Weekend warrior woes
Weekend warriors are those who engage in physically demanding recreational sporting activities on weekends despite minimal physical activity during the work week. Consequently, they risk the following:
Achilles Tendon Rupture. The Achilles tendon is one of the largest in the human body, originating from the gastrocnemius and soleus muscles (large muscles in the posterior calf) and attaching to the calcaneus (heel bone). This muscle/tendon powers the foot to push off the ground during walking and running. Sporting activities are the primary cause of Achilles tendon rupture. In general, men are affected more commonly, as are the middle-aged and obese.
Patients often report a feeling of being kicked in the posterior ankle, sometimes hearing a “snap” or “pop.” Inability to bear weight on that leg follows. The diagnosis usually can be made by history and physical exam, though ultrasound or MRI may confirm. Initially, the affected leg is splinted. Subsequent treatment will be decided by you and your orthopedist.
Plantar Fasciitis. This has been covered in a previous column, which I feel confident you have read, clipped and filed. This is one of the most common causes of inferior heel pain, occurring in up to 10 percent of folks, and may be associated with heel spurs.
The diagnosis here too is generally made by history and physical. Patients often report inferior heel pain, especially upon taking the first few steps in the morning. Frequently, the pain is alleviated by further walking, only to return after a period of rest or exercise. It's typically a self-limiting condition; in one study, 80 percent of patients had complete resolution within four years. Treatment often consists of icing, NSAIDS (nonsteroidal anti-inflammatory drugs), and rest. The use of orthotics and exercise can be decided by you and your PCP.
Tennis Elbow (lateral epicondylitis). Repetitive dorsiflexion of the wrist and rotation of the forearm cause microtears and collagen breakdown at the origin of tendons. This condition is obviously not restricted to tennis players, but to those having an occupational and/or recreational history of repetitive activity. It is more common in those over 40 years of age.
Again, the diagnosis is usually made by history and physical exams. Although the treatment selected will be determined by you and your PCP or orthopedist; I read one study where watchful waiting was comparable to physical therapy but superior to cortisone injections. NSAIDS often provide temporary relief, and there are available straps and braces. Some say that if conservative therapy fails after six to 12 months, surgery is often recommended.
Ankle Sprain. This is one of the most common injuries in the US and occurs when the foot twists, rolls, or turns beyond its normal range of motion. When excessive force is experienced in the foot during these involvements, it can cause stretching and tearing of ligaments in the ankle capsular ligaments. Patients may report they heard a “pop,” followed by swelling and pain, along with inability to bear weight on the affected extremity.
The diagnosis is made by the history and physical exam. These injuries are generally classified into three grades, as follows:
Grade 1 sprain: Mild stretching/damage to ligament fibers; there is little to no functional loss and no joint instability.
Grade 2 sprain: Partial tearing of ligament(s), which can cause laxity of the ankle on exam; there is moderate to severe swelling and ecchymoses (bleeding into the skin), with moderate functional loss and mild to moderate joint instability.
Grade 3 sprain: Complete rupture of ligament(s), resulting in instability of the ankle; there is immediate, severe swelling, ecchymoses, and inability to bear weight, with moderate to severe joint instability.
X-rays are used to rule out ankle fracture
A grade 1 sprain can be treated with RICE (rest, elevation, compression, and elevation).
A grade 2 sprain can be treated with RICE, NSAIDS, and maybe a walking boot or splint, to be determined by you and your physician.
A grade 3 sprain may result in permanent instability regardless of treatment. It is not uncommon for a patient who has suffered an ankle sprain to experience additional fractures in the future. Your physician may advise you as to preventative measures you might take to avoid such.
The oft-repeated advice given to me by my old line coach, “Walk it off, boy,” would not apply to any of the above.
Shin Splints. Shin splints or medial tibial stress syndrome (MTSS) refers to pain along the anterior shin, a condition that is common to runners, dancers, and military recruits. Risk factors include running, playing sports on hard surfaces, uneven terrain, flat feet or high arches, and military training. Diagnosis is again based on clinical features. The patient may experience tenderness, soreness, pain, and swelling along the anterior shin. X-rays may be of assistance. Management will be determined by you and your physician.
Come on lads and lassies, we're all getting older – accept it.
Dr. William McKell is a Northsider. His email is email@example.com.