Part I: Introduction
Many of us know how important exercise is to keep us healthy, and it is good to see that a growing number of Singaporeans are engaged in an active lifestyle. From 16% in 2001 to 35% in 2016, Singaporeans of all ages are doing their best to keep themselves fit. However, with more people being involved, the number of orthopaedic injuries recorded has also risen. These injuries range from a mild ankle sprain to a severe bone fracture condition. Often due to repeated force and continuous use of our muscles and bones during strenuous exercise, these injuries may affect our quality of life if not properly treated.
Moreover, children and young people are also more prone to getting sports-related orthopaedic injuries as their bodies are still developing and they are also usually more active. In fact, in Singapore, at least 65 percent of sports injuries are sustained by those in the 5-24 years-old age group. For growing children especially, these injuries can interfere with their growth if they are not taken care of properly.
As doing sports and strenuous activities come with some risk of injury, it is good to be aware of what causes such injuries and what we can do to prevent them or treat them in cases when it happens. As such, in this comprehensive guide, the causes and treatments of common sports-related orthopaedic injuries will be discussed, as well as exercise tips and what to expect when visiting an orthopaedic clinic.
Part II: Causes & Treatments of Sports-Related Orthopaedic Injuries
2.1. Types of Sports-Related Orthopaedic Injuries
The first thing that needs to be understood is that most sports-related injuries can be classified into two categories: chronic and acute. Acute injuries refer to those that happen suddenly such as a sprained ankle caused by an awkward landing. Usually, these injuries heal quite fast as well. Sports-related chronic injuries are more common, as they are a result of repeated overuse of muscles and joints. They may also take a longer time to heal. Unfortunately, as they may not be as painful as acute injuries in the beginning stages, many people tend to ignore them until they develop into something serious.
Under these 2 categories, sports-related orthopaedic injuries can be further divided into 5 different types. They are:
Our bones are connected by fibrous connective tissue known as ligaments. They maintain our bodies’ structures and ensure that the bones do not twist too far out. However, continuously overstretching them or tearing them can lead to sprains.
While they are often mistaken for sprains, strains refer to injuries that occur when muscles or tendons are overused. Tendons are fibrous cords of tissue that connect muscle to bone – different from ligaments that connect bone to bone. Sprains and strains display different symptoms as well. The main one being that sprains will result in bruising around the affected joint while a strain causes muscle spasms.
3. Bone fractures
Ranging from a thin crack to a complete break, fractures happen when the bone meets a force that is greater than it can structurally withstand. Fractures can either be open or closed. Closed fractures mean that the bone did not break the skin while in open fractures, the bone does break the skin.
Referring to when a bone falls out of a joint, a dislocation occurs when a body part experiences unbalanced impact or an unexpected force. These often occur during falls or contact sports like rugby and hockey. Children are also more prone to dislocations as their joints are quite flexible – which may not hold bones together as strongly as they are supposed to.
5. Achilles tendon rupture
The strong fibrous cord that connects your heel bone to your calf at the back of your ankle is known as the Achilles tendon. Sustained force on the tendon during sports can cause it to break. When that happens, you may experience severe pain and difficulty walking.
2.2. Ankle & Foot Injuries
Considered one of the most complex regions of the body, our ankles and feet are responsible for supporting our weight, providing balance, and transferring ground reaction forces. The ankles, however, are the most vulnerable to injury, since they are built for a restricted range of motion and sprains may occur due to a sudden change of direction. Whereas foot injuries normally arise from daily wear and tear.
Being that they are one of the most important parts of the body in ensuring its mobility, any injury or discomfort should be medically examined to minimise any long-term effects. Here are a few of the most common ankle and foot sports-related injuries that can occur.
1. Ankle sprains and strains
The ankle joint consists of a series of interconnected ligaments, muscles and tendons, which guarantees its stability. These are also areas that are subjected to acute or chronic sprain or strain. There are two primary causes of these injuries. The first is a force that pushes the joint of the ankle out of its usual range of motion. The second being overuse resulting from a repeated ankle impact, such as hard landings in sports like long-distance running and basketball. Other examples include: tripping on an uneven surface, rolling the ankle or landing awkwardly after a jump.
Ankle strains involve the tendons being overstretched due to a persistent overuse of the ankle. Even though they are less common than sprains, they should still be managed properly as they can lead to instability, chronic pain in the ankle and re-injury.
Besides experiencing pain, other symptoms of ankle sprains and strains include swelling, bruising and difficulty walking or putting weight on the injured area. With strains, the tendon might even feel slightly warm to the touch.
For ankle sprains, the most common form of treatment will be the RICE approach. For mild sprains, doing this approach can reduce the pain in a few days. The doctor may prescribe anti-inflammatory cream to bring down the swelling as well. For moderate and severe sprains, an orthopaedic doctor may use a boot or a splint to stabilise the ankle and require the patient to undergo physical therapy to restore strength and motion to the ankle.
For strains, the treatments are similar except that in more severe cases, surgery may be required to repair the tendons and the supporting structures of the foot.
2. Ankle & Foot Fractures
Our ankle joint consists of 3 bones – the tibia, the fibula and the talus. The tibia is further divided into the medial malleolus and the posterior malleolus and the lateral malleolus is known as the end tip of the fibula. These are the areas that are usually involved in an ankle fracture. Caused by a repetitive force or a sudden impact, ankle fractures typically happen when the ankle is twisted or rolled too much. People who play running sports like soccer and basketball are often at risk of this.
One of the most apparent signs of an ankle fracture is sharp and immediate pain and the foot or ankle looking out of place. Common symptoms such as bruising, swelling and being unable to put any weight on the foot are expected as well. In severe cases, the bone may even protrude out of the skin. As you may have noticed, the symptoms of an ankle fracture are quite similar to a sprain. Therefore, it is crucial to visit a doctor when you experience any of the above signs so that you can be properly diagnosed and treated.
Treatment options for fractures often depend on the area and severity of the injury. If the ankle is stable and the broken bone is not too out of place, a walking boot or a cast may be used to keep the bone in place as it heals. In more severe fractures, where the bone may be completely out of place, surgery may be required to realign the bones back in their proper positions.
Stress fractures are another orthopaedic condition that we can develop. These are tiny cracks in the bone that are developed over a long time. Stress fractures are most common in our feet as they bear all our weight. A condition also caused by repetitive force to the foot, these usually occur when the intensity of activity increases too quickly. The impact is usually not enough to cause an acute injury but just enough for microscopic tears to happen in the bones. Medical conditions such as osteoporosis and flat or high arch feet increase the risks of getting stress fractures as well.
For stress fractures, pain is gradual and usually intensifies during any weight-bearing activity. Often, the pain goes away once the activity stops. Swelling and tenderness may also develop at the fracture site. If not given medical attention, these can result in the bone breaking completely.
Similarly, stress fracture treatments are based on the area and severity of it. For nonsurgical treatments, an orthopaedic doctor may prescribe protective footwear or a cast to keep pressure off of the foot. If a stress fracture requires surgery, it usually means inserting a type of fastener (e.g. pins or screws) into the bone to support it. In most cases, stress fractures can heal in 6 to 8 weeks.
3. Plantar fasciitis
Plantar fasciitis is a condition in which inflammation occurs to the plantar fascia – the dense tissue band that stretches around the bottom of your foot and attaches your heel bone to your toes. The purpose of the plantar fascia is to support the arch of your feet and absorb shock when you walk. Subsequently, with so much pressure exerted on it all the time, small tears can happen and constant overstretching may lead to the plantar fascia being inflamed.
As the most common form of heel pain, there are many causes of plantar fasciitis. Besides any strenuous exercise that requires a lot of movement of the feet, wearing the incorrect footwear, being overweight and having flat/high arch feet can lead to this condition as well.
The most common symptom of plantar fasciitis is pain around the inner edge of the heel and along the arch of the foot. This pain usually worsens when weight is placed on the foot, especially after a period of inactivity. That is why, after waking up from sleep, those who have plantar fasciitis feel pain when they put their feet on the floor. Pulling back the toes in the direction of the face also causes discomfort for those who have this condition.
If plantar fasciitis is not treated properly, it can lead to the development of bone spurs. These are bony outgrowths that develop along the joints and the body’s way of trying to attach the plantar fascia to the heel bone.
Nonsurgical treatments are usually the most common for treating plantar fasciitis. As pressure needs to be alleviated from the heel, night splints and a heel cup inserted into the shoe are usually prescribed. The doctor may even recommend some calf exercises to further take off some pressure from the plantar fascia. Anti-inflammatory medication may also be given to reduce the swelling in the area.
Shock wave therapy is a newer form of treatment which involves sending mechanical high energy sound waves to the affected area. This treatment is usually done for 3 weeks and has been shown to reduce pain while improving mobility.
Surgery, as a treatment option, is often done as a last resort if plantar fasciitis develops into chronic heel pain that affects the daily activities of a person. This will include the removal of any bone spurs, the release of the plantar fascia and the reduction of pressure around the area on the small nerves.
Also known as hallux valgus, a bunion is a bony bump which forms on the big toe joint. This typically happens when undue pressure is exerted on the big toe, forcing it to push towards the smaller toes and causing the big toe joint to stick out. The most common cause of bunions is wearing tight and narrow shoes as it forces your toes to squeeze together.
You may be developing a bunion if you notice a small bump on your big toe joint. This may also be accompanied by soreness and redness around the affected area. It can also result in intermittent or constant pain in more serious cases.
For treatment options, doctors will recommend wearing footwear that properly fits the foot – such as shoes with a wider front. Bunion pads and toe spacers may also be prescribed to reduce rubbing and pressure on the toes. Besides, physical therapy sessions are recommended for those with painful bunions.
When non-surgical treatments cannot manage the symptoms, bunion surgery is typically performed. This includes removing the bunion, re-adjusting the bones that make up the big toe, and stabilising the muscles around the joints to prevent the condition from returning.
There are several types of surgical procedures to treat bunions and only a medical assessment can reveal which one can treat your condition properly.
2.3. Knee Injuries
As one of the strongest and most important joints in the body, our knees facilitate the mobility of our legs while bearing the weight of our bodies. As such, they are essential for many everyday activities like walking, running, and standing.
The majority of knee injuries are caused by an external force that bends or twists the knee out of shape. Sustained overuse of the knees also results in wear and tear of the ligaments and tendons and can greatly hinder a person’s mobility and stability. People who engage in high-impact activities, like running, cycling and many team sports are the most susceptible to knee injuries.
Just like foot and ankle injuries, knee injuries should be taken care of properly. Here the causes and treatments of 5 common sports-related knee injuries.
1. ACL and Meniscus tears
4 ligaments make up the knee. The ACL, which is the dense tissue band that goes through the knee, is the most essential tissue that provides the knee with structural support during intense activities. As such, it is also the most commonly injured knee ligament.
The cartilage that covers the knee is known as the meniscus. Its purpose is to function as a shock absorber and to help transfer weight between the upper and lower legs. ACL and meniscus tears usually happen due to excessive twisting and repeated force on the knees. In some cases, both areas can be injured together.
Some common signs of an ACL tear include tenderness and discomfort along the joint, swelling and difficulty bearing weight on the knee. For meniscus tears, daily activities such as squatting and kneeling can cause discomfort inside and outside the knee joint, along with some stiffness and swelling.
As usual, treatment options depend on the severity and location of the injury. In mild to moderate tears, a cast may be placed on the joint to stabilise it and physical therapy is recommended to restore the knee’s mobility. Surgery is only required if the tear is quite severe or if nonsurgical treatments are not enough to heal the injury.
2. Knee-joint dislocation
Our knee joints are made up 3 bones – the femur (thigh bone), the tibia (shin bone) and the fibula, and covered by the patella – the kneecap. When the 3 bones go out of alignment, the knee is said to be dislocated. While rare, knee joint dislocations happen when knees are overextended or experience a hard fall.
Besides pain and swelling, the knee looking as if it has been knocked out of place is a clear sign that it has been dislocated. If the dislocation is not too severe, the doctor will treat it by popping the joints back in place and putting a splint on it so that it can heal without having any weight put on it. After the splint has been taken off, rehabilitation is normally advised so that movement can be restored.
If the dislocation results in any broken bones, torn ligaments or damaged nerves, surgery will be required to return everything to normal. As knee dislocations are severe injuries, it should be treated right away and aftercare should be done properly so that it does not cause more injuries.
3. Knee fractures
Knee fractures typically involve the patella. This is because it serves as protection to the knee joint, making it particularly prone to fracture. This is often caused by a direct blow to the kneecap – either from a hard fall or an external force. Patellar fractures can differ from a simple break to one where the bone is fragmented into various parts.
Common symptoms include severe pain around the kneecap, extreme bruising and swelling, tenderness and being unable to walk.
If the fracture is simple enough, wearing a cast and undergoing physical therapy might be enough to treat the injury. Surgery is only done if the bone fragments are far apart or when the bone breaks the skin.
4. Runner’s knee & Jumper’s knee
The common term used to describe any one of many conditions causing pain around the kneecap is runner’s knee. Also known as patellofemoral pain syndrome, runner’s knee is caused by repeated stress to the knee joint. This often irritates the ligaments and wears out the cartilage. Most strenuous activity that results in overuse of the knee can lead to this orthopaedic condition.
The symptoms include a dull pain around the kneecap, especially when engaging in simple activities like walking, climbing stairs or kneeling. In most cases, runner’s knee is treated nonsurgically by applying the RICE method consistently. Surgery is only done when the cartilage is damaged or the kneecap needs to be readjusted.
Jumper’s knee is also another common condition of patellofemoral pain syndrome. It has similar causes and symptoms to runner’s knee except for the pain being located beneath the kneecap during movement. In both conditions, using the RICE method and stopping all strenuous activities for a while will help in the healing process.
In cases where knee pain continues to be severe and does not seem to improve even after rehabilitation, total knee replacement surgery may be advised. Although this is a more common treatment choice for those suffering from arthritis, this treatment may also be undertaken by those suffering from sustained knee injuries that result in reduced mobility. Besides, an evaluation by an orthopaedic doctor is needed to determine a patient’s suitability for such a surgery.
Part III: How To Reduce Risks of Sports-Related Orthopaedic Injuries
3.1. Understanding Risk Factors of Sports-Related Orthopaedic Injuries
Certain risk factors may increase your chances of sustaining sports-related orthopaedic injuries. They are your age, weight, whether you use the proper techniques and how well you take care of past injuries.
As we age, we lose muscle mass and bone density – which is why older people are more at risk of getting injured. The effects of injuries may also last longer, with new injuries aggravating older ones. Conversely, children are also more prone to sports-related injuries as they are more active and often do not understand their limits.
Maintaining a healthy weight is not only crucial for reducing the risks of medical conditions such as high blood pressure and hypertension, but it also reduces the stress that is placed on our joints, muscles and bones. Excess weight exerts undue pressure on our bodies, which is then amplified by rigorous activities.
Be it cardio or weights training, ensuring that you are wearing the proper gear and utilising the proper form is key to reducing the risks of injuries. This includes doing a proper warm-up, correctly using gym equipment and especially wearing the proper shoes.
Injuries should always be taken care of properly so that you do not risk re-injury. Sprains and strains are often the culprits of bigger and more serious injuries that require surgery as many people may not give them enough attention. Subsequently, no matter how small the injury is, it is crucial to get it checked out by a doctor so that they can determine its severity and treat it accordingly.
3.2. 5 Things To Remember When Playing Sports or Being Active
Most sports-related orthopaedic injuries are preventable as long as proper precautions are taken before, during and after exercise. This is especially crucial for children and young people. As such, here are 5 guidelines that can help you reduce your risks of getting sports-related orthopaedic injuries.
1. Stretch before and after your workout
Also known as warming up and cooling down, these exercises entail doing your activity at a lower intensity and slower speed.
Warmup exercises help the body prepare for strenuous exercise. By gradually revving up your cardiovascular system, these exercises raise your body temperature and increase blood flow to the muscles, ensuring that they are supplied with oxygen. They also ease the stress on the joints and tendons – which minimises the risk of injury.
After an intense workout, stopping suddenly can cause light-headedness because your heart rate and blood pressure may drop rapidly. That’s why cooling down is just as important as it allows for a gradual recovery of the heart rate and blood pressure before exercise. For competitive endurance athletes, such as long-distance runners, cooling down is the most crucial because it helps regulate blood flow. As a general rule, your cooldown exercises should be twice as long as your warmup.
2. Alternate exercise between different muscle groups
For many people, there is a tendency to stick to one form of exercise – either cardiovascular or strength training. However, a fitness plan should include exercises that target different muscle groups on different days. As mentioned earlier, many injuries are caused by repeated force. Subsequently, alternating between different muscle groups ensures that other muscle groups get adequate rest and heal properly.
3. Gradually increase the intensity of your workouts
Our bones progressively adapt to heavier loads via a process called remodelling. During this natural process, bone tissue is destroyed (known as resorption) and then repaired. Without enough time for healing, bones exposed to unaccustomed force resorb cells faster than your body can replace them, rendering you more vulnerable to stress fractures. Therefore, it is vital to slowly increase the intensity of your workout and schedule enough rest in between exercises so that your body can adapt properly.
Your heart rate is the best measure of how strenuous the exercise is. As a general rule of thumb, your exercise heart rate should be 50 to 70 per cent higher than your resting heart rate. Once you feel your heart rate going below 50 per cent, you can increase the intensity of your workout.
It is advisable to see the doctor and ensure that you are in good physical health if you are suffering from any medical problems or want to be involved after having been sedentary.
4. Ensure proper nutrition and hydration
You lose a lot of fluids through sweat during exercise. When you are dehydrated, it may result in lower blood volume and place undue stress on your body. As such, hydrating yourself regularly throughout your exercises helps to regulate your body temperature and blood pressure. Fluids also help in transporting essential nutrients to your muscles and removing metabolic wastes, thus decreasing the risk of injuries such as strains and cramps.
Eating the right foods ensures that your bones and muscles are getting the proper nutrients to carry out their functions. Not only should you consume healthy food before exercise but after exercise as well to replenish the energy that you lost. Having a well-balanced diet of fruits, vegetables and lean proteins will help in keeping your body in good condition to exercise.
5. Stop whenever you are feeling too much pain
While some degree of discomfort is to be expected when you exercise, you should stop once it gets too much and have some rest instead. This is because exercising through pain might just result in an unnecessary injury. If you still happen to experience persistent pain long after your workout has finished, a visit to an orthopaedic doctor is strongly recommended. Also, it is important to take adequate rest after an injury so that your body can heal properly and not be re-injured again.
3.2. What To Expect When Visiting An Orthopaedic Doctor
Sometimes, injuries can happen even when we take all the precautions. During such times, you may be thinking if you should visit a general practitioner (GP) or an orthopaedic doctor.
Orthopaedic doctors are those who specialise in diagnosing and treating conditions related to the musculoskeletal system. In this field, they can further specialise in different areas such as foot and ankle, paediatrics and sports service. As such, if you experience a sports-related injury, an orthopaedist can provide a more accurate diagnosis as compared to a GP and offer customised treatment for it.
In general, when you first visit an orthopaedic doctor, three things will happen. First, the doctor will do a medical history evaluation so that they can properly diagnose the cause. Second, physical tests like moving or bending the injured area will be conducted to determine its mobility. Lastly, an orthopaedic doctor may do diagnostic imaging, such as an X-ray or MRI to assess the severity of the condition. After this, they can create a proper treatment plan that will aid in healing your injured area.
Be sure to bring the correct documentation with you during your visit (such as identification card medical and insurance forms if needed) and keep any questions you have in mind. Be assured that your doctor is there to help you and should be more than willing to clarify any doubts that you may have.
Part IV: Conclusion
As our lower body carries a lot of our body weight and is essential for many of our daily activities, we must take care of it properly. As Singaporeans, we often lead busy lifestyles that leave us no time to visit the doctor when we experience pain in our lower body – especially the foot and ankle. Nonetheless, please bear in mind that prevention is always better than cure. That’s why small injuries should be taken care of properly before they have a chance to develop into more serious conditions. All in all, we hope you have a clearer understanding of how the lower body functions, the injuries it is vulnerable to and ways to reduce the risk of injuries through this detailed guide.
Dr Kannan Kaliyaperumal is a leading foot and ankle specialist in Singapore. With his expertise and years of experience, you can be sure that your orthopaedic injuries will be taken care of properly at the Specialist Orthopaedic Centre!