Tears of the anterior cruciate ligament, one of four main knee ligaments, are all too familiar to serious athletes and even weekend warriors. ACL tears commonly happen when the knee is hyperextended during activity, or is suddenly torqued.
Two recent studies present new takes on ACL surgery and recovery.
NFL players who underwent ACL surgery had longer careers than their peers who had meniscus repairs, or who underwent both procedures. Researchers analyzed a database of NFL player injuries from 1987 to 2000 and found 54 who had had meniscus repairs, 29 with a history of ACL reconstruction, and 11 with a history of both. They were matched with a control group with no prior surgeries and matched by position, year drafted, round drafted and other injury history. ACL surgery alone didn't substantially shorten the careers of the players, either by year or game number. However, the careers of those who had had meniscus repairs shrunk were about 1.5 years shorter, or 23 games. And players who had both procedures had careers cut by almost two years, on average, and 32 games.
"A combination of ACL reconstruction and meniscectomy may be more detrimental to an athlete's durability than either surgery alone," said lead author Dr. Robert Brophy of the Washington University School of Medicine, in a news release. "With further research, we will be able to better understand how these injuries and surgeries impact an athlete's career and what can be done to improve long-term outcomes."
ACL surgery in young athletes is becoming more common. But some health experts (and parents) worry that such surgery could carry risks because bones haven't finished growing. But a new study suggests that delaying surgery might have even worse consequences. Researchers examined records of 70 children 14 and younger who had ACL reconstruction surgery between 1991 and 2005. A little less than half (29) who put off treatment for more than 12 weeks had four times as many medial meniscus tears, 11 times as many lateral compartment chondral injuries, and three times as many patellotrochlear injuries. They also had more instability in their knees.
Domestic violence is believed to be vastly under-reported, and emergency and other physicians have long been urged to be on the alert for patients with unexplained injuries. The right questions can help identify victims -- the majority of them women -- and secure referrals to community service agencies.
Now doctors have a new clue. Rather than trying to read injured patients' faces for signs of fear or shame, physicians can read their facial injuries.
Women who had been assaulted by intimate partners generally sustained different patterns of facial injuries than women who were injured in car crashes, falls or assaults by strangers, according to a study published today in Archives of Facial Plastic Surgery.
Women who were assaulted by a husband or boyfriend had higher than expected numbers of orbital blow-out fractures (breaks or cracks in the bones surrounding the eye) and traumatic brain injuries.
Previous studies of facial injuries in men and women from car accidents and assaults had found that mandible and nasal fractures -- broken jaws and noses -- were the most frequent injuries, followed by zygomatic complex fractures, or cracks in the cheekbones and the bones that adjoin them.
Researchers had expected to find similar results in women who were victims of domestic violence. They looked at medical records of women age 18 years and older who went to the University of Kentucky Medical Center to be treated for trauma to the face.
The most common cause of facial injury was car accidents, followed by falls, then assaults. Of 45 assault victims identified, 19 were documented victims of domestic violence.
Women who were in motor vehicle crash or had suffered falls had higher than expected numbers of fractures to the alveolar ridge fractures (the horseshoe of bone directly beneath the teeth) and facial cuts. Women who were assaulted by a stranger were more likely to have broken jaw bones and zygomatic complex fractures.
In addition to distinctive patterns of injury, domestic violence victims also differed in presentation: They were more likely to delay seeking care for their injuries.
"For more than a decade, we have known that when healthcare providers assess patients for domestic violence and refer those who need help to local domestic violence programs, it can save victims' lives," said Esta Soler, president of the San Francisco-based Family Violence Prevention Fund. "But not nearly enough doctors, nurses and other providers are doing this. This study makes it even easier for surgeons and other providers to recognize when patients are victims of violence -- and creates an even more urgent mandate for them to intervene."
Considering the pounding gymnasts’ bodies take, it’s no secret they’re prone to chronic and serious musculoskeletal injuries. This is especially worrisome since many start at a young age when bones are still growing.
A new study finds that teenage gymnasts may be developing some injuries to their wrist and knuckle bones that have not been seen before.
Researchers did MRIs on the wrists and hands of 125 adolescent gymnasts ages 12 to 16, including 12 who had chronic wrist or hand pain. Injuries were found from the radius bone (a long bone in the forearm), to the small bones of the wrist, and the ends of the finger bones at the knuckles. Some had necrosis, or early, unnatural death, of their knuckle bones.
"The broad constellation of recent injuries is unusual and might point to something new going on in gymnastics training that is affecting young athletes in different ways," said Dr. Jerry Dwek, assistant clinical professor of radiology at UC San Diego, and the study’s lead author, in a news release. The research was presented at the Radiological Society of North America’s annual meeting this week in Chicago.
He added that more research is necessary to find the cause of the injuries, and said, "It is possible that by changing the way that practice routines are performed, we might be able to limit the stress on the joints and on delicate growing bones."
-- Jeannine Stein
Photo: Japanese gymnast Koji Yamamuro. Credit: Udayan Nag / Associated Press
We all know professional athletes suffer injuries all the time, but that’s an understood part of the gig.
But amateur athletes can experience serious aches and pains as well, according to a study that examined amateur bowlers. Researchers at Tel Aviv University in Israel surveyed 98 amateur bowlers involved in two bowling clubs. They were given questionnaires to assess musculoskeletal disorders as well as other factors such as features of the game itself.
Some 62% of bowlers said they experienced musculoskeletal symptoms in one or more joints during the last year. The number of leagues that bowlers participated in was a predictor of painful joints in the upper extremities, and the average achievement of bowlers predicted the number of painful joints in the entire body.
A few tips for amateur athletes was offered by Navah Ratzon, lead author of the study published recently in the journal Work, and director of the occupational therapy department at Tel Aviv University, via a release. She said that players of ball sports such as tennis, golf and basketball should understand that one unnatural move, such as a twist of the back, could have painful consequences. While stretching is always important, so is exercising the muscles that don’t get used that often. For example, tennis players and bowlers need to work their non-dominant arms, as well as shoring up other muscle groups to balance any asymmetries.
"Increasing numbers of adults are pursuing amateur athletics during their leisure hours," Ratzon said. "But we've found worrying indications that this activity — when not done properly — may have negative effects on the musculoskeletal system."
She added that people should avoid stressing out about their amateur endeavors. Becoming anxious about missing practices or spending too much time on a sport can aggravate persistent health issues.
Amid all the hoopla that is the Beijing Summer Olympics, it’s understandable that some things are lost in the wake of feats such as acquiring eight gold medals.
Take, for instance, the live-from-the-Beijing Olympics blog being written by Dr. Scott Rodeo (pronounced row-dee-oh, not the fancy row-day-oh), an orthopedic surgeon on the medical team treating U.S. Olympic athletes. He may not have the cachet of Oprah-approved Dr. Mehmet Oz, but Rodeo has great creds — he’s the co-chief of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York City, associate team physician for the New York Giants, and a former competitive swimmer. He’s done the Olympics gig before as the U.S. Olympic team’s physician at the Athens Games in 2004. The hospital’s public relations director suggested he blog via his Blackberry about his experiences as one of several medical personnel at the event, and so he has, starting with the swim team’s training camp in Singapore. Which is great, except the posts are … less than spine-tingling.
"I have continued to treat both gastrointestinal illness as well as sinusitis, upper respiratory conditions, coughs, and sore throats," he writes. "We have also had a few minor injuries in swimmers (finger, elbow) which occurred from a forceful finish."
All righty then.
Frankly, we feel for Rodeo, who must be caught between a rock and a hard place. On one hand, he certainly has no desire to see nasty injuries befall the athletes, most of whom have trained years for this opportunity. On the other hand, flying about 7,000 miles to treat diarrhea must be … a touch of a disappointment.
"There’s enough other stuff going on," he says, chuckling. "The less I see the better, because it means that everybody’s healthy."
A phone conversation (part of which took place en route to an event as Rodeo’s bag, filled with syringes and such, was being checked by security) yielded more info on what Rodeo’s been up to. Although his main focus is on swimmers, he cares for other U.S. and foreign athletes as well, plus a few media people and NBC staffers thrown in for good measure.
As for the athletes, "There may be a number of little things that you treat," he says. "More significant things are small fractures, which can be taped, and if it’s not too serious the athlete may keep competing. Most things are muscle strains — some are acute and demand attention." Those, he adds, are usually treated with ice and anti-inflammatory medications.
Various sports, he explains, yield specific types of injuries. Swimmers, for example, typically suffer overuse injuries such as shoulder strains, caused by repetitive arm movements. They can also suffer acute injuries such as fractures if they smash their hands against the pool wall during a finish. Track athletes can have stress reactions, a chronic bone injury that can be a precursor to a stress fracture.
It’s obvious that Rodeo must be prepared to treat anything, like the aforementioned gastrointestinal issues, which are typical for travelers and can stem from changes in water, food, and environment and can alter the GI tract’s bacterial balance. Nerves, he adds, are probably a factor in some of these cases. He’s been treating most mild cases with anti-diarrheal medications, and more serious ones with antibiotics. The danger here, Rodeo says, is dehydration: "Athletes can lose a lot of fluid, and that can affect performance."
For those hoping Rodeo would name names of who’s been injured and how, don’t hold your breath. The United States Olympic Committee prohibits him from giving out specifics. But a couple of nuggets were extracted: Michael Phelps is a stand-up guy who hasn’t gotten a swelled head from his phenomenal accomplishments. "He’s a good person, normal, he puts his pants on one leg at a time." Or should that be super-duper Speedos? Most athletes at this level, he adds, are pretty savvy about injuries and treatment and don’t act like prima donnas around the docs.
Despite a rigorous work schedule (he’s had little time to sightsee), Rodeo’s perks are getting to attend the competitions (he witnessed Phelps’ win in the 100-meter butterfly), as well as gather useful information to take home.
"You see injuries as they occur, as opposed to people coming in to see me a day later," he says. "So we can see what the best scenario is right away and learn how to get someone back quickly."
The blog has received about 1,000 visitors over seven days of tracking, and has received five comments. He sums up his month away from home this way: "It’s a neat experience on a lot of levels."
-Jeannine Stein
Photo credit: Martin/Presse Sports via US PRESSWIRE.
All political spouses and their vote-seeking mates smile and extend their hands to the masses -- over and over and over, tens of thousands of times. Today in Michigan, Cindy McCain had one handshake too many, and a presumably well-intentioned grip resulted in a sprain that sent her to a hospital in West Bloomfield for X-rays. A campaign spokeswoman said McCain's had previous surgeries for carpal tunnel syndrome and the handshake exacerbated the condition.
"Funny as it may sound, handshaking is a common source of people having sore hands," says Dr. Leon Benson, professor of orthopedic surgery at Northwestern University School of Medicine. "There are people, in the name of giving a strong handshake, who squeeze in a way that's pretty uncomfortable." He himself remembers having a sore hand for three days after an aggressive handshake.
But surgery for carpal tunnel syndrome, unless it was within the last six to nine months, probably wouldn't make the hand or wrist any more vulnerable than normal, he said. "If you catch somebody the wrong way, it can really hurt, but I've never seen anything serious come of it." The American Academy of Orthopedic surgeons has a wealth of information on all sorts of injuries, including hand and wrist sprains and strains. (Editor's note: the above-linked page at the AAOS site wasn't loading at the time of this post. UPDATE: site loading as of 4:15 p.m.)
Meanwhile, anyone out there with adoring fans, whether politician or movie star, might consider wearing a wrist brace to signal a vulnerable extremity. Cupping the hand could prevent a squeeze, or offering the fingers only, royalty-style, rather than the full hand. Or you could always cross your arms over your chest, bow respectfully and say, "Sorry, but I think I'm getting a cold and don't want to spread germs."
But those things might smack of social aloofness. "There are so many social issues that arise over the meaning of a handshake, that people just suffer through it," says Benson.
-- Susan Brink
Photo: Associated Press / Mary Altaffer. Cindy McCain, her arm in a sling after handshake injury.
Craning the neck while watching the Lakers battle the Boston Celtics in the NBA finals could be hazardous to your health, says Joe Horrigan, director of the Soft Tissue Center at D.I.S.C. Spine and Sports Center in Marina del Rey. Watching a sporting event, such as a Lakers game, while leaning forward and lifting the chin up, can pinch delicate nerves in the neck, causing pain and numbness. Although the pain will normally subside in a few hours, for some the pain is an indicator of a possible bone spur or structural problem in the neck.
"People sit on stools and they’re not in a great posture to begin with," says Horrigan, "and then they lean forward talking to their friends and they extend their neck, and they look up to watch television, and maybe call a friend and cradle the phone between their shoulder and ear." As the game goes on, he says, "you have more and more compression."
The best posture for the back and neck is to sit with the upper back straight, not rounded out, and with the neck neutral. Thus, for healthy Laker watching, try to view the game from eye level or lower. If you must watch the game on an overhead TV, you might want to get out of that posture from time to time during the game or even do the following exercise: Stand up tall, looking straight ahead. Slowly tuck your chin in towards your neck, making a double chin. Hold the position for five to 10 seconds. Relax your chin and repeat three times.
Keep in mind, the longer the game, the more the compression. "Triple overtime," says Horrigan, "is tough on everybody."
Booster Shots recently reported that some cities are outlawing the use of metal bats in youth baseball in order to reduce the risk of injuries to the pitcher and fielders from hard-hit balls. Now a study has been published calling for the use of face shields or mouth guards for all high school-age fielders.
The study, published today in the journal Pediatrics, reviews baseball injuries from 100 high schools from 2005 through 2007. The authors, from Nationwide Children's Hospital in Columbus, Ohio, found that shoulder injuries were the most common (17.6%), followed by ankle injuries (13.6%) and head and face injuries (12.3%). But it was the nature of the head and face injuries that concerns the authors of the study. They noted that greater proportions of injuries attributed to being hit by a batted ball were to the head, face or mouth compared with injuries not caused by the batted ball. In addition, a greater proportion of injuries caused by a batted ball required surgery (18%) compared to other baseball-related injuries.
High school baseball is relatively safe, the authors say. But they "strongly recommend helmets with face shields or at least mouth guards and eye protection be used by pitchers, infielders and batters at the high school level." Baseball players are used to wearing batting helmets, and softball rules have changed to mandate the use of a face shield on the batting helmet. Are fielding helmets next?
High school is tough on the psyche -- and it's not that great for the knees either. Knee injuries are the second-most frequently injured body part in high school sports and the leading source of high school-sports related surgeries, says a study from the Center for Injury Research and Policy at Nationwide Children's Hospital.
Using data from nine sports at 100 schools, researchers examined the incidence, risk and severity of knee injuries. Among the most common problems were incomplete and complete ligament tears, torn cartilage, fractures and muscle tears. The results are published in the June issue of the American Journal of Sports Medicine. (And, for the statistic-averse, here's a special link.)
Some of the findings:
* Gender matters. Boys are more likely to suffer an injury to the knee, but girls are much more likely to suffer a "major" injury to the knee and to have a season-ending injury. They're twice as likely to need surgery (which is darned expensive), in fact. And contact? That's more a factor in boys' injuries than it is in girls. For girls, jumps and pivots are the real problem. (Think body structure.)
* So does the sport. For boys, football and wrestling were especially risky. For girls, soccer and basketball were the most likely to result in knee damage.
* Rule-breakers are evil. Perhaps not, but the researchers did point out the physical dangers of illegal play. Such rule-breaking is a factor in 5.7% of knee injuries, they said, but 20% of knee injuries caused by such play result in surgery. Tsk.
With these kinds of stats, it's no wonder the hormonally challenged among us tend to be sullen when preparing for their school day. It's dangerous out there.
(Oh, the most frequently injured body part? That would be the ankle. No one seems too worked up about that though...)
To help prepare high schoolers -- and give their knees a fighting chance -- check out this primer on knee injuries from the Nemours Foundation and this wealth of info from the Sports Injury Clinic.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
A new study finds that teenage gymnasts may be developing some injuries to their wrist and knuckle bones that have not been seen before.
But amateur athletes can experience serious aches and pains as well, according to a study that examined amateur bowlers. Researchers at 
many, and a presumably well-intentioned grip resulted in a sprain that sent her to a hospital in West Bloomfield for X-rays. A campaign spokeswoman said McCain's had previous surgeries for carpal tunnel syndrome and the handshake exacerbated the condition.
Booster Shots recently reported that 
