Sports Injury Conditions

Ankle SprainBroken Collar BoneBroken Hand | DehydrationDislocated KneeForearm FractureFractured Fibula | FracturesGroin StrainMeniscus TearShoulder (AC Joint)Torn Achilles TendonTorn ACL | Torn Labrum


 
Ankle Sprain

Most people know what a sprained ankle feels like, but what's causing the pain? It's the ligaments, the flexible tissue that bonds your bones and keeps your joints stable, that are stretched or torn. The injury usually affects one or more ligaments on the outside of the ankle.

Types Of Ankle Sprains

The three types of ankle sprains:

  • Grade 1: Stretched ligaments that will improve with light stretching.
  • Grade 2: Partially torn ligaments that could require a splint or cast.
  • Grade 3: Fully torn ligaments that might require surgery. When it happens, you'll feel severe pain.

BJIanklesprain.jpg

Recovery Time

The recovery timetable depends on the extent of the injury. Nearly all ankle sprains are managed non-surgically. Mild injuries can often be rehabilitated quickly, with players returning to play the following week. More severe ankle sprains, and those involving the end of the tibia and fibula (high ankle sprain), require a much longer period of rest and rehabilitation.

When Does An Ankle Sprain Turn Black And Blue?

Grades 2 and 3 sprains could include tears in small blood vessels. Blood that then leaks into tissues causes the discoloration, even though it might not show for several days. The blood is usually absorbed from the tissue within two weeks.

Low Ankle Sprain vs. High Ankle Sprain

A low ankle sprain affects the ligaments supporting the subtalar joint, just below the true ankle joint -- a set of of three bones, the tibia (inside part of ankle), fibula (lateral, or outside) and the talus (lower). A high ankle sprain affects the ligaments connecting the tibia and fibula, the lower leg's two bones.  A high ankle sprain hurts whenever you place rotational force on the ankle.

Cutting puts more stress laterally, which is where the ankle sprain commonly occurs. A severe high ankle sprain would not tolerate even straight running for up to 8-12 weeks.

Treatment

A low ankle sprain is usually caused by an inward twisting motion. It's less serious than a high ankle sprain  -- most athletes will return anywhere from a few days to a month. Recovery from a high ankle sprain, often caused in football when a player plants a foot on the ground before an extreme outward twist of the foot, can take 4-6 weeks. 

Severe high ankle sprains can take up to six months and might require surgery. An X-ray, CT scan or MRI can help determine if you have a high ankle sprain or possible fracture.

A cast, splint or brace and physical therapy could part of the recovery plan, depending on the injury's severity.

If you suffer a mild ankle sprain:

  • Apply ice hourly during waking hours, 20 minutes at a time, for the first 24 hours after the injury.
  • After the initial 24-hour period, apply ice for 20 minutes three or four times a day.
  • Warning: Even though pain medications (ibuprofen) can reduce pain and swelling, do not use them for 24 hours after the injury because it could increase the risk of bleeding.

Back to top

Broken Collar Bone

It's hard to miss a broken collarbone because the injury is usually caused by a direct blow or the violent impact when falling, or being driven, to the ground.

It's a break in the clavicle (also called collarbone), the bone that extends from the front of the shoulder to the sternum (breast bone) in the middle of the chest.

The clavicle is a strut that connects the entire upper extremity to the rest of the skeleton. It is important in the elite athlete to restore normal length and alignment to the clavicle to optimize muscle function around the shoulder.

Where It Breaks:

Middle: The most common area.

Distal: The end, where it connects to the shoulder.

Medial: The other end, where it connects to the sternum.

Fracture location can predict stability of the fracture and need for surgery. Medial fractures are rare and are almost always treated nonoperatively. Mid-clavicle fractures and some distal fractures can be more displaced and more likely to need surgery, particularly in the throwing arm.

BJICollarbone.jpg

Pain

It's substantial. You might have only a slight crack or the bone could break into multiple pieces, a comminuted fracture. The pieces can remain aligned or become displaced. The pain makes it hard to move your arm.

Because the injury is usually caused by a direct blow or the violent impact when falling, or being driven, to the ground, it's hard to miss a broken collarbone.

Some symptoms:

  • Pain when moving the shoulder.
  • Difficulty lifting the arm because of the pain.
  • A bulge in the shoulder area.
  • Tenderness, swelling and bruising.
  • A grinding feeling as you raise the arm.
  • Shoulder sags down and forward.

A newborn can suffer a birth-related collarbone fracture. (The baby will not move the arm for several days.)

Treatment

After an X-ray confirms a fracture, your arm is immobilized using a sling or other method for up to six weeks. You'll need pain medication to get through this period. After the initial immobilization, try to avoid shoulder stiffness with deliberate arm movements. Avoid any type of lifting.

If the injury is to the middle-third of the clavicle with minor displacement, you might avoid surgery. As the pain subsides and you no longer need a sling, you can begin range-of-motion exercises recommended by a physical therapist. After radiography testing and your doctor's approval, you can begin overhead activities. You can return to your favorite sport up to six weeks after the injury has healed.

These injuries are pretty easy to rehabilitate. The fracture does not affect the shoulder joint so there should not be problems with loss of mobility. Once pain is diminished, you can get moving right away.

Risk Of Reinjury

If the fracture is completely healed in anatomic or near-anatomic alignment, it will be as strong, or possibly stronger than its pre-injury state.

The challenge with athletes is getting them back early and if the fracture repair site is partially healed it is still the weak area for reinjury. New bone starts to form at 6-8 weeks but it can take several weeks more to be mature bone, capable of taking hard impact. Surgery may facilitate earlier rehabilitation.

Recovery Time For The Athlete vs. Non-Athlete

Any blunt impact to the top of the shoulder, or a fall on the shoulder can cause a clavicle fracture.

Recovery time is similar for the civilian - the decision to operate or treat in a sling depends partially on the individual patient's demands.

Back to top

Broken Hand

Someone with a simple pattern wrist fracture (extra-articular distal radius fracture) can have surgery and rapidly rehabilitate. Fractures that disrupt the joint surface can take a little longer. Metacarpal fractures are problematic because no matter how they are treated (operative or nonoperative) stiffness of the band is a problem.

What Constitutes A Broken Hand?

The hand has 27 bones, including the wrist. When one of these bones is fractured, it can affect the use of your hand wrist and fingers.

  • Carpals: The 8 bones in the wrist, technically not part of the hand but vital to the hand's movement.
  • Metacarpals: The palm's 5 bones.
  • Phalanges: The 14 small bones that form the fingers and thumb.

A carpal fracture, usually caused by a fall braced by the hand, causes immediate pain with swelling and, eventually, bruising. The wrist is difficult to move and tender.

A metacarpal fracture, often near the knuckle in the small finger of athletes, especially boxers. (A break in the neck of the metacarpal, frequently caused by hitting something with closed fist, is often referred to as a "boxer's fracture.") Treatment begins with a splint that leaves room for additional swelling, with fingers exposed so they do not stiffen.

A finger (phalange) fracture: This injury is grouped into three types:

  • Avulsion: When ligament or tendon, and part of the accompanying bone, is separated from the main bone.
  • Impacted: The ends of fractured bone driven into each other.
  • Shear: A bone split by force.

The risks: Sports, motor vehicle accidents and falling onto opened hand.

Hand.jpg

Symptoms

  • Severe pain that worsens with movement.
  • Swelling.
  • Bruising.
  • Tenderness.
  • Limited range of motion.
  • Bent or crooked finger.
  • Numbness in hand or fingers.

If it happens to you: Call your doctor or visit an hospital emergency department. Apply ice to the injured area as soon as possible to reduce pain and swelling. Swelling may be severe, so remove any jewelry on the hand or wrist. Otherwise, it might have to be cut off if there's a danger it will restrict blood circulation. Take acetaminophen or ibuprofen to treat pain and swelling.

Diagnosis

An X-ray, description of how the injury happened and an examination of your fingers, hand and wrist will help the doctor determine the type of fracture.

Treatment

Your hand might be placed in brace, splint or cast to restrict movement. A broken finger might be secured to the adjacent finger for support. An open fracture, or compound fracture, with a break in the skin near the broken bone may require debridement, a cleaning that removes damaged and infected tissue.

Nerve and blood vessel damage is not likely unless there is an open wound with the fracture. Some may get a feeling of numbness or tingling, but that is likely just a transient nerve bruise that should resolve quickly and completely.

Which hand injury is least likely to heal properly? A fracture of the joint surface of the phalanges/metacarpals.

Do you have to worry about osteoarthritis years after a broken hand? No - if the fracture does not affect the joint surface and the bone heals in reasonable alignment, arthritis is not such a problem down the road. Since we don’t walk on our hands, any arthritis of the majority of the hand is well-tolerated. Look at anyone you know with knuckles that look thick -- that’s arthritis -- and only complaint they may have is trouble getting a ring on or off.

Types Of Surgery

  • External Fixation: Screws placed through your skin and into your broken bones. The screws are then secured to an external device that stabilizes the bones.
  • Pin Fixation: Metal pins straighten and hold the pieces of broken bone in place as they heal.
  • Open Reduction And Internal Fixation: Screws, a metal plate and other methods hold together your broken bones.
Rehabilitation: Occupational therapists are critical in hand rehabilitation. In pro sports, compliance with rehab is near 100 percent. "Weekend warrior" compliance is less consistent.
Dehydration

Water makes up about 60 percent of our body composition and is essential for proper circulation and metabolic function within organs and tissues.  Dehydration results in reduced plasma volume, reduced cardiac output, and can adversely affect performance with as little as 2 percent loss of body weight due to water loss. Inadequate hydration/electrolyte balance predisposes to muscle aches and, worst case, debilitating cramps that can be as (or more ) painful as any other orthopedic injury.

Dehydration Risks

For the athlete, dehydration heightens the risk of injury. Sodium and potassium, electrolytes controlled by the body to aid the contraction and relaxation of muscles, are lost during rigorous physical activities. Athletes unaccustomed to high altitude are particularly vulnerable. 

Sports And Dehydration

An athlete can lose up to 3 quarts of fluid an hour during intense physical activity. A trainer or team doctor looks for muscle aches and repeated cramping that's not responding to stretching/warming.

What Is High Altitude?: High altitude is 5,000 to 11,500 feet, very high altitude 11,500 to 18,000 feet. Anything beyond 18,000 feet is classified as extreme altitude. (Hartford is 59 feet above sea level.)

The effects of high altitude: Because sweat evaporates more quickly because of lower humidity at higher altitudes, you might not realize how much fluid you're losing during physical activity and the need to replenish with water. The lower oxygen levels at higher altitudes also force your body to adapt: Your breathing becomes faster, and deeper, accelerating the loss of fluids. Your body loses water twice as fast, in fact, at high altitude.

Signs Of Dehydration

An estimated 20 percent of people experience mild symptoms at altitudes between 6,300 and 9,700 feet.

  • Fatigue.
  • Dizziness.
  • Light-headedness.
  • Drowsiness.
  • Slower reaction time.
  • Reduced aerobic capacity.
  • Shortness of breath after physical exertion.
  • Increased heart rate.
  • Swelling (hands, feet and face).
  • Naseau, vomiting.
  • Impaired judgement.

What Is Altitude Sickness?

This phenomenon is more likely experienced by mountain climbers who go too high, too fast. Types of altitude sickness:

  • Acute Mountain Sickness (AMS): Headache, nausea and fatigue.
  • HAPE: Breathlessness form excess fluid on the lungs. This life-threatening condition can cause a fever and pink, frothy sputum.
  • HACE: Fluid on the brain. Drowsiness and loss of consciousness followed shortly by death.

How To Prevent Dehydration

Everyone knows the solution is drinking water, but how much and when? Drink fluids regularly during physical activity, including a sports drink with electrolytes (mostly salt) if needed. Don't wait until you feel thirsty. If you do, you might be dehydrated already.

Athletes should not rely on thirst as an indicator of need for fluid because it is not reliable. Athletes should develop a hydration routine starting with a baseline that is supplemented prior to, during and after athletic activities.

Weigh yourself before an immediately after physical activity. If you've lost weight, it's fluids. For every pound lost, you workout should include an additional 20 ounces of fluids.

Drink 14 to 22 ounces two or three hours before a workout, says Dr. Rios, then 4 to 12 ounces every 15 minutes during athletic activity.

Water Or Sports Drink To Maintain Hydration?

Beverages supplemented with 4 percent to 8 percent of carbohydrates are recommended during activities lasting longer than 1 hour.  Sodium content must also be at normal levels, so it is commonly added to sports drinks. But, it's mostly a personal preference.

Back to top

Dislocated Knee

A knee dislocation is the worst of the worst. In broad terms, the knee is stabilized by four ligaments -- the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. A knee dislocation means that at least three, and sometimes all four, of these ligaments are ruptured. It is a very high-energy injury and there is risk of nerve and blood vessel damage when this occurs.

What's A Popliteal Artery?

It's an extension of the femoral artery after it routes through the thigh and, as it reaches the popliteal area in back of the knee, splits into the anterior and posterior tibial arteries. It is the primary blood supply to the leg below the knee, which explains the urgency of Miller's treatment. If blood flow is not restored within six hours, the patient risks losing the leg. Mark Bowen, the Bears' team doctor, was credited with identifying the vascular emergency by noticing Miller's dropping pulse.

Comparable Cases

When Chicago Bears tight end Miller dislocated his knee in an October 2017 loss to the New Orleans Saints, ESPN reported that the artery was "shredded from above the knee joint to below the knee." Miller, the network said, was in danger of losing the leg. Emergency surgery that night repaired the damaged popliteal artery in his leg.

Napoleon McCallum, a former Los Angeles Raiders running back, didn't play again after doctors replaced his popliteal artery in 1994 after his leg was twisted severely in a game against the San Francisco 49ers. Robert Edwards, a New England Patriots running back, likewise injured his knee while playing flag football on Waikiki Beach in 1999 after his rookie season. Although he avoided having his leg amputated below the knee, doctors told him he might not walk again. Edwards, in fact, resumed his football career in 2002  in a part-time role with the Miami Dolphins. In 2005, he rushed for more than 1,000 yards with the Canadian Football League's Montreal Alouettes.

Running back Willis McGahee, while at the University of Miami, suffered a torn ACL, PCL and MCL in the national championship Fiesta Bowl following the 2002 season. McGahee, whose injury did not include vascular damage, was drafted in the first round by the Buffalo Bills in 2003.

Dislocated-Knee.jpg

Knee Dislocation With Vascular Damage

Multiple orthopedic surgeries are needed to reconstruct the torn ligaments.

The popliteal artery is the primary blood supply for the entire lower leg and this artery is at high risk for injury with a knee dislocation. Nerve injury, ranging from a brief period of numbness to complete paralysis of some of the muscles to the ankle, can also occur with a knee dislocation. In this case, an injury to the popliteal artery occurred and this is what required emergency surgery.  If this injury was not treated he would have been at risk for permanent muscle damage or, worst case, amputation.  It will take some time before he is ready to undergo ligament surgery because the artery injury needs time to heal before planning a large surgical procedure.

Outlook: People with a knee dislocation can face even more problems if they suffered damage to two branches of the sciatic nerve, the common peroneal nerve and the tibial nerve.

Best-case recovery scenario for an athlete: Nine or 10 months, but often you do not see players coming back from this injury at the same capacity, or at all. If the athlete required a stent or a bypass to treat his arterial injury, it is unlikely that anyone would recommend he return to a contact sport.

Back to top

Forearm Fracture

In everyday life, arm fractures account for close to half of all broken bones in adults. (For children, collarbones and forearms are 1-2 in bone breaks.) The radius, because it's weight-bearing, is the forearm bone fractured most often.

For an athlete, eight weeks is a standard guideline for this injury. Some NFL players miss little time because they can play wearing a cast -- Carolina Panthers linebacker Thomas Davis played in Super Bowl 50 two weeks after suffering a similar injury -- but that's not an option for a quarterback.

A simple fracture pattern in the mid-portion of the ulna should heal and rehabilitate fully. A fracture near either end of the ulna can involve the motion and function around the elbow or wrist joint, and greatly affect motion and function here.


What's The Ulna?

It's one of the forearm's two bones. Drop your arms to your side, palms facing outward. The bone closest to your body is the ulna. It's longer and larger than the forearm's other bone, the radius. (While maintaining that palms-out position, the radius is closest to your thumb.) The ulna is biggest at the elbow, the radius biggest at the wrist. Together, they give the forearm its rotational flexibility -- that's how you were just able to turn palms up or palms down.

NewForearm.jpg

Where's The Fracture?

Forearm fractures can happen near the wrist (distal), in the middle of the bone or near the top (proximal), near the elbow. It's among the most common injuries in the NFL. Players return routinely, but perhaps at some long-term cost: A Washington University (St. Louis) study published this year found that the careers of players who underwent surgery for a forearm fracture were shortened by one year and that they played in almost two fewer games a season than the "matched control" segment of the study.

Does that mean broken forearm bones do not heal the same way as, say, a broken collarbone? This depends on the forearm bone that is fractured. The motion of the radius is more complex and any alteration of the anatomy to this bone can affect forearm function.  The ulna functions more like a hinge at the elbow and is not as involved with forearm rotation.

Radius vs. ulna fracture: It depends on the mechanism of injury, but radius fractures are more common. The ulna is more often fractured from a direct blow, whereas radius fractures, especially those closer to the wrist joint, are much more common with falls on an outstretched arm."

Signs of a broken forearm: Sudden, extreme pain and, in severe cases, bone sticking out at the skin's surface.

Treatment/Recovery

When a fracture is suspected, immediately put the arm in a sling and try to keep it immobile. If X-rays indicate the bones are not displaced, a cast will be required for 4-8 weeks. If the bones are out of place, they can be manipulated manually or through surgery. In surgery, the bones are pinned or plated together.

Recovery is probably a little longer for the non-athlete - typically it will take six to eight weeks before an athlete with these types of injuries are back on the field.

If you break one or both of your forearm bones, expect some cryotherapy (cold-pack treatment), followed by 6-8 weeks in a hard cast. After such inactivity, you'll need muscle-strengthening exercises for your forearm and wrist. Both areas will have at atrophied and lost strength. Your physical therapist will devise a program to strengthen every muscle related to the wrist joint. Wrist pain or stiffness caused by scar tissue could be treated with deep tissue massage.

Next, weight-bearing exercises using resistance bands or other exercises using your own weight, such as pushups, will help restore the forearm's normal function.

The biggest risk is too much stress too soon. Stressing a fracture too soon can lead to delayed healing, or complete failure of healing.

Back to top

Fractured Fibula

Any contact sport -- football, soccer or lacrosse -- increases the risk of a traumatic fibula injury. If you play a sport that requires sharp twists, such as basketball, you're also vulnerable. In everyday life, people with hormone disorders, nutritional deficiencies and metabolic disorders are at greater risk.

What's a fibula?

A lower-leg bone that extends from the knee to the outside of the ankle parallel to the tibia (shinbone). It stabilizes the ankle and supports lower-leg muscles. A severe ankle sprain can cause a fibula fracture. It's a fairly common injury in the NFL. 

Where's the Fracture?

That's the critical question. A fracture in the upper half, though rare, is often allowed to heal on its own. A fracture in the lower half is far more complicated and typically requires surgery.

This has to do with the mechanism of injury and stability of the fracture, as well as the proximity to the joint surface. Most fractures around the upper part of the fibula are actually the result of an injury that started at the ankle. For example, a severe twisting can cause a fracture around the ankle and the energy travels up the leg and exits near the upper part of the fibula.

People can also tolerate some malalignment of a fracture in the upper and mid-portion of the fibula.  It is important to restore normal alignment near the ankle to allow normal motion of the ankle and minimize the risk of post-traumatic arthritis.

Three types of fibula fracture:

  • Caused by injury to the ankle joint.
  • Part of injury that includes a tibia fracture.
  • Stress fracture.

"An acute fracture will generally take longer to recover from than a stress fracture because there has been more disruption," says Dr. Rios. "The Key to both injuries is allowing ample healing time because the fracture can become worse if stressed too soon.

The bones in a woman's foot:

NewFibula.jpg

Treatment

Sometimes, an isolated fibula fracture -- a classic "twisted ankle" -- that doesn't affect the ankle joint can be treated with a brace, no surgery required. An injury to the inner portion of the ankle, however, can require surgery.

An orthopedic surgeon can manipulate the bone into its proper place and reinforce the bone with a metal plate and screws.

Plate and screw fixation is the standard. Generally, these are left in, but it is not uncommon to remove them because once the swelling goes down this hardware can be prominent and may be bothersome.  Hardware removal does carry some risk of refracture when the bone is stressed, so it is important to weigh the risks and benefits of removing the plate and/or screws.

How painful is a broken fibula? Probably not as painful as a fracture of a load-bearing bone like the tibia.

Not all fractures are created equally, but they still hurt. The fibula bears approximately one-sixth of the body's load.  The tibia bears the majority.  An isolated fibula fracture can, in some circumstances, be considered like a bad ankle sprain.

Because the fibula is not a weight-bearing bone, your doctor might allow you walk as the injury recovers. You also might be advised to use crutches, avoiding weight on the leg, until the bone heals because of the fibula's role in ankle stability.

Fibia fracture vs. knee injury (torn ACL): A fractured tibia will cost an athlete playing time in the short term but usually has no long-term effects. A serious knee injury to a NFL running back or receiver can alter a career.

Athletes tend to recover better from fracture than a ligament or tendon injury. Fractures heal without a scar and bone heals to bone better than it heals to ligament or tendon. A key distinction in a fracture around a joint is whether the cartilage -- protective covering of the bone at a joint surface -- got injured. A bad cartilage injury in association with a fracture is going to be much more detrimental to career length.

Rehabilitation

It's a slow recovery, starting with minimal weight on the injured ankle. Your physical therapist will recommend exercises that help tissues heal by enhancing blood flow. You can also work out, even with one leg, by doing water exercises, using an elliptical machine with the injured leg supported, rowing and yoga.

Typically, it's non-weight-bearing or limited weight-bearing for six weeks. Most fractures will have some degree of protected weight-bearing for 10-12 weeks, then at least another month to fully rehabilitate.

Back to top

Fractures

Fractures of the bones, or broken bones, can occur in the collarbone (clavicle), hand, forearm, leg (fractured fibula), ankle (fractured tibia) and more.

Signs of a break include sudden, extreme pain and, in severe cases, bone sticking out at the skin’s surface.

Broken bones can range from a hairline fracture to a complete separation into two or more pieces. Fractures can occur along with other injuries like strains, sprains and dislocations.

Recovery time can range from a few weeks to many months depending on the location, severity and type of fracture. Recovery also depends on the age and condition of the athlete and whether other injuries have occurred that could complicate treatment.

Learn more 

Back to top

Groin Strain (Pull)

Groin strains are common in any sport that requires running and jumping. Hockey players are also susceptible to groin injuries. 

What is a groin strain (or pull)?

It's a muscle injury caused by sudden or forceful movement in the front hip that affects the primary hip flexor muscles or the hip adductor muscles (or, sometimes, both areas).

The adductor (groin) muscles are a group of muscles that primarily adduct the thigh, or bring the thigh closer to midline (squeezing the legs together). They are involved with lateral movements primarily, but also have activity with running straight. It's important to test agility and strength with cutting and other explosive lateral movements prior to returning to competition.

The three degrees of groin strains

Grade 1: Overstretched or torn muscle, damaging up to 5 percent of muscle fibers. It's possible to walk without pain but running, jumping, stretching and other "football activities" are truer tests of the injury.

Grade 2: More significant damage to muscle fibers caused by a tear. Walking might cause pain.

Grade 3: A tear through most or all of the muscle or tendon. The injury causes severe pain, immediately, and much swelling and bruising. Don't even try running or jumping. The injury is so severe that you might actually feel the space where muscle fibers have been torn.

A groin strain can feel like a pop or snap when it happens, but later you might also feel pain when:

  • Closing your legs.
  • Raising a knee.

What might appear to be a groin strain deserves closer examination because the similar symptoms are caused by bursitis of the hip, a hip strain or a stress fracture.

Recovery/Treatment

A mild groin strain might require three weeks of rest. A more serious strain could take up to six weeks. A complete tear would require surgery and up to three months' recovery. Your doctor might also request an MRI to confirm a mild-grade strain.

An MRI can provide some objective evidence regarding the extent of the injury, but is not typically necessary for every muscle strain. If an athlete can get up and bear weight with minimal or no assistance, this is a good sign that the injury may be more mild.  An athlete who cannot put weight on the injured leg may have a more severe injury.

How much time missed often depends on treatment. A standard regimen includes protection, rest, ice, compression and elevation, or P.R.I.C.E.

Protection: Don't aggravate the injury. A Grade 2 groin strain might require crutches.

Rest: Let the injury heal. It takes time.

Ice: Ice reduces swelling and lessens pain. Treat the injury for 10 to 15 minutes, skin protected, pause up to two years, then apply ice gain. For profession athletes, a cold-therapy machine provides consistent cold temperatures for deeper penetration into damaged tissue and active compression that aids recovery.

Icing is important but mobility is good for muscle recovery too. The muscle will want to tighten up after an acute injury and early motion can help with the recovery process.

As treatment progresses, with reduction in pain and swelling, heat (either moist or dry) replaces ice as rehabilitation shifts to regaining strength and range of motion. Heat applied for up to 15 minutes increases circulation to the affected tissue, increasing tissue extensibility. With renewed flexibility, you can begin stretching exercises.

When full range of motion is restored, you can begin functional exercises for the hip, such as lunges and wall squats. In the final stage of recovery, the athlete resumes exercises related to his or her sport.

Back to top

Meniscus Tear

A partial meniscectomy for a tear that involves relatively little of the meniscus will allow a quick return to sport. A repair of any significance will keep someone out 4-5 months, at least. 

Most athletes are going to be treated surgically.  If the tear is small, they can try to get through the season on it, particularly if there are not many symptoms.The risk is another injury causing a larger tear.

Meniscectomy in an NFL lineman, for example, is more detrimental to knee function and career length than an ACL injury. That's likely because meniscus is a critical shock absorber and in heavier people degenerative arthritis will occur rapidly after loss of meniscus.

The overall outlook for other athletes, like basketball players, who put an extreme load on their knees can face rapid deterioration over subsequent years.

What is meniscus?: It's rubbery, C-shaped cartilage in your knee joint that acts as a shock absorber between bones in a joint. The knee includes the thigh bone (femur), leg bone (tibia) and kneecap (patella). Each knee, between the femur and tibia, has an inside (medial) and outside (lateral) meniscus.

Meniscus.jpg

Risks

A blow to the knee, like a hard tackle in a football game, can causes a tear. Twisting or overextending your knee and quick direction changes can cause a meniscus tear, too. In everyday life, squatting to pick up a coin on the ground can do it.

First signs of torn meniscus: Pain, on either side of the knee (not around the kneecap), and swelling. An athlete often describes the sensation of tearing a meniscus as a pop. 

Treatment

First, your doctor will want an MRI to see if the meniscus has been stretched or torn and X-rays that will reveal any damage to the surrounding bones in the knee. If it's a mild tear, some RICE will help:

  • Resting your leg.
  • Icing your knee three or four times a day for 20 minutes.
  • Compressing the affected area with a compression wrap or elastic bandage.
  • Elevating your leg above heart level.

Surgery: The meniscus does not heal on its own without surgery. If surgery is required, your doctor will repair or trim the meniscus using an arthroscope. In most cases, the torn fragments are removed. About 80 percent of the meniscus has no blood supply, which prevents healing when torn (even after being repaired and stitched). Recovery is longer for a repair, but preserves the knee’s long-term function.

Removing torn meniscus, a minimally invasive procedure, requires two or three small punctures. The patient might need crutches for a few days, but the non-athlete can return to work in a couple days. The athlete can return in 4 to 6 weeks, which includes physical therapy.

Meniscus removal, for any patient, increases the risk of arthritis starting at age 45 to 50.

Back to top

Shoulder (AC Joint)

Hartford HealthCare Sports Health sees dozens of shoulder-separation injuries each year, usually around football, hockey and lacrosse seasons. The great majority are treated non-operatively.  Even mild or moderate injuries are well tolerated, once the acute pain/inflammation resolve. The ones that need surgery have significant displacement (Grade 5) and can cause moderate dysfunction of the shoulder.

What's The AC joint?

The acromioclavicular (AC) joint is the small joint, two bones, at the front the shoulder at the junction of the collarbone (clavicle) and the bone at the tip of the shoulder (acromion). Four ligaments hold the clavicle and acromion in place.

An AC joint sprain, or separation, occurs when the ligaments are stressed, either by trauma or overuse.

What's the difference between a shoulder separation and shoulder dislocation?: A shoulder separation affects the AC joint. Your shoulder is dislocated when the bone in your upper arm pops out of the socket at the shoulder blade.

Types Of AC Joint Injuries

Each of these most common classifications qualify as an AC joint sprain, or shoulder separation.

  • Grade 1: A mild shoulder separation. Ligaments partially torn or stretched but no visible lump on the shoulder.
  • Grade 2: A partial separation. The AC ligament is torn but the coracoclavicular ligaments, which stabilize the AC joint, are undamaged. A small lump is visible on the shoulder.
  • Grade 3: A complete separation of the joint. The AC ligament and coracoclavicular ligaments are completely torn. A more pronounced bump is visible on the shoulder.

Whatever the severity, the injury rarely requires surgery. Injuries are common during football, hockey and lacrosse seasons. The great majority are treated non-operatively.  Even mild or moderate injuries are well tolerated, once the acute pain/inflammation resolve. The ones that need surgery have significant displacement (Grade 5) and can cause moderate dysfunction of the shoulder.

Symptoms

Your doctor will suspect an AC joint sprain if you have:

  • A visible lump above the shoulder.
  • Loss of shoulder strength, movement.
  • Swelling, bruising.
  • Pain when lying on the injured side.
  • A popping sound feeling that joint "catches" when moving the shoulder.
  • Pain when lifting significant weight either overhead or across the body.

Problems with the AC joint lead to pain with direct contact (like a collision to top of shoulder), reaching across body and reaching above shoulder level.

Treatment

 An AC joint injury is treated initially with PRICE therapy.

  • Protection: Protect damaged tissue to prevent further damage.
  • Rest: Stop training. Take it easy and allow time for healing. Check with your physical therapist before resuming exercise.
  • Ice: The simplest and most effective treatment after the injury. It reduces bleeding and the risk of cell death. It will also reduce pain.
  • Compression: Reduces swelling.
  • Elevation: Drains fluid from the injury, reducing swelling and pain. Elevate the ankle above the hip.

An anti-inflammatory (example: ibuprofen) can reduce pain and swelling. Your doctor will recommend immobilizing the shoulder by placing it in a sling for up to three weeks -- or four weeks for a Grade 3 sprain. A Grade 3 sprain might require surgery. Broncos quarterback Trevor Siemian missed one week last season with left shoulder (non-throwing) Grade 3 separation but chose off-season surgery.

Taping the joint for two or three weeks is also an option to provide support as it heals.

The AC joint does not contribute to mobility of the shoulder, so post-injury stiffness is not really an issue.  Rehab goals will be stimulating muscles that do not cause pain so they don't get weak while waiting for the injury to recover.

Back to top

Torn Achilles Tendon

The Achilles is the largest tendon in the body, thick connective tissue extending from the bones of your heel to your calf muscles. It supports an athlete's entire body weight. It also aids balance and supports the ankle joint for running, jumping and other activities. Any injury is usually non-contact, with a foot planted.

Achilles Injuries

The tendon can become inflamed, strained, partially torn or ruptured completely.

Tendinitis: Inflammation typically caused by overuse. You will feel the pain whether standing or walking. A professional athlete usually misses 2 to 4 weeks. Anti-inflammatory medications are the go-to treatment.

Strain: An overstretched Achilles that's often a warning of something worse -- a tear.

  • Grade 1: Mild, with few torn tendon fibers. It produces some tenderness and sometimes minor swelling.
  • Grade 2: Less than half of tendon fibers torn, causing pain, tenderness and some swelling. Most activities (walking, running or jumping) are accompanied by pain.
  • Grade 3: A full rupture, often with a "pop" or other sensation in the calf area. You no longer have the power to walk, much less run or jumpHVIRupturedAchilles.jpg

How Is A Ruptured Achilles Repaired?

When surgery is required, doctors make an incision over the torn tendon, realign the tissue and sew it together. The tendon remains in no shape to support the body's weight -- most patients use crutches for about six weeks, followed by a walking boot. Physical therapy is a vital component of rehabilitation, with light running or jogging about six months after surgery. More intense physical activity begins anywhere from one to three months later.

Muscles and tendons are in a constant balance of damage and regeneration. When the scale tips too far toward damage, without adequate time for regeneration/repair, injury happens. This can be due to repetitive overuse (microtrauma) or a single traumatic event. A chronically inflamed tendon is more prone to acute rupture.  There are other modalities -- ultrasound, iontophoresis, eccentric strengthening, etc. that help -- but inadequate recovery time before significant stress is going to cause injury eventually.

Recovery Time

Seattle Seahawks cornerback Richard Sherman, in a December 2016 article headlined "Why I Hate Thursday Night Football"  he wrote for the The Players' Tribune, called Thursday Night Football "terrible" because of the injury risk. "Maybe the league should take away one preseason game and add a second bye week for each time, which would occur before its Thursday game," Sherman wrote. "That way, at least teams would have a full week to recover and prepare."

Sherman eventually ruptured his right Achilles in a Nov. 2017 game against the Arizona Cardinals. 

Football is one of the hardest sports on the body. Adequate rest between contests is critical. This is why pro and most college teams do not do contact practices once their season begins.

Which Recovery Is More Difficult, Torn Achilles Or Torn ACL?

Tendon repair rehab is different than ligament (ACL) reconstruction. A tendon repair requires limited mobility for a period of time. Trying to 'stretch' immediately after a tendon repair will only put the repair at risk for failure. Early on, the repair site is the weak link in the system.

Generally speaking, an athlete can progress to obtaining full motion immediately after ACL reconstruction. There are a lot of strengthening/muscle stimulation exercises that can occur immediately/soon after ACL reconstruction.  An athlete needs to wait months before strengthening after Achilles repair so the repair site doesn't come undone.

If the tendon lengthens even a short amount (through the repair site), there will be more slack in the muscle and the muscle will be less effective.  In addition, nearly all other strengthening of the lower extremity (bike, squats, etc.) need to come to a halt because these would stress the Achilles repair.

Back to top

Torn ACL

Not everyone who tears their ACL will hear or feel a pop. But when a patient comes for evaluation and volunteers he or she felt/heard a pop and had immediate swelling, there is very high chance that this is an ACL injury.

What's The Anterior Cruciate Ligament?

The ACL is one of  the knee's four major ligaments. It keeps the bones aligned and controls knee movement. It's a common injury in the NFL, especially for running backs and wide receivers because of rapid change of motion, cutting and quick stops -- and the increased likelihood they will get hit in the knee area by the opposition defense.

The ligaments:

  • Anterior Cruciate Ligament (ACL): At the center of the knee. Controls rotation and the tibia's forward motion.
  • Posterior cruciate ligament (PCL): Also at the center of the knee. Controls the tibia's backward movement.
  • Medial Collateral Ligament (MCL): At the inner side of the knee. Adds stability to the inner knee.
  • Lateral Collateral Ligament (LCL): Runs along the outer knee joint. Adds stability to the outer knee.

ACL.jpg

Contact vs. Non-Contact

Most ACL tears in sports happen on non-contact plays, usually when the foot  becomes stuck on the playing surface. Muscles that usually support the knee, absorbing the force, do not respond fast enough. That leaves the ligament as the only support.

How Is A Torn ACL Repaired?

An ACL that's fully torn is usually not repaired. Doctors instead perform a reconstruction, creating a new ligament using a tendon from the patient's hamstring muscle or knee (patellar tendon) or from a donor. The new ligament is affixed to the knees with screws or other method.

During the initial post-op phase the patient cannot do high-level training because of the risk of rupture of the graft. The graft is actually weakest in the 6-10 week time period after surgery due to the biology of tendon remodeling. While things can be done to minimize muscle atrophy, the full neuromuscular and plyometric training cannot actually start safely until three or four months post-op.

Rehabilitation

Six months is considered the minimum recovery period before a patient returns to competitive sports. A safer estimate is 7 to 9 months. For an NFL running back, it could take even longer. Adrian Peterson, then with the Minnesota Vikings, returned in less than 10 months after being injured in 2011 in what was recognized as an extraordinarily fast recovery. Jerry Rice, the Hall of Fame wide receiver with the San Francisco 49ers, played less than four months after an ACL reconstruction in 1997. In his first game back, Rice fractured his kneecap -- the source of his ACL graft -- ending his season.

Return to pre-injury performance level: Research by the American Journal of Sports Medicine revealed most athletes are not the same when they return from this injury. More and more studies show that athletes have a hard time returning to the same level of play. Pros have the advantage of starting out as best-of-best going into the injury. They also have access to the best rehabilitation. A high-level high school or collegiate athlete may have a harder time recovering. Less than 80 percent will return to the same level.

Back to top

Torn Labrum

The labrum, the cartilage around the arm socket, supports the shoulder joint and gives the arm socket sufficient depth to fit the arm bone and facilitate movement. A quarterback, baseball pitcher and tennis players are particularly vulnerable to shoulder joint tears.

Think about a quarterback's throwing motion. Rotating the arm outward when preparing to throw contracts the biceps and drags on the labrum. For the non-athlete, lifting heavy objects can result in a torn labrum.

The best-case scenario with surgery would be a good-as-new shoulder, but many elite throwers can have difficulty reaching their pre-injury level. An injury like this can shorten career length, but not all labral tears are the same. A larger tear, or tear of the superior labrum may be more problematic.

When it happens to an athlete, the injury is often described as the shoulder popping out of socket or a feeling that something is "catching." It's a sensation than signals the beginning of prolonged inactivity.

Depending on the size or extent of the labral tear you can expect 6-8 months before a throwing athlete is ready to return to play.

Because labral tears are difficult to see, your doctor will request a diagnostic test such as an MRI that will show shoulder tissues and a CT scan that uses a special dye that outlines the labrum. With a CT scan, a type of computer-enhanced X-ray, the dye reveals the outline of the labrum.

Labrum Tears

Two types of should labrum tears:

1. Superior Labral Anterior to Posterior, or SLAP: A tear often attributed to repetitive motion, normal wear and tear, age or acute trauma.

Common types of SLAP tears:

Type 1: Fraying at the top of the labrum, though it remains attached to the glenoid (part of the shoulder). Probable cause: Aging. Treated non-surgically.

Type 2: Labrum and biceps tendon separated from the glenoid's top. Usually repaired with arthroscopic surgery.

Type 3: The torn labrum can sag into the shoulder joint as the biceps tendon remains intact. Usually treated arthroscopically.

Type 4: A tear that reaches into the biceps tendon. The amount of damage to the biceps tendon determines the treatment.

Recovery/Treatment: Recovery for most patients who undergo labrum surgery is nine months to one year.

Acute pain: 4-6 weeks. (This includes difficulty sleeping.)

Strengthening/stretching: Three to four months. Continued discomfort, however minimal, in the shoulder.

Final stage: 6-12 weeks. Adjusting to a new lifestyle of maintenance exercise. Once healed, ongoing strength and conditioning is continued.

2. Bankart Tear: A byproduct of a shoulder dislocation, usually in a patient under 30 years old.

This injury can be teated with rest, followed by physical rehabilitation. If surgery is required, your doctor can reattach the torn ligament to the shoulder socket. Because the labrum does not heal perfectly, this type of injury can leave you susceptible to another shoulder dislocation. 

Some players can play with a torn labrum depending the injury's severity. For some, a shoulder brace or harness can help by protecting the shoulder and limiting movement. Pain medication and over-the-counter anti-inflammatories can be helpful, too.

Labrum Surgery

A small tear that "catches" as you move your shoulder is usually removed. In this arthroscopic procedure, called a labral debridement, the frayed edges and any loose segments of the labrum are removed.

A larger tear could require repair instead of removal. Sometimes your doctor will reattach the labrum, anchoring into the bone surrounding the shoulder joint, using an arthroscope.

Back to top

Connecticut Orthopaedic Institute at MidState Medical Center