Sports Medicine

Sports injuries occur when playing indoor or outdoor sports or while exercising. They can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. The most common sports injuries are sprains and strains, fractures and dislocations.

The most common treatment recommended for injury is rest, ice, compression and elevation (RICE).

Rest: Avoid activities that may cause injury.
Ice: Ice packs can be applied to the injured area, which will help reduce swelling and pain. Ice should be applied over a towel on the affected area for 15-20 minutes, four times a day, for several days. Never place ice directly over the skin.
Compression: Compression of the injured area also helps reduce swelling. Elastic wraps, air casts and splints can accomplish this.
Elevation: Elevate the injured part above your heart level to reduce swelling and pain.

Some of the measures that are followed to prevent sports-related injuries include:

Follow an exercise program to strengthen the muscles.
Gradually increase your exercise level and avoid overdoing the exercise.
Ensure that you wear properly-fitted protective gear such as elbow guards, eye gear, facemasks, mouth guards and pads, comfortable clothes, and athletic shoes before playing any sports activity, which will help reduce the chances of injury.
Make sure that you follow warm-up and cool-down exercises before and after the sports activity. Exercises will help stretch muscles, increase flexibility and reduce soft tissue injuries.
Avoid exercising immediately after eating a large meal.
Maintain a healthy diet, which will nourish the muscles.
Avoid playing when you are injured or tired. Take a break for some time after playing.
Learn all the rules of the game you are participating in.
Ensure that you are physically fit to play the sport.

Some of the common sports injuries include:

Shoulder injuries

Severe pain in your shoulders while playing your favorite sport, such as tennis, basketball and gymnastics, may be caused by a torn ligament or dislocation of the shoulder bone. These may result from overuse of your shoulder while playing sports. Simple pain or acute injuries may be treated with conservative treatment, while chronic injuries may require surgical treatment.

Hip injuries

Fractures of the femur bone, labral tear and hip dislocation are some of the common sports injuries affecting the hip. The hip joint bears more weight and is more susceptible for injuries while playing sports. Hip injuries require immediate medical intervention to avoid further complications. Rehabilitation programs and physical therapy is often recommended following medical intervention, where you need to perform certain exercises to strengthen your muscles and improve movements.

Knee injuries

The anterior cruciate ligament (ACL) is major stabilizing ligament in the knee, which may tear with over use while playing sports. The ACL has poor ability to heal and may cause instability. Other common sports injuries in the knee include cartilage damage and meniscal tear. Knee injuries during sports may require surgical intervention, which can be performed using open surgical or a minimally invasive technique. Your surgeon will recommend physical therapy to strengthen your muscles, and improve elasticity and movement of the bones and joints.

Ankle Sprains and Chronic Instability

Ankle Sprains

Ankle Sprains are common injuries that occur from over stretching or tearing of the ligaments that support the ankle. The ankle is composed of bones forming a joint and ligaments are the elastic structures which are responsible for holding these bones in their proper place. Ligaments and other soft tissues function to prevent abnormal movement such as twisting, turning, and rolling of the foot beyond the normal range.

Causes

Ankle sprains occur due to sudden inward or inverted movement of the foot during sports activities, or while walking and running on uneven surfaces. An ankle sprain can occur from falling, or sudden force on the ankle which twists the joint beyond its normal range, resulting in damage to the ligament. Ankle sprains can occur at any age and although commonly seen as a sports injury, ankle sprains can occur to non-athletes as well.

Symptoms

Ankle sprains result in pain, swelling, bruising, and stiffness of the ankle region. Mobility, range of motion and weight bearing are adversely affected. The severity of the ankle sprain depends on the condition of the torn ligament.

Grades of ankle sprain

Based on the severity of the ligament’s condition, ankle sprains are categorized as grade 1,2, or 3.

Grade 1: a mild sprain with some damage to the ligament fibers.

Grade 2: a moderate sprain with partial tearing of the ligament.

Grade 3: a severe sprain with complete tearing of the ligament.

Diagnosis

The diagnosis of ankle sprain starts with the physical examination, which is painful as the ankle is bent in various directions to assess which ligament is injured. Then X-rays are taken to confirm whether any fracture is present, as the symptoms of a sprain are similar. The doctor grades the ankle sprain by looking at the amount of swelling and bruising of the ankle. In complex cases, an MRI scan is ordered for analyzing the injured ligament.

Treatment

Treatment and healing time of an ankle sprain will depend on the grade of the sprain. All sprains will be treated with the R.I.C.E. method: Rest, Ice, Compression, and Elevation.

Your physician may also order the following treatment measures if the sprain is a grade 2 or 3.

Immobilization: A splint, short leg cast, or boot may be used to immobilize the ankle and allow healing to take place with a grade 2 or 3 sprain.

Medications: Medications such as aspirin and NSAID’s, non-steroidal anti-inflammatory drugs, can be prescribed for your comfort and to minimize swelling.

Physical Therapy: Strengthening and range of motion exercises may be prescribed by a therapist to regain normal function of the ankle and prevent chronic ankle problems. Your therapist may utilize ultrasound and electrical stimulation to decrease pain and swelling and instruct you on taping the ankle for support while it heals.

Surgery for ankle sprains is rarely needed but may be necessary if the sprain is a grade 3 with complete tearing of the ligament and the patient does not improve with conservative treatment measures and months of adequate healing time.

Your surgeon will perform Ankle Arthroscopy surgery to evaluate and repair the torn ligament.

Arthroscopy is a surgical procedure in which an arthroscope, a small, soft, flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat a variety of conditions.

The benefits of arthroscopy compared to the alternative, open ankle surgery, include:

Smaller incisions
Minimal soft tissue trauma
Less pain
Faster healing time
Lower infection rate
Less scarring
Earlier mobilization

Usually performed as outpatient day surgery

Your surgeon will look for any loose fragments of bone or ligament inside the joint with the help of an arthroscope through a small incision.

The torn ligament is repaired by stitching it back together with sutures or by using the surrounding ligaments or tendons to repair the damaged ligament.

Conclusion

Ankle sprain is a common and painful condition in which ligaments supporting the ankle joint are torn or damaged. Sprains are most often treated conservatively by resting the injured joint, applying ice to the injury, using a compression bandage, and elevation of the foot. In severe cases, surgery may be necessary.

Ankle Instability

Ankle instability is a chronic condition characterized by a recurrent slipping of the outer side of the ankle. It usually results from repeated ankle sprains. It is generally noticed during movement of the ankle joint but can also occur during standing as well.

Causes

Repetitive injury of the ankle ligaments on the same side is the most common cause of ankle instability. Inadequate healing of the sprained ligament or incomplete rehabilitation of the affected ligament can result in instability of the ankle. Recurrent injury of the ligaments further weakens them and aggravates the instability which predisposes to the development of additional ankle problems.

Symptoms

Pain is the most common symptom and is associated with swelling and tenderness of the ankle. There may be a persistent discomfort and instability in the affected ankle joint. The ankle is unstable and may turn repeatedly while walking on uneven surfaces or during a sporting activity.

Diagnosis

A complete medical history, including a history of any previous ankle injuries, and a physical examination is essential for an accurate diagnosis of the condition. An X-ray may be ordered to confirm the diagnosis. Other imaging tests may also be used to evaluate the injury.

Treatment

The management of ankle instability depends on the findings of physical examination and the activity level of the patient.

Conservative treatment

Conservative treatment includes physical therapy for improving the strength, balance and range of motion of the joint, bracing to support the affected ankle and prevent further sprain, and non-steroidal anti- inflammatory (NASAIDs) to reduce the pain and inflammation.

Surgical treatment

Surgery is recommended in patients with a high degree of instability and in those who have failed to respond to non-surgical treatments. Commonly used surgical procedures involve repair or reconstruction of the damaged ligament.

Achilles Tendon Tears and Tendonitis

Achilles Tendon Tears

Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to heel bone. It is used when you walk, run and jump. When the Achilles tendon becomes thin, weak, or if it is not used, it may be susceptible to injury or damage. Achilles tendon rupture occurs most often in middle-aged athlete participating in sports that involve running, pivoting, and jumping. Recreational sports that may cause Achilles rupture include tennis, racquetball, basketball, and badminton.

If Achilles tendon is ruptured you will experience severe pain in the back of your leg, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound is heard when the injury occurs. You may also feel a gap or depression in the tendon, just above heel bone.

Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor will gently squeeze the calf muscles, if the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.

Achilles tendon rupture is treated using non-surgical method or surgical method. Non-surgical treatment involves wearing a cast or special brace which is changed after some period of time to bring the tendon back to its normal length. Along with cast or brace, physical therapy may be recommended to improve the strength and flexibility of leg muscles and Achilles tendon. Surgical procedure involves opening the skin and suturing the torn tendon together. Surgery helps to decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment.

To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.

Patellar Tendinitis

Patellar tendinitis, also known as “jumper’s knee” is an inflammation of the patellar tendon that connects your kneecap (patella) to your shinbone. This tendon helps in extension of the lower leg. Patellar tendinitis usually results from repetitive trauma or overuse, particularly from sports activities involving jumping such as basketball or volleyball. Therefore, this condition is also known as jumper’s knee. Rarely, this condition may also occur because of an acute injury to the tendon that has not healed properly.

Pain over the patellar tendon is the first symptom of patellar tendinitis. You may also have pain during activities, especially jumping or kneeling. Rarely, swelling around the tendon may be seen.

Your doctor will evaluate your condition based on your symptoms and physical examination. X-ray of the knee may be taken to make sure there is no problem involving the bones or bone spur around the knee. An MRI scan can reveal degenerative changes in the patellar tendon.

Treatment options for patellar tendinitis include:

Rest the injured knee and avoid activities such as running and jumping that worsen the condition.
Non-steroidal anti-inflammatory medications (NSAIDs) may be prescribed to provide relief from pain and swelling associated with patellar tendinitis.
Stretching out before exercising is important to prevent recurrence of patellar tendinitis. These exercises can also help strengthen the patellar tendon and nearby muscles such as the quadriceps, hamstrings, and calf muscles.

Application of ice to the affected area helps to control the inflammation and reduce the swelling.
A knee support or strap (called an intrapatellar strap or a Chopat strap) can be worn to relieve pain by directing the force away from your tendon and into the strap.
Iontophoresis: In this technique, a topical corticosteroid medication is applied to the affected area with the help of a small device that uses an electric charge to deliver the medication through your skin.
Corticosteroid injection: With the guidance of an ultrasound, corticosteroid injection may be given directly into the sheath around the affected patellar tendon. This helps to relieve pain and perform strength exercises without any pain.

In rare cases such as when there is persistent pain despite of the other treatment options, surgery may be considered. Surgery involves removal of severely damaged parts of your tendon and repair of any tears in the tendon.

Chronic Exertional Compartment Syndrome

Coming Soon

Endoscopically Assisted Compartment Release