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What is an Achilles tendon injury?
The achilles tendon is a band of tissue that connects the heel bone to the calf muscle of the leg.Injury to the tendon may cause it to become inflamed or torn.
Achilles tendonitis is the term used when the tendon is inflamed. The inlammation causes pain at the back of your leg near the heel. A tear of the tendon is called a rupture. It also causes pain near your heel.

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How does it occur?
Achilles tendonitis can be caused by:

- overuse of the Achilles tendon

- tight calf muscles

- tight Achilles tendons

- lots of uphill running

- increasing the amount or intensity of sports training,sometimes along with switching to racing flats,which are racing shoes with less heel lift

- over-pronation,a problem where your feet roll inward and flatten out more than normal when you walk or run

- wearing high heels at work and then switching to lower heeled shoes for exercise.

An Achilles tendon may tear during sudden activity. For example the tendon might tear when you jump or start sprinting.

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What are the symptoms?
Achilles tendonitis cause pain and may cause sweeling over Achilles tendon. The tendon is tender and may be swollen. You will have pain when you rise up on your toes and pain when you stretch the tendon. The range of motion of your ankle may be limited.
When the tendon tears or ruptures,you may feel a pop. If there is a complete tear,you will be unable to lift your heel off the ground or point your toes.

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How is it diagnosed?
Your health care provider will examine your leg,looking for tenderness and swelling. Your provider will watch your feet when you walk or run to see if you over-pronate.

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How is it treated?

- Put ice packs on the Achilles tendon for 20 to 30 minutes every 3 to 4 hours for the first 2 or 3 days or until the pain goes away.

- Raise your lower leg on a pillow when you are lying down.

- Take anti-inflammatory medication as prescribed by your health care provider.

- If your health care provider prescribes a heel lift insert for your shoe,wear it at least until your tendon heals and possibly longer.The lift prevents extra stretching of your Achilles tendon.

- While you are recovering from your injury,change your sport or activity to one that does not make your condition worse.For example,you may need to swim instead of run.

- Do any exercises your health care provider gives you to stretch and strengthen your Achilles tendon.

- If you over-pronate,your health care provider may prescribe custom-made shoe inserts,called orthotics,which help keep your foot stable.

- In some severe cases of Achilles tendonitis,your foot may be put in a cast for several weeks.

- A tear of the tendon may require surgery.Or your foot may be put in a cast for 6 to 10 weeks.

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When can I return to my sport or activity?
The goal of rehabilitaion is to return you to your sport or activity as soon as is safely possible.If you return too soon you may worsen your injury,which could lead to permanent damage.Everyone recovers from injury at a different rate.Return to your activity is determined by how soon your Achilles tendon area recovers, not by how many days or weeks it has been since your injury occurred.In general, the longer you have symptoms before you start treatment the longer it will take to get better.
You may safely return to your sport or activity when,starting from the top of the list and progressing to the end,each of the following is true:

- You have full range of motion in the injured leg compared to the uninjured leg.

- You have full strength of the injured leg compared to the uninjured leg.

- You can jog straight ahead without pain or limping.

- You can sprint straight ahead without pain or limping.

- You can do 45-degree cuts,first at half-speed,then at full-speed.

- You can do 20-yard figures of-eight,first at half-speed,then at full-speed.

- You can do 90-degree cuts,first at half-speed,then at full-speed.

- You can do 10-yard figures of-eight,first at half-speed,then at full-speed.

- You can jump on both legs without pain and you can jump on the injured leg without pain.

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How can I prevent Achilles tendonitis?
The best way to prevent Achilles tendon injury is to stretch your calf muscles and Achilles tendons before exercise.If you have tight Achilles tendons or calf muscles, stretch them twice a day wheather or not you are doing any sports activities that day.
If you have a tendency to get Achilles tendonitis, aviod running uphill a lot.

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What is an ankle sprain? An ankle sprain is an injury that causes a stretch or tear of one or more ligaments in the ankle joint. Ligaments are strong bands of tissue that connect bones at the joint.
Sprains may be graded, I,II,or III depending on their severity:

grade I sprain: pain with minimal damage to the ligaments

grade II sprain: more ligament damage and mild looseness of the joint

grade III sprian: complete tearing of the ligament and the joint is very loose or unstable.

Sometimes sprains are just classified as mild or severe depending on the amount of ligament damage.
Most sprains occur on the outside part of the ankle,but they can occur on the inside as well.

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How does it occur? A sprain is caused by twisting your ankle. Your foot usually turns in or under but may turn to the outside.

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What are the symptoms?
Symptoms of a sprained ankle include:

mild aching to sudden pain

swelling

discoloration

inability to move the ankle properly

pain in the ankle even when you are not puttin any weight on it

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How is it diagnosed? To diagnose a sprained ankle, the doctor will review how the injury occurred and consider your symptoms. He or she will examine your ankle carefully. X-rays may be taken of your ankle.

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How it is treated?
Treatment may include:

Applying ice packs to your ankle for 20 or 30 minutes every 3 to 4 hours for the 2 to 3 days or until the pain goes away. Thereafter, ice your ankle at least once a day or until the other symptoms are gone.

Elvating your ankle by placing a pillow underneath your foot. Try to keep your ankle above the level of your heart.

Wrapping an elastic bandage around your ankle to keep the swelling from getting worse.

Wearing a lace-up brace or ankle stirrup(an Aircast or Gelcast).

Using crutches until you can walk without pain.

Taking anit-inflammatory medication or other pain medication prescribed by your doctor.

Doing ankle exercises to improve your ankle strength and range of motion. The exercises will help you return to your normal activity or sports.

Rarely,severe ankle sprains with complete tearing of the ligaments needs surgery. After surgery your ankle will be in a cast for 4 to 8 weeks.

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How long will the effects last?
The length recovery depends on many factors:

age

health

severity of injury and pervious injuries to that joint.

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When can I return to my sport or activity? The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your ankle recovers,not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment,the longer it will take to get better.
You may safely return to your sport or activity when starting from the top of the list and progressing to the end, each of the following is true:

You have full range of motion in the injured ankle compared to the uninjured ankle.

You have full strength of the injured ankle compared to the uninjured ankle.

You can jog straight ahead without pain or limping.

You can do 45-degree cuts,first at half-speed,then at full- speed.

You can do 20-yard figures of-eight,first at half-speed,then at full-speed.

You can do 90-degree cuts,first at half -speed,then at full-seed.

You can do 10-yard figures-of-eight,first at half-speed,then at full-speed.

You can jump on both legs without pain and you can jump on the injured leg without pain.

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How can I help prevent an ankle sprain?
To help prevent an ankle sprain,follow these guidelines:

Wear proper,well-fitting shoes when you exercise.

Stretch gently and adequately before and after athletic or recreational activities.

Aviod sharp turns and quick changes in direction and movement.

Consider taping the ankle or wearing a brace for strenuous sports,especially if you have a previous injury.

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What is the anterior cruciate ligament (ACL)?
Ligaments are strong band of tissue that connect one bone to another. The anterior cruciate ligament (ACL) is one major ligaments in the knee. It is in the center of the knee joint, connecting the thigh bone (femur) to the shin bone tibia. The ACL helps keep the knee stable by limiting twisting and forward sliding motions of the knee. The ACL is commonly injured in sports when there is a forced twisting motion of the knee or when the knee is hit while the foot is planted. It may also be injured during a sudden stop when the femur moves forcefully over the tibia.

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What is an ACL reconstruction?
A torn ACL will not heal by itself. In the past, doctors tried to repair the ACL by sewing the torn ends of the ligaments together, but this did not work. The ACL must be reconstruction by using ligaments or tendons from another part of the body from another part of the body to replace the torn ACL. Tendons are connective tissue bands that attach muscles to bones. The replacement tissue is called a graft. The grafts can come from several places. Most often graft is taken from the patellar tendon, which attaches your kneecap (patella) to your shin bone (tibia). The graft is made up of the middle third of the patellar tendon and small pieces of bone from the kneecap and the shin bone. A graft may also come from your hamstring tendon. The hamstring muscles are in the back of your thigh. If the graft come from someone who has died, it is called an allograft. Doctors have tried using some types of synthetic grafts but so far these have not worked well. Research is being done to see if there are better types of grafts that can be used. Your doctor will discuss the options with you and will help decide which procedure is best for you. You may consider having reconstructive ACL surgery if:

- Your knee is unstable and gives out during routine or athletic activity

- You are high-level athlete and your knee could be unstable and give out during your sport ( for example, basketball, football, or soccer).

- You are younger person who is not willing to give up an athletic lifestyle

- You want to prevent futher injury to your knee. An unstable knee may lead to injuries of the meniscus and arthritis

You may consider not having the surgery if:

- Your knee is not unstable and is not painful and you are able to do your chosen activities without symptoms.

- You are willing to give up sports that put extra stress on your knee

- You are not involved in sports

If a growing child tears an ACL, the doctor may recommend that surgery be postponed until the child has stopped growing.

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How do I prepare for an ACL reconstruction?
Plan for your care and recovery after surgery. Allow time to rest, and try to find people to help you for a few days. Follow your doctor’s instructions. You may be asked not to take aspirin for a week or so before your surgery. Do not eat or drink anything after midnight or the morning before surgery. You may have physical therapy before surgery to begin your rehabilitation.

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What happens during surgery?
You will have either general or spinal anesthesia. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. A spinal anesthetic leaves you awake but unable to feel anything from the waist down. Your doctor will prepare the graft. If your patellar tendon is to be used, the doctor will make an incision 1 to 3 inches below your kneecap. Then he or she will remove your torn ACL using an arthroscope. An arthroscope is a thin tube through which your doctor can view the inside of your knee joint. Various thin, small instruments are used to perform surgery in the knee. Your doctor will drill holes in your femur and tibia where the graft will be attached. The graft will be passed through the holes and anchored in place by screws or staples. The incisions from the graft site and the arthroscopy will be closed with stitches, tape, or staples. During your surgery, your doctor may also treat any other knee injuries such torn cartilage.

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What happens after surgery?
You may be allowed to go home a few hours after surgery or you may have to spend the night in the hospital. Treatment after surgery may include:

- Elevating your knee on a pillow several times a day as long as it is swollen and painful

- Pitting ice packs on your knee for 20 to 30 minutes 3 to 4 times a day for a few weeks

- Taking medication prescribed by your doctor for pain and swelling

- Having physical therapy to rehabilitate your knee

You may be on crutches for a week or two after surgery. You may not be able to drive for at least a few weeks.

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What are the complications?
Complications may include:

- Loss of range of motion in your knee, joint stiffness

- Persistent pain

- A blood clot in the leg

- Bleeding

- Infection

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When should I call the doctor?
Call the doctor immediately if :

- You have a lot of bleeding or a discolored drainage from the puncture sites.

- You have a lot of pain in your knee.

- You get a fever

- You have swelling in your calf or thigh that does not improve when your elevate your leg

Call your doctor during office hours if:

- You have questions about the surgery or its results

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When can I return to my sport or activity?
The goal of rehabilitation is to return you to full participation in your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined by how soon your knee recovers, not how many days or weeks it has been since your surgery. Rehabilitation from ACL surgery is very complex. Your doctor and therapist will watch your progress very carefully and gradually allow you to be more active. It may take 4 to 9 months of rehabilitation to get back to some activities. It may take 12 months or more for your knee to feel the way it did before your injury.

Pierre Rouzier, M.D. The Sports Medicine Patient Advisor

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What is an anterior cruciate ligament (ACL) Sprain?
A sprain is a joint injury that causes a stretch or a tear in a ligament. Ligaments are strong bands of tissue that connect one bone to another. The anterior cruciate ligament (ACL) is one of the major ligaments in the middle of the knee. It connects the thigh bone (femur) to the shin bone (tibia). This ligament, along with the posterior cruciate ligament, helps keep the knee stable and protects the femur from sliding or turning on the tibia.
Sprains are graded I,II,or III depending on their severity:

- Grade I sprain: pain with minimal damage to the ligaments

- Grade II sprain: more ligament damage and mild looseness of the joint

- Grade III sprain: the ligament is completely torn and the joint is very loose or unstable.

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How does it occur?
The anterior cruciate ligament is frequently injured in forced twisting motions of the knee. It may also become injured when the knee is straightened further than it normally can straighten (hyperextended). It sometimes occurs when the thigh bone if forcefully pushed across the shin bone, such as with sudden stop while you are running or sudden stop while you are running or a sudden transfer of weight while you are skiing.

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What are the symptoms?
There is usually a loud, painful pop when the joint is first injured. This is often followed by a lot of swelling of the knee within the first several hours after the injury. This is swelling is called an effusion and is made up of blood in the knee joint. If you have torn your anterior cruciate ligament in an injury that occurred months or years ago and you haven’t had reconstructive surgery, you may have the feeling that they knee is giving way during twisting or pivoting movements.

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How is it diagnosed?
Your doctor will examine your knee and may find that your knee has become loose. If you have swelling in the joint, your doctor may decide to remove the blood in your knee with needle and syringe. You may need x-rays to see if there is an injury to the bones in your knee. An MRI (magnetic resonance imaging) scan may also be done and should clearly show the condition of your ACL( as well as that of other ligaments and cartilage).

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How is it treated?
Treatment includes the following:

- Put ice pack on your knee for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain goes away.

- Keep your knee elevated whenever possible by placing a pillow underneath it until the swelling goes away

- Do the exercises recommended by your doctor or physical therapist

Your doctor may recommend that you:

- Wrap an elastic bandage around your knee to keep the swelling from getting worse.

- Use a knee immobilizer initially to protect the knee

- Use crutches

For complete tears, you and your doctor will decide if you should have intense rehabilitation or if you should have surgery followed by rehabilitation or if you should have surgery followed by rehabilitation. The torn anterior cruciate ligament must be reconstructed by taking ligaments or tendons from another part of your leg and connecting them to the tibia and femur. You may consider having reconstructive ACL surgery if:

- Your knee is unstable and gives out during routine or athletic activity

- You are a high-level athlete and your knee could be unstable and give out during your sport (for example, basketball, football, or soccer).

- Your are a younger person who is not willing to give up an athletic lifestyle

- You want to prevent further injury to your knee. An unstable knee may lead to injuries of the meniscus and arthritis.

You may consider not having the surgery if:

- Your knee is not unstable and is not painful and you are able to do your chosen activities without symptoms.

- You are willing to give up sports that put extra stress on your knee

- You are not involved sports

If a growing child tears an ACL, the doctor may recommend that surgery be postponed until the child has stopped growing.

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When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined buy how soon your knee recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.

You may safely return to your sport or activity when starting from the top of the list and progressing to the end, each of the following is true:

- Your injured knee can be fully straightened and bent without pain

- Your knee and leg have regained normal strength compared to the uninjured knee and leg

- The effusion is gone

- You are able to jog straight ahead without limping

- You are able to sprint straight ahead without limping

- You are able to do 45-degree cuts

- You are able to do 90- degree cuts

- You are able to do 20-yard figure-of-eight- runs.

- You are able to do 10-yard figure-of-eight runs

- You are able to jump on both legs without pain and jump on the injured leg without pain.

If you feel that your knee is giving way or if you develop pain or have swelling in your knee, you should see your doctor. If you’ve has surgery, be sure that your doctor has told you that you can return to your sport.

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How can I prevent an anterior cruciate ligament sprain?
Unfortunately, most injuries to the anterior cruicate ligament occur during accidents that are not preventable. However, you may be able to avoid these injuries by having strong thigh and hamstring muscles and maintaining a good leg stretching routine. In activities such as skiing, make sure your ski bindings are set correctly by trained professional so that skis will release when you fall.

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What is biceps tendonitis?
Tendons are connective tissue bands that attach muscles to bones. The biceps muscle is located in front part of the upper arm and attaches at the elbow and in two places at the shoulder. Biceps tendonitis, also called bicipital tendonitis, is inflammation that causes pain in the front part of the shoulder or upper arm.

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What is a calf strain?
A strain is an injury in which muscle fibers or tendons are stretched or torn. People commonly call such an injury a “pulled” muscle.A calf strain is a injury to the muscles and tendons in the back of your leg below your knee.

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How does it occur?
A strain of your calf muscles can occur during a physical activity where you push off forcefully from your toes. It may occur in running,jumping,or lunging.

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What are the symptoms?
A calf muscle strain may cause immediate pain in the back of your lower leg.You may hear or feel a pop or snap.You may get the feeling that someone has hit you in the back of the leg. It will be hard to rise up on your toes. Your calf may be swollen and bruised.

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How is it diagnosed?
Your doctor will examine your lower leg.Your calf muscles will be tender.

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How is it treated?
Treatment may include:

- applying ice packs to your calf for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days until the pain goes away

- elvating your leg on a pillow while you are lying down.

- wrapping an elastic bandage around your calf to kepp the swelling from getting worse

- using crutches,if it is too painful to walk

- taking anti-inflammatory medications

- getting physical therapy,which may include treatment of the muscle tissue by a therapist using ultasound or muscle stimulation

- having your doctor or therapist tape the injured muscles while they are healing to help you return the athletic activities

- doing rehabilitation exercise

While you are recovering from your injury,you will need to change your sport or activity to one that does not make your condition worse.For example,you may need to swim instead of run.

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When can I return to my sport or actvity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury,which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined by how soon your calf recovers,not by how many days or weeks it has been since your injury occurred. In general,the longer you have symptoms before you start treatment,the longer it will take to get better. You may safely return to your sport or activity when,starting from the top of the list and progressing to the end,each of the following is true:

- You have full range of motion in the injured leg compared to the uninjured leg.

- You have full strength of the injured leg compared to the uninjured leg.

- You can jog straight ahead with out pain or limping.

- You can sprint straight ahead without pain or limping.

- You can do 45-degree cuts,first at half-speed,then at full-speed.

- You can do 20-yard figures-of-eight,first at half-speed,then at full-speed.

- You can do 10-yard figures-of-eight,first at half-speed,then at full-speed.

- You can jump on both legs without pain and you can jump on the injured leg without pain.

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How can calf strains be prevented?
Calf strains are best prevented by warming up properly and doing calf-stretching exercises before your activity. This is especially important if you are doing jumping or sprinting sports.

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What is carpal tunnel syndrome?
Carpal tunnel syndrome is a common, painful disorder of the wrist and hand.

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How does it occur?
Carpal tunnel syndrome is caused by pressure on the median nerve in your wrist. People who use their hands and wrists repeatedly in the same way (for example, illustrators, carpenters, and assembly-line workers) tend to develop carpal tunnel syndrome. Pressure on the nerve may also be caused by a fracture or other injury, which may cause inflammation and swelling. In addition, pressure may be caused by inflammation and swelling associated with arthritis, diabetes, and hypothyroidism. Carpal tunnel syndrome can also occur during pregnancy.

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What are the symptoms?
The symptoms include:
– Pain, numbness, or tingling in your hand and wrist, especially in the thumb
and index and middle fingers: pain my radiate up into the forearm
– Increased pain with increased use of your hand, such as when you are driving
or reading the newspaper
– Increased pain at night
– Weak grip and tendency to drop objects held in the hand
– Sensitivity to cold
– Muscle deterioration especially in the thumb (in later stages).

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How is it diagnosed?
Your doctor will review your symptoms, examine you, and discuss the ways you use your hands. He or she may also do the following test:
– The doctor may tap the inside middle of your wrist over the median nerve.
You may feel pain or a sensation like an electric shock.
– You may be asked to bend your wrist down for one minute to see if this cause
symptoms
– The doctor may arrange to test the response of your nerves and muscles to
electrical stimulation

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How is it treated?
If you have a disease that is causing carpal tunnel syndrome (such as rheumatoid arthritis), treatment of the disease may relieve your symptoms. Other treatment focuses on relieving irritation and pressure on the nerve in your doctor may suggest:
– Restricting use of your hand or changing the way you use it
– Wearing a wrist splint during sleep and physical activity involving the wrist
– Exercises
Your doctor may prescribe a cortisonelike medicine or a nonsteroidal anti- inflammatory medicine, such as ibuprofen. Your doctor may recommend an injection of a coritsonelike medicine into the carpal tunnel area. In some cases surgery may be necessary.

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How long will the effects last?
How long the symptoms of carpal tunnel syndrome last depends on the cause and your response to treatment. Sometimes the symptoms disappear without any treatment. Sometimes the symptoms disappear without any treatment, or they may be relieved by nonsurgical treatment. Surgery may be necessary to relieve the symptoms if they do not respond to treatment or they get worse. Surgery usually relieves the symptoms, especially if there is no permanent damage to the nerve. Symptoms of carpal tunnel syndrome that occur during pregnancy usually disappear following delivery.

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How can I take care of myself?
Follow your doctors recommendations. Also try the following:
– Elevate your are with pillows when your lie down
– Avoid activities that overuse your hand
– Find a different way to use your hand by using another tool or try to use
the other hand
– Avoid bending your wrists down for long periods.

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When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport will be determined by how soon your wrist recovers, not by how many days or week it has been since your injury occurred. In general, the longer it will take to get better. You may return to your sport or activity when you are able to painlessly grip objects like a tennis racquet, bat, golf club, or bicycle handlebars. In sports such as gymnastics, it is important that you can bear weight on your wrist without pain. You must have full range of motion and strength of your wrist.
What can I do help prevent carpal tunnel syndrome?
If you do very repetitive work with your hands, make sure that your hands and wrists are comfortable when you are using them. Take regular breaks from the repetitive motion. Avoid resting your wrists on hard or ridged surfaces for prolonged periods. If you have a disease that is associated with carpal tunnel syndrome, effective treatment of the disease might help prevent this condition. In some cases is known and carpal tunnel syndrome cannot be prevented.

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What is a dislocated shoulder?
A dislocation of the shoulder joint happens when the bones making up your shoulder joint are moved apart so that the joint no longer functions. Your shoulder is made up of two bones: the ball (the end of the arm bone, or humerus) and the socket (part of your shoulder blade, or scapula). When the ball part of the joint is dislocated in front of the socket, it is called an anterior dislocation. When it is dislocated behind the socket, it is called a posterior dislocation. In server cases, ligaments, tendons, and nerves also can be stretched and injured.

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What is a frozen shoulder?
A frozen shoulder is stiffness and pain in the shoulder.

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How does it occur?
A frozen shoulder develops after a shoulder injury that causes pain and does not allow you to move your shoulder enough. If you have limited movement of your shoulder for weeks, months, or years because of the injury, the capsule surrounding the shoulder joint ma become very stiff. Your shoulder may develop scar tissue, or adhesions, in the joint.

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What are the symptoms?
Your shoulder will lose its normal ability to move in all directions. You may not be able to lift your arm above your head or be able to scratch your back. Movement of the shoulder may be very painful. You may feel grinding when moving your shoulder.

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How is it diagnosed?
Your doctor will examine your shoulder and may take x-rays. In some cases he or she may want to do an arthrogram (an x-ray of your shoulder after dye is injected into your shoulder joint) or an MRI (magnetic resonance imaging scan).

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How is it treated?
Your doctor will probably send you to physical therapy for a supervised exercise program. You will also be given exercises to do at home. Your doctor may prescribe an anti- inflammatory medication and may choose to do an injection of corticosteroid medication into your shoulder joint. When your shoulder is painful it is important to use ice packs on your shoulder for 20 to 30 minutes 3 to 4 times a day. In cases that do not respond to therapy, your doctor may talk to you about doing a manipulation under anesthesia. In this procedure, you are put to sleep with general anesthetic and your doctor moves your shoulder in various directions to break up the adhesion, bands of scar tissue, in your shoulder capsule.

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When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined by how soon your shoulder recovers, not by how many days or weeks it have been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. You may safely return to your sport or activity when:
- Your injured shoulder has full range of motion without pain.
- Your injured shoulder has regained normal strength compared to the uninjured shoulder.
In throwing sports, you must radually rebuild your tolerance to throwing. This means you should start with gentle tossing and gradually throw harder. In contact sports, your shoulder must not be tender to touch and contact should progress from minimal contact to harder contact.

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How can I prevent a frozen shoulder?
After you have had an injury to your shoulder it is important that your do not
limit your shoulder motion for a prolonged period of time. It is important to
do your shoulder rehabilitation exercises as they have been prescribed. If you
feel that you are losing range of motion in your shoulder you should see your
doctor.

Pierre Rouzier, M.D. THE SPORTS MEDICINE PATIENT ADVISOR

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What is a hamstring strain?
A strain is a stretch or tear of a muscle or tendon. People commonly call such an injury a pulled muscle. You hamstring muscle group is in the back of your thigh that allows you to bend your knee. It is made up of three large muscles: the biceps, semimembranosus, and semitendinosus.

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How does it occur?
A hamstring muscle strain usually occurs when these muscles are contracted forcefully
during activities such as running or jumping.

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What are the symptoms?
You will often feel a burning or popping as the injury occurs. You will have pain when walking or when being or straightening your leg. A few days after the injury, you may have bruising on your leg just below the injury.

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How is it diagnosed?
Your doctor will examine your leg and find tenderness at the site of the injury.

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How is it treated?
Treatment may include:
- Applying ice packs to your hamstring for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain goes away
- Elevating your leg by placing a pillow underneath it
- Wrapping an elastic bandage around your leg for compression to keep the swelling from getting worse
- Taking anti-inflammatory medication according to your doctors prescription
- Using crutches if it is too painful to walk
As you return to your activity, you may be given an elastic thigh wrap to give extra support to your hamstring. While you are recovering from your injury, you will need to change your sport or activity to one that does not make you condition worse. For example, you may need to swim or bicycle instead of run.

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When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon you leg recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer t will take to get better. You may safely return to your sport or activity when, starting from the top of the list and progressing to the end each of the following is true:
- You have full range of motion in the injured leg compared to the uninjured leg
- You have full strength of the injured leg compared to the uninjured leg
- You can jog straight ahead without pain or limping
- You can sprint straight ahead without pain or limping
- You can do 45-degree cuts, first at half-speed, then at full-speed
- You can do 20-yard figures-of-eight, first at half-speed, then at full-speed
- You can do 90-degree cuts, first at half-speed, then at full-speed.
- You can do 10-yard figures-of-eight, first ad half-speed, then at full-speed
- You can jump on both legs without pain and you can jump on the injured leg without pain

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How can I prevent a hamstring strain?
A hamstring strain is best prevented by warming up properly and stretching your hamstring muscles prior to your activities. This is especially important in sprinting or jumping.

Pierre Rouzier, M.D. THE SPORTS MEDICINE PATIENT ADVISOR