| Sports Injuries Questions |
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Q: My daughter is a senior in high school and tore her knee anterior cruciate ligament while playing basketball. She had surgery to reconstruct
this ligament and is back on the basketball courts. Fortunately, she has
scholarship offers for softball and basketball. Which sport would you
recommend for her in college and why?
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| Answer: |
Taking into consideration your daughter's history of previous injury and
subsequent knee reconstructive surgery, I would advise softball. Incidents of anterior cruciate ligament injuries in women athletes have been reported in certain sports, such as gymnastics, handball, volleyball and
snow skiing. The National Collegiate Athletic Association reported that women basketball players experience four times as many anterior cruciate ligament injuries as their male counterparts. Female soccer players had twice the injury rate compared to men. No conclusive evidence exists to explain the gender difference in this injury. Researchers think light differences in bone anatomy of the knee may be implicated as an etiology.
The archway of bone through which the anterior cruciate ligament crosses in the knee is called the intercondylar notch. This notch has been found in
several studies to be more narrow in women. It is thought that this finding, as well as increased joint laxity and limb alignment, may be reasons for the greater propensity toward anterior cruciate ligament injuries in women athletes. Sports which require repetitive stopping/starting, pivoting and quick reversal of direction have more
potential for producing knee ligament injuries. Basketball has far more of
these characteristics than softball.
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Q: I am a 34-year-old woman athlete who likes to compete in triathlons.
I recently developed pain in the front of my knee and was diagnosed with
''Jumpers knee.'' What is this? And what part of my training is causing it?
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| Answer: |
Jumpers knee is an inflammation of the patellar tendon as it attaches to the lower end of the knee cap (patella.) Excessive stress on the patellar tendon where it attaches to the patellar bone can result in microtears of the tendon fibers. The microtears of the patellar tendon can lead to inflammation and pain. Continued stress can result in deterioration and further breakdown of the tendon fibers. More than likely, the running portion of your training is the source of your symptoms. Several factors such as training errors, differences in shoes and surfaces and variations in anatomy alignment have been identified. Of these factors, training errors, particularly rapid transitions in training, are responsible
for these injuries. Most knee injuries can be resolved with conservative treatment. Surgery is sometimes needed.
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Q: My 7-year-old son was kicked in the knee while playing soccer. He complained of pain and swelling, which caused him to limp. After one week the knee pain and swelling are now gone. Is it safe for him to resume his soccer activities?
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| Answer: |
Resolution of pain and swelling following a trauma to a knee joint is one sign of recovery. In addition, the child should be able to bear weight and move the knee without pain before resuming his soccer activities. If any of these symptoms persist, he should be examined by a physician. |
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Q: I am a 38-year-old avid tennis player. Two years ago I fell directly on the corner of my shoulder. I was told that I had a second-degree separation of my shoulder and that no surgery was required. The initial pain on the top of my shoulder subsided. However, overhead movement causes deep pain in the shoulder and on the side of my upper arm. Did my original injury heal?
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| Answer: |
The original injury, which you describe as a ''separated shoulder,''
relates to the acromion (shoulder blade) and clavicular (collarbone) joint. This is one of the four joints that make up the shoulder complex.
The acromion-clavicular joint is commonly referred to as the AC joint. The
AC joint is most commonly injured from a direct blow to the tip of the
shoulder. The degree of AC-joint injury can be determined by an X-ray.
The second-degree separation means that the supporting joint capsule has
been disrupted and the ligaments have been stretched. This allows the
collarbone to elevate in relation to the shoulder blade.
A slight bump on the top of the shoulder blade results and widening of the
joint space occurs. Both of these findings can be noted on X-ray examination.
Second-degree separations of the AC joint are treated with short-term use
of a sling and ice followed by early range of motion and strengthening
exercises.
The joint eventually heals in this position. Since your pain is not on top
of the shoulder, near the AC joint, your source of pain may be coming from the
underlying rotator-cuff tendon and/or bursal tissue.
Studies report a 5 percent to 15 percent incidence of associated
rotator-cuff injury and/or pain, which is elicited when the arm is raised
into an overhead position.
The pain is a result of the bursal tissue and rotator-cuff tendon being
squeezed between the shoulder blade and the arm.
Injury to the AC joint has the potential for narrowing the space where the
bursal tissue and the rotator-cuff tendon move to and from between these bones
(acromion and humerus) with overhead movements.
Rotator-cuff tendon tear and pain could co-exist in the shoulder after
AC-joint injury. Often a physical examination can identify these problems in
the shoulder.
In some instances, an MRI is required to assist in making the diagnosis.
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Q: I am 52 and still competing in 5K-10K races. My running has been significantly affected by a recurrent hamstring strain. I have tried anti-inflammatory medication, magnets, massage and patience. Is there any advice other than the usual regimen of stretching to prevent this nagging problem? Is surgery an option?
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| Answer: |
There is no doubt recurrent hamstring strain can hamper and frustrate a competitive runner like yourself. Hamstring strains are among the most common injuries in athletes. A hamstring strain is an injury that occurs most commonly where the muscle begins to transform into tendon tissue. A few hamstring strains occur where the muscle's tendon inserts into the bone and in some cases will detach a fragment of bone as part of the injury. Two factors commonly cited in hamstring strain injuries are lack of flexibility and strength and balances. Strength and balances refer to a
difference in muscle strength when you compare each limb (right versus left) or thigh muscles (quadriceps versus hamstrings) in one particular limb. A strength imbalance of 10 percent or more between right and left
hamstrings is felt to increase the likelihood of strains. Studies have looked at the comparison between the quadriceps and hamstring muscle strength in an individual limb. As a general rule, a ratio of at least 50 percent to 65 percent for hamstring strength compared to the quadriceps strength is recommended to decrease the chance of sustaining a strain.
Failure to adequately rehabilitate the injury will lead to a chronic
injury. When an injury does occur, use rest, ice, compression and elevation - the preferred first aid approach. A graduated pain-free stretching program and eventual progressive strengthening program to correct muscle imbalances is important. Rarely is surgery indicated except in cases involving a detachment of the muscle tendon complex from the bone.
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Q: Seventeen years ago I had a snow-skiing injury in which I tore my meniscus cartilage. They removed the cartilage in surgery and found a broken bone on the joint line which eventually healed. I am 54 and now have been diagnosed as having arthritis confined to the side where the injury occurred. Surgery has been advised to realign the joint. Do I have any nonsurgical options?
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| Answer: |
You described a scenario common in knees that have had the type of trauma you described. Post-traumatic arthritis of the knee often occurs years after a broken bone involving the joint line. The fracture, coupled with the loss of the shock-absorbing meniscus cartilage, is a recipe for arthritis. The surgery that you were advised to have is called an osteotomy, in which the weight-bearing line of the joint will be realigned. A wedge of the bone is removed from the femur (thigh bone) or tibia (leg bone) to shift the weight-bearing line away from the arthritis side of your joint. By shifting the weight-bearing line, you shift the joint pressure away from the arthritic side, essentially taking weight off the painful side of your knee. A brace can be made that can accomplish this weight-shifting to ease the arthritic side of your joint. The brace is not as definitive in producing this effect as surgery. However, if the brace is effective enough to reduce your symptoms, you may be able to defer surgery for some time. |
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Q: I am a golf instructor who has right knee pain as I shift my weight when I hit a drive. My family doctor took an X-ray which looked normal. During the past two weeks, my knee has been catching and will actually lock up for several minutes. What is your opinion?
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| Answer: |
There are two meniscal cartilages in each knee. They are C-shaped wafers of cartilage that act as protective shock absorbers. A tear in the cartilage can be especially painful when twisting, pivoting and squatting. A meniscus tear can enlarge to a point where it will fold on itself and lock into position. Loose bone fragments also can prompt a knee-locking episode. Your normal X-ray should help to rule out bone fragments as a source of your symptoms. However, an X-ray is only one part of the information-gathering process. A thorough history and orthopaedic examination combined with your X-ray will lead to a diagnosis in the majority of cases. A magnetic resonance imaging (MRI) study can assist in confirming the diagnosis, but are not always necessary. Arthroscopic knee surgery should be considered for meniscus tear especially in those individuals experiencing locking. Depending on the location and the pattern of the meniscus tear, some can be repaired arthroscopically. Meniscus tears that do not fit the criteria for repair are then arthroscopically trimmed to remove the torn segments of the tear to prevent further tearing and locking symptoms. |
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Q: Two days ago I twisted my ankle while running. I have been told to apply an elastic bandage wrap. Do you start above or below the ankle?
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| Answer: |
Application should begin below the ankle. Overlap each wrap as you advance toward and above the ankle. A snug uniform tension is advised. The wrap should be removed and reapplied two to three times a day during initial treatment. I also advise elevation, ice packs and crutches. |
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Q: My son wants to play again in the summer Little League program. He was a pitcher last year and often complained of pain on the inside part of his throwing elbow. What can we do to avoid a recurrence of these problems?
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| Answer: |
Your son was probably suffering from a condition called ''Little League elbow.'' This is predominantly seen in the Little League pitcher and catcher positions. The condition is a result of high repetitive tension forces on the medial or inner side of the elbow during the acceleration phase of the throwing. These tension forces stress the growth plate of a player's developing elbow, if overuse is allowed to occur without guidance. Concern for protecting the Little League player against injury resulted in rules being adopted by the Little League Baseball Inc., limiting a player to pitching six innings per week. However, at that age, children often play sandlot baseball with friends on
a daily basis. This can result in 100 throws per week, thus limiting the innings pitched competitively must be tempered with guiding the throwing during unsupervised free time. The development of an effective pitching style requires a balance between repetition and the risk of overuse syndrome, such as Little Leaguer's elbow. Signs to look for are persistent pain and swelling on the inside of the elbow. Often the player will report a popping sensation. Typically, the symptoms develop over a period a few weeks. Loss of full extension can occur as well. In most cases, a 36-week period of rest will end symptoms of full-blown Little League elbow. Ice and aspirin are useful in controlling the initial symptoms. Before a player can return to competition, one should have a painless full range of motion of the affected elbow. Above all, a return to throwing should be gradual. It would be advisable to initially limit the throwing activities by having a player play first base or designated hitter for a few weeks. If symptoms persist, an evaluation by a physician and X-rays should be obtained.
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Q: My 10-year-old son is eager to begin lifting weights. He is tall for his
age, but I am concerned that he may stunt his growth. Can you make any recommendations?
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| Answer: |
With the onslaught of superheroes with perfect physiques and muscle magazines lining all the magazine racks, body image is now a concern of our children at a younger age. Several studies have shown that weightlifting, under proper supervision, instruction and while using specific guidelines, is safe. These studies showed no interruption of the skeletal growth and noted strength gains in those who participated. At ages 9 and 10 the strength gains were primarily from improving the coordination rather than increasing the size of the muscle. To increase muscle size, you must exercise, but you also have to have the sex hormone - namely testosterone. The most important guideline for initiating an exercise program is supervision. I recommend he begin lifting against his own body weight, such as pullups, pushups, dips and leg lifts. When a pattern of consistency has been reached, then I recommend he start an exercise program using weights while supervised. It is best to start out with machines rather than free weights because the machine eliminates the balance requirements. One set of six to 15 repetitions is a good starting point. If the repetitions are too easily performed, he may add 1 to 3 pounds. No maximum lifts should be performed or ballistic-type movements. It is important to make sure that warmup and stretching is performed before any exercise session, which should last between 20 and 30 minutes. I recommend that this exercise program be done two to three times a week. Your 10-year-old can safely lift weight if he is properly supervised and instructed for a slow, progressive increase in the amount of weight-resistance used. |
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My daughter is a senior in high school and tore her knee anterior cruciate ligament while playing basketball. She had surgery to reconstruct
this ligament and is back on the basketball courts. Fortunately, she has
scholarship offers for softball and basketball. Which sport would you
recommend for her in college and why?
