ABSTRACT
En Puerto Rico, la especialidad de medicina física y rehabilitación surgió en la década de los años cincuenta y a partir de ese momento ha progresado gracias a la creación de programas de adiestramiento de vanguardia, el establecimiento de una cultura de investigación científica y el desarrollo de la especialidad primaria y de subespecialidades como manejo de dolor, medicina del deporte, rehabilitación pediátrica, medicina neuromuscular, medicina de trauma cerebral y medicina de lesiones medulares. La práctica clínica más común es la de atención a pacientes externos con dolor, lesiones musculoesqueléticas y daños en el sistema nervioso, pero se ha presentado un aumento en los servicios de rehabilitación intensiva de pacientes que requieren hospitalización; en el uso de técnicas intervencionistas para manejo de dolor, lesiones de tejido blando y articulares, así como en el manejo de espasticidad. Actualmente, la especialidad de fisiatría en Puerto Rico enfrenta grandes retos, como lo son el control de las aseguradoras sobre los servicios que se les ofrecen a pacientes con impedimentos físicos y restricciones de participación, el incremento en la cantidad de documentos requeridos para que se aprueben estos servicios y la competencia de otros profesionales de la salud que han incursionado en el campo de rehabilitación. Las oportunidades para la especialidad incluyen el aumento de la población mayor y con discapacidad que requiere servicios de rehabilitación; el desarrollo de las prácticas de subespecialidad, y la necesidad de aumentar la evidencia científica que demuestre la efectividad de los tratamientos que se ofrecen y de apoyar las políticas públicas que aumenten el acceso a servicios de rehabilitación para personas de escasos recursos.
In Puerto Rico, the specialty in physical medicine and rehabilitation emerged in the 1950s and since then it has progressed thanks of the creation of cuttingedge training programs, the establishment of a culture of scientific research and the development of the primary specialty and subspecialties such as pain management, sports medicine, pediatric rehabilitation, neuromuscular medicine, brain trauma medicine, and spinal cord injury medicine. The most common clinical practice is the care of outpatients with pain, musculoskeletal injuries and damage of the nervous system, but there has been an increase in intensive rehabilitation services for patients who require hospitalization, in the use of interventionist techniques for the management of pain, soft tissue and joint injuries, as well as for the management of spasticity. Currently, the specialty of physiatry in Puerto Rico faces big challenges, such as the control of the insurers on the services offered to patients with physical impairments and participation restrictions, the increase in the number of documents required for the approval of these services, and the competition of other health care professionals who have ventured into the field of rehabilitation. The opportunities for the specialty include the increase in the elderly and disabled population requiring rehabilitation services, the development of subspecialty practices, and the need to increase scientific evidence that demonstrates the effectiveness of the treatments offered and to support public policies that increase the access to rehabilitation services for people with limited resources.
Subject(s)
Humans , Puerto Rico , ResearchABSTRACT
ABSTRACT: Workload plays important roles in sports-related injury and athletic performance by influencing exposure to external injury risk factors and potential events, promoting changes in fitness level, which involves positive adaptations to training that may lead to improved performance, and/or stimulating fatigue which leads to negative effects in the body that may increase the risk of injury and negatively affect performance. In addition to the physical stress and significant time required for practice and training, student athletes also face subjective stressors. The total workload affects injury risk, but acute changes or spikes in external and/or internal loads seem to affect injury risk the most. These also may lead to poor recovery practices that may affect physical and academic performance. It is important for the medical team, coaches, parents, and the student athlete to understand the vulnerability of this population to increased amounts of workload and its positive and negative effects.
Subject(s)
Academic Performance , Athletic Injuries , Athletic Performance , Physical Conditioning, Human , Athletes , Athletic Injuries/epidemiology , Athletic Injuries/prevention & control , Humans , Students , WorkloadABSTRACT
CONTEXT: Two-thirds of an individual's gut microbiota is unique and influenced by dietary and exercise habits, age, sex, genetics, ethnicity, antibiotics, health, and disease. It plays important roles in nutrient and vitamin metabolism, inflammatory modulation, immune system function, and overall health of an individual. Specifically, in sports it may help decrease recovery time and improve athletic performance. EVIDENCE ACQUISITION: PubMed and Medline databases were used for the literature search. Bibliographies based on the original search were utilized to pursue further literature search. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Diet and exercise play very important roles in the composition of the gut microbiota in the athletic and nonathletic individual. Ingestion of carbohydrates during and after exercise seems to have an anti-inflammatory effect postexercise. Supplementation with probiotic seems to aid in recovery after exercise, too, especially restoring the "normal" gut microbiota. Physically active individuals of all levels have more alpha diversity and "health-promoting gut species" in their microbiome than nonactive individuals, along with higher concentrations of short-chain fatty acids (SCFA) and SCFA-producing organisms. However, exercise interventions should be longer than 8 weeks to see these positive characteristics. Immune function is highly influenced by the gut microbiota's response to exercise. A transient immune dysfunction occurs after prolonged high-intensity exercise, which correlates with microbiota dysregulation. Nevertheless, long-term exposure to exercise will enhance the immune response and lead to positive changes in the gut microbiota. CONCLUSION: Although the exact mechanisms of the effects that diet, exercise, and genetics have on the gut microbiota remain largely unknown, there is evidence that suggests overall health benefits. In the athletic population, these benefits can ultimately lead to performance improvement.
Subject(s)
Athletic Performance , Gastrointestinal Microbiome , Probiotics , Humans , Gastrointestinal Microbiome/physiology , Diet , Athletic Performance/physiology , ExerciseABSTRACT
Physical medicine and rehabilitation-trained physicians are increasingly interested in caring for patients with musculoskeletal and sports disorders. Sports medicine fellowships are designed to provide competency in sports medicine and musculoskeletal care. The authors, with endorsement from the Association of Academic Physiatrists, provide a framework and tools that Accreditation Council for Graduate Medical Education accredited sports medicine fellowship programs can use to enhance and meet the Accreditation Council for Graduate Medical Education program requirements. Based on the position statement from the American Medical Society for Sports Medicine, we propose recommendations for Accreditation Council for Graduate Medical Education-accredited sports medicine programs to achieve standards of excellence. We also provide recommendations for research requirements during the course of a sports fellowship. With the proposed recommendations, a sports medicine fellowship program can achieve excellence and enhance fellowship training by increasing proficiency in physical medicine and rehabilitation-based skills relevant to sports and musculoskeletal medicine. Given the multidisciplinary nature of musculoskeletal and sports medicine, it is also key that fellowship programs (regardless of the department that they are accredited through) have faculty members that represents these disciplines and accept applicants with residency training in physical medicine and rehabilitation, internal medicine, family medicine, pediatrics, and emergency medicine.
