Women are 2-10 times more likely to suffer ACL injuries than men

Sports medicine physicians have seen a surge of ACL injuries in athletes, especially among female athletes, in recent years. Female soccer players, followed by basketball and volleyball players, are the most prone to this type of injury. And, after a female athlete tears her ACL, studies show that the risk she will injure the opposite knee increases dramatically.

ACL injuries are often non-contact, meaning that the ligament tears without a collision or fall and most frequently occurs when cutting or landing from a jump. The athlete will usually feel his or her knee buckle or give way, hear a pop and fall to the ground. Rapid swelling and a “wobbly” feeling often occur after the injury.

Though reconstructive surgery has advanced to allow more than 95 percent of athletes to return to competitive play after ACL reconstruction, the main goal is to proactively prevent this serious injury from ever occurring. ACL injury prevention programs are helping athletes nationwide.

ACL injury prevention programs involve controlling strength and technical errors in running, cutting and landing motions. Research is now conclusive that training in these areas may decrease the risk of ACL injury by more than 50 percent. Training programs focus on cutting and jumping with a bent knee and gaining better control over the knee when the player is off balance.

An orthopedic sports medicine specialist can conduct a simple screening test to identify athletes who have poor landing and cutting mechanics and teach them the proper techniques. Receiving a more specific muscular evaluation, similar to what we provide to the Columbus Crew players, offers even more preventive suggestions.

While athletes of any age and gender can benefit from these prevention programs, female athletes across the country are experiencing remarkable results—significantly increasing their strength and improving their overall performance, and reducing the chance of an ACL injury.

If you experience an ACL injury, you should:
• Seek immediate care from an orthopedic sports medicine specialist.
• Follow their instructions and rehabilitation programs after surgery for a likely return to athletic activities.
• But, better yet—begin taking preventive measures now to protect yourself against an ACL injury and save yourself a visit to an orthopedic surgeon.

Growing Pains – Are they fact or fiction?

Parents frequently hear their young soccer player’s knee pain is due to “growing pains.” I believe this is a misnomer. Growing, in and of itself, is not painful, nor does it directly result in pain. Physiologic consequences of skeletal growth can lead to a condition such as muscular imbalance that can secondarily become painful, but to lump painful knee conditions into the category of “growing pains” is inaccurate.

Knee pain among young athletes is commonly a result of trauma, muscular imbalance, growth plate irritation and overuse. Traumatic injuries are easily recognized as they are acute, and the source and mechanism of injury are observed. Muscular imbalance occurs as soccer players’ long bones grow faster than the surrounding muscles. This imbalance frequently leads to hamstring tightness. As a result, the patella and anterior knee are overloaded leading to pain. Growth plate irritation often occurs in active young athletes as well. This condition occurs due to overload of the growth plate at the top of the soccer player’s leg in the anterior knee. It results in a bump at the front of the knee. Finally, young athletes often experience overuse injuries, such as tendonitis. Patellar tendonitis and plica irritation are common examples.

Treating non-traumatic injuries usually begins with rest and ice. Muscular imbalance and tendonitis are usually treated with physical therapy and specific exercises and stretching. Growth plate problems are treated with rest and immobilization. Traumatic injuries are treated variably according to their type.

In conclusion, knee pain in the growing athlete is not due to growth alone. A specific diagnosis should be made and treatment directed accordingly. Lumping all sources of knee pain under the diagnosis of “growing pains” results in failure to provide appropriate treatment, which, in turn, slows down the athlete’s recovery time.

When A Sprain is not a Sprain…Syndesmosis and Mid-foot Injuries

By Peter H. Edwards, Jr., M.D.

A sprain is a generic term for an injury to a ligament. Sprains are graded first degree, second degree and third degree. First degree sprains are mild, and minimal ligament damage occurs. Swelling is mild, and bruising usually does not occur. Second degree sprains are moderate, and some, but not all, ligament fibers are torn. At least some bruising and moderate swelling are normal. Grade three sprains are severe, and the ligament is completely torn. Extensive bruising and marked swelling occur.

Among soccer players, any foot or ankle injury often is lumped into the “it’s just a sprain” category. Many sprains can heal well without surgery or even medical care, but certain “sprains” can be much more serious. The high ankle or syndesmosis sprain and the mid-foot sprain are two such injuries. When serious injury occurs to these joints, detailed specific care and often surgery are needed.

The syndesmosis sprain occurs above the “normal” ankle sprain at the level of the lower leg and ankle junction. These sprains swell higher in the ankle and often are more painful than regular ankle sprains. X-rays should be obtained to evaluate for fracture, but also to determine if a ligament tear allowed the bones to slip apart. If slippage has occurred, surgery will be needed. Terrell Owens and Kellen Winslow both required surgery for this injury in the N.F.L. Soccer players are more at risk of this injury than athletes playing other sports due to the nature of the game.

Mid-foot sprains are a similarly serious injury. This sprain results from a fall forward over the flexed foot or from a direct blow. Even slight slippage of the bones in this area results in long-term problems unless treated surgically. Often, this injury’s severity is not picked up on first evaluation. Significant swelling and/or bruising in the mid-foot should prompt evaluation by a specialist. Again, soccer players frequently injure this area in ground strike or 50/50 situations.

In conclusion, sprains often are more serious than soccer players usually believe. If you experience significant swelling and bruising after injury, seek an evaluation from a sports orthopedist. Initial treatment with R.I.C.E. and crutches is recommended prior to evaluation.


Ankle Sprains: #1 Cause of Soccer Players’ Emergency Room Visits

By Peter H. Edwards, Jr., M.D.

Ankle sprains are not only the biggest reason athletes visit the emergency room, but are also the most common soccer injury. Sprain is the term that describes an injury to a ligament. All sprains are graded I-III.

Grade I injuries are mild and do not involve any tearing of ligament fibers. Grade II sprains result in tearing of some, but not all, of a ligament’s fibers. Grade III tears are complete tears of the ligament.

Ankle sprains occur in athletes of all ages, but teenage athletes are more likely to experience severe injuries than young athletes.

Understanding the Ankle’s Structure
The ankle has four major ligaments. The anterior talofibular (ATFL) and calceaneofibular (CFL) ligaments are on the outside. The large deltoid ligament is on the inside. The syndesmotic ligament is actually a group of smaller ligaments that connect the two bones of the leg near the ankle. Each ligament helps hold certain parts of the ankle in place. The ATFL and CFL keep the ankle from rolling outward. The deltoid keeps the ankle from buckling inward. The syndesmotic ligaments keep the ankle from twisting apart at the bottom of the leg.

Causes of Ankle Sprains
Ankle sprains happen when a force is placed on the foot that stresses the ligament to the point of injury or failure. Sprains most often occur when a soccer player steps in a hole and “rolls” his or her ankle. The player feels immediate pain on the outside of the ankle and varying degrees of swelling and bruising, depending on the severity of the injury. Grade I sprains are mild enough that the athlete often may continue playing only to feel sorer after the game. In Grade II/III injuries, the athlete usually cannot continue playing, and his or her ankle will swell and bruise over the first one to three days. Crutches are often needed initially. Syndesmosis sprains, though less common, are usually more severe and often occur with ATFL/CFL sprains.

Treating Your Injury
Initial treatment for all sprains is the same: Rest Ice Compression Elevation, otherwise known as the RICE method. Thereafter, consult your sports medicine physician to evaluate any significant injury. Often, fractures and other ankle injuries appear to be a sprain. Coaches and parents should not try to determine the nature of the injury. An X-Ray may be required to identify fractures that may mimic ankle sprains. Control of swelling and pain treatment often involves physical therapy to speed recovery and ensure the player’s return of strength and balance. However, only five percent of all ankle sprains result in an injury that requires surgical treatment. This usually involves a delayed reconstruction if the ankle becomes unstable and repeatedly sprains.

Local HS Soccer Star on the Mend after ACL Injury

Clear Fork’s Jordyne Helinski, a two-time, first-team, All-Ohioan, suffered an ACL injury during practice.  Her operation and recovery is featured in the Mansfield Journal on September 28, 2015. In the article she shares that she “was given reassurance from Dr. Peter Edwards, of Orthopedic One in Columbus, who successfully performed the surgery Friday. He’s operated on members of the Columbus Crew as well as scores of college and high school players, and he sat down and gave her the odds of re-injury with the different surgical techniques.”

Read the full article here.

Power, Takeoff Speed and Agility

Speed is of great importance in most sports and especially soccer. Recovery from a stolen ball, breaking to a header, outrunning a defender to the ball and breaking to an open space all depend on explosive takeoff speed. Speed often defines a player and clearly distinguishes the exceptional player from the average one.

In a medical and physical sense, speed is the muscles ability to generate power. Maximum power and related maximum force are directly related to strength. Thus, strength is a major component of speed. Speed is also dependent on the stretch shortening cycle of the muscle and the ability of muscle to store elastic energy. This depends both on flexibility and neuromusclar interaction. Thus, speed is dependent on strength, flexibility and neuromuscular activation – all of which are trainable.

Speed training has evolved as medical science has isolated the essential elements of speed. This training involves specific strength base development and explosive power or plyometric training. Monitoring strength/speed progression allows for optimal improvement.

Along with speed, agility is a key factor in elite athletes. Agility is the ability to change direction at high speed and under control. This allows for speed to become more effective in attacking players. Agility is dependent on strength, flexibility and neuromuscular reaction time – all of which are trainable as with explosive speed development. Agility training is not ball dependent and can be trained off the field (i.e. the school gym, etc.).

Speed and agility are integral components in soccer performance. Strength gains, improvement in reaction time and in overall agility also help in injury avoidance and decreased injury severity. The agility to outrun or avoid a tackler or better withstand a blow are added benefits to speed/agility training. As soccer physicians, it is this dual benefit of improved performance and injury avoidance that is most exciting.

Stress Fractures Common Among Soccer Players

Stress fractures were first described in 1855 by a Prussian military physician. He observed signs and symptoms of stress fractures in soldiers’ feet resulting from their long marches. Stress fractures are now commonly experienced by all athletes, but especially among athletes competing in sports requiring significant running, such as soccer.

Causes of Stress Fractures

For soccer players, lower extremity stress fractures are obviously most common. These injuries occur as a result of repeated overload of the bone without adequate recovery time. This occurrence creates an imbalance between normal bone formation and resorption. When this imbalance happens, a microfracture gradually grows into a true stress fracture. Unlike a true fracture, a stress fracture does not usually result in displacement of the bone and an inability to bear weight. Pain over the affected bone, local swelling and warmth are the normal symptoms.

Diagnosis and Treatment

Your physician can diagnose a stress fracture with a plain X-ray or a bone scan test. Treatment usually involves rest, crutches and sometimes casting. Unfortunately, recovery can take from six weeks to four months or more depending on the boney location of the stress fracture. Certain high risk stress fractures, such as the “dreaded black line” stress fracture of the tibia/shin and the Jones fracture of the fifth metatarsal, heal poorly and often are treated with surgery.

Injury Prevention

As with most injuries, preventing stress fractures from occurring is the goal. Training should always follow a hard/easy pattern allowing for a 24-hour recovery period after hard training. Appropriate shoe wear and soft training surfaces also are helpful. Allowing for post season recovery and variation in sports are recommended.