- Sports injuries - orthopaedic surgery
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Sports injuries

 

Sports and exercise medicine is a specialty concerned with the care of the recreational and elite athlete.  Our renowned and highly experienced physician, Dr Geoff Davies, works alongside a team of specialist physiotherapists to diagnose, treat and rehabilitate all sports and musculoskeletal injuries.

 

The St Joseph’s team have substantial experience working with numerous sports at all levels, from national teams such as the Wales rugby team to regional and local sports teams and individuals.  They have access to state-of-the-art imaging technology and our on-site pathology laboratory.

 

The team have specific interest in the following areas:

 

  • chronic tendon injuries
  • exertional compartment syndrome and compartment pressure testing 
  • knee ligament injuries and specific measurements 
  • medical acupuncture 
  • the management of football and rugby injuries
  • the management of lower back pain
  • sports-related advice including overtraining, exercise induced asthma
  • utilisation of a number of injection techniques


The team use techniques including Extracorporal Shockwave Therapy (ESWT), Pulsed Electromagnetic Therapy, and a new treatment for traumatic osteitis pubis for groin injuries.

 

Shin splints

 

This is a general, non-specific term used to describe a chronic exercise induced (usually running) shin pain.

 

The important point is to diagnose the cause of the shin splints.  For example, one of the more common causes is periostitis, which is an inflammation/stress response of the bone lining (periosteum) caused by muscular traction forces.  Periostitis of the front and inner aspect of the lower shin is specifically termed Medial Tibial Stress Syndrome.


Often a variety of investigations are adopted to confirm the clinical diagnosis, particularly if there is concern about the presence of a stress fracture.  If plain x-rays are normal, a Technetium bone scan will help differentiate between a periostitis and a stress fracture.  MRI can also be used.


Treatment usually revolves around a reduction or change in activity level.


Post-exertional ice massage together with a short course of anti-inflammatory medication and taping may help medial tibial stress syndrome.  Stress fractures require the avoidance of impact activities for up to 3 months, sometimes longer depending on the severity and location of the injury.

 

Sprains and strains

 

Sprains

 

These are acute injuries to ligaments, and the sprained ankle is one of the most common injuries seen in sport.  They can be classified according to the degree of injury.  In Grade 1 sprains, few ligament fibres are damaged or stretched.  Often there is little swelling or loss of function, although there is ligament tenderness.  In Grade 2 sprains, more fibres are damaged and there is a partial tear, which causes moderate tenderness, swelling and some loss of function.  Grade 3 sprains represent complete rupture of ligaments, with widespread swelling, bruising, gross instability and disability.  However, the pain response can be variable, as the nerve fibres supplying the ligaments are also damaged and tend to reduce overall pain.

 

Investigations such as x-rays are sometimes necessary to rule out a fracture in locations such as the ankle. This is particularly important if there is difficulty in weight bearing or widespread swelling and significant bony tenderness.  Ultrasound scans may be useful, and MR scans may also be used if there is concern about secondary damage to other structures.

 

Treatment consists of R.I.C.E. This means Rest, which may involve the use of crutches until the patient can walk without a limp.  Ice (taking care to protect the skin) is applied for 15-20 minutes, 3-5 times a day until the swelling resolves.  Compression with a bandage (ice can be combined with this) or with an ankle stabilising brace, and Elevation above the level of the heart will reduce swelling.  Care should be exercised when using painkillers or anti-inflammatories in the early management of these injuries.  Follow-up physiotherapy may be required.

 

Strains

 

These represent pulled muscles and have a similar grading system to sprains (see sprains).  However, bruising and significant loss of function with secondary complications may occur.  For example, a condition called Myositis Ossificans may occur if there has been a contusion injury (blunt trauma to a muscle or soft tissue) to the quadriceps (thigh) or other large muscle group.

 

This represents the formation of calcium and new bone within the muscle itself, and can be prevented by the early application of R.I.C.E.  Anti-inflammatory medication is normally administered for between 2-4 weeks if the consultant is concerned about this, providing the internal bleeding has stopped.  Physiotherapy tends to be delayed in cases of Myositis Ossificans.

 

Investigations such as x-rays and ultrasound scans are helpful especially in more severe strains or contusions.

 

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