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  1. SPORTS INJURIES David C. Koronkiewicz, D.O. Iugoshen Orthopedics & Sports Medicine Indiana Osteopathic Association 32nd Annual Winter Update December 6,2013

  2. Sports Injuries-Outline • Overview • Types of injuries • Prevention • Specific injuries

  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.

  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.

  5. Top 15 Sports/Recreational Injuries* *Treated in ER based on data from the US Consumer Produce Safety Commission on 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

  6. Acute vs. Overuse Injuries Acute - sudden trauma causing sprains, strains, bruises & fractures Overuse - series of repeated small injuries resulting in pain

  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

  8. When to See the Physician Decreased ability to play Inability to play Limp, loss of motion or swelling Visible deformity Severe pain

  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

  10. Preventing Sports Injuries Know and abide by rules Wear appropriate protective gear Know how to use equipment Never “play through pain”

  11. Preventing Sports Injuries Skilled sport specific instruction Year round conditioning

  12. Preventing Sports Injuries Make Sure Your Athletes Always Warm Up First!

  13. Preventing Sports Injuries Break a sweat Marching Walk in place Jumping jacks Mimic the sport you are about to do WARM UP

  14. Stretching Stretching: Breathe slowly and deeply Relax into the stretch Should not feel pain Avoid bouncing Hold stretch 30 seconds Stretch both sides

  15. Injuries MOST COMMON Strains & Sprains THIS NOT THAT

  16. Strain Strain • Overstretching of a muscle • Caused by overexertion or by lifting • Frequent site is the Back

  17. Prevention Proper warm-up Stretch Proper mechanics Proper cool-down/ stretch Proper nutrition & hydration Strains Signs & Symptoms • Localized swelling • Cramping • Inflammation • Loss of function • Pain • General weakness • Discoloration

  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 don’t improve

  19. Sprain 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

  20. Sprain • First aid for sprain • Rest and limited or no movement of the affected part • Ice to reduce swelling and pain • Compression with elastic bandage to control swelling • Elevation of the affected part • Obtain medical help if swelling is severe or if there is any question of a fracture

  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

  22. Tendon Injuries • Tears commonly at muscle belly, musculotendinous junction, or bony attachment Tendonitis: inflammation of tendon-muscle attachments, tendons, or both

  23. Tendonitis • Signs & Symptoms • Pain & inflammation • Worse with movement • Treatment • RICE • NSAIDs-Advil, Aleve • Ultrasound therapy • Rehabilitation • Prevention • Slowly increase intensity & type of exercise • Don’t try to do more than ready for • Proper warm-up & stretch

  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

  25. Fracture Fracture is a break or loss of structural continuity in a bone Wrist/Forearm Fractures

  26. Why are Injuries on the Rise? • Increase youth participation • Immature bones and muscles • Insufficient rest after an injury • Poor training or conditioning • Specialization in just one sport • Year-round participation

  27. Children & Sports Youths of same age can differ tremendously in size and physical maturity.

  28. Injuries in Female Athletes

  29. Injuries in Female Athletes • Common injuries in women/girls include: • Anterior cruciate ligament (ACL) injuries • Patellofemoral pain syndrome • Stress fractures

  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

  31. ACL Injury Direct blow to knee Non-contact injury, with foot plant Landing on straight leg Making abrupt stops

  32. ACL

  33. ACL Injuries 400,000 reconstructions per year in the US Females 4 times more likely to tear ACL with non-contact injury

  34. ACL Women have an increased predisposition to ACL injury Many theories, but no one proven definitive cause

  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

  36. ACL • Female athletes rely more on their quads and calf muscle than their hamstrings • Jumping & landing techniques in women are also different

  37. MRI ACL Normal Torn-ACL

  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

  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?

  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

  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

  42. Do You Need X-rays?

  43. AP Hip X-ray

  44. MRI

  45. Groin pain in runner or jumper- don’t 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 Femoral Neck Stress Fracture

  46. 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 Treatment

  47. Complications if Missed Stress to complete fracture Avascular necrosis Chronic pain End of career

  48. Patellofemoral Pain Syndrome • Anterior knee pain • Probably more than one etiology • Chondromalacia (softening of cartilage) • Malalignment of patella

  49. Patellofemoral Pain Syndrome

  50. Patellofemoral Pain Syndrome 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