Sports Medicine: Pharmacology, Rehabilitation, and Head Injuries

Vocabulary practice flashcards covering athletic pharmacology regulations and administration routes, the nine components of therapeutic exercise and rehabilitation, and the pathophysiology, diagnosis, and staging of sports-related concussions.

Pharmacology

The branch of science that deals with the actions of drugs on biological systems.

Drugs

Chemical agents utilized to prevent, treat, or diagnose disease.

Pharmacokinetics

The physiological method by which drugs are absorbed, distributed, metabolized, and eliminated by the body via the kidneys; physical exercise increases drug absorption due to increased blood flow.

Occupational Safety and Health Administration (OSHA)

The regulatory agency responsible for overseeing and mitigating contamination of and exposure to hazardous drugs in the workplace.

Drug Enforcement Administration (DEA)

The federal agency tasked with enforcing statutory regulations and laws related to controlled substances.

Food and Drug Administration (FDA)

The governmental body responsible for ensuring the safety, efficacy, and security of pharmaceutical drugs, including proper drug labeling.

Routes of Internal Administration

Systemic administrative methods for delivering drugs into the body, including inhalation, intradermal, intramuscular, intranasal, intraspinal, intravenous, oral, rectal, and sublingual-buccal routes.

Types of External Administration

Topical pharmaceutical preparations applied to the body surface, consisting of ointments, pastes, plasters, transdermal patches, and solutions.

Oral Phenylephrine

An active ingredient found in over-the-counter multi-symptom cold and sinus remedies (e.g., Sudafed PE, NyQuil, Benadryl, Mucinex) that does not effectively relieve nasal congestion when administered orally.

NCAA Banned Substance Warning

The official policy statement advising: "There is no complete list of banned substances. Do not rely on this list to rule out any label ingredient."

NCAA Caffeine Testing Threshold

The urinary concentration threshold exceeding $15\,\mu\text{g/mL}$ that constitutes a positive banned substance test under NCAA regulations.

Pre-hab

A preventive athletic training rehabilitation strategy that begins prior to injury occurrence to optimize physical status and minimize prospective injury risk.

Pathophysiological Effects of Immobilization

Adverse consequences of joint inactivity, including muscle atrophy, decreased motor nerve efficiency, decreased joint lubrication (depriving articular cartilage of normal nutrition), reduced bone strength, and diminished cardiovascular conditioning.

Nine Components of Rehabilitation

The foundational components required across all comprehensive rehabilitation programs: 1. Minimize swelling, 2. Control pain, 3. Restore full ROM, 4. Restore muscle strength and endurance, 5. Reestablish neuromuscular control, 6. Regain balance/postural control, 7. Enhance core stability, 8. Maintain cardio-respiratory fitness, and 9. Functional progression.

Cardio-Respiratory Fitness (in Rehabilitation)

The systemic physical conditioning element recognized as the most commonly neglected component in athletic injury rehabilitation programs.

Muscular Strength

The maximum force that a muscle can generate during a single maximal voluntary contraction.

Muscular Power

The ability of neuromuscular tissue to generate a large amount of force rapidly.

Muscular Endurance

The capacity to perform repetitive muscular contractions against a resistance over an extended period of time.

Concentric Contraction

A dynamic muscular contraction where the muscle fibers shorten under tension, generating force to produce acceleration.

Eccentric Contraction

A muscular contraction that occurs as muscle fibers lengthen under tension, serving primarily to absorb shock and decelerate movement.

Isometric Contraction

A muscular contraction where internal muscle tension increases without producing joint movement or changing total muscle length.

Isokinetic Exercise

A resistive exercise modality executed at a preset, constant angular velocity, delivering accommodating, consistent resistance across the full range of motion.

Phase I Rehabilitation (Immediate)

The initial rehabilitation phase focused on protecting repaired biological tissue, restoring range of motion within prescribed limits, decreasing pain and swelling, and preventing muscular inhibition.

Phase IV Return-to-Competition Criteria

The objective functional criteria required prior to full sports return: full pain-free ROM, hip strength greater than $85\%$ of the uninvolved limb, completion of sport-specific drills at full speed without pain, and passing a functional sports test.

Joint Mobilizations

Passive clinical manual techniques that restore accessory joint movements (spin, roll, and slide) to increase joint mobility, enhance ROM, break adhesions, and decrease protective muscle guarding.

Sports-Related Concussion (SRC)

A traumatic brain injury induced by biomechanical forces from a direct blow to the head, neck, or body, causing an impulsive force to transmit to the brain and triggering a neurometabolic cascade, blood flow alterations, and cellular inflammation.

Neurometabolic Cascade of Concussion

A post-concussive pathophysiological state characterized by indiscriminate neurotransmitter release (excess extracellular potassium and glutamate, intracellular calcium accumulation), high energy consumption by $Na^+/K^+$ ATPase pumps, and reduced cerebral blood flow leading to an acute cellular energy crisis.

Concussion Incidence Statistics

Epidemiological benchmarks indicating that $3.8\text{ million}$ concussions occur annually in the US, $47\%$ of reported high school concussions happen in football, $1\text{ in }5$ high school athletes sustain a concussion per season, $90\%$ occur without loss of consciousness, and cumulative concussions increase catastrophic injury risk leading to permanent disability by $39\%$.

Amsterdam Statement 12 Rs

The 2022 international consensus framework for concussion management: Recognition, Reduce, Remove, Re-evaluate, Rest and Exercise, Refer, Rehabilitation, Return (learn, sport), Reconsider, Recover, Retire, and Refine.

Concussion Recognition Tool 6 (CRT6)

A standardized concussion identification tool formulated specifically for non-medically trained individuals to detect red flags and suspected concussions on the field in children, adolescents, and adults.

Sport Concussion Assessment Tool 6 (SCAT6)

A comprehensive, standardized clinical assessment tool reserved for healthcare professionals to evaluate athletes aged 13 years and older during the acute post-injury phase (ideally within 72 hours and up to 7 days).

Sport Concussion Office Assessment Tool 6 (SCOAT6)

A standardized clinical evaluation protocol utilized exclusively by healthcare professionals in an office environment to assess athletes typically from 72 hours ($3\text{ days}$) post-injury onward.

Mild and Brief Symptom Exacerbation

A clinical threshold during concussion return protocols defined as an increase of no more than 2 points on a $0\text{--}10$ scale lasting for less than 1 hour compared to pre-activity baseline values.

Return-to-Sport (RTS) Strategy

A 6-step exertional progression requiring a minimum of $24\text{ hours}$ per step: Step 1 (symptom-limited activity), Step 2 (aerobic exercise: 2A light up to $\approx 55\%$ maxHR, 2B moderate up to $\approx 70\%$ maxHR), Step 3 (individual sport-specific exercise), Step 4 (non-contact training drills), Step 5 (full contact practice), and Step 6 (full return to sport).

Subgaleal Hematoma

A subaponeurotic cranial hematoma occurring between the epicranial aponeurosis and the periosteum of the skull, clinically visible as a substantial localized scalp hematoma ("goose-egg").

Meninges

The three layered protective membranes surrounding the brain and spinal cord: the tough outermost Dura Mater lining the skull, the vascular middle Arachnoid Mater (housing cerebrospinal fluid in the subarachnoid space), and the delicate innermost Pia Mater covering brain tissue.

Epidural Hematoma

An intracranial hemorrhage caused by arterial rupture peeling the dura mater away from the inner table of the skull; manifests rapidly (10 minutes to 1 hour post-impact) with projectile vomiting, pupil dilation, and a characteristic biconvex ("lemon") shape on CT.

Subdural Hematoma

An intracranial hemorrhage resulting from venous blood leaking between the dura mater and arachnoid mater; develops slowly over hours to days with classic lucid intervals, demonstrates a crescent ("banana") configuration on CT, and carries higher mortality.

Traumatic Encephalopathy Syndrome (TES)

The clinical diagnosis representing the progressive cognitive decline and neurobehavioral dysregulation (rage, impulsivity, explosiveness) associated with repeated head impacts and Chronic Traumatic Encephalopathy (CTE), superseding obsolete terms such as "punch drunk" and "dementia pugilistica."