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Women in sports such as association football, basketball, and tennis are significantly more prone to ACL injuries than men. The discrepancy has been attributed to gender differences in anatomy, general muscular strength, reaction time of muscle contraction and coordination, and training techniques.
Gender differences in ACL injury rates become evident when specific sports are compared. A review of NCAA data has found relative rates of injury per 1000 athlete exposures as follows:
- Men's basketball 0.07, women's basketball 0.23
- Men's lacrosse 0.12, women's lacrosse 0.17
- Men's football 0.09, women's football 0.28
The highest rate of ACL injury in women occurred in gymnastics, with a rate of injury per 1000 athlete exposures of 0.33
Of the four sports with the highest ACL injury rates, three were women's – gymnastics, basketball and soccer.
According to recent studies, female athletes are two to eight times more likely to strain their anterior cruciate ligament (ACL) in sports that involve cutting and jumping as compared to men who play the same particular sports (soccer, basketball, and volleyball). Differences between males and females identified as potential causes are the active muscular protection of the knee joint, the greater Q angle putting more medial torque on the knee joint, relative ligament laxity caused by differences in hormonal activity from estrogen and relaxin, intercondylar notch dimensions, and muscular strength.
Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, the presence of a leg length inequality, and flat feet. The tendency of flat feet to excessively roll inward during walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with plantar fasciitis and is an independent risk factor.
Studies have suggested a strong association exists between an increased body mass index and the development of plantar fasciitis in the non-athletic population; this association between weight and plantar fasciitis has not been observed in the athletic population. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors.
Plantar fasciitis is the most common type of plantar fascia injury and is the most common reason for heel pain, responsible for 80% of cases. The condition tends to occur more often in women, military recruits, older athletes, the obese, and young male athletes.
Plantar fasciitis is estimated to affect 1 in 10 people at some point during their lifetime and most commonly affects people between 40–60 years of age. In the United States alone, more than two million people receive treatment for plantar fasciitis. The cost of treating plantar fasciitis in the United States is estimated to be $284 million each year.
Plantar fasciitis is a common cause of calcaneal spurs. To quote Edward Kwame Agyekum, "When stress is put on the plantar fascia ligament, it does not cause only plantar fasciitis, but cause[s] a heel spur... where the plantar fascia attaches to the heel bone. Generally, a calcaneal spur develops when proper care is not given to the foot and heels. People who are obese, have flat feet, or who often wear high-heeled shoes are most susceptible to heel spurs.
Ankle sprains can occur through either sports or activities of daily living, and individuals can be at higher or lower risk depending on a variety of circumstances including their homeland, race, age, sex, or profession In addition, there are different types of ankle sprains such as eversion ankle sprains and inversion ankle sprains. Overall, the most common type of ankle sprain to occur is an inversion ankle sprain, where excessive plantar flexion and supination cause the anterior talofibular ligament to be affected. A study showed that for a population of Scandinavians, inversion ankle sprains accounted for 85% of all ankle sprains Most ankle sprains occur in more active people, such as athletes and regular exercisers.
The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful, especially when hit. Activities such as kneeling may also irritate the tendon.
The syndrome may develop without trauma or other apparent cause; however, some studies report up to 50% of patients relate a history of precipitating trauma. Several authors have tried to identify the actual underlying etiology and risk factors that predispose Osgood–Schlatter disease and postulated various theories. However, currently it is widely accepted that Osgood–Schlatter disease is a traction apophysitis of the proximal tibial tubercle at the insertion of the patellar tendon caused by repetitive micro-trauma. In other
words, Osgood–Schlatter disease is an overuse injury and closely related to the physical activity of the child. It was shown that children
who actively participate in sports are affected more frequently as compared with non-participants. In a retrospective study of adolescents, old athletes actively participating in sports showed a frequency of 21% reporting the syndrome compared with only 4.5% of age-matched nonathletic controls.
The symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses. In some cases the symptoms do not resolve until the patient is fully grown. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures.
OSD occurs from the combined effects of tibial tuberosity immaturity and quadriceps tightness. There is a possibility of migration of the ossicle or fragmentation in Osgood-Schlatter patients. The implications of OSD and the ossification of the tubercle can lead to functional limitations and pain for patients into adulthood.
Of people admitted with OSD, about half were children who were between the ages of 1 and 17. In addition, in 2014, a case study of 261 patients was observed over 12 to 24 months. 237 of these people responded well to sport restriction and non-steroid anti-inflammatory agents, which resulted in recovery to normal athletic activity.
High school athletes are at increased risk for ACL tears when compared to non-athletes. This risk increases with certain types of sports. Among high school girls, the sport with the highest risk of ACL tear is soccer, followed by basketball and lacrosse. The highest risk sport for boys was basketball, followed by lacrosse and soccer. Children and young athletes may benefit from early surgical reconstruction after ACL injury. Young athletes who have early surgical reconstruction of their torn ACL are more likely to return to their previous level of athletic ability when compared to those who underwent delayed surgery or nonoperative treatment. They are also less likely to experience instability in their knee if they undergo early surgery.
Bone mineral density decreases with increasing age. Osteoporotic bone loss can be prevented through an adequate intake of vitamin C and vitamin D, coupled with exercise and by being a non-smoker. A study by Cheng et al. in 1997, showed that greater bone density indicated less risk for fractures in the calcaneus.
In a study comparing the prevalence of ankle sprains between age, race, and sex, individuals who were aged 10–19 years old had highest incidences of ankle sprains. It can be suggested that adolescents are more physically active, which leads to higher chances of ankle sprains. Since sports deal with high utilization of the ankle, over 50% of ankle sprains are due to sport related injuries.
The prevalence of Achilles tendinitis fluctuates greatly among different ages and groups of people. However, Achilles tendinitis is most commonly found in individuals aged 30–40. A study was conducted in 1981 on recreational and competitive runners and what type of injury they were most likely to suffer from. Out of the 232 runners, 25 (11%) complained that their Achilles bothered them.
A study conducted in the city of Oulu found that a peak incidence of 18 injured Achilles occurred in 1994 and was highest in the male group aged 30–39. The study also found that 90% of the injuries occurred while playing a sport.
Risk factors include participating in a sport or activity that involves running, jumping, bounding, and change of speed. Although Achilles tendinitis is mainly diagnosed in runners, it does occur in basketball, volleyball, dancing, gymnastics and other athletic activities. Other risk factors include gender, age, improper stretching, overuse, and conditions which the individual may be born with. Congenital conditions occur when an individual’s legs rotate abnormally, which in turn causes the lower extremities to overstretch and contract; this puts stress on the Achilles tendon and will eventually cause Achilles tendinitis.
Calcaneal fractures are often attributed to shearing stress adjoined with compressive forces combined with a rotary direction (Soeur, 1975). These forces are typically linked to injuries in which an individual falls from a height, involvement in an automobile accident, or muscular stress where the resulting forces can lead to the trauma of fracture. Overlooked aspects of what can lead to a calcaneal fracture are the roles of osteoporosis and diabetes.
Unfortunately, the prevention of falls and automobile accidents is limited and applies to unique circumstances that should be avoided. The risk of muscular stress fractures can be reduced through stretching and weight-bearing exercise, such as strength training. In addition, footwear can influence forces that may cause a calcaneal fracture and can prevent them as well. A 2012 study conducted by Salzler showed that the increasing trend toward minimalist footwear or running barefoot can lead to a variety of stress fractures including that of the calcaneus.
The most common examples of this condition:
- Prepatellar bursitis, "housemaid's knee"
- Infrapatellar bursitis, "clergyman's knee"
- Trochanteric bursitis, giving pain over lateral aspect of hip
- Olecranon bursitis, "student's elbow", characterised by pain and swelling in the elbow
- Subacromial bursitis, giving shoulder pain, is the most common form of bursitis.
- Achilles bursitis
- Retrocalcaneal bursitis
- Ischial bursitis, "weaver's bottom"
- Iliopsoas bursitis
- Anserine bursitis
It is often seen as a repetitive stress injury, and thus lifestyle modification is typically the basic course of management strategies. For example, a person should begin doing foot and calf workouts. Strong muscles in the calves and lower legs will help take the stress off the bone and thus help cure or prevent heel spurs. Icing the area is an effective way to get immediate pain relief.
There can be several concurrent causes. Trauma, auto-immune disorders, infection and iatrogenic (medicine-related) factors can all cause bursitis. Bursitis is commonly caused by repetitive movement and excessive pressure. Shoulders, elbows and knees are the most commonly affected. Inflammation of the bursae may also be caused by other inflammatory conditions such as rheumatoid arthritis, scleroderma, systemic lupus erythematosus and gout. Immune deficiencies, including HIV and diabetes, can also cause bursitis. Infrequently, scoliosis can cause bursitis of the shoulders; however, shoulder bursitis is more commonly caused by overuse of the shoulder joint and related muscles.
Traumatic injury is another cause of bursitis. The inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results. Sometimes the cause is unknown. It can also be associated with various other chronic systemic diseases.
Development of tendinitis depends on the type, frequency and severity of exercise or use; for example, rock climbers tend to develop tendinitis in their fingers, swimmers in their shoulders. Achilles tendinitis is a common injury, particularly in sports that involve lunging and jumping. It is also a known side effect of fluoroquinolone antibiotics such as ciprofloxacin, as are other types of tendinitis.
Swelling in a region of micro-damage or partial tear can be detected visually or by touch. Increased water content and disorganized collagen matrix in tendon lesions may be detected by ultrasonography or magnetic resonance imaging.
Achilles tendinitis is thought to have physiological, mechanical, or extrinsic (i.e. footwear or training) causes. Physiologically, the Achilles tendon is subject to poor blood supply through the synovial sheaths that surround it. This lack of blood supply can lead to the degradation of collagen fibers and inflammation. Tightness in the calf muscles has also been known to be involved in the onset of Achilles tendinitis.
During the loading phase of the running and walking cycle, the ankle and foot naturally pronate and supinate by approximately 5 degrees. Excessive pronation of the foot (over 5 degrees) in the subtalar joint is a type of mechanical mechanism that can lead to tendinitis.
An overuse injury refers to repeated stress and strain, which is likely the case in endurance runners. Overuse can simply mean an increase in running, jumping or plyometric exercise intensity too soon. Another consideration would be the use of improper or worn-down footwear, which lack the necessary support to maintain the foot in the natural/normal pronation.
Enthesopathies may take the form of spondyloarthropathies (joint diseases of the spine) such as ankylosing spondylitis, plantar fasciitis, and Achilles tendinitis. Enthesopathy can occur at the elbow, wrist, carpus, hip, knee, ankle, tarsus, or heel bone, among other regions. Further examples include:
- Adhesive capsulitis of shoulder
- Rotator cuff syndrome of shoulder and allied disorders
- Periarthritis of shoulder
- Scapulohumeral fibrositis
- Synovitis of hand or wrist
- Periarthritis of wrist
- Gluteal tendinitis
- Iliac crest spur
- Psoas tendinitis
- Trochanteric tendinitis
In medicine, an enthesopathy refers to a disorder involving the attachment of a tendon or ligament to a bone. This site of attachment is known as the entheses.
If the condition is known to be inflammatory, it can more precisely be called an enthesitis.
Working on steep hills, galloping, and jumping all contribute to navicular syndrome, as they place greater stress on the DDF tendons, and may cause overextension of the pastern and coffin joints.
Regular exercise on hard or irregular ground increases concussion on the hoof, thus increasing the risk of navicular syndrome.
It is possible that standing can also increase the chance of navicular disease (such as a horse that spends most of the day in a stall with little turnout, as with some racehorses and show horses). Blood flow to the hoof decreases when the horse is not in motion. The horse is also constantly applying pressure to the navicular bones (which is intermittent as the horse moves).
Certain conformational defects may contribute to navicular syndrome, especially defects that promote concussion. These include upright pasterns, small feet, narrow and upright feet, significant downhill build (commonly seen in American Quarter Horses), and long toes with low heels (commonly seen in Thoroughbreds).
The long toe, low heel conformation places constant stress on the navicular bone, even as the horse is standing. Upright feet increase concussion, especially in the heel region of the hoof where the navicular bone is located. Excess concussion cannot be absorbed as well by the structures designed to do so (the frog, heels, and digital cushion), so more impact is transmitted to the structures within the foot.
Poor hoof shape is usually inherited, although poor shoeing and trimming can contribute to these shapes.
With the long toe, low heel conformation can come contracted heels (narrowing of the heel) which further compresses the navicular bone along with sheared heels adding more stress to the tendons and navicular bones.
Plantar calcaneal bursitis is a medical condition in which there is inflammation of the plantar calcaneal bursa, a spongy fluid filled sac that cushions the fascia of the heel and the calcaneus (heel bone). It is characterized by swelling and tenderness of the central plantar heel area. It is sometimes called 'Policeman's heel'. It sometimes was, and should not be, confused with plantar fasciitis, which is inflammation of the plantar fascia and can affect any part of the foot.
The main differential diagnosis of heel pad syndrome is plantar fasciitis. In heel pad syndrome all parts of the heel are tender while in plantar fasciitis typically only the part of the heel closer to the toes is sore.
For several reasons, a Jones fracture may not unite. The diaphyseal bone (zone II), where the fracture occurs, is an area of potentially poor blood supply, existing in a watershed area between two blood supplies. This may compromise healing. In addition, there are various tendons, including the peroneus brevis and fibularis tertius, and two small muscles attached to the bone. These may pull the fracture apart and prevent healing.
Zones I and III have been associated with relatively guaranteed union and this union has taken place with only limited restriction of activity combined with early immobilization. On the other hand, zone II has been associated with either delayed or non-union and, consequently, it has been generally agreed that fractures in this area should be considered for some form of internal immobilization, such as internal screw fixation.
These zones can be identified anatomically and on x-ray adding to the clinical usefulness of this classification.
It should be emphasized that surgical intervention is not, by itself, a guarantee of cure and has its own complication rate. Other reviews of the literature have concluded that conservative, non-operative, treatment is an acceptable option for the non-athlete.
Retrocalcaneal bursitis is an inflammation of the bursa located between the calcaneus and the anterior surface of the Achilles tendon. It commonly occurs in association with rheumatoid arthritis, spondyloarthropathies, gout, and trauma.
The pain is usually on the back of the heel and swelling appears on lateral or medial side of the tendon.
Shoulder impingement syndrome, also called subacromial impingement, painful arc syndrome, supraspinatus syndrome, swimmer's shoulder, and thrower's shoulder, is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion. This can result in pain, weakness and loss of movement at the shoulder.