Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: acute ankle, knee exercise, overuse injury, patella, patellar tendon, patellar tendonitis, quad, quadriceps muscles, RICE, ROM, strrengthening, tendonitis
Patellar tendonitis is an injury that affects the tendon that connects the patella (knee cap) and the tibia (shin bone). The patellar tendon is a continuation of the quadriceps muscles, which are responsible for knee extension. Also known as jumper’s knee, patellar tendonitis is prevalent in athlete’s who perform a great amount of forceful knee extension (ex. volleyball, soccer, and basketball). Although this specific injury is highly noted in jumpers, all types of athletes are susceptible to it.
Patellar tendonitis is a common overuse injury. An overuse injury is a certain condition that materializes over time due to repetitive stresses. In the case of patellar tendonitis, repetitive forceful knee extension begins to cause micro tears in the patellar tendon, which accumulate over time and result in inflammation of the tendon. Along with repetitive jumping, a sudden increase in the frequency of activity is also a culprit.
Tightness of the quadriceps or hamstrings may also contribute to the occurrence of patellar tendonitis. In either case, the first resulting in possible hyperextension and the second resulting in slight knee flexion, the patellar tendon will be placed under an increased amount of strain.
Alignment of the pelvis, femur, patella, and tibia may also attribute to the development of jumper’s knee. Genu valgum (knock knee) and genu varum (bow leg) both put shear forces on the patellar tendon resulting in increased stress. Another bony abnormality, patella alta (raised kneecap), can add additional stress to the tendon by elongating it.
As with other injuries, immediate care of patellar tendonitis is to follow the R.I.C.E. protocol (Rest, Ice, Compression, Elevation), which is explained in full detail in February 15th’s posting entitled, Immediate Care of Acute Ankle Sprains. The main purpose of the R.I.C.E. protocol is to control swelling and minimize pain. To build onto the rest component, athletes who are experiencing patellar tendonitis should attempt to stay away from activity that exacerbates the pain such as jumping, sprinting, and kicking.
Once swelling and the pain associated with swelling is resolved, range of motion and strengthening exercises (Strengthening and stretching exercises) may be included in the treatment. As noted earlier, patellar tendonitis is a result of subsequent micro tears. To accompany the natural healing properties of the body, knee extension exercises should be incorporated to strengthen the quadriceps and the patellar tendon. Dependent on the underlying cause, different types of stretches and overall knee strengthening exercises should be performed.
Along with strengthening and stretching, proprioceptive exercises may be performed to increase neuromuscular control. Proprioception, a joint’s ability to position itself in the correct position while in space, may help to maintain a neutral position of the knee during activity and therefore decreasing shear forces on the tendon. A popular proprioceptive exercise for the lower extremity is a stork stand. To perform this exercise stand on the involved leg with the contralateral leg raised and your hands on your hips, hold this position for thirty seconds staying as still as possible. If this becomes too easy try closing your eyes.
When returning to activity patellar tendon straps may be used to assist in the function of the tendon. Average time for return to participation can rely on the severity of the injury and may even cause issues for an extended amount of time as long as activity is continued. For the competitive athlete however, these procedures will assist in recovery and more than likely make a speedier recovery.
Additional Resources:
- http://www.summitmedicalgroup.com/library/sports_health/patellar_tendonitis_exercises/
- http://www.mayoclinic.com/health/patellar-tendinitis/DS00625
Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: athletic trainer, MLB, personal trainer, trainer
Great article that was posted on the MLB website discussing the difference between athletic trainer and personal trainer. Take a look and let us know what you think.
http://mlb.mlb.com/news/article.jsp?ymd=20080319&content_id=2444052&fext=.jsp&c_id=mlb
Filed under: Athletes, Athletic Trainers, Coaches | Tags: ankle, ankle ligaments, ankle sprain, extremity injuries, inversion, inversion sprain, lateral ankle sprain, ligaments of the ankle, peroneal, RICE
The most common injury to the ankle is a lateral, or inversion sprain. This is when the sole of the foot rolls inward, thus injuring the lateral, or outside structures of the ankle. This type of injury compromises the ligaments of the ankle (most commonly injured: Anterior Talofibular, Posterior Talofibular, and Calcaneofibular ligaments) and the peroneal muscles that come down the lateral side of the leg. This injury is usually sustained from either taking an awkward step (off of a curb, or onto someone’s foot, etc.) or from landing in an unstable way. The peroneal muscles on the outside of the leg are responsible for pulling the foot from an inverted position to a neutral or everted position. The ankle is most susceptible to a sprain when it is pointed and inverted. Due to this mechanism we can conclude that the strength of the peroneal muscles have a big role in preventing this type of injury.
Whenever a ligament is sprained for the first time it causes a lot of swelling and bruising which results in pain and loss of function. Swelling, or inflammation, is the body’s response to many injuries and it is not always bad. Inflammation allows for chemical mediators in the blood to be transported to the injury site to help heal the wound and eventually form a clot at the trauma site. The amount of swelling and inflammation can vary from individual to individual and also from injury to injury.
There is a common acronym that is used to treat acute extremity injuries, RICE. RICE stands for Rest, Ice, Compression, and Elevation. This protocol is usually used within the first 24-48 hours of the injury and helps to decrease the effects of the trauma. These steps encourage the swelling that has occurred after the injury to be pushed out of the joint and back into the cardiovascular system via the capillaries. Rest, as the name implies, is to stop using the affected extremity. This may mean sitting out of a game, or not finishing the walk to work if it is too unbearable. Ice works to decrease the amount of bleeding by causing the blood vessels to shrink (vasoconstriction), thus lowering the amount of fluid that can leak into the injury site. Ice is also used because it can numb the area and decrease pain at the injury site. A good rule of thumb is to ice for 15 minutes every hour (“15 on, 45 off”). You should not ice more than that, as frost nip and frost bite are possible when the skin is exposed to extreme cold for extended period of time. Under NO CIRCUMSTANCE should you place heat on an acute injury (injury less than 48 hours old). This can cause in increase in pain and swelling, thus lengthening the amount of time for healing to occur. Compression helps to move the inflammation out of the joint, which is imperative to promote return to function. It is important to not place compression too tight, or for extended period of time as the compression can impede normal blood flow to an extremity, or cut off nerve transmission. Elevation is imperative in treating lower extremity injuries due to the force of gravity which pushes the swelling downward, pooling in the lowest spot, which is the farthest away from the heart, making it harder to get reabsorbed by the lymphatic system. Getting the swelling, or inflammation, to go down and to decrease pain are always of utmost importance in any treatment plan. More severe ankle sprains can require that crutches or a boot is needed in order to prevent further damage that weight bearing exercises could cause.
Once the swelling has diminished, range of motion and strength exercises can be incorporated as tolerated. After strength (Examples of ankle exercises) is regained, balancing exercises are implemented to regain neuromuscular function. Plyometric and functional training are integrated in the last stages of treatment, just prior to return to full activity. Example of general progression of exercises
The time it takes to return to normal activity can range depending on how severe the injury was and what your lifestyle demands may be. Returning to a sport or activity before the ankle is fully healed puts one at risk for continued discomfort and makes one more susceptible for recurring ankle sprains due to chronic instability. For further information on management of ankle sprains check out the link below:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164367/
Filed under: Athletic Trainers, Coaches, Uncategorized | Tags: carpal bones, Carpal Tunnel, median nerve, night splint, phalen test, surgery, symptoms of carpal tunnel syndrome, transverse carpal ligament, wrist, wrist pain
Carpal tunnel syndrome is a condition prevalent in those who spend a lot of time in front of the computer typing. Seeing that this is a sports medicine blog however, this condition is seen in a wide range of populations with different underlying causes. But before we get to that lets take a few steps back and define carpal tunnel syndrome.
The carpal tunnel is located on the anterior (palmar aspect of the wrist). The floor of the structure is made up of your carpal bones and the roof by the transverse carpal ligament. Within this space, about the circumference of your thumb, a number of structures run through it including the eight longer finger flexor tendons, their respected synovial sheaths, and the median nerve (Carpal Tunnel Image). Carpal tunnel syndrome is a result of inflammation of the flexor tendons and their sheaths which leads to compression of the median nerve. If you can imagine, an area about the circumference of your thumb could easily become crowded. This condition is prevalent in those who repetitively perform actions that involve wrist flexion (i.e. typing), although it can also result from a direct trauma to the anterior portion of the wrist.
The main symptoms of carpal tunnel syndrome are numbness and tingling in your fingers and hand, specifically all fingers except for your pinky and also the lateral (outside) portion of the hand. Holding a steering wheel, phone, or newspaper most often causes symptoms. As the condition worsens motor skills of the hand may also begin to decrease.
A quick and easy way to test yourself for carpal tunnel syndrome is to perform the Phalen Test. In order to carry out this test place the dorsal (backside) aspect of your hands together so that your wrists are fully flexed. Hold this position for one minute. If numbness and tingling are present this is indicative of carpal tunnel syndrome.
Initially conservative treatment is R.I.C.E. (Rest, Ice, Compression, and Elevation), immobilization, and NSAIDS. For the individual who is susceptible to or is experiencing pain due to carpal tunnel syndrome, some home exercises may help alleviate the pain. Exercises that include stretching and strengthening both the flexor and extensor tendons of the wrist in junction with R.I.C.E. with help reduce swelling in the carpal tunnel, the underlying cause of the condition. For pictures and descriptions of some exercises visit CT Exercises .
In most cases people tend to flex their wrist while they sleep, so a night splint (Image) which holds the wrist in a neutral position can be very beneficial to one with carpal tunnel syndrome. On top of wearing the brace at night, a more functional one (Image) should also be worn throughout the day because the neutral positioning of the wrist places the carpal tunnel in its most widened state which decompresses the nerve. In more severe cases a physician may turn to corticosteroid injections into the carpal tunnel to decrease swelling and inflammation; however more conservative treatments should always be attempted prior to this step. And finally in the most severe of circumstances surgery may be offered. When surgery is performed the transverse carpal ligament is cut to decrease compression of the median nerve.
Hopefully this blog finds those in need who are suffering from this common condition and sheds some light on what they are experiencing. Good luck to those of you who relate to this article and we hope this blog helps you on your road to recovery.
References and Resources
http://www.eatonhand.com/hw/ctexercise.htm
http://orthopedics.about.com/cs/carpaltunnel/a/carpaltunnel_3.htm
http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326
