Preventing sports injuries

If you take part in regular sporting activities, the chances are you will suffer an injury at some point. However, being aware of the risks and how to prevent them can ensure you are able to continue playing your chosen sport rather than spending lengthy periods recuperating on the sidelines.

We take a look at some of the most common sports injuries and share advice on how to reduce your risk of developing them. We also share advice from some of our leading orthopaedic surgeons who specialise in helping people get back on their feet after a sporting injury.

Meniscal Tears

Mr Bhupinder Mann, consultant orthopaedic surgeon at The Chiltern Hospital and The Shelburne Hospital, offers his insights on a common sports injury: the meniscal tear.

“A useful way to look at it is that surgery is the first half of your treatment for a sports injury. The second half, which is equally as important, is the physiotherapy.” – Mr Bhupinder Mann

What are meniscal tears?

“The meniscus is a c-shaped structure inside the knee joint. Its function is to protect the knee joint. Injury to the meniscus can occur from relatively low velocity-twisting mechanisms through to more high velocity sporting injuries.”

What are the symptoms of a meniscal tear?

“A torn meniscus classically causes mechanical symptoms in the knee. These include pain, locking (an inability to fully extend the knee), giving way and clicking.”

What tests are required for diagnosis?

“Often the history and examination is strongly suggestive. There is often a twisting and indirect knee injury with a delayed onset of swelling. An instantaneous swelling is often suggestive of an anterior cruciate ligament rupture. On examination an inability to crouch is often present.

“The gold standard is to obtain an MRI scan which provides an unrivalled view of any structural derangement within the knee.”

What treatment is available for meniscal tears?

“Acutely one requires rest, elevation and ice packing along with the usual pitchside first aid measures. Physiotherapy including massage, range of motion work, strengthening and proprioceptive work may be beneficial.

“Early intervention in the form of arthroscopic surgery is indicated in young athletes, especially when there is a repairable meniscal tear. In such cases the meniscus is repaired with keyhole sutures. This is a fully tissue-preserving technique.

“In cases where the site and morphology of the tear are such that repair is not possible, a partial meniscectomy is performed. This is a very gentle trimming/shaving away of the damaged tissue down to a stable edge until the c-shape is reconstituted.”

What are the benefits of the treatment? What are the risks or side effects?

“The benefit is very often a return to the previous functional level. Overall, it’s a very safe procedure which is performed as a day-case under general anaesthetic. Complications can include infection, bleeding, numbness, nerve damage, non-resolution of symptoms, stiffness, swelling, the need to redo the procedure, clots and embolism. The risk of all of these is low.”

How long will it take to recover?

“A useful way to look at it is that surgery is the first half. The second half, which is equally as important, is the physiotherapy. This is often divided up into phases.

“The first phase focuses on soft tissue massage, wound healing, range of motion and strengthening exercises. In the second, phase cardio and proprioceptive work is added in. In the third phase more aggressive plyometric and sports specific work is encouraged.”

Achilles tendonitis

Overuse of the Achilles tendon, which is located at the back of the ankle, can lead to it becoming inflamed and painful. If it is ignored it can become chronic, worsening to the point where you can no longer run.

Achilles tendonitis tends to be most common in people who participate in sports that involve a lot of running and/or jumping, however, you can lower your risk of developing it by doing regular strengthening and stretching exercises for the calf muscles.

Achilles tenon injury

While tendonitis is caused by overuse, a sudden traumatic injury to the ankle can cause your Achilles tendon to snap. Mr Ahmad Malik, consultant orthopaedic and trauma surgeon, offers his insights into this common sports injury.

“Most patients describe hearing a pop, bang or feeling the tendon snap. Quite often they feel as if someone has kicked them from behind.” – Mr Ahmad Malik

What is an Achilles tendon injury?

“This is when the Achilles tendon snaps. The Achilles tendon connects the calf muscle to the heel bone. When it ruptures you are unable to stand on tiptoe and point the foot down and will have a flat-footed walk. While it typically occurs in patients while playing recreational sports, it can also occur from innocuous injuries such as stepping off a kerb.”

What are the symptoms of Achilles tendon injury?

“Most patients describe hearing a pop, bang or feeling the tendon snap. Quite often they feel as if someone has kicked them from behind. While some people complain of a sharp pain, many have no pain whatsoever. Any pain is short-lasting and replaced by an ache. Patients will lose normal power in their leg and walk with an obvious limp. Patients describe losing the ‘spring’ in their step.”

What tests are required for diagnosis?

“Examination will reveal whether a gap exists, however an ultrasound scan will confirm whether the tear is complete or partial, whether the torn tendon ends come together, where the site of the rupture is, and whether it is amenable to repair.”

What treatment can heal a torn Achilles tendon?

“To enhance recovery and maximise probability of return to pre-injury levels of activity, surgery is recommended. We use the latest minimally invasive technique with cutting edge technology to achieve this. Benefits of minimally invasive (keyhole) surgery include lower risk of re-rupture, return to normal power and strength and enhanced recovery and return to sports. The risk of complications is low (less than 1%) but can include infection and blood clots.

“If you want to avoid surgical risks then non-operative treatment is an option, but advisable only in those patients whose tendon ends come together. Your surgeon will be able to guide you.”

How long will it take to recover?

“Treated non-surgically, recovery from Achilles tendon injuries can take 12 months. Surgical repair will result in recovery in four to six months.”

Tennis elbow

Tennis elbow affects the outside of the elbow and can cause pain when bending the arm, gripping and twisting the forearm. It is caused by overuse of the muscles, particularly through repeated backhand strokes. There are a number of exercises regular tennis players can do to ward off tennis elbow, including forearm-strengthening exercises such as wrist curls and squeezing a rubber ball. Wearing an elbow brace could also be helpful if it’s a known problem.

Iliotibial Band Syndrome

Mr Richard Hughes, consultant radiologist at The Chiltern Hospital, offers his insights on a common sports-related condition: iliotibial band syndrome.

What is iliotibial band syndrome?

“This condition is caused by friction in the tendon that runs along the lateral aspect (the outer side) of the knee. The iliotibial tract (tendon of the tensor fasciae latae muscle) extends from the hip to the top of the shin bone and is vulnerable to rub against the outside of the femoral bone at the knee as it crosses the bone. It is an injury pattern which we very commonly see in long distance runners, cyclists, tennis players and footballers.”

“When symptoms are acute, ice treatment and anti-inflammatories can help with the symptoms and are useful after exercise. Alteration of activities which exacerbate the pain and periods of rest from sport may be required.” – Mr Richard Hughes

What are the symptoms of iliotibial band syndrome?

“Pain and tenderness on the outer aspect of the knee which gets worse on activity. When severe, it can ache at rest and cause pain when lying on the affected side or on pressure.

“A physiotherapist or knee/ sports injury specialist will be able to diagnose this condition based on the history of the injury and the examination. In difficult or atypical cases, MRI and ultrasound are useful tests to confirm the diagnosis and the severity of the inflammation within the iliotibial tendon and adjacent soft tissues.”

What treatment is available for iliotibial band syndrome?

“When symptoms are acute, ice treatment and anti-inflammatories can help with the symptoms and are useful after exercise. Alteration of activities which exacerbate the pain and periods of rest from sport may be required.

“A sports physiotherapist can guide treatment and activity levels and will work on stretching the tendon and strengthening the hip/ buttock muscles. Analysis of running style/ gait and running shoes may be useful, in cyclists with ITB friction, adjustment of pedals and clip-ons can help offload the area.

“When these measures fail, ultrasound-guided injections of corticosteroids (cortisone) around the tendon are an option to help relieve symptoms and provide a pain-free window for rehabilitation. Rarely surgery is required for intractable cases and involves releasing and/or lengthening the tendon.”

What are the benefits of the treatment? What are the risks or side effects?

“Most people improve without need for invasive treatments. Corticosteroid injections are relatively safe and low-risk procedures. However, there are low risks of causing skin thinning and lightening at the injection site and very low risk of infection and allergy as with any injection.

“Multiple cortisone injections can weaken tendons and most specialists recommend no more than two to three injections into the one area, however in most cases only a single injection is required.”

Dislocated shoulder

Dislocations can occur in any joint, however, they most commonly affect the shoulder, which is the most mobile joint in the body. Pretty much any sport which involves a lot of overhead movement – swimming, tennis, volleyball, basketball, weightlifting and goalkeeping – puts people at increased risk of dislocating their shoulder.

Once you have suffered from one dislocation, you are more likely to suffer a second, so it is even more important to take appropriate precautionary measures. Repeated dislocations can lead to stretching of the shoulder joint and result in people needing prolonged periods of rest or joint surgery. To prevent shoulder injuries, you should ensure you exercise the joint regularly, even during the off season.

Hamstring Injury

Mr Gurdeep Biring, consultant orthopaedic and trauma surgeon at The Chiltern Hospital and The Shelburne Hospital, offers his insights on hamstring injuries.

“Hamstring injuries are common in athletic population is and can affect all levels of athletes. The hamstrings are a group of muscles on the back of your thigh which originate from the ischial tuberosity (the bone in the buttock that you sit on).

“The muscles include the semimembranosus, semitendinosus and biceps femoris. Typically, there is a history of a traumatic event with forced hip flexion and the knee in extension. Any sporting activity requiring rapid acceleration and deceleration can also cause these injuries.”

Grades of injury include:

• Grade 1: a mild strain, with few muscle fibres being torn
• Grade 2: a moderate strain, with a definite loss in strength
• Grade 3: a complete tear of the hamstrings

What are the symptoms of a hamstring injury?

“Athletes typically describe a popping or tearing sensation with associated pain and bruising over the posterior buttock. Patients also get pain at the back of the thigh and lower buttock when walking, straightening the leg or bending over. There is hamstring tenderness and bruising. Patients may experience sciatica-type pain due to irritation of the sciatic nerve.”

What tests are required for diagnosis?

“Plain x-rays exclude fractures. The gold standard test is an MRI scan which allows for an accurate measurement of the amount of tendon damaged and the degree of tendon retraction after rupture.”

What treatment is available for hamstring injuries?

“Non-operative treatment is commonly recommended in the setting of partial tears. Initial treatment consists of active rest, non-steroidal anti-inflammatory drugs and a physical therapy program consisting of a gentle hamstring stretching and strengthening program.

Injections of platelet rich plasma (PRP) can also help the healing process in selected cases. Patients with failure of non-operative treatment may benefit from surgical repair.”

When do you require surgical treatment for an injured hamstring?

“Failed non-operative treatment or if the hamstring tendons are retracted more than 2 cm with persistent pain. Early intervention should be considered before the torn tendon sticks to the sciatic nerve and makes operative intervention harder.”

“It is important to wear supportive footwear that suits your foot type, and trainers should be replaced regularly as the treads and heels wear down.”

How long will it take to recover from a hamstring injury?

“If treated conservatively recovery should take around six weeks. If surgical intervention is required then the patients are placed in a brace restricting knee extension. Patients walk on crutches with toe-touch weight-bearing for two weeks and are then full weight-bearing by four to six weeks.

“The brace is removed at six to eight weeks. Hamstring strengthening can begin at six to 10 weeks, and dry land and sport specific training are initiated at 12 weeks. Full return to sports typically between occurs five and eight months.”

Sprained ankle

Sprained ankles are common among sports men and women who regularly run, jump or make sharp turning movements, which can lead to the ankle twisting and tendons or ligaments tearing. To bolster the ankle’s strength, there are a number of exercises you can do at home, including ankle lifts and light stretches. It is also important to wear supportive footwear which suits your foot type and trainers should be replaced regularly as the treads and heels wear down.

Groin strains

Mr Gurdeep Biring offers his insights on another common sports injury: the groin strain.

“A groin strain occurs in the muscles of the inner aspect of the thigh called the adductors. The injury occurs when the muscle is stretched beyond its limits and results in a tear.” – Mr Gurdeep Biring

“Hip and groin injuries are common amongst athletes, especially in football, hockey and rugby. Athletes who are involved in repetitive clicking, quick starts and changes in direction have a higher incidence of these types of injuries.

“A groin strain occurs in the muscles of the inner aspect of the thigh called the adductors. The muscles typically involved including the adductor longus, brevis and magnus. The injury occurs when the muscle is stretched beyond its limits and results in a tear.”

There are first, second and third degree tears dependent on how much of the muscle is torn:

• 1st degree: Mild pain with little loss of strength or movement
• 2nd degree: Moderate pain with mild/ moderate loss of strength/ movement
• 3rd Degree: Severe pain with complete loss of strength and function

What are the symptoms of groin strain?

“There is pain in the groin and inner side of the thigh, or when bringing your legs together or raising your knee. A popping or snapping feeling can occur during the injury followed by severe pain.”

What tests are required for diagnosis?

“Plain x-rays are required to exclude any fractures. An ultrasound scan can be used to dynamically assess the muscle and its integrity. However an MRI scan is the gold standard test, which allows you to visualize all the tissues and associated structures and the extent of the injury.”

What treatment is available for groin strains?

“The immediate treatment involves rest, ice and compression. Non-steroidal anti-inflammatories help ease the pain and shorten the recovery time. Activity modification along with physiotherapy is required which consists of soft tissue mobilisation, stretching, frictional massage and neuro-muscular rehabilitation. Injections of platelet rich plasma (PRP) can also help the healing process in selected cases.

“If there is complete rupture then an opinion from an orthopaedic surgeon is required. An initial period of non-operative treatment is tried for six to twelve weeks but if the pain persists and there is more than 2cm of muscle retraction then surgery should be considered.”

How long will it take to recover from a groin strain?

“If treated conservatively then recovery usually happens within six weeks. If surgery is undertaken the postoperative rehabilitation begins with protected weight-bearing for two to four weeks. Strengthening exercises begin at six to eight weeks. Most people return to play after 12.”

Hip bursitis

Hip bursitis is common among runners and cyclists and is caused by the inflammation of the bursae, a small sac containing fluid which acts as a cushion between the bones and overlying soft tissue. The inflammation can either be caused by overuse or injury if people bump or fall on their hip. The best treatment for hip bursitis is rest and a prolonged period of not taking part in activities that aggravate the bursa.

Once the initial pain has eased off, stretching exercises and physical therapy can offer some relief. Regular stretching of the muscles and tendons around the hip, particularly the iliotibial band, which runs down the outside of the thigh from the hip to the shin, will keep them in good condition, helping them glide more easily and reducing the risk of bursitis.

Hip labral tears

One fairly common sports injury that can affect even the most seasoned of athletes is the hip labral tear which, if left untreated, can result in a lot of pain and stiffness in the hip joint. Mr Gurdeep Biring offers his insights on the labral tear, explaining the nature of the injury, what the treatment options are and what to expect with recovery.

“Athletic hip injuries that cause disabling groin pain typically involve the labrum, which is a horse-shaped ring of fibrocartilage that follows the rim of the hip joint. It acts like a washer and allows lubrication of the joint whilst creating a vacuum seal to keep the hip joint in place. Tears of the labrum can lead to pain and dysfunction.

“These labral tears are usually associated with other abnormalities of the hip joint, which can cause impingement of the labrum.”

What are the symptoms of a hip labral tear?

“Movement can be restricted and stiffness can set in”

“Athletes describe experiencing labral tear pain in the groin and hip region with episodes of locking, catching or clicking. Their movement can often be restricted and stiffness can often set in. Certain movements such as flexing and rotating the hip inwards can also cause intense discomfort.”

What tests are necessary to diagnose a labral tear?

“A standard X-ray of the pelvis will identify bony abnormalities; however, the gold standard test is a high resolution MRI scan which will define the labrum and any injuries to the articular cartilage. Sometimes a contrast MRI may also be necessary.”

How is a hip labral tear treated?

“Athletes with symptomatic labral tears should undergo non-operative treatment in the first instance; this can include activity modification, anti-inflammatories and a short course of physiotherapy. If the symptoms don’t settle down in four weeks, then assessment by an orthopaedic surgeon with an interest in hip injuries should be considered. Hip injections may also be considered at this stage.”

When would someone require surgical treatment?

“Athletes with persistent symptoms that are not settling and which have persisted for longer than six weeks may require hip arthroscopy. This is a keyhole procedure which allows a camera and instruments to be inserted into the hip joint, enabling the labrum to be repaired or debrided, and any structural abnormalities to be assessed and treated.”

Is it possible to return to sport following hip surgery? How long will recovery take?

“When a labral tear is identified early, and where appropriate treatment with arthroscopic intervention has been administered, then favourable outcomes and return to sport is achievable.

“Rehabilitation is very important and depends both on the extent of the injury and treatment of any associated structural abnormalities. Typically, you can expect recovery to take up to 12 weeks.”

Skier's Thumb

Mr Simon Wimsey is one of our experienced consultant orthopaedic surgeons at The Cavell Hospital and The Kings Oak Hospital. He shares advice about the injury commonly known as skier's thumb, including how it happens and how it is treated.

What is skier's thumb?

“It is an acute injury to the ligament at the base of the thumb, more specifically the ulnar collateral ligament of the metacarpophalangeal joint. This ligament is vital to the stability of the thumb in function. As the name suggests it can occur skiing but in fact in this country occurs more commonly in people playing rugby or other contact sports, or simply falling on an outstretched hand.”

Is skier's thumb a common injury?

“Skier's thumb represents 5-10% of all skiing injuries but skiing actually only accounts for 3% of acute ulnar collateral ligament injuries. So, the injury is actually more common outside of the sport it’s associated with!”

What can I do to prevent it?

“Warming up properly can help reduce the risk of injury.” – Mr Simon Wimsey

“Obviously avoiding activities which predispose to these injuries can help. Warming up properly can help reduce the risk of these types of injuries from occurring. Also, when skiing, make sure you do not wrap the ski pole strap around your thumb so if the pole gets stuck in a divot, the thumb does not get pulled backwards! Just let the pole go! However, as almost 50% of skier’s thumbs occur after a simple fall, prevention could prove difficult.”

How is skier’s thumb treated?

“If you hurt your thumb in a fall and the pain and instability persist, you should suspect that you might have sustained this injury. Clinical examination of the thumb by a medical practitioner would look at swelling, bruising, pain and instability during function. Prompt referral to a hand surgeon is important to ensure an optimum outcome. Get yourself a referral for peace of mind.

“Many British skiers sustain this injury on the slopes of Europe, assume it is ‘just a sprain’ and ignore it. It is common for these people to present for treatment quite late. The sooner you seek help, the quicker and easier the resolution. Most skier’s thumbs are partial ligament injuries which can be treated by immobilising the base of the thumb for six weeks using individually fabricated casts or splints. If the injury is a complete injury (a full rupture of the ligament) then these commonly require surgery, particularly if there is a Stener lesion (interposition of adductor aponeurosis). This is where a muscle attachment gets trapped in the gap and prevents healing. In some injuries a bony fragment is pulled off the thumb base and if displaced these require surgical fixation.

“Both conservative and surgical methods have good long-term outcomes for patients, but the most important aspect of care is determining what treatment is required. Patients can expect to regain 80-90% range of motion, and pinch grip returns to 90-95%.

“Complications are rare, but following surgery some numbness around the scar and dorsum of the thumb can occur, which is usually temporary.”

What can I do post treatment to reduce the chance of it happening again?

“After treatment, stay in the splint for as long as has been advised by your doctor. You should also diligently follow your hand therapist’s advice to minimise the risk of long-term stiffness which, surprisingly, is more common than instability.”

Treating common sports injuries

Consultant Orthopaedic Surgeon Mr Winston Kim, who practices at The Alexandra Hospital, shares his advice on treating joint pain from injuries or arthritis.

“Improving your fitness with non-impact exercises is my number one tip. It would improve general wellbeing and possibly result in weight loss. If you can manage it, Pilates and yoga may help. Steroid injections are used as an aide to facilitate your rehab or exercise, but do not generally cure joint pain.

“Improving your fitness with non-impact exercises is my number one tip to ease joint pain caused by injuries and prevent them happening again. If you can manage it, Pilates and yoga may help.” – Mr Winston Kim

“Off-loader knee braces for mild to moderate knee arthritis may help in some patients. Ideally you should firstly be assessed by a physiotherapist, orthopaedic surgeon or your family doctor. But non-impact exercises (exercise/stationary bicycle, swimming, and use of the cross-trainer) can improve and maintains fitness. This is important as a starting point to strengthen core, hip and knee muscles.”

Sports injury rehabilitation

“Exercise improves your joint movements and improves stiffness,” explains Mr Kim. “It has general health benefits and enhances general wellbeing. If you have discomfort and pain whilst exercising, which is worse two to three days after exercise, you have done too much. Too much exercise may cause muscle sprains, making things worse.”

He continues: “The key is to gradually increase the intensity and frequency of exercise. A good physiotherapist will supervise an appropriate exercise regime based on the individual patient. They will monitor, adjust, motivate and ensure progress is made with the right exercises. If non-operative measures such as exercises and injections are not effective, then surgery may be suggested.

“The primary benefits of joint replacement surgery include an improved quality of life and significant improvement in pain once you’ve recovered from surgery. You are likely to have a better range of movement and better overall function. Most patients after hip and knee replacements are very happy with their clinical outcomes.”

If you think our physiotherapists or consultant orthopaedic surgeons could help you with your sports injury, give us a call or book online to arrange a consultation. We usually have appointments available within 48 hours.