IT BAND SYNDROME

What is it?
The iliotibial band (“IT band”) is a thick band of fascia (a kind of hard flesh) that extends down the outside of the upper thigh. It begins on the pelvis, crosses the hip and knee, and attaches just below the knee. Pain is a result of friction or rubbing of the iliotibial band against the bone on the outside of the knee, which results in irritation of the band. It is one of the most common knee injuries (second only to patellofemoral pain syndrome) and has been reported in as many as 12 percent of runners. Athletes involved in cycling, weightlifting, football, soccer and tennis may also experience pain from the IT band. 

Symptoms

• Pain on the outer part of the knee with sporting activities
• Popping or rubbing sensation on the outer knee
• Pain after sitting for long periods of time with the knee bent
• Pain typically worsening with activities

Sports Medicine Evaluation and Treatment
A sports medicine physician will ask an athlete questions about potential risk factors for ITBS, including running mileage, change in mileage, uphill and downhill running routines, and track workouts. Running the same direction around a track for a long time may worsen ITBS symptoms. A sports medicine physician will perform a thorough physical exam of the athlete’s knee and leg. The provider may look at muscle imbalances, flexibility, leg length, hip and knee alignment, running gait, foot arches and footwear.

For ITBS, imaging is not usually necessary, unless the physician suspects that other causes within the knee may be causing the pain. Treatment of ITBS includes rest, ice and anti-inflammatory medications. Athletes may also have to alter training routines during the recovery period to avoid activities that cause pain. Stretching is an important component to the treatment of ITBS, as well as identifying and correcting strength imbalances. Other treatment options include steroid injections, foot orthotics and very rarely, surgical referral.

Injury Prevention
Athletes should maintain appropriate flexibility and strength, and ensure a proper warm-up prior to activity. 

Return to Play
Athletes may expect to return to activity once the symptoms have improved. Cross training is often a useful tool to use to aid in recovery. Once symptoms are improved, the athlete can gradually return to activity, generally over a period of about four to six weeks.

Authors: AMSSM Members Raul Raudales, MD, and David Berkoff, MD

CERVICAL STRAIN/SPRAINS

What is it?
A strain or sprain is an injury to a muscle or ligament.  There are many parts of the neck that can be injured, such as the muscles, ligaments, bones, discs, and nerves.  A cervical strain or sprain is a neck injury that involves the muscles or ligaments of the neck. This type of injury can happen in any sport when there is a collision between two athletes, a fall, or contact with impact to the head.   In some collisions or falls, the neck may not be directly injured, but the force of the injury may cause a whiplash of the neck and cause a sprain or strain.  This can occur in many sports, but more often in football, ice hockey, lacrosse, wrestling, and soccer. 

Symptoms
The athlete may start to feel symptoms immediately after the injury, or may slowly feel worsening pain over the course of a few days.  He or she may feel soreness or stiffness in the neck muscles.  It may be difficult to move the neck in certain directions.  The athlete may also feel a spasm or tightness in the neck muscles.  This type of neck injury does not typically involve the bones, nerves, or discs of the neck.  The athlete should not have any numbness, tingling, or weakness in the arms from a true cervical strain or sprain.

Sports Medicine Evaluation/Treatment
 A sports medicine physician will perform a thorough physical examination in order to rule out a more serious neck injury, such as an injury to the spinal cord.  If there are any worrisome signs at the time of the injury, the athlete may be referred for evaluation at the emergency department.  The physical examination includes evaluation of neck movement, location of the pain, and evaluation for muscle spasm.  The athlete can expect a neurological exam to make sure there is no injury to a nerve in the neck.  Sometimes, an x-ray will be ordered to rule out a more serious neck injury.

The treatment of this condition depends on the severity of the injury.  The healthcare provider may prescribe medications to help with the pain or spasm, such as anti-inflammatory medications or mild muscle relaxers.  If the pain is mild, the athlete may be able to do exercises at home to regain full range of motion of his or her neck.  If the pain is worse, the provider may have the athlete work with the athletic trainer if available, or refer the athlete to a physical therapist.  If the athlete is not improving with these treatments over time, an MRI might be ordered to look for a disc or nerve injury.

Injury Prevention
In any collision sport such as football, it is important to play with proper form.  This includes keeping the head up for any collisions or tackles, and not leading with the helmet or head.  Athletes should be taught the proper form for tackling at practice by their coaches, and avoid tackling other athletes until proper technique has been demonstrated.

Return to play
For a cervical sprain or strain that does not include any other worrisome signs, the athlete can return to play once the pain is controlled and he/she has regained full range of motion and strength of the neck.

AMSSM Author: Kris Fayock, MD

AMSSM'S COACHES CORNER - KEEPING YOUR ATHLETES HYDRATED

It takes more than having water coolers around to keep your athletes safe and performing at optimal levels. Here are some tips to educate your athletes on maintaining proper hydration, especially as we enter the warmer summer months.

• Have weigh-ins before and after exercise if possible. This will help an athlete know how much fluid intake is necessary for them and if they are falling behind or drinking too much.
   
• Educate athletes on urine color. (Lighter is better hydrated)
   
• Modify practice in hot, humid conditions. Adjust practice time, amount or intensity. Allow frequent hydration breaks and consider equipment modification.
   
• Encourage athletes to drink fluids before, during and after exercise. Water is encouraged unless the exercise is greater than 60 minutes. You may consider sports drinks if activity is greater than 60 minutes.
   
• Keeping fluids cold will encourage more hydration by the athletes.
   
• For optimum performance, athletes should continue drinking BEFORE becoming thirsty.

Source: Lopez, R., Casa D. Hydration for Athletes: What coaches can do to keep their athletes healthy and performing their best, 2006.

OVERTRAINING SYNDROME

What is it?
Overtraining syndrome occurs when an athlete’s training schedule is too much to allow for his/her body to recover. It often is the reason that the athlete’s performance declines despite increasing the training schedule and intensity of training. Poor performance continues even after weeks to months of recovery.

Risk Factors
• Early single sport specialization • Significant increase in training over a short period of time • Training for an important event • Excessive parental and/or coach pressure to succeed

Symptoms
• Increased fatigue • Decreasing performance • Sleep problems • Anxiety • More frequent injuries • Frequent illness • Bradycardia or tachycardia • Irritability • Weight loss • Depression • Lack of mental concentration • Vague muscle and/or joint pain

Sports Medicine Evaluation
The sports medicine physician will ask detailed questions about the athlete’s current training schedule and the actions that have been taken to help with the symptoms being experienced. He/ she will also obtain a dietary history. The physician will then perform a comprehensive physical exam. Depending on the findings of the comprehensive history and physical exam, the doctor may order laboratory studies, and ask the athlete to complete a questionnaire about mood and behavior. If overtraining syndrome is suspected and all other diagnoses are ruled out, a period of rest for 3-5 weeks is generally recommended, followed by a gradual return to full training over an additional 3 months. Alternatively, non competitive, low level recreational physical activity may be allowed during this modified rest period to maintain some cardiovascular fitness. Psychotherapy and counseling may also be prescribed as part of the treatment.

Injury Prevention
• A training log should be maintained. • Intense exercises with short rests, and frequent competition, should be avoided. • Weekly and yearly participation time should be limited. • Early morning heart rate should be monitored. • Sudden increases in training load should be avoided and a steady increase of 5% intensity per week should be followed. • Skill development, rather than competition and winning, should be emphasized with young athletes

Return to Play
A period of reduced training and competition stress is generally recommended for up to 4 months.

AMSSM Member Authors
Kristina Wilson, MD

MEET THE PHYSICIANS: JOHNSON COUNTY ORTHOPEDIC & SPORTS MEDICINE

JOHNSON COUNTY ORTHOPEDICS & SPORTS MEDICINE
20920 WEST 151ST STREET, SUITE 100
OLATHE, KANSAS 66061
P: (913) 782 - 1148

Please note all information listed below is the most current information on the physicians' clinic websites. Any incorrect information is not the responsibility of Champion Performance and Physical Therapy, but we'd like to get the information corrected immediately. Please contact us with any changes at 913-291-2290. We do not accept submissions of change to any information listed below without a valid NPI number. 

Brian Kendrid, MD

Focus lies within general orthopedic surgery, with emphasis and training in sports medicine. Dr. Kendrid treats a wide variety of conditions, including arthritis, necrosis, ligamentous tears, by means of reconstruction and joint replacements. He treats at two locations, including Olathe and Paola, Kansas. 

Gregory Lynch, MD

Focus lies within sports medicine as a fellowship-trained and board certified surgeon. Dr. Lynch has created and established a successful presence in the sports medicine orthopedics market in the Kansas City metro, and is consistently rated one of the best by his patients who have come to work with us here at Champion. 

Daniel Schaper, MD

Focus lies within general orthopedic surgery, as well as a listed clinical interest in sports medicine. Dr. Schaper is a long-time local of Kansas City, and practices at both locations in Olathe, being College Point and off 151st Street. 

Keith Scheffer, MD

Focus lies within general orthopedic surgery, as well as a clinical interest in sports medicine. Dr. Scheffer is fellowship trained in a number of procedures, and has completed hundreds, if not thousands of successful procedures throughout his years spent between Indiana and Kansas. 

For more information, please visit http://www.olathehealth.org/Clinics/Johnson-County-Orthopedics-Olathe#.V5Y9qSOAOkr

OUR BLOG SEGMENT TITLED MEET THE PHYSICIANS PROVIDES GENERAL FOCUS INFORMATION OF SOME OF THE BEST, AND MOST PROMINENT ORTHOPEDIC CLINICS IN THE KANSAS CITY METRO AREA, RESPECTIVELY. FROM THESE CLINICS, A NUMBER OF THEIR MOST PROMINENT SURGEONS REFER TO US HERE AT CHAMPION PERFORMANCE AND PHYSICAL THERAPY.