Many of my patients are very active and exercise every day. This is a good thing, but some of them overdo it or they fail to warm up properly and wind up with torn ligaments and/or tendons. These can be very painful and may necessitate surgery to repair them. Instead of being active and feeling great, these common athletic injuries can have you sitting on the sidelines for several weeks.
If you’re someone who exercises frequently, I’d like to talk to you about how to take care of your ligaments and tendons to avoid injury. First let me give you a little basic anatomy lesson about what your ligaments and tendons do and the most common injuries that occur.
Ligaments and Tendons Help You Move
When you think of going for your daily run, do you realize that there are several ligaments and tendons in your ankles, knees, hips, that if they weren’t there, your legs wouldn’t be able to move properly? Or when you play basketball, they enable your shoulders to keep your arms up so you can make that slam dunk? That’s right. Without them, you couldn’t participate in your favorite sports. That’s why they’re so important to consider before exercising.
Ligaments are flexible cord-like structures that are attached to your bones. They connect your bones/joints together so that they can move correctly. They act like shocks in your car, absorbing the impact of your movements on your bones. Although ligaments are very flexible and have a lot of bend and give to them, they can sometimes give too far, stretch beyond their limit and sprain or sometimes even tear.
Tendons are very similar to ligaments, they are made out of basically the same collagen material as your ligaments, but they have a different job. Tendons attach your muscles to your bones so your muscles and skeletal structure move together when you go for a run. Tendons are also very flexible and stretch quite a bit. Like ligaments, though, they can stretch too far and sprain and/or tear as well.
Common Injuries of Ligaments and Tendons
There are many ways you can injure ligaments and tendons that don’t involve playing sports. For example, in a job that requires repetitive motions of lifting heavier objects overhead may put strain on your shoulder, elbow, or wrist ligaments and tendons. If you do a lot of walking while at work, or are on your feet most the day, you could put stress on ankles, knees, and hips, especially the Achilles and knee tendons and ligaments.
However, most ligament and tendon injuries do come from participating in sports, especially where there is direct foot/ground impact, or players crunching into each other, falling or running into barriers. Let’s look at some of the most common, starting from the shoulders down:
- AC injuries: The acromioclavicular ligament – a big word that can be a big pain. 40% of ACL injuries occur in sports involving primarily the shoulder and upper arm like basketball, baseball, football and even overhead lifting in weight training. Injury to 1 or all 4 of the ACL ligaments usually occurs by either direct force – during a fall directly onto the shoulder with the arm held at the side, or by indirect force – during a fall onto an outstretched arm. There are six grades of severity of ACL ligament injury, all depending on how damaged the ligament is. Symptoms: Pain and swelling over the shoulder joint, restricted movement due to pain, laxity, or wrong movement, of the shoulder joint itself.
- UCL/LCL injuries: The ulnar and lateral collateral ligaments – these are 2 ligaments of the elbow that can be injured doing repetitive back and forth movements such that occur in “throwing” sports like baseball (most common), football and racquet sports like tennis, hockey, polo, javelin throwing. Symptoms: Pain, sometimes swelling along the inner elbow, bruising if the ligament was ruptured, closing/opening the hand, making a fist causes pain.
- Elbow Tendinitis: Tennis elbow and golfer’s elbow are the most common injuries to the elbow and affect the medial (middle) and lateral (side) epicondyles (tendons) of the elbow. This is a painful inflammation and stiffness caused by overuse and may recur frequently. It occurs most often in racquet sports or activities where there is repetitive back and forth movement of the elbow. Symptoms: Pain, swelling, stiffness of the joint, loss of range of motion.
- ACL injuries: The anterior cruciate ligament is one of the 4 stabilizing ligaments of the knee. An ACL sprain or tear is a very common injury in people who exercise moderately to heavily and occurs most frequently in women. It occurs from force placed on the knee from a twisting body movement where the foot is planted firmly on the ground, overstretching the ligament. Symptoms: A pop or crackle sound at the moment of injury may be heard, it is very painful, swelling of the knee occurs, and you cannot straighten out the leg.
- Achilles tendon injuries: The Achilles tendon is the largest and thickest tendon of the body and connects the heel to the lower leg muscles. It can be subject to several times the weight of your body in pushing off into a run or sprint. The Achilles tendon can be injured by improper support in shoes, accidents, or even some medications can weaken it. Achilles tendon tightness is also associated with heel spurs which can be very painful and prevent you from doing any foot/ground impact sports for several weeks. Symptoms: Soreness/stiffness especially noted getting out of bed. An Achilles tear may start with a sudden pop heard at time of injury with immediate pain and inability to stand on the leg.
Treatments for Sprained or Torn Ligaments and Tendons
If you’ve ever had a ligament or tendon injury you know how painful and debilitating it can be. Treatments of these injuries depend on how badly damaged the ligament or tendon is. In mild to moderate injuries, treatment usually includes:
- The RICE formula (rest, ice, compression, elevation)
- A short course of anti-inflammatory medications.
Elbow tendon and shoulder ligament injuries can take longer to heal as it is difficult to completely rest the ligaments and tendons of these areas.
More severe sprains and/or tears may often involve the following:
- Surgery to the ligament or tendon to restore the proper tension to keep bones/joint in proper alignment for correct movement. X-rays and/or MRI films are used to see how badly the ligament or tendon injury is.
- Arthroscopic surgery of the anterior cruciate ligament of the knee sometimes is necessary to repair the ligament. Under anesthesia, several ports are made in the knee for an insertion of an arthroscope to enable the surgeon to see/repair the ligament directly.
- AC ligament separations or tears: Reconnective/reconstructive surgery is often necessary.
Recovery from ACL and AC ligament injuries can be slow and may require several weeks of physical therapy. Afterwards treatments include whirlpool, range of motion exercises, direct ultrasound stimulation, heat, and/or ice to the affected areas.
Preventing Ligament and Tendon Injuries
As I tell my patients, the best way to avoid ligament and tendon injuries is to make sure you take time to warm up before exercising. I can’t stress how important this is, especially in people just starting an exercise regimen, as ligament and tendon injuries can seriously curb their enthusiasm for future exercise. Here are some basic tips on how to warm up each section of ligaments and tendons that are most prone to injury:
- General stretching: Lay on the floor, raise your arms overhead and stretch out like a cat does, slowly twisting in several directions. Do this for about 5 minutes, breathing in deeply as you go. Your muscles, tendons, ligaments all need oxygen to fire correctly.
- Shoulder shrug/rotations: Slowly shrug your shoulders, bring them up to your ears and rotate them backward slowly. This loosens up tension in the large muscles of the neck and shoulders.
- Elbow stretches: Hold your arm out straight ahead, slowly flex your hand/arm back towards you to the mid position and stop, lower your hand back down.
- Leg stretches: Stand straight, bend over and touch the floor with your fingertips and then slowly, gradually try to flatten your palm on the floor. Be sure to keep your feet flat on the floor and do not twist to the side. This stretches your hamstrings and loosens up tight knee and leg muscles.
- Achilles stretches: Stand facing a wall, about 1 foot away from it, lean into the wall, placing the palms of your hands on it. Extend one leg back behind you on the ball of your foot. Slowly, deliberately, bounce your heel towards the floor. This stretches out the Achilles tendon and helps to avoid heel spurs as well from a tight Achilles pulling on the calcaneus bone.
- Weight Train: Start with light weight training to strengthen ligaments and tendons, build up gradually.
- Get Enough Sleep: Inadequate sleep doesn’t allow your muscles, tendons, ligaments to re-strengthen themselves correctly and makes them more prone to injury.
- Drink Water! Your muscles, ligaments and tendons, need water to move fluidly and remove lactic acid that builds up during exercise. It also helps create adequate fluid for joint cushioning. Drink half your body weight in ounces of water per day, more if you are exercising in very hot, humid weather. Sport drinks can also help keep you hydrated.
Exercise does your health a world of good. Injuries to ligaments and tendons, however, can really put a damper on your fitness goals. It’s better to do a little exercise everyday than to do the ‘weekend warrior’ thing and wind up straining and/or hurting yourself. Remember, exercise should be fun and not be something that lands you on the couch watching television waiting to heal!
Mark Bromson, M.D.