Non-surgical Treatment of Sports-related Injuries
Athletic activity is often associated with complex effects on joint cartilage, bone, ligaments, and tendons due to highly repetitive movements and impact activities. These effects can significantly affect the musculoskeletal structures and make them susceptible to a variety of acute and chronic problems. These acute or chronic conditions may impair the mobility as well as the quality of life of the affected athlete. Appropriate treatment of these conditions may be surgical or non-surgical to restore to normal activities. Many effective non-operative orthopedic treatment options exist that can provide symptomatic relief and improving ability to participate in sports. Besides established nonoperative treatment methods, regenerative biologic treatment options are increasingly being developed for sports medicine and can help to effectively decrease pain as well as promoting functioning and quality of life even without surgical treatment.
Non- pharmacological intervention
Non-pharmacological interventions may range from simple lifestyle modification or physical exercises and rehabilitation programs. Activity modification can be a very effective method to reduce sports-related overuse injuries by altering or removing the sports activity that has been causing the athlete’s acute or chronic problem. Activity modification should be guided by your sports medicine specialist.
In addition, weight reduction can be a powerful tool in the treatment and prevention and management of sports-related conditions, and particularly for conditions resulting from joint overload. . The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered overweight and BMI over 30 is considered as obese. Exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore, rigorous exercises are not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional. Nutritional counseling by a sports nutrition specialist can also be very effective for weight optimization as well as can be helpful with improvement of athletic performance.
Physical therapy and Rehabilitation
Sports injuries are often associated with structural, biomechanical or biologic abnormalities that either result from pre-existing conditions, repetitive overuse during sports, as a result of acute injury. Depending on the degree of the abnormality, non-operative rehabilitation is always considered. Physical therapy under the supervision of your sports medicine specialist and certified physical therapist can help improve many sports-related abnormalities by optimizing critical factors such as flexibility, strength, endurance, proprioception and movement patterns and provide a guided, stepwise return to athletic activity. Rehabilitation is an important component of improving sports-related musculoskeletal abnormalities non-operatively, but can also be a critical tool in preparing an injured athlete for surgery (so called Prehabilitation).
Transcutaneous electrical nerve stimulation
The transcutaneous electrical nerve stimulation (TENS) method involves the use of low-voltage electric impulses to relieve the pain. It is believed to provide pain relief by inhibiting the conduction of pain impulses to reach the receptors in the brain and spinal cord. The patient is made to wear a device and this device generates the impulses that offer pain relief to the patient. Frequency of the impulses, duration of treatment and location of the electrical electrodes on the body are decided by your physician based on the severity of the condition as well the response of the patient. Using the device for at least 4 weeks may provide better pain relief. It should not be used by patients having a pacemaker or cochlear implants, or those suffering from epileptic conditions. It should also not be used during pregnancy.
Thermotherapy involves the application of hot or cold packs at the affected area. There is some evidence to support the use of cold therapy in providing symptomatic relief. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease, and hypertension, or who are pregnant should use it with caution.
This method involves the insertion of sterile needles into specific acupuncture points or pressure points. It is believed that insertion of needles at specific points restores the flow of “qi”, a form of energy and thereby relieves the pain. A modification in acupuncture is electro-acupuncture where the needles are stimulated by and electro-stimulator. Acupuncture performed by trained professionals is considered to be safe and offers pain relief. However, it may have certain risks if treated by untrained professionals.
Kinesiotaping is used as a short term treatment particularly when performing normal activities deteriorates the sports-related condition. The principle behind the treatment is stabilization of the knee joint by altering the distribution of stress and joint pressure. The response depends on the strapping technique used and the time for which it is strapped.
It is one of the oldest methods of treatment and reduces pain by increasing the circulation of blood and lymph as well by reduction of muscle tension or because of the therapeutic effect of the touch.
Pharmacological interventions include management of pain using medicinal preparations such as pain-relieving capsules or injections.
Non-steroidal anti-inflammatory drugs
These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the knee. Patients with liver and renal diseases as well as gastrointestinal problems such as ulcers must take extreme care while using them and should consult with their physician. They can cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.
These injections of steroids are given directly into the affected joint for severe pain when the use of NSAIDs does not bring much relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly.
Disease-modifying anti-rheumatic drugs and biological agents
Disease-modifying anti-rheumatic drugs (DMARDs) aim at halting the progression of the disease and offer symptomatic relief. Biological agents are the antibodies against the disease-causing agents manufactured using genetic engineering technology. These agents are recommended in individuals with severe disease conditions. Other treatments – Your physician may recommend the use of braces and orthoses, prescribe chondroitin sulfate, electromagnetic therapy, vitamin supplements, herbal and other dietary therapies.
discuss with your physician about these therapeutic options before initiating the treatment.
Regenerative Interventions (Orthobiologics)
Orthobiologics are natural substances such as cells, tissue, blood components, and growth factors that are used to aid in the regenerative treatment of sports-related injuries or conditions. They may be used to replace lost tissue, stimulate regeneration, accelerate healing, reduce pain and inflammation, and improve joint function. They are mostly obtained from your own body or sometimes from a donor and may be administered in the form of injections or may require a surgical procedure. Orthobiologics present treatment options that may be used alone as conservative treatment or following orthopedic surgery to enhance results. Orthobiologics present a key component of the innovative and rapidly developing field of Regenerative Sports Medicine:
- Regenerative Sports Medicine
- Stem Cell Treatments
- Orthobiologics in the Knee
- Orthobiologics in the Shoulder