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An athlete who has just suffered an injury probably has one dominant thought in mind: "How soon can I get back on the field?"

One step that will help you recover faster from sports injuries is to see a specialist surgeon for diagnosis and treatment, rather than a general practitioner. While many injuries occur in everyday life that your family doctor can treat, a specialist doctor will approach treating your injury from a different perspective.

Georgios Panagopoulos MD is a specialized orthopedic surgeon, with experience in sports injuries and their management.

What are Sports Injuries?

The term sports injuries describes injuries that occur to athletes (professional or amateur) during sports activities (training or competition).

In fact, the same injuries can happen to everyday people. The distinction is done for the following reasons:

• Athletes suffer injuries with different frequency and in different parts of the body depending on the sport.
• There is a difference in energy released during injury due to the greater muscle mass and speed athletes develop
• The performance of the team, but also the career of the athlete directly depends on the rehabilitation, and often a more aggressive approach and faster decisions are required.
• Sports injuries require intensive physical therapy & rehabilitation with a physical therapist in order to achieve the fastest possible return to play.
• Injuries to athletes may also have financial implications, both for the athlete himself (non-renewal of contract) and for the team.

Common sports injuries may include:

• Joint sprains
• Muscle strains
• Fractures & dislocations
• Concussion
• Tendonitis
• Shin splints
• Knee injries
• Meniscal Tears or ACL tears
• Rotator cuff tears
• Sports hernia - groin pain

Of these injuries, some injuries can be acute (occurring suddenly, once) or chronic (occurring gradually over a long period of time, usually from overuse).

Common sports injuries tend to vary by sport. Soccer players typically suffer muscle strains in the muscles of the lower limbs, such as adductors, hamstrings and cuff muscles, or knee injuries, such as torn collateral ligaments, meniscal tears, cruciate ligament tears. Basketball players often get ankle sprains and finger injuries. Swimmers put a lot of strain on their shoulders, while throwing athletes may often experience elbow problems.

How you receive treatment for a sports injury can make or break your further sports career, whether you are a professional athlete or a beginner. It is important that your doctor is trained and experienced in the evaluation and treatment of sports injuries. The goal is for the athlete to return to playing condition as soon as possible.

Treatment & rehabilitation 

While Dr Panagopoulos usually begins the treatment of a sports injury with the standard RICE (rest, ice, compression, elevation) protocol, he also stays abreast of developing treatments and technologies such as regenerative therapies that use your body's healing abilities to accelerate during the healing process (PRP therapy is an example).

Again, our goal is to see you back at the games soon. Therefore, our main concern is to develop for you a treatment and rehabilitation program that prepares your body to withstand the stress and impact of athletic competition. This plan often includes specialized physical therapy that doesn't just restore normal function like an office worker would need, but takes you beyond that to a more intense level of strength and performance ideal for athletes.

Your holistic return to play plan may also include nutritional counseling, a specific training program, and a recommendation for psychological counseling to ensure you are fully confident when you return to the field. If you are hesitant or timid in any way, you risk re-injuring yourself.

Surgery is a more invasive procedure that prolongs recovery time, so unless surgery is indicated (such as with a cruciate ligament tear, or a torn shoulder tendon), Dr. Panagopoulos first exhausts less invasive treatment methods, including physical therapy, of injections and medicines.

If you have a sports injury that needs treatment, our team is ready to help. Call our office and make an appointment to receive the expert guidance and treatment needed to get you back in the game as quickly as possible.

FAQs - Frequently Asked Questions

Pain in the back of the ankle or foot is often the result of problems along the course of the Achilles tendon, or where it attaches to the heel. Achilles tendon disorders range from chronic overuse conditions that lead to inflammation and degeneration of the tendon (Achilles tendinitis), to acute injuries from sports or other activities (Achilles tendon rupture).

What's the achilles tendon?

The Achilles tendon is located at the back of the ankle and connects the calf muscles to the heel bone. Facilitates activities such as walking, running and jumping. The Achilles is the largest and strongest tendon in our body. Subject to 2-3 times body weight during normal walking and 3-6 times body weight or more with running and jumping activities.

Achilles tendinopathy

Achilles tendinitis is a chronic condition characterized by pain and often swelling in the Achilles tendon. The symptoms are due to swelling and inflammation of the tissue surrounding the Achilles tendon.

What are the types of achilles tendonitis?

There are 2 main categories of tendinopathy and Achilles tendinitis:

• Non-insertional Achilles tendonitis : In classic Achilles tendonitis, symptoms of pain and swelling are typically located 2-6 cm above the insertion of the Achilles tendon on the heel bone.
• Insertional achilles tendonitis: In this type, the pathology is located in the adhesion of the Achilles tendon to the heel bone. A bony prominence of the heel, or Haglund deformity, is typically found in these cases.

Achilles tendonitis - Symptoms

Symptoms of Achilles tendinitis can vary depending on the severity of the condition. 

Typical symptoms include:

• Pain and stiffness in the Achilles tendon, especially in the morning, or after periods of inactivity.
• Pain that worsens with activity, or exercise
• Swelling and tenderness in the tendon
• Creaking sensation during movement in the ankle
• Swelling or thickening in the Achilles tendon near the heel
• Haglund deformity

Diagnosis - Clinical exam

Examination will usually reveal swelling and tenderness around the Achilles tendon. The doctor may detect swollen, inflamed tissue. If there has been any type of associated injury, it is important to ensure that the tendon is intact and that the problem is not, in fact, a ruptured Achilles tendon. This is done by performing the Thompson Test, where the patient lies face down with their legs hanging over the edge of the bed. The calf muscle is then compressed and the foot must move into plantar flexion if the Achilles is intact.

Diagnosis - Imaging

X-rays will usually be negative in non-enveloping, classic Achilles tendinitis, unless there is calcification of the Achilles tendon, which is relatively rare (more common in older patients). However, for catatrophic Achilles tendonitis, a heel osteophyte may be seen on radiographs. An MRI can provide a detailed picture of the soft tissues, but is usually not indicated for the initial evaluation of Achilles tendonitis unless the doctor is trying to answer a specific question (maybe the tendon has ruptured tendon;). If needed, ultrasoundcan also be used, as it is more readily available and less expensive than an MRI.

Achilles tendonitis - Conservative treatment

Most patients with Achilles tendinitis can be effectively treated with non-surgical treatment. This usually involves a period of rest for symptoms to subside, followed by a gradual return to normal activities. Elements of conservative treatment may include:

• Activity Modification. In the short term, they may need to stop any activities that may be making the problem worse. This includes running, jumping, walking up hills, climbing stairs repeatedly.
• Shoe modification. It is important to avoid shoes that aggravate the symptoms. In general, wearing well-fitting and comfortable shoes is beneficial. A few shoe modifications may also be helpful. Some patients feel more comfortable wearing insoles. An increased heel height tends to take some of the load off the Achilles tendon.
• Drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs), 1-3 times a day, can help relieve symptoms in the short term and break the cycle of pain and discomfort. However, for successful long-term management, NSAIDs usually need to be combined with other treatment strategies.
• Stretching of the gastrocnemius and Achilles. A tight muscle increases the force passing through the Achilles tendon and predisposes to microtears. A consistent program of calf stretches is an important part of treatment.
• Double leg heel rises. A high-rep, low-resistance strength program can be very helpful. Perform double heel raises while standing on the edge of the stairs (for more ankle movement). Start with 5 sets of 5 reps, and slowly progress to 10 sets of 15 reps.
• Heel drops. Eccentric Achilles Tendon Exercises: Controlled exercises where the Achilles tendon is lengthened have been shown to be very helpful in improving symptoms. Patients should progress up to performing 5 sets of 10 repetitions. These exercises should be performed 5-6 days a week during the active treatment phase, and 3 times a week thereafter, to minimize the chance of relapse. It is critical that this exercise be done carefully. Patients should always warm up first (eg exercise bike for 5-10 minutes) before performing these exercises to avoid injury.
• PRP Injections. It has been suggested that injecting PRP, taken from the patient's own blood, can stimulate healing. However, there is a lack of evidence to confirm that PRP injections are more effective than traditional treatment options. Cortisone injections are generally not recommended, due to the increased risk of weakening or even tearing the tendon.

Achilles tendonitis - Surgical treatment

Surgical treatment of Achilles tendinitis is rare. Surgery is indicated only when appropriate conservative treatment has failed. Patient compliance and postoperative management are important factors in preventing ankle stiffness or recurrence of symptoms.

Surgery usually requires removal of the damaged tissue and surgical repair of the tendon. In some cases of extensive damage, a local healthy tendon transfer (tendon transfer) is performed to strengthen the diseased Achilles tendon. Postoperative immobilization is required, followed by gradual introduction of range of motion and strengthening exercises. It may take 3-6 months to achieve full recovery. Some known complications are recurrence and ankle stiffness.

Achilles tendon rupture

Achilles ruptures usually occur in athletic people in their 30s, 40s and 50s. However, there is also a small group of patients in their 70s and 80s who suffer from this injury. The injury usually occurs after a sudden application of force resulting in the rupture (rupture) of the Achilles tendon.

Regaining normal Achilles tendon function is important to resuming an active, healthy lifestyle. Achilles tendon rupture can be successfully treated conservatively or surgically. Recent studies indicate that nonsurgical and surgical treatment of Achilles tendon ruptures produce equivalent results.

Patients who undergo surgical treatment for an Achilles tendon rupture can expect a faster return to a pre-injury activity level and a lower rate of re-rupture. However, surgery carries risks of complications such as infection or wound healing problems. For this reason, conservative treatment may be preferable, especially in patients with diabetes, vascular diseases and long-term smokers.

Mechanism of injury

The Achilles tendon receives the maximum load when the calf muscle contracts while simultaneously moving the ankle upwards (dorsiflexion), which causes the tendon to lengthen (eccentric loading). This can happen when changing direction, starting to run, stopping suddenly, or landing from a jump. This sudden increased force through the tendon can lead to a tear, in the same way that a stretched rubber band can break.

The patient with Achilles rupture feels a intense and acute pain in the back of the leg. Depending on the activity, patients often describe the sensation of being "hit in the back of the leg" with a ball, bat, or kick. Tendon rupture can be extremely painful. The injury may be accompanied by swelling and ecchymosis in the area.

Immediately after the injury, the pain varies. Some describe very little or no pain, while others describe a lesser but persistent discomfort. Sometimes there may be an inability to walk. It is very rare for an Achilles tear to be partial. However, a painful Achilles tendinitis or a partial tear of the gastrocnemius can also cause pain in this area. Examination by an experienced orthopedic surgeon is essential to confirm the correct diagnosis.

Diagnosis

The diagnosis of Achilles tendon rupture is easily made by physical examination. Usually, there is a gap in the Achilles tendon at the site of the tear that can be felt by lightly palpating the area. However, the main test to determine if the Achilles has ruptured is the Thompson test. This essentially involves placing the patient in a prone position and compressing the calf. If the Achilles is intact, the foot will lift (plantar flexion). If it is torn, the leg will not move and will tend to be in a lower position.

Plain radiographs may show a blur or shadow on the lateral view. However, more often plain x-rays are normal as the injury is to the tendon and therefore does not affect the bones of the foot. Imaging with ultrasound or MRI confirms the diagnosis.

Achilles tendon rupture - Treatment

Achilles tendon ruptures can be treated both conservatively and surgically. Both treatment approaches have advantages and disadvantages. Recent studies suggest that conservative and surgical treatment of Achilles tendon ruptures produce equivalent results in many. However, the decision on how to treat an Achilles tendon rupture must be based on each patient individually, with an individualized approach. A neglected Achilles tendon rupture can lead to chronic weakness, lameness, and often secondary problems with the knee, ankle, and foot. 

Conservative treatment

Conservative treatment of Achilles tendon rupture consists in placing and immobilizing the foot in equinus until the tendon heals. This usually involves some type of boot (cam walker) with a heel lift with insoles or wedges, or a cast.

The primary advantage of conservative treatment is that there are no problems with healing or infection since no surgical incisions are made. Wound infection after Achilles tendon surgery can be a devastating complication, and therefore, for many patients, especially those with diabetes, vascular disease, and long-term smokers, nonsurgical treatment should be considered.

The main disadvantage of non-surgical treatment is that recovery is slower. The overall effect of long-term immobilization and the deviation from "normal" activity for each individual patient must be considered. Surgical treatment may allow faster loading. Additionally, the relapse rate appears to be higher with conservative treatments.

Surgical Treatment

The surgical treatment of Achilles tendon tears involves making an incision in the center of the tendon tear. The tendon is then repaired using sutures in such a way that the ends of the tendon touch. Both open and percutaneous techniques are described. The minimally invasive Achilles rupture repair technique has been shown to be equivalent, but with fewer wound complications and infection than the standard open technique, although with a higher risk of nerve injury. Surgical repair allows faster loading and mobilization. Individualized physical therapy is important to restore strength and balance after surgery.

The advantages of Achilles tendon repair surgery include:

• Quicker recovery
• Early motion
• Lower rerupture rate - recurrence rate is 2-5% with surgery, as opposed to 8-12% with conservative treatment.

The main disadvantage of surgical Achilles tendon tear repair is the potential for surgical complications, such as healing problems, infection, or painful scarring.

FAQs - Frequently Asked Questions

An ankle sprain is one of the most common musculoskeletal injuries. It occurs when the ankle turns inward, leading to a tear in some or all of the ligaments around the ankle. Ligaments of the ankle joint are stretched or torn.

Risk factors for developing an ankle sprain include: a history of previous sprains, participation in high-risk sports (basketball, volleyball, soccer, etc.), a high arch, or an excessively loose joint.

The severity of a sprain will determine the length of recovery time. Initial treatment includes: rest, activity modification, ice, elevation, and compression. Physical therapy focuses on range of motion and strengthening, and is especially helpful once the initial pain and swelling subsides.

Symptoms

Patients with an ankle sprain usually describe an episode where they roll their ankle inward, which tears the ligaments on the outside of the ankle. Patients usually immediately have significant pain and swelling, and are usually limping or unable to walk immediately after the injury. However, quite often those who have sprained their ankle are still able to bear some weight.

It is often possible for athletes who have suffered a mild or even moderate ankle sprain to be unable to complete their game, albeit with significant pain and some functional limitations. Swelling and redness (bruising) usually become apparent within 24 hours of the injury and tend to spread down the leg. Bruising can take two weeks or more to resolve.

Symptoms may include:

• Pain
• Swelling
• Bruising
• Stiffness
• Inability to weight bear

Causes

Causes may include:

• Sports injuries, especially in sports that require frequent jumps or pivoting, ie basketball, volleyball, or soccer.
• Falls from height
• Simple everyday walking, ie ankle twisting in the curb
• Inappropriate shoes
• Prior history of multiple sprains - ankle instability

Classification

The symptoms caused by an ankle sprain vary depending on the severity of the sprain, as well as the ligaments it affects. Some sprains involve damage to multiple ligaments. Doctors often give a "grade" to sprains (grade 1, 2, or 3), depending on their severity:

• 1st degree sprains are mild and occur when there is a stretch and microscopic tear of the ligaments of the ankle joint. They usually cause only mild pain and swelling. A mild sprain involves a partial tear of the anterior talofibular ligament (ATFL) – the first ligament to be stretched when the ankle turns inward. In a mild sprain, this ligament has been stretched or some fibers are torn, but is intact. Mild sprains will take 4-7 days to recover.
• 2nd degree sprains are of moderate intensity and occur when the ligament is partially torn. They cause moderate pain and swelling. They are usually accompanied by partial damage to the ATFL and CFL (calcaneofibular ligament). Grade 2 ankle sprains often take 7-14 days to fully recover.
• 3rd degree sprains are serious and occur when a ligament is completely torn (complete tear). There is usually complete failure of the ATFL & CFL +/- PTFL. They can cause significant pain and swelling that can make it difficult to move the ankle. A grade 3 sprain may require 4-6 weeks of treatment.

Although all sprains can be painful, very severe pain generally means a more serious sprain is present.

Diagnosis

Dr Panagopoulos will take a detailed history and examine you carefully. On clinical examination of a sprain there is usually swelling in the area around the ankle and pain on palpation or movement of the joint. It is important to assess other areas of tenderness and potential injury, as the same mechanism that creates an ankle sprain can also lead to other injuries (eg ankle fracture, anterior calcaneal process fracture, ankle osteochondral injury, peroneal tendon injury, 5th metatarsal fracture).

After a sprain, X-rays will often be required (taking into account the Ottawa rules), especially if a tibial fracture is suspected. Sometimes, especially in cases of chronic instability, an MRI may be needed to assess the condition of the ligaments.

Treatment

The basic treatment of the sprain is done with the well-known RICE (Rest, Ice, Compression, Elevation) approach:

• Rest: rest & modify activities. Time is usually the best cure for a typical sprained ankle. The body simply needs time to heal the injured tissue.
• Ice: Applying ice to the injured ankle helps reduce swelling and improve pain control. Ice should be applied for 10-15 minutes several times a day. Ice helps restrict blood flow to the injured ankle during the acute phase of the injury, reducing swelling.
• Compression: Compression helps reduce swelling. This can be achieved with an elastic band.
• Elevation: Elevating the ankle (eg, placing two pillows under the leg while lying down) helps reduce swelling.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be helpful in reducing pain after an ankle sprain. NSAIDs reduce pain by reducing the inflammatory response to injury. However, there is some evidence to suggest that anti-inflammatories may have an adverse effect on ligament healing.

Patients may benefit from a short period of immobilization in a walking boot. In severe sprains, short periods of off-loading may be needed. However, early mobilization of the ankle is generally recommended and leads to better healing and recovery. When the acute phase passes and the symptoms subside, physical therapy is extremely important, with exercises designed to improve range of motion, strengthening exercises and improving balance - proprioception.

Surgical treatment

Surgical treatment extremely rarely has a role in the treatment of acute ankle sprains. An exception is the presence of accompanying injuries, such as osteochondral damage, tendon ruptures, or unstable fractures. Patients who have recurrent ankle sprains due to ankle instability may be candidates for ankle ligament stabilization surgery. 

When should I see a doctor?

Many sprains heal without medical treatment, especially if the sprain is small. However, only a doctor can accurately diagnose a sprain. This is because the symptoms of a sprain are very similar to those of other injuries and disorders, including fractures and arthritis.

 You should seek medical help for a sprain if:

• If the sprain involves a child
• The pain is severe or unbearable
• Walking is still difficult after 2-3 days
• There is constant pain for several weeks after the sprain
• If re-injury occurs after a sprain
• If there is external trauma to the ankle, such as bleeding or discontinuity of the skin
• If there is chronic pain that lasts several weeks
• If there is chronic ankle instability with a history of multiple sprains 
• Home remedies don't help the pain or the pain gets worse.

Dr Panagopoulos has extensive experience in sports injuries and orthopedic trauma and will discuss your case in detail during your office visit.

FAQs - Frequently Asked Questions

If you are an athlete, you know that there are many reasons for playing a sport. The reasons vary from maintaining a healthy body weight, the well-being and endorphin rush that exercise provides, to socializing and enhancing team building and leadership skills. 

But in order to be able to participate in sports activities safely, we should also treat our bodies with the necessary respect. Taking proper care of your body and being aware of your limits is key to avoiding mishaps, whether you're a competitive athlete or a weekend warrior.

Our first question after a sports injury is usually: “When can I get back to playing?” The answer to this question varies depending on the type and extent of the injury.

In the following article, we will take a look at the most common sports injuries and their causes.

ACL tears

The ACL or anterior cruciate ligament is one of the most important knee ligaments and is located in the center of the knee. Its main function is to maintain knee stability and prevent the tibia (leg bone) from moving forwards. An ACL tear is one of the most common knee injuries. It also manifests frequently in association with other injuries, such as MCL tears, a torn lateral meniscus, or a PLC (posterolateral corner) injury. 

ACL injuries are very common in sports that require a sudden “start-stop” or a sudden change of direction, pivoting or jumping. These sports include football, basketball, skiing, squash, etc. The mechanism of injury typically includes an external twisting motion in a bent and loaded knee. You can have this if you get tackled, stop suddenly from running or land awkwardly after a jump.

When the ACL tears, patients typically feel severe pain accompanied by a snap or pop, and the knee gives way and feels unstable. The knee also becomes very swollen very quickly. Patients are usually unable to weight bear immediately after the injury.

The diagnosis is confirmed by magnetic resonance imaging (MRI), which allows imaging of accompanying soft tissue injuries, such as medial collateral ligament injuries, external meniscal tears, or posterior and external angle tears. It is noted that a meniscal tear combined with a cruciate tear is extremely common. 

Initial management typically involves rest, ice, anti-inflammatory medications and physiotherapy. Up to 1/3 of patients will be ok with this treatment, eventually strengthen their muscles and circumvent the ACL-deficient, potentially more unstable knee.

Some patients will do initially well, but will be unable to resume sport activities to the pre-injury level and eventually might need surgery. The decision in that case boils down to their athletic aspirations. Some other patients will have a persistently wabbly knee and will need surgery.

Meniscal tears

Each knee has 2 C-shaped pieces of cartilage between the femur (thigh bone) and the tibia (leg bone), the medial and the lateral meniscus. The medial meniscus is on the inside and the lateral on the outside of the knee. The menisci look like potato wedges. The menisci act as shock absorbers and load sharers. They are the cushions of the knee joint. A torn meniscus is one of the most common knee injuries. 

Meniscal tears can usually develop in one of 2 ways, traumatic in the young and degenerative in the old. In younger (<40 years) and active individuals, a torn meniscus can result from forceful twisting of the knee, such as a sudden “stop & turn”, or sudden pivoting of the knee. Essentially what happens is that you twist your bended knee while you put your weight on it. Certain sports increase the risk of this happening, such as tennis, squash, football and skiing. In older people (>40 years), the menisci start to become weaker and more friable and can tear more easily, even without significant trauma. In fact, many of these occur spontaneously or with innocuous activities, such as kneeling or squatting while you do your house errands or your gardening.

Common symptoms include:

• Sharp pain on the inside or outside of the knee, depending on the involved meniscus
• Pain on deep sitting or squatting, if the back part of the meniscus is involved
• Sometimes there can be a dull ache rather than sharp pain
• Painful clicking and catching or locking. If your knee is locking, you might have an unstable torn meniscus that needs more urgent medical attention
• Your knee may also feel like giving way

In case of suspicion of a meniscal tear, the imaging method of choice is magnetic resonance imaging (MRI) of the knee, which also allows the diagnosis of possible accompanying injuries, such as ACL tears.

If you have an isolated torn meniscus and your symptoms are mild, you might opt for conservative management. This will involve rest, avoiding activities that aggravate your knee as well as physical therapy. 

In younger patients, bigger tears, or evidence of locking, arthroscopic treatment may be more appropriate.

Ankle sprains

An ankle sprain is an injury that occurs when the ligaments in the ankle joint are stretched or torn. These ligaments hold the bones of the ankle together and help stabilize the joint. Sprains occur when the foot turns excessively in one direction, i.e. moves beyond normal limits. It is the most common cause of ankle pain.

Causes

Causes of sprains include sports injuries – sports with frequent landings from jumping or frequent changes of direction, eg basketball. A sprain can be caused by a simple everyday injury, eg tripping or twisting (my leg turned).

Symptoms & diagnosis

Symptoms of a sprain include swelling, bruising, pain and inability to walk. The diagnostic approach may include an X-ray to rule out the possibility of a fracture. MRI may be needed in chronic cases, in order to rule out ligament insufficiency, osteochondral lesions, or for preoperative planning. 

Treatment

Initial treatment includes rest, ice, elevation of the leg, elastic banding, and pain medication, or nonsteroidal anti-inflammatory drugs. In some cases, offloading with crutches, or immobilization for some time may be necessary. In some cases, surgery may be needed to restore ligaments, remove loose bodies or treat cartilage damage.

Adductor injuries

Adductor strain is a common injury in athletes. It is characterized by stretching, partial or total rupture of one or more of the adductor muscles (brevis, magnus & adductor longus). The adductor longus is most commonly involved. The adductors stabilize the pelvis and move the legs toward the center of the body (adduction).

The adductors are especially strained during sports activities after repeated changes of direction. If a sudden contraction occurs, particularly great violence may be induced at the point of origin of the muscle, causing rupture of muscle fibers or leading to bone swelling. Passively, rupture can also occur with overstretching. Rupture can be classified in 3 types depending on severity.

Causes 

Damage can be caused by a sudden contraction, a sudden change in direction, or a lack of warm-up. Older athletes are more susceptible.

Clinical exam

Athletes usually describe a sharp, piercing pain in the inner thigh during the injury. In mild damage, they can continue the sport, but in type II damage they stop, or start to limp. In type III, the symptomatology is acute (heaviness in the groin, difficulty rising from a chair, or limping when walking).

Treatment

• RICE protocol (Rest, ICE, Compression, Elevation)
• Mild groin stretching exercises, if pain allows
• Kinesiotapping, for offloading
• Exercise program focused on stretching and strengthening
• Gradual return to individual and team training

Sports hernia

Abdominal pain can occur after an injury during sports activity, but it can also be the result of persistent exercise or abdominal strain. This damage is often known as groin pain, sports hernia, athletic pubalgia or osteitis pubis. Rather, it is a spectrum of lesions that are difficult to distinguish clinically from each other.   

The abdominal muscle complex consists of the rectus abdominis, the internal oblique, and the external oblique. The function of the rectus abdominis is to bend the spine. The internal and external obliques work together to assist in rotational movements of the trunk. These muscles can be injured during a sudden muscle contraction, or in a sudden twisting in an uncoordinated manner.

This is a difficult diagnosis. The condition is common in athletes who use the abdominal and core thigh muscle groups a lot, such as football and hockey players. 

Symptoms & diagnosis

The athlete is often in pain for a long time before complaining of severe pain to the team staff. The rectus abdominis is most often involved, and the pain is localized at the rectus insertion at the pubic symphysis. Clinical examination and imaging (MRI) often lead to nonspecific findings. The differential diagnosis may include adductor strain, stress fractures, or hip impingement syndrome.

Treatment

The initial treatment includes rest, massage, stretching. This is followed by strengthening and a gradual return to training and play. Mesh surgery is a solution for resistant cases. 

Hamstring injuries

The hamstrings are the muscles at the back of the thigh. These muscles are the biceps femoris, semitendinosus and semimembranosus. The hamstrings cause knee flexion and hip extension. 

What causes a hamstring injury?

A hamstring injury often occurs during sudden, powerful movements, such as an explosive sprint, or jumps that overstretch the tendons and cause a sudden contraction. The injury can also occur gradually during slower movements.

Repetitive injury is common in athletes. You are more likely to injure your hamstring if you have injured it in the past. Doing regular stretching and strengthening exercises and warming up before exercise can help reduce your risk of hamstring injury.

How do I know I have a hamstring strain?

Mild injuries (grade 1), usually cause sudden pain and tenderness in the back of the thigh. It may be painful to move your leg, but muscle strength will not be affected. Partial hamstring tears (grade 2) are usually more painful. There may also be swelling or bruising in the back of the thigh, as well as loss of muscle strength. Severe hamstring tears (grade 3) are usually very painful, tender, with swelling and ecchymosis, making walking and standing difficult. There may have been a "cracking" sensation at the time of the injury, and you will not be able to use the affected leg.

What's the treatment?

The initial treatment includes rest, massage, stretching. This is followed by strengthening and a gradual return to training and play. Surgery is very rarely needed. 

Achilles tendinopathy

The Achilles tendon is the largest and strongest tendon in the human body. The Achilles tendon connects the calf muscles to the heel bone. It is responsible for propulsion when we walk, run or jump. Achilles tendonitis is one of the most common causes of foot and heel pain.

Causes

The condition occurs most often in runners and athletes who participate in sports that require jumping, spinning, or sudden changes of direction, such as basketball, tennis, or soccer. Overuse is the most common cause of Achilles tendonitis. The tendon is subjected to repeated stress or tension, and can develop swelling and inflammation.

Symptoms

Common symptoms include:

• Pain and stiffness, exacerbated by activity
• Swelling of the achilles tendon
• Creaking sensation during movement in the ankle
• Swelling or thickening in the Achilles tendon near the heel

Treatment

The initial treatment is conservative and includes rest, ice therapy, elevation, physical therapy, special insoles, shockwave therapy, etc. Surgical treatment is applied in resistant cases. 

FAQs - Frequently Asked Questions