Types of Injuries

Plantar Fasciitis

There are many potential causes for heel area pain, but the vast majority of cases are due to an irritation of the insertion of the attachment of a tough tissue (planter fascia) onto the heel bone.

This tissue supports the arch of the foot and once this attachment site becomes inflamed a chronic, painful, and disabling condition can develop.

The primary symptom of plantar fasciitis is pain specifically located on the weightbearing area of the heel. It is commonly most severe in the first weightbearing steps on arising in the morning, decreased to some degree with activity as the fascia stretches and recurs again after a period of rest. Rarely is there any visible swelling, redness, or other apparent change in the foot.

Predisposing Factors
  1. Strenuous Training
  2. Overweight Individuals
  3. High Arches
  4. Long and Narrow Feet
  5. Barefoot Walking on Hard Surfaces
  6. Previous or Repetitive Trauma

Achilles Tendonitis

Achilles Tendonitis (AT) causes inflammation and degeneration of the achilles tendon. The achilles tendon is the large tendon located in the back of the leg that inserts into the heel. The pain caused by AT can develop gradually without a history of trauma. The pain can be shooting pain, burning pain, or even an extremely piercing pain. Achilles tendonitis should not be left untreated due to the danger that the tendon can become weak or ruptured.

Achilles Tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptom. It is a common problem often experienced by athletes, particularly distance runners. Achilles Tendonitis is a difficult injury to treat in athletes due to their high level of activity and reluctance to stop or slow down their training.

Individuals who suffer from AT often complain that their first steps out of bed in the morning are extremely painful. This pain often lessens with activity.

Risk Factors
  1. Tight Heel Cords
  2. Foot Malalignment (excessive pronation)
  3. Recent Change in Running Shoes
  4. Sudden Increase in Workout Intensity
  5. Excessive Hill Climbing

Angle Sprains

The ankle is often injured while performing daily activities of work, play, and sports. The ankle, a hinged type joint, takes a tremendous amount of stress, especially while running.

Ankle sprains are the result of the ankle rolling in or out, stretching or tearing the ligaments on the inside and/or outside of the ankle. The pain of an ankle sprain is significant and often keeps the injured person out of play or work for a period of time. With appropriate treatment, ankle sprains often heal quickly and do not become a chronic problem.

Types of Ankle Sprains:
First Degree
Ligaments that connect the bones of the ankle are stretched (minimal swelling).
Second Degree
Ligaments are partially torn resulting in usually 3-6 weeks recovery (swelling).
Third Degree
Ligaments are severely torn but rarely require surgery and a recovery time of 8 weeks or more (extensive swelling).
Treatment for Sprains

A good rule to follow for ankle sprains is R-I-C-E (rest, ice, compression, and elevation).

  • Rest: If necessary (talk with your doctor) eliminate all weight bearing activity.
  • Ice: Fill a plastic bag with crushed ice or a frozen bag of pees or carrots and apply to the skin with a protective covering for approximately 30 minutes.
  • Compression: Compress the injured area by wrapping it with a compression pad and an elastic bandage.
  • Elevation: Along with application of ice elevate the injured area above the level of the heart.

Patellofemoral Syndrome

Injury Description:

Knee injuries or pain are the most common complaint by sports participants. Studies have shown that patellofemoral pain syndrome comprises up to 50% of all overuse injuries. The syndrome is caused by an irritation of the under-surface of the patella (knee cap). The pain is usually a dull pain that seems to come from deep in the knee. It is worst with deep knee bend-type sports. Usually there is pain climbing stairs and after sitting for a prolonged period of time.

The patella is a moving part that glides up and down a groove in the femur (thigh bone) as you bend and straighten your knee. The pain is caused by compression of the patella and the femur which increase as you bend your knee.

Basically, the irritation of the patella causes an inflammation which causes the pain. THIS IS NOT ARTHRITIS. It is most common in chrildren and adolescents who always grow out of this problem.

Predisposing Factors:
  1. Maltracking (Patellas not gliding on the femur properly)
  2. Flat, pronated feet
  3. Overuse (too much too soon)
  4. Weak inner thigh muscles
  5. Tight outer knee structures
  6. Muscles inflexibilities
  7. Previous or Repetitive trauma

Osgood-Schlatter Disease

Injury Description:

Osgood-Schlatter Disease (OSD) is an inflammation (irritation) where the tendon from the patella (kneecap) attaches to the tibia (shin bone). Preteens and young teens are particularly susceptible to stresses in this area because the bone is growing rapidly at this age. Any activity can cause OSD but it is more common following activities that involve a lot of jumping like basketball, volleyball, soccer, figure skating, and gymnastics.

A typical symptom of OSD is pain in the front of the shin about 2 to 3 inches below the kneecap. There may also be swelling in the area, especially if you have had the condition for several months. Symptoms can range from mild knee pain only during sports to constant pain that makes participation impossible.

Predisposing Factors
  1. Overuse (too much too soon)
  2. Weak Muscles or muscle imbalance
  3. Age
  4. Strenuous Training
  5. Rapid Growth
  6. Previous or Repetitive Trauma

Knee Ligament Injury

Injury Description

The stability of the knee is dependent on powerful muscles which act as active restraints and four strong ligaments which act as passive restraints.

The four ligaments are as follows:

  1. The medial collateral ligament (MCL) prevents the knee from buckling inwards
  2. The lateral collateral ligament (LCL) prevents the knee from buckling outwards
  3. The anterior cruciate ligament (ACL) prevents the tibia from sliding forward under the femur.
  4. The posterior cruciate ligament (PCL) prevents the tibia from sliding backwards under the femur

Ligament injuries (sprains) are classified according to severity as follows:

  1. Grade I (mild) where the ligament is stretched but only a few fibers are disrupted
  2. Grade II (moderate) where the ligament is partially disrupted
  3. Grade III (severe) where the ligament is totally disrupted and there is instability

Treatment Options
  • Grade I and II sprains can be treated with a cast or a brace followed by exercises to regain mobility and strength
  • Grade III sprains usually require surgical repair followed by intensive rehab for up to 12 weeks
  • Cruciate ligament tears are not amenable to direct repair and may require reconstruction at a later date

Rotator Cuff Tendinitis

Injury Description

This is one of the most commonly occurring injuries in sport and work where the arm is used in an overhead motion. The pain is usually felt on the tip of the shoulder or part way down the shoulder muscle. The pain is felt when the arm is lifted overhead in a certain direction. In extreme cases pain will be present all the time and it may even waken the injured individual from a deep sleep.

The shoulder is a ball and socket joint but the socket is not very big and the shoulder is relatively unstable. This puts a lot of stress on the tendons and muscles that move the arm and help support the shoulder. The tendons are further prone to becoming inflamed as they go through a very tight channel of bone. When the arm is raised the channel becomes smaller and makes the area more prone to inflammation.

Predisposing Factors
  1. Overuse (too much too soon)
  2. Weak muscles or muscle imbalance
  3. Improper Techniques
  4. Strenuous Training
  5. Loose shoulder joint
  6. Poor posture
  7. Shoulder Blade Dysfunction
  8. Previous or Repetitive trauma

Shoulder Bursitis

Injury Description

The shoulder is a ball and socket joint whose articulations allow for a wide range of movement. This wide range of motion in the shoulder occurs at the cost of decreased stability.

The bursa is a fluid-filled sack found in those areas in the body where the friction between tissues might occur. Their main function is to provide cushion and support in areas where repetitive motion are common. Overuse of muscles or tendons in regions where bursae are found, as well as continuous external compression or trauma, can cause bursitis. Symptoms include swelling, pain, and often a loss of muscular strength and range of motion. Repeated cumulative trauma may eventually lead to the formation of calcium deposits and to degeneration of the internal lining of the bursae.

There are several bursae in the shoulder region: the subacromial, the subdeltoid, the subcoracoid, and the subscapular, which, as their names imply, lie beneath the acromon, deltoid, coracoid, and scapula, respectively.

Treatment
  1. Superficial icing to decrease swelling
  2. Deep heat from diathermy or ultrasound for pain relief
  3. Anti-Inflammatory medications
  4. More serious cases: cortisone injection and/or physical therapy

Epicondylitis - Tennis/Golfers Elbow

Injury Description

Epicondylitis is caused by inflammation of the forearm muscle attachments to the body knob (epicondyle) on the elbow. It is a form of tendinitis. Lateral epicondylitis, also called "tennis elbow", is a term used when the muscles of the elbow are inflamed. Medial epicondylitis, known as "golfer's elbow", refers to inflamed muscle attachments on the inside of the elbow. In either type of epicondylitis pain may be felt where the muscle tissue attaches to the bone of the elbow or it may radiate down the forearm muscles, occasionally to the wrist.

Epicondylitis is usually related either to overuse or a direct blow to the area. Pain is most noticeable during or after stressful an/or repetitive use of the arm. Activities involving strong grasp or repetitive forearm rotation are especially aggravating.

Treatment Options

Non-surgical treatment involves three major components:

  1. Protection: Involves minimizing pain-causing activities and decreasing the time/intensity of activity.
  2. Decreasing Inflammation: Ice and friction massage can be used to decrease inflammation and promote healing of the inflamed tendons and bursae.
  3. Strengthening and Stretching: Before beginning a strengthening and stretching programme consult a registered physiotherapist for a tailored home exercise programme.

Neck Strain

Injury Description

Neck pain may result from abnormalities in the soft tissues -- the muscles, ligaments, and nerves -- as well as in bones and joints of the spine. The most common cause of neck pain are soft tissue abnormalities due to injury or prolonged wear and tear. In some people neck problems may be the source of pain in the upper back, shoulders, or arms.

Degenerative diseases that cause neck pain include osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in older people as a result of wear and tear of the joints between the bones in the neck. Both of these major types of arthritis can cause stiffness and pain.

Cervical disc degeneration also can cause neck pain. The disc acts as a shock absorber between the bones in the neck. In cervical disc degeneration the normal gelatin-like centre of the disc degenerates and the space between the vertebrae narrows. As the disc space narrows added stress is applied to the joints of the spine causing further wear and tear and degenerative disease. The cervical disc may protrude and cause pressure on the spinal cord or nerve roots when the rim of the disc weakens.

Causes
  1. Poor Posture
  2. Repetitive Strain Injury
  3. Whiplash
  4. Head Forward Posture
  5. Cervical Degenerative Disc Disease

Carpal tunnel syndrome

Injury Description

Carpal Tunnel Syndrome (CTS) is a problem involving the hand, caused by pressure on the median nerve at the wrist. This leads to symptoms including numbness and tingling in the hand, especially involving the thumb, index, middle and half of the ring finger. There may be pain associated with CTS that can be isolated to the hand or wrist, but sometimes radiates up the arm.

CTS frequently awakens people at night and symptoms may occur with activities such as driving, writing, or other actions involving significant hand use. With advanced carpal tunnel syndrome loss of strength or muscle bulk at the base of the thumb may occur.

The carpal tunnel is a canal formed by bones on the back of the wrist and a ligament across the palm side of the wrist. Through this tunnel travels all the tendons that bend the thumb and fingers and the nerve that supplies feeling to the thumb, index finger, middle finger, part of the ring finger, and the muscles at the base of the thumb.

Hand intensive activities that lead to a tendinitis involving tendons that flex the thumb and fingers causes these tendons to swell. The subsequent swelling "fills up" the tunnel and can apply pressure to the nerve causing the numbness.

Treatment Options
  1. Activity Modification
  2. Use of Wrist Splint
  3. Physical Therapy
  4. Cortisone Injection
  5. Nerve Conduction Study
  6. Surgical Treatment

Low back pain

Injury Description

Low back pain can be divided into two main types:

  1. Mechanical Type pain
  2. Compressive Type pain

Mechanical type pain results from inflammation caused by irritation or injury to the disc, the facet joints, the ligaments,or the muscles of the back. A common cause of mechanical pain is disc degeneration. A typical muscle strain or lumbar strain can also be the cause of mechanical type symptoms. Mechanical type back pain usually starts near the lower spine. Mechanical type pain may also spread to include the buttock and thigh areas.

Compressive or neurogenic (nerve-related) type pain occurs when the nerve roots that leave the spine are irritated or pinched. A common cause of compressive pain is herniated disc. The nerves that leave the lower lumbar spine join to form the sciatic nerve. This nerve provides sensation and controls muscles of the lower leg.

One of the earliest signs of pressure on a nerve root is numbness in the area supplied by the nerve. There s commonly pain in the same area, usually extending below the knee to the foot. This can be confusing at times since there is no back pain, but the problem is located in the lumbar spine.

Treatment Options

The treatment for any back condition should involve two goals:

  1. relieve the immediate problem
  2. reduce the risk of re-injury

Conservative treatment which includes exercise, medication, physical therapy, and other non-operative therapy.

Surgical treatment which includes laminectomy, discectomy, and spinal fusion.