Clinical practice in prevention and treatment of sports injuries pdf

There is no universal solution for the prevention and treatment of sports injuries. Clinical decisions need to be anchored in the three core variables of sport characteristics, individual basic conditions, and injury development stages. Evidence-based medical evidence has the same priority as the patient's subjective body perception. There is no need to blindly follow one-size-fits-all standardized guidelines. The following is a breakdown of the practical content of this clinical manual (which has been compiled into an archiveable PDF version and is currently a common material used by our team for science popularization at cooperative sports venues and community hospitals). It all comes from the frontline practice of more than 1,200 outpatient clinics + provincial youth sports team follow-up in the past five years.

I just picked up a 28-year-old amateur runner last Wednesday. He had sprained his ankle after running a half-marathon. I followed the "General Treatment Guidelines" I searched online to rub away the congestion and then apply safflower oil. Three days later, the ankle was swollen like a freshly steamed sourdough bun. The MRI showed that it was a grade two injury to the anterior talofibular ligament. I was supposed to be able to return to jogging after two weeks of braking, but now I have to undergo four weeks of rehabilitation before I can walk normally. To be honest, there can be seven or eight cases in a clinical week of using standardized guidelines to apply to one's own situation.

When it comes to prevention, the current views in the industry are not unified. Academic rehabilitation specialists first recommend functional screening. By doing a set of FMS and SFMA, problems with power generation habits and movement patterns can be clearly identified, and then muscle strength shortcomings can be replenished in a targeted manner. This set is really useful for professional athletes - we previously conducted pre-season screening for the provincial team's sprint group and found three players with asymmetric hamstring strength. We conducted special strength intervention 8 weeks in advance, and the hamstring strain rate throughout the season was directly reduced by 42%. But another group of colleagues doing community science popularization believe that there is no need for ordinary sports enthusiasts to spend hundreds of dollars for a full set of screenings. As long as they remember the four words "step by step", increase the amount of each exercise by no more than 10% of the previous time, and do dynamic stretching before exercise and static stretching after exercise, they can avoid 80% of daily injuries. This is true. Last year, we did science popularization for square dance aunts in the street and only taught these few points. In three months, the frequency of aunts complaining about knee pain and sprained feet was directly reduced by half. I usually give advice to patients based on both ends of the spectrum: For ordinary people who exercise less than three times a week, just keep it simple and don’t mess around with stuff like stacking buffs on protective gear or recharging energy before games. ； If you regularly exercise more than 4 times a week, or have special hobbies such as running or playing ball games, it is still recommended to do functional screening 1-2 times a year. It is better to eliminate hidden dangers in advance than to run to the hospital if you feel pain. In fact, sports injury prevention is like maintaining your car. A car that runs on the highway every day must be inspected frequently. If you just drive it out for a walk on the weekend, you can go there once every six months. There is no need to dismantle the engine every day to troubleshoot problems, right?

Compared with the small differences on prevention, the controversy on the treatment side is actually much greater. Many patients ask the first question when they come in: "Should my injury be resting or moving?" ”, there is really no direct standard answer to this question. As for the treatment of acute injuries, the old guidelines have used the RICE principle (rest, ice, compression, elevation) for more than ten years. Now it has been updated to the POLICE principle, which has an additional requirement of "appropriate load". However, this does not mean that the old principle is wrong: if the ligament has been completely ruptured or fractured, you must first strictly brake according to the old principle. Don't listen to the saying "the sooner you move, the faster the recovery". ； But if it is just a soft tissue contusion or first-level ligament injury, then doing pain-free activities after 24 hours is indeed faster than lying down for half a month. There was a 42-year-old amateur badminton enthusiast who had a grade-two rotator cuff injury. He went to another hospital and was directly recommended for surgery. He was afraid of the sequelae and came to us. After the evaluation, we decided on a plan of strict immobilization and ice application in the first week. In the second week, he began to do pendulum exercises without weight-bearing. In the third month, he gradually added shoulder and back strength training. Now, half a year later, he can still play mixed doubles twice a week, and his smashing is not affected at all.

To be honest, there are two extremes that we see most in clinical practice: one is to bear the injury and feel that "the pain will be gone in a few days." As a result, the acute injury becomes chronic. This is how many people suffer from patellar chondromalacia. At the beginning, they don't take the pain in their knees seriously after running, and they forcefully increase the amount of running. In the end, it is difficult to go up and down stairs.； The other is excessive anxiety. When I take an MRI and see that the report says "a small amount of effusion" and "a first-degree meniscus injury," I am so scared that I dare not move anymore. In fact, many of these are normal reactions after exercise. There are no symptoms of obvious pain or limited movement, and no special treatment is needed at all.

We update this PDF every year. Every time new evidence-based evidence comes out, or when we encounter some typical cases, we will add two strokes to it. There is no obscure academic terminology piled up, it is all practical experience gained from the front line. Whether you are a professional athlete or an ordinary person who usually only takes a walk after a meal, you can always use it after flipping through it. After all, sports medicine itself is constantly changing with everyone's exercise habits. In the final analysis, whether it is prevention or treatment, the most important thing is that you must first understand your own body. Don't force yourself to do it, and don't be overly anxious. It's better than anything else.