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Sports and Exercise Medicine is a speciality concerned with the care of the recreational and elite athlete. The service is provided by Dr Daniel Baron and Dr Stephen Motto and the City Sports Clinic provide a team of highly experienced Physiotherapists. Their aim is to diagnose, treat and rehabilitate all sports and musculoskeletal injuries. The correct diagnosis, treatment and rehabilitation go a long way in preventing further injuries.
All the doctors and physiotherapists have substantial experience working with numerous sports at all levels. The team are able to use a variety of state of the art imaging techniques and blood tests available within the hospital.
The team have specific interest in the following areas:
- Chronic tendon injuries
- Exertional compartment syndrome and compartment pressure testing ( Dr S Motto)
- Knee ligament injuries and specific measurements using the KT1000 Device (Dr D Baron)
- Medical acupuncture treatment
- The management of football and rugby injuries
- The management of lower back pain
- They can also help regarding advice about sports related matters such as overtraining, exercise induced asthma etc.
- Utilisation of a number of injection techniques
The team are currently using a number of newer treatment techniques including Extracorporal Shockwave Therapy (ESWT), Pulsed Electromagnetic Therapy, and a new treatment for traumatic osteitis pubis for groin injuries.
Numerous contacts with other sports and exercise specialists have been developed and sometimes refer to a number of our Orthopaedic Surgeons who know about sport. Many members of the team are also involved in teaching both undergraduates and postgraduates.
This is a general, non-specific term used to describe a chronic exercise induced (usually running) shin pain.
The important point is to diagnose the cause of the shin splints. For example, one of the more common causes are: Periostitis, which is an inflammation/ stress response of the bone lining (periosteum) caused by muscular traction forces. Periostitis of the front and inner aspect of the lower shin is specifically termed Medial Tibial Stress Syndrome.
Often a variety of investigations are adopted to confirm the clinical diagnosis, particularly if there is concern about the presence of a stress fracture. If plain X-rays are normal, a Technetium bone scan will help differentiate between a periostitis and a stress fracture. MRI can also be used.
Treatment usually revolves around a reduction or change in activity level.
Post-exertional ice massage together with a short course of anti-inflammatory medication and taping may help medial tibial stress syndrome. Stress fractures require the avoidance of impact activities for up to three months, sometimes longer depending on the severity and location of the injury.
Sprains and Strains
These are acute injuries to ligaments, and the sprained ankle is one of the most common injuries seen in sport. They can be classified according to the degree of injury. In Grade 1 sprains, few ligament fibres are damaged or stretched. Often there is little swelling or loss of function, although there is ligament tenderness. In Grade 2 sprains, more fibres are damaged and there is a partial tear, which causes moderate tenderness, swelling and some loss of function. Grade 3 sprains represent complete rupture of ligaments, with widespread swelling, bruising, gross instability and disability. However, the pain response can be variable, as the nerve fibres supplying the ligaments are also damaged and tend to reduce overall pain.
Investigations such as Xrays are sometimes necessary to rule out a fracture in locations such as the ankle. This is particularly important if there is difficulty in weight bearing or widespread swelling and significant bony tenderness. Ultrasound scans may be useful, and MR scans may also be used if there is concern about secondary damage to other structures.
Treatment consists of R.I.C.E. This means Rest, which may involve the use of crutches until the patient can walk without a limp. Ice (taking care to protect the skin) is applied for 15-20 minutes 3-5 times a day until the swelling resolves. Compression with a bandage (ice can be combined with this) or with an ankle stabilising brace, and Elevation above the level of the heart will reduce swelling. Care should be exercised when using painkillers or anti-inflammatories in the early management of these injuries. Follow-up physiotherapy may be required.
These represent pulled muscles and have a similar grading system to Sprains (see sprains ). However, bruising and significant loss of function with secondary complications may occur. For example, a condition called Myositis Ossificans may occur if there has been a contusion injury (blunt trauma to a muscle or soft tissue) to the quadriceps (thigh) or other large muscle group.
This represents the formation of calcium and new bone within the muscle itself, and can be prevented by the early application of R.I.C.E. Anti-inflammatory medication is normally administered for between 2-4 weeks if the Consultant is concerned about this, providing the internal bleeding has stopped. Physiotherapy tends to be delayed in cases of myositis ossificans.
Investigations such as X-rays and Ultrasound scans are helpful especially in more severe strains or contusions.
Sport Injury video from Dr Stephen Motto
Sport Injury Video
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