How to Prevent Ankle Injuries

How to Prevent Ankle Injuries

Ankle injuries can keep you from enjoying the activities you love. If you participate in any of these sports or athletic activities that put players at a higher risk of damaging the joint, here are the steps you can take to avoid getting hurt.

For many athletes, ankle injuries are a common cause for concern. While most sprains can heal in less than two months through rest, icing, and bracing, that still means time off from playing sports and enjoying other aspects of an active lifestyle.

In addition to the pain and discomfort they cause, sprains can put you at risk for developing more serious conditions. Even after they heal, they can leave the ankle weaker and more prone to dislocations, fractures, or osteochondral defects formed by cracks in the cartilage.

Whether you’ve had sprains before or simply want to avoid this painful condition, careful prevention is key to maintaining your health and continuing to enjoy your favorite sports. Here’s what it takes to avoid ankle injuries while playing soccer, running, and more.

SOCCER

In sports and in life, it’s a good idea to look before you leap. Aside from being on the receiving end of an unexpected slide tackle, the most common way to sprain your ankle is jumping — perhaps for a contested header — and landing badly. If you jump in a crowded area, spare some attention to where you touch down. While in competitive leagues it’s expected that you go for every ball you can, weekend warriors might exercise some caution and avoid risky jumps.

Soccer is a sport of quick acceleration, and the rapid directional changes it requires can also cause ankle injuries. Preemptive balance training can help you avoid sustaining any damage. This training consists of exercises like standing on one foot with your other ankle behind your back, catching and throwing a ball while on one foot, and one-legged squats.

BASKETBALL

As much as fans and announcers talk about “ankle-breaking” ball handling, the main cause of ankle injuries in basketball is actually rebounds. Be careful of risky leaps, whether it’s a heavily covered jump shot or a battle at the rim. Similar to soccer, landing on an uneven surface after a jump causes the most problems. So if the area is too congested, don’t be afraid to fall.

In addition, the stiff floor and rapid pivots of basketball are a recipe for ankle strain. Basketball shoes are designed with this in mind, so someone playing on a competitive team can take comfort in that layer of ankle protection. However, if you’re playing a pickup game in a regular pair of sneakers, watch out for quick stops and turns.

FOOTBALL

In any sport, it’s important to know your risks — and in football, those can vary by position. The causes of injury for a lineman are going to be different from those for a receiver or defensive back. For open-field positions that make rapid cuts and go up for the ball, the primary risk is landing unevenly. For those closer to the line of scrimmage, the bigger worry is getting forced into an unnatural position by the weight of a pileup.

Football is a contact sport, so some risks must be accepted. Still, a consistent stretching and strengthening regimen can go a long way. Jumping and skipping exercises can both strengthen the ankle and prepare it to absorb the impact of hitting the ground with force. Band exercises are useful for stretching your ankle beyond the normal pressures of practice, and could make all the difference if your foot ends up lodged at an awkward angle.

DANCE

Dancing is rigorous exercise, and ballet in particular puts the ankles under intense strain. As you learn new routines, it’s vital to gradually strengthen and work up to moves that force your feet into more difficult contortions. It is also important to strike a balance between mastering a move and overworking the muscles of the foot.

In what is already a standard practice, wrapping satin shoe ribbons around the ankle while dancing en pointe will help keep the foot stable in this elongated, high-pressure position. Although less research has been done on other forms of dance, proper warm-up, strengthening, and stretching have all proven helpful for injury prevention among ballet dancers.

RUNNING

Beyond buying sturdy shoes, choosing the right surface is key to safe running. By sticking to flat surfaces, you can decrease the risk of rolling your ankle. If you prefer running trails, then make sure not to lose sight of the changes in terrain. While some ankle injuries come from missteps and twists, others can stem from repetitive pounding. When you start to feel consistent pain, it’s time to take a break. Stretching before and after running sessions is also useful.

If you’re suffering from an ankle injury, consult an orthopedic specialist to learn about your treatment options. At Comprehensive Orthopaedics, our team of ankle specialists —Dr. Engel,  Dr. Nute and Dr. Lasee — have helped countless patients get back on their feet and return to the activities they enjoy. Contact us today to take your first step on the road to recovery.

Health Tip: When To Call Your Doctor If You Have Lower Back Pain

Health Tip: When To Call Your Doctor If You Have Lower Back Pain

Few people go through life without having episodes of lower back pain.

For some people, though, it’s a daily struggle.

The American Academy of Family Physicians says back pain may be controlled by maintaining proper posture and sitting, lifting, standing and exercising properly.

Others have to seek medical attention for relief. The academy mentions these warning signs that you should see a doctor about your aching lower back:

  • If pain radiates down your leg below your knee.
  • If your leg, foot or groin feel numb.
  • If you have fever, chills, nausea, vomiting, stomach pain or weakness.
  • If you have difficulty going to the bathroom.
  • If the pain was caused by an injury.
  • If pain is so intense that you can’t move.
  • If your pain doesn’t improve or gets worse after two weeks.
  • If you notice any muscle atrophy.
Too Much or Too Little Weight May Worsen Rheumatoid Arthritis

Too Much or Too Little Weight May Worsen Rheumatoid Arthritis

Obesity may accelerate and amplify the crippling symptoms of rheumatoid arthritis, new research suggests.

Conversely, the researchers also found that unexplained weight loss might also signal problems for these patients, because it could mean that they’re at greater risk for disability.

“While patients and rheumatologists may be focused mostly on disease activity, we should also consider this common condition [obesity], which can contribute to problems that are usually attributed to the arthritis itself,” said study author Dr. Joshua Baker.

“In addition, unintentional weight loss should alert us that the patient may be becoming frail and is at risk for developing new disability,” he added. Baker is an assistant professor of medicine at the University of Pennsylvania’s Perelman School of Medicine.

Rheumatoid arthritis is an autoimmune condition. It develops when immune cells that normally fight germs attack the lining of the joints, or cartilage. This causes the joints to swell and the surrounding bones, ligaments and muscles to gradually erode. Rheumatoid arthritis worsens over time, often leading to disability.

For the study, Baker and his colleagues looked at the effects of obesity on the progression of rheumatoid arthritis in just over 25,000 people with the disease.

The investigators found that the disease advanced more quickly among those who were very obese. This was true regardless of the level of inflammation in their joints.

In addition, people who were thin but lost weight without trying also became disabled more quickly.

The study was published April 30 in the journal Arthritis Care & Research.

“So, this study suggests that patients with rheumatoid arthritis and obesity would benefit from intentional weight loss through a comprehensive management strategy,” Baker said in a journal news release.”

“However, when we see that someone is losing weight without trying, it’s probably a poor prognostic sign, especially if they are already thin,” he added.

Although the study could not prove a cause-and-effect link, the researchers suggested that new treatments and strategies to help people maintain a healthy weight might help prevent disability among people with rheumatoid arthritis.

And, Baker’s team noted, the findings could help doctors recognize signs of frailty among their rheumatoid arthritis patients who may benefit from strength training and physical therapy.

More information

The Arthritis Foundation has more about obesity and rheumatoid arthritis.

SOURCE: Arthritis Care & Research, news release, April 30, 2018

4 in 10 People Will Suffer Arthritic Hands Over Lifetime

4 in 10 People Will Suffer Arthritic Hands Over Lifetime

If you have stiff, aching fingers and hands, you’re not alone — a new study reports that 40 percent of people will be affected by the pain of arthritis in at least one hand.

The rate seen in the new research is “just slightly below the percentage of osteoarthritis seen in knees and is significantly greater than that seen in hips,” noted Dr. Daniel Polatsch. He’s co-director of the New York Hand & Wrist Center at Lenox Hill Hospital in New York City.

Arthritis “affects hand strength and function and causes difficulty doing activities of daily living,” Polatsch said.

The study team was led by Jin Qin, of the Arthritis Program at the U.S. Centers for Disease Control and Prevention. The researchers looked at 1999-2010 data on more than 2,200 people from North Carolina. All people in the study were aged 45 or older.

The information collected included symptoms the participants reported as well as hand X-rays.

Women were at higher risk than men, with nearly half of women (47 percent) developing hand arthritis. Only about a quarter of men had hand arthritis, Qin’s team said. Whites were more prone to the ailment than blacks, with rates of 41 percent and 29 percent, respectively.

Excess weight was also a risk factor for hand arthritis. Lifetime risk among obese people was 47 percent, compared to 36 percent for non-obese people, the study found.

Dr. Steven Carsons is chief of rheumatology at NYU Winthrop Hospital in Mineola, N.Y. He said the finding that hand arthritis is more common in women “has been long thought to have a genetic and hormonal basis.”

The obesity link is more intriguing, Carsons said.

“While obesity has always been assumed to be a risk factor for osteoarthritis of weight-bearing joints, such as the knee, these data reveal the somewhat surprising association of obesity and lifetime risk of development of hand osteoarthritis,” he said.

Recent studies have suggested that obesity may set up “systemic inflammation” in the body, Carsons said, which may raise the odds of arthritis in a non-weight-bearing joint, such as the hand.

Because arthritis in the hands can be disabling, Polatsch said, “treatment options and access to hand specialists need to improve in order to minimize the impact of this potentially disabling condition in our aging population.”

The study was published May 4 in Arthritis & Rheumatology.

More information

Find out more about arthritis at the Arthritis Foundation.

Obesity to Blame for Epidemic of Knee Dislocations, Complications

Obesity to Blame for Epidemic of Knee Dislocations, Complications

Need another reason to keep your weight under control?

Excess weight can cause dislocation of your knee and may even lead to a complication that results in amputation of your leg.

A new study attributes a surge in dislocated knees to the U.S. obesity epidemic.

“Obesity greatly increases the complications and costs of care,” said study lead author Dr. Joey Johnson, an orthopedic trauma fellow at Brown University’s Warren Alpert Medical School.

“As the rate of obesity increases, the rate of knee dislocations increases. The total number of patients who are obese is increasing, so we are seeing more of these problems,” Johnson explained.

Knee dislocations result from multiple torn ligaments. Vehicle crashes or contact sports, such as football, are common causes.

For the study, the researchers analyzed more than 19,000 knee dislocations nationwide between 2000 and 2012. Over that time, people who were obese or severely obese represented a growing share of knee dislocation patients — 19 percent in 2012, up from 8 percent in 2000.

Obesity is also linked to more severe knee dislocations, longer hospital stays and higher treatment costs, according to the study published recently in the Journal of Orthopaedic Trauma.

And the chances that a knee dislocation would also injure the main artery behind the joint and down the leg were twice as high for obese patients than for those whose weight was normal, the findings showed. This severe complication of knee dislocation — known as a vascular injury — can lead to leg amputation if not treated, the study authors said.

Patients with a vascular injury averaged 15 days in the hospital, compared with about one week for other patients. Their average hospitalization costs were just over $131,000 and $60,000, respectively.

The study authors said doctors should be especially watchful for vascular injury in obese patients whose knees are dislocated.

“That subset of obese patients who come in with complaint of knee pain need to be carefully evaluated so as not to miss a potentially catastrophic vascular injury,” said study co-author Dr. Christopher Born, a professor of orthopedics at Brown.

Reducing obesity rates could help reverse the growing number of knee dislocations, the researchers suggested.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on knee problems.

SOURCE: Brown University, news release, Nov. 3, 2017

Don’t Delay Hip Fracture Surgery. Here’s Why

Don’t Delay Hip Fracture Surgery. Here’s Why

Seniors with a fractured hip need surgery as soon as possible or they could suffer life-threatening complications, a new Canadian study concludes.

Having surgery within 24 hours decreases the risk of hip fracture-related death. It also lowers odds of problems such as pneumonia, heart attack and blocked arteries, the researchers found.

“We found that there appears to be a safe window, within the first 24 hours,” said lead researcher Daniel Pincus, a doctoral student with the University of Toronto.

“After 24 hours, risk began to clearly increase,” Pincus said.

U.S. and Canadian guidelines recommend hip fracture surgery within 48 hours of injury, but it’s likely that many people don’t receive care that quickly, he noted.

In the United Kingdom, guidelines call for surgery within 36 hours, but hospitals often fail to get patients promptly into the operating room, Pincus added. Rates range from 15 percent to 95 percent among U.K. hospitals, according to the report.

Oftentimes, there’s no operating room or surgeon available, or other patients are awaiting surgery, Pincus explained.

“There’s a triage system and these patients historically were not prioritized,” he said. “Sometimes there’s medical reason for the delay, but that’s very rare. We’re starting to realize there’s almost no reason why a patient should be delayed.”

Delay also likely occurs because doctors approach these elderly patients with a good deal of caution, said Dr. Harry Sax. He is executive vice chair of surgery for Cedars-Sinai Medical Center in Los Angeles.

“The perception is that if you’re old and you’ve broken your hip, that you’re going to have a lot of other [health problems],” said Sax, co-author of an editorial accompanying the new study. “Therefore, I need to spend several days running tests on you to try to make sure I can get you through the hip fracture surgery. ”

To see how this delay affects the health of patients, Pincus and his colleagues evaluated data on over 42,000 people treated for hip fracture at 72 hospitals in Ontario between April 2009 and March 2014. The patients’ average age was 80.

The investigators compared patients based on whether they had surgery before or after 24 hours.

Overall, about 12 percent of hip fracture patients died within the month following their surgery.

However, patients who got surgery within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery, the findings showed.

Those patients also had lower complication rates. They were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.

“The problem is the longer you sit in bed, the more likely you are to get pneumonia and blood clots. The unfixed bone is continuing to flick off little bits of fat, which can go to the lungs,” Sax said. “The delay doesn’t necessarily make things better. It could make things worse.”

People with an elderly relative facing hip fracture surgery should ask the health care team to get their loved one into surgery as soon as possible, with as little additional testing as possible, Pincus and Sax said.

“A prompt evaluation to make sure there’s nothing quickly correctable should be done, but otherwise the patient should move to the operating room as quickly as possible,” Sax said.

Families should ask doctors about every test, scan or screen that delays the surgery, Sax said.

“The question needs to be, what is the information that you’re going to gain and how would that change your management of this patient,” Sax said. “There are very few things you find with all this expensive testing that you can do anything about.”

The patient would be best off in a hospital that has a specific program to manage elderly people with hip fractures, Sax added. These programs have a team of surgeons, geriatricians, anesthesiologists and other professionals well-versed in the procedure.

“If you can find a hospital that does that, the chances are your outcomes are going to be better,” Sax said.

The study was published Nov. 28 in the Journal of the American Medical Association.

More information

For more on hip fractures, visit the American Academy of Orthopaedic Surgeons.

SOURCES: Daniel Pincus, doctoral student, University of Toronto, Ontario, Canada; Harry Sax, M.D., executive vice chair, surgery, Cedars-Sinai Medical Center, Los Angeles; Nov. 28, 2017, Journal of the American Medical Association