Einstein's own sports medicine expert Brett Sweitzer, MD, joins Ike Reese on Sportsradio 94WIP this week to discuss the most important injuries of interest to Philadelphia football fans. Going into week eight of the season, Dr. Sweitzer weighs in on Jason Kelce's Plantar Fasciitis and possible short term and long term treatments. Plus, he discusses what players like Bennie Logan and Marcus Smith could have done to prevent groin injuries. And finally, should we be concerned about Jordan Matthews dealing with tendinitis?
Jason Kelce was suffering from Plantar Fasciitis this week. What are the short term and long term treatments for that?
That’s a great question, because Plantar Fasciitis is definitely something that needs both a short term and long term solution in order to keep the athlete on the field.
The plantar fascia is a tight band of tissue on the bottom of the foot that spans from the front of the heel, along the arch, out to the front of the foot. It basically acts to support the arch. Oftentimes, especially in runners and other athletes on their feet a lot, such as football players, the plantar fascia tightens up too much becoming inflamed and painful on the bottom of the foot. Usually it is very tight and painful first thing in the morning or after being on your feet all day. Other foot and ankle problems, such as tight Achilles tendons and flat feet, can exacerbate the problem.
Short term solutions for plantar fasciitis are aimed at getting the inflammation under control, minimizing pain, and getting the foot and ankle stretched out again. We usually start with anti-inflammatory medicines like ibuprofen, but I usually do not recommend corticosteroid injections. Ice is actually a great anti-inflammatory, so I usually recommend rolling the bottom of the foot with a frozen water bottle a few times a day. This helps pain, inflammation and tightness all at the same time.
Other heel and ankle stretches are also important early on in the treatment. Sometimes we even recommend wearing a splint at nighttime to keep the ankle and foot stretched while sleeping. Rarely, someone will need to wear a hard boot during the day or even require a cast for a short period of time to get things to calm down.
Long term solutions are usually just a continuation and maintenance of the short-term treatments. Ongoing stretching is important and use of anti-inflammatories as needed can help prevent recurrence. Another important solution is to support the arch with orthotics in shoes and cleats, especially if the athlete has an underlying flat foot deformity.
Occasionally we’ll try injections with something called platelet-rich plasma to help facilitate healing in the area, but this usually isn’t necessary. Surgery to debride or repair a ruptured plantar fascia is also very rare, and usually can be avoided by sticking to a well thought out plan like we’ve discussed.
Both Bennie Logan and Marcus Smith were dealing with groin injuries this week. What are some things players can do to prevent groin injuries?
Groin injuries and pain are extremely common, especially in big strong athletes that need to do a lot of lateral movements, as well as a lot of sprinting, stopping and changing direction.
These guys obviously are extremely strong individuals and are amazingly quick and agile for their size. However, they often get themselves into trouble if there’s an imbalance between their strength and flexibility. There also needs to be a balance between different muscle groups that need to work synergistically.
For example, it’s important to work on strengthening the various parts of the quads, hamstrings, hip, and abdominal muscles that make up the core, but this needs to be done in a dynamic fashion that facilitates the muscle groups working in a coordinated manner. Stretching is also important.
If something is out of sync in the core, it can put unneeded stress on another muscle group or tendon and lead to a strain or other injury. So, the best way to prevent groin injuries is to keep a balanced workout routine. Proper nutrition and hydration are also certainly important, but finding that perfect balance between strength, flexibility and agility is key.
We hear the word "tendinitis" a lot in sports injuries. Jordan Matthews is dealing with it in his knee. What is tendinitis exactly?
The simplest answer is that tendinitis is inflammation of the tendon. It can be a little more complex than that, though.
Tendons are the fibrous structures that connect muscles to bones. In the knee that includes the hamstrings, quadriceps, patella, and gastrcoc tendons. When an athlete has tendinitis, they usually have swelling and initially an annoying level of pain that can become increasingly more intense and persistent. It’s usually due to overuse and often times exacerbated by some other underlying problem.
The issue becomes that pain and swelling inhibit muscle function, which results in abnormal muscle function and movement, which results in worsening swelling and pain; it becomes a vicious cycle. If left untreated, the pain and swelling can become severe and debilitating.
It’s rare that tendonitis will lead to a significant tendon tear or rupture, but it definitely can occur. For example, when athletes rupture their patella tendon in their knee, we usually find that the patient had some ongoing issues with the tendon that preceded the tear, and the tendon itself at the time of surgery usually is unhealthy looking.
I wouldn’t be too concerned about the tendonitis we’re hearing about in Matthews, or most of our athletes, but it definitely is something that needs to be managed carefully by the medical staff so that it doesn’t become a bigger issue.
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