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DAVID C. KORONKIEWICZ, D.O. IU GOSHEN ORTHOPEDICS & SPORTS MEDICINE SPORTS INJURIES Indiana Osteopathic Association 32 nd Annual Winter Update December 6,2013 Slide 2 Sports Injuries-Outline Overview Types of injuries Prevention Specific injuries Slide 3 Statistics In the United States, about 30 million children and teens participate in some form of organized sports, and about 3.5 million injuries occur each year. Participation in high school athletics is increasing, with more than 7.3 million high school students participating annually * High school athletes account for an estimated 2 million injuries and 500,000 doctor visits and 30,000 hospitalizations each year. ** *(Source: National Federation of State High School Associations) **JS Powell, KD Barber Foss, 1999. Injury patterns in selected high school sports: a review of the 1995- 1997 seasons. J Athl Train. 34: 277-84. Slide 4 Injuries Most sports and recreational injuries are the results of: sprains (ligamentous injuries), strains (musculotendinous injuries),and contusions. Knee injuries (meniscal & ACL), bursitis, fractures, and dislocations are all commonly seen. Slide 5 Top 15 Sports/Recreational Injuries* Basketball: 512,213 Bicycling: 485,669 Football: 418,260 Soccer: 174,686 Baseball: 155,898 Skateboards: 112,544 Trampolines: 108,029 Softball: 106,884 Swimming/Diving: 82,354 Horseback riding: 73,576 Weightlifting: 65,716 Volleyball: 52,091 Golf: 47,360 Roller skating: 35,003 Wrestling: 33,734 *Treated in ER based on data from the US Consumer Produce Safety Commission on Injuries Slide 6 Acute vs. Overuse Injuries Acute - sudden trauma causing sprains, strains, bruises & fractures Overuse - series of repeated small injuries resulting in pain Slide 7 Causes of Overuse Injuries Increasing activity too quickly Running or jumping on hard surfaces Training vigorously without adequate rest Poorly functioning equipment Improper techniques Working through pain Lack of stretching/strengthening Slide 8 When to See the Physician Decreased ability to play Inability to play Limp, loss of motion or swelling Visible deformity Severe pain Slide 9 Injury Classifications Sprains: injuries to ligaments Strains: injuries to muscles, tendons or the junction between the two Contusions: common bruises or contusions are the most frequent sports injury. Fractures & Dislocations: fractures and dislocations represent two categories of injuries involving either bones or joints of the body Slide 10 Preventing Sports Injuries Know and abide by rules Wear appropriate protective gear Know how to use equipment Never play through pain Slide 11 Skilled sport specific instruction Year round conditioning Preventing Sports Injuries Slide 12 Make Sure Your Athletes Always Warm Up First! Preventing Sports Injuries Slide 13 Break a sweat Marching Walk in place Jumping jacks Mimic the sport you are about to do WARM UP Slide 14 Breathe slowly and deeply Relax into the stretch Should not feel pain Avoid bouncing Hold stretch 30 seconds Stretch both sides Stretching Stretching: Slide 15 Injuries MOST COMMON Strains & Sprains THIS NOT THAT Slide 16 Strain Overstretching of a muscle Caused by overexertion or by lifting Frequent site is the Back Slide 17 Strains Signs & Symptoms Localized swelling Cramping Inflammation Loss of function Pain General weakness Discoloration Prevention Proper warm-up Stretch Proper mechanics Proper cool-down/ stretch Proper nutrition & hydration Slide 18 Strain First aid treatment Rest the muscle affected while providing support Cold applications initially to reduce swelling Warm wet applications applied later because warmth relaxes the muscles Obtain medical help for severe strains and back injuries that dont improve Slide 19 Sprain Injury to the tissues surrounding a joint Usually occurs when part is forced beyond its normal range of motion Ligaments, tendons and other issues are stretched or torn Common sites for sprains are the ankles and wrists Signs and symptoms Swelling, pain and discoloration Impaired motion at times Slide 20 Sprain First aid for sprain R est and limited or no movement of the affected part I ce to reduce swelling and pain C ompression with elastic bandage to control swelling E levation of the affected part Obtain medical help if swelling is severe or if there is any question of a fracture Slide 21 Contusion Bruise Sudden traumatic blow to body (severe compression force) Usually injury to blood vessels under skin Speed of healing depends on tissue damage and internal bleeding Hematoma formation is caused by a pooling of blood and fluid in a tissue Slide 22 Tendon Injuries Tears commonly at muscle belly, musculotendinous junction, or bony attachment Tendonitis: inflammation of tendon- muscle attachments, tendons, or both Slide 23 Tendonitis Signs & Symptoms Pain & inflammation Worse with movement Treatment RICE NSAIDs-Advil, Aleve Ultrasound therapy Rehabilitation Prevention Slowly increase intensity & type of exercise Dont try to do more than ready for Proper warm-up & stretch Slide 24 Skeletal Injuries Subluxation Occurs when bone displaces and partially separates Dislocation Excessive force that causes the ends of the bone to separate and usually remain apart requiring them to be put back together Slide 25 Fracture Fracture is a break or loss of structural continuity in a bone Wrist/Forearm Fractures Slide 26 Increase youth participation Immature bones and muscles Insufficient rest after an injury Poor training or conditioning Specialization in just one sport Year-round participation Why are Injuries on the Rise? Slide 27 Children & Sports Youths of same age can differ tremendously in size and physical maturity. Slide 28 Injuries in Female Athletes Slide 29 Common injuries in women/girls include: Anterior cruciate ligament (ACL) injuries Patellofemoral pain syndrome Stress fractures Slide 30 ACL Girls Soccer 1 torn ACL for every 6,500 times a girl competes or practices Boys Football 1 torn ACL for every 9,800 times a guy competes or practices Girls Basketball 1 torn ACL for every 11,000 times a girl competes or practices Slide 31 ACL Injury Direct blow to knee Non-contact injury, with foot plant Landing on straight leg Making abrupt stops Slide 32 ACL Slide 33 ACL Injuries 400,000 reconstructions per year in the US Females 4 times more likely to tear ACL with non-contact injury Slide 34 ACL Women have an increased predisposition to ACL injury Many theories, but no one proven definitive cause Slide 35 ACL Injuries Intrinsic factors: Joint laxity Hormones Limb alignment Ligament size Intercondylar notch size Extrinsic factors: Conditioning Experience Skill Strength Muscle recruitment patterns Landing techniques Slide 36 ACL Female athletes rely more on their quads and calf muscle than their hamstrings Jumping & landing techniques in women are also different Slide 37 MRI ACL NormalTorn-ACL Slide 38 ACL- What to do? Prevention Learn how to fall, jump and to cut Plyometric training Reduce landing forces and improve strength ratios (quadriceps:hamstrings) Increase hamstring activation Slide 39 Hip Pain in Runner 18 year old female runner with 1 month of anterior groin/inguinal pain Pain worse with weight bearing Over past week she has developed night pain What are the possibilities? Slide 40 Differential Dx. Torn adductor muscle Avulsion of adductor or sartorius muscle Pubic ramus fracture Femoral neck fracture Femoral shaft fracture SI joint subluxation Ruptured iliopsoas bursa Slide 41 Physical Exam Swelling noted in groin and high proximal femur Pain with all attempts at motion, especially internal rotation Distal pulses 2+ No distal sensory deficits Slide 42 Do You Need X-rays? Slide 43 AP Hip X-ray Slide 44 MRI Slide 45 Femoral Neck Stress Fracture Groin pain in runner or jumper- dont ignore Female triad at increased risk as well as those with an increase in training and postmenopausal women Need to know which side the stress fracture is on (compression vs tension side) Plain films often negative Get MRI Slide 46 Treatment If stress fracture by x-ray or further imaging Compression side 12 weeks to heal +/- NWB Tension side Ortho consult/surgery Femoral neck fracture- surgery Cross train Proper nutrition and calories Slide 47 Complications if Missed Stress to complete fracture Avascular necrosis Chronic pain End of career Slide 48 Patellofemoral Pain Syndrome Anterior knee pain Probably more than one etiology Chondromalacia (softening of cartilage) Malalignment of patella Slide 49 Patellofemoral Pain Syndrome Slide 50 Clinical Features and Exam: Reports of anterior knee pain Pain with climbing stairs and/or sitting for prolonged periods of time Pressure on the kneecap during bending and straightening of the knee may elicit cracking and popping with discomfort Abnormal kneecap alignment Genetic Acquired Slide 51 Patellofemoral Pain Syndrome Other causes Muscle imbalances Foot type (either flat or high arched feet) Shoes Overuse Treatment includes: decreasing activity, correct alignment issues, physical therapy for strengthening, bracing or taping Slide 52 Patellar Dislocation Planted foot with twisting of the body around the knee (similar to ACL) Kneecap off to the side Very painful Slide 53 Patellar Dislocation MRI Slide 54 Patellar Dislocation Loose Body Arthroscopy Brace? Rehab Return to play when comfortable Slide 55 Osgood-Schlatter Disease Jumping sports- basketball, volleyball Dull, aching pain below the knee Bump may be present Boys 10-16 Girls 9-13 Slide 56 Osgood-Schlatter Disease Overuse injury Traction apophysitis (growth plate) Slide 57 Osgood-Schlatter Disease Overuse injury Traction apophysitis (growth plate) Slide 58 Osgood-Schlatter Treatme nt NSAIDS Ice Brace Relative rest Full rest Physical therapy Knee immobilizer Cast Slide 59 Osgood-Schlatter Disease Pain usually goes away after