Common Basketball Injuries:

 Jumper’s knee - Jumper’s knee, or patellar tendonitis, is an overuse condition that causes pain and aching in the front of the knee just below the kneecap.  The pain is worse with running and jumping activities, but if severe, can also cause pain with daily activities.  Usually there is no specific injury, but a gradual onset and worsening of pain.  The treatment is a period of rest and activity modification (decrease jumping) as well as a thin brace which is worn under the kneecap to take some of the pressure off the attachment of the tendon at the kneecap.  Other treatments include anti-inflammatory medications and physical therapy focusing on a special kind of exercises called “eccentric exercises” which strengthen the tendon while lengthening it.  If these therapies are not successful, an athlete may be treated with Platelet Rich Plasma injections, or PRP.  This is a technique in which the athlete’s own blood is drawn and then spun in a centrifuge to separate it into different components, and the plasma layer is isolated and injected into the tendon to promote healing.  Return to play is variable for this condition, and largely depends on pain level.  In mild to moderate cases, the athlete may not need to sit out at all, and may play through pain.  However in severe cases where pain limits the athlete’s ability to function at a high level, a period of relative rest may be beneficial.

 

ACL tear - The anterior cruciate ligament (ACL) is one of the main stabilizing ligaments in the knee, and it is the most commonly torn ligament in the knee.  It prevents the thighbone (femur) from moving forward on the shinbone (tibia).  It may be torn by pivoting and twisting the knee, or by hyperextension.  Landing awkwardly from a jump may also result in a torn ACL.  Symptoms include hearing or feeling a pop in the knee, swelling in the knee, pain, and a feeling of instability, especially with side to side movement.  The knee may “give way” or “buckle” with weight-bearing.  An athlete in a sport which requires pivoting, cutting, or jumping requires surgical reconstruction to prevent recurrent episodes of instability and further knee damage such as meniscus tears and cartilage damage.  The surgery involves reconstructing a new ACL from either the athlete’s own tissue or donor tissue from a cadaver.  The rehabilitation process after surgery takes several months, and return to play depends on the type of surgery and the sport, however on average the recovery time is 7 to 10 months.

Women are more likely to tear their ACL than men for a number of reasons.  One is the anatomical difference in the knee-joint, the space where the ACL sits is narrower in women, and so the ligament has less room when the knee is hyperextended or twisted and therefore more prone to injury.  Another reason is the alignment of the female knee as compared to the male knee.  Women in general have wider hips and therefore place increased stress on the ACL when the knee is twisted.  Additionally there are hormonal differences in women which may make the ligaments looser and more prone to tearing.  Lastly, an important factor in ACL injury is conditioning and muscle strength of the muscles surrounding the knee.  There are a number of conditioning programs specifically designed to reduce a female athlete’s risk of ACL tear.

 

Ankle sprain - The ankle is stabilized by 3 ligaments on the outside and one large ligament on the inside of the ankle joint.  The ligaments on the outside of the ankle are most commonly injured.  These ligaments can be stretched or torn with a roll, twist, or misstep of the foot.  The symptoms include swelling, pain, and decreased range of motion.  After a sprained ankle, the athlete is at increased risk for future sprains.  The treatment is rest, ice, compression, and physical therapy to strengthen the muscles of the foot and ankle, focusing on balance.  The recovery time is variable depending on the severity of the sprain.  Mild sprains recover within a few days, moderate sprains normally recover in 1-3 weeks (but may require protective bracing for 5-8 weeks).  Severe sprains may take 6-12 months to fully recover, although return to sports is generally much sooner.  Only the most severe and unstable ankle sprains require surgery. Ligament instability reconstructions for the ankle require three to four months to fully heal, with full strength and sport activity occurring closer to five to six months. This comes with extensive physical therapy and training for balance, agility, and conditioning.

 

Achilles Rupture - The Achilles tendon attaches the calf muscle to the heel.  It may be torn during a forceful contraction of the muscle such as a quick sprint or jump.  The athlete may feel a sudden, sharp pain in the back of the leg.  Symptoms include swelling, pain, and a defect in the area of the tendon.  A complete rupture may either be treated conservatively or with surgery.  Conservative treatment involves serial casting and bracing with the toe pointed down which allows scar tissue to form in the tendon gap.  This is followed by the use of heel lifts and physical therapy.  Surgical repair involves sewing the two torn ends together, and is also followed by a period of protective bracing and physical therapy.  Athletes and highly active individuals are treated with surgery at an increased rate, and this is mainly due to the increased strength of the repair compared to non-operative treatment.  However, newer studies are revealing over-all outcomes may be similar between people with surgical repair versus those treated without surgery.  Return to play after surgical repair is 4-6 months, and return to play after non-operative treatment may take up to 1 year.

 

Finger injuries - Finger injuries are common in football, and may include dislocations, fractures, or soft tissue injuries.  When the finger is forcefully jammed or hyperextended, it may dislocate (or come out-of-place) and requires manipulation to restore it to its normal position.  Symptoms include pain, swelling, and visible deformity.  Dislocations may also be associated with finger fractures (or broken bones), and depending on the location and severity, may require surgery.  Another common finger injury is called Mallet Finger.  This type of injury results from forced flexion while the finger is extended, which tears the extensor tendon (which is responsible for straightening the tip of the finger).  After this injury the athlete is unable to straighten the tip of the finger.  This is usually treated with a splint to keep the finger straight for several weeks.  If the injury is associated with a fracture, or if splinting is unsuccessful, this may require surgery.  “Jersey Finger” is another common injury that results from hyperextension while the finger is flexed, such as when an athlete grabs another player’s jersey and the finger is pulled away.  This tears the flexor tendon (which is responsible for curling the fingertip towards the palm).  This injury may require surgery to heal correctly.

 

Concussion - A concussion is a traumatic brain injury.  It may be caused by a blow to the head or by being violently shaken.  It is not necessary to have loss of consciousness.  The symptoms of a concussion may include any of the following:  Headache, nausea, vomiting, dizziness, sensitivity to light or sound, mental fog, drowsiness, amnesia, fatigue, concentration problems, irritability, sleep disturbances, blurred vision, depression, poor balance, and ringing in the ears.  If an athlete has a very short period of symptoms such as a few seconds to minutes of blurred vision, headache, or loss of balance, but fully recovers all these functions after a few minutes, this athlete will most likely have a speedy recovery. If an athlete has more extreme symptoms or a longer time of symptoms, for example; loss of consciousness for several seconds, retrograde amnesia where the athlete can’t remember events before the game, and prolonged ability to think clearly and quickly, this athlete will have a much longer time frame for recovery. After a concussion, the chemicals in the brain are altered and it may take several days to return to its normal state, however recovery time is variable.  During this time the brain is vulnerable to subsequent injury.  The treatment of a concussion is physical and mental rest until the symptoms resolve.  After an athlete has sustained a concussion he is at increased risk for future concussions, and multiple concussions may lead to permanent brain impairment.  If a second concussion is sustained before the symptoms of the first concussion have resolved, it may result in rapid and fatal brain swelling, called “Second Impact Syndrome.”  For this reason it is important for the athlete to not return to play until all symptoms have resolved and cleared by a physician. Return to play is often very hard to predict, and as mentioned above, will be determined by the degree of symptoms and how long they last. Concussions in the mildest form can keep an athlete out of competition for one week, and in the more severe form can be season ending injury.

 

Stress fracture - A stress fracture is a partial bone fracture or microfractures resulting from repetitive forces or microtrauma.  Risk factors include overuse, lack of conditioning or abrupt increase in activity level, inappropriate footwear, hard training surface, as well as nutritional deficiencies, low bone mineral density, and abnormal alignment (low or high arches).  Some ways to prevent this injury are gradual increase in activity, adequate rest and nutrition, and proper footwear.  Stress fractures are more common in women, and most often occur in the lower leg and foot.  Symptoms include pain with activity, which subsides with rest.  If unrecognized, a stress fracture may worsen and progress to a fracture.  The treatment is rest, but depending on the location and severity, treatment may also require crutches or a walking boot or a cast for a short period of time.  Return to play is permitted once the fracture has completely healed and the athlete is pain free.

 

MCL tear - The Medial collateral ligament is located on the inside of the knee which supports the knee in side to side stability.  This ligament may be stretched or torn by a blow to the outside of the leg while the knee is bent.  The symptoms include swelling, a pop, and pain in the inside of the knee.  Often this ligament heals on its own, however in severe cases it may require surgery.

 

Meniscal tear - The meniscus is a C-shaped cartilage between the bones in the knee which acts as a shock absorber.  This may be torn with a pivoting and twisting injury.  Symptoms include a popping sensation, swelling, locking, giving way, pain, and inability to straighten the knee.  This is frequently associated with other injuries in the knee, such as ligament tears or cartilage damage.  This injury typically requires arthroscopic surgery, which means the surgeon will use a small camera to look into the knee joint and make only small portal incisions about the knee.  The meniscus tear may either be repaired (by sewing the tear together) or cleaned out (by removing the torn flap of tissue).  The recovery is variable, depending on the type of surgery performed.

 

 

Hamstring strain - The hamstring refers to the large muscle group located in the back of the thigh.  They may be pulled or excessively stretched, or even torn, with sprinting.   Symptoms include sudden and severe pain that occurs while exercising, along with bruising, swelling, or weakness.  The pain is located in the back of the thigh and may radiate to the buttock or the back of the knee.  The treatment depends on the severity of the tear.  If the hamstring is partially torn, it may heal with rest, ice, and anti-inflammatory medications.  If the hamstring is completely torn at its attachment from the bone it will require surgery to repair.  The return to play is variable, depending on the severity of the injury, and may take weeks to months.  If surgery is required, the recovery time usually 6 months (for a tear at the pelvis) or 3 months (for a tear at the knee)

 

 

Common Football Injuries head to toe:

Head

Concussion - A concussion is a traumatic brain injury. It may be caused by a blow to the head or by being violently shaken. It is not necessary to have loss of consciousness. The symptoms of a concussion may include any of the following: Headache, nausea, vomiting, dizziness, sensitivity to light or sound, mental fog, drowsiness, amnesia, fatigue, concentration problems, irritability, sleep disturbances, blurred vision, depression, poor balance, and ringing in the ears. If an athlete has a very short period of symptoms such as a few seconds to minutes of blurred vision, headache, or loss of balance, but fully recovers all these functions after a few minutes, this athlete will most likely have a speedy recovery. If an athlete has more extreme symptoms or a longer time of symptoms, for example; loss of consciousness for several seconds, retrograde amnesia where the athlete can’t remember events before the game, and prolonged ability to think clearly and quickly, this athlete will have a much longer time frame for recovery. After a concussion, the chemicals in the brain are altered and it may take several days to return to its normal state, however recovery time is variable. During this time the brain is vulnerable to subsequent injury. The treatment of a concussion is physical and mental rest until the symptoms resolve. After an athlete has sustained a concussion he is at increased risk for future concussions, and multiple concussions may lead to permanent brain impairment. If a second concussion is sustained before the symptoms of the first concussion have resolved, it may result in rapid and fatal brain swelling, called “Second Impact Syndrome.” For this reason it is important for the athlete to not return to play until all symptoms have resolved and cleared by a physician. Return to play is often very hard to predict, and as mentioned above, will be determined by the degree of symptoms and how long they last. Concussions in the mildest form can keep an athlete out of competition for one week, and in the more severe form can be season ending injury.

Stinger/ Burner - A stinger or burner refers to an injury of the nerves in the neck. These nerves are stretched when the shoulder is depressed and the head is pushed up and away from that side. Symptoms include numbness or tingling down the arm, weakness of the arm, and pain or an “electric shock” shooting down the arm. These symptoms are temporary and normally last a few seconds to minutes, however in some people they may last longer. No treatment is typically required, and normally these injuries heal without causing permanent damage. Return to play is allowed once the symptoms have resolved and the athlete has full range of motion and strength of the arm. Most stingers will not cause a player to miss much time away from the game, but if a player has a documented history of repeat singers or burners, they may be at increased risk for long term damage, and may elect complete rest from contact sports with neurologic evaluations to determine exact location and degree of nerve injury. If weakness and numbness persists, this may also force the player to remain on injured reserve for the rest of the season.

Shoulder

A-C separation – AKA “shoulder separation”. The A-C, or acromio-clavicular joint, is the joint above the shoulder that consists of the collarbone (clavicle) and top of the shoulder blade (acromion). One or more of the ligaments that hold this joint together may be stretched or torn due to a fall on the shoulder or a direct blow. The symptoms include pain in the shoulder, decreased range of motion, and a bump at the top of the shoulder. A mild (grade 1) form of this injury is a partial tear to one of the ligaments. A moderate (grade 2) form is a complete tear of one of the ligaments, leaving the others intact. A more severe (grade 3) form is a complete tear of all of the ligaments. The most common forms are grade 1 and 2, which typically do not require surgery, and are treated with rest, ice, and pain medications. Return to play for a grade 1 separation is approximately 2 weeks, and for a grade 2 separation approximately 6 weeks. A grade 3 separation results in a noticeable deformity of the AC joint, and may take up to 12 weeks to heal. These return to play guidelines are based on standard recommendations, but for competitive athletes, especially in contact sports, they may return to play in the same game for grade one and grade two A-C separations. On the sideline, the decision to return to play is based on the athlete’s pain tolerance, and ability to maintain normal shoulder strength and range of motion.

Shoulder dislocation
 - A shoulder dislocation occurs when the upper arm (humerus) comes out of the socket (glenoid). This can be due to a forceful blow or extreme rotation of the arm. The shoulder is a ball and socket joint, and is the most mobile joint in the body. Because of this, however, it is also the most unstable and vulnerable to dislocation. After this injury, the athlete is at increased risk for future dislocations because the capsule (soft tissue that helps to keep it in place) gets stretched out. The shoulder may dislocate forward, backward, or downward. Symptoms of a shoulder dislocation include intense pain, inability to move the shoulder, and a visibly deformed or out of place shoulder. Associated symptoms may include numbness or tingling down the arm and weakness of the arm. Treatment is to gently manipulate the arm back into place. This may require a sedative. Once the shoulder is back in place the severe pain should subside immediately. The shoulder may also partially dislocate, which is called a subluxation. In this case, the shoulder moves partially out of socket, and pops back into place on its own. Treatment after a dislocation or subluxation includes physical therapy to strengthen the muscles and tendons around the shoulder that help to hold the shoulder in place. There may be other injuries associated with a shoulder dislocation. The cartilage, which lines the socket (labrum), may be torn, or there may be a small chip fracture of either the upper arm or the socket. Additionally, the blood vessels and nerves in the area may be injured. Sometimes these associated injuries may require surgery. Additionally, recurrent shoulder dislocations that do not respond to therapy (shoulder instability) may require surgery to tighten the capsule and prevent future dislocations. A first time shoulder dislocation may recover after 4-6 weeks of therapy. Due to the high rate of dislocating again after the first time, some athletes elect to repair the torn labrum and tighten the shoulder right away. Recovery after surgery takes approximately 3 months for non-contact sports, and 5-6 months to return to contact sports. For athletes with loose ligaments and recurrent shoulder dislocations, they may continue to play during the season with a shoulder brace for some mild protection and restricted range of motion. If they dislocate again, or have subluxations that prevent the athlete from playing at their maximum potential, some elect to undergo the surgery immediately after the season.

Elbow

Elbow injuries in football - Elbow injuries in football are less common than knee, ankle, wrist and shoulder injuries. The elbow joint is very complex, as three separate bones come together to form one large joint, with three separate joints or articulations within the main joint. The elbow joint is also a very stable with a relatively narrow range of motion. In comparison, the shoulder is a very open joint with a wide range of motion.
One study published over a decade ago specifically looked at elbow injuries in the N.F.L. over a five year - five season time period. They found that most (77%) injuries were regarded as general “sprains”. These injuries occur when the ligaments get stretched out a little or the bones collides with each other causing a bone bruise. Elbow sprains will require treatment in the form of maintaining range of motion and strength, local modalities such as heat, ice, ultrasound, and electric stimulation. Supportive braces or sleeves are often used in play. These injuries do not generally result from any time lost from play, but may require several weeks to months for full return to pre-injury strength. Most athletes can play with 85-90% strength without affecting their ability to play at a maximum level without increased risk of re-injury. Of these, around 55% were hyperextension injuries where the arm gets straightened out beyond its normal range, 3% lateral collateral ligament injuries, 21% general or non-specific sprains, and 20% medial collateral sprains.
In terms of the medial collateral injuries, this is the main stabilizing ligament or structure on the inside of the elbow and very important in overhead athletes and throwers. These injuries typically occurred while the hand was planted on the ground and the elbow had a twisting force. Lineman had the highest rate of these injuries, followed by wide receivers. Although most baseball pitchers don’t do well with bad medial collateral tears, and in fact, a lot of them end up getting surgery to reconstruct this ligament, in football, most of these players did well with very little games missed and no need for surgery.
Another, and more devastating injury involved dislocations or partial dislocations (called subluxations) of the elbow. These occurred around 18% of all elbow injuries in the N.F.L. studied during this five year time period. Elbow dislocations can be considered “simple”, in which no bone fractures are involved but the ligaments that support the elbow are torn and the bones separate from their normal position. These may result in significant swelling and stiffness, and depending on the player’s position, may lead to time off for several weeks. If the dislocation involves a fracture, this may be a season ending injury, especially if the fractured bone requires surgery to place back in place. Even in the best of scenarios, it can take an athlete several months to achieve full strength and range of motion, and be back to pre-injury form.

Reference: Acute elbow injuries in the National Football League. J Shoulder Elbow Surg. 2000 Jan-Feb;9(1):1-5.

Hand/Wrist

Finger injuries - Finger injuries are common in football, and may include dislocations, fractures, or soft tissue injuries. When the finger is forcefully jammed or hyperextended, it may dislocate (or come out of place) and requires manipulation to restore it to its normal position. Symptoms include pain, swelling, and visible deformity. Dislocations may also be associated with finger fractures (or broken bones), and depending on the location and severity, may require surgery. Another common finger injury is called Mallet Finger. This type of injury results from forced flexion while the finger is extended, which tears the extensor tendon (which is responsible for straightening the tip of the finger). After this injury the athlete is unable to straighten the tip of the finger. This is usually treated with a splint to keep the finger straight for several weeks. If the injury is associated with a fracture, or if splinting is unsuccessful, this may require surgery. “Jersey Finger“ is another common injury that results from hyperextension while the finger is flexed, such as when an athlete grabs another player’s jersey and the finger is pulled away. This tears the flexor tendon (which is responsible for curling the fingertip towards the palm). This injury may require surgery to heal correctly.

Groin/Hip

Hip pointer – A hip pointer refers to a bruise of the hip bone and its surrounding structures. It is caused by a direct blow or a fall onto the hip bone. Symptoms include pain and bruising. The treatment is rest, ice, and anti-inflammatory medications. Return to play depends on the severity of the injury, and may take 2-4 weeks, once full range of motion and strength have returned.

Hamstring strain - The hamstring refers to the large muscle group located in the back of the thigh. They may be pulled or excessively stretched, or even torn, with sprinting. Symptoms include sudden and severe pain that occurs while exercising, along with bruising, swelling, or weakness. The pain is located in the back of the thigh and may radiate to the buttock or the back of the knee. The treatment depends on the severity of the tear. If the hamstring is partially torn, it may heal with rest, ice, and anti-inflammatory medications. If the hamstring is completely torn at its attachment from the bone on the pelvis, and the athlete wants to compete at the same level, it may require surgery to repair. The return to play is variable, depending on the severity of the injury, and may take weeks to months. If surgery is required, the recovery time usually 6 months (for a tear at the pelvis) or 3 months (for a tear at the knee).

Sports Hernia - A sports hernia is actually not a true hernia, and it does not cause a bulge in the groin or testicle. It refers to microscopic tears in the abdominal or groin muscles where they attach to the pubic bone on the pelvis. It is also known as “athletic pubalgia”. Symptoms include severe pain in the groin, which gets better with rest, but returns with sports activity such as sit ups, sprinting, or twisting. Treatment is with rest, anti-inflammatory pain medications, and physical therapy. Many cases resolve after 4-6 weeks of physical therapy, however, if the pain persists, surgery may be required. If surgery is performed, the return to play is around 6-12 weeks after surgery.
Knee

ACL tear - The anterior cruciate ligament (ACL) is one of the main stabilizing ligaments in the knee, and it is the most commonly torn ligament in the knee. It prevents the thighbone (femur) from moving forward on the shinbone (tibia). It may be torn by pivoting and twisting the knee, or by hyperextension. Landing awkwardly from a jump may also result in a torn ACL. Symptoms include hearing or feeling a pop in the knee, swelling in the knee, pain, and a feeling of instability, especially with side-to-side movement. The knee may “give way” or “buckle” with weight bearing. An athlete in a sport which requires pivoting, cutting, or jumping requires surgical reconstruction to prevent recurrent episodes of instability and further knee damage such as meniscus tears and cartilage damage. The surgery involves reconstructing a new ACL from either the athlete’s own tissue or donor tissue from a cadaver. The rehabilitation process after surgery takes several months, and return to play depends on the type of surgery and the sport, however on average the recovery time is 7 to 10 months.

Meniscal tear - The meniscus is a C-shaped cartilage between the bones in the knee that acts as a shock absorber. This may be torn with a pivoting and twisting injury. Symptoms include a popping sensation, swelling, locking, giving way, pain, and inability to straighten the knee. This is frequently associated with other injuries in the knee, such as ligament tears or cartilage damage. This injury typically requires arthroscopic surgery, which means the surgeon will use a small camera to look into the knee joint and make only small portal incisions about the knee. The meniscus tear may either be “repaired” (by sewing the tear together) or “cleaned out” (by removing the torn flap of tissue). The recovery is variable, depending on the type of surgery performed: a meniscal repair typically takes 3-4 months to return to play while a debridement (clean out) return to play may take 3-6 weeks.

MCL tear - The Medial collateral ligament is located on the inside of the knee that supports the knee in side to side stability. This ligament may be stretched or torn by a blow to the outside of the leg while the knee is bent. The symptoms include swelling, a pop, and pain in the inside of the knee. Often this ligament heals on its own, however in severe cases it may require surgery. If no other ligaments are injured, the athlete is braced for four weeks and transitioned back to play with therapy to achieve full motion and strength. This may be an additional two to three weeks. If the MCL is torn with a meniscus or an ACL, this athlete will usually require surgery and will be out for the season.

Knee Contusion or Bruise – Most significant knee contusions are associated with more obvious injuries such as ligament tears. Sometimes, however, the athlete will have significant bone pain right over the ends of the thigh (femur) bone or tibial (shin) bone, which make up the knee joint, and the MRI scan will be negative for any ligament tear. What the MRI scan will show is increased signal seen in classic areas of the bone that represent a collision. A knee contusion or bruise is simply caused by the bones colliding with each other or another object such as a helmet, and with enough force to cause the bones to bleed. These injures often look worse on MRI scan than in reality, but some can linger from a few weeks to several months. For severe bone contusions, athletes should remain off the injured knee while there is still swelling and pain to direct palpation.

Foot/Ankle

Ankle sprain - The ankle is stabilized by three ligaments on the outside and one large ligament on the inside of the ankle joint. The ligaments on the outside of the ankle are most commonly injured. These are called the Anterior Tibial Fibular Ligament and the Calcaneal Fibular Ligament, and they are named based on the bone structures that they connect. They can be stretched or torn with a roll, twist, or misstep of the foot. The symptoms include swelling, pain, and decreased range of motion. After a sprained ankle, the athlete is at increased risk for future sprains. The treatment is rest, ice, compression, and physical therapy to strengthen the muscles of the foot and ankle, focusing on balance. The recovery time is variable depending on the severity of the sprain. Mild sprains recover within a few days, moderate sprains normally recover in 1-3 weeks (but may require protective bracing for 5-8 weeks). Severe sprains may take 6-12 months to fully recover, although return to sports is generally much sooner. Only the most severe and unstable ankle sprains require surgery. Ligament instability reconstructions for the ankle require three to four months to fully heal, with full strength and sport activity occurring closer to five to six months. This comes with extensive physical therapy and training for balance, agility, and conditioning.

High ankle sprain (Syndesmosis injury)– This injury involves a strong ligament that holds the two bones at the bottom of the leg together – the tibia and fibula – and is called the Syndesmosis. If the syndesmosis ligament is torn, this ankle sprain can last longer than a typical “bad” ankle sprain. The recovery can involve a period of non-weight bearing and take twice as long to heal. These injuries can easily sideline an athlete for the entire season.

Turf toe - Turf toe refers to a hyperextension injury to the great toe. It may occur with a fall forward when the toe stays planted on the ground, or while pushing off of the ground. The toe is a hinge joint with tendons on the top and bottom that act as a pulley to move the toe up and down. Turf toe results in a stretching or tearing of the pulley underneath the great toe. A grade 1 injury is the most mild and is caused by a stretching of the tendon and results in pinpoint pain and swelling. A grade 2 injury is a partial tear of the tendon, and causes widespread tenderness, moderate swelling, bruising, and limited and painful toe movement. A grade 3 injury is a complete tear of the tendon, and causes severe tenderness, swelling, bruising, and difficulty and painful toe movement. Although this injury does not sound significant, it can be debilitating because while it is healing, an athlete will not be able to push off of the toes to accelerate, quickly change direction, or jump. The treatment is rest, ice, anti-inflammatory pain medication, and wearing a hard-soled shoe or hard insert to prevent bending at the toe. A grade 1 injury may return to play immediately with a hard insert. A grade 2 injury may require up to 2 weeks of rest before returning to play. A grade 3 injury may require immobilization in a walking boot, and return to play may be several weeks. It has not been unheard of for a lineman to miss a substantial portion of the season due to a grade-three turf toe sprain.

Achilles Rupture - The Achilles tendon attaches the calf muscle to the heel. It may be torn during a forceful contraction of the muscle such as a quick sprint or jump. The athlete may feel a sudden, sharp pain in the back of the leg. Symptoms include swelling, pain, and a defect in the area of the tendon. A complete rupture may either be treated conservatively or with surgery. Conservative treatment involves serial casting and bracing with the toe pointed down which allows scar tissue to form in the tendon gap. This is followed by the use of heel lifts and physical therapy. Surgical repair involves sewing the two torn ends together, and is also followed by a period of protective bracing and physical therapy. Athletes and highly active individuals are treated with surgery at an increased rate, and this is mainly due to the increased strength of the repair compared to non-operative treatment. However, newer studies are revealing over-all outcomes may be similar between people with surgical repair versus those treated without surgery. Return to play after surgical repair is 4-6 months, and return to play after non-operative treatment may take up to 1 year.

LisFranc Injury (Midfoot) – This injury is more rare in sports and can be one of the more debilitating injuries to have. It is usually encountered in traumatic events from car accidents or fall from heights, but with the right torque and velocity, we can see these injuries in the athletic arena. This injury involves the Lisfranc or midfoot region of the foot, and more specifically, the Lisfranc ligament. This ligament is one of the most important structures that hold the foot together and allows it to have strength while pushing off. Injuries to this region of the foot are often seen in football and soccer when someone else falls over the top of the foot while it is positioned or pointing downwards. Injuries to the Lisfranc region can be simple strains all the way to multiple bone fractures and dislocations. Weight bearing or standing XR’s are often required, and sometimes MRI scan and/or CT scan are required to fully understand the injury. If no surgery is recommended, treatment may consist of non-weight bearing for six weeks, followed by progressive weight bearing and strengthening. Close observation is required to ensure the joint does not move out of place. If there is evidence that the Lisfranc ligament is completely torn and joint are out of place, or there are fractures at the Lisfranc joint, surgery is recommended. In any case, these injuries can be quite devastating to an athlete and usually are season ending injuries, with a prolonged and very guarded recovery to get back to pre-injury level of play.

Foot/ankle bone contusions or bruises – These are usually caused by the bones colliding with each other with enough force to cause the bones to bleed. Like in the knee, these injures can linger from a few weeks to several months.

General

Heat Exhaustion - During exercise, heat is released through sweat and evaporation. If these fluids are not replaced, an athlete may become dehydrated. Mild heat illness can result in muscle cramps that are painful muscle spasms and are treated by stretching the involved muscles, and replacement of salt, electrolytes, and water. Moderate heat illness is called heat exhaustion. This is caused by prolonged exercise in extreme heat causing either excessive water loss or salt loss. Core body temperature may reach 104 degrees. Symptoms may include excessive thirst, headache, dizziness, and nausea. Extreme heat illness is called Heat Stroke, in which core body temperature exceeds 104 degrees. Symptoms of heat stroke include confusion, seizures, disorientation, nausea and vomiting, and even death. This is a medical emergency and is treated with immediate immersion in an ice bath and replacement of fluids. Risk factors for heat illness include high humidity (does not allow proper evaporation of sweat and cooling of the skin), wearing dark clothing (which absorbs heat), young age (children are more susceptible than adults), dehydration, inadequate pre-activity hydration, sun exposure, lack of acclimatization (athletes need time to adjust to warmer climates), fever, and sickle cell trait or disease. Prevention begins with understanding the risk factors for heat illness, recognizing the symptoms, and seeking immediate treatment.