1

Strains, Pulls, and Tears: Preventing Summertime Injuries

Now that COVID-19 cases are waning and summer is here, it’s time to play. But with increased activity comes the increased risk of injury.

The following guide will help you determine if and how a strain, pull, or tear has occurred, and when to go to the professionals for an assessment.

Common Injuries

Summit Health’s internal medicine physician Dr. David Brown says that during the summer he usually sees an assortment of ankle and knee sprains, hamstring and calf strains, and general soft tissue injuries. He feels many of these are common overuse injuries that may occur from playing too much, trying to get fit too fast, or being overly aggressive in an activity.

For instance, many knee ACL (anterior cruciate ligament) and meniscal tear injuries occur from non-contact activities that result from changing direction very quickly or landing in an awkward position. Typically soft tissue injuries and torn ligaments happen when you land in an awkward position with your momentum resulting in a sudden twist such as when your body goes one way and your knee another.

Risk Factors

Repeating the same activity day after day, such as the way kids do when specializing in one sport, can be particularly stressful on the knees for instance. Participating in “cutting” sports like soccer and basketball (those that emphasize certain movements over and over) can also increase the risk for ACL and meniscal tears. As well females are at greater risk of tearing their ACLs than males and it is important to focus on biomechanics and neuromuscular (core, quadriceps, hamstring) strengthening. This is because women are often more flat-footed than men and may not bend their knees and hips as much during training. As well this may be due to the shape of the female pelvis and relative weakness in their core and gluteal (buttock) muscles.

Symptoms

So how do you know if you’ve merely tweaked your ankle or knee, or if it’s something more serious? Here are some signs that the injury is more significant:

  • Immediate pain
  • Pain upon touching the area
  • Pain when using the limb or joint
  • Swelling

Dr. Brown recommends icing, resting, and gently stretching the injured area without worsening pain. Then, if it hasn’t improved in a few days it’s time to seek medical attention. However, if you feel a pop, shift, or a buckle in the knee, or experience severe pain or swelling, Dr. Brown advises being seen by a medical provider as soon as possible.

Diagnosis

“Often sprains and strains and pull can be diagnoses based on the history and physical exam.” Says Dr. Brown, “However, if there is a concern of more serious injury an  X-ray to rule out a fracture or an MRI to evaluate for a torn ligament, meniscus tear, or other soft tissue injuries may be recommended”. Depending on the diagnosis, you may be referred to an orthopedic specialist or physical therapist to help co-manage the injury and get you back in the game.

Treatment

If you are diagnosed with a ligament tear or cartilage injury there are several options. For older adults who only want to walk, swim or hike as long as the knee doesn’t buckle four to six weeks of rest might be enough to allow for a return to daily activities. Dr. Brown cautions however that up to one-third of the patients who opt for this route will wind up with a chronic injury and possibly require surgery in the future.

For people who plan to perform more intensive activity surgical repair may be an option. In many cases, orthopedists may perform same-day reconstructive surgery.

Dr. Brown recommends physical therapy soon after surgery, often within 48 hours, and notes this is the key to returning to full function and activities as soon as possible.

Prevention

After surgery and rehabilitation, Dr. Brown recommends getting fit before you play. Focusing on strength training, speed, and agility, and neuromuscular balance control will assist with proper landing and torso control.  Similarly retraining your core, quads, and hamstrings will further help prevent injury.

Finally, Dr. Brown’s primary preventative care recommendation regarding injuries is to take the time to stretch both before and after training as well as in between sessions to maximize the range of motion and flexibility.