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| Q&A: Dr David Hartman on Head Injuries (824 Posts)
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Severe Brusing
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On 1/14/2004
Sketchmaster
wrote in from
(4.22.nnn.nnn)
When does bruising stop being a painful, ugly annoyance and graduate to the point that it is a serious injury that should be evaluated by a medical professional? I locked up on a fakie rock'n'roll and now have a 3.5"x6" or larger bruise on my *ss due to having a tool in my back pocket. When it finally stopped expanding it was hard and black and swollen over 1 inch. There is no broken skin. The swelling has diminished and the color is beginning to normalize so I'm assuming it's just going to go away but I am interested in knowing when something like this is more than just a casual issue.
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Jason under the knife
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On 12/27/2003
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Jason,
Here's a couple of ideas and maybe others will think of more:
1. Find a cheap health club/YMCA with trainers you can ask for help.
2. Try swimming to keep your knee limber if it doesn't cause pain.
3. See if your insurance will pay for a pain clinic, rather than PT. Try to find a loophole because if you are still in pain, you need to get it treated.
4. See if your doctor will petition your insurance company for a review. They should not be able to leave you half-treated.
5. See the previous post on over the counter pain/osteoarthritis treatments.
6. Get on Official sports-MD-type opinion before you go boarding with a brace. Know the risks.
Readers?
drdh
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ACL, MCL, and miniscus tear, going snowboarding
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On 12/27/2003
jason
wrote in from
(205.188.nnn.nnn)
not really a skate related topic, but its still boarding.
im going snowboarding new years eve, in mid august, i tore my acl (type 3 all but 1 bundle) mcl (type 2 overall)and miniscus (type 1 , surgeon described it as if someone took a cheese grater to my miniscus) in a biking accident, bent it sideways and backwards, ok, so he went in to replace the acl with a patellar tendon graft and he found the intact bundle of acl in my knee, and also found the torn miniscus (he thought acl was gone, and miniscus was possible, though he didnt think it was torn) he examined my lower quad structure with the scope and decided i have a strong/large enough quad structure (THANK YOUUUUU longboarding), to get to the point, he left the acl alone, shaved down the miniscus so it was smooth again, and removed some destroyed flesh from the knee (grossing anyone out yet?)
anyways, he gave me a donjoy brace, carbon fiber, matches my moms pt cruiser in color, lol, anyways, its the same brace as used by the us ski and snowboard teams, i did 3 weeks therapy before the surgery, and 2 months after the surgery, havent been to pt for a while now as insurance ran out of money for me.
my knee feels unstable without the brace, i will be wearing the brace when i board, but i was wondering if there was anything else i can do other than stretches, to decrease my chances of injury,reduce pain, and help me keep my knee under controll on the mountain.
thanks alot
jason
p.s. i developed patellar tendonitis during my pt after surgery, thanks to a therapist that likes to ignore the closed chain notices on my scripts and push me too hard, so ive got daily pain from that
(sorry this post is so long)
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Cramping Brady's style
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On 12/27/2003
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Brady,
If they are "cramps" it's either muscle imbalance, nutrition or loss of blood flow (see below). It could be as simple as bad shoes. . .*but*. . .because you've got diabetes in your family, you might want to see a neurologist, because foot pain could be due to "neuropathy" or a dying back of peripheral nerves, which is a sign of diabetes (or WAY too much alcohol use, by the way. . :)
Either way, because it's increasing it's a definite ticket to the doc to figure it out. Remember to tell him/her about your family diabetes hx. And let us know. drdh
The following is from www.myfootshop.com and may help you figure out what is going on:
Muscle cramps can be broken down into three main categories.
Ischemic
Metabolic
Biomechanical
Ischemia is the term used to describe a situation when there is insufficient circulation to tissue. When blood flow to a muscle is inadequate, the muscle will cramp. The pain that accompanies the cramp prompts us to walk or rub the cramp which in turn results in increased circulation. Ischemic cramping typically occurs at night and is called nocturnal claudication. Muscle cramping due to ischemia can also occur with exercise and is called intermittent claudication. Doctors will often ask patients with poor circulation to describe how far they can walk before the cramp and will use this as a measure of their peripheral vascular disease.
The most common metabolic deficiency that causes foot and leg cramping is low potassium. Hypokalemia (low potassium) can result from over exercise, use of diuretics (water pills) and a host of other reasons. Potassium is one of the two primary molecules that controls how our muscles work. In addition to potassium, sodium works to initiate muscle contraction and an imbalance or lack of these two salts will result in cramping
Biomechanics is the science of how the body moves. The biomechanics of walking and running is quite complex. The act of walking is a finely tuned symphony of brain messages and muscle contraction. If an imbalance is found in muscle groups and one group is forced to work too much, muscle cramping can occur. Muscle cramping happens often in the foot as evidenced by a cramp of the big toe or calf. As with ischemic cramping, we will be forced to walk off the cramp and in this case affecting the biomechanics. Biomechanical cramping can be helped with supportive shoes and arch supports.
Cramping can often be a sign of a more serious health problems and usually means that a trip to your family doctor may be in order. We recommend you visit your physician should you have any questions regarding cramping.
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Bradys cramps
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On 12/27/2003 wax
wrote in from
(24.9.nnn.nnn)
well. I will skip the comment that Brady's west coast buddy would post about being a bitch and the effects of PMS....I would guess you get the same cramp pains I get when dehydrated, your posting about getting them after drinking says that much...when i start to feel the pain, i just drink lots of non-alcahol fluids (powerade rules) then resume my normal activities (beer
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oops
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On 12/27/2003 Brady
wrote in from
(68.211.nnn.nnn)
I weigh 160, not 130.
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feet cramps
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On 12/27/2003
Brady
wrote in from
(68.211.nnn.nnn)
Dr Dave,
I am inquiring on what can be the reason and or remesies to foot cramps.
Here`s the deal, I get them after a long days riding skateboards. Don`t matter if it`s slalom or just beach cruising. If I ride long and hard enough, I`ll get the cramps. Not always and usually not until the following day.
What puzzles me is there are other times that they can occur, like dancing at the local country joint, or even more puzzling, when I tie one on. Yep, after a night out shooting pool, playing cards, or just hanging with my boys, if I drink enough alcohol spirits, I`ll get the cramps, with little or no exersize.
Diabetes is in the family tree and I know it can affect the feet, but I show no other signs of the disease (sp?). I`m 45 yrs old, weigh 130 and 5`10' tall. Pretty much good health. I get checksfor diabetes every other year and no signs of it.
Is this common? Something I should worry about? Remedies?
It`s been like this for years but seems to be more frequent as I am just getting into my middle 40`s.
Any advice would be appreciated.
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Thanks alot
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On 12/27/2003 Kludy
wrote in from
(205.188.nnn.nnn)
Myself, I feel i could take the pain or a very long time but my kids are very cool and the ball games are big.Thanks doc dave, I think i will see the doc next week.
This site rocks as much as the speedboard site.
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Glucosamine Chondroitin
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On 12/27/2003
kmg
wrote in from
(64.84.nnn.nnn)
About 2 years ago I was referred to a sports injury specialist, an MD who is employed by an NFL football team. He diagnosed me with a torn lateral miniscus. He told me that even though he was a surgeon, he didn't want to operate on my knee until I had tried G & C for 6 months. He said after 6 months, if my knee was still screwed up, he would cut me. With the help of the G & C, my knee healed itself and is fine now. BTW, the doc told me there was only 1 brand he would recommend; Cosamin DS. I still take it every day.
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G&C
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On 12/27/2003 snoball
wrote in from
(68.200.nnn.nnn)
Hey Doc...I see what you're saying with the business
decisions by pharm corps...alot of docs are conservative,
mine included...i think his words were,"If there
were any unbiased, scientific proof that glucosamine
had a substantial affect on preventing joint deterioriation,
most of us would be recommending it."
I don't buy that completely becuase doctors are constantly
being seduced by those pharm corps.
And I met an old man into jogging who insists it has
helped his knees. I'd thought about getting some for
my Dad who has knee issues, but understand there's some
concern about people with heart conditions and glucosamine(?). Like anything else, especially supplements
that don't have to pass the same standards as
prescription drugs, folks should look at this kind
of thing from every angle.
I think alot of us are going to pay later for what
we do now, athletically speaking. Kind of like football
players...
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Sprain Sprain Go Away
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On 12/26/2003
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Hey guys, sprains can take up to 3 months to heal and some of the most severe ones may need a doc to look you over and open you up. Pain is more severe in the early morning because your endorphins (natural pain killers) are low.
Kludy, I can't tell from your descriptions what's happened, but I'm going to give my standard advice: if ice, Advil and rest don't work, see your ortho/sports medicine doc. This goes double if you've got limitation of movement. What starts out as an annoyance ends up with you being unable to toss the football with your kids.
Keep us posted - thanks for the props - do what I can. . .drdh
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Sprained Ankle
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On 12/26/2003 Old Dave
wrote in from
(67.164.nnn.nnn)
I sprained my ankle 3 months ago and it has slowly been
getting better. I am a bit worried that it will never be
the same again. How long can it take to heal? It there
any PT I can do at home? It was more of a twisting injury
not a ankle roll. I was able to snowboard yesterday and
had fun but did feel the ankle several times.
Thanks
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Wow, I never knew we had a doc on hand
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On 12/26/2003
Kludy
wrote in from
(64.12.nnn.nnn)
Hi, have been on the speedboard site for a long time and just did not know untill now there is such a cool site, bored and just looking around.Doc Dave , I have hit the hay a few time during races and hate docs, not you!Maybe you can help me.My left shoulder has had a bad pain when I try to sleep and at work, its in the front and just passed the shoulder blade toward my arm. Nothing is popping, just hurts real bad.Mostly at nite and in the am hours.Thanks alot for just being here, very cool!I do know the day that I hit the hay that i honesty thought my shoulder was very broke that nite.
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Glucosamine Chondroitin
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On 12/25/2003
Dr. Dave
wrote in from
(63.189.nnn.nnn)
snoball,
there's plenty of evidence that G&C help joint pain. All your doc had to do is scan medline. As for "crunchy" sounds, it sounds like either bone rubbing on bone which might mean that there's not enough fluid or cushion. See a sports doc and demonstrate it to him/her. Here's a recent review of some non-drug tx for joint pain. By the way, companies don't research drugs they can't make tons of money on and since glucosamine/chondroitin are marketed as a "health supplement" by virtually everyone, big companies are not too interested in funding research.
drdh
1: Clin J Pain. 2004 Jan-Feb;20(1):13-8.
Selected CAM Therapies for Arthritis-Related Pain: The Evidence From Systematic Reviews.
Soeken KL.
SUMMARY: OBJECTIVES The purpose is to examine what is known about the efficacy of selected complementary and alternative medicine (CAM) therapies for pain from arthritis and related conditions based on systematic reviews and meta-analyses.METHODS Results specifically related to pain were retrieved from review articles of acupuncture, homeopathy, herbal remedies, and selected nutritional supplements.RESULTS Evidence exists to support the efficacy of reducing pain from osteoarthritis (OA) for acupuncture; devil's claw, avocado/soybean unsaponifiables, Phytodolor and capsaicin; and chondroitin, glucosamine, and SAMe. Strong support exists for gamma linolenic acid (GLA) for pain of rheumatoid arthritis (RA).CONCLUSIONS Despite support for some of the most popular CAM therapies for pain from arthritis-related conditions, additional high quality research is needed for other therapies, especially for herbals and homeopathy.
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crunchy bones
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On 12/18/2003 snoball
wrote in from
(68.200.nnn.nnn)
I broke my left wrist badly last May. I think it
didn't set right but the ortho said it did and it
works good enough so i'm not worried about it. But
when I asked him about Glucosamine etc, he kind of
snickered at it as though I were suggesting snake oil.
BTW, he's been a consultant with the Bucs here for awhile.
He said there is no *medical science* behind the
claims for Glucosamine's effects and believes its
psychological ( not that that's necessarily bad..).
As a side issue, he pointed out the fact that no pharmacutical companies have jumped on that band wagon
to make money 'in the system'.
I asked about my crunchy knees I've had since 12 and
was told these are just little pockets of air and
not much can be done. Recent research even suggests
that alot of the ACL surgeries done are unecessary. But
my knees get crunchier all the time and other than diet,
can't think of anything to help it.
As for shin splints, one other ortho I saw said that
the way they treat pro ball players is to reduce their
activity by 50% for a few weeks, take Napralan, and do heel to toe stretching. He said they don't really fully understand what causes shin splints but that 100% reduction of activity involving your legs is NOT the way to go.
As a competitive fencer at the time, I found this course
most useful. I could still train and not suffer. So,
maybe the answer isn't to stop skating, but not to
skate too hard for too long until that pain stops occurring.
yours in rambling...
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Plug for Sparker
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On 11/24/2003
Dr. Dave
wrote in from
(68.74.nnn.nnn)
Good advice, Sparker. Rest, ice, etc. Stretching exercises can be had in runner's magazines or websites. Haim, if your legs are out of shape, a little time at the health club ellipticals or weights might help. Glucosamine/Chrondroitin over the counter helps build strong tendons 12 ways (or is that Wonder Bread?)
And Haim, if you've got acute knee pain, swelling, hot spots, or if you hear clicking or crunching around your knee, then seeing a sports medicine orthopod is probably a good thing sooner rather than later.
Tell us how it goes drdh
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Funny Leg Pains
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On 11/23/2003 Sparker
wrote in from
(194.176.nnn.nnn)
Haim
Your pains sound like classic "over-use" injuries. That is, doing too much to soon.
As well as skating, I'm a long distance runner and have had the same pains over the last year or two.
The shin thing was a case of resting it and using ice etc. My Physio told me it was tendonitis and whould clear up in a
few weeks (and it did).
The groin thing was caused by the muscles on the outside of my leg being far too tight. Stretching the outside of my legs REALLY helped.
Look at http://www.coolrunning.com for advice on these injuries, possible causes and treatments. This site has helped me a lot in the past.
Of course if you are in a lot of pain or are worried please see a doctor or a sports physio.
Happy skating.
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Funny (not haha) leg pains
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On 11/18/2003
Haim Barr
wrote in from
(81.218.nnn.nnn)
Hi Dave,
I'm 39 and getting back into skating after 25 yrs. Last few sessions I started feeling sharp pain in my left (leading) leg, whenever I bailed and ran-out of a frontside trick on a mini-ramp. Pain is just below my knee, on the top, outside of the shin. I rested for a week, but when I tried to session again, the pain came back - and this time accompanied by a sharp pulling-pain from the inside of my thigh, up into my groin. Both pains are pretty acute when they happen, but pass quickly. My questions are 1- are they connected ie. is the groin thing a worsening of the shin injury and 2-are ther stretching exercises I can do to limber up these regions that seem prone to injury?
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Kims shoulder
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On 11/14/2003 Chris B
wrote in from
(204.78.nnn.nnn)
Hey Kim.....i'm assuming you're the Kim who posts on Scotts site too...look up Theramax PT's....there's several around the metro Detroit area...you wont get snake oils and "massages" at these places, they specialize in low weight, "target specific" excercises. The kind that develop the little-used muscles in the injured area to stabalize the joint and take the pressure off the damaged area, similar to what Yzerman went thru when he wrecked his knee...it's a looooong process, and they usually schedule 3 visits a week....I can tell you for a fact that it works though.
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separated vs. dislocated shoulders
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On 11/10/2003
Slim
wrote in from
(66.126.nnn.nnn)
Kim,
I had almost the same thing happen to me in '91 after a motorcycle accident. The first doctor said it would heal on its own and it didn't. He signed me up for physical therapy but on the way there I just knew that my problem was that things just weren't hooked up right. I mean, I wasn't just weak - I couldn't move it at all! I got a second doctor and he ignored the x-rays and felt my shoulder and said right away that it was screwed. He sent me to St. Francis (santa barbara) for the MRI to confirm it and then showed me what the problem was. He said it would have been much easier to do it right away but now that it had been a few months that it wasn't going to get any worse and so I might as well finish out my last semester and graduate (ucsb) and then do the surgery. So overall I spent like 5 months with my arm in a sling. Had to miss graduation ceremony since I had to go into the hospital before the official last day of school so that I'd still be a student and the insurance would cover me.
The good news is that 4 days in the hospital for a surgery to reshape my collarbone to fit in the socket and lots of fun stuff like that, a few months of rehab, and I was practically as good as new. I have at least 85% movement in that shoulder and it doesn't seem any weaker than before. No swimming (which means no surfing) for six months sucked but, hey, that's all forgotten now, and as the black leather racing guys say, "chicks dig scars" (and i assume dudes dig them too).
It sounds like you have some movement in your shoulder, while I couldn't move my arm at all, but still, things may not be right inside. If there is anyway to get another doctor, preferably of the "sports medicine" type like the guy I had who was a former team doctor for the LA Rams, then I'd try that. Those doctors know what's up.
Hope it works out for you soon! (And go easy on the Vicadin - it's great in the short term but hard to keep it shorterm...)
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Cold Shouldered Kim
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On 11/8/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Kim,
My guess is your doctor is part of an HMO or PPO and he loses money on every MRI he orders because it's outside the system.
Time for a second opinion. Any sports medicine orthopods in your neck of the woods?
Let us know how it comes out (as it were). . . .drdh
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grade III AC separation
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On 11/8/2003
Kim
wrote in from
(65.129.nnn.nnn)
I separated my left shoulder 12/03 in lower MI...ER Doc said it was just bruised. I knew better and requested a copy of my x-ray to take back to NJ with me. Saw an orthpedic here, who gave me the DX of "separated shoulder" with the instructions to wear a sling for 2-3 more weeks.
At each follow up visit (3) I was given new exercises to add into my weight lifing routine...I continued lefting the rest of my body even with the injury/sling.
I re-injuried my shoulder lifting a small table...which sent back to the orthpedic (shoulder was not feeling any better before lifting the table).
Enough of the back ground...it has been 10mos and 2wks since the inital injury...the Dr. said if it doesn't get better come back and I will schedule you an MRI. I just went back and he did not schedule the MRI as promised...I left with an order for PT 2-3x/wk x1mo.
I went home and thought about it, talked to my husband and decided to call back the Dr. to tell him that I will do the PT, but I would like an MRI first...he refused.
Please give some advice on how long it takes a grade III AC separation to heal on an otherwise healthy, active, 42y/o female and what direction do you think I should be headed now.
Thanks for your help,Kim
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damn shoulder
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On 11/8/2003 Justin
wrote in from
(196.25.nnn.nnn)
Thanx for the advice its always good to hear from other skaters of their situations and how they have gone about it. Im from South Africa and here medical attention can be quite costly. Luckly I have just started a new job and am hoping in the next few months I will be able to get medical denafites and fisrt thing on my list is to go for a examiation on my shoulder.
Thanx for the info
Later
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"Swellbow"
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On 10/30/2003
Clayton
wrote in from
(130.212.nnn.nnn)
Hi there,
I fall on my right elbow a lot. I wear pads all the time.
Nevertheless, I now have a golf ball size bump on/in it. It is quite hard and hurts madly when I fall on it.
otherwise not painful at all. What creates the "swellbow"? is it bone build-up? Any suggestions on treatment, appart from not falling on it?
Thanks,
Clayton
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Justins shoulder
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On 10/23/2003 Chris B
wrote in from
(204.78.nnn.nnn)
Hey Justin, i'm going thru the same thing now. Over the course of the summer, i dislocated BOTH my shoulders. It hurt ALLOT at first, but then subsided enough where advil would take care of the pain. Problem was whenever i worked out, i reaggravated it and started from square one. Then, out of the blue, just from laying down on the floor, my right one popped out again, with very little effort. I had an arthogram and mri and they found i tore my laibrum (spelling?) cartilage. This is a thin layer that covers your shoulder socket like a plate and has a thin lip on the edges. It's not uncommon with shoulder dislocations. Problem being, it really never heals. It is both the result of shoulder instability, AND makes it worse. To compound this, once you dislocate your shoulder, youre prone to do it again more easily. So what to do?...Surgery is an option. To me, personally, cutting thru muscle and tendons is a FINAL option, not the first. You could go with a support strap. Ive got friends with these. They work like those spongey straps for your knees. The wetsuit idea is good too. However, this is putting a bandaid on a broken leg. It will keep it tighter when you want to, but it's not solving the problem. I went with physical therapy, covered by my medical insurance....3 times a week for 4 weeks. What they are doing is working the small muscles around the rotator cuff to stabilze my shoulder. This is NOT something you can do on your own. They must first locate exactly where the discomfort is, then give you very very specific excercises to tighten it up, such as muscles in your armpit...i mean,...i wasnt even aware i COULD strengthen those muscles!....As you get older, if youre athletic, your joint stability will naturally loosen. Even if you work out, youre likley only working the major muscle groups that give good definition. This is an entirely different muscle group. They'll also teach you different techniques to maintaining strength in the area, as well as supporting areas in your back and shoulders. If you dont take it seriously, and get some real treatment, youre going to just do it again, and again.....hope that helps.
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