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This document is a curriculum for training in orthobiologics, which provides a framework for education and training in the field. It is primarily targeted towards physiatrists, but can be modified for physicians from other specialties. The curriculum focuses on orthobiologic treatments that align with current U.S. Food and Drug Administration guidelines and does not advocate for any specific treatment modality. It includes core and specialized competencies, and is designed to be adaptable to diverse training needs. The curriculum was developed by a group of subject matter experts and will be updated as the field of orthobiologics evolves. [Extracted from the article]

History: A 24-year-old male, former swimmer and soccer player, without significant medical history, was referred by his primary care physician with 3 weeks of bilateral, right greater than left, radicular low back pain, which began acutely with a "pop" while deadlifting 450 lbs. The low back pain was constant, 6/10, throbbing, aching, and radiated to his right anterolateral thigh, lateral calf, and foot, and to his left lateral thigh and knee. The pain increased with sitting, but improved with standing and walking. He denied saddle anesthesia and bowel or bladder changes. His symptoms remained stable for 3 weeks, except for minimally increasing right lower extremity (RLE) weakness. Despite symptoms, he continued working as a waiter. Physical Examination: General: 50900 male, 190 lbs, muscular build. Range of motion (ROM): Neutral lumbar alignment with decreased ROM limited by pain. Hip ROM normal. Strength: left lower extremity full strength. RLE strength decreased, with 4/5 hip abduction, 42/5 big toe extension, and 42/5 dorsiflexion. Functional testing: Difficulty in performing 5 heel raises on right. Right foot slap when heel walking. Special tests: Straight leg raise producing pain down posterior thighs bilaterally at 45 degrees. Sensation: intact to light touch and pin prick in L2-S1 dermatomes. Reflexes: patella and achilles 1 + bilaterally. Negative babinski. No clonus. Differential Diagnosis: The differential favored acute disc herniation causing L5 radiculopathy (through a central or paramedian protrusion compressing the traversing nerve at L4-5, or a far lateral disc protrusion compressing the exiting nerve at L5-S1), possibly associated with spondylolysis, spondylolisthesis, or vertebral compression fracture. Other mechanisms of L5 radiculopathy were less likely, such as infection, inflammation, neoplasm, abscess, and vasculitis. A broad differential included other less likely etiologies such as spinal stenosis, lumbosacral plexopathy, gluteus medius tendinopathy (trochanteric bursitis), iliotibial syndrome, sciatic nerve lesion, meralgia paresthetica, and fibular neuropathy. Tests and Results: At 4 weeks from injury, lumbar spine XR was unremarkable, but lumbar MRI showed a complex ventral epidural collection at L4-5 through L5-S1, causing severe dural compression and compressing bilateral L5 nerve roots and right S1 nerve root. Final/Working Diagnosis: Spontaneous Spinal Epidural Hematoma (SSEH) at L4-5 and L5-S1. Discussion: The etiology of SSEH is thought to be high pressure within the vertebral venous plexus induced by valsalva. It is an extremely rare occurrence, with an incidence of only 0.1 in 100,000. This patient's presentation was particularly uncommon: he was 24 years old (the median age of SSEH is 52), he had radiating pain at onset (89% have only localized neck/back pain), his hematoma was located at L4-S1 (less than 9% of SSEH are located below the L2 level), and he was managed conservatively (92% require emergent decompression). Outcome: The patient was managed conservatively given minimal and stable clinical findings. Neurosurgery referral did not alter management, as they anticipated that patient's symptoms would improve as his hematoma was reabsorbed. Serial follow-up appointments, at weeks 7 and 10, showed slow but gradual improvement in pain and strength. Repeat MRI at week 8 showed "decreased size of proteinaceous cystic epidural collection posterior to L5 vertebral body" with improved compression of both the thecal sac and the right L5 nerve root. Further workup of SSEH risk factors was unremarkable. Return to Activity and Follow-Up: A review of current literature could not identify a standard of care for return to activity after SSEH. Nevertheless, the patient was given a personalized return to activity schedule, focusing on cardiovascular and aerobic exercise, while restricting him from exercise that could induce valsalva. Particularly, this meant avoiding any activity that involved straining while holding his breath, such as weight lifting, performing sit-ups, swimming, and playing wind instruments. [ABSTRACT FROM AUTHOR]

Background: Adaptive sports programs are increasing across the country and there is a paucity of research investigating the epidemiology and sports injury risk factors in non-elite athletes., Objective: To assess the demographics, training regime, and injuries incurred by adaptive athletes participating in local adaptive sports clubs and to assess the athletes' type of medical care and prevalence of those with spasticity., Design: Descriptive cross-sectional study., Setting: Local area adaptive sports teams and programs., Participants: Sixty-one athletes participating in wheelchair basketball, wheelchair rugby, sled hockey, and adaptive rowing were surveyed, with a response rate of 70.5%., Interventions: Completion of self-report survey., Outcome: Report of injury prevalence, injury characteristics, type of medical care, and assessment of frequency and severity of spasticity using the Penn Spasm Frequency Scale., Results: Most athletes (86%) trained or competed in their main sport 9-12 months per year. Most athletes (79.1%) trained at least 4 hours per week. In the past 12 months, 39.5% of athletes surveyed sustained an injury that required them to miss practice or a competition, with 58.8% of these athletes having sustained a significant injury. Many of those injured (64.7%) had never participated in an injury prevention or conditioning program. Injury prevalence by sport was 42.9% in wheelchair rugby, 60% in sled hockey, 44% wheelchair basketball, and 0% in adaptive rowing. The most commonly injured body parts were the shoulder (52.9%) and wrist (52.9%)., Conclusions: This study shows that non-elite adaptive sports athletes sustain similar types of injuries as noted in published reports of elite athletes but could be provided with less injury prevention education and access to medical care. This area will require future study, especially investigating injury risk factors within specific sports and diagnoses., Level of Evidence: III., (Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)