Weekend Warrior

TGIF. Yes another weekend is upon us. Golf, tennis, hiking, running, biking, yard work. Money in the bank for the ER. Sprains, strains, stress fractures, sunburns and rashes all end up in the ER. Quick turn around and easy income, I love the weekend.

The added bonus is that spring has sprung. All those coach potatoes that have been rooted in front of the tube for the past 4 months are now coming out of hibernation. Muscles, tendons, ligaments, and joints atrophy without regular exercise. Swinging a driver after a winter of inactivity is sure to put a strain on your back and shoulders. Hitting the road for that first run since November may lead to tendonitis, arthralgias even stress fractures.

The recent Boston Marathon was a bonanza for local ER's. I saw the daughter of a dear friend who had run her first marathon and came in with severe foot pain the next day. Plantar fasciitis vs stress fracture, only the x-ray tech knows for sure. Stress fractures are subtle injuries to the bones from repetitive or sudden overuse. An initial x-ray may be normal. If the history is consistent, treatment is rest and limiting use of the injured part. A repeat x-ray in 2-3 weeks will reveal the fracture. Bone scans and MRI will show the injury earlier than plain x-ray.

Athletes who play their games on the weekend are ill prepared for the stresses on their bodies. Without proper training and conditioning the risk of injury is high. Muscle strains or tears are common. Ligamentous injuries to the ankles and knees, sprains, occur frequently. Ruptured tendons especially the Achilles tendon are severe injuries for our intrepid jocks. The calf muscles attach to the heel by the Achilles tendon. Jumping, running, pushing off can cause the unconditioned tendon to tear. The patella tendon in the front of the leg is also prone to rupture in the weekend athlete. The tendons at the elbow are often injured by baseball, softball, and tennis enthusiasts. Tennis elbow and pitcher's elbow are example of tendonitis from excessive strain on tendon attachments.

The shoulder is often the site of sports and recreational injuries. The mobility of the shoulder leaves it vulnerable to damage. The head of the humerus (upper arm bone) is held in the glenoid fossa by a ring of tissue, the rotator cuff. Falls, throwing, and wrestling can easily tear this cuff. The shoulder, like all large joints has bursas. These are fluid filled sacs that act to lubricate and promote the movements of ligaments and tendons around the joint. Overuse and aging lead to inflammation of these sacs, bursitis. Bursitis may be acute or chronic. Chronic inflamation leads to calcium being depositing in the bursa. Sharp, painful calcium spikes in a bursa is a call to get to the ER.

The knee has a complex anatomy that performed well for the running life style of our ancestors. Twisting, planting the foot and cutting, and getting hit with the foot encased in cleats is not good for one's knees. There are four main ligaments of the knee. The anterior and posterior cruciate ligaments are in the middle of the joint. They give stability to movements of the knee front to back. The lateral and medial collateral ligaments stabilize the knee to stress from the sides. The menisci are the two horseshoe shaped cartilages that cushion the movements of the femur and tibia. Fixing the foot and twisting may tear these structures.

The ankle is prone to sprains. The ligaments of this joint are easily stretched or torn by the rocking and rolling movements of football (pigskin-type, or soccer), basketball and baseball. Sprains are graded first to third degree. The higher the degree, the greater the damage to the ligaments. Third degree sprains may require surgery to reestablish the integrity of the joint. RICE: rest, ice, compression and elevation are the best treatment for mild sprains.

The world's oldest ER doc has had his share of orthopedic problems. I was a dedicated runner from an early age. Overuse injuries have made me an elliptical trainer devotee. Cross training with a rowing machine and free weights keep me fit and painfree. My advice to the athletes out there is to be active every day. Walk, run, bike, and lift regularly and smartly. Sitting at a desk all week and then playing sports on the weekend will lead to injury. Use proper equipment and foot wear. Stop when you feel pain. Warm up gradually. Stretch after you have warmed your muscles and before strenuous activities.

A last word about cycling, for men only. Sitting on a bicycle seat for those long rides can lead to injury to the blood vessels and nerves involved with an erection. ED, erectile dysfunction is rampant with cyclists. Wear padded shorts and use a padded or split-type seat. Frequently get off your seat, and up on your pedals as you ride. If you still get ED, there is always vitamin V.