reduced. But not only that, there is some evidence to suggest that the drug actually helps in reforming the articular cartilage.
A knee brace is also often prescribed for patients who want to stay active in sports. The usual brace prescribed is what is known as a patella stabilizing brace. It consists of a knee sleeve with a patella cutout, and a horse-shoe pad based laterally to keep the patella from tracking laterally. (see the AirPro™ Patella Knee Support)
With conservative treatment, about 85% of patients improve enough


that no further treatment is needed. In about 15% of patients, the pain stays severe, or becomes worse that surgical treatment is needed.
An MRI exam is usually not indicated for most cases of chondromalacia, unless the doctor suspects any other pathology.
The form of surgery done is usually an arthroscopic surgery. The surgery is performed through little keyhole incisions with the help of an arthroscope. It is usually performed as an outpatient procedure, under a light general anesthetic. The surgeon will check out the knee through the arthroscope, and confirms the lateral patella tracking. To correct the problem, a lateral release, consisting of dividing the vastus lateralis muscle is performed. This is done from the interior of the knee, so there is no visible incision from the outside. By dividing the vastus lateralis, this muscle is weakened, and if tight, stretched out; hence restoring balance to the Quadriceps muscle. Post-operatively, Physical therapy for 6 weeks will restore the knee back to health, and the patient back to sports.
In some patients, the pain continues even after surgery and intensive physical therapy. This happens especially in patients with severe structural problems, like markedly increased Q-angle and lateral subluxation or dislocation of the patella. When that happens, more than a lateral release is required. Open surgery is occasionally done for the recalcitrant case, and usually involve extensive open realignment of the Quadriceps mechanism and even bone work to correct the problem.
What can be expected after treatment?
Most patients do well with treatment. It is important that you keep up with the Quadriceps exercises on an indefinite basis. It takes only 5 minutes twice a day, and is a worthwhile long-term investment for your knees. Also, make sure you stretch adequately and warm up before sports.

OSGOOD-SCHLATTER DISEASE (KNEE PAIN)
A common form of growing pains or overuse in early adolescence involves the shinbone and the knee. The shinbone (tibia) has a raised area just below the kneecap called the tibial tubercle. The tubercle has two important functions:
• It contributes to the growth of the leg.
• It is where the thigh muscle attaches to the shinbone through the kneecap tendon.
Symptoms
Swelling, enlargement of the tubercle and pain are common in kids with year round sports schedules.
Risk Factors / Prevention
Those who participate in certain sports are at risk. These sports include soccer, gymnastics, basketball and distance running.
Treatment Options
Once the diagnosis is made, treatment is aimed at diminishing the severity or intensity of the pain and swelling. Treatment of symptoms includes taking scheduled doses of Advil or Aleve, and wrapping the knee. This is recommended until the child can enjoy sports activities without discomfort or significant pain afterwards. Weakness and pain that gets worse with activity may require rest for several months, followed by a conditioning program. In some susceptible teenagers, O sgood-Schlatter symptoms may last for 2 to 3 years. However, most symptoms will completely resolve with completion of the growth spurt. This happens at around age 14 for girls and 16 for boys.




STRESS FRACTURES


One of the most common injuries in sports is a stress fracture. Overcoming an injury like a stress fracture can be difficult, but it can be done.
What is a stress fracture?
A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.
What causes a stress fracture?
Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).
Are women more susceptible to stress fractures than men?
Medical studies have shown that female athletes seem to experience more stress fractures than their male counterparts. Many orthopaedic surgeons attribute this fact to a condition referred to as "the female athlete triad"-eating disorders (bulimia or anorexia), amenorrhea (infrequent menstrual cycle), and osteoporosis. As a female's bone mass decreases, the chances of getting a stress fracture increase.
Where do stress fractures occur?
Most stress fractures occur in the weight bearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.
What activities make athletes most susceptible to stress fractures?
Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete risks developing a stress fracture.
How are stress fractures treated?
The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.
If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Reinjury also could lead to chronic problems where the stress fracture might never heal properly.
Here are some tips developed by the American Academy of Orthopaedic Surgeons to help prevent stress fractures:
Slowly increase any new sports activity. For example, do not immediately start running five miles a day; instead gradually build up your mileage on a weekly basis. Running also can be done on alternate days. Try alternating the days you run on a weekly basis.
Maintain a healthy diet. Make sure you incorporate calcium-rich foods in your meals.
Use the proper equipment. Do not wear old or worn running shoes.
If pain or swelling occurs, immediately stop the activity and rest for a few days. If continued pain persists, see an orthopaedic surgeon.
It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.




WHAT IS A SHOULDER SUBLUXATION?

A shoulder subluxation is a temporary, partial dislocation of the shoulder joint. The shoulder is a ball and socket joint. The ball of the upper arm bone (humerus) is held into the socket (glenoid) of the shoulder blade (scapula) by a group of ligaments.

HOW DOES IT OCCUR?
A shoulder subluxation can occur from falls onto your outstretched arm, direct blows to your shoulder, or having your arm forced into an awkward position. If you have had a previous injury or if your shoulder ligaments are naturally loose, you may sublux your shoulder doing simple activities like throwing or putting on a shirt or jacket.

WHAT ARE THE SYMPTOMS?
Symptoms include the following

:
The feeling that your shoulder has gone "in and out of joint"
looseness in your shoulder
pain, weakness, or numbness in your shoulder or arm
HOW IS IT DIAGNOSED?
Your doctor will talk to you about your symptoms and perform a physical exam. Many times the diagnosis of a shoulder subluxation is made by your description of the injury. When your doctor examines you he or she may find that your shoulder is loose and may partially slip out of joint during the exam. Your doctor may order x-rays to see if you have had any fractures.


WHAT IS THE TREATMENT?
The pain from a shoulder subluxation is treated with ice packs for 20 to 30 minutes 3 to 4 times a day. You may take an anti-inflammatory medication, such as ibuprofen. You may need to avoid painful activities until the pain improves. The most important treatment for the looseness in the shoulder that causes a subluxation is shoulder strengthening exercises. Shoulders that continue to sublux and cause painful symptoms may require surgery to correct the joint looseness.

WHEN CAN I RETURN TO MY SPORT OR ACTIVITY?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity is determined by how soon your shoulder recovers, not by how many days or weeks it has been since your injury occurred. You may safely return to your sport or activity when:
your injured shoulder has full range of motion without pain

- your injured shoulder has regained normal strength compared to the uninjured shoulder.



Do these exercises as soon as your doctor says you can
PART I - ISOMETRICS




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CAREFUL RANGE OF MOTION



















A. FLEXION: Standing with your arms straight, raise your arm forward and up over your head. Hold this position for 5 seconds. Return to the starting position and repeat 10 times.
B. EXTENSION: Standing with your arms straight, move your arm backward while keeping your elbow straight. Hold this position for 5 seconds. Repeat 10 times.
C. ABDUCTION: Standing with your arms at your side, slowly raise your arms out away from your body and hold in position for 5 seconds. Return to the starting position. Repeat 10 times.
D. ELBOW FLEXION: Standing, bend your elbow, bring your hand toward your shoulder. Return to starting position. Repeat 10 times. As this becomes easier, add a weight to your hand to provide some resistance.

PART II - TUBING EXERCISES


A. INTERNAL ROTATION: Using tubing connected to a door knob or other object at waist level, keep your elbow in at your side and rotate your arm inward across your body. Make sure you keep your forearm parallel to the floor. Repeat 10 times. Do 2 sets of 10.
B. ADDUCTION: Stand sideways with your injured side toward the door and out approximately 8 to 10 inches. Slowly bring your arm next to your body holding onto the tubing for resistance. Repeat 10 times. Do 2 sets of 10.
C. FLEXION: Facing away from the door with the tubing connected to the door knob, keep your elbow straight and pull your arm forward. Repeat 10 times. Do 2 sets of 10.
D. EXTENSION: Using the tubing, pull your arm back. Be sure to keep your elbow straight. Repeat 10 times. Do 2 sets of 10.



LATISSIMUS DORSI STRENGTHENING: Sit on a firm chair. Place your hands on the seat on either side of you. Lift your buttocks off the chair. Hold this position for 5 seconds and then relax. Repeat 10 times. Do 2 sets of 10.




ALCOHOL SIDE EFFECTS
What is alcohol?
Ethyl alcohol, or ethanol, is a psychoactive drug found in beer, wine, and hard liquor. It is produced by the fermentation of yeast, sugars, and starches.
What is alcoholism?
Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol use despite adverse consequences, and distortions in thinking, most notably denial (ASAM, 2001).
Since alcohol so easily permeates every cell and organ of the body, the physical effects of chronic alcohol abuse are wide-ranging and complex. Large doses of alcohol invade the body's fluids and interfere with metabolism in every cell. Alcohol damages the liver, the central nervous system, the gastrointestinal tract, and the heart. Alcoholics who do not quit drinking decrease life expectancy by 10 to 15 years.
Alcohol also can impair vision, impair sexual function, slow circulation, cause malnutrition, cause water retention (resulting in weight gain and bloating), lead to pancreatitis and skin disorders (such as middle-age acne), dilate blood vessels near the skin causing "brandy nose," weaken the bones and muscles, and decrease immunity.
Persons suffering with alcohol abuse finally grow obsessed with alcohol to the exclusion of almost everything else. They drink despite the pleading of family and the stern advice of doctors. They may begin round-the-clock drinking despite an inability to keep down the first drinks in the morning. Although relationships with family and work may become completely severed, nothing, not even severe health problems, is enough to deter drinking.
The late-stage alcoholic suffers a host of fears, including fear of crowds and public places. Constant remorse and guilt is alleviated with more drinking. On top of mental disturbances, debts, legal problems, and homelessness may complicate his or her life. Late stage addiction is characterized by cirrhosis and severe withdrawal symptoms if alcohol is withheld (shakes, delirium tremens, and convulsions). Without hospitalization or residency in a therapeutic community, late-stage alcoholics usually succumb to insanity and death.
People suffering alcoholism do not have to "hit bottom" and reach the extreme late stages of alcoholism to decide to get help. Many men and women have recognized their alcohol problems before they lost their jobs or families, or began drinking in the morning, suffered DTs, or had to be hospitalized. For them, the labels "early stage," late stage," "problem drinker," or "alcoholic" were less important than the fact that their growing powerlessness over alcohol was causing them pain.
The liver breaks down alcohol in the body and is therefore the chief site of alcohol damage. Liver damage may occur in three irreversible stages.
• Fatty Liver. Liver cells are infiltrated with abnormal fatty tissue, enlarging the liver.
• Alcoholic Hepatitis. Liver cells swell, become inflamed, and die, causing blockage. (Causes between 10 and 30 percent mortality rate.)
• Cirrhosis. Fibrous scar tissue forms in place of healthy cells, obstructing the flow of blood through the liver. Various functions of the liver deteriorate with often fatal results. (Found in 10 percent of alcoholics.)
A diseased liver:
• Cannot convert stored glycogen into glucose, thus lowering blood sugar and producing hypoglycemia.
• Inefficiently detoxifies the bloodstream and inadequately eliminates drugs, alcohol, and dead red blood cells.
• Cannot manufacture bile (for fat digestion), prothrombin (for blood clotting and bruise prevention), and albumin (for maintaining healthy cells).
Alcohol in the liver also alters the production of digestive enzymes, preventing the absorption of fats and proteins and decreasing the absorption of the vitamins A, D, E, and K. The decreased production of enzymes also causes diarrhea.

BANDAGING TECHNIQUE


1. Start with the bandage held in place on the inside of the thigh just above the knee and unroll the bandage so that it is laid diagonally down the outer side of the stump while maintaining about two-thirds of the maximum stretch in the bandage.
2. Bring the bandage over the inner end of the stump and diagonally up the outer side of the stump.
3. Bring the bandage under the back of the knee, continue over the upper part of the kneecap and down under the back of the knee.
4. Bring the bandage diagonally down the back of the stump and around over the end of the stump. Continue up the back of the stump to the starting point on the inside of the thigh and repeat the sequence in a manner so that the entire stump is covered by the time the roll is used up. The end of the bandage is held in place with the special clips that are provided. It is important that the tightest part of the bandage be at the end of the stump.

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