The Low Down on Low Back Pain

Most low back pain can be treated non-operatively, says ONS neurosurgeon Scott Simon, MD.

Did you know that 80 percent of Americans experience low back pain at some point in their lifetime? According to neurosurgeon Dr. Scott Simon of Orthopedic and Neurosurgery Specialists in Blog sizeGreenwich and Stamford, the majority of low back pain is due to a lower back muscle and ligament strain or sprain.

“This type of low back pain usually occurs as muscles tighten after exercise or other exertions,” he said, adding that stress has also been shown to make people more susceptible to episodic low back pain. Avoiding sudden lifting away from your body and stretching before or after exercise can often help prevent pain.

In most cases, back pain from strains or sprains lasts two to five days and is best treated with heat and anti-inflammatory medication such as Naprosyn or ibuprofen. In the vast majority of cases, the pain subsides on its own without the need for additional treatment. Even as the pain dissipates, however, Dr. Simon recommends easing back into exercise. “Re-injury can occur if the muscles and ligaments are still healing,” he said.

Despite the claims of manufacturers, there is no conrete evidence supporting the use of a product to prevent or treat back pain.  “The best mattresses, pillows or chairs are the ones that are most comfortable according to the needs and prefences of the individual,” Dr. Simon explained.

Those who experience back pain that lasts longer than a week or produces leg pain, weakness, numbness or tingling sensations may have a more serious problem and should seek medical attention. Pain that radiates down one or both legs may be due to nerve irritation or pinching from either a disc herniation or arthritis. In the majority of these conditions, patients can be treated with physical therapy

Anyone should see a doctor immediately if the low back pain is a result of trauma or if the pain is accompanied by any of the following symptoms:

  • Fever and chills
  • Significant leg weakness
  • Sudden bowel and/or bladder incontinence
  • Difficulty passing urine
  • Severe continuous abdominal pain

Is Your Back and Leg Pain from Sciatica?

Pain from sciatica can radiate from the spine to the toes, says ONS neurosurgeon Mark Camel, MD.

While most back pain is confined to a specific region of the spine, those suffering from sciatica can experience pain from their back down to their toes.Herniated Disk According to neurosurgeon Dr. Mark Camel of Orthopaedic and Neurosurgery Specialists, “There are many causes of back pain. Making a correct diagnosis is the important first step before prescribing treatment.“

Sciatica is a condition in which pain travels along the sciatic nerve, which runs from the lower back through the hips and buttocks and down each leg. The pain from sciatica is usually limited to one side of the body and tends to affect people between the ages of 30 to 50.

The most common causes of sciatica is a herniated disk, spinal bone spur or a narrowing of the spine called spinal stenosis. These injuries put pressure on the nerve roots in the lower back and cause inflammation and pain. Sudden pressure on the the lower spine vertebrae from an acute injury can also trigger the condition creating a sharp, leg cramp that can last for weeks.

In most cases, sciatica can be resolved with such non-surgical treatments as rest, anti-inflammatory medications, heat and cold application as well as physical therapy. However, if the pain persists or worsens, doctors may administer a cortisone injection into the spine. If those measures fail to relieve the pain, surgery may be recommended. “Sciatica is a manageable condition with the appropriate treatment,” said Dr. Camel.

Patients experiencing lower back, hip, and leg pain or develop numbness, burning, and weakening in the leg or foot should consult with a physician.

Make an appointment with an ONS spine specialist to learn if sciatica is the root of your back and leg pain.

The Dangers of Sports Specialization

Every young athlete dreams of the pride and exhilaration of hitting the game winning home run, or scoring the goal that clinches the championship.  In today’s competitive sports environment, youth are under more pressure than ever to train harder and longer to excel in their sport, often with debilitating consequences, writes sports medicine specialist and orthopedic surgeon, Demetris Delos, MD in the latest issue of The Magazine for Greenwich Hospital.Sports Medicine Discussion

The greatest shift in youth sports in the last generation has been the trend toward sports specialization and year-round training. Twenty years ago, young athletes typically played a particular sport only during that sport’s season (i.e. football in the fall, baseball in the spring and summer), and most kids sat out a season or a summer.  Today’s young competitors don’t seem to enjoy that luxury.  Unfortunately, this has also led to a surge of sport specific injuries.

A recent study at the Departments of Kinesiology, Orthopedics and Rehabilitation at the University of Wisconsin-Madison, for instance, found that high school athletes who trained in one sport for more than 8 months were more likely to report a history of overuse knee and hip injuries, than those who had played a variety of sports throughout the year or played sports at less intense levels.

The results of this study reflect what orthopedists have noticed in the last decade with the increasing number of kids showing up in our offices with throwing injuries, torn knee cartilage and stress fractures.

Professional level injuries

 The growing corps of young adolescents and pre-adolescent baseball pitchers is now throwing excessive numbers of pitches during an unusually high number of innings for immature arm muscles. This has led to an epidemic of young athletes suffering ulnar collateral ligament (UCL) injuries, requiring the so-called Tommy John Surgery. Tommy John was a left handed pitcher for the Los Angeles Dodgers in the 1970’s, who was the first baseball player to undergo UCL reconstruction surgery.  His successful recovery and return to achieve a record of 288 career victories.

Anterior cruciate ligament (ACL) tears in youth athletes are also increasing at an alarming rate. While ACL tears are not so closely related to a particular sport statistic the way  UCL injuries are tied to pitch count, clearly the rapid rise of sports that involve running and sudden pivoting – think soccer, lacrosse, football, basketball and rugby – increases the likelihood of season ending ACL tears and reconstructive surgery.

Overuse injuries

Unlike ACL injuries, which can be dramatic on-field experiences with players being helped off the field, the vast majority of injuries associated with excessive specialization and training are overuse injuries. Overuse injuries develop slowly over time, starting perhaps as a mild twinge before progressing into relentless, often debilitating pain.  Ironically, these injuries are relatively easy to treat with a period rest and activity modification.  All too often, players, their coaches and, sadly, parents, are often reluctant to have the athlete sit out a few practices and games.  Left untreated, overuse injuries can lead to tears in the muscles and tendons of the affected area, which require a lengthier rehabilitation and sometimes surgery.

Overuse injuries are typically sport specific. In baseball, the upper extremity is most often affected.  With Little league shoulder, the growth place of the humerus (arm bone) becomes inflamed by the repetitive motion of throwing with excessive force.  Similarly, Little league elbow involves injury to the growth plate along the inner portion of the elbow.

In the lower extremity, overuse injuries of the knee and ankle are very common. Osgood Schlatter and Jumper’s knee are injuries to the growth plate of the knee that can be a frustrating source of pain. These injuries are typically associated with repetitive impact activities (running, jumping, etc.) as seen in basketball, soccer and track.  In the ankle, Sever’s disease can lead to pain in the back of the heel.

How can we prevent injuries?

The solution is simple but that doesn’t mean it is easy. Rest and activity modification can be difficult to execute in the middle of the season when the athlete is invested in playing and when parents have already invested much time and money to the sport.

Nevertheless, it is incumbent upon parents to insist their child rest to give the body the opportunity to heal before more serious injury occurs. If a week or two of rest doesn’t resolve the condition, the young athlete should be evaluated by an orthopedist or sports medicine specialist.

Repetitive activities such as throwing or running can lead to changes in the development of growing bones and joints. It has been known for some time now that significant amounts of pitching during adolescence can change the rotation and shape of the shoulder.

Moreover, there is a growing body of evidence indicating certain sports played excessively during adolescence are associated with the development of femoroacetabular impingement syndrome (hip impingement), which can lead to hip problems often requiring surgery in adulthood.

In addition, numerous studies have shown that exposure in youth to a range of different sports that utilize different muscle groups and mechanical skills lead to the greater overall athleticism and better athletes.

Treatments for Tennis Elbow

ONS Dr. David Wei Talks on Treatment for Tennis Elbow.

Tennis season is in full swing and so are the risks of overuse injuries such as Tennis Elbow.

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Tennis Elbow typically happens when a repetitive swinging motion pulls on the extensor tendons that connect the muscles in the forearm to the elbow, creating microscopic tears. Despite its name, there are many types of activities that can injure these tendons, especially those involving repetitive wrist motion. Although it continues to be a mystery as to why some patients develop Tennis Elbow while others are not affected, we do know that the end result is an abnormal change in the quality of the tendon itself, called angiofibroblastic hyperplasia.

Typical symptoms are pain along the outer side of the elbow with wrist motion and with gripping. The pain can be especially exacerbated by activities involving lifting objects with your elbow extended and the palm of your hand facing downward.

Recent data suggests that nearly all cases may resolve spontaneously, and the mainstay of treatment always begins with non-operative options. Avoiding aggravating activities or modifying the way you perform them can help decrease pain. For instance, lift things closer to your body, with your palms up. A splint or a counterforce brace can also help by relieving the strain on the tendon. In some cases, a physical therapy program and possibly injections will help the condition.

Most people don’t require surgery for Tennis Elbow. If, however, non-operative measures fail and the pain persists beyond six months, it may be time to consider surgery to repair the damaged tendons. Recovery time from surgery is relatively fast, but the tendons need time to regenerate, requiring approximately six to eight weeks.

Dr. Wei discusses tennis elbow in greater detail in this video.

 

Youth Rugby Safety Talk

ONS Sports Medicine Specialist Marc S. Kowalsky, MD, to speak about Youth Rugby Safety on May 4

Dr. Marc Kowalsky will discuss safe participation in youth rugby, the fastest growing sport among young athletes in the United StKowalskyMD_WorldRugbyPacificNationsCupates.

The informative lecture for coaches, players and parents of players presented by the Rye Rugby Club will take place on Wednesday, May 4 beginning at 7 pm at the Rye High School Performing Arts Center at One Parsons Street in Rye New York.

Dr. Kowalsky will draw from his extensive experience caring for rugby players at every level of competition in this discussion of strategies for injury prevention. Topics will include optimal diet and nutrition, as well as strength and conditioning in these athletes.  Dr. Kowalsky will also touch on the value of protective equipment in youth rugby. The critical role of coaching and officiating in maintaining safety of the game will be covered, as will prevention and management of concussion. The importance of collaboration among parents, coaches, trainers, and physicians will be addressed as well.

A former rugby player, Dr. Kowalsky serves as team physician for the USA Rugby National Team, the White Plains Rugby Football Club, Iona College Rugby Football Club, and the CT State Champion Greenwich High School Rugby Team.

ONS MDs to Discuss Chronic Pain

Demetris Delos, MD and Christopher Sahler, MD of ONS to discuss effective treatments for Chronic Pain.

Maintaining quality of life while living with chronic pain is no easy feat. Two orthopedic specialists from ONS will discuss effective new treatments to help people with relentless pain return to the WavenyPain Flyer (2)activities they enjoy.  Join Demetris Delos, MD, an orthopedic surgeon who specializes in sports medicine an comprehensive knee and shoulder, and interventional pain management physiatrist, Christopher Sahler, MD for this informative talk on Wednesday, May 11 at The Inn at Waveny, 73 Oenoke Ridge in New Canaan.  Doors open at 4:00 pm for refreshments. Presentation begins at 4:30. RSVP at 203-594-5310 or mntiri@waveny.org.

 

Regenerative Medicine and Chronic Pain

Is regenerative medicine the answer to your chronic pain?

In the past, most cases of damaged tissue within the body were considered irreversible, but developments in regenerative medicine hold the potential to change all that, writes Christopher Sahler, PRPMD, an interventional pain management specialist at ONS, in this week’s edition of the Greenwich Sentinel.  Although research into harnessing the body’s own healing process using amniotic fluids, blood, tissues, growth factors and stem cells is ongoing, certain biomedical therapies are in use today to help ordinary people suffering from orthopedic conditions and chronic pain.  The most common treatment, using platelet rich plasma collected from a patient’s own blood, is administered in a physician’s office using ultrasound guided injections directly into the diseased or damaged tissue to restart and increase the healing process.  Read the full article in the April 1 edition of Greenwich Sentinel.

Female Athletes and ACL Injuries

Did you know that female athletes are from two to ten times more likely to suffer an ACL injury than their male counterparts?  

Woman playing tennis at the professional tournamentDifferences in pelvis width, the size of the ACL and the intercondylar notch (where the ACL crosses the knee joint), are all thought to play a role. What’s more, the upper part of a female’s shin bone at the joint is much shorter and more rounded than a male’s, which creates a greater laxity in the joint. Women also tend to have an inward angle to their knees, otherwise known as knocked knees, which places more stress across the outer knee joint and ligaments, particularly when it comes to sudden or extreme movements, such as an abrupt change in direction or pivot. Women also move differently than men. For instance, they tend to land from a jump with their knees in a somewhat straight position, pulling on the quadriceps rather than the hamstrings. Because of this, the force of the impact is transferred to the knee, creating a high risk for an ACL rupture. Men, on the other hand, are better able to absorb the impact because they tend to land with bent knees.

For these reasons, it is crucial for female athletes of all ages to modify their natural biomechanics through neuromuscular training programs that can teach them better ways to move their bodies and protect their knees, said orthopedic surgeon Katie Vadasdi, MD, who heads the Women’s Sports Medicine Center at ONS. “Through neuromuscular training programs, we can help female athletes significantly reduce the risk of ACL ruptures by developing balance between the quadriceps and hamstrings and improving the landing biomechanics with more bent knees and hips to avoid a knock-kneed position on impact.”

Preventing ACL injuries has both near and long term benefits so the sooner you get started with this kind of a conditioning program the better. Studies indicate that there is a tenfold increase in the incidence of osteoarthritis in the knees of women who suffered an ACL injury at some point in their lives. Moreover, injuries that were incurred during youth seem to result in the onset of osteoarthritic symptoms at a much earlier age in adulthood.

Learn more about ACL injuries here.

Regenerative Medicine Benefits

Dr. Christopher Sahler
Dr. Christopher Sahler

ONS pain management specialist, Christopher Sahler, MD, will discuss the benefits of regenerative medicine at Greenwich Hospital talk.

Does your own blood hold the key to healing your medical condition? The evolving field of regenerative medicine uses biomedical materials, often from your own body, to regenerate cells and rebuild diseased and damaged tissues. Join Dr. Christopher Sahler to learn about this exciting new medical field that uses therapies from blood, platelets and stem cells to treat pain and cure complex, often chronic conditions of the musculoskeletal system.  Healing Yourself: The Promise of Regenerative Medicine for Chronic Pain and Orthopaedic Care will take place on Thursday, March 10 at Greenwich Hospital’s Noble Auditorium.  6 – 7:30 pm. Free.  To register, call 203-863-4277 or go to greenwichhospital.org.

The Importance of Injury Prevention: Don’t Become a Statistic

Quality of life, activity and productivity are affected by painful orthopedic conditions.

One in two Americans over the age of 18 and nearly three out of four age 65 and older have a musculoskeletal condition costing an estimated $213 billion each year in treatment, cadolori articolari 1re and lost wages, according to a report by the United States Bone and Joint Initiative (USBJI), The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action.

The study finds that the quality of life, activity and productivity of an estimated 126.6 million American adults are affected by painful conditions and disorders affecting the bones, joints and muscles, a number which is comparable to the total percentage of Americans living with chronic lung or heart conditions. Among children, musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.

The report states that arthritis and related conditions top the list of orthopedic ailments (51.8 million adults) followed by back and neck pain (75.7 million combined). With an aging population, the number of people faced with musculoskeletal discomfort can be expected to greatly increase.

Fortunately, advances in diagnostic and treatment technologies, such as those that are available from the sub-specialists at ONS, can provide patients with pain relief and a safe return to mobility. However, the report underscores the importance of injury prevention strategies for individuals of all ages and the need for prompt treatment when injuries occur and orthopedic conditions first appear. With top orthopedists, neurosurgeons, physical therapists and physiatrists, ONS is committed to finding non-surgical options as the first line of treatment. Only 10 percent of ONS patients require surgery.

Dr. Steven Hindman to discuss Fall and Injury Prevention, Thursday, February 25

Did you know that falls are the most common cause of traumatic brain injury (TBI)?HindmanWhite

From 2006–2010, falls were the leading cause of TBI, accounting for 40% of all brain injuries in the United States that resulted in an ED visit, hospitalization, or death, according to the Centers for Disease Control. Elderly adults and young children are the most likely to suffer falling accidents.

Falling out of bed or from a ladder, slipping in the bath or down a flight of stairs, and almost any other fall can result in a severe blow to the head that damages brain cells, blood vessels and protective tissue around the brain. Bleeding in the brain, swelling and blood clots can interfere with the oxygen supply to the brain, which can cause widespread damage.

You can learn how to prevent falls and protect yourself or your loved one by joining Dr. Steven Hindman on Thursday, January 25 at 6:30 pm when he discusses fall prevention strategies at Sunrise Senior Living, 251 Turn of River Road in Stamford. Refreshments will be served.

 

ONS’s Christopher Sahler, MD, Offers Tips for Combating Chronic Pain

Sahler - icontactExercise can help people with chronic pain return to daily activities with ease and comfort, writes Dr. Christopher Sahler, interventional pain management specialist at ONS in this week’s issue of the Greenwich Sentinel.  Slowing down is wise advice if pain is caused by an injury, he said, but a growing body of research suggests people suffering from chronic pain may feel better if they keep moving.  Not only does inactivity lead to a myriad of problems from weight gain to depression, it can actually exacerbate a person’s perception of pain.  Moderate, adaptive exercise, he explains, helps alleviate unrelenting pain because it releases endorphins, brain chemicals that improve mood and act as natural painkillers. Exercise provides the additional benefits of increasing a person’s agility and range of motion and it can stregnthen muscles to prevent injury.  Read the entire article which includes tips for gradually returning to normal, daily activities with greater ease and comfort.

 

Tips to Prevent Back Injury from Shoveling Snow

If the local forecasts are to be believed, many of us will be doing a fair amount of snow shoveling this weekend. Before you bundle up and head out, though, Dr. Jeffery Heftler, an interventional pain Blog-shoveling show 300 pxspecialist at Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, has a few words of advice to protect your back from strain and injury.

“The most important thing is to stay ahead of the accumulation of snow. It’s much easier on your back to shovel after every few inches has fallen than to wait and lift heavier loads of snow for a longer period of time,” he advises. Waiting can make the task even harder if the snow melts and then freezes over. Dr. Heftler also recommends investing in so called “push shovels” that are specially designed for pushing the snow aside while shovels with bent handles can help ease the tension on back and shoulders.

Without a doubt, Dr. Heftler sees more patients with back pain following a large snow storm. One reason, he suggests, is that people tend to think of shoveling snow as a nuisance and chore, when in fact it is an intense and strenuous exercise. “All too often, people who are generally inactive underestimate the physical challenge involved in clearing snow. Even someone in good shape can strain their back from the rotation of lifting the snow and throwing it over their shoulder,”   he says.

To protect your back, it’s best to take a few moments to warm up your muscles before going out in the cold. When shoveling, maintain the correct posture and technique to minimize the pressure on your weaker back muscles. Avoid rounding your lower back, for instance. Instead, go through the motions with a straight back leaning forward and your knees slightly bent. Use your core, hips and hamstrings to provide strength and stability instead of relying on your back and shoulder muscles to do the heavy lifting.

People with pre-existing back conditions are most vulnerable to shoveling related injuries and should avoid the activity altogether. “Even if you have to hire someone to clear the snow for you, it will pay for itself in terms of avoiding pain and days lost from work and winter sports,” Heftler says.

If you do experience pain while shoveling, Dr. Heftler says to stop, go inside and rest in a comfortable position until the discomfort passes. He recommends anti-inflammatory medications such as Advil or Aleve, and using ice or heat directly on the area where the pain is most acute. If the pain is severe and persists through the next day, consult with a physician.

ONS Stamford: Off to a Great Start

ONS_Stamford
5 High Ridge Park, 3rd floor, Stamford, CT 06905

On the evening of June 22, 2015, Orthopedic & Neurosurgery Specialists (ONS) held a grand opening celebration of a second ONS location at 5 High Ridge Park in Stamford, CT. The event was a first look at the new facility for the public, complete with informative stations about injury prevention, exercise tips and sports medicine stations with medical models and video presentations. Throughout the evening, around 200 guests toured the office, and learned about injuries and treatments of the foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine and Platelet Rich Plasma treatment. ONS physicians were available to answer questions. ONS Physical Therapy showcased injury prevention exercises for tennis, golf and running. Local businesses participated in the evening as guests enjoyed food and beverage and displays and a drawing of exciting prizes. The ONS physicians, clinicians and staff members were pleased with the opportunity to meet and greet the Stamford community! To learn more about our new Stamford office please visit http://onsmd.com/ons-stamford/.

Shoulder Pain? (Part I)

Marc Kowalsky MD
Marc Kowalsky, MD.

ONS welcomes Dr. Kowalsky,  a board-certified orthopedic surgeon with expertise in rehab-focused, as well as operative treatments for upper and lower extremity sports injury, and complex shoulder and elbow conditions including degenerative disease, trauma, and revision surgery. He has also authored original research manuscripts, review articles, textbook chapters focusing on AC joint reconstruction, rotator cuff repair, and shoulder replacement, and now he is adding to the educational articles ONS provides.

Shoulder pain is the second most common musculoskeletal complaint to a primary care physician, behind only back pain. Twenty percent of the population will suffer from shoulder pain during their lifetime.  A variety of conditions can contribute to shoulder pain, ranging from rotator cuff problems to arthritis of the shoulder joint.

The rotator cuff tendon consists of the tendons of the four muscles that originate on the shoulder blade and insert on the humerus adjacent to the ball of the shoulder joint.  These muscles participate in rotation and elevation of the arm.  A bursa, or fluid-filled sac, lies on top of the rotator cuff tendon, and helps to protect or shield the tendon from the adjacent structures of the shoulder as the tendon glides.

Although most people who present to their physician with a rotator cuff problem likely have simple tendonitis, or bursitis, some may in fact have a rotator cuff tear.  At least twenty-five percent of people over the age of sixty may have a tear in the rotator cuff tendon.  Most of these tears are chronic and degenerative in nature, without any traumatic cause.  These patients experience shoulder pain with motion away from the body and overhead, typically along the side of the shoulder and arm.  They may also experience night pain that awakens them from sleep.

Some patients may also notice weakness, depending on the size of the tear.  A rotator cuff tear, once present, is unlikely to heal on its own, and may enlarge over time.  Nevertheless, many patients with a tear can be successfully treated with conservative means, including physical therapy, oral anti-inflammatory medication, and perhaps an injection of corticosteroid.  For those patients who do continue to experience pain due to a rotator cuff tear, operative repair is an option.  This procedure is typically performed arthroscopically, and consists of anchoring of the torn tendon to its attachment site with a series of small screws, or anchors.  Ultimately this procedure is effective in improving a patient’s pain and overall function. (…to be continued)

If this topic interests you keep an eye out for the next installment and attend Dr. Kowalsky’s upcoming seminar on March 12th at Greenwich Hospital. The program is free and open to the public.
Registration Requested. Call (203) 863-4277, or register online at www.greenhosp.org.

Overuse Injuries: Cause and Effect (Part I)

Cohen headshot for letterGloria Cohen, MD is a specialist in non-operative sports medicine who believes in taking an integrative approach to medical management by considering a patients’ bio-mechanics, cardio-vascular and pulmonary function as it relates to athletic performance. Aside from her impressive medical career, Dr. Cohen is a successful competitive runner who has qualified twice for the New York Marathon and is also an off-road and road cyclist. Her academic insights are a combination of both research and real-world experience, the following article is her most recent commentary on the topic of “overuse injuries”:

What is an “overuse injury”?
An “overuse injury” is an injury that results when excessive stress is applied over a period of time to bones, muscles, tendons, and other supporting soft tissue structures of a particular body part.  This differs from an acute injury which happens quickly and is traumatic in nature. Too much stress to a body part will cause the tissues to break down faster than healing can occur, thereby resulting in an injury. A good analogy would be to consider what happens to a credit card or a piece of metal when you bend it back and forth repetitively – first you see the stress reaction, and then with continued stress the item breaks in two.  As you can appreciate, we want to avoid the latter situation when it comes to the body.

What are some common examples of “overuse injuries”?
Every body part can be affected by an overuse injury.  Some common examples you might be familiar with are: rotator cuff injuries of the shoulder; epicondylitis or tennis elbow; patellofemoral pain syndrome of the knee; and tibial stress syndrome or “shin splints” for the lower leg.  Here are a few case examples of classic overuse syndromes:

Jogging injury.

  1. A 40 year old male has recently increased the intensity and frequency of his swimming activity over the summer months. He now complains of pain in the front of his shoulder with overhead and rotation motion. Diagnosis: Rotator cuff tendinitis
  2. A 30 year old female has been playing tennis daily, now competing in matches at a more difficult level. She complains of increasing soreness in the outside aspect of her elbow. She had tried to play through the pain, but had to stop. She says that she can barely lift a coffee cup now because of the elbow pain. Diagnosis: Tennis Elbow /Lateral epicondylitis
  3. A 20 year college student takes up running during her summer break from school. When she returns to school, she decides to train for a half marathon. As she increases her mileage, and adds speed work to her training program, she develops pain in the inside aspect of one shin. She now complains of pain with just walking. Diagnosis: Shin splints/Medial Tibial Stress Syndrome

What are some of the specific causes of these “overuse injuries”?
As a primary care sports medicine physician I recognize that there are sport specific issues which may contribute to the resulting injury; but there are common “intrinsic” and “extrinsic” factors which play a major role in the development of these types of injuries. “Intrinsic” factors refer to the elements that we cannot control but that we can modify.  These include biomechanical alignment, such as knock knees, bowl legs, flat feet or high arched feet; leg length difference; muscle imbalance; muscle weakness; and lack of flexibility.  These factors can be modified to maximize the individual’s performance, and thereby treat or prevent injury.  An example would be a conditioning program and sport specific training. The “extrinsic factors” include training errors, such as doing “too much too soon”; training surfaces – running on too hard a surface, or playing on an uneven surface; shoes – it is important to wear the appropriate type of shoe for your foot mechanics and the sport; equipment; and environmental conditions. Paying attention to the “extrinsic factors” will help you modify the “intrinsic” ones.

… to be continued in the next segment, Overuse Injuries: Recovery (Part II)