How important is return to sport clearance?

Prior to starting sport activities after ACL reconstruction an athlete needs to be cleared by their orthopedic surgeon. Research shows that returning to sports activities without surgeon clearance can almost double chances of re-injury to the surgical leg and greatly decreases an athlete’s potential to attain the same level of pre-injury play. Chances of injury to the non-surgical leg also increase due to asymmetry and compensation if an athlete returns to sports prematurely.

What is return to sport clearance?

Before clearing an athlete to return to sport activities a surgeon will ensure that the athlete has full strength and range of motion and does not have pain or swelling. The athlete then completes a battery of tests on both legs which involve running, jumping, and agility drills that simulate sport activities. The results are then compared with the non surgical leg and must be within a few percentage points of symmetry. If near symmetry is not achieved between the surgical leg and non surgical leg, the athlete continues rehab and the tests are taken again.

Sport Specific Rehab

It is imperative for sport specific training to be incorporated into the final phase of rehab after ACL reconstruction. These activities included gradual progression of running, jumping, agility and balance activities that prepare the athlete to pass the clearance tests and return to full practice and play of their sport. Discuss sport sport specific rehab and return to sport clearance with your surgeon and ensure that both are incorporated into your physical therapy rehab plan. This is crucial to attaining or surpassing your pre-injury level of competition and preventing recurrence of knee injury as you continue participation in sports at any level.

What is it?

There are multiple types, but the two most common are cervical and lumbar radiculopathy. Cervical radiculopathy is a dysfunction of nerve roots of the neck. The seventh (C7; 60%) and sixth (C6; 25%) cervical nerve roots are the most commonly affected. Lumbar (or lumbosacral) radiculopathy is a dysfunction of nerves coming from the lower back. Both conditions can often mimic pain in the extremities but are actually due to pathology closer to the spine.

Image Credit: Royal College of Surgeons International

Image Credit: Premier Neurology and Wellness Center

What causes it?

Radiculopathy can be caused by disc herniation, impingement due to boney changes in the spine, shifting of vertebrae due to injury, and less commonly diabetes or spinal tumors.

How do you know you have it?

Symptoms of pain, numbness, and tingling in the upper or lower extremities are the most common. They can present as muscular or joint pain, but only a professional medical provider can truly distinguish between an orthopedic injury and pain caused by a nerve root.

How is it treated?

Commonly, this condition can be alleviated by a number of methods that can be performed simultaneously. Oral medication or epidural steroid injections by a physician may or may not be obtained prior to starting a physical therapy regimen. The injection can be a single episode or a series of multiple injections depending on the severity of the inflammation near the spine. Whether or not you receive an injection, a physical therapy consult is warranted to address the symptoms, the cause and prevention of future occurrence. This is done by manual therapy (hands on), modalities such as spinal traction, and therapeutic exercise to support and stabilize the spinal column.

What is PRP (Platelet Rich Plasma)?

PRP (Platelet Rich Plasma) is a biologic injection used in the sports medicine and orthopedic world to aid in injury healing. Biologics such as stem cells or PRP (which fall under the umbrella of regenerative medicine) use growth factors (chemicals released to stimulate healing and growth) and cells (found in adipose tissue or bone marrow), to rebuild injured/damaged tissue using natures’ pathways.

How is a PRP injection performed?

For a PRP injection, a person’s own blood is drawn and their platelets, which house growth factors, are concentrated into an injection. The concentrated injection is then placed under ultrasound guidance into and around the damaged tissue to speed up the healing of acute/new injuries and re-start the healing process in chronic/old injuries. A single PRP injection, which is a simple in-office procedure, has the ability to stimulate healing and growth for at least 6 months. Certain anti-inflammatories (NSAIDs) are withheld for 5 days prior to and 10 days post-injection to allow the platelets to secrete their growth factors without inhibition of response. Following an injection, a structured rehab program is instituted to allow healing of tissue targeted to the patient’s activity.

How do I know if I am a candidate for a PRP injection?

PRP can be used for a variety of sports medicine and orthopedic injuries. PRP is currently being used in the treatment of chronic and acute patella tendinitis, Achilles tendinitis, hamstring injuries, quadriceps injuries, tennis elbow, golfers elbow, partial rotator cuff tear, joint arthritis and partial UCL (Tommy John ligament) tears. If you have a sports medicine or orthopedic injury and you are interested in seeing if PRP is an option for you, please feel free to contact us for a consultation.

For additional information, visit our PRP page.

Simply put, the most important way to avoid an overuse injury, such as tendonitis, stress fractures, growing pains, burnout, etc., is to REST. However, when most people hear the word “rest” they think they must completely avoid any and all activity. This is not the case.

Depending on your sports or favorite activity, we ask that you rest that particular body part or biomechanical system. We want to avoid the same repetitive motion that can lead to muscle, tendon, and bone break down or a muscle imbalance that will create a set up for a future injury. For example, if you are a baseball player, we would ask that you abstain from throwing and other overhead activity to rest your arm.

TRY SOMETHING NEW

It’s important for young athletes to play different sports and not the same sport all year long. This will limit the same motion and muscle activation pattern. The off-season is a great time to recover, work on aerobic fitness, cross train, or play other sports. In fact, skills developed from a different sport, such as footwork, coordinated patterns, speed vs. strength, communication and teamwork, can be transferred and often makes the athlete better all around. To-date the only sport that has been literature supported by early sport differentiation has been gymnastics, because the peak performance age is earlier as compared to other sports.

Take Time Off

The American Medical Society for Sports Medicine recommends that all youth athletes take 1-2 days off per week and a total of two months off per year from sports. Time away may be taken at 1-2 week-intervals. This is a consensus from our society to prevent overuse injuries in youth athletes because of the high energy demands of a maturing body.

Growing pains have often been used as a label to explain the pain young athletes have in their legs. Often these pains are a result of too much force on young, immature bone and growth plates. This can result in stress fractures and injuries that result in bone malalignment, shortening, and chronic pain. Tendons often attach to areas of immature bone, and repetitive stress and poor training can often pull the growth plate off the bone leading to chronic pain and deformities. These issues are actually way more common than people think.

Keep it Safe. Keep it Fun. 

In the September 4, 2017 issue of Time magazine, it was estimated that youth sports are a $15.3 billion market. It’s very obvious that our society spends a lot of time, money, and energy on sports and with it comes pressure and intensity. It is important to keep kids safe and sports fun. The recommended rest will also help prevent burnout that is becoming more evident in premier high school aged athletes who no longer want to pursue a college scholarship or professional path. They often have lost the “love for the game” from the social pressures. Everyone usually knows a story of a child who would have been great if they had just stuck with it, but they quit and just wanted to be “a normal kid.”

With appropriate rest and variation of activity to avoid excess stress to the developing body in youth athletes, overuse injuries are very preventable. Not only that, it will keep sports and activities fresh and fun, so young athletes can truly enjoy their time.

If your child is complaining about pain due to a sport, be sure to schedule an appointment. We specialize in sports medicine for all ages and can help get your young athlete feeling better. 

What is plantar fasciitis?

Plantar fasciitis (fash-ee-eye-tus) is a painful condition where the large ligament (plantar fascia) that runs along the bottom of the foot becomes irritated and painful due to chronic stress and tension on the arch. This thick band of tissue connects the heel bone to the toes and is the main source of support for the foot. Pain is commonly felt around the heel or along the arch when walking on the injured foot. The pain may feel sharp or stabbing and may be more severe early in the day when you first begin walking. The pain is usually more severe when walking without shoes or with shoes with little or no arch support. This condition is more common in runners but can affect anyone. Those with extremely high or flat arches are more prone to this condition.

How is plantar fasciitis diagnosed?

Plantar fasciitis can be quickly diagnosed by a sports medicine physician with a physical examination. Severe cases that involved sprains of the fascia or coinciding bone spurs may require diagnostic imaging for confirmation.

Treatment

At home treatment includes applying ice to the area to relieve pain, and gently stretching the fascia as well as the calf muscle to relieve tension on the arch. Shoes with flat soles or heels should be avoided until the condition resolves. Tennis shoes should also be evaluated for proper fit and arch support and shoe insoles should be considered. Foot and shoe evaluations can be made by physical therapists or specially trained running shoe stores can also recommend tennis shoe options and insoles. If left untreated, this condition can become increasingly painful and potentially damage the fascia or cause bone spurs to develop on the heel. If pain increases in severity or does not resolve within a few weeks, seek further care from a sports medicine specialist.

As the skiing and snowboarding season approaches, Advanced Orthopedic Specialists will be seeing many patients who unfortunately have sustained an injury during their vacation. Our team of sports medicine specialists is prepared to care for any injury that can occur while on the slopes. Below we will discuss some of the more common injuries sustained while skiing or snowboarding.

Simple Precautions to Follow 

For starters, it is very important that all skiers or snowboarders wear a helmet. This is the biggest safety measure available to protect the head. It is also very important that you stay well hydrated as you travel to higher altitudes so you can perform at your best and enjoy your time as much as possible. Anybody who has sustained altitude sickness knows this can ruin an excellent vacation.

When hitting the slopes, it is important that the individual knows his or her limits and does not try to tackle runs that are outside of their ability. This is one of the more common causes of injuries.

Finally, the snowboarder/skier should never partake in any alcohol consumption prior to skiing, which impairs your judgement.

 COMMON Skiing INJURIES

Skiing injuries most commonly affect the lower extremities. In fact, the knee is the most common joint injured while skiing. Knee injuries can include a tear of the anterior cruciate ligament or the meniscus, which are usually treated operatively. Other common knee injuries are the medial collateral ligament, which is treated nonoperatively, or the tibial plateau. The tibial plateau is the top of the tibia. It is not uncommon with any torquing injury to sustain a tibial plateau fracture, most of which are treated with limited weight-bearing. However, some can be displaced and require surgical fixation. 

Typically, knee injuries in skiers are sustained when the ski twists, the bindings do not release, and there is significant torque placed upon the knee. This torque typically causes injury to the medial collateral ligament (or the ligament on the inside of the knee) and if the force continues, it can tear the anterior cruciate ligament and/or fracture the tibial plateau. 

If you sustain an injury where the bindings do not release, you feel a pop and have severe knee pain, you should not attempt to ski down the hill, but rather call ski patrol, and be transported to the bottom of the hill where you can be evaluated by a specialist. The majority of ski resorts now have orthopedic surgeons or emergency physicians available at the base where they can treat your injury temporarily until you are able to get home for further evaluation. 

Tibial fractures can also occur. This, unfortunately, is sustained with a very high torque to the tibia and can cause a fracture. This commonly is treated with surgical fixation onsite at the ski resort.

One common injury that often goes unnoticed is an injury to the thumb. This can happen when a direct force is applied to the tip of the thumb while the wrist is going in the opposite direction and tears the ligament at the base of the thumb. This is actually called “skiers thumb.” The technical term is a tear of the ulnar collateral ligament. The skier may experience difficulty grasping. This needs to be evaluated when you return home.

Common Snowboarding Injuries

Snowboarding has become more popular in recent years. The majority of snowboard injuries involve the upper extremity. We commonly see injuries to the clavicle, most of which can be treated nonoperatively. Also an injury to the acromioclavicular joint, which is toward the tip of the shoulder. This occurs with a fall directly onto the shoulder and these are treated nonoperatively. It is recommended that the snowboarder obtain an x-ray, be placed into a sling, and then follow up with the orthopedic surgeon upon their return home. 

 Snowboarders also commonly fall onto the outstretched arm and can sustain injuries to the elbow, such as elbow sprains and possibly a fracture. If you sustain a significant fall on the outstretched arm and have severe elbow pain, you should obtain a radiograph and then be placed into a splint and follow up with the orthopedic surgeon. 

Finally, the snowboarders can experience injuries to their hands and wrist, such as wrist sprains and/or wrist fractures. Again, this should be evaluated by the local clinic with x-rays, splinting and follow up with an orthopedic surgeon upon returning home. 

Helping You Get Back to the Slopes

All the physicians of Advanced Orthopedic Specialists are avid skiers. We also see a tremendous amount of skiing injuries during the winter and do our best to treat you without surgery and get you back to feeling better as soon as possible. However, if surgery is necessary, we would help get you back on the slopes once your injury resolves. 

If you’ve sustained an injury or need a second opinion, schedule an appointment with us now!

What is it?

Patella tendon rupture is a disruption of the tendon which attaches the knee cap to the tibia, which is the main bone in the lower leg. The patella tendon works with the quadriceps muscle to straighten the knee. Ruptures are rare but serious. The most common mechanism of injury occurs when the quadriceps muscle contracts forcefully while the knee is bent.

Who Is At Risk?

Patients who are at risk are those with inflammatory arthritis, chronic renal disease, diabetes, prior injury to the knee, history of patella tendonitis, fluoroquinolone antibiotic use, and/or corticosteroid injections. It is more common in males and those in their 3rd and 4th decades of life.

What are the Symptoms?

Patients will come experience a “pop” while playing sports or exercising. Tears that are chronic or incomplete may present as pain below the knee cap. Patients may also reports difficulty with weight-bearing on the affected leg.

What are the Signs?

The knee is often swollen and painful. The patient may not be able to fully straighten their knee and it may feel unstable.

How Is It Diagnosed?

Sports medicine physician will examine your knee looking for swelling, bruising, and pain around the patella tendon. X-rays may be of use to determine if the patella is abnormally high. Further imaging with an ultrasound or MRI may be used to evaluate the tendon for rupture.

How Is It Treated?

Partial ruptures of the patella tendon may be treated by immobilizing the knee for 6 weeks followed by physical therapy. Complete ruptures require surgery to re-attach the tendon. This procedure should be done within 1-2 week of injury. Surgery is followed by physical therapy to regain motion and strength.

When Can I Return to Play?

If surgery is required the patient should expect to refrain from sports for at least 6 months or longer pending progress. For those who don’t require surgery they may return to sports in 2-3 months.

What is Patella Tendonitis?

Patella tendonitis (also known as “Jumper’s Knee”) is an injury to the main tendon in the front of your knee. This tendon attaches the knee to the shin and works with the quad muscle to extend your leg. Injury to this tendon can occur from repeated extension of the knee, which may happen through repeated jumping, kicking, squatting, or running. Repeated stress to the patella tendon without adequate recovery results in a strain. A person may feel pain in the front of their knee after and/or during exercise. The tendon itself may even appear to slightly swell. In our athletes, this is commonly seen in basketball, volleyball, and soccer, but it may occur in any sport. This pain can worsen and become chronic resulting in poor performance or time away from the activities we love.

How Can I Prevent Patella Tendonitis?

Injury prevention is crucial in the world of sports. Before participating in sports or exercise you should warm up. A proper warm up will elevated your heart rate and bring on a light sweat. During or after this warm up, the parts of the body that are going to be stressed should be stretched. To help prevent patella tendonitis the quads and hamstrings should be stretched. After exercise, the muscles should be stretched again to improve flexibility. It is also important to remember to have days of rest during the week to allow your body to recover and heal. These simple techniques will help prevent you from getting patella tendonitis.

When Should I See My Doctor?

Sometimes after exercise your patella tendon may be a little sore from the added stress. Before seeing your doctor, you can always try a period of rest and ice to see if your pain improves. If this pain does not resolve or worsens over a few days, then you should see your doctor for evaluation and management before the injury becomes severe. Prompt evaluation and management are the keys to a quick and successful recovery!

Shin Splints are a common overuse injury typically reserved for runners or new runners who take their first run, or runs, a little too far. More precisely, shin splints are a condition referred to as Medial Tibial Stress Syndrome (MTSS) which is what we’ll refer to for the remainder of this post. A telltale sign of MTSS is an achy, sore pain along the front of the shin that is tender to the touch near the softer area. This pain will typically present itself hours or a few days following running activity and may persist up to a week.

When persistent or left untreated, MTSS may become worrisome and warrant a visit to your sports medicine physician or physical therapist. This condition requires no imaging or special tests to diagnose. Following your evaluation, your provider will be able to make recommendations for treatment based your activity level and severity of the injury.

Fortunately, MTSS can be treated yourself if you notice the symptoms early enough. This condition is often self-diagnosable by remembering the area of pain most commonly experienced following running. It is also easily self-treated by a combination of rest, ice, and your preferred over-the-counter anti-inflammatory medication following your successful diagnosis.

Prevention of MTSS is also possible by performing a few simple exercises and remembering key training points. The most basic rule in running is to progress your mileage at a slow, comfortable pace. Increasing mileage or duration too quickly can result in MTSS or more serious conditions. Shoe wear is heavily dependent on the individual, but for more flat footed runners a wider sole is important while those this high arches may require a more narrow, yet supportive sole. Nutrition and rest are also necessary to allow muscles and other soft tissues to recover from the repetitive trauma of running. Lastly, cross training with light weight lifting or band exercises will prevent injury.

If you experience pain similar to MTSS that does not seem to dissipate after a week of rest, schedule an appointment with a sports medicine physician to assess your leg. It may be necessary to rule out more serious conditions such as a stress fracture or chronic compartment syndrome.

It’s September, which means youth, high school, collegiate, and professional football are all in full swing, and there have been two publications regarding concussions. One from the Centers for Disease Control and Prevention, and the other from the Aspen Institute, a non-profit organization.

Earlier this month, the CDC published their “Guidelines on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.” The purpose of the paper was to “provide a guideline based on previous systematic review of the literature…toward developing clinical recommendations for health care professionals.” While the other publication by the Aspen Institute, published in the Wall Street Journal, highlighted the recommendation for children to avoid tackle football before age 14, focusing on flag football instead.

What the CDC Has to Say

Within the CDC guidelines are 19 recommendations regarding diagnosis and management of mTBI (Mild Traumatic Brain Injury, aka concussion). These include recommendations against routine use of CT, skull/facial X-rays or MRI in the evaluation unless and intra-cerebral injury is suspected, as well as the use of blood biomarkers. They also share guidelines for using validated neuropsychological testing tools, gradual exertional protocols, gradual return to school, and proper sleep hygiene.

Leaning into Flag Football

The Aspen Institutes’ paper, compiled from discussions with panelists, including retired NFL players, Dr. Robert Cantu, football coaches, and Dr. Andrew Peterson from the American Academy of Pediatrics and current research data, concentrated on a transition of starting tackle football at age 14. Similar to USA Hockey’s non-checking leagues for younger players, providing the opportunity for children to play flag football longer, allows them to learn the game and the skills needed without repetitive contact, which may be beneficial in the long term.

Stay Informed

As a sports medicine physician, sports-related concussions have been a growing part of my practice. I have seen the spectrum of injury from the young motocross rider at age 7 to the weekend mountain biker to the collegiate athlete. I realize this is a controversial topic with some parents minimally concerned and others very concerned about the potential risk of early repetitive trauma.

It’s good to stay informed on the topic and understand there is inherent risk with any sport. If our goal is to protect the next generation, it’s the appropriate diagnosis, evaluation, and safe return-to-sport that is the foundation of sport-related concussion treatment. So, if you feel like you or your child has suffered from a concussion, please have them evaluated and talk to your doctor about the best plan to move forward.