Sports Medicine

Establishment of a Laser Therapy Practice with Particular Reference to Sports Medicine Including Typical Case Studies

The basic tenet of any medical practice is to treat the patient as we, ourselves, would wish to be treated. In order to accomplish this, we must respect the patient as we respect ourselves.

Considerations of Importance to this Relationship:
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• We will react negatively to a patient.
• We will never be judgmental.
• We will never keep a patient waiting for a long time to be examined.
• We adopt a positive attitude at all times. If there is an increase in pain after the initial treatment, it is often that the reason for this is a good tissue response and it can be easily corrected by altering the parameters.
• How rapidly does the patient want to become well? With a positive outlook and particularly in chronic cases, a good attitude can go a long way towards wellness.
• If the clinical status plateaus, the patient may fall out of the standard category and require an individualized program which will be instituted.
• Persistence with laser therapy will almost guarantee that they will eventually turn the corner and improve, which occurs almost without exception.
• We make the patient part of the healing process. Therapy is a joint effort between the therapist and the patient.
• General tips we give patients on how to help themselves may include:
- Weight loss as indicated.
- Stretching exercises.
- Finding correct footwear.
- Encouraging gradual increase in activity levels and to develop specialized exercises designed for each patient.
- The utilization of a competent exercise therapist may be appropriate in these instances.
- Tailoring activity levels for each particular situation.
- Utilizing aqua-therapy, massage and other complementary modalities as indicated.
- Some daily vigorous activities may be essential unless pain restricts this endeavor.
- Swimming is the universal exercise with benefit to both musculoskeletal and cardio respiratory health.
- Most important, counsel patients on how to avoid stress!

Perspectives:
Please see this page for more info.

Assessment of Patient

• We will take a thorough history in routine fashion.
• We will carry out physical examination.
• We will discuss injuries to symptoms (review mechanics of injury).
• We will discuss what makes a condition better and what makes it worse.
• What is the degree of restriction of activities as a result of symptoms.

Physical Examination:
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• Range of motion
• Areas of tenderness
• Determine flexibility/suppleness of tissues
• Erythema
• Edema
• Observe gait
• Note deformities
• Instabilities
• Watch the patient’s movement and observe if possible to see how they get out of a car and approach waiting area, etc.
• In examining backs, check the degree of straight leg raising, determine range of motion of area of spine, i.e. flexion, extension, lateral rotation, and lateral flexion
• Check both passive and active range of motion of hips
• Neurological examination should include status of motor power, sensation, reflex change.
• Always be cognizant that problems in the lumbar spine and hips may mimic one another or be coexistent
• Always be aware of biomechanical factors
• Leg length
• Pelvic / Shoulder tilt

Possible Tests:
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• X-Ray
• U.S.
• MRI
• CAT scan
• PET scan
• Nerve conduction tests
• Range of motion: goniometer
• Upper body power: dynamometer
• Computer programs to measure diameter of lesion
• Biopsy of tissue

Consultations as Indicated:

• Neurologist
• Neurosurgeon
• Orthopedic Surgeon
• Endocrinologist
• Dermatologist

Examination of Knee:

knee3• Flexion
• Extension
• Eversion
• Inversion
• Varus/Valgus deformities
• Instability (A-P, lateral)
• Edema/Effusion
• Supra-, pre- and infrapateliar tenderness
• Tricompartmental tenderness
• Osteophyte formations along joint line with hypertrophy
• Discoloration (inflammation /hematoma)

Examination of Shoulder:

• Abduction
• Posterior extension
• Movement across chest
• Place hands behind head and lower back in sequence
• External rotation with elbows at 90 degrees
• These movements will assist in determining the exact area of involvement, i.e. acromioclavicular joint
separation, rotator cuff injury, tear of labrum, tendonitis of the long head of the biceps, capsulitis,
osteoarthritis
• Rule out fracture/dislocation

Epicondylitis:

• Medial, lateral; occasionally all four areas involved
• Diagnosis easy, involves extensor or flexor origins, sometimes accompanied by tricipital or bicipital
tendonitis (insertion of tendons)

Examination of Spinal Column
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• Flexion
• Extension
• Lateral rotation and lateral flexion
• Scoliosis
• Kyphosis
• Rotoscoliosis
• Active and passive range of motion of the hips
• Muscle spasm
• Areas of tenderness
• Straight leg raising
• Leg length
• Arterial pulses (IC)
• Tissue status
• Diameter of calf and thigh

Protocols:

A certain degree of complexity may be involved, but one can apply universal protocols in standard cases consisting of red continuous, infrared frequency of 50, duty cycle 50-80 and 75mW probe. This can apply in most instances and will be effective in over 75% of patients treated .
• If tissue hypersensitivity is anticipated, i.e. rheumatoid arthritis, autoimmune diseases, fibromyalgia,
superficial inflammatory lesions, best universal protocol is red SO/SO, infrared 10/60 and 75mW probe.
• These universal protocols are safe, effective and do not require much adjustment. They may prolong the number of patient visits, but this is not a significant problem.
• obtain as much therapeutic value out of each protocol setting as possible.
• Increase gradually if necessary based on clinical findings.

Treatment Objectives:

• Redaction of pain
• Increase in mobility and range of motion
• Reduce need for pharmaceuticals
• Return to normal work and activity levels
• Improve quality of life ie, sleeping patterns, appetite, sense of well-being

Forms of Therapy:
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• Laser – Basic Platform
• Massage
• Thermal – heat or cold
• Exercises
- stretching
- back extensions
- quadriceps drill
- swimming
- aquatherapy
- isometrics
- yoga
- pilates
- tailor to individual needs