Sports Injuries - Doctor Q&A

Posted by Dave

I am a tennis coach playing 4 to 6 hours daily.

Over the past year, my front top part of my chest gets very pain for no apparent reason, all the way to the collar bone. It is so pain that it is hard to turn and move, especially at night when lying down.

Sometimes it is the left side, sometimes the right side, and sometimes both at the same time. The pain can last for days....

Can you pls tell me what could be the reason, and what can I do about it to cure it once and for all.

I have been using the relief cream 'bengay', and sometimes 'kefentech' anti-inflammatory plaster, which provide some temporary relief. Are these the best that I can do, or anything else?

I had been to see a doctor once, but all he said was 'just rest', and no need for any medications, etc Look forward to your advise. Thanks

Answered by Dr. Roger Tian, Associate Consultant, Sport Physician, Change General Hospital

It is important to make sure that heart disease, referred pain from the cervical spine and lung disease is not the cause of the pain. More common and “benign” causes of your symptoms include pain from the chest wall muscles or joints between your ribs and breastbone. These may be exacerbated by physical activity and may be due to overuse or biomechanical errors.

Posted by vincenttan

I am 27 years old and injured my right knee during basketball game a few years back. I had ACL reconstruction and meniscus repair done, approximately 3 to 4 years ago. I am done with physical therapy and have returned to sports and regular physical activity. I am able to run, jump, etc.; however after any strenuous activity I get significant pain, mostly in the front part of my knee. The pain is the most intense when my leg is in full extension. I am very worry. What’s the reason that causes the pain? What should I do? And do I need to see a specialist (hopefully not)? I'm hoping that more stretching and strengthening of my leg is the solution.

Answered by Dr. Roger Tian, Associate Consultant, Sport Physician, Changi General Hospital

The pain may be related to your initial ACL injury – research has shown that there is significant cartilage injury, which may only manifest 10-15 years later, resulting from the same mechanism that cause the ACL injury. However, it may not be related, and may be due to overuse of the muscles and ligaments around the knee, or excessive muscle tightness. A doctor or physiotherapist should be able to assist with the diagnosis.

Posted by limsk

I have been running 3-5 times per week (each about 4-5 km) for the past few years. For the past few months , I found that there are pains when I was walking down the stairs. Recently, I found that I do not feel the pain when walking down the stairs, but there are some pains when walking up the stairs. However, I do not experience any pains when running, (I wear knee support in my regular runs and marathon) or other activities. Is it the symptoms of Jumpers Knee ? or some others knee injury ? What is the treatment required ? How to prevent it from getting worst ?

Answered by Dr. Roger Tian, Associate Consultant, Sport Physician, Changi General Hospital

Your symptoms may due to patellofemoral pain syndrome (PFPS), or degeneration of the menisci. Jumper’s knee is a different entity, due to an overuse injury to the patellar tendon. PFPS is usually due to a combination of factors, include muscle imbalance, tightness, running technique and foot biomechanics. These need to be addressed for a successful outcome.

Posted by shalineo

My right knee started to feel pain during my last marathon in Dec 09 at the 19km mark. I continued till 25km when the pain became worse. However, I was able to continue walking and I finished the marathon by walking. I rested for 1 month and starting running again. However, when I increase my distance to 8km, the pain came back. The pain is located at the right middle portion of my right knee. I tried using knee brace and changed the running style to land at my mid-foot but to no avail. What should I do to prevent the pain and increase my distance again?

Answered by Dr. Roger Tian, Associate Consultant, Sport Physician, Changi General Hospital.

Many conditions can cause the symptoms you’ve described. These range from degenerative conditions such as osteoarthritis, overuse injuries such as iliotibial band friction syndrome, patellofemoral pain syndrome and even acute injuries such as a meniscal tear. An examination by a doctor, and radiological imaging may be required to obtain the correct diagnosis and treatment.

Posted by limsk

HI, I am 41 years old male, would like to ask your opinions on barefoot running or in minimal footwear (Vibram Five Fingers). Recently, there has been some research papers suggesting that barefoot running will prevent some injuries on knees, hips and ankles.

Answered by Ms Jessie Phua, Senior Podiatrist, Changi General Hospital

This has been quite a hot debatable topic recently. Barefoot running is not for any or all occasions and is not for everyone. Yes, it may help to prevent some injuries but it also has the tendency to create new set of injuries. Barefoot and shod running will each have its own set of injuries depending on running styles and foot biomechanics.

Posted by lee

My friend asked me to post this question:

1. Tennis elbow- how can I prevent it, and what is the treatment for it.

2. Application of heat rub creams for muscle aches and sprains - is this a good and effective remedy? Are there long term bad effects or side effects? When do I know I need something else instead? Is there a real difference between the off the shelf creams vs the creams you get from/through a doctor? Are such creams good to use as a preventive measure as well, instead of only when you already have the pain? Some of my friends haev the habit of putting on such creams before they start playing each game. Is that alright?

3. What about those 'tapes' people use when they play some games like tennis? Are those good to use? thanks

Answered by Dr Roger Tian, Associate Consultant Sports and Mr Darek Lam, Senior Physiotherapist, Changi General Hospital

(1) It is usually due to an overload or overuse of the wrist extensor muscles. this may be sport or non-sports related eg. repetitively lifting heavy loads (files/boxes or housework. Prevention centres on prevention of the overload through proper lifting/playing technique; using a tennis elbow brace is also useful, as well as regular stretching of the wrist flexors & extensors, as well as strengthening exercises such as wrist curls. Pain relief can be achieved via NSAIDS, ice massage. Corticosteroid injection or extracorporeal shockwave therapy (ESWT) may be useful in recalcitrant cases.

Answered by Dr Roger Tian, Associate Consultant Sports Physician, Changi Sports Medicine Centre

(3) Sports tapes are used to achieve different effects on the joints and muscles. For example, rigid sports tape can be used on the ankle as a way to decrease the serious injuries to the ligaments in an ankle sprain. (ie preventative manner). Taping over tendon can also help to decrease the stress thereby decreasing pain. Kinesio taping has also been reported to aid in muscle recovery and contraction.

Answered by Mr Darek Lam, Senior Physiotherapist, Changi General Hospital

Posted by nelsontan

I have a few questions. When we sprain or strain, Should we Use ice or heat treatment? What’s the difference between these 2 treatments? For each treatment, how long should we applied and What are the precautions that we need to take note. Thanks

Answered by Mr Darek Lam, Senior Physiotherapist, Changi General Hospital

We use ice for acute injuries or up to 48hours after the injury. With injury, the affected area will initially swell as a result of our body's reaction to start the repair process. Excessive swelling will cause additional pain.

Applying ice to the injured area will restrict blood flow to the region. This helps to control excessive swelling and also to reduce the pain. Application of heat has the reverse effect; it will trigger an increase blood flow to the region thereby increasing the swelling.

We should apply ice for 20 minutes every 2 hourly if possible. This should be practised with elevation and compression of the area.

Application of ice directly to the skin may cause ice burns, therefore always make sure that there is a towel between the ice pack and the skin. Apply ice with caution if you have an impaired skin sensation, ie you are not able to tell the difference between hot and cold.

Posted by hweelian

I am a 50+ female with degeneration of lumber spine. I would like to know whether there is any exercise that I can do to prevent further degeneration or slow down the degeneration. Are there any exercise or sports that I have to refrain from doing.

Answered by Mr Darek Lam, Senior Physiotherapist, Changi General Hospital

Degeneration of the spine is a natural process of aging and it may not neccesary cause pain.

Good healthy spine care starts with proper posture (ie sitting) and correct ergonomics during daily task (ie lifting of groceries). Exercises targeting the core muscles of the trunks are generally useful to maintain a healthy spine.

The core muscles are a group of muscles that surrounds our trunk forming a natural corset that protects our spine and helps us to maintain a good posture. These muscles may get weaken if you have a history of back pain or if you adopt a poor posture. A weaken core muscles may place the spine under more stress.

Hence exercises targeting specific core muscles will be useful to strengthen them again. Speak to a physiotherapist and he/she should be able to advise you more about the specific muscles that you need to train.

Most exercises/sports are suitable if you have good awareness of your core and posture but practice caution when doing very high impact sports eg. Marathon running.

Posted by rachel

I am lady in my mid 40s. I used to be very active when young - into competitive sports,etc. But. now I have been sedentary for many years now. Unfortunately, must admit that have since grown a bit overweight too as a result. Recently, I made a vow to try to get back to some level of fitness, and have been going for walks, slow jog on the pavement or the gym treadmill. However, funny thing is I am feeling a slight creak and pain on both my knees - near the top part - when I walk up or down the stairs. It comes on and off, not all the time. I've read that I should do some resistance training to strengthen the thigh muscles. Is that what I should do? I sure hope its not osteo-athritis(?) or some other cartilage/tendon problem? Surely I am too young for that? Pls advise. Thanks much

Answered by Mr Darek Lam, Senior Physiotherapist, Changi General Hospital

You have likely overstressed your knee caps; this condition is called runner’s knees.

Our knee cap is this piece of bone that sits in front of the knee. The underside of the kneecap (the cartilage) can be place under a lot of pressure when we run, squat or climb up/down stairs. More so if we suddenly increase the amount of activity at one go.

Tight quadriceps muscles, weak VMO muscles (the inner portion of the quadriceps), weak buttocks muscles or even a flat foot can increase this stress on the knee cap many folds.

A physiotherapist will be able to assess which of the above is/are the main problem(s) contributing to your knee pain.

Meanwhile, try to decrease your amount of jogging/ walking by 50% for now and spend a week doing regular stretching to the quadriceps, hamstrings and calves. Hold the stretching position for 30seconds and do 3 times. Visit www.sportsmed.sg to learn how to perform the stretches.

If your symptoms still persists, please seek early treatment as it can prevent more serious injuries to your joints.