Avoid Torn Ligaments and Tendons – Exercise Correctly!
Many of my patients are very active and exercise every day. This is a good thing, but some of them overdo or fail to warm up properly and end up with torn ligaments and/or tendons. These can be very painful and may require surgery to repair. Instead of being active and feeling great, these common sports injuries can have you sitting on the sidelines for several weeks.
If you are someone who exercises frequently, I would like to talk to you about how to take care of your ligaments and tendons to avoid injuries. First let me give you a little basic anatomy lesson on what your ligaments and tendons do and the most common injuries that occur.
Ligaments and tendons help you move
When you think about going for a run every day, do you realize that there are several ligaments and tendons in your ankles, knees, hips, that if they were not there, your legs would not be able to move properly? Or when you play basketball, do they allow your shoulders to keep your arms up so you can make that dunk? That’s how it is. Without them, you would not be able to participate in your favorite sports. That is why it is so important to take them into account before exercising.
Ligaments are flexible rope-like structures that attach to bones. They connect your bones/joints so they can move properly. They act like shock absorbers in your car, absorbing the shock of your movements on your bones. Although ligaments are very flexible and bend a lot, they can sometimes give too much, stretch beyond their limit and become twisted or sometimes even torn.
Tendons are very similar to ligaments, they are basically made of the same collagen material as ligaments, but they have a different job. Tendons attach muscles to bones so that the muscles and skeletal structure move together when you go for a run. The tendons are also very flexible and stretch quite a bit. However, just like ligaments, they can be overstretched and sprained or torn as well.
Common Ligament and Tendon Injuries
There are many ways to injure ligaments and tendons that don’t involve playing sports. For example, in a job that requires repetitive movements lifting heavy objects overhead can put pressure on ligaments and tendons in the shoulder, elbow, or wrist. If you walk a lot while you’re at work, or are on your feet most of the day, you could put stress on your ankles, knees, and hips, especially your Achilles tendons and ligaments and your knee.
However, most ligament and tendon injuries come from participating in sports, especially when there is a direct impact between the feet and the ground, or when players bump into each other, fall, or crash into barriers. Let’s look at some of the most common, starting from the shoulders down:
•AC injuries: The acromioclavicular ligament – a big word that can be a big pain. 40% of ACL injuries occur in sports that primarily involve the shoulder and upper arm, such as basketball, baseball, soccer, and even overhead weightlifting. Injury to 1 or all 4 ACL ligaments usually occurs by direct force, during a fall directly onto the shoulder with the arm held at the side, or by indirect force, during a fall on an outstretched arm. There are six degrees of ACL ligament injury severity, all depending on how damaged the ligament is. Symptoms: pain and swelling over the shoulder joint, restricted movement due to pain, laxity or incorrect movement of the shoulder joint.
•UCL/LCL injuries: The lateral and ulnar collateral ligaments: These are 2 ligaments in the elbow that can be injured by repetitive forward and backward motions, such as those that occur in “throwing” sports like baseball (more common), soccer, and racket sports like tennis , hockey, polo, javelin throw. Symptoms: pain, sometimes swelling along the inside of the elbow, bruising if the ligament is torn, closing/opening the hand, clenching the fist causes pain.
•Elbow tendinitis: Tennis elbow and golfer’s elbow are the most common injuries of the elbow and affect the medial (middle) and lateral (lateral) epicondyles (tendons) of the elbow. This is painful swelling and stiffness caused by overuse and can recur frequently. It most often occurs in racket sports or activities where there is repetitive forward and backward movement of the elbow. Symptoms: pain, swelling, joint stiffness, loss of range of motion.
•ACL injuries: The anterior cruciate ligament is one of the 4 stabilizing ligaments of the knee. An ACL sprain or tear is a very common injury in people who engage in moderate to intense exercise and occurs more often in women. It occurs from the force exerted on the knee by a twisting motion of the body where the foot is planted firmly on the ground, overstretching the ligament. Symptoms: A snapping or crackling sound can be heard at the time of injury, it is very painful, knee swelling occurs, and the leg cannot be straightened.
•Achilles tendon injuries: The Achilles tendon is the largest and thickest tendon in the body and connects the heel to the muscles of the lower leg. You may be subjected to several times your body weight when pushing to jog or jog. The Achilles tendon can be injured by improper support in shoes, accidents, or even some medications can weaken it. Achilles tendon stiffness is also associated with heel spurs, which can be very painful and prevent you from playing any impact sports on the foot or the ground for several weeks. Symptoms: Pain/stiffness especially noted when getting out of bed. An Achilles tear may begin with a sudden snapping sound heard at the time of injury with immediate pain and an inability to stand on the leg.
Treatments for Sprained or Torn Ligaments and Tendons
If you’ve ever had a ligament or tendon injury, you know how painful and debilitating it can be. Treatments for these injuries depend on how damaged the ligament or tendon is. For mild to moderate injuries, treatment generally includes:
•The RICE formula (rest, ice, compression, elevation)
•A short course of anti-inflammatory medications.
Elbow tendon and shoulder ligament injuries may take longer to heal, as it is difficult to fully rest the ligaments and tendons in these areas.
More serious sprains and/or tears can often involve the following:
•Surgery on the ligament or tendon to restore proper tension to keep the bones/joints in proper alignment for proper movement. X-rays and/or MRIs are used to see how severe the ligament or tendon injury is.
•Arthroscopic knee anterior cruciate ligament surgery is sometimes necessary to repair the ligament. Under anesthesia, several ports are made in the knee for the insertion of an arthroscope so that the surgeon can view/repair the ligament directly.
•AC Ligament Separations or Tears: Reconstructive/reconnective surgery is often necessary.
Recovery from ACL and AC ligament injuries can be slow and may require several weeks of physical therapy. Subsequent treatments include whirlpool, range-of-motion exercises, direct ultrasonic stimulation, heat, and/or ice to affected areas.
Prevention of ligament and tendon injuries
As I tell my patients, the best way to avoid ligament and tendon injuries is to make sure you take time to warm up before exercising. I can’t stress enough how important this is, especially for people just beginning an exercise regimen, as ligament and tendon injuries can seriously dampen your enthusiasm for future exercise. Here are some basic tips on how to warm up each section of ligaments and tendons that are most prone to injury:
•General stretches: Lie on the floor, raise your arms above your head and stretch like a cat, slowly twisting in various directions. Do this for about 5 minutes, taking deep breaths as you go. Your muscles, tendons, ligaments all need oxygen to function properly.
•Shrugs/Rotations: Slowly shrug your shoulders, bring them up to your ears, and roll them back slowly. This loosens the tension in the large muscles of the neck and shoulders.
•Elbow stretches: Extend your arm forward, slowly flex your hand or arm towards you to the middle position and stop, lower your hand back down.
•Leg stretches: Stand up straight, bend over and touch the ground with your fingertips and then slowly try to flatten your palm against the ground. Make sure to keep your feet flat on the ground and don’t twist to one side. This stretches the hamstrings and loosens tight muscles in the legs and knees.
•Achilles stretches: Stand facing a wall about 1 foot away, lean into the wall, and place your palms on it. Extend one leg back on the ball of your foot. Slowly and deliberately bounce your heel back toward the ground. This stretches the Achilles tendon and helps prevent heel spurs because the Achilles tendon is tight and pulls on the heel bone.
•weight train: Start with light weight training to strengthen ligaments and tendons, gradually increase.
•Get enough sleep: Inadequate sleep doesn’t allow your muscles, tendons, and ligaments to re-strengthen properly and makes them more prone to injury.
•Drinking water! Your muscles, ligaments, and tendons need water to move smoothly and flush out the lactic acid that builds up during exercise. It also helps create the proper fluid for joint cushioning. Drink half your body weight in ounces of water per day, more if you exercise in very hot and humid weather. Sports drinks can also help you stay hydrated.
Exercise does a lot of good for your health. However, ligament and tendon injuries can really put a damper on your fitness goals. It’s better to get a little exercise every day than to do the “weekend warrior” and end up straining and/or hurting yourself. Remember, exercise should be fun and not something that leaves you on the couch watching TV hoping to heal!
Dr Mark Bromson