Thursday, April 24, 2014
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Eugene Hong

POSTED: Wednesday, April 2, 2014, 5:30 AM

There is a saying taught in medical school to all medical students—usually around the second year—that a key part of becoming a good doctor is “knowing the science and practicing the art of medicine.”

I learned this particular mantra over 20 years ago and still find it very much relevant and applicable today as it was two decades ago (and likely will continue to be in the future). I was recently reminded of this important principle in medicine because of an issue that is a source of discussion (some say semi-controversy) among healthcare providers in sports medicine and musculoskeletal medicine—how to best manage knee osteoarthritis in an active person.

My intent in this blog is not to review the medical literature and cite medical studies supporting one treatment over another; rather, my intent is to highlight to readers of this sports medicine blog that while we know some things about the science of medicine, there is still much room for practicing the art of medicine.

POSTED: Wednesday, February 19, 2014, 5:30 AM
Filed Under: Eugene Hong | Knee Injuries

Musculoskeletal complaints account for about 20-30 percent of all primary care office visits. Having pain or dysfunction in the front part of the knee is a very common presentation in the sports medicine office, and a common reason for a patient to see their healthcare provider with a knee issue.

There are a number of pathophysiological etiologies to anterior knee pain. This blog post will describe some of the common as well as some of the less common causes.  It should be said first, however, that a good history and thorough physical exam are essential to an accurate diagnosis of the cause of the anterior knee symptoms. In turn, an accurate diagnosis is essential to optimal management and the best possible outcome. 

Two of the most common causes of anterior knee pain in the active person, and what we see in the sports medicine office, are Patellofemoral Syndrome (or what I like to refer to as Patella Tracking Dysfunction) and articular cartilage conditions such as chondromalacia or osteoarthritis (from injury, damage, or wear and tear) involving the patellofemoral compartment.

POSTED: Wednesday, December 18, 2013, 5:30 AM
Michael Carter-Williams (1) passes the ball during the second half of the East Regional final in the NCAA men's college basketball tournament, Saturday, March 30, 2013 in Washington. (AP Photo/Alex Brandon)

Winter season is upon us, recreational and competitive athletes alike. For some of us that means the long anticipated basketball season is finally here (break out your favorite college or NBA gear), and that leads us to the topic of this week’s blog.

Patella tendonopathy is one of the most common causes of anterior knee pain in an active person of all ages and all levels of ability. It is seen more frequently in athletes participating in sports that involve a lot of jumping and running, such as basketball, volleyball, soccer and track (hence the term “jumper’s knee”).

In one study of high level basketball players, approximately 1/3 had some patella tendonopathy. Not surprisingly, the risk of developing patellar tendon problems does appear to increase with increasing training intensity, frequency and duration.  Poor flexibility, and specifically tight quadriceps and hamstrings, may also contribute to an athlete developing patellar tendonopathy.  It does appear to affect males and female athletes equally. 

POSTED: Wednesday, October 16, 2013, 5:30 AM
Filed Under: Eugene Hong | Football

If 100 US adults are followed over their entire lifetime, 16 will have at least one episode of clinical depression (the lifetime prevalence of depression is 16.5 percent).

In any given single year, 6 of the 100 will experience depression symptoms that meet the diagnostic clinical depression criteria. The 12-month prevalence of depression is actually higher in the 18-25 age group compared to the 26-49 or 50+ age groups (8 percent compared to 7 percent or 5 percent). So what do these facts have to do with athletes and sports medicine?

It is a common perception that athletes, by virtue of their athletic endeavors, are somehow immune to depression and other mood disorders. Though there is not enough research yet to definitively refute this belief, it is very likely that this is not true. In other words, it is a myth that athletes are immune to depression, anxiety, and other mood disorders simply because they participate in competitive athletics. We also know that an athlete may have different risk factors for developing depression, such as having an injury or having an athletic career come to end, when compared to non-athletes.

POSTED: Friday, August 16, 2013, 5:00 AM
Filed Under: Children, Teens | Eugene Hong
At what age should such training begin? Dr. Eugene Hong offers some evidence to help find an answer. (istockphoto)

In sports medicine circles, sports specialization is generally considered to be defined as intense year-round training in a single sport, with the exclusion of other sports. It is also generally accepted by sports medicine providers and the sports world at large that there is a need for practice and training to improve one’s skills and ability in any given sport—and certainly if that individual’s goal is to attain an “elite” status in that sport. 

What is a matter of debate and discussion, at least in sports medicine and the topic of this blog, is whether intense training in a single sport, to the exclusion of others, must begin at an early age and if so when. Some theory on this issue has been subverted from the area of music and music training—for example, the idea that 10,000 hours over 10 years are needed to achieve elite musical ability, and that music training must start at an early age and must be a full-time commitment to the exclusion of other pursuits.  Needless to say, while there may be some similarities in background between Yo Yo Ma and Peyton Manning, there are likely many differences in the training of a world class musician and a world class athlete.

This is not intended to be a commentary judging or lamenting the paradigm shift in youth sports in the US from child-focused recreational play (for the purpose of enjoyment) to adult driven, “structured, deliberate practice” (for the purpose of “sport- specific skill development”) (Jayanthi, Sports Health, May 2013). To be clear, one of the main goals of sports specialization at an early age is to improve performance in a particular sport.  It is not to improve enjoyment; in fact it may be that a specialized youth athlete has less satisfaction and enjoyment in their sport as they get older. So what are the risks and what are the rewards to early sports specialization in youth sports, as we best currently understand them to be?

POSTED: Wednesday, May 15, 2013, 4:40 AM

I am watching the NBA Western Conference playoffs as I write this blog post. Many people saw these playoffs irrevocably altered when Kobe Bryant went down with an acute Achilles tendon rupture last month.

The list of NBA players who have ruptured their Achilles tendon includes Isiah Thomas (arguably never the same afterwards), Dominique Wilkins (as good as ever by some assessments) and Elton Brand. Probably more people in Philadelphia watched Ryan Howard become injured on the way to first base during the NL division series against St Louis in 2011.

You may, in fact, know someone who has had the misfortune of having their Achilles tendon completely tear. It is a serious injury with potentially a significant impact for an active person at any age and at any level of sports. You may also know that many healthy active people will have a problem with their Achilles tendon at some point in their athletic lives. So what is this injury?

POSTED: Monday, March 25, 2013, 9:44 AM

You don’t have to be a healthcare provider who cares for athletes with concussions, however, to know that the topic of concussions has become a very prominent,  and sometimes very controversial  topic in our sports- crazy (some might say obsessed) culture. In recent years, you only have to turn on the TV to 60 Minutes or ESPN, or see the front cover of Sports Illustrated or your favorite newspaper to read or hear about a story having to do with sports related concussions.

The 4th International Consensus Statement on Concussion in Sport was just published last month. This statement was written by a group of international experts in sports-related concussions at a meeting held specifically for this purpose in Zurich in November 2012, and is an update from the 3rd Statement written in 2008 (with many of the same authors and also in Zurich).

Why Zurich? The world governing body of soccer (football), FIFA, is headquartered there, and hosted the quadrennial meeting. The first statement was published in 2001 and the second in 2004, known respectively as the Vienna and the Prague concussion statements.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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