March Madness – Preventing Basketball Injuries

The 2014 NCAA Men’s Basketball tournament starts on March 18, 2014 and OSS congratulates all the teams who have made it to the tournament. March Madness is a frenetic tournament of college teams on their quest to be the best.

Getting to this tournament has been long and sometimes with injury, but we hope that they have performed all the necessary conditioning so that they can compete with the best.

Basketball is a fast, moving sport and sometimes, injuries can occur. Common basketball injuries include:

Ankle Sprains

Treatment for an ankle sprain involves rest, ice, compression, and elevation (RICE). The need for X-rays and evaluation by an OSS physician is determined on a case-by- case basis and depends on the severity and location of pain. Pain and swelling over the bone itself may need further evaluation. An injury to the ankle could represent a simple sprain or could be the result of an injury to the growth plates located around the ankle and should be evaluated by a physician.

Jammed Fingers

Jammed fingers occur when the ball contacts the end of the finger and causes significant swelling of a single joint. Application of ice and buddy taping the finger to the adjacent finger may provide some relief and allow the athlete to return to play. If pain and swelling persist, evaluation by a physician or athletic trainer is recommended and an x-ray of the finger may be needed.

According to Dr. Scott Ruhlman, “It is often difficult to distinguish a devastating finger injury versus a simple sprain based on swelling alone. An x-ray is key to guide ideal treatment.”

Knee Injuries

Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can often be treated with ice, bracing and a gradual return to activity.

Deep Thigh Bruising

Treatment includes rest, ice, compression, and elevation. Commercially available girdles with thigh pads are now available for protection.

Foot Fractures

Stress fractures can occur from a rapid increase in activity level or training or from overtraining. Stress fractures in basketball most commonly occur in the foot and lower leg (tibia). Once diagnosed, a period of immobilization and non-weight bearing is recommended. Return to play is permitted once the fracture has completely healed and the athlete is pain free.

Prevention of Basketball Injuries

Have a pre-season physical examination and follow your doctor’s recommendations for basketball injury prevention
Hydrate adequately – waiting until you are thirsty is often too late to hydrate properly
Pay attention to environmental recommendations, especially in relation to excessively hot and humid weather, to help avoid heat illness
Maintain proper fitness – injury rates are higher in athletes who have not adequately prepared physically
After a period of inactivity, progress gradually back to full-contact basketball through activities such as aerobic conditioning, strength training, and agility training.
Avoid overuse injuries – more is not always better. Many sports medicine specialists believe that it is beneficial to take at least one season off each year. Try to avoid the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid “burn-out.”
Talk with your coach, an OSS physician and/or athletic trainer about an ACL injury prevention program and incorporating the training principles into team warm-ups.
The athlete should return to play only when clearance is granted by a health care professional.

Dr. Jonathan Franklin reminds everyone that “Conditioning and flexibility are key as they reduce the risk of injury during the season. Preparing your body for a game ahead of time will pay off with more success during the season.”

If you believe you are suffering from a basketball-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Dr. Ruhlman Featured in Swedish Ballard

This is Swedish Ballard’s third post in a four-part series to encourage and inspire Ballard residents and the surrounding communities to be healthy while leading active lifestyles in 2014. Below, posted in its entirety, is the article from Swedish Ballard’s web site; posted 1/29/14.

By Scott Ruhlman, MD
Orthopedic Surgeon

Looking to be more active in 2014? Have you been waiting all year to enjoy winter sports such as skiing or snowboarding?

There are a few common injuries that often get my patients down when they are on the go. Below are a few tips and tricks to help you prevent these common injuries and determine the best treatment options should you need it.

Sprains/Fractures
The most common injuries in the wrist and ankle are sprains and fractures. Throwing, twisting, weight-bearing, and impact can put you at risk for a wrist injury. Ankle sprains and fractures are typically caused by making a fast, shifting movement with your foot planted on the ground.

In most cases, I recommend the RICE approach: rest for around 48 hours; ice the injured area to reduce swelling (use a pack wrapped in a towel); compress with an elastic ACE wrap; and elevate the injury above heart level.

However, if you experience these symptoms, contact your provider for further evaluation.

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

More serious injuries will likely be treated with a splint, boot or cast. The healing process can take up to six weeks. Surgery may also be required.

ACL Tears
The ACL, or anterior cruciate ligament, is one of the major ligaments in your knee that helps with stabilization when turning or planting. ACL injuries take place during cutting or pivoting movements. The hallmark of a torn ACL is a distinct popping noise and your knee may give out. The affected knee will begin to swell and become stiff between 2-12 hours after the injury. People often experience pain or tenderness, and discomfort while standing or walking.

Treatment for ACL injuries depend on the severity of the tear, as well as your age and activity level. Non-surgical treatment such as physical therapy or using a brace may be sufficient. Other individuals will need reconstructive surgery. In all cases, it is important to consult with your provider as soon as possible if you suspect a problem.

Rotator Cuff Tears
The rotator cuff is a group of four small muscles and tendons in the shoulder that provide stability to the shoulder and mobility to the arm. A torn rotator cuff can happen in two ways. An acute tear happens suddenly, such as when you fall on an outstretched hand or lift a heavy object. Tears can also happen slowly over time. As we age, the tendons of the rotator cuff become weaker and gradually fray.

Symptoms of a rotator cuff tear include pain with movement of the shoulder and tenderness to touch. Inability to lift even household objects out to the side or overhead is also typical. Another indicator is a prior history of shoulder tendonitis or bursitis as this would point to excessive stress on the rotator cuff over time.

Treatment can be conservative for some tears, including physical therapy to improve shoulder mobility and progressively strengthen the cuff muscles. However, the majority of tears will likely require surgery to restore shoulder function.

Meniscus Tears
The meniscus helps to absorb shock, as well as stabilize the knee joint. A lot of your body weight is distributed through the meniscus when you move, especially when performing athletic activity. Meniscus tears are caused by twisting and compression that can occur with such activities as running or jumping.

If you have a meniscus tear, you may hear a popping sound or feel a tear or rip in the knee. Swelling generally occurs within a few minutes to a couple of hours and your knee might feel like it is out of place. In less acute injuries, swelling may not occur. Your knee might feel like it’s catching during movement, or like it’s “out of place”. If you suspect you may have a meniscus tear, make an appointment with your provider right away.

Initial treatment of a meniscal tear is typically nonsurgical, and may include RICE (rest, ice, compression and elevation). If the tear doesn’t heal, you may need surgery.

Prevention
While the majority of these sports injuries are due to circumstance and pre-existing injuries, there are precautions that you can take to help prevent them from happening to you:

Maintaining a lifestyle involving consistent exercise
Warming up and stretching prior to rigorous activities
Cooling down and slowly relaxing after exercise.

Dr. Scott Ruhlman practices orthopedic surgery at Orthopedic Specialists of Seattle, and has extensive experience with sports medicine. If you have any questions regarding your shoulder pain or function, please feel free to contact Dr. Ruhlman’s office at (206) 784-8833.

Left Hip Injury knocks Olympic Gold Medalist, Evan Lysacek out of Sochi Olympics

USA Today reported that Evan Lysacek, U.S.’ Olympic gold medal winner in men’s figure skating pulled out of the Sochi Games in 2014 due to a torn labrum in his left hip.

The report states, “After a series of serious injuries, including a torn labrum in his left hip, 2010 Olympic champion Evan Lysacek ended his dream of competing in his third Games on Tuesday. Lysacek said the pain in recent months was excruciating. If he continued training, he would risk serious and permanent damage, his doctors told him. “With a warning like that, I felt I had no choice,” Lysacek said.

Figure skating is a very physical sport, with hips and knees greatly affected.Other notable Olympians like Kimmie Meissner, Tara Lapinski and even Michelle Kwan have suffered through orthopedic injuries and sometimes ending their careers. Another Olympian, Brian Boitano was also quoted in the article stating,“Skaters are leaving the sport and getting hip and knee replacements. There are a lot more serious injuries compared to when I competed. It’s sad. We’re losing a lot of young skaters.”

A hip labral tear involves the ring of soft elastic tissue, called the labrum that follows the outside rim of the socket of your hip joint. The labrum acts like a socket to hold the ball at the top of your thighbone (femur) in place. Athletes who participate in such sports as ice hockey, soccer, football, golf and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also can lead to a hip labral tear.

Symptoms include hip pain or a “catching” sensation in your hip joint. Initial treatment may include pain relievers and physical therapy. Using arthroscopic techniques, surgeons can remove loose fragments from within the joint and trim or repair the hip labral tear.Dr. Downer said the following of Evan’s injury, “I hope that this is not more than an isolated incident. Additional injury will have a negative impact on a successful recovery.”

If you would like more information on hip or knee replacements, call Orthopedic Specialists and make an appointment with one of our expert, orthopedic doctors at (206) 633-8100.

Dr. Ruhlman Finishes the California International Marathon (CIM)

Congratulations Dr. Ruhlman for completing the 2013 California International Marathon in Sacramento, CA on December 8, 2013!

According to the CIM’s web site, “The CIM was founded in 1983 by the Sacramento Running Association to bring a world-class running event to the Sacramento area. The same course developed then provides runners with a very fast, point-to-point, net-downhill marathon.

Tracing a historic route used by the gold miners during the 1849 Gold Rush, it begins at the Folsom Dam,passes through semi-rural suburbs into bustling midtown Sacrament, and has a spectacular finish in front of the California State Capitol. The CIM’s 26-mile, 385-yard distance is certified and sanctioned by USATF (#CA07004RS),and therefore is a Boston Marathon qualifier and an Olympic Marathon Trials qualifier. It is frequently a regional or national USATF Championship event as well.”

In Dr. Ruhlman’s words about the race, “”Great race, great people and a well organized race. The conditions and the distance pushed my limits as always, but it was really rewarding to cross the finish line.”Dr. Ruhlman’s official time for completing the marathon was 03:16:25!Congratulations Dr. Ruhlman and way to go!

ruhlman

Preventing Ski Injuries through Conditioning

A busy ski resort in the United States may see dozens of injuries on the slopes each day. As an orthopedic surgeon, I also see many patients with ski-related injuries throughout the season. Most injuries are the result of poor conditioning, or equipment failure.

The most common injuries amongst downhill skiers are knee sprains, shoulder injuries, head/face injuries and wrist/thumb injuries. The knee is the most commonly injured joint, resulting in about one third of all ski injuries. Injury rates and type vary with uncontrollable factors such as weather and snow conditions. Proper equipment and conditioning, however, are factors that we can control.

Equipment

When skiers examine their equipment, it’s important to make sure that: Skis, poles, and boots are in good condition and properly sized for the individual’s weight,size and skill. Bindings are adjusted and tested prior to each ski season.Helmets are properly fitted and checked for damage prior to the ski season.Sunglasses, goggles and sunscreen are part of one’s safety equipment

Conditioning

Skiers can increase their safety and performance this winter by starting with a pre-conditioning program that includes four components: endurance, strength, flexibility, and balance. Aerobic fitness is the key to preventing the end of the day injuries (the last run).Cross training, which includes multiple sports and activities in the conditioning regimen, has become popular, especially with a seasonal sport such as skiing. Strength and flexibility focusing on the legs and trunk are vital in injury prevention specific for skiing. Balance training has been shown to be the single most important exercise for preventing ACL tears in women.
A typical conditioning program can include:

1. Aerobic fitness (5 days/week for at least 30 minutes)

Running
Cycling
Swimming
Elliptical or stair climber
Jumping rope
Treadmill

2. Strength (3 days/week, 2 sets of 60 seconds each)

Leg press
Wall squats
Hamstring curls
Toe raises
Lateral leg raises
Sit-ups

3. Flexibility (daily, 2 sets of 60 seconds each)

Hamstring stretches
Achilles stretches
Quad stretches

4. Balance Exercises (daily, 2 sets of 60 seconds)

Standing on one leg, perform mini squats
Single leg hop, holding landing for 5 seconds, repeat

In addition to a conditioning program, skiers need to adequately warm up – an activity that is often neglected with skiing. No one would think of running out on the football field or onto the basketball court without warming up first. But with skiing, one typically sits in the car for an hour or more to get to the slopes, and then stands in line for tickets and for the lift, before finally sitting on the chair for several minutes. By the time one has arrived on the top of the hill, he or she is often stiff and cold.

It’s important for skiers to remember to warm up and stretch before starting down the hill.Often an easy, predictable run is a good idea before heading to the more challenging terrain.The few minutes spent warming up will be well worthwhile in injury prevention.

More about knee injuries

Every ski season, I treat many knee injuries. In the 1970′s, ankle injuries were more common, resulting from soft, leather boots. The development of stiffer boots has transferred much of the force to the knee.

The most common knee injury from skiing is the MCL (medial collateral ligament) injury. It often results from catching an edge or having the skis diverge, so that the foot is forced away from the body. This creates a distraction force on the inside of the knee. Fortunately, the MCL has a good blood supply, and can be treated non-operatively, with a period of bracing for 4-8 weeks, depending on the severity of the injury.

ACL (anterior cruciate ligament) injuries are also common skiing injuries. They are thought to occur from the forces created by the long lever arm of the ski that are transmitted to the knee ligaments. Commonly, the ACL is injured with a hyperextension mechanism. In expert skiers,we see ACL injuries when saving a backwards fall by a strong quadriceps contraction, pulling the tibia (lower leg) forward with enough force to rupture the ACL. Recent boot and binding technology has reduced the rate of ACL injuries. In young, active individuals, the ACL injuries often require surgical reconstruction. Success rates from surgery are excellent, but require aggressive rehabilitation and six months of recovery time before one can return to skiing or other twisting or pivoting sports.

No one wants to go down the path of surgery and recovery. But too many people wait to think about preparing for skiing until half way through the season, when snow has already accumulated and they are on their way to the top of the mountain. Many times, this is to late. Although injury is a risk we all take when participating in any sport, a conscientious approach to skiing – including equipment inspection and conditioning – will minimize the occurrence. Not only will these precautions reduce injury rate, but they will also enhance performance, decrease fatigue, and ultimately, increase one’s enjoyment of the sport.

We are fortunate in the Pacific Northwest to have great skiing terrain so close. Be safe and prepared so you can enjoy a great skiing season this year.