KEY TOPICS IN SPORTS MEDICINE Key Topics books contain the information you need for: • Clinical guidance – rapid access to concise details and facts • Postgraduate exams – an essential revision guide Clear and comprehensive, Key Topics in Sports Medicine is a single quick reference source for sports and exercise medicine. It presents the essential information from across relevant topic areas, and includes both the core and emerging issues in this rapidly developing field. It covers: • Sports injuries, rehabilitation and injury prevention • Exercise physiology, fitness testing and training • Drugs in sport • Exercise and health promotion • Sport and exercise for special and clinical populations • The psychology of performance and injury. Based on graduate programme teaching practice and with an international team of contributors, this is a valuable and practical resource for all those interested in sports and exercise medicine, including sports clinicians, general practitioners, team doctors, orthopaedic surgeons, accident and emergency doctors and physiotherapists. Amir Ali Narvani is Specialist Registrar in Orthopaedics and Trauma, North West Thames Rotation. Panagiotis Thomas is co-director of the MSc School of Human Health and Performance at University College London and Consultant Orthopaedic Surgeon at the Whittington Hospital NHS Trust, London. Bruce Lynn is Professor of Physiology and co-director of the MSc School of Human Health and Performance at University College London. The KEY TOPICS Series Accident and Emergency Medicine, Second Edition Anaesthesia, Third Edition Cardiac Surgery Cardiovascular Medicine Clinical Research Critical Care, Second Edition Evidence-Based Medicine Gastroenterology General Surgery, Second Edition Human Diseases for Dental Students Neonatology, Second Edition Neurology Obstetrics and Gynaecology, Second Edition Oncology Ophthalmology, Second Edition Oral and Maxillofacial Surgery Orthopaedic Surgery Orthopaedic Trauma Surgery Otolaryngology, Second Edition Paediatrics, Second Edition Pain Management, Third Edition Plastic and Reconstructive Surgery Psychiatry Renal Medicine Respiratory Medicine Sexual Health Thoracic Surgery Trauma Urology KEY TOPICS IN SPORTS MEDICINE Edited by A A Narvani, P Thomas and B Lynn First published in the United Kingdom in 2006 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Simultaneously published in the USA and Canada by Routledge 270 Madison Ave, New York, NY 10016 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2006 Routledge This edition published in the Taylor & Francis e-Library, 2006. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein. For detailed prescribing information or instructions on the use of any product or procedure discussed herein, please consult the prescribing information or instructional material issued by the manufacturer. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Narvani, A. A. (Amir Ali), 1971– Key topics in sports medicine / A.A. Narvani, P. Thomas, and B. Lynn. p. ; cm. –– (Key topics series) Includes bibliographical references and index. 1. Sports medicine—Handbooks, manuals, etc. I. Thomas, P. (Panagiotis), 1960– II. Lynn, Bruce, 1943– III. Title. IV. Title: Sports medicine. V. Series. [DNLM: 1. Athletic Injuries—Handbooks. 2. Sports Medicine—Handbooks. QT 261 N238k 2006] RC1211.N37 2006 617.1⬘027—dc22 2006008644 ISBN10: 0-415-41122-X (hbk) ISBN10: 1-841-84441-1 (pbk) ISBN10: 0-203-48015-5 (ebk) ISBN13: 978-0-415-41122-6 (hbk) ISBN13: 978-1-84184-441-1 (pbk) ISBN13: 978-0-203-48015-1 (ebk) To my father, who taught me how a father could also be his son’s best friend, defined kindness and generosity for me and introduced me to the wonderful world of sport. To my mother, who is the main reason for every success that I have ever had and whose sacrifices I truly appreciate. To my wife without whose support and patience this book would not have been possible. I would also like to thank my co-editors, all of the contributing authors and the publishing company Routledge. A A Narvani To my parents, my wife Jennie and my two daughters Bethany and Jessica Thomas. P Thomas To my long-suffering family. B Lynn Contents List of contributors x Preface xii Abdominal injuries in sport B Modarai 1 Achilles tendon rupture AA Narvani 4 Ageing and sport AA Narvani 6 Ankle – acute sprains AA Narvani 11 Ankle – persistent problems following sprains: overview AA Narvani 14 Ankle – persistent problems following sprains: lateral ankle instability AA Narvani 15 Ankle – persistent problems following sprains: other injuries AA Narvani 17 Back pain – overview AA Narvani 25 Back pain – lumbar strains and sprains AA Narvani 27 Back pain – discogenic AA Narvani 29 Back pain – spondylolysis AA Narvani 30 Biomechanics B Lynn 32 Calf pain P Thomas 35 Cervical spine injuries – overview AA Narvani 36 Cervical spine – cervical ligament and muscle injuries AA Narvani 38 Cervical spine – cervical disc injuries and herniations AA Narvani 39 Cervical spine – fracture/dislocation AA Narvani 40 Cervical spine – cervical cord neuropraxia AA Narvani 46 Cervical spine – nerve root/brachial plexus injuries AA Narvani 47 Chest injuries P Thomas 50 Compartment pressure syndromes P Thomas 53 Diabetes and exercise S Parnia 54 Disability and sport – overview AA Narvani 59 Disability and sport – classification AA Narvani 60 Disability and sport – medical problems AA Narvani 62 Disability and sport – equipment AA Narvani 65 Drugs in sport – overview B Lynn 68 Drugs in sport – the administrative framework: doping control procedures B Lynn 72 Drugs in sport – anabolic steroid abuse B Lynn 75 Drugs in sport – blood doping, erythropoietin and altitude training B Lynn 78 Diving – hyperbaric medicine B Lynn 82 Ear, nose, throat conditions in athletes N Munir 86 Elbow – lateral epicondylitis (tennis elbow) AA Narvani 89 Elbow – medial epicondylitis (golfer’s elbow) AA Narvani 92 Elbow – throwing injuries AA Narvani 95 Epilepsy and exercise S Parnia 102 Exercise physiology – circulatory and respiratory systems B Lynn 106 Exercise promotion B Lynn 109 viii Sports Medicine Eye injuries in sports AA Narvani 111 Female athlete – the triad B Lynn 116 Female athlete – exercise during pregnancy B Lynn 119 Fitness testing B Lynn 120 Forearm and wrist conditions P Thomas 121 Gender verification B Lynn 124 Groin pain AA Narvani and EE Tsiridis 125 Hand injuries P Thomas 129 Head injury P Thomas 131 Heel pain R Sreekumar 134 Imaging of sports injuries – plain radiograph (plain X-ray) AA Narvani 141 Imaging of sports injuries – ultrasound (USS) AA Narvani 143 Imaging of sports injuries – isotope bone scan AA Narvani 145 Imaging of sports injuries – magnetic resonance imaging (MRI) AA Narvani 148 Imaging of sports injuries – computed tomography (CT) AA Narvani 151 Infection and sport A Kamvari 153 Knee – acute injuries P Thomas 156 Knee – overuse injuries P Thomas 161 Knee – anterior knee pain P Thomas 162 Lumbar intervertebral disc herniation AA Narvani 164 Maxillofacial injuries in sport F Monibi 168 Muscle properties relevant to sports and exercise (including fatigue) B Lynn 172 Nerve injury – overview of peripheral nerve injuries O Haddo 178 Nerve entrapment syndromes – upper limb P Thomas 182 Nerve entrapment syndromes – lower limb O Haddo 183 Orthoses in sport JL Livingstone 186 Osteoarthritis and sport AA Narvani 194 Osteoarthritis – treatment AA Narvani 196 Paediatrics – sports medicine P Thomas 200 Paediatrics – sports injuries P Thomas 202 Paediatrics – osteochondrosis (osteochondritis) P Thomas 206 Physiotherapy – general principles T Betts 209 Physiotherapy – acute injury management T Betts 213 Physiotherapy – rehabilitation T Betts 218 Physiotherapy – the team physiotherapist T Betts 221 Prevention of sports injuries AA Narvani 225 Psychology – performance enhancement P Thomas 229 Psychology – sports injuries P Thomas 231 Pulmonary disorders and exercise S Parnia 232 Risk of sudden death in athletes MF Khan 235 Shin pain P Thomas 244 Shoulder – acute dislocation AA Narvani 245 Shoulder – instability AA Narvani 248 Shoulder – impingement syndrome/rotator cuff disease AA Narvani 253 Shoulder – acromioclavicular joint injuries AA Narvani 259 Skin infections in athletes A Kamvari 263 Contents ix Sport and exercise at altitude B Lynn 268 Sport and exercise in the cold – hypothermia B Lynn 270 Sport and exercise in the heat – thermoregulation and fluid balance B Lynn 272 Sport and travelling P Thomas 275 Sports footwear AA Narvani 277 Stress fractures in sports M Ramachandran 281 Team physician P Thomas 285 Thigh pain (anterior) – quadriceps muscle injuries AA Narvani and EE Tsiridis 287 Thigh pain (posterior) – hamstring strains AA Narvani and EE Tsiridis 291 Thigh – muscular contusions and myositis ossificans AA Narvani and EE Tsiridis 295 Thoracolumbar spine fractures AA Narvani 299 Training B Lynn 304 Unexplained underperformance syndrome B Lynn 306 Urinary tract injuries P Thomas 308 Index 310