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Child (Pediatric) Orthopaedics

Pediatric Orthopaedics (Child Orthopaedics) are specialized in traumatic deformities of the spine, bone fractures and extremities in children and young adults. Our clinics are located at the Gleneagles Medical Centre. Our pediatric orthopaedic surgeons are widely recognized both regionally and nationally for innovative surgical treatments, as well as conservative approaches to a wide variety of orthopaedic problems.

Child Orthopaedic

Child Orthopaedic

Among the most-common conditions we treat are:

  • Spinal deformities such as scoliosis, kyphosis, spondylolisthesis, and spinal trauma

  • Pediatric and adolescent sports injuries

  • Foot and hip development problems such as club foot and hip dysplasia

  • Lower extremity deformities such as knock knees, bowleggedness, and rotational problems

  • Upper extremity deformities, whether congenital or developmental

  • Leg length discrepancy

  • Benign and malignant tumors

  • Fractures and other trauma due to Sports

  • Cerebral palsy

  • Limb salvage

  • Radiofrequency ablation of osteoid osteomas

Our pediatric orthopaedic service receives patient inquires and consultations from around the world. Besides our busy operative practice, we are known for recommending non-operative methods or small incision techniques when possible to manage complex pediatric orthopaedic problems.

As a child’s body grows, problems related to specific stages of bone and muscle development may arise. Child Orthopaedics is the medical field concerned with the treatment of musculoskeletal disorders in children from infancy to 18 years of age. Many orthopaedic conditions are unique to a child’s age, and appropriate treatment can often correct problems early in life. Children orthopaedic fields including:

To set an appointment, please call us +65 64712744 or SMS to +65 92357641 (24 Hours Hotline)

Platelet Rich Plasma Therapy (PRP)

Platelet Rich Plasma (PRP)

In many recent years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of sports injuries.

Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.

Even though PRP has received extensive publicity, there are still lingering questions about it, such as:

  • What exactly is platelet-rich plasma?
  • How does it work?
  • What conditions are being treated with PRP?
  • Is PRP treatment effective?

What Is Platelet-rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugal. Then the increased concentration of platelets is combined with the remaining blood

How Does PRP Work?

Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.

To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:

  • PRP can be carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first week or two, and it may be several weeks before the patient feels a beneficial effect.
  • PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.

What Conditions are Treated with PRP? Is It Effective?

Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness of PRP treatment include:

  • The area of the body being treated
  • The overall health of the patient
  • Whether the injury is acute (such as from a fall) or chronic (an injury developing over time)

Chronic Tendon Injuries

According to the research studies currently reported, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.

An injection of PRP is used to treat tennis elbow.

The use of PRP for other chronic tendon injuries — such as chronic Achilles tendonitis or inflammation of the patellar tendon at the knee (jumper’s knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.

Acute Ligament and Muscle Injuries

Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains. There is no definitive scientific evidence, however, that PRP therapy actually improves the healing process in these types of injuries.

Surgery

More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures.

Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.

Knee Arthritis

Some initial research is being done to evaluate the effectiveness of PRP in the treatment of the arthritic knee. It is still too soon to determine if this form of treatment will be any more effective than current treatment methods.

Fractures

PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.

Summary:

Treatment with platelet-rich plasma holds great promise. Currently, however, the research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.

Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.

If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers’ compensation plans, provide even partial reimbursement.

To schedule for an Appointment, please call us at +65 6471 2744 or SMS to: +65 9235 7641 (24 Hours)

Dangerous Sports in Kids

What are some common forms of sports injury that kids in Singapore experience (e.g. fractures, concussions, and trauma)? Do provide statistics of these injury cases happening in Singapore, in recent years. How are these sports injury usually treated?

There are 2 most common injury in kids:

1. Bone Fracture

Depending on the severity of the fracture, the treatment is ranging from Splint, Cast/Plaster, and Surgery.

2. Ankle sprained

Sprained ankle is very common injury for kids, and the treatment is depending on the grades of the sprain. Most of the time it is treated with Cast or Ankle Air Cast in order to allow the ligament to heal properly. Tubigrip is also often used to reduce the swelling.

ACL Injury

Share with us the 5 most dangerous sports for kids. What is it about these sports that make them dangerous? Anything that kids/parents/teachers can do to keep the rate of accidents and injuries low?

1. Basketball

Basketball Game involving with twisting, jumping, pivoting, squatting, or making sudden stops puts kids at risk. Proper coach up can help to keep the rate of injuries low. Basketball Shoes which covered above ankle will help to protect the ankles.

2. Cycling

Wearing a helmet, elbow and knee guards greatly reduces risk as does educating children about the dangers of riding in traffic.

3. Soccer

Soccer-playing boys are at highest risk for ankle sprains as well as thigh and upper leg strains and knee injuries such as ACL and Meniscus Injuries. Proper coach up can help to keep the rate of injuries low.

4. Baseball

Baseball injuries caused by being hit by a batted ball, four in 10 caused fractures, lacerations, or concussions. There are even reports of sustaining a coma from a batted ball and haemorrhaging in the brain after being hit by a bat. Baseball has also the highest injury rate in elbows, mostly due to repetitive pitching and improper technique. Wear proper protective gear will help in reduce the rate of injuries.

5. Skateboarding

You are on a piece of wood with sandpaper and wheels. Doing tricks off ledges sometimes higher than 15 feet. The use of protective gear, such as closed, slip-resistant shoes, helmets, and specially designed padding for elbows, knees, and hands is helping to reduce the rate of injuries such as wrist fracture, elbow fracture, and clavicle fracture.

What’s the first thing to be done when someone gets hurt while playing sports?

Ans: Depending on the severity of the injury:

1. For severe cases and injured person no response: Call for help. Eg: 995

–          Check on ABC (Airway, Breathing and Circulation)

2. For non-severe cases:

–          In the event of bleeding – is to stop the bleeding but putting pressure on the affected area

–          In the event of fracture or soft tissue – is to put a splint to reduce the pain

–          Bring the injured patient to nearest A&E or GP

Having Sports Injuries? You are at the Right Place. Consult our Sports Specialist today. Call us +65 64712744 or SMS to +65 92357641 to schedule for an appointment. 

Achilles Tendon Pain

What is the Achilles tendon?

The Achilles tendon connects the calf muscle to the heel bone. It lets you rise up on your toes and push off when you walk or run.

What are common Achilles tendon problems?

The two main problems found in the Achilles tendon are:

  • Achilles tendinopathy. Achilles tendinopathy includes one of two conditions:
    • Tendinitis. This actually means “inflammation of the tendon,” but inflammation is rarely the cause of tendon pain.
    • Tendinosis. This refers to tiny tears (microtears) in the tissue in and around the tendon caused by overuse. In most cases Achilles tendon pain is the result of tendinosis, not tendinitis. Some experts now use the term tendinopathy to include both inflammation and microtears. But many doctors may still use the term tendinitis to describe a tendon injury.
  • Achilles tendon tear or rupture. An Achilles tendon also can partially tear orcompletely tear (rupture) camera. A partial tear may cause mild or no symptoms. But a complete rupture causes pain and sudden loss of strength and movement.

Problems with the Achilles tendon may seem to happen suddenly. But usually they are the result of many tiny tears to the tendon that have happened over time.

What causes Achilles tendon problems?

Achilles tendon problems are most often caused by overuse or repeated movements. These movements can happen during sports, work, or other activities. For example, if you do a lot of pushing off or stop-and-go motions when you play sports, you can get microtears in the tendon. Microtears can also happen with a change in how long, hard, or often you exercise. Microtears in the tendon may not be able to heal quickly or completely.

Being out of shape or not warming up before exercising may also cause Achilles tendon problems. So can shoes with poor arch supports or rigid heels.

An Achilles rupture is most often caused by a sudden, forceful motion that stresses the calf muscle. This can happen during an intense athletic activity or even during simple running or jumping. Middle-aged adults are especially likely to get this kind of injury.

A rupture most often occurs in sports such as basketball, racquet sports (including tennis), soccer, and softball. A tendon already weakened by overstretching, inflammation, or small tears is more likely to rupture.

What are the symptoms?

Symptoms of Achilles tendon problems include swelling in the ankle area and mild or severe pain. The pain may come on gradually or may only occur when you walk or run. You may have less strength and range of movement in the ankle.

A rupture of the Achilles tendon may cause a sudden, sharp pain. Most people feel or hear a pop at the same time. Swelling and bruising may occur, and you may not be able to point your foot down or stand on your toes.

How are Achilles tendon problems diagnosed?

Your doctor can tell if you have an Achilles tendon problem by asking questions about your past health and checking the back of your leg for pain and swelling. The doctor may ask: How much pain do you have? How did your injury happen? Have you had other injuries in the ankle area?

If your symptoms are severe or do not improve with treatment, your doctor may want you to get an X-ray, ultrasound scan, or MRI.

How are they treated?

Treatment for mild Achilles tendon problems includes rest, over-the-counter pain medicine, and stretching exercises. You may need to wear well-cushioned shoes and change the way you play sports so that you reduce stress on the tendon. Early treatment works best and can prevent more injury.

Even in mild cases, it can take weeks to months of rest for the tendon to repair itself. It’s important to be patient and not return too soon to sports and activities that stress the tendon.

Treatment for severe problems, such as a torn or ruptured tendon, may include surgery or a cast, splint, brace, walking boot, or other device that keeps the lower leg from moving. Exercise, either in physical therapy or in a rehab program, can help the lower leg get strong and flexible again. The tendon will take weeks to months to heal.

Although treatment for Achilles tendon problems takes time, it usually works. Most people can return to sports and other activities.

Cure your Achilles Tendonitis today. Call us +65 64712744 or SMS +65 92357641 to schedule for an appointment.

Patient Guide to Shoulder Pain

Shoulder pain should not be ignored. Early treatment can prevent further injury and chronic shoulder problems. Pain in the shoulder may also be referred from other areas of the body, e.g. disc problems the neck.

The Shoulder Joint

The structure of the shoulder joint allows more range of motion than any other joint in the body.

The shoulder actually has several joints that work together to allow a wide range of motion. Most injuries occur at the “main” shoulder joint, where the head of the upper arm meets the shoulder blade; the term “shoulder joint” refers to this joint. The other smaller shoulder joints are referred to by their specific names.

The head of the upper arm bone sits on a very small and shallow socket in the shoulder blade. This allows for the shoulder’s wide range of motion but makes it susceptible to injury. Because there is little bony stability, the shoulder relies greatly on connective tissue (e.g. ligaments, tendons, muscles) to hold the bones of the joint together and to stabilize the joint.

Causes of Shoulder Pain

The Most Common Cause of shoulder joint pain is rotator cuff tendonitis – injury and inflammation of the tendons (rotator cuff tendons) that envelope the shoulder joint. The most common cause of rotator cuff tendonitis is overuse of the shoulder, though the rotator cuff tendons may be injured suddenly as a result of a fall or accident.

Muscle strain is common in the muscles that run over the shoulders to the neck . It is often the result of holding the shoulders in a raised position for long periods of time. The muscles between the shoulder blades are often strained from slouching from long periods of time. Muscle strain varies in severity.

Other painful shoulder conditions, such as frozen shoulder, may occur for no apparent reason. (The risk of frozen shoulder increases when the shoulder is not used enough after a painful injury). The cause of calcium deposits in the shoulder, which may trigger episodes of acute inflammation of the tendons, is also unclear. Arthritis sometimes occurs in a previously injured shoulder joint.

Slap Lesion

Slap Lesion

Risk Factors

WEAK ROTATOR CUFF MUSCLES

Weak or fatigued rotator cuff muscles can lead to soft tissue injury. If the muscles that stabilize the shoulder joint (mainly the rotator cuff muscles) are weak or fatigued, the muscles fail to fully stabilize the joint. If the head of the upper arm bone is not kept in place in its socket, abnormal force is placed upon tissue surrounding the shoulder joint and can lead to injury. Shoulder tendonitis and bursitis are common.

OVERUSE

Shoulder pain is frequently caused by chronic overuse of the shoulder. The shoulder may become injured suddenly from a blow or fall, but gradual injury from chronic overuse of the shoulder is more common. Repetitive lifting, pushing, pulling, throwing, and especially overhead activities may lead to injury. Pain may be mild and intermittent in the beginning and worsen over time. Combining repetitive overhead activities with force increases the risk of injury further (e.g. stacking heavy objects on a high shelf).

Repetitive overhead activities can be particularly damaging. When the arm is raised overhead, the head of the upper arm bone migrates upward on the shoulder socket somewhat and rotator cuff tendons come into contact with the roof of the shoulder blade. Repeated contact and friction of the rotator cuff tendons often leads to irritation and inflammation of the tendons (tendonitis).

A strong rotator cuff helps keep the head of the upper arm bone from riding up excessively but some contact between the rotator cuff and bones in the joint still occurs with overhead activity. The bursa that lies under the roof of the shoulder blade may also be affected and become inflamed (bursitis). Shoulder bursitis often occurs along with shoulder tendonitis.

AGING

Aging is a major factor in rotator cuff injuries Tendons lose elasticity with aging and they become more susceptible to injury. Muscle mass also decreases with age. Both the rotator cuff muscles and tendons can be strengthened with resistance exercises.

Prevention of Shoulder Pain

Overuse shoulder injuries often can be prevented.

Weak rotator cuff muscles may be unable to adequately stabilize the shoulder joint. Rotator Cuff Exercises can help. Building up strength of the rotator cuff through exercise helps to stabilize the shoulder joint to prevent abnormal pressure on the soft tissues surrounding the joint. The muscles that control the shoulder blade also play a role in stabilizing the shoulder joint.

Avoid repetitive overhead activities. If you are involved in activities that involve repetitive overhead movements, take frequent breaks. Fatigued rotator cuff muscles lose the ability to keep the shoulder stabilized.

Avoid doing too much too soon. If you are going to engage in any overhead activity you haven’t done for a long time, such as getting back into playing tennis, endurance must be built up slowly. Exercises to strengthen the muscles you will be using in an activity reduce the chance of injury.

Warm up before engaging in sports such as swimming, tennis or throwing sports that require overhead movement.

Proper form for your sport should be learned and practiced to prevent injury.

Maintain proper posture. Muscles over the shoulders become strained from holding the shoulders in a raised position for long periods of time. Muscles in the upper back, between the shoulder blades, become strained as a result of slouching.

Treatment of Shoulder Pain

Prevent major problems by treating minor problems early. If a minor injury is not given a chance to heal before it is subjected to the same activity, pain and inflammation may become chronic.

Treatment of shoulder pain depends on the cause – seek a proper diagnosis from a qualified physician. Most shoulder injuries heal with conservative treatment. Healing takes time. The time it takes to recover depends upon several factors, e.g. the severity of injury, the type of injury, how quickly one heals, how early one begins treatment.

Typical treatment of shoulder pain (for most conditions) involves a combination of rest (not complete rest), exercise, anti-inflammatory medication, applying cold or heat to the shoulder joint and, in some cases, an injection of steroids into the shoulder joint.

Doing activities that aggravate shoulder pain often cause further damage, delay healing, and may lead to long-term problems. However, not using the shoulder at all weakens the shoulder and leaves it more vulnerable to injury. Immobilizing the shoulder may also lead to frozen shoulder. Stretching exercises help prevent this condition.

Strengthening exercises for the muscles that support the shoulder, particularly the rotator cuff (the muscles and tendons that dynamically stabilize the main shoulder joint) are a major part of treatment for most shoulder injuries, but strength training before adequate healing has taken place may cause further pain and injury. A physician or physical therapist can determine when the shoulder is ready for strengthening exercises. Shoulder Exercises can prevent injury from recurring.

Massage therapy is also used to treat many soft tissue injuries. From muscle strain to tendonitis to frozen shoulder, massage therapy increases circulation, speeds healing, improves range of motion and relieves pain.

Most shoulder pain improves with conservative treatment; however, surgery may occasionally be required (depending upon the type of and severity of the injury). Surgery may be performed to tighten loose ligaments, repair a torn tendon, remove a calcium deposit, trim a damaged tendon, etc. when conservative treatment doesn’t adequately resolve symptoms.

Diagnosis of Shoulder Pain

Many shoulder conditions have similar symptoms and it may be difficult to diagnose the problem from symptoms alone. A physician, often an orthopedist, diagnoses the cause of shoulder pain by taking into consideration the patient’s symptoms and medical history, findings of a physical examination and sometimes diagnostic testing, such as x-rays, a CT scan, or an MRI.


CURE YOUR SHOULDER PAIN TODAY! CALL +65 6471 2744 OR SMS to +65 92357641 TO SCHEDULE FOR AN APPOINTMENT TODAY.

Wrist Pain Specialist Clinic

Wrist pain is a common complaint. Many types of wrist pain are caused by sudden injuries that result in sprains or fractures. But wrist pain also can be caused by more long-term problems — such as repetitive stress, arthritis and carpal tunnel syndrome.

Because so many factors can lead to wrist pain, diagnosing the exact cause of long-standing wrist pain sometimes can be difficult. An accurate diagnosis is crucial, however, because proper treatment depends on the cause and severity of your wrist pain.

DeQuervain's Tenosynovitis

DeQuervain’s Tenosynovitis

SYMPTOMS OF WRIST PAIN

Wrist pain may vary, depending on what’s causing it. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing type of pain. The precise location of your wrist pain also can give clues to what might be causing your symptoms.

When to see a doctor
Not all wrist pain requires medical care. Minor sprains and strains, for instance, usually respond to ice, rest and over-the-counter pain medications. But if pain and swelling last longer than a few days or become worse, see your doctor. Delays in diagnosis and treatment can lead to poor healing, reduced range of motion and long-term disability.

CAUSES OF WRIST PAIN

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand. Tough bands of ligament connect your wrist bones to each other and to your forearm bones and hand bones. Tendons attach muscles to bone. Damage to any of the parts of your wrist can cause pain and affect your ability to use your wrist and hand.

Injuries

  • Sudden impacts. Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures. A scaphoid fracture involves a bone on the thumb side of the wrist. This type of fracture may not show up on X-rays immediately following the injury.
  • Repetitive stress. Any activity that involves repetitive wrist motion — from hitting a tennis ball or bowing a cello to driving cross-country — can inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours on end without a break. De Quervain’s disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

  • Osteoarthritis. In general, osteoarthritis in the wrist is uncommon, usually occurring only in people who have injured that wrist in the past. Osteoarthritis is caused by wear and tear on the cartilage that cushions the ends of your bones. Pain that occurs at the base of the thumb may be caused by osteoarthritis.
  • Rheumatoid arthritis. A disorder in which the body’s immune system attacks its own tissues, rheumatoid arthritis is common in the wrist. If one wrist is affected, the other one usually is, too.

Other diseases and conditions

  • Carpal tunnel syndrome. Carpal tunnel syndrome develops when there’s increased pressure on the median nerve as it passes through the carpal tunnel, a passageway in the palm side of your wrist.
  • Ganglion cysts. These soft tissue cysts occur most often on the top of your wrist opposite your palm. Smaller ganglion cysts seem to cause more pain than do larger ones.
  • Kienbock’s disease. This disorder typically affects young adults and involves the progressive collapse of one of the small bones in the wrist. Kienbock’s disease occurs when the blood supply to this bone is compromised.

RISK FACTORS

Wrist pain can happen to anyone — whether you’re very sedentary, very active or somewhere in between. But your risk may be increased by:

  • Sports participation. Wrist injuries are common in many sports, including bowling, golf, gymnastics, snowboarding and tennis.
  • Repetitive work. Almost any activity that involves your hands and wrists — even knitting and cutting hair — if performed forcefully enough and often enough can lead to disabling wrist pain.
  • Diseases and conditions. Your risk of developing wrist pain is increased if you have diabetes, leukemia, scleroderma, lupus or an underactive thyroid gland.

TREATMENTS

Treatments for wrist problems vary greatly, depending on the type, location and severity of the injury, as well as on your age and overall health.

Medications
Over-the-counter pain relievers may help reduce wrist pain. Stronger pain relievers are available by prescription.

Therapy
If you have a broken bone in your wrist, the pieces will need to be aligned so that it can heal properly. A cast or splint can help hold the bone fragments together while they heal.

If you have sprained or strained your wrist, you may need to wear a splint to protect the injured tendon or ligament while it heals. Splints are particularly helpful with overuse injuries caused by repetitive motions.

Surgery
In some cases, surgery may be necessary. Examples include:

  • Severely broken bones. A surgeon may connect the fragments of bone together with metal hardware.
  • Carpal tunnel syndrome. If your symptoms are severe, you may need to have the tunnel cut open to relieve the pressure on the nerve.
  • Tendon or ligament repair. Surgery is sometimes necessary to repair tendons or ligaments that have ruptured.

CURE YOUR WRIST PAIN TODAY. CALL +65 6471 2744 or SMS to +65 92357641 for APPOINTMENT TODAY

Top 10 Sports Injuries

The most common sports-related injuries primarily are overuse injuries. As the name implies, an overuse injury results from wear and tear on the body, particularly on joints subjected to repeated activity.

Certain types of injuries plague sports participants. Most of them, however, are minor. Knowing the early signs and what to do can help prevent them from becoming nagging problems.

Here’s a look, from head to toe, at the Top Ten sports injuries you’re most likely to face:

Muscle Pull
Probably the most common sports injury is a muscle pull, which can happen to almost any muscle in the body. No matter how diligently you warm up and stretch, or cool down and stretch, you may pull a muscle from overuse, fatigue or taking a fall. There is little you can be done to prevent a muscle pull except to stay limber and work your muscles regularly.

A muscle pulls when a sudden, severe force is applied to the muscle and the fibers are stretched beyond their capacity. If only some of the fibers tear, that is a muscle pull. If most of the fibers tear, that is a muscle tear.

Neck Pain

A pulled muscle or a muscle spasm in the neck can happen when a tennis player looks up to serve or hit an overhead smash. The pain is on one side of the neck, and the neck may be pulled over slightly to that side. It is particularly painful to turn the head in the direction of the pain. That is, if the pain is on the left side of the neck, the player can turn to the right, but not to the left.

Cyclists who use racing handlebars may also feel neck stiffness. With your back bent low over the handlebars, you have to tilt your neck up to see ahead. After a long ride, the neck muscles may tighten up and go into spasm from this awkward position.

Shoulder Impingement
The shoulder bones are held together by a group of muscles known as the rotator cuff muscles. These muscles (supraspinatus, infraspinatus, subscapularis and teres minor) are responsible for the shoulder’s fine movements, such as throwing a ball. Because of the shoulder’s shallow socket and lack of ligament strength, any weakness of the small, rotator cuff muscles makes it easy for the head of the shoulder to slide around in the joint.

If the shoulder joint is continually stressed with the arm in an overhead position, as it is in softball, tennis, volleyball, swimming and weight training, the small rotator cuff muscles begin to stretch out. This allows the head of the joint to become loose within the shoulder socket. If the head of the shoulder is loose, when the arm is extended backwards over the shoulder the head will slide forward, catching the tendon of short head of the biceps between the ball and the socket. The same thing happens when the arm is raised to the side above parallel to the ground. The head will drop in the socket and the tendon of the long head of the biceps or the supraspinatus becomes impinged.

This impingement causes the tendons to become inflamed and painful. Tennis players feel the pain when they try to hit an overhead or serve. The same thing can happen to golfers in both the backswing and the follow-through when their shoulders are above parallel to the ground.

Lower Back Strain
Almost everyone who participates in sports experiences lower back strain at one time or another, usually from twisting awkwardly, lifting a heavy weight or doing some unpracticed activity. Virtually all lower back injuries are due to weak or tense muscles or muscle strain. Suddenly overloading muscles may pull or tear muscle fibers, sending the back muscles into spasm and causing pain.

Weightlifters, golfers, martial artists and tennis players are prone to back injuries because these sports involve unilateral motions. A golfer rotates the lumbar spine in only one direction, which is the equivalent of lifting weights with only one side of body. Martial artists generally have one dominant leg and kick with that one more than the other.

Tennis Elbow
Tennis elbow is really an inflammation of the muscles of the forearm and the tendon that connects the muscles to the bones in the elbow. These muscles bend the wrist backward and cause the wrist to turn the palm face up. When the muscles and tendon become inflamed from overuse, the pain is felt on the outside of the elbow (lateral epicondylitis).

A tennis player most often aggravates the elbow by hitting the ball late on the backhand side, straining the forearm muscles and tendon. Constantly turning the wrist to put more spin on the serve also can cause pain.

Golfers also suffer from tennis elbow, but on the non-dominant side, that is, a right-handed golfer will feel the pain in the left elbow. Pulling the club through the swing with the left wrist causes irritation in the left elbow.

A second type of tennis elbow is known as medial epicondylitis. This causes pain on the inside of the elbow. It is most often seen among golfers, baseball pitchers, tennis players who hit topspin forehands and weight lifters.

Runner’s Knee
The most common cause of knee pain is runner’s knee, known medically as chondromalacia patella. This is due to misalignment of the kneecap in its groove. The kneecap normally goes up or down in the groove as the knee flexes or straightens out. If the kneecap is misaligned, the kneecap pulls off to one side and rubs on the side of the groove. This causes both the cartilage on the side of the groove and the cartilage on the back of the kneecap to wear out. On occasion, fluid will build up and cause swelling in the knee.

Runners are not the only ones who develop runner’s knee. Pain can develop around the back of the kneecap or in the back of the knee after participating in any running sport.

Shin Splints
Shin splints are pains in the muscles near the shin bones. They can be caused by running or jumping on hard surfaces or simply overuse. They occur most often in people unaccustomed to training, although they can also plague experienced athletes who switch to lighter shoes, harder surfaces or more concentrated speed work.

The pain occurs on the inner side of the middle third of the shin bone. The muscle responsible for raising the arch of the foot attaches to the shin bone at that spot. When the arch collapses with each foot strike, it pulls on the tendon that comes from this muscle. With repeated stress, the arch begins to pull some of its muscle fibers loose from the shin bone. This causes small areas of bleeding around the lining of the bone, and pain.

If the irritated area is about the size of a 50-cent piece or smaller, or shin pain suddenly increases, you may have a stress fracture. The twisting of the tibia can cause the bone to crack. A stress fracture may not show up on an x-ray, and therefore a bone scan is indicated.

Ankle Sprain
The most common ankle sprain happens when the foot rolls to the outside and sprains the ligaments on the outside of the ankle. The outside of the ankle swells up and throbs, and may turn black and blue around the injury.

When a jogger steps gently off a curb and “twists” an ankle, this simply stretches the ligaments, with no real tearing, and is considered a mild sprain. When a tennis player lunges out over a poorly planted foot, partially tearing the fibers of the ligament, that is considered a moderate sprain. When a volleyball player jumps and lands on another player’s foot, twisting and forcing the ankle violently to the court, most or all of the fibers tear, and this is a severe sprain.

If weight-bearing is possible on the ankle after a sprain, the ankle probably is not broken. If you feel pain on the inside of the ankle, then it should be x-rayed to rule out a hair-line fracture.

Achilles Tendinitis
The Achilles tendon in the back of the ankle is the largest tendon in the body. It transfers the force of muscle contractions to lift the heel. Achilles tendinitis is an inflammation of the tendon, usually due to overuse, such as frequent jumping in basketball or volleyball. The most common cause is excessive pronation of the ankle and foot, which causes the Achilles tendon to pull off center.

The pain of a torn Achilles tendon feels like a gunshot in the leg. A partial tear is harder to spot. If the width of the injured Achilles tendon is smaller than the healthy one, or you feel intense pain when standing on your toes, see a doctor for treatment, and possibly surgery.

Arch Pain
The elastic covering on the sole of the foot–the plantar fascia–runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch.

The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while.

Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.

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Ligament and Muscle Damage (Managing Sprains and Strains)

Although the terms sprain and strain are used loosely and have no precise clinical definition, a sprain generally refers to an injury to a ligament – one of the tough, fibrous cords within a joint that connects the bones together – and a strain refers to muscle injury.

Sprains and strains often occur together in or near a joint, since joints absorb the stress of movement and are vulnerable to be being twisted or wrenched.  The ankle and the knee are the most common sites of such injuries.  In mild cases, the force of the injury tears a few fibres of the ligament or muscle, causing mild to moderate pain and swelling, which usually subside within a few days.  A more violent injury may completely tear a ligament or muscle and may involve bone damage such as a dislocation or fracture.

With proper care, most mild or moderate sprains and strains heal completely without complication.

The ankles are among the most vulnerable elements of the body.  These complex hinges of bone, ligament, tendon and muscle support the entire body weight and may transmit a force of impact equal to three times your weight.  Thus, ankle injuries, usually the tearing or straining of a ligament, are the most common of all joint injuries. 

The great majority of sprains are inversion sprains.  This happens when the sole of the foot turns inward, injuring the ligaments on the outside of the ankle.  Eversion injuries occur when the foot turns outward, affecting ligaments on the inner side.  Some sprains are minor and can be successfully treated at home, but many need medical attention.  An ankle sprain can put a patient at risk for another because as the injury heals, it leaves the tendon weakened and less flexible and thus more susceptible to injury.  Many sports activities place participants at risk for sprains and strains.  These injuries also often occur in normal everyday activities such as a slip on wet floors, a fall on the wrist, or jamming a finger.  Repetitive activities may also cause a sprain or strain.

Causes and Risk Factors of Sprains and Strains

Sprains and strains occur as a result of an injury, when the joint is subjected to more physical force that it can withstand.  Athletes, dancers and those who perform manual labour commonly suffer such injuries. Previous sprains may so weaken the ligaments such that recurrence is possible with only minor pressure.  The risk of sprains and strains increases with obesity and poor muscular conditioning.

Symptoms of Sprains and Strains

The symptoms of a sprain are typically pain, swelling, and bruising of the affected joint.  Symptoms will vary with the intensity of the injury; more significant ligament tears (Grade III injuries) cause an inability to use the affected joint and may lead to joint instability.   Less serious injuries (Grade I injuries) may only cause pain with movement.

Common Area of Sprains and Strains

Finger Sprain – caused by a violent overstretching of one or more ligaments that hold the finger joints together. 

Wrist Sprain – violent overstretching of one or more ligaments in the wrist joint can cause this common injury.

Knee Sprain – cause by violent stretching of one or more ligaments in the knee.  Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains.

Ankle Sprain – occurs following a sudden sideways or twisting movement of the foot.  An ankle sprain can occur during athletic events or during everyday activities.  All it takes is an awkward step or an uneven surface to cause an ankle sprain – that is why sprained ankles are among the most common orthopaedic injuries.  Orthopaedic doctors see patients for ankle sprains very often, and it is the most common foot and ankle injury.

Back Strain – commonly caused by muscle strains and lumbar sprains.  A low back muscle strain occurs when the muscle fibres are abnormally stretched or torn.  A lumbar sprain occurs when the ligaments – the tough bands of tissue that hold bones together – are torn from their attachments. Differentiating a strain from a sprain can be difficult, as both injuries will show similar symptoms.  Many doctors refer to both injuries as a category called “musculo-ligamentous injuries” of the lumbar spine.

Neck Strain – caused by injury to the muscles or tendons that attach to the vertebral column in the neck, to the skull and to the shoulder.

Groin Strain – caused by an injury to the muscles of the inner thigh.  The groin muscle, called the “adductor muscle” group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone).  These muscles pull the legs together, and also help with other movements of the hip joint.  The adductor muscles are important to many types of athletes including sprinters, swimmers, soccer players, and football players.

Hamstring (Thigh) Strain – often result from an overload of the muscles or trying to move the muscles too fast or from taking an impact at the back of the leg.

Treatment of Sprains and Strains

First aid measures for a sprain or strain can best be remembered by the acronym RICE – Rest, Ice, Compression, and Elevation:

Rest the injured area.  Try not to move or put pressure on the affected joint. A sling or splint may be recommended to immobilize the joint and allow damaged ligaments or muscles to heal.

Ice the affected area to reduce swelling.  After 24 hours, either ice or heat may be applied to reduce pain. 

Compress the joint by wrapping it in an Ace bandage to help reduce swelling and pain.

Elevate the joint to reduce swelling.

Over-the-counter pain relievers or stronger analgesics may be prescribed, depending on the severity of pain.  After the pain has subsided, a rehabilitation program may be implemented with the help of a physical therapist to help the joint regain strength and mobility.  In severe cases, surgery may be required to repair torn ligaments or muscles.

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A Patient’s Guide to Cuff (Rotator) Tear Arthropathy

The rotator cuff is a unique structure in the shoulder that is formed by four tendons. These four tendons attach to four muscles that help keep the shoulder stabilized in the socket (or glenoid) and help rotate the upper arm inward and outward. If the rotator cuff is torn and is not repaired, a type of wear and tear arthritis of the shoulder can develop over time. This condition is sometimes called arthropathy and the term cuff tear arthropathy is used to describe this type of arthritis of the shoulder that develops when the rotator cuff is damaged. If you develop this condition, your shoulder will be painful. Movement and strength of the shoulder will be decreased. Moving the arm away from the body and raising it over your head can be especially difficult.

This guide will help you understand

  • what parts of the shoulder are involved
  • what causes this condition
  • how doctors diagnose the condition
  • what treatment options are available

Anatomy

What parts of the shoulder are involved?

The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion. The shoulder joint is also called the glenohumeral joint. One of the bones of the glenohumeral joint is the humerus (the long bone of the upper arm). It has a ball, called the humeral head on the top end. The humeral head fits into a small, shallow cup called the glenoid fossa. It makes up the other part of the glenohumeral joint. The glenoid fossa is part of the shoulder blade. A large ligament runs from the front of the acromion to another part of the shoulder blade called the coracoid process. This ligament is called thecoracoacromial ligament. It adds stability to the front of the shoulder.

The rotator cuff is made up of tough, fibrous tissue. It forms a cuff (or capsule) covering the shoulder joint. There are four tendons that help form the rotator cuff. The muscles that form the tendons are the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles rotate the shoulder outward and inward. Along with another muscle, the deltoid, they also help lift the arm away from the body.

The rotator cuff slides between the humeral head and the acromion as we raise our arm. As this sliding occurs over and over, the rotator cuff tendons will often be pinched as you use the shoulder everyday. This pinching is called impingement. Over time this pinching can lead to damage and weakening of the rotator cuff tendons.

Causes

What causes this condition?

Dr. Charles Neer actually described rotator cuff tear arthropathy (RCTA) in 1977. Today, doctors generally refer to this as simply cuff tear arthropathy. Cuff tear arthropathy is actually a type of wear and tear, or degenerative arthritis of the shoulder that develops over time after the rotator cuff is damaged.

Normally, when the rotator cuff muscles contract, they pull the head of the humerus tightly into the socket of the shoulder. This stabilizes the shoulder and allows the the large deltoid muscle to raise the arm over the head as it rotates the humeral head like a pulley. This motion needs the rotator cuff and deltoid muscles to work together – in balance. When the rotator cuff is torn, the shoulder becomes unbalanced. The deltoid muscle pulls the head of the humerus up into the acromion in a sliding motion. When the top of the humerus hits the underside of the acromion, the deltoid may be able to pull the arm part way up as it levers against the underside of the acromion. But, over time this abnormal sliding motion causes wear and tear on the joint surfaces. Arthritis develops and any motion becomes painful. The shoulder becomes weaker and weaker until you can no longer raise the arm above the head.

Rotator cuff tears are very common. Trauma, such as falls, lifting, and pulling forcefully can also cause a rotator cuff tear. When this happens, it is called an acute tear. Although the rotator cuff can be damaged from a single traumatic injury, damage to the rotator cuff usually occurs gradually. Age can be a factor. As we age, the tendons of the rotator cuff become weaker and more likely to be injured. The blood supply to the tendons diminishes with age. Rotator cuff tears are much more likely to occur after the age of 40.

Certain activities can increase the wear and tear on the rotator cuff. Repetitive overhead activity such as painting, plastering, racquetball, weightlifting, and swimming can cause wear and tear of the rotator cuff.

Surgeons generally will recommend surgery to repair a rotator cuff tear when it occurs. A successful surgical repair of a torn rotator cuff tear can make the development of cuff tear arthropathy much less likely. But, sometimes a rotator cuff tear cannot be repaired. The tissue is simply too damaged and cannot fixed. This is not an uncommon situation in older patients with rotator cuff tears. In other cases, the patient simply elects not to have surgery to repair a rotator cuff tear and chooses to simply live with the discomfort. Over several years, both of these situations can result in the later development of rotator cuff arthropathy.

Symptoms

What does this condition feel like?

The most common symptom of rotator cuff tear arthropathy is pain in and around the shoulder. The pain can also radiate into your neck, arm, even into your wrist or hand. The shoulder can be especially painful when trying to lift the arm, or rotate it outward. The pain is usually worse at night. It can interrupt your sleep, especially if you try to sleep on the affected shoulder. If untreated, the pain can be nearly continuous and can be severe.

Weakness of the shoulder makes it difficult, if not impossible to lift the arm overhead. Often, even starting this motion can be difficult. The tendency is to shrug the shoulder in order to lift the arm part of the way. With time, weakness of the rotator cuff muscles will worsen. Range of motion can be quite limited. You will often find it difficult to do routine things, like reaching behind your back, reaching into a cabinet, or combing your hair. You may notice a crackling or popping sensation. When there is arthritis of the glenohumeral joint, there is often a creaking or grating sound.

Diagnosis

How do doctors diagnose this condition?

Your doctor will want to do a history and physical examination. He will ask you about activities or trauma that could have injured your shoulder. He will want to know the level of your pain, and what limitations you have. A physical examination is done. Range of motion and strength of the shoulder muscles will be evaluated. Your doctor will want to look at your shoulder to see if there is bony deformity, or atrophy (shrinkage) of the muscles. With a complete rotator cuff tear, moving the arm away from the body can be nearly impossible. If your doctor lifts your arm for you, and you cannot hold it up, this is called a positive Drop Arm Test. This usually means the rotator cuff is torn.

Other areas such as the neck may also need evaluation. A pinched nerve in the neck can mimic a rotator cuff tear. A neurological examination to include checking reflexes and sensation may be included. Your doctor may want you to have anelectromyogram (EMG). This checks the function of the muscles of the shoulder. An EMG uses a small needle in the muscle being tested. It measures the electrical activity of the muscle at rest, and when tightened.

Your doctor will request X-rays of your shoulder. X-rays show the shape of the bones and joints. When the rotator cuff is torn, the shoulder will often ride high, meaning that it sits higher in the joint than it should. It can also show how much damage ahs occurred to the joint surfaces.

Magnetic resonance imaging (MRI) allows your doctor to look at slices of the area in question. The MRI machine uses magnetic waves, not X-rays to show the muscle, tendons, and ligaments of the shoulder. MRIs will show tears of the rotator cuff tendons. Atrophy of the muscles can also be evaluated with MRI. A computerized tomography (CT) scan shows slices of bone. Like X-rays, it uses radiation. A CT scan can help to more accurately determine the degree of damage of the glenohumeral joint. A CT scan is especially useful to plan surgery if an artificial shoulder replacement is considered for treatment.

Treatment

What treatment options are available?

Nonsurgical Treatment

Conservative care that includes physical therapy, ice, heat, and anti-inflammatories is tried first. The goal of treatment is to reduce pain, and increase range of motion and function. Corticosteroid injection into the shoulder joint is also sometimes helpful. Steroids are very powerful anti-inflammatory medications that can reduce pain temporarily. These injections will not heal the tear but may give pain relief for several weeks to months. If arthritis of the shoulder is advanced, and pain is continuous and severe, surgery may be the best option available.

Surgery

Cuff tear arthropathy is the result of long standing lack of rotator cuff function. In almost all cases, repair of the rotator cuff tear is no longer an option. Surgery for cuff tear arthropathy is done when pain and decreased motion continue after conservative care. The simplest surgical procedure to try and improve the situation is a debridement. During a debridement, the surgeon will surgically remove (debride) any inflammed tissue, bones spurs and loose flaps of tendon tissue that may be catching in the joint and causing pain. This procedure may reduce pain, however, it does not always improve range of motion, strength, or function of the shoulder.

Patients with this type of arthritis would seem to be good candidates for a shoulder replacement, but replacing the shoulder in the typical fashion has not been successful. Replacing the shoulder with a special type of artficial shoulder joint is becoming more popular. This procedure is called a reverse shoulder replacement.

The “normal” artificial shoulder was designed to copy our real shoulder. The glenoid component (the socket) was designed to replace our normal shoulder socket with a thin, shallow plastic cup. The humeral head component was designed to replace the ball of the humerus with a metal ball that sits on top of the glenoid. This situation has been compared to placing a ball on a shallow saucer. Without something to hold it in place, the metal ball simply slides around on the saucer. In the shoulder that something is the rotator cuff and the muscles that attach to the tendons. Without a rotator cuff to hold the metal ball centered in the plastic socket, the metal quickly wore out the plastic socket and the joint became painful once again. The answer to this dilemma was to rethink the mechanics of the shoulder joint and design an artificial shoulder that worked differently than the real shoulder joint. The solution was to reverse the socket and the ball, placing the ball portion of the shoulder where the socket use to be and the socket where the ball or humeral head use to be. This new design led to a much more stable shoulder joint that could function without a rotator cuff. The artificial joint itself provided more stability by creating a deeper socket that prevented the ball from sliding up and down as the shoulder was raised. The large deltoid muscle that covers the shoulder could be used to more effectively lift the arm, providing better function of the shoulder. The final result is a shoulder that functions better, is less painful and can last for years without loosening.

Rehabilitation

What should I expect after treatment?

Nonsurgical Rehabilitation

Your physical therapist will show you how to use ice or heat to help with pain. You will also be instructed in exercises to strengthen your shoulder girdle as much as possible. Showing you joint protection tips, or motion that you can expect to do safely without causing more harm to your shoulder is also important. The goal is to reduce pain, increase range of motion and function, and prevent further arthritis.

After Surgery

A physical or occupational therapist will see you the day after surgery to begin your rehabilitation program. Therapy treatments will gradually improve the movement in your shoulder. Your therapist will go over your exercises and make sure you are safe getting in and out of bed and moving about in your room.

When you go home, you may get home therapy visits. By visiting your home, your therapist can check to see that you are safe getting around in your home. Treatments will also be done to help improve your range of motion and strength. In some cases, you may require up to three visits at home before beginning outpatient therapy.

Out patient therapy at a facility can often more effective and is often preferred over home physical therapy. The first few outpatient treatments will focus on controlling pain and swelling. Ice and electrical stimulation treatments may help. Your therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain. Continue to use your shoulder sling as prescribed.

As the rehabilitation program evolves, more challenging exercises are chosen to safely advance the shoulder’s strength and function. Finally, a select group of exercises can be used to simulate day-to-day activities, like grooming your hair or getting dressed.

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Plantar Fasciitis (Heel Pain / Sole Pain)

Plantar Fasciitis is a painful condition resulting in pain under the heel. It is often caused by overuse of the plantar fascia or arch tendon of the foot. We explain symptoms, treatment, exercises, sports massage and more.

The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot.  It is also known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.

The condition is traditionally thought to be inflammation. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone).

Plantar fasciitis symptoms

Symptoms of the plantar fasciitis include pain under the heel and usually on the inside, at the origin of the attachment of the fascia.  There can be pain when pressing on the inside of the heel and sometimes along the arch.  The pain is usually worse first thing in the morning as the fascia tightens up overnight and after a few minutes it eases as the foot gets warmed up.

As the condition becomes more severe the pain can get worse throughout the day if activity continues.  Stretching the plantar fascia may be painful and sometimes there may also be pain along the outside border of the heel. This may occur due to offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.

Tarsal tunnel syndrome symptoms can be very similar. If you have any shooting pain or tingling / numbness then consider this as an alternative diagnosis.

Causes

Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping. Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the fascia.

The most common cause is very tight calf muscles which leads to prolonged and / or high velocity pronation of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength

Some practitioners think overpronation can always be determined by the dropping and rolling in of the arch. This is not always the case. Sometimes it can only be seen with foot scans, especially if the patient has a high arched foot.

Other causes include low arch or high arched feet (pes planus / cavus) and other biomechanical abnormalities including oversupination which should be assessed by a podiatrist / physiotherapist / biomechanist.

Excessive walking in footwear which does not provide adequate arch support has been attributed. Footwear for plantar fasciitis – both prevention and treatment – should be flat, lace-up and with good arch support and cushioning.

Overweight individuals are more at risk of developing the condition due to the excess weight impacting on the foot.

Plantar fasciitis treatment

Although there is no single cure, many treatments can be used to ease pain.  In order to treat it effectively for the long-term, the cause of the condition must be corrected.

What can the athlete do?

  • Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation.
  • A good plantar fasciitis taping technique can help support the foot relieving pain and helping it rest
  • Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved.
  • Plantar fasciitis exercises in particular stretching the fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The fascia tightens up making the origin at the heel more susceptible to stress
  • A night splint is an excellent product which is worn overnight and gently stretches the calf muscles preventing it from tightening up overnight.

What can a Sports Injury Professional do?

  • Prescribe anti-inflammatory medication.
  • Perform gait analysis to determine if you overpronate or oversupinate and prescribe orthotics or insoles. An insole can restore normal foot biomechanics if overpronation is a problem.
  • Tape the foot and instruct the athlete how to apply taping, this is an excellent way of allowing the foot to rest.
  • Apply sports massage techniques to reduce the tension and also stretch the calf muscles.
  • Prescribe exercises to help stretch the fascia and strengthen it once pain free.
  • Use a corticosteroid injection – usually best combined with biomechanical correction with orthotics.
  • X ray to see if there is any bone growth (calcification). An X-ray may be able to show bone growth which may be a cause of pain but research has shown that the presence of a bony growth does not necessarily mean the athlete will feel pain. Bony growth can worsen even after symptoms have completely resolved.
  • Use Extracorporeal Shock Wave Therapy.
  • Operate if symptoms do not resolve. This is more common for patients with a rigid high arch where the plantar fascia has shortened to benefit from surgery.

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