Achilles Tendon

The tendon connecting your calf muscle to your heel bone is called your Achilles tendon. It is the largest tendon in your body. You use it every day when you jump, run, and walk. The Achilles tendon is prone to overuse (called tendinitis) because of the stresses it sees every day.

The Achilles tendon is one of the most commonly injured tendons, especially among athletes. Tendinitis is the most common form of injury, resulting in pain and swelling either within the tendon or where the tendon inserts into the heel bone (calcaneus). In worse cases, too much pressure on the Achilles tendon can cause it to partially tear or even rupture completely.

What can cause an Achilles tendon injury?

A rupture of your Achilles tendon often occurs when you abruptly start moving, such as while sprinting. Men age 30 years and up have more Achilles tendon injuries than other groups. We see these injuries a lot in so-called “weekend warriors.” There are a number of things that can cause or contribute to an Achilles tendon injury. Some of these might be:

• Overuse
• Inadequate stretching before a strenuous activity
• Performing high-impact activities, such as jumping or plyometrics
• Foot deformities, such as flat feet or high arches
• Tight muscles and tendons in your legs

Athletes who participate in the following activities may experience Achilles tendon injuries:

• Gymnastics & Dance
• Running
• Football
• Baseball
• Softball
• Basketball
• Volleyball
• Tennis

How can I prevent an Achilles tendon injury?

There are many ways to prevent an Achilles tendon injury.

Maintain a Healthy Weight: Make sure you maintain a healthy weight range that is ideal for you. Avoid being underweight or overweight.

Eat Well: Make sure that you are getting the recommended amounts of vitamins and minerals. A diet lacking in calcium could cause Achilles tendon injuries. The U.S. Institute of Medicine’s Recommended Dietary Allowance (RDA) and Dietary Reference Intake (DRI) suggest that adults should get 1,000-1,200 mg of calcium daily and at least 700 mg of phosphorous.

Calcium is essential for your bones to grow and also helps with muscle contraction. Too little calcium or phosphorous intake will result in your body taking what is needed from other places, and this can lead to weaker bones.

Exercise Regularly: Injury prevention involves exercising often to keep your tendons, muscles, and bones strong. Make sure you only do exercises approved by your doctor. If you go to a gym, ask a trainer to help you use the equipment properly.

Pick the Right Shoes: Make sure that you are wearing the correct shoes for your feet. Shoes vary in the amount of cushioning and arch support they provide. Have your athletic shoes fitted by a specialist.

Avoid Hard Surfaces: Soft surfaces, such as cushioned floors, are better on your feet than hardwood. Too much time spent on hard surfaces can cause injuries to the Achilles tendon. Simple choices such as picking a grass court over a hard court, or running on a dirt trail instead of a sidewalk will help to reduce impact and may reduce your risk of injury.

Warm Up and Cool Down: To avoid injury to your Achilles tendon, you should always warm up and cool down before and after exercising or any physical activity.

Start Low and Go Slow: As is the case with other structures in the body, the Achilles tendon responds better to gradual increases in intensity. To avoid injury you should not suddenly increase your distance, speed, or steepness. Gradually increase your exercises rather than jumping right in and making big changes to your work out.

Get Strong: Calf muscles tend to be weak in many people, so it is important to strengthen them through exercise. You can do leg exercises with machines, elastic pull bands, and weights. Some good techniques to strengthen your leg muscles include lunges, leg presses, calf raises, squats, and leg curls.

Do Aerobics First: If you are planning on doing aerobics and strengthening on the same day, make sure that you do the aerobic exercise first. This includes running, stair climbing, and playing sports. These activities put strain on the Achilles tendon. If you perform your strengthening activities first, you put your Achilles tendon at risk for injury because it temporarily weakens the tendon.

Test Your Achilles Tendon: You should test your Achilles tendon for injuries after you finish working out. Use your thumb and forefinger to pinch different areas along your Achilles tendon looking for tenderness. If you experience any pain, this could indicate tendinitis.

What do I do if I have pain?

If you develop pain in your Achilles tendon, see an orthopedic foot and ankle surgeon as soon as possible. If the diagnosis of Achilles tendinitis is made early enough, several options such as immobilization, physical therapy, and stretching are available.

If you continue to exercise and do strenuous activity after you develop pain in the tendon, you risk rupturing the tendon. If this occurs, your surgeon may recommend surgical repair of the tendon.

With ever-warming days in Seattle, and the Major League Baseball season in full swing, many people are taking to the fields once again to partake in America’s favorite pastime. As with every sport, there is a chance for a player to suffer an injury amidst play. Although baseball may not be as contact heavy as other sports (such as football), there are still a number of injuries players can avoid by proactively applying preventative strategies.

The most common injuries for players have a greater chance of occurring in the muscle groups with the most stress placed upon them in a sport that involves frequent stops and starts, and quick changes of direction: The shoulders, the elbows, and the knees. A higher incidence of injury is more likely if a participant does not take the time to stretch or properly warm-up prior to use. Even while taking precautions it is still possible to suffer injury in the middle of play from the extreme forces placed upon the body. … read more

As an orthopedic specialist, I see wrist injuries more commonly among people who participate in sporting activities, such as gymnastics, contact sports, skiing, skateboarding, snowboarding, and racquet sports. Below I will explain the four common mechanisms of injury, the common wrist sports injuries, and how these injuries are treated.

The wrist allows you to properly position your hand, representing arguably one the most complicated joints in the body. There are 15 bones and 27 articular surfaces in the wrist, not to mention its elaborate system of muscles, tendons and ligaments. Ligament injury is quite common among athletes, as the repetitive action of the wrist puts athletes at risk for injury. Wrist sprains result from a torn or partially torn ligament, and wrist strains are the result of a torn or partially torn tendon. The most common wrist fractures among athletes include: distal radius fractures and scaphoid fractures.

The Four Mechanisms of Wrist Injury

Throwing – With throwing injuries, there is an overuse of the wrist. These are common in baseball players, tennis athletes, and racquet ball participants.

Weight-bearing – I see many weight-bearing injuries among those who participate in gymnastics, weightlifting, and cheer-leading.

Twisting – With a twisting injury, the wrist suffers from a rapid rotation that disrupts the stability of the wrist. I see this type of injury a lot with radical skateboarders and snowboarders.

Impact – More common in football athletes, I treat impact injuries that result from either a direct impact or a fall onto an outstretched hand.

Wrist Sprains

The most common wrist injury among athletes is a sprain of the wrist. This often is an injury to one of the ligaments – the connective tissue that attaches one bone to another. Most sprains occur when the wrist is forcefully bent during a fall on an outstretched hand. Wrist sprains can be mild or severe, and I grade them based on the degree of injury. A grade 1 sprain indicates a stretched ligament without apparent tearing. A grade 2 sprain, however, involves partial tearing of a ligament. With a grade 3 sprain indicates ligaments are completely torn.

Distal Radius Fracture

The most common fracture is called a “distal radius fracture.” A distal radius fracture is a break that occurs at the wrist end of the radius bone. These breaks are common among athletes and can be mistaken for sprains. Wrist fractures often occur during a fall onto an outstretched hand. With fractures of the wrist, the break can occur in four ways: intra-articular, extra-articular, open, or comminuted (in many parts). Many can be treated with casting alone, though some require surgery.

Scaphoid Wrist Fracture

The scaphoid bone is one of the smaller bones of the wrist, but it is one that commonly breaks during sporting injuries. This bone is located on the thumb side of the wrist, and can be difficult to treat due to its tenuous blood supply. As with most wrist injuries, a break to the scaphoid bone typically occurs from falling onto an outstretched hand. Treatment usually requires casting if not displaced, or surgery if displaced.

Symptoms of Significant Wrist Injuries

• Pain at the time of injury
• Swelling
• Bruising or discoloration
• Difficulty moving the wrist
• A “popping” or tearing sensation during the trauma
• Warmth and tenderness of the skin

Treatment for Wrist Injuries

Treatment really depends on the type of injury you have. For mild sprains, I generally recommend the “RICE” method and over-the-counter pain relievers, like Tylenol or Motrin.

RICE

R – Rest the wrist for around 48 hours.
I – Ice the injured area to reduce swelling (use a pack wrapped in a towel).
C – Compress the wrist with an elastic ACE wrap.
E – Elevate the injury above heart level.

Nonsurgical Treatment

Simple Sprain –With mild to moderate wrist sprains, you will need to wear a splint for 1 to 3 weeks. This keeps the wrist immobilized while it heals. If you develop stiffness, I can teach you some stretching exercises to allow you to regain full range of motion of your wrist.

Simple Fracture –If your broken bone is in good position, I can treat it by applying a fiberglass or plaster cast. This is done so that the healing wrist bone remains protected from further injury while it heals. You may have to wear the cast for up to 6 weeks, depending on your injury.

Closed Reduction –If the alignment is out of place, I may need to “reduce” the bone and re-position the bone fragments. A “reduction” is the medical term for this process, and because I will not be operating on your wrist, the procedure is called a “closed reduction”. After I put the bone in proper position, I will apply a splint or cast for you to wear for 4 to 6 weeks. Depending on the nature of the injury, I will take X-rays at weekly intervals for around 3 to 6 weeks. After a 6 week period, I may recommend physical therapy for you to help improve your wrist strength and mobility.

Surgical Treatment

Complex Fracture –For those fractures that require surgery, I follow one simple rule – put the broken pieces back into position and prevent them from moving out of place while they heal. I offer several treatment procedures for distal radius fractures and scaphoid fractures, and the choice depends on your age, your athletic activity, and your injury. As with most wrist surgeries, I may order hand therapy and rehabilitation exercises following the repair. It may take as long as 6 to 8 weeks for a complex fracture to heal.

Open Reduction –To perform wrist surgery, I usually make an incision directly over the area of the broken bones and re-align them in a process called “open reduction”. It is considered “open” because I have to surgically correct the fracture. It may be necessary for me to insert pins, plate and screws to hold the bones in place. As with other surgical procedures, I may require you to undergo hand therapy after your cast or splint is removed. Keep in mind, and open reduction surgical procedure takes a while to heal, but with proper physical therapy and rehabilitation, you will regain strength and full function of the wrist.

Fractures of the forearm in children can occur near the wrist (at the distal bone end), in the middle of the bone, or near the elbow (at the proximal bone end). The two forearm bones are the radius and the ulna. A child’s bones are at risk for growth plate fractures because these sections are made of cartilage. Fortunately, children’s bones heal faster than adults’.

Forearm fractures make up around 50 percent of all childhood fractures, and the majority of these involve the wrist-end of the radius bone. Most forearm fractures in children occur from a fall onto an outstretched arm.

Types of Childhood Forearm Fractures

The main categories of fractures are non-displaced or displaced fractures and closed or open fractures. Displaced fractures involve the bone snapping into two or more parts and these parts do not line up. A non-displaced fracture is one in which the bones break but are still in anatomic position.

These fractures require a procedure to re-align the bones. A closed fracture is where the bone breaks but does not protrude through the skin. An open fracture, however, involves the bone breaking through the skin.

Torus Fracture

A torus fracture, is also called a “buckle” fracture, results in the top layer of the bone on one side compressing and buckling away from the growth plate. This is a stable fracture, with the broken segments not separated or displaced. These breaks hurt but do not cuase a deformity.

Metaphyseal Fracture

With a metaphyseal fracture, the break is across the upper or lower portion of the bone shaft. With this type of injury, the growth plate is not affected.

Greenstick Fracture

A greenstick fracture runs through a portion of the bone, causing it to bend on the other side. This term came about because doctors described this fracture like a green stick breaks. These types of injuries occur only in children, as adult bones won’t break in this manner.

Galeazzi Fracture

The Galeazzi fracture affects the radius and the ulna bones. These types of injuries are usually displaced with dislocation of the ulna at the wrist area.

Monteggia Fracture

With a Monteggia fracture, both forearm bones are affected. The ulna breaks and the top and the radius dislocates. This is a severe injury that requires immediate urgent care.

Growth Plate Fracture

Growth plate fractures, also called physeal fractures, occur at or across the growth plate, typically in the area where the radius attaches with the wrist. This area heals well, with less than 5 percent having complications.

Symptoms

Symptoms really depend on the type of fracture, but most fractures cause severe pain and numbness of the hand and forearm. Sometimes, the fracture causes a bent appearance of the forearm. Other symptoms include swelling, bruising, and inability to rotate or turn the arm.

Treatment

Treatment depends on the degree of displacement and the specific type of fracture. The severity of a fracture depends on the location and the amount of damage done to the tissue and bone. A minor fracture could heal within a few weeks, whereas a serious fracture could take months to heal.

Treatment also depends on the age of the child, the degree of deformity, and the stability of the break. The goal of treatment to a fracture involving the growth plate is restoration of normal alignment with minimal trauma.

Nonsurgical Treatment

Many fractures of the forearm in children can be treated without surgery. Casts and immobilizing devices protect the bones while they heal. Sometimes it is necessary for the orthopedic specialist to manipulate the bones into proper alignment, a process called reduction.

Surgical Treatment

Surgery to realign the bones and secure them in place is necessary if the skin is broken, if the fracture is unstable, if bone segments have been displaced, and if the bones cannot be manipulated to realign through reduction. Once the surgeon aligns the bone segments, he may use metal implants, pins, or a cast to hold these in place.

Long-Term Outcome

Once your child’s cast comes off, the wrist joint or elbow joint may be stiff for a few weeks. This will resolve without the need for physical therapy in most cases. Your child’s healing bones will be temporarily weak following immobilization, so you should not allow rough play, climbing, or contact sports for 3 to 4 weeks after the cast comes off.

Knee pain is a common complaint among skiers, and often knee pain in skiers is the result of an injury. The location and severity of the pain depends on the cause of the problem. Signs and symptoms that often accompany knee pain include redness, warmth, weakness, instability, swelling, stiffness, œlocking, and œpopping.

Be sure to notify your orthopedic specialist if you have knee pain accompanied with swelling, cannot fully extend of flex your knee, notice a deformity, have a fever, or if the knee œgives out.

Knee Injuries from Skiing

Because of the mechanics of the sport, knee injuries are quite common for skiers. These injuries can range from simple to complex, with 25% of all ski injuries affecting the knee.

MCL Injury – The most commonly injured knee structure is the medial collateral ligament (MCL). This is because of the type of stance and turn skiers use that places serious stress on the inside of the knee.

ACL Injury – The anterior cruciate ligament (ACL) is injured in more advanced skiers or from those who have a specific type of fall. ACL injuries are associated with sudden direction change with a twisting injury accentuated by the long lever arm of the ski.

Torn Meniscus – Another common skiing injury is a torn meniscus. The meniscus is a rubbery tough cartilage that acts a shock absorber for the joint. It is torn when you suddenly twist your knee with weight on it or from a direct contact blow during a fall.

Knee Bursitis – Certain knee injuries lead to inflammation of the bursae, the small sacs of fluid that cushion the knee joint. This condition is painful, especially with bending of the knee, and swelling is common.

Patellar Tendinitis – When one or more tendons are irritated and inflamed, patellar tendinitis develops. The tendons are the thick fibrous cords that attach bone to muscle. Skiers are prone to inflammation of this tendon that connects the quadriceps muscle on the front of the thigh to the tibia (shinbone).

Knee Dislocation – Pain from dislocation of the knee joint is rare and is a true emergency. The displacement of the leg stretches and tears the knee ligaments and may involove injuries to the arteries and/or nerves. This painful condition often produces an obvious knee deformity and requires immediate medical attention.

Kneecap (Patella) Dislocation – Dislocation of the patella is caused from direct trauma or forceful twisting of the knee. Obvious patella deformity occurs with this condition, and you should seek medical care immediately.

Runner’s Knee (Patellofemoral Pain)

Skiers put heavy stress on their knees that causes a condition called runner’s knee. This knee pain syndrome causes pain around the front aspect of the knee. The pain occurs with walking up or going down stairs, squatting, kneeling, or sitting.

Patellofemoral pain is caused by malalignment of the knee, partial dislocation, injury, flat feet, or tightness and weakness of the thigh muscles. Runner’s knee can be the result of soft tissue irritation in the front of the knee.

Treatment for Knee Pain

Treatment of your knee pain will depend on the particular problem that is causing the pain.

Basic First Aid for Knee Pain

Stop skiing and use the RICE formula:

Rest – Avoid putting weight on the painful knee.

Ice – Apply cold packs or ice wrapped in a towel for short intervals of time frequently.

Compression – Use an elastic bandage, like a simple knee sleeve with the kneecap cut out that fits snugly.

Elevation – Keep the knee raised up higher than your heart.

Nonsurgical Treatment

If you have knee pain, you should see an orthopedic specialist. The doctor may recommend physical therapy for you to learn reconditioning to regain full range of motion, power, strength, speed, and endurance. These exercises help the front thigh muscles (quads) and the back thigh muscles (hamstrings).

Another thing the doctor may recommend is a special brace to help protect and support the knee. Certain knee pain syndromes respond to injections of corticosteroids to reduce inflammation. The doctor may recommend a hyaluronic acid injection for joints that need extra lubrication.

Surgical Treatment

There are several surgical knee procedures for knee pain.

Arthroscopy – This is done when there is significant damage to the cartilage or meniscus. The orthopedic specialist uses a pencil-sized instrument (called an arthroscope) to look inside the knee joint to diagnose and repair your condition.

Realignment – This is done to reduce the pressure on the cartilage and supporting structures of the front aspect of the knee.

Partial Knee Replacement Surgery – This procedure is done when there is serious damage to the knee. The orthopedic specialist replaces the damaged portion with parts made of metal and plastic.

Total Knee Replacement – This surgery is done when the doctor must remove significant damaged bone and cartilage and replace it with an artificial joint.

Knee Pain Prevention

Keep weight normal – Maintaining a healthy weight is the best thing you can do to prevent knee pain and injury.

Get strong and stay limber – Weak muscles lead to knee injuries, so keep your quads and hamstrings strong. Balance and stability training allows the muscles of the knees to function properly. Also, avoid injury by stretching to increase flexibility.

Stay in shape – Prevent knee pain and injury by keeping yourself well-conditioned.

Use proper gear – Make sure your skiing shoes are good shock absorbers and of quality construction. Also, be sure your shoes fit properly.