Get to know tennis elbow

Tennis elbow is also called lateral epicondylitis. The cause is micro-tear at the bony attachment of the muscles at the outer aspect of the elbow. If repetitive force is continuously exerted, the tissue is torn again before it is recovered, making the condition worse and worse, finally leading to tennis elbow.

Cause of tennis elbow

Sports injury

When the flexibility of the muscles is inadequate, excessive bending and straightening of the elbow leads to tear in the extensor muscle group. The condition is commonly seen in sports such as tennis, badminton and squash.

Muscle injury
When the extensor musclesundergoe sudden traction or impact, the muscles may be injured.

Overuse
Repetitive movements of the wrist and fingers may lead to overuse of the muscles. These movements include typing, using a mouse, washing clothes or prolonged handling of heavy objects

Get to know plantar fasciitis

Plantar fasciitis is the inflammation of the plantar fascia and the surrounding soft tissue due to trauma or overuse. The condition may affect all age groups, but most commonly occurs in women between 40-60 years old.

Cause of plantar fasciitis

• The foot undergoes excessive stress with prolonged standing or walking
• Overuse of the calf muscles or prolonged stress on the foot due to long term use of poor shoe wear such as high heels, narrow shoes or shoes with very hard bottom
• Individual factors such as flat feet and overweight

Common injuries in Taekwondo athletes and their prevention

Training is accompanied with injuries and there is no exception in Taekwondo. Lower limb injuries are common in Taekwondo as it is a lower limb based martial art. Two major types of injuries are knee and ankle sprain and muscle strain due to explosive or repetitive movements. The above mentioned injuries can be prevented by different types of training which will be introduced below.

Sprain injuries

Knee and ankle sprain are often result from landing after jump over kicks or kicks with spinning of body. Cause of injuries may be due to poor landing skills, weak proprioception or insufficient muscle eccentric strength.

Landing skills

Poor landing skills will cause sudden stress on joints leading to sprain injuries. Landing skills can be improved by landing training to correct mechanics and improve proprioception. Training with single leg landing and hoping movements are desirable to improve landing skills.

Common training in Taekwondo

Taekwondo is a martial art which requires a high usage on lower limb muscles. Other than flexibility, other trainings are introduced to reduce the risk of injury and enhance performance.

Five common football injuries(5)

 5.Hamstring Strain

The hamstrings are responsible for hip and knee joint movement. During football games, players often have dribbling and sprinting movement. If the players lack warm-up or are inflexible, those muscles will be easily overstretched and finally result in muscle strain. The signs of muscle strain include swelling and haematoma. Apart from decreased flexibility, the injured players will also feel painful when contracting the muscles.

Muscle strains are categorized into 3 grades of severity:
Grade 1: The muscle fibers are slightly overstretched and there is no significant pain.
Grade 2: Nearly half of muscle fibers are torn. The injured players have significant pain and decreased muscle strength and flexibility.
Grade 3: Complete rupture of the muscle which means the muscle belly is torn in 2 parts. The force may induce avulsion bone fracture. Operation is needed to repair the ruptured muscle belly.

Five common football injuries(4)

4.Quadriceps Contusion

Quadriceps are one of the important muscle groups responsible for knee movement. During football matches, there may be a lot of body contacts between footballers. The quadriceps are easily hit by the opponents resulting in contusion. The signs of contusion include muscle swelling and haematoma. Players are recommended to take a X-Ray to exclude the possibility of bone fracture.

Electrotherapy is needed to reduce pain and inflammation in the first stage. Quadriceps stretching should be performed in pain free range to maintain the muscle flexibility. at later stages, leg extension with theraband can enhance the strength of quadriceps.  Sprinting and jumping training of quadriceps is also crucial to enhance the power of muscles. Players can return to play when they can perform these movements without pain.

Besides, the Kinesio tape could also be used on the injured muscles to promote blood circulation which facilitate muscle healing.

Five common football injuries(3)

3. Ankle Sprain

The ankle joint consists of the tibia, fibula, calcaneus and talus with three lateral ligaments which help stabilize the joint. Usually, players stepping on the uneven ground and landing on opponents’ foot will result in excessive stretch of the ligament leading to ligament sprain.

Ligament sprains are categorized into 3 grades of severity:
Grade 1: The ligaments are slightly overstretched and there is no significant pain.
Grade 2: Nearly half of ligaments are torn. The injured players have significant pain when walking and decreased muscle strength and flexibility.
Grade 3: Complete rupture of the ligament which means it is torn in 2 parts. The X-ray imaging test is needed to check if any bone fracture. Usually it takes 6 – 12 months to heal.

The signs of ankle sprain are significant swelling and bruising and the pain is one of symptoms when walking.
Apart from rest and ice, electrotherapy like ultrasound is important to help reduce pain and inflammation. Also, patients should perform active ankle stretching at pain free range to prevent joint stiffness.
Strengthening the calf muscle with proprioception training such as single leg stand with weight shifting on bosu and calf raise are the crucial rehabilitation exercises. It can enhance the muscle control ability on the uneven floor to prevent recurrent injury.

Five common football injuries(2)

2. The anterior cruciate ligament (ACL) injury

The anterior cruciate ligament (ACL) is a soft tissue that connects the femur and tibia to provide the stability control of the knee joint during walking, running and jumping. During the game, footballers often have acceleration in change of direction, landing and knee contact with opponents. The knee will be easily twisted or hyperextended by these movements. When knee joint is excessively twisted, the ACL will be overstretched and even ruptured.
The signs of ACL rupture include swelling and redness. The joint has laxity and cannot be flexed and extended smoothly.
Ligament reconstruction surgery is needed after getting ACL torn. After surgery, physiotherapy such as electrotherapy, ultrasound and manual therapy are important to promote soft tissue healing.
Besides, the trainings of strength and flexibility of thigh muscles are crucial during the rehabilitation.

1-2 weeks post-op: Performing isometric contraction training of the quadriceps and the hamstrings like straight leg raise and bridging is good to prevent muscle loss. In addition, players should perform quadriceps and hamstrings stretching in pain-free range to prevent joint stiffness.

2-6 weeks post-op: Players can progress to dynamic strengthening exercise such as wall squat and semi-lunge. Also, stability training like single leg stand is recommended to regain proprioception ability.

6-12 weeks post-op: Jumping and landing exercises like single leg hopping and lunge alternate jumping are good to build up plyometrics ability.

12 weeks post-op: SAQ (speed, agility and quickness) training such as sprinting, shuttle run are recommended for preparing return to play.

Troubling tingling fingers

Ms.M, aged 40, consulted for right shoulder stretching and dull pain, and for recent 2 months she had tingling feeling over right thumb and index finger especially after working. After clinical examination, neck seems not clinically related to her hand symptoms. Wrist examination revealed wrist/hand border had significant soreness and compression over there reproduced usual tingling. Compared to left hand, right thumb and wrist region is significantly tighter on palpation. She works as a beautician and frequent pinching and clipping actions are needed. Clinical tests such as tinel sign and phalen test are positive, implying she is likely to suffer from Carpal Tunnel Syndrome. This syndrome is common in jobs requiring repetitive wrist/hand movements e.g. computer users and mechanics.

Situated at the base of wrist, the carpal tunnel is formed by a fascia called Flexor Retinaculum, covering the 8 small carpal bones. The tunnel, of limited space, enclose 9 flexor tendons and the Median Nerve. When there is inflammation/swelling at those tendons or the fascia is tightened up, the median nerve may well be irritated and even compressed. Compromising the nerve can cause tingling/numbness over thumb to half of ring finger, and even weakness and muscle atrophy of thumb in severe cases. Common causes include repetitive wrist/hand movements, for example during mouse-using, typing and labour work. All these can contribute to tendon sheath inflammation and even hypertrophy, increasing pressure to the median nerve.

Major symptoms:

• During repetitive hand/wrist movements (e.g. using phone/computer work), tingling/numbness is felt over thumb/ index finger/middle finger and half of ring finger on the palm side. Resting symptoms are possible for more serious patients
• Symptoms may increase during night time and disturb sleep
• In severe cases, fine hand control is hampered along with thumb muscle atrophy.

         Diagnosis mainly rely on clinical tests e.g. Phalen test, Tinel’s sign, Durkan Test. MRI can be used to reveal any joint/soft tissue impairments. Nerve conduction test is to assist in diagnosis by reflecting how much nerve function is compromised.

Conservative treatments：

• Physiotherapy：corresponding treatments to individual patients: ultrasound therapy, hot/cold pad, electrical stimulation, acupuncture, joint mobilization, stretching and strengthening exercises

• Anti-inflammatory drugs
• Wrist splint to limit movements
• Surgical interventions to be considered if conservative treatments fail

According to her symptoms, we should have some ideas on how to tackle her symptoms

• Ultrasound therapy for inflammation relief

• Acupuncture to release tight fascia and muscle
• Stretching and strengthening exercise (As followed)

After few sessions of treatment, her symptoms have gone. Prevention is always better than cure. Therefore we suggest her to take breaks and perform stretching exercises regularly during work. In the long term, progressive strengthening exercises are needed to improve muscle strength and endurance, so as to prevent the muscle from getting tight again, and hence the recurrence.

Five common football injuries

During football games, players will need to sprint, dribble and experience a lot of physically contact with the opponents. They are prone to lower extremity injuries which includes muscle strain, ligament sprain and cartilage tear. Proper physiotherapy and rehabilitation exercises are crucial in preventing recurrent injuries. In the following articles, 5 common football injuries will be introduced.  

      Treatments of groin muscle strain include resting and physiotherapy. In the early stage, athletes should stop practicing and competition and receive physiotherapy such as electrotherapy and ultrasound treatment which help relieve pain and inflammation. For the rehabilitation exercise, athletes should perform groin muscle stretching and strengthening exercises to prevent re-injury.

For the stretching, players can abduct the hip joint at pain free range to stretch the groin muscle. For the strengthening exercises, players may external rotate the hip joint and kick forward against the theraband(hip adduction).
In addition, strengthening the muscles around the hip joints such as the buttocks muscles and quadriceps can also avoid groin muscle strain.