Sports Medicine for the Primary Care Physician PDF

Preface

Exercise in the natural form of work was a necessary and regular part of life before the Industrial Age. With the advent of work-saving machinery, people turned more and more to the "sedentary studious life." ¹ Despite the clairvoyant exhortations of some of our nation's political leaders (Thomas Jefferson and Benjamin Franklin) and the world's medical giants (George Cheyne and Joseph Addison), the "pamper'd Race of Men" prospered. ² The tempo of the past several decades has shown the wisdom and benefits of regular exercise. Serendipity has played a significant role in the observations that physically active individuals do not suffer proportionately from atherosclerosis, strokes, myocardial infarctions, and other chronically debilitating diseases as do their sedentary counterparts. Rudimentary exercise research has begun to yield the secret successes of fitness training. Established health benefits of regular physical activity include a reduction of coronary heart disease, hypertension, non-insulin-dependent diabetes, colon cancer, anxiety, depression, and all-cause death rates; maintenance of appropriate body weight and functional capacity; and increased bone mineral content. The general sociocultural swing back to naturalism, homeopathy, holism, and self-help has embraced exercise and sports activities as a necessary component and has once again brought us full circle to our ancestors' philosophies.

The first edition of this book sprang from the Society of Teachers of Family Medicine sports medicine panel in 1980. This invigorating panel and its chairman, Daniel Garfinkel, M.D., designed the sports medicine curriculum for the family practice programs of this country. The second edition moved to a problem-oriented, field-side format and became a practical authoritative guide for primary care physicians involved in the study and practice of sports medicine. This third edition brings further evolutionary changes, including several new chapters (complementary/ alternative sports medicine options, the radiologic evaluation of the athlete, and a revised and streamlined medical illness section) and incorporates the growing science of evidencebased medicine. In addition, Francis O'Connor, M.D., a recognized family physician who is a sports medicine authority, becomes the associate editor.

Because the world of sports and recreational activity encompasses all ages and both genders, as well as the entire health spectrum, it is fitting that the primary care physician should be the front-line sports medicine specialist. It is this individual who first sees the injured athlete at home, on the field, or in the office. Very often the physician recognizes the family or personal problem affecting a person's performance. Above all, it is the primary care physician who is best suited to integrate the patient's work, sport, family, and school environment so that maximum exercise potential and function under the safest health conditions can be realized.

While there are a number of professional resources for evidence-based medicine, this third edition utilizes a grading system described in the American Family Physician in 2002. ^3-5 Level A evidence is derived from a high-quality, randomized, controlled trial (RCT)/meta-analysis using comprehensive search strategies. Level B evidence is from a nonrandomized, well-designed clinical trial utilizing a nonquantitative systematic review with appropriate search strategies. Level C evidence represents expert opinion as consensus viewpoint.

Much work remains to be done in achieving the 2010 national objectives for physical fitness and exercise. ⁶ While the number of employer-sponsored fitness programs has significantly increased and the majority of primary care physicians include a careful exercise history as part of their initial examination of new patients, fewer than 50% of children ages 10 to 17 regularly participate in appropriate physical activities, particularly cardiorespiratory fitness programs that can be carried into adulthood. Only 10 to 20% of adults ages 18 to 65 are participating in vigorous physical exercise, and fewer than 8% of adults 65 years or older engage in appropriate physical activity (i.e., regular walking, swimming, or other aerobic activity). Only 5% of adults can accurately identify the variety and duration of exercise thought to promote cardiovascular fitness most effectively. Over 60% of adults and up to 15% of children are overweight or obese. These are profound challenges that must be addressed in the next decade through clinical practice and scholarly research. The message is clear: "Exercise is the easiest way to preserve health." 7 We are the medium. This textbook is one small effort in making the message happen. Read, learn, enjoy, and profit.