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.

Heat Illness & Warm Weather Training

As training for the fall soccer season heats up and hot temperatures continue, coaches, parents and players should remember the basics of temperature related illness. Heat exhaustion and heat stroke are serious medical conditions resulting from the body’s inability to cool itself and maintain fluids. Risks factors for heat illness include both elevated humidity and temperature. Compared to adults, young soccer players are at increased risk of temperature related illness because they sweat less than adults and, consequently, are less able to cool their bodies.

What is heat exhaustion and heat stroke?

Heat illness is divided into two main categories: heat exhaustion and heat stroke. Heat exhaustion occurs when the core body temperature rises to between 100.4° F and 104° F. Symptoms of heat exhaustion include chills, nausea, mild confusion, headache and collapse. If a player experiences any of these symptoms during a game or practice, he or she should drink cold fluids, move to a cool location, and consider cold fluid immersion if the core body temperature reaches 104°.

Heat stroke, on the other hand, is a true medical emergency. Heat stroke occurs when the core body temperature rises above 104°. Symptoms include abnormal mental status and confusion, with or without profuse sweating and loss of consciousness, leading to seizure and possible coma. The final stage of heat stroke results in multisystem organ failure and potentially death. In heat stroke, both the severity of the temperature increase and its duration are of great importance. If a player experiences any of these symptoms, he or she should seek medical treatment as quickly as possible. Treatment will likely include ambulance transportation, cold IV fluid administration, cold immersion and supportive care.

Prevention measures key to decreasing heat illness

Prevention of heat related illness is the central component for avoiding catastrophic problems. Soccer coaches and parents should adjust practice times to the coolest period of the day. Drinking water and fluid replacement drinks often and wearing appropriate clothing for warm temperatures are essential. Practices should allow for acclimatization to occur and gradually increase training times in extremely hot weather. Parents need to recognize that the presence of other illnesses that cause fever also increase the risk of heat illness for up to three to five weeks.

If you see a player collapse during a hot soccer practice or game, first check for pulse and cardiac abnormalities. If a steady pulse is recognized, you should assume a heat related illness. Having an awareness of heat illness prevention is far better than resorting to treatment measures. Avoiding practice conditions that place players at risk of heat illness is key to maintaining peak athletic participation for the fall soccer season.

Read more from Dr. Edwards on the Orthopedic One site.