Welcome
to the Southwest Soccer Club
Sports Medicine...by Steve Roth
Introduction
My name is Steve Roth and I am a licensed athletic trainer. Welcome to the new Sports Medicine section of the Southwest Soccer Club website. My vision is to be able to provide you with the most up to date sports medicine information on topics pertinent to the sport of soccer, as well as give you the opportunity to ask questions that are of special interest to you. In the upcoming months, I will be featuring articles and topics including concussions, knee pain, ankle sprains, heat illness and dehydration.
If there are any suggestions for topics or any questions, please feel free to email me.
Steve Roth
Athletic Trainer
THE KNEE
Injuries to the knee joint are amongst the most common in sporting activities and understanding the anatomy of the joint is fundamental in understanding any subsequent pathology.
Anatomy of the Knee
The knee joint is the largest joint in the body, consisting of 4 bones and an extensive network of ligaments and muscles. The four main bones in the knee are: the femur (thigh bone), the tibia (shin bone), the fibula (outer shin bone), and the patella (kneecap). The main movement in the knee occurs between the femur, tibia and patella. This interaction allows the knee to flex or bend and rotate slightly. Ligaments help control knee motion by connecting bones and supporting the joint. Each ligament has a particular function in helping to maintain optimal knee stability in a variety of different positions. Tendons join muscles to bones. Cartilage, both meniscal and articular, help cushion the knee joint.
The Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL) connect the femur (thigh bone) to the tibia (shin bone) in the center of the knee. The ACL limits rotation and forward motion of the tibia while the PCL limits backward motion of the tibia.
The Medial Collateral Ligament (MCL) and the Lateral Collateral Ligament (LCL) run along the inside and outside of the knee, respectively, and limit the sideways motion of the knee.
The medial and lateral meniscus are crescent shaped structures that act as shock absorbers during motion.
Articular cartilage covers the end of the bones and helps the joint move smoothly as the knee bends and straightens. Damage to this articular surface of the bones is considered arthritis.
Knee injuries can be categorized in one of two ways- sudden or acute injuries and injuries that build slowly overtime, based on activity level. These injuries are called overuse injuries. Acute injuries may be a result of a direct blow to the knee, an abnormal twist with the foot planted on the ground, or falling awkwardly. Overuse injuries occur with repetitive activities or prolonged pressure on the knee leading to inflammation and pain. Below are several of the more common conditions that can create pain in the knee joint. If you feel that your child may be presenting with any of these symptoms, the appropriate step would be to have him/her evaluated by a licensed medical professional and start a proper treatment program.
Conditions that Cause Knee Pain
Patello Femoral Syndrome: Patello Femoral Syndrome or PFS is an extremely common condition, covering a range of usually vague symptoms of pain “in”, “under”, or “behind” the patella or kneecap. The patella and the patellar tendon transmit power from the quadriceps muscle to the lower leg. Normally, as the knee bends, the patella glides smoothly in a groove at the end of the femur (thigh bone). However, under certain instances, the muscular balance around the knee is disrupted and the stronger pull of the lateral (outside) structures create a lateral tracking of the kneecap in the groove, causing pain. The pain can be either sharp or dull and is typically made worse by squatting or walking up/down stairs. There are several theories as to why some people are more prone to having patello femoral symptoms. These include: tightness in the lateral structures, hamstrings, and calves; VMO (the small tear drop muscle of the inner thigh) dysfunction, internal rotation of the hips, and increased pronation or flat feet. Treatment of PFS involves rest, ice, anti-inflammatories, bracing or taping, orthotics, and an appropriate stretching and strengthening program.
Patellar Tendonitis: Patellar tendonitis is an overuse injury that affects the tendon connecting the patella to your tibia or shinbone. Tendonitis occurs when a repeated stress is placed on the patellar tendon, often associated with a sudden increase in the intensity or frequency of a workout. Pain below the kneecap is the first symptom and is usually sharp during activity and dull upon completion. Most people with patellar tendonitis will find pain relief and improvement in function using conservative treatment techniques. The conservative approach to treating tendonitis aims to reduce the strain on your tendon and then gradually building up the strength and flexibility of surrounding muscles. These can also include: rest, anti-inflammatories, ice, massage, and patellar tendon straps.
Osgood Schlatter Disease: Osgood Schlatter is an overuse syndrome that causes pain, swelling, and tenderness over the bony prominence of the upper shinbone (tibial tuberosity) just below the kneecap. This bony prominence serves as the attachment point of the patellar tendon, which connects the quadriceps (thigh) muscle to the tibia. During sport, the contraction of the quadriceps muscle pulls on the patellar tendon. This stress can cause the tendon to pull away slightly from the shinbone- creating pain. The body’s reaction to this is to lay down new bone to close the gap, forming a bony lump in that spot. Pain will usually worsen with activity and improves with rest. Osgood Schlatter occurs more often in athletic children than non-athletes, affecting as many as one in five adolescent athletes. It commonly occurs in boys ages 13 to 14 and girls ages 11 to 12. It is a disease that can be frustrating because the athlete will need to limit his/her activities for a short period of time until pain/swelling improve. The good news is that Osgood Schlatter is temporary, and as your child’s bones finish growing, the pain should go away. Again, treatments include: rest-which means avoiding those activities that increase pain levels, ice, anti-inflammatories, and a comprehensive flexibility program.
Meniscal Injuries: The menisci of the knee are a pair of C-shaped fibrocartilages that provides cushion between the thigh and shin bone, as well as stability, while permitting both flexion and rotation of the joint. A meniscus tear can result from any activity that causes you to forcefully twist or rotate your knee, with the foot planted on the ground. Typical symptoms associated with a torn meniscus can include: a “catching” or “popping” sensation, swelling and stiffness, pain with weight bearing and rotation, and difficulty straightening your knee fully or experiencing what feels like a ”block” to movement of the knee, as if it were “locked” in place. The diagnosis of this type of injury can be identified during a thorough physical exam or an MRI. The treatment of meniscal tears is typically a surgical intervention to either repair the tear or trim out the torn piece, creating a stable edge and restoring its function. Recovery and return to full activities can range from 4-8 weeks.
Anterior Cruciate Ligament (ACL)
ACL injuries have become one of the most common injuries among athletes today. According to the American Orthopedic Society for Sports Medicine, about 150,000 ACL injuries occur in the U.S. every year. The same source reports that ACL injuries account for more than $500 million in U.S. health care costs each year.
Athletes that play high intensity sports, like soccer, commonly injure their ACL through one of two ways- contact with another player or other non-contact mechanisms. According to the American Academy of Orthopedic Surgeons, about 70% of all ACL injuries in athletes occur via non-contact mechanisms such as pivoting, cutting, side stepping, awkward landing, or out of control play. The remaining 30% occur from contact with other players.
Although many high-intensity contact sports such as football are played by males, females are actually at a higher risk of tearing their ACL’s. According to NIH Medline Plus, young females are 2-8x more likely to injure their ACL’s than their male counterparts.
More women and girls are playing competitive sports than ever before. The performance of women in recent Olympics, along with the popularity of women’s professional sports, has had a profound influence on girls participating in sports. The speed, power, and intensity displayed by female athletes have dramatically increased over the last 10 years. This more aggressive style of play has led to an increase in musculoskeletal injuries.
The ACL is one of 4 main ligaments inside the knee, running from the thigh bone to the shin bone. It keeps the shinbone from sliding forward on the knee and stabilizes the knee when it rotates or twists. Straight ahead sports place little stress on the ACL. It is those activities that involve cutting, planting, and changing direction, like soccer, in which the ACL plays a vital role, and where athletes, particularly females, are at greatest risk of an injury. Once a suspected ACL injury has occurred, a thorough physical evaluation is performed by an orthopedic physician and typically confirmed with a MRI. If a tear is confirmed, unfortunately, it will not heal on its own. Surgical intervention is necessary to replace the ACL and restore stability to the knee. The recovery process from surgery to return to play is generally 6-9 months.
Why females are more prone to tearing their ACL’s than males defies an easy explanation, but certain anatomical and hormonal differences between the sexes can contribute to this trend.
Theories of Increased Frequency of ACL Tears in Females
- Some research suggests the intercondylar notch, the tunnel in the knee in which the ACL passes through is narrower in females. It is possible that during cutting and jumping movements, the narrow notch may fray and weaken the ACL. This tends to be more serious in females since the ACL is typically a smaller structure.
- Female have a wider pelvis than males. This tends to exaggerate the angle made between the femur and the tibia when the foot is planted on the ground. This increases inward pressure on the knee and external rotation of the tibia; thus placing excessive stress on the ACL.
- Another theory states that the ACL in females is more lax than males, which makes it more susceptible to overstretching. There are receptors for both estrogen and progesterone on the ACL. Theory suggests that increases in either one or both of these hormones may slacken the ACL, increasing the risk of tearing the ligament. This suggests that the risk of injury may increase during the menstrual cycle.
- Lastly, studies have shown that females have less strength in their leg muscles and have slower muscle reaction times, which can increase the risk of ACL trauma. There is typically a significant imbalance between hamstring and quadriceps muscle strength in females, which is not present in males. Males have shown that during a landing from a jump, that the hamstrings will fire first, preventing excessive forward movement of the shinbone, thus protecting the ACL. Females tend to be more quadriceps dominant, which will increase the stress on the ACL.
There is good news. A recent 2 year study published by the American Journal of Sports Medicine found that an injury prevention and performance enhancement program was able to reduce the number of ACL tears by 88% in the first year and by 74% in the second year in female soccer players. Any program should include lower extremity flexibility, core strengthening, lower extremity strengthening, plyometrics, and agility training.
If you have any questions regarding the information just presented or concerns about your child’s knees, please feel free email me at srothatc@gmail.com.
The Knee
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