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Doctor On Call (DOC): Dr Sean Leo – Common Sports Injuries (Part 1)

Doctor On Call, or DOC for short, is a brand new series brought to you by Medical Channel Asia. This series aims to bring doctors and specialists from various fields to give you an introduction to common health and medical topics that you and the Asian population are interested in. In our 1st DOC, held on 28 May (Friday), from 8pm to 9pm (GMT+8), we have Dr Sean Leo, orthopaedic surgeon from Orthokinetics, to talk to us about Common Sports Injuries.

For Part 1 of the forum, we have Dr Sean Leo give us a short presentation on some of the pointers regarding common sports injuries. In Part 2, Dr Sean Leo answers some of the questions posted LIVE by our audience. Read below to find out what more about the basics of sports injuries as well as ACL tears!

Presentation by Dr Sean Leo

Sports in our life

Sports is an integral part of our life. It is not purely entertainment, but has developed into a social interaction. With people watching sports events together, to playing the sports, to having these sports as their occupation, sports has developed into an integral and important part of our lives.

Certain sports have garnered increasing attention over the past few decades, including CrossFit, cheerleading, ultimate frisbee etc. These sports are practically unheard of many years ago. But as these sports start to develop, we start to see more people participating in them, and each has their own injuries patters. Take adequate precautions to prevent such injuries.

Injuries sustained during sports

Every single sport has risk of injuries, even if they do not involve much contact and family-safe or family-friendly. One example is billiards, which can result in neck and shoulder pains as the participants look down the pole frequently. But of course, outdoor related and contact sports are associated with higher risk of injuries, and are often the type of patients that Dr Sean sees in his clinic.

Any part of the body can sustain injuries. It always pays to have adequate safety gears (such as helmet, guards) and proper instructions (especially for skilled sports such as skiing). Paying for instructors and coaches is important as it can save you money from the treatment required if you get yourself injured.

Prevention through warming up and conditioning (sports physiotherapy and stretching) as well as adequate rest are equally important. Citing Bruce Lee: ‘Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind‘. Flexibility is very important in preventing injuries in sports or activities.

Having adequate rest is also important, as the chance of sustaining acute injuries and chronic strains are much higher. If the muscles are too tired, they are unable to act as the joint stabilisers, leading to injuries.

However, we need to remember that even though sports carry risk of injuries, there is less risk in activity than in continuous inactivity.

Classification of sports injuries

Sports injuries are usually classified into 3 broad categories:

  • Acute injury: new onset of problem that did not exist previously. (e.g. broken bones, muscle sprain)
  • Chronic injury: a problem that you have before, did not fully recover and continues to trouble the patient. It can be exacerbated. With baseline level of discomfort, some patients have grown to accept that.
  • Stress-related injury: symptoms that occur due to overload. Participating in activities and exercises that your body is unable to cope. The body does not have a chance to recover in time, leading to breakdown over time. If it builds up over time, it becomes chronic injury.

Lower limb injuries

Lower limb injuries are commonly seen in my clinic, as we tend to put a lot of stress to our lower limbs (e.g. carry our body weight, running, jumping). Pushing, balance issues (swirling, twisting) etc. can also lead to injuring of the lower limbs and joints.

Types of lower limb injuries:

  • Bone injury – fracture or stress fracture (small micro-cracks, which can become full fractures if they are not taken care of)
  • Joint injury – hip, knee, ankle, small joints of the feet. Also include the cartilage, capsules around the joints
  • Muscle injury – strains, tears
    • Rhabdomyolysis – muscle breaking down after intense activity, such as spinning classes. Especially common when people do high-intensity activities they are not used to. Symptoms include dark chocolate urine, due to the myoglobin being released into the bloodstream and filtered to the urine.
  • Tendon injury – achilles tendonitis. Tendons are muscles that joint the muscles to the bones

When injury occurs, take note of:

  • How the injury occurred – if you do not remember, can remember spectators or team mates are around to help recount the incident
  • What happened immediately after injury – any swelling in the area where it was injured, able to continue with game, able to walk, able to still use your arms and legs
  • How the symptoms progressed – getting better or worse
  • Specific symptoms – e.g. unable to bear weight or giving way. May mean a pretty serious injury, and may be good idea to seek medical attention immediately

Investigations

  • X-rays
  • Specialised investigations: CT scans, MRI

Anterior Cruciate Ligaments (ACL) tears and associated injuries

Usually occurs as a result of a twisting injury. It can occur from multiple causes:

  • Contact or non-contact
  • Due to fall or can results in a fall
  • Can occur by itself or can occur with other injuries

Pivot injury (or a twisting injury) happens when the lower and upper bones twist in different directions. Especially when the athlete wear boots with studs, and the studs get stuck in the mud. If the ligament is torn, the bone and meniscus can both be injured.

Reasons why ACL injuries are more common:

  • Better pickup and diagnosis and increasing awareness of this injury
  • Increase in sports activities (both competitive and recreational)
  • Athletes pushing themselves: as the muscles are less able to adapt due to the fatigue

Proper training before sports

ACL injuries are more common in ladies than men

When jumping and landing, ladies tend to have the knees facing inwards, leading to the ACL being injured more easily. It puts a torque on both the lower and upper legs, putting the ACL in a position to tear it. Important is to undergo training and conditioning when undergoing these exercise.

Fatigued muscles

When you muscles are fatigue, they will be unable to compensate for the body’s momentum. Movements become exaggerated leading to more common injuries.

What to do (and what NOT to do) when you have a sports injury?

To-do:

  • Rest
  • Ice
  • Compression
  • Elevation

Not to do:

  • Harm
  • Alcohol
  • Running
  • Massage (especially in the early phase, as it can cause localised injury and swelling to the injured area)

If the pain persists > 2 weeks or gets worse, STOP PLAYING and GET EVALUATED by a doctor. There may be a long term injury or a chronic injury underlying.

Do you need surgery if your ACL is torn?

No correct answer to this, as it all depends on whether there is a need for surgery and what you want to get out of this surgery. If you are very well-conditioned (muscles are well conditioned enough to stabilise the joints), you may not even need your ACL, which basically acts as a secondary stabiliser. But we have to understand that not everyone is able to get to this level of physical conditioning, and also the required skill level to continue with the sports.

Torn ACL can be considered a significant trauma. If you are young, and participating in sports or activities that require pivoting and twisting of the joints and knees, you may consider doing surgery to repair it. This gives the support and prevent further injuries to the other parts of the knee. If the ACL is not repaired, the knee will be less stable, and you run a higher risk of injuries if you participate in sports (e.g. knee misalignment, meniscus and cartilage injuries). But it also depends on whether you will be going back to active sports. If you are older and more sedentary, you may get away with not repairing your ACL.

What’s next in store?

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