Dr. Kevin Most: Summer injuries
Well with summer here we are seeing more people getting out to exercise and participate in activities, with this comes a rash of injuries. Many of these are very common and frustrating as we want to participate and yet the injury makes us stop participating in the activities. Some of this is due to inadequate preparation for the season, some occurs because of bad body mechanics while participating and others due to overuse. The goal for those injured is to get back to an active state as well as not taking an acute problem and changing it into a chronic problem, so planning and treatment are key.
With these injuries we are also seeing a rash of ads on TV for the quick fix or the special braces. Let’s make sure understand the science before the late night TV ads gets into your wallet. We all may remember the copper craze a decade ago, everyone was wearing copper bracelets and sharing that their pain from arthritis was improved. That was shown to not have any scientific backing and that fad passed. Or has it, you have probably seen Brett Farve pushing for a line of copper infused compression wear. The ads make some claims and we want to be sure you are an informed consumer. The action of compression alone is very good for most sports injuries as long as the compression wear is properly fitted. Too tight and it will cut off circulation, to loose and it serves no value.
The more important one is the extended claim of what the copper benefits are. As we discussed above, copper itself has not been shown to have any medicinal properties to relieve pain, however we do know that copper is great for killing bacteria and viruses. So if you are concerned about bacteria being in your compression wear than copper will help, however I am not sure the premium price you pay is actually worth it. I guess I would say if you are concerned with bacteria and odor the copper may help, but for my money I will buy from the health or sports store where I can get fitted properly and pay a fraction of the copper compression clothes cost.
Let’s take a few minutes to discuss a few of the common injuries, what actually is occurring, what can be done to treat and rough estimates on the timing impact.
First a little anatomy, ligaments attach bones to bones and act as a foundation for bone structure. Tendons attach muscles to bones and allow for movement, as the muscle contracts it pulls and moves the bones. So a sprain in the ankle is often a ligament strain or tear, tendonitis on the other hand is an inflamed area where the tendon attaches to the bone.
A couple of confusing ones are lumped together, is there a difference between Golfers elbow and Tennis elbow? The elbow is an interesting joint that allows us to move our lower arm in many directions, it allows us to flex and extend our arm to pick items up, it also allows us to rotate so we can pour a glass of milk or write our name. The complexity of the elbow is interesting with not only nerves but also the complexity of the muscle attachment that causes movement. Although these 2 injuries have their specific names the injuries can occur with other sports or occupations. Baseball, Bowling or occupations requiring a twisting of the elbow against pressure (think screwdriver )
So what happens with Golfers and Tennis players and are these injuries the same? The injury is essentially the same injury they just occur on the opposite side of the elbow, and this is due to the mechanics of the movement of elbow for each of the common swings in tennis and golf. If you think of the golf swing the pressure is placed on the elbow when the club strikes the ground, for a right handed golfer it is the left inner aspect of the elbow that takes the most impact this impact causes small tears to the tendon that attaches to a bone called the medial epicondyle, thus this causes pain over that bone with any movement. It is an important muscle for activities as simple as lifting a cup of coffee in the morning, it can be so bad that it is impossible for the patient to lift anything of weight in that plane, however they still can flex and lift substantial weight as long as there is no rotation to the arm.
This same injury occurs in tennis players, however with tennis players the injury occurs on the outside of the elbow as the force of hitting a tennis ball puts a strain on the outside of the elbow for most shots with force. The same functionality for rotation occurs, think of rotating your arm/hand to pour a drink versus rotating your hand to have your hand in position to catch something (palms up) These injuries can be very painful and individuals think they are weaker in the muscle, in fact the muscle is rarely injured and is just as strong as it should be, however the tendon is injured. Tendons are the tissue that connect muscles to bones that allow for movement. Muscles contract and the tendon pulls the bone attachment and movement occurs. Ligaments connect bone to bone- think ankle sprain.
So these conditions are termed epicondylitis as the tendon attaches to the bone called the epicondyle, we have one on the inner aspect and outer aspect of the elbow, they are part of the Humerus bone or upper arm bone. The tendons that attach there also attach to the fingers. If you flex your arm and reach under the joint and squeeze, you will have your fingers on the 2 epicondyle, where these injuries occur. The tendon becomes inflamed there and any movement of that muscle causes pain and a perception of weakness.
So how do we treat this? The old “doc it hurts when I do this” is one way, rest. Many individuals want to get back to their activity and don’t have the patience for this, so we do have other options. Ice the area after use will minimize the swelling, anti-inflammatory medications help, some will revert to steroid shots. Another very popular treatment is a tendonitis brace although its success is limited in most cases. It may have more success as a preventative tool. This is a support that is worn on the forearm of the injured arm. The concept behind it is all physics, it is changing the angle at which the tendon works which changes the direction of the force on the inflamed portion, they have also been designed to absorb some of the force so it is not placed on the one inflamed area. Important that it fits properly
These can be very difficult to treat as rest is very difficult, you can’t eat with the arm affected, can’t pick up a drink, even dressing can be difficult. Rest, time, medications and compression are the best options.
What about the runner who has now picked up their running schedule and finds that they now have pain in their shin as they run. We all know these as shin splints. It is often a bucket term for pain below the knee, it is important to know what causes the pain as the treatment can be different. Pain in this area is often termed shin splints but it can also be a stress fracture or muscle problem. Classic shin splints occurs when the muscles of the lower leg essentially pull of the sheath that is attached to your leg causing micro tears, inflammation and pain.
Why do we get this, there are many factors but the most important is over use or advancing or changing your running pattern. Runners need to have good shoes as well, the science behind running shoes has advanced over the past 20 years. The shoes work to make sure you don’t put too much stress on either side of your lower leg based on how you run. Also running on hard surfaces is much more difficult, people will always say how nice it is to run on a good limestone running trail and not as hard on their legs.
Treatment for this can initially be preventative, get the proper shoes, that fit well. Start the training slow in both pace and distance and build slowly. Run on a surface that is even but has some give to it, limestone running paths are much better than asphalt. If you do end up with the pain, initial treatment is to get inflammation down with ice, compression, elevation and Advil. The runner who needs that exercise fix is encouraged to swim or cycle for a week or so to let the injury heal and then when returning make sure you do calf stretching as you slowly return.
There are many other injuries that we equate with some sports that actually carry over to others, an example of this is turf toe. We hear about it during the football season but it occurs in more than football players. Essentially what this is, is a sprain of the big toe, which on the surface sounds minimal but those who have had it will tell you the opposite. The big toe is surrounded by fibrous tissue and ligaments to provide support and prevent dislocation. The turf toe injury can be seen in runners, soccer payers, baseball and softball players as well. The big toe is important to allow us to walk and jump without pain. The normal walking motion is to have the heel raise and pushing your body weight forward and onto your big toe to push off. This is why we have a big toe. The mechanics of the foot and walking are actually quite interesting.
Treatment for this is rest, ice, elevation…. Starting to see a pattern here? It is about resting and minimizing inflammation and further injury. Well when it is your arm it is a bit easier than your great toe as we need it to walk, some will put on a walking boot which changes the mechanics of walking and minimizes the stress on the toe. Others will walk on the outside of their foot which may relieve the toe pain but can cause hip and knee pain. We will always tape the great toe to the second toe to give it some support and to take some stress off the great toe ligaments. This is another injury where biking and swimming will allow for continued exercise without doing more damage.
Overall message is to make sure you stretch before exercising, start slow and build up, have the proper equipment and if injured know to rest, minimize swelling and inflammation and most importantly do not come back and expect to be at full force, start slow and build up. You do not want to take an acute injury and make it a chronic problem.