Preventing Common Sports Injuries
Douglas Comeau, DO is the director of the Ryan Center for Sports Medicine. His clinical interests include Sports Medicine (all ages), Concussion Management, Osteopathic Manipulation (OMT), Exercise Prescription and Fitness Testing, and Compartment Testing. He is also the head team physician for Boston University.
Melanie Cole (Host): Exercising is good for you, but sometimes injuries happen when you play sports or exercise. Accidents, poor training practices or improper gear can cause them. My guest today is Dr. Douglas Comeau, he’s the director of Ryan Center for Sports Medicine at Boston University in Boston Medical Center. Welcome to the show, Dr. Comeau. What are some of the most common sports injuries whether it's weekend warriors or high school athletics or collegiate? What are some of the most common injuries you see?
Dr. Douglas Comeau (Guest): Well, I think we see a wide array of injuries, particularly from our weekend warriors and even our collegiate athletes. First of all, we see many concussions for our contact collision athletes. That can happen for a weekend warrior, and it can also happen for any high school or college setting. That could also be non-contact collision, but, you know, we see it more for that. Also, we see our wide array of knee injuries. Most of them begin with what we say insidious onset which means that we don't really know why it happens, but it could be someone who starts training for a marathon or even from a coach to a 5K, and that could be more of a tracking issue with the knee and we could help you remedy that by different home exercises and rehabilitation exercises. We also see a wide array of shoulder injuries such as rotator cuff strains for people playing in the weekend softball leagues. Also, people who are just trying to pick up a sport.
Melanie: So, then, let's just kind of start with the knee since these are common and we're seeing ACL in girls, and we're seeing injuries to the knee, and people always complain of knee pain. When, Dr. Comeau, would you like people to come to see somebody when they're experiencing knee pain and what are some things that they can try at home before they would have to go see somebody?
Dr. Comeau: That's a great question. I think people who end up getting the ACL tears are people who really don't know that's going to happen before it occurs because that's more out of -- could be non-contact or contact related, but more so the people who are trying to get into sport or try a new sport. If they start having pain on the front of their knee or even underneath their knee, and they notice it more as they're doing more set activity that would actually help to have them come into the office earlier on so we can fix any type of biomechanical issue or have any early diagnostic care for that injury.
Melanie: Can they ice? Should they try NSAIDs and what about wrapping or bracing the knee?
Dr. Comeau: That's a great question, too. You know, icing after working out can be helpful. The literature on heat and ice is very mixed these days so, some people believe in heating before and icing after, but that's more of a comfort thing. Anti-inflammatories such as your ibuprofens or naproxen, over the counter medications, can also be helpful, too, but sometimes the body's just telling itself that, "Hey, you know, there's a little inflammation going on; I'm trying to heal whatever's going on." So if those treatments aren't helping that’s when you should come in.
Melanie: Dr. Comeau, there's also been some, not controversy, but going back and forth about the benefits of flexibility or stretching before you go out and play a sport and especially for the knee, you can stretch the quadricep, everybody does that -- stretch before they go run. Do you advocate stretching before you workout or run or play a sport, or after you're a little warmed up, or after it all together?
Dr. Comeau: That's a great question, as well, because it is very controversial, and I feel like if you asked about 100 different providers, those 100 different providers would then give you different answers. You know, I think that it's more individually, patient-based, you know as far as who stretches before and who stretches after, who stretches during, and it all depends if they're nursing an injury or trying to do rehabilitation exercises prior to going back to running, let's say, or going back to a sport versus someone who is just running and injury-free. I think a lot of times people who are running and injury-free tend to stretch afterwards as part of their cooldown whereas people who are injured and rehabbing some type of lower body injury, would stretch prior to exercise, but because the data's skewed, we look at the individual patient, see what their injury history is to risk stratify which is the best recommendation.
Melanie: A common injury is shin splints. People feel it whether it's acute or chronic so I'd like you to speak about acute and chronic injuries and shin splints because this is so common; people get them when they just walk or start to run or play soccer or baseball. What do you do about shin splints?
Dr. Comeau: Well, shin splints -- it all depends on the level it is. We see that a lot in both our high school and our collegiate athletes and also our recreational runners around the Boston area. As you know, Boston is “Marathon Mecca” and a lot of people are running coming in. I think that the variety of diagnosis of shin splints could occur when you change footwear, change cleats, could pick up your pace. So, patients who are typical 5K or 10K runners who want to train for half marathon or a full marathon can sometimes over train at first when they're trying to follow a program on-line. So typically, if they come into the office, and it looks like shin splints, we may get an x-ray depending on how long the symptoms have been going on for, and particularly, if they're point tender in one area because shin splints can also lead to what's called a stress reaction and a stress fracture of the tibia bone which is typically where the lower leg bone that the shin splints typically occur. If everything looks ok via imaging like that, then we would give a modification of activity plan where we would have them do specific rehab exercises, and also, do either biking or elliptical for cross-training or swimming for cross-training while doing a return to run progression at a slower pace at first and then building back to their normal run.
Melanie: And so people hear acute and chronic injuries: shoulders, knees, and lower back, whatever. What's the difference?
Dr.Comeau: Well, I think well an acute injury is something that occurs within a few weeks, let's say, to a few months whereas chronic injury can be nagging over years, and sometimes, we can even an acute on chronic injury. So, somebody who has what would be deemed chronic knee pain, say, like growing pains growing up or different things like such, they could actually have an acute injury on top of that meaning that an event caused them to have certain knee pain or something that they were doing started gradually making that pain worse, and typically, you know, when you look at an acute injury, that would be more of a swelling. It could be hot. It could be more point tender pain whereas a chronic injury you’d have cool, dry skin where it would also be painful, but maybe in a different way painful -- more of an achy type chronic pain.
Melanie: So if somebody turns their ankle or starts to feel some of this knee pain or a little shoulder pain, do you advocate RICE? Are we still doing that? Is there movement involved, what would you like them to do right away if they feel like something's going on?
Dr. Comeau: Well, with ankle sprains, yeah, I think that when you go to the emergency room for it if you weren't seeing a sports med provider immediately they -- depending on what's called the Ottawa Ankle Rules -- if you are point tender over certain bony areas they would get an x-ray, typically to make sure there's no fracture. Assuming there are no bony tenderness over the ankle, and your classic ankle sprain, typically you would compress it, ice it, elevate it for about 24 hours, but then have early range of motion with it. I think a lot of times people think that they want to stay off of their ankle until it feels all better, but the data is now more after about 24 to 48 hours, you should be moving that ankle around in order to have that good inflammation that’s trying to heal the ligament, help heal it and then also you won't have the rest of the musculature in the ankle get stiff.
Melanie: So, it's really become RISEM now because movement is added in, and you don't want to just totally keep that immobile all the time anymore. Why don't you wrap it for us, Dr. Comeau, with tips for preventing injury in the first place -- what you'd like people to know about possibly cross-training, if they’re overdoing one sport, sports-specific training, and really taking care of themselves so that they can play sports or do whatever?
Dr. Comeau: Oh, yeah, and I think that, you know, most of these sports medicine societies nowadays do recommend not having a silo effect for sporting especially as a younger child. So, this day and age you see a lot more AAU in basketball or year-round competitors in certain sports, and what we really recommend is playing different sports because not only does that help your body adjust to different activities, it also allows you to participate in multiple different events so if you cannot make that one sport or if you are injured in that one sport, you have something else that you can go to. So, I think with that multiple sport variation, if you look at most of the professional athletes this day and age, they all -- the majority of the played multiple sports, so I think that if you're looking to get involved in activities we would recommend doing multiple different activities and not just one. I think that if you want to start something, don't try to go break the record for the 100 meter dash at first when you're running or try to break your 5K mark right away. Set a goal of actually completing it and try to work yourself in by cross-training using all your muscles as you build up your distance with running, and also if you're going to try a different sport, you know, don't try to jump into the professional setting right away. Try to ease into it because if you ease into it then that will allow you to actually be better for the long run.
Melanie: Thank you so much, Dr. Comeau, for being with us today. It's really great information, and if you'd like to learn more about the care offered at the Ryan Center for Sports Medicine, you can make an appointment by calling 617-358-3400, or you can go to www.bu.edu/sportsmedicine. That's www.bu.edu/sportsmedicine. You're listening to Boston Med Talks with Boston Medical Center. This is Melanie Cole. Thanks so much for listening.