This information is not a substitute for medical treatment. Before starting a rehabilitation program, consult your sports medicine specialist or your physician.   :::::::::::::::::::::::::::::::::: LINKS AND ARTICLES ON SPORTS MEDICINE Stretching and Flexibility   Consumer: fitness news   ::::::::::::::::::::::::::::::::	K N O W Y O U R I N J U R Y  ANKLE FRACTURES AND SPRAINS KNEE INJURIES SPINE INJURIES TENDONITIS SHIN SPLINTS LET YOUR MIND HELP YOU RECOVER       ANKLE FRACTURES AND SPRAINS The ankle is made of three bones, one of which (talus) sets inside a cavity formed by the other two (tibia and fibula). These bones are each joined by a short ligament. If any of these ligaments are torn it is called a sprain. If the bones break, a fracture occurs where the ligaments attach and is often the result of a twisting injury. Most sprains and some fractures may be treated by immobilization (casts, splints or fracture boots) but occasionally may need surgery. When a fracture occurs along a joint surface, the corresponding pieces must heal in a nearly anatomic position to reduce the odds of developing arthritis. An ankle sprain is a common sports injury and occurs in activities which involve footwork and jumping. Ankle sprains are generally classified in 3 categories: Grade I A stretched ligament with minimal swelling and pain. Grade II A partial tear of the ligaments with moderate pain and swelling. Grade III Complete tear of the ligament with instability, regular disabling pain, swelling and discoloration. Often, skaters will have a history of a "twisting" injury and will have difficulty weight bearing initially on the injured foot. Swelling will appear immediately or gradually over 3 to 4 hours. Others may be concerned about carrying weight on the involved foot. Your sports physician will usually order x-rays to confirm or rule out a broken bone and to evaluate for joint instability. Grade I or II sprains will be treated functionally with a brief period of immobilization, then icing, elevation and compression during the rehabilitation period. This will aid in the reduction of the inflammation. In a grade III sprain, casting or surgical repair are may be needed depending upon the severity of the injury. Grade I and II ankle sprains usually heal in a short time and progress is usually noted within 2 weeks. A grade III ankle sprain will take a longer to heal depending upon the severity of the injury. A well planned rehabilitation program undertaken with care, may help skaters resume normal activities over a 6 to 8 week period. back       KNEE INJURIES The knee is a hinged joint made of several parts. The femur (your largest bone) extends from the hip to the knee . The tibia (lower leg) connects to the knee also, and this area is covered by the patella (knee cap). Articular cartilage covers the bone ends of the femur and the tibia and helps it provide a gliding motion in the joint. The meniscii (lateral and medial meniscus) make a "C" shaped cartilage that forms a cushion inside the joint ... like a shock absorber. These bones are connected by supportive ligaments (anterior cruciate, posterior cruciate). Surrounding muscles help move the joint, reduce stress, and provide extra support. Support and stability in the knee are provided by its four ligaments (fibrocartilaginous meniscii) which are firmly attached to the tibia. During normal knee movement, they tend to move slightly inward or outward. Normal knee movement consists of a combination of movements (rotation, extension and flexion). These movements are controlled by the ligaments of the knee and by the meniscii, which also aid in shock absorption. Damage to the knee can stop normal rotation of the joint. The meniscii serve several purposes which include the control of normal knee motion. Meniscal tears are the most common knee injuries, but the characteristics of each tear vary. Generally, skaters with a tear of the medial (inside) meniscus have an injury history which includes a twisting fall while in a weight-bearing position . A skater's description of the injury may include a "popping" sensation, followed by severe pain on the inside of the knee. Several days to several weeks following the injury, there is often a sensation of the knee "locking up" or "giving way" and it may be difficult to walk up or down stairs or squat. Your physician will usually order an x-ray (known as a "plain film") to rule out injuries in addition to the meniscal tear. If the meniscal tear is acute, knee immobilization and the dedicated use of ice to decrease edema significantly, will be part of the recommended treatment. Arthroscopic surgery can be successfully performed on the meniscus with resumption of normal activities in 3-6 weeks! A subluxed patella is more difficult to diagnose. Usually this can be discerned on x-ray. Skaters will complain of medial knee pain, swelling and/or the knee "giving way." Sometimes, the patella may appear higher than normal when the knee is flexed (bent). This condition is known as patella alta. Immobilization of an acutely subluxed patella for 4-6 weeks along with the use of ice to control edema and pain followed by physical therapy to strengthen the quadriceps group will often be prescribed. Strengthening of this area will help in decrease susceptibility to dislocations. If dislocations recurr, surgery may become an option. A variety of other procedures may also be considered to prevent further episodes of dislocation. back       LUMBAR SPINE SPRAIN An exact diagnosis may be difficult since muscular strain, ligamentous sprain and mild disc herniation may all show similar symptoms including muscular tenderness and weakness. Many things can cause these symptoms but muscular or ligamentous injury are the usual culprits. Regardless of the cause, initial treatment will be the same. A brief period of rest (usually 24-48 hours) and anti-inflammatory medication followed with a gradual return to skating activities. Many doctors will recommend physical therapy for the skater. This may include an exercise program designed to strengthen and stabilize the muscles and ligamentous structures of the spine, and stressing how to properly perform activities of daily living. This would include increasing the flexibility of the spine for the skater in an effort to reduce recurrence of injury. back     ROTATOR CUFF TEAR/TENDONITIS The muscles and tendons of your rotator cuff secure your shoulder and help move it as well. It can become inflamed or irritated (tendinitis) for a lot of reasons. If this irritation causes fraying or bruising, the joint will get weak and painful. Overhead reaching may become difficult. Inflammation can also lead to a build up of calcium in the rotator cuff itself, which can reduce movement and strength. Severe tendinitis due to pinching, degeneration or a fall can cause a partial or complete tear in the rotator cuff. This can result in shoulder pain, weakness and loss of normal movement. An MRI (magnetic resonance image) would be helps in diagnosing a rotator cuff tear but a detailed history and exam are very important. Treatment consists of anti-inflammatory drugs, ice, and gentle stretching and strengthening exercises. Partial tears and chronic tendinitis often respond well, but occasionally, it is necessary to surgically repair a tear and debride tissue as necessary. back   SHIN SPLINTS This term refers to a syndrome consisting of pain along the inner tibial shaft causing a gradual increase in soreness and pain during skating. Therapy and rehabilitation consist of rest, ice, a course of anti-inflammatory medications, heel cord and hamstring strengthening and dorsiflexion of the foot. Shoes with proper flexibility and shock absorption should be employed for sports and athletic pursuits to prevent recurrence. back     LET YOUR MIND HELP YOU RECOVER Whether you are a competitive or recreational skater, recovering from an injury is a challenge. The way you understand and respond to the pain and limitation is a very individual experience. But certain responses and psychological skills can help most skaters take an active role in their own recovery. Where do I begin? Skaters often feel overwhelmed by an injury. Your ability to cope will improve if you work closely with your doctor and other healthcare providers to develop a plan for recovery. Rehabilitation begins with being informed about your injury. It's important to know the extent of the injury, the approximate recovery time, and what you have to do for a safe and effective recovery. You must see yourself as an active participant in rehabilitation planning and treatment. What psychological effects can I expect? The way you respond to injury is very important. Although certain sports have greater risk for injury than others, an injury is never expected, never planned and definitely not welcome. We train to prevent an injuries, but we never prepare for our emotional response to an injury. Injuries mean different things to different people. For some, an injury might be life threatening or career ending. For others, an injury takes them away from a team, event or social structure that gives them a sense of identity, accomplishment and community. An injury can also interfere with a job, school or responsibilities at home. It's important to know that this requires coping skills to help you work through this loss--with professional help if necessary. What type of mind-set is helpful? Directing or redirecting your response to the injury may aid recovery. Or at least, it may help you keep a positive outlook as you heal using these suggestions: Believe that your pain and injury is something that will go away and will heal. Be creative, humorous, and positive in your approach to inconveniences caused by your injury. Talk to yourself positively every day about your ability to cope with and recover from your injury. Use your desire to recover to help integrate your sense of self and your mental and physical healing power. Mentally and physically make friends with pain to get to recovery. Pushing too hard may cause reinjury, but fearing the pain may lead to a too-passive approach. Connect with your emotions and let them lead you through the healing process. Nurture yourself through tough times by having a little fun, then when you feel emotionally strong, use that energy to move ahead in recovery. Maintain your sense of identity and importance through activities that help you feel good about yourself. Express your needs and concerns to your physician and rehab team. Identify negative responses to your injury, and rebuild them to move toward a positive road to healing. Be aware of your current level of physical ability and what abilities you may have lost, then move beyond those limitations to visualise a future level of ability. Ask for and receive help. Surround yourself with supportive people, and limit your time spent with anyone who slows your healing process. What techniques are useful? These mental exercises can also help your recovery: Progressive relaxation. Your mind and body need to know what tension and relaxation feel like. Starting with your head and working down, alternate flexing the muscles in each body part (producing tension), then relaxing them. Mentally and physically memorize the feeling of relaxation. Incorporate that feeling whenever possible throughout your recovery. This technique also helps you recognize tension so that you can work through it. Breathing. Breath control can help modify stress and your response to pain. Pay attention to your breathing during times of pain. Try to breathe freely and stay relaxed. Allow your lungs to fill completely by extending your stomach as you breathe and by feeling the air move in and out of the bottom of your lungs. Visualize healing, relaxing energy entering your body as you inhale, and a release of any negative thoughts as you exhale. Visualization. Using imagery can help healing by creating a positive internal atmosphere. Focus on a scene you find positive, nurturing, and healing. You may also want to listen to peaceful music. Use your progressive relaxation and breathing and once you are totally relaxed (or as relaxed as your injury will allow), start your visualization. Some people concentrate on total healing and use a color or sound to represent healing as it moves slowly through their entire body. Others focus on the injured area and create a healing image and use the image to watch the area healing. Some even combine these exercises and images. Create this meditative, self-hypnotic state focused on healing daily, as often as possible throughout the day. You can combine visualization with mental statements like, "I am healing," "I am calm," or "I will get better." Visualization can also be used as a distraction from pain to pull yourself away from your body to a scene or favorite experience. You may this helpful to facilitate sleep. Just bring yourself into a relaxed state, let drowsiness creep into your body, and let yourself fall asleep. What's your ticket to success? The thought of recovering from an injury can be discouraging for anyone. Your success will depend on developing both your physical and psychological abilities to their peak. back