Monday, August 11, 2014

Treatment Options For a Sprained Ankle

Ankle sprains are one of the most common sports injuries. A sudden jolt or twist can overstretch and tear the supporting ligaments of the joint, causing pain and swelling. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of actvities. It can happen in the setting of an ankle fracture (i.e. when the bones of the ankle also break). Most commonly, however, it occurs in isolation.

The amount of pain depends on the amount of stretching and tearing of the ligament. Instability occurs when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.

See your doctor to diagnose a sprained ankle. He or she may order X-rays to make sure you don't have a broken bone in the ankle or foot. A broken bone can have similar symptoms of pain and swelling.

Nonsurgical Treatment
Walking may be difficult because of the swelling and pain. You may need to use crutches if walking causes pain. Usually swelling and pain will last two days to three days. Depending upon the grade of injury, the doctor may tell you to use removable plastic devices such as castboots or air splints.
Most ankle sprains need only a period of protection to heal. The healing process takes about four weeks to six weeks. The doctor may tell you to incorporate motion early in the healing process to prevent stiffness. Motion may also aid in being able to sense position, location, orientation and movement of the ankle (proprioception). Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately. Even if an ankle has a chronic tear, it can still be highly functional because overlying tendons help with stability and motion.
For a Grade 1 sprain, use R.I.C.E (rest, ice, compression and elevation):
  • Rest your ankle by not walking on it.
  • Ice should be immediately applied. It keeps the swelling down. It can be used for 20 minutes to 30 minutes, three or four times daily.
  • Compression dressings, bandages or ace-wraps immobilize and support the injured ankle.
  • Elevate your ankle above your heart level for 48 hours.
For a Grade 2 sprain, the RICE guidelines can also be used. Allow more time for healing to occur. The doctor may also use a device to immobilize or splint the ankle.

A Grade 3 sprain can be associated with permanent instability. Surgery is rarely needed. A short leg cast or a cast-brace may be used for two weeks to three weeks.

Rehabilitation is used to help to decrease pain and swelling and to prevent chronic ankle problems. Proprioception training is very important, as poor propriception is a major cause of repeat sprain and an unstable ankle joint. Once you are pain-free, other exercises may be added, such as agility drills. The goal is to increase strength and range of motion as balance improves over time.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control pain and inflammation. 

Long-term outcome
If an ankle sprain is not recognized, and is not treated with the necessary attention and care, chronic problems of pain and instability may result.
Surgical Treatment
Surgical treatment for ankle sprains is rare. Surgery is reserved for injuries that fail to respond to nonsurgical treatment, and for persistent instability after months of rehabilitation and non-surgical treatment.
Surgical options include: 

  • A surgeon looks inside the joint to see if there are any loose fragments of bone or cartilage, or part of the ligament caught in the joint. Reconstruction
  • A surgeon repairs the torn ligament with stitches or suture, or uses other ligaments and/or tendons found in the foot and around the ankle to repair the damaged ligaments.

Thursday, August 7, 2014

Exploring Sports - Related Concussions

OverviewA concussion is a complex process that impacts the brain. Typically, it is induced by trauma to the brain caused by jolts, bumps or blows to the head. Even a minor bump on the head can cause a concussion. A concussion can also occur from a blow to the body severe enough to cause the head to move violently back and forth. All concussions are considered to be serious. All concussions need prompt evaluation and treatment.

According to The Centers for Disease Control and Prevention, there are an estimated 1.6 and 3.8 million sports-related concussion injuries annually.  The actual incidence of this type of concussion may actually be much higher, because many injuries go unreported.

Risk Factors
A concussion can occur in anyone in any sport or activity. Athletes that engage in contact sports, youth athletes and female athletes are at an increased risk for concussions.

A major determinant that increases risk for sustaining a concussion is an athlete's prior history of concussions. Research suggests that if an athlete has received one concussion, they are 1-2 times more likely to receive a second one.

Signs & Symptoms
It is important that coaches, parents and athletes learn concussion signs and symptoms as well as how to respond when a suspected concussion occurs.  Some are the most common things to look for are listed below:
  • headache
  • dizziness
  • nausea
  • vomiting
  • balance problems
  • sleep disturbance
  • sensitivity to light
  • mood changes
  • difficulty with concentration and memory
I'm A Coach. What Should I Do If A Concussion Occurs?
  1. Remove the athlete from play. Look for signs and symptoms of a concussion.
  2. Ensure that the athlete is promptly evaluated by medical professional. Do not attempt to judge the severity of the concussion yourself. Do take note of the cause of the injury, any loss of consciousness, any memory loss, or any seizures immediately following the injury. Report this information to the athlete's parents and/or medical provider.
  3. Keep the athlete out of play until he or she is evaluated by a medical professional and is cleared to return to play.
Diagnosis & TreatmentRecognition, timely diagnosis and treatment for a concussion are very important and can prevent more serious complications from this type of injury. A history of developmental disorders, psychiatric disorders or a history of headaches/migraines all play a part in concussion recovery time.

Despite all best efforts, there is no way to completely prevent the occurrence of sports-related concussion.  However, there are several things you can do to reduce the likelihood of a concussion.

  • Create a concussion action plan. This will ensure that concussions are identified early and managed effectively.
  • Educate yourself, other athletes, coaches and parents about concussions. Talk about concussions and the potential long-term consequences of concussions.
  • Monitor the health of your athletes. Encourage parents to obtain a baseline ImPACT screening during their sports physical.  Dr. Larkin is an expert in scientifically-based concussion management. You can request an appointment with Dr. Larkin for an ImPACT screening and sports physical through our online patient portal.
  • Insist that safety comes first. Teach and practice safe playing techniques. Utilize appropriate equipment at all times. Encourage good sportsmanship.
  • Teach athletes it's dangerous to play with a concussion. Rest is key!
  • Work closely with league and school officials. This can help make sure appropriate individuals are available for initial assessment and referrals for further medical care.

The Centers For Disease Control and Prevention have developed the HEADS UP program, which includes educational materials aimed at youth coaches, high school coaches, parents, athletes, school administrators and medical professionals.

Monday, August 4, 2014

Stress Fractures: Cracking Under Pressure

What is a stress fracture?
A stress fracture is a small crack in the bone. You could consider a stress fracture as an overuse injury because it can be caused by repetitive application of force. Stress fractures can also occur as a result of normal use of a bone that has been weakened by a medical condition, such as osteoporosis.

Stress fractures most commonly occur in the weight-bearing bones of your legs and feet.

What causes a stress fracture?
You could consider a stress fracture as an overuse injury because it can be caused by repetitive application of force.

What are the symptoms of stress fractures?
According to the American Academy of Orthopaedic Surgeons:
  • Pain that develops gradually, increases with weight-bearing activity, and diminishes with rest.
  • Pain that becomes more severe and occurs during normal, daily activities.
  • Swelling at the site of the fracture.
  • Tenderness to the touch at the site of the fracture.
  • Possible bruising
When should I contact my doctor?
Contact your doctor if your pain becomes severe or persists even at rest.

How to recover from a stress fracture?
Rest is very important in the recovery from a stress fracture.  Your doctor will help you determine when your stress fracture has healed and the best way to go about your gradual return to normal activities.

How do I prevent a stress fracture?
The American Academy of Orthopaedic Surgeons offer helpful guidelines:
  • Maintain a healthful diet. Eat calcium and vitamin D rich foods to help build bone strength.
  • Use proper sports equipment.  Do not wear old or worn running shoes.
  • Alternate your activites. For example, you can alternate jogging with swimming or cycling.
  • Start any new sports activity slowly. Gradually increase your time, speed and distance. 
  • Strength training can help prevent early muscle fatigue and prevent the loss of bone density that comes with aging. 
  • If pain or swelling returns, stop the activity. Rest for a few days. If the pain continues, see your doctor.

Friday, August 1, 2014

What Is Female Athlete Triad?

What is female athlete triad?
There are times when a female athlete may focus on being thin or lightweight. As a result she may eat too little and exercise too much. This can be detrimental to athletic performance and may lead to long - term damage or even death.

When female athlete goes to extremes with diet and exercise, three interrelated illnesses may develop:
  • Menstrual dysfunction
    •  Poor nutrition, low calorie intake, high-energy demands, physical and emotional stress, or low percentage of body fat can lead to hormonal changes that stop menstrual periods.
  • Disordered eating
    • Abnormal eating habits and excessive exercise keeps the body from getting enough nutrition.
  • Premature osteoperosis
    • Lack of menstrual cycles disrupts the body's bone-building processes and weakens the skeleton, making bones more likely to break.
What populations are at risk?
 Female athletes in any sport may develop a component of the triad. It is important to recognize that the development of poor self - image and pathogenic weight control behaviors can contribute to the onset of female athlete triad.

How is female athlete triad diagnosed?
In order to effectively diagnose female athlete triad, the signs must be recognized. You should consult your physician if you have missed several menstrual cycles, experienced a stress fracture, or believe you may have disordered eating behaviors.  You doctor will provide you with a complete physical examination and may use laboratory tests to check for other medical conditions.

How is female athlete triad treated?
Treatment for female athlete triad often requires help from a team of medical professionals including your doctor (pediatrician, gynecologist, family physician), your athletic trainer, a nutritionist, and a psychological counselor.