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Expert Talk | Conservative Therapy and Rehabilitation Treatment of Overuse Syndromes A survey of team physicians in the top-tier Basketball Bundesliga by the “Sportärztezeitung”, carried out by Robert Erbeldinger, Masiar Sabok Sir, Dr. med. Christoph Lukas and Dr. med. Kai Fehske. In the last edition of “Sportärztezeitung” Dr. med. Kai Fehske, vice-chairman of Bas- one in every three active professionals is (01/18), we carried out a large-scale survey ketDocs and Team Physician at s.oliver Würz- suffering from patellar tendonitis. Over half of Bundesliga football team physicians relat- burg. The two advisers have provided an (55 %) of athletes currently have or previously ing to “Treatment of muscle and tendon inju- overview of patellar tendinitis as an introduc- had pain in the area of the patellar tip during ries” in cooperation with our adviser Dr. med. tion to this article. their career, and even in recreational sports, Jens Enepper. This was the first time that there is an astonishingly high prevalence of most of the clubs had provided a structured people affected by this condition; 12 % in the explanation of the procedures they follow in Patellar Tendonitis in Basketball case of basketball. the event of muscle injuries. The response to the survey was extremely positive. For this Jumper’s knee is a chronic and painful over- reason, we have decided to carry out a survey Patellar tendonitis, also known as jumper’s use syndrome at the osteotendinous junction, in a similar format with the team physicians knee, is the most common overuse issue in whereby the damage caused by countless of other important sports, with the aim of basketball. As the name suggests, jumping microtraumas ultimately ends up overtaking promoting the sharing of knowledge and the is a risk factor for this condition, with rapid the tendon’s ability to regenerate. In 2008, a transfer of this knowledge to practical applica- upward motions playing a particularly impor- tendon impingement with a prominent distal tions, extending to “normal patients”. We talk tant role. An athlete’s physical anatomy is patellar pole was postulated by Lorbach as to other teams and physicians and provide also a key factor. A flat plantar arch, reduced a possible cause, which explains why the you with solutions and approaches that can movement in the ankle, muscle shortening degenerative changes are primarily found in be used in your day-to-day medical practice. and general laxity all increase the risk of the the dorsal tendon section. Over the course of condition. One classic problem is the rela- the condition, this leads to a breakdown of the This edition contains a survey of all basket- tively short preparation period for upcoming parallel collagen fiber alignment, degenera- ball team physicians of the top-tier Basket- seasons. Athletic training, tactics training and tion of the collagen tissue and replacement of ball Bundesliga relating to the treatment of pre-season games all need to be completed type-1 collagen with type-3 collagen. Despite overuse syndromes, and in particular the in a period of around six weeks. Players who the fact that the term “patellar tendonitis” syndrome referred to as jumper’s knee. We have not worked on their fitness enough dur- is still commonly used, there are in fact no would like to take this opportunity to express ing the off-season are therefore particularly inflammatory cells at a microscopic level. The our heartfelt gratitude for the dedication and susceptible to overuse injuries. condition does, however, result in vascular- active involvement of our two advisers, Dr. ization, which causes nerve fibers to conduct med. Christoph Lukas, chairman of Basket- In high-performance basketball, 32 % of play- pain sensations. Docs, Deutsche Basketballärzte e.V. and ers complain of overuse injury, meaning that Against this backdrop, we asked all team physicians from the top-tier Basketball Bundesliga the following three questions: 1. Which traumatic and overuse sports injuries occur most frequently in your work with the basketball teams? 2. One-third of all training injuries occur in the two pre-season months of August and September. This could indicate an excessive training load and insufficient regeneration prior to the season, which also cause overuse syndromes such as jumper's knee to develop. How are examinations/diagnostics and therapy carried out at your practice – which conservative measures are used, and do surgical options play a role at all? 3. Prophylaxis – what do you and your team do to ensure that jumper's knee does not occur in the first place, and what preventative measures do you implement following treatment for jumper's knee? In this context, how can the issue of regeneration in basketball be improved upon and given higher priority, despite the tight schedule and large number of games? 22 sportärztezeitung 02/2018 | www.thesportgroup.de Expert Talk | Conservative Therapy and Rehabilitation Dr. med. Kai Fehske | s.oliver Würzburg 1. We primarily see injuries of the lower extremities, and in particular this imaging can be accompanied by an MRI. During the acute phase ligament lesions of the ankle joint. We also see an accumulation of of the condition, we administer systemic (e.g. NSAIDs and Traumeel) muscle injuries, in particular the hamstrings. In the area of the upper and local anti-inflamatory treatment. The application of ice or oint- extremities, there are regular hand injuries such as fractures of the ments, such as those containing arnica, have proven successful in metacarpus or ligament lesions of the wrist joint. Typical sports injuries this phase, as has the method of wrapping the affected area in plastic occur at the knee joint (e.g. jumper’s knee) and in the back area. wrap for an hour. In the event of persistent complaints, therapy can also be expanded to include infiltrations with Traumeel or platelet-rich 2. The “pre-employment” medical check is initially targeted towards plasma. Infiltration with corticosteroids is now an obsolete practice orthopedic issues, with a particular focus on the knee joint and the due to the local side effects. In rare cases, surgery may be required muscles surrounding the knee joint, particularly given the fact that as a last resort, and involves a resection of the affected tissue and jumper’s knee is virtually an occupational disorder. We often see denervation of the patellar pole. Arthroscopic procedures have bcome shortened thigh muscles. The therapeutic approach here prioritizes established in this area. the restoration of muscular balance through manual therapy, stretch- ing and concentric strength training. However, this approach is only 3. See above. Stretching of the entire thigh musculature, concentric successful over the medium-term. Players receive physiotherapeutic strength training. In all honesty, I have up to now had very little or no treatment over the entire season. In a new case of jumper’s knee, clear influence on training planning or regeneration phases in my role as evidence is provided by means of sonography in the majority of cases. team physician. In exceptional cases, or to rule out the possibility of any other injuries, Dr. med. Lars Homagk | Mitteldeutscher BC 1. Traumatic sports injuries: the most common sports injury by far a suitable working diagnosis. Additional diagnostic tools include is a muscle injury in the sense of a muscle contusion (hematoma) or sonograpy and, if bony injury or major structural damage is suspected, a muscle strain, or less frequently a torn muscle fiber. Overall, the CT or MRI scans. We have almost always been able to use exclusively frequency of these injuries is the same whether or not an opponent conservative methods to treat these injuries, with manual therapy, is involved. However, muscle contusions are more common on match physiotherapy, radial shock waves and analgesia where necessary. In weekends, and strains during training in the week. Looking at the pat- two cases, adductor tendonitis with accompanying osteitis was addi- terns over the course of the season, we record 4 - 5 muscle injuries tionally healed using long-term treatment with ibuprofen and minimal (with low levels of structural damage) per player per season, although loading. Strengthening of the thigh and hip muscles is also of utmost there are players who are predisposed. Smaller players are more com- importance in the athletics program. The same procedure applies to monly affected. The knee is also frequently affected by distortions or jumper’s knee, although it is rarely seen. abrasions. Overuse sports injuries: a problem that is more specific to ball sports is overuse injuries to the adductors and their attachments 3. We believe that prevention in the form of optimal muscular stabiliza- to the ischium and pubis. These types of sports injuries, ranging all tion, sensomotoric orthotics and briefing of athletes is the priority here. the way through to osteitis pubis, are the most common, and not only We also try to detect potential overuse damage as early as possible as a direct result of trauma. They are followed by degenerative knee through close contact between players and physiotherapist/physician. and ankle joint damage. If signs of overuse are detected, we temporarily reduce the load for a few days and intensify the physiotherapy. Once the player is symptom- 2. The aforementioned overuse damage occurs much more frequently free, based on our specific tests, he can return to intensity training. during the pre-season. Our primary diagnostic parameters are an athlete’s medical history (how often did the player train during the off-season etc.) and the clinical examination, which can often provide 23 sportärztezeitung 02/2018 | www.thesportgroup.de Expert Talk | Conservative Therapy and Rehabilitation Dr. med. Ralf Hamann | BG Göttingen 1. By far the most common traumatic sports injuries are muscle injuries (sub-)acute and chronic injury progressions.

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