Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Common Sport Injuries

An overuse injury results from excessive wear and tear on the body, particularly on areas and muscles subjected to repeated activity such as ankle, knee, shoulder and elbow joints.

The most common high impact sport that leads to injury is running. We see more runners than any other recreational athletes in our clinics, followed by those who participate in skate, mountain biking, dance (including high impact aerobics), tennis, skiing, basketball, gymnastics, football, soccer and figure skating.

Certain types of injuries plague sports participants. Most of them, however, are minor. Knowing the early signs, symptoms and what to do can help prevent them from becoming nagging chronic pain problems.

  1. Hamstring injuries are common among athletes who play sports that require powerful accelerations, decelerations or lots of running. The hamstring muscles run down the back of the leg from the pelvis to the bones of the lower leg. The three specific muscles that make up the hamstrings are the biceps femoris, semitendinosus and semimembranosus. Together these powerful knee flexors are known as the hamstring muscle group. An injury to any of these muscles can range from minor strains, a pulled muscle or even a total rupture of the muscle.

A hamstring injury typically causes by a sudden, sharp pain in the back of the thigh that may stop you mid-stride. After such an injury, the knee may not extend more than 30 to 40 degrees short of straight without intense pain. Like most sprains and strains hamstring injuries are usually caused by excessive stretching (tearing) of muscle fibers or other soft tissues beyond their limits.

Hamstring pulls or strains often occur during an eccentric contraction of the hamstring muscle group as an athlete is running. Just before the foot hits the ground, the hamstrings will contract to slow the forward motion of the lower leg (tibia and foot). Less commonly, a hamstring injury is the result of a direct blow to the muscle from another play or being hit with a ball.

Some of the factors which may contribute to a hamstring injury include:Doing too much, too soon or pushing beyond your limits, Poor flexibility, Poor muscle strength, Muscle imbalance between the quadriceps and hamstring muscle groups, Muscle fatigue that leads to over exertion, Leg Length Differences. A shorter leg may have tighter hamstrings which are more likely to pull, Improper or no warm-up, History of hamstring injury.

Treatment for hamstring injuries depends upon the severity of the injury. Due to the pain and limited ability to use the muscle, a third degree strain usually results in a visit to a physician for evaluation and treatment. Less severe hamstring strains may be treated at home. These general treatment steps are commonly recommended for mild or moderate hamstring injuries.

–          After an injury it’s important to rest the injured muscle, sometimes for up to two or three weeks before you can return to sports after your injury.

–        R.I.C.E – Rest, apply Ice and Compression. Elevate the leg if possible.

–          An anti-inflammatory can be helpful to reduce pain and inflammation.

–          A stretching program can be started as soon as the pain and swelling subsides.

–          A strengthening program should be used to rebuild the strength of the injured muscle in order to prevent re-injury. Make sure you increase this gradually.

–          A thigh wrap can be applied to provide support as the muscle heals.

  1. A stress fracture is a common overuse injury most often seen in athletes. Usually, a fracture, or broken bone, is caused by an acute event, such as a car crash or a fall. When this is the case, the bone experiences a very high force that causes the stress fracture.

A stress fracture occurs when the forces are much lower, but happen repetitively for a long period of time; these injuries are also known as “fatigue fractures.” Stress fractures are commonly seen in athletes who run and jump on hard surfaces, such as distance runners, basketball players, and ballet dancers.

A stress fracture can occur in any bone, but is commonly seen in the foot and shin bones. They rarely occur in the upper extremity because the weight of your body is not supported by your arms as it is in your legs.

Physical examination and history are important in diagnosing stress fractures. Because these overuse injuries have a typical course and common physical findings, the history and examination can be critical in the diagnostic evaluation. X-Rays usually do not show a stress fracture, but they may show evidence of bone attempting to heal around the stress fracture. Further studies, including an MRI or bone scan may be necessary if the diagnosis is unclear or if the problem does not resolve with treatment.

Another factor that can contribute to the development of a stress fracture is dietary abnormalities and menstrual irregularities. Because both factors contribute to bone health, any problems with diet (e.g. poor nutrition, anorexia, and bulimia) or menstruation (amenorrhea) may place an individual at higher risk for these injuries. This is one reason that adolescent female athletes are at particularly high risk for development of a stress fracture.

The best treatment is almost always resting the injured leg. If there is no evidence that the stress fracture may displace, then avoiding the overuse activity may be sufficient treatment. However, if there is a concern of displacement of the stress fracture, then weight-bearing should be avoided (i.e. use crutches), and a cast may be placed.

One rule of thumb (but not an absolute rule) is: if there is pain, don’t do it. This means if jogging causes pain where you have a stress fracture, don’t jog. If walking causes pain in that location, use crutches.

  1. Knee Injury – Anterior Cruciate Ligament Tear is most often a sports-related injury. ACL tears can also occur during rough play, mover vehicle collisions, falls, and work-related injuries. About 80% of sports-related ACL tears are “non-contact” injuries. This means that the injury occurs without the contact of another athlete, such as a tackle in football. Most often ACL tears occur when pivoting or landing from a jump. The knee gives-out from under the athlete when the ACL is torn.

The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear often have sustained an injury to the knee. The injury is often sports-related. They may have felt a “pop” in their knee, and the knee usually gives-out from under them.

ACL tears cause knee swelling and pain. On examination, your doctor can look for signs of instability of knee. These special tests place stress on the ACL, and can detect a torn ligament. An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee.

Many patients with an ACL tear start to feel better within weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist.

The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament.

There are several options for how to perform ACL sugery. The most significant choice is the type of graft used to reconstruct the torn ACL. There are also variations in the procedure, such as the new ‘double bundle’ ACL reconstruction.

Rehab is one of the most important, yet too often neglected, aspects of ACL reconstruction surgery. Rehab following ACL surgey focuses on restoring motion and strength, and improving the stability of the joint to prevent future injuries.

While general guidelines exist for ACL rehab, it is critically important that each individual progress through their rehab as their knee allows. Progressing too quickly or too slowly can be detrimental to overall results from surgery, therefore it is important to ensure your therapist and physician is guiding your rehab.

  1. Golfer’s elbow, or medial epicondylitis, is similar to its counterpart, tennis elbow. The primary differences between these conditions are the location of the pain and the activity that leads to injury. However, both conditions are caused by overused of the muscles and tendons of the forearm, leading to inflammation and pain around the elbow joint.

These problems, tennis elbow and golfer’s elbow, are both forms of tendonitis. Tendons are the ends of muscles that attach to bone. Because of the force of the muscle, the points of insertion of the tendon on the bone are often pointed prominences. The medical names of Tennis Elbow (lateral epicondylitis) and Golfer’s Elbow (medial epicondylitis) come from the names of these bony prominences where the tendons insert, and where the inflammation causes the pain. The pain of golfer’s elbow is usually at the elbow joint on the inside of the arm; a shooting sensation down the forearm is also common while gripping objects.

The mechanism of this injury can vary from a single violent action to, more commonly, repetitive stress injury where an action is performed repeatedly and pain gradually develops. No one is immune from these injuries, but they are most common at the beginning of the golf season, or when the offending activity is increased in intensity or duration. Golf is one common cause of these symptoms, but many other sport- and work-related activities can cause the same problem. Another common cause of this injury is with weekend carpenters who use hand tools on occasion.

Golfer’s elbow is usually a self-limited problem, and does not cause any long-term disability. Treatment is rarely surgical, as this condition is well managed with a little rest and proper rehabilitation.

Lifestyle modification is important if golfer’s elbow does not resolve or if it recurs. With athletes, often a change in technique can resolve the problem. Golf clubs should be sized properly, including grip size. Swing mechanics should be evaluated to ensure patients are swinging properly. Anti-inflammatory medications are often used to help control pain and inflammation.

The oral forms of these medications, such as a combination treatment of tramadol/paracetamol, are easy to take, and often help control the inflammation as well as manage the pain associated with golfer’s elbow. Shockwave therapy is one of the effective treatments for this condition.

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