Orthopedics: Conditions

Sprains and strains are among the most common injuries in sports. A sprain is a stretch and/or tear of a ligament that connects one bone to another bone. A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments. Chronic strains are the result of overuse of muscles and tendons. A person with a sprain will experience pain, bruising, swelling, and inflammation and will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone.

A strain is an injury of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction. Typical symptoms of a strain include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of activities. Risk factors are those activities, such as basketball and jumping sports, in which an athlete can come down and turn the ankle or step on an opponents’ foot.

Patients usually state they have twisted their ankle which means the foot rolls underneath the ankle or leg. It commonly occurs during sports. Patients will have pain on the outside of their ankle along with swelling and bruising. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot.

Low back pain is extremely common. It affects millions of individuals each year, and hundreds of millions of dollars are spent on lost work and medical care. Almost everyone has at least one episode of back pain sometime in their life. The good news is the vast majority of back pain episodes never require formal treatment and get better.

The causes of back pain are vast. They include the common low back strain of the muscles in the back that help to support the spine. Often rest, ice, and later heat can be helpful. Modification of activities and proper body mechanics along with weight reduction are the mainstays of treatment. Anti-inflammatory drugs can be helpful for both pain and inflammation. Sometimes muscle-relaxant drugs are prescribed to help with acute spasm. Physical therapy is often prescribed after the acute phase to help teach specific core or trunk muscle exercises as well as general conditioning and body mechanics. Usually muscle strains are self limited and recovery is full. The goal is to prevent further episodes.

Other causes of low back pain include lumbar degenerative disc disease, degenerative joint disease, herniated disc, spondylolisthesis, spinal stenosis, and scoliosis. All of these have been described in more detail in other areas specific to that particular disease.

Further causes of low back pain may be more serious in nature. Sometimes tumors or metastatic cancer can present as low back pain. Anyone with a history of cancer with new onset back pain should be evaluated for possible spread of the cancer.

Aortic aneurysms may present as knife like pain from the abdominal area to the back and may mimic acute low back pain. These usually occur in older individuals with vascular disease but can occur in younger people as well. Any new severe low back pain of this type, without a history of trauma or lifting, should also be urgently evaluated for vascular problems.

Sometimes kidney infections will present as a dull or sharp lateral back pain similar to a muscle strain. This may or may not be accompanied by urinary symptoms of burning, frequency, and cloudy urine. This should be evaluated as well, especially if fever is present.