We asked Dr Neil Forrest and Senior Physiotherapist from UFIT to highlight the most common injuries they see on a Monday
NF: My clinics each Monday often involve seeing people with sports injuries sustained during the weekend. Singapore offers many opportunities to participate in sports and we have many ‘weekend warriors’ who train and compete to a high level. Unfortunately, just like in elite athletes, injuries will happen from time to time. Below I’ve outlined some of the most common ones……and asked Declan Halpin, Senior Physiotherapist from UFIT to explain the physiotherapy required for each injury.
1. Ankle sprain
NF: A common sports injury where the ankle is twisted, rupturing the stabilising ligaments and causing pain and swelling. The doctor will examine you to check for signs of a fracture, and decide whether an X-ray is necessary. The immediate treatment is rest, icing and elevation of the affected ankle. Compression bandages will be helpful and more severe injuries may require crutches.
DH: As Dr. Forrest points out, this is a very common injury, so physios are well versed in looking after sprained ankle. The first stage is pain and swelling management, which involves soft tissue work to reduce selling, taping to ease pain and protect the joint, and some very gentle exercises to encourage blood flow. The next stage is much more important: strength and stabilization. The main role of the ligaments that have been injured are to stabilize the ankle, so we need to do a lot of work to make sure the ankle becomes stable again – lots of wobble board work, balancing exercises, and strength training for the muscles of the foot. Finally, we introduce the agility and plyometric stage: jumping, moving left and right, and reaction work. Once this stage is complete, the patient can return to sport safely and confidently!
2. Hamstring strain
NF: The hamstrings are a group of three muscles at the back of the thigh. These can be torn whilst running or jumping, especially if you have not warmed-up properly. A sharp pain and sometimes a popping sensation is felt at the back of the thigh. If these injuries are not managed properly they can become recurrent, so careful rehabilitation is key.
DH: The classic weekend warrior injury! All of Dr. Forrest’s points are correct, but I would add that dehydration is another risk factor for hamstring tears – so make sure you are well hydrated before running out onto the pitch! Obviously, the severity of the injury (ranging from a strain to a complete rupture) will change the treatment approach, but all hamstring rehabilitation work involves a lot of eccentric strengthening of the muscle group – lengthening the muscle under tension – to mimic the effects of running. Recurrent hamstrings strains can be frustrating, so you need to make sure the hamstring is strong enough before you return to full sprinting.
3. Shoulder tendon injuries
NF: The rotator cuff is formed by four important tendons which stabilise the shoulder. Injuries can occur either acutely with a blow to the shoulder, or as a result of gradual wear and tear. Symptoms include pain and reduced power or range of motion. Your doctor will assess the severity of the injury, as more extensive injuries can benefit from early surgical repair. In some cases, medication or shoulder injections can be useful to manage the pain.
DH: Shoulder tendon injuries are most commonly seen by those who throw a lot in their sport (cricket/baseball), or lift heavy loads overhead (Crossfit or rugby, for example), and are usually caused by faulty biomechanics of the rotator cuff group, which leads to a tendon becoming impinged – i.e. the shoulder is not moving properly because somewhere is tight or somewhere is weak, and the tendon becomes pinched. The physio’s main role is to figure out a rehab plan which addresses the weaknesses and tight areas to get the shoulder moving properly, and allow the tendon to heal (with or without medication or injections)!
4. Low back pain
NF: This injury is one of the most common reasons people see their doctor, and most of us will experience at least one episode in our lifetime. There are many different causes and your doctor will be able to assess your injury and recommend the most appropriate course of action. Recent research shows that painkillers do not make much difference for most back pain cases and that early mobilisation and exercise are beneficial.
DH: There are literally textbooks written on the causes and treatment for back pain, so I won’t try to cover everything in this short space. Your take home message: don’t take back pain lying down. Your back is not ‘broken’ and certainly does not need to be ‘cracked back into place.’ Exercise rehabilitation is the only treatment strategy which is proven to work in the long term. See your physio for guidance and help in getting over the initial pain, getting back on your feet, and getting back to being fit and healthy and pain-free. There is light at the end of the tunnel if you are willing to work for it!
5. Tennis/golfer’s elbow
NF: This is a sharp pain felt on the outside (tennis) or inside (golfer’s) of the elbow joint. It is often brought about by repetitive motion or a new activity (most cases in my experience come from carrying children/baby equipment!). In milder cases, all that is required is rest from the activity which is triggering the condition but many people will require physiotherapy.
DH: As Dr. Forrest points out – you don’t need to play golf or tennis to get these issues! These are both overuse injuries, and so the first step is to identify the aggravating movements and try to reduce these. Sometimes (as with new babies) this is impossible, so taping and bracing can help to off-load the inflamed tendons. In terms of treatment, dry-needling has been show to be very effective, which most physiotherapists now offer, and is not nearly as scary as it sounds!
If you experience an injury please seek medical advise and do not just ‘leave it’.
Dr Neil Forrest is based at IMC Camden (T: 6733 4440) or visit www.imc-healthcare.com
Declan Halpin is leading physiotherapist based at UFIT www.ufit.com.sg