MEDICAL MONDAYS: News Notes
Michael Jordan, MD: orthopaedic surgeon
MIDDLE TN MEDICAL CENTER
TOPIC: Sports Injuries & Kids
Monday, August 8, 2011
news notes via www.webmd.com
Strains, Sprains, and Other Sports Injuries: 3 Questions
If you engage in sports or a favorite workout at the gym, you have probably twisted an ankle or pulled a muscle at some point.
In many cases, injuries are due to overuse of a part of the body when participating in a certain sport -- runner's knee or tennis elbow, for example. Other types of injuries are caused by trauma -- hard contact with something, perhaps resulting in a broken bone or torn ligament or tendon.
At a recent meeting of the American College of Sports in Medicine in Austin, Texas, Edward G. McFarland, MD, spoke with WebMD about sprains, strains, tears, and other types of sports injuries: What they are, how to avoid them, and how to treat them.
McFarland is the Wayne H. Lewis Professor of Orthopedics and Shoulder Surgery at Johns Hopkins Medicine in Baltimore and a team physician for the Baltimore Orioles baseball team.
What are the most common types of sports injuries?
We usually divide them into two groups: traumatic injuries and overuse injuries.
First, traumatic [injuries]. In the lower extremities, the most common would be knee ligament injuries and fractures. In the upper extremities it would be fractures, rotator cuff injuries, and instability of the shoulder.
Overuse in lower extremities would be patellar [knee cap area] tendinitis or Achilles [heel area] tendinitis. In the upper extremities, it would be ... biceps and rotator cuff [shoulder muscle and tendon] problems.
With either type of injury, any type of musculoskeletal tissue can be involved: bone, ligament, tendon, muscle, or nerve.
What are the most common causes of these injuries and how can you prevent them?
Traumatic injuries are, of course, very unpredictable. Sometimes they're due to poor conditioning, poor surfaces, or poor equipment. Oftentimes, they are just bad luck.
Overuse injuries are almost always due to increasing the stress on the tissues too rapidly. So we see them very often in people who are out of shape and do things they are not used to doing or not conditioned for doing.
The other place we see them is in people who are fairly well-conditioned and try to bump up their level of fitness or level of expertise too rapidly.
I think that as you get more mature, you realize that it takes less and less to get your tissues aggravated.
I always tell people when you are starting out, do about one tenth of what you think you can do and try not to overdo it. We often see people who haven't done a sport in months or years and try to go out full-gun or full-bore. Suddenly they are hurting all over, or get tendinitis, or irritation of their tendons or ligaments or knees or their joints. The biggest issue is a large increase in [physical] stress too rapidly.
But still, it is very unpredictable, which is what makes it so frustrating.
What are the treatments for these different injuries?
With traumatic injuries, if you have bruising or swelling or can't move something, you of course need to see a health provider to make sure that you didn't break something.
For overuse injuries, there is a litany of things you can do. We usually recommend relative rest. In other words, you don't have to completely stop your sport, but you should back off a little bit. Maybe not exercise five days a week but go to three, or maybe don't exercise for two hours, but for 45 minutes.
You may want to do some cross training, exercising joints other than those that are irritated.
Also, use ice on places that hurt. Ice, not heat -- the old adage about ice for 24 hours followed by heat is really not believed anymore. Ice is better for pain and swelling and for getting range of motion back. You can ice after any exercise; you can even ice at night in bed. Heat is good for stretching and before exercise, but ice is always better afterward.
You can also take some acetaminophen in a low dose if you are so inclined, but it's a little trickier if you try to use anti-inflammatories [such as aspirin, ibuprofen or naproxen] because there are lots of side effects associated with them. But if you don't have trouble with those, then small doses are probably OK.
Basketball Injuries Land Many Kids in ER
Basketball-Related Strains, Sprains Most Common, But Traumatic Brain Injuries Up 70%
More than 375,000 boys and girls a year suffer basketball injuries that require visits to emergency rooms, a new study shows.
The most common injuries were strains or sprains in the lower extremities (30.3%), according to researchers, but traumatic brain injuries have increased by 70%.
More than 4 million basketball-related injuries among children aged 5-19 years required emergency room visits during the 11-year period.
Boys were more likely than girls to sustain cuts, fractures, or dislocations, but girls were more likely to sustain traumatic brain injuries, as well as injuries to the knee. Study authors say the big jump in traumatic brain injuries is cause for concern, and more research is needed to understand why it is happening.
Basketball is the most common team sport for both girls and boys in the United States, and though sports activity has health benefits, most sports have inherent injury risks that need further investigation, the researchers say. They also report:
Basketball Injuries Should Be a Major Concern
Basketball-related injuries occurred all year long, but 44.4% occurred between December and March.
The highest incidence for injuries was in January, during which 12.6% occurred.
Sports Training and Injury Prevention for Teen Girls
How to train, stay fit, and avoid injury.
If you're planning on participating in soccer, running, tennis, cheerleading, gymnastics, soccer, or any other sport, give yourself time to get in shape before jumping into the season.
You'll not only be faster and have better endurance, you'll also be less likely to suffer an injury that may prevent you from finishing the season.
The right training, combined with good nutrition, goes a long way toward keeping you in the best shape all season long. Here's what experts suggest.
Keep Your Knees Safe
After puberty, your pelvis is wider than a guy's pelvis. And that gives you a greater Q-angle -- the angle from hip to knee.
"This puts a woman's knee at greater risk when landing," says C. David Geier Jr., MD, director of the Medical University of South Carolina and assistant professor of orthopaedic surgery.
To understand why, imagine a circus performer walking on straight stilts versus walking on stilts that start out wide at the top and become narrow near the bottom.
Plus, your knee's femoral notch -- which is where your ACL (anterior cruciate ligament) is located -- is narrower than a man's. And hormonal fluctuations throughout your menstrual cycle (which may contribute to "looser" joints) may also make your knees more prone to ACL injuries.
"Women are two to eight times more likely to tear their ACL, which commonly occurs during activities such as jumping and landing," says Eric Lee, MD, orthopaedic surgeon and sports medicine specialist at St. Joseph Hospital in Orange, Calif.
An ACL tear will put you on the bench. So keeping your knees healthy should be a top priority.
You're more likely to land with less hip and knee flexion than boys, meaning you land with stiffer legs. That makes an injury more likely, Lee says.
A sports coach can teach you how to land properly and reduce the risk of injury.
Also consider including agility drills in your routine. Agility involves changing direction while moving quickly. Becoming more agile may help you land in a better position, Lee says.
Here are more tips:
If you have flat feet or other foot issues or imbalance, see a podiatrist.
Your sport may have a season for competitions. But your training needs a year-round approach.
"A well-rounded, year-round program should contain strength-training and cardiovascular training, as well as stretching and good nutrition," Geier says.
Balance training, plyometrics (explosive training), strength, and stretching may reduce the risk of ACL injuries in pre-season and in-season training programs, according to a study published in the Aug. 17, 2009 issue of Knee Surgery, Sport Traumatology, Arthroscopy.
The key? Don't do the same thing every day and don't do too much, too soon. You need to cross train, and you need a periodization program, which means tweaking your training throughout the year so you don't burn out and get injured.
"Cross training and slowly increasing intensity allows you to build up your fitness and avoids ramping up activity all at once," Geier says.
Make a Plan
It's best to have a strength training coach design a periodization program geared toward your specific fitness level and time of year (off-season, in-season, or post-season), Lee says.
"For example, off-season training begins six weeks before your first match and typically focuses on strength training," Lee says. In-season workouts involve more high-intensity training done less often, allowing you to focus more on your sport.
Geier recommends the following general pre-season and in-season training rules:
Cross training can also keep you motivated. "Burnout is very high at the high school level," Geier says. "Training can get boring, so doing different things makes it less likely to feel like a job."
Eat for Performance and Health
To perform at your best, you need good nutrition -- and that includes getting enough calories.
"Many young women athletes don't take in enough calories," says Rebecca Scritchfield, MA, RD, an ACSM health fitness specialist and a dietitian in Washington, D.C. "You need to nourish yourself both for growth and development as well as for long-term health and wellness and fueling your body for your sport."
Taken to an extreme, you could lose your menstrual period, develop eating disorders, and make bone loss more likely. You may also make injury more likely.