Chicago recreational basketball player recovers after Achilles rupture

basketball patient

“I heard a ‘bang’ and then felt as if someone stomped on the back of my left calf, slamming me down to the court. But, when I looked up, both the basketball and the other players were all several feet away staring at me. That’s when I knew I likely had a serious problem.”

This is how Ganesh Sundaram, 31, of Chicago, describes the incident that left him with a ruptured left Achilles tendon earlier this year. “I was playing with a bunch of friends on the weekend and went up for a rebound. Then, I quickly reversed my direction to get back on defense,” he explains. “I later found out that this rapid deceleration followed by acceleration and change of direction is a common cause of injury to the Achilles tendon at the back of the heel.”

He felt numbness, then pain as he limped off the court. He went directly to the nearest emergency department where the physician on duty conducted the Thompson test to determine whether or not his Achilles tendon was intact. After his foot hung loosely when his calf was squeezed, the physician told him it was most likely a full rupture and should see a foot and ankle specialist right away. Sundaram, at the suggestion of his brother-in- law (a Chicago-area physician), made an appointment with Dr. Simon Lee of Midwest Orthopaedics at Rush. Dr. Lee, an expert in treating Achilles injuries, confirmed the diagnosis and presented options for both surgical and non-surgical repair of his tendon.

Given Sundaram’s very active lifestyle which included a regular fitness and full-court basketball regimen, Tough Mudder/Spartan races and keeping up with his toddler son, he chose surgery given the higher likelihood of returning to full pre-injury function, strength and mobility. They also discussed the warning signs that Sundaram experienced several months earlier. After running in high heat while dehydrated and on vacation, Sundaram felt stiffness and pain in his left Achilles tendon when getting up after a long flight home.

Concerned, he took a rest from running, jumping and basketball for a few weeks but maintained the rest of his fitness regimen. He then resumed these activities once he felt minimal discomfort, but didn’t do any pre-activity stretching or warming up and he didn’t see a physician. Midwest Orthopaedics at Rush foot and ankle physicians explain that this scenario is becoming more and more common in their practices. “Over a recent ten-year period, we have seen our number of Achilles patients increase by almost 300 percent,” explains Dr. Lee.

So many more people are participating in extreme sports, like Tough Mudders, marathons and Spartan Races. They aren’t stretching or strengthening their Achilles tendons properly – or at all. We also see lots of weekend warriors who do the same thing.

For both types of athletes, Dr. Lee and his fellow foot and ankle physicians created aMOR300x250 useful resource for athletes to keep their ankles and tendons healthy called ‘Ankles for Life’. It includes injury prevention tips in both a downloadable brochure and video format. It was developed in conjunction with the Illinois Athletic Trainers Association. Sundaram, who is now back to basketball and working out, knows that he should have listened to his body when he had heel pain several months before the rupture.

“Dr. Lee told me that surgeons have a saying that ‘healthy tendons don’t rupture’. Mine was irritated or maybe even partially torn at the time and I should have attended to it earlier,” he says. Sundaram now incorporates lower body and heel stretching and strengthening into his routine before any sports activity – and encourages all athletes to do so.

For more information on preventing Achilles injuries and to request a gym bag tag with ankle injury prevention tips, visit the Ankles for Life website.

To schedule an appointment with Dr. Simon Lee to discuss your foot or ankle condition, click here or call 877-MD- BONES.

7 Common Youth Basketball Injuries

By Sean Leninger, PT, DPT for Athletico

Basketball is a popular sport among youth athletes, but the duration of the season inyouth-basketball-injuries combination with the athleticism required by players can lead to injury.

Some of the most common injuries experienced by youth basketball players include muscle strains, ankle sprains,  Jumper’s knee and shin splints. Fortunately there are ways to prevent these injuries from happening. Read below to learn more about seven types of injuries that young basketball players are at risk for, as well as some injury prevention tips to help keep young athletes on the court.

  1. Muscle Contusions

One of the most common acute injuries suffered by young basketball players is a muscle contusion, which occurs secondary to impact. In basketball, it is not unusual for a player to accidentally ‘knee’ another player in the thigh causing a bruise to develop. Although painful, this type of injury is typically not serious.

With acute muscle contusions (less than 72 hours after injury), typical treatment includes rest, ice and compression. Once beyond the acute phase of injury, gradual return to activity is recommended and may include light stretching, progressive strengthening, and eventual return to sport once pain has subsided and full function is regained.

  1. Muscle Strains

In addition to muscle contusions, many young basketball players experience muscle strains, or ‘pulled’ muscles. The hamstring, calf and adductors (inner thigh) are common sites for muscle strains to occur given the functional demands of a sport like basketball. Strains can vary in severity from mild (Grade I) to serious (Grade III). Grade I strains occur when the muscle/tendon is overstretched. Small micro-tears in the muscle may or may not occur and the integrity of the muscle remains intact. Grade II strains involve a greater amount of torn muscle fibers and require longer recovery than a Grade I strain. Lastly, Grade III strains occur when the muscle tears or ruptures completely. This type of strain may require surgical intervention for full function to be restored.

Depending on the severity of the muscle strain (Grades I and II), return to sport may take anywhere from 2-6 weeks in most cases. As mentioned previously with muscle contusions, treatment for a muscle strain may include modalities (e.g. ice or heat), stretching, gradual strengthening, eventually progressing to advanced therapeutic exercises, along with sport specific activities such as drills, running, cutting, jumping, etc.

  1. Ankle Sprains

Most people have experienced the classic ‘low’/lateral ankle sprain that is the result of rolling/inverting the ankle. In basketball, ankle sprains can occur when cutting, accidentally stepping on an opponent’s foot or landing awkwardly.  Lateral ankle sprains involve over-stretching of the ATFL (Anterior Talofibular Ligament) and/or CFL (Calcaneofibular Ligament). Much like muscle strains, sprains are graded on a scale from I through III, with Grade I sprains being mild and Grade III sprains being considered severe.

Acute ankle sprains (Grades I-II) are typically treated with RICES (rice, ice, compression, elevation, stabilization). Once beyond the acute phase of healing, gradual pain-free restoration of range of motion, strength, ankle stability, balance and functionality is addressed in order to facilitate safe return to play.  Improper progression or returning to play too quickly may place the athlete at an increased risk of re-injury.

  1. Concussions

Many parents worry about concussions in their young athletes. While most associate concussions with aggressive contact sports like football, hockey, lacrosse and rugby, this type of injury can also occur in basketball players. Such mechanisms of injury may include a player going up for a rebound and getting elbowed in the head, diving for a loose ball and hitting their head against the court, or during the process of defending or executing a layup if contact is involved. Concussions can be a complicated injury and may require rest, follow up with a physician, as well as a proper plan of care under the guidance of a Physical Therapist that specializes in vestibular rehabilitation for safe return to activity.

  1. ACL Injuries

The Anterior Cruciate Ligament or ACL is one of the four main ligaments providing stability to the knee. ACL injuries typically occur in sports that involve quick changes of direction, pivoting, cutting and jumping. Although ACL sprains can be managed conservatively with physical therapy, an ACL tear/rupture requires surgical intervention to reconstruct the torn ligament. It is also important to note that there are multiple predisposing factors (e.g., gender, bony structure, landing mechanics, playing surface) for ACL injuries. Athletes can take steps to reduce the risk of ACL injuries by engaging in a comprehensive strength and conditioning program.

  1. Overuse Injuries

Overuse injuries such as Patellofemoral Pain Syndrome (PFPS), Jumper’s knee/patellar tendinitis, shin splints and stress fractures tend to develop over the course of a season. Many athletes are hesitant to bring up injuries to their coaches because they don’t want to miss playing time. That being said, overuse injuries tend to get worse as the season progresses. This is because overuse injuries can be linked to repetitive jumping, hip/ankle weakness, muscle imbalances (e.g. quad dominance), and running/playing/practicing while not allowing for a proper rest and recovery period. Because of this, coaches and parents should encourage young athletes to speak up when they are feeling unusual pain and discomfort.

  1. Apophyseal Injuries

Apophyseal injuries are specific to the pediatric population. These types of injuries occur at sites where tendons attach to bony prominences and include inflammation and soreness to avulsion fractures. Common sites of apophyseal injuries in youth basketball players include the calcaneus/heel (Sever’s disease) and the tibial tuberosity/shin (Osgood-Schlatter’s disease). Apophyseal injuries are typically associated with skeletal immaturity, flexibility deficits, repeated trauma (e.g. repetitive jumping and running) and muscle imbalances. Conservative treatment is usually effective in managing such conditions, making physical therapy an excellent treatment option.

The Importance of Injury Prevention

Injury prevention is important because it lessens potential healthcare costs and keepsathletico300x250 athletes playing their respective sports at a high level. As such, many chronic and even some acute injuries may be mitigated or prevented through a proper “pre-hab” exercise program along with incorporating a sport-specific warm up routine. For example, youth basketball players may benefit from balance training, dynamic and static stretching, hip/ankle stability exercises, as well as strengthening of the core and lower extremities.

Should an injury linger, further follow up with a physician and formal physical therapy treatment may be the best route for optimal outcomes.

Athletico also provides complimentary injury screens at a location near you. Click here to get started.

ANKLE SPRAIN: WHEN CAN I PLAY AGAIN

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Recovery and return to play after ankle sprains will vary depending on the severity of the injury, and the injured athlete’s unique healing response
  • Sport specific reconditioning after an ankle sprain often takes much longer than you think
  • For the common Grade 1 sprain, I typically see return to play with a brace at 1-2 weeks after injury
  • For the common Grade 2 sprain, I typically see return to play with a brace at 4-5 weeks after injury

There’s never a good time to be injured. As we come up to the end of many winter sports, SwollenAnkle_2players often have their eyes on championships or important tournaments. When an injury happens one of the most important questions the young athlete wants to know is “when can I play again?” Usually their point of reference is the newsfeed on some professional athlete’s injury, and the answer from the news media is almost always “2-3 weeks.” The reality, however, is that full recovery as I outline below can often take much longer than that. Let me outline the general phases for injury recovery, and finish with some rough timelines for return to play after ankle sprains.

Treating the Injury

The treatment phase involves the healing of the injured part. For an ankle sprain, this may involve a brace, sometimes crutches, and typically “RICE”: rest, ice, compression, and elevation. Ankle sprains are classified by physicians in “grades”, ranging from Grade 1 (mild) to Grade 3 (severe, with complete ligament tear).

Rehabilitating the Injury

Once the treatment for the injury has started, the next phase of recovery begins. This will often involve referral to a qualified physical therapist or working with your athletic trainer. The physical therapist and athletic trainer are highly trained in techniques to restore function of the injured ankle, develop a plan for sport-specific training, or suggest equipment modification such as bracing. For many injuries we’ve learned over the years that early involvement by an athletic trainer or physical therapist speeds up return to play.

Conditioning the Injured Athlete for Return to Play

Here’s the part that can take some time, often much longer than you initially realize. Let’s say you’ve had a significant ankle sprain. You were treated in a brace for 2-4 weeks, and then you started getting some movement skills back for another 2-4 weeks. Now we’re up to 4-8 weeks from the time of your injury, and you know what you haven’t been doing- practicing or playing sports. Getting yourself fit will take a few more weeks (or even months, if you’ve been out a long time). In this phase we will usually rely on the trainer to start sport specific conditioning drills designed to safely return you to play.

Putting it All Together- How Long Until You Can Play Again?

ssd.bannerI’ve broken the process into “phases” above, but the reality is that there’s a lot of overlap between the phases. For example, treatment and rehabilitation will be going on at the same time and will overlap, and rehabilitation and conditioning will also overlap. Additionally, each person responds differently to injury and healing. So each situation can vary quite a bit with the specifics of your injury, but here are some very rough guides based on real world experience from my orthopedic practice.

  • “Mild” or Grade 1 ankle sprain: Brace or Ace wrap for 3-5 days, Return to play with ankle brace 1-2 weeks
  • “Moderate” or Grade 2 ankle sprain: Brace 2 weeks, Rehab and conditioning 2 weeks, Full return to training 4-5 weeks after injury
  • “Severe” or Grade 3 ankle sprain: Boot or brace 3 weeks, Rehab and conditioning 4-6 weeks, Full return to training 7-9 weeks after injury
  • “High Ankle” or syndesmosis sprain (highly variable return times): Boot or cast 3 weeks, possibly crutches as well, Rehab and conditioning 6-12 weeks, Full return to training 9-15 weeks after injury

Snowboarding Ankle Injuries

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Snowboarders tend to get more ankle injuries than skiers, and skiers tend to get more knee injuries than snowboarders
  • The “snowboarder’s fracture” is unique to ankle injuries in snowboarding
  • A fracture of the “lateral process of the talus” is sometimes missed on regular x-rays and it’s sometimes necessary to use specialized imaging to make a proper diagnosis
  • When treated early and properly this fracture will typically allow full return of sports participation but a missed diagnosis can result in significant problems

In this post I’m going to discuss a particular type of broken bone seen in snowboarding snowboardoften referred to as “the snowboarder’s fracture.” This particular fracture occurs in one of the ankle bones called “the talus”. A fracture in the lateral process of the talus is called the snowboarder’s fracture.

Patterns of injury are a bit different in snowboarding compared to skiing. Skiers tend to get more knee injuries than ankle injuries, and snowboarders tend to get more ankle injuries than knee injuries. One proposed reason for this difference is due to the less rigid boots used in snowboarding, which provide minimal protection to the ankle joint.

Most ankle injuries in snowboarding affect the lead leg. And about half of all ankle injuries in snowboarding are fractures. The “snowboarder’s fracture” occurs because of sudden upward movement of the foot, combined with the foot turning inwards. This injury typically occurs when landing from a jump. Pain is present on the outer side of the foot and ankle, and is often associated with swelling, bruising and significant tenderness to touch. Unfortunately, this injury is often missed, because regular X-rays don’t always show the fracture very well. If I’m suspicious for a snowboarder’s fracture and the x-rays look normal, I’ll often order a CAT scan as this can be a much more accurate way to diagnose this fracture.

Treatment of the snowboarder’s fracture depends on how big and how displaced the broken fragment is. For a small fracture that is in normal alignment, we can treat these without surgery. This typically means about 4 to 6 weeks of having the foot and ankle in a cast and no weight bearing on the leg. Large and displaced fractures are typically treated with surgery—the fragment is moved back into its normal position and screws are inserted to hold it in place. Recovery after surgery also includes a period of non-weight-bearing, followed by gradual restoration of motion, strength, and function of the ankle joint.

ssd.bannerOutcomes of snowboarder’s fractures are typically good if the injury is diagnosed early and appropriately treated.

Most athletes are able to get back to normal physical activity within 4 to 6 months. However, significant problems can result if this fracture is missed and appropriate treatment is delayed. These include non-healed bony fragments causing pain and poor function, as well as early arthritis of the joint, which can significantly limit movement of the foot. When a snowboarder presents with acute pain on the outer side of the foot or ankle after an injury on the slopes, it’s very important to see a skilled physician for a proper exam and appropriate diagnostic imaging to avoid missing this injury.

Tips for Keeping Your Feet Dancing Through the Holidays

By  Kelli Barton for Athletico

The Nutcracker is the most iconic holiday ballet performed by ballet schools and professional companies around the world.

Between December 10th and December 30th, the Joffrey Ballet Chicago will perform The Nutcracker 27 times. That’s an average of 1.2 shows per day! For optimal performance, it is crucial that dancers are proactive in preventing injuries from occurring and correctly manage injuries when they do occur. Foot and ankle injuries represent 34-62 percent of all injuries reported by dancers. Female ballet dancers are especially vulnerable to these injuries because of the increased demand put on the foot and ankle when dancing en pointe.

To help prevent dancing injuries from happening, consider the following tips:

Overuse Injuries
Overuse injuries are aches and pains that occur due to the repetitive nature of danceballet-dancing movements and lack of adequate rest. Examples of overuse injuries are stress fractures and tendinitis. Fortunately, the risk for these injuries can be decreased through appropriate rest, adequate warm up and nutrition.

 

Getting Appropriate Rest

Fatigue has been cited as a common reason for injuries in dancers as overall injury rates vary from 0.8 to 2.9 injuries per 1,000 hours of dance training. When fatigued, decreased trunk control and faulty lower extremity alignment results in increased demand on joints and ligaments to provide stability. While you may not be able to alter the amount of time you spend dancing, you can control what you do during time outside the studio. For example, active rest is preferred over complete rest, including gentle movements, stretching, as well as strengthening and stabilizing muscle groups. This helps avoid excessive stiffness throughout the body.

It is also important to note that fatigue-related injuries have been reported to increase when psychological stressors such as work or school conflicts are present. Since performances may induce additional stress, it is important to find strategies to appropriately rest your brain in addition to your body to stay healthy during this time.

Warming Up

An appropriate warm-up primes the body for optimal performance. Morrin et al found that a combination of static and dynamic stretching provided a significant change in hamstring flexibility as well as superior balance and vertical jump values in comparison to a static-only or dynamic-only warm up.

Static stretching involves holding a specific position for a period of time whereas dynamic stretching has an aerobic approach in which the body part is repetitively moved through its available range of motion. Examples of dynamic stretching include leg swings, alternating kick-to-buttocks and scissor jumps.

Good Nutrition

Low energy availability occurs when a dancer is not consuming enough food for the amount of energy expended during physical activity. Therefore, a dancer will need to eat more as the volume of dance participation increases.

Signs of low energy availability include fatigue, difficulty concentrating and loss of menstrual cycle. Consistently low energy availability can cause sub-optimal bone mineral density and place the dancer at increased risk for stress fractures. High caffeine intake, noted as greater than two cups of coffee per day, can also contribute to low bone mass density. For specific nutrition recommendations, please seek attention from a nutritionist in order to develop a plan based on your individual needs.

Acute Injuries

Acute injuries occur when a bone, ligament, tendon or muscle is extended past its capability or excessive force is placed onto a region of the body. Examples of acute injuries are ligament sprain and muscle strain.

When an acute injury occurs, the body releases chemicals to create an inflammatory response around the damaged structure. The inflammation assists with promoting new cell growth, defending the body against harmful substances, and disposing of damaged tissue. However, this process results in swelling, redness, warmth, pain and loss of function at the area of injury. The following steps should be taken after an acute injury:

“PRICED”

P: Protection

Relocate to a safe space away from additional danger such as fellow dancers continuing to perform and provide support to the region of injury.

R: Rest

Avoid painful movements with involved body part as continual stress may increase injury and delay healing.

I: Ice

Apply ice to the injured area for 20 minutes every 2 hours for the initial 2-3 days. Ice will decrease blood flow to the area, slow conduction of painful nerve impulses, decrease abnormal accumulation of fluid, and lower temperature.

C: Compression

Utilize an elastic compression bandage to wrap the area. If you experience sensation of pins/needles, numbness or change in skin color, the bandage is too tight. Start away from the heart using a figure 8 pattern with a gradual decrease in tightness as you pass the site of injury. Avoid gaps in bandage that expose skin as swelling will accumulate here.

E: Elevation

Raise the injury area above the heart to increase return of blood and therefore remove waste products away from the area.

D: Diagnosis

All acute injuries should be evaluated by a health-care professional for advice regarding appropriate next steps, especially if not resolved with “PRICE” or unable to bear weight. Choosing a health-care professional who has a specialty working with performing artists will be helpful to allow for a gradual, safe return to dance.

Basic First Aid for the Foot

Although blisters, cramping, split skin and bruising will not likely take you out of a performance, they can be a source of discomfort when participating in a higher volume of dancing.

Blister Blisters are caused by a combination of friction and moisture at bony prominences of the feet. It may be a sign that shoes should be re-sized as the structure of the foot can change over time. Petroleum jelly or tape placed on more vulnerable spots can decrease friction. In addition, using less absorbent material for tights or pointe shoe padding can decrease moisture. Blisters will heal independently and should avoid being popped due to risk for infection. If a blister does pop, it is important to cover with an antibiotic ointment and bandage that will stay secured in shoes.

Cramps A muscle cramp is a strong, painful tightening of a muscle that occurs involuntarily.  Another name that is commonly used to describe a cramp is a “Charley horse.” To avoid cramping, stay hydrated and perform an adequate warm up as well as cool down. Stretching the cramped muscle can assist with relieving symptoms faster.

Split Skin Split skin often occurs in the area of a callous, particularly on the ball of the foot. Prevent skin from splitting by using a fat-based balm such as coconut oil over areas of tough, dry skin. If a skin split does occur, be sure to keep the area clean to decrease risk for infection. There are some over-the-counter products that help to seal the split skin together to promote healing.athletico300x250

Bruising The best prevention for bruising is to wear padding and control descents to the floor during choreography. Avoid heating pads or warming topical creams, as this will bring more blood to the bruised region and delay healing.

By following the above recommendations, you are now ready to tackle the Nutcracker season injury free! If you experience an injury, please contact your physician or set up a screen with a performing arts physical therapist at a conveni ent Athletico Physical Therapy location.

Schedule a Complimentary Injury Screen

The Future of Ankle Bracing is Here

Get Into Your Comfort Zone

Exos Free Motion Ankle

The Exos™ Free Motion Ankle offers unparalleled comfort, support and ease of use. This anatomically formed ankle foot orthosis can be fit to a patient within 30 minutes to quickly alleviate pain and discomfort, restore mobility and prevent progression of a disease or deformity.

Posterior Tibial Tendon Dysfunction (PTTD)

  • Correct bony alignment and provide support in various planes of motion

Post-Trauma / Post-Op Rehabilitation

  • Arthritis
  • Weak ankles due to ligament damage and over stressed ligaments
  • High ankle sprains

Chronic Ankle Instabilities

  • Step down care following casting or walking boot
  • Controlled range of motion allows full-functional management and faster return to activities

Exos Free Motion Ankle is the first prefabricated Ankle Foot Orthosis that can be fully
customized and formed to the patient providing functional stabilization of the ankle- foot complex addressing bony abnormality, chronic instability and post-trauma rehabilitation.

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