Sports injuries vary greatly, especially depending on the type of sport a person participates in; however, the most common type of injury are hip and lower extremity injuries.
Sports-Related Hip Injuries
While running, the hip joint experiences nearly eight times a person’s body weight, which can cause both acute and chronic injuries. Differential diagnosis of hip pain includes gluteus medius tendinopathy, piriformis syndrome, stress fracture of the femoral neck, labral tear, and, less often, radicular pain from the lumbar spine.
Gluteus medius weakness and tendinopathy and piriformis syndrome — The gluteus medius originates at the external surface of the ilium and moves both distal and lateral to the greater trochanter of the femur. The main function of the gluteus medius is to provide pelvic stability during while a person runs. Pain along the gluteus medius usually occurs because of muscle weakness. Pain generally increases as the muscle stretches, which may result local tenderness along the ilium (its insertion point). The piriformis muscle provides important external rotation of the hip that crosses the sciatic nerve and may cause sciatica-type pain by compressing the nerve. The cause of Piriformis syndrome may stem from foot overpronation, weakness of the gluteal muscles and other hip abductors, and, finally, tightness of the hip adductors.
The common treatment for both gluteus medius tendinopathy and piriformis syndrome is physical therapy and any corrections of biomechanical aberrations. In addition to physical therapy, acetaminophen and nonsteroidal anti-inflammatory drugs may be used.
Labral tear — The acetabular labrum is a ring of fibrocartilage and connective tissue attached to the acetabulum. The labrum provides stability and decreases stress applied on the hip joint. A meaningful tear in the labrum may increase stress on the hip joint, decrease stability, and cause damage of the articular cartilage. Labral tears occur in athletes that use frequent hip rotation. Runners with a labral tear typically complain of pain in the front region of their hip or groin. They may also present with mechanical indications, such as clicking, locking, catching, or giving way. Labral tears are difficult to treat. Generally, arthroscopic surgery may be required; however, the recovery may be extensive.
Sports-Related Knee and Thigh Injuries
Knee pain – Knee pain is among the most common complaints from runners and athletes. In fact, patellofemoral pain syndrome (PFPS) accounts for 25 to 40 percent of all knee problems seen in a sports injury clinic. PFPS is believed to stem from overuse and poor alignment. Additionally, individuals with PFPS often have decreased strength in hip abduction, external rotation, and extension compared to healthy individuals. PFPS patients complain of forward knee pain (often around the patella) that intensifies when squatting, running, prolonged sitting, or when ascending or descending steps.
Iliotibial band syndrome — The iliotibial band (ITB) consists of connective tissue that runs from the ilium to the anterolateral aspect of the proximal tibia (figure 3). It is involved in hip abduction and internal rotation. Treatments include physical therapy with a focus on improving the strength and flexibility of the lower extremity and strengthening hip abductors and quadriceps. The long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) has no strong clinical support, and may cause medication-assoicated complications. Additionally, limited evidence supports short-term use as well.
Iliotibial band syndrome (ITBS) – Iliotibial band syndrome (ITBS) is described aching or burning pain at the site where the ITB crosses over the lateral femoral condyle with occasional pain that radiates up the thigh toward the hip. This pain is often experienced while participating in physical activity but may persist after the activity.
Hamstring injuries — Hamstring injuries generally involve sudden and sharp pain in the back aspect of the thigh while running at high speed or up hills. Examination includes assessment injury severit; ecchymosis; a visible defect in hamstring muscle; acute tenderness; and pain or weakness with muscle contraction. A majority of hamstring injuries are managed with simple rest and physical therapy. Standard treatment for acute hamstring injuries includes protection, rest, ice, compression, and elevation. Rehabilitation involves a gradual progression of exercises. Successful hamstring rehabilitation programs emphasize eccentric strengthening exercises. The time of recovery depends on many factors, and for most, the time for recovery is extensive.
Knee and hip osteoarthritis — The goal of Knee and Hip OA is to control swelling and pain, increase stability, and improve overall quality of life. Treatment options start with acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs). From there, intraarticular glucocorticoids or hyaluronate injections may be used. If these fail, low-potency opioids may be used. Present treatment strategies leading up to surgery are designed to reduce pain and not regenerate the underlying defect.
Chronic exertional compartment syndrome — Chronic exertional compartment syndrome (CECS) causes muscle ischemia and pain as a result of increased muscle pressure impeding proper blood flow. The lack of sufficient nutrition to the muscle promotes atrophy. The pain is often described as aching, squeezing, cramping, or tightness. However, pain generally resolves with rest overtime. Finding solutions to reduce pressure and improve circulation is the therapeutic goal for patients with CECS.
Sports-Related Foot and Ankle Injuries
Foot and ankle injuries account for up to 20 percent of running injuries, and are the most common injury reported by distance runners and marathoners. The result of foot and ankle injury is persistent absorption of the body’s weight with each stride. The most common foot injuries include overuse injuries of soft tissues, including tendons and fascia.
Plantar fasciitis —Plantar fasciitis is the most common cause of heel pain in adults, affecting one million persons a year in the United States. The predominant symptom of plantar fasciitis is pain in the plantar region of the foot that increases when initiating push-off while walking or running. The plantar fascia frames the structure of the medial arch of the foot. As a result, the fascia endures substantial mechanical stress when the foot bears weight. Over time, repetitive tension weakens the fascia’s architecture and presents clinically with “sharp” and “stabbing” heel pain – specifically focal point tenderness. The etiology is mainly associated with training errors, biomechanical issues, and excessive foot pronation or supination, and is more common in older and heavier individuals. Initial treatment is conservative, involving solutions that relieve pain, modulate shoes and gait, and exercise therapy. NSAIDs are often used; however, a non-significant improvement in pain and disability was reported in a study comparing NSAID subjects with placebo subjects. Other treatments include extracorporeal shock wave therapy, autologous whole blood or platelet-rich plasma injects, BOTOX injections, radiotherapy, and cryosurgery. The overall goal is to repair micro-tears in the plantar fascia, reduce fascial thickness, and improve overall blood flow to the area.
For all sports related injuries, promoting regeneration is key for reducing pain and restoring proper biomechanics. Improved blood flow, increased ATP, and reduction of inflammation and swelling are factors each sports medicine study identifies as a key component for proper management.