As part of the allied health care provider, I’ve worked closely with other health care professionals such as Orthopedic Surgeons to help clients and patients towards complete recovery of their musculoskeletal injuries. Today, I am honored to have the opportunity to ask Dr Amaleswaran a few questions regarding injury management for common sports injuries, when surgery is necessary and how exercise can play a role in injury prevention.
Hi Dr Amaleswaran,
Thank you for taking some time off from your busy schedule to talk to us.
Before we begin, please tell us more about yourself.
First of all, thank you for the opportunity in giving me a chance to educate the public on sports related injuries. My name is Amaleswaran and currently practicing in Penang General Hospital. I have an experience of slightly more than 10 years in this field and completed my masters in Orthopedics in May 2015.
As an orthopedic surgeon at Penang General Hospital, what are the most common reason patients visit you for?
Well the most common reason patients visit my clinics are due to lower back and knee pain.
Based on your observation, why are these two so common?
Firstly, these problems can be categorized into 2 age groups; young and elderly. In the young age group, the common reason of these injuries are mainly caused by sports activity related and motor vehicle accident. Whereas the elderly suffers from this problem due to degeneration secondary to wear and tear which all of us may experience in future as we age.
In what situation is surgery usually recommended? What are the risks and benefits of surgery?
Not all knee and back conditions require surgery. Most times, these conditions can be treated non operatively with proper rehabilitation and physiotherapy. Most sports related injuries can be treated with RICE protocol which I have modified slightly to PRICER protocol. This acronym represents Protection, Rest, Ice, Compression, Elevation and Recovery/Rehabilitation. PRICER therapy is the mainstay of treatment in majority of sports related musculoskeletal injuries such as sprains, strains, tear and wear.
Protection: is meant to prevent further injury. For instance, and injured knee or ankle may be protected by limiting or avoiding weight bearing with use of crutches. Besides, discontinuing from activity and partial immobilization of the injured area by using a sling, splint or brace may also be means of protection.
Rest: is important to allow healing. An individual should avoid activities that stress the injured area to the point of pain or that may slow or prevent healing. However, some movement such as protected range of motion and basic isometric exercises of the joints and muscles surrounding an injury encourages speedy recovery and prevent stiffness of the respective joint.
Ice: refers to the use of cold treatments, also known as cryotherapy, to treat acute injuries. Ice is recommended with the intent to minimize and reduce inflammation and swelling as well as to decrease pain. Cycles of 15 to 20 minutes every 2 to 3 hours are generally effective
Compression: is the use of compression bandage to apply external force to injures area to minimize swelling and provide support. However, the bandage should not cause numbness, tingling or color change of the soft tissue
Elevation: is recommended to help reduce the pooling of fluid in the injured extremity or joint. Controlling swelling can help decrease pain and limit the loss of range of motion and speeding up recovery time. Elevation is accomplished by positioning the injured area above the level of heart.
Recovery/Rehabilitation: is a must once acute injury phase is over in order to recondition the joint and muscle to prepare the individual to return to activity or work. In this phase, exercises and various modes of protective gears aid the road to recovery. Healthcare personnel such as, physiotherapist, occupational therapist, personal trainers plays a major role in this phase in order to educate the individual in avoiding and preventing the same injury to happen again.
Surgical intervention will be necessary should non operative treatment fails. In acute setting such as avulsion fractures which is common the young age group surgery will be the mainstay of treatment. Other injuries such as ACL and meniscus tear it is best treated surgically in order to delay the process of wear and tear. Meanwhile, surgery for spine related injuries is indicated only in acute neurological conditions.
All kind of surgeries carries a risk of infection, bleeding and injuries to adjacent structures.
As an orthopedic surgeon, you’ve come across many patients with various musculoskeletal injuries and pathology. Are a majority of them preventable? Why?
Honestly speaking most injuries are preventable. Most of this pathology occurs due to improper technique or method during exercise, games and even during their daily job. A comprehensive approach is needed in preventing these injuries. As I mentioned earlier the role of the therapist, coaches and trainers are essential in preparing the patients to be conditioned to the activity.
Besides that, the element of ergonomics also plays a major role in preventing injuries at work place. A conducive working environment and proper equipment can minimize the pathology especially lower back injuries.
Does exercise play any role in prevention?
Certainly. Every workout should start with a gentle warm up to increase blood flow to the muscle in order to improve our flexibility and decrease injuries. Incorporation of strength training and stretching prevents many sport related injuries. Nevertheless, these exercises have to be done in the right method. A proper cool down routine is also essential in prevention of injuries.
If there was one advice you could give to your patients or to the public, what would it be?
Personally I feel, the younger generation are prone to these injuries mainly due to their eagerness and impatience. Overzealous training in order to gain sculpt muscles at the expense of injuring the muscles and joints is hazardous not only to the musculoskeletal system but their general health too. They will feel the consequences as they age. So my advice to all of them will be, eat clean and train smart and the right way. Rest and sleep are essential in recovery.
MD, USM
M Med (Ortho),
USM Department of Orthopaedic & Traumatology,
Penang General Hospital, Jalan Residensi, 10990 Georgetown,
Penang, Malaysia
Contact Details:
amaleswaran@gmail.com +6014-6796223
Dr. Amaleswaran is an Orthopaedic Specialist with 11 years working experience who has spent his services at both tertiary hospital and university training-hospital. Currently working as an Orthopaedic surgeon with special interest in upper limb trauma and microsurgery.