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Health & Wellness
Presented by Barnes Jewish Hospital & Washington University Physicians

With professional athletes as our biggest investment, it's important to have doctors and physicians we can count on. It's because of that principle that the Blues work with doctors from Washington University and Barnes Jewish Hospital. Below, you'll find video and articles from one of these physicians about common athlete injuries, how they can be treated and how well these injuries can heal. [ TEAM PHYSICIAN INDEX ]

  Mark Halstead, MD
Assistant Professor of Orthopaedic Surgery
Washington University School of Medicine

Dr. Halstead serves as a team physician for the Washington University Athletic Teams and Lafayette High School. He also serves as an asistant medical director to the Go! St. Louis Marathon. His practice focuses on the nonoperative treatment and management of musculoskeletal and medical problems related to sports in pediatric and adult athletes, including concussion management, pre-participation evaluations for high school and college athletes, injuries and overuse problems in runners.

VIDEO: Weight Lifting | Sports-Related Concussions


TENNIS ELBOW (LATERAL EPICONDYLITIS)
Lateral epicondylitis, more commonly known as tennis elbow, is an overuse condition of the elbow that affects many patients. Pain typically occurs with gripping or grabbing objects, such as shaking hands or lifting a coffee cup and is located on the outer (lateral) side of the elbow. Most patients develop this pain after repetitive hammering, raking, painting, extensive typing on a computer, playing racquet sports, or golfing. Symptoms may persist for months in some patients.

This condition is easily diagnosed through physical examination. Sometimes, an x-ray may be performed to evaluate this further, although this would depend on other symptoms or results from a physical exam. An MRI is rarely needed for this diagnosis.

Treatment may include a stretching program, icing, brief trials of anti-inflammatory medication, the use of a forearm strap, and reduction of activities that cause pain. Physical therapy may be prescribed and occasionally an injection to the affected area may be considered. Surgery is rarely needed for tennis elbow.


PLATELET RICH PLASMA INJECTIONS
Platelet rich plasma (PRP) injections are a treatment option for patients with chronic injuries to the muscle, tendon or ligaments. Typically these injections are used once other treatment options, such as physical therapy, rest, and activity modification have failed.

PRP is obtained by using the patient’s own blood similar to having one’s blood drawn for a lab test. That blood is then spun in a centrifuge to separate the red blood cells from the white blood cells and platelets. The platelets are then concentrated and injected back into the patient at the site of injury or pain. Platelets contain growth factors which are known to help with the healing process, making them the preferred part of the patient’s blood to use in treating their condition.

At this point, most insurance companies consider PRP injections experimental, as large research trials demonstrating the benefit, or lack thereof, have not been published. These injections are considered safe, however, as they are comprised of the patient’s own blood. The main potential complication is an infection from performing an injection, which occurs in less than 1% of all injections.


ACHILLES TENDONITIS
Achilles tendonitis is a common overuse condition of the ankle, frequently seen in patients participating in running and jumping activities. The Achilles tendon is the thick rope-like structure in the back of the leg that attaches the calf muscles to the heel bone (the calcaneus). Pain occurs in the back of the heel and tends to hurt most commonly either at the middle portion of the tendon or where the tendon attaches to the heel bone. Most patients will have pain with running, climbing stairs, jumping or walking on their tip-toes. Symptoms may last for months in some patients.

Achilles tendonitis is frequently diagnosed by physical examination alone. An x-ray or MRI may be performed, but is not typically required to make the diagnosis. If an injury has occurred where a patient feels a pop in the back of their heel, develops a lot of swelling or bruising around the Achilles tendon and is unable to easily point their foot down, further evaluation should made by a physician for a possible Achilles tendon rupture.

Treatment for Achilles tendonitis may include icing, stretching, strengthening programs, medication, heel lifts and decreasing the activity that increases pain. Footwear should also be evaluated as older footwear may contribute to faulty mechanics and lead to pain. Cortisone injections are usually not performed for Achilles tendonitis as it may lead to an Achilles tendon rupture.


CONCUSSIONS
A concussion is a injury to the brain, sometimes referred to as a mild traumatic brain injury (mTBI). A concussion most commonly occurs from a direct blow to the head but can occur from a blow to the body that produces a quick jerking of the head. Symptoms typically include headache, dizziness, nausea (feeling sick to your stomach), sensitivity to bright lights or loud sounds, difficulty with concentration or memory, confusion, and feeling “foggy.” Most sport-related concussions will resolve in 7-10 days but up to 20% can take 4 weeks or longer to clear. There is not typically a structural problem in the brain with a concussion. A concussion should be thought of as more of a functional problem in the brain, similar to when a computer gets a virus and the computer cannot carry out its normal function.

How is a Concussion Diagnosed?
Concussions are primarily diagnosed by the history an athlete gives along with their symptoms. This is one of the main problems such that many athletes will not disclose their symptoms for fear of being taken out of the game. It is extremely important that athletes are honest to their athletic trainers or physicians about their symptoms to correctly manage their concussion. Imaging of the head, including CT and MRI scans, are typically normal in a sport-related concussion. Occasionally athletes are given a computerized test, called a neuropsychological test, to see how their brain is functioning.

What are the Treatment Options for a Concussion?
An important concept in the management of a concussion is “brain rest.” Similar to injuring your ankle, you wouldn’t walk or run on it before it is ready to do so and the pain has improved. We want the brain to be able to heal as well and stressing it too much while healing from the concussion may prolong or worsen the symptoms. The two things that may aggravate someone’s symptoms after a concussion are physical activity and cognitive/mental activity. It is important an athlete not exercise or practice for their sport if still having symptoms as that will often worsen a headaches, dizziness or any other symptoms associated with a concussion. The brain is unable to handle the extra energy it gets from exercise while recovering which is why the rest from physical activity is important. Cognitive rest means not doing activities that makes the brain work harder. This may include school work, particularly math and science subjects, reading, video game use, computer use, and taking tests. Sometimes it is even recommended that athletes spend a few days away from school or on a shortened school day if struggling a lot in school.

When can an athlete return to play after a Concussion?
It is recommended by many organizations, including the NFL, NCAA and NFHS (National Federation of High Schools) that athletes not return to play or practice the same day as their concussion. An athlete should be free of symptoms from their concussion both at rest and after they progress through increasing levels of physical activity before return to play is allowed. It is strongly recommended that any athlete who has had a concussion is evaluated by a physician prior to returning to play. Under no circumstances should an athlete return to play while symptomatic.


STRESS FRACTURES / COMPARTMENT SYNDROME OF LOWER LEG
Stress fractures and chronic exertional compartment syndrome (CECS) are common causes of lower leg pain in the athlete. These conditions are often initially diagnosed as shin splints. There are several differences between these conditions that may help in their identification.

Shin splints, also described as medial tibia stress syndrome, is an irritation of the lining of the shin bone (tibia) and one of the calf muscles (the soleus). Pain typically is most troublesome at the start of the run and hurts along a broad area of the medial side (towards the big toe) of the shin. Pain usually will lessen during the course of exercise and often returns when exercise stops. Usually there is not pain with daily walking. Shin splints usually respond to rest, icing, calf stretches and possibly changing footwear.

Stress fractures can occur in any bone in the body, most frequently in the bones of the lower half including the pelvis, femur, tibia, fibula and metatarsals. This injury occurs from repetitive stress to the bone, which weakens it, and produces a small fracture (or break) in the bone. Pain typically localizes to a small area and worsens with continued impact activities. Often pain will be present with everyday activities and may produce a limp. Typically stress fractures are identified with imaging tests such as x-rays, CT or MRI scans. Treatment often requires complete rest from impact activities for periods of 4-8 weeks, occasionally longer. Casting, crutches and, rarely, surgery may also be needed.

Exertional compartment syndrome most commonly affects the front and lateral side (towards the pinky toe) of the lower leg. Patients typically report progressively worsening pain and tightness of the leg with activity, frequently requiring stopping the offending activity. Numbness, tingling or loss of muscle function may occur. The diagnosis is made by measuring the pressure in the four compartments of the lower leg both at rest and after exertion. If pressure exceeds a certain threshold, the patient has the diagnosis of CECS. Treatment options include stopping the activity that causes pain or undergoing a surgical procedure called a fasciotomy, which keeps the pressure from building up in the compartments and allowing the patient to return to activity without symptoms.



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