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Making The Game Day “Go” Or “No Go” Decision

The decision whether an athlete should be allowed to play or should sit out after injury is always an interesting one to observe from afar. These decisions are particularly difficult for team physicians at the professional level when there is a critical need for an athlete to compete, as I wrote about last week with Egyptian soccer player Mo Salah. (I got that one wrong…).

I’d like to outline below the basic framework that a team physician would take when making this decision. These principles were nicely outlinedin an article co-authored by my former Stanford partner, Dr. Gord Matheson.

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Coming Back From: Shoulder Separation (Egypt’s Eyes Are On Mo Salah)

This week I’ll offer up some pre-World Cup injury recovery info, inspired by Egypt/Liverpool brilliant playmaker Mo Salah. There’s been much speculation about the nature of Salah’s recent shoulder injury, and I haven’t been able to find a clear diagnosis in publicly available sources. But if I had to guess (and this is a pure guess), given the way the injury occurred and the evaluation from the physician in the accompanying photo, I’d say he likely sustained a shoulder separation.

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Bone Bruise: What It Is And How It’s Managed

Many people are surprised to learn that bone has a blood supply. It’s every bit a living tissue as skin, your brain, or your heart. And like any of those other tissues with a blood supply, a bone can be bruised.

Lots of people are familiar with a bruise on the skin. If you bump the outside of the skin hard enough it will cause tiny blood vessels in the skin to break, leading to some bleeding in the skin. This causes the common black/blue/green discoloration. If you hit a bit harder the force can be transmitted deeper, to the underlying muscle. And if you hit harder still that force can go straight to the bone.

A bone bruise is an injury to the interior of the bone (the bone marrow) with enough force to disrupt the internal blood supply but not enough force to crack the outside of the bone.

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A New Way To Get Strong

As an orthopedic surgeon and sports medicine specialist I see a lot of folks who  need to gain strength to recover from injury, or as part of an overall rehabilitation program. The problem we often run in to is that the traditional way to build strength is often very difficult for these folks either because it will increase joint pain or because there are specific loading limitations that are part of their rehab plan after surgery.

What anyone in this situation really needs is a safe way to build strength that does not lead to joint pain or risk a surgical repair. What if there was a way to effectively build strength using much lower resistance loads than those associated with traditional strength building methods?  Recently I’ve started using a technology called “blood flow restriction” bands that I believe could open up an entirely new pathway for strength gains in these situations.

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Start ACL Injury Prevention Programs When The Players Are Young

I’ve written and spoken about how much I believe in the value of the FIFA 11 program to reduce ACL and lower extremity injury rates, and make better soccer players. In fact the value of the FIFA 11 has been demonstrated in other sports too. I honestly can’t see why any coach wouldn’t implement this program. It’s part of the regular warmup you’d be doing anyway, and it’s better for your players. Please do it.

ACL tears tend to happen more frequently in teenagers rather than in younger players. Does that mean you should wait until the players are teenagers to start the FIFA 11? This recently published study suggests that the younger players will have greater improvements in body mechanics than the teenagers. The key study result: start the FIFA 11 program in the younger age groups.

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CRISPR and the Super Athlete

CRISPR, or CRISPR-Cas9, is a technique that allows genetic scientists to edit specific parts of a person’s genome by removing or altering sections of DNA — also known as gene editing. This technology has massive potential to be a force for good, possibly leading to cures for diseases such as cystic fibrosis and others. Could it also be used to genetically manipulate an athlete’s genome to create a kind of “super athlete”?

The short answer is likely “no”. The reason for that is that athletic performance relies upon complex interactions between multiple processes controlled by multiple genes. There is also a huge impact from environment and training.

The dark side of CRISPR is that it might be possible to manipulate an athlete’s genome and go completely undetected by testing processes. In other words, a really easy way to genetically cheat.

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Long Distance Running Won’t Kill Your Knees

I see a lot of folks in my clinical practice with hip and knee arthritis and many of them have extensive running histories. Most of these folks believe that it’s the long term running that eventually led to the arthritis, but the belief that running causes knee arthritis is probably a myth. The idea that running can lead to arthritis makes sense. You run on a hard surface for long distances and over many years the impact leads to wear and tear. Seems pretty logical, right? Well the available evidence points us in a different direction.

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When An Injury Means You’re Going To Miss Out

I’m starting to see reports of some elite professional soccer players who will miss the upcoming World Cup due to recent injuries. The injury recovery process will require months of rehab, meaning they will not be ready in time to participate. For many athletes, whether an elite professional or a recreational athlete, dealing with the possibility of missing a really important event or even having to retire from sport can create significant psychological challenges.

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Rotator Cuff Repair For Young Athletes: An Uncommon Operation With Excellent Results

By Dev Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Rotator cuff tears requiring surgery are uncommon in young athletes Surgery typically leads to excellent function and very high return to sports at the same level or higher, although overhead athletes may need to change positions The…

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There’s A Lot We Don’t Know About Baseball and Softball Injuries

By Dev Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: There are likely many factors involved in shoulder and elbow injuries for young throwers The available data suggests that there are steps a young thrower can take now to minimize risk. These steps include: play less than…

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