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  • Overuse defects

    The major cause of chronic sports injuries is to be seen in misload and overstress, as well as acute damages which have not been cured. But still there is a chance for healing.

    Cartilage defects
    Runner’s knee
    Inflammation of the Achilles tendon
    Stress fracture
    Impingement Syndrome
    Rupture of the rotator cuff

    Cartilage defects

    It is important to cure acute sports injuries because long-term effects and abrasion phenomena may occur. The cartilage – the gliding layer of the joint - is particular at risk. Cartilage cells are rather individual. They need special conditions to survive. If there is a malfunction of the system, they degenerate and die. The result is arthrosis. Especially the knee joint is often affected – particularly after injuries such as a torn meniscus or cruciate ligament rupture.

    Symptoms
    Pain under physical stress and an increasing immobility in the joint are a result of degeneration.

    Therapy (MBST)
    During the last years the nuclear magnetic resonance therapy MBST has proven very successful. This is an electromagnetic stimulation of the body tissue, transmitted through an air coil and similar to radiation. The treatment three-dimensional magnetic fields activate repair mechanisms within the cartilage. This therapy is ideal for arthrosis of all degrees but it can also be employed immediately after an accident or sports injuries and can save the patient from surgery.

    Operation
    Cartilage defects can be treated with a minimal-invasive surgery. Various techniques are available. If the cartilage is missing the exposed bone can be covered with cultivated cartilage cells or by using the so called micro fracturing. To prevent arthrosis even small defects of the cartilage are repaired successful.

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    Runner’s knee

    The unbelievable success of running resulted in a new sports injury, the runner’s knee. The medical term is iliotibial band syndrome (ITBS). This is an overuse during which the kneecap grinds on the lower end of the thighbone. Every fourth runner is affected and women more often than men.

    Symptoms
    Typical is the pain at the passage from the thigh bone to the knee at the outside. Discomfort occurs primarily when walking/running. Over time the knees even hurt when climbing stairs or when sitting with angled legs. The reason for this is a bursitis as result of the overstress.

    Causes
    Malpositions, knock-knees and the wrong style of walking/running can result in a reduction of the tractus iliotibialis.

    Therapy
    During the acute phase an improvement can be achieved by using ice bags and anti-inflammatory medications. For a short time injections with cortisone or anesthetics may be given. The knee should be treated with care. Avoid running for two to three months makes sense. Massages and physiotherapy may loosen and stretch the shortened muscles. The subsequent treatment can be very tedious and time-consuming. Patience is required.

    Prevention
    In the following time an analysis of the physical strain should be carried out, in order to prevent new discomfort. Imperfections of the running style and deformities of the foot (orthopedic inserts!) promote the development of a runner’s knee. If the running shoe does not fit, an unconscious compensation movement and therefore improper loading may occur. It is imperative to perform a digital analysis of the footprint, as well as an analysis of the running style by using video. „Warm-up“and „cooling down“are the most important measures of prevention for runners. Here it is important to stretch especially the outer side of the leg, for example by crossing the legs when standing and leaning forward.

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    Inflammation of the Achilles tendon

    A very common overuse syndrome among runners is the inflammation of the Achilles tendon and the surrounding mucous membrane (Achillodynia). The Achilles tendon is exposed to very high levels of stress. Particularly the dynamic peak loads to which the Achilles tendon is exposed during sports are remarkable. If the Achilles tendon hurts it does not mean that it is ruptured. But Achillodynia could be a preliminary stage for a rupture of the Achilles tendon. Therefore it is not recommendable to delay treatment.

    Symptoms
    The inflammation and thickening of the Achilles tendon may result in pain which occurs under physical stress or during a resting phase at the base of the heel bone.

    Diagnosis
    Typical signs of an inflammation, such as warming, reddening and pain may be diagnosed quickly in an examination.

    Therapy
    Caused by the swelling the tendon does not have enough space in its sliding tube, the tendon sheath. This causes friction which continues to inflict damage on the Achilles tendon. The risk of a rupture increases. There are various possibilities for the therapy of the inflammation of the Achilles tendon. By all means the foot must be immobilized. An anti-inflammatory and pain relieving medication, as well as an ointment relieve the inflammation. Cryotherapy and heat therapy have both proven successful. Physical measures promote the healing process. As a rule Achillodynia may be cured by using conservative therapies. In case of chronical inflammation an endoscopic procedure has proven itself: First the tendon sheath will be splitted and the tendon is relieved from scarring and damaged tissue. After about ten days a nuclear magnetic resonance therapy is performed, in order to stimulate the metabolism of the tendon cells and therefore to accelerate their regeneration. With this treatment also the Achilles tendon is strengthened and a recurring inflammation is prevented. A heel cushion in the shoe provides pressure relief.

    Prevention
    The causes for Achillodynia are multiple. Extreme physical stress, shortened calf muscles, unsuitable running shoes, as well as malpositions of the foot can promote the inflammation of the tendon. By means of a biomechanical analysis of the running style, a misload can be determined. Orthopedic inserts or training of the leg axis may solve the problem. Regular stretching of the calf muscle and good warm-up training may also help preventative against inflammations of the Achilles tendon.

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    Stress fracture

    This is known by football players and runners: The stress fracture was in the past a less frequent sports injury which occurs nowadays more frequently because of an increasing sports activity. As a rule a bone breaks under heavy violence. But in case of the stress fracture, recurring lower levels of physical stress are the cause. In the beginning these result in a painful reaction within the bone or bone marrow. From the microscopically small cracks a break develops. Eventually the bone breaks without impact of a high external force. Therefore this injury is also called „fatigue fracture“. The metatarsal bones and the shin bone are affected most.

    Symptoms
    Dull or sharp pain in the area of the middle foot, especially if pressure is put on the foot. This is considered to be an alarm signal. The foot can swell.

    Diagnosis
    In the x-ray image the preliminary stage of the fracture is shown as thickening of the bony wall. During magnetic resonance imaging the liquid within the bone is shown as so called bone marrow oedema.

    Therapy
    During the acute phase the fluid transport from the affected region should be stimulated by lymph drainage. Pain relieving medication and relieving the foot may ease the acute pain further. Under ordinary circumstances the stress fracture is healing under rest (and possible immobilization with a splint or a plaster bandage). Surgery is only necessary in rare cases. But it is absolutely essential to start an analysis of the cause of injury.

    Prevention
    The physical overburdening which eventually resulted in a stress fracture has to be determined. A digital measuring of the weight bearing zones of the foot may explain such misloads. A gait analysis and running analysis, as well as the provision of orthopedically constructed inserts are important preventative measures. By means of a better load distribution at the foot a recurring stress fracture may be prevented. For professional athletes and hobby athletes it is of great importance not to pass the acceptable limits of physiological stress during training.

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    Impingement Syndrome

    The shoulder joint is a very complex structure and susceptible to injuries. The movement in the shoulder is mainly performed by a group of muscles, which are summarized under the term „rotator cuff“. Essentially these are the tendons of those muscles which are attached on a wide surface to the shoulder blade and lead towards the humerus head. These muscles also centre the humerus head within the very low socket at the shoulder blade. Thus there exists the right balance of the structures. If the balance is disturbed the humerus head moves in the wrong direction. This may cause inflammations and in the worst case even grinding and a rupture of a tendon. This inflammation is called „Impingement“of the shoulder. This impingement is very painful and as a result the patient is not able to raise the arm at all. Caused by these long-lasting inflammations the metabolism within the shoulder is thrown out of balance. Calcium crystals can form a real calcium depot and thus reduce the space in the socket further. This also affects the elasticity of the tendons to a high degree. Mostly the tendon of the upper musculus supraspinatus is affected. Explosive movements of the arm which are permanently performed forward and overhead may cause Impingement. Tennis and golf increase the risk.

    Symptoms
    The pain occurs typically in the evening and during the night. It is painful to sleep on the affected side. The ability to move is restricted.

    Diagnosis
    During examination a significant weakening of muscular strength is evident. A calcium deposit becomes apparent in the radiograph. The magnetic resonance tomography shows the exact extent of the damage.

    Therapy
    Cortisone can be injected against the acute inflammation. But this does not relieve the narrowing. Only in case of an Impingement which was caused by muscular tension, the injection may solve the problem permanently. Anti-inflammatory and pain relieving medications, as well as infiltrations may have the same effect. A defective posture of the shoulder girdle (which promotes the narrowing!) is corrected under the guidance of a physiotherapist. The patient can still do sports but a reduction of exercises in the area of the shoulder is recommendable. Especially overhead movements should be avoided.

    Prevention
    With specific exercises and muscle training the position of the humerus head should be improved. In doing so the subacromial space for the tendons increased. Overexertion – for example during strength training – may promote Impingement caused by a muscular imbalance.

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    Rupture of the rotator cuff

    In the most extreme case an Impingement can become chronic and may cause a rupture of the rotator cuff as a result of the degeneration of the weakened supraspinatus tendon. If one or more tendons are ruptured, surgery is required for the athlete. During an arthroscopic surgery the torn tendons are sewn or fixated to the bone by using specific anchors. The bottom of the bone will be flattened.

    Symptoms
    The pain can affect area from the upper arm to the hand. But usually the pain can be located in the shoulder and the side of the upper arm.

    Therapy
    The rupture of the tendon can be treated basically without surgery. The conservative therapy with anti-inflammatory medications, infiltrations and physiotherapy may achieve an improvement, but the tendons will not heal up. Therefore the ability to move the shoulder joint may remain limited.

    Aftercare
    A physical therapy is required and can take up to six months. Sports with overhead activities or strength training should be performed after six months at the earliest.

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