Sports Medicine: Just the Facts

• Chromolyn sodium is rarely effective when used alone
  and tends to be quite expensive in the required dosages.

Moderate to Severe Symptoms

• Athletes who require second-line medications should
  be further evaluated.


• Addition of a second medication listed above


• Addition of inhaled corticosteroid (budesonide, fluti-
  casone) or beta-agonist/corticosteroid combinations
  (Advair-Glaxo Wellcome).
  
  
  • Inhaled corticosteroid is effective in alleviating the
    postexercise cough brought on by late phase inflam-
    matory effects of EIA.
  
  
  
  


• Doping control:Care must be taken to ensure compli-
  ance with doping control measures in elite level skiers.


• Most asthma medications are restricted and appropri-
  ate procedures for documenting their use is required.
  Recently, the International Olympic Committee (IOC)
  and FIS have begun requiring documented testing of
  these athletes prior to the use of asthma medications.


• The USADA hotline is a useful resource for any ques-
  tions regarding the use of these medications (1-800-
  223-0393).

COMMON MUSCULOSKELETAL PROBLEMS

SACROILIITIS

• Pathophysiology:The sacroiliac(SI) joint is a bicon-
  cave articulation of the hemipelvis to the sacrum. It
  has relatively small rotational motion but functions
  primarily to transmit force from the lower extremity
  to the spine. Sacroiliac dysfunction is the most
  common cause of low back pain in the skier.


• Injury can result from direct trauma associated with a
  fall, but more commonly arises from repetitive load-
  ing. Contributing factors in this injury include SI joint
  hypermobility, excessive shear forces, and relative
  core strength deficits.


• Clinical features:Symptoms stem from inflammation
  in the SI joint and include local pain at the SI joint that
  is exacerbated with walking, running, or skiing.


• The athlete will often have associated lateral hip pain
  and pain at the gluteal prominance. Radicular symp-
  toms are unusual and are associated with piriformis
  spasm, facet irritation, or concomitant disk disease.


• Examination will typically reveal the following:
  Tenderness at the SI joint and relative hypomobility on
  the effected side with a standing knee to chest test
  •FABER test (flexion, abduction, and external rotation)
  will usually elicit symptoms. Neurologic examination
  is normal.


• Diagnostic testing: Radiographs may demonstrate
  arthrosis or degenerative disease of the lower spine.
  
  
  • Treatment:Pain relief strategies include oral anal-
    gesics/anti-inflammatory medications, chiropractic
    treatment, ice, massage, and stretching.
  
  
  • Long-term management aims at improving SI func-
    tion through core stabilization and muscle balance
    training (Thera-ball program, Pilates, or similar).
    •Technique and equipment issues should also be
    reviewed.
  
  
  
  

GREATERTROCHANTERBURSITIS

• See detailed description in chapter 57.
  RETROPATELLARKNEEPAIN(PATELLOFEMORAL
  DYSFUNCTION)/ILLIOTIBIALBANDFRICTION
  SYNDROME


• See detailed descriptions in chapters 60 and 61 respec-
  tively.

EXERTIONALANTERIORCOMPARTMENTSYNDROME

• Pathophysiology:In cross-country skiers, exertional
  compartment syndrome(ECS) typically effects the ante-
  rior or lateral compartments representing injury to the
  tibialis anterior or peroneus brevis muscles respectively.


• ECS is precipitated by exercise induced swelling of
  the soft tissue in the confined compartment leading to
  ischemic pain in the effected muscle.


• This is most common in skating technique where the
  foot is dorsiflexed and everted during ski recovery.


• This injury was very prevalent when the technique was
  first introduced due to the excessive length of the ski
  and relatively soft binding used with the classic stride.
  As equipment has been developed specifically for the
  skating technique, this has become less common. It is
  now most commonly seen with the use of combination
  equipment (designed for both skating and classic tech-
  nique) and with poorly fitting equipment.


• Clinical features:See detailed description of symp-
  toms in chapters 22 and 63.


• Diagnostic testing:Pre- and postexercise compart-
  ment pressure testing may be helpful although it is
  difficult to reproduce the specific conditions of skiing
  in the laboratory (see chapter 22).


• Treatment:Includes decreasing compartment inflam-
  mation using anti-inflammatory medications and
  improving function through a balanced stretching and
  strengthening program.


• Equipment modifications should be made to utilize a
  skating specific boot-binding-ski system. A stiffer
  binding and shorter ski may also help.


• In resistant cases a surgical fasciotomy may be neces-
  sary (see chapter 63).

PERONEUSTENDONINJURY

• Pathophysiology:Injury to the peroneus tendon can
  occur with an acute inversion dorsiflexion injury or

478 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS