It was announced late yesterday that Joe McKnight will not make the trip to Pullman because of his turf toe injury

Turf Toe is becoming more and more prevalent in football. It sidelined Beanie Wells earlier in the sasonand not it appears that it will sideline Joe McKnight

Turf Toe is also known as metatarsalphalangeal (MTP) joint sprain. It is a hyperdorsiflexion injury to the joint and connective tissue between the foot and the big toe.

Injury Epidemiology:

From The Athletic Advisor.

 

The injury usually results from a hyperflexion mechanism; the toe is bent to far upward. This can result from a hard push off on a rigid surface, having the toe forcibly flexed while being tackled, or by stopping short allowing the toe to jam in the toe box of the shoe. These mechanisms cause damage to the ligaments of the joint and the joint capsule.

 

The 1st MTP joint is instrumental in all sports that involve foot contact with the ground. The Great Toe is the final structure in contact with the ground on push-off. Due to this, up to 8 X a person’s body weight may be transferred through the 1st MTP joint. Contact sport athletes are at a greater risk of injury of the 1st MTP due to the possibility that during contact, the joint may be forcibly hyperflexed.

The joint is comprised of 4 bones, 9 ligaments, and 3 muscular attachments. This makes for a very complex joint. Of the 4 bones, 2 are sesamoid bones that are encapsulated within tendon. A common example of a sesamoid is the patella or knee cap. Sesamoids serve as fulcrums to increase the power of the muscles that cross them.

The sesamoids are contained within the Flexor Hallucis Brevis tendon and are connected to the under side of the toe by a ligament. Other muscles of the Great Toe are the Adductor Hallucis and Abductor Hallucis. The ligaments of the 1st MTP are comprised of 2 collaterals (located on either side of the joint) and two plantar (on the underside) ligaments. Their attachments combined with the muscular attachments make the great toe a strong yet flexible structure.

It is the amount of flexibility that may lead to easier injuries. The great toe usually has approximately 80º of flexion. It is when this normal range is passed that injury occurs. Another factor in the injury process is the amount of support offered by the athlete’s shoes. Worn out shoes allow too much freedom of motion in the forefoot area. This lack of support will assist in transference of forces from the shoe to the foot, increasing the likelihood of injury.

This injury didn't start to get attention until both college and pro football went to playing on artificial surface in the late 1960's. As artificial turf became popular in sports such as football, the incidence of MTP joint injuries appeared to increase.

The injury occurs when someone or something falls on the back of the calf while that leg's knee and tips of the toes are touching the ground. The toe is hyperextended and thus the joint is injured. Additionally, athletic shoes that tend to have very flexible soles combined with cleats that "grab" the turf will cause over extension of the big toe. It should be noted that this can occur on the lesser toes as well.

Turf toe injuries are divided into three grades by severity.

The severity of the injury usually predicts the length of time lost to playing.

Symptoms:

• Pain and tenderness in the ball of the foot and the big toe
• Swelling and bruising of the ball of the foot and the big toe
• Inability to bear weight on the ball of the injured foot
• Inability to push off on the big toe
• Reduced range of motion in the big toe

The immediate treatment for all grades of sprains is the same, Rest, Ice, Compression, and Elevation. This is the standard for acute care of any athletic injury.

First Degree Sprains

A 1º sprain usually results in very little time loss. The athlete must be able to run and change direction properly prior to return to competition. Application of ice and taping the toe may be enough treatment for return to competition on the day of the injury. Also, spring steel shoe inserts can be of great benefit to reduce the forces applied to the joint.

Second Degree Sprains

This type of injury often leads to time loss. This is due to the greater amount of tissue damage suffered. This athlete may need crutches for walking, and should be seen by a physician to rule out a bony fracture. When the athlete can run and change direction with out pain and loss of mobility, he/she may return to participation with the toe taped and a steel shoe insert.

Third Degree Sprains

These injuries are severe and may be a season ending injury. It must be determined if the joint surfaces have been damaged. If so, early return to participation may result in severe degenerative arthritis, and the loss of a career. Surgery may be required to repair the torn ligaments and tendons.

Diagnosis:

Turf toe is not a difficult diagnosis to make. The first step is for the doctor to obtain an accurate patient history. This will help determine how the injury happened. The patient usually states that a snapping sound was heard at the time of injury. It needs to be determined that the big toe was extended too much in an upwards direction, accompanied by pain and swelling. Depending on the severity of the injury, the big toe may have bruises on it and decreased range of motion when examined. Range of motion means the degree in which a person can move a body part. An x-ray of the foot is taken to make sure there are no breaks.

Rarely, a magnetic resonance imaging (MRI) scan or a bone scan may be performed to make sure there are not other causes for the foot pain. MRI scans produce extremely detailed pictures of the inside of the body by using very powerful magnets and computer technology. A bone scan is a scanning technique used to produce pictures specifically of bones.

Treatment:

Non-Surgical Rehabilitation

Rehabilitation for this injury is fairly simple. Acutely, ice and restriction of motion of the joint is critical in the healing process. As mentioned previously, crutches for walking may be necessary for a period of 1 - 2 weeks.

After the acute stage, it is necessary to return full strength and range of motion to the toe, foot, and ankle. During the acute phase lower body strength and endurance will decrease. Utilizing a stationary bicycle for aerobic conditioning is advised. Strength training in a non-weight bearing fashion for the affected limb is also appropriate. The strength of the foot and ankle should be addresses with Theraband® and range of motion exercises.

For the 1st MTP itself, gentle range of motion exercises should be instituted as pain allows. These are necessary to prevent Hallux Rigidus, a condition that arises when the joint is not moving properly. This can also result in degenerative arthritis of the MTP. Have the athlete bend the toe gently within the limits of pain. As the pain decreases, the amount of motion increases.

Surgical:

Surgery is only needed to repair turf toe if:

• A small piece of bone has been broken off by the injury to the ligament
• A ligament is torn completely

Well, thankfully its been a while but unfortunately its time for another Injury Clinic write-up.

Earlier this week it was revealed that TB Allen Bradford has a labral tear in his hip. This is a NEW injury in regards to its name recognition but it has been around for a while.This is the same injury that has also affected a number of other SC players recently.

The orthopedic community has done a much better job at identifying the injury and the treatment options has significantly improved.

So, lets take a look at it.

First, the Anatomy...

- - a basal surface which connects the labrum to the acetabular bony rim

- - an internal articular surface which is in continuation with the articular surface of the acetabulum

- - an external surface where the hip joint capsule attaches.

A network of blood vessels enter the outer third of the labrum on the external surface only. The lack of blood supply to the inner two-thirds is thought to impede healing after injury. Free nerve endings are found throughout the acetabular labrum but are most densely packed in the anterior and superior quadrants.

The main function of the acetabular labrum is to improve hip joint stability in two ways. Firstly it deepens the hip socket, providing it with extra structural support. Secondly it partially seals the joint to create a negative intra-articular pressure which counteracts any distractive (pulling-apart) forces.

A second important function of the acetabular labrum is to increase joint congruity. After removal of the labrum the frictional force between the femoral and acetabular articular surfaces is increased by up to 92%, showing that the labrum plays an important role in the even distribution of forces across the articular surface.

This is not the same type of injury as say a meniscal tear in the knee. That sort sort of injury is usually the direct result of a traumatic twisting of knee.

From the Mayo Clinic's website.

 Photo Credit: Hospital for Special Surgery

A tear in your labrum, known as a hip labral tear or acetabular labral tear, can result from injury, repetitive movements that cause wear-and-tear on your hip joint, or degeneration, such as from osteoarthritis.In many cases, a hip labral tear causes no signs or symptoms and doesn't require treatment. Occasionally, however, a hip labral tear may cause pain or a "catching" sensation in the hip joint.

Many hip labral tears cause no signs or symptoms. Occasionally, however, you may experience one or more of the following:

• A locking, clicking or catching sensation in your hip joint
• Pain in your hip or groin
• Stiffness or limited range of motion in your hip joint

The labral tear in the hip is not something that just happens because of repetitive motion or join reaction forces. It is usually caused by Femoro-acetabular impingement (FAI). Other reasons for FAI are capsular laxity, dysplasia, and trauma.

From the Hospital for Special Surgery website.

Femoro-acetabular impingement (FAI) occurs when the ball (head of the femur) does not have its full range of motion within the socket (acetabulum of the pelvis).

Impingement itself is the premature and improper collision or impact between the head and/or neck of the femur and the acetabulum. This causes a decreased range of hip joint motion, in addition to pain. Most commonly, FAI is a result of excess bone that has formed around the head and/or neck of the femur, otherwise known as "cam"-type impingement. FAI also commonly occurs due to overgrowth of the acetabular (socket) rim, otherwise known as "pincer"-type impingement, or when the socket is angled in such a way that abnormal impact occurs between the femur and the rim of the acetabulum.

The reason orthopedic surgeons have become better at diagnosing and treating this injury is because of better MRI capabilities. Once they have identified it they then can address a specific course of treatment.

 

Symptoms and Diagnosis:

The presentation of acetabular labral tears is very inconsistent but the most common complaint is a sharp groin pain after trauma. Other possible sites of pain are the anterior thigh, greater trochanter and buttock region. Other symptoms include clicking, locking and ‘giving way’ of the hip. The pain may be reproduced in sport by weight-bearing activities that require twisting, such as kicking a football.

Examination of the hip is often entirely normal with a full range of movement. There are specific tests for a labral tear. The impingement test (flexion, adduction and internal rotation of the hip joint) commonly produces pain or a clicking sensation when an antero-superior tear is present. The McCarthy test involves flexing both hips and then extending the affected hip patients with a labral tear will feel a catch. Passive hyperextension, abduction and external rotation elicit pain with a posterior tear.

Treatment- Non-Surgical:

Non-surgical treatment is always the first choice in treating these types of injuries Many labral tears may become asymptomatic, and these do not need specific treatment. However, for athletes with persistent pain from labral tears, there are many treatment options. Physical therapy is used to improve hip range of motion and strengthen the muscles around the hip joint. Pain medications such as anti-inflammatories can be used to decrease inflammation around the labrum and provide pain relief.

Treatment- Surgical:

Hip Arthroscopy

If non-surgical treatment is not effective then surgery is often indicated. The most effective way to address this injury is Hip Arthroscopy. This is very similar to the technique of Knee Arthroscopy but the set up and and actual procedure is much more involved.

As you can see, this is a little more involved than a typical knee arthroscopy. From HSS

From the Arthroscopy Association of North America (AANA)

Arthroscopic management consists of debridement and repair. The goal of arthroscopic debridement of a torn hip labrum is to relieve pain by eliminating the unstable flap tear that causes the observed hip discomfort. The surgical technique of a hip labral tear repair depends on the nature of the labral injury. There are at least two distinct types of acetabular labrum tears.

Type I consist of a detachment of the labrum at the zone of transition to the articular hyaline cartilage and require reattachment to the acetabular rim, usally with anchor.

On the other hand,Type II tears are intrasubstance splits with one or more cleavage planes can be repaired with a suture lasso technique and a bioabsorbable suture.

Images of the arthroscopic repair.

This is a great video of the procedure.

From the Southern California Orthopedic Institute (SCOI)

Post-operative Care:

After the surgery, the patient will be on crutches for two to six weeks; this is determined on a case by case basis. Physical therapy is used to improve the hip range of motion and muscle strength around the hip. Once a patient is free of symptoms and has regained their strength, they can return to play, which is usually between two and six months, depending on the extent of the injury.

Wolf reported it earlier this evening.

USC linebacker Chris Galippo will be out about three months following back surgery to repair a bulging disc. This is not the same disc Galippo underwent surgery on last fall but the surgery is similar.

He is expected to return somewhere around Games 3, 4 or 5. The injury occurred about a month ago and doctors recommended surgery, which took place last week. Galippo enjoyed a good spring and starred in the final scrimmage at the Coliseum with nine tackles, three sacks and two recovered fumbles.

A bulging disc, also known as a herniated disc, is more common than you think. It can happen in either the neck or lower back. Many people have bulging disks without any symptoms (asymptomatic), Depending on the severity these cases can go either way most of the time the patient is treated non-operatively but there are a number of different surgical options that also depend on the patient or severity of the injury.

So lets take a look, first some anatomy.

From The Energy Center:

 

Click to enlarge

The spine is made up of the following components:

 

Vertebrae - the bones that make up your spine

Nerves - your entire nerve system runs through your spine

Discs - soft, spongy material or rubbery pads that separates the hard bones (vertebrae), allowing the nerves to run between each bone segment. Discs act like shock absorbers and allow the spine to flex.

The Spinal Canal - a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots.

The natural curves of the spine are vitally important for giving your back strength and resilience. There are 24 vertebrae in your spinal column. The lumbar vertebrae are approximately two inches in diameter reflecting their weight-bearing role. The cervical vertebrae are smaller, since they must support only the head. Facet joints are located in pairs on the back of the spine, where one vertebra slightly overlaps the next. The facet joints guide and restrict movement of the spine. To the rear of each vertebra is a hole and when the vertebrae are stacked up, these holes form a continuous channel which holds the spinal cord.

The spinal cord provides a vital link between the brain and all body functions below the neck. Spinal nerves emerge from the spinal cord through gaps between the main body of the vertebrae and the facet joints. One frequent cause of back pain is a worn facet joint, which can result in a pinched nerve. Therefore, it is very important to keep your vertebrae in good shape.

Outside of a traumatic injury such as contact injury in football, the most common reason for herniated discs is usually a weight problem.

From The AAOS:

A disk herniates or ruptures when part of the center nucleus pushes through the outer edge of the disk and back toward the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain, numbness, or weakness in one or both legs.

The symptoms are unmistakable, from WebMD:

Surgical Treatment:

Surgery is appropriate only for people who have specific symptoms and conditions. A decision to have surgery should take into consideration results from diagnostic tests and physical examinations, your response to nonsurgical treatment, and discussions between you and your health professional about your options and expected results.⁴ Other factors include your age, overall health, the severity of symptoms, and what impact the symptoms have on your life (such as the inability to work). For example, you and your health professional may consider surgery if your job requires a rapid recovery, and there is no time to wait for the herniated disc to heal itself. If you are an older adult, you may be offered surgery if your herniated disc is less likely to improve without surgery because of other spinal diseases.

Disc surgery is not considered effective treatment for low back pain that is not caused by a herniated disc. Disc surgery is also not done if back pain is the only symptom the herniated disc causes.

Surgery Choices

• 
  Click to Enlarge
  
  Discectomy (also called open discectomy) is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. It is also used for bulging discs or ruptured discs. Discectomy may be the most effective type of surgery for people who have tried nonsurgical treatment without success and who have severe, disabling pain.

 

• Laminotomy and laminectomy are surgeries done to relieve pressure on the spinal cord and/or spinal nerve roots caused by age-related changes in the spine. Laminotomy removes a portion of the thin part of the vertebrae that forms a protective arch over the spinal cord (lamina). Laminectomy removes all of the lamina on selected vertebrae and also may remove thickened tissue that is narrowing the spinal canal, the opening in the vertebrae through which the spinal cord runs. Either procedure may be done at the same time as a discectomy, or separately. (Click here to see an image of the surgical approach.)
  

 

Click to Enlarge

Percutaneous discectomy is used for bulging discs and discs that have ruptured into the spinal canal. It is usually performed under local anesthesia with the patient awake and in the prone position on special pillows.This procedure inserts a special tool through a small incision in the back. The herniated disc tissue is then removed, thereby reducing the size of the disc herniation. This is done with the help of a laser or radio frequencey device. Percutaneous discectomy is considered less effective than open discectomy, and its use is declining. Unless future studies show that this technique is safe and effective, percutaneous discectomy should be considered experimental.

Continuing our series of posts on sports injuries. - Paragon

The Concussion Injury

It is thought that there may be microscopic shearing of nerve fibers in the brain from the sudden acceleration or deceleration resulting from the injury to the head.

The length of unconsciousness may relate to the severity of the concussion. Often victims have no memory of events preceding the injury or immediately after regaining consciousness with worse injuries causing longer periods of amnesia.

Often the maximal memory loss occurs immediately after the injury with regaining of some memory function as time passes. Complete memory recovery for the event may not occur.

Bleeding into or around the brain can occur with any blow to the head, whether or not unconsciousness occurs. If someone has received a blow to the head, observe closely for signs indicating possible brain damage.

Things to watch for include repetitive vomiting, unequal pupils, confused mental state or varying levels of consciousness, seizure-like activity, weakness on one side of the body or the inability to wake up (coma). If any of these signs are present, contact your health care provider promptly. (more on symptoms below)

The Anatomy
Image: The Hughston Clinic

The Anatomy (from The Hughston Clinic)

The brain is composed of soft tissues encased within the hard bone of the skull. A concussion occurs when your head is hit or jolted and your brain's soft tissue moves in reaction to the sudden force. At impact with the skull, the brain can become bruised, tissues can be torn, and minor swelling can occur. An injury to the brain can cause neurons (nerve cells) and nerve tracts (neurological pathways) to change or not function properly. The changes in brain function can change the way you think, act, or feel.

Three membranes, collectively called the meninges, provide protection by separating the brain's soft tissue from the rigid wall of the skull. Three layers cover the brain; the dura, a tough, leathery outer covering; the arachnoid, a thin inner layer with threadlike strands that attach it to the pia mater; and the pia mater, which is a thin, delicate layer tightly attached to the surface of the brain. In addition to the protection of the layers, cerebrospinal fluid surrounds the brain and cushions it as well. Even with these protections, the meninges and deeper tissues within the brain can become bruised when there is a blow or jolt to the head or when the head is severely jarred or shaken.

The brain is more delicate than some realize which is why there has been such an increase in the study of brain injuries.

From The Mayo Clinic:

I am sure that anyone who has played sports has seen someone get this injury and have seen the symptoms listed above. The brain does not like to be violently shaken disturbed. I am often amazed that boxers don't get concussions more than they do as they can take some pretty violent shots to the head.

These are the grades of concussions:

Grade 1 (mild): confusion without amnesia; no loss of consciousness--forces a player out of the game for at least 20 minutes, pending further evaluation.

Grade 2 (moderate): confusion with amnesia; no loss of consciousness--keeps a player out of the game and practice for at least a week

Grade 3 (severe): loss of consciousness--benches the player for at least a month.

This is serious business as it is sometimes hard to tell early on what grade of concussion the player has.

The Neurological Damage

Screening and Diagnosis

Diagnosing a concussion is usually straightforward. If a blow to your head has knocked you out or left you dazed, you've had a concussion. It's more difficult, however, to determine whether the blow has caused potentially serious bleeding or swelling in your skull. Signs and symptoms of these injuries may not appear until hours or days after the injury.

Your doctor may start your evaluation with questions about the accident, then proceed to a neurological exam. This exam includes checking your memory and concentration, vision, hearing, balance, coordination and reflexes.

The standard test to assess post-concussion damage is a computerized tomography (CT) scan. A CT scanner takes multiple cross-sectional X-rays and combines all the resulting images to produce detailed, two-dimensional images of your skull and brain. During the procedure, you lie still on a table that slides through a large, doughnut-shaped X-ray machine. The scan is painless and generally takes less than 10 minutes.

Not every concussion requires a CT scan, but the test is usually done as a precaution if there's a chance your injury is more severe than your immediate condition suggests.

You may need to be hospitalized overnight for observation after a concussion. If your doctor says it's OK for you to be observed at home, someone should check on you periodically for at least 24 hours. You may need to be awakened every two hours to make sure you can be roused to normal consciousness. Post-concussion syndrome, a poorly understood complication, as it causes concussion symptoms to last for weeks or months.

The bigger problem is when players have multiple concussions, they double their risk of developing epilepsy within the first five years after the injury.

There also is evidence that people who have had multiple concussions over the course of their lives suffer cumulative neurological damage. Chronic encephalopathy is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition called dementia pugilistica, or "punch drunk" syndrome, which is associated with boxers, can result in cognitive and physical deficits such as parkinsonism, speech and memory problems, slowed mental processing, tremor, and inappropriate behavior. It shares features with Alzheimer's disease, a link between concussions and the eventual development of Alzheimer's disease also has been suggested.

A "baseline" neurological evaluation by a physician determines appropriate treatment for an uncomplicated concussion. The best treatment for a concussion is rest.

Update [2008-2-23 9:59:52 by Paragon SC]: According to Wolf, in his Round 6 of answers this morning, Hazleton’s injury is NOT a sports hernia but they are tears in the abdominal muscle. The surgical treatment is probably the same, as they would use some sort of mesh, probably Marlex, to reinforce the abdominal muscle. I can pretty much guarantee that the procedure was done laprascopically as to minimize the soft tissue disruption that occurs with a standard surgical incision. This also speeds up the recovery time which should make it possible for him to ready for spring practice.

It was reported today that WR Vidal Hazleton had surgery to repair a torn abdominal muscle.

From The Daily News:

This could probably be considered a sports hernia.

What is a sports hernia?

A sports hernia occurs when there is a weakening of the muscles or tendons of the lower abdominal wall. This part of the abdomen is the same region where an inguinal hernia occurs, called the inguinal canal. When an inguinal hernia occurs there is sufficient weakening of the abdominal wall to allow a pouch, the hernia, to be felt. In the case of a sports hernia, the problem is due to a weakening in the same abdominal wall muscles, but there is no palpable hernia.

What is the inguinal canal?

The inguinal canal is a region in the lower abdomen, just above the groin. The canal is formed by the insertions of abdominal muscles and tendons, as well as several ligaments. Within the inguinal canal travels the spermatic cord (in males) or the round ligament (in females). This area of the abdomen is prone to weakening of the abdominal wall, allowing an outpouching, or hernia, to form.

The Abdominal Muscles

The abdominal wall is made up of several muscles. These include:

• Rectus Abdominis: the muscle over the front of the belly-this muscle give people a "six-pack" appearance when the rectus is well developed.
• Internal and External Oblique: the obliqes wrap around the sides of the body.

Abdominal muscle strains are graded according to the severity of the injury:

• Grade I (Mild): Mild discomfort, often no disability. Usually does not limit activity.
• Grade II (Moderate): Moderate discomfort, can limit ability to perform activities such as crunches or twisting movements.
• Grade III (Severe): Severe injury that can cause pain with normal activities. Often patients complain of muscle spasm and bruising.

Abdominal muscle strains are graded according to the severity of the injury:

• Grade I (Mild): Mild discomfort, often no disability. Usually does not limit activity.
• Grade II (Moderate): Moderate discomfort, can limit ability to perform activities such as crunches or twisting movements.
• Grade III (Severe): Severe injury that can cause pain with normal activities. Often patients complain of muscle spasm and bruising.

The problem with the abdominal wall in people with a sports hernia is not a muscle strength issue. Rather, the abdominal wall in a particular region is too thin, allowing the hernia to form. The sports hernia does not occur in the area of the large, thick part of the muscle.

Symptoms

A sports hernia typically begins with a slow onset of aching pain in the lower abdominal region. Symptoms may include:

• Pain in the lower abdomen
  
• Pain in the groin
  
• Pain in the testicle (in males)

Typically the symptoms are exacerbated with activities such as running, cutting, and bending forward. Patients may also have increased symptoms when coughing or sneezing. Sports hernias are most common in athletes that have to maintain a bent forward position, such as hockey players. However, sports hernias are also found in many other types of athletes such as football and soccer players.

Treatment

There are no treatments that have been shown to be effective for sports hernia other than surgery. That said, the initial treatment of a sports hernia is always conservative in hopes that the symptoms will resolve. Resting from activity, anti-inflammatory medications, ice treatments, and physical therapy can all be tried in an effort to alleviate the patient's symptoms.

If these measures do not relieve the symptoms of a sports hernia, surgery may be recommended to repair the weakened area of the abdominal wall. In number of studies have shown between 65% and 90% of athletes are able to return to their activity after surgery for a sports hernia. Rehabilitation from surgery for a sports hernia usually takes about eight weeks.

Laproscopic Hernia repair

A number of factors have led to the recent development of a new method of repair called laparoscopic hernia repair. This technique is really an extension of a traditional mesh repair method that was used in patients who had already experienced several hernia recurrences at the same site.

Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions.

This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of post-surgical pain.

Again, I'm not sure this is a sports hernia but it does sound like it.

I know it has been a while since I have posted anything of substance in regards to injuries thanks in part to SC staying healthy for the most part.

But...

I have updated the side bar with some posts on the Knee And the Foot and Ankle:

• The ACL Injury
• The Meniscal Tear
• The Achilles Tendon Injury

Enjoy... more to come.

My heart sunk when I saw Sam Baker limping to the sidelines on Saturday with a hamstring injury. This is another one of those injuries that can affect any athlete at any time and only time and rest will make it fully heal. We have all had a hamstring strain at some point in our lives so this is not foreign to any of us. Severity is always the key to this injury as you will see below.

The Hamstring Muscle Group

Hamstring injuries are common among athletes. The hamstring muscles run down the back of the leg from the pelvis to the lower leg bones, and an injury can range from minor strains to total rupture of the muscle. The three muscles that make up the hamstrings are the biceps femoris, semitendinosus and semimembranosus. A hamstring injury is recognized by a sudden, sharp pain in the back of the thigh that may stop you mid-stride. After such an injury, the knee may not extend more than 30 to 40 degrees short of straight without intense pain.

Physiology

Hamstring injuries are easier to prevent than cure. But to understand what causes a hamstring injury, you first have to know how muscles work.

All muscles work in pairs to perform a task. One set of muscles shortens (contracts) to exert force, while the other set of muscles relaxes. The hamstring muscles, located at the back of the thigh, work with the quadriceps muscles in the front of the thigh. When you bend your leg, the hamstring muscles contract and the quadriceps muscles relax. Conversely, when you straighten your leg, the quadriceps muscles contract and the hamstring muscles relax.

When one muscle group is much stronger than its opposing muscle group, the imbalance can lead to a strain. This frequently happens with the hamstring muscles. The quadriceps muscles are usually much more powerful, so the hamstring may become fatigued faster than the quadriceps. A fatigued muscle cannot relax as easily when its opposing muscle contracts, leading to strains.

Muscle strains are overuse injuries that result when the muscle is stretched without being properly warmed up. It's like pulling a rubber band too long. Eventually, the rubber band will either lose its shape or tear apart. The same thing happens with muscles.

Hamstring strain in young people often occurs because bones and muscles do not grow at the same rate. During a growth spurt, the bones may grow faster than the muscles. The growing bone pulls the muscle tight, and a sudden jump, stretch, or impact can tear the muscle away from its connection to the bone.

Sometimes, a muscle that tears away from a bone will pull a piece of bone with it. This is called an avulsion injury. If the hamstring tears near the hip, where it attaches to the pelvis, it may pull a piece of hip bone (ischium) away. This is a serious injury that may require surgery to reattach the muscle.

Classifications of the Injury

Sprains and strains are caused by excessive stretching (tearing) of muscle fibers soft tissues. Hamstring strains are classified as Grade I (mild), Grade II (moderate), or Grade III (severe) degree strains depending on the severity.

The Grade III Avulsed Hamstring

Grade 1: Consists of minor tears within the muscle.

    * May have tightness in the posterior thigh.

    * Probably able to walk normally however will be aware of some discomfort.

    * Minimal swelling.

    * Lying on front and trying to bend the knee against resistance probably won't produce much pain.

Grade 2: Is a partial tear in the muscle.

    * Gait will be affected-limp may be present .

    * May be associated with occasional sudden twinges of pain during activity.

    * May notice swelling.

    * Pressure increases pain.

    * Flexing the knee against resistance causes pain.

    * Might be unable to fully straighten the knee.

Grade 3: Is a severe or complete rupture of the muscle.

    * Walking severely affected- may need walking aids such as crutches

    * Severe pain- particularly during activity such as knee flexion.

    * Noticeable swelling visible immediately.

Common Causes of Hamstring Injuries

Some of the more common reasons for hamstring injuries are:

• Doing too much, too soon or pushing beyond your limits.
• Poor flexibility.
• Poor muscle strength.
• Muscle imbalance between the quadriceps and hamstring muscle groups.
• Muscle fatigue that leads to over exertion
• Leg Length Differences. A shorter leg may have tighter hamstrings which are more likely to pull.
• Improper or no warm-up.
• History of hamstring injury.

Hamstring injuries are usually readily apparent.

• Mild strains may involve a simple tightening of the muscle that you can feel.
• More severe injuries may result in a sharp pain in the back of the thigh, usually in full stride.
• A rupture or tear may leave you unable to stand or walk. The muscle may be tender to the touch, and it may be painful to stretch your leg. Within a few days after a tear, bruising may appear.

Prevention

• Warm up thoroughly. This is probably the most important muscle to warm-up and stretch before a workout.
• Stretching after the workout may be helpful.
• Try adding a couple sessions per week of retro-running or backward running which has been should decrease knee pain and hamstring injuries.
• Follow the "Ten Percent Rule" and limit training increases in volume or distance to no more than ten percent per week.
• Other ways to prevent injury are to avoid doing too much, too soon, avoid drastic increases in intensity or duration, and take it easy if you are fatigued.

Images from Eorthopod.com

Rey Maualuga punched his ticket in joining the injury list this past weekend with a hip pointer.

This is not an uncommon injury in football or soccer players and it can be painful to the injured player and unsightly to those who see the nasty bruise because of it.

Hip Pointer with an Avulsion Fracture

What is a Hip Pointer?

A hip pointer is an injury to the pelvis caused by a direct blow, often seen in contact sports such as football. The term hip pointer is somewhat confusing. It can refer to a deep bruise of the muscle and bone, a small chip fracture or even a complete break. Typically, however, this term refers to a severe bruise and not a fracture.

What happens when an athlete gets a hip pointer?

A hip pointer is an injury is to the iliac crest, the bony prominence that can be felt along the waist line. Spearing the hip/pelvis with a helmet while tackling may be the most common cause.When someone sustains a hip pointer injury, the bone and overlying muscle can be bruised.

In more serious cases of hip pointer, the hit can be so severe that a fracture of the bone results. While the treatment may not change, a fracture will likely cause a delay in healing and more painful symptoms.

Diagnosis:

The patient may walk with a limp and have difficulty moving the hip away from the body against resistance. X-rays are taken to rule out fractures. Occasionally, further studies may be indicated if the patient's symptoms do not improve with treatment.

Treatment:

Treatment of a hip pointer is best accomplished with rest. Ice applications and anti-inflammatory medication will also help, but only time will heal the injury. Again, X-rays may be taken if a fracture is suspected.

Surgery is very rarely indicated. It is usually reserved for patients with significant displacement of fractures of bone where the muscles attach around the pelvis.

Click Here to see a picture of the injury.

Information taken from About.com and Emedx.com