Long term effects of injuries: How early treatment prevents future problems

Over the years, we have seen an increased participation in sports and exercise across all age groups. Having an active lifestyle promotes general well-being and good health.

Yet, with the widespread pursuit of sports comes problems with sports injuries.

Dr Ramesh Subramaniam of Mount Elizabeth Hospitals explains how early treatment of sports injuries is important to prevent future problems. 

Sports injuries usually result from overuse, insufficient warm-up, overexertion of muscles and ligaments, or unfortunate accidents such as falls or crashing into another player. Research has shown that there is a higher risk of repeated muscle and joint injuries if you do not achieve full recovery from the initial injury.

It is important after suffering an injury to seek medical attention quickly, get an accurate diagnosis and undergo rehabilitation. Sometimes, if there is structural damage from the injury, surgery may be required for reconstruction or repair of the damage.

Here are some sports injuries that may cause future problems if not treated promptly and adequately.


Knee injuries


Knee injuries are very common in cycling. When cycling, the knee is subject to forces from the twisting and turning movements of the lower limb. This places undue stress on the ligaments of the knee which can get strained or rupture completely. 

It is common to hear accounts of a ‘cracking’ or ‘popping’ sound in the knee joint when there is a sudden twisting of the knee.

The knee then starts to swell, and it becomes impossible to continue playing the sport. This almost always points to a ligament injury of the joint resulting in bleeding into the joint (haemarthrosis).


How to prevent future problems

Cruciate ligaments are ligaments in the middle of the knee joint. Rupture of these ligaments makes the joint unstable. Instability of the knee joint will lead to repeated injuries of the knee, and cartilage wear and tear over the long term. 

For these reasons, it is important to get a scan of the knee joint and consider ligament reconstruction surgery, if ligament rupture is suspected. Ligament reconstruction of the knee has been shown to delay cartilage degeneration or osteoarthritis of the knee joint.

Besides ligaments, the meniscus of the knee joint may also be injured. The meniscus is the ‘cushion’ or shock-absorbing soft tissue in the knee joint.

Tear of the meniscus may result in swelling of the knee and restriction of motion of the knee. Not addressing a meniscus tear promptly will lead to cartilage injuries in the long term.


Ankle injuries


Ankle sprains are very common in the general population. You do not need to be playing sports to sustain an ankle sprain. An awkward step, or tripping over while walking or slipping on a wet surface may cause this common injury.

When an ankle is sprained, the ligaments, which are tissues that stabilise the joint, are partially or completely torn. Though these ligaments have the ability to heal well, there is a higher risk of repeated sprains in the future.


How to prevent future problems

Ankle sprains that are not treated promptly may also give rise to prolonged swelling and chronic stiffness. This affects the other joints of the lower limb during the gait cycle and may cause knee and hip pain in the future.

Inadequate rehabilitation of a sprained ankle may lead to poor proprioception (the ability of your brain to sense the position and movement of your joints) and poor balance for future activities. A key focus of physiotherapy after ankle sprains is to restore proprioception and balance of the joint.

It is crucial to have prolonged pain from an ankle sprain evaluated by a physician. MRI scans will be very useful to exclude an osteochondral injury. This refers to structural damage to the bone and cartilage of the talus bone in the ankle.

Structural damage may require surgical intervention, or there may be issues in the long term with weight bearing and ankle function.


Shoulder injuries


The shoulder joint is structurally unique because it allows a great deal of mobility in many different planes. This allows us to use our upper limbs for various activities, sports, and exercise.

Besides the bone anatomy, the soft tissue structures such as rotator cuff muscles and tendons, labrum and ligaments around the shoulder control its stability.

These soft tissues may be injured in sports injuries, especially during impact to the shoulder, which is common in contact sports like soccer, rugby, martial arts and boxing. Shoulder injuries are also common in ‘throwing’ sports like baseball, softball, and cricket.

These soft tissue shoulder injuries come with persistent pain or instability. They need to be evaluated by an MRI as x-rays alone may not be able to diagnose them. It is advisable to seek an opinion from an orthopaedic specialist for these shoulder injuries, to know the treatment options for them. 


How to prevent future problems

Most of these injuries are treated with physiotherapy but in situations where there is structural damage to the labrum or rotator cuff tendons, surgery is highly recommended.

Failure to address these injuries may lead to progressive damage to the shoulder and more complex problems in the future.

Inflammation of the shoulder tendons may be treated with physiotherapy. Chronic inflammation without treatment may lead to damage of the tendons and even progress to a full thickness tear.

When this happens, there may be persistent pain and an inability to raise your shoulder due to weakness. An untreated tendon tear may lead to progressive arthritis of the shoulder joint.

The labrum is a soft tissue that deepens the socket of the shoulder joint. It can tear when the shoulder dislocates completely or partially.

Tear of the labrum will render the shoulder joint unstable and an unstable joint will wear out in the long term. Thus, it is usually highly recommended to seek surgical repair for a torn labrum of the shoulder.


Preventing sports injuries

Musculoskeletal injuries are commonplace in sports and physical activity. Proper warm-up and physical conditioning are essential to prevent injuries.

However, when an injury strikes, it is important to seek medical attention to evaluate the injury and consider treatment options early.

Neglecting a sports injury or playing on despite the pain or swelling, may end up doing more harm to the joints and body in the future.


Article contributed by Dr. Ramesh Subramaniam, orthopaedic surgeon, Mount Elizabeth Novena Hospital. 

This article was first published on www.mountelizabeth.com.sg/healthplus – an online health and wellness resource developed by Mount Elizabeth Hospitals, Singapore.
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