Sports Medicine

Muscle Cramps

A muscle cramp the sudden involuntary contraction of one or more muscle groups usually results in intense pain. The exact cause of muscle cramps is unknown. However, overuse, heat, dehydration, and salt and mineral depletion are considered triggers. In general, overuse, injury, and exercise in hot weather often lead to cramps. Occasionally, muscle cramps can signal other serious medical conditions, such as narrowing of the arteries to the legs (atherosclerosis), nerve compression because of lumbar spine narrowing (spinal stenosis), or potassium depletion.

Just about everyone experiences muscle cramps in their lifetime. They often occur when you’re exercising, although they can happen while you’re sitting or sleeping. They are very common in endurance athletes and other people who perform strenuous activities. Athletes most often experience muscle cramps in the preseason of their sport, when their bodies are not yet conditioned. The most commonly affected muscles are the lower leg (calf) and the thigh (hamstring and quadriceps).

Muscle cramps usually go away on their own and don’t require medical treatment. There are a few things you can do to help relieve the pain and even prevent the cramps. The most important home-care management technique is to stay hydrated with salt-replenishing fluids. Other methods you can use to get rid of your cramps include:

  • Gentle stretching and massaging of the cramping muscle
  • Holding the muscle in a stretched position until the cramp stops
  • Applying heat to tense or tight muscles or cold to sore or tender muscles

Regular flexibility exercises can also help you prevent cramps from starting. Flexibility exercises are best done before and after you work out to stretch muscle groups that are prone to cramping.

Please see your doctor if your muscle cramps are severe, occur often, respond poorly to treatment, or have no obvious cause. Your doctor may choose to evaluate for possible problems with circulation, nerves, medications, or nutrition.

Meniscal Tear

A meniscal tear is a common injury of the knee. The meniscus is a wedge-like, shock-absorbing piece of cartilage found within your knee joint. It is shaped like a C and curves inside and outside the joint to stabilize your knee. It also allows your thigh (the femur) and your shin (the tibia) bones to glide and twist over each other with movement, as well as provide cushioning support for the weight-bearing job of your legs.

Injury to the meniscus often happens during sport activity, when a sudden twisting of the knee, pivoting, or deceleration causes a tear in your cartilage. A meniscal tear can also occur simultaneously with injury to other ligaments of the knee (in particular, the anterior cruciate ligament which helps to connect the upper and lower leg bones).

You may hear a popping sound at the time of injury to the meniscus, and you may still be able to bear weight and walk on the injured knee. Pain, swelling, and redness of the joint then develop over the next 12 to 24 hours. In some cases, a piece of cartilage can interfere with knee movement, and you may notice that your knee will “lock” or “pop” with attempted movement. Your doctor may choose to evaluate a possible tear with an MRI scan, a form of imaging that uses a large magnet to view changes in tissue.

Initial treatment of a meniscal tear follows basic home care management “RICE,” which stands for Rest, Ice,Compression, and Elevation. Nonsteroidal anti-inflammatory medications (NSAIDs) are helpful to relieve pain and inflammation. This may be all that is needed for minor tears that have occurred in the outer edges of the meniscus.

Surgery may be recommended for tears that are central, cause locking or instability of your knee, or for injuries that don’t heal on their own. Surgery may involve using a small, pen-sized camera (called an arthroscope) to trim torn flaps in the cartilage and repair any other damaged ligaments. Often, a brace or cast is needed after surgery, and physical therapy is an important part of recovery to relieve pain and strengthen and stabilize the muscles around your knee.

If you suspect that you have signs or symptoms of a meniscal tear, please see your doctor for further evaluation and treatment options.

Understanding Meniscal Tears

What is the meniscus and how can it be injured?

The knee joint is buffered by a layer of articular cartilage that caps the ends of the femur (thigh bone) and tibia (shin bone). Another cartilage component, called the meniscus, forms an extra cushion where the leg bones meet to form the knee joint — like a wedged shock absorber that helps distribute weight evenly in the knee.

The meniscus can be injured by trauma or through a degenerative process. Sports injury accounts for most trauma-induced meniscal tears, usually from a bend-and-twist motion. Other injuries may be due to wear-and-tear of more brittle cartilage, a byproduct of the aging process. Often meniscal tears occur at the same time other components of the knee are injured. A common injury among athletes involves simultaneously the anterior cruciate ligament (ACL), the medial collateral ligament (MCL) and the meniscus.

In part due to the “C” shape of the meniscus, tears occur in a number of different locations. Flap, transverse, torn horn and bucket handle rank among the most common tears.

What are the symptoms of a meniscal tear?

You may have heard a popping sound when your injury first occurred. After that, pain and swelling or tenderness may set in. Other symptoms include an inability to move your knee normally, or walk without pain or a clicking, uncomfortable feeling. For some, an injured knee may occasionally get stuck, or lock, at a 45° angle temporarily.

In order to diagnose you properly, your doctor will consider your symptoms, ask you about your activity leading up to the injury, and examine your knee carefully. Because meniscus injuries can also be accompanied by injuries to the other soft tissue in the knee, your doctor will want to look at the big picture. In addition to examining your knee in specific positions and manipulating its movement, your doctor will likely want you to have X-rays (to check for fractures) or an MRI (magnetic resonance imaging).

ACL Tear

Ligaments are tough, nonstretchable fibers that hold your bones together. A tear to the anterior cruciate ligament (ACL) of your knee joint is among the most common sport-related injuries. The ACL connects the thighbone (the femur) to the shinbone (the tibia) and acts to prevent your thighbone from moving too far forward over the knee joint. This ligament also helps stabilize the shinbone from rotating out of the knee joint.

The ACL can tear when it’s stretched beyond its normal range. This typically happens by sudden twisting movements, slowing down from running, or landing from a jump. You may hear a popping sound at the time of injury. Your knee may give way and begin to swell and hurt.

Because the ACL is not capable of healing itself (ligaments, unlike muscles, do not have their own blood supply), it can only be reconstructed (that is, replaced) surgically — it cannot simply be repaired. Less active people may choose to treat a torn ligament nonsurgically with a rehabilitation program focusing on muscle strengthening and lifestyle changes. Surgical reconstruction, however, may help many people recover full function after an ACL tear. Your doctor can discuss these different options with you and help choose what is right for you.

After ACL reconstruction, performing rehabilitative exercises may gradually return full flexibility and stability to your knee. Building strength in your thigh and calf muscles to support the reconstructed knee is a primary goal of rehabilitation. You may also need to use a knee brace for a short time, and it is important not to return to full activity too soon to prevent reinjury.

Understanding Anterior Cruciate Ligament (ACL) Injury

What is the ACL and how can it be injured?

Ligaments are tough, non-stretchable fibers that hold your bones together. The ACL, or anterior cruciate ligament, is one of four primary ligaments that connect the femur (thigh bone) to the tibia (shin bone) at the knee. The ACL’s position — running diagonally through the center of the knee — enables the ligament to provide stability to the knee, limiting side-to-side rotation and preventing the tibia from moving ahead of the femur. Along with ligaments, the knee also contains a cushion of articular cartilage that caps the ends of each leg bone, as well as additional shock-absorbing cartilage, called the meniscus, between them.

Injury to the ACL is one of the most common knee ligament injuries. Even though most ACL injuries occur during a sports activity, ACL injuries aren’t just caused by being tackled while playing football. Injury results when the ACL is stretched beyond its limit. You may have injured your ACL by pivoting quickly, landing poorly from a jump or by hyperextending your knee.

What are the symptoms of an ACL injury?

You may have heard a popping sound when your injury first occurred. After that, severe pain and severe swelling of the entire knee probably sent you right to your doctor or emergency room. Other symptoms include an inability to move your knee normally, or walk without pain or a feeling of instability.

In order to diagnose you properly, your doctor will consider your symptoms, ask you about your activity leading up to the injury, and examine your knee carefully. Because half of all ACL injuries are also accompanied by injuries to the other soft tissue in the knee, your doctor will want to look at the big picture. In addition to examining your knee in specific positions and manipulating its movement, your doctor will likely want you to have X-rays (to check for fractures) or an MRI (magnetic resonance imaging).

Understanding Rotator Cuff Injury

What is a rotator cuff and how can it be injured?

The rotator cuff is actually a combination of muscles and tendons at the top of the upper arm that helps stabilize the shoulder joint and move the arm (both lift and rotation). The “cuff” of muscles attaches to the scapula (shoulder blade) with a tendon connected to the front and side of the humerus bone (upper arm). This network of muscles and tendons gives the shoulder more mobility than any other joint in the body.

Although injury to the rotator cuff can be the result of trauma, such as a dislocation or fracture, tears in any component of the rotator cuff are most often caused by overuse, called wear-and-tear injuries. Any sport or activity that requires repetitive arm movement, like tennis, weight lifting or painting, can lead to a rotator cuff injury. Those who develop tears through overuse may also have experienced several months of pain associated with inflammation, either bursitis, which is inflammation of the joint bursa (fluid), or tendonitis, which is inflammation of one or more tendons.

What are the symptoms of a rotator cuff tear?

The symptoms of a rotator cuff tear depend on the cause. Tears caused by trauma may create an immediate and sharp pain in the shoulder and weakness in the arm. Tears caused by overuse may create pain that begins as a minor twinge when lifting the arm. With overuse injuries, pain may develop into chronic distress in the shoulder that radiates and limits your arm and shoulder movements. Pain may even interrupt your sleep.

In order to diagnose you properly, your doctor will consider your symptoms and examine your shoulder and neck to ensure that your pain isn’t caused by a pinched nerve, arthritis, or another condition. You will be asked to perform a few simple movements so that your doctor can measure your range of motion. Your doctor may also require you to have X-rays — to look for contributing bone issues, including spurs, an MRI (magnetic resonance imaging) — to look more closely at the soft tissue (muscles and tendons) of the joint, or an ultrasound.