Sports Medicine Newsletter

Introduction With the boundaries in athletic training constantly being pushed, today’s athletes are stronger and faster than ever, but unfortunately still at risk for injury. Anterior knee pain represents 20-40% of all knee problems. It is the most common running injury presenting to a sports medicine clinic. Patellofemoral pain syndrome (PFPS) or anterior knee pain, is an overuse injury with pain located around or behind the patella (knee cap). It is the result of repetitive explosive movements such as jumping and/or sprinting.

Risk factors: • Sudden increase or change in training• Poor foot motion• Poor running technique• Increased motion of the patella • Poor alignment/deformity of the leg• Poor jumping/landing technique• Weak musculature (including quadriceps

and gluteal muscles)• Tight musculature (adductors, gastrocs)

Prevention Incorporating agility and balance exercises into a home exercise program, has been shown to reduce non-contact knee injuries. With a thorough evaluation by a sports medicine specialist, this program can be tailored to meet the needs of individual athletes. This will reduce injury, and optimize performance.

Treatment80% of athletes with PFPS respond to conservative management. This includes: rest, ice, anti-inflammatory medication (NSAID’s), bracing/taping, acupuncture and/or physical therapy. Given its multifactorial origin, athletes should be assessed by a sports medicine specialist to confirm all facets are recognized and treated to ensure a speedy/safe recovery.

For more information, please call (631) 474-6797.

www.stcharles.org/sportsmed

Running Injuries: Anterior Knee Pain in Runners By Danielle DeGiorgio, DO, Sports Medicine Physician, St. Charles

Volume 4 | Issue 1

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Foam Rolling the Tensor Fascia Lata (TFL) •Foam rolling is a great technique that can keep muscles limber and help restore length. Key areas to roll out are muscles of the thigh, including the quadriceps and hamstrings. However, one the most common misconceptions or misused techniques is rolling out the Iliotibial band (IT band). The IT band is not a muscle; it’s a thick cartliganeuous tissue that does not have the same pliability and elasticity. Therefore, it should not be treated the same. Instead, one key area to roll out is a small triangular muscle located on the upper anterolateral

portion of the hip, known as the Tensor Fascia latae (TFL). The TFL begins on the hip bone and extends down the front outer portion of the thigh which then turns into the IT band. Keeping pliability in this muscle can help relieve tension and discomfort in the outside of leg extending to the knee, commonly referred to as IT band pain.

Tensor FasciaInstructions: Place foam roller on floor and bring your thigh on top of it keeping leg straight. Bend opposite leg for balance and keep arms on floor to help stabilize. Roll up/down in front outside of thigh for 2 minutes each leg. You may adjust amount of weight you put through foam roller by adjusting support on hands and foot. (Less is more)

Lacrosse Ball • • Another great self soft-tissue technique is using a lacrosse ball for certain areas of the body. The foam roller is big and bulky and is better for larger muscle groups. The ball can be used to get between smaller areas and be just as effective. One spot which is beneficial to roll out is the plantar fascia, which is the structure on the bottom of foot connecting the heal and the base of the toes. The other key area is the glut medius, which is a prime muscle that

keeps the hips level when in the running motion. This muscle is located at the top of the hip on the posterior lateral aspect and extends into the thigh bone.

Aftercare Following RunsBy Kaan Celebi, DPT, OCS, SCS, CSCS Clinical Coordinator, Sports Medicine & Orthopedics, St. Charles

Would you ever buy a brand new car, put thousands of miles on it while never getting the oil changed or rotating it’s tires? Most likely not, because this certainly would lead to some sort of break down. Wouldn’t it then make sense to apply the same principles to your own body? After all, the car is replaceable, your body is not.

One of the most important aspects of running which is often overlooked is aftercare. If you don’t take care of sore muscles, or minor aches following your sessions, eventually those parts will break down and lead to injury. Most folks know to warm-up and stretch before runs, but more importantly we need to take care of our selves following runs as this is when we are sore and tight.

Here are a few go to techniques, in addition to your regular stretching program that are not only cost and time effective, but will also help keep your body maintained while training

2 St. Charles Hospital | Sports Medicine Newsletter | Volume 4 | Issue 1

Nerve flossing in Runner’s Position • •Nerves are critical to proper muscle function, providing the “electricity” to turn them on. The two main nerve roots running down the leg are the sciatic and femoral nerves. Often times they can be over stimulated from increased volume of running and develop tension and/or become bound down. Below is a technique known as neural flossing, which essentially puts a certain amount of “on again, off again” tension to the track the nerves run along to help smooth out neural flow.

Femoral Nerve Flossing

Instructions: Start position is with the leg off the table allowing the hip to drop towards floor. Keep other leg tight towards chest. Begin by pointing toe and bending knee until stretch in front of the thigh is felt. Hold for 1 second and then relax foot and return to start position. Perform 2 sets of 10 reps.

Sciatic Nerve Flossing

Instructions: Start position is same as above, except the working leg is the one pulled towards the chest. Point toe up and extend knee

towards ceiling until stretch is felt in back of leg. Hold 1 second then relax foot and return to start. Perform 2 sets of 10 reps.

Lacrosse Ball • • Another great self soft-tissue technique is using a lacrosse ball for certain areas of the body. The foam roller is big and bulky and is better for larger muscle groups. The ball can be used to get between smaller areas and be just as effective. One spot which is beneficial to roll out is the plantar fascia, which is the structure on the bottom of foot connecting the heal and the base of the toes. The other key area is the glut medius, which is a prime muscle that

keeps the hips level when in the running motion. This muscle is located at the top of the hip on the posterior lateral aspect and extends into the thigh bone.

Plantar Fascia

Instructions: Standing with ball placed under foot. Apply tolerable pressure while simultaneously rolling back and fourth on the bottom of the foot for 2 minutes. Avoid rolling too far forward to toes and too far back onto the heel (stay more central). Slowly build your tolerance to greater pressure (less is more)

Gluteus Medius

Instructions: Begin laying on your side with ball under upper posterior outside of hip. Slowly relax body weight onto the surface of the ball and gently roll through the muscle. Roll for 2 minutes. (Less is more)

For more information, please call (631) 474-6797.

3St. Charles Hospital | Sports Medicine Newsletter | Volume 4 | Issue 1

Shin Splints By Mark J. Harary, MD, CAQSM, Sports Medicine Physician, St. Charles

What are shin splints?Shin splints, or medial tibial stress syndrome, is one of the most common and problematic running injuries. It is an overuse injury, which means that it develops gradually over time, rather than because of one single event. Shin splints are characterized as exercise induced pain in the medial part of the lower third of the tibia (the larger of the two shin bones). The muscles attaching to the tibia pull in a way that causes swelling of the muscle and the outer layer of the bone. Most people describe a burning pain on the inner part of the shin that radiates towards the foot.

What causes shin splints?There are many different factors that can lead to shin splints. They can be divided into intrinsic and extrinsic factors. Intrinsic factors are related to the person and their running mechanics. These can include low arches, high arches, being knock-kneed or bow-legged, or a history of injury to the lower leg, hip or back. Extrinsic factors are those that occur outside the body. These include hard or uneven running surfaces, incorrect shoe wear, failure to change shoes often enough, and increasing the frequency or intensity of a training regimen too quickly, which does give your body a chance to adjust to the new level.

How is it diagnosed?If you are experiencing pain while running, you should avoid this activity and schedule an appointment with a sports medicine doctor. They will take a detailed history and do a thorough physical exam to make an accurate diagnosis. X-rays will not show shin splints, but may be ordered to rule out other, more serious, injuries, such as a stress fracture.

What else could it be?Pain that does not go away with rest or pain that occurs at night might be a stress fracture. If your pain is in a different part of the leg, it could be the result of a muscle strain or chronic compartment syndrome.

Your sports medicine doctor will be able to accurately diagnose the problem and get you back to running as quickly as possible.

How are shin splints treated?Treatment of this condition involves two phases: treat the acute pain symptoms and prevent recurrence.

Acute treatment involves RICE (rest, ice, compression, elevation):

• Rest means relative rest. Activities should be modified so that they don’t cause pain. This includes lower impact activities, such as bike riding or swimming, or simply cutting back on the amount or intensity of running.

• Ice packs 15-20 minutes on and off a few times after activity can be helpful, as can ice massage to the painful area.

• Compressive calf sleeve can help to alleviate pain while walking or exercising.

• Elevate the leg while icing after activity.• Tylenol or Motrin are medications that can be taken as

needed for pain.

The key to preventing recurrence shin splints is to determine the underlying cause. Intrinsic factors such as arch problems or injuries are typically treated with orthotics and physical therapy, respectively. For serious runners, a running coach can help improve your mechanics to prevent a recurrence. Extrinsic factors need to be addressed as well.

For more information, please call (631) 474-6797. 4 St. Charles Hospital | Sports Medicine Newsletter | Volume 4 | Issue 1