Recipe For Joint and Sport Injuries

You don't have to be a sportsman to incur joint injuries. More than half of these happen in people doing desk jobs.  Health and safety measures are often lacking in our public areas and workplaces alike. We also have a long way to go towards awareness of fitness training and precautions when exercises are undertaken for weight reduction and recreational purposes. Individuals must be wary of the long-term ill- effects of neglecting joint injuries. Many cartilage injuries can be treated with minor surgery and quick return to activity, and damage to the joint that would otherwise occur can be prevented, so as to avoid having joint replacements later.

The term 'sports injury' is loosely applied to a range of conditions that affect joints, ligaments, and muscles and arise out of strain or trauma sustained commonly during sporting activity. Each sport predisposes particular parts of the body to unusual stresses. There is undoubtedly an increased risk of severe injuries, particularly during contact sports. Contact sports are the ones that involve impact and/or use of equipment. Sports from athletics to most outdoor games would come under this category. Non- contact sports, on the other hand, are sports like swimming or usually indoor sitting down games. The risk of severe injuries is obviously less in these. However, strain conditions and muscle injuries are not uncommon. 

Even though sports injuries are described with reference to sports, it is not that they are sustained only during such activities. In fact, a larger proportion of cartilage and ligament strains happen in people during their day-to-day chores. It is hence important that people are aware of what they might be doing in their everyday lives which predisposes them to damage their bodies. This article will provide a short overview of some common joint problems during young adult and working life. The lower limbs sustain the larger proportion of problems as they bear weight and impact during our regular routines i.e. standing and walking. Upper limb problems are experienced by people who are engaged in specific occupations that involve load-bearing with hands or those that experience repetitive strains.

Strains

A strain phenomenon is experienced when a body part or tissue is put under larger stress than it is built to undertake. Some strain issues are commonly noted in growing bones. Children often complain of bone pains during growth spurts. Muscles often do not grow as fast as bones do. This results in a strain on the points of muscle or tendon attachment to bone. A common condition around the knees is called 'Osgood Schlatter's disease' when school-going boys present with pain and swelling at the lower aspect of their knees. Treatment might require rest and reduction of sports activity at school. The strain of the quadriceps muscle and tendon, called 'Jumper's knee' was known in jumping sports like basketball, etc. However, it is increasingly being reported by otherwise healthy city dwellers who do desk jobs. This is particularly when they go out for walks or running. Most jogging or walking tracks in cities are paved or concrete. Running on hard surfaces with improper footwear causes these strains. Taking up exercise intermittently, as is common with individuals in high-demand corporate jobs also causes muscle and tendon strains around the hamstring group of muscles.

In the hip, long walking or running outdoors on uneven and banked surfaces can cause Iliotibial band strain which presents as pain radiating from the hip to the knee. In severe cases, the band that stretches from the pelvis beyond the knee can become tight and also cause the hip to snap intermittently. Overweight individuals trying to commence any form of exercise commonly experience strain with the hip abductor muscle. This combined with some weakness of the muscle leads to a condition called 'Abductor Tendinopathy' that can be protracted and take a long time to treat.

There are quite a few conditions associated with repetitive strains at some sports or related to work. These can be long-lasting and often resistant to treatment. We all have tissues called 'bursae' where bones are superficial and under the skin, so as to provide some lubrication. Excessive rubbing of skin over the bone causes inflammation, called 'bursitis'. It can mimic infection but often does not give good results with surgery. Caution must hence be exercised. 

Cartilage & Ligament Injuries

Even though cartilage and ligament injuries are most recognized during sport, at least two out of three meniscal cartilage tears occur during day- to day activities. As we age, the shock-absorbing cartilages or 'menisci' in the knee become less resilient. In the case of mild to moderate arthritis that is often present in a middle-aged person, the meniscus can easily sustain a tear during normal walking on irregular ground. However, a meniscal tear is significant only if it interferes during knee movement when it causes intermittent sharp pain or restriction of movement of the knee. Many a time, meniscal tears are diagnosed in knee MRIs done. These are often insignificant and do not require intervention unless they cause symptoms. Injuries that cause significant meniscal cartilage tears are often twisting in nature. The injury might vary from slipping on a wet floor to a tackle at football. The person is usually able to get up and walk after such an injury but notices that the knee becomes swollen over the next few hours. Meniscal tears do not heal usually. Few meniscal tears actually cause knee 'locking'. A 'locked knee' is not one that is stuck as the name implies, but one that cannot be straightened fully. If left alone for more than a couple of months, the knee might then become stiff and never be straightened despite late surgery. I attended to, these can be sorted by minor surgery even as day- case i.e. no requirement of staying in hospital overnight. If meniscal tears can be sutured (this is nowadays easily possible with keyhole surgery), the development of arthritis in the joint can be prevented.

The surface of bones within joints is covered by a different type of cartilage. Any injury to the bone surface can cause damage to this cartilage that does not heal as the cartilage itself does not have the capacity of regeneration. If the surface cartilage breaks off with a rim of bone (called an 'osteochondral fracture'), then it can heal if operated on in time. Such fractures commonly go unrecognized and cause joint arthritis at a relatively young age, when options of treatment are very limited. 

Ligaments are structures that join one bone to the other. Most ligament injuries are partial tears called sprains and heal themselves. When ligament tears are total (called 'third-degree sprains') surgical intervention may be required or else there is a risk of persisting joint instability. In severe injuries that cause joint dislocations, at least two or more ligaments are injured simultaneously. Some ligaments like the Anterior Cruciate ligament do not get partly injured. All ligament injuries are not easily diagnosed on MRI alone as the accuracy of this investigation is about 80% of cases. One, therefore, needs a careful understanding of the patient's injury and thorough examination by a specialist.

As regards hips, the concept of Hip Impingement is now being recognized across the world. Coastal Karnataka and Kerala are likely to have a high prevalence of this condition. It happens when there are subtle irregularities at the edges of the ball and socket components of the hip. This is due to slight differences in the coverage of the ball by the socket of the hip joint. This often goes unrecognized in families and surfaces only if and when one undertakes some activity or sport requiring a higher hip range of movement. It often mimics back pain and is resistant to treatment for back problems. Specific examination and MRI with joint injection aids in diagnosing this condition. Such conditions can be treated with keyhole surgery. 

Muscle tears

Muscle-related problems are the commonest sports injuries. They could be acute muscle tears or chronic conditions that are brought about by microscopic tears combined with degenerative and/ or inflammatory processes. The shoulder joint is unique in that it affords a large range of movement with limited bony conformity. This is made possible due to a fine interplay of different muscles that are arranged in two layers around the shoulder. Consequently, however, muscle tears are common in shoulder injuries. The shoulder gets injured in throwing and weight lifting sports but is also affected in cases of falls during contact sport that is stopped by the outstretched hand. Muscle and/ or ligament tears are a part and parcel of joint dislocations. In cases of shoulder dislocations that result from trauma, muscle tears are commoner at ages over 40 years. These end up commonly with joint stiffness. If the same injury happens at around 20 years or less, cartilage injury is caused that does not heal and predisposes to recurrent shoulder dislocations.

Tendon tears are also common, especially in sports that involve jumping. Tendons are tough structures at the ends of muscles that attach the muscle to a bone. The whole force of the muscle contraction is transmitted through the tendon, which usually retracts when it tears. Tendon tears, therefore, require an operation, whereas muscle tears do not.

Discussion

The way out for most sports injuries is not to avoid sport, but to undertake adequate training and seek professional help and/ or correct equipment. Employers are under regulations to provide safety measures to prevent workplace injuries and it is important for employees to be aware of facilities and available equipment. As regards minor injuries it might be worth consulting a specialist for advice or intervention at an early stage to prevent long-term complications. 

Treatment for most strains starts with physiotherapy that conditions the associated muscles. Resistant strains can be treated with injection therapy. A variety of injections are available with different success rates. Injections must, however, be delivered at the correct site of pathology so as to produce the desired effect. These must hence be administered by the treating specialist. There is recent emerging evidence on the use of the patient's own blood products as healing factors from blood can be concentrated on the affected tissue - called 'Platelet Rich Plasma'.

Significant cartilage and meniscal injuries might require surgery. If such injuries are neglected, abnormal joint movements and mechanics result and cause accelerated joint wear i.e. arthritis quite early in life. Once the surface cartilage gets worn, reversal is not possible and one then would require end-stage major surgery like joint replacement if functionally very limited. However, if properly attended to, most cases can be managed by minor surgical procedures which could be done as day cases i.e. not required to stay in hospital overnight, with a quick return back to work.   

It is important to maintain the range of joint movement while preventing stretching of an injured ligament during treatment so as to ensure better return to function following such injuries. Similarly, few sports injuries require prolonged rest. It is vital to preserve the function of the uninjured parts as well as undertake early rehabilitation of the injured part so as to prevent muscle wastage that occurs quite rapidly. Proper diagnosis and correctly focussed treatment are important in the working individual so as to return back to doing productive activity and prevention of chronic problems as it is in the sportsman so as not to lose a season.

 

Dr. Yogeesh D. Kamat

Knee & Hip Joint and Sports Injury Specialist 

KMC Hospital, Ambedkar Circle, Mangalore


 

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