First aid for sprains, fractures and more
We’re deep into football season so we thought we’d look at injuries often sustained on the gridiron. In this article, Jonathan Cluett, M.D. discusses some of the more common injuries and how to treat them.
And if the only thing you plan on tackling this month is a good book, this article is still for you. The information he gives is useful for injuries sustained in many other ways.
A burner, also called a stinger, is a common injury in contact sports, especially football. The exact mechanism of the injury is not well understood, but a burner is thought to be due to either stretch or compression, or a combination of both, of the brachial plexus, a network of nerves that has just exited the spinal cord. These nerves travel across the shoulder and into the arm. Symptoms of a burner are sudden pain and tingling extending from the neck and down the arm into the fingers. Most often burners are transient injuries, but they can be serious if they are persistent or recurrent. If a player has recurrent burners, he or she should be removed from competition until evaluated by a physician.
Achilles tendonitis is a syndrome of irritation of the Achilles tendon in the ankle. The Achilles tendon is the large tendon in the back of the ankle that inserts into the heel bone (calcaneus). When individuals overuse their Achilles tendon it becomes irritated and inflamed. This inflammation can cause pain and swelling which may lead to small tears within the tendon and make the Achilles tendon susceptible to rupture.
The two most common causes of Achilles tendonitis are inflexibility of the tendon and a habit of rotating the ankle to walk on the inner margin of the foot, called overpronation. If you tend to do this, watch out. Other factors associated with Achilles tendonitis are recent changes in footwear and changes in training schedules. And as people age, tendons, like other tissues in the body, become less flexible, more rigid and more susceptible to injury.
The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint. Problems with foot mechanics can also be treated with devices inserted into the shoes such as heel cups, arch supports and custom orthotics which can be used to correct for abnormalities such as overpronation and help prevent Achilles tendonitis. Other conservative measures used to treat Achilles tendonitis include icing the injury, anti-inflammatory medications and physical therapy. Resting the painful Achilles tendon will allow the inflammation to be minimized and allow for healing. Steroid injections are not used in the case of Achilles tendonitis because studies have shown an increase in incidence of Achilles tendon rupture after steroid injections.
Turf toe is a condition of pain at the base of the big toe, located at the ball of the foot. The condition is usually caused from either jamming the toe, or pushing off repeatedly when running or jumping. The most common complaint is pain at the base of the toe, but you may also have symptoms of stiffness and swelling. The name turf toe comes from the fact that this injury is especially common among athletes who play on artificial turf.
When a player sustains a turf toe injury they are actually tearing the capsule that surrounds the joint at the base of the toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe.
Treatment of turf toe consists of resting the sore toe, icing the area and elevating the foot; anti-inflammatory medications may be recommended by your doctor. Athletes diagnosed with turf toe should avoid their sport for about three weeks to allow the joint capsule to heal. Once returning to activities, special inserts can be used to limit the motion of the big toe and prevent further damage to the joint capsule. Unfortunately, turf toe can return, and rehabilitation may be slow. Surgery is rarely needed for treatment of turf toe, but in certain cases it may be called for. If a bone spur forms and severely limits motion of the toe joint, surgery to remove the spur may be helpful.
One of the most common problems involving the knee joint is an anterior cruciate ligament tear (ACL injury). Women are known to have a higher risk of injuring their ACL, but no one definitively knows why. The anterior cruciate ligament (ACL) is one of four ligaments that are critical to the stability of the knee joint. When an ACL injury occurs, the knee becomes less stable. This instability can make sudden, pivoting movements difficult and can make the knee more prone to developing arthritis and cartilage tears. When the knee is unstable, patients often complain of a sensation that the knee will ‘give out’ from under them. When this is a result of an ACL injury, the knee joint is sliding too much. Each episode of instability can cause damage to the knee cartilage, so an ACL injury makes patients more prone to developing arthritis and meniscus tears.
The leading treatment of this injury commonly involves using a segment of another larger ligament or tendon to replace the torn ACL. Some patients who experience ACL tears are able to resume normal daily activities without surgical repair of this ligament. Important factors to consider in making the decision as to whether or not an operation is needed include the age of the patient, the activity level of the patient (both recreational and occupational), the degree of instability of the joint and any other associated injuries to the knee. Rehabilitation after surgery is probably the least emphasized and most important aspect of care for a torn ACL. Whether or not a patient is diligent about their therapy determines how well their knee will perform after reconstruction.
Sprains and strains are the most common type of sports injury, but early treatment of a sprain can help to speed recovery and minimize the symptoms. Here are a few simple steps to follow should you sustain this injury:
- Protect the injured ankle. This is quite simple, but amazingly common for people to forget. Don’t walk on the leg, and protect it from further contact by immobilizing with a splint.
- REST. Take a few days off of your feet. You don’t have to be inactive, but be sure the ankle is being rested. Possible exercises you can do include swimming and cycling.
- ICE. This can be done several times a day for 15-20 minutes. This will keep the swelling to a minimum. Do NOT ice for more than 20 minutes! It will do more damage than good.
- COMPRESS. This does not have to be all of the time, but particularly when your foot is not elevated it would be advisable. A simple Ace wrap is fine for light compression.
- ELEVATE. This will also help to minimize the swelling that takes place. A few pillows under the ankle should be fine to get the leg up enough while keeping the injured limb comfortable.
- Seek professional help. While most ankle injuries are simple and heal naturally over a short time, some injuries are more severe and can necessitate more aggressive treatment.
Never ice for more than 20 minutes. Many people think the more the better, but this is not true! Maximum ice time should be 20 minutes every three to four hours. A bag of frozen corn or peas makes a great ice pack — and it’s both reusable and edible. Compression bandages should be snug, not tight. If too tight, your circulation will be impaired, and the healing process slowed.
Fractures account for one quarter of all serious football injuries (i.e. injuries that require hospital care). Despite what you may have heard, a broken bone is not worse than a fracture; they both mean the same thing.
In order for a fracture to heal as well as possible, a good reduction, or placement, of the bones must be attained. It is important to seek medical attention in the event of a fracture to achieve a proper alignment of the broken ends of the bone. In most cases reducing a fracture involves placing the broken bone in a cast, often after a little pulling and tugging to achieve improved alignment. If the alignment is not adequate or not sufficiently stable, then a further procedure may be necessary. This usually means surgery with fixation of the bone with pins, plates, screws or rods. If you break a bone, go to your doctor. Because treatments are individualized based on the patient, the x-ray appearance of the fracture and other factors such as the severity of the injury and the age and activity level of the patient, each fracture must be treated individually.
The Squirrel says: Stretching out before exercising is an important and often neglected step in your workout. A good routine should be established, and following the suggestions below will help you on your way.
- Know your activity. Whether you’re in the gym, on the track or anywhere else, know what your workout will involve. Understanding which muscles will be worked is the only way to know how to best stretch out.
- Focus on those muscles. While a good overall routine is helpful, your emphasis should be on the muscles that will be most heavily involved.
- Warm up. Just some easy walking or a light jog will be sufficient to warm up your muscles, but it will make the stretching session much more valuable.
- Begin slowly. You don’t need to touch your toes right away–begin slowly and push yourself as your muscles loosen up. Stretching too much too soon can be painful and potentially harmful.
- Hold it. Once you feel your muscles reaching their limit, hold the position for a count of 10. Then push yourself a little further and hold again for a count of 10.
- Don’t rush. If you’re going to have to cut your workout short, don’t skip or shorten the stretching. This is more important than an extra set of reps or another half mile.
- Do it again. Once you’re finished working out, stretch again. Not only is it an excellent way to cool down from the workout, but this is the time that you will improve your flexibility the most.
- Don’t bounce! You will get the best stretch, and prevent injuries if you avoid bouncing.
- Stretch both sides. Many people have a tendency to under-stretch the ‘healthy’ side after an injury.
- Get help. Gym trainers, physical therapists, exercise instructors will all know great ways to stretch.