Ask the Expert: Common Sports Injuries- Prevention and Treatment
Bashir Zikria, MD
Board-certified Orthopaedic Surgeon at Suburban Hospital
How should my kids best prevent knee injuries while playing sports?
There are few important points to preventing injury. A proper warm up and appropriate stretching for flexibility prior to playing any sport will help prevent injury. Also, many injuries happen when young athletes get fatigued. The best way to prevent this is to be physically fit and for coaches to make sure there are substitutes available if a child is getting tired while playing. Finally, managing muscle or cramping issues will help prevent injury. Be sure to keep your children hydrated before, during and after activities, especially on hot days.
My daughter tore her anterior cruciate ligament (CL) while playing lacrosse. What are the treatment options for this kind of injury?
Depending on her age, there are several options. If your daughter would like to continue to play lacrosse, we recommend reconstructing her ACL. Without surgery, she would have a very high likelihood of future knee injuries. The American Academy of Orthopaedic Surgery recommends reconstruction of the ACL within 5 months of the injury. Bracing alone does not protect the knee without an ACL and there has been no study to show that just keeping a brace on can protect an ACL-deficient knee. The ACL usually has a poor blood supply after injury and cannot be repaired. When this happens, we reconstruct the ligament using a graft from either the hamstring or patella tendon.
I tore my ACL while playing basketball and had surgery. How long until I can play sports again?
Rehabilitation after surgery is a progression. Immediately after surgery, patients will generally be on crutches for 7-10 days. At about a month, the patient should be walking without a limp. After about 3 months, the patient can begin straight line jogging. Around 6 months after surgery, we introduce them to their sport and gradually move to full, live games. I would say total, it’s a gradual 7-9-month wait time before the patient is able to play sports fully.
I’ve been experiencing sharp pain when going up and down the stairs. What should I do to make the pain go away?
This is one of the most common complaints an orthopaedic surgeon will see in the office. Anterior knee pain with stairs is most likely patellofemoral syndrome (PFS). PFS is an imbalance or weakness of the quadriceps muscles. The best way to treat PFS is with physical therapy.
My doctor said I may have a meniscus tear. What does that mean? Are there different types of meniscus tears? How do you treat a meniscus tear? Does it involve surgery?
The meniscus is a cushion that helps distribute force in the knee and protect the cartilage. There are two of them: medial (inside of the knee) and lateral (outside of the knee). The medial meniscus is the one most commonly torn. The meniscus does not have a good blood supply and does not heal well. Most often, we repair tears that are in the peripheral third because they have a good blood supply. The other area, which has minimal blood supply, gets treated with a partial menisectomy. This surgery consists of shaving out the area that is causing the pain or discomfort, while trying to leave as much of the remaining meniscus as possible. Repairing and partial menisectomies have completely different recovery periods. Partial menisectomy patients can walk the same day and they can play sports in 4-6 weeks. A full meniscal repair patient will have to wait about 4-6 months prior to participating in any sport.
The two most common types of meniscus tears that I see are traumatic and degenerative. Most traumatic tears that cause symptoms, such as pain and swelling, are treated with an arthroscopy.
Degenerative or chronic tears can be treated non-surgically, if the patient does not have significant symptoms. Also, surgery is only warranted if the patient does not have significant arthritis because knee arthroscopy in arthritic knees have a less favorable outcomes.
My son has played sports his entire life and is now complaining of knee pain. We believe he has early arthritis in his knees. How is that treated?
We generally do not see arthritis in young patients. However, if we do see early arthritis, we most often treat it conservatively. The most important treatment for early knee pain is conditioning the knee and keeping the muscles around the knee strong. The knee joint is only as good as the muscles moving the knee. Physical therapy will help strengthen the knee.
I’ve been getting pain in my knees while doing squats. Should I see a doctor?
Most often, this is caused by improper form. The most important aspect of squatting is having the correct form. Always be balanced and keep it a smooth motion. I would start with only squatting the bar to learn the right form and then gradually increase the weight. Also, never go past parallel to the ground or 90 degrees. Going too deep in a squat does not stress the muscle any more than not going as deep, but it can lead to injury.
If you have fixed your form and the pain still persists, I would consult a physician.
I’m in my 50s and an avid runner. How should I prevent injuring my knees during my runs?
There are several important points to consider in order to prevent injury. Proper warmup and stretching should be done before every run. Be sure to increase your mileage gradually. We generally recommend that you do not increase more than 20 percent per week. Also, I am a firm believer in including light weight training with your running program. This will help continue to keep the muscles around the hip and knee strong. Finally, proper equipment, such as good running shoes, is a must! Most running shoe stores will help fit you into the proper shoes for your feet and your type of gait.
A friend of mine had PRP treatment done for his tendinitis. Do you recommend this procedure as treatment for my Achilles tendinitis?
PRP is platelet rich plasma therapy and has significant popularity at this time. Many athletes are using it prior to any surgical procedure. The problem with PRP is that insurance does not cover most of the bill and it can get very pricey. At this time, there are only a few good studies about its efficacy and most studies do not show a clear, definite improvement. The pros to this type of therapy is that it is very safe and can be done in an office setting. I think it might be an option prior to any surgical treatment if all other conservative managements fail and it is affordable for the patient.
My fiancé has to get Tommy John surgery. What is that?
Tommy John surgery is reconstruction of the ulnar collateral ligament, which helps stabilize the elbow. The UCL is on the inside of the elbow and it becomes a major stabilizer during throwing. Most of the time, we will try to rehab the elbow and arm prior to any surgery. If the patient continues to have instability and pain and he is unable to throw, then we consider doing a reconstruction of the UCL, better known as Tommy John surgery. This is a common injury among pitchers.
My son has to get Tommy John surgery. Will he be able to play baseball again? What is the healing process for this?
Most patients who receive this surgery will be able to play baseball again. However, it is a long rehabilitation process that usually ranges between 12-18 months after the surgery until he will be able to pitch again.
I tore my rotator cuff while playing tennis. Do I have to have surgery? What are the other treatment options?
The rotator cuff consists of four tendons that help stabilize your shoulder and allow the shoulder to have proper mechanics. If your doctor has diagnosed you with a rotator cuff tear, there are several options you can proceed with.
We separate these tears into two categories, acute traumatic vs. chronic tear. Your tear falls in the acute traumatic category since it happened while you were playing tennis. We begin treating most chronic tears with physical therapy and an anti-inflammatory medication like ibuprofen. We only consider surgery for a chronic tear if the patient does not improve with physical therapy first.
We repair Most acute traumatic full thickness tears arthroscopically because it produces the best results for the patient.
My kids are very athletic, but they are also going through growth spurts. How can I tell the difference between a growing pain and a sports injury?
Growing pains happen in about 2 out of 5 young children and early teenagers. Most feel it is triggered by muscle and nerve growth in a growing child (bone growth).
Growing pains have a few key characteristics:
- Vague pain all over the legs and not joints
- Generally the pain involves both legs
- Usually at night or around bed time
The symptoms below are related to injury and not growing pains:
- Knee or joint swelling
- Loss of motion
- Any pain related to an activity or sport
- Fever or constitutional symptoms
- Morning pain
About Dr. Zikria:
Dr. Bashir Zikria is an associate professor of orthopedic surgery at the Johns Hopkins School of Medicine and a sports medicine specialist practicing in Maryland and Washington, DC. His primary practice locations are in Bethesda, MD and Washington, DC, and he also sees patients in Baltimore, MD and Nottingham, MD.
Dr. Zikria joined the Johns Hopkins faculty in 2007. His clinical focus is sports medicine, particularly shoulder, elbow, and knee injuries. He is a team physician for several colleges and high schools, including the Johns Hopkins Department of Athletics. He was a team physician for the Baltimore Orioles and its minor league affiliate, the Aberdeen Ironbirds, for seven years. In 2011, he was the physician for the Afghanistan national team that participated in the Asian Games.
Dr Zikria performs numerous joint replacement surgeries each year such as total elbow replacement. His specialty and research area are young patients with osteoarthritis, on whom he performs osteotomies and cartilage procedures.
Dr. Zikria is a recognized researcher, speaker and educator in the field of sports medicine.
To make an appointment with Dr. Zikria:
Johns Hopkins Health Care and Surgery Center
6420 Rockledge Drive
Bethesda, MD 20817