Conditions

At Champion Sports Medicine we diagnose and treat a variety of conditions. Below is a list of some of the common conditions we treat in our clinic.

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Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy (RSD), is a chronic pain condition. The main symptom is continuous, intense pain that is out of proportion to the severity of the initial injury. The pain occurs after an injury and typically gets worse rather than better over time. It most often affects an arm, leg, hand or foot. CRPS is most common in people aged 20-35; however it can also affect children and teens. The syndrome occurs more frequently in females than males.

How it occurs

Unfortunately, there is not a clear understanding of the cause of CRPS at this time. It is thought that the sympathetic nervous system plays a role in sustaining the pain of CRPS. Another theory is that CRPS is caused by an abnormal response by the immune system.

Signs and symptoms

The main symptom of CRPS is constant, intense pain. Other symptoms include changes in the color and/or temperature of the skin over the affected area, tingling and numbness, swelling or stiffness in the affected joint, changes in nail or hair growth patterns and a limited ability to move the affected area of the body. The symptoms of CRPS vary from person to person in both severity and length.

Diagnosis

Your doctor will take a thorough history and do a physical exam. The diagnosis is based on the history and examination. There is no specific diagnostic test for CRPS. Blood tests and imaging studies (X-rays, MRI, etc) may be done to rule out other conditions.

Treatment

Treatment for CRPS is aimed at relieving the pain. This treatment is most effective if it is started early in the course of the condition. Therapies include medications, such as topical pain relievers, narcotics, steroids and anti-seizure medicines, in addition to physical therapy, nerve blocks, spinal cord stimulation and medicine pumps. Physical therapy is the mainstay of treatment.

Returning to activity and sports The amount of time it takes to recover from CRPS varies from person to person. Spontaneous relief of symptoms occurs in some individuals; however others can have chronic pain and irreversible changes in their skin and hair patterns in spite of treatment. The affected area should be pain free with daily activities before returning to sports.

Ankle sprain

An ankle sprain is an injury to the ligaments that connect the bones of the ankle joint. Lateral ankle sprains (inversion injury) are the most common type of sprain. A grade I sprain is the mildest form of injury and consists of a stretch to the ligaments. A grade II sprain is a partial tear of the ligaments, and a grade III sprain is a complete tear of the ligaments.

How it occurs

An ankle sprain is caused by a twisting injury to the ankle.

Signs and symptoms

Symptoms include pain, swelling, bruising, limited ankle motion, and difficulty walking. Some people describe feeling a snap, pop, or tearing sensation at the time of the injury. Grade I sprains have little to no swelling. Grade III sprains can have significant swelling and bruising over a large area of the lower leg and ankle. Pain is located in the front of the ankle and is worse with walking.

Diagnosis

Your doctor will ask you to describe how your injury happened and to list your symptoms. After examining your ankle, your doctor may order x-rays to evaluate for a fracture. The amount of instability will determine the grade of your sprain.

Treatment

Treatment will depend on the grade of injury. For the first 24–48 hours after any ankle sprain, treatment is focused on reducing the pain and swelling. Wrap the ankle in an elastic bandage, elevate it as often as possible, and apply ice packs for 15-20 minutes every 2-4 hours. A pain medication such as ibuprofen can be helpful. Crutches are recommended until you can walk without pain. Your doctor may recommend a supportive brace, air stirrup, or walking boot to help you walk sooner without crutches.
For grade I and II sprains, rehabilitation should begin as soon as possible. Some grade II sprains may require a short period of immobilization in an air stirrup and occasionally a walking boot before rehabilitation can begin. In addition to helping control pain and swelling, rehabilitation is necessary to regain ankle mobility, strength, and balance (proprioception). Rehabilitation allows the ankle heal faster and reduces your risk of re-injury. Rehabilitation always involves a home exercise program. You doctor may prescribe treatment with a physical therapist or athletic trainer.
Grade III sprains and some grade II sprains will require surgery to stabilize the ankle joint, followed by physical therapy.

Returning to activity and sports

Return to sports will depend on the grade of injury and method of treatment. You should be able to return to sports and activities when you have regained full strength and mobility of the ankle joint, and can walk and jog without pain or a sensation of instability. You may also be given running program as part of your return to play protocol.

Preventing high ankle sprains

The best way to protect your ankle and reduce your chances of re-injury is to keep the muscles that support the ankle joint strong. This means continuing to perform ankle strengthening and balance exercises 2 or 3 times a week, even after your physical therapy has ended and you have been cleared to return to sports. Taping the ankle or wearing a supportive brace during sports can provide some added protection, but should not replace the strengthening exercises.

Joint hypermobility syndrome

Joint hypermobility is used to describe joints that easily move beyond the normal range. It is commonly called being ‘double-jointed’, although this is a misnomer, as these individuals do not have two separate joints.

How joints work

Joints are areas of the body where two bones are held together by ligaments. Ligaments allow for mobility (flexion, rotation, etc), so the bones can glide over one another smoothly and safely. Ligaments also provide stability, holding the bones together like hinges on a door, preventing dislocation. People with hypermobility syndrome have ‘loose ligaments’. This results in joints that are more mobile and less stable than normal. As a result, people with hypermobility syndrome are more prone to joint dislocations. They are also more prone to joint pain, as repeatedly moving a joint beyond its normal range puts stress on the joint and surrounding tissues.

How it occurs

Hypermobility syndrome is a condition that may be inherited or happen by chance. Normal ligaments are composed of a strong fibrous tissue called collagen. In people with hypermobility syndrome, there is a defect in collagen formation. This results in loose ligaments.

Signs and symptoms

For many there are no symptoms, but some people have recurrent joint pain and/or recurrent joint dislocations. The pain can be localized to the joint or include the nearby muscles. It tends to be worse with activity or at the end of the day, and is usually relieved with rest. Joint dislocations can occur with minimal trauma, such as rolling over in bed or going from sitting to standing.

Diagnosis

Your doctor will make the diagnosis by evaluating your symptoms and examining your joints to measure their range of motion. He will also assess your muscle strength and flexibility. X-rays and other imaging studies are not required to make the diagnosis of hypermobility syndrome. In some cases, blood tests may be helpful to rule out other causes of joint pain. In some cases referral to a geneticist may be recommended.

Treatment

Treatment of joint hypermobility syndrome is focused on joint protection. Strengthening the muscles around the joints improves joint stability and reduces pain. Despite loose ligaments, many people with joint hypermobility have tightness in large muscle-tendon groups. Since tight muscles can contribute to joint and tendon pain, stretching to improve muscle flexibility is often recommended. Pain medications can be used to treat the pain symptoms, but do not change the stability of the joint or tension on the muscles and tendons, so they only provide temporary relief. In some cases, supportive devices such as shoe inserts or knee braces may be helpful.

Association with other syndromes

Sometimes, Collagen is a major protein found in many body tissues. Its fibers give strength to ligaments, tendons, bone, skin, and cartilage. Many patients have isolated joint hypermobility, where the ligaments are the only tissues affected. In some patients, joint hypermobility is part of a more systemic collagen disorder, where other tissues are also affected. Ehlers-Danlos is a genetic syndrome that causes fragile skin, loose ligaments, heart valve defects, and eye problems. Tell your doctor if you have easy bruising, stretch marks, abdominal pain, chest pain, back pain, vision problems, or have been diagnosed with a heart murmur, as these may be signs of a more global collagen disorder.

Returning to activity and sports

Your doctor may initially advise you to modify your activities until the pain resolves and your strength and flexibility improve. High impact activities, such as gymnastics, football, basketball, soccer, and long distance running place a lot of stress on the joints and increase the risk for dislocation and pain. Activities such as swimming, bicycling, walking, and weight training are considered low impact and are safe to continue in most instances.

Management

Most people with joint hypermobility who follow recommended guidelines for joint protection do not suffer any damage to their bones or joints as they get older. However, some people with joint hypermobility can develop early onset of osteoarthritis, due to damage from recurrent dislocations or cumulative joint stress from years of high impact activity.

Osgood-Schlatter disease

Osgood-Schlatter disease (tibial tubercle apophysitis) is irritation and inflammation of the growth plate (apophysis) at the top of the shin bone (tibial tubercle), where the patella tendon inserts. In a child, the bones grow from areas called growth plates. The growth plate is made up of cartilage cells, which are softer and more vulnerable to injury than mature bone. Osgood-Schlatter disease commonly occurs in children between 9 and 15 years of age, usually during a period of rapid growth.

How it occurs

Osgood-Schlatter disease is caused by increased tension and pressure on the growth center. This pressure usually results from overuse of the knee (repetitive running and jumping). Sometimes it can be due to direct trauma of the tibia tubercle, “Traumatic Osgood Schlatters”. Poor flexibility in the quadriceps, hamstrings and puts pressure on this growth center and increases the risk for developing Osgood-Schlatter disease. Tight muscles are more common during a growth spurt as the bones growth at a faster rate than the muscles and tendons.

Signs and symptoms

There is pain at the tibial tubercle with running, jumping, or kneeling. Sometimes there is swelling. The pain may limit your ability to do sports or activities. Usually just one knee is affected, but for 20% of people with Osgood-Schlatter disease, both knees are affected.

Diagnosis

Your doctor will do a physical examination of the knee and review your symptoms. X-Rays are usually not required to make the diagnosis of Osgood-Schlatter disease. In Osgood-Schlatter disease, X-rays are usually normal, but many times there is soft tissue swelling over the tibial tubercle.

Treatment

You will need to rest from painful activities in order to take the pressure off the growth center and allow the inflammation to resolve. Ice packs can be applied to the knee for 15-20 minutes every 2 to 4 hours until the pain goes away. Regular stretching of the quadriceps, hamstrings and hips will help reduce the pain. Anti-inflammatory medications may be prescribed if rest, ice and stretching are not reducing your pain. You should never use ice or anti-inflammatory medications before playing a sport, because this can prevent you from sensing when further injury is occurring.

Returning to activity and sports

The goal is to return to sports as quickly and safely as possible. If you return to sports or activities too soon, or play with pain, the injury may worsen, which could lead to chronic pain and difficulty with sports. Everyone recovers from injury at a different rate.

Prognosis

With appropriate treatment, almost all children with Osgood-Schlatter disease are able to return to their usual sports and activities within a few weeks, but the timeline is different for each child. Though the pain may go away, sometimes the tibial tubercle remains enlarged, and some adults with a history of Osgood-Schlatter disease have pain when kneeling and may be susceptible to patella tendonitis.

Preventing Osgood-Schlatter disease
  • Perform a proper warm-up before starting any activity. Five to ten minutes of light jogging, cycling, calisthenics, or a dynamic warm-up before practice will increase circulation to cold muscles, making them more pliable so that they put less stress and tension on their attachment sites (apophyses).
  • Wear shoes that fit properly and are appropriate for the sport or activity. Replace worn out shoes promptly.
  • Stretch quadriceps and hamstring muscles 1-2 times a day. It is better to stretch after exercise than before exercise. Hold each stretch for 30 seconds. Don’t bounce.

Do not play through pain. Pain is a sign of injury, stress, or overuse. Rest is required to allow time for the injured area to heal. If pain does not resolve after a couple days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport.

Patellofemoral pain syndrome

Patellofemoral pain is a common knee problem. People with this condition feel pain under and around your kneecap. The patellofemoral joint is made of the patella (kneecap), femur (thigh bone), and soft tissue supporting structures (patellar ligaments, bursae and tendons). The pain usually comes from these supporting structures.

How it occurs

For most people with patellofemoral pain syndrome there are a collection of factors that cause the pain. Anything that increases the strain on the soft tissue supporting structures around the kneecap can lead to a problem with how the patella moves through its groove in the thigh bone as you bend and straighten the knee. Patellofemoral pain syndrome can result from direct trauma such as falling onto the kneecap or hitting the knee on the dashboard in a car accident. It most commonly occurs from overuse of the knee in sports or activities that involve intense and repetitive running and jumping. Activities of daily living such as prolonged sitting or standing and going up and down steps create extra pressure between the patella and the femur causing more stress and irritation.
Some variants of normal hip, knee, and foot alignment can put additional strain on the patellofemoral joint and supporting structures. People who are “flat-footed,” “knock-kneed,” or “pigeon-toed” tend to have higher rates of patellofemoral pain syndrome. Weak hip and thigh muscles are an important cause of patellofemoral pain. These muscles support the patella. When they are weak, the patella will not glide smoothly through its groove. This increases the strain on the patella’s supporting structures which causes pain. A tight IT band (a tendon that runs along the outside of your thigh from your hip to your shin bone) is another risk factor for patellofemoral pain, since it also helps to control the movement of the patella in its groove. Finally, tight hamstrings are a frequent cause of patellofemoral pain, especially in growing bodies. Since muscles grow faster than bones, it is common for larger muscles to become relatively tight during growth spurts. Tight hamstrings increase the pressure behind the kneecap, which can lead to pain.

Signs and symptoms

The most common symptoms are pain during and/or after activity and pain or stiffness after prolonged sitting or standing. There may also be a grinding or popping feeling under the kneecap, and some people may experience mild swelling. The pain is usually dull and achy, and may shift from one side of the kneecap to the other. People may have pain in both knees or only in one knee. The pain is usually worse when kneeling, walking downhill, or going up and down stairs.

Diagnosis

Your doctor will review your symptoms and examine your knee. X-rays, MRIs, and other imaging studies are not valuable in diagnosing patellofemoral syndrome, but may be helpful to rule out other sources of knee pain.

Treatment

Treatment includes temporarily reducing irritating activities until the pain is better controlled. For example, you might want to bike or swim instead of run. The mainstay of treatment is a customized rehabilitation program to strengthen and stretch the hip and thigh muscles so that they can help the patella move smoothly through its groove. Ice often helps to reduce the pain. Ice should be applied for no more than 20 minutes at a time, and can be used as often as every hour. Medications, such as ibuprofen, are typically not very helpful except when there is swelling and pain. Your doctor may recommend shoe inserts if you have flat feet that are contributing to the knee pain. A patellofemoral brace can provide support to the patella, and may reduce pain during activity.

Returning to activity and sports

The goal of treatment is to return to your sport or activity as soon as it is safely possibly. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your knee recovers, not by how many days or weeks it has been since the pain started. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.

Preventing patellofemoral pain syndrome
  • Maintain strong and flexible thigh and hip muscles.
  • Make sure you wear shoes that fit well, have good support, and are appropriate for the activity.
  • Begin any new activity slowly and increase the intensity, duration, and frequency gradually.

Do not play through significant knee pain. If pain persists despite rest for a few days, see your physician.

Rotator cuff tendonitis

Rotator cuff tendonitis is inflammation (swelling) or irritation of the rotator cuff tendons, which leads to pain and restriction of motion at the shoulder joint. There often is swelling of the subacromial bursa, also; this is called bursitis. The bursa is the small fluid-filled sac that helps to reduce friction created by the rotator cuff tendons as they move back and forth under the acromion. Inflammation can weaken the tendons, making them more susceptible to tears. Rotator cuff tears are rare in children and adolescents but commonly seen in swimmers and throwing sports.

How it occurs

Rotator cuff tendonitis usually results from repetitive use of the rotator cuff muscles, which commonly occurs in sports such as baseball, volleyball, tennis, and swimming that involve repeatedly raising the arm above the head. This overhead motion can pinch the rotator cuff tendons between the ball and socket joint and the coraco-acromial arch. As the tendons become irritated and swell, they occupy more space in the joint – which leads to further pinching. When this pinching of the tendons occurs, it is called impingement.

Sign and symptoms

There is pain along the front and side of the shoulder. Raising the arm out to the side or overhead causes pain. Movements that cause pain at home might include reaching for objects on high shelves or brushing your hair. Pain worsens with activity. There also may be stiffness, weakness or inability to raise the arm completely. Lying on the involved shoulder can cause discomfort, and there may be achy pain at rest or at night.

Diagnosis

Your doctor will examine your shoulder and arm to assess strength, joint stability and range of motion, and to check for pinching or a tear of the tendons. Most cases of rotator cuff tendonitis can be diagnosed by a doctor’s review of your history and examination of the shoulder. In cases where the diagnosis is unclear, a MRI with contrast can be performed to confirm to presence of inflammation in the tendons and determine whether there is a tear (tendon and/or labrum) or other injury.

Treatment

The most effective treatment is rest from overhead motions to allow the swelling and inflammation of the tendons to resolve. Rest is also important to prevent further injury, since inflamed tendons are more likely to tear. Ice and anti-inflammatory medication also can help reduce swelling and pain. After a period of rest, rehabilitation helps to re-establish range of motion at the joint and strengthen all of the shoulder muscles, including the rotator cuff. Athletes with strong rotator cuff muscles are less likely to develop rotator cuff tendonitis.

Returning to activity and sports

The goal is to return you to sports and activities as quickly and safely as possible. If you return too soon, or push through pain, then the injury may worsen, which could lead to chronic pain and difficulty with sports. Everyone recovers from injury at a different rate. Return to sport or activity will be determined by how soon your shoulder recovers, not by how many days or weeks it has been since the injury occurred. In general, the longer you have symptoms before starting treatment the longer it will take to get better. You should be pain-free with everyday overhead activities before return to sports.

Preventing rotator cuff tendonitis
  • Strengthening the rotator cuff muscles and complementary shoulder muscles, such as the rhomboids and trapezius, can help prevent injury.
  • Do not play through pain. Pain is the first sign that the tendons are becoming inflamed and irritated. Rest is needed to allow those tendons to heal and prevent further injury. If pain does not resolve after a couple days of rest, then consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport.
  • Avoid rapid increases in training frequency, intensity or duration.

Sever disease (Calcaneal apophysitis)

Sever disease is most often seen in physically active boys and girls between the ages of 8 and 13 years. Sever disease is painful irritation and inflammation of the apophysis (growth plate) at the back of the calcaneus (heel bone), where the Achilles tendon inserts. In a child, the bones grow from areas call growth plates. The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone. The condition is most often seen in physically active boys and girls between the ages of 8 and 13 years and is the most common cause of heel pain in this age group. It is most commonly seen in soccer, basketball and gymnastics. Approximately 60% of Sever disease is bilateral.

How it occurs

Sever disease is caused by repetitive tension and/or pressure on the growth center. Running and jumping generate a large amount of pressure on the heels. Tight calf muscles are a risk factor because they increase the tension on the growth center. The condition can also result from wearing shoes with poor heel padding or poor arch support.

Signs and symptoms

The most common complaint is pain in the heel. The pain usually occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse with wearing cleats. The pain may limit your child’s activities and when severe, may cause a limp.

Diagnosis

Sever disease is diagnosed based on your doctor’s physical examination of the lower leg, ankle and foot and review of your child’s symptoms. X-rays have minimal use in the evaluation of Sever disease.

Treatment

Your child needs a short period of rest from painful activities in order to take pressure off the growth center and allow inflammation to resolve. Ice is very helpful in reducing pain and inflammation. Apply ice for 10-15 minutes as often as every hour when sore. Do not use ice immediately before activity. It is very important to warm and stretch tight calf muscles in order to relieve tension on the growth center. Shoes with padded heel surfaces and good arch support can decrease pain. Your doctor may also recommend gel heel cups or supportive shoe inserts for severe or intractable cases. In some cases, the doctor may prescribe an anti-inflammatory medication.

Returning to activity and sports

The goal is to return your child to his sport or activity as quickly and safely as possible. If he returns to activities too soon or plays with pain, the injury may worsen. This could lead to chronic pain and difficulty with sports. Everyone recovers from injury at a different rate. Your child’s return to sport or activity will be determined by how soon his injury resolves, not by how many days or weeks it has been since the injury occurred. In general, the longer he has had symptoms before starting treatment, the longer it will take for the injury to heal.