Αθλητισμός

Swimming injuries 101: What every swimmer should know

Leave a Comment / Αθλητισμός / Georgios Panagopoulos / 1 June 2023 / Αθλητισμός, Κολύμβηση, Τραυματισμοί

Swimming is a great form of exercise that provides a full body workout and can be beneficial for people of all ages. However, like any other sport, swimming can also lead to certain orthopaedic problems if not performed correctly or if an underlying condition is present.

Swimming combines endurance, strength, and control in a non-weight-bearing environment. Highly repetitive upper extremity overhead movements provide most of the propulsive force in all four main strokes: free- style, butterfly, breaststroke and backstroke.¹

Table of contents

Swimmer's shoulder

One of the most common orthopaedic problems associated with swimming is shoulder pain. The repetitive motions of the stroke can put a lot of stress on the rotator cuff and other muscles and tendons in the shoulder. This can lead to inflammation, tears, and other injuries. It is not surprising that often swimming-induced shoulder pain is referred in literature as “swimmer’s shoulder”.

This is term that generally describes a syndrome with anterior shoulder pain elicited by repetitive impingement of the rotator cuff under the coracoacromial arch.² To prevent shoulder pain, it is important to use proper technique when swimming and to gradually increase the intensity and duration of your training.

Swimming & back pain

Another common problem is lower back pain. The constant kicking and twisting motions of the legs can put a lot of stress on the lower back, particularly if the swimmer has poor core strength or poor technique. Lumbar disc degeneration, spondylolysis and spondylolisthesis are among the most common problems encountered.³

Lumbar spine pain also may be related to the ‘‘flip turn,’’ used by freestyle swimmers to change directions when reaching the pool wall. To prevent lower back pain, it is important to engage the core muscles when swimming and to focus on proper technique, including maintaining a neutral spine.

Swimming & knee pain

Knee pain is another orthopaedic problem that can be caused by swimming. The repetitive motions of the kick can put a lot of stress on the knee joint, particularly if the swimmer has a pre-existing knee condition.

Knee pain in competitive athletes is commonly referred to as breaststroker’s knee. This is a syndrome of anterior and medial knee pain. Etiology is unclear, but may be related to MCL sprain, adductor sprain or patellar tendonitis.⁴ To prevent knee pain, it is important to use proper technique when swimming and to gradually increase the intensity and duration of your training.

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Swimming is also known to cause stress fractures not only in the foot and ankle, but also in other areas. This is particularly common among competitive swimmers who train for long hours each day. Stress fractures are caused by overuse and can lead to pain and inflammation. To prevent stress fractures, it is important to gradually increase the intensity and duration of your training and to rest and recover properly.

In conclusion, swimming is a great form of exercise, but it can also lead to certain orthopaedic problems if not performed correctly or if an underlying condition is present. To prevent these problems, it is important to use proper technique when swimming, to gradually increase the intensity and duration of your training, and to focus on maintaining good overall fitness and strength. If you experience pain or injury, it is important to seek advice from an orthopaedic specialist.

References

1. Sein ML, Walton J, Linklater J, Appleyard R, Kirkbride B, Kuah D, et al.: Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. Br J Sports Med 2010;44:105-113.

2. Tate A, Turner GN, Knab SE, Jorgensen C, Strittmatter A, Michener LA: Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers. J Athl Train 2012;47:149-158.

3. Nyska M, Constantini N, Cale-Benzoor M, Back Z, Kahn G, Mann G: Spondylolysis as a cause of low back pain in swimmers. Int J Sports Med 2000;21:375-379.

4. Nichols AW: Medical Care of the Aquatics Athlete. Curr Sports Med Rep 2015;14:389-396.

Frequently Asked Questions

What's swimmer's shoulder?

This is a syndrome presenting with anterior shoulder pain, caused by repetitive impingement of the cuff tendons under the coracoacromial arch.

Which are the most common swimming injuries?

– Swimmer’s shoulder
– Breaststroker’s knee
– Back pain

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The road to recovery: How to bounce back from cycling injuries

Leave a Comment / Αθλητισμός / Georgios Panagopoulos / 1 June 2023 / Αθλητισμός, Ποδήλατο, Τραυματισμοί

Cycling is a popular form of exercise and transportation, but it can also lead to a variety of injuries. As an orthopedic surgeon or a biker, it is important to be aware of the most common cycling injuries and how to treat them.

Knee pain & cycling

One of the most common cycling injuries is knee pain, often caused by overuse or improper bike fit. This can include patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinitis. To prevent knee pain, it is important to make sure your bike is properly fitted to your body and to gradually increase the intensity and duration of your cycling. If you do experience knee pain, rest, ice, and physical therapy can help alleviate symptoms. In severe cases, surgery may be necessary.

Wrist pain & cycling

Another common cycling injury is hand and wrist pain, often caused by vibrations from the handlebars. This can include carpal tunnel syndrome and hand numbness. To prevent hand and wrist pain, it is important to make sure your handlebars are properly adjusted and to take frequent breaks to shake out your hands. If you do experience hand and wrist pain, rest, ice, and physical therapy can help alleviate symptoms. In severe cases, surgery may be necessary.

Back pain & cycling

Low back pain is also a common cycling injury, often caused by a poor riding position or a poorly adjusted bike seat. To prevent low back pain, it is important to make sure your bike seat is at the right height and that your back is properly supported while riding. If you do experience low back pain, rest, ice, and physical therapy can help alleviate symptoms. In severe cases, surgery may be necessary.

Other injuries that can occur from cycling include neck pain, shoulder pain, and saddle sores. To prevent these injuries, it is important to maintain good posture and to take frequent breaks to stretch.

Cycling & fractures

Cycling can also lead to a variety of fractures. One of the most common fractures in cycling is a collarbone fracture, also known as a clavicle fracture. This type of fracture occurs when the rider falls and lands on their shoulder, resulting in a break in the collarbone. Collarbone fractures are common among both competitive and recreational cyclists. Treatment for a collarbone fracture typically involves immobilization in a sling or brace, followed by physical therapy to regain range of motion and strength. Surgery may be necessary in more severe cases.

Another common fracture in cycling is a wrist fracture, which occurs when a rider falls and lands on an outstretched hand. This type of fracture can occur in both competitive and recreational cyclists. Treatment for a wrist fracture typically involves immobilization in a cast or splint, followed by physical therapy to regain range of motion and strength. Surgery may be necessary in more severe cases.

Hip fractures are also a common injury in cycling, especially among older adults. This type of fracture occurs when a rider falls and lands on their hip, resulting in a break in the hip bone. Treatment for a hip fracture typically involves immobilization, such as traction or a cast, followed by physical therapy to regain range of motion and strength. Surgery is often necessary to fix the fracture and to prevent complications.

Other common fractures in cycling include ankle fractures, knee fractures, and rib fractures. These injuries occur when a rider falls and lands on a specific part of the body. Treatment for these fractures typically involves immobilization, such as a cast or brace, followed by physical therapy to regain range of motion and strength. Surgery may be necessary in more severe cases.

In conclusion, cycling is a great form of exercise and transportation, but it can also lead to a variety of fractures. As an orthopedic surgeon, it is important to be aware of the most common fractures in cycling and how to treat them. By taking preventative measures, such as wearing protective gear and riding in safe conditions, and seeking treatment when necessary, cycling can be a safe and enjoyable activity for all.

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Skiing & Snowboarding Injuries

Leave a Comment / Αθλητισμός / Georgios Panagopoulos / 1 June 2023 / Skiing, Snowboarding, Αθλητισμός, Τραυματισμοί

Skiing and snowboarding have become the most popular winter sports. They are fun and a great activity for the whole family. Skiing has been around for a long time, being first introduced as a sport in the Winter Olympics in the 1930’s. By comparison, snowboarding is a young sport, that became officially an Olympic sport in 1998.¹ However, they can both be dangerous and a single mistake that leads to an injury may be a moment away. Fortunately, most snowsport injuries are minor and can be treated with bracing, rest and NSAIDS. However, some injuries may require surgical intervention, with recovery varying from 3 to 6 months.

Table of contents

Epidemiology – Statistics

No anatomic location is exempt from the risk of potential injury. However, it seems that the patterns of injury are a bit different between sports. Snowboarders are more likely to injure their wrist, whereas skiers are more likely to get an ACL injury.²

Snowboarders seem much more likely to sustain an acute injury overall, as compared to skiers.³ This is probably because of the more frequent falls sustained because of the inherent nature of the sport. Another reason is that ski equipment has been modified to prevent injuries.

Skis are programmed to come off at more appropriate times during a crash, whereas snowboards don’t come off. However, when it comes to a real serious injury, skiers are still at higher risk (US National Ski Areas Association). Skiing is all about racing, whereas snowboarding is all about tricks and manoeuvres.

As a result, a skier is more likely to experience a high-speed collision leading to a high-energy injury. On the contrary, a snowboarder sustains frequent falls at lower speed, that may lead to minor injuries.

Knee injuries

Knee injuries are more common in skiers rather than in snowboarders, in major part due to differences in fall mechanism, general stance and equipment used.⁴ Skiers undergo much higher torsional forces, placing the knee at risk of ligamentous injury.²

ACL rupture typically occurs as a result of valgus load and internal rotation, after the inner side of the ski catches in the snow while going downhill and the boot fails to come off (slip catching).⁵ MCL tears and meniscal tears can also occur. Most ACL tears will require surgery (ACL reconstruction) in active individuals or athletes.

Although less commonly, experienced snowboarders that perform risky tricks and jumps can also get a serious knee injury. Fractures, such as tibial plateau, tibial plafond, or tibial shaft fractures (“boot-top fractures”) may also occur with both sports. Most of these typically require urgent surgical fixation.

Foot & ankle injuries

Improvements in ski boots and bindings have significantly reduced foot & ankle injuries in skiers. Ankle sprains and fractures remain common in snowboarders.⁶ Snowboarders may also characteristically sustain a fracture of the lateral process of the talus, the so-called “snowboarder’s fracture”.⁷ A CT scan is warranted if there is a high degree of suspicion, as this fracture may easily be missed on plain radiographs. Metatarsal fractures are also common in snowboard, after a hard landing in a flat surface. If isolated, these fractures may be treated nonoperatively.⁷

Hand & wrist injuries

Wrist fractures are the most common fractures seen in snowboarders, even though they are commonly seen in skiers, too.⁸ They typically result from a fall on the outstretched hand. Many of these can be treated conservatively in a cast, but angulated, widely displaced fractures may need surgery.

Injuries to the thumb ulnar collateral ligament (UCL) are more commonly seen in skiers, and are known as “skier’s thumb”. They occur after a sudden valgus force to the thumb, such as when the skier falls to the ground with the ski pole still in hand. Treatment is based on the degree of the injury, with surgery reserved for unstable injuries.⁴

Shoulder injuries

Fractures are common in snow sports after a fall on the shoulder. Clavicle fractures may occur in both skiers and snowboarders. The frequently involve the midshaft of the clavicle and can be treated nonoperatively if stable and not widely displaced. Shortened and displaced fractures with skin tenting usually require surgery.

Proximal humerus fractures and AC joint injuries are also common. Shoulder dislocations may also occur in skiing and snowboarding. Dislocations should be reduced as soon as possible. Subsequent management will depend on factors such as age, history of recurrent dislocations, concomitant injuries.⁹

Head injuries

Head injuries can occur in skiing after a high-speed collision with an obstacle (tree, rock, lift pole, etc.), or in snowboarding from a failed landing after a jump. They may vary from a concussion to a severe traumatic brain injury.¹⁰ Head injuries are the leading cause of death and critical injury in skiing and snowboarding. It is critical to recognize early a serious head injury that necessitates transfer to a tertiary facility.

Ski & Snowboard injuries overview

Prevention

Lessons from expert instructors are extremely important before attempting to hit the slopes. The teacher will teach the beginner not only the correct technique, but also the correct use of the equipment. Malfunctioning or incorrectly fitted equipment, such as too loose or too tight bindings, or equipment that is not the correct size, or that is still unsuitable for the conditions or type of snow, can lead to serious and easily avoidable injuries.

The use of protective equipment, such as helmets, wristbands or knee guards, is also extremely important. Most injuries can be avoided by applying common sense. The skier or snowboarder should be well-hydrated, avoid skiing in conditions of physical fatigue, and always take into account the weather conditions and the condition of the piste (ice, powder, tricked-out spots, off-piste spots). Finally, children need adult supervision.

Finally, we should not forget that the more fit and prepared we are, the less likely we are to get injured. Especially important for skiing and snowboarding are certain muscle groups, which it is good to practice before the winter holidays. The quadriceps, hamstrings and gluteal muscles are extremely important. Core strength is equally essential.

References

1. Deady LH, Salonen D: Skiing and snowboarding injuries: a review with a focus on mechanism of injury. Radiol Clin North Am 2010;48:1113-1124.

2. Kim S, Endres NK, Johnson RJ, Ettlinger CF, Shealy JE: Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am J Sports Med 2012;40:770-776.

3. Wijdicks CA, Rosenbach BS, Flanagan TR, Bower GE, Newman KE, Clanton TO, et al.: Injuries in elite and recreational snowboarders. Br J Sports Med 2014;48:11-17.

4. Owens BD, Nacca C, Harris AP, Feller RJ: Comprehensive Review of Skiing and Snowboarding Injuries. J Am Acad Orthop Surg 2018;26:e1-e10.

5. Bere T, Florenes TW, Krosshaug T, Koga H, Nordsletten L, Irving C, et al.: Mechanisms of anterior cruciate ligament injury in World Cup alpine skiing: a systematic video analysis of 20 cases. Am J Sports Med 2011;39:1421-1429.

6. Sachtleben TR: Snowboarding injuries. Curr Sports Med Rep 2011;10:340-344.

7. Helmig K, Treme G, Richter D: Management of injuries in snowboarders: rehabilitation and return to activity. Open Access J Sports Med 2018;9:221-231.

8. Matsumoto K, Miyamoto K, Sumi H, Sumi Y, Shimizu K: Upper extremity injuries in snowboarding and skiing: a comparative study. Clin J Sport Med 2002;12:354-359.

9. Weinstein S, Khodaee M, VanBaak K: Common Skiing and Snowboarding Injuries. Curr Sports Med Rep 2019;18:394-400.

Frequently Asked Questions

What are the most common skiing injuries?

– ACL/PCL tears
– Meniscal tears

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Tennis Injuries

Leave a Comment / Αθλητισμός / Georgios Panagopoulos / 1 June 2023 / Tennis, Αθλητισμός, Τραυματισμοί

Tennis is one of the most beloved sports in the world, with widespread popularity among all ages, both amateur and professional. Unlike other sports, a tennis match is not limited by any specific time duration, which means that a match can last many hours.¹ The very nature of the game involves a series of repetitive stresses for the tennis player, intense serves and hits, as well as continuous explosive manoeuvres, which make the athlete vulnerable to a particular injury profile.² Acute injuries in tennis usually involve the lower extremity,³ while chronic overuse injuries involve the upper extremity.⁴

Table of contents

Play Surface

Contrary to other sports, tennis can be played in a variety of surfaces. Play surfaces include clay, grass or acrylic. To mention a few examples, Wimbledon uses grass courts, French Open is a clay court tournament, US Open is played on acrylic, whereas Australian Open uses synthetic courts. A clay court is “slow”, and the ball tends to lose speed due to more friction at the ball-surface interface. Hard surface courts are associated with a higher ball velocity, which may put more strain on the upper extremity of the tennis player.⁵

Equipment

Racquets nowadays are lighter, larger and stiffer, weighing up to 250g, as opposed to the wooden and heavy models that existed back in the day.⁶ Racquet stiffness characteristics, string technology and consequent “sweet spots”, as well as type of hand grip can all contribute to the type of injury incurred. For example, ulnar-sided wrist problems are more common with the western or semi-western grip, whereas the eastern grip tends to affect the flexors.⁷

Tennis Biomechanics

Familiarity with the biomechanical factors involved in tennis provides a better understanding of the nature of injuries encountered in tennis players. The most demanding stroke in tennis is the serve, which has been shown to comprise 45-60% of all strokes during a match.⁸

The serve has been divided into 5 phases: (i) wind up, (ii) early cocking, (iii) late cocking, (iv) acceleration, (v) follow-through.^9-11 Other types of stroke include the forehand or backhand, which include 3 phases of movements: (i) racket preparation, (ii) acceleration, and (iii) follow-through.

In order to hit a good stroke, linked muscle groups must perform coordinated movements that will lead to a greater force summation. This concept is referred to as the kinetic chain. In tennis, this chain starts from the feet and knees, passes through the core (trunk/back), moves through the shoulder and elbow, and then the wrist and the racquet.¹²

Mastering this process is what distinguishes a hard hit of a professional from a soft hit of an amateur player. It also explains how a breakdown in this chain can result in overload and injury further down the chain.⁴ In other words, if you don’t position your knee right, then you might overload your shoulder or elbow.

Relevant Studies

According to a metanalysis by Pluim et al., the incidence of injuries in tennis players of all levels was found to be 0.04-3 injuries per 1000 hours played.² Epidemiologic studies show that most injuries occur in the lower extremity, followed by the upper limb, and the trunk.^{2, 13, 14} Furthermore, lower extremity injuries tend to be acute and result from traumatic event, whereas upper extremity injuries tend to be related to repetitive strain and overuse.³

Similar conclusions have been drawn from epidemiological studies regarding professional tournaments. A study of the US Open from 1994 to 2009, showed an overall injury rate of 48.1 injuries per 1000 match exposures.

Acute injuries were more prevalent than chronic overuse problems. Most acute injuries involved the lower extremity, with the ankle being the most common location, followed by the wrist, knee, foot and shoulder. Among chronic injuries, the distribution between lower and upper limb was more even.¹⁵ Similar results have been yielded from Wimbledon data from 2003 to 2012, with acute injuries representing 73% of total and chronic-onset injuries 27%.¹⁶

Upper Extremity Problems

Wrist

Most wrist injuries in tennis relate to ulnar-sided pathology pertinent to the extensor carpi ulnaris (ECU). The generation of ECU tendinopathy is thought to be related to the technique of the low forehand groundstroke and the 2-handed backstroke.

The western and semi-western grip types are also implicated.⁷ ECU tendinopathy is treated with rest, technique modification, splinting and NSAIDS. Acute ECU injuries, with subsheath disruption and subluxation can also occur in tennis players.

This injury is connected to sudden supination with wrist flexion and ulnar deviation during the low forehand stroke. It is treated with immobilization and subsheath reconstruction in severe cases.³

Elbow

Common elbow conditions in tennis include lateral epicondylitis and medial epicondylitis. Lateral epicondylitis is more often seen in less experienced players, possibly due to striking a backhand with a more flexed wrist.¹⁷ Medial epicondylitis is instead more common in elite players and involves the pronator teres and flexor carpi radialis.¹⁸ In all cases, treatment involves rest, physical therapy, steroid injections, or surgery for recalcitrant cases.

Shoulder

Shoulder problems include internal impingement, SLAP tears and partial-thickness rotator cuff tears. Internal impingement typically occurs during the late cocking phase of the serve. Treatment involves mostly rest and physical therapy, with surgery reserved for resistant cases.

Lower Extremity Problems

Ankle sprains are probably the most common of all tennis injuries. They typically involve the lateral ligament complex. Treatment is usually conservative, but high-grade sprains may warrant surgical treatment. Hip injuries are also mostly muscle strains that can be treated with rest, ice, NSAIDS and physical therapy. If they fail to resolve, however, the possibility of a hip labral tear should be raised, which warrants further investigation with an MRI scan.⁴

Other Injuries

Other problems in tennis include abdominal strains and lumbar disk herniation or degeneration. Abdominal muscle strains are very common in tennis, as these muscles are involved in the serving motion. In fact, the overhead serve involves activation of the rectus abdominis, the obliques, iliopsoas and gluteal muscles.¹⁹ Rest, ice, NSAIDS and physical therapy are usually effective.

Low back pain is also very common in tennis. Pain could be related to ligament sprains, paraspinal muscle strain, or in injury to the lumbar disks. The occurrence of these injuries is related to the increased rotational forces on the back during tennis, as there is an element of rotation with all tennis strokes.⁴ If lumbar disk herniation is suspected or there are neurological symptoms, an MRI of the lumbar spine is warranted for further investigation.

References

1. Kovacs MS: Applied physiology of tennis performance. Br J Sports Med 2006;40:381-385; discussion 386.

2. Pluim BM, Staal JB, Windler GE, Jayanthi N: Tennis injuries: occurrence, aetiology, and prevention. Br J Sports Med 2006;40:415-423.

3. Chung KC, Lark ME: Upper Extremity Injuries in Tennis Players: Diagnosis, Treatment, and Management. Hand Clin 2017;33:175-186.

4. Dines JS, Bedi A, Williams PN, Dodson CC, Ellenbecker TS, Altchek DW, et al.: Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg 2015;23:181-189.

5. Nigg BM, Yeadon MR: Biomechanical aspects of playing surfaces. J Sports Sci 1987;5:117-145.

6. Miller S: Modern tennis rackets, balls, and surfaces. Br J Sports Med 2006;40:401-405.

7. Tagliafico AS, Ameri P, Michaud J, Derchi LE, Sormani MP, Martinoli C: Wrist injuries in nonprofessional tennis players: relationships with different grips. Am J Sports Med 2009;37:760-767.

8. Johnson CD, McHugh MP, Wood T, Kibler B: Performance demands of professional male tennis players. Br J Sports Med 2006;40:696-699; discussion 699.

9. Elliott B, Fleisig G, Nicholls R, Escamilia R: Technique effects on upper limb loading in the tennis serve. J Sci Med Sport 2003;6:76-87.

10. Fleisig G, Nicholls R, Elliott B, Escamilla R: Kinematics used by world class tennis players to produce high-velocity serves. Sports Biomech 2003;2:51-64.

11. van der Hoeven H, Kibler WB: Shoulder injuries in tennis players. Br J Sports Med 2006;40:435-440; discussion 440.

12. Eygendaal D, Rahussen FT, Diercks RL: Biomechanics of the elbow joint in tennis players and relation to pathology. Br J Sports Med 2007;41:820-823.

13. Lynall RC, Kerr ZY, Djoko A, Pluim BM, Hainline B, Dompier TP: Epidemiology of National Collegiate Athletic Association men’s and women’s tennis injuries, 2009/2010-2014/2015. Br J Sports Med 2016;50:1211-1216.

14. Okholm Kryger K, Dor F, Guillaume M, Haida A, Noirez P, Montalvan B, et al.: Medical reasons behind player departures from male and female professional tennis competitions. Am J Sports Med 2015;43:34-40.

15. Sell K, Hainline B, Yorio M, Kovacs M: Injury trend analysis from the US Open Tennis Championships between 1994 and 2009. Br J Sports Med 2014;48:546-551.

16. McCurdie I, Smith S, Bell PH, Batt ME: Tennis injury data from The Championships, Wimbledon, from 2003 to 2012. Br J Sports Med 2017;51:607-611.

17. Blackwell JR, Cole KJ: Wrist kinematics differ in expert and novice tennis players performing the backhand stroke: implications for tennis elbow. J Biomech 1994;27:509-516.

18. Vangsness CT, Jr., Jobe FW: Surgical treatment of medial epicondylitis. Results in 35 elbows. J Bone Joint Surg Br 1991;73:409-411.

19. Atkins JM, Taylor JC, Kane SF: Acute and overuse injuries of the abdomen and groin in athletes. Curr Sports Med Rep 2010;9:115-120.

Frequently Asked Questions

I feel clicking in my wrist after a tennis match. What's going on?

A painful click in the wrist after a tennis match is usually related to disruption of the sheath of the ECU, and consequent ECU subluxation.

What are the common shoulder problems related to tennis?

– SLAP lesions
– Impingement syndrome
– Internal impingement
– Rotator cuff tears

Athens

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Mobile

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Email

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Basketball Injuries

Leave a Comment / Αθλητισμός / Georgios Panagopoulos / 1 June 2023 / Basketball, Αθλητισμός, Τραυματισμοί

Basketball can be a rough game to play and comes with an inherent risk even for the professional athlete. Basketball injuries are common and can easily send a player to the sidelines either temporarily or, even worse, for the whole season. Basketball involves running, jumping, blocking, twisting, and passing, all of which make a player prone to acute injury or overuse symptoms. Playing basketball involves continuous sudden starts and stops and frequent intermittent bursts of explosive activity, which combined with intense physical contact can lead to an injury.

Table of contents

Ankle Injuries

Ankle injuries are probably the most common injury in basketball, representing 21.9% of all basketball injuries. Incidence varies from 3.8-5.2 injuries per 1000 exposures. Ankle injuries in basketball can be severe and difficult to recover from. They may also lead to chronic residual problems, like persistent pain or ankle instability, that can easily compromise a timely return to play.

Ankle Sprains

Ankle sprains may result from rebounding, general play, defending or shooting. Most sprains in basketball are lateral ankle sprains (approximately 80%).4 They occur because of excessive ankle inversion, which puts stress to the anterior talofibular ligament (ATFL), calcaneofibular (CFL), and posterior talofibular ligament (PTFL). Most injuries can be treated conservatively, with the RICE protocol (rest, ice, compression, elevation), especially in the first 24-48 hours, to avoid excessive swelling and reduce pain. Wrapping or bracing can also help. The injured athlete can use crutches initially and transition to a walking boot in 1-2 weeks if pain allows. Physiotherapy, with proprioceptive training, strengthening and closed chain exercises may start 2-3 weeks after the injury.

Medial ankle sprains are much less common and are caused by excess eversion and dorsiflexion. They involve the deltoid ligament. They are similarly treated nonoperatively, but deltoid reconstruction may be needed if instability ensues. High ankle sprains or syndesmotic injuries can also occur in basketball, typically after forceful external rotation of the plantar-flexed foot. These injuries are more severe, and typically require surgery.³

Ankle Fractures

Acute ankle fractures are relatively uncommon in basketball (0.5%). Lateral fibular fractures below the level of the syndesmosis (Weber A fractures) are usually stable and can be treated in a boot, with return to play at about 8 weeks. Lateral fibular fractures at the level of the syndesmosis (Weber B fractures) are potentially more severe and may require surgery if unstable. Ankle fractures above the level of the syndesmosis (Weber C fractures) are the most severe type and are more likely to require surgical intervention.

Achilles Tendonitis & Achilles Rupture

Basketball poses a continuous stress to the Achilles tendon, with microtears that can lead to chronic inflammation and pain. Achilles tendonitis can be both insertional and non-insertional. Achilles rupture is rare, but can be rather problematic for the athlete, requiring 6-9 months prior to return to play. The mechanism involves a forced dorsiflexion of the ankle with concomitant gastrocnemius contraction. Most Achilles ruptures in professional athletes get surgical repair.

Knee Injuries

Not surprisingly, knee injuries are also very common in basketball. These can be either acute injuries, or chronic overuse problems. ACL tears are the most common acute knee injury, with rates being higher in women players. Return to play varies after ACL reconstruction. A study among NBA players found that 22% of players did not return to play, whereas 44% had decreased overall performance after their return.

Overuse problems in the knee are typically related to patellar tendinitis, the so called jumper’s knee. Proper warm-up, cool-down and muscle training are fundamental to prevent these problems.

Jammed Fingers

Finger and thumb injuries are very common in basketball. We often see basketball players with deformed fingers. Injuries can involve both the proximal and distal interphalangeal joint (PIP and DIP). Capsule and ligament injuries are common, as well as intra-articular fractures. In the DIP, the terminal extensor tendon can be injured (mallet finger), or the flexor tendon (FDP – Jersey finger).

A mallet finger typically occurs with forced flexion of an actively extended DIP joint, when the ball jams on the fingertip. If the injury is stable, it can be splinted in extension and the player can return to play with their splint on. An unstable bony mallet needs surgery, with wiring. Metacarpal fractures are also common during dunks or fouls. Dunking lacerations (cuts) are also possible.⁸

Stress Fractures

Stress fractures in basketball may involve the foot metacarpals, anterior tibia, talus or the navicular bone. These can also go misdiagnosed for a long time. Upon suspicion, even in the presence of a negative x-ray, an MRI is warranted to confirm the diagnosis. Treatment involves unloading with crutches and progressing weight-bearing in a walking boot. Basketball players can also get a Jones fracture, which is a fracture of the base of the 5th metatarsal. These usually heal on their own, but surgery may still be warranted in an elite athlete to accelerate return to play.

Concussion

Concussions can occur in basketball after contact with another player or an impact to the court flour. A player with concussion may experience nausea, blurred vision, dizziness, and headache. A concussion should not be taken lightly. Even a reportedly mild case should be examined properly by the team physician.

Eye Injuries

Common eye injuries in basketball include corneal abrasions and eyelid lacerations. Most of these injuries occur during rebounds. Protective goggles and eye-shields can help prevent these injuries.¹⁰

Other Injuries

Deep thigh bruising, facial injuries, dental injuries and various muscle strains are common in basketball, given the contact nature of the sport.

References

1. Andreoli CV, Chiaramonti BC, Buriel E, Pochini AC, Ejnisman B, Cohen M: Epidemiology of sports injuries in basketball: integrative systematic review. BMJ Open Sport Exerc Med 2018;4:e000468.

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