ORTHO NEWS

Sports Injury Rehabilitation Techniques for Athletes – Athletic Health Guide

Injuries are an extremely prevalent outcome, both in recreational and competitive sports alike. While there are injury prevention protocols that can and should be implemented, injuries, both mild and severe, are never out of the realm of possibility.

Because of the inevitability of injury in sports, rehabilitation programs are necessary for an athlete’s regimen. Not only do rehabilitation techniques aid in the general recovery and healing of injuries, but they also promote improved stability, movement mechanics, and range of motion after full recovery has been achieved.

A rehabilitation program combines the functions of physiotherapy, sports physiology, orthopedic surgery, and pharmacology. These programs are crucial for allowing an athlete to return to peak form and begin participating in sport again. The organization of rehabilitation protocols depends on several factors, including the type and severity of injury and the athlete’s health status and activity level.

Without a proper rehabilitation program, injuries can worsen, damage can become more severe, and secondary injuries can occur as a result. That’s why it’s imperative that you consult with a trusted, reliable, and experienced medical professional for the proper evaluation, diagnosis, recommendation, and treatment recommendation that’s most suitable for your situation.

The following will be a general discussion about sport-related injury rehabilitation, its goals and objectives, and specific techniques for effective healing and complete recovery of a given injury.

Common Sports-Related Injuries

Common injury types amongst athletes are those related to joints and surrounding areas. Joints are extremely vulnerable and susceptible to injury due to their role in movement and skeletal support.

Because of its responsibility for movement, range of motion, and stability, joints are typically the first area of the body to be impacted by injury when placed in compromised positions or under stressful environments.

For example, the sport of football, in which athletes attempt to tackle other athletes, leads to impact on joints from any direction, and the impact is often applied to a joint in a compromised position.

Of the most common sports-related injuries, the shoulders, knees, and ankles are some of the most vulnerable regions of the body.

The following are some of the most common injury types in sporting events that often require some level of rehabilitation:

Sprains (Ankle Sprain, Knee Sprain, Wrist Sprain)
Strains
Tears (Rotator Cuff Tear, ACL Tear, Achilles Tendon Rupture)
Fractures (Ankle Fracture, Patellar Fracture)
Dislocations (Shoulder Dislocation)
Separations (AC Joint Separation)
Depending on the injury type and severity level, a specific rehabilitation protocol will be required.

While a sprain, for example, will likely only require at-home self-care and over-the-counter anti-inflammatory medication, tears and fractures will often require more complex surgical procedures, physical therapy, stronger pain medication, and regular monitoring of progress by a physician to reach the same end-goal of complete restoration and recovery.

A Step-By-Step Guide Towards Rehabilitation

No matter the injury or severity level, the rehabilitation process requires a multidisciplinary approach. The following is an example of a step-by-step guide for rehabilitation that athletes and sports medicine specialists will often follow to achieve the best outcomes.

Step 1: Diagnosis
Step 2: Attend to Inflammation
Step 3: Promote Primary Healing (Rehabilitation Exercise, Pain Management)
Step 4: Improve Fitness (Sport Specific Training & General Conditioning)
Step 5: Control Physical Stressors & Prevent Re-Injury

Throughout the duration of the rehabilitation process, it’s encouraged to focus on the quality of activity rather than quantity. Just as overtraining can cause initial injury, it can also result in poor recovery and an unsatisfactory rehabilitation outcome.

Goals of Rehabilitation

The primary aim of injury rehabilitation is an imminent return to sport in peak form and a focus on preventing re-injury.

The best methodology in rehabilitation uses goal identification and the creation of a roadmap to that goal. Along the way, the athlete will need encouragement and motivation since they can always be at risk of becoming discouraged. The rehabilitation process can be quite draining, both physically and mentally, for the athlete. Therefore, a constant positive focus on achieving the goal and reaching the destination is critical for success.

The following are the primary goals of an effective rehabilitation program:

Regaining Stability After Injury
Regaining Normal Movement After Injury
Restoring Function & Performance to Pre-Injury Levels
Encouraging Safe Return to Sport
Minimizing Risks of Re-Injury

Once all of these goals and objectives have been met, the rehabilitation process is all but complete. It’s now the physician’s job to monitor progress frequently and ensure the athlete follows preventative measures. The athlete must play their part by actively following the recommendations outlined by their physician to ensure a safe return to sport with the new target of health and longevity.

Final Thoughts

All severely injured athletes, as well as non-athletes, can benefit from rehabilitation programs. In fact, according to the World Health Organization, it’s estimated that 2.4 billion individuals globally live with an injury or health condition that could benefit from rehabilitation. This number will certainly increase in the years to come.

Rehabilitation markedly assists in recovery and healing, and it reduces time away from athletic participation. The process focuses on retraining of proper movement mechanics and encourages the overall health and well-being of the athlete, both mentally and physically.

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Guideline: Timing Is Everything for RA and Lupus Patients Needing Joint Replacement

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Conventional disease-modifying antirheumatic drugs (DMARDs) may usually be continued in patients with inflammatory arthritis or systemic lupus erythematosus (SLE) undergoing total knee or hip replacement, but the same is not necessarily true for more targeted agents, according to an updated guideline from two medical societies.

Biologic drugs and so-called JAK inhibitors should generally be stopped before arthritis patients have such procedures, and so should biologics such as belimumab (Benlysta) and immunosuppressants in patients with non-severe SLE, according to the guidance from the American College of Rheumatology and the American Association of Hip and Knee Surgeons, with Susan M. Goodman, MD, of the Hospital for Special Surgery in New York City, as lead author.

With severe lupus, however, it’s generally better to keep patients on their regular immunosuppressant regimen as well as belimumab. But for patients with severe SLE taking rituximab (Rituxan), the societies recommend scheduling surgery for the final month of the drug’s dosing cycle when blood levels have bottomed out.

The new guideline replaces an earlier version published in 2017 and takes account of new agents introduced in that time and better understanding of how traditional agents affect patients in the postoperative period, particularly the risk of joint infection.

In explaining the rationale for these guidelines, Goodman and colleagues noted that rheumatic disease patients are at substantially higher risk of periprosthetic infection following joint replacement relative to people without such conditions — by 50% in the case of rheumatoid arthritis. The immunomodulatory drugs that most of these patients take surely contribute to this increased risk.

That creates a management challenge, for simply withholding all the patients’ regular medications raises the likelihood of disease exacerbation. Flares may be less problematic than a deep joint infection, but the latter is relatively rare while flares are common when antirheumatic drugs are withdrawn. Thus, it becomes a question of balancing low risks of a potentially devastating complication against high risks of a lesser but still significantly adverse outcome.

For the update, committees from the two societies reviewed papers published through August 2021 addressing medication use in patients with inflammatory arthritis — rheumatoid arthritis, psoriatic arthritis spondyloarthritis, and juvenile idiopathic arthritis — and SLE undergoing hip and knee replacement.

The major recommendations — all rated as conditional — can be summarized as follows:

Inflammatory arthritis and SLE patients may continue usual dosing with conventional DMARDs such as methotrexate, leflunomide, and hydroxychloroquine, as well as apremilast (Otezla) in the case of psoriatic arthritis.
Arthritis patients taking biologic drugs including rituximab should stop them prior to surgery, and procedures should be scheduled for around the time the next doses would be due, to obtain some degree of washout.
In non-severe lupus, patients should have drugs such as mycophenolate mofetil, azathioprine, cyclosporine, and tacrolimus stopped 1 week before surgery, and usual doses of belimumab and rituximab should be delayed.
In severe lupus, conventional DMARDs as well as anifrolumab (Saphnelo) and voclosporin (Lupkynis) — both first approved in 2021 — should be continued at usual doses. Belimumab and rituximab can also be continued, but as mentioned above, surgery should be scheduled for late in the latter’s dosing cycle.
No changes in corticosteroid medications are generally needed.
In all cases where regular medications were stopped, they may be restarted when surgical wounds have started to heal and no signs of infection or other complications are evident.

As with any guideline, Goodman and colleagues emphasized that these are not intended as hard-and-fast rules and clinicians should engage in shared decision-making with patients to take account of their particular preferences and circumstances. “One patient representative on the current Voting Panel noted the anxiety that patients experience around changes to their medication regimens and urged clinicians to be cognizant of this important issue,” the authors wrote.

Goodman and colleagues also acknowledged significant gaps in the available evidence and called for new research, including prospective randomized trials, to “provide clearer answers” to questions about use of conventional DMARDs, for which such evidence is often lacking. “Perioperative management of biologics also needs more definitive study,” they added.

Notably, the guideline update did not address other issues related to joint replacement, such as risk of venous thromboembolism and other cardiovascular events.

John Gever was Managing Editor from 2014 to 2021; he is now a regular contributor.

Disclosures

Guideline development was supported by the American College of Rheumatology and the American Association of Hip and Knee Surgeons.

Goodman and many other co-authors reported relationships with pharmaceutical and medical device companies.

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Joint Preservation: Restoration Rather Than Replacement

If you have chronic hip or knee pain, you may think joint replacement surgery is your only treatment option. The good news is — there are less invasive procedures that can help many people relieve their pain and maintain their mobility as they age, says James R. Ross, M.D., an orthopedic surgeon with Baptist Health Orthopedic Care.

“Total joint replacement surgery is generally performed to treat late-stage osteoarthritis after conservative treatments have failed,” explained Dr. Ross. “While joint replacement may be the best choice for some people, innovative joint preservation procedures are helping others, especially younger patients, prolong the life of their hip or knee joint.”

Preserving the Hip Joint

Dr. Ross performs advanced arthroscopic procedures and open hip preservation surgery to resolve bone impingement and repair or reconstruct soft tissues that have been torn or otherwise compromised. Femoroacetabular impingement (FAI), which occurs when the femoral head (ball of the hip) pinches up against the acetabulum (cup of the hip), is just one of the hip conditions he treats. FAI is thought to be a precursor to osteoarthritis because it leads to lesions of the labrum and/or articular cartilage.

Using 3D reconstruction and technologically advanced software for pre-operative planning and guidance during surgery, Dr. Ross precisely repairs damaged tissue and corrects the abnormal shape of the hip joint. This protocol, he says, minimizes complications, pain and the need for a hip replacement later in life.

Preserving the Knee Joint

Similar to the anatomy of the impingement that causes cartilage problems in the hip, mechanical alignment problems in the knee can cause isolated cartilage defects, says Dr. Ross. An osteotomy procedure can halt this uneven deterioration of knee cartilage. The procedure, which is most commonly performed on active people under age 60, involves removing or adding a wedge of bone to the tibia (shinbone) or femur (thighbone) to help shift body weight off the damaged portion of the knee joint and prolong its life span. Osteotomy is often performed in combination with a cartilage restoration procedure to address the gap in cartilage and bony exposure.

Dr. Ross also specializes in cartilage replacement techniques to treat patients who have good bone structure but suffer with cartilage-only defects. Matrix-induced autologous chondrocyte implantation, or MACI, is just one of the innovative techniques Dr. Ross employs to restore cartilage and preserve the knee joint.

Performing Cartilage Restoration

The MACI procedure is comprised of two steps. First, Dr. Ross harvests cartilage cells from the patient’s knee. These cells are sent to a laboratory where, over the course of four to six weeks, they grow into additional cartilage. The second part of the procedure involves implanting the new cartilage back into the patient’s knee, where it will mature and fill in the defect.

“Prevention is the best medicine,” Dr. Ross explained. “Rebuilding the patient’s cartilage will keep the cushion between the bones intact, which can reduce the risk of developing osteoarthritis and requiring joint replacement surgery in the future.”

Assessing Your Options

So how do you know if you are a candidate for a joint preservation procedure? In general, you should see an orthopedic specialist if your joint pain limits your activities and/or you have recurring episodes of the same pain over several weeks or months. Orthopedic surgeons at Baptist Health Orthopedic Care will determine the best treatment methods to reduce your pain, restore your mobility and prolong the life of your hip and knee joints.

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Genetic Basis for Joint Replacement Failure

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Scientists from ExplantLab have identified a genotype that is associated with joint replacement failure in some patients. Based on these findings, the scientists developed a machine-learning algorithm called Orthotype, which uses a patient’s genotype and other factors to accurately predict the outcome of joint replacement surgery.

More than five million joint replacements are performed globally each year. Although most patients are satisfied with the results of their surgery, a significant number of joint replacements fail early, following adverse immune responses.

One of the most popular implant materials used in joint replacements is cobalt chrome (CoCr). When small particles from CoCr joints are released into the blood, it can lead to an immune response that results in pain and joint failure in some patients.

“Essentially, the immune system attacks the implant in a process similar to how a patient rejects an organ transplant,” explained David Langton, PhD, director of ExplantLab. “How quickly this happens is variable and unpredictable, but it appears to be dependent on the type of material, the amount of wear debris released, and other patient-specific factors.”

One of those patient-specific factors is their genes. The HLA genes play a central role in immune function, and Langton and his colleagues determined that patients with certain HLA genotypes are likely to develop responses to CoCr-containing implants. Their results were published in Communications Medicine.

Taking the research one step further, ExplantLab, working with bioengineers, medical staff, and patients from collaborating institutions, developed a machine-learning algorithm called Orthotype, which uses a patient’s genotype to provide a risk profile of that patient developing hypersensitivity to CoCr. Orthotype was developed and validated from the results from 606 patients implanted with metal hip replacements and resurfacings, each of whom had been followed for a mean duration of ten years.

This could herald a new era where it will become routine for patients to undergo genetic testing prior to receiving medical implants. Orthotype will identify patients more likely to have a reaction to a joint replacement made of CoCr components, helping surgeons select an implant based on the manufactured material most suited to the individual patient.

“This represents a significant advance in orthopedic care for patients,” said Langton, “with potentially significant financial repercussions for global healthcare systems, through the avoidance of repeat surgery.”

As populations around the world grow older and heavier, joint replacements are more common than ever. The number of joint replacement surgeries carried out globally is forecast to double over the next two decades.

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Intraosseous Morphine During Total Knee Arthroplasty Reduces Pain, Hospital Stay

Intraosseous (IO) infusion of medication during surgery has been shown to be a new and effective way to manage pain in patients undergoing total knee arthroplasty (TKA), according to a recent study.

To determine the safety and efficacy of injecting pain medication directly into the tibia during surgery and the impact that this method may have on pain levels and time spent in the hospital, the researchers performed a double-blind, randomized controlled study examining patients undergoing TKA (n = 48). The patients were divided into 2 groups: the experimental group (n = 24) who received both an IO antibiotic injection and 10 mg of morphine, and the control group (n = 24) who received only a standard IO injection of antibiotics.

The researchers assessed pain, nausea, and opioid use up to 14 days post-surgery for all patients. Additionally, the researchers examined morphine and interleukin-6 serum levels in a subgroup of 20 patients 10 hours post-surgery.

The researchers used the Visual Analog Scale to determine the level of pain each patient had postoperatively. Patients in the experimental group had a lower pain score at 1-, 2-, 3-, and 5-hours post-surgery (P = .0032, P = .005, P = .020, P = .10) when compared with the control group. The decrease in pain continued for postoperative day 1 (40% reduction, P = .01), day 2 (49% reduction, P = .036), day 8 (38% reduction, P = .025), and day 9 (33% reduction, P = .041).

Furthermore, the researchers saw a lower opioid consumption within the first 48 hours and the 2nd-week post-surgery among the experimental group when compared with the control group (P < .05). Serum morphine levels in were significantly less in the experimental group than in the control group 10 hours after IO injection (P = .049). The experimental group also has significant improvement (P < .05) in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at 2- and 8-weeks post-surgery.

Overall, the experimental group showed significant improvement and outcome post-surgery.

“IO morphine combined with a standard antibiotic solution demonstrates superior postoperative pain relief immediately and up to 2 weeks,” the researchers concluded. “IO morphine is a safe and effective method to lessen postoperative pain in TKA patients.”

—Jessica Ganga

Reference:

Brozovich AA, Incavo SJ, Lambert BS, et al. Intraosseous morphine decreases postoperative pain and pain medication use in total knee arthroplasty: a double-blind, randomized controlled trial. J Arthroplasty. 2022;37(6):139-146. doi:10.1016/j.arth.2021.10.009.

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Nanomaterial-Coated Alloy Improves Muscle Joint Regeneration

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The primary disadvantage of the total joint replacement (TJR) treatment is the critical loss of skeletal muscle attached to metal joint prostheses, resulting in the formation of fibrous scar tissue, ultimately leading to motor dysfunction. Consequently, tissue engineering technology may come to the rescue in addressing this issue.

Study: Improved Muscle Regeneration into a Joint Prosthesis with Mechano-Growth Factor Loaded within Mesoporous Silica Combined with Carbon Nanotubes on a Porous Titanium Alloy. Image Credit: gowithstock/Shutterstock.com

An article published in the journal ACS Nano demonstrated the fabrication of a two-layered mechano-growth factor (MGF) carrier, an alternative isoform of insulin-like growth factor-1 (IGF-1) expressed in response to mechanical stimulation.

The two-layered MGF carrier was made of a porous titanium alloy scaffold coated with mesoporous silica nanoparticles (MSNs) and carbon nanotubes (CNTs) via electrophoretic deposition (EPD). The two-layered coating exhibited a nanostructured topology with excellent MGF loading and extended-release performance via covalent bonding.

In vivo studies on the fabricated scaffolds revealed that they preferentially promoted muscle growth than fibrotic tissue into titanium alloy structure and improved the muscle-derived mechanical properties, immunomodulation, and migration of satellite cells.

Thus, the fabricated MGF-loaded MSN and CNT-coated titanium alloy scaffolds were presented as a robust platform to restore the motor function of implanted joints like the natural joint by periprosthetic muscle regeneration.

Disadvantages of TJR Treatment and Titanium alloy in Prostheses

TJR treatment is popularly applied to replace natural joints with prostheses through arthroplasty surgery by orthopedic surgeons. However, in vivo degradation results in a shorter lifetime for these artificial joints compared to natural synovial joints. This occurs primarily because of the higher wear rates associated with artificial implant materials and the consequent adverse biological effect of the generated wear debris on bone mass/density and implant fixation.

Further, when compared to the initial TJR surgery, revision surgery of an implant is challenging, has a lower success rate, may induce additional damage to the surrounding tissues, and increases health care costs by one-third. Thus, a paradigm shift to periprosthetic muscle regeneration can increase the lifetime of prostheses.

Motor dysfunction due to the connection loss between prostheses and muscle tissue is a common complaint of patients after TJR. Thus, the periprosthetic muscle regeneration into prostheses can help to regain normal joint motor function.

Titanium alloy is considered the best solution to address the above concerns and can match both the aesthetic and the functional requirements guaranteed by the implant. Titanium alloy exhibits low values of Young’s modulus and offers a wide span of properties.

Improved Periprosthetic Muscle Regeneration

MSNs have adjustable pore diameter, high surface area, large pore volume, and excellent biocompatibility and hence stand as promising candidates to deliver therapeutic agents. However, a few studies based on MSN-coated porous titanium alloy scaffolds mentioned the brittleness of MSNs. On the other hand, CNTs have high strength and elastic modulus compared to other reinforcement fibers.

In the present work, CNTs were incorporated into MSNs as reinforcement fibers to relieve the strain between titanium alloy and MSNs. Integrating CNTs and MSNs into titanium alloy improved biomechanical behavior and imparted a sufficient biomolecule-loading capacity.

In the present work, a three-dimensionally (3D) printed porous titanium alloy was coated with a CNT-MSN layer via the EPD method, followed by loading of MGF into MSNs via covalent bonding with the help of 1-ethyl-3-(3- dimethylaminopropyl) carbodiimide hydrochloride (EDC) and N-hydroxysuccinimide (NHS). This helped achieve a long-term, slow release in prepared scaffolds.

Furthermore, the periprosthetic muscle regeneration into the prepared [email protected] coated titanium alloy scaffold was evaluated by conducting in vivo and in vitro studies. The results revealed an increased expression of myogenic genes and proteins, enhancing myoblast differentiation without biotoxicity, leading to the formation of myotubes and skeletal muscle fibers, indicating the potential of a prepared scaffold for periprosthetic muscle regeneration.

Additionally, the [email protected] coated titanium alloy scaffold activated the biological mechanism that induced the myoblast differentiation through the Akt/mTOR signaling pathway, indicated by the expression of Akt/mTOR signal-related proteins. Thus, proving the potential of MGF in serving as a local cell growth factor.

Conclusion

In summary, the two-layered MGF carrier that maintained a long-term release was composed of an inner CNT buffer layer and an outer [email protected] functional layer in the porous titanium alloy scaffold and was deposited using the EPD method.

The designed [email protected] porous titanium alloy scaffold enhanced the myoblast differentiation compared to the traditional prosthesis, without cytotoxicity, by increasing the expression of myogenic proteins and genes, forming myotubes and skeletal muscle fibers in vivo and in vitro.

The periprosthetic muscle regeneration into prostheses is needed to regain normal joint motor function. The scaffold fabricated in the present work was presented as a promising nanomaterial-based platform for periprosthetic muscle tissue regeneration into prostheses during recovery to regain normal joint motor function.

Examining the biomechanism of myogenesis gave insights into the ability of titanium alloy based on the [email protected] scaffold in activating the Akt/mTOR signaling pathway, promoting myoblast differentiation.

Reference

Wei, X et al. (2022). Improved Muscle Regeneration into a Joint Prosthesis with Mechano-Growth Factor Loaded within Mesoporous Silica Combined with Carbon Nanotubes on a Porous Titanium Alloy. ACS Nano. https://pubs.acs.org/doi/10.1021/acsnano.2c04591

Disclaimer: The views expressed here are those of the author expressed in their private capacity and do not necessarily represent the views of AZoM.com Limited T/A AZoNetwork the owner and operator of this website. This disclaimer forms part of the Terms and conditions of use of this website.

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4 recent studies for spine, orthopedic surgeons to know

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Becker’s has reported on four studies since Aug. 23 that spine and orthopedic surgeons should know.

1. Taking aspirin after a joint replacement surgery could increase the risk of blood clots, according to a study published Aug. 23 in the Journal of the American Medical Association.

2. A study published in The Spine Journal concluded that patient improvement in neck pain was greater than improvement in arm pain following cervical disc replacements.

3. A study published in the July 2022 edition of Operative Neurosurgery supports the long-term use of Premia Spine’s Tops spinal joint replacement system.

4. Pacira BioSciences’ Exparel drug was found to be effective in treating pain after total knee replacements, according to a study.

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The Most Common Gymnastics-Related Injuries – Athletic Health Guide

Gymnastics is an extremely difficult sport that involves excessive body strength and power, extreme precision and skill, and complex routines that drastically increase the risk of injury.

The sport itself is known as one of the highest-risk sports in the National Collegiate Athletic Association (NCAA) when it comes to injury, in large part due to the extreme stresses that occur during a given maneuver or maneuvers.

As a result of the nature of the sport, more injuries are certainly more common than others, though both upper body and lower extremity injuries are prevalent.

In what follows, we’ll be discussing the most common gymnastics injuries, the likely causes of each, as well as preventative tips and recommendations. Because of the nature of the sport, not all injuries can be prevented; however, certain proactive steps should be taken to reduce the risk of injury.

Most Common Gymnastics Injuries

Gymnastics has one of the highest rates of injury for any sport, especially for females. In fact, an average of 100,000 women, both young and old, report a gymnastic-related injury annually.

While a certain level of skill, strength, and preparation is required of gymnastics, no amount of preparation can prevent all potential risk of injury. With the rigorous efforts and complex movements involved, injuries will inevitably occur, both minor and severe.

There’s a multitude of causes of gymnastics-related injuries; however, the most common injuries result from weight-bearing stresses and traumatic impact. Other causes include overtraining and lack of recovery.

The following are the most common Gymnastics injuries:

Traumatic Knee Injuries (i.e., ACL Tear)
Achilles Tendon Rupture
Ankle Fractures
Labral Tears
Sprains & Strains

Other notable injuries include shoulder dislocations and elbow separations, lower-back strain, burns and blisters, and herniated discs.

Many strategies can be implemented to help prevent such injuries. While these are not full-proof, they certainly drastically decrease the risk.

ACL Tear

Traumatic knee injuries such as an ACL tear are unfortunately prevalent in gymnastics, especially at the elite levels. The ACL, in particular, is a knee stabilizing ligament that provides necessary function to the joint.

An injured or torn ACL can sideline an athlete for many months and requires immediate surgery followed by a rigorous and thoughtful rehabilitation program.

Achilles Tendon Injury

The Achilles tendon is the largest tendon in the body, and it attaches the calf to the heel. Its primary function is to allow lower extremity movement via the leg and foot. As you can imagine, the consequences of injuring the Achilles tendon are severe and sometimes can be career-ending for the gymnastic athlete.

An Achilles tendon tear requires immediate surgery and months of rehabilitation. It most commonly occurs due to the overuse and constant stress and strain placed on the tendon during competition.

Ankle Fracture

The ankle incurs constant impact and is often subject to stress fractures, which can sometimes be called “hairline” fractures. These can be quite painful and can take a long time to heal. Ankle fractures typically occur during the landing of a complex gymnastic maneuver.

Labral Tear

A Labral tear is one of the most common upper extremity injuries in gymnastics. While any gymnast can experience a labral tear, they’re most common in ring and bar specialists.

In short, a labral tear is an injury to the labrum, which is the cartilage attached to the shoulder socket that ensures proper stability of the joint.

Sprains & Strains

Though less severe, sprains and strains are extremely common in gymnastics and several other sports and can develop into more severe injuries if not proactively managed.

Because of the complexities of movement, copious amounts of training, and general physical demands involved in gymnastics, sprains and strains can occur at a moment’s notice.

The most common sprains and strains in gymnastics occur in the fingers, hand, wrist, ankles, and legs. The good news is that gymnasts can be very successful in preventing these types of minor injuries.

Injury Prevention Tips for Gymnasts

Injury prevention is the standard to achieve in this sport. While all injuries can’t be prevented, the effort to prevent as many injuries as possible is key to improving longevity within the sport. Unfortunately, many unpredictable accidents do occur in this sport.

By prioritizing physical health, you provide your bones, muscles, joints, ligaments, and tendons with the most substantial environment to perform yet remain uninjured.

Prioritizing physical health requires proactive actions, consistent exercise implementation, and rehabilitative strategies before an injury occurs. The following are the most common and effective preventative measures for gymnasts to reduce the risk of injury:

Stretching
Hydration
Avoiding overtraining
Follow rehabilitation protocols (i.e., physical therapy)
Ensure proper techniques
Avoid loose clothing and wear proper gymnast attire
Wear protective gear during training (i.e., hand grips, chalk, heel pads, wrist wraps, braces)
Rest and recover
Use spotters
Ensure the basic equipment safe and intact

Final Thoughts

Gymnastic injuries often don’t require surgery, but they usually require some medical attention. When injuries occur, no matter the severity, it’s important to seek treatment immediately.

Ignoring symptoms prolongs healing, increases suffering, and can result in more significant problems down the road.

Following preventive techniques can greatly reduce the risk of injury.

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Injections for the Athlete

There are several categories of injections for athletes, each with its purpose and benefits. Athletes may benefit from certain types of medical injections, and those will be discussed.

Generally, there are three particular reasons an athlete might require an injection. These are to combat pain, reduce inflammation, and aid in surgical procedures. Injections can also be used in a rehabilitation program for injury maintenance.

In the following, we’ll discuss some of the details about injections used to treat athletes. In addition, we’ll distinguish several types of injections and their uses and benefits.

Types of Injections

Athletes often require injections for some type of treatment. With so many different injuries and problems with pain, certain injections can help pave the way for an athlete to return to the sport they love.

The most common athlete-related injuries requiring injection include bursitis, tendonitis, carpal tunnel syndrome, muscular injuries such as strains and contusions, and more severe injuries such as tendon or ligament tears or ruptures.

Below are the three most common injections that athletes receive for various treatments:

Corticosteroid Injection
Local Anesthetic
Ketorolac (non-steroidal anti-inflammatory pain killer)

Corticosteroid Injection

A staple in history for the treatment of muscular trauma and inflammatory injuries in athletes, corticosteroids have been known to many as the superior option of treatment.

Its reputation in the medical literature is profound, such that it has been the most consistent symptomatic relief of pain for so many people with minimal bad side effects.

Corticosteroids do have some potential risks and side effects, and complications, especially when intramuscularly injected. Nevertheless, corticosteroids are a common injective treatment used on athletes regularly, and they have been shown through comprehensive research and systematic reviews to be extremely beneficial both in the short-term and long term.

Corticosteroid injections may also have the benefit of decreasing the overall need for additional steroid use in the future by the athlete.

Local Anesthetic

The use of local anesthetic is highly beneficial for the immediate relief of pain, whether caused by injury or other inflammatory conditions. It also plays a significant role during surgical procedures both at the pre-surgical stage and the postsurgical recovery. More and more surgeons have adopted the use of local anesthetic at the area of surgical incisions at the conclusion of the operation. This significantly improves immediate postoperative pain control.

Like any type of injection to the body, local anesthetic can cause potential adverse reactions such as an allergic reaction. This possibility must be closely monitored post-injection, such that treatment can be administered in the event of an allergic reaction.

Interestingly, in some sports federations, local anesthesia for the sole purpose of pain relief has been banned due to its apparent performance-enhancing benefits.

Ketorolac (Toradol)

Ketorolac, or Toradol, is one of the most common pharmaceutical drugs used in medicine. When injected intramuscularly, Toradol acts as an extremely effective pain reliever without causing the undesirable side effects of some more potent pain medications.

While Toradol has been used regularly for pain control over the years, its uses are still somewhat controversial in certain settings due to its potential ineffectiveness and side effects on certain patients. Toradol can be especially harmful to the kidney in patients who already have kidney damage or have a higher risk of developing kidney damage.

Potential Side Effects

The risks of the most commonly used injections in athletes are generally low, but it’s best to be aware of what these potential effects are.

The following are some of the side effects and complications that can occur when injecting an athlete with a medication such as a steroidal or non-steroidal therapeutic drug:

Infection
Allergic Reaction
Further Weakening of the Tendon Resulting in Rupture
Increase in Pain Rather Than a Decrease
Muscle Atrophy & Weight Gain
Vascular Injury and Bleeding
Nerve Damage
Breast Tissue Development in Men
Infertility
Acne
Elevated Blood Pressure
Syncope (passing out)

These are only some of the potential side effects of injections. In addition, many of these side effects are specific to the type of injection that the athlete receives, as well as the overall health of the athlete at the time of injection. It’s important to understand that not all athletes will be good candidates for medication injections, such as steroids. Therefore, it’s essential that the administration of any injection should be overseen by a medical professional.

Yet, while any medication poses potential risks, the most commonly used injections that have been discussed have been shown to be very safe. It’s best to discuss these issues with your medical doctor to understand these potential side effects better and know your risk.

Final Thoughts

Medical injections used for athletes in sports medicine have proven to be extremely useful. Following particular protocols and safe methodology helps the athlete to be able to continue their sport in the face of obstacles such as pain.

When injections are performed by medical professionals in the organization of a well-designed sports program, the best outcomes for athletes can be achieved.

It’s also important to understand the safety and concerns of injections and their application in your respective sport.

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Sports Ultrasound Use – Athletic Health Guide

Ultrasonography is a diagnostic and evaluation modality that has been used in medicine since the mid-1900s, although the physics of ultrasound were initially considered in the late 1800s. In recent years, ultrasound use has become more popular for sports medicine and surgical procedures, among other functions.

Unlike MRI’s and X-Rays, ultrasounds have the unique ability to provide a safer, more comfortable environment for the patient, free of radiation, while still providing effective and useful information to the operator and physician in charge.

While the sophistication and development of ultrasound technology continues to grow rapidly, there are still restraints, limitations, and disadvantages of this interventional modality.

In what follows, we’ll be discussing what a sports ultrasound is, why and how it’s used in a medical context, and its advantages & disadvantages, among other things.

What is a Sports Ultrasound?

A sports ultrasound, or more specifically a musculoskeletal ultrasound, is a non-invasive imaging and evaluation tool that uses sound waves to identify specific body regions and aid in the diagnosis of an injury or condition.

Ultrasound use, in general, is wide-ranging, with applications in medical fields such as obstetrics, general surgery, gynecology, orthopedics, and urology.

In the context of sports medicine, ultrasounds are of primary benefit when it comes to sport-related injuries such as ligament or tendon tears, dislocations, tendonitis, fractures, sprains, and ruptures because of its ability to effectively scan structures with high accuracy and resolution.

This makes it an incredibly effective tool for evaluating injuries of the ankle, hip, leg, and shoulder.

The prevalence of ultrasound use in sports medicine has grown in recent years due to the many obvious benefits for the athlete and its potential to reduce healthcare costs drastically.

As mentioned, however, this innovative technology does come with some limitations. The following information will discuss ultrasound use and its advantages and disadvantages.

Sports Ultrasound Uses

Ultrasound in the context of sports medicine is a diagnostic technology that is especially beneficial due to its ability to evaluate musculoskeletal structures non-invasively.

Ultrasound has been used by physicians to examine fluid surrounding structures that may indicate tendonitis, for example. It can also be used to evaluate range of motion functionality and evaluate possible bone fractures.

Outside of its diagnostic utilization, ultrasounds can also be an effective visualization tool during certain medical procedures, such as proper localization of injection sites for medications such as steroids. This improved visualization is much safer for the patient and more accurately treats the condition.

It can also be utilized in joint aspiration, which can help diagnose a joint condition as well as relieve pain and pressure in a joint.

Advantages of Sports Ultrasound (US)

Ultrasound meets all of the necessary requirements of utility in the healthcare industry, and more specifically, in sports medicine.

Not only is it cost-effective for the user and physician, but its resourcefulness, portability, safety, and high-resolution imagery make it a superior medical tool in many contexts, sports medicine included.

While ultrasonography is still underutilized, many are becoming more and more aware of its specific benefits.

Below are the Several Benefits of Using a Sports Ultrasound [5]:

It’s non-invasive
Provides real-time assessment data
Readily available
Equipment portability
Safe in health-compromised patients
Use is repeatable for monitoring
Relatively cost-efficient
Offers high-quality resolution imagery of examination
Free from ionizing radiation
Interactive

The advantages of a sports ultrasound far outweigh its few disadvantages.

It’s important to realize the safety that ultrasound provides versus ionizing radiation. Anytime that radiation can be avoided, it is much more healthy for the injured athlete.

Ultrasound operators should not only have a keen understanding of how to use it, but they should also be aware of its limitations. For example, while an ultrasound is effective for examining and diagnosing certain injuries and conditions, it doesn’t adequately assess deeper-rooted injuries, such as fractures of bones.

Disadvantages of Sports Ultrasound (US)

The disadvantages of ultrasound should be considered; however, these can be managed well in most sports medicine programs. The primary disadvantage of the ultrasound is its user-dependency.

These are some of the Disadvantages of Using a Sports Ultrasound [6]:

Highly user-dependent
Requires a lengthy training period for the operator
Inability to examine deeper structures of the body
May be ineffective in obese or overweight patients

Regardless of these few disadvantages, ultrasounds are an extremely beneficial tool for the healthcare system. With the ability to evaluate tendinopathies, rotator cuff pathology, and other soft-tissue conditions, ultrasound is an invaluable modality in sports medicine.

Final Thoughts

Sports ultrasound is cost-efficient for both the user and the patient, and it provides extremely useful information in an extremely high-quality format. More importantly, it’s safe, readily available, fast, and portable.

Luckily, sports ultrasound use is growing and will continue to be a helpful benefit to the field of sports medicine.

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