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Paging Dr. Frischer - Sports Injuries
WRITTEN BY :   Dr. Alan Frischer

My column today is for all of you weekend warriors, as well as for those of you who take your sports activities more seriously. Unfortunately, for most of us, the occasional injury is inevitable. I must reluctantly admit that the most common sport to cause these injuries happens to be my own personal favorite: running. The most common injuries are those of overuse; they generally start out small, and by knowing the early signs, they can be prevented from becoming more serious. Let’s take a look at the most common sports injuries and how we can help avoid and treat them.
Number one on the list of sports injuries is the muscle pull. These are so common because they are generally hard to prevent; no matter how good the warm-up, muscle pulls can still occur from overuse, fatigue, or taking a fall. Keeping your core muscles strong and maintaining good balance will help. Treatment involves ice and rest until the pain and swelling subside. Ice, used for 20 minutes on and 20 minutes off, relieves spasms. Once tolerable, slow stretches will stretch the muscle back to its proper length, so that it is not re-injured.
The second most common injury is to the neck. Pulled muscles and muscle spasms can occur with nearly any movement of the neck – even sleeping with the neck in an unusual position. The pain is usually one-sided. The best treatment is to apply ice, again for 20 minutes at a time, to take anti-inflammatory medication, and to gently stretch the neck.
The third most common injury is to the shoulder, known as shoulder impingement. The rotator cuff muscles hold the bones of the shoulder together. If the shoulder joint is continually stressed with the arm in an overhead position, as it is in softball, tennis, volleyball, swimming and weight training, the small rotator cuff muscles begin to stretch out. This causes the head of the joint to become loose within the shoulder socket. If the head of the shoulder is loose, then when the arm is extended backwards over the shoulder, the head will slide forward, leading to impingement. Treatment involves use of anti-inflammatory agents (such as Celebrex, or Motrin/Advil) or corticosteroid injections. Physical therapy can help strengthen the rotator cuff muscles, which in turn will help to hold the shoulder in place. When all else fails, surgery may be necessary.
The next most common is lower back strain, often seen in weight lifting, golfing, martial arts, and tennis. It usually results from twisting awkwardly, lifting a heavy weight, lifting to one side, or participating in a new, untried activity. When the muscles of the low back are suddenly overloaded, they can pull or tear, sending them into spasm. Treatment can be as simple as resting the back, and pain often resolves in a few weeks. If the pain doesn’t improve significantly within the first 7 to 10 days, physical therapy may be recommended, and may include exercises to strengthen the lower back, hamstrings and abdominal muscles, ice and heat, electrical stimulation of muscles, stretching, and deep tissue massage. Anti-inflammatory agents (Celebrex or Motrin/Advil) may help.
The fifth most common sports injury is tennis elbow, an inflammation of the muscles of the forearm and of the tendon that connects these muscles to the bones in the elbow. These muscles allow the wrist to bend backward and to turn the palm face up. When they become inflamed from overuse, known as lateral epicondylitis, the pain is felt on the outside of the elbow. A golfer will cause this injury on the non-dominant side – a right-handed golfer, for example, will feel this on the left arm, although pulling the club through the swing with the left wrist can cause irritation in the left elbow as well. Medial epicondylitis is a different type of tennis elbow, causing pain not on the outside, but on the inside of the elbow. This is seen among golfers, baseball pitchers, tennis players and weight lifters.
How is tennis elbow treated? Exercises such as wrist curls, reverse wrist curls, and squeezing a soft rubber ball can improve forearm strength. Cortisone injections will reduce the inflammation around the elbow and ease pain. However, exercises and injections do not address the underlying cause of the problem – overstressing the tendon of the forearm. The only real treatment for tennis elbow focuses on changing whatever pattern caused the problem in the first place. The tennis player learns to move the body to set up a shot so that all of the body weight is behind it, taking stress off the elbow. Golfers with chronic elbow problems may need to change their swing.
It comes as no surprise that running is the most common cause of knee pain, and the sixth most common sports injury is runner’s knee. The condition is known as chondromalacia patella, and is due to the misalignment of the kneecap. The kneecap normally goes up and down in a groove, as the knee flexes or straightens out. If the kneecap is misaligned, the kneecap pulls off to one side and rubs on the side of the groove, causing both the cartilage on the side of the groove and the cartilage on the back of the kneecap to wear out. Fluid can build up as well. Treatment involves strengthening the quadriceps muscle, which hooks into the kneecap and helps to align it into the center of the groove. Isometric exercises strengthen the quadriceps by contracting and relaxing the muscle, and soft tissue massage works on the center of the quadriceps. Non-steroidal anti-inflammatory medication can be helpful.
Unfortunately, this list goes on and on, but the last injury I’ll address is the shin splint. This is pain in the muscles near the shinbones. Running or jumping on hard surfaces or simple overuse can be the cause. Shin splints occur most often in people unaccustomed to training, although they can also plague experienced athletes who switch to lighter shoes, harder surfaces, or more concentrated speed work. The pain of a shin splint occurs on the inner side of the middle third of the shinbone, which is where the muscle responsible for raising the arch of the foot is attached. When the arch collapses with each foot strike, it pulls on the tendon that connects to the muscle. With repeated stress, the arch begins to pull some of its muscle fibers loose from the shinbone. This causes small areas of bleeding around the lining of the bone, and is painful. Treatment requires proper arch support, which props up the foot and prevents excessive pronation and pull on the tendon. To prevent shin splints, start exercising slowly to warm up the leg muscles, wear athletic shoes with good support, and run on a soft surface such as dirt or grass.
In general, most sports injuries cause temporary damage, and can be treated at home. However, expect that some may take months to heal, and if a sprain or strain is severe, with the entire muscle, tendon or ligament torn away, surgery may be recommended.
A few words on stretching. What coaches have taught us for decades is now being questioned! Current research does find that stretching improves range of motion, however, it has not been proven to prevent injuries or decrease muscle soreness when done before exercise. Most experts now do NOT recommend stretching before exercise because your muscles have not yet properly warmed up. Instead, stretch immediately following your warm-up, and again following your workout. These are the times when the muscles are warm and more elastic, and stretching will best increase flexibility and maximize the range of motion around joints. Be sure to stretch all the major muscles groups that were used during the workout.
Good health and safe exercising to you all.
Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: November 27, 2009 – Volume 8 – Issue 32



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