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INERTIA: A Therapist's Thoughts

INERTIA - Archive

10/24/2012

Injury Clarifications

Fall is officially here.  The leaves are falling and the temperature is dropping.  For the many in this state, that means one thing: Time to watch football.

One of the things that is bound to happen with football is that there are going to be some injuries.  We have seen a bunch of knee, ankle and shoulder injuries here in the clinic with our local high school athletes.  However, football injuries also hit the national sports news when high profile professional athletes are involved.  I often get questions about what these injuries really are, so I thought I would talk about a couple that have been in the news lately.

Lisfranc injury:  This one hit close to home with Packer RB Cedric Benson out for many weeks with this diagnosis.  Basically, this injury is a sprain or dislocation, depending on severity, of the midfoot. Instead of spraining the ligaments at the ankle joint, the injury occurs where the metatarsal bones attach to the small foot bones in the arch. When someone is in a plantar flexed position (toe pointing down) and a force is applied (like another player landing on them in a pile up), then the foot is twisted causing the injury. The long recovery is due to the fact treatment involves non-weight bearing for around six weeks to allow the ligaments to heal. If really unstable, then surgery may be needed which can also affect the recovery time.

High Ankle Sprain:  This injury happens more often but can be just as debilitating as a Lisfranc depending on the severity. These injuries are referred to as "high" ankle sprains because of the location being above the ankle at the ligaments that connect the tibia and fibula. More common ankle sprains occur below the ankle, usually at the ligaments coming from the fibula attaching to the talus or calcaneus bones of the foot. High ankle sprains are often caused more when the foot is turned out and a significant amount of rotation is involved. Due to the need for that stability between the tibia and fibula, these take longer to heal and at times might need surgery with pins placed to provide the stability while the ligaments heal. Either way, it is usually a long recovery of six to eight weeks before someone is able to get back to playing sports.

I hope this helps when you hear about these injuries as the season wears on. Hopefully your favorite players can avoid these difficult injuries.

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Time to get the upper extremities involved in the "Exercises I Love" series.  We treat a lot of shoulder injuries in the Sports Medicine Center, so I want to make sure to include some of the exercises that I use a lot for these injuries also.

Prone Scapular Strengthening
Some call these “Y,” “I” and “T” exercises, and I understand that I am kind of cheating adding three exercises into one here, but they go together well and I usually give them out all at once. Most people do not address the posterior shoulder stabilizers with workouts, and combining that with poor posture, leads to weakness around the shoulder blade.  I hate to say all, but I’m pretty sure that all of my patients with shoulder issues get these exercises (or some variation) as part of their home program.

Prone Extension



Lie on stomach with involved arm hanging off the table. Set shoulder blades back and hold position. In a thumb-up position, slowly raise your arm behind you to table height keeping your elbow straight.

Prone Shoulder Abduction



Lie on stomach with the involved arm hanging off the table. Keeping the elbow straight, pull the shoulder blades back and hold. In a thumb-out position, slowly lift arm sideways to table height and maintain the retracted position as you return to the starting position.


Prone Shoulder Flexion



Lie on stomach with the involved arm hanging off the table. Keeping the elbow straight, pull the shoulder blades backward and hold. Slowly lift arm forward to table height and maintain the retracted position as you return to the starting position.
 
 
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Griffin Ewald, MPT, OCS, CSCS
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Griffin Ewald, MPT, OCS, CSCS is a 2002 graduate of Marquette University's Physical Therapy program. He has worked in outpatient orthopaedics and sports medicine rehabilitation since graduation in both private practice and at Froedtert & The Medical College of Wisconsin. He is board-certified as an orthopaedic specialist and also has a certification as a strength and conditioning specialist. Griffin also works as a lab instructor at Marquette for the Physiology of Activity class.

Griffin and his wife, Kathleen, live in Wauwatosa. He enjoys running, playing soccer and golf. His favorite part of his job is returning his patients to the activities they love.
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Griffin Ewald, MPT, OCS, CSCS
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