Question and Answer Category Results

Sports medicine is a multidisciplinary academic and clinical medical specialty that carries out the prevention, diagnosis, treatment and rehabilitation of injuries and disorders that arise from participation in exercise and physical activity at every level, and that works to protect public health by trying to promote a physically active lifestyle in society. As can be understood from this definition, in addition to amateur and professional athletes engaged in high-level performance sports, people who do not hold a license in any sport or who exercise only for a healthy life also make up the group served by sports medicine. The areas on which sports medicine mainly focuses are as follows:

• Medical checks and screenings carried out for participation in sports or before competition,

• Field-side (on-field) medicine,

• Diagnosis and treatment of sports injuries,

• Special medical situations such as travel problems and acclimatization encountered at international sports events,

• Use of pharmacological agents and supplements, doping control,

• Prevention and treatment of chronic diseases caused by a sedentary lifestyle in individuals of all ages,

• Carrying out studies and research in basic sciences and in the many clinical fields that may be related to sports medicine.

The main pursuit of sports medicine is to encourage participation in exercise and sports in order to improve quality of life, and to resolve problems that arise during participation as soon as possible so that the person can return to activity. As can be understood from these definitions, it is possible to see that sports medicine is concerned not only with the treatment of injuries but also with different aspects of exercise and sports performance. Today, many disciplines work in joint cooperation to reveal the positive and negative effects of exercise and sports on human health, and to address the diagnosis and treatment of problems and the medical aspects of athletic performance within the framework of clinical work and research.

Athletes who play sports with a license at the professional or amateur level are recommended to undergo a comprehensive health check under the supervision of a specialist sports physician at least once a year. These checks aim to evaluate the athlete's general health, identify risk factors that may cause sports injuries, review existing injuries, compare current results with evaluations made in previous years, and share up-to-date information with the athlete by discussing the nutrition and exercise program. Physical activity and exercise done for a healthy life carry less risk. Individuals who decide to exercise in order to improve quality of life, reduce risk factors for chronic diseases, and be more active and energetic during the day are advised to undergo a general health check before starting sports, particularly if they have the risk factors below. The view of American sports medicine on this subject is given below. Accordingly, each of the following risk factors in a person is counted as one risk point, and a total risk score is calculated:

• Family history (a history of death due to heart disease or an unknown cause before the age of 65 in female relatives or 55 in male relatives)

• Smoking (if still smoking or if quit less than 6 months ago)

• High blood pressure (blood pressure above 140/90 mmHg)

• Dyslipidemia (Cholesterol > 200 mg/dl, LDL > 130 mg/dl, HDL<40 mg/dl). If the HDL value is above 60 mg/dl, on the contrary, this cancels out one risk point.

• Impaired fasting glucose (>100 mg/dl)

• Obesity (Body Mass Index > 30, or waist circumference greater than 88 cm in women and 102 cm in men)

• Sedentary lifestyle (taking fewer than 5000 steps a day)

If a person planning to exercise regularly is a man younger than 45 or a woman younger than 55 and has at most one of the risks listed above, they can start moderate- and low-level exercise without undergoing a health check.

If the person has more than one risk factor or is above the stated age limits, they must undergo a medical check before starting moderate-intensity exercise. If the patient is followed by an internal medicine, cardiology or endocrinology physician, that physician is also consulted and a personalized exercise program is shaped.

In addition, if your doctor has previously told you that you have a heart condition, if you feel chest pain during physical activity, if you have had chest pain at rest within the last month, or if you have previously experienced dizziness or loss of consciousness during physical activity, you are advised to undergo a health check for safer participation in sports.

Sudden death in sports is the term given to deaths that occur during physical activity or within the following hour without any trauma. The rate is higher in men and in those over 35 years of age. Compared with their non-athletic peers, young adult athletes have a 2.5 times higher frequency of sudden death. Extreme heat, humidity and cold may increase the risk. Some doping substances (such as anabolic steroids, stimulants and blood doping), excessive alcohol consumption, and excessive and heavy exercise combined with cocaine use increase the risk. An athlete's participation in heavy activity during illnesses such as diarrhea, vomiting and influenza-like infections is also among the factors that increase the risk.

80% of the causes leading to sudden death in athletes originate in the cardiovascular system. The great majority of deaths seen under the age of 35 are congenital (familial/genetic) structural problems of the cardiovascular system. The majority of these include different causes such as hypertrophic cardiomyopathy (abnormally enlarged heart muscle), coronary artery anomalies and cardiac conduction problems.

Pre-participation examinations or license examinations reduce the risk of sudden death in sports, but they are not 100% sufficient. Certain suspicious findings detected during the physical examination and a family history in the athlete require further cardiological evaluation.

Regular exercise is effective in preventing the development of many chronic diseases, such as hypertension, diabetes, osteoporosis (bone loss), certain cancers such as breast cancer and colon cancer, obesity, hyperlipidemia (high blood fats), some vascular diseases, metabolic syndrome, fibromyalgia (widespread muscle pain in the body), depression, etc. Exercise is also effective in reducing the loss of muscle mass and strength seen in older ages, called sarcopenia. In addition, in all of these diseases, exercise programs planned individually for the person also contribute to treatment.

In addition to their medical treatment, hypertension patients can exercise regularly with an appropriate exercise prescription to regulate blood pressure. For hypertension patients, individualized exercise prescriptions of appropriate type, duration and intensity are planned under the supervision of a sports physician. Patients whose blood pressure is higher than 180/105 mmHg should avoid physical activity until they bring their blood pressure below these values with medication.

Diabetes is a disease that develops because a person cannot regulate their blood sugar level and that, if not taken care of, leads to serious health problems later in life. Exercise has an important place in the treatment of diabetes. Muscle cells absorb blood sugar independently of insulin. Therefore, when people exercise regularly and increase their muscle mass, insulin doses can be reduced in type 1 diabetes patients, and in type 2 diabetes patients, medication may not even be necessary together with a proper diet. In addition, the body weight and fat mass reduced by exercise and diet increase the sensitivity of tissues to insulin and contribute to lowering blood sugar levels.
These people's blood sugar levels must have followed a stable course for a certain period before they start exercising. Therefore, diabetic patients are advised to undergo a comprehensive pre-participation evaluation examination before starting sports and exercise.

During pregnancy, unless there is a risky condition that could prevent the pregnancy from continuing (such as high blood pressure, premature rupture of membranes, threatened preterm birth, bleeding during pregnancy, cervical insufficiency or growth retardation in the baby), exercise is generally recommended after the third month. Exercise is known to make normal delivery easier and shorter in pregnant women and to reduce labor pain. In addition, it helps the expectant mother feel better both psychologically and physically, reduces the postural and body shape changes that occur in pregnancy, reduces low back and back pain, and relieves sleep problems. Exercise in pregnancy allows the expectant mother to gain weight more appropriately during pregnancy and also helps the mother's body recover more easily after birth.

For pregnant women evaluated jointly by an obstetrics and gynecology specialist and a sports medicine specialist, when no objection to exercising is found, walking, swimming, water exercises, stretching exercises, pelvic floor exercises, yoga, dance and Pilates exercises may be recommended. Exercises involving weightlifting, combat sports because of the risk of blows to the abdomen, ball sports (such as basketball, volleyball and tennis), and sports such as cycling and horseback riding because of the risk of falling are not recommended during pregnancy.

Before participating in sports, it is recommended that children, as with adults, be evaluated by a specialist sports physician. In particular, diseases that would prevent participation in sports and anatomical causes that could increase the risk of injury can be identified in the pre-participation evaluation. If the child plays sports regularly, they should undergo a health check by a physician at least once a year. The most important part of this examination is taking a good history of the child and their family, and the child's physical examination. However, if the child is aimed to become an athlete in the future, their physical characteristics and development suitable for the intended sport need to be evaluated. During this evaluation, it is necessary to determine whether the intensity and frequency of training are appropriate for the child's age and physical characteristics and, when necessary, to give the family nutrition recommendations for the child athlete.

Because of their physique and regular exercise, athletes differ from ordinary individuals in terms of their physical requirements. One of the basic elements in athlete nutrition is the need to calculate daily energy expenditure specific to each sport. A personalized program should be prepared with a sports dietitian on this subject. Athletes should pay attention to their daily protein intake. During an intensive training period, the daily amount of protein needed both to preserve the immune system and to reduce fatigue is on average around 1.2-1.7 grams per kilogram. Taking the recommended daily amounts of vitamins and minerals from food or supplements is important for enzymes to work optimally. It is very important for athletes to replace the energy they spend during physical activity with carbohydrates within 2 hours after the activity, in order to reduce fatigue and increase the efficiency of the next day's training. Another important point is that athletes should replace the fluid they lose through sweat during physical activity, preferably using a sports drink suited to the characteristics of the fluid lost.

You can do physical activity and exercise in any environment, avoiding air pollution and extreme heat and cold. In this context, municipal walking/running tracks and equipment that allows strengthening of various muscle groups and improvement of flexibility and balance provide suitable environments. On the other hand, movements done without knowing how can cause sudden traumatic injuries as well as overuse injuries that can develop over time. Before using this equipment, the body must be warmed up sufficiently, and each time the range, speed and load of the movement should be started from a lower level. In addition, people need to know which part of the body a movement works and whether this exercise could pose a risk for them. It is important to put up informational signs explaining how the movement should be done, and to carry out routine checks of the equipment and repair/replace any that carry a risk of injury or are worn out.

To protect against sports injuries, first of all a physical activity suited to the person must be chosen, and this physical activity must be done at an intensity, duration and frequency suited to the person. In addition, it is possible to reduce the risk of injury through a suitable environment, weather conditions and surface for the sport, use of suitable equipment and clothing, use of protective equipment when necessary, appropriate warm-up and stretching exercises to prepare the body before physical activity, and cool-down exercises after physical activity. Furthermore, special training programs aimed at preventing injuries are applied for various sports.

Although research shows that injuries are more frequent on first- and second-generation synthetic turf surfaces, because of the shock-absorbing feature of new-generation synthetic turf surfaces, it reveals that such injuries do not differ significantly from those on natural surfaces. Therefore, playing football on high-quality synthetic turf under optimal environmental conditions appears to be safe when combined with the individual precautions the athlete should take. However, recently published data report that higher amounts of lead are found on synthetic fields because of the dyes used to prevent the color of artificial turf from fading in sunlight. In addition, dust and fiber fragments found on synthetic fields can enter the body through inhalation or ingestion and may threaten the athlete's health.

Injuries seen in athletes without a sudden injury and caused by repetitive minor trauma are called overuse injuries. Stress reaction in bones and, when it progresses, stress fracture; osteitis pubis (strain due to the pulling effect of the groin muscles at their attachment point on the bone); deterioration of the joint cartilage; some tendon injuries (tendinopathy); chronic compartment syndrome (a fatigue-related, intermittent and reversible rise in pressure between muscles); and bursitis (swelling of the fluid-filled sacs usually located between muscles and bones), etc. are examples of overuse injuries in athletes.

In many acute sports injuries, it is recommended to apply the R.I.C.E. (rest, ice, compression, elevation of the injured limb) protocol in the early stages of the injury. Activities that cause pain in the muscle or joint involving the injured area should be stopped. To control swelling and pain, ice should be applied 3-4 times a day. During cold application, it is important to place a thin barrier (such as a cloth or bandage) between the tissue and the cooling material to avoid cold burns. If sensations such as numbness, tingling or pins and needles occur after an elastic bandage is applied, the bandage should be loosened a little. The injured limb should be kept above heart level as much as possible. Be sure to consult your doctor to determine the degree of the injury and for appropriate treatment.

The menisci are shock-absorbing structures made of cartilage tissue, two in each knee (medial and lateral meniscus), which act as shock absorbers in the knee joint. Injury is common especially after a rotational trauma on a planted foot. There is usually no collision or contact with another athlete. Injuries to the medial collateral ligament and cruciate ligaments may accompany the event. Meniscus tissue can tear as a result of trauma to the knee, particularly sudden twisting movements. Although this damage is mostly seen in athletes and is therefore perceived as an athlete's disease, meniscus disorders can occur not only in those who play sports but in anyone who has strained their knee in any way. Patients most often see a doctor with the complaint of pain. In addition, if there are complaints such as swelling in the knee, reduced range of motion of the joint, catching or locking, a physician must be consulted and, when necessary, evaluation can be made with MRI. Meniscus degeneration (damage due to chronic strain) is initially followed with conservative methods (such as rest, cold application, bandaging and analgesic medications). To reduce the load on the menisci, the patient must do exercises aimed at strengthening the muscles around the knee. In pain that does not respond to these treatment methods, and in meniscus tears that cause swelling or locking in the knee, arthroscopic repair may be necessary.

The Achilles tendon is the tendon that connects the calf muscle, which allows us to rise on our toes, to the heel bone (calcaneus). Although it has a very strong structure, it can still rupture as a result of a strong blow or following chronic fatigue. A complete rupture is usually repaired surgically. For partial ruptures, a decision is made according to the patient's functional status. After treatment, return to sports is possible with an appropriate physical therapy program.

Rehabilitation protocols after anterior cruciate ligament repair may vary according to the surgeon's preference, the graft material used or the patient's social expectations, and in general the rehabilitation program after anterior cruciate ligament surgery lasts at least 4 months at certain intervals, under your doctor's supervision and accompanied by a physiotherapist. In this process, the first aims are to regain the range of motion of the joint and to regain the muscle strength lost after not putting weight on the operated knee. At the end of the 4th month, after physical examination and tests, a transition to sport-specific exercises is possible when your doctor considers it appropriate, and the isokinetic test, which numerically evaluates muscle strength and is performed in our department, is quite helpful in making this decision.

Platelets contain healing factors. It has been shown that when these factors are given to injured tissue, they shorten the repair time in the tissue. The platelet-rich plasma obtained by subjecting blood taken from the person to various centrifugation and separation processes, so that it is 2-3 times more concentrated than the platelet count found in normal blood, and planned to be given back to the same person, is called PRP (platelet-rich plasma).

PRP treatment is a form of treatment that is becoming increasingly common and finding a wide range of applications. It is applied to the injured area to speed up recovery after musculoskeletal injuries and shorten the time to return to sports. The main areas of application are tendon injuries, ligament injuries and intra-articular applications.

Joint health has gained great importance in recent years because of the expectation of a better quality of life with longer human life expectancy. Following this growing interest, various products and methods aimed at protecting intra-articular structures have emerged and have become a large market. At present, it has not been conclusively proven that the existing methods and products regenerate damaged cartilage tissue. In addition, there are various contradictions in studies on these methods and products. Before starting to use such products and methods, the opinion of a specialist doctor must be obtained.

As is known, in recent years, as part of the fight against doping in sports, doping control samples are frequently taken in national and international competitions and even out of competition. Therefore, elite athletes in particular must absolutely not use any medication without the knowledge of their team doctors or sports physicians. Athletes can check whether the medications they use fall within the scope of prohibited substances by searching the names of the substances listed in the medication's package insert in the Prohibited List updated every year by the World Anti-Doping Agency (WADA). (http://list.wada-ama.org)