Prevention of Overuse Injuries in the Middle and High School Athlete

There are 2 main types of injuries that occur in sports – Acute and Overuse. An acute injury is one that occurs as a result of a single traumatic event. Examples include fractures, acl tears, ankle sprains and shoulder dislocations. In contrast, overuse injuries occur over time and are the result of repetitive micro-trauma to the tendons, elbows and joints. Examples include stress fractures, little league shoulder, runners knee and tennis elbow. 

Overuse injuries have been on the rise over the past few years. Over 50% of overuse injuries are also preventable. Equipment, training and communication are all imperative to prevention and early detection.

Causes of Overuse Injuries:

•  Training errors
• Poor Technique
•  Improper surface for practicing/conditioning
•  Excessive Pressure from Peers/Coaches
•  Improper Equipment – shoes are VERY importan

Guidelines for Prevention:

• DO NOT have kids “play through the pain” – Avoid the “No Pain, No Gain” attitude
• Avoid early specialization in one sports: vary the sports & activities that kids participate in
•  If you suspect an athlete has a sports injury, seek medical attention EARLY
• Communicate with Athletes: Ask how they are feeling and encourage them to rest
• Mandate Pre-Season Physicals
• Encourage Proper Strength Training Routines
• Enforce Warm-Up, Stretching & Cool Down Routines

If athletes are injured at a young age, this can set them up to drop out of sports completely.  If this happens, kids lose out on the benefits of exercise and participation in Team Sports.  Early injury can also lead to arthritis and other chronic conditions that can last a lifetime.  Athletes are also more susceptible to future injuries.  We want to encourage coaches, trainers & parents to facilitate an environment where kids can enjoy a lifetime of activity and sports. 

If you suspect that you have an overuse injury, Skyview Orthopedics is here to help. Contact our office to make an appointment: 973-300-1553.

Ultrasound Guided Injections in Orthopedic Practice

Recently, my office has begun utilizing ultrasound for the diagnosis and treatment of various musculoskeletal disorders. There are numerous benefits for the use of ultrasound in orthopedics. For one, ultrasound is a non-invasive exam that allows for a high resolution evaluation in real time. This is a wonderful tool for diagnosis. A second use of ultrasound is for performing guided needle procedures. By using ultrasound for guided injections, we can ensure the exact path of the injection.

What can be diagnosed using ultrasound?

Musculoskeletal ultrasound can be used to evaluate the following:

• Tendons
• Partial and full thickness tears
• Degeneration
• Scar tissue formation
• Ligaments
• Muscles
• Tears
• Soft-tissues
• Masses
• Cysts
• Calcification
• Joints
•  Effusions
• Loose bodies
• Hematomas

What procedures are performed?

• Aspiration and/or injection of joints
• Tendon origin injections (i.e. tennis elbow)                           
• Bursa injections and aspirations
• Aspiration of cysts, fluid collections and abscesses
• Lavage and aspiration of tendon calcifications
• Injection of platelet-rich plasma (PRP)

Ultrasound is allowing procedures to be safely performed in the office that historically could not have been treated. For example, we had a patient recently with a painful cyst behind her leg. In the past, we would have had leave the cyst alone because blindly aspirating could increase the risk of damaging surrounding tissues, blood vessels and nerves. With ultrasound, we were able to locate and aspirate the cyst right in the office. Ultrasound allowed us to find the cyst, correctly position the needle and watch the cyst disappear. Musculoskeletal Ultrasound provides physicians with the ability to differentiate between cystic and solid and vascular from non-vascular lesions adding a greater benefit for patient safety.

If you would like to learn more about Musculoskeletal Ultrasound or to make an appointment, please contact the office at 973-300-1553.

What is Runners Knee?

Runner’s knee or Patellofemoral pain syndrome (PFPS) is a condition where the cartilage under the knee cap begins to wear away. Running can cause irritation where the kneecap rests on thighbone, which causes pain. The pain can be sharp or a dull ache that does not go away.

Causes

Runner’s knee can result from a biomechanical issue or from weak quadriceps and tight hamstrings. Some common biomechanical issues are flat feet, high arches in the feet, size and placement of the patella and worn cartilage. Weak quadriceps can cause alignment issues, while tight hamstrings and calves can put pressure on the knee. Also, the repetitive, jarring motion of running can often be enough to cause runner’s knee.

Symptoms

Symptoms of runner’s knee include pain behind or around the patella. Pain may also be felt toward the back of the knee. Some report a feeling of the knee ‘giving out’ and others have cracking in the knee.

Runner’s knee is more common in women due to the q-angle (see previous post on q-angle) – wider hips, which results in a larger angle of the thighbone to the knee, putting more pressure on the kneecap. It is also a condition that tends to strike younger athletes.

Prevention

Run on softer surfaces and make sure you are wearing the correct shoes. Local specialty running stores can be a great resource to see that you are fitted properly. Orthotics can also be helpful in the prevention of runner’s knee. 

Strength training is another great way to prevent runner’s knee. Focus on strengthening the quadriceps, hamstrings and calves. By doing this, you will reduce pressure on your knees. Also, remember to stretch the hamstrings and calves as this will also help with prevention.

If pain occurs, cut back on your running and avoid activities that involve extensive knee bending. Giving the knee a rest is the best way to begin to heal. If the pain persists, see a doctor.

SLAP Lesions

A superior labral anterior posterior (SLAP) lesion is a tear where the biceps tendon meets the labrum. These tears are common in overhead sports; such as baseball, volleyball and pitching. The most common SLAP tear is referred to as a Type II lesion. In Type II lesions, the superior labrum and biceps anchor have pulled away from the superior glenoid tubercle.

How do SLAP lesions occur?

There are 2 main ways a SLAP lesion occurs. The first is due to a trauma or direct impact to the biceps. This can occur during the deceleration phase of throwing or in a car accident or fall. The second cause of a SLAP lesion is overuse. In this case, repetitive motion, such as throwing, can cause a tear. SLAP lesions are often seen in conjunction with a condition called GIRD (for more information on GIRD, see our recent post).

What are the symptoms?

•  Anterior shoulder pain
• Clicking or popping in the shoulder
• Decreased function
• Pain with overhead activities
• Decreased power/velocity in throwing

How is a SLAP lesion diagnosed?

To diagnose SLAP lesions, a physician will perform a number of physical tests to determine if the injury is present. In these tests, the physician will look for range of motion, pain level and overall function. After the physical exam, an MRI will normally be performed.

What is the Treatment?

SLAP tears can be treated conservatively at times, but can require surgical repair. When surgery is required, the procedure is performed arthroscopically. The repair is made using suture anchor techniques. If you suspect that you have a SLAP tear, it is important to contact your orthopedic surgeon.