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Summer, Sports, Injuries

A play-by-play on summer sports injuries with Dr. Heather Cichanowski

ExploreJohn Gordon, Content DeveloperJul 20, 2020

It's summer, and that means it's time for outdoor activities! But that also means that it's the season of outdoor activities’ less popular cousin: sports injuries. While being forced to spend a couple of months on the couch sounds pretty good to me, it’s probably a less-than-ideal summer plan for a lot of you. To help us walk (or sprint or limp) through some of the most common sports injuries, how to avoid them, and what to do when you didn’t avoid them, we’re talking to Dr. Heather Cichanowski, sports medicine physician and Medical Director of Women’s Sports Medicine at TRIA Orthopedics.

1. Sprained Ankles

A sprained ankle seems like a classic summer injury to me. It's like your worst uncle at a family picnic; no one likes him, but it wouldn't feel like summer if he didn't show up. I know that sprains are injuries to ligaments, and I know that ligaments are the tough bits of tissue that connect bones to each other in a joint. But that’s about all I know, so I’ll let Dr. Cichanowski take it from here.

Dr. Cichanowski:

Thanks! (And you can call me “Dr. C” if you want.) Ligaments are tough, but when they are stretched too far (beyond what they can bear) from a sudden twist, turn, or rolling of the ankle, the result is a sprain or—depending on the severity—a tear. The good news is that almost all ankle sprains can be treated with rest, ice, compression, and anti-inflammatory drugs (like ibuprofen). In more severe cases, a walking boot or brace and crutches are used to protect your ankle and help your body heal the ligament. In order to prevent recurrent ankle sprains, physical therapy is often necessary to regain ankle strength and stability. Wearing an ankle brace for activity for several months after the sprain can help with prevention as well. Ankle sprains can take anywhere from a few weeks to months to fully heal.

2. Muscle Pulls

Pulled muscles sound sort of self-explanatory—a muscle gets stretched too hard. Right? What happens when a muscle gets pulled, Dr. C?

Dr. Cichanowski:

When a muscle gets overstretched, it can lead to injury called a strain. A strain is like a sprain except it’s muscles or tendons (tissue that attaches muscle to bone) getting stretched or even torn. Muscles of the inner thigh (groin) can get injured due to rapid movements to the side or jumps. Similar to a groin pull, hamstrings (the muscles behind the thigh) can get injured with running, jumping, or kicking activities. Waterskiing is also a classic way to injure the hamstring. The hamstring can get injured anywhere along the muscle from the connection at the hip to the connection at the knee. Rest, ice, compression, and physical therapy are your tickets to getting better. These injuries can take months to heal and returning to your activity too quickly can set you back. The best way to prevent these injuries is to keep your muscles strong and do an active warm-up before activity (such as leg swings or jumping jacks). Surgery is only necessary in rare instances, and only for complete hamstring tears from the hip.

3. Shin Splints

I’ve had shin splints before—I started getting sharp pains in my lower legs when I was doing a lot of running. I think mine were pretty mild since they went away on their own after I eased up on running. But what was happening inside my legs, and how could I and other runners avoid them in the first place?

Dr. Cichanowski:

Shin splints happen when the muscles that attach to your lower legs get overused and inflamed. This is very common in any activity that involves running, especially when you do too much too soon or have a sudden change to your workout. Poor shoe wear and poor running mechanics can contribute as well. Untreated shin splints can turn into stress fractures, but as long as that hasn’t happened yet they’re pretty easy to treat: rest to give your body time to heal, and apply ice to relieve pain and swelling. You can also try some cross-training like cycling or swimming, as long as pain is not increasing. To prevent shin splints from happening again, you must figure out why they happened in the first place—that often includes physical therapy and looking back at how quickly you ramped up your activity levels.

4. Bone Stress Fractures

You mentioned stress fractures, Dr. C. That’s different from what we usually think of when we talk about bone fractures (that is, broken bones), right?

Dr. Cichanowski:

Yes, a stress fracture is a crack or break in a bone, but instead of coming from falling off your bike and breaking your bone, a stress fracture is caused by too much stress being put on the bone. It usually develops gradually over time, and most commonly affects bones of the lower extremity, such as the larger of the shin bones. This particular injury is seen more often in active females. When pain is very point specific, it hurts to walk with every step, and you get increased pain the more activity you do, then you might have a stress fracture. For all of you active females out there, a normal menstrual cycle is critical to help prevent getting a stress fracture. Disrupted menstrual cycles can lead to decreased estrogen levels, which can adversely affect bone health and increase risk for a stress fracture. Proper nutrition is very important for bone health, too.

5. Torn ACL

I have friends who have torn their ACL while playing soccer or basketball, but . . . well, what is an ACL? And what happens when it tears?

Dr. Cichanowski:

The ACL is a ligament (remember, a ligament attaches bone to bone) that is one of the main stabilizer structures in the knee; its full name is the anterior cruciate ligament. It helps stabilize the knee when we suddenly stop or start, quickly change direction, pivot or cut, and land from a jump. Thus, an awkward move or landing can injure this ligament. Like stress fractures, this injury is seen more often in active females. One reason for this is that female athletes move differently, especially when landing from a jump. Instead of landing with knees pointing forward and more bend to the hip and knees, females tend to land with a more upright position and their knees pointing inward. See my photo of a landing gymnast for an example:

gymnast landing with stress on the knees

Landing this way puts a lot of stress on the knee joint. Not all ACL injuries go onto surgery . . . but many do, especially if you are more active and participate in sports that involve a lot of pivoting and cutting. Prevention is the best medicine when it comes to ACL injuries. You can most effectively prevent ACL injuries through proper jump-landing technique and by keeping your leg muscles strong and balanced—making sure all muscle groups are healthy, without any being much stronger or weaker than the others.

6. What else?

People want to enjoy the summer while it’s here! So, Dr. C, what should people keep in mind to have fun and stay safe during summer activities?

Dr. Cichanowski:

Aches and pains do happen, but most can be treated with the home remedies that you already know—rest, ice, and compression. In addition, a good active warm-up can go a long way to help prevent those nagging injuries. However, there are some pains that should be looked at by a sports medicine specialist: When a few days of the home remedies (rest, ice, compression) and cross-training don’t decrease your pain

-When pain does not decrease after 48 hours of rest

-When pain gets worse the more you exercise

-When pain causes you to significantly modify your daily activities

-Any night pain

In addition, it’s important to remember that men’s and women’s bodies are different, so injury patterns might look different for active women vs. active men. In my work at TRIA, I’m part of a team of sports medicine specialists focused on care for girls and women of all ages and abilities. We call our team “Women’s Sports Medicine at TRIA.” We’re among the first in the metro to bring together doctors, physical therapists, athletic trainers, and a sport-trained registered dietitian with the common goal of providing comprehensive care to female athletes. We provide care for males, too—we’re here for all athletes of all types, ages, and abilities!

Alright! Thanks, Dr. C!