More than 8 million student athletes participate in fall sports and many of them will be sidelined before the end of the season due to a sports-related injury.  In fact, according to the American Academy of Orthopedic Surgeons, nearly 1.8 million student athletes will be injured this year.

Heat exhaustion, sprains and strains, and acute injuries are commonly seen in athletes returning to fall sports. After a long summer, kids are less physically prepared to hit the playing field, which can lead to an increase in injuries. A pre-season physical, wearing properly-fitting equipment and recognizing pain early can prevent some of these injuries.

Following are some of the most common injuries faced by athletes that participate in the fall’s most popular sports, including football, basketball and wrestling:

Football
More than 920,000 student athletes are treated for football-related injuries each year – the most of any fall sport. The most common football-related injuries include:
• Strains and sprains: These are the most common injuries in football and usually affect the ankle, knee or wrist. Signs of this type of injury include pain, swelling, bruising and limited ability to move the affected muscle or joint.
• Fractures: Fractures to the wrist, arm and leg account for more than one quarter of all serious football injuries. Bruises, swelling, localized pain and the inability to move the affected area, are all signs of a fracture.
• ACL tears: Indications of a possible ACL tear include hearing a “pop,” instability of the knee, immediate pain and swelling.
• Concussions: If a player experiences a significant “blow” to the head it can be very serious. They should seek immediate medical treatment if they have a headache, nausea or confusion. Loss of consciousness is also possible.

Wrestling
According to the American Academy of Pediatrics, wrestling ranks fourth in participation but second in the rate of injuries suffered by athletes. In addition to concussions, the most common wrestling-related injuries include:
• Prepatellar Bursitis: Also known as “housekeeper’s knee,” key symptoms include swelling and pain on the top of the kneecap along with limited movement.
• Rotator cuff tendonitis: The wear and tear on the shoulder during wrestling can cause tendonitis, which is an inflammation within the shoulder joint. This can cause pain with movement of the arm, trouble sleeping due to pressure on the shoulder and weakness of the arm when reaching overhead.

Basketball
Each year, more than 481,000 basketball-related injuries are treated, according to the U.S. Consumer Product Safety Commission. Some of the most common basketball injuries seen are:
• Jammed fingers: Blunt impact to the tips of fingers can cause the joints in the fingers to jam, causing pain, bruising and swelling.
• Ankle sprains: Pay attention to tenderness, pain and swelling around the ankle. These symptoms, along with the loss of movement of the ankle, can indicate an ankle sprain.
• Plantar Fasciitis: A sharp pain in the heel of the foot, especially in the morning, is a common symptom of this injury.

As with any time of year, athletes that participate in fall sports must make sure their bodies are properly conditioned before hitting the playing field. If they do experience discomfort or an injury they should seek help from their onsite medical staff and follow up medical care from an experienced orthopedic surgeon.

Even though golf is a low-risk sport, injuries can occur. According to the Academy of Orthopaedic Surgeons, more than 100,000 golf-related injuries are treated each year.  Shoulder, wrist and elbow injuries occur most often in golf. Most shoulder injuries are due to overuse, while wrist and elbow injuries most likely occur due to improper swing or holding the clubs the wrong way.

Dr. Arthur Rettig recommends some simple ways you can prevent an injury from sidelining you from the links:

• Warm Up and Strengthen Your Muscles – Warm up your muscles to prevent strain. Also, by strengthening your forearm and shoulder muscles, it will help decrease shock in the arm when hitting the ball and reduce the risk of tendonitis or “golfer’s elbow.”

• Learn the Correct Technique and Practice Gradually – By learning the proper way to swing, you will put less strain on your muscles and joints.  Tendonitis or tears of the rotator cuff can occur with poor backswing or overuse. Lessons from a golf instructor will help ensure the correct form.

• Use Correct Equipment – Using clubs that are too heavy or light may increase the risk of shoulder strain. It is important to use the correct equipment for your body type. Also, replace club handle grips as needed and get larger, softer grips to decrease wrist injuries.

• Wear the Proper Clothing – Wearing comfortable clothing protects you from the elements and wearing shoes such as cleats help your feet grip the ground, allowing for a more stable swing.
If you experience pain for more than seven days, visit an orthopedic surgeon to determine the extent of your injury and treatment options. While most injuries are not severe, more extensive injuries such as a torn rotator cuff or carpal tunnel syndrome may require surgery.  A delay in treatment could cause further damage and keep you off the course when the greens beckon.

From baseball to soccer to football, everyday millions of children and young adults participate in sports activities. These activities teach children team work and improve their physical fitness, coordination and self-discipline.  It also increases their chance of experiencing sports-related injuries such as concussions, sprains, fractures, muscle tears, and back and neck injuries. However, there are measures that can be taken to help prevent these types of injuries, such as:
• Undergoing medical exams prior to the sport’s season, which should include concussion screenings and physical evaluations;
• Using proper protective gear, such as shin guards for soccer and helmets for football and baseball;
• Staying hydrated and always warming up before practice or a game;
• Never playing through pain or an injury.

If an athlete does experience an injury it is important that it is not ignored or taken lightly.
Sports-related injuries in children are of great concern because their bones, muscles, tendons and ligaments are still growing. To avoid long-term damage, young athletes should seek immediate care for any minor or serious injury.

Following are several signs to help determine if immediate care is needed:
• Inability to play following a sudden injury;
• Decreased ability to play due to a chronic or long-term complication following an injury;
• Visible deformity of the athlete’s arms or legs;
• Severe pain from a sudden injury, which may prevent the use of an arm or leg.

Sometimes, sports-related injuries occur after office hours or on the weekends.  If and when this happens I recommend that my patients visit the emergency room or an orthopedic walk-in clinic like the one we have at Methodist Sports Medicine / The Orthopedic Specialists. One of our fellowship-trained orthopedic surgeons is available to treat patients with sudden or recent sports or active lifestyle-related injuries.  Patients can visit our Avon or Greenwood locations Monday through Friday from 8 a.m. to 10 a.m., or our Carmel location Monday through Saturday from 8 a.m. to 10 a.m. For more information, please visit www.methodistsports.com or call 317-817-1200.

According to the Health & Wellness section of associatedcontent.com, while these games can improve exercise for those who are inactive or need physical therapy, it can cause injuries if not used properly.  Some injuries include muscle strains and rotator cuff or shoulder damage. Most injuries from the Wii Fit are overuse injuries.

Here are some pointers when using the Wii and Wii Fit and how to avoid injuries:

• Stretch before your workout – As with any exercise routine, it is important to stretch before play Wii games.  Stretching for approximately eight to ten minutes warms up your muscles and prepares them for play. A majority of the Wii games involve rotating the shoulder.  Range-of-motion exercises will keep the shoulder muscles loose.

• Take 15-minute breaks – Just as you would take breaks during physical exercise and sports practice, remember to take 15-minute breaks when playing games on the Wii and Wii Fit. Since overuse injuries are so common, taking breaks will give your muscles a rest and help deter injuries.

• Know your physical limitations – Yes, the Wii is a game, but with any physical involvement, you need to know your limitations. If you feel pain or discomfort in your arm or shoulder, stop playing.

• Read the game warnings – The Wii instruction manual gives advice for use and warns of muscle and joint pain that can be caused by the games. Take a good look at these warnings before starting play to make sure you use proper techniques to avoid shoulder injuries.

It’s important to remember to check with your doctor before you start any exercise routine and ease into something new. If an injury does occur, speak with an orthopedic physician to identify a treatment option that fits your unique injury and individual lifestyle.

Many athletes already have begun training and conditioning in preparation for fall sports. Activities such as weightlifting can help build strength and endurance, but if done improperly can lead to a serious shoulder injury. In fact, approximately 7.5 million people go to the doctor for a shoulder problem each year, according to the American Academy of Orthopaedic Surgeons.

Some of the most common weightlifting shoulder injuries include a torn rotator cuff, tendinitis, bursitis, sprains and strains. Luckily there are ways to prevent, detect and treat these shoulder injuries. Follow these basic guidelines to lift weights more safely:

• Stretch before a workout: It’s important to warm up your muscles before lifting weights. Doing so will allow your muscles to become more flexible, which can help prevent future injuries.

• Don’t overdo it: A weightlifting routine should be done no more than four times a week for 20-30 minute sessions.  It’s always a good idea to conduct an evaluation with your trainer on a continuous basis to ensure you are using the proper lifting technique to avoid injury. Also, don’t increase weight amounts too quickly as this can place strain on muscles, which may cause you to use an improper? lifting technique.

• Know the warning signs of a shoulder injury:  There are several signs to look for to determine if you have suffered a shoulder injury. Those include a lack of movement and stiffness in the shoulder, inability to rotate the shoulder and arm in all normal positions, feeling that the shoulder could be dislocated and/or pain in the shoulder when doing daily activities. If you experience any or all of these symptoms, seek medical attention immediately.

Shoulder injuries should not be ignored. If you do experience pain or lack of motion, it is essential to obtain a consultation with an orthopedic specialist who can diagnose your injury and determine the proper course of treatment. Depending on the extent of your injury, your doctor may recommend rest, prescription pain and anti-inflammatory medication, or possibly surgery.

Fortunately, there are ways to prevent a rotator cuff tear.  Many orthopedic surgeons recommend one or all of the following prevention techniques: regular exercise; resting after using repetitive arm and shoulder motions; and applying cold or heat packs to reduce shoulder pain or inflammation. However, if you are unable to prevent a rotator cuff tear, there are many things you and your orthopedic surgeon need to consider before determining the form of treatment that will best treat your injury.

The decision on how to treat rotator cuff tears is based on the patient’s severity of symptoms, functional requirements and presence of other illnesses that may complicate treatment. At first your physician might recommend a nonsurgical treatment approach, which may include activity modification (avoidance of activities that cause symptoms), anti-inflammatory medications and physical therapy. 

Research shows that 50 percent of patients who use nonsurgical treatment options will receive relief from pain and discomfort.  However, the other 50 percent will need to consult with their orthopedic surgeon to determine if their injury requires surgery. Following are a few things to consider when making that decision:

• Degree of Symptoms – Patients with minimal symptoms may choose to delay surgery in an effort to achieve success with nonsurgical treatment options. On the other hand, patients who have more constant pain, difficulty with simple activities (e.g., getting dressed, lifting household objects), or pain at night interfering with sleep may opt to have surgery immediately.

• Requirement & Expectations – Some patients might not need rotator cuff surgery if their symptoms don’t interfere with their usual activities. On the other hand, athletic patients who injure their shoulder may choose surgery in order to return to their sport of choice.

• Type of Tear – Smaller tears can be monitored to determine if nonsurgical treatments can help alleviate symptoms. On the flip side, larger tears could benefit from earlier surgical intervention. Large tears can retract (leading to a permanently shortened tendon), and the muscle may irreversibly weaken, making it more difficult to delay repair. In patients with these tears, early surgery might help increase the likelihood of a successful recovery.

• Age of the Patient – Rotator cuff tears in people less than forty are rare but they do occur, and generally require surgery.  Rotator cuff tears will not heal without assistance and evidence shows that tears will likely increase in size as time goes by.  Admittedly, orthopedic surgeons do not know when this will occur, so those patients that have higher physical demands will likely need surgical intervention to repair a tear.

As we move into our 30s and 40s, our muscles and tendons can begin to degenerate and weaken, predisposing the shoulder joint to wear and tear disorders.  While rotator cuff injuries are the most common cause of problems in the aging shoulder, arthritis is also a frequent source of pain and disability. 
 
If you have experienced a previous shoulder injury or are genetically predisposed to shoulder arthritis, it’s important to be familiar with the symptoms of this condition so that you can address any arthritis problems early and prevent extensive damage. The most common symptoms include:

• Pain with activities
• Limited range of motion
• Night-time discomfort
• A feeling of grinding or catching within the joint

Similar to other arthritic conditions, initial treatment of shoulder arthritis is usually nonsurgical and may incorporate physical therapy and medications. Nonsurgical treatments may include shoulder exercises, nonsteroidal anti-inflammatory medications (e.g., ibuprofen, Advil or naproxen) and the application of moist heat or ice two or three times a day to reduce inflammation and ease pain. If nonsurgical treatments do not reduce the pain, surgery may become an option. Not all treatments are appropriate in every patient, and you should have a discussion with your orthopedic doctor to determine which treatments are appropriate for your condition.

The most common shoulder injuries included sprains, strains, dislocations, separations and fractures. Of those injuries, 6 percent required surgery, and dislocations and separations accounted for more than half of all shoulder surgeries. In addition to surgery, rehabilitation was extensive, with almost one in four athletes missing at least three weeks of their athletic season following their shoulder injury.

These findings illustrate that athletes need to take precautionary measures while competing. Following are a few things to consider:

• Do not ignore shoulder pain and “play through” an injury. This will only aggravate the condition and may possibly cause more problems.

• Early detection is key to prevent serious shoulder injuries.

• There are a number of shoulder exercises that athletes can do to strengthen their shoulder muscles, including:

- Basic shoulder strengthening – Attach elastic tubing to a doorknob at home. Gently pull the elastic tubing toward your body. Hold for a count of five. Repeat five times with each arm. Perform twice a day.

- Wall push-ups – Stand facing a wall with your hands on the wall and your feet shoulder-width apart. Slowly perform a push-up. Repeat five times. Hold for a count of five. Perform twice a day.

- Shoulder press-ups – Sit upright in a chair with armrest, with your feet touching the floor. Use your arms to slowly rise off the chair. Hold for a count of five. Repeat five times. Perform twice a day.
If you think you might be suffering from a shoulder injury, seek medical attention immediately. It’s better to be safe than sorry.

Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching and weightlifting. Injuries also can occur during everyday activities such as washing walls, hanging curtains and gardening.

To prevent injury, there are a number of exercises that you can use to help strengthen the shoulder muscles. A basic strength training program and stretching program done three days per week is usually sufficient to maintain overall muscle integrity. The stronger and more flexible your joints, the more easily they are able to withstand impact or hold up under repetitive motions. You may also consider working with a physical trainer to ensure that you are using proper body mechanics, which also can help prevent shoulder injury.

If you are experiencing pain in your shoulder, there are a few things you should consider:  

• Is the shoulder stiff? Can you rotate your arm in all the normal positions? 

• Does it feel like your shoulder could pop out or slide out of the socket? 

• Do you lack the strength in your shoulder to carry out your daily activities? 

If any of these things are a factor, you should consult an orthopedic surgeon for help in determining the severity of the problem. If you are suffering from a shoulder injury, such as a strain, capsule tear, bursitis, tendonitis, or a separation or dislocation, medical care should be sought immediately.

Question: I played football in high school and like to stay active in sports and weight training, but lately, I’ve been experiencing pain and limited range of motion in my shoulder.  I suspect a rotator cuff strain or injury.  Am I on the right track?

Answer: Shoulder pain is a common occurrence.  The good news is that the majority of shoulder pain can be treated non-operatively.  Most of the ache in the shoulder of middle aged people is due to an imbalance of the shoulder musculature.   This imbalance causes the muscles in the shoulder to work poorly, leading to impingement of the rotator cuff underneath the tip of your shoulder (acromium).  The common name for this condition is rotator cuff tendonitis or bursitis or impingement syndrome. It can be analogous to the imbalance that occurs on the tires in your car.  Just wear and tear can cause an imbalance or you can run your car into the curb.  The results are the same. You are able to drive the car, but not really well.  Your shoulders can experience the same problem.

With activity modification, physical therapy and the use of nonsteroidal medications the balance can return.  Occasionally your physician may recommend a steroid injection into the subacrominal space (space underneath the acromium where the rotator cuff tendon lies), attempting to bathe the rotator cuff tendon causing a shrinkage of the tendon and preventing an impingement of the rotator cuff.  When the balance is restored, the pain usually decreases.

If conservative measures fail then operative intervention may be necessary.  Your doctor may recommend an acrominoplasty.  This is performed as an outpatient surgery and usually requires approximately 3 months of recovery.  The surgery is designed to increase the space for the rotator cuff tendon, thus stopping the impingement process.   The post operative exercises can now help to balance the shoulder.

If these symptoms sound familiar seek the counsel of an upper extremity surgeon.

Transcript from Indianapolis Colts “Medical Minute”

Question: My husband dislocated his shoulder two days ago.  He said it happened once before in high school but that it feels much worse this time.  Does he need surgery?

Answer: There is a very good chance that surgery won’t be necessary. 

When young people experience shoulder injuries, about 95 percent will have recurrent problems in the future.  However, if this is your husband’s first injury since high school, he should respond well to a combination of ice, pain medications and physical therapy. Of course, if the pain and disability continue, we could certainly consider surgery as another option.

As it appeared in the Indianapolis Star - September 16, 2008

By Barb Berggoetz

Stiff, painful shoulders causing problems?

While the American Academy of Orthopaedic Surgeons estimates the disorder affects about 2 to 3 percent of people in this country, Dr. Pete Sallay, of Methodist Sports Medicine/The Orthopedic Specialists, believes the number is higher because many are misdiagnosed or not diagnosed at all.

“Many people are thought to have bursitis or arthritis because the initial stages of the disorder can mimic these diseases,” he said.

Although the exact cause is unknown, certain factors may increase your risk: age (40-70 years), gender (women are affected three times more than men), diabetes, thyroid conditions, cardiovascular disease and lung disease.

Here are ways Sallay says to identify the disorder and encourage the thaw:

Recognize the signs: Onset is gradual; initial stage results in vague pain or constant dull ache in shoulder, radiating into the arm. Gradual stiffening occurs over weeks or months, as the capsule surrounding the joint thickens and shrinks. Rapid movements may cause sharp pain that can linger.

Understand the stages: First “freezing” stage can last six weeks to nine months, with onset of pain and loss of motion. Over the next four to nine months, in the “frozen” stage, pain may improve but stiffness remains. In the “thawing” stage, shoulder motion slowly returns to normal, but physical therapy is needed.

Seek medical advice: Many patients ignore temporary symptoms. If significant pain progresses, combined with stiffness, restricted range of motion and night pain in arm, seek the care of an orthopedic surgeon.

Know treatment options: Treatment consists of anti-inflammatory medications, occasional injections and, in later stages, physical therapy. Heat and cold can relieve short-term pain. Surgery may be needed if symptoms don’t improve.

More