Sports Medicine and Athletic Health Risks

Skeletal Muscles

• There are over 600 skeletal muscles in the human body, making up 40-50% of total body weight in healthy adults and over 60% for many athletes.
• Skeletal muscles generate forces for voluntary movements and postural control, contribute to thermoregulation, and play a key role in whole-body metabolism and endocrine and paracrine functions.

Muscle Structure

• Whole muscles are composed of individual muscle cells (muscle fibres) that are long, cylindrical, and enclosed by connective tissue (endomysium).
• Groups of fibers are organized into fascicles surrounded by perimysium, and the whole muscle is surrounded by epimysium.
• Muscles are separated from each other by a connective tissue fascia.

Muscle Function

• Muscles are arranged into opposing muscle groups: flexors (reduce joint angle) and extensors (extend joint angle).
• The active muscle group is known as the agonist, while the inactive group is the antagonist.
• Synergist muscles help stabilize joints during movements.

Energy Production

• There are three main metabolic pathways to synthesize ATP: anaerobic (not requiring oxygen) or aerobic (requiring oxygen).
• Anaerobic phosphocreatine (PCr) reaction is the simplest and fastest way to resynthesize ATP.
• Anaerobic glycolysis converts glucose into 2 pyruvate + 2 ATP, which can be used for aerobic ATP production or converted to lactate.
• Aerobic ATP production takes place in mitochondria, converting pyruvate and fatty acids into ATP.

Sports Medicine

• Sports medicine physicians provide comprehensive care for athletes, including prevention, diagnosis, treatment, and rehabilitation of musculoskeletal pathologies and medical illnesses.

Preparticipation Evaluation (PPE)

• PPE is a medical assessment of athletes performed prior to participation in sports, including medical history, physical examination, and identifying risk factors.
• Goals of PPE include ensuring player safety, determining fitness and health, and documenting risk factors.

Cardiac Evaluation

• The screening process involves asking about personal and family risk factors, and if necessary, further diagnostic tests and cardiology consultations.
• Key cardiovascular risk factors include family history of heart disease, high blood pressure, smoking, high cholesterol, diabetes, and cardiac symptoms.

Pulmonary Evaluation

• Controlled asthma is not a contraindication for athletic participation, but severe pulmonary compromise may discourage high-intensity sports.
• Pulmonary risks factors include uncontrolled severe asthma, serious pulmonary infections, and conditions compromising respiratory status.

Neurological Evaluation

• Risks factors include history of concussions, traumatic brain injury, seizures, and persistent post-concussive symptoms.

Musculoskeletal Evaluation

• The exam should focus on body parts most at risk, depending on the sport and athlete's personal history of injuries.
• One good indicator for return to sports is if the athlete can simulate sports-specific exercises without acute symptoms.

Other Important Medical Conditions

• Athletes with one kidney, organ transplant, or chronic organ enlargement need individual assessment before clearance for contact/collision sports.
• Athletes with one functional eye must take special precautions to protect the intact eye.
• Diabetic athletes need to pay attention to hydration, diet, and insulin therapy.
• Sickle cell disease patients may be allowed limited participation in non-contact sports, but must avoid overheating, dehydration, and chilling.