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Achilles tendon injuries

- can affect professional and amateurs athletes

- one of the longest tendons in the body

- tendon can become swollen and painful – tendonitis

- too much force can cause partial tear or rupture


-  overuse                         -  increasing physical activity too quickly 

-  insufficient stretching      -  wearing high heels

-  flat feet                         -  muscles/tendons that are too tight

Common in:

-  running                         -  gymnastics

-  dance                            -  football

-  baseball/softball              -  basketball

-  tennis                            - volleyball


-  pain in back of leg, above heel

-  tenderness

-  swelling

-  stiffness

-  snapping/popping during the injury

-  difficulty in pointing toes up/down


-  rest                     -  ice

-  compression         -  elevation

-  NSAIDs                -  heel lift may be recommended

-  stretching and strengthening exercises as recommended.

-  in severe cases, casting or surgery may be indicated

Knee ligament injuries (ACL, PCL, MCL, LCL)

ACL injury causes:

-  twisting of the knee with a planted foot

-  getting hit in the knee

- extending knee too far

-  jumping and landing on a bent knee

-  sudden stop when running

-  shifting weight suddenly from one leg to the onter.

-  common in basketball, football, soccer, skiers, and gymnast

-  common cause of disability in the US

-  more common in women the men


-  rest 

-  ice

-  compression

-  elevation

-  bracing


-  stretching and strengthening is recommended by doctor

-  surgery may be necessary for severe collateral ligament tears

-  if the ACL or PCL is damaged, reconstruction may be indicated

PCL injury causes

-  blow to the knee while it is bent

-  striking knee against dashboard in car accident

-  falling on knee while its bent

-  common in football, soccer, baseball and skiing


-  Grade I – partial tear

-  Grade II – partial tear, looser than in Grade I

-  Grade III – complete tear with instability of the knee

-  Grade IV – PCL is damaged with another ligament in the knee

-  can be acute or chronic

-  acute are due to sudden injury

-  chronic develop over time


-  most people think the problem is mild

-  swelling – can be mild or severe

-  pain

-  difficulty with walking and weight bearing positions

-  feeling of instability 

-  arthritis can develop over time 


-  history of injury mechanism, physical examination, x-rays and MRI


-  bracing to protect from further injury

-  rest

-  ice

-  compression

-  elevation


Nonsurgical treatment (in addition to above)

-  use of crutches with gradual weight bearing

-  physical medicine modalities

Surgical treatment 

-  may be required if there are bone fragments present

-  if more than one ligament injured

-  chronic looseness of the PCL 

-  arthroscopically or open type surgery

Ankle injuries

-  can happen to anyone

-  men between 15-24 years old have higher incidence

-  women older than age 30 have higher rates than men

-  most common injuries are sprains and fractures


-  tripping/falling                                - landing awkwardly after a jump

-  walking/running on uneven surfaces    -  sudden impact

-  twisting or turning the ankle


-  pain            -  swelling

-  bruising        -  inability to weight bear on the ankle/foot


-  rest                 - ice

-  compression     -  elevation

Fracture treatment:

-  surgical 

- non surgical        - bracing/splinting or casting

Sprain treatment

-  Grade I (mild) – rest, ice, compression and elevation until pain and swelling subside/improve

  -  when weight bearing is tolerated, then stretching, strengthening and     range of motion exercises may begin.  Only if you can tolerate it

-  Grade II (moderate) – rest, ice, compression and elevation and boot or splinting

              -  physical medicine when can be tolerated

-  Grade III (severe) – immobilization followed by physical medicine treatment

      -  if this type of sprain does not heal, surgery may be considered

Concussions/Head Injury (traumatic brain injury)

-  most common and least serious type of traumatic brain injury

-  commonly caused by blow or injury to the head

-  can result in in bruising of the brain tissue, damage to blood supply and nerve injury

-  results in abnormal function of the brain

-  may cause unconsciousness, loss of balance and/or visual disturbances

-  if child is suspected to have suffered a concussion, monitor them for the first 24 hours for    changes in behavior. 

-  DO NOT give a child suspected of having a concussion any medications until consulted by a         doctor


• headache                                  • memory loss

• vision problems                          • balance problems

• changes in personality                 • slurred speech

• memory loss                              • ear ringing

• nausea                                      • vomiting

• difficulty with concentration         • noise/light sensitivity


a) mild (grade I) – symptoms last for less than 15 minutes

-  no loss of consciousness

b)  moderate (grade II) – symptoms last longer than 15 minutes

-  there is no loss of consciousness

c)  severe (grade III) – there is loss of consciousness, sometimes just for a few seconds

What to do

go see a doctor

-  further diagnostic testing may be recommended pending physical examination

rest to allow your brain time to heal

-  if the concussion occurred during a sporting event, stop play and do not resume play the same day

protect against repeat concussions

-  repeat concussions have a cumulative effect on the brain

-  can result in brain swelling, permanent brain damage, disabilities or death

-  do not return to work or play until cleared by doctor to do so


-  wear protective gear to safeguard against traumatic brain injury

-  wear seat belts

-  don’t drink or use drugs and drive

-  avoid fighting

Shoulder dislocation

-  fall or blow causes the shoulder to pop out of the socket

-  chronic dislocations can result in instability and weakness

-  separated shoulder

-  fall or blow tears one of the ligaments that connects the collar bone to the     shoulder blade

-  full recovery with time


-  fall onto shoulder

-  blow to the shoulder

-  breaking fall with outstretched hand

High risk sports are:

-  football          -  hockey

-  rugby             -  soccer

-  skiing             -  volleyball

Symptoms of shoulder dislocation

-  deformity of the shoulder

-  pain in the shoulder and upper arm

Symptoms of shoulder separation

-  immediate onset of pain            -  tenderness about the shoulder

-  swelling                                  - bruising

-  deformity

-  diagnosis is made by examination and x-ray


- dislocated shoulders should be treated ASAP, by putting the arm bone back in    the socket

-  ice

-  sling

-  NSAIDs – Advil, Aleve or Motrin

-  stretching and strengthening exercises, if recommended by medical     professional

-  surgery may be indicated 


- depends of severity of the injury – usually 3 – 12 weeks is a good range


-  stop activity if you experience pain

-  exercise and stretch 

-  ice shoulder after physical activity if previous shoulder injury

-  protect the shoulder with padding, if you are at risk of dislocation

Golfer’s Elbow (medial epicondylitis)

-  pain and inflammation in the tendons that connect the inside of the forearm to the inside of the elbow

-  usually caused by overuse of the muscles that allow you to grip and rotate your arm and flex your wrist

-  repetition of this motion may cause tiny tears in the tendons on the inside of the elbow

-  i.e. tennis, bowling, throwing a baseball using screw driver,  painting

Groin pull/strain

- stretching or tearing of the muscles in the groin/thigh from putting too much stress on them

- common in running and jumping sports


-  pain and tenderness in groin/inner thigh

-  pain with raising you knee

-  popping sensation during the injury, followed by immediate pain

-  pain with squeezing knees together


a) First degree – pain with little loss of strength or movement

b) Second degree – pain with some damage to the tissues

c)  Third degree – pain with loss of function and compete tear of muscle

-  diagnosis is made on physical examination, x-rays and/or MRI.


-  usually heals on its own with rest and time

-  ice the inside of your thigh

-  compression


-  stretching and strengthening exercises if recommended by doctor

Hamstring pull/strain

-  are common and painful injuries to all types of athletes

-  is a group of three muscles that enable you to bend the leg at the knee

-  occurs during running, jumping or sudden stopping/starting

-  can occur when:     do not warm up/stretch prior to activity

hamstrings are weaker than quad muscles

teenager going through growth phase


-  sudden/severe pain during exercise with popping

-  pain in back of thigh or buttock with walking or bending over

-  tenderness in back of leg

-  bruising in back of leg

-  diagnosis is made on physical examination and questioning on how injury occurred


-  usually will heal on their own over time

-  rest the leg

-  ice

-  compression

- elevation of the leg


-  practice stretching/strengthening if recommended by doctor

-  severe cases may require surgery

-  recovery time depends on severity of the injury


-  adequately stretch before/after activity

-  stop exercising/activity if you experiencing pain in back of thigh

-  stretch and strengthen the hamstrings

Muscle strain

-  damage to a muscle or its attaching tendons

-  caused by placing undue pressure on muscles during normal activities, heavy lifting,

    sporting activities or work activities

-  can cause damage to small blood vessels, resulting in bruising

-  can cause irritation to nerves, resulting in pain


-  swelling                -  bruising

-  redness                 -  pain at rest or with use

-  weakness of the muscle

-  inability to use the muscle

-  diagnosis is determined by history and physical examination

-  x-rays may be indicated, if injury is severe


-  rest

-  ice

-  compression

-  elevation


-  avoid activities until pain subsides

-  most strain injuries fully resolve with proper treatment

-  more serious injuries should be evaluated and treated under supervision of doctor


-  stretch daily and after exercise

-  warm-up prior to exercise

Repetitive motion injuries

-  common injuries in the U.S.


a)  tendinitis  - inflammation of a tendon

1.  tenosynovitis – inflammation of the sheath where the tendon connects to the muscle

b)  bursitis -  inflammation of a bursa

-  bursa is a small fluid sac that cushions the area between the tendon and the bone


-  repetitive activity                       -  trauma

-  deposits of crystals (gout)          -  friction

-  rheumatoid arthritis


-  pain over site                           -  worsened with activity

-  tenderness                               -  decreased range of motion

-  swelling

seek medical advice when:

-  pain with movement                 

-  tenderness at the joint

-  redness and warm skin over joint

-  waking from sleep due to pain

-  inability to sleep due to pain

-  difficulty with performing normal daily activities

-  go to hospital when:

-  joint pain associated with fever, chills, nausea or vomiting

-  severe joint pain

-  treatment:

-  immobilization


-  injections may be recommended

-  physical medicine modalities

-  rest, ice and elevation

-  if there is infection associated with the condition, anti-biotics may be prescribed

-  prevention:

-  proper warm up

-  avoid activities that cause pain

-  use of splints or braces

-  range of motion exercises to maintain motion of the joint

-  surgery may be indicated if conservative measures are unsuccessful

Rotator cuff tear

-  rotator cuff is comprised of four muscles that about the shoulder that holds the arm in

    place and allows for movement of the shoulder

-  increased stress on the rotator cuff can lead to partial tears

-  some causes include:  throwing a ball, falling on shoulder or outstretched hand

-  symptoms:  pain, weakness, decreased or difficulty in moving the shoulder

-  diagnosis is confirmed by history, physical examination, x-ray and MRI

-  treatment:

-  rest, ice, NSAIDs, physical medicine

-  surgery is an option if conservative treatment fails or if the injury is serious

-  prevention:

-  keep the muscles about the shoulder strong

Running injuries

-  runner’s knee

-  stress fractures

-  shin splints

-  tendonitis

-  pulled muscles 

-  sprains

-  plantar fasciitis

-  iliotibial band syndrome

-  blisters

-  temperature related injuries:

-  sunburn, frost bite, heat exhaustion, hypothermia

-  prevention:

-  warm up

-  stretch

-  strength train

-  wear proper clothing and shoes

-  drink plenty of fluids

-  treatment:

-  rest, ice, compression, elevation

-  stretch

-  NSAIDs or over-the-counter pain medications

Shin Splints

-  are common running injuries

-  can be caused by: muscle irritation/inflammation, stress fractures or being flat footed

-  symptoms:

-  dull, achy pain in the front of the shin bone (tibia)

-  diagnosis:  

-  history, physical examination and x-rays may be needed

- treatment:

-  rest, ice, elevation, NSAIDs

-  physical medicine treatments

-  orthotics for the shoes

-  prevention:

-  wear proper shoes 

-  warm up

-  stop the activity when you experience pain

-  avoid activity on hard surfaces

Skier’s thumb/Gamekeepers thumb

-  injury to the ulnar collateral ligament of the thumb

-  causes:

-  fall on outstretched hand with ski pole in palm

-  car crash with thumb on steering wheel

-  any time where thumb is bent backward or sideways

-  symptoms:

-  pain at base of thumb with swelling

-  difficulty with grabbing

-  tender to touch

-  bruising or discoloration of the thumb

-  pain with movement of the thumb

-  may have wrist pain

-  diagnosis:

-  history, physical examination, x-rays

- treatment:

-  self treatment:  ice, compression/bracing, NSAIDs and evaluation by doctor

-  medical treatment: 

immobilization for partial tears

surgery for complete rupture

-  prevention:  

-  teach how to fall properly while skiing without the pole

-  keep thumbs on the outside of the steering wheel

Coccyx injury (tailbone injury)

-   causes:

-  trauma to the area

-  fall onto buttocks/tailbone

-  direct blow to the tailbone

-  childbirth

-  bicycling or rowing

-  other causes

-  unknown

-  osteophytes

-  pressure on nerves

-  infection(s)

-  tumors

-  symptoms:

-  pain and tenderness to the area

-  pain worse with sitting

-  pain with bowel movements

-  women may have pain with sexual intercourse

-  diagnosis:

-  history and physical examination and x-rays may be recommended

-  treatment:

-  home treatment – avoid sitting positions, ice, NSAIDs, donut pillow to sit on, high fiber diet to soften stools

-  medical treatment – prescription pain medication, stool softeners, injections

        -  surgical removal is a rare option

-  prevention:

-  are difficult to avoid, due to the fact that this area is usually injured as a result of an accidental fall

-  prognosis:  

-  depends on cause of pain, compliance with treatment and your bodies ability to heal

Tendon injuries

-  tendonitis  - inflammation of the tendon

-  tendinosis – small tears in or around the tendon

-  tendinopathy – both inflammation and small tears of the tendon 

-  causes:

-  gradual wear from overuse and/or aging

-  acute/sudden injuries

-  trauma

-  symptoms:

-  pain, stiffness, weakness

-  tenderness, inflammation, skin may be warm to touch

- diagnosis:

-  history, physical exam and x-rays may be ordered

-  additional diagnostic testing such as ultrasound or MRI scan may be ordered

-  treatment:

-  home treatment:  rest, ice, NSAIDs, avoid painful activities, gradual introduction to stretching and range of motion to the area

-  medical treatment:  physical medicine treatment, bracing or casting

Tennis elbow (lateral epicondylitis)

-  is a tendonitis

-  swelling of the tendons that causes pain in the elbow/arm region

-  common reason why people see doctor for elbow pain

-  usually develops over time

-  symptoms:

-  pain with lifting- pain with making a fist

-  pain with opening an object-  pain with grabbing an object

-  diagnosis:

-  history, physical examination and x-rays or MRI may be ordered

-  treatment:  

-  rest, ice, compression, NSAIDs, physical medicine treatment, or injections

-  surgery is an option if conservative measures fail

-  prevention:

-  avoid activities that cause the pain

-  warm up prior to activity and ice after activity

Exercise injuries

-  strained or pulled muscles

-  joint sprains

-  joint injuries

-  dislocations

-  prevention:

-  consult you medical professional prior to starting a program

-  warm up prior to starting program

-  have variety in your work out

-  discontinue an exercise if you experience pain

-  drink plenty of fluids

-  use proper technique; if unsure about proper technique seek instruction from a certified trainer

-  rest to allow your body to recover

-  treatment:  rest, ice, compression, elevation and NSAIDs


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Posture and Neck Pain

Chronic neck pain is a miserable experience. Although some cases of neck pain are caused by an injury, many are simply due to poor posture. Poor posture stresses the muscles of the neck and can cause muscle spasms, stiffness and pain. Over time, the stresses of poor posture on the neck can cause degenerative diseases to develop in the discs and bones of the neck. Forward head A very commonly seen posture that puts a lot of strain on the neck is the forward head. The individual habitually thrusts the head forward, carrying it out in front of the shoulders. In this position, the weight of the head is constantly pulling on the spine and the shoulders. Sitting for hours hunched over a desk or a computer is a common cause of forward head. Many people with this habitual forward head carriage suffer from sore shoulders as well as a sore neck. Over time, the vertebrae at the base of the neck (C5 and C6) can develop painful degenerative conditions due to the constant weight of the head pulling on them in the forward head posture. Correct posture A correct posture is one that keeps the spine in alignment. Some people call it a neutral or balanced posture. One exercise to encourage a neutral posture is to focus on opening the chest wide as you try to squeeze your shoulder blades together. Once your chest is open, bring your head into alignment. Think of a string pulling up the top of your head and lengthening the neck. When you do this, your chin will tuck in and your head will naturally shift into proper alignment with your spine. Do the open chest/ string exercise multiple times a day. Other exercises to build better posture are head nods and chin tucks. To do a head nod, slowly nod your head slightly up and down without moving your neck. To do chin tucks, tip your nose down toward the ground and move the top of your head backwards. Repeat head nods and chin tucks several times a day. These exercises strengthen the muscles on the front of the neck. Individuals with habitual forward head posture usually have very weak muscles in the front of the neck. If you've worked hard at correcting your posture and you are still suffering from neck pain, why not give us a call?

Note: The information on this Web site is provided as general health guidelines and may not be applicable to your particular health condition. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. Remember: There is no adequate substitution for a personal consultation with your physician. Neither BPF Specialty Hospital, or any of their affiliates, nor any contributors shall have any liability for the content or any errors or omissions in the information provided by this Web site.