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By Dr. Shane Hervey, LuskinOIC Center for Sports Medicine
With the holiday season in full effect, there is a transition in sports for our young athletes. Our contact or flag football athletes may be exchanging cleats for the latest basketball shoes, and our volleyball players may be going from the courts to the soccer pitch. With this transition comes a different set of injuries and conditions that your child may experience. As an expert in primary care sports medicine, I’m here to highlight three common injuries in winter sports, how they happen, how to prevent them, and how to treat them.
1) Ankle sprains
How do ankle sprains happen?
Ankle sprains are among the most common sports injuries. They occur more frequently in athletes who change directions quickly or jump and land on another athlete. When someone “rolls” their ankle, the ligaments (the tissues that connect bones to provide support) are stretched or torn due to the sudden inward or outward movement of the ankle. In addition to the type of sport being played, another risk factor is a prior ankle sprain, especially in the 6–12 months following the injury.
How to prevent ankle sprains
If your child has recently suffered an ankle sprain, it is important to regain strength and stability through home exercises and/or physical therapy. Regardless of recent injury, it may also be beneficial to support the ankle using a brace or athletic tape.
How to treat ankle sprains and when athletes can return to play
A sports medicine physician will examine the ankle and determine the next steps, including whether imaging is needed (usually an X-ray to ensure the bones are not broken), rehabilitation, medications, immobilization (in an ankle brace or walking boot), or crutches. Most simplesprains can be treated with rest, ice, compression, and elevation. Additionally, a provider may prescribe a nonsteroidal anti-inflammatory drug (NSAID) to assist with pain and inflammation.
As pain improves, functional exercises become essential. Sprains disrupt the neuromuscular connection (nerve-muscle communication) by damaging the ankle’s sensors (proprioception), which leads to poor balance and a higher risk of re-injury [1][6-7]. Physical therapy retrains this connection through balance and strength exercises, restoring stability and significantly reducing the chance of future sprains [4-6]. A home exercise program may also be prescribed.
Return to sport is safe when the athlete can run, jump, and cut without pain.
2) Patellar tendinopathy (“Jumper’s Knee”)
What is patellar tendinopathy?
A tendon connects a muscle to a bone. The patellar tendon connects the kneecap (patella) to the top of the shin bone (tibia). Patellar tendinopathy, also known as jumper’s knee, occurs withrepeated stress to the patellar tendon from activities like repetitive jumping, running, cutting, or changing direction. Thisstress causes tiny tears to the tendon, leading to degeneration and pain at the front of the knee.
How to prevent patellar tendinopathy
As mentioned by LuskinOIC Sports Medicine Associate Director Dr. Joshua Goldman, gradually increasing training volume can reduce the risk of overuse injuries such as patellar tendinopathy. Ensuring correct running, jumping, and landing mechanics by strengthening the muscles in the buttocks, thighs, lower legs, and core (abdominal muscles) can also help.
How to treat patellar tendinopathy
Treatment often begins with rest to reduce stress on the tendon. To help with pain and/or swelling, a patellar strap, knee brace, and ice may be beneficial. NSAIDs may also be used to help with pain.
Physical therapy is essential for strengthening the leg muscles. For tendon healing, research supports progressive tendon loading (like isometric holds) and eccentric exercise therapy. Eccentric exercises strengthen the muscle while lengthening the tendon, such as slowly controlling the return phase of a knee extension machine [2]. Tendon healing can take months, so consistent rehabilitation is key.
3) ACL injury
How do ACL injuries occur?
The anterior cruciate ligament (ACL) is one of four major ligaments of the knee. It connects the femur (thigh bone) to the tibia (shin bone). The other three are the posterior cruciate ligament (PCL), lateral collateral ligament (LCL), and medial collateral ligament (MCL). The ACL stabilizes the knee during sudden stops, cuts, or pivots.
ACL injuries range from sprains (stretching of the ligament without tearing) to partial or full-thickness tears. Most ACL injuries are non-contact injuries, though they may also result from collisions. Muscle imbalance, female sex (may be related to hormone fluctuations as it relates to menstrual cycle; [3]), prior ACL injury, and high-intensity physical activity are risk factors.
How to prevent ACL injuriesExercise programs guided by an athletic trainer, physical therapist, or other trained professional that incorporate plyometrics, strength, agility, balance, and feedback on movement technique can reduce ACL injury risk. An example of this is our Luskin OIC injury prevention program.
Prevention exercises should start in the preseason and continue throughout the season. Proper warmups, balance training, and professional evaluations for individuals at high risk (such as those with prior ACL injury) can also help.
How to treat ACL injuries
Sports medicine professionals can assess ACL stability with a physical examination. It can be difficult to accurately assess the ACL immediately after an injury due to pain and swelling. X-rays can rule out bone injury, while MRI confirms an ACL injury and identifies additional soft-tissue damage.
Not all ACL injuries require surgery. The decision depends on multiple factors, including desired activity level and whether other knee structures were damaged.
If surgery is recommended, it likely won’t happen right away. Pre-rehabilitation is essential to restore range of motion, reduce swelling, and build strength before surgery. Return to sport after ACL reconstruction generally requires 9–12 months of recovery and rehabilitation.
References:
1. Alghadir AH, Iqbal ZA, Iqbal A, Ahmed H, Ramteke SU. Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes. Int J Environ Res Public Health. 2020;17(15):5318. Published 2020 Jul 23. doi:10.3390/ijerph17155318
2. Breda SJ, Oei EHG, Zwerver J, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. Br J Sports Med. 2021;55(9):501-509. doi:10.1136/bjsports-2020-103403
3. Herzberg SD, Motu’apuaka ML, Lambert W, Fu R, Brady J, Guise JM. The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2017 Jul 21;5(7):2325967117718781. doi: 10.1177/2325967117718781. PMID: 28795075; PMCID: PMC5524267. 4. Holmes A, Delahunt E. Treatment of common deficits associated with chronic ankle instability. Sports Med. 2009;39(3):207-224. doi:10.2165/00007256-200939030-00003 5. Kaminski TW, Hertel J, Amendola N, et al. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013;48(4):528-545. doi:10.4085/1062-6050-48.4.02 6. Martin RL, Davenport TE, Fraser JJ, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302 7. Mattacola CG, Dwyer MK. Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. J Athl Train. 2002;37(4):413-429.
