Posts in sports injuries
Previous History of Hamstring Injury Associated With Reduced Sprint Performance
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Hamstring injuries are one of the most common injuries in both individual and team sports. In sports such as soccer and football these injuries involve a traumatic pull of the muscle while sprinting or accelerating. After the initial healing phase athletes must rehabilitate the injury with Physical Therapy exercises to regain optimal muscle function and reduce their risk for future injury. Hamstring injuries often become recurrent if strength is not normalized along the hip, knee, and ankle muscles along the back of the leg. A new article highlights how these injuries also limit performance in sprinting trials.

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Roksund and colleagues studied professional soccer players and collected data on previous hamstring injuries, as well as, each athlete’s strength, flexibility, aerobic capacity, and sprint performance (Front Physiol. 2017). Of the 75 athletes included in the study, 16% sustained a hamstring strain over the previous 2 years. The previously injured athletes demonstrated a significant loss of velocity during a 40 meter sprint test, as well as, a drop in performance over repeated sprints compared to their healthy peers. Interestingly, measures of flexibility, strength, aerobic capacity, and maximum power was not significantly different between groups. Injured athletes are encouraged to work with their local Physical Therapist to accelerate their recovery from muscle strains and eventual return to sport.

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When will my knee tendinitis get better?
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Knee tendinopathy, either in the quadriceps or patellar tendon, is a common source of knee pain among jumping athletes, but can occur in non jumping athletes as well. This overuse injury is caused by repetitive sub maximal loading of the knee through a bending range of motion. If the loading is faster and/or greater than the tendon’s capacity to tolerate this tensile loading pattern, tendinopathy can occur leading to pain and decreased knee function. Our current understanding of these tendon injuries has moved from passive care (rest, anti inflammatories) to an active Physical Therapy approach focused on optimal loading of the tendon to promote remodeling and healing of the injured tissues. A new article sheds light on when patients can expect to recover from their knee tendinopathy.

van Ark and colleagues randomized 29 volleyball and basketball players with patellar tendinopathy to a 4 week full range of motion or isometric exercise program (Am J Phys Med Rehab. 2018). Patients were assessed for symptoms and function, as well as, each player underwent a baseline and 4 week ultrasound scan of the injured tendon. Interestingly, although players reported decreased pain and improved function after the exercise program, no structural changes were detected in the injured tendon. This study is consistent with the research on achilles tendinopathy which demonstrated improved clinical symptoms after 8-12 weeks of Physical Therapy treatment, but continued healing of the injured tendon up to 12 months after the onset of symptoms.

Physical Therapy exercises are the gold standard treatment for tendinopathy but should be continued after resolution of symptoms for optimal recovery of the tendon.

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Identifying Causes of Patellar Tendon Pain Among Jumping Athletes
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Patellar tendinopathy (tendonitis) is a common sports medicine overuse injury most commonly found in jumping (volleyball, basketball) athletes.  This injury has been found in up to 40% of these athletes secondary to the repetitive forces applied to their tendons during their respective sports.  Repetitive loading, without adequate rest, is often found to be the cause of these symptoms, but abnormal loading patterns also play a role.  Changes in dynamic knee alignment due to strength, coordination, and mobility impairments can place the knee at an abnormal angle in preparation for these jumping or landing movements.  A recent research paper looked to identify impairments of flexibility and strength among jumping athletes.

Mendonca and colleagues studied the flexibility and strength of 192 professional basketball and volleyball athletes (JOSPT. 2018). The authors placed athletes in one of two groups based on the presence of patellar tendinopathy (n = 59). The key examination techniques which helped identify those with or without tendinopathy included ankle and leg alignment, hip mobility, and hip external rotation and abduction strength. The study highlights the importance of examining the hip and ankle joint in athletes with patellar tendinopathy. Consistent with the majority of knee diagnoses, hip strength impairments are one of the strongest correlates with knee pain.

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Identifying Soccer Players At Risk For Future Groin Injuries
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Groin strains are the second most common muscle strain, behind the hamstring, among soccer players.  The dynamic movements required by both offensive and defensive players place high demands on the long muscles of the hip and knee.  Our previous blogs have shown the effectiveness of Physical Therapy interventions to reduce the risk of future hamstring strains, but before we reduce the risk for groin injury we must first understand the risk factors for these injuries.  

A recent journal article aimed to identify pre season risk factors which helped identify professional soccer players who sustained a groin injury during their upcoming season (Langhout et al. JOSPT. 2018).  Authors completed medical histories and physical exams (flexibilty, strength) on 190 players from 9 professional teams.  They reported 11% of athletes sustained a groin injury at some point during their season.  Consistent with previous research athletes who reported a prior groin injury were 3 times more likely to sustain a future groin injury.  Similar to what we find in hamstring injury, hip flexibility did not identify players at risk for future groin injury.  

This article highlights the importance of rehabilitating a previous muscle injury with Physical Therapy.  Athletes who complete a standardized Physical Therapy program are able to both accelerate the healing of their injury, as well as, reduce their risk for future injury.

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Injury Prevention Program Reduces ACL Risk by 38% in Female Basketball Players
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In our previous posts on ACL injury we have highlighted girls are 6-8 more likely to sustain an ACL injury compared to boys in the same sport.  Multiple research studies have attempted to reduce this risk by implementing sport specific strength, agility, and balance programs.  On average, these programs have a significant impact on injury rates with ACL injury by 1/3 to 1/2.  A recent long term study was conducted over a 12 year period studying the impact of a hip focused prevention program on girls basketball players.   

Omi and colleagues conducted a prospective intervention study on 309 college female basketball players (Am J Sp Med. 2018) over a 12 year period.  The girls were tracked and observed over the first 4 years of the study and sustained 16 ACL injuries (13 non contact).  Next the authors implemented an 8 year intervention program consisting of strengthening, balance, and agility exercises.  The authors reported ACL injuries were 1/3 as frequent during the intervention program compared to the observation period.  Dropping the risk of ACL injury by 38%.  Amazingly, the exercise compliance rate was 89% during the trial demonstrating the impact of focused, consistently performed exercises in this population.

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Calf Muscle Weakness Remains Up To 7 Years Post Achilles Tendon Repair
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Achilles tendon ruptures are most commonly seen in patients 30-40 years of age and 4-5 times more likely in males versus females.  The injury is often associated with a sudden increase in force placed upon the tendon either from rapid progressions in sport activities or trauma (ex. fall from height).   These injuries can also occur in patients who have a history of unresolved Achilles tendinopathy with residual tendon and calf muscle weakness.  Many of these patients who sustain a rupture do well with either Physical Therapy or surgical repair.

Brorsson and colleagues examined patients who underwent Achilles tendon repair after a rupture to determine how the calf muscles heal and perform following this intervention (Am J Sp Med. 2017).  66 patients were followed over time to determine how quickly their strength, power, and jumping ability returned compared to their uninvolved leg.  The authors reported a rapid improvement in strength following the surgery followed by slower recovery of strength, power, and jumping ability up to 2 years.  No further gains were found after this time point and patients continued to demonstrate weakness and limited muscle performance up to 7 years after the surgical repair.

This study highlights the importance of continuing to rehabilitate the injured extremity first in Physical Therapy and then independently at home.  Patients are encouraged to continue a lower body strength training program to both improve function and decrease risk of re injury.