Your Doctor and Sports Injuries

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Dr. Press

The treatment of the various sprains, and strains resulting from participation in sports, are the stock in trade of a Board Certified Sports Chiropractor. Dr. Press was a graduate of the very first Post-Doctoral program ever held in the specialty of Sports Chiropractic. He has spent more than thirty years working around the World as a Sports Chiropractor, first with local teams, and then progressing to attend as Doctor at National events, and ultimately achieving the dream of all Sports Doctors, Olympic Team Physician; and not just a team doctor, but this US native was appointed to serve as the Chief Physician for the entire Olympic Team of the Soviet Union, at the Winter Olympic Games in Albertville, France in 1992.

In 1993, he was US National Team Doctor at the World Championships of Tae Kwon Do. He was Medical Director for the World Armwrestling Championships in England.

He has worked Sports events at Madison Square Garden, Nassau Coliseum, the Meadowlands, in England, South America and Africa. He was medical Director for two years at the Jersey Shore Marathon, and subsequently worked as a Doctor at the New York Marathon. Doctor Press has experience with injuries of Skaters, Dancers, Runners, Fencers, Ball Players, Golfers, and Martial Artists.

Subsequently, Doctor Press was appointed to the highest administrative, medical post for any sport, that of Chairman of an IOC recognized sport's World Governing Body, and he remains the ONLY DC ever to be appointed to such a position. Chairing the Medical Commission of the FIRS (Roller Sports) for two years, he was coopted by the World Chess Federation and employed by them to found a Medical Commission, necessitated by their formal recognition by the International Olympic Committee.

Prevention:

Overall, the best way to prevent sport injuries is by learning ways to prevent them, applying that knowledge, using intelligent training methods and, of course, a little luck.

These brief tips are not intended to replace the reading of scientific, or athlete oriented articles or visiting a sports professional or physician. Our recommendation is to seek out Chiropractic care because, in many cases, Chiropractic will help allow you to avoid drugs and surgery. Our view is that drugs and surgery should, whenever possible, be the last resort in treatment of sports-related injuries. In many cases, sports chiropractic allows the athlete to continue training without interruption. Chiropractic care is considered by most National Olympic Teams, and now by the World Olympians Association, to be the conservative modality of first resort.

Before discussing injuries in general, we should first discuss the important role of prevention. For example, the anatomical distribution of common running injuries is: knee area 42%, leg 28%, foot 17%, hip 5%, and thigh 4%. The remainder is usually back related. Other sports have their own distribution levels. We stress the importance of wearing the correct running/workout shoe and warm-up exercises for prevention, as well as determining the normality of your gait to see if a chronic imbalnce could be at the root cause of your problems. It is also important to note that many claims by shoe companies are not as reliable as one might imagine. Some shoe companies state that more shock absorbing qualities are likely to protect the feet from impact-related injuries. No studies have been done by a legitimate biomechanical lab using human subjects to prove that shock absorbing material underfoot reduces impact shock to the spine! A recent study of 3,000 Marine Recruits using sorbathane insoles in their boots showed that, in fact, this elastic polymer actually increased tibial impact loading by 26%. Soldiers using the product had a higher incidence of foot and lower leg injuries. Another misnomer is that shoe design can reliably control rear foot motion. The idea that a running shoe can be designed to reliably control over-pronation may be interesting, but is also unsupported by scientific data. Lab tests on human subjects actually have disclosed that softening of the mid-sole material actually increases the speed of the pronation movement. The shock-absorbing qualities in a shoe may lead to injuries to the person wearing them. Available research indicates that the only method of controlling over-pronation at the sub-talar joint is by an insole orthotic

Orthotic devices MUST be made by someone very knowledgeable in foot biomechanics; a very complicated process. Various methods of casting are around. Please discuss this at length when in our office.


Knee Injuries:

A common knee injury occurs when there is slippage of the kneecap in front of the knee, and abrasion to the underlying cartilage. Symptoms include soreness underneath the kneecap with aggravation during movement. Most of the time this condition, "runner's knee," can be relieved by rest, proper shoes, a re-analysis, and a change in running workout. Strengthening the knee and avoiding uneven surfaces can also be beneficial. Exercises to strengthen the knee include using weight machines and deep knee bends. A Chiropractic knee adjustment can also relieve the tension in the joint and restore normal movement. The quadriceps muscle, the one in front of the thigh between the knee and hip, is important in stabilizing the kneecap. Bicycling is a good cross-training exercise that will help strengthen the knee. You may find that, just prior to a running exercise, icing your knee for 10-20 minutes is helpful.

Lower Leg Injuries:

The lower leg or foreleg (portion of the leg between the knee and the foot) is an area that can be problematic in runners and bikers. The most common problem is "shin splints." When this happens, pain occurs in the front of the foreleg. Often, the pain feels as if it is "in the bone." Shin splints can also occur in the posterior or rear portion of the leg, but this is less common. The usual cause for shin splints is over-impact, such as track workouts, street running, or foot imbalances. Prevention, rather than treatment, is the answer. The condition may progress to the point where surgery is necessary to relieve the pressure that builds up in the shin "compartment". Prevention includes exercises that strengthen the anterior compartment of the foreleg. Bicycling for runners can be very helpful. Stretching of the anterior compartment, before and after exercise, as well as deep tissue massage, can prevent the area from "scarring down." Shin splints is an injury that can "retire" a runner. If the area is recurrently sore, you should ice it down prior to exercise.

Reassess your running shoes for cushion and fit. Some runners have to stop hard surface running and take to the trails. Shin splints in the posterior compartment (back of the foreleg) usually indicates damage to a muscle or the muscle-tendon complex. The usual symptoms include pain or soreness "behind the bone." Posterior shin splints can be confused with a stress fracture of the foreleg bones, especially the tibia. Pressing on an area behind the tibia can cause pain in both conditions. When this occurs, particularly in young women runners, you may want to get x-rays or a bone scan if the symptoms are persistent. A tibial stress fracture can retire a runner for 6-8 weeks and prevent impact exercise during that time. Alternative exercises then become swimming, deep water running, bicycling, kick-board and fins, etc. Runners that over-pronate are more likely to get this problem. Sports Chiropractors and sports medicine physicians often see these problems and you should consider them a resource.

Achilles Tendon:

The Achilles' tendon, the tough connecting band just behind your ankle which attaches the rear bone of the foot to the gastrocnemius or calf muscle, is another area that is more commonly injured in runners. This can occur, either as a tearing of the Achilles or "micro-tearing." When this occurs, an inflammatory reaction occurs which is called tendonitis. A sudden tearing of the Achilles' tendon is extremely painful and usually "stops you cold." You should seek assistance from a podiatrist or orthopedic surgeon on an urgent basis for this condition.

Achilles' tendon strains and inflammation usually create pain and soreness after running, or just after your start exercising. I have found, in my experience, that Chiropractic adjustments to the rear portion of the foot and heel area can give relief in many cases. Thus the axiom - "Once you have Achilles' tendonitis, you always have Achilles' tendonitis" is probably not true. The Achilles' tendon, once inflamed, may tend towards stiffness and be accompanied by morning stiffness and aching. Usually, these symptoms may return after completion of your exercise regime. The key to recovering from an Achilles' strain is rest, modification of exercise regime, and stretching and strengthening of the calf-tendon complex. This usually takes 7-21 days. When you resume running, avoid speed workouts and attempt to build up your distance base both gradually and by training on alternative days. Avoid hill training and intervals and be sure that your shoes don't have "too much mileage," i.e. are still in good shape. Ice massage may be effective, as well, especially after your workout.

Foot Injury:

Foot injuries in runners may be as simple as a blister or as complicated as a stress or other fracture or a ligament tear. The most common problem is plantar fasciitis. The plantar fascia is a band of tough connective tissue under the foot that extends from the base of the toes to the heel. It creates and supports the arch of your foot. When the plantar fascia is strained or partially torn, an inflammatory reaction occurs with symptoms of soreness and pain. This condition is more likely in runners with high arches, flat feet, or over-pronation syndrome. The usual treatment for chronic plantar fasciitis includes a reassessment of your shoes and arch supports or orthotics to be used for no more than 2-3 months. Sometimes, a flexible heel counter or lift will reduce some of the strain on the rear end of the foot. Your foot may benefit by a larger toe box. Some runners, who have recurrent problems with plantar fasciitis, find that orthotics are "the only way to go." Many shoe manufacturers now address the problem of over-pronation, supination, and arch inconsistencies by making different shoe models and inserts (i.e. Nike). Plantar fasciitis will often respond to ice massage or icing just before exercise. Sometimes, taping your foot to reinforce the arch is the only alternative. The symptoms of plantar fasciitis may start in the morning, as soon as you put weight on your foot. Often the ache or pain will lessen once you warm up. Usually, an hour after you stop the running activity, the pain resumes. Plantar fasciitis has a tendency to gradually worsen unless you intervene and reduce the precipitant cause by changing some running biomechanical stress. In most cases orthotics or cortisone shots seldom give long lasting relief. Some orthopedists have even put the foot in a cast which has yet to be shown to be the method of choice. Chiropractic treatment is most appropriate in this situation to relieve pain and address some of the imbalances occurring in the foot. In my practice, I have found certain foot adjustments can bring great relief and successful results to the painful problem.

Muscle Injuries in the Leg:

Muscle strains and sprains are common injuries in the leg. They generally occur in the hamstring, quadriceps and calf muscles. Often, a muscle sprain will have a warning cramp or "twinge." We recommend treatment with ice, elevation, and compression. A sprain may be severe enough to warrant non-weight bearing, i.e. crutches. A sprain or strain may progress to a muscle tear. Small strains are usually partial muscle tears (micro-tears) and, fortunately, usually respond to conservative treatment. As the sprain resolves, the pain and swelling remits. If a tear occurs, the area usually swells and becomes discolored (black and blue). The pain is usually more severe and requires the attention of a doctor. The quadriceps muscle is the large group of muscles in front of the thigh. This muscle inserts above the hip and attaches below the knee joint with a large tendon, the patella tendon, incorporating the patella or kneecap on its way to the top of the tibia (shin bone). This muscle group is probably the most powerful in the body. It can be sprained and torn, though the usual cause for a quadriceps tear is a violent and sudden activity such as a sprint. Prevention, once again, is recommended. Athletes who tend to use this muscle group explosively have found that weight training, a proper warm-up, and stretching is a necessary part of their workout. When the muscle feels strained, i.e. an aching feeling, or several spots are painful to the touch without swelling or discoloration, the muscle is strained and is being overused. When this occurs, you should consider reducing impact exercise. Sprinting, intervals, and hurdles will only cause the strain to be aggravated and make it more likely that a tear will occur.

The hamstring muscle, the muscle behind the thigh, attaches from the buttock to below the knee and acts as a counterbalance to the quadriceps. The hamstring muscle is responsible for power during "stride running" and is very important in bike sprinting. This muscle can also be sprained, strained, or torn. A tear of this muscle is usually signaled by a sudden searing and deep pain. The torn muscle usually bleeds inside itself and into nearby tissues and may extend down the leg and behind the knee. Hamstring injuries tend to be recurrent but may respond to a prolonged nonimpact exercise. If a tear is significant, the rule here is prevention. Cross-training, using nonimpact exercise modalities, massage, swimming, and Chiropractic treatment, have been found to reduce hamstring injuries.

There are many other leg injuries that need to be discussed. In future articles, the Chiropractic assessment and treatment of sciatica, iliotibial band syndrome, ankle sprains, low back pain, and upper extremity problems will be discussed. Clearly, your Sports Certified Chiropractor should be your FIRST stop for such sports related injuries. Experience, over the years, supports this contention. Chiropractors do not do surgery or prescribe drugs. However, in addition to adjustments, modalities such as physiotherapy, Chinese herbs, bracing, and vitamins are commonly used, adn we are both expert in nutritional medicine and now abel to dispense whatever is required to help you. The sub-specialty skill of extremity adjustment has been developed and is particularly applicable to golfers, runners and bikers.

You may find it helpful to check our links page, or write to the American Chiropractic Association, Council of Sports Fitness and Physical Fitness, 1201 W. Marleton Pike, Cherry Hill, New Jersey, 08002, to find a sports chiropractor in your area. The American College of Sports Medicine, P.O. Box 1440, Indianapolis, Indiana, 46206-1440, has a directory of sports medicine physicians credentialed across America. Other resources for sports medicine professionals include the American Osteopathic Association, Academy of Sports Medicine, P.O. Box 623, Middleton, Wisconsin, 53562-0623. The American Physical Therapy Association, 111 N. Fairfax St., Alexandria, Virginia, 22314, the American Academy of Orthopedic Surgeons, 222 S. Prospect Ave., Parkridge, Illinois, 60068, the American Academy of Podiatric Sports Medicine, 1726 Glastonbury Road, Potomac, Maryland, 20852.

Thanks and credit is given to Dr. Jeff Burres, of Reno, NV, whose article was edited and used here.

Whatever your sports injury, (if you suspect you have a fracture go to your local emergency room), otherwise click here for an appointment.

Remember, if yours is NOT a Chiropractic case, we will refer you to someone who can help you. But, if yours IS a Chiropractic problem, then nothing else will ever likely help you.