Title and Text-Orange - Cayuga Medical Center

Figure Skating Medical
Ithaca, NY December 6, 2010
Andrew Getzin, MD
[email protected]
• Andrew Getzin, MD,
Medical Treatment of
figure skaters
• Jake Veigel, MD,
Injury Prevention
• Deb King, PhD,
Figure Skating
Stretching and Warm
• Discussion
Incidence of Injuries in Elite Junior
Figure Skaters- Acute Injuries
Ankle Sprain
Head Injury
Fracture, arm
Fracture, leg
Knee ligament sprain
Knee injury
Shoulder dislocation
Fracture, wrist
Fracture, finger
Dubravcic-Simunjak, AJSM 2003
Incidence of Injuries in Elite Junior
Figure Skaters- Overuse Injuries
Stress Fracture
Jumper's knee
Shin splints
Osgood Schlatter
Groin pain
Hamstring Syndrome
Achilles tendonitis
Ankle Impingement
Plantar fasciitis
Dubravcic-Simunjak, AJSM 2003
What is a Concussion?
Mild traumatic brain
A disruption in
normal brain
function due to a
blow or jolt to the
CT or MRI is
Invisible injury
Neurometabolic Cascade
(Giza and Hovda 2001)
Abrupt neuronal depolarization
Release of excitatory neurotransmitters
Changes in glucose metabolism
Altered cerebral blood flow
The brain goes into an ENERGY
CRISIS that usually last up to 7 – 10
Vulnerable Period
• There exists a
window period when
individual is at
increased risk
• Should factor in return
to play decision
Common Physical Symptoms
Nausea and vomiting
Clumsiness and poor balance
Dizziness and lightheadedness
Blurred vision and light
• Fatigue and lack of energy
• Sleep disturbance
• Symptoms often get worse
before they get better
Common Emotional Symptoms
More extreme moods
Easily overwhelmed
Personality change
Lack of motivation
Common Cognitive Symptoms
Feeling ‘dazed’ or ‘foggy’ or ‘fuzzy’
Easily confused
Slowed processing
Easily distracted
Memory problems
Trouble reading
Poor mental stamina
• Outcome after
concussion is difficult
to predict
• Don’t be fooled by
severity of injury at
the time of injury
Physical Exam
• Regular physical exam including HEENT,
neck, and neurological exam
• 5 Word Recall- immediate and 5 minutes
• Months of the year backwards
• Digits backwards
• Speech
• Pronator drift: Rhomberg
• Finger-to-nose
• Gentle push with their eyes closed
Neuropsychological Testing
• Computerized tests that measure
attention, memory, and processing speed
(reaction time)
• Sensitive to effects of concussions
• Tests can be repeated multiple times to
monitor recovery
• Ideally, a baseline is done but there is
normative date for ImPACT
Who Should Have a CT Scan?
GCS < 15
History of emesis
Severe headaches
Signs of basilar skull fracture
Severe mechanism
Kuppermann Lancet 2009
Principles of Concussion Treatment
• No cure for concussion, but treatment can
help the person feel better and function
better while symptomatic
• Early diagnosis and education is critical,
and can improve outcome
• Rest early (7-10 days?) and then gradually
increase activity
Treatment Strategy
• Education and reassurance
• Medications for sleep, headache, etc.
• Physical & Occupational Therapy
• Neck & back problems
• Balance (fall prevention)
• Vision and Cognition
• Neuropsychological Testing
Academic Accommodations
Out of school if necessary
Limit study time
Possibly hold on testing
Stress Fractures
• Overuse from
attempted skill over
and over again
• Usually insidious
• Most common
location is long bones
of the feet
Pecina, Stress Fractures in Figure Skaters.
AJSM 1990
Stress Fracture Treatment
• Unload the affected
• Pain is a helpful guide
• What can the skater
do while he/she
Stress Fracture Prevention
• Listen to your body for warning signs
• Ensure good bone health
– Sufficient Vitamin D
– Calcium
– Energy balance
• Increase activity by <10%/week
• Jump counts?
• Biomechanics
Asthma in Figure Skating
• 1/3 – ½ of all figure skaters suffer from
exercise induced bronchospasm
• Symptoms exacerbated by cold, dry air,
and chemicals
• Skaters may present with chronic cough,
decreased aerobic capacity or wheezing
Effect of the Interaction between the Intensity of Exercise and the
Thermal Environment on the Pulmonary Mechanical Response
McFadden E and Gilbert I. N Engl J Med 1994;330:1362-1367
EIB Treatment- Non pharmacologic
• Increase physical fitness
• Warm up for at least 10 minutes at sub-threshold level (60-70%
VO2max) before exercise begins (refractory period)
• Cover mouth and nose with a scarf or mask (balaclava) during cold
• Exercise short bouts in warm, humidified environment
• Avoid aeroallergens and pollutants
• Cool down or gradually lower the intensity of exercise before
• Wait at least 2 hours after a meal before exercising
• Low salt diet?, Fish Oil Supplementation?
Tan and Spector, Exercise-Induced Asthma, Sports Med. 1998;25(1):1-6
EIB Treatment-pharmacologic
• Inhaled beta 2
• Inhaled
• Inhaled cromolyn
• Inhaled nedocromil
• Inhaled ipatropium
• Oral leukotriene
Not All Shortness of Breath is
Exercise Induced Brochospasm
Vocal Cord Dysfunction/Paradoxical Vocal Cord Motion
Lack of Fitness
Panic Attack
Overtraining syndrome
Cardiac abnormalities
Thank You

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