Sports Injuries Management | Dr. Rohan Vakta

HOW TO AVOID SPORTS INJURIES?

Playing any sports, going for a walk or swimming regularly is first step in disease prevention. One has to change sporting activity as age advances and also the body needs a change due to various other conditions. One has to understand that our body has limitations before beginning of any exercises or sporting activity. If you are beyond 40 years of age, it will be better to consult a sports doctor/physician before you start your activities.

The most common cause of a sports injury is the failure to warm-up sufficiently before beginning strenuous activity, however injuries are also often caused by the incorrect use of equipment and insufficient safety precautions. Those most susceptible to sports injury are competitive and professional athletes, whose intense training can make certain muscles vulnerable to injury through overuse.

Although it is impossible to prevent injury all the times due to the unpredictable nature of sports and physical activities, it is possible to undertake precautionary steps.

Warm up for 5-10 min before any physical activity (exercise or sports)

Warming up in this way allows an increased flow of blood to reach the muscles, increasing the flexibility of the muscle fibers and significantly reducing the risk of pulling or straining a muscle. Ideal warm-up exercises include steady walking and jogging. These activities allow you to gradually increase the pace to further prepare your body for strenuous exercise.

Use the correct protective equipment and correct surface

For some sports, protective equipment is important to prevent damage to participants. This is particularly important when the sport or activity involves physical contact with other players and participants. It is also important to wear correct footwear when participating in sports. The correct shoes can offer support to the foot and ankle, helping to prevent twisting and injury. Protective headgear is also important to avoid any damage to the skull and the brain. It will be better to run on a tar road as compared to a cemented road or a very uneven ground to prevent injury to knee or an ankle joint.

Use the correct techniques

Many sports involve particular techniques that if used correctly help minimize the risk of injury. It is important to learn the correct techniques associated with your chosen sport or physical activity. By practicing correct techniques an individual can greatly reduce the risk of sports-related injury to muscles, tendons and bones. This is also applies to individuals carrying out fitness programs in the gym.

Don’t over-reach yourself

It is extremely important, when taking part in physical activities, to listen to your body and know your physical limits. When you begin a new sport, begin slowly and steadily to avoid pulling or straining muscles which your body may not be used to using or stretching. If you have not undertaken strenuous exercise for some time, it is especially important to build up your stamina and strength gradually to avoid injury. Over time, you will notice your fitness increases, and you will be able to undertake physical activity for longer periods of time.

Keep yourself hydrated

Water is vital to keep the body going, and this is especially true when you are active and exercising. If you are exercising in heat or in sunny weather, it is especially important to keep your body hydrated as dehydration can significantly reduce mental and physical fitness.

Cool Down for 5-10 min post your activity / work-out

Just as it is important to warm-up properly, it is also essential that you cool down sufficiently after physical activity in a gentle form of exercise (such as walking) to return your heart rate to a normal pace. The cool-down process allows your body to remove the muscles’ waste products and replace these with oxygen and nutrients. This helps to prevent stiffness of the muscles after exercising, and allows your muscles to recover steadily from physical activity. At this stage you may also wish to do some gentle stretching exercises to lengthen the muscles that you have been using during physical activity.

NOTE: Any swelling or discomfort of a joint for more than 10-15 days after the start of a sport or a physical activity indicates danger to your body. You should stop doing that activity and consult a sports medicine expert and resume.

ILIOTIBIAL BAND FRICTION SYNDROME

It is very encouraging to see that in India awareness regarding health is increasing by leaps and bounds. Year around one can see lots of people, especially young individuals jogging and running taking part also in 5K, 10K, half marathons, full marathons or long cycling trips. Unfortunately, most of these young individuals learn about warming up, stretching exercises and cooling down which is usually inadequate. So they become prone to many sports related injuries. One of the commonest injuries in above mentioned events is ITBFS- Ilio-tibial band friction syndrome or ITB syndrome. It is also seen in wrestlers as well as Kabbadi players.

The iliotibial band is a thickened fibrous band that runs from pelvic bone all the way down to the outside of the thigh & inserts in the upper part of the shin bone known as tibia. This band has few functions, one of them is to connect major hip muscles to the knee, The other function is to keep thigh muscles into place to increase their efficiency to perform. It seems to have stabilising knee function during foot strike which is very important for a long-distance runner.

How does pain precipitates?

Usually this is an overuse injury in most of the athletes. Too frequent training or too fast increase in the running distance or training weights are the most common causes of ITB friction syndrome. When the knee is bent and straightened as in running, cycling or in other activities, the band gets rubbed on the bony bump on the outside of the upper part of the knee joint (Femur bone). ITB syndrome accounts for approximately 8% to 10% of running injuries & common in both the sexes as well as in recreational & elite runners or cyclists. Most susceptible group for ITBFS is between 20-40 yrs. of athletes. It is believed that more than 1 million people are affected in India with this problem.

How does it feel?

ITBFS pain appears near the end of the session and disappears on stopping, over a period of time. Gradually frequency of problems increases. It can progress from a dull ache to a sharp pain with or without burning sensations. It hurts more going downhill or in cross legged sitting position. It If this is ignored and if he/she continues doing the same activity, the pain becomes more intense and starts appearing early in the session and takes more time to disappear. Sometimes there is burning sensations due to inflammation of a small nerve lying in that area. If it becomes more, an athlete is forced to stop his sport.

Why ITB syndrome?

There are many causes for this syndrome. The main are………

1/ Overuse: Technically this is an overuse injury & one has to understand this for recovery. Overuse without proper body preparation is one of the main causes of IT band friction The remedy starts with icing and resting for few days till irritation is over. Next step is to change the training regimen. One should try by changing running route or get away from the treadmill to jog outside. Try some cross training while you slowly increase your kilometres.
2/ Tight hamstring muscle: Tight hamstring muscles or muscles of back part of leg is considered as a major contributing factor to this problem [common in cyclists]. Hip muscles are connected to the knee by IT band so proper evaluation and exercises of hip and back muscles is very important. It is very easy to stretch these muscles and we have found yoga ( Butterfly pose, Parivratt Trilokasana, Supt Matsyendrasnan etc.) to be very good for this problem. This should be done every day before starting the run. If you cannot do it, take help of a sports medicine expert and physiotherapist.
3/ Hip muscles: Weak hip muscles is one of the biggest reasons that Micheal Fredericson from Stanford university found out for the cause of ITBS in his research. Strengthening various hip muscles is a very important part of ITB syndrome healing. Along with the hip muscles, one should also strengthen the lower back muscles and for this once again we will insist for yoga training.
4/ Poor running form: One will be surprised that little change in the running pattern can get rid of ITBS. Ask a more experienced runner to evaluate your Gait pattern. Over striding, that is taking too long of steps or strides that cross over the midline of the body could be the causes of your problem. These are pretty easy to notice by an expert eye. Very rarely one might need professional video gait analysis & treatment.
5/ Shoes & orthotics Shoes is the most imp. part of the gear in any sports. Examine the soles of your shoe. If they have given way or they are more rubbed on outer or inner side, it reflects problems in the architecture of your foot or your running form. Over worn shoes can cause your foot to land at an awkward angle, which transfers lots of stresses to the knee, hip and spine. Harder the soles, more is the impact. So changing your shoes within their recommended mileage is essential. If you are a regular jogger or runner, not only it is important to buy a running shoes from a reputed manufacturer but also to change them at every 1200 to 1500 kms. of use depending on the terrain you are running on. If required gel insoles or orthotics should be inserted inside the shoe to improve the running pattern and to reduce injuries If you are a barefoot runner, you must keep ITB syndrome in mind because one is likely to get more problems if the foot architecture is not right.

What one should do to make it heal?

As discussed, there are multiple causes for iliotibial band friction syndrome, 1st step of treatment is to stop runningNishith Shah , AHmedabad or take part in precipitating sports till the time pain is almost gone. In acute stage, icing of inflamed part is done by using an icepack or crushed ice wrapped in a towel. This is applied for 15 to 20 minutes at the painful area every 3 to 4 hours for few days. Anti-inflammatory medicines (NSAID) can hasten recovery in case of excessive pain. Electrical modalities in a physiotherapy unit in form of ultrasound, IFT & supervised stretching as per recommendation by a sports medicine expert can help in recovery.

If pain still persists, one can have an injection at the tender area. The world is moving away from a steroid shots. Better injection modalities like Prolotherapy is available. So do not be afraid for taking a shot if your ITB syndrome is affecting your daily life, but avoid steroid. Surgery to release ITB & to remove inflamed tissue will be the last resort & is hardly needed.

How to prevent ITB syndrome?

1/ Start with a walk before u start running- approximately 500 meters of walking before running is mandatory
2/ Do warm up exercises like Hip muscles stretching, calf stretching and back muscles exercises. Cooling down with stretching after an event is also very important. It helps to relax overloaded muscles, removes lactic acid accumulation, lowers body temperature & heart rate. This in turn prevents chronic injuries.
3/ Examine your shoes repeatedly. They should be without any visible sole damage. If you are a serious runner, replace them frequently though they might appear good from the top
4/ If your foot is deformed, have orthotics [inserts] after consulting a sports medicine specialist or a podiatrist
5/ If possible don’t run on the inclined surface [side of the road], on a concrete surface or extremely hard surface.
6/ While running frequently change directions repeatedly so that a particular group of muscles or joint is not overloaded.
7/ Do not try to match the pace of a fast runner. Choose your own pace. It will be better find out a colleague who can match your side strides & run with him/her.U will enjoy the exercise & have less injuries.
8/ When increasing mileage, stick to the rule of increasing it by no more than 10% every week.
9/ Cross train with activities like swimming or cycling if possible.
10/ If you are attempting to do a half marathon or full marathon, additional muscle strengthening and stretching exercises in a gym will help you to increase your performance
11/ Reduce kilometers or take a rest for few days once you start experiencing pain of iliotibial band