RESUMEN
Prevention of musculoskeletal injuries (MSKI) is critical in both civilian and military populations to enhance physical performance, optimize health, and minimize health care expenses. Developing a more unified approach through addressing identified movement impairments could result in improved dynamic balance, trunk stability, and functional movement quality while potentially minimizing the risk of incurring such injuries. Although the evidence supporting the utility of injury prediction and return-to-activity readiness screening tools is encouraging, considerable additional research is needed regarding improving sensitivity, specificity, and outcomes, and especially the implementation challenges and barriers in a military setting. If selected current functional movement assessments can be administered in an efficient and cost-effective manner, utilization of the existing tools may be a beneficial first step in decreasing the burden of MSKI, with a subsequent focus on secondary and tertiary prevention via further assessments on those with prior injury history.
Asunto(s)
Huesos/lesiones , Medicina Militar/métodos , Músculo Esquelético/lesiones , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/prevención & control , Medición de Riesgo/métodos , Medicina Deportiva/métodos , HumanosRESUMEN
Exertional heat injuries have gained public attention over the past several years, as have the means to prevent and treat them. One of the simplest preventive measures is to refrain from physical training and competition during times of increased environmental heat stress. Unfortunately, this often is not possible or desirable in certain populations. As a result of operational and training requirements, the U.S. Marine Corps and the U.S. Navy medical team have developed an effective exertional heat injury prevention strategy that relies upon education, leadership, and continuous hands-on observation. The fundamental aspects of this approach can be applied to other team sporting activities.
Asunto(s)
Trastornos de Estrés por Calor/prevención & control , Capacitación en Servicio , Personal Militar , Trastornos de Estrés por Calor/diagnóstico , Trastornos de Estrés por Calor/terapia , Humanos , Aptitud Física , Factores de Riesgo , Estados UnidosRESUMEN
Exertional heat illness can affect athletes during high-intensity or long-duration exercise and result in withdrawal from activity or collapse during or soon after activity. These maladies include exercise associated muscle cramping, heat exhaustion, or exertional heatstroke. While certain individuals are more prone to collapse from exhaustion in the heat (i.e., not acclimatized, using certain medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect seemingly healthy athletes even when the environment is relatively cool. EHS is defined as a rectal temperature greater than 40 degrees C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. Early recognition and rapid cooling can reduce both the morbidity and mortality associated with EHS. The clinical changes associated with EHS can be subtle and easy to miss if coaches, medical personnel, and athletes do not maintain a high level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion during exercise occur more rapidly as heat stress increases and are the most common causes of withdrawal from activity in hot conditions. When athletes collapse from exhaustion in hot conditions, the term heat exhaustion is often applied. In some cases, rectal temperature is the only discernable difference between severe heat exhaustion and EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic care and oral fluid support. Exercise associated muscle cramping can occur with exhaustive work in any temperature range, but appears to be more prevalent in hot and humid conditions. Muscle cramping usually responds to rest and replacement of fluid and salt (sodium). Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.
Asunto(s)
Conducta Competitiva/fisiología , Agotamiento por Calor/etiología , Trastornos de Estrés por Calor/etiología , Actividad Motora , Resistencia Física/fisiología , Esfuerzo Físico/fisiología , Deportes/fisiología , Humanos , Factores de Riesgo , Sociedades Médicas , Medicina Deportiva , Estados UnidosRESUMEN
A comprehensive review of shoulder impingement reveals numerous causes, contributing factors, and therapeutic options for the resolution of symptoms and return to optimal shoulder function. The clinical diagnosis of shoulder impingement is rather straightforward, but the challenge arises in identifying causative factors and directing treatment options to alleviate symptoms and restore normal function. Shoulder impingement occurs when the space between the proximal humerus and the coracoacromial arch is narrowed such that the transversing tendons, primarily the supraspinatus and to a lesser degree, the infraspinatus, are injured. As the most diagnosed shoulder ailment an understanding of shoulder anatomy, supporting musculature and function, inciting factors, and individual demands are critical in directing the appropriate treatment plan. Medications, therapeutic exercise and surgical interventions all have their place in the treatment of shoulder impingement.
Asunto(s)
Lesiones del Manguito de los Rotadores , Síndrome de Abducción Dolorosa del Hombro/diagnóstico , Síndrome de Abducción Dolorosa del Hombro/terapia , Acromion/cirugía , Artroscopía , Desbridamiento , Descompresión Quirúrgica , Diagnóstico por Imagen , Glucocorticoides/uso terapéutico , Humanos , Examen Físico , Síndrome de Abducción Dolorosa del Hombro/clasificación , Síndrome de Abducción Dolorosa del Hombro/rehabilitación , Síndrome de Abducción Dolorosa del Hombro/cirugía , Articulación del Hombro/anatomía & histologíaRESUMEN
The understanding and treatment of meniscal injury has evolved at a rapid pace over the past 20 years. With the realization of the meniscus as a vital structure to proper knee integrity, function, and longevity, the sports medicine and orthopedic communities have shifted the focus of conservative and surgical treatment to that of meniscal conservation. Hand-in-hand with this increased understanding, advances in surgical procedures, techniques, and equipment have followed. Likewise, postoperative rehabilitation protocols, based on an increased understanding of the meniscal physiologic response to injury, concurrent knee injury, repair technique, and patient-specific considerations, have advanced. Various surgical repair techniques have demonstrated superior results to complete and partial meniscectomy. Multiple factors including tear orientation and location, surgeon preference and experience, associated injuries, and patient goals and expectations often guide the type of surgery performed. Limitations in weight bearing, pivoting, and return to sporting activities in the rehabilitative process are currently areas of active rehabilitative research.