What is a Concussion?

The term concussion refers to a mild traumatic brain injury (MTBI) resulting in a temporary loss of awareness or consciousness. Concussions can result from falls in which the head strikes against an object, or when a moving object strikes the head.

The length of unconciousness may relate to the severity of the concussion, and affected individuals often have no memory of the events preceding the injury or immediately after regaining consciousness. Other symptoms include vomiting and unequally sized pupils.

Concussions are classified into five grades, as follows.

Grade I: Involves only confusion.

Grade II: Involves anterograde amnesia of less than five minutes as well as confusion.

Grade III: Involves the Grade I and II symptoms as well as retrograde amnesia and unconsciousness lasting up to 5 minutes.

Grade IV: Involves the Grade I, II, and III symptoms as well as unconsciousness lasting 5-10 minutes.

Grade V: Same as Grade IV, except unconsciousness lasts longer than 10 minutes.

Treatment of a Concussion

The best course of action depends on the severity of the concussion. In all cases, care should be taken to avoid a second blow to the head until well after the symptoms have subsided. If you are unsure of how best to proceed, a trained medical professional should be consulted for guidance.

What is Delayed Onset Muscle Soreness

The term delayed onset muscle soreness (DOMS) is used to describe the discomfort that is often felt 24-72 hours after exercising. While DOMS is often attributed to a buildup of lactic acid, there is little empirical support for this view.

Rather, it seems more likely that DOMS is a byproduct of microscopic tearing of muscle fibers caused by over-exertion. The extent of these micro-tears, and thus the amount of discomfort that they cause, largely depends on the type of exercise and the level of exertion.

Whatever the cause, the symptoms associate with DOMS can include muscle pain, inflammation, stiffness, and weakness.

Treatment of Delayed Onset Muscle Soreness

Perhaps the best course of action is to prevent DOMS before it happens. Warming up before exercise and cooling down afterwards, along with proper stretching, can help to reduce the incidence and severity of DOMS. It is important to keep in mind, however, that excessive stretching can cause DOMS.

While the R.I.C.E. regimen may alleviate the symptoms associated with DOMS, the often diffuse nature of this sort of muscle soreness makes it difficult to apply in many cases. Nonetheless, there is evidence to suggest that rest, ice, compression, and elevation all have the potential to speed recovery.

Active recovery, which involves light aerobic exercise to increase blood flow throughout the body, has been suggested as a means for minimizing the occurrence of DOMS in the first place, as well as for reducing symptoms once it occurs. While anti-inflammatories such as ibuprofen may be effective at reducing the discomfort and inflammation associated with DOMS, they do nothing to reduce weakness.

Finally, though massage has been suggested as an effective treatment for DOMS, the data here are mixed. Likewise, it has been suggested that nutritional supplements such as vitamin C and fish oil may help to alleviate the symptoms of DOMS, but there is little in the way of scientific support for this view.

What is a Dislocated Shoulder?

Not to be confused with a shoulder separation, a dislocated shoulder refers to removal of the ball of the humerus (upper arm bone) from the shoulder socket. Partial dislocation refers to the case in which the upper arm bone is partially in/out of the socket.

Shoulder dislocation can potentially result in the tearing of ligaments or tendons associated with the joint capsule and, in some cases, nerve damage. This injury is typically accompanied by pain, swelling, numbness, weakness, and bruising.

While a dislocation can usually be diagnosed via physical examination, x-rays are often taken to confirm the diagnosis and rule out the possibility of a bone fracture.

Treatment of a Dislocated Shoulder

Dislocated shoulders are treated by placing the ball of the humerus back into the socket of the scapula (also know as the glenoid fossa). This process, known as ‘manipulation and reduction’ (M&R), is usually accompanied by an x-ray to ensure that the reduction didn’t result in a fracture. The arm is then immobilized in a sling for several days, during which time most doctors recommend icing the shoulder 3-4 times/day.

Rehabilitation involves exercises to restore strength and range of motion. Because ligaments may have been stretched or torn, a previously dislocated shoulder is often susceptible to re-injury. Severe or repeated dislocations might require surgical repair to tighten or re-attach stretched or torn ligaments. Seek the advice of a trained medical professional.

What is a Groin Pull, Strain, or Tear?

A pulled groin occurs when the adductor muscles of the inner thigh are stretched beyond their limits. This stretching can result in small muscle tears that cause pain/swelling. In severe cases, these muscles can be completely torn or ruptured.

The adductors are muscles in the upper thigh that run for the pelvis to the femur. They pull the legs together when they contract, and also help to stabilize the hip joint. Proper warm up and stretching is the key to prevention of a pulled groin.

Treatment of a Groin Pull, Strain, or Tear

Groin pulls are typically treated following the R.I.C.E. regimen. Potentially aggravating activity should be avoided for 1-2 weeks following the injury. Anti-inflammatory medications can also be used to reduce pain and inflammation for up to a week following the injury.

Once inflammation subsides, a stretching program followed by a low-intensity strengthening program should be initiated. Once normal activity has been resumed, the affected region should be iced following exercise to minimize swelling.

Pulled groins can best be avoided via proper stretching/warmups, as well as post-workout stretching. In the case of a severe injury, seek the opinion of a trained medical professional.

What is a Separated Shoulder?

Not to be confused with a shoulder dislocation, the term shoulder separation refers to the stretching/tearing of ligaments where the clavicle (i.e., collarbone) meets the scapula (i.e., shoulder blade), which is referred to as the acromioclavicular joint (AC). A mild separation is sometimes referred to as a sprained AC joint.

A shoulder separation is usually caused by falling forward onto an outstretched hand, or by an impact to the front of the shoulder. In severe cases, where the ligaments tear, the collarbone can move forward and detach from the shoulder blade. The primary symptom is shoulder pain, and sometimes a small bump will be present on top of the shoulder.

Shoulder separations are classified into one of six types, as follows.

Type I: Injury to the capsule that surrounds the AC joint. The bones do not move out of position, and the primary symptom is pain.

Type II: Injury to the AC joint capsule as well as a partial tear of the coracoclavicular ligament. Patients with a Type II shoulder separation may have a small bump over the injury.

Type III: Same as Type II, but more severe. Patients with a Type III shoulder separation usually have a large bump over the injured AC joint.

Type IV: An unusual type of shoulder separation where the clavicle is pushed behind the AC joint.

Type V: An exaggerated Type III injury, wherein the muscle above the AC joint is punctured by the end of the clavicle, resulting in a significant bump.

Type VI: An exceedingly rare injury wherein the clavicle pushes downward and become lodged below part of the scapula (the corocoid).

Treatment of a Separated Shoulder

The recommended course of treatment depends on the severity of the injury. Conservative treatment, involving rest and wearing a sling until the ligaments heal, is the simplest option. Ice may help reduce the pain and swelling, and physical therapy can be used to increase range of motion and strength.

Most shoulder separations heal within 2-3 months without complications, but in the case of severe injuries, surgical repair may be indicated. Seek the advice of a trained medical professional.

What is Sever’s Disease?

Sever’s disease, also know as calcaneal apophysitis, is a common source of heel pain in young, growing athletes. The most common symptoms are pain or tenderness in one or both heels, discomfort when the heel is squeezed, and more severe pain when walking, running, jumping, or playing sports.

The pain associated with Sever’s disease is typically localized to the side and back of the heel bone, though there may sometimes be pain at the bottom of the heel. In severe cases, Sever’s disease can result in limping.

Sever’s disease is caused by irritation of the bony growth plate at the back of the heel bone, and is directly related to overuse of the bone and tendons in the heel. Sever’s disease occurs in children ages 7-15, though it is most common in 10-14 year olds. Overuse can come from participation in sports (e.g., soccer, basketball, or football) or any other activity that involves a lot of heel movement.

Sever’s disease is sometimes associated with starting a new sport, or the start of a new season.

Treatment of Sever’s Disease

Sever’s disease is “self-recovering,” meaning that it will go away on its own when activity subsides, or when the heel bone is done growing. Symptoms generally subside within two to eight weeks after activity levels are reduced, though Sever’s disease can recur following an increase in activity, such as at the start of the next sports season.

Possible treatments include elevation of the heel, regular stretching of the hamstring and calf muscles, following the R.I.C.E. regimen, and the use of foot orthotics. In severe cases, a cast or medication might be necessary. Seek the advice of a trained medical professional.

Please see separated shoulder for a description of, symptoms associated with, and treatment options for a sprained AC joint.

What is a Sprained Ankle?

The term sprain refers to the stretching and/or tearing of ligaments. The most common ankle injury is a sprained ankle, which can occur when the ankle is forced into an abnormal position. Sprained ankles are most commonly caused by ‘rolling’ of the foot in (inversion; as in the case of a common ankle sprain) or out (eversion; as in the case of a high ankle sprain). The primary symptoms of an ankle sprain are pain and swelling of the ankle.

Sprained ankles are classified into one of three ‘grades’ of severity:

Grade I: Refers to a stretch or minor tear of the ligament with loosening.
Grade II: Refers to a ligament tear accompanied by some degree of loosening.
Grade III: Refers to a complete ligament resulting in a very loose joint.

Treatment of a Sprained Ankle

Short-term treatment of an ankle sprain should follow the R.I.C.E. regimen. Anti-inflammatory medication can also be used to reduce pain an inflammation. Exercises designed to improve range of motion should be initiated early in treatment, as tolerated. The simplest of these exercises to is to ‘draw’ the letters of the alphabet in the air with your toes. Weight-bearing exercises should be gradually introduced as tolerated. An injury that fails to respond to treatment within 1-2 weeks might be more serious, and a physician should be consulted.

What is a Torn Rotator Cuff?

The term ‘rotator cuff‘ refers to the muscles that support and stabilize the arm, allowing it to move up and down as well as rotate. The rotator cuff is made up of four muscles — the supraspinatus, infraspinatus, subscapulairs, and teres minor. Injuries to these muscles can cause pain and reduce the range of motion. Symptoms of a torn rotator cuff include shoulder pain, decreased range of motion, weakness, and a deep ache.

Treatment of a Torn Rotator Cuff

A torn rotator cuff needs to be evaluated by a trained medical professional to determine if surgery is needed. If left untreated, large tears can lead to arthritis due to inflammation of the joint. A torn rotator cuff can often be repaired via arthroscopic surgery. Recovery then involves medication to reduce inflammation and physical therapy to improve strength and range of motion.