Sports Medicine


The specialty of Sports and Exercise Medicine does not restrict its focus to sports injuries alone.

Many of Dr. Lewis’ patients have never participated in any sports yet still require specialist musculo-skeletal guidance. There are many musculoskeletal problems that are not necessarily related to sport or exercise participation, such as chronic pain syndromes and osteoarthritis. Additionally, athletes and sports participants encounter a myriad of potential health issues that may affect their performance or ability to safely participate in sports and recreation activities.

Injury prevention


Preventing injuries from occurring in the first place is far easier than treating the consequences.

Though this concept seems obvious enough, it is surprising how little it is pursued by sports participants and sporting teams.

Dr. Lewis places a strong emphasis on injury prevention and is involved in research on the benefits of implementing a neuromuscular training program in young Australian sports participants to prevent knee anterior cruciate ligament (ACL) injuries.

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Nutrition


Some sports related conditions are related to inadequate nutrition.

A well known example of this is a stress fracture, which is often the result of inadequate energy intake in endurance athletes. Another is exercise induced hyponatraemia (low blood sodium) post endurance events due to inappropriate fluid intake. However there are numerous other problems that are also related to food intake. If appropriate, Dr. Lewis will assess for any dietary issues contributing to your problems and help you address these.

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Exercise prescription


Especially for first time exercisers, those attempting a lifestyle change or those wishing to resume exercise after a health scare – eg. post heart attack

Some people come to Dr Lewis with minimal fitness and little exercise experience. Some people are worried that they are not medically fit to train. No matter what your medical condition, there is always something that can be safely achieved through exercise. Dr Lewis will spend time with you discussing your medical problems and assessing your safety to exercise by performing a thorough medical screen (including relevant investigations such as blood tests, ECG, echocardiogram respiratory function tests). He will then provide you with advice and support to help you on your journey.

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Peak training & performance


Whereas some people are just getting started, others are already addicts!

And for many addicts, it isn’t just about participation, but also about squeezing every ounce of performance out of their body. Having worked in elite sporting environments and with elite athletes across numerous sports, Dr. Lewis can use his experience to help guide you on your journey to achieving your sporting goals.

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Diving medicine


All divers are aware of the unique risks related to the surrounding underwater environment.

High barometric pressures underwater pose a threat to the normal physiology of the human body and problems such as barotrauma, air embolism, and decompression sickness (“the bends”) are life threatening problems that can be prevented with the proper preparation. Moreover, certain medical conditions carry a high risk for diving and medical assessment prior to diving is recommended. Please advise the clinic prior to your arrival if you require a pre-diving medical assessment.

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Altitude medicine


Climbing high mountains is a challenge increasingly being undertaken by men and women of all ages. We do this because we can… as world famous mountaineer George Mallory once said when asked why he would attempt to climb Mt. Everest, “Because it’s there.”

However ascent to high altitude poses a physiological threat to the body, as it is exposed to much lower barometric pressures at high altitude (and consequently much lower oxygen supplies) as well as extremely cold temperatures.

Before traveling to altitude, it is wise to seek medical advice regarding the proper precautions to take whilst ascending to altitude as well as finding out what medications may be useful to take with you in case of emergency. In addition, some conditions carry increased medical risks at high altitude (eg. heart and lung conditions, clotting disorders and pregnancy) and you may want to discuss this with Dr. Lewis prior to deciding whether it is appropriate to attempt to travel to altitude.

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Performance in extremes of temperature


Sporting events are held all year round in a wide variety of climates ranging from scorching hot to freezing cold. Extreme humidity or dry air can also wreak havoc with the body’s ability to cope with climatic conditions.

Understanding how your body may react to extreme conditions and how you can best prepare for this may prove to be the difference between safely and successfully competing and completing an event vs ending up with a life threatening medical condition.

If you are unsure how best to approach your preparation and performance in extreme weather conditions, ask Dr. lewis for guidance.

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Travel preparation (team & individual)


Team travel poses its own set of logistical nightmares that team managers spend countless sleepless nights trying to anticipate. By the same token, travel to a sporting event as an individual can also be stressful and pose specific risks to your health and performance.

Problems such as infection prevention, adjusting to jet lag and different time zones, poor sleep and acclimation/acclimatisation to different weather conditions are just a few of these. Dr. lewis has traveled with teams both domestically and internationally and has the experience to help you plan your individual or team sporting journey. Ask Dr. Lewis for information.

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Psychological problems related to performance


Physical preparation is only a part of sporting performance. Whilst we have all heard over and over again commentators providing us with made up statistics about how a certain proportion (“let’s say 83.48%) of performance is “between the ears”, the fact is that there is no denying that psychology plays a massive role in determining the outcome of sporting events.

Whilst trying to quantify the influence of psychology in sports is futile, trying to address psychological factors that may be contributing to a decline in your performance is far from a waste of time. Dr. Lewis will often ask you questions surrounding the psychology of your performance and if necessary make the appropriate referral to a sports psychologist.

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Chronic pain


Chronic pain is an issue that is often poorly understood and inadequately or inappropriately treated.

Dr Lewis’ philosophy in treating chronic pain is to minimise the use of addictive and often harmful medications in favour of attempting to find and treat the actual cause of the pain. This will often involve a multidisciplinary approach, utilising the expertise of a wide range of practitioners such as physiotherapists, psychologists, pain specialists, radiologists and alternative practitioners to name just a few.

Motivation also plays a large role in overcoming chronic pain. Though there is no guarantee of success, be assured that Dr. Lewis will take your problem seriously and engage with you in undertaking a comprehensive treatment program to help get your pain under control and restore your quality of life.

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Back and neck pain


Back and neck pain are common problems that are often simply accepted as an unavoidable part of ageing.

Moreover, though most of the time acute painful episodes will settle with a bit of rest and the passage of time, inevitably at some point the problem will come back to haunt us over and over again. With the appropriate diagnostic tests, treatment, rehabilitation and preventive measures, Dr. Lewis will guide you along a pathway to reduce the frequency and severity of your back and neck problems.

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Osteoarthritis (OA)


Osteoarthritis (OA) is a process of wear and tear to the articular cartilage lining the surface of the joint. It can occur in any joint in the body, including the upper and lower limbs, the pelvis and the spine. In some patients the reason for this will be due to an old injury to the joint or another joint condition such as gout. In other patients there is no clear cause.

The main features of OA are joint pain, swelling and loss of joint function. Pain from OA tends to be episodic and often unpredictable. Some people may have no pain at all for long periods with quite severe cartilage loss, whilst others will experience significant pain and disability despite only minor cartilage loss. However as a general rule, symptoms tend to worsen with heavy activity and tend to progress over time as more of the cartilage becomes damaged.

X-ray is the best form of imaging to demonstrate the changes of OA. The main signs of OA on X-ray are bone spurs and hardening (sclerosis) at the joint margins, bone deformity and malalignment and narrowing of the joint space (especially on weight-bearing views in a weight bearing joint). MRI can also be helpful in picking up other joint problems or very subtle cartilage damage, but is usually not required.

Despite the fact that osteoarthritis tends to progressively worsen, most patients with osteoarthritis do not need any form of surgery and benefit substantially from appropriate non-operative treatment.

Treatments for OA

Weight loss

Being overweight is one of the biggest risk factor for development of lower limb arthritis. Moreover, once cartilage is lost in the hip or knee, being overweight or obese will cause the joint to degenerate more rapidly. Therefore, maintaining a healthy weight is crucial in both preventing and treating OA. It is simple mathematics. Each step we take we place 2x our body weight through the knee and hip joints. Most of us take at least 5000 steps a day (even more if we are trying to impress our fitbit). Increasing your weight by just 1 kg will place 5 more tonnes of load through each knee and hip joint EVERY SINGLE DAY! That’s a lot of extra load going through an already partially damaged joint. Put another way, for every 5kg in extra weight you carry, your risk of developing OA doubles.

Appropriate exercise

It is a bit simplistic to tell people with OA that their weight needs to be kept down with-out helping provide an achievable strategy to reach their weight goals. We all know that the best way to keep weight down is to maintain a healthy diet and burn energy through exercise. But the pain of OA often makes it difficult for patients to adhere to an exercise regimen. Dr. Lewis places a great emphasis on improving pain in order to enable exercise to be performed without discomfort. He will then prescribe exercise/activities that help build muscle strength and endurance, are low impact on the joints and are less likely to cause OA flare-ups. Examples of low impact exercise include cycling, swimming, elliptical (cross-trainer) and rowing. Slow walking is also relatively low impact, whilst fast walking and running are examples of higher impact activities that may exacerbate OA.

Appropriate analgesia (Pain relief)

Paracetamol is the first line medication in the treatment of OA pain. Non-steroidal anti-inflammatories (NSAIDs) should only be used for short periods (maximum 2 weeks) and ONLY under direction of your doctor. The long-term use of NSAIDs is NOT recommended due to the potential for side effects. Topical NSAIDs are generally safe. Whilst complementary medicines (eg. glucosamine, chondroitin and fish oil) are useful for many patients with OA, the effects are vary from individual to individual and studies have not shown any clear benefit. Click here for more information.

Physiotherapy and strengthening programs

Physiotherapy treatment is useful to ensure that muscles surrounding arthritic joints are kept strong and joint range of motion is maintained. Physiotherapy treatment is not only about what the physio can do for you in the rooms. Far more important are the exercises the physio can give you to take home and do yourself. These are the tools that will help you to treat the condition yourself. Whilst we all wish we could bring our physio home with us for treatment whenever we desire, the reality is that if we can learn to be our own physical therapist when we are on our own at home we are going to be much better off much more of the time.

Braces and taping

Braces range from simple neoprene sleeves (which help the knee feel warm and score and can provide compression to force fluid away from the joint) to stabilising or offloading braces that can help reduce pressure through certain parts of a joint. Taping can also provide similar support for some problems. In general bracing and taping is effective for brief periods when active (eg. when playing golf or going for a walk). If braces or taping do not help relieve your pain, it is best to cease using them.

Injections

Injectible treatments used by Dr. Lewis to treat OA include corticosteroids (cortisone), PRP and Synvisc. Click on the links to find out more about these injection.

Surgery

Joint replacement (knee, hip and shoulder – occasionally other joints)

Whilst joint replacement surgery is an excellent pain-relieving operation, it does not significantly restore joint function and is an end-stage procedure reserved for those with chronic unremitting osteoarthritis related pain. It is best done as late in life as possible to minimise the chances of requiring a revision operation once the artificial joint has worn out.

Arthroscopy

It is a common misconception that an arthroscopy will help improve arthritis pain. On the contrary, arthroscopy has been shown not to be helpful for treatment of osteoarthritis in most cases and may in fact hasten the need for definitive joint replacement surgery. In some cases, however, there is a clear need for arthroscopy to treat a complication of OA (such as a loose body in the joint causing mechanical locking or for a repairable meniscal tear). Dr. Lewis will help you decide if surgical referral is necessary.

Osteotomy

In young patients with knee arthritis in particular, a realignment osteotomy may be required to help redistribute the forces placed across a joint and slow or halt the progression of OA. This procedure is only done when arthritis is limited to one compartment of the knee. If your pain is not able to be controlled with non-surgical methods and you fit the criteria for realignment osteotomy (young patient with arthritis restricted to one knee joint compartment), Dr. Lewis may refer you to a surgeon to discuss this treatment option.

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Rheumatoid/ inflammatory arthritis & related conditions


Rheumatoid arthritis and other closely related conditions (eg. psoriatic arthritis, reactive arthritis and ankylosing spondylitis) are autoimmune problems.

They arise when the body’s own immune system erroneously attacks its own joints. This process leads to joint destruction which is painful and disabling. prompt diagnosis and treatment is essential to slow or halt the progression of these diseases. The good news is that with modern medications we can now better treat this group of disorders.

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Cardiovascular problems


We have all heard tragic stories of local and professional sports participants collapsing in the field and being taken to hospital having suffered what is usually described as a “major cardiac event”. Whilst not always preventable, cardiac screening can pick up a reasonable proportion of “at-risk” individuals.

We can then use this information to advise you whether the exercise you want to undertake is appropriate. Cardiac screening is particularly important in those with a family history of sudden cardiac death or cardiac conditions at a young age (under 50). It is also important in individuals with a known personal history of cardiac problems (eg. post heart attack – Read more). If you are concerned about your heart risk during exercise, Dr. Lewis will counsel you through the issues surrounding exercise and heart disease and ensure you are fully investigated prior to exercise participation.

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Respiratory problems


Many people are restricted by respiratory symptoms such as wheeze or shortness of breath during exercise. These can occur all year round or seasonally. They can also be specific to exercise in a certain environment such as a swimming pool or in the cold.

Coming up with a strategy to recognise the cause of the symptoms and treat them can often allow training to be performed all year round with much more ease. If you are troubled with respiratory issues that affect your ability to exercise, ask Dr. Lewis if there is anything that can be done to help.

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Gastrointestinal problems


Athletes and non-athletes alike suffer from a range of gastrointestinal problems that affect their ability to exercise and participate in sports.

These are often quite easy to address by simply recognising the cause of the problem and building strategies to treat or prevent their occurrence.

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Neurological problems


Many neurological problems masquerade as musculoskeletal problems.

Dr. Lewis is trained to recognise these problems and provide the appropriate referral to specialist neurologists for treatment guidance.

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Biomechanics


A comprehensive treatment program does not stop when the injury has settled. The aim of treatment is not just to help an injury to heal, but also to prevent the injury from returning.

To achieve this outcome, it is important to assess and correct any predisposing biomechanical issues that may be contributing to your injury. These issues may be related to unique physical characteristics of the patient, incorrect equipment used by the patient, incorrect technique used during sport/exercise and various other factors. Often these are very sport-specific and require specialist coaching or assessment to correct.

Dr. Lewis will point you in the right direction at every step along the way and ensure you have access to the best available resources for biomechanical correction.

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