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Overuse injury primer
Dr Richards' four top sports
injuries list: runner's knee, jumper's knee —
often seen in basketball and volleyball players,
shin pain and heel pain. Here is a rundown of
the symptoms and treatments.
 Runner's
knee
The Dx: Usually pain in the front of the
knee associated with running, or even prolonged
walking. "People tend to feel more pain when going
downhill or down the stairs," says Dr Richards.
The Tx: Dr Richards suggests
telling the patient to bring down their activity
level. To adjust for biomechanical problems, the
patient can do two things.
1. Get the right shoes.
The right fit will correct any pronation or supination.
In some cases orthotics can be helpful. "Over-the-counter
orthotics are good, especially for people who
can't afford the custom made ones," says Dr Richards.
2. Strengthen the muscles
around the kneecap. Dr Richards explains that
in many cases there is an imbalance in the forces
pulling on the kneecap. "In those cases we get
the person to stretch the structures on the lateral
side of the kneecap that are creating too much
tension and strengthen the muscles on the medial
side [of the knee cap] that aren't making enough
tension."
Jumper's
knee
The Dx: This is a problem with the tendon
of the quadriceps mechanism that extends the knee,
explains Dr Richards. It usually occurs at one
of the junctions of the tendon and the bone like
the attachment of the tendon to the tibial tubercle,
inferior pole of the patella or the superior pole
of the patella.
The Tx: Patients need
to stop jumping. Dr Richards also suggests an
exercise regimen that stimulates healing.
 Shin
pain
The Dx: There are two types of shin pain,
tibial stress syndrome, which is the most common,
and exertional compartment syndrome.
The Tx: The main treatment
is to modify activity level. If they don't, they
risk fracturing their tibia. Patients can also
try arch supports to stop pronation of the feet,
one of the roots of the pain. They can also wrap
the shin from knee to ankle with a cohesive bandage.
Icing, in this case, can also do more than mask
the pain. So patients should ice down the shin
after an activity.
Heel
pain
The Dx: "Heel pain comes in a few different
flavours," says Dr Richards, "and sometimes physicians
make the mistake of labelling all heel pain as
plantar fasciitis." He does point out that it's
the most common. Plantar fasciitis is associated
with two types of feet — people who pronate
or supinate. In both cases, there is usually a
problem with the calf being too short or inflexible.
The Tx: Patients can
wear a more cushioned shoe or use a cushioned
heel pad. They also need to get into the right
pair of shoes suited to their kind of feet —
motion control for people who pronate and cushioned
footwear for those with stiff supinated feet.
Orthotics can also really help. Dr Richards suggests
a lot of calf stretching, which helps about 50%
of sufferers. Patients need to stretch in two
positions, both with the knee extended and flexed.
If that doesn't help, you might want to put patients
in night splints, which allows passive stretching
of the calf
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With the warm weather more Canadians
are exercising, and that means more patients presenting
with sports-related injuries. As the years go by you can
expect a higher and higher percentage of these patients
to be 'baby-boomers' whose oldest members will reach age
60 in 2006. "From my perspective too suddenly increasing
activity levels is a recipe for problems," says Dr Doug
Richards, a professor of sports medicine at the University
of Toronto and the physician for the national women's
basketball and volleyball teams.
"We see two things with boomers,"
says Dr Devin Peterson, an orthopedic surgeon and professor
at McMaster. "There are the ones who are 55, not in
shape but think they are, and go out two times a week,
do crazy stuff and end up injuring themselves." Another
segment train regularly and are in shape but go at it
as though they still have the body of a 20-year-old.
Whether 16, 46 or 66, "the most important thing is that
if a patient has an injury they have to stop and treat
it," says Dr Peterson.
Unfortunately, for many stubborn
patients stopping isn't an option. Dr Richards believes
that by modifying the activities of a patient you can
help them keep active while also giving their body time
to heal. "Rest is a dirty word in our business," he
says. "It doesn't fix the problem. The underlying issue
— the athlete obsession with constant training
— hasn't been resolved." What does he suggest?
Switch them to an exercise that gives the affected part
a chance to heal. Tell someone who runs to cycle instead,
or perhaps to try swimming.
MORE
THAN OVERUSE
"All of these [overuse] injuries are a combination of
factors from two things," says Dr Richards, "the total
amount of loading that the person is subjecting their
tissue too and or some sort of biomechanical susceptibility."
One example of these kinds of susceptibilities is feet
that either pronate, when the foot rolls inward, or
supinate, when the foot rolls outward.
"Biomechanical problems have quite
a big impact on sports-related injuries," agrees Dr
Peterson. "Any sort of mal-alignment can really cause
a lot of difficulty and really needs to be addressed."
He adds that part of your treatment for this person
would be to see if and where the biomechanical problem
is and then to see if the patient would benefit from
something like an orthotic or a knee brace.
Another way to go is to suggest
a good strengthening program. If the patient can afford
it, a personal trainer can develop a program to strengthen
particular muscle sets.
RELIEVING
THE PAIN
"In general, if patients use modalities like drugs and
ice that reduce the perception of pain, then they aren't
fixing the problem," says Dr Richards. His interventions
aren't aimed at hiding pain but fixing it. He does concede
that icing after a workout can ease the "ouch" but he
avoids suggesting patients medicate with anti-inflammatories.
Dr Peterson is big on physiotherapy.
"That's probably the most important thing because physio
can do local pain stuff like ultrasound which helps
ease the inflammation."
Catching the injury early is the
best way to ensure the patient will fully recover. That
can be a challenge in that most patients only call you
once the injury has become severe. Still, Dr Peterson
believes that intervention can help at any stage.. "Proper
diagnosis and early rehab is what it's really all about,"
he says. "You have to make the people stop what they
are doing because unless they do it's only going to
get worse."
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