Sports Injuries Pain

Tendon Injuries
Tendons are strong bands or cords of tissue that attach muscle to bone. They help move the bones and joints when muscles contract.
The main types of tendon injury are:
tendonitis – inflammation of a tendon
tendinopathy – the gradual deterioration of a tendon
tenosynovitis – inflammation of the protective sheath that surrounds a tendon
Tendon injuries usually happen during sports or activities that involve sudden, sharp movements, such as throwing or jumping, or after repeated overuse of the tendons, such as running. They can also be caused by repetitive daily activities, This is known as a “Repetitive Stress Injuries”

Muscle Injuries (Strains)
A strain occurs when muscle fibres stretch or tear. They usually occur when the muscle has been stretched beyond its limits or it has been forced to contract (shorten) too quickly. Muscle strains are particularly common in the legs and back, such as hamstring strain and lumbar (lower back) strains.
Symptoms of a muscle strain can include

Rest
Avoid activities that cause pain, swelling or discomfort — but don’t give up all physical activity. While you’re healing, try low-impact exercises, such as swimming, bicycling or water running. Take a break from strenuous activitiesand allow the damaged tissues to repair. For a more extensive injury, your doctor may recommend that you use crutches so that you keep your weight off your injured leg.

Ice the affected area
Even if you’re seeking medical help, ice the area immediately. For the first few days after the injury, put an ice pack on the injured area for 15 to 20 minutes every two to three hours while you’re awake. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It may also slow bleeding if a tear has occurred. If your skin turns white when it’s being iced, stop treatment immediately. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.

Compression
Compression of the affected area is required in ligament sprain and muscle strain types of injuries. Compression helps to reduce the oedema and pain of affected area. . Wrap your hand or leg with an elastic compression bandage until the swelling goes down. Be careful not to wrap your leg too tightly for you may impair circulation. Begin wrapping at the end farthest from your heart. Loosen the bandage if the pain increases, the area becomes numb or swelling occurs below the wrapped area.

Elevation
This is mainly applicable to leg injuries. Many times hand can be elevated above the level of heart by applying sling and resting hand over the opposite shoulder. Sit or lie back with your leg elevated while resting. If possible, elevate your leg higher than the level of your heart. Gravity helps reduce swelling by draining excess fluid and reduce the intensity of pain.

Take an over-the-counter pain reliever
Try ibuprofen, naproxen sodium, diclofenacsodium or acetaminophen to reduce pain and inflammation. Many times this medication are useful for acute pain of injuries but for long standing chronic “ Repetitive Strain Injuries” this types of NSAID is not much effective for long term pain relief.

Physiotherapy
Though it is not useful in acute pain but it can be started after the intensity of pain reduce. It can be started with gradual stretching exercise followed by strengthing of muscles. This therapy should be taken under guidance of qualified physiotherapist doctor.

HIGH INTENSITY LASER:
LASER (Light Amplification by Stimulated Emission of Radiation)

Why  it called a High Intensity

The output power of High intensity laser is 30 to 50 times higher than the conventional cold laser and LLLT (Low level laser therapy). It has a wavelength of 1064 nm and having a higher tissue penetration power with almost 10 cm depth.
Laser principle consist of converting the energy supplied to light that is coherent, monochromatic. A laser beam transmits the large amount of energy which converted mainly into heat.

Laser has two mode of treatment.
Analgesia : The mechanical stimulation of free nerve endings block pain pathways in the nervous system and brings immediate pain relief.
Biostimulation : The light is absorbed by the cell and photon energy induces photochemical changes in the cell. Mitochondria of the cells are stimulated to produce the ATP and cellular metabolism is improved. Both effects led to faster healing of the tissue. Laser energy also affects the increased activity of fibroblasts, collagen synthesis, angiogenesis and that it promotes the formation of new cells of immune system. It also improves the local microcirculation and support the lymph drainage of the pathological area.

Clinical Applications

SHOCK WAVE THERAPY
Shock wave therapy is new non invasive solution for chronic musculoskeletal pain. Scientific name is “ Extracorporeal Shock Wave Therapy “ (ESWT). Shock wave therapy is frequently used for orthopaedics and sports medicine.

Mechanism of Action
A shockwave is an acoustic wave which carries high energy to painful spots and myoskeletal tissue with subacute, subchronic& chronic pain. The therapy promotes regenerating and reparative processes of bones, tendons and other soft tissue.

Therapeutic Effects

Common Clinical Applications

PLATELET RICH PLASMA (PRP THERAPY)
PRP therapy is recently introduceswithin 4-5 years and gain huge attention of the athletes and all the sportsmen worldwide. It is consider as a “ Biological Treatment “ and it is approved therapy for treatment of painful musculoskeletal condition by World Anti-Doping Agency (WADA).
PRP is a component of our blood. It contains the higher concentration of platelets which is helpful for tissue healing. Platelets contain various growth factors which is required for regeneration of tissue and faster the biological healing process.

Procedure Details
PRP therapy required only 20 to 40 ml of the patients own blood and that is processed in USFDA approved “ drPRP “ kit in refrigerated centrifuge machine. After first cycle RBC & PLASMA being separated then in second cycle PRP  is concentrated in lower part of plasma. Which is taken in the disposable syring  and injected  in to the affected tissue of the patients.

Benefits of Therapy

PRP THERAPY can be repeated after 3 to 4 week if patient is not getting fully cured. Many tendino-muscular pain required 2 to 3 sitting of PRP treatment for fully cured.

Clinical Applications

Shoulder Injuries Pain
Any sports activity that involved lots of overhead movement  that results into the shoulder impingment and rotator cuff  muscle injuries. Repeated throwing can inflamed and irritate the biceps tendon. This is called Bicipital Tendinitis.
Commonly seen in Tennis, Cricket, Baseball, Volleyball, Weight lifting &Swimming. They are mainly caused because of overuse of the shoulder, which can strain the rotator cuff muscle. Its also related to poor muscle tone and less stretching and strengthing  exercise of shoulder muscles. Commonly seen symptoms are pain, weakness and many times stiffness in shoulder. It can be prevented by the regular stretching and strengthing exercise and specific training exercise. Sportsmen affected by shoulder impingment : Maria Sharapova, Roger Federer

Tennis Elbow / Golfers Elbow Pain
Person develops the pain in elbow when the forearm is overused by repetitive movements in sports like Tennis, Golf, Badminton& Cricket. These are the group of muscle which involve the activity of forearm and wrist. Due to repetitive movement of the muscle it causes chronic micro trauma and inflammation of tendon and muscle. Usually in tennis elbow pain feel on outer part of elbow joint and in golfers elbow pain is inside part of elbow joint. Pain may radiate down the forearm and may be deteriorated with activity like turning the door knob or lifting the heavy objects.
Sportsman affected by Tennis elbow pain : Sachin Tendulkar

Stinger
A stinger is a sports related injury to the nerves about the neck or shoulder. It is sometimes called a burner or nerve pinch injury, but the term stinger is most descriptive of the symptoms that the athlete experiences including painful electrical sensations radiating through one of the arms. Athletes competing in various sports (most common in football and wrestling), playing specific positions (such as defensive back or offensive line) or performing certain athletic manoeuvres (such as tackling, blocking or executing a take downmaneuver) are at greatest risk of sustaining a stinger. The athlete will experience sudden and severe painful, stinging sensations in one of his arms frequently lasting from seconds to minutes, occasionally hours and less frequently days or longer. There is often associated weakness of the muscles in the shoulder and arm that are supplied by the injured nerve. The arm symptoms are usually more severe than neck pain. Stinger is diagnosed by a careful history and examination of athletes and if required doing Investigation like MRI & EMG-NCV. These are used to locate the nerve which got impinged in cervical spine. Treatment will be a Rest, Ice or Heat application, Cervical collar and Specific pain reliving drugs. If pain consistently felt more than 6 weeks then Nerve root block can be given to reduce the inflammation around the nerve.

Low Back Pain
Usually the Low back pain can affects the most of all sports player but specifically it more affects the Runners, Cyclists, Golfers, Tennis and Baseball players. Muscle spasms, Bulging disc, stress fracture of pars interarticularis and sciatica are the common reasons of low back pain. Improper training techniques, weakness and poor preparation are the most common reason for sports related back pain. Treatment options are Rest, regular stretching exercise, anti-inflammatory medications.
Sportsman affected by backpain : Andre Agassi, Dennis Lillee

Runner’s / Jumper’s Knee Pain
Knee injuries pain comprise about 55 % of all sports injuries. Not only Runners but it can strike any athlete like a Cyclist, Footballer, Volleyball players and others. It usually caused by weak quadriceps and tightness of other muscle groups like hamstrings. Many times it can be due to chronic micro trauma when tendon of fascia lata friction with lateral condyle of femur bone. Pain mostly fees below the knee cap and outer side of knee joint. Pain aggravated with the motion like running or jumping and sometimes may be doing up-down motion on staircase.
Sportsmen affected by Runner’s knee : Serena Williams, Danielle Slaton, PavelBure

Shin Splints
Shin splints is a generic term used for shin pain. But correctly it’s called Medial Tibial Stress Syndrome (MTTS). It is caused by inflammation of the muscle and their attachment to shin bone on inner side of leg. Shin splints may occur when the intensity of working out is increased from normal level, wearing worn-out shoes or by jumping on hard ground. Pain to touch the region and occasionally swelling present on inner side of the leg bone. Soreness to jog or walk, are most of the common symptoms of shin splints.
Sportsmen affected by the shin splints : Monica sales, Grant Hill, James Kirtly.

TendoAchilles Tendonopathy
It is a very common injuries among the Runners and people involved in sports that required Jumping like basketball, long jump. There is an inflammation of the Tendo Achilles tendon which is attachment of calf muscle with the heel bone. It is a strongest tendon of our body but not very flexible and hence prone to micro-tearing which results in inflammation. Poor foot biomechanics and incorrect foot wear are other common aggravating factors for the pain. Pain commonly felt below and back of heel bone, when person starts walking after prolong rest or in the morning. Pain gradually reduced after walking for some distance. In later part of pain can be felt throughout the day.
Sportsmen affected by Achilles Tendonopathy : Shaquille O’Neal ( NBA – Basketball player )

Planter Fasciitis / Heel Spur
Planter fasciitis is a pain in heel and bottom of the foot. It frequently associated with the long runners and jumpers. Heel pain is also associated with leg length inequality and flat feet. Commonly pain usually occur after long period of rest like putting first step after overnight sleep. After walking some distance pain usually resolve. But for long standing disease pain may be feel over the whole day. Many patient had a bone spur over the heel bone (calcaneum spur) , but in this patients inflammation of planter fascia is main cause of pain. Modality of treatment are stretching exercise, hot & cold bath, rest, shoe packing and many more. High intensity Laser and PRP therapy consider as a best treatment for this condition.