ARTICLES

A labral tear is a fairly common injury of the hip, but it is easy to misdiagnose. Sometimes a patient receives treatment for another condition such as a hip flexor strain or tendonitis, and when the pain doesn’t improve, further investigation reveals a torn labrum.

The hip labrum is a thin layer of cartilage that lines the hip socket and cushions the joint. The labrum can be torn by trauma, such as a car accident or a collision during a contact sport. Tears can also result from repetitive stress, especially from the twisting motions common in ballet, softball or golf. The labrum can be also be damaged by a degenerative condition such as arthritis. Symptoms may include pain, stiffness, a clicking sound and a catching sensation in the hip.

Many people with labral hip tears have a positive impingement sign. This means that groin pain occurs after the following test: as you lie on your back, your knee is brought toward your chest until the angle between your thigh and torso is 90 degrees, and then your upper leg is moved in and toward the opposite shoulder while downward pressure is applied at the knee. Magnetic resonance arthrography with contrast can diagnose most hip tears. The most accurate diagnosis comes from arthroscopic surgery, in which a tiny camera is used to view the labrum.

Moderate cases can be treated with rest and physical therapy. A physical therapist can teach you exercises to improve hip strength and stability. Your therapist can also evaluate your movements and show you how to avoid the ones that stress the hip. Some patients may also benefit from corticosteroid injections. If the pain is severe or does not respond to physical therapy, arthroscopic surgery is recommended. The surgeon may remove the torn area or repair the cartilage with sutures.

Hiking is great exercise, but crossing uneven terrain poses a risk of injury, most commonly to the joints of the legs. Walking downhill can be hard on the knees and ankles, especially if you walk too fast or land too hard on your feet.

Hitting the ground too hard repeatedly can wear away articular cartilage, which lines the ends of the bones in your joints. This can lead to osteoarthritis. Improper downhill walking technique can also cause bursitis, which is inflammation of the fluid-filled sacs that cushion the joints. Going downhill too fast increases your risk of falls and ankle sprains.

The following steps can reduce the risk of hiking injuries:

It’s best to go downhill slowly, even if it feels more natural to go quickly.

Taking small steps can prevent the knees from flexing excessively.

A hiking stick allows your arm muscles to support some of your weight, taking pressure off your knees, and some people use ski poles for this purpose. Support is especially helpful if you’re carrying something heavy, such as a backpack. Studies have shown that one stick is sufficient when not carrying anything, but two sticks make it easier to keep your balance when carrying a load.

If the trail is wide enough, walking from side to side across the trail as you go down can reduce the effect of the slope on your knees.

Supportive hiking boots can reduce the risk of ankle sprains.

Consult a physical therapist to learn exercises that stretch and strengthen the muscles that support the hips, knees and ankles.

If a hiker experiences moderate to severe pain and swelling in the knee or ankle, it’s best to rest the leg, even if it’s necessary to cancel the rest of the hike. Ideally, ice should also be applied, but if none is available on the trail, it can be helpful to soak a cloth in cold water from a stream and wrap it around the injured joint. Hikers should carry an elastic bandage to wrap an injured area; compression can reduce swelling. Elevating the injury above the heart will help drain fluid and reduce swelling. These steps can be easily remembered by using the acronym RICE, which stands for rest, ice, compression and elevation.

Bursitis sometimes goes away after one to two weeks of rest, but treatment may involve draining the fluid, cortisone injections, or physical therapy to learn appropriate exercises and stretches. Treatment of arthritis can include medication, physical therapy and surgery.

People have been climbing rocks for centuries, but with hundreds of gyms now offering climbing walls, sport climbing is no longer limited to the outdoors. In 2006, Climbing Magazine estimated its readership at close to 121,000 people, and an earlier U.S. government study found that 7.4 million Americans had tried rock climbing.

Sport climbing requires strength, endurance, balance and flexibility, and it provides an excellent workout. However, frequent climbing can lead to overuse injuries, especially in the hands, wrists elbows and shoulders.

Common injuries include:

Climber’s finger: damage to the flexor tendon pulleys that encircle and support the tendons that cross the finger joints. Climber’s finger is caused by putting more weight on the fingers than they can support. Treatment may include rest, ice, anti-inflammatory medication and range-of-motion exercises.

Climber’s elbow: this usually refers to strain of the brachialis tendon, but it can also refer to medial epicondylitis or lateral epicondylitis. For all of these, treatment may include rest, ice, anti-inflammatory medication and range-of-motion exercises.

Rotator cuff injuries: these are more common in older climbers. The rotator cuff is a group of muscles and tendons that stabilize the shoulder. Treatment may include ice, rest, physical therapy and sometimes corticosteroid injections or surgery.

Strengthening the upper body can reduce the risk of injury. The following exercises can help:

Pull-ups can develop strength in the shoulder, back, stomach, forearms and grip. One-armed pullups are especially useful.

Fingers can be strengthened by squeezing a tennis ball, holding for five seconds and relaxing, then repeating 30 to 40 times.

Lateral raises can strengthen the shoulders. Standing with your feet about shoulder-width apart, hold a light weight in each hand. With your elbows slightly flexed, raise your arms out to the sides until they are at shoulder level, with your palms facing the floor. Slowly lower your arms, then repeat the sequence, doing three sets of ten repetitions each.

As with any exercise, it’s best to warm up and stretch before rock climbing, and to maintain overall conditioning. If you’re new to climbing, a lesson is always a good idea.

Plantar fasciitis is an inflammation of the plantar fascia, and it is the most common diagnosis given to patients with medial heel pain.  The plantar fascia originates on the calcaneus (heel bone) and plays an important role in stabilizing the foot during walking.

Factors that can increase tension on the fascia and lead to symptoms include:

• Acute trauma or strain to the fascia

• Excessive or prolonged pronation

• A high-arched foot

Chronic tension to the fascia where it inserts on the heel can lead to a heel spur, which is a buildup of calcium. Risk factors for heel spurs include:

• Age: generally over 40, but as early as the 20s for athletes

• Excessive weight

• Hard surfaces

• Inadequate footwear

• Calf tightness

Common symptoms include:

• Pain in the heels that is worst when first getting out of bed in the morning, and that eases gradually with walking

• Pain upon standing after sitting five minutes or more

• Pain that is worse with activity or increased weight-bearing and is usually relieved with rest

Cortisone injections can give temporary relief, but finding the cause and eliminating it is more effective. Physical therapy can help. Treatment may include:

• Stretches for calf muscles while maintaining an arch in the foot

• Use of a night splint to maintain calf muscles on stretch during sleep

• Providing support and control by taping the bottom of the foot or using an orthotic

• Increasing the strength of stabilizing muscle groups.