Dr Rod Hughes Sports
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Sports Injuries

Thank you for fitting me in – 10 days later I am more energetic and joint pain is considerably less.
SB May 2016
Dear Dr Hughes
I cannot thank you enough for slotting me in to your busy schedule so promptlyand I am truly grateful for your kindness and support. Many, many thanks.
SJ July 2016
I cannot thank you enough for listening to my woes and getting to the bottom of 2 years of pain. I was beginning to think I would have to spend the rest of my life on so many tablets. My daughter and friends cannot believe the difference in such a short time. I am so happy to be almost pain free already.
CC May 2016

When talking about sports injuries you may see mental images of professional sports people such as footballers and Olympic athletes.

Most of us also have sporting hobbies; whether simply dog walking or going to the gymn, playing occasional games such tennis or golf or going to aerobics or Pilates classes or recreational running. Whatever the ‘sport’ there are certain injuries that can occur as a result of either bad luck, overuse, being a little less fit than desirable and straining something or having a sporting accident. Lots of Sport’s injuries arise without ever going near a sports field.

Most of these injuries or pains are such that they do not require surgery and will be the sort of problem that a rheumatologist can help with. Whilst I see people with a lot of different sports injuries there are certain conditions that are frequently seen and can be diagnosed and treated to shorten the time that you will have pain and restriction. Treatment is often undertaken in conjunction with referral to a good physiotherapist although people have often gone down that route before I see them.

Tennis elbow (lateral epicondylitis) and Golfer’s elbow (medial epicondylitis) occur after lots of different sports and after repetitive use in other activities such a work around the house or garden or at work.

They can both be disabling and very painful at night and after rest and are easy to diagnose and often easy to treat. Enthesitis means inflammation at the attachment of a tendon to bone – these two conditions are exactly that and if not treated properly can continue for months or even years.

With a combination of topical non-steroidal gels, extension exercises and a strategic steroid injection these conditions can almost always be treated to avoid the need for any surgery.

There are several causes of wrist pain – a wrist fracture, a swollen inflamed wrist joint after injury, pain from osteoarthritis at the base of the thumb after sporting use, tendonitis around the wrist due to repetitive strain and tendonitis down the forearm from de Quervains tenosynovitis affecting the extensor tendons of the thumb.

Clinical examination will often lead to an immediate diagnosis and treatment that may involve steroid injection – sometimes ultrasound imaging or even MRI may be needed to ensure that there is no lasting damage done as a result of injury.

De Quervain’s tenosynovitis

This is an overuse tendon inflammation involving two tendons running from the thumb down the inside of the forearm. Once again steroid injections can be very helpful and lead to fast relief.

Tendons join muscles to their bony attachments and can get inflamed after repetitive use or injury or in inflammatory conditions such as Rheumatoid arthritis.

The longer the tendon the more likely it is to get inflamed and I see tendonitis at the heel (Achilles), the knee (Patellar), the wrist, elbow and shoulder most often. Diagnosis, ultra sound to ensure there is no tear to the tendon and local treatment with injections or a range of anti-inflammatory drugs can be more effective than simple stretching to relieve these conditions.

Many ‘sports injuries’ involve the hip and the tissues around the hip especially the tendons and the bursae.

I frequently see people with hip pain due not to joint problems but to inflammation between muscles in the ‘bursa’. Each large muscle around the hip runs across another muscle under some tension and inflammation can occur after overuse or injury. It is important to diagnose these conditions and reassure the patient that they do not need hip surgery or even hip MRI in many cases.

Knees are complex with a main hinge joint surrounded by ligaments that hold the joint together, tendons that attach the muscles of knee movement and bursae that can become inflamed over the knee cap (Housemaid’s knee) and below the knee on the inside of the leg (anserine bursa).

Knee examination can usually tell the rheumatologist a lot about the knee and allow diagnosis and a treatment plan to be drawn up. However, given their complex structure knee MRI scans are very often used to investigate whether there has been structural injury or a tear to the cartilage. Apart from thee shoulder the knee is perhaps the most common site of Sports injuries. In many cases underlying inflammation drives knee pain and needs the rheumatologist to control the inflammation before the physiotherapist can make any progress.

Whether due to a sports injury or just occurring as we use our shoulders in every day activity shoulder pain is common as we get older.

The two main causes of shoulder pain, an inflammation of the shoulder joint itself (capsulitis) and inflammation or damage to the long tendon that runs above the shoulder joint and behind the collar bone (supraspinatus tendonitis) are common in people undertaking sports or repetitive activities such as gardening or leaf sweeping.

Clinical examination of the shoulder and arm will usually distinguish between the two and steroid injection can be both safe and very effective – not only can the pain go but shoulder stiffness is eased and the potential to progress to a stiff and immobile shoulder (frozen shoulder) can be avoided.

Some pain in the shoulder can actually be the result of a neck or upper spinal problem and not be the result of shoulder problems. Obviously in these cases treatment to the shoulder itself will not be helpful and attention should turn to treating the neck.

Plantar fasciitis or Policemen’s heel (as a result of new shoes on the beat) is a condition causing pain below the foot just in front of the heel and can result from running on hard pavements, walking on cobbles or with bare feet or wearing hard or unsuitable shoes. It can be agony especially when getting out of bed in the morning.

Whilst suitable insoles (sorbithane heel pads available on line) can really help bad plantar fasciitis may need a steroid injection to relieve the pain.