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INTRODUCTION

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The clinical field of sports medicine involves the care and treatment of those injured during sporting activities. Physiatrists were granted the ability to become subspecialty certified in sports medicine in 2006. In this chapter, common sport-specific injuries are discussed, with the injuries organized by sport rather than by body region (the more usual format). The chapter describes the most prevalent injuries in the most common sports, and while many of these injuries can occur among participants in various sports, to avoid repetition they are discussed once, under the most relevant sport.

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CONTACT SPORTS

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Contact sports are those in which participants strike or crash into one another with external force. Examples include football, rugby, and ice hockey. Athletes involved in collision sports are at a high risk for injury due to the violent nature of the competitions.

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COMMON INJURIES IN FOOTBALL & RUGBY

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1. Concussion
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ESSENTIALS OF DIAGNOSIS

  • Direct or indirect force transmitted to the head.

  • Rapid onset of transient neurologic disturbance that resolves spontaneously.

  • Functional rather than structural impairment, with normal neuroimaging.

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General Considerations
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Concussions are considered mild traumatic brain injuries caused by biomechanical forces affecting the head, with symptoms improving spontaneously over time. All athletes suspected of having a concussion must be immediately removed from competition and evaluated onsite.

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Clinical Findings
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Immediate symptoms may include but are not limited to headaches, neck pain, dizziness, visual or auditory disturbances, loss of balance, post-traumatic or retrograde amnesia, confusion, drowsiness, difficulty concentrating, or fatigue. More objective measures, such as the Sport Concussion Assessment Tool 2 (SCAT2), aim to determine the presence of a concussion and its severity by compiling a number of acute measures.

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Computed tomography (CT) imaging should be performed if loss of consciousness (LOC) lasts more than 60 seconds, with suspected skull fracture, or in the presence of any focal neurologic deficits to rule out acute subdural or epidural hematomas.

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Treatment
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Managing concussion begins with baseline neurocognitive testing. The SCAT2 may be used to this end, though computer-based programs such as the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have been found to be valid and reliable and are popular on all levels of play. Once a concussion has been diagnosed, the player must be monitored for cognitive or functional decline. High school and college athletes who suffer a concussion are not allowed to return to game action on the same day; this applies to all athletes, not only football and rugby players. Physical and cognitive rest is the mainstay of initial postconcussive management. Athletes of all ages should refrain from activity until symptoms have cleared. Student athletes should refrain from activities that challenge cognition or concentration, such as texting, video game play, and test taking. ImPACT continues to be ...

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