1 Ankle sprain
A sprained ankle is the most common sports injury. Unfortunately the term “sprain” fails to convey the degree of pain and disability this can cause. Feet have evolved to perform over uneven surfaces and therefore have the ability to tilt sideways as they land on sloping ground. Such adaptability comes at a price and the ankle is susceptible to twisting too far, restrained only by relatively weak ligaments. When the foot rolls under the ankle like this these ligaments can be overstretched or even torn, resulting in a sharp pain and subsequent swelling across the outside of the ankle.
Treatment
When an ankle has been sprained once without correct management it will always be susceptible to recurring injuries. This is because even after the ligaments are fully repaired the ankle has lost it’s proprioception – the joints sense of position. Without retraining this proprioceptive element the ankle’s ability to prevent recurrent sprains is diminished.
Once the initial pain and swelling is resolving, retraining can begin. This is achieved by subjecting the ankle to progressively more challenging balancing acts. Start with one foot on a flat surface and advance onto a wobble board with distractions such as bouncing a ball against a wall or closing the eyes.
Even considerably torn ligaments can repair themselves but beware if the ankle isn’t resolved by six to eight weeks; there may be a more serious additional injury.
2 Achilles tendon pain
Homer’s mighty warrior Achilles’ only weakness was the large tendon at the back of his leg, so the many runners who suffer with Achilles tendenopathy are in distinguished company. The Achilles main role when running is to absorb and store the energy of impact and release it as a forward propulsive force with each stride. Tremendous forces are transmitted through the legs when running, many times the weight of the runner, and it is no surprise when the tendon starts to fail. Pain and stiffness at the back of the ankle is the hallmark of an Achilles tendonopathy.
Initially the runner can cope and symptoms ease with a warm up but given time each stride is painful and even walking can become compromised. The strong fibres, intrinsic to the tendon, have stopped repairing themselves and no longer align themselves longitudinally.
Treatment
Often there is an identifiable responsible change in loading either an increase in distance or intensity, and modifying training may be all that is needed to control symptoms. Failing that, there are a number of interventions that can help. The principal treatment is known as an “eccentric loading programme” and consists of loading the lengthening tendon with increasing weights over a period of weeks. Analysis of the running style with prescription of appropriate foot orthotics is often indicated or even injections into the tendon to promote healing.
Prevention is always better than cure so Achilles problems can be avoided by adequate stretches and warm ups, decent fitted running shoes and varying the mileage and surface. Excessive road running is asking for trouble.
3 Osteoarthritis (OA) of the knees
The old joke amongst veteran rugby players is that they have to retire to a bungalow, as they can’t manage stairs any more. Repeatedly injuring knees hastens the onset of OA but regular exercise probably protects. As the knee cartilage (the lining of joints) wears down with age it becomes less able to glide smoothly with movement and produces less lubricating synovial fluid. Knees are particularly susceptible to OA with sufferers complaining of painfully stiff and swollen joints.
Treatment
Strong, supple joints will remain healthier for longer. A stable knee is one with powerful, well coordinated musculature and this is achieved by training the knees to work effectively through the whole range of movement. A slow, controlled lunge keeping the knee in line with the toes will achieve this while holding additional weights
and balancing on a wobble cushion increases the difficulty.
For those with established OA non impact exercise is the key. Pounding the streets will only add to the problem while cycling, rowing or cross-trainers build up strength without causing damage. Injecting a synthetic synovial fluid into the knee can be beneficial for some.
4 Shoulder impingement
Most racket sports and many ball games require an overhead action with the arm. The shoulder is an exquisitely designed piece of kit with a huge range of motion controlled with a plethora of muscles working in synergy. Gymnasts can launch themselves into the air off one arm and pitchers accelerate a ball to over 100mph thanks to the power and finesse of the shoulder joint. But inevitably it can all go wrong and when it does impingement often follows. A large protective bursa cushions the shoulder mechanism from the protective bony roof above. Shoulder injury inhibits muscle function and the forces then acting on the joint squeezes this bursa causing inflammation. This dull shoulder ache with a sharp pain when raising the hand is indicative of impingement.
Treatment
Firstly rest from aggravating activities will allow the inflamed bursa to settle down. Anti-inflammatory tablets or a cortisone injection may help to accelerate this process. Next the shoulder must be re-taught its normal function. Working with a strong elastic theraband will strengthen the rotator cuff, the ring of muscle which binds the ball and socket joint together. The role of the shoulder blade is to provide a platform from which the shoulder joint performs its work. Regaining control of the shoulder blades synchronicity to shoulder function can be achieved by press-ups against a wall balancing the hands on small medicine balls.
5 Back pain
Some will argue that low back pain is a fact of life that is the payoff for standing upright. Others say that it is a consequence of our sedentary lifestyle. Either way almost everyone will experience some form of backache at some time in their life. More than 90 per cent of cases have mechanical back pain, meaning symptoms with a structurally normal spine. Vertebral joint stiffness, lax ligaments and weak muscles produce an uneven loading of weight through the spine resulting in that familiar ache.
Treatment
Exercise is a double-edged sword when it comes to back problems. Activity will loosen up the spine and strengthen muscles but subjecting a weak back to the uncontrolled forces experienced in sport can precipitate backache or overstress associated structures. Recurrent hamstring strains are often due to an unremitting spine not doing its fair share of work.
Regular gentle back mobilisation exercises will return suppleness but never force the spine. Core stability is key to lower back rehabilitation for the last twenty years and aims to train the deep abdominal muscles weakened by years of slouching on chairs. Critics argue that no evidence exists for its effectiveness but all would agree that working the spine in a strong postural position provides benefits. Ever more challenging balancing exercises are performed on inflatable Swiss balls whose inherent instability provide a focused workout for the spine.
Dr Dominic Radford has been specialising in sports injuries for seven years. He has worked in a variety of professional sporting environments including Fulham Football Club, the England Rugby League and for the last four years with the England Rugby Union. He also runs a sports injury clinic in Canary Wharf.
