Staying in the Game

The most common sports injuries—what causes them and how to prevent and treat them.

By: Marilyn Dickey

Sports injuries are a job hazard, says Mystics point guard Lindsey Harding. She tore her ACL in 2007 but was back on the court six months later.
Lindsey Harding, a guard for the Washington Mystics, remembers feeling her knee pop. It was near the end of her 2007 rookie season with the Minnesota Lynxes (she was the league’s top draft pick), and she had just torn the anterior cruciate ligament, or ACL, in her left knee.

It was Harding’s first serious injury and fortunately not a career ender. She needed surgery and rehab but was back on the court after six months. For pro athletes, dealing with injuries is part of the game. Says Harding: “It’s a job hazard.”

Whether you’re a professional or amateur, the challenge in any sport is to get close to your limits without going over them, says Richard Reff, a Bethesda orthopedist. Unfortunately, he adds, “man doesn’t know his limits until he’s exceeded them.” But taking precautions can reduce your chances of getting hurt.

Warm up and stretch before you jump into an activity, says Benjamin Shaffer, an orthopedist in Chevy Chase and downtown DC. “Muscles are prone to injury when they’re cold,” he says. “But people go on the tennis court, they’re a little late, and they start whaling away at the ball.”

Shaffer suggests three to five minutes on a stationary bike or walking—any low-impact activity to get the blood flowing. Follow with slow and gentle stretches, holding each for 30 seconds. Then warm down and stretch after a workout.

Instead of trying to get in shape overnight, orthopedist Kenneth M. Fine suggests following the 10-percent rule: increasing your distance, time, or intensity by no more than 10 percent a week. Giving yourself time to recover is key, especially as you get older. “There’s a perception that if you miss a day or two, you’re going to decondition yourself,” Reff says. But if you’re in good shape, it takes a while to lose fitness.

The amount of recovery time an athlete needs can vary widely. The younger and fitter you are, the less time it takes your body to rebound. Reff advises breaking up your workouts with a different activity as needed.

But the risk of injury shouldn’t keep you from staying fit. “If you’re active and work out, inevitably you’re going to have some injuries,” Fine says. “But the rewards of exercise outweigh the risks.” You may end up spending more time with a sports-medicine doctor, he says, but you’ll probably see the cardiologist, oncologist, and psychiatrist less.

>> Turn the page for some of the most common sports injuries, with advice on how to prevent and treat them.

Patellofemoral Pain Syndrome

A condition that involves pain in the front of the knee, this injury is common in both athletes and non-athletes. It happens when the kneecap doesn’t track perfectly in its groove because it’s slightly tilted and the soft tissue on the outside of it is tight.

The syndrome often affects people who run on hilly terrain or who do step aerobics or squats and lunges, as well as cyclists and rowers, who repeatedly flex and extend their knees. Some people may have the problem and never know because they don’t do an activity that causes pain.

Symptoms: Pain and stiffness and sometimes a grinding sensation when going up and down stairs.

Treatment: Take time off from the activity that causes the pain as well as anti-inflammatory drugs (Advil, Motrin, etc.) or Tylenol.

Prevention: The quadriceps control the kneecap, so strengthening them will help. One exercise to try is a straight-leg raise: Lie on your back with one knee straight and the other bent, foot on the floor. Lift your straight leg, hold it for a count of ten, then lower it. Do ten of those with each leg, then repeat for two more sets. You can add an ankle weight closer to the knee for resistance.

Some patients also benefit from taping the knee or using a knee sleeve to improve kneecap alignment. You can buy a sleeve at the drugstore, but taping should be done by a physical therapist.

Ankle Sprains

These injuries occur when you stretch the ligaments around the ankle bones beyond their normal range. In more-severe sprains, you can have a partial or complete tear of the ligament.

The most common type of ankle sprain is an inversion sprain, in which you roll your foot inward and your ankle outward and stretch the ligament on the outside of your ankle. (The opposite, an eversion sprain, is rarer.) Inversion sprains happen most often when the toes are pointed down—the ankle’s most unstable position—such as when you’re playing basketball and come down from a jump.

A high ankle sprain occurs where the two bones of the lower leg—the tibia and fibula—come together, about five inches above the ankle joint. It’s caused by an external rotation; the foot rotates out and the ankle rotates in. It’s common in basketball, soccer, football, and gymnastics but can occur in just about any sport.

Symptoms: In most cases, if you’ve just stretched the ligament but not torn it, you’ll have pain and swelling but may be able to walk. If you have a partial tear of the ligament, walking will be painful—you may make it only a few steps—and you’ll probably have some bruising. If it’s a complete tear, you may not be able to walk at all and the ankle will likely feel very unstable.

Treatment:
For any ankle sprain, remember the acronym RICE—rest, ice, compression, and elevation. An anti-inflammatory medication such as Advil or Aleve can help, too.

In mild sprains, you want to protect the ligament while continuing to use your ankle, says Daniel Lahr, a Rockville orthopedist who specializes in the foot and ankle. You can use a functional splint or stirrup brace—available at drugstores or through your doctor or physical therapist—to prevent the ligaments from stretching again.

Most patients with mild sprains should be able to resume full activity pain-free within three to six weeks, Lahr says. But up to 15 percent will have continued problems, such as stiffness or loss of balance, that require physical therapy. In some cases, surgery is necessary.

If you suspect you have a partial or full tear, see a doctor right away. You may need a walking cast or crutches and physical therapy.

High ankle sprains can take 6 to 12 weeks to heal. Lahr recommends using crutches for two or three weeks, then physical therapy. In rare cases, surgery may be necessary.

Prevention:
Balance training that strengthens your lower leg can reduce the risk of ankle sprains, says physical therapist Barbara Fallon Wallace. Try standing on one leg on a Bosu ball, foam mat, or other unsteady surface. If that’s easy, close your eyes or practice catching and throwing a ball with a partner. Orthotic shoe inserts can help if you have high arches or if you pronate—meaning your foot rolls inward when you walk or run.

It helps to wear shoes made for your sport so you get the right support. People with a history of ankle sprains may want to wear an ankle brace while playing sports such as basketball, tennis, and soccer.

ACL Injuries

The anterior cruciate ligament—dead center in the middle of the knee—provides stability. ACL tears are common in basketball, volleyball, racquet sports, soccer, skiing—any activity that involves a lot of twisting. Says Reff: “People run, change direction, and all of a sudden, pop.”

ACL tears tend to occur in more active people and are most common among girls and women.

Symptoms:
“If you hear the pop, see a doctor right away,” says Wallace. If your ACL is torn, your knee will quickly become swollen and painful.

If your knee hurts but you don’t feel or hear a pop and the pain isn’t extreme, it’s possible you have a more mild ACL sprain. Carefully try to put weight on your leg. If that’s uncomfortable or if you feel you can’t support your weight, see a doctor to have it immobilized and possibly get crutches.

Treatment:
You’ll need a physical exam and possibly an MRI to confirm that the ligament ruptured. If it did, surgery may be necessary to reconstruct it, followed by rehab to restore strength, stability, and range of motion. Some people—particularly those who are older and don’t participate in sports that involve a lot of pivoting—decide not to have the surgery.

If it’s not torn, then ice and elevation may be enough. If it hurts to bend the knee, you can immobilize it with a pillow splint—wrap a soft pillow around the knee and wrap an Ace bandage around the pillow to hold it in place.

Prevention: Strengthening your hamstrings, quadriceps, and hip muscles can help prevent ACL injuries.

To work on your hip abductors—muscles on the upper back part of your hip—try this exercise: While holding onto a chair, stand on one leg and raise and lower the other leg straight out to the side. You can use a band to add resistance. The VMO muscles (vastus medialis oblique)—located on the inside of your knees—are also important. To work them, try squeezing a ball between your knees while doing squats.

Don’t forget your external hip rotators, says physical therapist Tony Touma. He suggests doing hip hikes: Stand with one foot on a step. Keeping your legs straight, move your opposite hip up and down so you’re lifting and lowering that side of the pelvis. Then repeat on the other side.

Rotator-Cuff Injuries

The rotator cuff is a group of muscles and tendons that cover the shoulder. Injuries to the rotator cuff can come from any activity that involves reaching overhead, such as volleyball, tennis, pitching, or swimming.

The rotator cuff can tear all of a sudden or can develop tendonitis, an inflamed tendon, from repetitive overhead movement. Tendonitis can happen at any age but is most common in people over 40.

Symptoms: With tendonitis, you’ll feel pain or discomfort when moving your arm at shoulder level. It may hurt to reach out in front or overhead. Tendonitis can come on gradually or all of a sudden.

Tears are diagnosed with a physical exam and sometimes an MRI but usually involve a lot of pain when you raise your arm above your shoulder and a loss of strength overhead when reaching.

Treatment: For tendonitis, take time off from activities that involve overhead reaching. If you think tennis is causing the problem, do something else for a while. Then slowly return to the game or continue to play but don’t serve overhead.

In addition, ice the shoulder and take an anti-inflammatory. If the pain persists, you may need physical therapy or a cortisone shot. If the pain doesn’t go away, you may need surgery.

In rotator-cuff tears, says orthopedist Steven Bernstein, “the tendon pulls away from the bone, and it won’t naturally reattach itself without surgery.” Some people can live with the injury, but if it interferes with your life—making sleep difficult or keeping you from doing a sport you love—then surgery may be the best option, he says.

Prevention: Limiting repetitive reaching helps, as does strengthening your shoulder muscles. Here’s one exercise: Stand with your elbow at your side and your forearm at a 90-degree angle, parallel to the floor. Without moving your elbow, slowly swing your forearm outward, away from your body. Return to the starting position and repeat. Use a band for resistance or push against a wall. If your arm starts to hurt, stop and talk to your doctor or physical therapist.

Shin Splints

Shin splints are a painful condition along the shin caused by too much stress on the bone and the periosteum, a thin layer of connective tissue that covers the bone.

They’re usually the result of overuse—running or playing sports that have a lot of stopping and starting. David Johnson, an orthopedist at the National Sports Medicine Institute in Lansdowne, says he sees shin splints mostly in people who run five to seven days a week or in gymnasts who work out three or four hours a day six days a week—“people really pounding on their body,” he says. But he also sees shin splints in people who have been sedentary and suddenly decide to run a marathon.

Other causes include wearing shoes that are worn out, don’t fit well, or aren’t made for the sport you’re doing; running on hard or uneven surfaces; and high arches or flat feet.

Symptoms: You’ll feel pain along the inner or back part of the shin, roughly midway between the ankle and the knee. Occasionally there can be swelling, which sometimes indicates a crack in the bone, usually diagnosed with a bone scan or MRI.

Treatment: Ice and anti-inflammatories can bring relief. Dr. Johnson sometimes recommends stretches and physical therapy and a soft compression sleeve to give the leg extra support, though sleeves don’t help in every case.

He also recommends taking a break from the activity that caused the problem and doing some other exercise until the pain goes away. Don’t try to push through it—the pain could be due to a stress fracture, and you should see a doctor if it doesn’t go away after you take time off.

Prevention: Don’t overdo it, and vary your exercise program. When you run, avoid concrete in favor of soft—but even—surfaces such as dirt, grass, or synthetic tracks. Wear the right shoes for your activity. After warming up, stretch your calf muscles.

To stretch your shin muscles, sit on the floor with your legs straight out in front of you and pull your toes toward your knee—use a strap or towel if you can’t reach. To strengthen your shin muscles, you can walk backward on your heels or, while standing, raise and lower your toes with an ankle weight on top of your foot.