By: Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN

With warmer weather moving in it is appropriate to discuss sports injuries and prevention. Most sports injuries occur to ligaments, tendons and/or muscles. Sports injuries are common, most frequently affecting the neck and back, shoulders, elbows, and knees. As more Americans are attempting to keep their bodies physically healthy through regular exercise, more seniors and women are actively participating in both organized and leisure sports. As a result, physical therapists are seeing more sports related injuries such as those sustained by joggers, runners, golfers, tennis players and amateur and professional athletes.

Mechanisms of injury
Approximately 95% of sports injuries are due to minor trauma involving soft-tissue injuries such as contusions, muscle pulls, sprains, strains and cuts or abrasions. The other 5% are due to major trauma, which can result in dislocations; fractures; stress fractures, tears in cartilage, muscle, tendons and ligaments; and head, neck, shoulder and spine injuries. Injuries can occur to tissues as a result of compression forces such as falls and collisions; tension forces such as from traction or hanging movements; shearing forces such as those activated by throwing motions, twisting and repetitive- motion trauma.

Avoiding sports injuries.
Sports injuries are a part of life, especially those resulting from golf, tennis and other activities that require repetitive motion. Reasons for these injuries include: Poor body mechanics, lack of or improper, warm-up prior to participation, absence of customized exercise programs, poor nutrition and absence of a consistent daily diet.

There are a variety of ways to prevent sports injuries such as wearing appropriate protective clothing and adequately training for a specific sport. Warming up, giving the body rest, flexibility, and strengthening are also big components that can help prevent injuries. Stretching the muscles is a good way to give the body a heads up that it is about to work. Tight muscles don’t react as quickly as loose muscles and warming up will help to prepare the body. Another great way to prevent injury is by resting. Most people don’t realize how helpful it is to rest. Athletes are trained to work hard, but pushing the body too much can result in injury. Rest is critical to every athlete’s performance. Tune into your body and it will pay off in the long run. Tired and overworked muscles are very prone to injury and taking a day off can help the body recuperate. Flexibility and strength are every important. It takes both strength and flexibility to succeed as an athlete. Lifting light weights is a good way to maintain strength and of course stretching every day will keep the muscles loose and ready to go.

Common injuries seen:
Tennis and Golf Injuries will undoubtedly re-emerge as the big injuries of the New Year in this area. Both are common and both are preventable.

Common Tennis Injuries

Shoulder Injuries
Overhead activities in the game of tennis place great demands on the shoulders of tennis players. Shoulder injuries such rotator cuff injuries plaque tennis players. They are common because of repetitive forces about the unstable shoulder joint with various strokes such of the serve,
overhead smash, high forehand and backhand volley which wears down the rotator cuff. Injuries to the shoulder tendons are almost always caused by eccentric overload. In other words, high-intensity decelerative muscle contractions of the rotator cuff during the follow through phase of the serve can lead to tendinous inflammation. Additionally, because the shoulder is dependent on the rotator cuff muscles for dynamic stability, any fatigue or asynchronous firing of these muscles will lead to instability of the glenohumeral joint. The improper biomechanics of the glenohumeral joint may progress to a secondary impingement which may cause a rotator cuff tear if allowed to continue over time.

Elbow Injuries
Tennis elbow is an overuse injury and, like other such injuries is a result of placing too much demand on muscles and tendons that are not equipped to handle the stress. Any repetitive stress that entails use of the wrist and finger extensors can lead to their overuse and subsequent inflammation. If those tissues are not sufficiently strong or flexible it takes less demand to overdo it. Lateral Epicondylitis is the technical name for tennis elbow. The literal definition is that there is an inflammation (“itis”) at the tendons attaching to the bony prominence at the outer (lateral) region of the elbow (the epicondyle). The lateral epicondyle is on the thumb side of the elbow when your palm is facing forward. The tendons that attach to it are those that connect the muscles that extend the wrist and fingers. Though transient symptoms are generally due to a simple extensor tendonitis (inflamed tendon), persistent cases of tennis elbow are generally a result of a degenerated or torn tendon (tendinosis). One tendon in particular is usually the culprit, and that is the extensor carpi radialiis brevis tendon (known as the ECRB).

Poor stroke mechanics are another big reason that recreational tennis players suffer from tennis injuries. This is particularly true for those who have a wristy backhand or who maintain a rigid forearm and don’t follow-through properly on their backhands. Hitting the ball in the sweet spot of the racquet is also a key to minimizing the vibrations that otherwise place excessive stress on the muscles and tendons.

Treatment of Tennis Injuries

Anti-inflammatory medication, ice and cross friction massage can treat the inflammation, and stretching the involved muscles and tendons is also very important. It is crucial to strengthen the muscles as well but only in a progressive manner that does not provoke any discomfort or pain. It is also generally helpful to wear a brace designed to lessen the stress to the involved tissues with routine activity. Of course, it is important to minimize the ongoing stress to the area by limiting or refraining from the offending activities while rehabilitating. Rest alone is never the answer though, as it will result in further de-conditioning of the muscles, leading to recurrent injury once activity is resumed.

Cortisone injections are often used, though they should not be a first resort. Injections do address the inflammation though they do not impact the cause of the condition. Without restoring normal joint range of motion and muscle flexibility and strength to the shoulder, forearm, wrist and hand, the condition is likely to return. Cortisone combined with other restorative treatments is more beneficial, though it is best to first approach care more conservatively to see if injection can be avoided. This is when Physical Therapy may be recommended for your injury.

Surgery is a last resort and is generally only used in instances of tears common to more chronic conditions or in the instance of a traumatic tear from a violent and sudden cause of injury.

Common Golf Injuries

80% of all golfers will experience some type of injury while playing the game, many of which can be prevented. Posture, body mechanics, flexibility and conditioning play a large role in golf swing dynamics. Limitations in any of these areas can cause altered swing mechanics which places excessive stress on joints and soft tissues causing injury and pain which limits the ability to play the game.

Some of the more common ailments experienced by golfers are neck and back pain, shoulder pain, elbow pain, hip and knee pain. Back pain is the most common complaint of golfers. The golf swing puts an extreme amount of stress throughout the neck, back and spine. The pain caused by golf is usually mechanical in origin caused by poor swing mechanics from physical limitations in spinal mobility which places excessive stress on the spinal joints, discs and nerves.

Elbow pain is also very common in golfers, and can be caused by excessive strain with club impact, excessive grip pressure, too much speed during the backswing and poor transition from backswing to downswing.

Shoulder pain is also very common among golfers, with the most common cause being weakness or dysfunctions of the rotator cuff. The rotator cuff is a dynamic group of muscles that assists with elevating the arm, and provides stability to the shoulder joint once the arm is overhead.

Loss of hip mobility is the main cause of hip pain with golf. The hip is exposed to high velocity rotational stresses especially on the down swing which requires a lot of mobility, but also a lot of stability of the surrounding pelvic musculature. Deficits in either mobility or stability in the hip can cause excessive stress to the joint, causing hip and groin pain.

Excessive rotational stresses to the knee during the golf swing can cause damage to the cartilage and ligaments. Cartilage in the knee is particularly vulnerable to rotational stresses.

Whether you are a pro golfer, amateur, or a weekend warrior awareness of posture, proper flexibility, strength and conditioning are all equally important. Golfers spend thousands of dollars every year on new clubs but show minimal investment in the most important piece of equipment they have, their bodies. Physical Therapists are licensed Healthcare professionals trained in the evaluation and treatment of musculoskeletal and movement dysfunctions. Many golfers are now seeking the skills of Physical Therapists for consultations on joint mobility, flexibility, strength and conditioning deficits that are affecting their swing dynamics and ultimately their game performance. If an injury has already occurred, a physical therapist can implement an individualized treatment plan that employs noninvasive pain-management techniques for the injury.

Physical Therapy Treatment for Sports Injuries

Sports injuries come in many forms. It has become a major imperative among patients and their physicians to find the least invasive means to treat injuries. An athlete who is suffering from a sports injury can be effectively treated using physical therapy, which is one of the most effective methods that facilitate speedy recovery and helps athletes to quickly return to sports. With physical therapy, various sports injuries including rotator cuff tendonitis, shoulder injuries, jumping/cutting/landing injuries, running injuries, fractures, head injuries, neck injuries and tennis injuries can be treated.

Professional Rehabilitation Services is a Physical Therapist owned Private Outpatient Physical Therapy Practice specializing in pain, orthopedics, balance and sports injuries with offices in Myrtle Beach and Pawleys Island, SC. For more information on this topic or to schedule a FREE 15-Minute Consultation please contact Brian Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, at our Pawleys Island office at (843) 235-0200, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN at our Myrtle Beach office at (843) 831-0163 or Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN at our Myrtle Beach office at (843) 839-1300, or visit us at: www.prsrehabservices.com to learn about our GOLF PROGRAM