Exercise Injuries Below the Belt

From the WebMD Archives

Some long-distance runners constantly feel pain in their feet when they exercise. Soccer players might hear a loud pop in their knee, followed by swelling and joint instability. Still other athletes wonder why they always have nagging aches in their hip.

Over and over again, sports medicine doctors see patients coming in with certain sports and exercise injuries in the hips, knees, ankles, and feet. What are some of these common problems, and what can you do about them? WebMD asked two sports medicine experts to share their expertise.

Hip and groin injuries

Several common injuries can plague the hips and groin. If someone takes a bad tumble to the ground or is struck in the hip during a contact sport, a contusion or bruise may develop.

When people cut quickly to the side during running, or stop and start too fast, they may strain their groin or the hamstring (back of the thigh) or quadriceps (the front of the thigh). Such strains can happen in many sports, according to Jeanne Doperak, DO, a sports medicine physician and assistant professor at the University of Pittsburgh School of Medicine. But they often occur in “track and field athletes who do quick starts and stops,” she says. Such muscle strains are usually treated with physical therapy and rest.

In recent years, doctors have become more aware of a hip injury called a “labral tear,” says James E. Carpenter, MD, chairman and associate professor in the department of orthopedic surgery at the University of Michigan and a team physician.

The labrum is a ring of cartilage that surrounds the hip socket. “It helps support the joint and stabilize the joint,” he says. During physical activity, if the labrum is repeatedly “pinched” between the socket and the head of the thigh bone, it can eventually tear. “They’re common throughout sports,” Carpenter says of labral tears. “We see it in gymnasts and people who have to use a wide range of motion in the hip.”

Doctors diagnose labral tears through magnetic resonance imaging, or MRIs. Milder cases often don’t require surgery, Carpenter says, but more serious and painful cases may call for an operation.

Continued

Knee injuries

Knees can ache for many reasons, including runner’s knee. Runners with weak thigh muscles may have kneecaps that move sideways and rub abnormally against the thigh bone, causing pain.

Furthermore, “The knee is vulnerable,” Carpenter says, “because of all your weight and your pivoting, and it’s often hit in contact or twisted. That is still far and away the most commonly injured joint.”

If people play team sports such as football and soccer, trauma to the knee can damage ligaments, for example, when the knee is struck during a block or tackle, Carpenter says. If the knee is struck from the outside, the medial collateral ligament inside the knee can be stretched -- and if the force is significant -- it can be injured or torn.

In contrast, non-contact injuries usually result from twisting the knee or deceleration. A “sudden plant and cut in one direction” or an awkward landing from a jump can damage the knee, Carpenter says. “Those are more typically injuries to the anterior cruciate ligament (ACL),” he says. “If someone comes in and no one hit them, they just turned sharply, the knee went ‘pop’ and swelled up, the majority of time, that’s an injury to the anterior cruciate ligament.”

Women are more at risk for ACL tears, but according to Doperak, doctors aren’t sure of the reasons. “There are a lot of theories, but no one really knows exactly why. Some people think it has to do with hormones, or the way [women] land when they jump, or anatomy.”

Strengthening the knee with targeted exercises and having good balance will help prevent ligament tears, according to Doperak, who is also a team physician for the University of Pittsburgh and Carnegie Mellon University. Bracing the knee might also help prevent injuries, Carpenter says.

Entire textbooks have been written about the extensive range of knee injuries, Doperak says. The bottom line: “You should be concerned about your knee injury if there’s knee swelling,” she says. “That would suggest that there’s something going on within the joint, like a ligament tear or a meniscal tear, or perhaps some sort of cartilage injury. You should probably see your doctor about that.”

Continued

Ankle and foot injuries

The lower leg is prone to many common injuries, including shin splints, calf strain, Achilles tendinitis, and sprains and fractures.

Ankle sprains are common, Doperak says, causing swelling, bruising, and pain, most often on the outside of the foot. Often, these sprains can be treated at home with rest, icing and elevating the ankle, and compression, she says. After a serious ankle sprain, a physical therapy program can help rehabilitate the ankle, as well as protect against more sprains, she says. “Work on strength and balance because that can be protective against a future injury.”

Doctors also commonly see stress fractures in the foot, small cracks in the bone when feet repeatedly hit the ground. These stress fractures stem from overuse and can happen in distance runners and basketball players, among others. “Anytime someone starts to get pain in their foot, especially with activity, and it doesn’t seem to resolve, it’s probably worthwhile to have someone look at it and get an x-ray,” Doperak says.

After any kind of ankle or foot injury, “If you can stand within a day or two and put all your weight on your injured ankle or foot, it’s not likely that it’s that badly injured,” Carpenter says. But if you’re still struggling to bear weight on your leg after an ankle or foot injury, see a doctor, he says.

Tips for reducing lower body injuries

The legs are athletic workhorses, prone to injuries from overuse and accidents. The University of Pittsburgh’s Center for Sports Medicine offers the following advice to help protect the hips, knees, ankles, and feet during sports and exercise:

  • Wear proper footwear for an activity, such as running shoes for running and basketball shoes for basketball.
  • If you have flat feet or high arches, wear shoe inserts to support your feet. You may need to wear the inserts for brief periods of time at first, because it may take a couple of weeks to become accustomed to wearing them.
  • Tape or brace your ankles for more stability.
  • Before you exercise, always warm up and carefully stretch the muscles needed for certain exercises or sports. Be sure your muscles are warm before you stretch, because cold muscles are more prone to injury, according to some studies.
  • Start training slowly and increase the intensity of your workouts gradually; don’t take part in activities above your skill level.
  • Avoid running on uneven surfaces or trail running.

WebMD Feature Reviewed by Brunilda Nazario, MD on September 24, 2010

Sources

SOURCES:

James E. Carpenter, MD, chairman and associate professor in the department of orthopedic surgery at the University of Michigan, and a team physician.  

Jeanne Doperak, DO, sports medicine physician; assistant professor, University of Pittsburgh School of Medicine.

University of Pittsburgh Medical Center Sports Medicine: “Lower Leg, Ankle and Foot Injuries”

Merck Manual: “Knee Injuries”.

Merck Manual: “Lower Leg Injuries”.

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