Massage Therapy State Continuing Education Requirements

Alabama

Alabama massage therapists are required to to complete 16 Massage Therapy Continuing Education hours every two years. For more information on Alabama Massage Therapy continuing education requirements, visit the board website at: http://www.almtbd.alabama.gov/default.aspx

 

Arizona

Massage therapists in Arizona are required to complete 24 Massage Therapy Continuing Education Hours every two years. Out of the 24 hours, only 12 hours can be obtained through online or home-study courses. For more information, visit the board website at: https://massagetherapy.az.gov/

 

Connecticut

Massage therapists in Connecticut are required to complete 24 Massage Therapy Continuing Education Hours every two years. Out of the 24 required hours, no more than 6 hours can be obtained through online or home-study courses. Also, no more than 12 hours can be obtained from programs that are not approved by the NCBTMB. For more information, please visit the board website at: https://portal.ct.gov/DPH/Practitioner-Licensing–Investigations/Massagetherapist/Massage-Therapist-Licensing-Requirements

 

Delaware

Delaware massage therapists must complete 24 Massage Therapy Continuing Education Hours biennially on even numbered years. Out of these 24 hours, 3 credit hours must be in ethics, 12 hours can be elective or core credits, and only 15 hours can be obtained online. For more information, visit the board website at: https://dpr.delaware.gov/boards/massagebodyworks/

 

 

Florida

Licensees are required to complete 24 Hours of Massage Therapy Continuing Education every two years. Out of these 24 hours, 2 hours must be in professional ethics, 2 hours must be in laws & rules, 2 hours must be in the prevention of medical errors, 12 hours must be complete LIVE, and only 12 hours may be obtained online. For more information, please visit the board website at: https://floridasmassagetherapy.gov/

 

 

Georgia

Georgia massage therapists are required to complete 24 Massage Therapy Continuing Education Hours every two years. Out of these 24 hours, only 12 hours can be obtained online. For more information, please visit the board website at: http://sos.ga.gov/index.php/licensing/plb/33

 

 

Illinois

Illinois massage therapists are required to complete 24 Massage Therapy Continuing Education Hours every even numbered year. Out of the 24 hours, 2 hours must be in ethics. Only 12 hours may be obtained through distance learning, self-study, or online courses. For more information, visit the board website at: https://www.idfpr.com/profs/massagetherapy.asp

 

 

Iowa

Iowa massage therapists are required to complete 16 hours of Continuing Education biennially. Out of those 16 hours, only 8 hours may be obtained through online courses. For more information, please visit the board website at: https://idph.iowa.gov/Licensure/Iowa-Board-of-Massage-Therapy

 

 

Kentucky

Kentucky massage therapists must complete 24 Massage Therapy Continuing Education Hours every two years. 3 of those required hours must be in ethics. For more information, please visit the board website at: http://bmt.ky.gov/Pages/default.aspx

 

 

Maryland

Maryland massage therapists must complete 24 hours of Massage Therapy Continuing Education biennially. Out of the 24 hours, 3 hours must be in HIV/AIDs, 3 hours must be in ethics, 1 hour must be in cultural diversity, and 17 hours must be massage related. For more information, please visit the board website at: https://health.maryland.gov/massage/Pages/home.aspx

 

Michigan

Massage therapists in Michigan are required to complete 18 Massage Therapy Continuing Education Hours every three years. For more information, please visit the board website at: https://www.michigan.gov/lara/0,4601,7-154-89334_72600_72603_27529_53660—,00.html

 

Missouri

Massage Therapists in Missouri must complete 12 Hours of Continuing Education every two years. For more information, please visit the board website at: https://pr.mo.gov/massage.asp

 

 

Montana

Licensees in Montana are required to complete 12 Hours of Massage Therapy Continuing Education every even numbered year. For more information, please visit the board website at: http://boards.bsd.dli.mt.gov/lmt

 

 

Nebraska

Licensees must complete 24 Hours of Massage Therapy Continuing Education every two years. Out of these 24 hours, 14 must be Live and 3 hours must be in ethics. Only 10 out of the 24 hours may be obtained online. For more information, please visit the board website at: http://dhhs.ne.gov/licensure/Pages/Massage-Therapy.aspx

 

 

Nevada

Massage Therapists in Nevada must complete 12 Hours of Massage Therapy Continuing Education per year. For more information, please visit the board website at: http://massagetherapy.nv.gov/

 

 

New Hampshire

New Hampshire massage therapists must complete 12 Massage Therapy Continuing Education Hours every two years. For more information, please visit the board website at: https://www.oplc.nh.gov/massage-therapy/

 

New Jersey

New Jersey massage therapists are required to complete 20 Hours of Massage Therapy Continuing Education every two years. 2 of the 20 required hours must be in ethics and only 6 hours may be completed through online courses. For more information, please visit the board website at: https://www.njconsumeraffairs.gov/mbt/Pages/default.aspx

 

New Mexico 

New Mexico massage therapists are required to complete 16 Massage Therapy Continuing Education Hours every two years license renewal. Four hours must be in ethics. Only 8 of those 16 hours may be obtained online. For more information, please visit the board website at: http://www.rld.state.nm.us/boards/massage_therapy.aspx

 

 

New York

Massage Therapists in New York are required to complete 36 hours of Massage Therapy Continuing Education every three years. A maximum of 12 hours may be self-instructional coursework. For more information regarding New York Massage Therapy Continuing Education Requirements, please visit the board website at: http://www.op.nysed.gov/prof/mt/

 

 

North Carolina 

Massage therapists in North Carolina are required to complete 24 Hours of Massage Therapy Continuing Education every two years for license renewal. Out of these 18 hours, only 12 hours may be obtained through distance learning and a minimum of 3 hours in ethics is required. For more information, visit the board website at: https://www.bmbt.org/

 

 

North Dakota

Massage Therapists are required to complete 32 Hours of Massage Therapy Continuing Education for license renewal. Only 12 out of the required 32 hours may be obtained online. For more information, please visit the board website at: https://www.ndbmt.org/

 

Oregon

Massage therapists in Oregon are required to complete 25 Massage Therapy Continuing Education Hours each year. 4 hours must be in professional ethics, boundaries and/or communication. Only 10 of the 25 hours may be obtained through distance learning. For more information, visit the board website at: https://www.oregon.gov/OBCE/Pages/index.aspx

 

 

Pennsylvania

Massage therapists are required to complete 24 Massage Therapy Continuing Education Hours each biennial renewal period. Out of the 24 hours, 4 hours must be in ethics and 2 hours must be in child abuse. A minimum of 16 hours must be Live contact hours. Only 8 hours may be obtained through distance learning. For more information, please visit the board website at: https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/MassageTherapy/Pages/default.aspx

 

 

South Carolina

Massage therapy licensees are required to complete 12 Massage Therapy Continuing Education Hours per two year renewal cycle. For more information, please visit the board website at: https://www.llr.sc.gov/POL/MassageTherapy/

 

 

South Dakota

Massage therapy licensees in South Dakota are required to complete 8 Massage Therapy Continuing Education Hours per 2 year renewal cycle. For more information, please visit the board website: https://doh.sd.gov/boards/massage/

 

 

Virginia

Virginia massage therapy licensees must complete 24 Hours of Massage Therapy Continuing Education every two years for license renewal, along with maintaining NCBTMB Certification. For more information, please visit the board website at: https://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/Forms/

 

 

Washington 

The state of Washington requires 24 Massage Therapy Continuing Education Hours every two years. Only 12 out of the 24 hours may be obtained through distance learning. 8 hours of continuing education must be LIVE. Out of the 24 hours, 4 hours must be in ethics and 2 hours must be in rules & boundaries. For more information, please visit the board website at: https://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/MassageTherapist

 

 

West Virginia

West Virginia massage therapists must complete 24 Massage Therapy Continuing Education Hours every two years. 3 of the 24 hours must be in ethics. For more information, please visit the board website at: http://www.wvmassage.org/

 

 

Wisconsin

Licensees must obtain 24 Massage Therapy Continuing Education Hours every two years. For more information, please visit the board website: https://dsps.wi.gov/Pages/Professions/MassageTherapistBodyworkTherapist/Default.aspx

Survey Key Topics in Healthcare Ethics

Ethics for massage continuing education

Key Topics In Healthcare Ethics Quiz

Most common sports injuries For Massage Therapy Continuing Education

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Ethics for massage continuing education

Key Topics in Healthcare Ethics Lesson

When you are finished with the reading material, scroll to the bottom of the page to read the directions on how to proceed.  Thanks & we hope you enjoy the course!

Key Topics in Healthcare Ethics
3 Credit Hours

Course Overview: “Key Topics in Healthcare Ethics” will cover a broad array of important topics healthcare providers and massage therapists alike should have a basic understanding of in order to successfully navigate the landscape of healthcare ethics, laws, rules and morals in the industry today.

Confidentiality & Privacy

From past to present, confidentiality has come a long way and some would even say that we are even more at risk now for breach of confidentiality than we were in the past. Now let’s think about this. Several years ago, your medical record was one of hundreds, if not thousands of files, most of them going untouched in a doctor’s office until you come in for an annual checkup, or if you happen to randomly be sick. Your record is only available to one person at a time (because there is no copy machines), and when your doctor is finished viewing, back on the shelf it goes with all the others.

Of course, this is not all encompassing for every circumstance. There is always risk for breach of confidentiality especially in larger, more urgent-care related facilities.  This system may have its cons in the respect that one could make the argument that this is in fact less secure because tons of private health information is merely secured by locks and doors. If an unauthorized individual were to dig around in your medical records, no one would know, and no “alarms” or “notifications” would go off to alert you or other personnel who would protect your information and take legal action against this person. Nor was there any sign out protocol.

But let’s take a look at the set-up we have now, which is much more integrated. Our medical records are now becoming electronic and easily accessible between health care providers allowing for a more integrated health care experience. For example, if you get blood work done in one office, that information on your medical record is now accessible to your primary care physician’s nurse, medical assistant, or physician assistant in another office. Because of integrated care, more and more people lay eyes on pertinent and private medical information. The same goes for an medical spa with receptionist, billers, and other personnel having access to medical health information.

Once way to protect yourself as a provider is to have the colleagues you work with to sign an ethical code of conduct stating the repercussions of breaching confidentiality and sharing someone’s personal health information (PHI) for reasons unrelated to patient care. Personal Health Information (PHI) constitutes information that identifies the patient, diagnoses, treatment, medications, clinical notes from physician-patient visits, and any blood work or lab results conducted. In addition, many health care institutions provider user-specific based access to individuals who need to access patient care. For example, user names and passwords are provided for specific access based on what the employee needs to look at in the patient file, to do his or her job. To improve security, biomarker logins may be used such as with a finger-print or face scan.

The electronic health record (EHR) is much more active today than it ever was. Although patient medical records are mostly online based as of now, it is important to note that there must be proper disposal of any printed patient medical records through a paper shredder. Hard copies of medical records should not be left out in the open for unauthorized personnel or other patients to see. This means that paper records with personal health information on them should not be thrown in the trash.

The reason being is because anyone can have easy access to see what is in the trash, which may contain a glimpse of information that is sensitive to your patient. Protect your patients by shredding all papers and records that are not in use. Should your practice need printed copies of health records, please be sensitive to this information and either shred hard copies that are going un-used or keep them in a secure environment. The same thing applies to computer based medical record systems where files can be opened and closed. Usually medical record system software has a time-out and logs the user out after several minutes of no activity. Although the software itself has good preventive measures to keep records confidential, it is important to check ourselves and log out of any un-used files and close the screen.

 

The main reasons for medical record keeping is for the purpose of patient care, research, and also for insurance companies. For every patient there are many viewers of the medical record for insurance and care purposes. While the health care company/hospital/ or clinic may own the medical record and can be held liable for keeping in confidential from purposes other than patient care, it is the patient who owns the information in the document. Patient information can only be released by written consent of the patients themselves.

For other medical uses such as administration, diagnosis, insurance coverage/payment, medical records can be issued without the patients consent because this process is directly related to patient care. The medical record essentially represents the person. Regarding electronic health records, there are three components that are vital to understand when running a health care operation, and those are confidentiality of patient records, keeping them secure, and the data availability.

Confidentiality standards and adolescents

In most states, teenagers may seek treatment without the consent of their parents for specific conditions, such as for aborting pregnancy, sexually transmitted infections, mental health concerns, and substance abuse. It is better to get familiar with what the rule of the state, the local laws, and the institutional policies are with regards to adolescents and healthcare.

 

Case Study

In the court case Emily Bryne v. Avery Center for Obstetrics and Gynecology, P.C. argued March 12, 2013, the State Supreme Court ruled that patients will now be able to sue for negligence if a medical office violates regulation that dictate how medical offices must maintain patient confidentiality. In the appeal to the State Supreme Court, the ultimate goal was to determine if HIPAA lacks a private right of action and preempts state law claims for negligence and negligent infliction of emotional distress against a health care provider who has breach confidentiality of a patient’s medical record.

The story of this case goes as follows… Emily Bryne went for a visit to Avery Center for Obstetrics and Gynecology, where upon her first appointment she received gynecological care and signed a privacy policy, from the health care provider, stating that her personal health information would not be disclosed without her authorization. Within the months to follow, Bryne developed a romantic relationship with a man named Andro Mendoza, which lasted 5 months.

Upon conclusion of the relationship, she instructed the Avery Center to not release her medical records to Mendoza. Shortly thereafter Mendoza filed paternity actions against Bryne, and the Avery Center was given a subpoena (an order for a person to attend court) to provide Bryne’s medical records at the New Haven Regional Children’s Probate Court. The main issue arises in this case because the Avery Center did not alert or notify the plaintiff (Bryne) of the subpoena to provide her medical record to the court. Instead, the Avery Center simply mailed a copy of her medical records to the court. Shortly thereafter Mendoza informed Bryne through phone that he reviewed her medical record in the court file, and Bryne claims that she received extortion threats and was harassed since he viewed the record.

Bryne ended up taking the Avery Center to court on the claims that they breached their contract with her on the privacy agreement by disclosing her protected medical records without her authorization, and also acted negligently by “failing to use proper and reasonable care in protecting her medical file, INCLUDING disclosing it without authorization in violation of General Statues and the Department’s regulations implanting HIPAA.”

Additional claims she made against the Avery Center include negligent infliction of emotional distress and that the Avery Center was negligent in abiding her requests that her medical file be protected in accordance with law; in other words, that her records would not be shown to Mendoza.

Ultimately, the State Supreme Court has ruled that patients can sue for negligence if a medical office violates regulations that dictate how medical offices must maintain patient confidentiality. This case is the first time the state’s highest court has ruled regarding this particular HIPAA issue. According to lawyer Bruce Elstein, “Before this ruling, individuals could not file a lawsuit claiming violation of their privacy under the HIPAA regulations. It was for that reason that we filed a negligence claim, claiming the medical office was negligent when it released confidential medical records contrary to the requirements set forth in the regulations.” (Tepfer, 2014).

The main take away of this court case is to comply with HIPAA forms and policy’s you implement within your practice. For example, if you have our patient sign a privacy agreement that states you will not disclose their medical records without their authorization for reasons other than pertinent medical care, then you must inform them. In this case, a court of law wanted Bryne’s medical records. What should have happened- The Avery Center should have informed Bryne of the subpoena (per the privacy policy she signed, letting her authorize/or not authorize the distribution of her medical records), so she could file a motion to protect her records and take appropriate legal action against Mendoza.

 

Here are some ways providers can hold staff accountable to patient confidentiality laws and regulations.

  • Have all staff read and sign an ethics code of conduct with a specific section on Patient/Client Confidentiality Laws & Rules.
  • Have strict office protocol for how PHI is to be handled. Ex: no papers with PHI are to be left facing up on office desks during business hours, if not being used for any purpose patient files should be paper shredded and disposed of.

 

Purpose of HIPAA

In 1996, President Clinton signed the Health Insurance Portability and Accountability Act (HIPAA).  this new law was enacted as part of a broad congressional attempt at incremental healthcare reform.

HIPAA stands for the Health Insurance Portability and Accountability act and has two primary purposes.  One is to provide continuous insurance coverage for workers who change jobs, and the other is to “reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of many administrative and financial transactions that are currently carried out manually on paper.

It is important to hold regular meetings with staff to discuss the importance of confidentiality so your clinic stays up to date on laws, rules and regulations regarding this subject and so your staff continues to be mindful of their practice and to safeguard information. A code of ethics in your practice is a great way to remind patients and colleagues of your standards of care and how you respect patient rights.

 

Benefits of having code of ethics in plain view of patient

  • Provides the patient/client a sense of trust
  • Plays into informed consent
  • So the staff knows the standards to which they are held

Confidentiality is usually useful in handling the discussions that healthcare providers have with their patients. This conception is generally referred to as provider-patient privileged information. There are regulations that mandate healthcare providers not to reveal their discussions with patients, even when they are under oath in court.

Confidentiality is authorized in the American HIPAA laws, particularly the Privacy Rule, and many other state laws. Some of them are more stringent than the HIPAA. Nevertheless, there are a number of exceptions that have been structured down the years. For instance, majorities of states need doctors to report wounds caused by gunshot to the police. There are also required to report drivers who are impaired to the Department of Motor Vehicles.

Confidentiality is as well challenged in situations that involve the diagnosis of a sexually transmitted disease in a patient who fails to inform the spouse, and in an underage girl who visits the hospital to terminate the pregnancy without informing the parents. There are various state laws in the US that govern how healthcare practices should handle instances like this.

The Security Rule in the HIPAA law stipulates the regulation that protects the data of an individual and also explains the how the rules can be made compulsory if needed. The security rule describes the way covered bodies must work together to guard patient medical data.

Part of this relationship involves the production of computerized physician order entry (CPOE) schemes and electronic healthcare records (EHRs) which medical billing and coding specialists utilize daily to file and process medical claims.

The Security Rule as well stipulates that the technologies formulated by covered entities to make their administrative work easy must be protected. It must as well meet the standards established by HIPAA.

Who does HIPAA Apply to?

The HIPAA act covers both organizations and individuals.  Those who are required by law to comply with HIPAA are often called HIPAA covered entities.

It is important to know if you and/or your business practice falls in the requirements of HIPAA, so you can take appropriate action and conduct your operation lawfully and ethically.  To provide some more background on understanding HIPAA and how it may be connected to your massage therapy practice, here is some info from the Centers for Medicare and Medicaid Services website, which provides a wealth of information on the topic.

What are the HIPAA Covered Entities?

Health Plans

For HIPAA purposes, health plans include:

  • Health insurance companies
  • HMOs, or health maintenance organizations
  • Employer-sponsored health plans
  • Government programs that pay for health care, like Medicare, Medicaid, and military and veterans’ health programs (CMS, 2016)

Clearinghouses

Clearinghouses include organizations that process nonstandard health information to conform to standards for data content or format, or vice versa, on behalf of other organizations (CMS, 2016).

Providers

Healthcare providers who submit HIPAA transactions, like claims, electronically are covered. These providers include, but are not limited to:

  • Doctors
  • Clinics
  • Psychologists
  • Dentists
  • Chiropractors
  • Nursing homes
  • Pharmacies (CMS, 2016)

About Business Associates

If a covered entity engages a business associate to help carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that:

  • Establishes specifically what the business associate has been engaged to do
  • Requires the business associate to comply with HIPAA

Examples of business associates include:

  • Third-party administrator that assists a health plan with claims processing
  • Consultant that performs utilization reviews for a hospital
  • Health care clearinghouse that translates a claim from a nonstandard format into a standard transaction on behalf of a health care provider, and forwards the processed transaction to a payer
  • Independent medical transcriptionist that provides transcription services to a physician (CMS, 2016)

Also, a covered health care provider, health plan, or health care clearinghouse can be a business associate of another covered entity (CMS, 2016).

What does HIPAA deem as covered transactions?

It depends on how you are using computerized transactions.  Under HIPAA, the U.S. Department of Health and Human Services adopted certain standard transactions for the electronic exchange of health care data. These transactions include:

  • Claims and encounter information
  • Payment and remittance advice
  • Claims status
  • Eligibility
  • Enrollment and disenrollment
  • Referrals and authorizations
  • Coordination of benefits
  • Premium payment (CMS, 2017)

HIPAA-covered entities who conduct any of these transactions electronically must use an adopted standard from ASC X12N or NCPDP (for certain pharmacy transactions) (CMS, 2017).

If you are not using these types of transactions in your practice then you are most likely not a “covered entity”.

Depending on how you conduct your business operations, and if you notice on this list certain procedures your practice might engage in, it is recommended to visit the HIPAA website to investigate your situation further.  Also, be sure to check your state board requirements on the laws and rules your profession must adhere to. This includes how to handle patient/client records, and how long by law you are required to keep them for.   Every massage therapy practice may do things slightly differently which is why it is important to do the research to find out.  Your practice could be a covered entity under HIPAA, or it may not be.

One thought leader on the subject, Gael Wood, states the following opinion about HIPAA:

“It is probably a very good idea for most massage therapists to follow HIPAA guidelines (Wood, 2018). However, knowing what is required of you by law can help you to make a logical plan to implement your procedures. I hate to think of a therapist going through a lot of stress and expense, for something that is not required of them. Purchasing a filing cabinet that locks and a good computer firewall system may be sufficient. Spas and in-home massage businesses may just need to use good old fashioned common sense (Wood, 2018),”

Keeping Medical Records Private & Confidential

When medical professionals respect patients’ privacy and confidentiality, it helps to build trust, promote selfless decision making and boosts care. Protecting data collected in connection to the patient care is a central value in health care.

Confidentiality

Patients must be able to trust that healthcare providers will protect, and be respectful of, the data collected from them.  In the case of ‘respect’, for example, this includes the patients choice to have a provider leave (or not leave) a voicemail on a personal cell phone or home phone.  Have you ever noticed in your healthcare providers office, they ask you to check off a box or two, essentially granting or declining the provider permission to leave a voice mail, or to speak to you directly?  This is just one good example of how healthcare providers today can respect patient/client confidentiality.

Confidentiality is imperative in handling the discussions that doctors have with their patients. This conception is generally referred to as a patient-physician privilege. There are regulations that mandate doctors not to reveal their discussions with patients, even when they are under oath in court.  Confidentiality is authorized in the American HIPAA laws, particularly the Privacy Rule, and many other state laws. Some of them are more stringent than the HIPAA. Nevertheless, there are a number of exceptions that have been structured down the years. For instance, majorities of states need doctors to report wounds caused by a gunshot to the police. There are also required to report drivers who are impaired by the Department of Motor Vehicles.

We see this concept also challenged in situations that involve the diagnosis of a sexually transmitted disease in a patient who fails to inform the spouse, and in an underage girl who visits the hospital to terminate the pregnancy without informing the parents. There are various state laws in the US that are related to how the parents of under-aged girls seeking an abortion must be notified.

When healthcare professionals respect patients’ privacy and confidentiality, it helps to build trust, promote selfless decision making and boosts care. Protecting data collected in connection with the patient care is a central value in health care.

Patients must be able to trust that providers will protect data collected from them with confidence

Confidentiality is, above all, an instrument of protection of privacy, which it has an additional value insofar as it serves to promote other values (trust, security, friendship, respect …), or because it protects other rights (equality, non-discrimination), or because it avoids certain ills (damage to reputation and to honor, loss of jobs and opportunities).

In this way, the value of confidentiality can be greater or lesser depending on the case, depending on the purposes it serves. For what is only defensible to the extent that it contributes to achieve goals that are desirable in themselves and confidentiality that is at the service of undesirable or criminal objectives should not be protected.

Confidentiality protects the patient and his or her well-being.  It is crucial to not reveal confidential data for purposes other than as it relates to or is needed for the patient/clients direct treatment or care.  Additionally, confidential health information should not be shared with un-related personnel unless it is required by law and under very specific legal circumstances.  Even in cases like this, the patient has a right to know that their data is being shared.

But it has not always been like this. Throughout history professional confidentiality has gone through three phases:

1. Unilateral professional duty: The beginning of this phase can be seen in the Hippocratic Oath that requests the healthcare practitioner to keep patients’ lives a secret. But it was the healthcare practitioner who decided what things should remain secret, his duty was not matched or derived from any right of the patient.

2. It is a right of the patient: The patient’s right to confidentiality has been recently recognized and imposes on the professional a duty of secrecy that can only be dispensed by the patient himself.

3. Institutional and collective obligation to protect confidential data: This expanded way of understanding the secret arose because the computer systems for recording and storing data allow access to the patient’s privacy in other ways and require extreme precautions and impose standards on all the levels.

Confidentiality in professional conduct has an added value because it promotes important specific assets, among them:

1. Confidentiality enables an effective therapeutic relationship, based on truthfulness and trust. Without confidentiality, patients would stop disclosing potentially relevant information for diagnosis and treatment; some may even stop seeking medical or therapeutic help.

2. Facilitate the reliable and complete medical records, which may also be useful for scientific research and quality control.

3. Promote other values (trust, security, respect …).

4. Ensure the protection of other rights (equality, non-discrimination …).

The requirements of confidentiality have never been considered absolute. The following circumstances may justify exceptions:

1. The patient gives his or her written consent for the permission to use or share certain information.

2. When it is in clear benefit of the patient and it is impossible to request their consent due to a life threatening incident.

3. Legal obligation: in diseases of obligatory declaration, child abuse, elderly abuse, sexual abuse, injuries, illegal abortions, suspicious deaths, etc.

4. Judicial requirement, made by a judge that instructs a process.

The medical profession has always felt obliged to keep the privacy of the patient secure. The Hippocratic Oath expresses this ancient tradition: “What in the treatment, or even out of it, sees or hears in relation to the life of men, that which should never be divulged, I will keep it secret.”

However, it is up to the legislative and administrative authorities to set the limits and the rules. This is the reason why a judge, in a judicial investigation, can request data and exempt a medical secret professional.

The new demands of medical confidentiality

The patient’s privacy is maintained while the health professional, does not disclose what he knows. But now medical care is provided by teams of professionals who need to share information, and medical records are stored in computerized and interconnected data banks. In these new circumstances, it can become increasingly more complicated to keep data secure and personal health information in the hands of only the personnel who require it to perform their jobs.

Privacy

Patient privacy includes some aspects like personal space or physical privacy, personal data or informational privacy, personal preferences like cultural and religious association or decisional privacy, and personal relationships with family members and other intimates or associational privacy.

Medical Records

Medical records provide significant data that assures the continuity of care of the patient and are essential both for present treatment and for the treatment of the patient in future cases. It is also significant for insurance, job and other uses.

Health care practitioners are obliged to take reasonable steps to protect medical information and keep them confidential according to the wish of the patient. For instance, a discussion between the doctor and the patient regarding the care of the patient must be done in private. The preference of a patient may be that the doctoring their mobile phone instead of the homeland phone. The data of a patient is not supposed to be revealed to even well-meaning members of the patient’s family.

Every patient’s right to confidentiality must be maintained except the individual permits the disclosure of such information or in a situation where they can no longer state their preference like when they are seriously confused or comatose. The federal Health Insurance Portability and Accountability Act HIPAA act are applicable to the majority of healthcare practitioners and its law referred to as the Privacy Rule, stipulate in detail regulations that must be followed with regards to privacy, access, and disclosure of patient’s data. Some of the regulations that must be followed in handling patient’s information as stipulated in the HIPAA acts include the following:

  • Patients have the right to see and acquire copies of their medical records. They can as well request for corrections to be made if they discover any oversight.
  • Individuals who are legally approved to make health care decisions for an individual who lacks the capacity also have equivalent right like the sick individual to access medical records of such individuals.
  • Health care practitioners must regularly reveal their practices about the privacy of private medical data.
  • Health care providers may share a patient’s medical data but only among colleagues in so far as it is necessary to care for the individual.
  • Personal health data must not be disclosed for the sake of business promotion or marketing efforts.
  • Health care providers must take realistic precautions to make sure that their conversations with the patient are confidential.
  • Patients may file complaints regarding privacy breaches by healthcare practitioners straight to the health care practitioner or to the Office for Civil Rights in the US Department of Health and Human Services.

The HIPAA Privacy Rule does not imply barriers to the standard communications between medical providers and members of the patient’s family or their friends. The rules allow doctors or other health care providers to reveal data that is immediately required for the participation of a spouse, family members, friends, or other individuals allowed by the patient. If the patient is able to make health care decisions, the doctor may talk about this data with the family or others present if the patient gives the consent or when it is necessarily required by law.

Even in the absence of the patient or when it is not logical to ask the patient’s permission due to emergency or incapacitation, a doctor may share a patient’s data with the family members or friends if the doctor thinks that such would be to the interest of the patients while exercising professional judgment.

Health care providers are occasionally required by law to reveal specific data, normally due to the fact that the condition may be dangerous to others. For instance, the health providers must report specific infectious diseases like human immunodeficiency virus (HIV) infection, syphilis, and tuberculosis to state or local public health agencies. Health care practitioners who notice medical signs of child, adult, or elder mistreatment, abuse, or neglect normally must report such information to protective services. Conditions that might seriously impair a person’s ability to drive, such as dementia or recent seizures, must be reported to the Department of Motor Vehicles in some states.

Difference between confidentiality, privacy, and security of health data

When it comes to the concepts of privacy and confidentiality of health data, there are three different essential and similar concepts that are frequently mistakenly used as one concept while investigating protection of health data in the U.S. healthcare system. However, they have different basic meanings.

Whenever the issues regarding the privacy of health information are being discussed, the first law that comes to mind is the “HIPAA. This part of the guide discusses these three concepts vary from each other.

 Confidentiality is the mandate of health professionals who have access to patients’ health records or discussion to keep the acquired information confidential. The professional obligation of health professionals to hold these data in confidence is implied in professional association codes of ethics, as represented in the American Health Information Management Association Code of Ethics. Confidentiality is legally identified as advantaged contract between two parties in a professional relationship like the patient-physician, a nurse or other healthcare professional. Patients anticipate that the healthcare professionals must keep that information about them confidential. However, during legal lawsuits, the cases are judged on a case by case basis given the evidence on the ground and factoring the public good or need for the same information with support for the privileged discussion.

When handling sensitive health data that requires particular layers of confidentiality, like those involved in mental health treatment, the state laws offer assistance for health data management expert. In Illinois, for instance, the Mental Health and Developmental Disabilities Confidentiality Act provide thorough requirements for right of entry, utilization, and disclosure of confidential patient information which includes legal proceedings.

Professional persons in health care delivery fields (including those working in the public schools) have legal and ethical responsibilities to safeguard the confidentiality of information regarding the clients in their care. Scholars and those involved in human research have legal and ethical obligations to protect the privacy of persons who agree to participate in clinical studies and other research projects. Children and adults who are legally incompetent have the same right to privacy enjoyed by adults who are competent, though their rights will be mediated by a designated family member or a legal guardian.

There are federal statutes binding on all ASHA members who treat clients or patients, whether they work in healthcare facilities (where the HIPAA privacy and security rules apply), schools (which operate under the Family Education Rights and Privacy Act, as well as HIPAA), or private practice. There are also stringent federal statutes governing the treatment of human subjects in medical and other forms of scientific research. Individual states also have statutes governing the confidentiality of patient and client information, the protection of data gathered in research, and the privacy of students.

If there is variation among the different sources of rules on privacy, the professional should follow the most restrictive rule; for example, if the law seems to allow an action that the Code of Ethics seems to prohibit, follow the Code of Ethics. If there is a conflict between sources, do what the law requires; for example, if workplace policies conflict on some point with legal requirements for confidential handling of records, the law takes precedence.

Privacy, different from confidentiality, is the right of the patient to be allowed to make decisions regarding the way personal data is shared. Although the U.S. Constitution does not state a “right to privacy”, privacy as regards to a person’s healthcare decisions and health data are specified in court decisions, in federal and state statutes, licensing organization guidelines and professional codes of ethics.

The greatest among them is the federal HIPAA Privacy Rule that set up the national standards for privacy of health data and defining “protected health data. The purpose of the HIPAA Privacy Rule is to identify and mark the frontier of the scenarios where a person’s protected health data may be utilized or disclosed.

The privacy rule as established in the broader Health Insurance Portability and Accountability Act of 1996 (HIPAA) as expressed in the U.S. Department of Health and Human Services (HHS), strike a balance that allows significant utilization information even as it protects the privacy of individuals who search for medical care and healing.

People are offered some elements of control like the right to access their own health data in a number of instances and the right to ask that any erroneous health info should be amended. Nevertheless, while trying to maintain a balance; the Rule makes provision for a number of exceptions regarding the utilization and disclosure of protected health data without patient authorization. Some of these exceptions include treatment, compensation, health care providers’ operations and for specific public health activities.

Even as there continues to be a debate about if the HIPAA Privacy Rule has significantly boosted people’s privacy rights, it has surely enhanced understanding of the topic of privacy of health data, issues that concern its protection and what the patient’s duty is in the process. The duty of the health information management professionals has clearly been significantly impacted by tasks for HIPAA Privacy Rule compliance.

HIPAA has developed during the last ten years and was significantly strengthened by the 2009 HITECH Act and the HIPAA amendment regulations published in January 2013. Whatever is your view about HIPAA, it is difficult to argue that it has had a huge impact on patients, the healthcare industry, and many other industries and would control the operations of healthcare and HIM professionals for many years to come.

Security

Security means protection directly, and particularly to the method that is employed to keep the privacy of health information intact and support experts to hold such information in confidence.   The concept of security has over the years been applied to health records in manuscript from like locked file cabinets. While the utilization of electronic health record systems broadened and when the issue of transferring health information to support billing started, there arose the need to come up with regulatory guidelines that relate to the electronic health information.

The HIPAA Security Rule offered the first national standards for the safeguard of health information. In handling technical and administrative safeguards, the HIPAA Security Rule’s specified that the objective is to keep independently identifiable electronic health data safe-a part of information covered by the Privacy Rule while giving healthcare providers suitable access to information and flexibility to adopt technology as enshrined in the HHS, 2003b. Once more, that concept of balance exists in the law: necessary access by healthcare providers vs. protection of individuals’ health information.

A HIPAA violation case example is sending patient bills, that contain identifiable health information, to collections firms.  In one case concerning an ardent patient privacy advocate, the psychologist regularly had employees forward overdue patient bills to a collections firm.  Unfortunately, the bills contained protected health information, such as CPT (Current Procedural Terminology), DSM/ICD codes, that can identify a patient’s diagnoses.  After catching wind of the issue, the state sought to suspend and revoke the psychologists license.  The personal health information on any documentation of bills sent to the collections agency should have been redacted before sending.

Another example of a HIPAA violation is viewing patient or client medical records when not indicated or related to care.  In one case from 2008, there were 13 hospital workers terminated for viewing Britney Spears’ medical records during her hospitalization at the University of California, Los Angeles (UCLA) Medical Center. 

With the advent of social media, HIPAA and privacy violations are unfortunately becoming ever-more common, which is why it is important for healthcare providers to know what is acceptable to post, and what is off limits.

First, let’s start with a definition.  A violation, as defined by HIPAA, is a breach that is an impermissible use or disclosure under the Privacy Rule, that compromises the security or privacy of the protect health information of the individual. 

Examples that constitute a HIPAA violation:

  • Posting images or gossiping about a patient to individuals not related to patient care, even if the name is not mentioned.
  • Posting images of patient files, such as x-rays, pictures related to care, or other health records, with identifiable health information without consent provided by the patient.
  • Discussing the personal health information (PHI) of a patient, such as a diagnosis, within earshot of other individuals not related to patient care.
  • Disclosing PHI to individuals associated with the patient but have not been authorized by the patient to be privy to their health information.

Medical professionals who breach confidentiality presently face more stringent penalties due to the adjustments made to the HIPAA Privacy and Security Rules during the publication of final ruling of the HITECH Act.   The publication of these alterations is referred collectively as Omnibus Rule and was meant to make a great impact on health care and protect patient privacy. It would as well keep patient’s health data safe especially as we see escalating innovations in technology.

The HITECH Act

What is it?

The Health Information Technology for Economic and Clinical Health Act, also known as HITECH, was signed into law on February 17, 2009 to advocate the adoption and purposeful use of health information technology.  The HITECH Act was enacted as part of the American Recovery and reinvestment Act of 2009, modified the Department of Health and Human Services Secretary’s authority to impose civil money penalties for violations occurring after Feb. 18, 2009.

A certain section of the HITECH Act, subtitle D, acknowledges the security and privacy concerns associated with the electronic transmission of health information and through a few provisions, strengthens the criminal and civil enforcement of the HIPAA law (OCR, 2017).

Essentially, the HITECH Act revisions significantly increase the penalty amounts the Secretary may order for violations of the HIPAA rules (HHS, 2009). 

The director of the Department of Health and Human Services Office for Civil Rights, Georgina Verdugo, commented on the HITECH Act, stating that, “the strengthened penalty scheme will encourage health care providers, health plans, and other health care entities required to comply with HIPAA to ensure that their compliance programs are effectively designed to prevent, detect, and quickly correct violations of the HIPAA Rules.  Such heightened vigilance will give consumers greater confidence in the privacy and security of their health information and in the industry’s use of health information technology, (HHS, 2009)

The Omnibus Rule

The purpose of this rule was to make modifications to the HIPAA rules that enhance public protection in regards to electronically transmitted health data.  There are 4 key rules included.  In short, they go as follows:

  1. Final modifications to the HIPAA privacy, security, and enforcement rules mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, and certain other modifications to improve the Rules.  One of these modifications, among several others listed on the document, include holding business associates of covered entities directly liable for compliance with certain HIPAA Privacy and Security Rules’ requirements.
  2. Changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act.
  3. Breach Notifications for Unsecured Protected Health Information under the HITECH Act, which replaces the breach notification rule’s “harm” threshold with a more objective standard and supplants an interim final rule published on August 24, 2009.
  4. Final rule modifying the HIPAA Privacy rule as required by the Genetic Information Nondiscrimination Act (GINA), to prohibit most health plans from using or disclosing genetic information for underwriting purposes which was published as a proposed rule on October 7, 2009 (Federal Register, 2013). 

The Omnibus Final Rule, which began enforcing compliance on September 23, 2013, contained the most significant changes to the HIPAA Privacy and Security rules since their start.  Additionally, the Omnibus Final rule also extends to the Office of Civil rights the capability to enforce the rules and render fines (Stryker, 2013).

Data and the private data of patients who take part in research studies must also be kept confidential. There must be watchful supervision of employees to make sure that they keep to the recommended research protocol required to ensure the data of all individuals involved are kept safe. Some practical precautions to safeguard and maintain the confidentiality of the participant include the following:

  • Transferring research findings without revealing private data that could easily be recognized.
  • Ensuring the safety of saved research records and minimizing access to un-authorized personnel alone;
  • Taking away, camouflaging, or coding individual information that could be easily identified, such as names, medical record numbers, or date of birth.
  • Getting consent from the research participant and if the participant is a child the consent of the parent or the guardian must be sought before transferring results that include photographs, videos or audio voice recordings that may make it easy for the individual to be identified.

Due to the fact that the legal requirements in this regard are very strict and given that health institutions monitor research on human subjects very cautiously, professionals must get additional guidance straight from the correct personnel in their home institutions.

In a research study that involves the peer review of tendered manuscripts, all results, information, and images in the manuscripts ought to be handled as highly confidential, and reviewers and editors are obliged to protect findings from any form of untimely disclosure. In a blind-review process, the personal data of the researchers must be protected. In a double-blind review procedure, the vagueness of authors and reviewers similarly must be thoroughly maintained. Editors and reviewers must not publish any information they gathered from the manuscripts.

If a patient is a competent adult, he or she is the only person with the authority to grant access to his or her medical information. If the case has to do with a minor, only the parent or the guardian can grant such right of access. However, there are instances, such as custody disputes or under custody agreements where both the biological and adoptive parent do not have right of access to the patient information or the right to give permission for such information to be disclosed.

In the case of minors, the right of access to the medical data of the patient is only granted to the designated family member(s) or legal guardian of the patient. The standard for good practice in this regard includes the following:

  • In every form of treatment situations, a written form that stipulates disclosure of information must be provided to and signed by, the patient/client or the patient’s representative before the commencement of the treatment of the individual.
  • Every patient/client record must be made up of a clear, precise, up-to-date, and easily situated statement of the person who is authorized to have access to the patient’s data and the person who has the right to give the right of access to a third party who has the right to view client information and who may authorize the release of such information to other parties related to care.

For any disclosure of information apart from the one that is contained in the first round of privacy agreement or as the law requires, the doctor needs to get a release of information agreement from the patient/client or their assigned representatives. This involves getting permission to share information with a second healthcare professional. The permission to do so should be obtained in writing, instead of verbal consent, for documentation purposes and legal reasons.

Printed records of a patient’s data have a durability and reproducibility that differs from spoken information. There are thus extra concerns regarding the protection and management of paper files or automated records. These fears and challenges continue to get more complex and intense due to the electronic media and the use of laptops and smart phones.  While this can be rare, breaches of confidentiality through computer or software hacks can happen due to how the records are produced, stored, or transmitted.

For example, around May of 2017 the United States Department of Health and Human Services, Office of Civil Rights (OCR) announced a $2.5 million dollar settlement in connection with an employee’s stolen laptop with electronic personal health data on it (Day, 2017). 

The settlement was reached with CardioNet, Inc., covered entity and provider of remote mobile monitoring services, after CardioNet’s disclosure of multiple discontinuities of data taking place of electronic protected health information in 2012.  The breach affected more than 1,300 and 2,200 people, respectively, and both involve stolen laptops (Day, 2017).

Typically, professionals should not produce, update, or save patients records on their personal electronic devices like computers and flash drives or personal online accounts. If the workplace permits such off-site management of health records, there must be the implementation of privacy and safety measures like password protection and anonymized client data representations. Staff must not open or read patients records on portable devices should when they are in public places like coffee shops or on a public transport system.

All therapists who practice autonomously and all healthcare organization must have clearly written policies that address the safety and security of client records.  This includes a detailed risk analysis of vulnerabilities, a risk management plan to handle and reduce any potential security risks, implement HIPAA security rule procedures and policies, with a specific focus on hand held devices and other media controls, and/or implement a “HIPAA security rule training program” with a focus on encryption of personal data, security, and handling of devices and out-of-office transmissions (Day, 2017).

Ethical Workplace Policies – maintaining secure patient/client health records.

  • Record accurate patient health data;
  • Electronic and paper record storage system
  • Record logging in and out into the health data system to prevent access by workers who may want to read and influence the record and with regard to the right of access by clients;
  • Record, review and maintain records according to relevant state laws and regulations.
  • Secure and encrypted transfer of data (if needed) which includes transfer by electronic means;
  • Procedures for managing requests for data by an individual other than the client or the client’s spokesperson;
  • Have employees sign off on a confidentiality agreement as it relates to their interactions with clients and client health information.

Failure to comply with the requirements planned to defend patients’ records not only puts patient welfare at risk but as well makes the practitioner susceptible to ethics complaints and legal action.

Suitable steps must be taken to make sure that the confidentiality and protection of electronic and automated client records and data. All data must be password protected, and only authorized individuals should be given access to the records and information. Automated records must be backed up regularly, and there must be plans for protecting computer systems in the event of emergencies.

Ethics & Electronic Health Records (HER)

An electronic health record (EHR) is a record that contains a patient’s healthcare information which includes history, physical examination, investigations, and treatment in digital format. Doctors and hospitals are currently making use of electronic health record because they have many advantages over paper records. They boost access to health care, enhance the quality of care and reduce costs.

The office of the National Coordinator for Health Information Technology (IT) sees the patient’s health record as not merely a range of data, but that you are protecting the individual’s most personal information. The information that is in the patient health record is owned by the patient. The doctor and the organization own the physical medical record. Nevertheless, ethical issues that consign the EHRs are challenges to the health personnel. When patient’s health data are transferred from place to place or from individual to individual or connected to without the knowledge of the patient, it puts the individual’s autonomy at risk and can breach HIPAA if not directly related to care..

The patient may cover up and conceal some information because of fear regarding the degree of security of the electronic system on which the data is stored. This could significantly affect their treatment due to the compromise regarding the incomplete disclosure of information. There is the risk that healthcare data of thousands of patients’ can be misplaced in error or be stolen. Leaders, health personnel, and policymakers must be aware of the ethical implications of using EHRs and set up strategies to ensure that the healthcare data of patients in electronic forms are properly safeguarded.

The advantages of electronic health records over the traditional paper records

In the past, the health record of patients was documented on paper for the purpose of research, medical, administrative and financial uses. Its major disadvantage was in the difficulty of accessing the information. Again, it can also be accessible to one individual at any given time. It takes about one month to six months to complete such data or even more time because the update of paper documentation of health records is required one once every year.

The aim of documenting health data through the electronic media is still equivalent to that of the standard paper storage. However, the electronic health record is more beneficial than the paper records.

Some of these advantages include the following:

  • EHRs are more legible and this eliminates issues of wrong prescriptions, doses, and processes.
  • Furthermore, unpleasant drug reactions can be minimized greatly when the EHRs are linked to drug banks and pharmacies. This can be achieved by not allowing prescription and order for drugs which has a recognized adverse reaction for a specific patient.
  • It allows easy access from anywhere at any given time.
  • Electronic records require less storage space and can be stored forever. They lessen the number of lost records, assist in research activities, assist in the production of a whole set of backup records at low cost, speed data transfer and are money-spinning.
  • EHRs boosts patient compliance, aids quality assurance and minimize medical errors.

Four key ethical priorities for electronic health records (EHRS):

  • Privacy and confidentiality
  • Security Breaches
  • System implementation,
  • Data errors

Privacy and confidentiality

The health care data of a patient ought to be provided to others only when it is allowed by the patient or the law. When a patient can no longer give such consent as a result of age or mental inability, the decisions about sharing their healthcare information can be made by the legal representative or legal protector of the patient. Healthcare data shared due to clinical interaction is taken as confidential and need to be protected. Data from which the uniqueness of the patient cannot be discovered, for instance, the number of patients with breast carcinoma in a government hospital, is not covered by this category.

Healthcare organizations, insurance companies, and others will need access to the data if EHRs are functioning as planned. The major reason for protecting confidentiality is to permit just authorized individuals to access the data. This starts with authorizing users. The user’s access must be based on pre-established role-based privileges. The manager of the electronic health data discovers the user, decides the level of information shared and designates usernames and passwords.

The user must be informed that they would be made accountable for the use and misuse of the healthcare data revealed to them. Their access to the information is limited to merely what they require to fulfill their obligations. Therefore, transmission of user privileges is a key aspect of the security of medical record security.

Despite the fact that it is significant to control access to health information, it is not enough to protect the confidentiality. There must be additional security steps in a place like a robust privacy and security policies to ensure that patients’ health care data are adequately protected.

Addressing Electronic Health Record Security Breaches

Security breaches are committed against patient privacy when confidential health data is provided to others without the consent or approval of the person. Two incidents of security breaches that occurred at Howard University Hospital, in Washington demonstrated that insufficient data security can affect a large number of people.

On May 14, 2013, one of the hospital’s medical technicians, Laurie Napper, was charged with violating the Health Insurance Portability and Accountability Act (HIPAA). The technician for a 17-month period used her role in the hospital to access the names of patients, their addresses and Medicare numbers for trading purposes. The hearing of the case conducted on the 12th of June 2013 found the technician guilty and she was imprisoned for months in a half-way house with an additional fine of 2,100 dollars.

Before that incident, the same hospital notified more than thirty-four patients in their database that their medical data had been compromised. A contractor working with the hospital downloaded the patients’ data to a personal laptop that got stolen from his car. The data was password protected but was not encrypted. This implies that anyone who guessed the password correct could have access to the patients’ data without an arbitrarily generated key.

The information contained in the patients’ file that was compromised included the names, addresses, and Social Security numbers and in some instances, diagnosis-related data.

Another hospital chain by name the Prime Healthcare Services Inc. has accepted to pay two hundred and seventy-five thousand dollars to settle a federal investigation that alleged violation of patient privacy. The security breaches are constantly becoming a major challenge faced by doctors, public health officials and federal regulators.

Cloud storage, password protection, and encryption are all procedures health care providers can take to keep their portable EHRs additionally secure. A survey carried out discovered that roughly seventy-three percent of doctors send a work-related text to colleagues.

Mobile devices are meant for personal use. They are not structured to be managed by the central IT Department. Mobile devices can readily be misplaced, spoilt, or stolen. There must be a great emphasis on encrypting mobile devices that are utilized in the transmission of confidential information. Portable EHRs can be made more secure with the use of cloud storage, password protection, and encryption.

The use of two-factor validation system with security tokens and password are essential in securing EHRs. Security means like firewalls, antivirus software, and intrusion detection software have to be included to protect data integrity.

Specific policies and measures must be set to maintain patient privacy and confidentiality. For instance, staffs must not share their ID with anyone and they must constantly log off when leaving a terminal and make use of their assigned ID to access patient electronic records.

A security officer must be chosen by the healthcare provider to work with a team of health IT experts.

Regular random audits ought to be carried out on a constant basis to ensure that the staffs comply with the hospital policy. The whole system activity can be tracked by audit trails. This is detailed listings of content, length of use and the user; generating date and time for entries and logs of all s to EHRs.

When there is improper access to a medical record, the system should be structured to provide the name of the individual gaining access; the time, date, the screens from which the access is gained and the duration of the review. This data is essential to determine if the access is the result of an error or just an intentional, unauthorized view.

The HIPAA Security Rule needs organizations to carry out audit trails. This requires that they document information systems activity and have the hardware, software, and measures to record and scrutinize activity in technological systems where health information is stored.

Outside contractors constitute specific privacy issues. There should be the implementation of employee-only access to the EHR. This implies any external contractor should only gain access to the healthcare information under the approval and supervision of a staff of the organization.

System implementation

Healthcare providers face a lot of challenges while making use of the EHRs. These challenges result in a waste of resources, frustrated providers, breach of confidence of patients and patient safety issues. To set up, carry out, and maintain the EHRs needs adequate funds and the participation of a number of individuals which includes physicians, other healthcare professionals, information technologists, educators, and consultants.

Hospitals and healthcare providers are improving greatly without so much engagement by the clinicians. Most EHR execution projects do not succeed due to the fact that the health organizations undervalue the significance of getting one or more clinician to act as opinion leaders for providers in the healthcare institution. Therefore, the clinician must develop strategies to let their colleagues understand what roles they have in the implementation of the EHR. They must enlist their participation in duties like as EHR choice, workflow design, and quality improvement.

Data error

Maintenance of integrity helps to keep the data accurate and non-manipulated. EHRs help to boost the patient’s safety by minimizing healthcare errors, minimize health disparities and boost the health of the public. Nevertheless, concerns have been raised about the correctness and consistency of data keyed into the electronic record.

Erroneous representation of the patient’s present condition and treatment takes place as a result of improper utilization of options like “cut and paste”. This practice is offensive due to the fact that it boosts the risk for patients and liability for clinicians and organizations.

Another thing that can result in an issue in the data integrity is the drop-down menu and disposition of relevant information in the trash. Such menus minimize the choices accessible to the clinician who may hurriedly select a wrong data which may result in a great error. Doctors and contractors have been working to find a solution to software issues to make EHRs both user-friendly and correct.

Loss or destruction of data happens during data transfer. This raises concerns regarding the accuracy of the database since patient care decisions are based on those data. An increasing issue is of medical identity theft. This results in the incorporation of incorrect data into the record of the victim. The individuals’ insurance company would be billed for medical services that were not received by the actual policyholder and the patient’s future treatment is structured on that wrong information from thief’s health record without the immediate knowledge of the patient or the healthcare provider.

Management of electronic health data comes with a lot of regulatory compliance challenge, for ethical consideration and eventually for the quality of care. While the need for electronic health record system continues to increase, and additional data are gathered from mobile health devices, for instance, it comes with additional challenges for healthcare providers.

All employees in healthcare organization including professionals that manages health informatics and health information, clinicians, researchers, business managers and the rest people that work in a medical setting are all obliged to keep the collected health information private. Patients’ privacy rights with regard to their health information and confidentiality must be maintained and protected.

The public interest of citizens in health information, however, subsists in issues that relate to public health or crime. It is essential to balance the entire interests in health data. Maintenance of the confidentiality, privacy, and security of healthcare data present constant and significant challenges in the U.S. healthcare and legal systems and at the same time, it presents a prospective career choice for health IT management professionals.

Different healthcare professionals need the help of the computer to carry out their work effectively. Producing a practical EHR system will need the expertise of doctors, technology professionals, ethicists, managerial personnel, and patients. Despite the fact that electronic health records are more beneficial than the paper records, the future of healthcare requires that the healthcare professionals recognize that there are risks inherent and must properly manage the system to surmount the obstacles it poses to the health and safety of individuals under medical care.

There are a lot of strategies that can be implemented to minimize the risk of overcoming the barriers inherent in the execution of digital health records. Leadership, teamwork, suppleness, and flexibility are the main ways to arrive at some solutions. EMRs capacities ought to be maximized to be able to boost the quality, safety, efficiency, and efficiency of health care and health care service systems.

 

“No one shall be subjected to arbitrary interference in his private life, his domicile or correspondence, or damage to his honor or reputation. Everyone has the right to the protection of the law against such interference or damage. “

Universal Declaration of Human Rights of 1948

Ethical Research

Attention to the protection of privacy begins with the planning of a research project, is crucial to the way research on human subjects is conducted and extends through the review of research results (on both human and animal subjects) for publication and the sharing of data sets. Everyone involved—researchers, human subjects, support personnel, editors, reviewers, and data managers—should be aware of the ethical and legal requirements regarding privacy and should not compromise confidentiality for any reason.

Understanding the IRB

To ensure ethical research is conducted with human subjects, the APUS Institutional Review Boards must be consulted to review and approve the research study.  The IRB performs these reviews to certify that the research is conducted in conformity with federal, institutional, and ethical guidelines. 

For the purposes of APUS IRB, research is defined as being both:

1.  Systematic
2.  Generalizable (APUS, 2016)

Systematic research includes research development, testing, and evaluation, and it is designed to create generalizable knowledge. Generalizable knowledge involves the creation of new knowledge that may be the basis for scholarly publication, including a capstone thesis or project. In summary, if the project is designed to include human subjects, create new knowledge and may be published, an IRB review will be required prior to conducting any research (IRB, 2016).

All human subject research under the backing of the American Public University System (APUS), regardless of funding source, must be reviewed and approved by the IRB before research can commence. 

To ensure ethical standards are followed in research, there are certain criteria the research needs to meet before it can be reviewed or approved by the IRB. 

For example, the APUS IRB reviews research studies proposed by colleges and universities and follows the below criteria. 

  • The research is conducted or directed by an employee or trainee of the university in connection with his or her APUS responsibilities
  • The research is sponsored by the American Public University System
  • The research involves access to any property or facility of APUS
  • The research involves APUS faculty, staff, and/or students.  This research may also need approval of the Internal Research Review Board (APUS, 2016).

Some research the IRB would declare it as exempt since it is a considered-low risk involvement of human subjects.  For example, this would include research involving the collection or study of existing data if it is publicly available or if subjects cannot be identified. Here are some other criteria for studies that would be exempt.

  • Research conducted in established or commonly accepted educational settings, involving normal education practices
  • Research using anonymous or no-risk tests, surveys, interviews, or observations. 
  • Most research involving public officials
  • Research examining public benefit or service programs
  • Taste and food quality evaluation and consumer acceptance studies (APUS, 2016).

Human subjects have a right to expect that their personal information will not be divulged when the results of a study are published or when data sets from a research project are shared with other investigators. Protecting the privacy of research subjects is an obligation for all those who are involved in the research.

Clinical research is a scientific activity designed with the objective of achieving specific knowledge pertaining to medicine and health. We know that methodical clinical research is absolutely essential to obtain evidence to validate the effectiveness & safety of medical procedures and implement best practices.

Validated clinical practices are those that have scientifically proven their efficacy and safety. On the contrary, the practices that have not been validated can be ineffective and harmful, in any case, their benefit / risk ratio is unknown. For all these reasons, clinical research can also be defined as an activity designed to validate clinical practices. After all, a practice, treatment, or procedure, not based on scientifically validated practices can be unsatisfactory, misleading and dangerous. It is necessary to investigate to produce maximum benefit and minimum damage to the patients.  The necessity of research lies in its ability to determine the best way to do something; is this something effective at producing positive outcomes; and is it safe.  To perform treatments or procedures on patients/clients without prior evaluation the safety and effectiveness of the event, can cross certain ethical lines of care.

The validation process of research becomes highly unethical if it involves the misleading or coercing of individuals, with or without their consent, to participate in a clinical research study that has potential risks and side effects.  As we can see from history, medical research has not always followed ethical considerations and guidelines with human subjects.

A Brief History of Unethical Human Research

The Tuskegee Syphilis Experiment

The study began in 1932 when the Tuskegee Institute and the Public Health Service, working in conjunction, initiated a research study to document the natural history of syphilis, in hopes of justifying treatment programs for African Americans.  The research study was called the “Tuskegee Study of Untreated Syphilis in the Negro Male.”

Six hundred African American men were involved in the study; 201 without the disease, and 399 with the disease.  The study started on its way without proper informed consent and disclosure to the individuals.  Researchers told the men they were being treated for “bad blood”, a local term used to describe multiple ailments, such as syphilis, anemia, and fatigue.  In actuality, the men never received proper treatment to cure their ailment.  To compensate for their time and partaking in the study, the men were given free meals, medical exams, and burial insurance.  The study was supposed to last 6 months, but dragged on for a long 40 years, wreaking havoc on the health and lives of these men (CDC, 2017).

Then, in 1972 a news article broke the story of the Tuskegee Syphilis study which caused major public concern and uprising.  Due to the reaction, the Assistant Secretary for Health and Scientific Affairs appointed an Ad Hoc Advisory Panel to examine the study.  Contained in the panel was 9 individuals from various fields, such as public affairs, religion, law, medicine, labor, education, and health administration (CDC, 2017).

There was zero evidence found that indicated the researchers had informed the individuals of the true intention and purpose of the study.  Even though the men had agreed willingly to be examined and treated, they had been utterly misled, without having all the facts required to give them informed consent.  On top of this, when penicillin quickly became popular in 1947 for the treatment of syphilis, the men were never offered nor given this treatment for their disease.  The Ad Hoc Advisory Panel found no evidence showing that subjects were every given the freedom to leave the study, even when this highly effective treatment became used throughout the U.S (CDC, 2017).

In light of this new information about the study, the advisory panel deemed the study to be “ethically unjustified” – meaning, the knowledge gained was minimal when compared with the damages and health risks the study brought for its subjects.  In October of 1972, the panel ordered the study to a halt.  The Assistant Secretary for Health and Scientific Affairs announced the end of the Tuskegee Study a month later (CDC, 2017). 

A class action lawsuit, filed a year later, was filed on behalf of the research study individuals and their families.  Then in 1974, an out-of-court settlement was reached of $10 million.  Included in the settlement, the United States Government guaranteed a lifetime of medical benefits and burial services to all living individuals from the study.  Established to offer these services was the Tuskegee Health Benefit Program, or the THBP.  Wives, widows, and children were added to the program in 1975.  Twenty years later, the program was expanded to include health as well as medical benefits.  The Centers for Disease Control was given responsibility for the program, where it is held today. The last study participant died in January 2004. The last widow receiving THBP benefits died in January 2009. There are 12 offspring currently receiving medical and health benefits (CDC, 2017).

In 1974, due to the Tuskegee scandal, the United States Congress appointed the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, with the ultimate goal of placing research under public control.

In 1978, the Commission presented the ethical principles of research with human beings in the so-called Belmont Report, many recommendations of the National Commission became law, becoming part of the Federal Regulations of 1981. Finally, investigations with human beings were subject to the regulation and control of laws, standards and ethics committees.

Misuse of Research & Human Study

The health practitioners, to know the efficacy of the remedies, had to try to cure the diseases and observe the results, they could only change the usual treatments when they had reason to think that this would benefit their patients more. Also, to observe the interior of the body had to wait for the chance of having to treat open wounds.

In this way it can be said that the “doctrine of double effect” was the guiding principle of clinical research until the nineteenth century. Knowledge could only be a second effect, not directly sought, in a treatment whose intended effect was the healing of the patient.

While not ethical according to today’s standards in healthcare, below is a brief explanation on the doctrine of double effect:

The doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. According to the principle of double effect, sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end.”

  • Stanford Encyclopedia of Philosophy, 2014

Recall that the ancient medical ethic, as it appears in the Hippocratic Oath was guided by the principles of beneficence and individual non-maleficence. Today we would qualify it as a principle ethic of individual benefit. In this it was impossible to carry out investigations that did not have intention to cure, and that in addition they could produce damages.

Experimentation with the exclusive purpose of acquiring knowledge could only be carried out on animals, relying on their analogy with man.

At the end of the eighteenth century, some doctors began to realize that to obtain certain knowledge it was not enough to simply observe the results of the treatments, and that it was necessary to carry out experiments whose design was not designed to maximize the benefit of the treated patients, but to obtain reliable evidence of the effectiveness of the treatment. Thus, control groups emerged that left certain patients untreated in order to compare results. James Lind, in 1747, was among the first to leave some patients untreated to demonstrate the efficacy of citrus in the treatment of scurvy. It came also the need to experiment with healthy subjects, such was the case of the first virilizations, which subjected healthy people to the risk of contracting smallpox.

There began to be talk, on the other hand, of the necessary voluntary consent of the sick, it was thought that this was enough to justify any intervention. William Osier, in 1908, justified the experiments of inoculation of yellow fever that Walter Reed had carried out, claiming that “any man is free to submit to experiments”, and that voluntary consent changes “entirely” the problem of morality of subjecting human beings to risk.

During the first half of the twentieth century, experiments with humans were increasing and the requirement of consent was repeatedly violated. In Europe and America, mainly institutionalized patients were used, without their consent, to study the natural course of certain diseases and to try remedies, vaccines or diagnostic tests. Sometimes they were inoculated with germs, they were caused nutritional deficiencies, or they were administered dubious treatments with undesirable effects.  Despite the unethical experiments, it did not raise legal complaints or initiate corrective laws or convictions in professional codes. The medical profession and public opinion did not react to it, silenced by the prestige of science and because these practices affected only marginalized populations. It was during the Second World War when the experiments with human beings reached extremes of atrocity and shame for humanity. These experiments they were most notorious in Nazi Germany. But today we know that shameful experiments were also carried out in Japan and in the United States, as well as in other countries.

Some German researchers conducted a large number of experiments using concentration camp prisoners. They investigated ways to sterilize prisoners more efficiently and kill them more quickly.

They also conducted experiments to find solutions to the health problems of German soldiers. One of those problems was the freezing, for that reason they conducted hypothermia experiments in which they congealed until the death to the prisoners. To improve war surgery, they were wounded and mutilated, or bled to the limit.

They also inoculated germs to try treatments and studied the limits of resistance of the human organism depriving them of oxygen or exposing them to lethal gases.

Other Japanese researchers during the Second World War conducted experimental attacks with biological weapons in at least eleven Chinese cities.

In the United States, experimentation with human beings also changed radically during the war. The research was carried out on a large scale, coordinated and financed by the government, it was oriented primarily for the benefit of soldiers and military needs, the urgency and seriousness of the situation eliminated the requirement of consent of patients. President Roosevelt created a “Medical Research Committee” to combat health problems that compromised the efficiency of American soldiers.

This committee recommended more than 600 research projects, they were interested in dysentery, malaria, flu, wounds, venereal diseases and physical alterations such as freezing and sleep deprivation. Dysentery was investigated in asylums of orphans and mentally retarded, to study malaria were tested inmates of mental hospitals and prisons were infected.

Influenza vaccines were tested in the homes of the sick and mentally weak, to whom the flu was subsequently inoculated. More than 60,000 people were forcibly recruited in exposure studies to chemical warfare agents (mustard gas and Lewisite), at least 4,000 were exposed to high concentrations of them.

In the period of war, a utilitarian ethic prevailed with hardly restrictions it sought the good of the social group at the expense of a few, But over the next twenty years, many investigators continued to apply the same tactics under the pretext of the Cold War. It was secretly irradiated to the terminally ill and to prisoners to know the effect of the radiation on the soldiers in a possible atomic war. Radioactive plutonium was injected to mentally handicapped people. Psycho-pharmaceuticals and techniques for interrogation were tested.

Many investigations were carried out against ethics, which led to the implementation of controls and regulations at all levels.

The codes and general statements initially had little impact on clinical research. The governing bodies of scientific research did not require practically any safeguards for the experimental subjects, the researchers continued to have complete freedom to make decisions adjusting only to their own conscience.

In 1962 it was discovered that an epidemic of facomielia that had affected thousands of newborns worldwide was produced by thalidomide (an antiemetic that taken by pregnant women produces agenesis of the limbs). This discovery was what prompted the US Food and Drug Administration (FDA) to implement regulations that required evidence of safety, efficacy and consent of research subjects.

In the face of evidence on the misuse of research and human subjects, the National Institute of Health (NIH) appointed a committee to review research with humans. This committee concluded that “the researcher’s judgment is not sufficient as a basis to reach a conclusion on the set of ethical and moral issues.” Consequently, in 1966, the US NIH published guidelines that called for control of the experiments by independent committees: the so-called Institutional Review Boards (IRB). Initially, they were only required to be reviewed by a committee the projects that had public funding. But this demand soon spread to all research with human beings. In this way, the decisions traditionally left to the doctors’ conscience were subjected to external control for the first time.

The ethics resulting from this whole process has become an ethic of responsibility towards all those affected, which recognizes certain principles and weighs benefits and risks, harmonizing maximum protection of the experimental subject with a reasonable defense of the collective interest.

In short, the public scandals aroused by biomedical research in the first two thirds of the twentieth century moved public opinion and prompted the emergence of laws, regulations and ethical analyzes that are at the origin of current bioethics. It has managed to monitor scientific research without suppressing or undermining it. This has shown that scientific progress and ethical improvement are compatible.

Codes and declaration of principles

To ensure the ethics of research with human beings, it is necessary to establish controls at three levels.

1. Statements of general principles: made by organizations or institutions, National and international

2. Systems of detailed rules: laws and regulations that regulate specific aspects.

3. Ethical review committees: they must previously authorize and supervise each research.

Experience has shown that if any of these levels fails, the ethics of the research may be broken.

The Nuremberg Trials Resulting in the Declaration of the Nuremberg Code
A Brief History

The Nuremberg Trials were held with the intent of bringing Nazi war criminals to justice for the ethical atrocities against humans committed during World War II.  There were 13 trials carried out in Nuremberg, Germany, between 1945 and 1949. The defendants, who included Nazi Party officials and high-ranking military officers along with German industrialists, lawyers and doctors, were indicted on such charges as crimes against peace and crimes against humanity, such as the cruel research they performed on human subjects, against their will (History, 2010).

Nazi ruler Adolf Hitler (1889-1945) committed suicide and was never brought to trial. Although the legal grounds for the trials and their procedural innovations were controversial at the time, the Nuremberg trials are now regarded as a milestone toward the establishment of a permanent international court, and an important precedent for dealing with later instances of genocide and other crimes against humanity (History, 2010).

The Allies eventually established the laws and procedures for the Nuremberg trials with the London Charter of the International Military Tribunal (IMT), issued on August 8, 1945. Among other things, the charter characterized three categories of crimes:

    1. Crimes against peace:  Including planning, preparing, starting or waging wars of aggression or wars in violation of international agreements.
    2. War crimes:  Including violations of customs or laws of war, including improper treatment of civilians and prisoners of war.
    3. Crimes against humanity:  Including murder, enslavement or deportation of civilians or persecution on political, religious or racial grounds.

It was determined that civilian officials as well as military officers could be accused of war crimes (History, 2010).

Nuremberg Code

After the Nuremberg trials of Nazi medical experiments, this code promulgated ten principles for research. It requires voluntary consent, with sufficient knowledge and understanding, as well as the expectation of fruitful results not achievable by other methods.

Below is the Nuremberg Code from the Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10″, Vol. 2, pp. 181-182. Washington, D.C.: U.S. Government Printing Office, 1949.

THE NUREMBERG CODE

1. The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved, as to enable him to make an understanding and enlightened decision. This latter element requires that, before the acceptance of an affirmative decision by the experimental subject, there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person, which may possibly come from his participation in the experiment. The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity (Trials, 1949).

2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.

3. The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problem under study, that the anticipated results will justify the performance of the experiment.

4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.

5. No experiment should be conducted, where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects.

6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.

7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.

8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.

9. During the course of the experiment, the human subject should be at liberty to bring the experiment to an end, if he has reached the physical or mental state, where continuation of the experiment seemed to him to be impossible.

10. During the course of the experiment, the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgement required of him, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject (Trials, 1949).

Understanding Research Ethics & the Declaration of Helsinki (1964)

The Declaration of Helsinki, also sometimes abbreviated as “DoH”, contains ethical principles for medical research in humans, published by the World Medical Association. They have been revised several times: Tokyo 1975; Venice 1983; Hong Kong 1989, Somerset 1996, Edinburgh 2000, with clarifications in 2002 and 2004.

It distinguishes clinical research with patients, from non-clinical research without benefits for the subjects, it adds the important requirement that the participation of a subject in a research study should not put the participant at a disadvantage in anything that refers to his medical treatment.

On a more recent note, the South African Journal of Bioethics and Law published an article explaining the FDAs discontinued compliance with the Declaration of Helsinki (specifically referring to the 2000 revision and all subsequent revisions) for conduct of clinical trials outside its borders (Burgess, 2012).

It instead ruled that compliance with the Good Clinical Practices (GCP) of the International Conference of Harmonization (ICH) is sufficient. However, the ICH-GCP guidelines do not address certain ethical requirements stipulated in the Declaration of Helsinki, such as the use of placebos v. standard therapy, post-trial access to treatment and other benefits for participants; public disclosure of trial design; publication of trial results; and disclosure of conflicts of interest (Burgess, 2012).

To view this from a more analytical standpoint, the FDA’s adoption of a less ethically demanding guideline may encourage pharmaceutical companies to take ethical shortcuts in their research and drug development.  Additionally, it could also have practical repercussions for trial ethics in developing countries, especially where research ethics committees may not be establishing and promoting high standards of protection for participants in clinical trials because of lack of financial and human resources (Burgess, 2012).

Pharmaceutical companies may also burden research ethics committees to relax guidelines and legislation, in order to facilitate future clinical trials in developing and emerging countries that lack the resources to conduct their own clinical research on epidemics such as HIV/AIDS, which have calamitous effects on their populations (Burgess, 2012).

In April of 2008, the FDA released its contestable decision to abandon the Declaration of Helsinki as an ethical guideline when conducting, and reviewing data from, clinical trials performed outside the USA.

Another point of controversy was earlier in 2006, when the FDA stated it would eliminate all reference to the 2000 and revisions hereafter of the Declaration of Helsinki.  On the flip side, the FDA said it would still recognize the 1989 revision, which is considered invalid by the World Medical Association, the authors of the first declaration.

Accordingly, the FDA now considers it adequate that a trial performed outside USA soil adhere to the Good Clinical Practices of the International Conference of Harmonization (ICH-GCP). The reasons for this decision include the need to protect human subjects and to assure the quality and integrity of foreign data obtained from studies performed outside the USA (Food, 2008).

The surprise behind all of this is that the DoH is considered to be the ethical benchmark of medical standards in clinical trials worldwide.  Even though it is not a legally binding document in international law, the DoH was authored by the World Medical Association, which includes 85 national medical societies from around the world.

The ICH, on contrary, contains only voting members from Japan, the European Union, and the United States. 

In 2008, the WMA General Assembly met in South Korea and voted to adopt the latest revision of the DoH after completing an 18-month revision process (Williams, 2008). The 2008 DoH is considered the only official revision and is regarded as internal policy and a universal statement of medical research ethics (Williams, 2008).

The 2008 edition of the DoH has more ethical demands than the ICH-GCP and cover moral issues that the ICH-GCP framework does not.

Here is what the 2008 edition of the DoH covers:

  1. The restriction of placebo controls in clinical trials in developing countries.
  2. The disclosure of the trial design to the public.
  3. The requirement that the population in which the research is conducted should benefit from it, particularly in developing countries.
  4. That participants should have post-trial access to treatment.
  5. The need to publish results.
  6. The disclosure of conflicts of interest (Kimmelman, 2009).

There are concerns that the FDA’s dismissal of the DoH might cause other regulators and organizations to do the same.  Certain individuals are concerned about the implications in the collapse of ethical standards in patient safety in Third-world countries if this becomes the case.

 

The clinical research testing of new ways for the deterrence and treatment of epidemics, such as HIV/AIDS, has become a critical necessity, yet, developing countries, which stand to benefit the most from such research, lack the many of the resources needed to conduct their own clinical trials (Moffett, 2009).  The health infrastructure may be limited, or citizens may not have access to basic medical services.

According to Article 32 of the DoH, it provides for the limited use of placebo arms in clinical trials. While a new test drug should be compared with the available golden standard of treatment or therapy instead of a placebo, placebo-controlled trials are allowed where no standard therapy exists, or, according to the ICH-GCP,

“where for compelling and scientifically sound methodological reasons the use of placebo is necessary to determine the efficacy or safety of an intervention and the patients who receive placebo or no treatment will not be subject to any risk of serious or irreversible harm, (International, 1996)”

Beginning in the 1990s, debate began over the use of placebo-controlled trials in developing countries and applying research ethics, particularly involving the early prevention of mother to child transmission (MTCT) of HIV (Landes, 2005). 

Then, in 1994, existing protocol for preventing MTCT from the AIDS Clinical Trial Group 076 was established yet due to the high costs of antiretroviral (ARV) and scarce infrastructure, this treatment was placed out of reach for most of the HIV-infected population in the developing world (Burgess, 2012).  The trial had an almost 70% reduction in the risk of HIV transmission and the ARV zidovudine became the standard of care.

To get applicable treatment at a better price-point for resource-poor settings, randomized placebo-controlled trials were initiated to investigate a short-course ARV regimen (Landes, 2005), but these trials ended up causing some controversy.  The controversy stemmed over the matter that the trials were viewed as being exploitative, since they violated the condition of equipoise, or equality.  Meaning, placebo groups are surmised as ethical only if the benefit of the intervention is amply uncertain.

On the opposite end, some individuals took note of the benefits of the study using the placebo, stating that without the short-placebo-based trial, countries such as South Africa would not have refined a low-cost intervention to prevent MTCT. 

The CDC (Center for Disease Control, U.S.) and the NIH (National Institutes of Health) funded the initiation of these trials, and raised questions when people realized that patients taking part in United States trials had unfettered access to ARV zidovudine (Burgess, 2012).

The defense from the CDC and NIH stemmed from the rational that the developing countries had a low standard of care, and pregnant women in these countries were not accessing care early enough (Landes, 2005).  Even with the early hesitation of the trials’ design, they began in 16 countries and included over 12,000 HIV-infected women.

Additionally, ethical complications continued to arise because the trials also appeared to be in direct contention with the Council for International Organizations of Medical Sciences’ guidelines for international research.

Herein, it states that “ethical standards should be applied no less exactingly than they would be in the sponsoring or initiating country,” (Levine, 1993)

In South Africa, clinical trial investigators and pharmaceutical companies need to adhere to the South African Good Clinical Practice (SAGCP) guideline, published by the Department of Health in 2000 and revised in 2006 (SA, 2006).  That is on top of meeting international regulatory requirements. 

The South African Good Clinical Practice guideline connects to the National Health act in its documents and is additionally based on the ICH-GCP and Declaration of Helsinki (2004). Ultimately, the SAGCP states that,

“the use of placebos should be justified, and only when there is no known effective treatment should it be considered ethical to compare a potential new treatment with a placebo,” (SA, 2006).

In this case, we truly see the ethical complications that can arise out of ethics and research.  The use of placebos in the studies where known and effective treatment is available does more harm than good, because the individual could be successfully treated.  Why prolong someone’s suffering, disease, or condition, if a viable solution is available?  That is the key question here, and also a reason why the use of placebos has sparked much controversy in research ethics.  Today, the grounds for using placebo-controlled trials is founded on compelling methodology and strong scientific justification, and even this can be on flexible grounds. 

The Declaration of Helsinki discusses that clinical trial protocol should have a statement of ethical considerations, and it should also report how participants can receive appropriate care or benefits resulting from the trial.

“In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.”

  • The Declaration of Helsinki, Post Trial Provisions, 2018, WMA

However, this demand is vacant from the ICH-GCP. SAGCP also stipulates that specific recommendations should be made for the continuation of treatments after the trial, especially in research requiring additional attention, such as HIV research involving vulnerable communities (SA, 2006).

There is a concern for developing countries in regards to ethical research because they are without this additional guarantee of benefits post trial, which could be problematic in terms of health and wellbeing of study participants.

Since the FDA moved to forgo the Declaration of Helsinki, some pharmaceutical companies are choosing to omit any reference to the Declaration of Helsinki when drafting protocols for trials conducted in developing countries. These companies can also test their new drugs in developing or emerging countries without planning to register them there, and with no obligation to provide participants with post-trial access to any treatment or other benefits (Burgess, 2012).

Additionally, the Declaration of Helsinki also has requirements regarding the “Research Registration and Publication and Dissemination of Results.”

Every research study involving human subjects must be registered in a publicly accessible database before recruitment of the first subject.”

“Researchers, authors, sponsors, editors and publishers all have ethical obligations with regard to the publication and dissemination of the results of research. Researchers have a duty to make publicly available the results of their research on human subjects and are accountable for the completeness and accuracy of their reports. All parties should adhere to accepted guidelines for ethical reporting. Negative and inconclusive as well as positive results must be published or otherwise made publicly available. Sources of funding, institutional affiliations and conflicts of interest must be declared in the publication. Reports of research not in accordance with the principles of this Declaration should not be accepted for publication.”

  • Declaration of Helsinki, 2018, WMA

The FDA’s confidence on the ethically less strict ICH-GCP standards rather than the Declaration of Helsinki might damper the protection of research participants in many developing countries. This will depend on how well drug developers and clinical trial investigators will be able to abide by moral ethics, and how well they regulate themselves in terms of ethical conduct when conducting research in Third-world countries (Burgess, 2012).

In South Africa, research participants should be properly alerted about these areas of concern in order to maintain awareness and stress the importance of a strong bio-ethical system.

Articles, discussion forums, public conferences, training methodologies for investigators and research personnel, are all ways to increase awareness and promote ethical human research (Burgess, 2012).  Luckily for South Africa, the SAGCP goes a long way towards protecting research participants. It is crucial, however, that researchers in other developing countries are also made aware of these issues and petition for stronger national moral-ethical research guidelines (Burgess, 2012). 

Healthcare Ethics & Conflicts of Interest

Conflicts of interest remain a very important topic in regards to healthcare, research and ethics.  There are several reasons for this.  One reason is because a conflict of interest can sway or alter research outcomes and when the research is disseminated, it can mislead the public.  It can also cause potential harm to innocent people, as we will see in this next example.

In 2012 the FDA announced that it might relax certain conflict of interest restrictions that prevent scientists with financial ties to the drug industry from becoming members of the FDAs advisory panels.  There was some opposition to this because loosened rules around conflicts of interest could make a negative impact on the process of drug development and industry.  The individuals who want to keep tight rules were concerned about safety, and that financial conflicts of interest would no doubt, sway investigators (Philippidis, 2012).

Then in the same year, a conflict-of-interest scandal arose with the FDA when a pharmaceutical giant was allowed to keep its oral birth-control product on the US market, despite the FDA’s own reports of dozens of deaths caused by blood clots in women using the product (Malone, 2012). The FDA had appointed at least three scientists with financial ties to the pharmaceutical company to the product’s advisory committee, who voted in favor of the product (Malone, 2012). The FDA did not disclose their ties with the pharmaceutical company (Burgess, 2012). 

The Declaration of Helsinki makes it clear that disclosure of conflicts of interest, information on sponsors, funding, institutional affiliations, and incentives for subjects and information regarding provisions for treating and/or compensating subjects who are harmed as a consequence of participating in a research study, are crucial in establishing a transparent landscape when conducting morally based research on human (Declaration of Helsinki, 2018).

Understanding Research Ethics & the Principles of the Belmont Report (1978)

Respect for People

Individuals should be treated as autonomous agents and people with diminished autonomy (children, mentally ill …) should be subject to special protection. An autonomous person deliberates on his own objectives and acts in accordance with it.

“An autonomous person is an individual capable of deliberation about personal goals and of acting under the direction of such deliberation. To respect autonomy is to give weight to autonomous persons’ considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others. To show lack of respect for an autonomous agent is to repudiate that person’s considered judgments, to deny an individual the freedom to act on those considered judgments, or to withhold information necessary to make a considered judgment when there are no compelling reasons to do so. (U.S., 1979)”

“However, not every human being is capable of self-determination. The capacity for self-determination matures during an individual’s life, and some individuals lose this capacity wholly or in part because of illness, mental disability, or circumstances that severely restrict liberty. Respect for the immature and the incapacitated may require protecting them as they mature or while they are incapacitated, (U.S., 1979)”

Therefore, the main practical consequence of this principle as it connects with research ethics is the need to obtain the informed consent and provide the individual with adequate information of the research study.

Beneficence

This principle is related to an obligation that healthcare providers have always had. As Hippocrates said: “As for diseases, make a habit of two things: helping, or at least not harming.” That is why there are those who break down this principle into two: a principle of beneficence and another of non-maleficence.

“The obligations of beneficence affect both individual investigators and society at large because they extend both to particular research projects and to the entire enterprise of research. In the case of particular projects, investigators and members of their institutions are obliged to give forethought to the maximization of benefits and the reduction of risk that might occur from the research investigation. In the case of scientific research in general, members of the larger society are obliged to recognize the longer-term benefits and risks that may result from the improvement of knowledge and from the development of novel medical, psychotherapeutic, and social procedures (U.S., 1979).”

Justice

It obliges to distribute the benefits of research among all, and not only among those who can pay for them, especially when the research is carried out with public funds.

“An injustice occurs when some benefit to which a person is entitled is denied without good reason or when some burden is imposed unduly. Another way of conceiving the principle of justice is that equals ought to be treated equally. However, this statement requires explication. Who is equal and who is unequal? What considerations justify departure from equal distribution? Almost all commentators allow that distinctions based on experience, age, deprivation, competence, merit and position do sometimes constitute criteria justifying differential treatment for certain purposes. It is necessary, then, to explain in what respects people should be treated equally. There are several widely accepted formulations of just ways to distribute burdens and benefits. Each formulation mentions some relevant property on the basis of which burdens and benefits should be distributed. These formulations are (1) to each person an equal share, (2) to each person according to individual need, (3) to each person according to individual effort, (4) to each person according to societal contribution, and (5) to each person according to merit (U.S., 1979).”

Informed Consent

Informed consent is always mandatory, however there are sometimes circumstances in which informed consent may be nullified. The cases in which obtaining consent is not necessary, or is not recommended, constitute the following exceptions:

1. Urgency: When there is an immediate and serious danger to the patient, which requires acting without time to obtain informed consent.

2. Therapeutic privilege: When in the opinion of the healthcare practitioner, the information may be detrimental to the course of the disease. Traditionally, this privilege covered the vast majority of the patient. But at present it has been very restricted and should only be invoked in very special situations.

3. Patients unable to decide, who cannot give valid consent. However, the capacity admits degrees. So the more transcendental or delicate a decision, the greater the level of capacity required must be.

4. Express waiver of the patient, or power of attorney: The patient can, if he wishes, renounce the information and voluntarily let others decide for him in the case he or she is unable to do so. In this case, there must be a family member or legal substitute willing to take responsibility for the decisions.

5. Treatments required by law: In cases that represent a danger to public health. This justifies the obligatory nature of certain diagnostic tests, vaccinations and forced treatments.

Conditions that the Patient Must Meet for Informed Consent

The patient must meet four conditions so that his or her decision are made autonomously and with a sound mind:

  • The patient/client has sufficient information to make an informed decision.
  • The patient/client Is awake and coherent to understand the information presented.
  • The patient/client is free to decide according to his own values.
  • The patient is not being coerced or manipulated by another into a decision.

Understanding Healthcare & Insurance Company Ethics

As the laws and rules of healthcare continue to adapt to present times, it is important that we also adapt to understand the connection between healthcare delivery and insurance company ethics.  With proper understanding of this relationship, the health professions as a whole will be able to move forward responsible with patient/client care and conduct business with insurance companies ethically. 

In this section of the reading we discuss key components healthcare providers must know about insurance companies and ethical relations.

Explanation of Reasons

If an insurance company wants to terminate the contact with a Provider, it must give explanation of Reasons.  HMOs and insurance companies providing a managed care plan cannot terminate the contract with a health care provider without providing to the health care professional a written justification of the reasons for the planned contract termination and a chance to apply for the decision to be reviewed or qualified for hearing. However, this condition does not hold when cases with impending damage to patient care is involved or during fraud investigation, or a concluding disciplinary action by a state licensing board that damages the ability of the provider to practice.

 

Notice Requirements

HMOs and insurers providing a managed care plan needs to incorporate the following in a notice of a proposed contract termination:

Some of the reasons that may be given for the proposed action are

  • Notice that the health care provider has the right to apply for a hearing or review if the health care professional deems fit before a panel arranged by the insurance company;
  • A time limit for the medical practice to request for a hearing must be up to 30 days.
  • The time limit for the hearing date which is required must also not be less than 30 days after the medical practice has requested for a hearing.

Performance and Practice Information:

Evaluation Information

HMOs and insurers that offer a managed care contract need to formulate policies and procedures that constantly let the contracted healthcare providers aware of the information maintained by the insurer to access the operation of the health care professionals.

Health care’s provider’s profiles

HMOs and insurers providing a managed care contract need to contact health care professionals when formulating procedures to gather and access the medical provided by a health care provider.

Data profiles

Any profile data utilized by an HMO or insurer that offers a managed care contract to access the operations of medical practices needs to comply with the regulations of the state and the association of medical practice that the healthcare provider belongs to with the use of related management modalities helping similar numbers of patients.

Non-permissible Termination of insurance contract with a provider

No HMO or insurer providing a managed care contract may end the contract with or fail to renew the contract with an eligible health care professional’s contract mainly because of the following actions of the health care professional:

  • Pleaded on a patient’s behalf
  • Filed a complaint against the insurance company
  • Appealed a decision of the insurance company.
  • Supplied information or filed a report with a suitable body of the government about the actions of the insurance company.

Basis for Termination

No partaking health care professional contract with an HMO or insurer that provides a managed care contract may have conditions that surpass or prejudice the right of the health care professional to obtain a notice of basis for contract termination and a chance for a hearing.

 

Patient Care and Treatment:

Treatment Information

HMOs and insurers must not prevent health care provider from informing their patients any of the following:

  • The whole type of treatments options that the patient can access together with treatments that are not covered by the health insurance plan.
  • The conditions or expressions of the patient’s health plan in connection to the patient.

Filing Complaints

HMOs and insurers cannot prevent a healthcare provider from filing a complaint to a suitable government entity about policies or procedures the provider thought may negatively impact the quality of care or access to care.

Patient Advocacy

HMOs and insurers cannot prevent or restrict an insurer from pleading for a patient to be covered for a specific health condition.

Processing of Claims & Accepting Claims

HMOs and insurers must accept and process all health care claims submitted by doctors that fits into the current version of the American Medical Association’s CPT codes, reporting guidelines and conventions and the centers for Medicare and Medicaid services (CMS) health care common procedure coding system (HCPCS).

 

Reasons for Claim Denials

HMOs and insurers may conclude that a claim is not entitled for part or full payment based on the reasons below:

  • The claim is not comprehensive;
  • The service offered is not covered by the insurance plan of the patient
  • The patient with the insurance plan did not get a referral or pre-qualifications or fulfill any other condition before receiving covered benefits from the doctor;
  • The covered benefit go over the limits of benefits on the contract or agreement;
  • The patient is not eligible for coverage or is not complying with the terms and conditions of his or her contract.
  • A different HMO or insurer ought to be responsible for all or part of the claim; or
  • The insurance plan has a practical feeling of fraud or abuse.

 

Health Claims billing Software

HMOs and insurers must supply the name of the claim editing software they use which must be available for purchase. They must as well specify any reasonable edits that may be required on the website of health provider and the newsletters of such software providers. Insurance companies must also supply any information requested for by any participating medical doctor.

Claim Submission

HMOs and insurers must write to acknowledge the reception of all claims sent to them through internet, by e-mail or by fax. 

Filling of Ethical Health Care Claims:

Health care providers need to provide health care claims to the insurance providers within 120 days after the date they provided the service to the patient to make the claim valid and enforceable against the HMOs and insurers, except the parties have an agreement on a time period more favorable to the provider. Providers need to submit claims within 90 days after the date they render the service to a patient under the Medicaid managed care insurance plans

 HMOs and insurers ought to pay for the claims for health care services submitted to them within thirty days the claims were sent to them either through the internet or by e-mail and within forty-five days of receiving claims submitted through paper or by fax apart from instances where the obligation to pay is not realistically obvious or there is proof that the claim may likely be fraud.

Responsibility to pay

If the responsibility to pay is not realistically clear, an HMO or insurer must pay any acknowledged part of the claim and either inform the healthcare provider, in writing, within thirty calendar days of receiving the claim that the health plan is not under obligation to pay and the reasons or that. Alternatively, they should request for extra information to establish liability to pay the claimed amount.

 

Time structure

Once they receive the requested information or an application for appealing the denial of a claim for supplied health care services, an HMO or insurer must conform to the thirty or forty-five day condition for clean claims.

Reassessment of claims

Health care providers that are eligible under any health insurance plan may apply for the claim to be re-considered mainly because it was inappropriately submitted. If the health care provider can show that his or her non-compliance was due to an extraordinary incidence and that he or she used to submit claims on time. In such instance, the HMO or insurer must pay from such claim, but may minimize the payment by about twenty five percent of the amount the HMO or insurer must have paid if the claim was submitted on time.

 

Hospital Claims

Before the expiration of thirty days from the day payment of a claim that was adjusted as a result of a specific coding to a patient, a hospital may submit the said claim with medical records that supports the hospital’s original coding of the claim. Once received, the HMO or insurer must re-access the submitted data to determine the correct coding for payment and process the claim following the time structure specified above. If the HMO or insurer processes the claim related to its original determination, it must supply a statement decision and give reasons that justifies the initial adjustment.

Violation

Processing a claim or bill after the thirty or forty-five day time period is a considered an infringement of the prompt payment law.

Payment of Interest

If an insurer breaches the prompt payment law, the company would be charged an interest for overdue payment. The interest payable is estimated to be more than twelve percent every year or the interest rate stipulated by the commissioner of taxation and finance for corporate taxes pursuant to New York Tax Law Section 1096(e)(1).

Interest is estimated from the date the claim was made or the date the payment was supposed to be made. When the amount of interest payable is not up to two dollars, the HMO or insurer may forfeit paying the interest.

 

Processing of Overpayment

Notice: Apart from recovering double payments, , HMOs and insurers must inform healthcare providers through a thirty day’s notice of an overpay before they set out to recover the amount paid in excess.

The following are what the notice must contain:

  • The name of the patient;
  • The date the service was offered;
  • The amount paid
  • The projected alteration to be made; and
  • A realistically specific reason why the adjustment request is being made

Opportunity to dispute overpayment request

HMOs and insurers must also provide to the healthcare provider an opportunity to dispute and overpayment recovery request. They must also have an established written policies and procedures that the providers must follow to dispute the recovery request.

 

The Time frame for initiating Overpayment Recovery processes

HMOs and insurers are only allowed to start overpayment recovery within 24 months of the date of making the initial payment to the healthcare provider. Apart from cases that involve fraud, deliberate misbehavior, offensive billing or when started by a self-funded plan, needed by a federal or state government program or coverage that is made available by the State or a metropolis to its staffs, retirees or members.

How to request for claim payment Offsets

If a healthcare provider makes assertion for underpayment of a claim, the HMO or insurer may defend or offset the claim by overpayments that were made within the length of time that traces back to the underpayment in question. If the underpayment is established, the HMO or insurer may minimize or offset the amount owed to the healthcare provider by discovering the amount the HMO or insurer overpaid to the healthcare provider beginning from the period the said underpayment was made till the present time the assertion is made.

Nevertheless, the HMO or insurer may not save overpayments that are above the amount owed to the healthcare provider in underpayment except the overpayment issue happened within the last 24 months or there is any type of exception.

 

The responsibility of the Provider for Claim Forms:

Patient Bills

A doctor that is not taking part in any form of insurance plan must incorporate a claim form for a intermediary payer with a patient bill for the health care services provided apart from the bill that must be settled by the patient under the copayment, coinsurance or deductible arrangements.

Handing over of Benefits Form

If a doctor who is not participating in an insurance plan is billing a patient for a surprise bill (services offered in a participating hospital or ambulatory surgical facility or a referral to a provider that doesn’t participate in the plan without the permission of the patient), the medical doctor that is not taking part in the patients’ insurance plan must incorporate assignment of benefits form with the patient’s bill and the claim form.

 

Healthcare Professional and doctors Disclosure Requirements:

A health care provider must disclose to patients or potential patients:

Health insurance Plan.  They must let their patients know the health insurance plans and insurance providers they participate in. They must provide these in writing or through their website before they provide any non-emergency services and orally when they visit the office for their scheduled appointment.

Hospital Affiliations

They must also inform their patients the hospital they are affiliated with. This is necessary to be provided in writing or through a website before the provision of non-emergency services and orally when they come for their scheduled appointment.

Cost of Services

The health care provider must inform the patient the cost or estimated cost of service that would be rendered to them if they are not insured by the insurance company that the health care provider participate in.

They must inform their patient about these if they are providing them with non-emergency services if the patient request for the information.

Doctors organizing Services in His or Her Office or arranging or Referring a Patient for Services

A doctor that schedules a health care provider to carryout anesthesiology, laboratory, pathology, radiology or assistant surgeon services in relation with care to be given at his or her office, or a doctor that organizes for medical treatments or refers a patient for a service like that must offer to the patient or prospective patient with the information provided below at the time of referral to or arranging with that provider:

  • The name of the health care provider if the physician schedules a particular provider in a medical treatment service
  • The services provided by that health care provider
  • The address of the healthcare provider
  • The phone number of the health care provider

 

Doctors organizing for Inpatient or Outpatient medical care in a Hospital

A doctor that organizes with other medical doctors to treat a patient during the period the patients is scheduled for hospital admission or scheduled for outpatient hospital services must provide to the hospital and the hospital when the services are not emergency medical services at the appointment time with the following information about the other physicians whose services are programmed to be used for the pre-admission test, registration or admission:

  • The name of the doctor if the doctor plans for a particular doctor in the practice.
  • The doctor’s practice.
  • The doctor’s address.
  • The doctor’s phone number.
  • How to discover the health insurance plans that the doctor is a participant of.

 

 

Detailed explanation of the Health Insurance Portability and Accountability Act (HIPAA)

What is HIPAA?

HIPAA is the short form for the Health Insurance Portability and Accountability Act that was promulgated by the Congress in 1996.  HIPAA aims to achieve the following:

  • Provides patients with the capacity to transfer and maintain health insurance coverage together with their family members when they lose their employment or change from one type of employment to the other.
  • It helps to minimize fraud and abuse in the healthcare industry.
  • It set up standards that must be followed while handling electronic bill to ensure that the patient’s personal health records remain private.
  • It also safeguards and protects confidential management of health care data.

The section of HIPAA laws that manage the capacity of an individual to maintain health insurance cover is taken care of the Department of Insurance and the Department of Managed Health Care.

 

Healthcare provider and contract with insurance companies

Probably one of the greatest documents that govern the operation of things in the medical environment is the contract the health care provider makes with the insurance company.

The contract between these two bodies must include such this as the length of time the patients have to wait in the waiting room and the way the medical claims would be billed and sent.

The healthcare must sign a contract with every health care provider he plans to work with. The contract will determine the practice to be followed by the doctor and also help him to negotiate the reimbursement for every code that his office bills.

This contract includes the section that specifies how the healthcare provider should treat patients who visits the facility commonly within the standards of ethical medical practice, and for realistic and essential services. The contract as well incorporates significant billing rules which the health care office needs to comply with.

Among these rules are balance billing. When a doctor’s office signs a contract with an insurance company, he accepts to take a specific percentage or compensation amount for particular services.

The amount that the doctor bills above the amount arranged with the insurance provider need to be disregarded by the doctor’s office.

This implies that the health care provider must not charge the patient for an amount above the agreed rate. If the healthcare provider fails to comply with the agreed condition, it is known as balance billing. Balance billing is unlawful, in relation to the contract the health care provider makes with the insurance company.

 

Protection and Confidential management of Health care data

The HIPAA Privacy regulations mandate health care providers and organizations together with all their business connections, to formulate and track procedures that make sure that the patients’ health data remains confidential and secure during transmission, reception and while being handled or shared.  This is applicable to all forms of patient health information (PHI) like the paper documents, oral communications, and electronic documents and so on. In addition, the medical biller only shares just the patients’ health information needed for a transaction and nothing more.

 There are many regulations of government that govern the medical billing industry. HIPAA, or the Health Insurance Portability and Accountability Act, is one of the largest of such laws. The HIPAA has set up a lot of reformation of existing laws and creation of new ones in the medical industry for the past 20 years since after the establishment. It has also resulted to a lot of medical billing laws. A section of the HIPAA law mandates the healthcare providers to inform the patients of their right to privacy under the act.

One among the billing laws the patient confidentiality regulation has made the healthcare providers to additionally improve their practices to ensure they protect the private medical information of their patients.

Every employee of a medical billing office are required to sign a form attesting that they would comply with the condition of ensuring that the patient’s medical data are kept private.

This aspect of the HIPAA legislation is known as the HIPAA 5010 act.

An additional requirement of HIPAA is to make use of ICD-10 codes, which makes it possible for the medical biller to be more specific in reporting the diagnoses of a patient.

 

What is HIPAA 5010?  Laws & Rules

The implementation of ICD-10 codes took effect in October of 2013 as a replacement of the previous codes.

The new HIPAA gets less attention than the ICD-10. Irrespective of that, the new HIPAA rule is still essential in the healthcare industry. It was a key change in the manner medical businesses are being treated through electronic means, and handles alterations in the electronic claim transactions.

HIPAA 5010 was implemented to take the place of the previous version 4010, which was in place. Just like the ICD-10, the HIPAA regulations as well had a particular implementation date. It took effect from January 1, 2012.

Starting from that time till now, all parties that handle electronic claims transactions, patient eligibility, or patient data must comply with the new HIPAA regulations.

 

HIPAA 5010 and electronic transactions

The electronic transactions that HIPAA 5010 is concentrated on imply the transfer of healthcare data from one party to another.

For instance, a health care provider that has to submit claims to an insurance company for payment. Other individual or organization that deal with these types of transactions are handling patients with insurance cover, insurance health plans, medical billing clearinghouses, and healthcare providers.

Under the Health Insurance Portability and Accountability Act of 1996, or HIPAA specific standards were stipulated to manage particular electronic transactions. Some of these transactions are:

  • Insurance claims and data about patient’s visit
  • Making inquiries about the status of the claim
  • Checking the patient eligibility
  • Insurance payments and clarification of benefits
  • Patient insurance plan enlistment and disenrollment
  • Referring a patient before authorizations

All the above standards were in place for more than fifteen years and were thought to be outdated which occasioned the launch of the new HIPAA. It was aimed at updating the standards for electronic transactions and integrates all the essential updates that emerged when ICD-10 was implemented.

It as well incorporated the entire changes that took place in the healthcare industry and incorporated conditions to maintain patient privacy, extra severe security procedures, and faster business dealing.

 

The reason behind the change from HIPAA 4010 to HIPAA 5010

The 5010 regulations was launched to remedy most of the flaws found in the previous version of HIPAA 4010 Electronic Data Interface (EDI) transactions which amounts to more than 850.

The new HIPAA rules minimized transaction costs, reduced manual claims processing, and lessen the need to make use of human personnel. It will as well incorporate fresh features that weren’t previously available.

The new HIPAA regulations were also projected to yield roughly extra eleven to thirty billion dollars in the medical billing industry.

This boost in revenue will lead to these set of advantages:

  • Support of ICD-10 codes
  • allocating many identifiers
  • NPI instruction that is easy to comprehend
  • Data requirements on verifications of eligibility
  • Minimized claim denial as a result of less data error messages

HIPAA 5010 makes the electronic transactions faster and boost efficiency in the whole healthcare industry.

The difference between the new HIPAA and the old HIPAA rules

One of the changes brought about by the new HIPAA 5010 is the augmentation of the field size for patient diagnosis, to be capable of accommodating ICD-10 codes.

To further explain ICD-9 codes are made up of three to five digits. This implies that when a coder is configuring a claim on the claim system, the field size for the diagnosis code is five figures long. These systems don’t permit any coding with more than 5 digits to be keyed in.

ICD-10 diagnosis codes, however comes with three to seven figures long. Thus, the new HIPAA regulations boosts the allowable field size of the diagnosis code box to seven digits, and makes available room for the ICD-10 codes to fit.

The next update that comes with the new ICD-10 is the execution of an indicator system, which would permit you to distinguish between ICD-9 and ICD-10 codes. This implies that if you’re correcting a mistake on a claim, or if you’ve executed HIPAA 5010 prior to the use of ICD-10 codes, you can still make use of the previous set of codes.

This will assist insurance companies, clearinghouses, and medical billing professionals to differentiate between ICD-9 and ICD-10 codes.

The new HIPAA law as well comes with special built-in rules to make bizarre circumstances more comprehensible. It will assist to boost the understanding of claim turnarounds and adjustments, recoupment of claims payments, and processing of claim refund.

In the healthcare industry the changes that come with the new HIPAA 5010 is a minor section of your medical billing software package. This is to fulfill the fresh regulations such as alterations in field size of the diagnosis code.

However, bigger portion of the changes will be taking place behind the scenes in the medical billing clearinghouses and in the in-house functioning of insurance companies and their multiple parts.

The changes that come with the new HIPAA 5010 rule is not merely a software update, it needs alterations of business practices, budget, and medical billing procedures.

 

HIPAA Compliance and HIPAA Title Information

Patient Rights Under HIPAA Regulation

The most popular medical billing law is the Health Insurance Portability and Accountability Act (HIPAA). The basic understanding of most patients concerning this regulation is that HIPAA protects their medical treatment and records privacy.

Nonetheless, the HIPAA stands for much more than that, it also offers patients some kind of protection as well. HIPAA as well comes with the capacity of the patient to transfer and continue to benefit from health insurance cover when policy holders alters or are laid off from their employment. It as well minimizes the fraud in the health care industry as well as abuse; and stipulates the standard for handling the health care data across electronic billing process together with other health care processes.

Given the wide collection of rules in HIPAA and the intricacies involved in complying with the guidelines stipulated in the HIPAA rules, a lot of healthcare providers prefer to outsource the medical billing process to a certified medical billing professional.

The majority of patients share the opinion that their medical data together with other data that consigns their health should be kept confidential, private and be safeguarded. Frequently, patients want to be informed about the people that have access to their medical data. Under the federal rule the Privacy Rule offers to the patient the rights over his or her health information and stipulate rules and limits about the individual who can view or have access to the patients’ health data. The Privacy Rule applies to all forms of individuals’ protected health data which could be electronic, printed, or oral info. The Security Rule is a Federal law that mandates providers to ensure that the health data of patients are secured when making use of electronic data storage or transfer.

HIPAA set up guidelines that must be followed while handling patients’ data by the health care providers and insurance companies to ensure that they are safe and secure.

The HIPAA statutes include the collection, filling and transmission of all the data that has to do with the medical record of a patient. The major aim of HIPAA rules for medical billers and coders is to reduce and entirely eliminate the occurrence of fraud prior to, while a claim is being processed and after the determination and verdict on a claim. It also set out standards that must be followed while the patient’s data is transferred online.

HIPAA is classified into Titles. The key points of HIPAA that is mostly connected to the operations of the medical billers and coding experts are the rules in Titles 1 and 2 as explained in the ensuing section.

 

Title I:  HIPAA Health Insurance Reform like portable and renewable coverage

Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) offer protection for the health insurance plan of workers who change employment or lose their jobs and the members of their households.

Title I of HIPAA takes care of the health insurance policies under the umbrella of an individual’s employment. Under Title I, HIPAA provides guidelines that stipulate what an employer can do and what he or she cannot do with a staff’s healthcare insurance plan as supplied by the employer. Basically, Title I safeguards health insurance cover for employees and their dependents by making healthcare insurance plans accessible to individuals who have either lost their job or individuals who are about to work for a new employer.

Title I safeguards employees right by adjusting and enhancing the Consolidated Omnibus Reconciliation Act of 1985 (COBRA). Title I of HIPAA extends healthcare benefits that already come from COBRA together with making the time factor of the benefits of the disabled people who qualify for COBRA from 18 to 36 months. Title I as well permitted dependents of an individual that is protected under COBRA to keep receiving the equivalent healthcare cover as they did when that individual is under employment and are receiving health benefits.

Title I as well takes care of the way health insurance organization handles patients who have previous health conditions. Prior to HIPAA an individual with a previous medical condition may face difficulty discovering insurance policy that covers their medical bills. This is usually due to the fact that profit-making insurance companies regard them as risky conditions to provide cover for.

Title I of the act limits few amounts of restrictions that could be imposed in their healthcare plans for individuals who have previous health conditions.

Title is very significant to Medical billing and coding specialists due to the fact that it makes more people qualify for health insurance. As a result of the new set of laws in Title I, medical billers can process claims that consign patients that have COBRA coverage or persons who have previous health conditions that are still covered.

 

Title II:  HIPAA Administrative Simplification and Medical Liability Reform

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) mandates the Department of Health and Human Services to set up national standards for electronic health care business management and national identifiers medical facilities, health care insurance plans, and employers. It as well handles the safety and confidentiality of health data which helps to eliminate medical healthcare Fraud and abuse. Keeping to these standards will boost the effectiveness and efficacy of the health care system in the US by boosting the extensive utilization of electronic data transaction in the medical industry.

The U.S. Department of Health and Human Services (DHHS) sets up and publicizes the regulations that relates to the execution of HIPAA and standards to be utilized.  All health care organizations affected by HIPAA must meet up with the required standards.

Title II handles a lot of issues that have to do with the medical billing and coding field, such as patients’ data security and privacy and implementation of processes that would make the billing and processing of claim procedures easier. It as well stipulates conditions for electronic records and electronic communication between different in the healthcare system.

Title II as well specifies the way healthcare providers and insurance companies must stay away from engaging in fraud. The law mandates the Officer of the Inspector General (OIG) of the Department of Health and Human Services (DHHS) to scrutinize and where necessary arraign offenders before the court of law.

Title II deepens the security and privacy law in the healthcare industry by formulating the Privacy Rule and the Security Rule. The Privacy Rule handles the manner followed by insurance companies and providers to manage patient data through the regulation of the way they reveal the data to each other and to other bodies that may need the patients’ healthcare data. Under the Privacy Rule, medical billing and coding professionals have to be cautious not to reveal a patient’s Protected Health Information (PHI) to parties that don’t belong to covered organization like the health care providers and insurance companies plus many others required as specified by Title II. A patient’s PHI incorporates the data below:

  • The patient’s medical record which encompasses present and past medical health situation or sicknesses and treatments provided for the conditions.
  • The place and form of healthcare provider that offers such service to the patient.
  • The fees paid by the patient either fully or in part or by the patient’s insurer to provide coverage for healthcare operating cost for the services that are provided by the health care provider.

Title II as well produces single identifiers for healthcare providers, employers, and patients while trying to optimize contact between these different bodies of the healthcare system and making the billing process more widespread. This is achieved following the Electronic Data Interchange (EDI) Rule stipulated Title II. The distinctive identifiers produced for the EDI are either personal numbers or code sets designated to bodies that are covered for the purpose of electronic transactions and ought to have equivalent value and meaning for any medical billing professional. The most common exclusive identifiers are the following:

  • The National Standard Employer Identifier Number (EIN). This identifier is assigned by the Internal revenue service (IRS) and is provided to businesses operating in the United States for purposes of Identification.
  • The National Provider Identifier Number (NPI). This identifier is used for discovering healthcare providers like private clinics, hospitals, and nursing homes.
  • The National Health Plan Identifier Number (HPID). This identifier tracks eligible health insurance companies.

For the purposes of medical billing and coding, the standards stipulated under Title II are highly essential due to the fact that they help to make the claim process more efficient. The format and operation of electronic claims especially is non-complicated and safer than before due to the rulings of Title II of HIPAA.

 

Title III:  HIPAA Tax connected Health requirements

Title III specifies conditions for specific deductions for medical insurance and implements additional changes to health insurance regulation.

Title IV:  Applying and Enforcement group health plan conditions

Title IV stipulates the requirements for group health plans concerning the cover of individuals of persons with pre-existing conditions and modifies continuation of coverage requirements.

Title V:  Revenue Offsets

Title V comes with conditions that are connected to company-owned life insurance, treatment of persons who lose U.S. Citizenship due to non-payment of income and cancellation of the regulations of the financial institution regulations to the interest of allotment rules.

Handling violation of Sexual Boundaries

Sexual boundary violations by physicians and other health care providers is a form of behavior that adversely affects the public welfare and harms patients individually and collectively. Boundary violations tend to occur as a result of exploitation of patient trust, abuse of power, miscommunication or misinterpretation of body language, or by not taking appropriate action when issues tend to arise.

 Provider-patient sexual boundary violations are a violation of the public trust, and is frequently known to cause harm, both mentally and physically, to the patient. Sexual misconduct is an issue that affects all jurisdictions and is not limited by geographic or socioeconomic boundaries. It is the primary responsibility of state medical boards to protect the safety and welfare of the public it serves.

By so doing it is medical boards’ role to inform licensees that sexual misconduct, in any form, will not be tolerated and, when sexual misconduct does occur, to take prompt and decisive action against any licensee found to have participated in such conduct. As state medical boards are required to respond to an increasing number of complaints, it becomes imperative that medical boards use guidelines for dealing with sexual boundary issues and take measures to educate their licensees about sexual boundary issues.

Irrespective of whether sexual misbehavior is viewed as emanating from an underlying form of impairment, it is unarguably a violation of the public’s trust. It should be noted that although an addictive disorder, mental disorder, sexual disorder, phase of life crisis may be a contributory circumstance, boards are still charged with taking appropriate steps to see that the public is protected. Although sexual addiction is a regularly used phrase, it is not documented as a disease in the Diagnostic and Statistical Manual of Psychiatric Disorders, Version IV (DSM IV).

The subsequent sections report defines doctor’s sexual misconduct and provides recommendations to assist medical boards with the investigation process, grounding for formal hearings, crafting a suitable punitive response, doctors monitoring, and physician education. Physician sexual misbehavior is behavior that exploits the physician-patient relationship in a sexual way.

Sexualized behavior between a doctor and a patient is never diagnostic or therapeutic. “Sexualized behavior” can be defined as behavior that is verbal or physical, and may include expressions of thoughts, feelings, or gestures that are sexual or that reasonably may be construed by a patient, patient’s surrogate, or health care provider as sexual

For the purposes of this part of the guide, there are mainly two forms of professional sexual misconduct: sexual impropriety and sexual violation.

The two types of violation are the basis for corrective action by a state medical board if the board determines that the behavior exploited the doctor-patient relationship. Sexual impropriety includes behavior, gestures, or expressions that are seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient, that may include, but are not limited to:

•      Conducting an intimate examination of a patient in the presence of medical students or other parties without the patient’s informed consent or when such consent has been withdrawn;

•      Making unsuitable comments about or to the patient, including but not limited to, making sexual comments about a patient’s body or underclothing, making sexualized or sexually demeaning comments to a patient, criticizing the patient’s sexual orientation, making comments about potential sexual performance during an examination;

•      Using the power differential to ask for a date or an intimate relationship;

•      The provider starting a discussion about the sexual issues, preferences, or fantasies;

•      Carrying out an intimate examination or consultation without clinical reason or not within scope of practice and not licensed to do so.

•      Asking for details of sexual history; asking about sexual preferences of the patient/client when they are not essential to care, examination or consultation

•      Touching breasts, genitals, or any body part for any purpose other than appropriate examination or treatment, or where the patient has refused or has withdrawn consent;

•      Offering to provide practice-related services in exchange for sexual favors.

Additionally, a sexual boundary violation may include physical sexual contact between a provider and patient/client, whether or not started by the patient, and engaging in any behavior with a patient/client that is sexual or may be rationally interpreted as sexual.

 

Ethical Responsibilities as a Massage Therapist

There are a few key concepts all health care providers share when it comes to ethics and patient interactions. The purpose of mentioning this is to bring awareness to the higher-level awareness providers should have towards their practice and patient encounters. Intense education, training, and skills bestow upon the provider the ability to use their expertise to heal, help, maintain health, and build trusting, therapeutic relationships. To use these abilities for personal gain and manipulation does an immense disservice to health care as a whole and decreases public trust in providers. This is why sexual boundary training & awareness in health care is so vital.

Responsibility to the public

In this case, “the public” refers to patients who come to you seeking treatment or receiving treatment. This key concept includes the providers’ duty to respect the rights, privacy, and dignity of patients and to maintain confidentiality and professional boundaries at all times. “Responsibility to the public” also includes patient/client referrals to an appropriate provider if you are unable to continue services, or if the patient/client complains of another health ailment not within your scope of practice.

Responsibility to the profession

Health care providers of all types are responsible for their professional behavior, for the reputation of their profession, and for promoting ethical conduct among their fellow providers.

For example, according to the AMTA, massage therapists/practitioners agree to follow specific principles of ethics and rules of ethics.

The Principles of Ethics by AMTA

  1. Demonstrate commitment to provide the highest quality massage therapy/bodywork to those who seek their professional service.
  2. Acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudicial manner with clients and/or colleagues.
  3. Demonstrate professional excellence through regular self-assessment of strengths, limitations and effectiveness by continued education and training.
  4. Acknowledge the confidential nature of the professional relationship with clients and respect each client’s right to privacy within the constraints of the law.
  5. Project a professional image and uphold the highest standards of professionalism.
  6. Accept responsibility to do no harm to the physical, mental and emotional well-being of self, clients and associates (AMTA, 2010).

Rules of Ethics by AMTA

  1. Conduct all business and professional activities within their scope of practice and all applicable legal and regulatory requirements.
  2. Refrain from engaging in any sexual conduct or sexual activities involving their clients in the course of a massage therapy session.
  3. Be truthful in advertising and marketing, and refrain from misrepresenting his or her services, charges for services, credentials, training, experience, ability or results.
  4. Refrain from using AMTA membership, including the AMTA name, logo or other intellectual property, or the member’s position, in any way that is unauthorized, improper or misleading.
  5. Refrain from engaging in any activity which would violate confidentiality commitments and/or proprietary rights of AMTA or any other person or organization (AMTA, 2010).

Massage therapists, like other healthcare providers, must also treat within their lawful scope of practice and training only if they are able to safely, competently, and effectively do so.

While these are just two core competencies and ethical obligations of health care providers, there are several more equally as important. These are ethical responsibilities towards employers & colleagues, responsibility in promoting health education, and ethical responsibility in research.

As we know, setting physical boundaries is vital in a massage therapy session.  Communication and respect with the client are key in this setting so the individual can feel safe, secure, and enjoy their treatment.  Appropriate draping is important and should only enable access to the body where massage is required.  If you do need to touch an area that is draped, make sure that you communicate this with the client, explaining exactly what you will be doing as a part of the treatment, and get the client’s permission to do so.

Sexual boundary violations are unacceptable in the massage therapy profession, as well as any healthcare profession.  It is never permissible to massage a client in the area of their backside or genitals.

The same holds true for the massage therapist; clients should respect your boundaries and have no right to touch you in an inappropriate fashion.  If this happens, immediately let them know their actions are not wanted, and if the situation warrants, halt the session and do not re-book that client.

Emotional Boundaries between the Client & Therapist

Transference

In the subject of massage therapy, transference is something that happens when a client brings past experiences, relationships, and feelings to the present and in turn makes a professional relationship personal.  Massage therapists should keep this concept in the back of their mind and be aware should it begin to happen with a client.  You will need to bring the client back to the reality of the professional relationship.

Examples of Transference:

A client who contacts you outside of the practice.
Requesting a discounted price for treatment.
Repeated requests to go out on a date, or for a relationship outside the professional one.
Gift giving for no reason or purpose.

Counter-transference

This is when the therapist is too divulging with the information they give the client about themselves, such as telling the client about past issues, current problems, or other personal information.  For one, this can turn a lot of clients off and can prevent them from ever returning to your office.  Secondly, it is important to keep these details out of the clients’ session.  After all, the treatment is for the client and they are there to unwind and heal from the things in life that ail them.  Additionally, counter transference also refers to the client who is unable to separate emotional feelings from a professional therapeutic relationship.

Examples of Counter-transference:

Dwelling on clients’ issues and how you can fix them.
Discussing your own personal issues with a client while they are receiving treatment.
Assuming the role of the confidant and helper for the client.

Power Differentials

An important emotional boundary to discuss, power differentials are crucial for massage therapists to understand and be aware of.  Due to the set-up of a massage therapy session, with the client laying down, in the nude beneath a drape, and you standing up providing treatment, it is a clear power differential.  So, in this setting, massage therapists should be mindful not take advantage of the client. An example of a power differential would be to have a medical doctor on the table, and you begin to ask them about ailment that’s been bothering you.  This is not appropriate and should be refrained from.

Clients & Talking

First and foremost, your clients engaging in conversation with you is normal and, in most cases, starts off to be nice or friendly, or to break some of the initial tension, especially if it is their first time in the office.  While it is important to show all clients’, we are interested in them and care, we need to remember the keep point of the session, and that it be therapeutic for the client.  This can be tricky to achieve when the client is chatting with you for half of the session about their last vacation to Mexico, and you exchanging similar vacation stories.  As a massage therapist it is important to learn how to control the environment, and re-direct your client away from talk, and toward a relaxing state of mind.  Remind the client that silence is not a problem, that it helps you focus on your technique, and to relax and enjoy their session (Bryant, 2018). 

The Four Different Types of Boundaries

Social Boundaries – This type of boundary is more common in small towns, where there is sometimes an overlap between a client, and what you would call a friendly acquaintance.  Most professionals advise to keep clients and friends/relationships separate because this may lead to inappropriate behavior.

Emotional Boundaries – because of the calm and comforting setting of a massage therapy session, some clients may be inclined to talk to you about personal problems, which may include sensitive issues dealing with mental health.  There are certain topics that massage therapists are not qualified to provide information on because it is out of scope of practice.  It is important to know your limits and in cases like these, to refer the client to an medical professional who can help them with their concerns.

Physical Boundaries – Clients are in a vulnerable position during a massage therapy session because they are fully or partially undressed. It is imperative to respect the clients space and body, and to not touch them in unwanted areas.  Prior to the session starting, you should also inquire if they have any areas that they prefer to not have massaged.  Listening to the clients’ response and comments on this matter also goes a long way in respecting physical boundaries

Professional Boundaries – This primarily includes maintaining a clean work environment, conducting your massage business ethically, and maintaining up to date business records of clients and transactions (Bryant, 2018).

Diversity, Culture, & Boundaries

As health care providers and acupuncturists, we have the opportunity to meet a variety of people from different cultures, ethnicities, and backgrounds. Because of this diversity, it is imperative to understand how patient diversity and/or culture connects with boundaries in practice.

For example, a conservative woman of Arab descent may be less likely to book treatments with a male health care provider on the grounds of specific customs and expectations of her pertaining to religion and family life.

In another scenario, you may find a male patient of Asian descent to be less probing with questions in your discussion because of his respect of authority or desire to be polite in that social interaction. In the case of a boundary violation, this individual may also be less likely to voice concerns or discomfort with the health care provider out of respect or to be polite, even if they may be uncomfortable.

According Marcia Carteret, M.Ed.,

“Asian cultures are typically high context cultures in which gesture, body language, eye contact, pitch, intonation, word stress, and the use of silence are as important as the actual words being spoken in conversation,”

“Asians are typically polite in social encounters whereas Americans, being very low context communicators, are comfortable with very direct questions and answers and often seem abrupt to people from high context cultures. This is important to keep in mind when communicating with Asian people, especially those who are relatively new to the United States. Asian people may be “tuned” to the moods of the others during conversation, and culturally they expect others to be similarly sensitive. Asians patients may expect doctors to sort out their concerns, confusion, and hesitance within the context of polite conversation, while western doctors mistake head-nodding, smiles, and verbal assent as clear indication of understanding and agreement when the opposite is in fact true (Carteret, 2010).”

Keep in mind that the above two examples are general scenarios, not hard and fast rules. Every patient or client you encounter will be different with his or her own unique values, customs, and behaviors.

 

Boundary Violations from Provider to Patient

Take a look at some of the below warning signs and red flags of potential boundary issues from a provider to a patient. These early warning signs could be an indication of future sexual boundary violations if not addressed early enough.

  • Discussing intimate or personal issues with a patient
  • Engaging in behaviors that could reasonably be interpreted as flirting
  • Keeping secrets with a patient or for a patient
  • Believing that you are the only one who truly understands or can help the patient
  • Spending more time than is necessary with a particular patient
  • Speaking poorly about colleagues or your employment setting with the patient and/or family
  • Showing favoritism
  • Meeting a patient in settings besides those used to provide direct patient care or when you are not at work

 

 

Boundary Violations from Patient to Provider

In most cases of sexual boundary violations, we typically hear stories of patients accusing providers for crossing personal lines. Let it be known that boundary crossing does not only go one way. Providers too can be put in situations where their personal and professional boundaries are being crossed.

  • Patient comments or remarks expressing desire to engage in sexual activity.
  • Any unwanted or inappropriate touching from patient to provider.
  • Patient over-involvement such as asking intimate or personalized questions.
  • Requests for personal contact information such as personal phone, e-mail, and home address.

If you feel uncomfortable with a certain patient or believe your boundaries have been crossed, request assistance from a trusted colleague or supervisor. Any incident you experience with a patient that you believe violated your personal and professional boundaries should be documented in a timely manner. You may decide to address the issue yourself with the patient using direct language, asking them to stop the behavior. Another option is to have a superior address the incident or refer the patient elsewhere for treatment. Sexual harassment from patients is a real issue and should not go un-noticed. If the health care provider is an employee working at a superior’s practice, the employee has an obligation to inform their superior of the incident.

Lastly, if these boundary violations or sexual harassment continues it is highly advisable to contact your local state board or respective licensing organization to see what they recommend for appropriate actions to prevent this situation from continuing (every state has their own process), and/or to consult with your attorney about the incident.

 

 

Investigations of Sexual Boundary Violations

It is imperative that state medical boards have sufficient statutory authority to investigate complaints and any reported allegations of sexual misconduct. State medical boards should place a high priority on the investigation of complaints of sexual misconduct due to patient vulnerability unique to such cases.

The purpose of the investigation is to determine whether the report can be substantiated in order to collect sufficient facts and information for the board to make an informed decision as to how to proceed. If the state medical boards indicate a reasonable probability that the physician has engaged in sexual misconduct, the state medical board should exercise its authority to intervene and take appropriate action to ensure the protection of the patient and the public at large.

Each complaint should be investigated and judged on its own merits. The investigation should include a review of previous complaints to identify any such patterns of behavior, including malpractice claims and/or settlements. The investigation of all complaints involving sexual misconduct should include interviews with the physician, complainant(s) and/or patient and/or patient surrogate.

The investigation may include an interview with a current or subsequent treating practitioner of the patient and/or patient surrogate; colleagues, staff and other persons at the physician’s office or worksite; and persons that the patient may have told of the misconduct.

Information and physical evidence that can be valuable in resolving discontinuities are:

details about each incident or extent of the relationship; identifying marks on practitioner that would be known only to someone who had been intimate with physician; objects in physician’s home or environment, outside the office, where the misconduct occurred; articles of clothing with possible DNA; billing records related to visits; patient record; appointment book; phone records; written communications (e-mail, letters, cards, etc.); motel or hotel bills; credit card receipts, etc.

In some cases, an undercover operation, in which the patient is wired, may be used to obtain statements and admissions from physician. It may also be necessary to discreetly involve other practice areas in an investigation, such as hospitals where the physician has privileges. Complainant Sensitivity to Investigation Because of the delicate nature of complaints of sexual misconduct, boards should have special procedures for interviewing and interacting with such complainants.

Therefore, professionals who are appropriately trained in the area of sexual misconduct should conduct the investigation and subsequent intervention. Boards also should consider providing specialized training for investigators and consider using investigators appropriate to the gender of the complainant. In the event complainants express a desire to “tell their side of the story,” the board is encouraged to afford complainants the opportunity to appear before a board subcommittee or the board itself.

Guidelines for State Medical Boards: Hearings

Following investigation and evaluation, if deemed appropriate, the state board overseeing the healthcare provider should determine whether sufficient evidence exists to proceed with formal charges against the physician. In most jurisdictions, initiation of formal charges is public and will result in an administrative hearing unless the matter is settled. This section will discuss issues encountered by boards when preparing for an administrative hearing and will provide specific recommendations regarding those issues. In assessing whether sufficient evidence exists to support a finding that sexual misconduct has occurred, corroboration of a patient’s testimony should not be required.

Although establishing a pattern of sexual misconduct may be significant, a single case is sufficient to proceed with a formal hearing. Boards should have the authority to amend formal charges to include additional complainants identified prior to the conclusion of the hearing process.

Open vs Closed Hearings

If boards are required, by statute, to conduct all hearings in public, including cases of sexual misconduct, many patients may be hesitant to come forward in a public forum and relate the factual details of what occurred. Boards should have the statutory authority to close the hearing during testimony which may reveal the identity of the patient. The decision to close the hearing, in part or in full, should be at the discretion of the board. Neither the physician nor the witness should control this decision. Boards should allow the patient the option of having support persons available during both open and closed hearings.

Complaints about Boundary Violations

Complaints about sexual violations are highly sensitive. Therefore, enhanced attention must be given to protecting a patient’s identity so that patients are not discouraged from coming forward with legitimate complaints against physicians. The boards should have statutory authority to ensure nondisclosure of the patient’s identity to the public. This authority should include the ability to delete from final public orders any patient identifiable information.

Testimony

Sexual misconduct cases do involve complex issues; therefore, boards may consider the use of one or more expert witnesses to fully develop the issues in question and to define professional standards of care for the record. Additionally, the evaluating/treating physician or mental health care practitioners providing assessment and/or treatment to the respondent physician may be called as witnesses. The provider may provide details of treatment, diagnosis and prognosis, especially the level of insight and change by the practitioner.

Also, a present or subsequent treating doctor of the patient, particularly a mental health provider, may be called as a witness. Such witnesses may provide insight into factors that led to the alleged sexual misconduct, an opinion regarding the level of harm incurred by the patient, and describe the physician’s rehabilitative potential and risk for recidivism.

Other problems about sexual boundary breaches

1. Rules of evidence applicable in all other administrative hearings should be applied in hearings involving sexual boundary breaches

2. Boards should not consider romantic involvement, patient initiation or patient consent a legal defense, although these may be factors for the board’s consideration in cases of sexual misconduct.

3. Witness credibility is often an important factor in hearings involving sexual misconduct.

All-inclusive Evaluation

State medical boards constantly make use of diagnostic evaluations for health professionals who may have a physical or mental impairment. Similarly, the use of diagnostic evaluations when handling a complaint regarding sexual misconduct provides significant information that may not otherwise be revealed during the initial phase of the investigation. A comprehensive psychological evaluation may be valuable to the board’s ability to assess future risk to patient safety.

The aim of the evaluation is not to establish findings of fact but rather to assess and define the nature and scope of the behavior, identify any contributing illness or underlying conditions that may have predisposed the physician to engage in sexual misconduct, make treatment recommendations if rehabilitative potential is established, and identify any underlying illness or condition that might put patients at risk in the future. An evaluation may be valuable in determining whether or not an ancient maladaptive pattern of unsuitable behavior exists.

If its study showed a high potential that sexual misconduct has happened, the state medical board should have the authority to order an evaluation of the physician and the physician must be required to consent to the release to the board all information gathered as a result of the evaluation. The evaluation of the physician follows the investigation/intervention process but precedes a formal hearing.

The guidelines to be considered by the board when selecting an assessor(s) to conduct the evaluation:

1. Assessor (s) must be licensed health care professionals who have demonstrated knowledge, based upon education, training, and supervised experience in the realm of sexual misconduct and recognition of the features of doctors who have engaged in sexual misconduct with patients or patient surrogates.

2. The evaluation should be carried out by an independent evaluator to avoid a conflict of interest.

3. There must be no initial professional or personal relationship between the evaluator and the physician being evaluated.

4. Previous sexual violation offenders should not be accepted to conduct evaluations.

5. Assessor (s) must be approved in advance by the board. The assessment of a physician for sexual misconduct is complex. It may require a multidisciplinary approach and should contain the following elements:

The general goals of the evaluation

•      Identify, if present, the nature and severity of any psychiatric, psychological, medical, or cognitive impairment.

•      Help medical boards and doctor health programs understand any causative factors that may have predisposed the physician to engage in sexual misconduct.

•      This insight does not excuse the physician’s conduct but may assist parties involved understand, in part, why sexual delinquency occurred in order to inform treatment and possibly the nature of disciplinary action (e.g., history of antisocial behavior or severe personality disorder(s), bipolar illness, cognitive impairment, addiction disorder(s), professional burnout resulting in depression and poor judgment and so on.

•      Gauge the doctor’s risk to re-offend and devise an opinion regarding the physician’s rehabilitative potential.

•      Comprehensive medical evaluation with suitable laboratory studies, medical history, toxicology screens for substances of abuse.

•      The appraisal must include a review of all collateral materials believed pertinent by the assessment team including, but not limited to, the board’s exploratory file; prior applicable diagnoses and courses of treatment; data from the state’s physician health program; and, if available, the results of any prior medical, social, psychiatric evaluations and psychological testing.

•      Conduct al-inclusive psychiatric evaluation and history with a mental status examination.

•      Alcohol and drug history that includes checking: that there are no presences or history of substance abuse, Psychosocial/development history and comprehensive psychological testing and clinical interview following a forensic protocol.

Within the framework of this constituent of the assessment, the inspector will employ valid and reliable psychological instruments and clinical means to exclude cognitive/neuropsychological deficits, latent or frank psychosis, affect/mood instability, bipolar spectrum, depression, impulse-control, anxiety, paraphilic, and thought disorders.

Based on these findings, the inspector will describe the nature and severity of difficulties, if present, and determine their impact on future risk to patient safety.

•      Comprehensive sexual history that incorporates: checking whether the doctors suffer from the presence of compulsive sexual behavior or paraphilic interests or practices.

•      Forensic polygraph examination if indicated (questions need to be clearly focused on past behavior and not intent).

•      Multidisciplinary team meeting where all members involved in the evaluation can present clinical data, review collateral information, explore personal and professional biases, challenge each other’s conceptualizations, and arrive at a consensus regarding the physician’s psychiatric, psychological, medical, and cognitive disposition.

•      A report that summarizes all the elements of assessment.

How the conclusion would be reached

•      A medical/psycho-legal determination regarding the physician’s psychiatric, psychological, medical, and cognitive disposition and fitness to practice.

•      Statement regarding the physician’s risk to reoffend and rehabilitative potential.

•      Recommendations may include PHP monitoring, boundary monitoring, extensive treatment, further evaluation, e.g., neuropsychological testing, MRI, MRA, SPECT, PET, additional laboratory studies, etc). The evaluation of a physician for sexual misconduct must be reliant upon agreement by the independent evaluator to release to the board all records pertaining to the identity, diagnosis, prognosis, and treatment of the physician.

Such records must incorporate but not be limited to those records maintained in connection with the recital of any program or activity relating to substance abuse education, prevention, training, treatment, rehabilitation, or research. Upon completion of the evaluation, results must be released to the medical board.

 

Discipline Regarding Boundary Violations

State medical boards have a broad range of disciplinary responses designed to protect the public. Upon a finding of sexual misconduct, the board should take appropriate action and impose a sanction(s) reflecting the severity of the conduct and potential risk to patients.

Findings of sexual misconduct are often sufficiently egregious as to warrant revocation of a physician’s medical license. However, boards may find that mitigating circumstances do exist and, therefore, stay the revocation and institute terms and conditions of probation. In the event the board makes a finding of sexual impropriety, the board may consider a less severe sanction than for a finding of sexual violation.

In determining an appropriate disciplinary response, the board should consider the following:

•      Patient harm

•      Subsistence of social support system

•      Chance (type of practice)

•      Ruthlessness of indecency or inappropriate behavior

•      Background within which impropriety occurred

•      Responsibility of licensee

•      Psychotherapeutic relationship

•      Existence of a physician-patient relationship

•      Scope and depth of the physician-patient relationship

•      Unfortunate termination of physician-patient relationship

•      Age and competence of patient (minor)

•      Susceptibility of patient

•      Amount of times behavior occurred

•      Number of patients involved

•      Period of time relationship existed

•      Assessment/evaluation results

•      Previous professional misconduct/disciplinary history/malpractice

•      Recommendations of assessing/treating professional(s) and/or state physician health program license reinstatement/removal of license restriction(s)

In the event of license revocation, suspension, or license restriction, any petition for reinstatement or removal of restriction should include the stipulation that a current assessment, and if recommended, successful completion of treatment, be required prior to the medical board’s consideration to assure the physician is competent to practice safely. Such assessment may be obtained from the physician’s treating professionals, state physician health program, or from an approved evaluation team as necessary to provide the board with adequate information upon which to make a sound decision.

Monitoring Following a finding of sexual misconduct, if a license is not revoked or suspended, it is essential that a board establish appropriate monitoring of the physician and his continued practice. Monitoring should be individualized and based on the findings of the multidisciplinary evaluation, and, as appropriate, subsequent treatment recommendations.

If a diagnosis of causative mental/emotional illness, addiction, or sexual disorder has been established, the monitoring of that physician should be the same as for any other mental impairment and boards are encouraged to work closely with their state physician health program as a resource and support in monitoring. Conditions, which may also be used for other violations of the medical practice act, may be imposed upon the physician, such as:

•      Supervision of the physician in the workplace by a supervisory physician

•      Requirement that chaperones constantly attend and sign the medical record attesting to their presence during examination or other patient interactions as appropriate.

•      In addition, the doctor must provide the chaperone a copy of the order, and the chaperone must certify to the board she/he read the order.

•      Regular on-site review by board investigator or physician health program staff if required.

•      Practice restrictions as may be recommended by evaluator(s) and/or the state physicians health program.

•      Constant interviews with the board and/or state physician health program as required to assess status of probation.

•      Constant reports from a qualified and approved licensed practitioner, approved in advance by the board, conducting any recommended counseling or treatment.

•      A complete course that trains the doctor about maintaining suitable professional boundaries, which shall be approved in advance before registering with the board.

 

Boundary Training

Realizing that sexual misbehaviors can be a major issue affecting care in medicine as a whole, many medical schools, university, and other healthcare programs have implemented boundary training.  A lack of training, awareness, and skill sets needed to implement effective boundaries and handle uncomfortable situations can put providers and patients/clients both at risk. 

Educational curriculum should be developed about what is acceptable and what is not acceptable in relation to the boundary issue. State boards regulating the healthcare field usually formulate cooperative relationships with healthcare organizations, programs, medical schools and training programs to offer healthcare providers the required training that would boost awareness of sexual misdemeanors in a healthcare setting.

Additionally, state licensing boards sometimes require this as mandatory continuing education. 

Doctors must be trained about the extent of injury patients witness due to sexual misconduct. Information about boundary issues, including physician sexual misconduct. It must be publicized in medical board information sheets and brochures. Media associates must be organized to make the general public more informed and aware of what to do when confronted with such situations

Health care provider sexual boundaries breaches may include a broad collection of behaviors and can happen in different ways. It is extremely injurious to patients and patient surrogates. It as well mars the dignity of the medical profession. This guide may not cover all possible cases of the violation. Nevertheless, it can serve as a guiding principle of   medical boards to manage instance of such sexual boundary breaches between a doctor and his or her patients.

Dual Relationships in Health Care

A dual relationship is present when a provider has a second significantly different relationship with his or her patient/client in addition to the traditional patient-provider one (Zur, 2013).

The relationship could be of a professional nature. Take a massage therapist for example who sees patients/clients in her practice, but also teaches massage therapy at a local university. If a student sees the massage therapist for regular treatments, and also takes courses the LMT teaches, then there is a dual professional relationship. The massage therapist plays the part of both counselor and teacher, but in separate settings.

A dual relationship can also be unprofessional in nature. Take for example the scenario of a psychiatrist who is also a friend or intimate partner of the person seeking medical care/support.

Due to the complications that can arise in sexual and in rare circumstances, nonsexual situations, the presence of a dual relationship may present ethical and potentially legal issues.

As discussed above, it is important to note that not all dual relationships are stamped as unethical. It may even pave the way for a strengthened trust and respect or a beneficial exchange of goods or services for both parties.

The distinguishing factor between unethical and ethical relationships is the foundation of mutual trust and whether it is honored or misued (Zur, 2013).

Even as specialists in psychiatry have been debating the advantages and disadvantages of issuing such guidelines, non psychiatric doctors have not engaged in discussions like that. In this guide, we will provide a conceptual framework for discussion of professional boundaries in the physician-patient relationship and provide our view of measures the medical profession can take to prevent severe violations of these boundaries.

What the boundaries imply

Commonly, they are the parameters that explain the limits of a fiduciary relationship where a patient entrusts his or her welfare to doctor to whom a fee is paid for service to be rendered. Boundaries means professional distance and respect must be maintained, which, includes avoiding sexual relationship with patients. While sexual contact is likely the most extreme form of boundary violation, other types of doctor’s behaviors may take advantage of the dependency of the patient on the doctor and the available power difference.

These are things like double relationships, business operations, specific gifts and services, use of some languages, use of some forms of physical contact, time and duration of appointments, appointment locations, mismanagement of fees, and misuses of the physical examination. The breaches of some of these boundaries may sometimes be essential and beneficial. For instance, it would clearly suitable to hold the hand of a patient who reaches out to a physician after the loss of a loved one.

There are differences between minor boundary violations and severe boundary violations that spoil professional careers and badly damage the patient’s life. In the say way, some issues may crop up from dishonest and unethical doctor’s behavior, while some occurs from honest misinterpretations. Much of the medical profession’s augmented interest in boundaries has derived from the consciousness of the destructive effects of sexual misbehavior. Examination of cases of doctor- patient sexual relationships has shown that sexual exploitation is normally preceded by a progressive series of nonsexual boundary violations. This occurrence is normally referred to as the “slippery slope. In this instance, what seems to be minor violations may in the real fact be considerably more severe when it is viewed in the recurring sense.

   

 

Relationships with a Patient/Client:  Varying healthcare provider opinions.

A recent Medscape Ethics Survey, where over twenty-one thousand healthcare providers participated, although the violation is still considered unethical to some respondents, some doctors are beginning to give it a second thought more than what it used to be in the past.

Many of those who participated in the survey were strictly against a doctor sexual relationship with his present patient, and most were also against doctor having intimate relations with a former patient irrespective of how long it has taken which closes matches with the position of the American Medical Association (AMA) and as number of specialty societies.

In spite of that, from the survey, it was also found that the numbers of doctors who have differing views are increasing more and more.

Sixty eight of the participants were of the opinion that an intimate relationship with a patient, whether current or former, was unmistakably unethical and immoral.

In Medscape’s 2010 Ethics Survey, the number of participants who took that position was eighty-three percent. In the two surveys only, one percent of respondents think that sex with a present patient is allowable. Just twelve percent of participants in 2010 survey think it was okay to relate sexually with a former patient. However, in the most recent survey, more than one fifth of the participants, twenty two percent of them think it is no longer unethical.

 

The Opinions:

 

“I think we are enormously misguided, if not narcissistic, to believe that there is no amount of time out of the physician/patient relationship that ‘resets’ the relationship,” an emergency physician wrote in response. “If ‘individual patients often unquestionably submit to a physician’s authority,’ as an expert was quoted as saying, then we should give up on the concept of medical informed consent, as our patients clearly cannot separate themselves from the omnipotent physician/patient relationship adequately to be able to give such consent. As a profession, let’s at least be logically consistent in our positions.”

“What about caring for a person with whom you have had a relationship in the past?” a family physician wanted to know. “How about the conflict with having to care for someone (in the ER after hours, as an example) with whom you have/had a relationship or conflict? This goes to show that blanket statements/rules cannot be concrete and cannot fit all situations.”

“Consider this scenario,” a general practitioner suggested. “You’re the only physician in a small town. If you can’t date a patient or potential patient, then you can’t date anyone, since every person in the town is potentially your patient. I guess you’d just have to get a mail-order bride from Russia. Once you’re married, you can’t have sex with your wife because she will also be a patient of yours. This is why hard-and-fast, zero-tolerance rules are always a bad idea.”

“I think that it borders on delusional to believe that we as doctors are so all-powerful that it is an abuse of power and a crime to have a sexual relationship with a competent adult who happens to have been or even is a patient,” a psychiatrist wrote. “If such an act is to be a crime, don’t you think each case stands on its own to show the harm done? Otherwise, the authorities should respect a doctor’s privacy and stay out of the bedroom.”

“It’s like many blanket statements—not applicable in all circumstances,” an emergency physician wrote. “A lot depends on the nature of the doctor/patient relationship. A male gynecologist and a patient who has seen that doctor many times—probably not. An ER doc who sees someone once for a broken ankle? I don’t see the problem. How about a radiologist who interprets the ankle x-ray? Does the radiologist get a blanket pass?”

“I believe that the ‘rules’ are in place for very good reasons,” a cardiologist commented. “Intelligent physicians before us have seen the ramifications of doctor/patient relationships over many years and on a larger scale.

“Individual circumstances vary. There will always be exceptions to the rule on a small scale, and there are exceptions in remote locations or small towns. However, the dynamic of our relationships is unique and should be held up as such by our community.”

“Rules are rules, and for a good reason,” a family physician pointed out. “They remain rules until exceptions are created. Respect for our profession is eroding constantly. The least we can do is hold ourselves to a higher standard and stay out of such entanglements. If a physician becomes involved with a patient, there’s always the possibility of HIPAA violations, as the physician enters the patient’s social or even family circle. We all ought to have the discipline and self-control to avoid such entanglements.”

“I hate to say it, but the AMA is absolutely right,” a psychiatrist stated. “Certainly, for psychiatrists and pediatricians it is an absolute. How adept are people at knowing when it is ‘true love’? Because ‘some are happy’ is the worst kind of anecdotal information.”

“Medical ethics is what it is for very good reasons, and what was true about the doctor/patient relationship in Hippocrates’ time hasn’t fundamentally changed,” another psychiatrist noted. “Exploitation of this relationship in any way, by either party, is all too possible if the boundaries are not recognized and strictly adhered to. Boundary violations almost inevitably bring trouble. It’s the doctor’s, not the patient’s, responsibility to behave ethically at all times.”

“While I believe a doctor must not have a relationship with a current patient, it is also true that the traditional doctor/patient relationship does not exist as before,” commented a family physician. “We have become ‘healthcare providers’—service providers not much different from plumbers, hairdressers, and auto mechanics. Whose fault is this? I don’t know. Maybe plumbers should also be prohibited from having relationships with their clients, or maybe, in the modern world, doctors should be allowed to have relationships with their ‘clients.'”

 

Laws and Regulations guiding the healthcare industry

The laws, regulations and standard decision practice of healthcare providers and related professions in the health industry that are regulated by the Medical Board are specified in the Business and Professions Code.

This section describes key medical billing laws, and how the doctors must comply with them. Just like every other profit-making business, the healthcare industry must keep to specific state and federal regulations to operate lawfully. In addition to the standard ethical business practices businesses in the healthcare industry must comply with extra rules and regulations.

The additional rules and regulation is due to the fact that the medical service deals with both the business aspect and the health care of people. The implication of this is that they have a bigger role to play to comply with the ethical standards of business, and their medical practice.

On a federal level the activities of the healthcare providers are being regulated by the CMS and the CDC. The CMS oversees the Medicare and Medicaid medical services aimed at alleviating the financial health responsibilities of the poor, elderly, and disabled, and the control of diseases (CDC). These organizations work together to set up fresh new regulations.

These rules ensure that all workers in the medical profession offer to their patients updated and reliable health care services. Major laws and regulations that are connected to the medical billing industry include HIPAA, ethical standards, contract responsibilities, fraud laws, and good business practices.

The Key Medical Billing Laws and Regulations 

False Claims Act

The False Claims Act is enacted to take care of fraud committed by health care industry professionals against the government, an important law to be aware of for any healthcare provider.

Managers are commonly the very last form of protection for a healthcare provider to ensure that they stay away from overbilling patients for particular tests or sending patients for irrelevant tests.

The False Claims Act mandates individuals who are not working for the government to file a case on the government’s behalf. This ethical standard provides legal protection to whistleblowers that may face retaliatory attack from their employers.

According to the law, 

“Individuals and entities that make false claims are subject to civil penalties of up to $11,000 for each false claim, plus three times the amount of damages the government sustains by reason of each claim (31 U.S.C. § 3729).

Violation of the False Claims Act may lead to exclusion from Federal health care programs (Social Security Act § 1128).

Civil legal actions for penalties and damages under the False Claims Act may be brought not only by the government, but by private persons, such as competitors or employees of a provider, on behalf of the government. If the legal action is successful, the private person is entitled to a percentage of the recovery. The False Claims Act protects all persons from retaliation for reporting false claims or bringing legal actions to recover money paid on false claims (Civil Actions for False Claims, 31 U.S.C. § 3730).

Failure to return overpayments may lead to liability under the False Claims Act. Under section 1128J(d) of the Social Security Act, persons who have received an overpayment from a Federal health care program must report and return the overpayment within 60 days of the date the overpayment was identified. Failure to do so may make the overpayment a false claim (Social Security Act § 1128J(d)).

False claims made knowingly may also be subject to criminal prosecution. Persons who knowingly make a false claim may be subject to criminal fines up to $250,000 (Sentence of Fine, 18 U.S.C. § 3571) and imprisonment of up to 5 years (False, Fictitious or Fraudulent Claims, 18 U.S.C. § 287).”

Stark Law

The Stark Law, also known as the Ethics in Patient Referrals Act, was passed in 1989 by congress. Unfortunately, this law is not very commonly understood among the citizens and healthcare providers alike. It is only individuals who have sophisticated education of the law in healthcare that may be familiar with this law. The Stark Law is another ethical billing law that helps to prevent the occurrence of fraud in the healthcare industry.

Healthcare providers with unethical practice may try to defraud the government by referring a patient to a family member or financial partner. In this case, the doctor that refers the patient is compensated financially. This type of unethical practice would have escalated if not for the fact that it is kept under close watch by the overseers of the scheme.

To provide a brief overview of the law itself, final regulations under Stark I were not issued until six years after the act was passed in 1995.  The regulations covered just the self-referral prohibition for clinical laboratory services (these have now been nullified by the final Stark II regulations).

By then, Congress had already broadened the Stark Law in 1993 to apply to nine other general divisions of designated health services (Stark II) beginning in 1995 (MMS, 2005).

Proposed Stark II regulations were first issued on January 9, 1998 and set forth a wide scope agency application of the law. For instance, in the proposed Stark II regulations, a referring physician could not be compensated based on personally performed services.

After much backlash to many aspects of the proposed Stark II regulations were communicated by the health care community through extensive remarks, the Centers for Medicare and Medicaid (CMS) decided to issue final Stark II regulations in two major initial phases.

Final Stark II Phase I regulations were issued in January 2001, and began officially on January 4, 2002. Final Stark II Phase II regulations were issued in March 2004 and went into effect on July 24, 2004.

With the exception of Medicaid managed care plans, the Centers for Medicare and Medicaid has not yet addressed the application of the Stark Law to Medicaid and other state health programs in these two phases of the Stark II regulations and is also considering public comments on Final Stark II Phase II regulations (MMS, 2005). 

Stark II Phase III marked the final component of the Centers for Medicare and Medicaid rulemaking process.  The new regulations were to be deemed effective on December 4, 2007, but in November of 2007 the CMS prolonged the effective date of the provisions of Stark III for nonprofit integrated health care systems and academic medical facilities until December 4, 2008.  All other provisions of Stark III Regulations became started on December 4, 2007. 

According to the Centers for Medicare and Medicaid, the purpose of the Stark III rules are to lesson the burden of regulation on the healthcare industry through the CMS’ explanation and changes of previously disseminated exceptions to the Stark Laws general prohibition on referrals.  Yet, Stark Law continues to be one of the most complicated and opaque laws concerning medical groups today.  Lawyers in the healthcare space and government regulators alike engage in on-going debates on the meaning of Stark.  Healthcare providers should consult with a legal expert in the space if they have concerns or questions about how Stark law applies to them and their practice (Bilimoria, 2008). 

During the process of issuing the Stark regulations over the last 10 years, the CMS has wrestled with the right balance between certainty, consistent with the legislative drafters’ intent to provide a “bright line” approach, and the effort to carve out a variety of exceptions to address concerns raised by healthcare personnel across the U.S (MMS, 2005).

It is interesting to note that prior to the enactment of the Stark Law, the American Medical Association (AMA) had since 1977 an ethical rule limiting physician ownership in health care facilities to which the physician refers to situations involving community need, and a general ethical standard that wherever a physician may have a conflict of interest, he or she should seek alternative arrangements for the care of his or her patient (MMS, 2005).

Thus, the Stark Law legislatively proscribes in an extremely vast way what the medical profession had long before considered and crafted as a more balanced approach toward addressing physician conflicts of interest between ethical patient care and financial self-interest.

The Stark Law bans the making of referrals or the billing for payment for certain designated health services (DHS) covered by Medicare or Medicaid if there is a financial relationship between the referring physician (or immediate family member of the physician) and an entity receiving payment for the health services unless the relationship comes within one of several itemized exceptions to the prohibition (MMS, 2005).

The key language states that if a physician (or immediate family member) has a financial relationship with a designated health service entity, the physician may not make a referral to the entity for the furnishing of any Medicare- or Medicaid-reimbursable health service (MMS, 2005). 

Also, the entity may not present or cause to be presented a Medicare or Medicaid claim or bill to either program or any individual, third-party payor, or other party for such referred or ordered services (MMS, 2005).

The Stark Law was put into place to only cover a specific set of services and items believed by Congress to have a tendency of over-use and abuse, specifically for cases in which the referring physician had a financial relationship with the entity receiving payment for such services and items (MMS, 2005).

Initially, between 1992 and 1994, the Stark Law only applied to clinical laboratory services reimbursable by Medicare. Since 1995, the Stark Law covers the following expanded list of so-called designated health services (DHS) reimbursable under either Medicare or federally funded state health programs (MMS, 2005):

• Clinical laboratory services

• Occupational and physical therapy services (including speech-language pathology services)

• Radiology services including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services, even if they are cardiac (e.g. echocardiograms), vascular, obstetric, gynecological, or ophthalmic and not generally performed by radiologists (but this 4 Massachusetts Medical Society category specifically excludes nuclear medicine procedures,3 radiology procedures integral to and performed during a nonradiological medical procedure, certain radiology procedures performed immediately after a nonradiological medical procedure, and x-ray, fluoroscopy, and ultrasound services that require the insertion of a needle, catheter, tube or probe)

• Radiation therapy services and supplies (not including nuclear medicine procedures)

• Durable medical equipment and supplies

• Parenteral and enteral nutrients, equipment, and supplies

• Prosthetics, orthotics, and prosthetic devices and supplies (not including certain surgically implanted devices at ambulatory surgical centers (ASCs) and eyeglasses and contact lenses prescribed after cataract surgery)

• Home health services

• Outpatient prescription drugs

• Inpatient and outpatient hospital services, including services provided under arrangement (MMS, 2005)

As is apparent from this list of designated health services, Congress and the Centers for Medicare and Medicaid included both services and items. To eliminate confusion about which items and services are prohibited for four of the ten designated health services categories (clinical laboratory services, physical and occupational therapy, radiology and certain other imaging services, and radiation therapy services), the CMS has issued a list of CPT/HCPCS codes to specifically identify the services and items within these categories of DHS that are subject to the Stark Law (MMS, 2005).

Exceptions to Stark Law

In the case of a financial relationship between an entity that bills for designated health services and a physician who makes referrals (or any immediate family member of such physician), the Stark Law prohibits referrals from the physician to the entity and prohibits the entity from billing Medicare or Medicaid for those referred services, unless the financial relationship falls directly within one of the Stark Law exceptions. The exceptions determine if health care financial relationships are allowed under Stark (MMS, 2005).

There are three categories of exceptions according to Stark Law:

1. General exceptions that apply to both ownership/investment interests and compensation arrangements

2. Exceptions that apply only to ownership/investment interests

3. Exceptions that apply only to compensation arrangements (MMS, 2005)

Within these categories there are exclusions that originally were made by Congress and appeared in the Stark statute, with others added by the CMS in the Stark regulations under its statutory authority to add additional exceptions as it deems advisable. The additional regulatory exceptions all require adherence to the federal anti-kickback law, which we will discuss in the next section, as a condition for complying with the Stark Law immunity (MMS, 2005).

Acceptable Healthcare Financial Relationships under Stark Law

General Exceptions

  • Physician services
  • In-office ancillary services
  • Temporary Noncompliance
  • Eyeglasses and Contact Lenses Following Cataract Surgery
  • Intra-family Rural Referrals
  • Services furnished prepaid plan enrollees
  • Academic Medical Centers
  • Implants Furnished by an ASC
  • EPO and Other Dialysis-Related Drugs
  • Preventive Screening Tests, Immunizations, and Vaccines (MMS, 2005)

Ownership Exceptions

  • Publicly Traded Securities
  • Mutual Funds
  • Rural Providers
  • Entire (Non-specialty) Hospital (MMS, 2005).

Compensation Exceptions

  • Office Space Rental
  • Bona Fide Employment
  • Equipment Rental
  • Retention Payments in Underserved Areas
  • Community-Wide Information Systems
  • Personal Services Arrangement (Including managed care incentive plans)
  • MD Recruitment
  • MD Recruitment through practice
  • Professional Courtesy
  • Isolated Transactions
  • Non-DHS Hospital Remuneration
  • Pre-1990 Group-Hospital Arrangements
  • Referral Services (Anti-kickback Safe Harbor)
  • Payments by an MD
  • MD Charitable Donations
  • Non-monetary compensation
  • Fair Market Value Compensation
  • Medical Staff Incidental Benefit
  • Risk Sharing Arrangements
  • Compliance Training
  • Indirect Compensation Arrangements (MMS, 2005).

If Stark Law is Violated, what happens?

When this occurs, several things can happen.  First would be the denial of payment, meaning a program is prohibited from paying for the health service furnished due to the banned referral.  If the entity received a payment for the health service they provided that was performed in regards to the banned referral must refund the payment.  Certain civil monetary penalties may be imposed by the Centers for Medicaid and Medicaid services for conducting unethical referral schemes in violation of Stark Law. In addition, any individual who bills medicare for designated health services that the person or entity knew (or should have known), and resulted from a prohibited referral is also subject to an assessment by the Office of the Inspector General (OIG) of three times the amount claimed for the designated health service (42 CFR § 1003.100(b)(viii)

).  The civil money penalty to be paid is at maximum of $15,000 for each service found in violation (AMA, 2011). 

The Penalty

There is a civil monetary penalty for involvement in a circumvention scheme (see below for example). Any physician or other entity that enters into an arrangement or scheme (such as a cross referral arrangement) that the physician or entity knows or should know has the main purpose of assuring referrals by the physician to a particular entity which, if the physician directly made referrals to such entity, would violate the Stark Law, is subject to a civil money penalty of not more than $100,000 for each such arrangement or scheme (AMA, 2011).

According to the American Medical Association, here is an example of a possible circumvention scheme.

“Suppose Physician A has an ownership interest in an independent diagnostic treatment facility (IDTF 1). Suppose also that Physician A is not permitted under the Stark Law to refer Medicare patients to the IDTF 1 for the provision of DHS. Suppose that Physician B practices in the same town as Physician A and also has an ownership interest in another IDTF (IDTF 2) to which she is not permitted to refer Medicare patients for the provision of DHS. Finally, suppose that the Stark Law does not prohibit Physician A from referring to IDTF 2 and Physician B is not prohibited from referring to IDTF 1. Physicians A and B would enter into a prohibited circumvention scheme if Physician A agreed to refer all of his/her Medicare patients to IDTF 2 in exchange for Physician B agreeing to refer all of his/her Medicare patients to IDTF 1 (AMA, 2011).”

Exclusion from Federal health care programs.

A violation of the Stark Law can result in a ban from federal health care programs (AMA, 2011).

When does a “referral” occur?

The Stark Law only applies to a physician when he or she makes a “referral.” The Stark Law does not apply to all physician activities. Instead, the Stark Law only applies when a physician has made a “referral,” as defined by the Stark Law. Accordingly, in terms of deciding whether or not the Stark Law applies, the physician or individual must ask whether or not he or she is making Stark Law referrals (AMA, 2011).

What is a referral?

According to Stark Law and the AMA, a referral is a “request, order, or certification. A “referral” is the request by a physician for, the ordering of, or the certifying or recertifying of the need for, any designated health service, including the request for a consultation with another physician and any test or procedure ordered by or to be performed by (or under the supervision of) that other physician. A “referral” does not include DHS personally performed or provided by the referring physician,” (AMA, 2011).

The Anti-Kickback Law

It is not a criminal offence to go against the Stark Law. However, it is a criminal offense to violate the Anti-Kickback law. Also known as the “self-referral” or “conflict of interest laws”), the Anti-Kickback law was enacted in 1972 and is a billing law that all the healthcare providers, hospital administrators and facility owners must be aware of.  Conviction for a single violation under the Anti-Kickback Statute may result in a fine of up to $25,000 and imprisonment for up to five (5) years (Health, 2018). This also results in a mandatory exclusion from participation in federal health care programs.  The Anti-Kickback Statute is an intent-based statute requiring the party “knowingly and willfully” engage in the prohibited conduct.  For example, in 1995, the Ninth Circuit, in Hanlester Network v. Shalala, determined that a party may violate the federal fraud and abuse laws “knowingly and willfully” only if he or she (i) knows that the Anti-Kickback Statute prohibits offering or paying remuneration to induce referrals and (ii) engages in the prohibited conduct with the specific intent to disobey the law (Health, 2018). 

The anti-kickback law forbids the healthcare professionals from substituting or offering to substitute any valuable material (or money) to encourage or reward the referral of federal health care plan business. This form of fraud was recorded greatly in North Texas and by the end of November 2016, twenty-one individual’s cases were filed for engagement in the kickback scheme.

Anti-kickback and fee-splitting problems can have challenges for alternative medicine clinics and medical spas. 

We see this when healthcare organizations like medical spas or wellness center, run into “corporate practice of medicine” issues.  Anti-kickback law concerns and the corporate practice of medicine doctrine often are related but can be confusing to the lay person.  Here, we explain some of the background of these laws, and how they are applicable to healthcare providers in these settings.

‘The Corporate Practice of Medicine’ Doctrine

This doctrine forbids corporate entities from practicing medicine, or from interfering in the physician’s practice of medicine.  State corporate practice of medicine rules often require physicians to be housed within their own professional medical corporation, which can then contract with the alternative/integrative medical center/spa.

The Anti-kickback law on the other hand, prohibit physicians from getting or giving a percentage-based referral.  In other words, they cannot receive or render any fee, discount, payment, that would essentially make it look as if the money or reward is given in exchange for accepting or giving a patient referral (Cohen, 2015). 

While this is a simple concept, it can sometimes be difficult in real life.  This is because healthcare corporations, such as a medical spa, alternative med. Clinic, holistic care center, will need to set up its financial arrangements so that the facility can make a profit, and also reward the healthcare provider for his or her labors.  This can be tricky to do without it looking like a unlawful ‘referral’ scenario if the arrangement is connected to patient volume (Cohen, 2015).

One possible remedy is to format the arrangement as a lease, so that the physician pays fair market value for rental of space, and additionally, pays the corporate entity (center or clinic), which then acts as a medical services organization (MSO), for administrative services. The patient makes the check out to the doctor and the doctor gives the facility a flat, monthly fee for the lease and the administrative services. The facility has to calculate the economics so that this is mutually profitable, even though it does not give the appearance of having payments flow based on patient volume (Cohen, 2015).

Some states extend the anti-kickback rule / prohibition on fee-splitting to other professions, such as massage therapy, nursing, chiropractic, and psychology. If you take a look at New York’s law below, you’ll notice it holds several health professions liable to this rule, while exempting massage therapists:

§6500 Introduction.

This title provides for the regulation of the admission to and the practice of certain professions. This first article applies to all the professions included in this title, except that prehearing procedures and hearing procedures in connection with the regulation of professional conduct of the profession of medicine and physician’s assistants and specialist’s assistants shall be conducted pursuant to the provisions of Title II-A of article two of the public health law. Each of the remaining articles applies to a particular profession. §6503 Practice of a profession.

Admission to the practice of a profession (1) entitles the licensee to practice the profession as defined in the article for the particular profession, (2) entitles the individual licensee to use the professional title as provided in the article for the particular profession, and (3) subjects the licensee to the procedures and penalties for professional misconduct as prescribed in this article (sections sixty-five hundred nine, sixty-five hundred ten, and sixty-five hundred eleven).

§6509-a Additional definition of professional misconduct; limited application.

Notwithstanding any inconsistent provision of this article or of any other provision of law to the contrary, the license or registration of a person subject to the provisions of articles one hundred thirty-two, one hundred thirty-three, one hundred thirty-six, one hundred thirty-seven, one hundred thirty-nine, one hundred forty-one, one hundred forty-three, one hundred forty-four, one hundred fifty-six, one hundred fifty-nine and one hundred sixty-four of this chapter may be revoked, suspended or annulled or such person may be subject to any other penalty provided in section sixty-five hundred eleven of this article in accordance with the provisions and procedure of this article for the following:

That any person subject to the above enumerated articles, has directly or indirectly requested, received or participated in the division, transference, assignment, rebate, splitting or refunding of a fee for, or has directly requested, received or profited by means of a credit or other valuable consideration as a commission, discount or gratuity in connection with the furnishing of professional care, or service, including x-ray examination and treatment, or for or in connection with the sale, rental, supplying or furnishing of clinical laboratory services or supplies, x-ray laboratory services or supplies, inhalation therapy service or equipment, ambulance service, hospital or medical supplies, physiotherapy or other therapeutic service or equipment, artificial limbs, teeth or eyes, orthopedic or surgical appliances or supplies, optical appliances, supplies or equipment, devices for aid of hearing, drugs, medication or medical supplies or any other goods, services or supplies prescribed for medical diagnosis, care or treatment under this chapter, except payment, not to exceed thirty-three and one-third per centum of any fee received for x-ray examination, diagnosis or treatment, to any hospital furnishing facilities for such examination, diagnosis or treatment. Nothing contained in this section shall prohibit such persons from practicing as partners, in groups or as a professional corporation or as a university faculty practice corporation nor from pooling fees and moneys received, either by the partnerships, professional corporations, university faculty practice corporations or groups by the individual members thereof, for professional services furnished by any individual professional member, or employee of such partnership, corporation or group, nor shall the professionals constituting the partnerships, corporations or groups be prohibited from sharing, dividing or apportioning the fees and moneys received by them or by the partnership, corporation or group in accordance with a partnership or other agreement; provided that no such practice as partners, corporations or in groups or pooling of fees or moneys received or shared, division or apportionment of fees shall be permitted with respect to care and treatment under the workers’ compensation law except as expressly authorized by the workers’ compensation law. Nothing contained in this chapter shall prohibit a medical or dental expense indemnity corporation pursuant to its contract with the subscriber from pro-rationing a medical or dental expense indemnity allowance among two or more professionals in proportion to the services rendered by each such professional at the request of the subscriber, provided that prior to payment thereof such professionals shall submit both to the medical or dental expense indemnity corporation and to the subscriber statements itemizing the services rendered by each such professional and the charges therefor.

1. directly or indirectly offering, giving, soliciting, or receiving or agreeing to receive, any fee or other consideration to or from a third party for the referral of a patient or client or in connection with the performance of professional services;

2. permitting any person to share in the fees for professional services, other than: a partner, employee, associate in a professional firm or corporation, professional subcontractor or consultant authorized to practice the same profession, or a legally authorized trainee practicing under the supervision of a licensed practitioner. This prohibition shall include any arrangement or agreement whereby the amount received in payment for furnishing space, facilities, equipment or personnel services used by a professional licensee constitutes a percentage of, or is otherwise dependent upon, the income or receipts of the licensee from such practice, except as otherwise provided by law with respect to a facility licensed pursuant to Article 28 of the Public Health Law or Article 13 of the Mental Hygiene Law;

: § 29.13 Special provisions for the profession of massage therapy.

a. Unprofessional conduct in the practice of massage therapy shall include all conduct prohibited by Sections 29.1 and 29.2 of this Part, except as provided in this section, and shall also include the following:

1. advertising not in the public interest shall include but not be limited to:

i. using pictures depicting an unclad or undraped human form;

ii. using any proper name under which the licensee is not registered unless it is the name of the establishment, firm, partnership, corporation, or professional limited liability partnership or corporation;

2. nothing in this Part shall be construed to prevent a licensed massage therapist, when advertising his or her practice, from using the letters “LMT” or from identifying areas of practice, such as, but not limited to: shiatsu, acupressure, amma, bodywork, reflexology, Swedish medical massage therapy, polarity, tuina, and connective tissue massage, provided that such identified areas of practice are within the scope of practice of massage therapy as defined in Section 7805 of the Education Law.

3. nothing in this Part shall be construed to prevent the ownership of a firm or corporation practicing massage therapy in this State by an unlicensed person or persons, or to prevent any contractual or employment arrangement between such person or persons and the professional licensee conducting such practice and computing the salary of professional employees, or the amount due the owner of such firm, partnership, or corporation on the basis of a percentage of the receipts from the performance of professional services. This provision shall apply in lieu of Section 29.1(b)(4) of this Part;

4. the provisions of Section 29.1(b)(5) of this Part prohibiting immoral conduct shall apply in the practice of massage therapy. Massage of genital areas and massage of a client who is not properly draped for massage, or by a massage therapist who is not properly dressed, shall be considered immoral conduct;

In conclusion, New York law appears to allow fee-splitting for a massage therapist, while prohibiting fee-splitting for the Title VIII professions which include:, nurse, psychologist, chiropractors, and others (Cohen, 2015).

However, these healthcare providers do not have corporate practice of medicine issues, so it may be possible to structure the agreement between them and the health care facility more directly than the way the arrangement is structured with the physician or professional medical corporation set up (Cohen, 2015).

To determine whether the anti-kickback provisions apply more liberally than to physicians, the healthcare professional will have to look at his or her individual state laws and regulations.  Also note that in some states, the ‘kickback’ issue is separate from an additional but related concern, that of the physician or health care practitioner having a financial interest in an entity to which he or she refers (Cohen, 2015).

 

Fair Debt Collection Practices Act – Ethics & Healthcare

The U.S. Federal Trade Commission states that the Fair Debt Collection Practices Act, also known as FDCPA, “forbids debt collectors from making use of abusive, unfair or deceptive practices” in the process of debt collection. Consumer debts, such as those acquired primarily for family, household, or personal reasons, are covered by the FDCPA.  Since medical debt and healthcare is obtained for personal reasons, it is also subject to the act (Baker, 2018).  The FDCPA controls the conduct of debt collectors, and this includes “anyone who collects a debt” (Baker, 2018), such as a collection agency or any other entity that is pursuing a debt on behalf of another.

As you will find out in this reading, ethical conduct and contact with a debtor is heavily regulated by the FDCPA.  This statute identifies when a debtor may be contacted (day or time of night), where and how the debtor may be contacted (cell phone, work, home phone, answering machines, etc), and what kind of communication is acceptable vs in violation of the statute. Prohibited acts and communication under the FDCPA are quite extensive (Baker, 2018).  The FDCPA also regulates debt collectors and their communication with the individual who owes the debt.

In the health-care industry, a number of patients may be unable to handle their health care medical bill if their insurance claims are denied.

Under the fair debt act, the medical billers must not pester or pressure patients to pay their debts. For cases of similar nature, the medical billing company must be able to schedule the bill and offer the patient a repayment plan that allows the patient to pay the medical bill by installments and more comfortably.

As time passes through the years the Fair Debt Collection Practices Act remains an important legal protection for consumers who are dealing with debt collectors.

The FDCPA was put into law in 1977 to restrain abusive behavior by debt collectors. It covers the activity of anyone who collects debts owed to another party—that means it does not apply directly to the original creditor, but only to 3rd parties working to collect debts on the creditor’s behalf.  Businesses who have debts are exempt from FDCPA coverage, the FDCPA law only protects individuals and families with personal debt, not businesses or even sole proprietorships (Opperman, 2018).

The law has many stipulations on collector behavior to prevent unethical conduct by 3rd parties working to collect debts and to avoid undue harassment.  Here are the following rules debt collectors must follow according to the Provisions of the Fair Debt Collection Practices Act.

  • Collectors may not call before 8:00 a.m. or after 9:00 p.m unless you agree to it.
  • Collectors must stop contacting debtors when requested to in writing.
  • Collectors may not contact debtors at work when they are told (orally or in writing) to stop, that the debtor is not allowed to get calls there.
  • If a debtor has legal representation and has provided notice thereof, the collector may only contact the attorney, not the debtor.
  • Consumers may request debt validation, after which the collector must stop contact until they comply.
  • Collectors cannot lie or use deception to collect a debt.
  • Collectors may not make a consumer’s debt a public matter or without the debtors written consent, discuss the debt with any third parties.
  • Collectors may not threaten legal action they are not actually contemplating.
  • Collectors may not behave in an abusive manner, like using profane language, or calling repeatedly to harass the consumer.
  • Collectors must identify themselves as debt collectors in every communication with the consumer.
  • Collectors must notify the consumer they can dispute the debt.
  • If a collector sues a consumer, they must do so only in the consumer’s local jurisdiction (Opperman, 2018).

You may be thinking, why is this important?  It is important in the field of healthcare and massage therapy because healthcare providers, hospitals, or health organizations may outsource their debt collection practices to a 3rd party.  It is crucial to make sure that 3rd party collector follows these standards so they are not in violation of the Fair Debt Collection Practices Act.

Let’s take a look at a court case of Amanda Summers (Plaintiff) v. Merchants & Medical Credit Corporation (Defendant).

The lawsuit was brought under the Fair Debt Collection Practices Act, and the Michigan Occupational Code, claiming that a medical collections agency engaged in unethical collection practices when speaking with the plaintiff over the phone to collect the debt she owed Hurley Medical Center.

The collections agency worker accused Summers (the Plaintiff) of “lying” and “not being honest” about not working as a massage therapist.  The worker continued to press Summers to loan money from family, “to go the bank and get a credit card”, and additionally threatened legal action, stating,

Collections agency worker to the Plaintiff:  “I am going to have to turn this over to my client’s attorney.  You know what that means don’t you?”

Plaintiff:  “That means you are going to sue me?

Collections agency worker:  “I am going to send this to my clients attorney and they will decide,”

In another call thereafter to the plaintiff, the worker continues to ask if Summers has a credit card to pay off the debt, to which Summers replies that she made a payment agreement with Hurley Medical Center (the original creditor of the debt).  The worker replies that “this is not acceptable.  You pay us and we pay Hurley”.  Summers answers to this stating she has a confirmation number from the medical center (Summers, 2013).

In the conversations to follow on this call, the worker continues to accuse the Plaintiff, Summers, of being deceitful about her occupation, and threatens legal action again unless the Plaintiff calls before 8 PM that night to pay the debt to the collections agency.

Summer’s alleges that as of the date she filed the complaint for the case that she had not received anything in writing from the collections agency, nor had she received any lawsuit regarding this alleged debt (Summers, 2013). 

According to the case, the Michigan Occupational Code largely reflects the prohibitions contained in the FDCPA, which are below.

MCL § 339.915 prohibits:

(a) Communicating with a debtor in a misleading or deceptive manner, such as using the stationery of an attorney or the stationery of a credit bureau unless it is disclosed that it is the collection department of the credit bureau.

(e) Making an inaccurate, misleading, untrue, or deceptive statement or claim in a communication to collect a debt or concealing or not revealing the purpose of a communication when it is made in connection with collecting a debt.

(f) Misrepresenting in a communication with a debtor any of the following:

(i) The legal status of a legal action being taken or threatened.

(n) Using a harassing, oppressive, or abusive method to collect a debt…

(o) Using profane or obscene language.

Plaintiff’s Complaint does not identify which specific sections of the FDCPA or the MOC Defendant allegedly violated. However, from Plaintiff’s response brief, it appears that Plaintiff is alleging violations of §§ 1692d (Harassment or Abuse), 1692e (False or Misleading Representations) and 1693g (Written Notice of Requirement) of the FDCPA and of § 915 (stated above) of the MOC (Summers, 2013).

The key take away from this case is to understand that fake legal threats and calling someone a “liar” can violate the FDCPA, and cause an individual to press charges against the collections agency for harassment.

The Consumer Financial Protection Bureau (CFPB) has oversight of the FDCPA, and the Federal Trade Commission enforces the law. The main way collectors are punished for violating the law is through lawsuits. Consumers can be awarded legal fees and a $1,000 fine from the collector or agency if they can prove in court the FDCPA was violated. That is on top of actual financial damages that may have been caused by illegal collection activity (Opperman, 2018).

The first big amendments to the FDCPA happened in 1986 when lawyers were included in the law as “debt collectors” when they conduct debt collection activities. Ten years later, the official notice collectors are required to send to consumers was amended by Congress, and the law changed to require notification only in the first communication by the creditor to the consumer.

Another notable alteration occurred in 2006, when the FDCPA was changed again to specifically exclude government agencies from the law, including third parties working with the government agencies to collect debts (Opperman, 2018).

While the law remains a key of protection for citizens, it has been 40 years since the laws inception, and the fine for violations remains $1,000.  If there was a new fine accounting for inflation, it should now be well over $4,000 (Opperman, 2018).

Consumer Financial Protection Bureau is now under new management in the year of 2018. The Bureau had previously issued a rule, stating:

“Debt collection continues to be a top source of complaints to the Bureau. The Bureau has also received encouragement from industry to engage in rulemaking to resolve conflicts in case law and address issues of concern under the Fair Debt Collection Practices Act (FDCPA), such as the application of the FDCPA to modern communication technologies under the 40-year-old statute.

“…the Bureau has now decided to issue a proposed rule concerning FDCPA collectors’ communications practices and consumer disclosures. The Bureau intends to follow up separately at a later time about concerns regarding information flows between creditors and FDCPA collectors and about potential rules to govern creditors that collect their own debts (Opperman, 2018).”

One key issue legislatures are concerned with is how the law can reasonably apply to moderate collector communication when it was created prior to the internet. 

These kinds of issues have come up before; the law makes it clear that collectors can’t disclose info about the debt to unauthorized third parties (Opperman, 2018). So, when telephone answering machines became popular, the court had to rule how to interpret the law, which was written before most people had telephone answering machines.

The courts ruled that leaving an audio recording on an answering machine as “communication” by the collectors.  Therefore, collectors couldn’t do anything to violate the FDCPA, since they do not know who is on the receiving end of the messaging system, or to whom the message it is being played too.  More privacy is assumed for individuals carrying cell phones for collectors to use without as much risk for violating the FDCPA (Opperman, 2018).  However, if the collector violates any of the provisions in the FDCPA listed prior, they could have themselves a problem with the law.

Understanding the CFPB & Ethics

The Consumer Financial Protection Bureau (CFPB) was formed during the 2008 financial collapse and began with the mission of focusing on the collection practices of financial institutions and other lenders.  The year of 2014 was when the CFPB finally began analyzing the collection and reporting of medical debt.  Through a research study, the CFPB found out that more than 43 million U.S. citizens have overdue medical debt on their credit reports.  After further analysis, the CFPB began initiating enforcement actions against collectors (Baker, 2018).

We find it crucial to have knowledge in this area because if a healthcare provider outsources debt collection to a third-party collector, and if the collector does not ethically follow applicable laws, you could have a problem.  The Telephone Consumer Protection Act (TCPA), and as we discussed previously, the FDCPA, are two laws that have reined in unethical practices in the area of debt collection. Since, many states have developed similar regulation, as we saw in the previous court case example (Baker, 2018).

Essentially, healthcare providers and their legal counsel should understand and discuss the actual risk and exposure involved, including the penalties for every contact or phone call made in violation of these statutes. Large scale violations could potentially lead to a class action lawsuit, or other actions by the CFPB which could impose a financial burden for the provider (Baker, 2018).

A good working knowledge of both the FDCPA and the TCPA can help prevent violations, and help providers to conduct their healthcare practices ethically, especially when attempting to collect debts from clients/patients.

 

Ethical Business Practices

Apart from all the laws governing medical billing procedure and the standard of medical practice, the healthcare providers must engage in ethical and efficient business practices. The majorities of these requirements has a lot to do with how you conduct yourself with clients and maintaining good and ethical relationships.

Just as people are required to provide excellent services in any industry they operate in, the medical billing industry is as well expected to be carried out following the most excellent and ethical standard. Although the health care provider may be able to manage the process of medical billing personally, it might be better if the organization consider outsourcing that part of their operations top a professional medical biller and coder.

To be able to operate more efficiently in the healthcare industry and also due to the complex laws and regulations that need to be complied during medical billing, it is recommended that the healthcare provider outsource this aspect of their job to expert professionals to be more able to comply with the requirements of the law. This would free them up some time and allow them enough time to take care of their patients more efficiently.

Otherwise, the healthcare providers would waste enormous time to learn and update their knowledge of billing laws and regulation leaving the medical profession to suffer because of divided attention.

Medical billing healthcare administrators usually obtain an advanced degree like an MBA prior to working in healthcare industry while those who are already working in health care industry can get certified by registering for an online MBA program. The knowledge gained through these online programs assist these workers to put when they have learnt into practice and help to minimize the existence of fraud and other related unethical practices in the healthcare industry.

 

The Ethical Aspects of Billing

All healthcare professionals need to operate within a stipulated standard for ethical medical practice. This standard they must comply to includes; relationship with the patient, how they treat their patients inside their office, the health condition and a good quality care. Despite the fact that not complying with these standards is not essentially illegal by themselves, it can result to a litigation action against a provider. If a patient receives substandard care due to their sexual orientation or race, the provider may face litigation if the patient dies or the sickness becomes more serious.

Hospitals and large bodies of healthcare organizations have ethical committees that assist to spell out a specific standard that must be followed. These committees may come together in specific instances to talk about the ethical treatment of patients. These bodies assist to eliminate unethical practices and escalation of lawsuits in the medical industry.

Apart from the medical billing laws that we have explained above, there are other medical billing laws that healthcare professionals must comply with like the discrimination law. There other laws that are also varied depending on the state where the medical facility is located.

You must be careful when handling patient’s medical data. Healthcare providers must avoid being nosey or gossiping with patient’s medical data as this can make them face legal suit even when they engage in minor slip of tongue. As small as that act is, it could impact heavily of the life of the patient consigned. The key here is to avoid doing that which you know by golden rule you would not want it done to you.

OIG (Office of Inspector General) Compliance

The OIG that functions via the DHHS has the duty to ascertain that covered entities comply with the confines of privacy and security laws as stipulated in HIPAA and connected federal healthcare law. One of the major duties connected to the medical billing and coding industry is to prevent fraud occurrence amongst entities covered by the insurance.

You must be watchful as medical billing and coding specialist and avoid engaging in any activity that would be considered a fraud by the OIG.

If the OIG thinks that a health care provider or an insurer’s claim involves fraud, they may carryout audit. The OIG is authorized as the acting party of the DHHS to enforce laws discovered not to be complied with by any covered entity. The medical billing expert must stick to the federal healthcare laws and regulations to stay away from committing an offence that would be punishable by the OIG.

The OIG as well set up compliance recommendations for the health care industry to stick to stay away from fraud.

The National Association of Insurance Commissioners (NAIC) has a list of state insurance departments to which healthcare providers, insurance providers and individuals can report any fraudulent activity.

If you notice the occurrence of medical billing fraud as you work in the industry, you can report it to your local state insurance department or the medical association of your state.

It is considered a felony to engage in fraudulent acts. It can result to either prison sentence or the payment of a large fine.

 

Understanding Healthcare Ethics & Fraud

Health care fraud is an offense that can include falsification of health data, covering up information, or misleading the patient/client or body to receive benefits, or benefit from it financially. Individuals and healthcare providers can be guilty of fraud.

The fraudulent activities they are involved in however may vary. The regulations about health care fraud differ from place to place. However, there are state and federal regulations that are established to minimize the occurrence of fraud and also to penalize those guilty of the offense.

This type of fraud utilizes the health care system by an individual, medical provider, or insurance company in a fraudulent way for personal benefit. Although, healthcare fraud may appear less injurious to others, it negatively impacts on the lives of others. Health care fraud manipulates insurance rates daily increasing the premiums people pay to be able to make up with the losses incurred by insurers. The fraudulent act committed by a healthcare provider can result to the loss of professional license. It may influence the healthcare of their patients.

Health Care Fraud and Abuse

Health care fraud and abuse is regularly regarded as the act of deliberately faking identity, symptoms, or other medical data to increase the money or benefit the provider or individual will gain from the insurance company. Insurance companies in the US lose billions of dollars per annum as a result of this form of health care fraud.

Health care providers can also commit fraud by billing insurance companies for healthcare services they did not render, or medical supplies they did not use or for billing for more complicated service than that which was actually carried out. For instance, a psychiatrist attends to six patients during the day and spent roughly five minutes with each of them as a result of “med checks.” Instead of billing these services for the 15 minutes spent, they billed the services for one hour each necessitating an extra pay from the insurance company of the patients.

The medical fraud against Medicare and Medicaid is widespread and as a result there are federal laws that punish offenders of health care fraud and abuse in addition to state’s law and local trial.

 

Impartiality with Patients/Clients

You must not show any act of partiality in your practice. Giving favorite treatment to a patient or insurance company ought not to influence your decision-making. You must be as impartial as possible. For instance, if your best friend received a service from your work-place and because your friend does not have good insurance cover or cannot pay for treatment, he or she would have to shoulder the majority of the bill. It would be unethical to manipulate the medical code or to ask your biller to do so to receive compensation for the treatment. 

 

Integrity

You must maintain an impeccable integrity as a medical coder. With the patient medical information at your disposal and the task of gathering funds for the health care provider together with the requirement to maintain good customer relations, you must work according to stipulated guidelines and avoid any fraudulent action like stealing, coding treatments that are not offered to patients and many other similar practices.

The biller or coder is also bound by law to report any unethical behavior observed from fellow staff or doctor. Occasionally some patients are addicted to specific prescriptions and may seek out medical services from more than one physician. If you find out a patient in your practice with similar dubious character, you must also report the patient to the doctor immediately for the proper discipline to be given.

 

Respect for patient rights

The medical biller must also treat all the patients what works into their office with respect. Most patients visit the medical health center very helpless. The medical coder must show them respect and treat them with utmost care and kindness as he or she would to any of their loved ones. No matter how difficult a patient proves, they must never let them down or disrespect them.

You must maintain privacy when discussing with patients on issues that consigns them. If you must discuss any issue consigning patients, take them to an isolated place and away from the hearing and view of people around.

If you need to ring a patient or listen to their voice message, you must be conscious to avoid exposing your conversation to a second ear. For instance, you would be into trouble if you phoned a patient to inform him or her that the result of HIV test was positive and discover later that you left the message on a wrong phone number.

Patients as well have the right to demand for specific disclosures of their medical data. A patient who was treated for a health condition some years back can ask for his or her data be concealed as much as possible. If you must reveal any information about a patient’s medical record to outside bodies, you must obtain authorization.

 

Professional reliability

You must be professional when communicating with patients, insurance providers, colleagues, and anyone else you may come in contact with. When talking with the patients in person or over the phone try to remain calm as much as possible and avoid being angry in the midst of aggravations.

Ensure that you account for all the codes are accounted for and that no extra codes are incorporated and that you included all billing details before submitting claims. You must work to the best interest of the healthcare company you work with.

Maintain good relationship with your employer. The medical biller is a part of medical team of a healthcare provider. You must act professionally and ethically because whatever you do wrong affects the whole team.

The doctors take responsibilities of their action and the actions of the staffs working for them. This law is known as vicarious liability or respondent superior.

Doctors must follow rules and regulations consigning ethical behavior to ensure they remain safe. Going against the rule may lead to criticism and loss of your job.

The American Medical Association in 1980 set up a code of ethics known as the Principles of Medical Ethics. Despite the fact that medical billers and coders are not mandated to follow the AMA code of ethics, it will help to use it as a standard.

Medical billing professionals assist health care professionals and insurers to communicate and take care of the costs of treating a patient. Their job is to mainly help doctors receive pay for their services. They ensure that all medical processes are properly reported.

In the US patients hardly ever pay for any healthcare services they receive directly to the doctor. They rather make co-payments and pay insurance premiums from where the insurance companies pay for their healthcare services. As soon as patients walk into a doctor’s office and are treated by the doctor, it starts off a composite billing process which is structured to make sure that all the health care professionals that contribute to looking after the patient’s health are properly credited and compensated.

By standard, the office of your doctor or the hospital you attended begins the procedure by submitting an insurance claim to your health insurance company. If the medical processes stipulated in the claim they make about your care meets the requirement of your insurance policy, your insurance company pays the doctor or hospital straight. However, if the medical procedures are not covered by your insurance plan, you’d be billed directly by the doctor or the hospital.

Although this process appears to be smooth and well-established, in real life, the medical billing staffs take care of gigantic volume of works. Occasionally too, they face the issue of insufficient numbers of staff and a complicating collection of statutes and set of processes they must follow and comply with.

Insurers structure their coverage and payments following a standard known as “necessary procedures”. The necessary procedures are processes considered to be medically essential to boost the patient’s well-being. In addition to providing you with a suitable care, it is also the responsibility of your doctor to provide your insurance company with correct and suitable document.

These set of tasks are not easy to perform, given the fact that every insurance company needs a different type of documentation before they pay the doctor or the hospital. If your doctor did not submit accurate documentation, they may not be remunerated for the services they rendered to you.

Again, if the office of the doctor did not efficiently handle the documentation, it can either delay the payment or result to payment denial.

When you consider that the doctor has to basically follow the procedure for all the patients who walk into his office and into the hospital on a day to day basis, you’d discover that the medical billing process can easily become an uphill task.

To be able to manage the bulk of the work and ensure they get remunerated for all their services, healthcare providers rely on medical billers and coders to set up bills and supply the supporting documents they need to be reimbursed. Thus, the work of billers and coders is to ensure that doctors are appropriately paid and health care processes are followed and correctly reported.

 

For many decades, medical billing was carried out nearly on paper alone. Nevertheless, with the launch of medical practice management software, as well referred to as health information systems, billers are now more easily able to efficiently take care of huge numbers of medical claims. A number of software has been developed by various software companies to offer medical billing software to hospitals and billers to make the task much easier.

Many companies as well provide complete billing solutions through the platform on their websites and this reduces the cost of having to pay for all the certified software packages singularly. As a result of the fast altering conditions stipulated by the U.S. health insurance companies, the major parts of medical billing and medical office administration have necessitated training professions in this specific field. Medical offices staffs may be licensed through many organizations that offer a number of specialized education and in a number of instances obtain a certification credential to show they have acquired such professional position.

Medical billing is the primary mode of payment followed in the United States health care system, with some patients/clients who decide to pay out of pocket.  The payment procedure involves how a healthcare provider ethically and correctly submits and follows up on claims with health insurance companies of their patients to be able to get recompensed for services they offer like medical treatments and medical supplies. The process is the same no matter the insurer and whether it is a public or private insurance company. They are public company when they are sponsored through a government program.

Through medical coding, the diagnosis and treatments are reported and charges are properly applied. It is recommended although not compulsory by law that Medical billers get certified by undertaking the CMRS and RHIA Exams. Certification schools are set up to offer theoretical courses for students who want to choose the medical billing career. A few colleges in the United States provide students with certificates, or associate degrees in medical billing.

Individuals who want to do advanced medical billing course may obtain cross-training in medical coding or transcription or auditing and may be awarded with a bachelor’s or graduate degree in medical information science and technology.

 

Ethical issues in Medical Billing & Coding

Billers and coders have a significant job at hand that comes with responsibility due to the sensitive nature of information they handle on a daily basis, both for the patient and the provider. Maintaining ethical and moral conduct in this position is imperative because the consequences of not doing so are burdensome to say the least.

Here are some common ways we see ethical conduct fall to the wayside in health care practices today, and tips on how you can prevent them in your practice.

 

Coding Out of Bounds

This scenario can be seen when the provider wants to increase their reimbursement rate and sees modifiers for billing and coding as a way to achieve that objective. Modifiers should be used as a tool to “increase specificity” when reporting services rendered. How do you avoid this? Advise your biller to only use modifiers to increase specificity of the treatment, and to leave the code alone if added specificity is not needed. In case of an audit, we can all conclude that it is far better to have precise and accurate records instead of false information that can get you in trouble.

Breaking Patient Confidentiality

Using patient information for any other purpose not related to performing your job function may be seen as a violation of the HIPAA (Health Insurance Portability and Accountability Act). The purpose of this act is to protect the patient’s private information. Actions taken that violate HIPAA can result in hefty fines, lawsuits, or jail. In previous cases, it seems HIPAA violations arise not from harmful intent, but a poor understanding of the law itself (Gerencer, 2017).

Examples of HIPAA violations may involve improper handling of records, illegal access to a patients’ medical record, sharing patient medical information with another party without the patient’s consent, giving a patient’s medical bill to a collection agency without removing medical information that would indicate their diagnosis, texting about personal health information (PHI) of a patient or sharing of this information on social media.

In one HIPAA case example, a doctor frequently forwarded over due patient bills to a collections agency. The primary issue in his case was that the bills contained protected information, such as CPT codes, which indicate a patient’s diagnosis. In conclusion, the doctor’s state of practice sought to suspend and revoke his license (Gerencer, 2017).

 

Medical Billing Guidelines

As the world is becoming more and more complex and the economy is becoming tightened up, the business aspects of the medical industry can sometimes take priority over the proper treatment of a medical condition for estimating whether or not a medical practice is sustainable or not.

One of the most difficult obstacles for medical professionals is hardly ever the care of the patient. Rather a number of doctors and hospitals are much more concerned about the business part of the services they render to their patients. This particularly consigns the medical billing processes and coding.

Again, due to the fact that medical practices is very much interconnected with the health of individuals, individual risks and comfort, the medical industry and billing procedures must follow stipulated legal and ethical standards which must evolve or come with a structure that ensures that the rights of the individual patients are respected.

This implies that all healthcare practitioners must act with competence and meet the ethical standard. They must also show their integrity through their conducts and activities.

 The medical billing procedure involves the relationship between a health care provider and the insurance company who pays the medical personal for services rendered. The whole interaction is referred to as the billing cycle and is occasionally known as Revenue Cycle Management. Revenue Cycle Management involves managing claims, payment and billing of claims.  The billing cycle can last for many months and needs to pass through many interactions before it is finally decided upon. The health care provider relates to the insurance company as a vendor or a subcontractor.

Insurers usually contract health care providers to offer health care services. The relationship starts as soon as a patient visits their office. The doctor or a staff of the hospital basically set-up or update the medical record of the patient.

After the patients’ visit to a doctor, they’d be designated with a diagnosis and treatment codes. The codes help the insurance company to establish coverage and whether the services are essential medically. Immediately after the designation of the procedure and diagnosis codes, the medical biller transfers the claim to the insurance company or the payer. The transfer is done online and the claim is formatted as an ANSI 837 file and submitted through Electronic Data Interchange straight to the payer or through a clearinghouse.

The insurer or payer sends the claim to medical claims examiners or medical claims adjusters to process. For claims involving a huge sum of money, the insurers get medical directors to examine the claims and estimate if the claims were valid or not with the use of processes that ensure eligibility of the patient, the credentials of the physician and the medical necessity of the procedure.

If claims are approved, they are paid for a specific percentage of the services that are billed. The rate to be paid to the health care provider is usually pre-structured and arranged between the health care provider and the insurer. If the claims fail and are either denied or rejected, the notice is normally sent to provider in the form of Explanation of Benefits (EOB) or Electronic Remittance Advice.

Once received, the provider ought to interpret the message, correct the original claims and submit it back. This procedure of exchanging claims and denials may be carried out for many occasions till the full claim are paid or the provider decides to accept the partial payment.

A “denied” claim is different from a “rejected” claim, despite the fact that the two are commonly used interchangeably. A denied claim is a processed claim that the insurer deems non-payable. You can commonly correct a denied claim or appeal for the decision. Insurers commonly state why their claims are denied and how you can argue the decisions. A rejected claim is one that was not processed by the insurer because of serious mistake in the submitted data. While there could be any number of reasons a claim gets denied, two are worth mentioning. 

These two are called up-coding and under-coding.  Both are considered fraudulent practices.

Up-coding occurs when the provider exaggerates or misrepresents the services they performed on a patient.  This could be coding for services the patient/client did not receive, or entering the code for services more extensive than what the provider performed, and would get paid more money for by insurance (Potential, 2018).

Under-coding on the other hand is when a provider intentionally leaves out information or codes for less involved procedures than what the patient was given.  This may be done so a provider can avoid an audit for certain therapies or procedures, but is nevertheless still illegal and fraudulent (Potential, 2018).

The standard reason for rejecting a claim is when the personal data is not correct like when there is a mismatch in the name and identification number. It can as well occur if there is a mistake in the data supplied like truncated procedure code, invalid diagnosis codes, and related mistakes. You cannot appeal for a rejected claim because it has not been decided upon. Rather, you need to research it, correct it and send it back.

The medical coding process is usually not carried out by an individual. It is commonly done by front office managers like receptionists together with back office staff like the medical biller and coder. It is, thus, significant to have a thorough knowledge of the entire steps required for the procedure if you want to work as medical biller and coder.

The main job undertaken by medical billers are:

  1. To ascertain the responsibility of every individual to be paid. This is necessary because payment may vary from individual to individual.
  2. To estimate and investigate insurance cover and medical bills and organize suitable billing forms
  3. Gather accurate payments from insurance plans and/or single patients

These three primary tasks need a lot of special tasks in the medical billing process. In the ensuing part of this guide, we have broken these tasks into a succession of steps that start with the patient scheduling an appointment and when the payment is made by the insurance company and or the patient.

Steps involved in medical billing process

Patient Check-in

The medical billing process commences in the office of a medical doctor. The first process is initiated when a patient pays a visit to his or her visit. The receptionist of the hospital takes care of the preregistration.

When a patient books an appointment, he or she is assigned with a time slot. If it is the first time the patient is visiting the hospital, the data of the patient is usually collected at the front desk. The data commonly include things like the patient’s name, address, birth date, and intention for visiting the health care provider.

The front office needs to as well obtain the patient’s insurance information which must include the name of the insurance company, and the insurance policy number of the individual. The medical biller would make use of these set of collected data to initiate a file for the patient that should be stored in a secure and confidential area.  This file is usually accessed during the billing process.

Initiating and updating a patient’s medical files regularly makes the billing process faster and makes the check-in of the patient simpler and more efficacious. It as well reduces the possibility of erroneous reports and registration setbacks like the patient not remembering to come to the appointment with their insurance information.

 

Establishing Financial Responsibility

As soon as the patient data has been obtained or updated, the office of the doctor determines who is responsible for paying for the medical services that they’d provide during the appointment. Insurance coverage varies significantly from one insurer to the other and from one insurance plan to the other. For this reason, the first thing the health care provider or the billing professional will do is to become familiar with what the patient’s insurance cover stands for.

With the insurance data supplied by the patient in addition to the insurance policy number, the doctor’s office will be able to establish which medical services are covered by the parent’s present insurance policy and the type of medical diagnoses required by the insurance company to be able to process such payments.

For an example, an insurance policy may provide coverage for specific form of blood work. However, the coverage is only effective if the healthcare provider makes a certain type of diagnoses like hypercholesterolemia. Again, to manipulate this kind of information and submit it to insurance companies would be considered fraudulent activity.  The doctor’s office must as well establish which medical services are clearly not covered by the patient’s insurance policy explicitly not covered under the patient’s insurance policy. The knowledge of this is essential to ensure that the health providers get paid for their services. If a patient wants to see the doctor for a medical service that is not covered by their insurance police, the doctor’s office should be able to inform the patient that he’d be responsible for the payment and is supposed to pay before the service is offered.

Insurers may as well need the physicians to follow specific billing processes. Thus, the office of the physician must as well verify from the insurer which particular billing process they follow. They must as well keep to those specific billing requirements. Some insurance companies may require prior approval of all services rendered before billing them. If a service is previously authorized before the patient books appointment with the doctor, everything will proceed efficiently for all parties involved including the patient, insurer and the health care provider.

After contacting the insurer and meeting all the requirements, the health care provider will explain the billing process to the patient and inform the patient of the services that are not covered by the insurance policy. Such services would be paid from the patients’ pocket.

Getting all the parties involved to understand and consent to their financial responsibility makes the medical billing process an easy one from hassles. In the same way if the patient’s insurance plan comes with a copayment requirement, the patient would be told the amount to pay from his or her pocket. A number of health care providers require the patient to pay for the copayment prior to receiving any medical service.

 

Patient Check-Out

Any time a health care provider renders a service to a patient, it is accounted for in the patient’s medical record. It is significant that every care related service rendered to the patient is recorded to help the office prepare a correct medical bill, maintain accurate records in case of an audit, and to forward to the insurers or to the patients.

To make it easy to bill a patient’s visit to the doctor, medical coders convert all diagnoses and medical processes offered during the visit into a collection of medical codes that serve as a general language used in the healthcare industry. These codes make recording of medical services more efficient and make sure that these services are correctly interpreted by both the health care providers and insurers.

As soon as the medical coder established the patient’s diagnosis and the offered medical services and put these into medical codes with the use of the ICD and CPT, the medical bill can be pulled together. This operation for the visit together with bills and payments made by the patient is known as the patient ledger.

The ledger is prepared by the medical biller and includes the estimation of the balance to be paid by the patient merging the fresh charge with the previous balance and deducting the payments already made out of the total amount. It can be payment made by the patient’s insurance company or the patient himself or herself. The remaining amount stands as the patient’s current balance. After this, the patient can then check out.

 

Ethical Coding and Billing Compliance

Prior to recording a bill and sending it officially to the insurer or the payer, it ought to fulfill specific official conditions. These conditions vary for coding and billing processes and also for insurance providers and the services/treatment given to the patient. For instance, the billing procedure must meet the requirement set out in the Health Insurance Portability and Accountability Act (HIPAA), and the Office of Inspector General (OIG).

As a standard, complying with the required guidelines in medical billing involves partly ensuring that the charges are correct. The medical biller ought to verify that every charge is connected to a particular treatment code. Various health care providers have various charges and fees for their medical services. Thus, charges need to be equivalent to the standard established by the specific medical practice like the office of the doctor. Various medical practices commonly have their standard fees scheduled in a typical fee plan.

The medical biller needs to as well verify that all the codes can be billed. It is the insurers that determine which code that is billable and the one that is not. Every insurance company has a collection of rules that establish the services that are billable and hose that are not billable given the insurance plan of the patient. It is essential that the medical biller comply with these requirements stipulated by the insurer to avoid denial.

If the medical biller sends to the insurer a bill for the services that are not covered, it would be denied and sent back to the doctor’s office for corrections to be made. When a claim is denied, it amounts to a waste of time and resources and makes things difficult for all the parties involved.

 

Submitting Accurate and Ethical Claims

As soon as all diagnoses and medical processes have been recorded, coded, and examined to ensure that it meets the requirement, the bill should be posted to the insurer for consideration. This is a very critical step that must be accomplished during the medical billing process. The insurance claim offers to the insurer a significant data regarding the diagnosis, treatment methods, and the bills incurred by the patient. A correct and accelerated insurance claim makes it easier for the health care provider to be reimbursed for the services he or she provides to the patient as soon as possible. It also let the patients know where he stands with regards to the payment of his medical bills.

Most healthcare providers processes claim and send them off through electronic means. This is the most effective and suitable way to send the insurance claims for processing. It also saves money to the health industry much more than when the submissions are done through a printed paper.

The main reasons for switching from ICD-9-CM to ICD-10 is because the new code is more adaptable and can easily be used through electronic means. Electronic billing minimizes the quantity of manual work that the biller needs to carry out. Due to the fact that it includes lesser amount of manual communications, electronic billing is more proficient, comes with lesser number of mistakes and eventually results to a boost in the number of correct claims submissions to insurers.

A number of health institutions and insurers make use of different types of software to forward and receive insurance claims. It is significant for the medical biller to be conversant with the types of software used in his organization. Although, the use of digital billing makes the process faster, easier, and more error free, you can make a mistake if you don’t know how to use the software. Although some forms of insurance claim software routinely flags when you make any mistake, proper knowledge of the use of the software would save some time and money for all involved.

The submission of paper and electronic insurance claims can be carried out in some ways. Basically, the doctor or the doctor’s office forwards an insurance claim to the insurer with the use of a clearinghouse. A clearinghouse is a private, third-party company that works as an intermediary between healthcare providers and insurers. Clearing houses are commonly used for electronic billing. The clearing house commonly receive insurance claims from the healthcare provider, format the claim to meet the conditions set out by the insurer and submit the claim to the insurance company.

If the claim is to be sent to a high-volume insurer like Medicaid, the clearing house is not used. Rather the claim is submitted straight to the insurer. In addition, insurance companies like private payers, Medicare, or TRICARE all set up a lot of different requirements to be met during the submission process of the claim. Given the fact that a clearinghouse is not constantly used to configure claims properly, it is essential to know what the conditions are set up by these different insurance providers and be capable of submitting the correct claim that meets with the requirements directly.

Please keep in mind that all healthcare providers involved with insurance company have an ethical duty to report accurately.  To defraud the Federal Government and its programs is an illegal activity.  In the case of Medicare for example, this includes the following activities:

  • Billing Medicare for appointments the patient failed to keep
  • Knowingly billing for services at a level of complexity higher than services actually provided or documented in the file
  • Knowingly billing for services not furnished, supplies not provided, or both, including falsifying records to show delivery of such items
  • Paying for referrals of Federal health care program beneficiaries (CMS, 2017)

 

Receiving Payment from Insurers or payers

When the clearing house or the healthcare provider sends the insurance claim to the payer or insure, it is evaluated through a process known as adjudication. During adjudication, the insurer passes a claim through many steps, taking many factors into consideration to be able to evaluate the bill. The insurer will establish if the whole bill is payable, a part of the bill, or if the bill should be denied straight away. The amount of money the insurer pays depends of the insurance policy of the patient and its contract with the healthcare provider.

After the insurance claim has gone through adjudication, the resolution reached whether full payment, partial payment or none payment is sent back to the doctor’s office in the form of a report. If the insurer is not covering the whole bill, the first thing the medical biller will do is establish whether or not more than one insurer is covering the patient. If the patient is covered by additional insurance plans, the medical biller forwards a claim for the outstanding bill to the second payer.

The next key step for the medical biller is to establish the charges and fees coincidence between healthcare provider and insurance company. It is uncommon that fees for the parties correspond completely. In addition, the amount paid back to the healthcare provider is based on the contract with each insurer. Medical billers estimate the payment made by the insurer to prove many factors.

The first thing the medical biller would verify is to see if all the processes enumerated on the insurance claim sent by the doctor’s office as well appear on the statement received from the insurance company. In the same way, all codes in the claim also supposed to be the same with the transaction of the insurer. If the codes for the processes are equivalent, the medical biller scrutinizes the payments for ever medical procedure. Each payment ought to match with the contract between the doctor’s office and the payer. If the insurer decides not to pay for specific procedures, those unpaid charges ought to be clarified completely on one report.

If there is any inconsistencies in the transaction, the healthcare provider need to include that in an appeal process. This procedure includes various rules and regulations. It varies from state to state depending on the insurance contract. Overall, it is significant that the doctor’s office receives the greatest suitable payment following the agreement reached by the doctor’s office and the insurer.

 

Billing Patients

If the treatments and codes specified in the bill of the insurer is similar with the one sent by the doctor’s office, all charges match up with the financial contract reached by the both parties, and the doctor’s office has obtained suitable payments for the services they provided, the payments are reflected in the patient’s account.

In situations where the insurer did not provide cover to some or any service provided, and some of the bill is not paid for, these unpaid charges becomes the responsibility of the patient. The medical biller need to certify that the amount paid by the insurer together with the amount billed to the patient, is equivalent to the anticipated cost of the whole medical services offered.

When the healthcare provider bills the patient directly, it is essential to include in the bill all data about the whole transaction. Also, the medical biller needs to confirm that the patient bill list all the service the patient received from the healthcare provider. It must as well contain the date those services were offered to the patient, the payments made by the insurer subtracted from the whole bill, and the extra balance that the patient supposed to pay.

The doctor’s office needs to make this information correct and clearly specified to help their patient know what he or she needs to pay. This would greatly eliminate any possible difficulty that may hamper him from being paid by the patient.

 

Accepting Payment

When the doctor’s office sends the bill for the extra balance remaining from the cost of services rendered to the patient, it would usually come with the date the patient is supposed to pay on the bill. As soon as the patient pays the bill, the payment info is recorded on the patient’s record to show that the doctor has been paid for all the services rendered to the patient. This brings the transaction to a close.

If the patient did not pay up by the scheduled date, the doctor’s office must follow up and ensure they collect their pay from the patient. If a patient is unable to pay till a specific time period, the health care provider must start a collection process to collect what the patient owes the hospital. The length of time it would take before the healthcare provider initiates a payment action against the patient depends on the hospital and their financial institution.

Prior to starting a collections process for medical debts, its important to refresh yourself on the laws and rules concerning this.  Please re-visit the section above regarding the FDCPA Act about this topic.

 

Concluding the medical billing process

Starting from the time the healthcare provider checks the patient in till the time the patient’s entire bill is paid up by the patient or the insurer, the medical billing process requires adequate knowledge of the profession and compliance with the ethics of the law. The use of technology in modern day has made the process easier and faster to accomplish. In spite of this, to be able to carry out the process effectively, you need to be aware of what the rules are and be able to spot any possible mistake that can land you into trouble. Obtaining more knowledge about the financial policies, insurance policies and billing laws you need to comply to in addition to proper coding language and good relationship with the patient, you’d be able to improve the operation of things in the health care industry as a medical biller or coder.

 

Understanding Ethics & The Medical Claims Process

The health care system in the United States has been shown to be lucrative industry and vital sector of the economy. It encompasses the different sections of the health industry including the pharmacy stores, pharmaceutical companies, producers of medical equipment, medical insurance companies, healthcare providers of all types, and those involved in the construction of medical care facilities.

The multifaceted infrastructure used in the industry that ensures the health and safety of millions of patients’ day by day depends on the ability of the professionals to work effectively within their specific fields to ensure the operation of things moves smoothly and hitch-free. One of the procedures that ensures smooth running of things in the industry is the medical claims process. The process involved in medical billing is intense and complicated but it is nevertheless an essential part of the healthcare industry.

The medical claim process is a two-way interaction between two of the biggest and most significant part of the healthcare system: the healthcare providers and medical insurance companies.

Parties in the Medical Claims Process

It is vital to understand what connection exists between the holders of insurance police, the healthcare providers and insures to be able to understand very well how the medical billing and coding process works.  As we learned in previous sections on ethics laws and regulations regarding healthcare, this is one of the interactions where healthcare fraud can occur.

Healthcare providers

A Healthcare provider in this context is any facility or practice that offers service related to health and bills the individual or insurance company for the service rendered. 

Health care providers include the hospitals, complementary and alternative medicine providers, private physician offices, pharmacies, nursing homes, chiropractors, physical therapists, in-home nurses, and others.

Insurance companies

Health insurance companies pay subsidies on the medical bill of their insurance policy holders depending on the particular plan they are holding. While at one point it was not required to have health insurance in the United States, this has since changed.  Previously, the majority of individuals had private health coverage or received it as a part of their occupation. There are different types of insurance policy. By 2014, citizens and legal residents of the United States were now required to have a basic health insurance coverage plan.  Those without coverage were subject to a penalty (Goguen, 2015).

An insurance policyholder would commonly pay a specific sum of money every month or year to the insurance company and this amount paid is usually referred to as insurance premium. If the account holder goes for a medical treatment which is covered under his or her insurance policy, the bill is handled by the insurance company; otherwise, the patient takes care of the bill directly. The bill may also be shared in part between the account holder and the insurance company.

While health care providers and insurance billers can be held liable of fraud, so can insurance companies. Insurance fraud happens when an insurance company, agent, adjuster, or consumer commits an intentional act of deception in order to obtain an unlawful gain (NAIC, 2017). An example of this is a legitimate insurance company, not licensed in that state to sell insurance, leading customers to think they are selling “insurance” while evading state insurance regulations (NAIC, 2017).

It may occur during the process of buying, selling, using, or underwriting insurance (NAIC, 2017). Fraud is constantly changing and affects all varieties of insurance, but the most common in terms of frequency and average cost are in the automobile industry and tend to be most affected by fraud.

On the other hand, the general public can also be held liable for insurance fraud. Examples include the attempt to stage and injury, theft, car accident, or any type of loss that would be covered by an insurance company (NAIC, 2017).

 

Policyholders

A policyholder is a person who bought the health insurance. For instance, an adult who wants a standard insurance plan may buy an insurance policy that would cover all his or her medical bills with cost above the deductible. The deductible is a fixed sum of money that the policyholder needs to pay from his or her personal pocket before insurance company payments kick in to pay the rest.

 

Understanding the Medical Claims Operation

The process of medical claims starts as soon as an insurance policy holder visits a health care provider for any service which may be minor like recurring monthly subscription or major health issues like surgical procedures.

As soon as the policyholder finishes receiving treatment from the health care provider, he or she pays the deductible to the healthcare provider and submits his or her insurance data to the hospital. As soon as the policy holder pays the deductible and submits the insurance info to the health facility, his or her business with them finishes while the healthcare provider commence the process of obtaining the rest balance from the patient’s insurer.

The healthcare provider would submit the records of the entire medical services they rendered to the patient and their associated costs. The record is what is referred to as medical claim, or bill. The job of medical billing is frequently undertaken by medical billers who are frequently employed by the health care provider solely for the purpose of obtaining their medical claims. The medical billers and coders commonly create patient’s medical records and forward the claim to the insurer of their patient who is a policyholder’s insurance company. The insurers can do one of the following on receiving the claims:

  • They can either take responsibility for all the billed amount
  • Deny the medical claim if there is any error on the claim like discrepancies on the patient’s information. In this situation, the bill is normally sent back to the healthcare provider for corrections to be made.
  • The insurance company can as well straight away reject the claim. This situation usually applies if the services provided to the patient are not covered by the patient’s insurance policy. If this is the case, the patient must pay the medical bill from his or her pocket.

 There are two key different types of insurance providers that the healthcare providers have to deal with. These are managed care plans and public insurance.

 

Managed care

A huge section of insured U.S. citizens have their insurance coverage provided for by their employer, typically via managed care insurance plans. These insurance plans are accepted by particular group of doctors, hospitals, pharmacies, labs, medical equipment sellers and other healthcare providers. People who have managed care insurance plans must access their medical care within their managed care network. There are three major parts of managed care. These include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point of service plans.

 

HMOs or Health Maintenance Organization

These set of insurers need their insurance policyholders to receive the large number of or their entire medical care under the insurers managed care network. The policyholders also need to choose a specific primary care doctor. If HMO policyholders receive a service from a health specialist outside the referral of their primary care physician or receive medical treatment outside of the managed care network, the medical bill will not be covered by the insurance company. Such a patient has to pay the bill from his or her personal pocket.

 

PPOs or Preferred Provider Organization

These insurers as well have a network of healthcare providers they work with. Their policy holders must access care from all the healthcare providers in this network for the insurer to cover their medical bill. The difference between PPOs and HMOs is that their policy holders don’t need to choose a specific doctor as their primary care provider.  PPOs typically enable more mobility for the patient to see a variety of healthcare specialists, incase their health situation warrants it. Again, as opposed to the HMOs, if a policyholder receives medical treatment outside of the managed care network, they can directly cover the bill and subsequently request for a re-imbursement from their insurer.

 

Point-of-service Plans

Point-of-service insurance plan is an amalgamation of the PPOs and HMOs. Just like HMOs, point-of-service plans give their holders right to choose physicians and medical services of their choice in so far as they are within a dedicated network of providers.

As opposed to HMOs, policy holders can receive medical treatment from network providers outside the insurer’s network of healthcare providers. However, they must pay a specific amount as deductibles.

The processes involved in making insurance claims vary among HMOs and PPOs. The entire healthcare providers in a managed care network need to file a claim with the HMO. In so far as the patients receive the service within the network, the policyholders don’t need to file a claim to their insurance company themselves.

The healthcare providers may also not provide a direct bill to the policyholder. For PPOs, policyholders need to file a claim to their insurance provider if they want to receive treatment outside the managed care network. For POS insurance plans, it is not necessary to file insurance claims.

 

Public insurance coverage

The government is another key insurance provider in the US. The government does this through public insurance plans like the Medicaid and Medicare.

Medicaid

Medicaid is a health insurance service plan structured for the sake of low-income earners and the members of their families. Individual who are under Medicaid programs are provided with the amount of cover that is stipulated by their state. Although, some coverage are mandated by the federal government like inpatient and outpatient hospital care, in a Medicaid plan the states pays the hospital bill either on a fee-for-service system or via an arrangements with HMOs.

Medicare

Medicare is also an insurance program that is funded by the government. It is mainly for the needs of the elderly. Just like Medicaid, a certain amount of medical services are paid for any patient who is under this insurance plan like services received while under hospital stay and nursing care. This standard cover is referred to as Medicare Part A. Receivers of this insurance cover may as well be covered in Medicare Part B, as well referred to as Supplementary Medicare, for services like medical equipment, x-rays and labs, and outpatient visit to the hospital. Receivers of Medicare Part B need to pay a monthly premium together with annual deductible. There are also Medicare Advantage plans that allow users to set up customized plans that meet their particular needs.

 

References

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(2016). Code of Ethics

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(2014) A Nurses guide to professional boundaries.

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Federal Register.  January 25, 2013.  Department of Health and Human Services, Office of the Secretary.

Stryker, C.  (2013) Two Essentials for HIPAA Omnibus Final Rule Compliance.  Physicians Practice

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Jessica De Bord, DDS MSD MA, Wylie Burke, MD PhD, & Denise M. Dudzinski, PhD MTS (2013).  Confidentiality – Ethics in Medicine.  University of Washington School of Medicine.

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Sports Injuries Lesson

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Sports Injuries

What is an Injury?

An injury is an act that hurts or damages the body. Generally, it refers to damage caused by falls, weapons, hits, accidents, and more. Every year, millions of people injure themselves in the U.S.

How Injuries occur

Injuries can occur at play or work, walking across the street, outdoors or indoors, or driving a car. There are different types of injuries, and all of them range from minor to life-threatening.

Types of Injuries

Some of the common types of injuries are:

  • Burns
  • Wounds
  • Animal Bites
  • Fractures
  • Dislocations
  • Bruises
  • Electrical injuries
  • Sprains and strains

Sports Injuries

What are Sports Injuries?

Sports injuries refer to the types of injury that occur during exercise, athletic activities or sports. Direct impact, overuse commonly cause these injuries or if the force, greater than the part of the body can withstand structurally is applied. In the United States, about 30 million children and teenagers are those who participate in sports. Out of these 30 million, 3 million participants are of 14 years of age and experience sports injuries annually.

  • Classification of Sports Injuries
  • Sports injuries are classified into two main types:
  • Acute sports injuries
  • Chronic sports injuries
  • Acute sports injuries

Acute sports injuries occur all of a sudden, like a sprained ankle due to an awkward landing.

Chronic sports injuries

Mainly, the chronic sports injuries commonly occur from the repeated overuse of joints or muscle groups. The poor technique and structural abnormalities can also cause these injuries to develop. It is essential to know if a client has a current sports injury before beginning a session.  Sometimes more complicated injuries, such as a bone fracture, may mimic a simple ankle sprain.  If a client complains of pain in a particular area from a sports-related injury, a referral to a specialist in that area may be most appropriate for the client to get medically evaluated. 

Types of Sports injuries

Some of the common types of sports injuries are as follows:

  • Hip flexor strain
  • ACL tear
  • Concussion
  • Groin pull
  • Shin splints
  • Sciatica
  • Hamstring strain
  • Tennis or golfer’s elbow
  • Shoulder injury
  • Patellofemoral syndrome
  • Ankle Sprain
  • Athlete’s foot
  • Bursitis
  • Fractures
  • Cramping muscles
  • Delayed onset muscle soreness
  • Frozen shoulder
  • Iliopsoas syndrome
  • Impingement syndrome
  • Iliotibial band syndrome
  • Overstraining syndrome
  • Overuse syndrome
  • Plantar fasciitis
  • Soft tissue injuries
  • Dehydration
  • Nosebleed
  • Achilles Tendon Injury
  • Turf toe
  • Tommy John’s Surgery
  • Posterior Cruciate ligament injury
  • Skier’s Thumb
  • Meniscus Tear injury

Now we will discuss all types of sports injuries one by one along with their introduction, signs and symptoms, diagnostic approaches, treatments and preventive measures.

Shin Splints – Symptoms

Medial Tibial syndrome symptoms: the symptoms for the most common type of shin splint, the medial tibial stress syndrome includes pain in the lower tibia during or at the beginning of a workout.  Repetitive and intermittent pain, gradually growing pain, severe pain in the morning which decreases through the day, palpations, swelling, bumps, tenderness, lumps and new bone growth in the shin area. Physical symptoms may also include redness, inflammation and repeated trauma.

Compartment Syndrome:

  • Muscle enlargement
  • Increased pressure
  • Increased pain
  • Pain due to movement
  • Discomfort with exercising
  • Little or No tenderness

Stress fracture symptoms:

  • Most symptoms of Medial tibial stress syndrome
  • Sharp pain
  • Increasing pain during exercising
  • Excessive tenderness of muscles

Complications in Treatment and diagnosis of Shin Splints

Since it’s difficult to diagnose the shin splints and the right kind, it can lead to underestimation by the doctor and the patient which can worsen the condition.

In most cases, the complication of severe muscular dysfunction can emerge in situations of shin splints, which are often left unnoticed. Cases of shin splints can also be misunderstood as the tissue fatigue and vice versa. The problem is often generalized as common muscular pain.

Causes of Shin Splints

This particular problem can occur due to many reasons. The most common causes of shin splints include:

  • Running on hard surfaces
  • Using the wrong sized and fitted footwear
  • Sudden exertion and workout without stretching warming up
  • The weakness of muscles, bones, hips, and ankles
  • Overpronation due to flat feet
  • Intense and longer workouts
  • The reduced endurance of pressure due to inactivity.
  • Stress fracture and lesion on the shin bone
  • Over supination due to foot displacement
  • Training rigorously without a gradual increase
  • Lack of flexibility

Risk Factors of Shin Splints

The most important risk factor associated with shin splints is excessive physical stress due to a variety of reasons. Apart from that, there may be other risks involved, such as tissue overloading, biomechanical problems, history, anatomical and posture issues, and tissue fatigue.

Diagnosis of Shin Splints

The diagnosis for Shin splints is relatively tricky since sometimes injury is extremely severe and difficult to treat. Things can get very complicated, and the condition can become extremely persistent. Nonetheless, the primary diagnosis includes a physical examination where the patient is examined for any apparent symptoms of pain and swelling. The doctor may also carefully determine by moving the shin and knee joint in different positions to see if the movement is limited and painful. Numbness is also considered to be one of the initial indications. Once the physical examination and the medical history evaluation is done, the doctor will see for the scope of diagnostic tests. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound will help the doctor to locate and study the internal structures to see any possible damage.

Treatment for Shin Splints

There are different approaches to the treatment of shin splints. The best way to treat this condition is the natural recovery. It should be assisted by resting your legs more and walking less. After the diagnosis, the natural treatment can be helped in the following ways:

  • RICE therapy
  • Anti-inflammatory medication
  • Using accessories in the shoes or supporting shoes.

RICE therapy is a widespread treatment plan for most of the sports injuries that involve pain and swelling. It is followed in the long run after the first aid response at the time of the injury. Shin splints can include pain and swell apart from other symptoms in almost all cases. These are adequately addressed by using ice on the injured area, compressing it with the help of a bandage, and resting the injured area as much as possible.

The treatment options for shin splints may vary from person to person depending on the type of injury and the severity of each case. In most cases, shin splints can heal naturally. If the problem persists, you may visit a doctor who will carry out a physical examination of the condition. In some cases, the doctor may ask you to walk or run to witness the problem. The first thing that you must ensure is to get enough time to rest as your body needs a break to recover. This involves a whole body rest so that your body can focus on healing the injury instead of spending your energy on other activities.

Using ice on the injured area can also help soothe the pain and reduce the swelling in the case of shin splints. Patients are usually advised to continue to do so for a few days several times during a day for 30 minutes. Once the pain has subsided, they can cease the icing protocol.

Treatment for shin splints may also involve aids and insoles for shoes as it allows to reduce pressure on the injured area and put your legs on the right position. The insoles may be made upon request depending on each case. Otherwise, you can buy the default styles from the market.

Medication is also helpful in case of shin splints as it can alleviate pain and reduce swelling. For shin splints, you should use regular OTCs and NSAIDs that are prescribed by your doctor. Unless it’s necessary, you should avoid taking steroid drugs. Due to the side effects. Naproxen and Aspirins work best for these injuries. It’s also important to understand the specific side effects of these medicines and ways to handle them. Some of them may cause ulcers and bleeding. Therefore, you should use them in moderation, and you must take a prescription from a specialist before making them.

Shin splint injuries can be related to the muscles or the bones. Your treatment will also follow depending upon the type of structures that are injured. In case multiple structures as damaged your treatment may take a compound approach. Careful diagnosis and physical examination will tell the cause.

In case of muscle injuries, a standard approach to treatment is the use of foam rollers. Foam rolls consist of soft foam material that can massage and soothe the injured muscles, including fascia. You should use a foam roller multiple times during the day for 10 minutes at least on the shin and thigh. It can relax the fascia muscle and help loosen it. Apart from foam roll, you can also get a had massage on your shin and thigh area gently. It’s recommended to consult an expert regarding a hand massage since you don’t want to cause any damage to the injured area. It can relax the legs as well as feet, allowing better blood flow. As a result, the movement of your injured area can also be improved. If the problem persists after these treatments, it is best to see a doctor regarding your situation. In the case of bone-related injuries, you may experience stress fractures. The treatment for such bone injuries involves active rest as well as isolation of the injured area. This should be followed by injury friendly exercises that don’t involve using legs too much.

The shoes can use insoles and accessories to the shelf and absorb the shocks of walking and standing. The purpose of treatment is to alleviate the symptoms of inflammation and pain, improving the posture and biomechanical issues, and restoration of the muscles. The rehabilitation therapy can take up to 3 months. Exercising, taping and shin massages are effective ways to treat shin splints. In very severe and rare cases, surgery may be required for the problem of shin splints.

Recovery from Shin Splints

Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. Recovery time varies significantly from patient to patient depending on the severity of the condition, the strength of the injured area and other factors. For effective recovery, you should get back to the normal routine activities slowly and gradually according to your doctor’s advice. Once you start using your muscles and bones again, it will complement the complete healing of the injured parts. If the patient were healthy before the injury, the recovery would usually be faster. However, due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the injury can take from a few weeks to 6 months of time to recover.

Here is what you can do to ensure speedy recovery:

  • Rest day and night
  • Avoid demanding everyday physical activities
  • Gradually start easy activities
  • Only use prescribed medication
  • Eat healthy as it speeds up the recovery
  • Visit your doctor for a checkup of tibia cracks
  • Once you are fully recovered from shin splints, you will notice that :
  • Both your legs are equally flexible
  • Both your legs are equally strong
  • You don’t feel pain upon compression
  • You can run, walk, and jump painlessly.

Sciatica

What is Sciatica?

Sciatica is a common medical condition that results from sports injuries. The condition is characterized by severe and persistent pain in the back, hip and the leg areas which spreads along the way. The most common causes for this pain is pressure and compression on the sciatic nerve which is a primary part of the spinal nerve root in the lower back. This condition can lead to deterioration of the nerve and degeneration of the intervertebral disc. 

Sciatica is a painful condition specifically associated with the sciatic nerve caused due to irritation of the nerve. This nerve is the largest one that is found in the human body, and also extremely important. One of the main physical characteristics of this nerve is the range of its coverage in our body. Sciatic nerve starts from the nerve roots of the spine located near the tailbone, and it’s spread towards the hip and extends down towards the lower part of the legs. This is why the inflammation and pain in the sciatic nerve can cause terrible back pain that spreads all the way down to the legs, thighs and the knee area. The condition can be mild or in many cases extremely severe. The treatment for this condition also depends on the severity of the pain, the symptoms and the causes behind the pain. Therefore, it’s very important to understand and diagnose the right cause of sciatica.

Causes of sciatica

There can be many different causes which lead to sciatica pain.  One of the most common causes of sciatica is a hernia of the disc in the lumbar area which can result in a direct pressure and compression of the sciatic nerve. As a result, this pressure can cause irritation and the inflammation in the sciatic nerve and lead to severe pain which the patient may not be able to endure in some cases. The condition in which the pain due to a hernia or abnormality of the intervertebral disc and irritation of the sciatic nerve is experienced is known as radiculopathy. The pressure on the nerve is also referred to as pinching of the nerve.

The pain and irritation of the sciatic nerve can also occur due to a presence of a tumor, proximal muscular displacement, the presence of adjacent bones causing nerve pinching, inflammatory conditions and infectious conditions in the lumbar area of the spine of a nearby location. 

The sciatic pain can also result from internal bleeding that occurs due to an injury or some other reasons, accidental injury,  and numerous other reasons which may cause pressure on the area. In females, some instances of pregnancy, the consequences of pregnancy can result in a force on the sciatic nerve which causes pinched nerve symptoms. These symptoms can alleviate and completely get eliminated after the delivery of the baby.

Risk factors associated with the Sciatica

The causes and risk factors for developing sciatic pain are numerous.  The most common risk factors include secondary and other underlying health conditions that the patient may already be suffering from. This could consist of degenerative arthritis that resides in the same region of the lumbar spine. Other diseases and health conditions of the proximal region also include terms like slipped disc, lumbar disc disease, and trauma. All these conditions can occur as a result of injuries, heavy blows, and accidents that are usually experienced by the people involved in sports and athletics.

Symptoms of Sciatica

There are several symptoms associated with sciatica pain, and different patients may experience a variety of symptoms which may be more or less different from the other patients. In general, the patients suffering from sciatica pain will experience severe pain that originates at the nerve roots in the lower back lumbar area and extends towards the buttocks, hips, shin, thighs, knees and the lower limbs. Apart from pain, other characteristic symptoms may include a tingling sensation, a feeling of heat and pain radiation from the lower back, a burning sensation, numbness of the back area, and a variety of pain, such as hip pain, lumbar pain, leg pain, and buttock pain, depending on the point of the nerve where the pressure and irritation is experienced. Although sciatic nerve has a lot to do with the back and the tailbone area, it is not necessary that every sciatica patient will experience pain in the lower back region indefinitely. As it’s explained that the pain and the location of the pain vary with and depends on the point where the compression of the nerve is experienced, it may not cause pain in the back region at all. This is one reason that sometimes the pain of sciatica can be misunderstood, mistreated and mistaken as some other condition. However, the proper diagnosis and identification of the condition are extremely important to ensure that proper treatment is administered on the patients. As the severity of the pain progresses, it may cause difficulty or complete limitation for the patient to walk or even move around because of severe pain. Moving from a particular position can cause unbearable pain for some patients. In such cases, these symptoms are alleviated by the administration of medication and certain painkillers. For people involved in sports, sciatica can be a big concern, as it can take away a person’s ability to play for quite a while. In severe cases, the patient may experience an inability to bend, move the waist or the back. Resting in a lying position can be a good and effective way for the treatment as lying down can alleviate the pain and keep the patient at ease for the time being.

Diagnosis of Sciatica

For the diagnosis of sciatica, it’s important to learn about the important physical events taking place in the life of the patients, as well as the history of these events and medical conditions. Since the list of causes is so long, it becomes important to evaluate the patient. In case of sports injuries, it remains most probable that the underlying cause of sciatica is the injury and the compression of the sciatic nerve caused by it. However, in some cases, the injury may not be the only reason for the pain caused by sciatic compression, and there may be some other underlying health condition or reason for the sudden onset of the pain.

Characteristic Pain

Although it’s easy to mistake the sciatica pain with some other kind of pain, the sciatic pain can be identified by specific symptoms, including:

  • Persistent pain in either the left leg or buttock or the right leg or buttock.
  • Sitting for long periods of time typically results in more pain.
  • Specific sensations of tingling, burning and/or searing
  • Nerve pressure resulting in numbness, weakness, and disability or difficulty in moving the lower limbs
  • Piercing and sharp pain disabling a person from standing up and/or walking.
  • Pain spreads through the leg except for the foot in most cases.

This is one reason why the diagnosis of sciatica in some cases can be complicated, because it may be mistaken as another issue. The condition can vary among different clients greatly and present itself in different ways.

The primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. The doctor may also carefully examine by moving the back joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the CT scan will help the doctor to locate and study the internal structures to see any possible damage. In certain cases, the diagnostic test may also make use of electromyogram for the determination of possible sciatic condition.

From acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely and the severity of it. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine position, and the movement and flexion of the hip and legs are examined. The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain and tenderness.

Treatment of Sciatica

The treatment for sciatica is based on the diagnosis, the cause of the pain and depends greatly on the severity of the condition. Mostly the patients can rely on the treatments such as medication, muscular relaxant pills, reducing inflammation with the help of medicine, resting, and physical therapy. The condition can get better with time. However, in certain cases, it can persist and intermittent pain can be experienced. In most cases, the condition is improved, and the pain is alleviated without the need for surgery. However, in severe cases, sports people, as well as other people, may require a surgical procedure to alleviate the symptoms of pain. Cortisone injections are also used for the treatment of sciatica pain.

As the condition of sciatica has so much to do with a variety of specialization subjects, people in different medical sectors can assist and help treat the condition. After the evaluation and diagnosis of sciatica, a variety of generalists, specialists and sub specialists can treat the condition. Specialists in the fields of general medicine, internal medicine, gynecology, family medicine, orthopedic specialists, physiatrists and even neurosurgeons can administer a variety of techniques to treat the condition. Other specialties that deal with sciatica pain also include massage therapists, rheumatologists, chiropractors, physical therapists, acupuncturists, and psychologists. The effectiveness of the treatment therefore greatly depends on the reaching out to the right specialists for your kind of sciatica.

Apart from these factors, an important question is what are the treatment options available to sciatic patients and what approach should be taken to ensure effective treatment? Although the conventionally accepted approach to pain treatment such as resting is widely accepted for most conditions, research shows that for sciatica it isn’t the most amazing way to treat the condition. Therefore, the cause of the sciatica pain is detrimental for the choice of the treatment. Effective treatment may include the treatment of the secondary underlying cause or health condition which is causing the sciatica pain or making use of physical therapy. For chronic forms of sciatica which become persistent, treatment options like transcutaneous nerve stimulators can be effective. Apart from that, the exercising, working out and stretching is quite useful to treat the condition of sciatica and help people get back on their feet.  Massage therapy can be helpful for relief of this condition, and in some cases, patients/clients may visit a chiropractor or acupuncturist for relief.  On top of physical treatment options, medications and painkillers may also provide relief from pain but can have unwanted side effects. These may also include the medicines for inflammation as well as for depression. Certain drugs are also capable of dimming the ability of our brain to feel pain, which can work for patients suffering from severe sciatica pain. Depending on the severity of the condition and the underlying cause of sciatica, surgical treatment or operation may also be required for certain patients who are suffering from persistent and chronic sciatica with severe pain. Applications and training of pain management also play a significant role in the treatment and alleviation of the symptoms.

Recovery from Sciatica

The recovery time of sciatica varies greatly because of its dependency on the factors such as the underlying cause of the persistent sciatica pain, the severity of the condition and the capability of the patient’s body to recover from the condition. In certain conditions, such as the hernia of the disc, the degenerative lumbar spine syndrome, the back sprains and conditions such as shingles can lead to comparatively quicker recovery as these conditions are temporary, reversible and treatable. Sciatica that occurs due to these conditions can be treatment in a matter of days or a couple of weeks. However, in more severe and persistent cases, sciatica can be something extremely stubborn and persistent. Such a condition is referred to as chronic sciatica and may even require surgical procedures for the alleviation of pain.

Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area, the type of causes of sciatica and other factors. For your part in effective recovery, you should avoid the normal routine activities according to your doctor’s advice. Due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the sciatica pain from injury can take from a few weeks to 6 months of time to recover.

Hamstring Muscle Injuries

What is Hamstring Strain?

A hamstring injury is a strain or tear that is characteristic to the areas of tendons, back, thighs, and the larger muscles. It is most commonly observed in people involved in sports and athletes. Depending on the causes the severity can range from mild to extremely severe.

While many different injuries, such as pulled hamstring can be considered as a hamstring muscle injury, there are certain things common in this condition. Hamstring muscle surgery is common in people who are involved in running, sprinting, exertion, walking too much, rigorous training, and sports such as soccer, football, basketball, and other similar sports that need a lot of movement of the legs and excessive exertion. The condition of a pulled hamstring injury or a strain is involved in the pulling and damage of one or more than one muscles located in the thigh area. In most cases, hamstring pulls, and muscular injuries are easily treatable and don’t cause too much trouble. However, in certain cases, the condition can be extremely severe. Nonetheless, there is a lot that can be done to treat the condition, and surgical procedures are very rarely needed to address the most severe cases.

What is a Hamstring Muscle?

Hamstring muscle is a kind of large muscles that extends from the start till the end of the posterior side of thighs. The muscles can be further divided into three main types, namely biceps femoris, semitendinosus, and semimembranosus. These muscles begin from the end of the pelvic region from the point of ischial tuberosity and extend down to intersect the knee joint and crawl further towards the lower part of the leg. These muscles usually consist of strong tissues used for connective purposes, and these are responsible for the power that we have in our legs, which is comparatively a lot more than other parts of our body. These muscles are what helps us with the movement of our leg joints, walking, sitting, bending, lying and everything that our legs are capable of doing.

The injuries and strain related to the hamstring muscles can be in the form of muscle tearing, muscular, complete tearing or the partial tearing of the muscles. The grading of these muscles is dependent on how severe is the damage caused to the muscle. The healing time of hamstring muscle injuries can be as long as three months in case of severe injuries. The most common part that is damaged as a result of hamstring muscle injury is the thicker and core region of the muscles where the tendons and muscles are joined. In the most severe grade 3 cases, the tendons are entirely ripped off from the bones, and in certain cases, a part of the bone is also torn away with it. This most severe type of muscular hamstring injury is referred to as avulsion injury.

Grades of Hamstring Muscle Injuries

There are different grades for Hamstring Muscle Injuries similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three grades are:

  • Grade 1: This is the mildest grade for hamstring injuries. It includes less than moderate pain, while the patient retains the ability to feel and move the injured area.
  • Grade 2: This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.
  • Grade 3: This condition usually includes severe pain, while the patient loses the ability to feel and move the injured area.

Causes of Hamstring muscle injuries

There can be a variety of different reasons which can be responsible for mild or severe cases of hamstring muscle injuries. One of the most common cause for Hamstring injury is muscle overload, which can result in the straining of the hamstring muscles. Such a condition may occur if the larger muscle is pulled or stretching too much beyond its threshold of getting back into the place. In this way, it can even get pulled off or ripped off from the bone. This can happen as a result of putting a lot of loads all of a sudden. The most common reasons for this cause include accidents, heavy blows, and sports injuries.

A phenomenon called eccentric contraction can also lead to the occurrence of hamstring muscle strains and injuries due to the lengthening of the hamstring muscles while contracting or shortening. A pressure put on the muscle due to contraction and getting pulled to lengthen it at the same time can result in tearing of the muscle. At the time of running or doing something similar, the eccentric contraction of the muscles is prominently happening. As the running begins, the runner uses the toe to straighten the leg and sprint forward, which is the moment when eccentric contraction takes place. Avulsions are the most severe form of hamstring tendon and muscular injuries, which are caused as a result of putting a lot of load on the tendons all of a sudden.

Risk Factors associated with hamstring muscle injuries

There are some risk factors associated with hamstring muscle injuries. However, the most important ones deserve the attention. The risk of hamstring muscle injury can be increased due to the tightness of muscles which renders it susceptible to strain.  Doing light warm-up exercises and stretching before a rigorous sports workout is very important to prevent this type of injury.  Another factor is the lack of balance of the muscles due to the difference in the strength of the muscles opposite to each other. Due to such an imbalance, a strain can be caused.  Hamstring muscles consist of more powerful front muscles while the posterior muscles are less strong, which can experience fatigue quicker than the stronger muscles on the front. As a result, hamstring muscle injuries and strains can take place. Fatigue can also occur due to other reasons, such as the ability of the muscles to absorb and retain the energy and protect itself from the injuries and heavy blows. Furthermore, another important factor is the condition and the strength of the muscles; if the muscles are strong, they are less likely to get damaged from the exercising, training, pressures and the stress resulting from it. Another factor that matters in determining the risk is the type of activities that a sportsperson chooses to take. Although hamstring muscle injuries can be experienced by any person, certain activities put the people involved in the more at risk of getting a hamstring muscle injury. These activities include certain sports such as basketball, soccer, football, and other activities such as athletics, dancing, running and old age athletics. Since the body is growing unequally at adolescence, people at this age are more at risk of getting a hamstring muscle injury. At the time of growth spurt, bones are capable of growing quicker than the muscles. As a result, the muscles can be pulled and lengthened due to a stretch being caused by a very sudden growth.

Symptoms of Hamstring Muscle injuries

As easy as it is to imagine, hamstring muscle injuries can be very painful at times. The extent of the symptoms however greatly depends on the severity of the injury and the grade. The symptoms that result from hamstring muscles injury includes a sudden and sharp pain in the back region of the thigh due to the injury which will make a sprinting person stop at once or fall terribly. Due to the damage, other symptoms can also show up, such as swelling and redness soon after the injury or after a few hours, bruises and change of color impact on the skin due to internal bleeding or other reasons, and the weakness of the tendons and hamstring muscles which can be prolonged for a couple of months.

Diagnosis for Hamstring Muscle Injury

The primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. The doctor may also carefully examine by moving the thigh and knee joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. An X-ray test will be able to analyze the bone condition. Imaging tests are most important for accurate diagnosis.

By acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely and the severity of it. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine position, and the movement and flexion of the hip and legs are examined.

Treatment for Hamstring Muscle Injuries

Depending on the type and reason of the injury, and the location of the injured area, the treatment for the Hamstring Muscle Injury will be different. The treatment may also be different depending on the consent of the patient as well as the severity and the grade of the injury. The core purpose of the treatment is to normalize the condition of the Hamstring Muscle Injury and achieve painless movement and healing. Only in severe cases, a surgical procedure may be required to treat the Hamstring Muscle Injury. However, in most cases, non-surgical procedures are recommended and opted by the specialists as much as possible. It is very important to comply with the measure and directions of the doctor to ensure effective treatment and restoration of the muscular health.

In most cases of Hamstring injury apart from severe cases, the injuries can easily heal naturally. Nonetheless, you must always make sure that you take enough rest to allow time for your injury to heal. For speeding up the healing and recovery, there are certain measures that you can take.

Icing can be done as an effective way to treat hamstring injuries related symptoms. This involves putting ice on the injured area for up to 15 to 25 minutes several times a day. It should help reduce the swelling and alleviating the pain. Upon the offset of these symptoms, you should stop the icing treatment.

For resting your leg, you need to take some proper measures in hamstring injuries. It can be done bests by avoiding walking, running and all types of sports that involve legs for a while. This will allow your body to focus its energy on healing the injured leg. Resting is more important than other treatments and if you take it for granted other treatments may also not work. Therefore, make sure you don’t put any pressure on the injured leg as it can reverse the healing and cause symptoms to show up again.

Along with resting, you can also consider a physical therapy if you are more concerned about the severity of your condition. A physical therapist will ensure that everything goes smoothly and you can recover quicker. It can also help you avoid stiffness that can be caused due to the lack of activities during the rest period. You should be aiming for the proper stretch, flexibility, and improved movement.

Compression therapy can also be performed as it helps alleviate the symptoms in most cases. Compression is done with the help of a bandage in most cases, but some other technique may be used depending on the type of the injury.  This should also be coupled with the elevation technique, the one that you usually see in hospitals. It involves the lifting the leg when the patient is lying down or sitting. At home, you can do this by putting a pillow under your leg as it will allow your leg to elevate. Use multiple pillows if required.

Apart from these physical treatments, you can also opt for medical treatments. In most cases, it won’t be necessary. However, if you’re not able to bear the pain and the acute symptoms, you can opt for medications. The common medicines that are used for hamstring injuries are over the counter drugs, such as Motrin and Advil, or other NSAIDs that can make the pain and other symptoms tolerable. You should understand that these medications work at the cost of side effects. Therefore, if you feel that the pain is better than the side effects that you may suffer from, it is best to avoid taking those medications. Your doctor will carefully examine your condition to tell you if you require medication or not.

Apart from all these treatment options, you can opt for proper exercising. Exercising should not be ignored for the treatment unless otherwise instructed by your doctor or physical therapist. Some of these exercises may be a part of your physical therapy, while there are others that you can try on your own. You must make sure that if any of your exercises in your workout regime is causing even the slightest trouble to your injured area, you must immediately stop doing that and consult your physical therapist to try something else that works for you. Some of the most effective exercises may involve strengthening and stretching exercises. Strengthening exercises should also be a part of your regular workout, as it can prevent you from having a hamstring injury at the first place.

If the problem and symptoms persist and the case is severe, you may require undergoing an operation or a surgery to fix the problem. However, this is very rare, and most hamstring injuries can heal naturally. Surgery may involve the reattachment of a torn hamstring muscle.

Another part of your treatment is to take proper measures to prevent further injury or worsening of the situation. This complementary approach involves the use of aids, crutches and other things that would help to prevent you from getting into further trouble. You should also avoid lifting any weights or putting any pressure on the legs. All of these approaches may be administered until the patient is recovered and the symptoms are gone. You should be able to get back on the sports ground and easily use and move your legs to the full range.

Recovery for Hamstring Muscle Injuries

In most cases, a rehab therapy results in complete recovery from hamstring muscle injuries. Physical therapies along with the RICE treatment can effectively treat the condition and get the patient back on the ground. However, there is a chance of healing process getting reversed if proper measures are not taken and if healing has not completed. Therefore, it’s essential to let your injured muscles recover completely by following the protocol provided by the doctor to eliminate the chances of getting repetitive injuries, chronic conditions, and permanent damage. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area, the type of causes of the Hamstring muscle injury and other factors. For your part in effective recovery, you should avoid the normal routine activities according to your doctor’s advice. Depending on the severity, the Hamstring muscle injury can take from a few weeks to a couple of months of time to recover. Hamstring muscle injuries are painful. Therefore, usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time.  A regular visit to the doctor will ensure that it’s time to go ahead.

Tennis and Golfer’s Elbow

What Is Tennis and Golfer’s Elbow?

As the name suggests, Tennis and Golfer’s elbow is a condition that usually occurs in people involved in certain types of sports that makes use of the arm extensively. The condition is characterized by inflammation and pain in the muscles and tendons that serve connective purposes on the arm and the elbow. It specifically functions to enjoin the forearm with the elbow. For Golfer’s elbow, the condition is also known as medial epicondylitis in medical terms. The inner area of the elbow is affected which causes an extending pain towards the forearm. The condition may be mild or severe, and it may be treated easily or require prolonged caring. The painful condition and inflammation are developed due to the overuse and overexertion of the muscles of the arm. This mostly happens in athletes, in cases where the overuse of the arm, too much rotating, gripping and flexing of the wrist can result in inflammation. As a tennis or golf player, one requires to twist swing and rotating the forearm and the muscles located there in certain ways to set up for the right shot. As a result, the muscles and tendons can be damaged, degenerated and get torn.

Nonetheless, the name doesn’t imply that these forms of tendinitis conditions are only experienced by tennis players or golf players. In fact, anyone can experience this type of inflammation of tendons. There are people from other sports as well who experience this condition frequently, such as baseball players, basketball players, and bowling players. The tennis elbow tendinitis is characterized as the inflammation of the outside tendons, while the golf elbow tendinitis is characterized by tendinitis of the inner tendons of the elbow. Tennis elbow is also known as lateral epicondylitis, while the golf elbow is medically termed as medial epicondylitis.

Symptoms for Tennis and Golfer’s Elbow

The patients suffering from golf and tennis elbow can experience several symptoms that can indicate the injury and the severity of the injury. While the symptoms may vary from patient to patient, some of the most commonly observed symptoms of tennis and golf elbow syndrome are:

  • Burning sensation inside the elbow (golf elbow)
  • Burning sensation outside the elbow (Tennis Elbow)
  • Pain in the affected area of the injury which can spread towards the wrist through the forearm.
  • Numbness of the elbow
  • The weakness of the elbow
  • Difficulty and pain in the movement of the elbow
  • The difficulty, pain, and weakness in the movement of the wrist
  • Difficulty in gripping the objects
  • Tenderness inside of the elbow and extending along with the tendons
  • Swelling of the affected area
  • The stiffness of the injured area
  • Pain during the gripping and fisting of the wrist.
  • Tingling and numbing sensations on the elbow which is extended towards  the forearm and the wrist
  • Difficulty in doing everyday things, such as pouring coffee, shaking hands, moving the arm, and typing on the keyboard.

Both injuries are usually the result of repetitive strain on the tendons, and although you don’t have to be a golfer or tennis player to experience them, the repeated forceful motions involved in both sports make them very common.

Treatment for Tennis and Golfer’s Elbow

Natural and non-invasive treatments are usually recommended for tennis and golfer’s elbow syndromes. The right approach to treat this condition is the treatment of the causes instead of alleviating the symptoms of the condition. It could include a personal treatment plan, healthy diet plan, changes to the lifestyle and exercising regime. Due to the overuse and overexertion, the painful and inflammatory condition can be specifically treated. Tennis elbow is usually experienced by people involved in the different profession and its most commonly found in the people within the age group of 30 to 50 years old.  On the other hand, the golf elbow syndrome which affects the inner tendons of the elbow is experienced by people that practice golf, swimming, painting, tennis, rowing, and baseball. Due to the improper use of the technique, gripping and moving repetitively, and throwing and lifting improperly, golf elbow can result in injury to the inner tendons.

Some things should be taken into account, including the type of the injury, the severity of the injury, and the structures that are damaged due to the injury to determine the right and effective type of the treatment for golf or tennis elbow syndrome. However, for mild to moderate conditions the approach for the treatment remains common in most cases. Some of the common and most effective minimally invasive and non-surgical treatment options available are the ones you should start with.

The best approach you can take for the treatment of golfer’s and tennis elbow injuries is to start off with the right treatment options as soon as possible. Earlier treatment can save you from a lot of trouble in the long run as the symptoms keep developing gradually if proper care is not given. The sooner you start with your treatment, the earlier it will be possible for you to continue your sports practices.

The injury can start off slow but gradually develop into severe conditions. Sometimes mild pain is ignored by the players who become a reason for critical conditions. Therefore, it’s imperative that you take proper rest as soon as the symptoms start to show up. The rest usually involve a break on your sports activities and minimizing the use of your arm and elbow. You should immobilize your arm to allow it to heal your injured structures. Once the pain is gone, and you’re able to move the elbow easily, and to the full range, you can continue with your sports again while administering proper preventive measures to avoid recurrence.

If the pain keeps on troubling your arm despite immobility, you can use ice on the injured elbow and nearby area. It can immediately soothe your pain and reduce the swelling. You should also make sure that you don’t use ice directly on your skin to avoid ice burns. You can wrap the ice into some covering, such as a thin cloth or towel, and use it for 25 minutes after every 2 to 3 hours throughout the day. It may take a few days to eliminate pain and swelling with this treatment.

Some patients may decide to take medicines for the tennis and golfer’s elbow syndrome when the discomfort is interfering with everyday tasks. Ibuprofen and aspirin work well for this purpose. Other OTCs are available on the market, and you should go for non-steroid drugs. These medicines may have a side effect, and they should only be used minimally. If these medicines don’t work, alternative medical treatments may be administered, such as injections of corticosteroids for temporary and short-term relief. They are effective regarding alleviating the symptoms. However, it’s not a permanent solution especially in case of severe conditions that take a lot of time to recover. Medical advancements have also unleashed another innovative method of treatment for this injury, which is known as PRP or platelet-rich plasma technique.

Since the immobility and support are important in this regard, you should go for physical aids and braces to keep the injured arm in place and avoid jerking. It can reduce the pressure and the strain on the muscles that are sensitive due to injury. Counterforce braces may be advised by your doctor or physical therapist.

Stretching and strengthening exercises also play an important role in the treatment of tennis and golfers elbow injuries. These exercises can also prevent you from getting an injury and help you avoid secondary injuries. A specific exercise for this type of injury is administered by the physical therapists, which involves the lengthening of the wrist extensor muscles. This exercise is particularly effective for these injuries. For this injury type, some other physical aids can also be used to support your arm and limiting the movement, such as strapping, braces, supporting pads and other aids that are relevant to arm support. You should also ensure that corrective measures are taken, as the very cause of your tennis or Golfer’s elbow could be wrong training practices and angles of movement. By improving the movement of your arm and elbow joint especially for overhead movements, and by improving your posture you can avoid these injuries as well as speed up the treatment process.

Compressing the elbow region that is injured with a bandage or a wrap can also alleviate the symptoms very effectively. It can also hold the elbow into place and help you reduce unnecessary movement. The treatment involves gradual rehabilitation, which means that you should continue with the treatment measures and gradually return to your sports or other daily activities. You should also inform your trainer or instructor about the condition, and he will make sure that you play the safe way after returning from the treatment.

In severe cases, you should keep a regular contact with your doctor who will closely monitor the condition and the improvement occurring over time. If the condition doesn’t show significant improvement, your doctor may consider certain operation and surgery options for you. The surgery may differ from person to person, and it is rarely administered. However, if no other treatment options are effective, you may immediately need invasive surgery. Usually, the doctor will closely monitor your condition for up to one year and try his best to treat you with non-surgical treatment options. However, in certain cases, the damage is not recoverable naturally, and a surgical aid may be required. The latest surgical procedures involve the removal of damaged tendons from the injured area.

A relatively different approach to the treatment of pain and inflammatory conditions developed by tennis or golfer’s syndrome is the acupuncture technique. It is scientifically accepted by many specialists and can be quite effective for alleviation of the pain. This can be coupled with massaging as well. Both of these traditional treatments can be useful for some patients. Some other less common treatment options include cortisone injections, platelet rich plasma technique, and operation or surgery.

Recovery for the tennis and Golfer’s Elbow

Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area and other factors. It can take anywhere from a week to some months. For effective recovery, you should get back to the normal routine activities slowly and gradually according to your doctor’s advice. Once you start using your muscles and bones again, it will complement the complete healing of the injured parts. If the patient were healthy before the injury, the recovery would usually be faster. However, due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the injury can take up to 6 months of time to recover.

Shoulder Injuries

What are Shoulder Injuries?

The shoulder injuries can be a very common type of injuries when it comes to sports. It can be considered as one of the most mobile and easily dislocated joints in the human body. Due to this factor, athletes and people involved in similar activities are very much susceptible to get such a condition. For the sports people and the people involved in athletes, this can be caused due to rigorous movement of the shoulder, overuse of the shoulder joint, too much taxing of the shoulder, overhead movements involved in certain sports, and too many repetitive movements. Many sports utilize the movement of the shoulder joint to ensure the proper shots, such as cricket, baseball, basketball, badminton, golf, tennis, bowling and other similar sports which also makes it prone to injury. If you’re an athlete, taxing your shoulder over time with repetitive, overhead movements or participating in contact sports may put your shoulder at risk for injury.

The shoulder injuries is a broad term, and therefore it can be classified in many different conditions and injuries that are associated with the shoulder. Each condition is characterized by the type of the injury, the type of body parts impacted by the injury, the severity of the injury and the causes of it. Concerning sports, these injuries related to shoulders can be classified into three most common types which are mostly experienced by the athletes and the sports people. Here are three of these most common shoulder injuries that are normally seen in the sports arena.

SLAP tear

The slap tear is a very common condition which is often seen in sports people. Our shoulder joint has a localized socket that ensures the proper fixation of the bones. The shoulder socket is covered with a ring of cartilage that is called a labrum. In this condition, the labrum wears and tears due to a heavy blow, jerk, overhead shots, repetition of the movement and the wrong movement of the shoulder. The condition causes acute and severe pain. However, the condition is developed over time with a gradual deteriorating of the cartilage. Which is why it’s very important that if the patient experience even a little pain and discomfort of the shoulder, the condition should not be ignored and proper measures should be taken to ensure that the problem gets resolved. If the condition is not addressed promptly, it can grow and cause more trouble to the patient and even result in permanent damage. Due to this tear, the patient can experience a sudden onset of pain and disability of the proper function of the joint.

Due to this injury, the people involved in sports and the athletics can experience deterioration of their performance and difficulty in moving the shoulder joint the way they are trying to do. The pain can be severe or less severe. However, the patient may feel that something is not wrong with the shoulder and it will pop out and dislocate at any minute with any movement. It is important to know and ensure that the warning signs are observed and not left unnoticed since it can result in a more terrible condition. Some of the most important warning signs include pain and discomfort due to certain movements of the shoulder on certain angles. The movement of the shoulder joint is also reduced in range, and the patient may not be able to mobilize the arm to the full range. It can be mistaken for stiffness and difficulty in stretching. The pain is also characteristic in a way that it’s difficult for the patient to pinpoint and exactly tell the place and location where the pain is coming from. If these symptoms are rightly understood, and proper action is taken at the right time, it can prevent the patient from getting further damage.

Symptoms of SLAP Tear in shoulder injuries

Some of the most common symptoms experienced by the players and sports people suffering from a shoulder injury of SLAP Tear includes:

  • Grinding feeling with the movement of shoulder joint
  • Prominent sound and friction occurring due to joint shoulder movement
  • A clicking feeling or sound occurring due to movement of the shoulder.
  • A feeling and a sound of popping in the shoulder joint upon movement.

Shoulder instability

Three factors can make the shoulder more susceptible to dislocation: repetitive overhead movement, previous dislocation, and genetics. Read Causes and Risk Factors for a Dislocated Shoulder

Another very common type of shoulder injury experienced by people involved in sports is the shoulder instability. The condition can be commonly experienced by the athletes, and it can occur in people involved in contact sports, such as soccer, hockey, and rugby. Other types of sports which include the rigorous movement and repetition of the shoulder movement also have a good portion of players experiencing shoulder instability. It is a condition which is characterized by the injury to the muscles, tendons, and ligaments. As the name suggests, the instability is caused in the shoulder muscles that are supposed to cover and protect the shoulder joint. As a result, the shoulder joint is left unsecured. The humeral head is the bone of the arm located in the upper part, which gets dislocated due to the instability and the bone can dislocate and pop out completely or partially from the shoulder socket.

Due to this dislocation, the patient can experience a very severe and sudden pain. If the bone is partially dislocated, the pain can be sharp and shocking in the form of bursts and throbs. Along with the pain comes the disability of a person to use their dislocated arm and severe weakness of the shoulder. Concerning physical changes, the patient can also experience severe swelling, discoloration and the bruising on the injured area.

Rotator cuff injury

Another very common type of shoulder injury is the rotator cuff injury. In the  Rotator cuff injury, the patient’s condition is caused due to the repetition of the movement of shoulders, overhead movement, overuse of the should joint and other similar activities. People involved in a variety of sports are vulnerable to this condition. Rotator Cuff injuries may be very painful accompanied by the disability to continue sports for a while. The condition makes it very difficult for the patient to sleep, and they may get up from sleep several times during the night due to the shoulder pain. It’s also difficult to get a comfortable lying position where the shoulder doesn’t pain. The pain can get worse with moving the shoulder joint in certain angles, and it can be extended towards the rest of the arm. It can also make the usual everyday activities a challenge for the patient due to the pain, such as combing the hair.

Rotator cuff injuries are also one of the most commonly seen injuries and require more attention. The rotator cuff can be defined as the collection of different tendons and the muscles that are surrounding the shoulder joint and the socket. This is the place where the upper arm is connected strongly to the socket, and this connection is strengthened by the group of tendons and muscles called the rotator cuff. Injury to this group of muscles can result in a dull pain in the shoulder. And the condition can easily get exacerbated while making the pain worse with time. Therefore, proper care, especially with the right sleeping position, is required to treat the condition promptly and not cause further damage.

Causes of injury

If an injury causes a sudden weakness and disability, you should see a doctor as soon as possible. The most common cause in sports for this injury is a hard hit, heavy blow or contact sports. As a result, the wearing and tearing can take place in the Rotator cuff muscles. If the condition is chronic, it can be called as the rotator cuff disease.

Other causes include:

  • Overhead strokes and movements
  • Repetitive movement
  • Sudden jerking
  • Heavy hit
  • Hard blows
  • Falling on the shoulder

How to Diagnose Rotator Cuff Injuries?

The primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The doctor may also carefully examine by moving the knee joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound will help the doctor to locate and study the internal structures to see any possible damage.

Treatments for injury

Physical therapy is a very effective treatment method for the injuries related to the rotator cuff or the shoulder. The treatment may greatly differ depending on the severity of the condition as well as the type of damage an injury that is caused to the shoulder. The treatment aims to bring back the displaced joint or tendons back to their original place, increase the strength and bearing capacity of softer tendons, and improve the flexibility of the tendons and the muscles to keep the shoulder protected. Shoulder injuries may be chronic or acute, and the treatment also differs depending on the type of the injury. Normally, a single heavy blow, jerk or an injury can result in the rotator cuff injury, or the tendons and muscles may get deteriorated over time by repetitive and smaller injuries. Physical or occupational therapy, a sling or shoulder immobilizer, or surgery are the treatments that come into practice the most. You may also take medication along with the treatment, which includes NSAIDS and other over the counter drugs which can be beneficial regarding reducing symptoms and alleviating the pain. In severe cases, bold measures may be taken, and the patient can be given corticosteroid injections and cortisone injections.  The approach is only for temporary and only implied if the symptoms are unbearable for the patient. They may also have serious side effects on the patient which is why it is essential to make a favorable decision while deciding to take them.

Regarding home remedies, there are several things that you can do to treat the problems associated with your shoulder. The most important is resting your arm as much as possible and pausing your sports activities for a while. This should quickly fix any mild sprain or strain, and you may not need to get advanced treatment. However, when the symptoms are enhanced, you should try putting the ice on the area for 20 to 30 minutes at least four times a day. You can use a towel wrap to prevent direct contact of the ice with the skin so you can avoid burning. You can also use aids and slings as it can limit the movement of the shoulder in cases of acute injuries. However, you should make sure that you don’t wear the sling for a very long time to avoid stiffness of the shoulder. This is where the exercising and physical therapy becomes important, as you don’t want to jam your shoulder joint by not using it. It will also be helpful in restoring the full range movement of the arm.

Medication can also help in case of shoulder injuries, and the most common medicines that are used for this purpose are ibuprofen and naproxen. However, these medications can interfere with other underlying conditions in a patient. That is why if you are already taking some medicines previously or if you have a previous health condition you should consult the doctor to see if the medicines can react to each other or if they can affect the treatment of other medicines. You should not even use over the counter drugs against or without the prescription of a doctor or a specialist. Depending on the severity of the condition and the type of the structures damaged, it may take as from a few weeks to a few months for you to recover completely and get back to your everyday activities.

Before going for a surgery, you should consider trying other non-surgical options as well. Some of these treatment options for shoulder injuries include:

  • Steroid drugs and injections can be administered to reduce the inflammatory conditions in the tight spaces
  • Shockwave therapy can be done for shoulder injuries, also known as extracorporeal shockwave therapy. It is a common treatment that is used by orthopedic specialists for various purposes.
  • Depending on your case, you may also be a good candidate for a therapeutic ultrasound treatment. Your doctor will examine to determine if you are a good candidate for this treatment or not.
  • Another effective treatment for the shoulder injuries is called a dry needling technique. In this treatment is a common treatment administered by physical therapists for various types of injuries. The procedure is also referred to as myofascial trigger point try needling, in which a dry needle is used to treat the pain and the impaired movement without the use of medicine and anesthesia. It is also considered to be an unproven technique by some practitioners, while others find it effective. It could be a preferable substitute for surgery which is more invasive.
  • If nothing works, you may opt for surgery. In severe cases, surgery is more viable as it provides a quick fix to severely damaged or torn structures, and it can also clean up other pieces of bones. The reattachment of torn tendons ensures that it’s healed quicker. It can also fix any unnatural tightness or stretch of muscles due to injury.

For surgery, an arthroscopic technique can be used in which the surgeon inserts an arthroscope which can visualize and repair the damage. This is comparatively less invasive as compared to open surgical procedures. Surgery is also a viable option for athletes and sports people who are more interested in their career and wish to get back to the ground as soon as possible. Surgery may also be avoided for people who are above the age of sixty years. In case of rotator cuff injuries, surgery is avoided unless there is a complete tear or a degree 3 injury. The doctor may also choose to go with a surgical procedure if the injury is not responding to non-surgical treatments even after two months from the time of injury.

You may also require surgery if you were involved in a sports activity that required constant use of the shoulder. Apart from that, certain Codman exercises can prove to be helpful for the treatment of shoulder injuries. These are usually administered under the supervision of a physical therapist. It’s aimed at reducing the symptoms of pain and swelling, and enabling the natural full ranged movement of the should joint. This requires a person to lean towards the injured side and hang the arm freely. The patient should move the arm in circles slowly while it’s hanging. The proper diameter and the speed are regulated by the physical therapist, so it should be done under supervision at least for the first few times. Due to the hanging arm, It is also referred to as a pendulum exercise. Apart from that, a broom can also be used for exercising. This is done by gripping the broom with both hands and slowly moving it along a wide arc back and forth gently and slowly as it can make the softer tissues more flexible and stretch them effectively. Resting the shoulder for several days before returning to normal activity and avoiding any movements that might cause pain can be helpful. Limit overhead work or activities. Most shoulder injuries can be treated at home with a proper caring regime.

Risk factors for Rotator cuff Injuries

Risk of rotator cuff injuries is based on some different factors. As a general rule, the overall resilience and strength of the patient is a very detrimental factor. If the muscles are wrong, the injury is likely to be less severe. Apart from that, the strength of the muscles can also be affected by growing age, especially after the age of forty years. Therefore, age is another important risk factor. The type of sports that a person is involved in is also detrimental to the risk. Sports like tennis, baseball, soccer, and golf are the high-risk sports. The professional practices, as well as the medical history of the patient and his family, is also very detrimental.

Complications of Rotator Cuff Injuries

The timely treatment is one of the most important factors when it comes to rotator cuff injuries. If the problem is not addressed promptly and with intensive care, the condition can gradually become worse and even result in permanent damage. It is therefore important to demobilize the shoulder as much as possible and make use of aids like braces and strappings to reduce the movement. If proper care is practiced, the complications are less likely to happen.

Patellofemoral pain syndrome

What is Patellofemoral Pain Syndrome?

The PFPS is one of the very common conditions that are experienced by the people involved in heavy sports, abbreviated as Patellofemoral pain syndrome. In common language, the condition is also called the runner’s knee. The Patellofemoral pain syndrome can be defined as a condition in which the patient experiences the pain in the knee which can either be very severe or less severe. Sometimes it may just be discomfort. However, it should be addressed in the standard way. The back of the kneecap is known as the patella which is connected with the thigh bone, medically known as the femur. The pain is characteristic to the meeting point of the femur and the patella. The condition is different from the other conditions of the knee because of its particular symptom of pain in the anterior knee which involves the retinaculum and the patella. It is difficult to know exactly what the injury is Patellofemoral pain syndrome at the time of the injury, and it may be required to run diagnostics to identify the condition. As the name suggests, the condition is very much common in people who are involved in rigorous and heavy running sports activities and other similar activities. the sports people who experience

Causes of Patellofemoral pain syndrome

Patellofemoral pain syndrome the most are cycling, running, athletics, football, soccer, and hockey. The most common reason is the sudden change in the training practices and the exercise regime of the players, or accidental injuries caused during the running. Another most common cause of Patellofemoral pain syndrome is an accidental injury. Other causes include severe hit, falling on the knee directly, stopping too quickly during a run, and quickly moving in different directions. Women as found to be more prone to Patellofemoral pain syndrome injuries due to the tenderness of muscles and tendons, while men may also experience tearing and spraining.

If an injury causes a sudden weakness and disability, you should see a doctor as soon as possible. The most common cause in sports for this injury is a hard hit, heavy blow or contact sports. As a result, the wearing and tearing can take place in the femur and patella. There are several other causes and risk factors associated with the condition of Patellofemoral pain syndrome. The injury can be a result of the wrong kind and size of the shoes which may put pressure on the muscles up along the legs. Other factors are also important such as the intensity of the hit. Overtraining and intense training all also among the most common causes of this condition.

Other causes include:

  • Running several steps
  • Suddenly stopping while running
  • Legs stretching
  • Leg displacement or foot displacement while running.
  • Wrong posture and legs movement
  • Sudden jerking
  • Heavy hit
  • Hard blows
  • Falling on the knee

Signs and symptoms of Patellofemoral Pain Syndrome

The onset of the condition can be gradual over time, or it can be acute due to a sudden injury. Depending on the severity, the signs and symptoms can vary. In less severe cases the patient may experience a sudden discomfort in the knee during a walk or run. Diffuse peripatellar pain is experienced in this condition around the kneecap. In most cases, it’s difficult for the patient to identify the exact location of the pain. The patient may feel and experience a grinding feeling with the movement of the knee. Prominent sound and friction occurring due to knee joint movement are also experienced. The patient may also feel a clicking feeling or sound occurring due to movement of the knee. A feeling and a sound of popping in the knee joint upon movement may also occur. In such cases, the injury includes a pop sound from the knee along with the loss of control over the knee muscle. In severe cases, the movement of the knee joint is severely limited, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling. The patient can experience discomfort while walking, bending knees and while sitting. The everyday activities such as walking up or down the stairs can also become a challenging task.

Diagnosis for Patellofemoral pain syndrome

As discussed before, the diagnosis for the Patellofemoral pain syndrome is not a very simple task. Therefore, a differential diagnosis is commonly carried out for Patellofemoral pain syndrome. The diagnosis of Patellofemoral pain syndrome is complicated and difficult, which is the reason why it can be easily mistaken as another syndrome, such as, Osgood–Schlatter disease. Prepatellar bursitis, Sinding-Larsen, and Johansson syndrome, plica syndrome and patellar tendinitis. There isn’t any single best method for the diagnosis of the Patellofemoral pain syndrome, as the muscle damaged and the conditions can vary among different patients greatly, and some other diseases, problems, and health conditions can result in a similar kind of a pain in the knee. Therefore, a differential diagnosis is administered to eliminate the possibilities of other conditions.

The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case.

Once the initial examination is performed, and the doubts are reduced, the doctor may follow up with diagnostic procedures. The techniques used in this case are radiographic investigations, ultrasonography, the differential diagnosis, and sonographic evaluations. If necessary, the doctor may also use MRI scans to find out the exact location of the damage.

From acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine or elevated position, and the movement and flexion of the knee and legs are examined.

The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain, tenderness of the femur and patella area. The diagnosis also includes the identification of the grading and category for the condition.

Treatment of Sciatica

The treatment for sciatica is based on the diagnosis, the cause of the pain and depends greatly on the severity of the condition. Mostly the patients can rely on the treatments such as medication, muscular relaxant pills, reducing inflammation with the help of medicine, resting, and physical therapy. The condition can get better with time. However, in certain cases, it can persist, and intermittent pain can be experienced. In most cases, the condition is improved, and the pain is alleviated without the need for surgery. However, in severe cases, sports people, as well as other people, may require a surgical procedure to alleviate the symptoms of pain. Cortisone injections are also used for the treatment of sciatica pain.

As the condition of sciatica has so much to do with a variety of specialization subjects, people in different medical sectors can assist and help treat the condition. After the evaluation and diagnosis of sciatica, a variety of generalists, specialists and subspecialists can treat the condition. Specialists in the fields of general medicine, internal medicine, gynecology, family medicine, orthopedic specialists, physiatrists and even neurosurgeons can administer a variety of techniques to treat the condition. Other specialties that deal with sciatica pain also include massage therapists, rheumatologists, chiropractors, physical therapists, acupuncturists, and psychologists. The effectiveness of the treatment therefore greatly depends on the reaching out to the right specialists for your kind of sciatica.

Apart from these factors, an important question is what are the treatment options available to sciatic patients and what approach should be taken to ensure effective treatment? Although the conventionally accepted approach to pain treatment such as resting is widely accepted for most conditions, research shows that for sciatica it isn’t the most amazing way to treat the condition. Therefore, the cause of the sciatica pain is detrimental for the choice of the treatment. Effective treatment may include the treatment of the secondary underlying cause or health condition which is causing the sciatica pain or making use of physical therapy. For chronic forms of sciatica which become persistent, treatment options like transcutaneous nerve stimulators can be effective. Apart from that, the exercising, working out and stretching is quite useful to treat the condition of sciatica and help people get back on their feet. Other treatment options include chiropractic therapy, massage therapy or acupuncture therapy. On top of physical treatment options, medications and painkillers can also prove to be a promising and effective treatment option. These may also include the medicines for inflammation as well as for depression. Certain medicines are also capable of dimming the ability of our brain to feel pain, which can work for patients suffering from severe sciatica pain. Depending on the severity of the condition and the underlying cause of sciatica, surgical treatment or operation may also be required for certain patients who are suffering from persistent and chronic sciatica with severe pain. Applications and training of pain management also play a significant role in the treatment and alleviation of the symptoms.

Recovery from Sciatica

The recovery time of sciatica varies greatly because of its dependency on the factors such as the underlying cause of the persistent sciatica pain, the severity of the condition and the capability of the patient’s body to recover from the condition. In certain conditions, such as the hernia of the disc, the degenerative lumbar spine syndrome, the back sprains and conditions such as shingles can lead to comparatively quicker recovery as these conditions are temporary, reversible and treatable. Sciatica that occurs due to these conditions can be treatment in a matter of days or a couple of weeks. However, in more severe and persistent cases, sciatica can be something extremely stubborn and persistent. Such a condition is referred to as chronic sciatica and may even require surgical procedures for the alleviation of pain.

Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area, the type of causes of sciatica and other factors. For your part in effective recovery, you should avoid the normal routine activities according to your doctor’s advice. Due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the sciatica pain from injury can take from a few weeks to 6 months of time to recover.

Hamstring Muscle Injuries

What is a Hamstring Strain?

A hamstring injury is a strain or tear that is characteristic to the areas of tendons, back, thighs, and the larger muscles. It is most commonly observed in people involved in sports and athletes. Depending on the causes the severity can range from mild to extremely severe.

While some different injuries, such as pulled hamstring can be considered as a hamstring muscle injury, there are certain things common in this condition. Hamstring muscle surgery is common in people who are involved in running, sprinting, exertion, walking too much, rigorous training, and sports such as soccer, football, basketball, and other similar sports that need a lot of movement of the legs and excessive exertion. The condition of a pulled hamstring injury or a strain is involved in the pulling and damage of one or more than one muscles located in the thigh area. In most cases, hamstring pulls, and muscular injuries are easily treatable and don’t cause too much trouble. However, in certain cases, the condition can be extremely severe. Nonetheless, there is a lot that can be done to treat the condition, and surgical procedures are very rarely needed to address the most severe cases.

What is a Hamstring Muscle?

Hamstring muscle is a kind of large muscles that extends from the start till the end of the posterior side of thighs. The muscles can be further divided into three main types, namely biceps femoris, semitendinosus, and semimembranosus. These muscles begin from the end of the pelvic region from the point of ischial tuberosity and extend down to intersect the knee joint and crawl further towards the lower part of the leg. These muscles usually consist of strong tissues used for connective purposes, and these are responsible for the power that we have in our legs, which is comparatively a lot more than other parts of our body. These muscles are what helps us with the movement of our leg joints, walking, sitting, bending, lying and everything that our legs are capable of doing.

The injuries and strain related to the hamstring muscles can be in the form of muscle tearing, muscular, complete tearing or the partial tearing of the muscles. The grading of these muscles is dependent on how severe is the damage caused to the muscle. The healing time of hamstring muscle injuries can be as long as 3 months in case of severe injuries. The most common part that is damaged as a result of hamstring muscle injury is the thicker and core region of the muscles where the tendons and muscles are joined. In the most severe grade 3 cases, the tendons are entirely ripped off from the bones, and in certain cases, a part of the bone is also torn away with it. This most severe type of muscular hamstring injury is referred to as avulsion injury.

Grades of Hamstring Muscle Injuries

There are different grades for Hamstring Muscle Injuries similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three grades are:

Grade 1: This is the mildest grade for hamstring injuries. It includes less than moderate pain, while the patient retains the ability to feel and move the injured area.

Grade 2: This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.

Grade 3: This condition usually includes severe pain, while the patient loses the ability to feel and move the injured area.

Causes of Hamstring muscle injuries

There can be a variety of different reasons which can be responsible for mild or severe cases of hamstring muscle injuries. One of the most common cause for Hamstring injury is muscle overload, which can result in the straining of the hamstring muscles. Such a condition may occur if the larger muscle is pulled or stretching too much beyond its threshold of getting back into the place. In this way, it can even get pulled off or ripped off from the bone. This can happen as a result of putting a lot of loads all of a sudden. The most common reasons for this cause include accidents, heavy blows, and sports injuries.

A phenomenon called eccentric contraction can also lead to the occurrence of hamstring muscle strains and injuries due to the lengthening of the hamstring muscles while contracting or shortening. A pressure put on the muscle due to contraction and getting pulled to lengthen it at the same time can result in tearing of the muscle. At the time of running or doing something similar, the eccentric contraction of the muscles is prominently happening. As the running begins, the runner uses the toe to straighten the leg and sprint forward, which is the moment when eccentric contraction takes place. Avulsions are the most severe form of hamstring tendon and muscular injuries, which are caused as a result of putting a lot of load on the tendons all of a sudden.

Risk Factors associated with hamstring muscle injuries

There are some risk factors associated with hamstring muscle injuries. However, the most important ones deserve the attention. The risk of hamstring muscle injury can be increased due to the tightness of muscles which renders it susceptible to strain. This is the reason which makes the warming up and stretching part before getting involved in rigorous sports and works out so important. Another factor is the lack of balance of the muscles due to the difference in the strength of the muscles opposite to each other. Due to such an imbalance, a strain can be caused. This kind of training is usually caused by hamstring muscle due to its size and the scope of imbalance. Hamstring muscles consist of more powerful front muscles while the posterior muscles are less strong, which can experience fatigue quicker than the stronger muscles on the front. As a result, hamstring muscle injuries and strains can take place. Fatigue can also occur due to other reasons, such as the ability of the muscles to absorb and retain the energy and protect itself from the injuries and heavy blows. Furthermore, another important factor is the condition and the strength of the muscles; if the muscles are strong, they are less likely to get damaged from the exercising, training, pressures and the stress resulting from it. Another factor that matters in determining the risk is the type of activities that a sportsperson chooses to take. Although hamstring muscle injuries can be experienced by any person, certain activities put the people involved in the more at risk of getting a hamstring muscle injury. These activities include certain sports such as basketball, soccer, football, and other activities such as athletics, dancing, running and old age athletics. Since the body is growing unequally at adolescence, people at this age are more at risk of getting a hamstring muscle injury. At the time of growth spurt, bones are capable of growing quicker than the muscles. As a result, the muscles can be pulled and lengthened due to a stretch being caused by a very sudden growth.

Symptoms of Hamstring Muscle injuries

As easy as it is to imagine, hamstring muscle injuries can be very painful at times. The extent of the symptoms however greatly depends on the severity of the injury and the grade. The symptoms that result from hamstring muscles injury includes a sudden and sharp pain in the back region of the thigh due to the injury which will make a sprinting person stop at once or fall terribly. Due to the damage, other symptoms can also show up, such as swelling and redness soon after the injury or after a few hours, bruises and change of color impact on the skin due to internal bleeding or other reasons, and the weakness of the tendons and hamstring muscles which can be prolonged for a couple of months.

Diagnosis for Hamstring Muscle Injury

The primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. The doctor may also carefully examine by moving the thigh and knee joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. An X-ray test will be able to analyze the bone condition. Imaging tests are most important for accurate diagnosis.

By acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely and the severity of it. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine position, and the movement and flexion of the hip and legs are examined.

Treatment for Hamstring Muscle Injuries

Depending on the type and reason of the injury, and the location of the injured area, the treatment for the Hamstring Muscle Injury will be different. The treatment may also be different depending on the consent of the patient as well as the severity and the grade of the injury. The core purpose of the treatment is to normalize the condition of the Hamstring Muscle Injury and achieve painless movement and healing. Only in severe cases, a surgical procedure may be required to treat the Hamstring Muscle Injury. However, in most cases, non-surgical procedures are recommended and opted by the specialists as much as possible. It is very important to comply with the measure and directions of the doctor to ensure effective treatment and restoration of the muscular health.

In most cases of Hamstring injury apart from severe cases, the injuries can easily heal naturally. Nonetheless, you must always make sure that you take enough rest to allow time for your injury to heal. For speeding up the healing and recovery, there are certain measures that you can take.

Icing can be done as an effective way to treat hamstring injuries related symptoms. This involves putting ice on the injured area for up to 15 to 25 minutes several times a day. It should help reduce the swelling and alleviating the pain. Upon the offset of these symptoms, you should stop the icing treatment.

For resting your leg, you need to take some proper measures in hamstring injuries. it can be done bests by avoiding walking, running and all types of sports that involve legs for a while. This will allow your body to focus its energy on healing the injured leg. Resting is more important than other treatments and if you take it for granted other treatments may also not work. Therefore, make sure you don’t put any pressure on the injured leg as it can reverse the healing and cause symptoms to show up again.

Along with resting, you can also consider a physical therapy if you are more concerned about the severity of your condition. A physical therapist will ensure that everything goes smoothly and you can recover quicker. It can also help you avoid stiffness that can be caused due to the lack of activities during the rest period. You should be aiming for a proper stretch, flexibility, and improved movement.

Compression therapy can also be performed as it helps alleviate the symptoms in most cases. Compression is done with the help of a bandage in most cases, but some other technique may be used depending on the type of the injury. The bests way to go about it in consultation with an expert, and it’s even better if you let the expert to the job. Once done you can mimic the same approach if it works out for you. This should also be coupled with the elevation technique, the one that you usually see in hospitals. It involves the lifting of the leg when the patient is lying down or sitting. At home, you can do this by putting a pillow under your leg as it will allow your leg to elevate. Use multiple pillows if required.

Apart from these physical treatments, you can also opt for medical treatments. In most cases, it won’t be necessary. However, if you’re not able to bear the pain and the acute symptoms, you can opt for medications. The common medicines that are used for hamstring injuries are over the counter drugs, such as Motrin and Advil, or other NSAIDs that can make the pain and other symptoms tolerable. You should understand that these medications work at the cost of side effects. Therefore, if you feel that the pain is better than the side effects that you may suffer from, it is best to avoid taking those medications. Your doctor will carefully examine your condition to tell you if you require medication or not.

Apart from all these treatment options, you can opt for proper exercising. Exercising should not be ignored for the treatment unless otherwise instructed by your doctor or physical therapist. Some of these exercises may be a part of your physical therapy, while there are others that you can try on your own. You must make sure that if any of your exercises in your workout regime is causing even the slightest trouble to your injured area, you must immediately stop doing that and consult your physical therapist to try something else that works for you. Some of the most effective exercises may involve strengthening and stretching exercises. Strengthening exercises should also be a part of your regular workout, as it can prevent you from having a hamstring injury at the first place.

If the problem and symptoms persist and the case is severe, you may require undergoing an operation or a surgery to fix the problem. However, this is very rare, and most hamstring injuries can heal naturally. Surgery may involve the reattachment of a torn hamstring muscle.

Another part of your treatment is to take proper measures to prevent further injury or worsening of the situation. this complementary approach involves the use of aids, crutches and other things that would help to prevent you from getting into further trouble. You should also avoid lifting any weights or putting any pressure on the legs. All of these approaches may be administered until the patient is recovered and the symptoms are gone. You should be able to get back on the sports ground and easily use and move your legs to the full range.

Recovery for Hamstring Muscle Injuries

In most cases, a rehab therapy results in complete recovery from hamstring muscle injuries. Physical therapies along with the RICE treatment can effectively treat the condition and get the patient back on the ground. However, there is a chance of healing process getting reversed if proper measures are not taken and if healing has not completed. Therefore, it’s essential to let your injured muscles recover completely by following the protocol provided by the doctor to eliminate the chances of getting repetitive injuries, chronic conditions, and permanent damage. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area, the type of causes of the Hamstring muscle injury and other factors. For your part in effective recovery, you should avoid the normal routine activities according to your doctor’s advice. Depending on the severity, the Hamstring muscle injury can take from a few weeks to a couple of months of time to recover. Hamstring muscle injuries are painful. Therefore, usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time.  A regular visit to the doctor will ensure that it’s time to go ahead.

Tennis and Golfer’s Elbow

  

What Is Tennis and Golfer’s Elbow?

As the name suggests, Tennis and Golfer’s elbow is a condition that usually occurs in people involved in certain types of sports that makes use of the arm extensively. The condition is characterized by inflammation and pain in the muscles and tendons that serve connective purposes on the arm and the elbow. It specifically functions to enjoin the forearm with the elbow. For Golfer’s elbow, the condition is also known as medial epicondylitis in medical terms. The inner area of the elbow is affected which causes an extending pain towards the forearm. The condition may be mild or severe, and it may be treated easily or require prolonged caring. The painful condition and inflammation are developed due to the overuse and overexertion of the muscles of the arm. This mostly happens in athletes, in cases where the overuse of the arm, too much rotating, gripping and flexing of the wrist can result in inflammation. As a tennis or golf player, one requires to twist swing and rotating the forearm and the muscles located there in certain ways to set up for the right shot. As a result, the muscles and tendons can be damaged, degenerated and get torn.

Nonetheless, the name doesn’t imply that these forms of tendinitis conditions are only experienced by tennis players or golf players. In fact, anyone can experience this type of inflammation of tendons. There are people from other sports as well who experience this condition frequently, such as baseball players, basketball players, and bowling players. The tennis elbow tendinitis is characterized as the inflammation of the outside tendons, while the golf elbow tendinitis is characterized by tendinitis of the inner tendons of the elbow. Tennis elbow is also known as lateral epicondylitis, while the golf elbow is medically termed as medial epicondylitis.

Symptoms for Tennis and Golfer’s Elbow

The patients suffering from golf and tennis elbow can experience several symptoms that can indicate the injury and the severity of the injury. While the symptoms may vary from patient to patient, some of the most commonly observed symptoms of tennis and golf elbow syndrome are:

  • Burning sensation inside the elbow (golf elbow)
  • Burning sensation outside the elbow (Tennis Elbow)
  • Pain in the affected area of the injury which can spread towards the wrist through the forearm.
  • Numbness of the elbow
  • The weakness of the elbow
  • Difficulty and pain in the movement of the elbow
  • The difficulty, pain, and weakness in the movement of the wrist
  • Difficulty in gripping the objects
  • Tenderness inside of the elbow and extending along with the tendons
  • Swelling of the affected area
  • The stiffness of the injured area
  • Pain during the gripping and fisting of the wrist.
  • Tingling and numbing sensations on the elbow which is extended towards  the forearm and the wrist
  • Difficulty in doing everyday things, such as pouring coffee, shaking hands, moving the arm, and typing on the keyboard.

Both injuries are usually the result of repetitive strain on the tendons, and although you don’t have to be a golfer or tennis player to experience them, the repeated forceful motions involved in both sports make them very common.

Treatment for Tennis and Golfer’s Elbow

Natural and non-invasive treatments are usually recommended for tennis and golfer’s elbow syndromes. The right approach to treat this condition is the treatment of the causes instead of alleviating the symptoms of the condition. It could include a personal treatment plan, healthy diet plan, changes to the lifestyle and exercising regime. Due to the overuse and overexertion, the painful and inflammatory condition can be specifically treated. Tennis elbow is usually experienced by people involved in the different profession and its most commonly found in the people within the age group of 30 to 50 years old.  On the other hand, the golf elbow syndrome which affects the inner tendons of the elbow is experienced by people that practice golf, swimming, painting, tennis, rowing, and baseball. Due to the improper use of the technique, gripping and moving repetitively, and throwing and lifting improperly, golf elbow can result in injury to the inner tendons.

There are many things that should be taken into account, including the type of the injury, the severity of the injury, and the structures that are damaged due to the injury to determine the right and effective type of the treatment for golf or tennis elbow syndrome. However, for mild to moderate conditions the approach for the treatment remains common in most cases. Some of the common and most effective minimally invasive and non-surgical treatment options available are the ones you should start with.

The best approach you can take for the treatment of golfer’s and tennis elbow injuries is to start off with the right treatment options as soon as possible. Earlier treatment can save you from a lot of trouble in the long run as the symptoms keep developing gradually if proper care is not given. The sooner you start with your treatment, the earlier it will be possible for you to continue your sports practices.

The injury can start off slow but gradually develop into severe conditions. Sometimes mild pain is ignored by the players who become a reason for critical conditions. Therefore, it’s imperative that you take proper rest as soon as the symptoms start to show up. The rest usually involve a break on your sports activities and minimizing the use of your arm and elbow. You should immobilize your arm to allow it to heal your injured structures. Once the pain is gone, and you’re able to move the elbow easily, and to the full range, you can continue with your sports again while administering proper preventive measures to avoid recurrence.

If the pain keeps on troubling your arm despite immobility, you can use ice on the injured elbow and nearby area. It can immediately soothe your pain and reduce the swelling. You should also make sure that you don’t use ice directly on your skin to avoid ice burns. You can wrap the ice into some covering, such as a thin cloth or towel, and use it for 25 minutes after every 2 to 3 hours throughout the day. It may take a few days to eliminate pain and swelling with this treatment.

You can also take medicines for the tennis and golfer’s elbow syndrome if the pain and discomfort are bothering you. Ibuprofen and aspirin work well for this purpose. Other OTCs are available on the market, and you should go for non-steroid drugs. These medicines may have a side effect, and they should only be used minimally. If these medicines don’t work, alternative medical treatments may be administered, such as injections of corticosteroids for temporary and short-term relief. They are effective regarding alleviating the symptoms. However, it’s not a permanent solution especially in case of severe conditions that take a lot of time to recover. Medical advancements have also unleashed another innovative method of treatment for this injury, which is known as PRP or platelet-rich plasma technique.

Since the immobility and support are important in this regard, you should go for physical aids and braces to keep the injured arm in place and avoid jerking. It can reduce the pressure and the strain on the muscles that are sensitive due to injury. Counterforce braces may be advised by your doctor or physical therapist.

Stretching and strengthening exercises also play an important role in the treatment of tennis and golfers elbow injuries. These exercises can also prevent you from getting an injury and help you avoid secondary injuries. A characteristic exercise for this type of injury is administered by the physical therapists, which involves the lengthening of the wrist extensor muscles. This exercise is particularly effective for these injuries. For this injury type, a number of other physical aids can also be used to support your arm and limiting the movement, such as strapping, braces, supporting pads and other aids that are relevant to arm support. You should also ensure that corrective measures are taken, as the very cause of your tennis or Golfer’s elbow could be wrong training practices and angles of movement. By improving the movement of your arm and elbow joint especially for overhead movements, and by improving your posture you can avoid these injuries as well as speed up the treatment process.

Compressing the elbow region that is injured with a bandage or a wrap can also alleviate the symptoms very effectively. It can also hold the elbow into place and help you reduce unnecessary movement. The treatment involves gradual rehabilitation, which means that you should continue with the treatment measures and gradually return to your sports or other daily activities. you should also inform your trainer or instructor about the condition, and he will make sure that you play the safe way after returning from the treatment.

In severe cases, you should keep a regular contact with your doctor who will closely monitor the condition and the improvement occurring over time. If the condition doesn’t show significant improvement, your doctor may consider certain operation and surgery options for you. The surgery may differ from person to person, and it is rarely administered. However, if no other treatment options are effective, you may immediately need invasive surgery. Usually, the doctor will closely monitor your condition for up to one year and try his best to treat you with non-surgical treatment options. However, in certain cases, the damage is not recoverable naturally, and a surgical aid may be required. The latest surgical procedures involve the removal of damaged tendons from the injured area.

A relatively different approach to the treatment of pain and inflammatory conditions developed by tennis or golfer’s syndrome is the acupuncture technique. It is scientifically accepted by many specialists and can be quite effective for alleviation of the pain. This can be coupled with massaging as well. Both of these traditional treatments can be useful for some patients. Some other less common treatment options include cortisone injections, platelet rich plasma technique, and operation or surgery.

Recovery for the tennis and Golfer’s Elbow

Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area and other factors. It can take anywhere from a week to a number of months. For effective recovery, you should get back to the normal routine activities slowly and gradually according to your doctor’s advice. Once you start using your muscles and bones again, it will complement the complete healing of the injured parts. If the patient was healthy before the injury, the recovery would usually be faster. However, due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the injury can take up to 6 months of time to recover.

Shoulder Injuries

What are Shoulder Injuries?

The shoulder injuries can be a very common type of injuries when it comes to sports. It can be considered as one of the most mobile and easily dislocated joints in the human body. Due to this factor, athletes and people involved in similar activities are very much susceptible to get such a condition. For the sports people and the people involved in athletes, this can be caused due to rigorous movement of the shoulder, overuse of the shoulder joint, too much taxing of the shoulder, overhead movements involved in certain sports, and too many repetitive movements. A number of sports utilize the movement of the shoulder joint to ensure the proper shots, such as cricket, baseball, basketball, badminton, golf, tennis, bowling and other similar sports which also makes it prone to injury. If you’re an athlete, taxing your shoulder over time with repetitive, overhead movements or participating in contact sports may put your shoulder at risk for injury.

The shoulder injuries is a broad term, and therefore it can be classified in a number of different conditions and injuries that are associated with the shoulder. Each condition is characterized by the type of the injury, the type of body parts impacted by the injury, the severity of the injury and the causes of it. In terms of sports, these injuries related to shoulders can be classified into three most common types which are mostly experienced by the athletes and the sports people. Here are three of these most common shoulder injuries that are normally seen in the sports arena.

SLAP tear

The slap tear is a very common condition which is often seen in sports people. Our shoulder joint has a localized socket that ensures the proper fixation of the bones. The shoulder socket is covered with a ring of cartilage that is called a labrum. In this condition, the labrum wears and tears due to a heavy blow, jerk, overhead shots, repetition of the movement and the wrong movement of the shoulder. The condition causes acute and severe pain. However, the condition is developed over time with a gradual deteriorating of the cartilage. Which is why it’s very important that if the patient experience even a little pain and discomfort of the shoulder, the condition should not be ignored and proper measures should be taken to ensure that the problem gets resolved. If the condition is not addressed in a timely manner, it can grow and cause more trouble to the patient and even result in permanent damage. Due to this tear, the patient can experience a sudden onset of pain and disability of the proper function of the joint.

Due to this injury, the people involved in sports and the athletics can experience deterioration of their performance and difficulty in moving the shoulder joint the way they are trying to do. The pain can be severe or less severe. However, the patient may feel that something is not wrong with the shoulder and it will pop out and dislocate at any minute with any movement. It is important to know and ensure that the warning signs are observed and not left unnoticed since it can result in a more terrible condition. Some of the most important warning signs include pain and discomfort due to certain movements of the shoulder on certain angles. The movement of the shoulder joint is also reduced in range, and the patient may not be able to mobilize the arm to the full range. It can be mistaken for stiffness and difficulty in stretching. The pain is also characteristic in a way that it’s difficult for the patient to pinpoint and exactly tell the place and location where the pain is coming from. If these symptoms are rightly understood, and proper action is taken at the right time, it can prevent the patient from getting further damage.

Symptoms of SLAP Tear in shoulder injuries

Some of the most common symptoms experienced by the players and sports people suffering from a shoulder injury of SLAP Tear includes:

  • Grinding feeling with the movement of shoulder joint
  • Prominent sound and friction occurring due to joint shoulder movement
  • A clicking feeling or sound is occurring due to movement of the shoulder.
  • A feeling and a sound of popping in the shoulder joint upon movement.

Shoulder instability

Three factors can make the shoulder more susceptible to dislocation: repetitive overhead movement, previous dislocation, and genetics. Read Causes and Risk Factors for a Dislocated Shoulder

Another very common type of shoulder injury experienced by people involved in sports is the shoulder instability. The condition can be commonly experienced by the athletes, and it can occur in people involved in contact sports, such as soccer, hockey, and rugby. Other types of sports which include the rigorous movement and repetition of the shoulder movement also have a good portion of players experiencing shoulder instability. It is a condition which is characterized by the injury to the muscles, tendons, and ligaments. As the name suggests, the instability is caused in the shoulder muscles that are supposed to cover and protect the shoulder joint. As a result, the shoulder joint is left unsecured. The humeral head is the bone of the arm located in the upper part, which gets dislocated due to the instability and the bone can dislocate and pop out completely or partially from the shoulder socket.

Due to this dislocation, the patient can experience a very severe and sudden pain. If the bone is partially dislocated, the pain can be sharp and shocking in the form of bursts and throbs. Along with the pain comes the disability of a person to use their dislocated arm and severe weakness of the shoulder. In terms of physical changes, the patient can also experience severe swelling, discoloration and the bruising on the injured area.

Rotator cuff injury

Another very common type of shoulder injury is the rotator cuff injury. In the  Rotator cuff injury, the patient’s condition is caused due to the repetition of the movement of shoulders, overhead movement, overuse of the should joint and other similar activities. People involved in a variety of sports are vulnerable to this condition. Rotator Cuff injuries may be very painful accompanied by the disability to continue sports for a while. The condition makes it very difficult for the patient to sleep, and they may get up from sleep several times during the night due to the shoulder pain. It’s also difficult to get a comfortable lying position where the shoulder doesn’t pain. The pain can get worse with moving the shoulder joint in certain angles, and it can be extended towards the rest of the arm. It can also make the usual everyday activities a challenge for the patient due to the pain, such as combing the hair.

Rotator cuff injuries are also one of the most commonly seen injuries and require more attention. The rotator cuff can be defined as the collection of different tendons and the muscles that are surrounding the shoulder joint and the socket. This is the place where the upper arm is connected strongly to the socket, and this connection is strengthened by the group of tendons and muscles called the rotator cuff. Injury to this group of muscles can result in a dull pain in the shoulder. And the condition can easily get exacerbated while making the pain worse with time. Therefore, proper care, especially with the right sleeping position, is required to treat the condition in a timely manner and not cause further damage.

Causes of injury

If an injury causes a sudden weakness and disability, you should see a doctor as soon as possible. The most common cause in sports for this injury is a hard hit, heavy blow or contact sports. As a result, the wearing and tearing can take place in the Rotator cuff muscles. If the condition is chronic, it can be called as the rotator cuff disease.

Other causes include:

  • Overhead strokes and movements
  • Repetitive movement
  • Sudden jerking
  • Heavy hit
  • Hard blows
  • Falling on the shoulder

How to Diagnose Rotator Cuff Injuries?

The primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The doctor may also carefully examine by moving the knee joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound will help the doctor to locate and study the internal structures to see any possible damage.

Treatments for injury

Physical therapy is a very effective treatment method for the injuries related to the rotator cuff or the shoulder. The treatment may greatly differ depending on the severity of the condition as well as the type of damage an injury that is caused to the shoulder. The treatment aims to bring back the displaced joint or tendons back to their original place, increase the strength and bearing capacity of softer tendons, and improve the flexibility of the tendons and the muscles to keep the shoulder protected. Shoulder injuries may be chronic or acute, and the treatment also differs depending on the type of the injury. Normally, a single heavy blow, jerk or an injury can result in the rotator cuff injury, or the tendons and muscles may get deteriorated over time by repetitive and smaller injuries. Physical or occupational therapy, a sling or shoulder immobilizer, or surgery are the treatments that come into practice the most. You may also take medication along with the treatment, which includes NSAIDS and other over the counter drugs which can be beneficial in terms of reducing symptoms and alleviating the pain. In severe cases, bold measures may be taken, and the patient can is given corticosteroid injections and cortisone injections. Although they would reduce the pain. However, they approach temporary and only implied if the symptoms are unbearable for the patient. they may also have serious side effects on the patient which is why it is important to make a favorable decision while deciding to take them.

In terms of home remedies, there are several things that you can do to treat the problems associated with your shoulder. The most important is resting your arm as much as possible and pausing your sports activities for a while. This should quickly fix any mild sprain or strain, and you may not need to get advanced treatment. However, when the symptoms are enhanced, you should try putting the ice on the area for 20 to 30 minutes at least four times a day. You can use a towel wrap in order to prevent direct contact of the ice with the skin so you can avoid burning. You can also use aids and slings as it can limit the movement of the shoulder in cases of acute injuries. however, you should make sure that you don’t wear the sling for a very long time in order to avoid stiffness of the shoulder. This is where the exercising and physical therapy becomes important, as you don’t want to jam your shoulder joint by not using it. It will also be helpful in restoring the full range movement of the arm.

Medication can also help in case of shoulder injuries, and the most common medicines that are used for this purpose are ibuprofen and naproxen. However, these medications can interfere with other underlying conditions in a patient. That is why if you are already taking some medicines previously or if you have a previous health condition you should consult the doctor to see if the medicines can react to each other or if they can affect the treatment of other medicines. You should not even use over the counter drugs against or without the prescription of a doctor or a specialist. Depending on the severity of the condition and the type of the structures damaged, it may take as from a few weeks to a few months for you to recover completely and get back to your everyday activities.

Before going for a surgery, you should consider trying other non-surgical options as well. Some of these treatment options for shoulder injuries include:

  • Steroid drugs and injections can be administered to reduce the inflammatory conditions in the tight spaces
  • Shockwave therapy can be done for shoulder injuries, also known as extracorporeal shockwave therapy. It is a common treatment that is used by orthopedic specialists for various purposes.
  • Depending on your individual case, you may also be a good candidate for a therapeutic ultrasound treatment. Your doctor will carry out an examination to determine if you are a good candidate for this treatment or not.
  • Another effective treatment for the shoulder injuries is called a dry needling technique. In this treatment is a common treatment administered by physical therapists for various types of injuries. the procedure is also referred to as myofascial trigger point try needling, in which a dry needle is used to treat the pain and the impaired movement without the use of medicine and anesthesia. It is also considered to be an unproven technique by some practitioners, while others find it effective. It could be a preferable substitute for surgery which is more invasive.
  • If nothing works, you may opt for surgery. In severe cases, surgery is more viable as it provides a quick fix to severely damaged or torn structures, and it can also clean up other pieces of bones. The reattachment of torn tendons ensures that it’s healed quicker. It can also fix any unnatural tightness or stretch of muscles due to injury.

For surgery, the arthroscopic technique can be used in which the surgeon inserts an arthroscope which can visualize and repair the damage. This is comparatively less invasive as compared to open surgical procedures. Surgery is also a viable option for athletes and sports people who are more interested in their career and wish to get back to the ground as soon as possible. Surgery may also be avoided for people who are above the age of sixty years. In case of rotator cuff injuries, surgery is avoided unless there is a complete tear or a degree 3 injury. The doctor may also choose to go with a surgical procedure if the injury is not responding to non-surgical treatments even after 2 months from the time of injury.

You may also require surgery if you were involved in a sports activity that required constant use of the shoulder. Apart from that, there are certain Codman exercises that can prove to be helpful for the treatment of shoulder injuries. these are usually administered under the supervision of a physical therapist. It’s aimed at reducing the symptoms of pain and swelling, and enabling the natural full ranged movement of the should joint. This requires a person to lean towards the injured side and hang the arm freely. The patient should move the arm in circles slowly while it’s hanging. The proper diameter and the speed are regulated by the physical therapist, so it should be done under supervision at least for the first few times. Due to the hanging arm, It is also referred to as a pendulum exercise. Apart from that, a broom can also be used for exercising. This is done by gripping the broom with both hands and slowly moving it along a wide arc back and forth gently and slowly as it can make the softer tissues more flexible and stretch them effectively. Resting the shoulder for several days before returning to normal activity and avoiding any movements that might cause pain can be helpful. Limit overhead work or activities. Most shoulder injuries can be treated at home with a proper caring regime.

Risk factors for Rotator cuff Injuries

Risk of rotator cuff injuries is based on a number of different factors. As a general rule, the overall resilience and strength of the patient is a very detrimental factor. If the muscles are wrong, the injury is likely to be less severe. Apart from that, the strength of the muscles can also be affected by growing age, especially after the age of forty years. Therefore, age is another important risk factor. The type of sports that a person is involved in is also detrimental to the risk. Sports like tennis, baseball, soccer, and golf are the high-risk sports. The occupational practices, as well as the medical history of the patient and his family, is also very detrimental.

Complications of Rotator Cuff Injuries

The timely treatment is one of the most important factors when it comes to rotator cuff injuries. If the problem is not addressed in a timely manner and with intensive care, the condition can gradually become worse and even result in permanent damage. It is therefore important to demobilize the shoulder as much as possible and make use of aids like braces and strappings to reduce the movement. If proper care is practiced, the complications are less likely to happen.

Patellofemoral pain syndrome

What is Patellofemoral Pain Syndrome?

The PFPS is one of the very common conditions that are experienced by the people involved in heavy sports, abbreviated as Patellofemoral pain syndrome. In common language, the condition is also called the runner’s knee. The Patellofemoral pain syndrome can be defined as a condition in which the patient experiences the pain in the knee which can either be very severe or less severe. Sometimes it may just be discomfort. However, it should be addressed in the standard way. The back of the kneecap is known as the patella which is connected with the thigh bone, medically known as the femur. The pain is characteristic to the meeting point of the femur and the patella. The condition is different from the other conditions of the knee because of its exclusive symptom of pain in the anterior knee which involves the retinaculum and the patella. Obviously, it is difficult to know exactly what the injury is Patellofemoral pain syndrome at the time of the injury, and it may be required to run diagnostics to identify the condition. As the name suggests, the condition is very much common in people who are involved in rigorous and heavy running sports activities and other similar activities. the sports people who experience

Causes of Patellofemoral pain syndrome

Patellofemoral pain syndrome the most are cycling, running, athletics, football, soccer, and hockey. The most common reason is the sudden change in the training practices and the exercise regime of the players, or accidental injuries caused during the running. Another most common cause of Patellofemoral pain syndrome is an accidental injury. Other causes include severe hit, falling on the knee directly, stopping too quickly during a run, and quickly moving in different directions. Women as found to be more prone to Patellofemoral pain syndrome injuries due to the tenderness of muscles and tendons, while men may also experience tearing and spraining.

If an injury causes a sudden weakness and disability, you should see a doctor as soon as possible. The most common cause in sports for this injury is a hard hit, heavy blow or contact sports. As a result, the wearing and tearing can take place in the femur and patella. There are several other causes and risk factors associated with the condition of Patellofemoral pain syndrome. The injury can be a result of the wrong kind and size of the shoes which may put pressure on the muscles up along the legs. Other factors are also important such as the intensity of the hit. Overtraining and intense training all also among the most common causes of this condition.

Other causes include:

  • Running several steps
  • Suddenly stopping while running
  • Legs stretching
  • Leg displacement or foot displacement while running.
  • Wrong posture and legs movement
  • Sudden jerking
  • Heavy hit
  • Hard blows
  • Falling on the knee

Signs and symptoms of Patellofemoral Pain Syndrome

The onset of the condition can be gradual over time, or it can be acute due to a sudden injury. Depending on the severity, the signs and symptoms can vary. In less severe cases the patient may experience a sudden discomfort in the knee during a walk or run. Diffuse peripatellar pain is experienced in this condition around the kneecap. In most cases, it’s difficult for the patient to identify the exact location of the pain. The patient may feel and experience a grinding feeling with the movement of the knee. Prominent sound and friction occurring due to knee joint movement are also experienced. The patient may also feel a clicking feeling or sound occurring due to movement of the knee. A feeling and a sound of popping in the knee joint upon movement may also occur. In such cases, the injury includes a pop sound from the knee along with the loss of control over the knee muscle. In severe cases, the movement of the knee joint is severely limited, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling. The patient can experience discomfort while walking, bending knees and while sitting. The everyday activities such as walking up or down the stairs can also become a challenging task.

Diagnosis for Patellofemoral pain syndrome

As discussed before, the diagnosis for the Patellofemoral pain syndrome is not a very simple task. Therefore, a differential diagnosis is commonly carried out for Patellofemoral pain syndrome. The diagnosis of Patellofemoral pain syndrome is complicated and difficult, which is the reason why it can be easily mistaken as another syndrome, such as, Osgood–Schlatter disease. prepatellar bursitis, Sinding-Larsen, and Johansson syndrome, plica syndrome and patellar tendinitis. There isn’t any single best method for the diagnosis of the Patellofemoral pain syndrome, as the muscle damaged and the conditions can vary among different patients greatly, and a number of other diseases, problems, and health conditions can result in a similar kind of a pain in the knee. Therefore, a differential diagnosis is administered to eliminate the possibilities of other conditions.

The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case.

Once the initial examination is performed, and the doubts are reduced, the doctor may follow up with diagnostic procedures. The techniques used in this case are radiographic investigations, ultrasonography, the differential diagnosis, and sonographic evaluations. If necessary, the doctor may also use MRI scans to find out the exact location of the damage.

On the basis of acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine or elevated position, and the movement and flexion of the knee and legs are examined.

The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain, tenderness of the femur and patella area. The diagnosis also includes the identification of the grading and category for the condition.

Categories of Patellofemoral pain syndrome

There are different grades for Patellofemoral pain syndrome similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three grades are:

Grade 1: This is characterized by less than moderate pain, while the patient retains the ability to feel and move the injured area.

Grade 2: This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.

Grade 3: This is characterized by severe pain, while the patient loses the ability to feel and move the injured area.

Treatment for the Patellofemoral pain syndrome

The treatment can be administered in different ways, as the type of injury will determine the treatment. after the initial first aid response, a careful physical examination can give a good idea of the condition, and other tests may be administered to choose the desired treatment. The treatment approach is three-fold: eliminating pain and other symptoms, recovering the damage that is caused to the structures and recovering a full ranged natural movement of the leg. It can be treated naturally at home in cases of mild to moderate injuries. Simple measures can be taken to begin the treatment of patellofemoral pain. You should rest your knee as much as possible and avoid all the activities that involve the knee as it can worsen the condition. Exercises  and sports should be paused while everyday activities should be limited.

A number of medicines can also be taken for reducing symptoms if needed. Some of the drugs like ibuprofen, acetaminophen and naproxen sodium can be taken along with other over-the-counter pain relievers. Apart from these anti-inflammatory drugs, other medicines can be used, such as the Glycosaminoglycan polysulfate (GAGPS) are also widely used for the inhibition of enzyme production. Apart from drugs, it’s recommended to have therapy for the treatment. a physical therapist will help you with certain exercises that you can practice throughout the rehabilitation process. These may especially include strengthening exercises, as this type of injury may very well be due to the lack of strength. The muscles surrounding the knee are there to support the joint and control the movement of the knee. Tearing of these muscles can cause dislocation and displacement of the joint. The physical therapy will be used to control the alignment or various muscles, especially related to the hip, thigh, leg, calf, and quadriceps. Apart from therapy supporting aids can be used for keeping the joint and the injured area in the right location and avoiding pressure or strain on it. Knee braces and arch supports are commonly used, and they can also help in to alleviate the pain quicker. Another aid is taping procedure that can reduce the pain and improve the mobility of the knee joint. It can also keep the injured area compressed which is an effective technique for the alleviation of the symptoms. Icing the area should be done after the physical therapy and exercises for the best results. to avoid stiffness and loss of movement, you should also incorporate knee friendly exercises in your treatment regime according to your doctor’s advice. Such as swimming and bicycling.

In worst case scenarios the last resort would be surgery. For the runner’s knee syndrome, the most commonly administered surgical procedures include arthroscopy and realignment surgery depending on the type of the injury and the diagnosis of the condition. In the arthroscopic procedure, the doctor will insert an arthroscope in the injured area which has a preinstalled camera and light. It can be used to view the condition inside and treat it effectively in a minimally invasive manner. The surgeon can reach the injured area with his instruments through the arthroscope. In cases of dislocation and displacement, the surgeon would carry out a realignment procedure. This may require open surgery to realign the knee back to its natural position to fix the stretch and pressure that it is causing on the proximal cartilages.

To speed up the recovery, you should keep up with the regular physiotherapy until the symptoms of pain and swelling are gone, and the knee is capable of a full-ranged movement. The patient should focus on rehabilitation therapies and non-surgical procedures, and operation and surgery should be avoided as much as possible, at least for the first six months. Your doctor will make sure of when it is a good time for you to get back to life and continue with everyday activities. at first, you should be doing light exercises and training which require less movement and jerking. Here is a brief for the quick measure that can be taken for the treatment of Patellofemoral pain syndrome:

  • Resting as much as possible
  • Icing the aching area
  • Using compression bandages
  • Anti-inflammatory medication
  • Exercising, stretching, friendly workouts
  • Gradually start physical activities, don’t rush.
  • Surgery as a last resort, if no results and symptoms persist after the treatment.

Ankle Sprain

What is an Ankle Sprain?

Ankle Sprain can be defined as the injuries that are caused to the tendons and the muscles of the ankle that results in palpation, pain and other symptoms. The proximal tendons, connective tendons in the ankle that connects the foot to the leg and the injury to the bone can cause pain. Ankle Sprain can be a common sports injury in many different games and athletic activities. The most common activities include soccer, football, ice hockey, running, tennis, rugby, American football, basketball and other similar games. It is the most common injury experienced by soccer players. Due to the strong involvement of such tendons in these games, groin strains can occur accidentally or when no prevention measures are taken. Usually, the damage is caused when the bone is detached from the tendon accidentally. The Ankle Sprain is a result of twisting and turning of the ankle in displacement and unnatural manner. As a result, the tendons can wear, stretch and tear. These ligaments and the tendons that are holding the bones together may cause them to lose when they are torn.

Categories of Ankle Sprains

There are different grades for Ankle Sprains similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three grades are:

Grade 1: This is characterized by less than moderate pain, while the patient retains the ability to feel and move the injured area.

Grade 2: This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.

Grade 3: This is characterized by severe pain, while the patient loses the ability to feel and move the injured area.

The grade of your sprain will determine the time of your recovery and the mode of your treatment.

Causes of an ankle sprain

The most common cause of an ankle sprain is the turning and the twisting of the ankle joint due to displacement. As a result, the ankle is pushed out of its normal and natural position, and it can cause muscular and tendon damage. Such unexpected movements are very common in sports that involve a lot of running and the use of legs. These tearing of the muscles can be very painful at times and could be accompanied with other symptoms such as bruising discoloration and the swelling of the area. Although it’s mostly the tendons, ligaments, and muscles that are damaged or injured due to ankle sprains, it can also damage other structures, such as the blood vessels and cartilages. There are several risk factors involved, such as the types of sports, etc. however, it can occur in people of all ages.

Some of the other most common causes for Ankle Sprain includes:

  • Walking on uneven or hard surfaces
  • Wearing the wrong sized or kind of shoes
  • Rigorous sports activities and feet movements
  • Twisting of feet and ankle muscles
  • Turning suddenly during a play
  • A sudden strain due to kicking
  • Running and stopping suddenly
  • Continuing sports after mild strains and pain.
  • Wrong diagnosis of a previously occurring pain.
  • Repeated minor injuries
  • Overuse syndrome
  • Microtraumas

Symptoms of an Ankle Sprain

An ankle sprain can result in a number of different symptoms, and it may vary from person to person depending on the severity of the condition and the type and location of the injury. However, the most common symptoms that indicate that the patient has an ankle sprain are the following:

  • Bruising on the skin
  • Discoloration of the injured area
  • Tenderness of the injured area
  • inability to walk
  • Mild to severe pain due to muscular damage
  • inability to move the ankle
  • swelling on foot or around the ankle
  • the stiffness of the injured area

However, since the ankle is prone to a number of different sports-related injuries, it is easy for a person to mistake it with some other underlying condition which can cause a lot of trouble in the future for the patient. Therefore, it is strongly recommended that once such symptoms start to show up after an injury, the patients should reach out to their doctors as soon as possible for the examination of the condition.

How is an Ankle sprain diagnosed?

The diagnosis for an ankle sprain is relatively difficult since there are a number of different injuries that the ankle is susceptible to, and sometimes they can be extremely severe and difficult to treat. Things can get very complicated, and the condition can become extremely persistent. Nonetheless, the primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The doctor may also carefully examine by moving the ankle and foot in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound can sometimes help the doctor to locate and study the internal structures to see any possible damage.

How is an Ankle sprain treated?

An ankle sprain is one of the most common injuries in orthopedics as well as sports. Usually, the severity of the injury ranges from mild to moderate. There are different types of treatments for ankle sprains. One of the most suggested methods is the P.R.I.C.E. method, which is an acronym for protecting, rest, ice, compress,  elevate. Generally, the more natural the treatment is, the better. Self-care is certainly one of the most important factors when it comes to ankle sprains. The very first response should be immediate first-aid care to alleviate the symptoms of pain and swelling. After the diagnosis, the doctor will assign to you an easy to follow the treatment plan that you can practice at home.

Around 25 thousand people suffer from ankle sprains in the United States alone. Even if you are not involved in athletic activities, you can get an ankle sprain due to a sedentary lifestyle.

Every day, about 25,000 people in the U.S. suffer an ankle sprain. Ankle sprains occur in both athletes and those with sedentary lifestyles, and they can occur during sports or when walking to carry out daily activities.

The approach should start with proper protection of the injured ankle as much as possible. We can quickly forget our condition and continue with our daily activities. However, an ankle sprain can get worse with something as simple as walking. It is essential to take proper measures to ensure that we do not do anything to aggravate the condition. Protection should be followed by maximum rest, as rest is the most favorable phase for any injury. Not putting pressure on the ankle will allow it the time to heal. Therefore, you should avoid using the injured ankle as much as possible to let the healing elements of our body start acting. You can also use ice on the injured ankle to alleviate the pain and reduce symptoms. Make sure you don’t burn yourself as it can leave marks. Doing it for a few days can significantly lower the pain and even eliminate it completely. Bandaging and wrapping your ankle with an elastic bandage is also a very common practice and works a great deal for the quick recovery. It can keep the ankle from moving or twisting in the wrong direction and also put compression on the ankle which will soothe the painful symptoms. You need to make sure that the pressure is not too much or too little. Too much pressure will cause problems while too little pressure will not work effectively. You should also keep your foot elevated when you are sitting or lying down, as it can increase the blood flow and improve circulation. This will be especially effective for healing the ankle sprain condition quicker.

NSAIDs and OTCs can also be useful as a secondary treatment aid. These drugs can reduce the inflammatory conditions and alleviate the pain. They can also be used for reducing the swelling of the area which can limit the range of movement. The reason we are calling this a secondary treatment is that it will not be helpful and effective in terms of treating the damage. These drugs, such as painkillers can only alleviate the symptoms, which can make it easier for you to bear the pain. Cortisone injection is another viable option for severe cases. In most cases, you will not require to go to a doctor for mild injuries, and it may heal naturally in a matter of days. Knowing a few measures will enable you to take care of the problem by yourself without any assistance from an expert. However, if the pain is severe, you should not hesitate to see a doctor as soon as possible. It could be a torn or broken tendon or ligament which requires an emergency response.

Once you are treated initially, you need to avoid stiffness due to lack of exercise. For that purpose, it’s important that you start with some light activities and gradually increase them. Some of these exercises would include walking, gentle stretching and strengthening exercises according to the advice of your specialist. The balance exercises are the most important ones for the treatment of ankle sprains. These exercises are also called proprioception exercises, which includes simple techniques to strengthen our balance. It involves multiple attempts to balance yourself on the sprained ankle for a short period of time to note your ability. If you feel that the activities are causing more pain to the damaged ankle, you must immediately stop doing those things and consult your doctor about it once again. Moving around can also tell about the severity of the condition and whether or not you require surgery. You will also have to follow a rehabilitation plan during the adjustment period after the treatment. this will ensure that the condition is not reversed.

The most important factor for an effective treatment of ankle sprain is not to delay the treatment for later. You should start with the treatment as soon as possible, in fact right after the injury. The faster you react to the issue, easier it will be for you to get rid of the problem. Your approach should also include wearing the right type of shoes and using aids. You should also completely avoid walking on uneven and rough surfaces. Try not to climb the stairs unnecessarily. You should try to depend on the natural treatment and rehabilitation and avoid surgical procedures and operations. Some of the best ways to go about the treatment of ankle sprain are:

  • Resting as much as possible
  • Icing the painting area
  • Using compression bandages
  • Anti-inflammatory medication
  • Exercising, stretching, friendly workouts
  • Physical Therapy
  • Gradually start physical activities, don’t rush.
  • If the treatment shows no results and symptoms persist, you may need surgery.

You may undergo a surgery depending on your case. Which surgery is right for you is the question that depends on several factors, such as the severity of your condition and the type and location of the injury. The surgery for your ankle sprain can be done in one of the following ways:

Reconstruction surgery: Reconstruction surgery, as the name suggests, will reconstruct the damaged muscles, tendons and ligaments in the injured area. They may also be replaced by other healthy tendons which will help the repairing and speedy recovery.

Arthroscopy: If the bone and the cartilages are also affected (Usually in the most severe cases) then your doctor may be required to do an arthroscopy.

Self-Care treatments

You need to take care of yourself too. Here are the things that you can do:

  • Using not so tight elastic bandages for ankle support.
  • Make sure that you are wearing a brace to
  • Make sure you’re using aids like crutches if you feel the need
  • The elevation part of the RICE treatment will help you lot.
  • Take your medication regularly
  • Again, rest, rest, and rest. Then repeat.

Preventive measures for an ankle sprain

You can lower your risk for future sprains by:

Prevention

Prevention is always better than care. Several preventive measures should be understood and exercised in the fields. The best way to go about it is to practice the corrective measures and precautionary measures during the training until they become your reflexes. The prevention measures can be classified as primary and secondary preventions, and each one of them has its own importance. The risk factors associated with ankle sprains should also be addressed and taken care of, including the patient’s history of ankle sprains, the strength of the muscles and the previous injuries. The patients who have experienced previous injuries are 2 times more susceptible to experience it again upon a heavy blow.

  • Completing the rehabilitation therapy for any previous ankle sprains
  • Practice core strengthening exercises
  • Taping and using a bandage to wrap ankle not too tightly
  • Avoid further damage by braces and right shoes.
  • Stretching and warm up
  • Careful on the uneven and hard surfaces
  • Don’t do overexertion and stop when your body tells you to stop.
  • Say no to high heels

Recovery for an ankle sprain

Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area and other factors. Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. For effective recovery, you should get back to the normal routine activities slowly and gradually according to your doctor’s advice. Once you start using your muscles and bones again, it will complement the complete healing of the injured parts. If the patient was healthy before the injury, the recovery would usually be faster. However, due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the injury can take from a few weeks to 6 months of time to recover.

Here is what you can do to ensure speedy recovery:

  • Rest day and night
  • Avoid highly demanding everyday physical activities
  • Gradually start easy activities
  • Visit your doctor for a checkup regularly
  • Only use prescribed medication
  • Avoid intoxication to avoid tripping and falling
  • Eat healthy as it speeds up the recovery

Athlete’s Foot or (Tinea Pedis)

What is athlete’s foot?

Athlete’s Foot is a painful condition usually experienced by the people involved in sports and athletics. That is how it has begotten its name, while in medical terminology the condition is called as Tenia Pedis, which means the infection of the foot. This is a condition in which the athletes develop an infection of the foot because of the dermatophyte fungus which grows progressively and becomes resistant to end. Obviously, the most apparent reason for such an infection occurring in athletes is their usual routine of wearing socks and shoes for hours straight in a go, sweating in them while playing and using those wears again. As this infectious fungus thrives in the humid environment, an athlete’s foot tends to be the most suitable breeding ground for this fungus.

Another reason for the occurrence and prevalence of this fungus is that it’s quite contagious and the players of the same team or the ones playing on the same ground are usually at risk of getting it from other players they’re playing with. Due to its contagious nature, you can pick it from things that were previously in use of another person before you who had an athlete’s foot fungus. The infection can sometimes get problematic and spread to the hands as well as the nails of the toes.

Although it may sound like a terrible disease, athlete’s foot is common, not very serious and also very much treatable. The patient or the athlete can retain their ability to continue their sports, unlike other injuries. The only problem is that sometimes this characteristic infection gets to be very tricky and difficult to treat and cure. Certain people are also prone to experiencing persistence of this infection, such as the people who have weaker immune system and defense system of their bodies, or the people who are involved in a certain health condition such as diabetes. In such cases, it’s a good idea to not think for a minute before calling your doctor about your condition once you’ve diagnosed that it is athlete’s foot.

Causes of athlete’s foot

Tinea Pedis or Athlete’s foot can be caused due to many reasons. The most common reasons due to which tinea pedis may occur are when the growth of tinea fungus on the feet is made possible. For the growth, all that the fungus needs are an inoculum and a favorable environment. An inoculum is basically a small number of fungus cells that are very less to be visible to the naked eye, and it can be picked from anywhere upon closure and direct contact with the infected object. In this way, an athlete can catch this fungus from an infected person through direct or indirect contact, or by getting in contact with the surfaces where the fungus is already present. As far as the favorable environment is concerned, the foot of an athlete is already a very warm and moist environment which is a perfect situation for the fungus to grow and thrive.

The infection with tinea pedis has a lot to do with the hygiene practices as well as the behavior of the athletes. There are certain things that you should be aware of as the causes of tinea pedis or athlete’s foot and the ways to avoid them:

Other common causes include:

  • Sharing the outfits or footwear with other people
  • Being barefoot on the public floor or other places
  • Being barefoot in the locker rooms, showers, and swimming pools
  • Sharing footwear, like towels, socks and even washed laundry.
  • Keeping tight shoes on for hours straight
  • Keeping your feet moist not allowing them to dry
  • Sweating too much and staying inside your shoes
  • Having an open wound, open nail or open injury
  • Sharing the lockers and the closets with other people
  • Using a common bathroom or shower that other athletes also use
  • Catching from water at places like swimming pools.

Symptoms of athlete’s foot

There can be a number of symptoms associated with the condition. Although there aren’t many types of athlete’s foot, it still depends on the severity of the condition. The symptoms that are most common and characteristic to athlete’s foot are:

  • burning sensation in the area of the foot, heel, sole and the nails
  • stinging sensation in the proximity of the heal, foot, sole and nails
  • Itching on the front of the feet, on the sole, ankle and nails.
  • Blistering and painful eruptions on the feet
  • Skin peeling and cracking due to itching and scratching
  • Peeling of skin between the toes and the sole
  • Drying of the skin on the affected area
  • Discoloration of the skin, the death of surface skin cell
  • Devitalized skin with thicker nails
  • Discoloration of nails with crumbling toenails
  • A detachment of the two nails in severe cases.

How is athlete’s foot diagnosed?

Since it’s an infectious disease and not a physical injury, it will require physical examination as well as microscopic examination for the presence of the fungus characteristic to the athlete’s foot disease. The very first phase of the diagnosis involves a thorough physical examination to check and test for the symptoms that are mentioned above. Once the symptoms are checked, and it’s verified that it’s a fungal infestation, then the doctor will proceed to the examination of the fungus cells under the microscope to study its shape and morphology in order to know if it’s really the one for the athlete’s foot or something else. To achieve this, the doctor will scrape off some skin from the infected area and dissolve it in a solution of potassium hydroxide (KOH), which is why this test is also called as a skin lesion potassium hydroxide examination. The purpose of KOH is to destroy the normal human cells from the sample so that only the resistant fungal cells can survive. After that, these cells are inoculated and studied under a microscope to ensure that it’s the same fungus.

Treatment for athlete’s foot

The purpose of the treatment is to kill, eliminate and destroy the fungus completely that is living there. If some of it is left remaining, it can grow back once the environmental conditions for the fungus are favorable. Therefore, it’s important to follow the entire recovery regime until your doctor gives you the go-ahead sign. The condition is a fungal infection, and it can be treated by the use of the over the counter drugs which has antifungal properties. The application depends on the severity and the dose prescribed by your doctor. If the over the counter antifungal medication doesn’t work, the doctor may prescribe you other oral and topical drugs to treat the underlying condition. Some over the counter drugs that you can use are miconazole, clotrimazole, butenafine, terbinafine, and tolnaftate as they all have antifungal properties. Some home treatments can also turn out to be very effective in some cases and show great results.

Apart from over the counter drugs, the doctor may also ask you to take prescription medications, which may include topical antifungal medication, oral medication, oral steroid or antibiotics in case of bacterial infestation. Soaking your feet in the salt water or vinegar water can help alleviate the wet blisters. For some patients in certain and rare cases, complications can also develop, such as allergic reactions may occur with fungus infestation which can cause excessive blistering. Like we discussed before, the infection can reappear if it wasn’t completely eliminated the first time. a secondary infection may also take place in certain cases, such as a bacterial infection on top of the fungal infection, which can make the condition even worse. The bacterial infection can then enter the bloodstream as well as the lymphatic system causing a lymph node infection.

Prevention for athlete’s foot

There are numerous preventive measures that you can take in order to avoid getting an athlete’s foot infection. These measures include your everyday activities, your behavioral habits, and your hygiene practices. To prevent yourself from catching an athlete’s foot fungus infection, there are certain things that you should take care of. Firstly, you must keep up with the hygienic practices. Sometimes you may feel like you’re clean, but you can’t see the little tiny invisible microorganisms that are waiting to infect you. So always use soap to clean and wash your hands, feet and other exposed parts of the body through the day and work your way through the area between the toes and those that are not usually reached. After you’re done, also dry them soon and use a clean cloth or towel if you use any at all. Killing the fungus is another good way to avoid getting infected by a booming growth of fungus. For that, you should go for a hot water wash of your feet (preferably 140 degrees), and you can also have the over the counter drugs and antifungal medications to kill them. Also, disinfect your shoes instead of never washing or cleaning them even once in a lifetime.  You can also use antifungal powder for these purposes which you can put on your feet each day. Avoid sharing the footwear, especially the socks at all costs unless absolutely necessary. The fungus can get accumulated in the fiber, live and grow in there to infect you again. You should also consider using the socks that ensure proper aeration. That way you will not create a damp environment on your feet. Go barefoot when you’re home, and wear breathable shoes if you do. Also by wearing two different pairs every alternating day, you can allow your shoes to get dry which will prevent the growth of fungus.

Recovery for Athlete’s Foot

The severity of the Athlete’s foot infections can range from being mild or severe. There are cases in which the infection is easily treated within a week or so, while in other cases it can take as long as months of time. There are a number of factors that determine the recovery time and the phase of each patient.

Bursitis

What Is Bursitis?

Bursitis is a condition that is characterized by pain in the Bursae. Bursa is the small sacs that are filled with fluids, and they act as the cushions to the bones, tendons, ligaments and the muscles in the proximal locations of the joints. The condition can result in inflammation of the bursae that can cause mild to severe pain. The purpose of bursae is to smoothen the movements of the muscles and joints and reduce the friction due to the impact of grating, irritation, and rubbing. Inflamed. The most common places where bursitis can take place are the elbow, shoulder and the hip joint. However, this condition can also be experienced in the knee, big toe of your feet and the heel.

Causes of Bursitis

There are a number of different causes of bursitis. Specific to the people involved in sports activities, Bursitis can be experienced most commonly due to the overuse and repeated use of a certain area. As most sports require repetitive movement of a certain part of the body, the athletes and sportsmen can become vulnerable to such conditions.

Other causes of bursitis may include:

  • Sudden jerking
  • Running several steps
  • Suddenly stopping while running
  • Legs or arms stretching
  • Wrong posture and legs movement
  • Heavy hit
  • Hard blows
  • The weakness of the tendons
  • Lack of flexibility of the tendons and muscles
  • Tearing of the muscles
  • Overexertion of joints
  • Not stretching or warming up before working out
  • Arthritis
  • Length difference of legs
  • Infection in rare cases
  • Gout
  • Psoriatic arthritis
  • Thyroid disorders
  • Reactions of medication
  • Abnormal placement or displacement of joints and bones

People who are involved in sports activities such as scrubbing, tennis, golf, skiing, throwing and pitching are more prone to bursitis conditions.

Hip Flexor Strain

What is Hip Flexor Strain?

A hip flexor strain is a tear or stretches in one or more of the muscles which are responsible for the flexion of hips. This tearing or stretching leads to pain in the groin or the front of the hip. Tendonitis of the hip flexors also causes hip pain, but it is a different condition. In hip flexor tendonitis, the inflammation or damage of the tendon occurs that attaches muscles to the upper thigh bone.

What is the Hip Flexors?

Flexors are a group of muscle tissues that are responsible for stretching and adding a range of motion to the area. Flexors of the hip connect the upper part of the large leg bone (femur) to the groin, hip and lower back. 

Muscles which are responsible for lifting the knees towards the body are collectively known as hip flexors. The primary work of hip flexors is to bring knee towards the chest and to bend at the waist. These hip flexor muscles include

  • the psoas major and iliacus muscles.  These muscles are also referred to as iliopsoas
  • .  the rectus femoris, which is part of one’s quadriceps

Figure 1: Showing Hip flexors, i.e., Iliacus, Psoas Major and Rectus Femoris

Overstretching or overuse of these muscles and tendons can easily result in reduced mobility, injury and accompanying pain.

Causes of Hip Flexor Strain

As discussed before, hip flexor strain usually occurs when one of the hip flexors has been injured, pulled very hard, or torn. Most often, the hip flexor injuries occur due to acute trauma or injury, like pulling a muscle when jumping or running. Activities like martial arts, sprinting, kicking and dancing which put hip flexors under the most strain also causes this. Weakness in the surrounding core muscles is another common cause of hip flexor pain. The contribution of hip flexor muscles in stabilizing the pelvis is not alone. Due to the weakness of lower abdominal muscles, the flexors of the hip are forced to bear more than they can handle, and this results in muscle strain. Athletes who put their hip flexors under stress in their training and sports are more prone to hip flexor injury or strain that may lead to a muscle tear. In sports medicine, sometimes injuries of hip flexors have a strong association with hamstring strains. It is because injured or tightened tissues of hip flexors can put additional pressure on the lower leg tissues which are commonly known as hamstrings.

Sign and Symptoms of Hip Flexor strain

Usually, hip flexor wounds are rarely diagnosed in clinical settings. However, the chief symptom of hip flexor strain is the pain at the front of the hip. Other signs and symptoms of this type of injury include:

  • An intense and quick pain in the hip right after hard blow receiving
  • Upper leg area tenderness, muscle cramping, and clenching
  • Bruising or swelling around the thigh or hip area
  • Inability to continue sprinting, kicking or jumping.
  • Tightness or stiffness after being stationary, for example after sleeping
  • Loss of sensation in the front of the groin or tugging feeling
  • Severe, continual discomfort in the upper area of the leg

Symptoms usually get worse when a person with a wound of hip flexors traveling upstairs, tries to lift his or her knee up and towards the torso or attempting to kick, jump or run.

Grades of Hip Flexor Strain

Remember, hip flexor strains are not equal. They all vary from grade 1 to grade 3 in severity. These grades depend on pain levels, muscle damage and functionality of the muscles. These grades of injuries also indicate the expected time of recovery and the level of required treatment.

Hip Flexor Strain Grade 1

This grade allows the full functionality to the hip. However, due to the damage of a small number of muscle fibers, mild pain may occur.

Hip Flexor Strain Grade 2

In this grade, moderate loss of functionality occurs. Due to the damage of a significant number of muscle fibers, moderate pain also occurs.

Hip Flexor Strain Grade 3

This grade causes severe pain and significant loss of functionality due to the damage to all the muscle fibers.

Treatment of Hip Flexor Strain

Hip flexor pain and strain can be treated by many methods, starting from self-administered therapies to surgeries of torn hip flexor for severe cases. Following are the few common treatment options for hip flexor strain:

Pain relief and healing

The protocol of RICE is one of the most effective treatment option and widely used for all kinds of inflammatory-based ailments and injuries. Although RICE protocol can provide benefit and encourage healing at all stages, it is most effective when used within the first 72 hours following the injury.

Rest

Putting too much strain on the hip flexor following injury may cause swelling, inflammation and further damage. Therefore resting, by the time, allows the body to heal itself.

Ice

Applying an ice pack for a few minutes can play an essential role in reducing inflammation and pain.

Compression 

A compression bandage helps prevent further injury and reduces swelling and pain.

Elevation

Usually, it is advised to raise the injured part of the body above the heart to reduce inflammation and restrict the blood flow. But this can be difficult when it comes to the hip. Therefore it is recommended to position the hip in a way that it is not the lowermost part of the body.

Activity Modification

Engaging too early in usual exercise routine may result in further damage and can cause chronic hip flexor problem. Therefore, exercises that put stress on the hip flexors and cause pain should be avoided.

Swimming is, however, a great option that does not aggravate hip flexor strain. Another fantastic option is a seated exercise that includes seated yoga or chair cardio.

Contrast Therapy

Contrast therapy utilizes the alternating application of ice and heat. It is one of the best technique which quells inflammation and pain, boosts circulation, and increases the flow of oxygen and nutrients towards the damaged tissue.

This technique can be performed at home, and it is considered a low-risk treatment for hip flexor strain.  Keep in mind that the contrast therapy should not be done within the first 72 hours following the hip flexor strain.

Dry Needling

Dry needling also knew as intramuscular stimulation, is the technique that physiotherapists usually recommend to those who have hip flexor strain. In this therapy, acupuncture needles or other needles are used to minimize the muscular pain.

Dry needling is thought to be worked by creating “movement” in the muscles, reducing pain and tightness, and increasing circulation. Sometimes, following this treatment, patients may feel some soreness, just like the pain felt after a strenuous exercise.

Massage

Another effective way to treat hip flexor strain is soft tissue massage. It increases the flow of oxygen to the damaged tissues and stretches out the tight muscles. This technique also aids healing by removing waste products from around the muscles. But it is advised to avoid any form of massage within the first few days following injury as it may exacerbate inflammation.

Medication

Anti-inflammatory medications play an essential role in providing benefit to Grade 3 hip flexor strains and pain. Aspirin and ibuprofen are one of the best over the counter anti-inflammatories that can alleviate symptoms. However, clinical consultation with a specialist is a must before taking medicines as these medications may cause gastrointestinal tract bleeding or irritation

Prevention of Hip Flexor Strain

Preventing hip flexor strain is very easy. Following are the few methods which can help in preventing hip flexor strain:

Always Stretch yourself

One of the leading causes of injuries related to activity is when a person forgets to stretch before activities. Daily stretching plays a vital role in reducing stiffness and improving mobility and flexibility and of this ultimately help prevent hip flexor strain.

Be Supportive

It is recommended to support your groin, hips, and legs with braces or taping techniques. These techniques maintain the alignment of the body and reduce the risk of further injury to the hip flexor and relapse.

Workouts

Exercise that involves raised legs, sprinting motions, or kicking all increase the risk of a hip flexor strain. However as mentioned earlier, yoga or swimming are the alternate options.

Give hips a break

It is better to schedule rest days and give hips a break between strenuous workouts with recovery days. Taking adequate time to rest before returning to the activities provide benefit and prevents the additional damage or re-injury.

Recovery Time for Hip Flexor Strain

For a hip flexor strain, recovery time varies significantly from person to person. The critical dependence factors of recovery are lifestyle factors, general fitness and health, and severity of the strain.

In the majority of the cases, hip flexor strain is dealt with minimally invasive treatments. Minor tears usually take two to three weeks in healing, whereas it may take four to eight weeks to treat the more severe injury. The recovery time of severe hip flexor strain is longer too.

It is, therefore, better to respond quickly to hip flexor strain because this increases the chances of speedy recovery. It is advised too to use RICE protocol, following the hip flexor strain symptoms onset as soon as possible and proper consultation with a specialist or physiotherapist.

ACL Tear

What is ACL Tear?

ACL tear or anterior cruciate ligament tear is one of the most common injuries of the knee, commonly experienced by the sportsmen and athletes. The condition can be excruciating, and the patient could need knee surgery to get it back to normal. However, each case differs and it depends on the severity of the condition.

What is Anterior Cruciate ligament?

The knee joint is a meeting point of three important bones, the tibia, patella, and the femur. Due to the natural knee cap placement, the joint usually remains protected. Four ligaments are also attached to the bones and the joint, which are classified as cruciate ligaments and collateral ligaments. The cruciate ligaments are present on the inside and intercept each other. The upper intercepting ligament is termed as anterior while the one below is called the posterior cruciate ligament. The anterior cruciate ligament protects the femur and tibia and keeps them stable.

ACL Tear

ACL tear and a sprain is a result of injuries to the meniscus, knee structure, ligaments and articular cartilage that is present in the area. These injuries can be graded and classified into three main types, depending on the severity of the injury and type of injury. Type 1 includes less severe injuries and stretching, type 2 tear is comparatively severe and causes looseness, while type 3 is the most severe form in which the ligaments tear and split. If the condition is not treated timely, it may cause further complications. It can also develop a risk of osteoarthritis and deterioration of the joints.

Causes of ACL Tear

The most common cause of an ACL tear is an accidental injury. Other reasons include a severe hit, falling on the knee directly, stopping too quickly during a run, and abrupt movement in different directions. Women as found to be more prone to ACL injuries due to the tenderness of muscles and ligaments, while men may also experience tearing and spraining.

Signs and Symptoms of ACL Tear

Depending on the type of ACL tear or sprain, the signs and symptoms can vary. In less severe cases the patient may experience a sudden discomfort in the knee during a walk or run. In most cases, ACL cases include a pop sound from the knee along with the loss of control over the knee muscle. In severe cases, the movement of the knee joint is severely limited, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling.

Diagnostic Tests for ACL Tear

The primary diagnosis includes a physical examination, where the patient is examined for any apparent symptoms of pain and swelling. The doctor may also carefully examine by moving the knee joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound will help the doctor to locate and study the internal structures to see any possible damage.

Treatment for the ACL Tear

The commonly used RICE treatment plan can treat the condition. The very first response should be immediate first-aid care to alleviate the symptoms of pain and swelling. After the diagnosis, the doctor will assign to you an easy to follow the treatment plan that you can practice at home.

The RICE treatment stands for resting, icing, compressing and elevating. Resting is the most crucial part of the healing process, as a wrong pressure and movement can reverse the healing and make the condition worse. The patient should avoid walking around and bearing any weights. Furthermore, icing can help alleviate the symptoms of pain and swelling, while speeding up the healing process at the same time. The knee area should also be compressed by fastening an elastic wrap around it, and the patient should keep the knees elevated with the help of a pillow whenever they’re laid down. It may take several weeks for the patient to recover through a rehabilitation process. Regular physiotherapy can ensure a speedy recovery, and a variety of different aids can be used for protection, such as crutches and braces. The treatment and rehabilitation should be extended until the symptoms of pain and swelling are gone, and the knee is capable of a full-ranged movement. People who tend to remain inactive and minimize the movement can recover from the injury sooner. Therefore, it is recommended that the patient should get involved in injury-friendly exercises and other tasks that don’t require robust movements.

Surgical treatment for ACL Tears

In certain severe cases, surgery may be required to fix the problem. It becomes critical when the patient needs immediate recovery, when the injury persists, or when the injury keeps bending and displacing the knee. The surgery may also be required if multiple ligaments are injured. In the surgical procedure, the damaged ligament is removed and replaced by another tissue known as a graft, which allows it to heal and recover. The graft may be taken from a donor area which is usually another area of the knee. However, rehabilitation is a must after the surgery. The surgery is minimally invasive and reconstructs the damaged ligament.

Surgery is usually prescribed to the ACL patients, as it can effectively recover the patients bringing them back to the normalized knee condition. However, if the patient isn’t involved in heavy activities, such as jumping, running, too much manual work, or sports, the alternative treatment options can be administered.

The surgical treatment is initiated after a delay of around one month. The delay is to monitor the healing speed of the patient and let the swelling and bleeding reduce. This also gives an idea of the persistence of the injury. Physiotherapies are mainly involved in the post-operative rehabilitation therapy. The recovery highly depends on the consistent care and physiotherapeutic treatment, without which the recovery may be delayed or reversed. It’s important to note that the surgical procedure also requires 7 to 9 months of rehabilitation therapy and the sportsmen can return to the playgrounds after a year. The process starts with light exercises and later on the focus is gradually shifted towards enabling the full-range movement of the knee joint. Flexing and bending your muscles too much should be avoided, and the gradual increase in the exercising routine should be practiced. The rehabilitation therapy also uses aids like crutches and braces to improve the protection level and prevent pressure, jerking and stress.

How to prevent ACL Tears and Injuries?

It’s important to stick to proper training and exercising methods to avoid getting an ACL Tear due to a training accident. Sportsmen and athletes should also be mindful of the possibility of a knee injury and should be aware of measures to prevent the knee from severely damaging in case of an accident, Should be aware of measures to prevent the knee from severely damaging in case of an accident. Another effective way of avoiding ACL tears is to strengthen the core muscles by exercising.  Some exercises such as hamstring can help increase the strength and endurance of leg muscles. Stronger legs can also help to reduce the pressure on the knee due to falling. Athletes and sportsmen must also practice techniques of jumping, cutting, pivoting, proper knee positioning and landing to prevent injury from sudden falling.

Concussion

What is Concussion?

Concussions can be described as a condition in which the patient experiences temporary unconsciousness, disorientation, confusion and other symptoms as a result of an injury of the head due to heavy blow or violent shock. Concussions can be a result of traumatic brain injury due to violent shaking or hit. Around 0.2 million were hospitalized due to a concussion during the last decade. It is a common sports injury and should be considered as a grave concern. Our skull is the hardest bone of our body, but it houses the very soft tissues of the brain and neurological parts. An injury to the brain can be extremely severe, and in some cases, it can lead to unconsciousness, memory loss, disability, and death. A sudden hit or blow can damage or puncture the blood vessels, resulting in stroke and other severe conditions. Neuropathic conditions can also develop due to brain injury. If our nerves and neurons are damaged, our brain may not function properly and may not be able to transfer and communicate the signals to the rest of our body. This can result in behavioral changes in the patients.

Concussions can also occur in children due to the larger size of their skull compared to the rest of the body. Due to several physiological changes the children go through, they remain to be more susceptible to the risk of concussions.

Types of Concussions

Similar to ACL Tear as discussed before, concussions are also classified into three different types depending on the severity of the condition and the symptoms that are experienced by the patient, such as unconsciousness, disorientation, memory loss, amnesia, and the loss of balance. On a grade from 1 to 3, the cases of concussions are classified as 1 being least s1 to 3, the cases of concussions are classified as one being least severe, and 3 being the most severe. In the least severe case, the patient may experience the mild symptoms for 10 to 12 minutes before getting back to normal. The patient tends to remain conscious. In type 2 concussion, the patient may experience symptoms for more than fifteen minutes. However, the consciousness is retained. In the most severe type of concussion, the patient becomes unconscious. This consciousness may be regained in 5 seconds, or it may get prolonged.

Causes for Traumatic Brain Injury or Concussions

Causes for concussions and brain injury are most commonly the accidental injuries. People involved in sports and athletics are most prone to such injuries. The most common causes for concussions can be classified into four types:

Falling

Tripping and falling can result in a direct blow and heavy hit on the head if the victims directly land on their head. Deaths due to falling are less frequent, but certainly possible.

Road accidents

Road accidents are one of the leading causes of injuries and deaths.

Heavy Blows

Getting struck by a sharp object of hitting oneself against an object on the head can lead to severe head injuries.

Being attacked

Getting hit on the head by an attacker can lead to severe damage to the head and remains to be the most common cause of concussions.

Regarding sports, many games have a higher risk of getting traumatic brain injuries leading to concussions. Some of the most common games and sports include:

  • Ice skating
  • Soccer
  • Cycling
  • Gymnastics
  • Skiing/Snowboarding
  • Football

Signs and symptoms of Concussions

It is difficult to understand concussion every time as the injury could cause other conditions as well. However, if there are physical signs, swelling, bruising, cut, or bleeding from the head after a hit you need to be attentive to that situation. Since the span of concussion symptoms is very small, a concussion might even go unnoticed. Sometimes the symptoms and signs are unnoticeable at the time of the injury and may start showing up after a couple of weeks. That is what makes the head injuries such a sensitive subject.

Since head injuries could lead to several different conditions, it’s imperative to understand and diagnose if it’s a concussion before starting off with the treatment of the condition, even when a concussion is a prevalent type of head injury. The symptoms and signs can occur in some ways, such as physical symptoms, behavioral changes, irritability and moodiness, emotional signs and mental retardation. Here are the symptoms that are experienced by the patients with traumatic brain injuries or concussion.

  • Commotion and confusion: Feeling confused due to the lack of cognition.
  • Dizziness: Feeling dazed and disoriented
  • Feeling clumsy: Lack of control over voluntary movement
  • Difficulty in speaking: the patient can experience slurry speech due to neuropathic conditions and nerve damage.
  • Feeling Nauseous: Vomiting and nausea can be experienced after a violent shock.
  • A headache: persistent Headaches can be a symptom of damage to the brain.
  • Difficulty in maintain equilibrium: due to dizziness and disorientation, it gets difficult to maintain balance.
  • Blurred visions can also be associated with a head injury and concussions.
  • The patient may also experience sensitivity to light and sensitivity to noise
  • traumatic brain injury can make the patient sluggish
  • A beeping or ringing sound in the back of the head.
  • The patient may also experience emotional changes, behavior changes or changes in personality.
  • A concussion can cause difficulty in focusing and retaining the concentration
  • Memory loss is also a sign of a concussion.

Diagnosis for the traumatic brain Injury (Concussion)

The initial stages of diagnosis include an examination done by the doctor carefully in which the physical symptoms are noted, and the and the medical history of the patient is evaluated. Upon the onset of symptoms, the doctor will administer some neurological tests to ensure the condition. The signs and symptoms may take a few days to occur. 

Depending on the types of symptoms experienced by the patient, the specialist will run one or more of the following tests:

Tests for Neurological symptoms

Physical examination will usually include testing for neurological symptoms. The doctor may examine the patient’s condition regarding hearing ability, vision, loss of balance, loss of reflexes, loss of coordination and cognition, loss of sensual perception, and the loss of core strength of the body.

Since the concussions are very closely related to the brain and its functional abilities, the specialist may also administer testing for cognition as a part of neurological examination, in which the patient’s evaluation will be based on their ability to focus and concentrate, the effectiveness of their memory and the ability to recall short term and long term information. CT scans for the bran may also be carried out by the doctor to identify the damage caused due to the injury. A CT Scan is a computerized cranial tomography test in which several X-ray tests are conducted to examine the bones of the skull. The Imaging of the brain for physical brain tests could be done if the doubts are well established. The doctors will also take notes for various symptoms related to concussion, such as seizures, swelling, persistent nausea, and headaches. The patient’s medical history is also examined as the part of the diagnosis. Since X-rays cannot singlehandedly identify the condition of brain tissues, an MRI may be administered to image the condition of brain issues and find the location of the damage for effective treatment.

Treatment for Concussion

After the tests show positive results and symptoms are apparent, the doctor may keep the patient under observation in the hospital or at home with someone to monitor if the symptoms alleviate or get worse. This would include checking on the patient again and again through the night to make sure that the patient can wake up from the sleep. If any abnormality is observed, emergency care would be required.

Rest is the most appropriate way to allow your brain to recover from a concussion. Your doctor will recommend that you physically and mentally rest to recover from a concussion. The patient should minimize or altogether avoid the activities that require physical exertion and too much activity, as a lot of exertion, wrong pressure and movement can reverse the healing and make the condition worse. The patient should avoid walking around and bearing any weights. It should also be ensured that the patient takes no mental pressure or stress of any kind, as it can also worsen the symptoms. If the patient is a student, activities that require mental exertion, concentration, focusing, and using too much brain power should also be avoided until things get back to normal. Entertainment activities that require mental and sensual involvement should also be avoided, such as watching movies, playing sports or video games, using a computer, doing homework, reading and using laptops or tablets. The best way to go about is to calm the mind and relax in nature.

If necessary, you will also be recommended to have shorter workdays and schooling, postpone homework, and take more breaks throughout the day. When the signs start showing improvement, the patient can gradually get back to carrying out their everyday activities that require mental and physical exertion. The specialist or doctor will make sure of when it is a good time for the patient to get back to life and continue with everyday activities. It will usually start by initially allowing the patient to do less rigorous exercises and training which requires less movement and jerking. Sports are highly recommended to be avoided for a long time after the injury, even when the patient recovers, as it can severely increase the risk of reversing the healing and causing a life-threatening injury. Medication can also be used to alleviate the symptoms that are causing trouble for the patient, such as pain, headaches, and bleeding.

Recovery & Effective measures after the injury

Concussions are not usually life-threatening as they are characterized as a kind of mild injury on the head. However, it doesn’t mean that the condition is not severe. Here are the things that you can do supplement the healing process and speed up recovery.

  • Rest day and night
  • Avoid highly demanding everyday physical activities
  • Gradually start easy activities
  • Visit your doctor for a checkup regularly
  • Only use prescribed medication
  • Avoid intoxication
  • Eat healthy as it speeds up the recovery.

Groin Pull/Strain

What are Groin strains?

Groin strains can be defined as the injuries that are caused to the tendons and the muscles that result in palpation, pain and other symptoms. The proximal tendons such as adductor tendons and the injury to the bone can cause pain. Groin strains can be a common sports injury in many different games and athletic activities. The most common activities include soccer, football, ice hockey, running, tennis, rugby, American football, basketball and other similar games. It is the most common injury experienced by soccer players. Due to strong involvement of the adductor longus and such tendons in these games, groin strains can occur accidentally or when no prevention measures are taken. Usually, the damage is caused when the bone is inserted in the tendon accidentally.

A similar condition to groin strains is known as tendinosis. However, it is considered to be a gradually increasing chronic condition. On the other hand, groin strains are acute due to an injury of the localized myotendon connections.

The groin area covers the connection of the abdomen to both the legs through the pubis. The muscles of the groin can be classified into three types, the adductor group, abdominal group, and iliopsoas group.

  • Adductors: there are six different muscles in this group.
  • Abdominals: this group consists of three muscles.
  • Iliopsoas: there are two main muscles in this group.

The most common group of tendons injured due to groin strains is the adductor group. The groin strains can cause a tear, avulsions, and contusions in the muscles. It can occur as a result of hip flexion and leg stretching. Depending on the severity of the contraction, the strength of the tendons, and the pressure put on the adductor, the tendons can get severely damaged and torn.

Categories of Groin strains

There are different grades for groin strains similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three grades are:

Grade 1: This is characterized by less than moderate pain, while the patient retains the ability to feel and move the injured area.

Grade 2: This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.

Grade 3: This is characterized by severe pain, while the patient loses the ability to feel and move the injured area.

Causes of Groin Strains

There are many causes for groin strains that result from sports injuries. The most common causes include:

  • Rigorous sports activities and movements
  • Twisting of groin muscles
  • Turning suddenly during a play
  • A sudden strain due to kicking
  • Running and stopping suddenly
  • Continuing sports after mild strains and pain.
  • An incorrect diagnosis from a previous injury.
  • Repeated minor injuries
  • Overuse syndrome
  • Microtraumas
  • Acute muscle hematoma of softer tissues
  • Insertion of adductor tendons to bone.
  • Chronic tendinitis

Types of Groin Strains

Groin strains can be classified into three different types:

  • Repeated injuries
  • Forced contraction
  • Direct Blunt Trauma
  • Symptoms for Groin Strains
  • The result of groin strains can be painful and disabling. Here are some of the most common symptoms experienced due to groin strains:
  • Tearing and disability of movement
  • Tenderness of muscles in the groin, thigh, and spreading through the legs.
  • Pain in muscles of the groin, thigh, and spreading through the legs.
  • Pain in adduction movement and closing the legs
  • Pain due to movement of the knee.
  • Popping or snapping feeling

Diagnosis of Groin Strains

The diagnosis of groin strains is complicated and difficult, which is the reason why it can be easily mistaken as another syndrome. There isn’t any single best method for the diagnosis of the groin strains, as the muscle damaged and the conditions can vary among different patients greatly, and many other diseases, problems, and health conditions can result in a similar kind of a pain in the groin. Therefore, a differential diagnosis is administered to eliminate the possibilities of other conditions.

The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. If the adductors are damaged, the adduction movement of the thighs and legs become difficult and painful for the patient.

Once the initial examination is performed, and the doubts are reduced, the doctor may follow up with diagnostic procedures. The techniques used in this case are radiographic investigations, ultrasonography, the differential diagnosis, and sonographic evaluations. If necessary, the doctor may also use MRI scans to find out the exact location of the damage.

From acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine position, and the movement and flexion of the hip and legs are examined.

The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain, tenderness of the abdominal, adductor and the iliopsoas tendons.

Treatment for Groin Strains

The treatment can be administered in different ways. One of the most common treatment is rest, ice, compression, known as RICE procedure. The very first response should be immediate first-aid care to alleviate the symptoms of pain and swelling. After the diagnosis, the doctor will assign to you an easy to follow the treatment plan that you can practice at home.

Exercises

The injuries related to groin strains can be treated with the help of proper exercises that are administered under the supervision of a doctor or a physical therapist. Some different simple exercises can be helpful. In most cases, the problem of groin strains can be solved within one or two days after a person experiences an injury. The approach of these exercises is to stop the bleeding, reduce the swelling if there is any, and to alleviate the pain in the injured part to ease the patient.

The first approach to treatment is resting the leg as much as possible. The patient should avoid walking unless it’s necessary and physical therapy should regularly be administered. The patient shouldn’t move the injured area and keep it still as much as possible.

To avoid stiffness, careful movement of the leg should be gently done every two days. For raising the leg, the patient should use a footstool or other aid.

To avoid swelling and alleviating pain, icing can be done by the patient according to the advice of the doctor. For that purpose, Ice pads and ice packs can be used to soothe the injured area. In case if regular ice is not available, the patient may also use a pack of refrigerator items which is frozen, such as frozen peas. It’s important to know that the patient should not put ice on the injured area directly, as the direct contact of ice with the skin can cause burning, referred to as ice burning. The best practice is to ice the injured area after 2 hours throughout the day. For each icing session, the patient should ice the injured area gently for as long as 20 minutes.

Another approach for treating this problem is compression technique. This technique involves compressing the area which is injured for alleviating the pain and reducing the swelling. This compression can be done by bandaging the injured area tightly at the right place on the thigh. This may be very effective for most cases, and may not work for some patients depending on the area, type and severity of the injury. That’s why it’s important that an expert person who is trained to do this should be consulted, as experts know better about where and how to tie the bandage.

Medication can also be used for the injuries related to groin strains. These may include painkillers and other drugs that can help treat the swelling and provide relief. Some OTC drugs are available in the market which should be used according to the prescription of the doctor.

Physical therapy is another effective method for the treatment of groin strains. This is effective not only at the time of acute trauma, but it can also be used continually for an extended period as a rehabilitation response to the injury. This treatment requires the supervision of an expert and trained physical therapist who will examine your condition and decide which exercises are suitable for you. Each patient may have to go through different physical therapy. Therefore, it’s essential to get a proper examination of your condition before moving on with the therapy. Once your physical therapist finalizes the right kind of exercises for you, he may give you an exercising routine which you can follow on your own on a regular basis. The approach of physical therapy is to restore the affected movement of the leg and to improve the body’s capacity to ensure quicker healing and speedy recovery. Following the right treatment plan can make a significant difference regarding healing time and effectiveness. Apart from the exercises involved in your physical therapies, you may also be able to benefit from the massages of the injured area. These massages are aimed to soothe the soft tissues associated with the injured area which can improve the blood flow and ensure a quicker recovery. For this purpose, you can count on your physical therapist and learn the right approach from him to practice it on your own later on.

Here are some of the most effective and easy exercises that you can try for the treatment of groin strains. However, you must understand that some of them may not be suitable for you and you should consider these after advising from your physical therapist or a doctor.

These exercises may be continued at least two days after the injury. During that time you should allow your injured area to rest as much as possible. It’s important to keep these exercises simple and on point.

Floor stretches

Floor stretches are done by lying on the floor straight on your back with your legs stretched. Legs are moved by stretching them outwards from the body posture one by one after returning each leg to the original position before moving the other.

Chairlift

Chairlift exercise can also help in some cases. It can be done by sitting on a chair with your knees bent, and slowly lifting each foot as high as your ankle is lifted to your groin level. The lifted foot should be kept that way for a few seconds before putting it down and doing the same thing with the other foot.

Knee Squeeze

As the name suggests, knee squeeze exercise involves a movement of the knee to squeeze a soft object. It is done in a sitting position and placing a soft rolled towel or a ball between the knees while holding it. Press your knees together to squeeze it for a few seconds before releasing the squeeze. This involves using the muscles that are stretched up to the groin area.

Apart from exercises, you must rest as much as possible and avoid a lot of activity. In severe cases, you may also use steroid based medication. However, the use of it is discouraged unless it’s absolutely necessary for treatment and recovery. Some severe conditions may also require surgery or operation, such as adductor tenotomy. Each type of treatment option may involve a post-treatment rehabilitation therapy in most cases.

Here is a quick to-do list for the treatment:

  • Resting as much as possible
  • Icing the painful area and between the legs
  • Using compression bandages
  • Anti-inflammatory medication
  • Exercising, stretching, friendly workouts
  • Gradually start physical activities, don’t rush.
  • Surgery as a last resort, if no results and symptoms persist after the treatment.

Prevention from Groin Strains

Prevention is always better than care. Several preventive measures should be understood and exercised in the fields. The best way to go about it is to practice them during the training until they become your reflexes. The prevention measures can be classified as primary and secondary preventions, and both of them are very important. The risk factors associated with groin strains should also be addressed and taken care of, including the patient’s history of groin strains, the strength of the muscles and the previous injuries. The patients who have experienced previous injuries are two times more susceptible to experience it again upon a heavy blow, while the risk of groin strains in people with lesser strength in the adductor tendons is quadruple.

These risks can be minimized by taking the rehabilitation therapy seriously. If the previous injury is not healed completely, there is an excellent chance that the little healing that is done will be reversed and the same acute condition will occur again. This can also make the region very week and easily injured again and again. Muscular exercises and workout that focuses on strengthening the core muscles and the tendons are very effective to build strength and endure pressures on such area. These include several core strengthening exercises, adduction exercises, coordination practices, skating and sliding workouts, and balancing practices.

Here is a brief checklist of the preventive measures:

  • Sufficient warming up of groin and legs before rigorous sporting, running, and activities.
  • Use the right footwear
  • Start off slow, and gradually improve and intensify your exertion.
  • Don’t continue exertion after pain and stiffness in the area.
  • Exercise regularly and keep your body used to exertion and pressure.

Recovery from Groin Strain

Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area and other factors. Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. For effective recovery, you should get back to the usual routine activities slowly and gradually according to your doctor’s advice. Once you start using your muscles and bones again, it will complement the complete healing of the injured parts. If the patient were healthy before the injury, the recovery would usually be faster. However, due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the injury can take from a few weeks to 6 months of time to recover.

Here is what you can do to ensure speedy recovery:

  • Rest day and night
  • Avoid highly demanding everyday physical activities
  • Gradually start easy activities
  • Visit your doctor for a checkup regularly
  • Only use prescribed medication
  • Avoid intoxication
  • Eat healthy as it speeds up the recovery

SHIN SPLINTS

What are Shin Splints?

Shin splints can be defined as a condition of acute pain in the leg and shin area which is caused due to overuse, overexertion, or prolonged running on the hard ground. It can result in a throbbing and aching condition after a sprint. In medical terms, shin splints are also called as medial tibial stress syndrome based on the muscles affected by it. Due to acute stress on the muscles and tissues located in the thigh bones and shin, pain, swelling, and inflammation can occur.

Shin splints can be considered as one of the most common types of repetitive strain injury experienced by the athletes and sportsmen. A variety of conditions can be defined as shin splints. The most common shin splint conditions are medial tibial stress syndrome, compartment syndrome, and the tibial stress fracture. Medial tibial stress syndrome is the most common type of shin splint, and it’s characterized by the degeneration of the shin bone, irritation and the damage to the muscles and soft tissues around it. The myofascial trigger points are the muscle knots in the anterior tibial muscles which can often remain undiagnosed and untreated. Due to these complications, the wrong treatments and diagnosis may be administered to the patient.

Risk Factors for Bursitis

Age is one of the most critical risk factors for bursitis. People involved in sports who are older than 30 years are more at risk of getting a Bursitis inflammation. Apart from that the type of sports and the strength of tendons and muscles also have a significant amount of determining the impact on the risk of bursitis.

Symptoms of Bursitis

Pain is the most important symptom of bursitis which can be aggravated by the movement. The pain can either be chronic or develop gradually over a long term, or it can be due to a sudden injury or blow. Difficulty or complete loss of movement ability is also experienced by the people suffering from bursitis. One such condition is known as adhesive capsulitis when it happens to the shoulder. As a result, the shoulder gets frozen and cannot be moved. Occasionally the patient may also experience swelling, redness, and warming of the injured area. The symptoms you should generally look for are the following:

  • Feeling pain and stiffness
  • Increased pain occurring due to movement or compression
  • Redness and swelling.
  • Difficulty or inability of moving joint due to pain
  • Bruising and rashes
  • Sharp and stinging pain during exercising
  • Feeling feverish

Treatment for bursitis

Bursitis treatment may have different approaches depending on the severity of the condition and the type of pain the treatment method is chosen to be administered. This also involves the type of structure and the part of the body that is suffering from bursitis. Preventive measures, as well as proper care, can significantly factor in for the effective treatment. The pain and swelling should be addressed first, and it should be ensured that there is no bleeding as a first aid response. In the long run, your doctor will guide you through with some treatment plans to cure the condition.

Bursitis treatment also involves the consideration of infection along with the condition. The treatment is chosen based on the presence or absence of infection along with bursitis. Bursitis that occurs with an infection is referred to as septic bursitis, while the one that occurs without an infection is called as aseptic bursitis. In the case of non-infectious or aseptic bursitis, some treatment options can be administered. The most commonly administered treatments are anti-inflammatory drugs, compression, rest and pain relieving medicines. These techniques can effectively reduce the symptoms and help speed up the recovery. The patient may also require bursa fluid aspiration in some cases. For that purpose, a syringe is used with a sharp needle to remove the fluid. It is done by an expert as it requires several sanitation and other considerations. It is usually done in the clinic or the doctor’s office. The fluid is retrieved, and it is forwarded to the labs for analyzing the conditions. The bursitis cases involving non-infectious conditions, the doctor may treat the patient under the action of anesthesia. The cortisone injectables are used for the treatment, and it is administered in the swollen area of the injured bursa. The chemical substance is very active and provides quick results. It can also recover the patient in a matter of a few days in most cases. This injection procedure can be carried out in combination with other treatments, such as the bursa fluid aspiration procedure. Apart from these options, you may also use other medication, NSAIDs and over the counter drugs. The most commonly used drugs in this regard are Motrin, Advil, Tylenol, and Aleve.

The treatment of bursitis may also involve other secondary aids. The patient can use braces and crutches. Moreover, the bursitis patients can also benefit from wearing footwears that are proper for bursitis as a preventive measure and to ensure that healing is accelerated. Other approaches can be incorporated in the treatment, such as weight reduction.

Exercising is also important to keep up with a healthy treatment regime. These involve stretching exercises which can prevent the patient from stiffness. The patient should be careful while choosing the exercises and they should be administered under the supervision of a physical therapist or a doctor. The patient should also avoid climbing the stairs and walking on uneven, hilly and rough surfaces. You should also avoid walking on steep surfaces. Some anti-inflammatory exercises may include Stairmaster and other such exercises.

Septic bursitis or infectious bursitis requires a more thorough approach because of the infection. The condition is rare, and it may require a surgical fixture of the problem by draining the infected bursa fluid using the technique of bursectomy.

Some of your lifestyle habits may also be responsible for a bursitis condition. That is why it’s important to take corrective measures regarding the things you may be doing wrong that caused bursitis. For this purpose, you can consult a physical therapist who will evaluate your lifestyle to observe the things that you might be doing wrong. You should also adopt an anti-inflammatory lifestyle which can help you effectively avoid inflammatory conditions. Some of the best ways to go about the treatment of bursitis are:

  • Resting as much as possible
  • Icing the painful area
  • Using compression bandages
  • Anti-inflammatory medication
  • Exercising, stretching, friendly workouts
  • Physical Therapy
  • Gradually start physical activities, don’t rush.
  • Surgery if no results are seen, and symptoms persist after the treatment.

Preventive measures for Bursitis

People who are not used to exercising and rigorous movement are more at risk of developing a bursitis condition. As a preventive measure, you should keep up with your exercising and work out regime to avoid any sudden damage to your muscles and tendons. Training can help make the tendons and muscles more flexible and robust. As a result, the impact of the injury can be minimized. In case if you already have a pain in particular part of your body, you should avoid training and sporting until the pain gets better. Otherwise, the pain can get worse with exertion and lead to a more severe condition. If you feel an onset of pain while playing or training, you should stop instead of ignoring it and continuing with your activity. Certain types of bursitis are not preventable. However, there are certain things that you can do to minimize the risk of bursitis, such as:

  • Using the particular type of padding to decrease the compression and pressure
  • Correctly lifting weights and take preventive training measures
  • Not lifting heavy loads on your back
  • Taking more breaks whenever your body asks for it
  • Preventing obesity as it can increase the risk of bursitis.
  • Making your muscles and joints stronger by exercising and training.
  • Always making sure that you do stretching and a warm up before training and exercising.

Fractures

  

What are Fractures?

The term Fracture means a break in medical terms. Generally, the fracture is used to refer to the break in any bone in our body. However, in everyday language, the term is also used as muscle fracture to indicate the twisting, polling and spraining of the muscles. There are many reasons why fracture is characterized by a very severe injury or health condition. The injury causing fractures can be excruciating in most cases. A break in the bone can be healed naturally, for which some aids such as crutches and plasters are used to keep the broken bone into its right place. An average human adult has 206 different bones in their body. Therefore, there are numerous possibilities of a fracture, and it can be classified into different types. The most common fractures are experienced in the limbs, arms, legs, ribs, fingers, and jaw. In some different sports, the fracture is one of the most common sports injuries, as certain sports can be rough. However, preventive measures and right training can significantly minimize the risk of fractures in athletes and people involved in sports.

Symptoms of a Fracture

A fracture is a serious injury; the condition can lead to severe and sudden pain. Broken bones also damage the tissues, muscles, and tendons that are serving the covering purposes. Usually, it’s easy to identify that an injury has caused a fracture as the symptoms are usually very evident. However, sometimes a physical examination, as well as the diagnostic tests, may be needed to make sure that it’s a fracture. The common symptoms that occur with fractures are swelling, bruising, and discoloration of the skin, inability to move the injured area, tenderness, evident bone displacement, obvious deformity, and a lot of pain. Depending on the type and the location of the fracture, the symptoms may be different.

Other common symptoms may include:

  • Bruising and discoloration
  • Angulation and bending of the affected area.
  • Inability to bear weight on the injured bone
  • Inability to move the injured bone
  • A feeling and sound of grating sensation
  • Bleeding in case of open fractures.
  • Severe and larger fracture can cause paleness
  • dizziness
  • feeling nauseous

Different Types of Fracture

Fractures can occur due to a variety of different causes in people who are involved in sports. Usually, it’s due to a heavy blow, falling, or a severe traumatic injury. Sometimes the fracture can also result from overuse, repetition of the movement and put too much stress and pressure on the area. Depending on the location and the severity of the fracture, it can be classified into different types. The simplest classification puts it into two distinct groups, known as the closed fracture of the compound or open fracture. The first type is a lot more common in cases of sports injury, and under these conditions, the skin is not torn, and the fracture happens internally. In case of open fracture, due to the breakage, the broken bone can poke out from the skin causing bleeding and severe muscular damage.

Regarding other classifications, the fractures can be classified into several groups, such as:

Transverse fractures: this type of fractures are characterized by a straight line as of breakage.

Avulsion fractures: avulsion occurs when muscle tearing can pull apart a piece of bone along with it.

Comminuted fractures: it can be simply understood as multiple fractures on a single bone.

Spiral fractures: in this type, a spiral breakage is formed around the bone.

Oblique fracture: as the name suggests, this second type of causes a diagonal split of a bone

Compression fracture: this type results from a fracture in spongy and soft bones upon compression and pressure.

Fracture dislocation: this type causes dislocation of the joint. 

Greenstick fracture: in this type of fracture, the bone only breaks partially. This means that it’s not a complete fracture, and only one side of the bone is cracked.

Hairline fracture: this type is difficult to diagnose even with X-rays as the split is as thin as a hair. In several cases, it is left unnoticed. 

Impacted fracture: a fracture of one bone due to the piercing of another fractured bone in it can cause impacted fractures.

Intraarticular fracture: this fracture occurs on the bone, and it’s extended towards the joint with another bone.

Longitudinal fracture: in this type of fracture the length of the bone is affected.

Pathological fracture: pathological fractures can occur as a result of another underlying health condition or a disease that is causing the weakening of the bones, such as osteoporosis.

Stress fracture: due to the repetition of the movement and persistent stress, a fracture can be caused.

Buckle fracture: it results in bone deformity instead of an actual split.

Complications of Fractures

A post fracture treatment requires proper healing and the enjoining of the broken segments of the bone. However, if this does not happen properly, it can result in a bone deformity and displacement. Sometimes fractures can also result in infections typically in the open fractures type where the skin is torn. The possibility of infections is eliminated by administering the precautionary measures and antibiotics. In the majority of cases, fractures can cause damage to the proximal tissues and softer muscles located on or near the broken bone. It can also damage the nerves, the tendons, ligaments, and the blood vessels. The symptoms of fractures may get worse gradually with the passage of time. If proper measures are not taken, and the condition is ignored, it can develop into serious complications. Fractures can also result in muscle wasting in most cases. The death of proximal muscles may be caused due to fractures. Proper therapy can reduce the risk of this problem. Another complication, as well as a risk factor involved in cases of fractures, is the deep vein thrombosis. To avoid such complications, it’s best to follow a strict physical therapy and maintain the blood circulation.

How is a Fracture diagnosed?

The diagnosis for fracture can be a thorough procedure in certain cases. However, in many cases, it is quite evident just by looking that it’s a fracture. The patient is also mostly able to tell if the pain is muscular or if it’s in the bone. Sometimes muscular damage can also occur due to a fracture, which can cause confusions. Since there are some different fractures that various parts of our body are susceptible to, sometimes they can be extremely severe and difficult to handle. Things can get very complicated, and the condition can become extremely persistent. Nonetheless, the primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain, the inability of movement, bone condition, and swelling. The doctor may also carefully examine by moving the bone and the joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an X-ray diagnostic test to identify the bone condition, an ultrasound test or an MRI (magnetic resonance imaging) test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound can sometimes help the doctor to locate and study the internal structures to see any possible damage.

Treatment for the Fractures

Fractured bones usually recover and help through a natural procedure. However, the recovery can be supplemented by eating healthy, resting the fractured area as much as possible and taking supplements such as calcium and vitamin D. 

The most important part of the treatment process is ensuring the healing is supplemented with the help of aids to ensure that the location and placement of the healing bones are kept perfectly to avoid any dislocation or deformities. It is focused on ensuring that the most suitable and optimal conditions are provided for allowing the bone to heal properly and promptly. This is usually achieved by administering a variety of ways to cause immobilization of the area.

The treatment starts with the lining up of the broken bones bringing them together as one unit. The process is called reducing the fracture as it brings the fractured bone closer together. This procedure is carried out under the effect of anesthesia which causes the patient to sleep in most cases as the process can be very painful. Surgery may be done to achieve this purpose if the case is severe. After the alignment, a variety of techniques may be used for the immobilization of the fractured bone, such as:

Plasters and braces- these are used to hold the bone exactly in the same position for a couple of weeks or even months. After the healing, it’s cut with the help of a saw.

Metal plates and screws – screwing and putting metal plates can keep the bone into place.

Intra-medullary nails – nails or rods are used on the larger bones and wires are used to hold the bone into place.

External fixators – this uses scaffolding technique by internally placing the carbon fiber directly into the bones.

The immobilized procedure is required for as much as two months in severe cases. During this period, the patient practices self-care practices and other complication may be monitored. It results in a simple healing process as the bone cells merge into each other by absorbing the old cells and producing the newer ones. A new bone may be formed, which is called a callus.

Physical therapy

After healing, a physical therapy remains to be a very effective treatment for the conditions of fractures. It can ensure the proper placement of muscles, bone and the joint, improve the strength and enhance the flexibility of the muscles and the tendons that surround the fractured bone. The condition can be developed in an acute manner as well as in a continuous and gradual manner. A single heavy blow, jerk or an injury can result in the fracture, of the tendons and muscles may get deteriorated over time by repetitive and smaller injuries.

Surgery: Plastic surgery may be administered to heal the damaged skin and muscles. However, in certain cases, a surgical procedure may be required for the alignment for the immobilization technique. 

Preventive measures for a Fracture

There are certainly a number of different ways in which we can ensure that a fracture is prevented. Sports can leave a person susceptible to an accident. However, taking proper measures and training can help a person in protecting himself even when he experiences an accident.

Here are some of the most effective ways to prevent a fracture:

  • Ensuring the bone health by eating healthy
  • Wearing the right suits for the sports, including paddings, etc.
  • Training to strengthen the bones and the muscles surrounding the bones
  • Stretching and regularly flexing along with the workout
  • Ensuring calcium and vitamin D intake to strengthen the bones
  • Preventing the direct impact of stress and pressure on the softer bones at the time of an accident
  • Treating any underlying health conditions which may weaken the bones, such as osteoporosis, osteogenesis, osteoarthritis, and cancer.
  • Preventing oneself from falls and accidents
  • Ensuring muscular health to avoid avulsion fractures

Muscular cramps

What are Muscular Cramps?

A muscle cramp is a very common condition in the sports injuries which is characterized by a strong and very painful contraction or tightening of a muscle. The condition usually occurs all of a sudden, and it may continue for a few seconds or several minutes.  In most cases, muscle cramps take place in the leg, feet or thigh area. The condition is also known as charley horse in common terminology. Sometimes the muscular cramps can occur during the night as a result of muscular spasms, muscular loosening and tightening as the person relaxes. It can also be experienced by people involved in sports. Therefore, it can occur both due to a lack of activity as well as too much vigorous activity. Most of us get muscular cramps at some point in our lives, so it’s quite a common condition. It results from forced contraction of the muscles which is involuntary. The causes of muscle cramps are numerous, and so are the types of muscle cramps. However, we will focus more on the causes related to the sports arena. It can occur due to the muscular contraction during a workout or exercise, and it can also occur when a person is relaxing. Each type of muscle cramp is associated with a cause. In the case of people involved in sports, they can be prone to dehydration as sports can cause too much perspiration. Therefore, dehydration is also a very common cause of muscle cramps in sports people and athletes. There are several medications as well that can result in muscle cramps as a side effect, and it’s usually written in the side effects of those medicines. In certain cases, the muscle cramps can be excruciatingly painful, and the patient may scream out of pain, and it can even last for as much as 45 minutes. Cramping of other involuntary muscles is also possible, such as the bowels, blood vessels, uterus, urinary tract, and bronchus. However, we will focus on the cramps that involve a musculoskeletal system of the human body, as these are the ones that are mostly associated with sports.

Although the condition is not a very serious issue, it can be really painful and uncomfortable at times. A person who is prone to muscle cramps may experience cramping repeatedly and frequently. That is why a proper treatment is advice for those people to eliminate the problem completely. The cramps of the muscles can be stopped if it’s possible to allow the stretching of the muscles. It can the muscle stretching is not possible, it can be difficult to address this problem sometimes. However, it’s mostly a condition that ends itself, and the person can get back to normal instantly. There are a number of things that we can do to prevent it from happening and to alleviate the pain at the time of a cramp. There are a number of factors that can increase the possibilities of a muscle cramp. Some of the factors that are in our control include a healthy and proper diet, healthy lifestyle and activities, and adequate stretching, workout and exercising. A person involved in sports should also care about keeping himself hydrated at all times not only to prevent muscle cramps but also to ensure overall body health in a number of different ways.

Risk Factors for Muscular Cramps

  • Being inactive
  • Lack of exercise
  • Being older
  • Being a female
  • Pregnancy
  • Dehydration
  • Improper training
  • The type of sports
  • The type of medicines taken

Types of muscle cramps in sports injuries

There are several different types of muscle cramps. However, sports injuries and sports related muscle cramps as associated with the musculoskeletal system of our body. Therefore, the relevant types of cramps are important to us. The musculoskeletal muscle cramps can be classified into four major types, including the true cramps, dystonic cramps, contractures, and the tetany cramps. The classification is based on the types of the cramps, the underlying causes for the cramps, and the area of the affected region.

True cramps are the most common type of muscular cramps experienced in sports people and athletes. They can be experienced in a part of a group of different muscles that function in combination. Such muscles include the flexion muscles of the legs and fingers. The most common cause of true cramps is considered to be a simulation of the muscles and the hyperexcitation of the nerves involved in them. It can be a result of injury and cause persistent muscular spasms. It can be considered as a reflexive response of the muscles to resist the impact of injuries to the muscles and the bones, such as in case of a fracture. It causes inability or serious limitation of the movement of the injured area, stabilization of the injured part and muscular spasming. These cramps can also result from vigorous activities involved in many sports. It can be a result of fatigue, overuse, and overexertion of certain muscles. Another reason for such cramps is resting, which is experienced by aged sports people. It usually occurs during the night and causes a severely painful condition. Dehydration can also cause serious cramping for the sportsmen and athletes as a result of heatstroke or excessive perspiration. Such cramps may also be caused due to the low levels of magnesium, potassium, and calcium in the bodies of people involved in sports. Body fluid imbalances can also result in muscular cramps.

Another type of muscular cramps is tetany cramps, which are caused due to the stimulation of the muscles and the excitation and activation of the proximal nerves. It may cause cramping in all the body. Sometimes it can be difficult to differentiate tetany cramps from true cramps.

Dystonic cramps are caused due to the contraction of muscles that are not meant or intended to be moved. It usually includes the cramping of muscles that work in the opposite direction. This is a less common type and occurs in smaller muscles. It can also be a result of overexertion and fatigue.

Contracture is the fourth type of cramping. However, it is not an actual type of cramping. In fact, it’s a distinguishable condition that can be mistaken as cramping. It is a condition characterized by scarring of the softer muscles and tissues involved in the muscular movement. As a result, the movement of the muscles is limited with the onset of pain.

Causes of Muscle Cramps

Muscular cramps can occur out of the blue and very suddenly. However, there is always an underlying cause for the condition. The causes differ from patient to patient and greatly determines the type of the cramp and the condition the patient is expected to experience. Although there are several causes for muscular cramps, the most common causes of muscle cramps are:

  • Fatigue of the muscles
  • Overexertion of muscles
  • Pain in the affected area
  • The weakness of the muscles
  • Inactivity
  • Vomiting can cause cramps
  • Lethargy and exhaustion
  • Sudden Weight Loss
  • Swelling of the muscles
  • Difficulty in breathing
  • Confusion during movement
  • Lack of the muscles’ strength
  • Fever can cause cramps
  • Medication
  • Deficiency of vitamins and minerals
  • Poor blood circulation

Diagnosis of muscle cramps

Physical examination is performed for the diagnosis. The symptoms are observed in the physical examination stage. These symptoms include:

  • Inability to use and move the injured area
  • Persistent Swelling
  • Soreness
  • Bulging due to muscle knotting
  • The firmness of the muscles
  • Tenderness
  • Mild to severe Pain

If these symptoms are observed, the diagnosis indicates the possibility of muscle cramps. Although there aren’t any specific diagnostic tests for muscle cramps, they aren’t required either since it is comparatively easy to diagnose a muscular cramp. In most cases, the patient himself is aware that he is experiencing a muscular cramp, and the doctor can endorse the doubt.

Treatments for muscle cramps

Stretching of the muscles is a good way to stop and treat a muscle cramp condition. The stretching can be done by softly allowing the muscles to move and function in the proper way they’re meant to function. For instance, in the case of leg cramps, standing, flexing and walking around can help alleviate the condition. Moving the leg in different directions to find the most comfortable spot can also help alleviate pain and stretch the muscle. The stretching is usually more about common sense, and the patient can understand what is needed to be done with a little knowledge and interaction with the pain. Similarly, calf cramps can be treated by standing close to the wall and leaning towards the wall and stretching. These techniques can be easily learned with a short tutorial. The cramps can also be treated by massaging the muscles in certain cases. Massage oil can be used for the treatment. Medication is usually not required neither prescribed because the cramps are self-ending in most cases and they will be gone even before the medicine starts to absorb and act. However, if absolutely required, certain muscle relaxants can be administered to soothe and relax the muscles that are experiencing cramping temporarily. Latest medicines are also using Botox toxin and injectable to treat severe cramping conditions. However, this remains aloof from the scope of sports injuries.

Preventive measures for Muscular Cramps

Almost everyone is bound to experience cramps at some point in their life. Therefore, the best approach is to prevent it from happening. There are certain things that you can do to minimize the risk of cramps, such as:

  • Stretching before starting activities, sports, and exercise
  • Warming up and cooling down
  • Keeping yourself hydrated at all times
  • Avoid overexertion and fatigue
  • Keep electrolytic balance
  • Keep up with vitamins and minerals
  • Avoid excessive weight loss

Delayed onset muscle soreness

What is Delayed Onset Muscle Soreness?

Delayed onset muscle soreness is a condition that is often referred to as DOMS. This condition is especially characterized by the symptoms of the pain and the stiffness in the muscles which can last from several hours to several days after going through rigorous training or exercises which the body is usually not accustomed to. It’s a very common condition experienced by people in sports, athletes, people who train and gym, and newcomers to heavy training.

The more we train, the more our muscles get strong. However, if your muscles are not used to heavy exertion, you must start slow and gradually increase the training. Otherwise, too much stress and pressure on your tender muscles all of a sudden will definitely cause muscle fatigue, overexertion, wearing and tearing of the muscles. This can result in soreness that can last for up to 4 days depending on the severity of the condition. This condition is extremely common as almost every second or even first person will experience delayed onset muscle soreness after their first heavy workout. Therefore, this is where proper guidance by your trainer comes in handy. The reason behind it is so common is that the symptoms, stiffness, and pain start building up gradually a while after you’re done with your workout. During the workout, our body remains warmed up, and we are not aware of the threshold capacity of our muscles. As a result, in the phase of it, sportspeople usually end up doing it out of enthusiasm. However, it will do more harm than good. That’s why doing less is better than overdoing it during your first few sessions.

DOMS is considered to be a result of muscular lengthening exercises which can cause micro damages to the muscles, often referred to as microtrauma of the muscular fibers. In simple terms, the muscle fibers break and heal again. This breakage can cause pain, stiffness, and the inability to move them. It doesn’t mean that this breakage is not required. That is how our muscles build up stronger after healing. However, it needs to happen gradually and slowly. If the pain from the DOMS is mild and the patient continues the exercise, it can get more severe. Therefore, it’s recommended to rest until the pain is gone. Delayed onset muscle soreness can also be a condition as a symptom of muscular damage caused due to exercising and training. Although the pain is not evident during the workout when the body is warm, the condition starts to show up once the body temperature drops and the body cools down.

Signs and symptoms of Delayed Onset Muscle Soreness

Pain is the most important symptom of DOMs which is usually accompanied by the stiffness of the muscles. Apart from these symptoms, other common symptoms include muscular soreness, a dull and aching pain, sometimes a swelling, tenderness of the muscles, pain upon touch and a feeling of palpation. There may be particular positions and angles in which the perceived pain is minimized, and the pain can increase if the damaged muscles are contracted, stretched, pressurized stressed and moved. Muscular tenderness is among the common symptoms and in this condition is it known as mechanical hyperalgesia of the muscles. The soreness and pain can remain for up to a week depending on the severity. However, it is maximum during the first four days, with the exception of the first day when pain gradually starts building up.

Causes of Delayed Onset Muscle Soreness

The causes are usually the same in the majority of the cases. Some of the most common causes associated with DOMS are as under:

  • eccentric exercise (lengthening exercise)
  • muscular contractions during exercises
  • static or isometric exercises
  • overexertion during workout
  • working out for more than 1 hour without warming up
  • Starting off with heavy training all of a sudden.

Preventive measures for Delayed Onset Muscle Soreness

Depending on the causes of Delayed onset muscle soreness, we have the most control over protecting ourselves from it and preventing the DOMS Condition from happening. It is not likely to be caused due to an accident, and in most cases, it is due to the behavior, habits and the mistakes of the patient. Here are some of the most effective things you can do to prevent DOMS from happening:

  • Avoid intense workout at the starting
  • Gradually increase the workout time and intensity
  • Make use of the repeated-bout effect
  • Limit the concentric and static types of exercises
  • Avoid muscular fatigue
  • Avoid overstretching in the name of warming up
  • Limit the movement range and stretching during the workout
  • Use the correctly fitted compression garments
  • Eat healthy and nutritious
  • Keep electrolytic balance
  • Keep up with vitamins and minerals intake
  • Use Turmeric in a routine with the workout

Treatment for the Delayed Onset Muscle Soreness

There are certain measures that can be taken to reduce the condition and treat it. The most important treatment is taking proper rest to ensure that the body gets enough time to heal the muscles and avoid the damage from further exercising. In most cases, you’ll be good for a couple of days, so there isn’t much to worry about. However, it shouldn’t be underestimated, and proper care should be administered. Even if the injury is less severe and you don’t take proper care, it can worsen with further mistakes. So reduce your intense activities as much as possible for the time being. Although not necessary in mild soreness, but sometimes the PRICE treatment can give significant and effective results especially when the condition is severe. Gentle massages for the issue of DOMS can be very effective due to the nature of the problem. A soft, gentle massage will help improve the circulation of the blood in the area and speed up the healing of the damaged muscles. This healing can be accelerated by eating foods that fight inflammation and have healing properties. Turmeric, also known as curcumin is also a magic ingredient which has amazing healing properties. So, make sure that you use that. Hot baths can also help alleviate the pain and soreness, so don’t hesitate to try sauna. Massages, on the other hand, can increase the overall blood flow in the region and help speed up the recovery. Another approach to take for alleviating the symptoms is resting, Icing, compression, and elevation can also help in to reduce the symptoms. Resting is the most important part of the healing process, as a wrong pressure and movement can reverse the process of healing and make the DOMS condition worse. Furthermore, icing can be done for 20 minutes to 30 minutes a number of times throughout the day for a few days until the symptoms are eliminated. The sore muscles can also be compressed by compression bands and fastening an elastic wrap around it. The pressure should be moderate to avoid any excess strain on the area. The recovery time for DOMS may range from a few days to a few weeks. Although it’s not recommended to exercise rigorously, it’s also suggested to not get into a rest phase entirely. Exercising can actually help alleviate or at least suppress the pain to some extent if you know how to do it right. You certainly don’t have to do a lot of stretching and worsen your condition. This effect is known as exercise-induced analgesia. Some people do consider it the best way to alleviate the soreness. However, it cannot be endorsed scientifically. Therefore, it’s better to stick with the conventional plan, as the condition will eventually be treated in a matter of days in most cases. Your plan should overall include:

  • Taking a break from the normal exercise routine
  • Stay limber with your exercising and practice light exercising
  • Physical therapies like RICE and massaging
  • Eat and drink healthy
  • Try anti-inflammatory medication in severe cases
  • See a doctor if needed

Frozen shoulder

What is Frozen Shoulder?

Frozen shoulder is a common condition in sports injuries which is characterized by pain and stiffness in the shoulder joint. In medical terms, it is also known as adhesive capsulitis. It is one of the most common shoulder injuries. However, unlike other injuries, the condition can persist for a long time and may even remain a problem for three years. The symptoms usually start to begin gradually with an initial onset of discomfort, which gradually turns into mild pain and then starts getting severe. This is one reason why it’s important to limit or even stop exertion and rigorous activities if the shoulder joint starts to show mild symptoms. This should be followed by a proper treatment plan. The treatment for the problem of frozen shoulder in most cases requires very thorough and aggressive treatment in a number of ways. In severe cases, medication and injectable are also required. The medication usually includes anti-inflammatory drugs, and the injections are needed to be administered on the shoulder area, such as cortisone injections.  Apart from these methods, physical therapy is also essential for an effective treatment of frozen shoulder. There is intensive care needed in the treatment of the frozen shoulder as the condition can become permanent if proper measures are not taken and if the condition is repetitively ignored. The problem can sometimes show excessive resistance to various treatment methods. Therefore, this is a problem that all the people involved in sports should be aware of. Other underlying conditions can also increase the risk of getting a frozen shoulder, such as a mastectomy or a stroke. Usually, the treatments which require the patient to limit the movement of the arm can increase the risk of frozen shoulder. The condition can also be mistaken with other conditions, such as arthritis. However, this is a totally different and unrelated condition.

There can be a number of ways to treat this condition, and in most cases, it will require a combination of several effective treatments. Steroid drugs may also be required in cases of severe injuries. However, it’s usually avoided due to the heavy side effects. If the problem persists, surgical procedures may be required to treat the condition. The most common surgical procedure administered for the treatment of frozen shoulder is arthroscopic surgery. A number of complications may also be experienced by the patient. The most common complication is the recurrence of the frozen shoulder problem on the same shoulder even after the complete treatment is administered. However, the second frozen shoulder can be experienced on the opposite shoulder as well.

Symptoms of Frozen Shoulder

The symptoms of the frozen shoulder may vary from patient to patient depending on the severity of the condition and the time period for which the problem has existed. The symptoms start to build up gradually, and the problem can span three stages. On each stage, the problem can persist for months before entering the next stage.

First Stage: The first stage for a frozen shoulder can be considered as a Freezing stage. As the name suggests, it completely disables the movement of the shoulder and can cause severe pain. The condition starts building up gradually, first with a limitation of the full range movement, which slowly develops into complete freezing.

Second Stage: The second stage can be considered as the frozen stage. This stage begins at the end of the first stage when the shoulder movement is disabled to the maximum. The stiffness is maximized at this stage. However, the pain in the shoulder starts to get duller gradually. The

Third Stage: The third staging is the final stage of frozen shoulder. It is normally referred to as the Thawing stage. As the name suggests, in this stage the frozen shoulder begins to thaw, and the movement gradually starts to get enabled. At the end of this stage, the person can feel painless, and the full range of movement is enabled. The pain throughout these phases can usually be more severe during the night, which can severely impact the sleep of the patient causing restlessness. 

Causes of Frozen Shoulder

The physiological cause of frozen shoulder includes the tightening and thickening of the ligaments, tendons and the connective tissues of the shoulder. The shoulder joint is very sophisticatedly covered by a combination of ligaments, tendons, and muscles, some of which serves the connective purposes. The inflammation and stiffness of these tissues can result in an inability of movement and pain. The exact underlying cause of this stiffness is still unknown to the researchers and doctors. However, certain risk factors are associated with this condition, such as an underlying health condition of a patient, including diabetes or a fracture. Usually, the primary cause of frozen shoulder is considered to be immobilization of the frozen shoulder.

Risk factors for Frozen Shoulder

There are various risk factors involved in the development of a frozen shoulder. Although it doesn’t mean that all such people will definitely develop the condition, these factors can significantly increase the underlying risk. Some of the most common factors include:

Age

Older people and athletes are more at risk of developing a frozen shoulder. People above forty years of age have a significant risk. Therefore, exercising is especially recommended.

Sex

Women athletes are more at risk of developing a frozen shoulder.

Lack of mobility

Partial lack or complete absence of mobility and movement of the shoulder can significantly increase the risk of frozen shoulder. This will include people who are required to limit their daily mobilization and exercise due to their lifestyle. A number of other factors can also influence the possibility of developing a frozen shoulder, such as:

  • Fracture
  • Health conditions like diabetes and Stroke
  • Post-surgical complications.
  • Rotator cuff injury
  • Systemic diseases
  • Hyperthyroidism
  • Heart-related diseases
  • Inactive thyroid
  • Parkinson’s disease and neuropathy
  • Tuberculosis

Prevention for Frozen Shoulder

Prevention is essential for minimizing the risk of frozen shoulder, especially in cases where patients have certain underlying health conditions. These preventive measures should include:

  • Increased mobility of the shoulder
  • Exercising and stretching
  • Physical therapy in case of fractures
  • Correct exercising in case of underlying diseases
  • Lifestyle changes.

Exercising can significantly help in the reduction and the prevention of frozen shoulder symptoms. These exercises need to be simple if you have experienced recent trauma. However, they can very effectively decrease the risk and possibility of a frozen shoulder. Exercises like crossover stretching of the arm and others can help keep the tissues healthy and moving. Here we discuss some of the most effective exercises that can prevent frozen shoulder. However, it’s important to note that these exercises should be administered under the supervision or with the guidance of a specialist of a physical therapist.

Crossover arm stretch:

Stretching out the frozen arm to the front and pulling it to hold next to your chin for half a minute before releasing.

Pendulum stretching:

Hang your pained arm and swing it in a circular motion, gradually increasing the diameter of the circle with time.

Towel stretching:

With the help of a towel, pull the towel with the healthy arm from behind your back while holding it with both hands in order to move the pained arm up in the direction of the shoulder.

Diagnosis of Frozen Shoulder

The primary diagnosis is initially performed. In this diagnosis, only the medical history and the physical symptoms are evaluated carefully, such as apparent symptoms of pain and swelling. The doctor may also carefully examine by moving the shoulder joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists for the structural problems. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition.

Treatment of Frozen shoulder

The treatment for the problem of frozen shoulder can be multidimensional. Frozen shoulder is a more dynamic problem compared to other shoulder injuries. Therefore, the treatment approach may also differ depending on the type of condition and severity. Unlike other injuries, the problem of frozen shoulder can be very persistent, and the symptoms can remain for as long as three years. This deteriorates a quality of a significant portion of your life. Hence it is extremely important to take proper measures for the treatment of Frozen shoulder. All the treatments are aimed at alleviating the pain and improving the mobility of the arm by reducing stiffness. This can be done in a number of ways and with a combination of different treatment methods, such as injectable, medication, physical therapy and exercise.

The approach follows the following pattern:

  • physical therapy
  • medication
  • surgery
  • home care

Physical therapy is almost essential for all cases of the frozen shoulder due to the nature of the problem. The objective remains to be free movement of the shoulder joint without pain, which is where physical therapy plays an important role to stretch your shoulder joint and regain the lost motion. The recovery period can take anywhere from a few weeks to nine months to experience significant progress. If physical therapy is not leading to good results, in the long run, it is a very strong reason to see your doctor regarding the condition.  Certain medicines can also be taken for relieving the pain as well as lowering the inflammatory condition that the shoulder may be suffering from internally or externally. The most commonly used drugs for this purpose is naproxen sodium, aspirin, and ibuprofen. In severe cases, you may be required to take steroid injectables. However, there are several side effects of steroids, and they should only be administered if there are no other options or any options except a surgery.

You should also take proper care at home and incorporate these changes and preventive measures in your everyday activities. This would include a regular administration of icing, compression, and other exercises. You also need to cut down on your everyday activities and limit the movement by bringing drastic changes to your lifestyle. An expert will be able to guide you on how easily and effectively you can carry out everyday tasks without the use or with minimal uses of your arm and the shoulder. Another treatment that can be applied for alleviating the pain is a hot and cold treatment which utilizes the difference between temperature extremes can also help alleviate the symptoms this is usually done by the padding or hot and cold packs that are available in the market. Your doctor will also guide you regarding the exercises that you should do and the exercises that you should avoid on a daily basis.

In case if other treatments are not showing positive results in the long run, you may have to opt for a surgical procedure. The procedure is invasive, but it may be inevitable in certain cases since we have talked about how persistent a problem of frozen shoulder can be. The stiffens and freezing may be a result of dislocation or a certain type of adhesion which is causing a jam. The surgery is aimed at removing the cause of the frozen shoulder after figuring out what the problem is after careful diagnosis. For movement of the arm and shoulder, joint anesthesia may be administered. Diagnosis, as well as treatment, may be carried out with the help of an arthroscope and arthroscopic surgical treatment. When the cause of frozen shoulder is an injury, you should look forward to performing surgery after a few weeks if no positive results of physical therapy are seen. After the surgery, your stitches will be removed in ten days. The rehabilitation and postoperative care, exercise, and physical therapy is the most important part to ensure that you get back to the ground at the earliest. Most athletes are able to continue with their sports within three months from the time of injury if effective treatment is given. Nonetheless, there are certain risks associated with the surgical procedures, and you should take some time out to discuss it with your doctor in detail and to think about it before getting into the treatment. Sometimes even surgery can be ineffective, and the pain may persist for a longer time.

Shoulder manipulation

The patient, in this case, is administered with anesthesia so that the pain cannot be felt. Under the impact of anesthesia, the specialist may move the shoulder joint to fix the dislocation that can alleviate the symptoms. This strongly depends on the type of the condition the patient is experiencing.

Transcutaneous electrical nerve stimulation

This is achieved by using equipment which aims at numbing the nerves that work as pain receptors. These nerves are numbed from the back and spine area. This method is also referred to as TENS, and it can be used to alleviate pain. However, this should only be administered by a specialist.

Sometimes surgery may be the only viable option in case of frozen shoulder, and to ensure faster results it is also often recommended. Here are some of the best measures that can be taken for the treatment of frozen shoulder:

  • Resting as much as possible
  • Icing the painting area
  • Using compression bandages
  • Anti-inflammatory medication
  • Exercising, stretching, friendly workouts
  • Gradually start physical activities, don’t rush.
  • Surgery as a last resort, if no results and symptoms persist after the treatment.

Iliopsoas Syndrome

What is Iliopsoas Syndrome?

Iliopsoas syndrome is another name for iliopsoas tendonitis, which is a common condition in sports injuries characterized by the inflammation of the tendons or the proximal tissues or the area close to the tendons. It can be a result of overuse, overexertion, and repeated flexion of the hip muscle resulting in pain and inflammation caused by acute trauma. This is specific to the tendons of the hips. Although there are a number of other conditions that can affect the hip region, iliopsoas syndrome is one of the most common among the sports people and the athletes. This syndrome may cause tendinitis as well as bursitis of the hip. The iliopsoas is a regional muscle in the anterior hip, consisting of three main parts. These are named as psoas major, psoas minor, and the iliacus. These muscles serve the purpose of flexion of the hip. Bursae are also present in the hip joint similar to many other parts of the body. Bursa is the small sacs that are filled with fluids, and they act as the cushions to the bones, tendons, ligaments and the muscles in the proximal locations of the joints. In the hip, there are two bursae which are usually prone to inflammation. In simple terms, when one of these bursae becomes inflamed, the condition is known as hip bursitis, and when the tendons of iliopsoas which joints the thigh bone with the muscles are inflamed, the condition is termed as tendinitis.

Causes for Iliopsoas Syndrome

There are a number of different causes of Iliopsoas syndrome. Specific to the people involved in sports activities, Iliopsoas syndrome can be experienced most commonly due to the overuse and repeated use of a certain area. As most sports require repetitive movement of a certain part of the body, the athletes and sportsmen can become vulnerable to such conditions.

Other causes of Iliopsoas syndrome may include:

  • Sudden jerking
  • Running several steps
  • Suddenly stopping while running
  • Legs or arms stretching
  • Wrong posture and legs movement
  • Heavy hit
  • Hard blows
  • The weakness of the tendons
  • Lack of flexibility of the tendons and muscles
  • Tearing of the muscles
  • Overexertion of joints
  • Not stretching or warming up before working out
  • Arthritis
  • Length difference of legs
  • Rheumatic arthritis
  • Reactions of medication
  • Abnormal placement or displacement of joints and bones

Symptoms of Iliopsoas Syndrome

Pain is the most important symptom of iliopsoas bursitis and iliopsoas tendinitis which can be aggravated by the movement. The pain can either be chronic or develop gradually over a long term, or it can be due to a sudden injury or blow in most cases. Difficulty or complete loss of movement ability is also experienced by the people suffering from iliopsoas bursitis and iliopsoas tendinitis. Occasionally the patient may also experience swelling, redness, and warming of the injured area. The symptoms you should generally look for are the following:

  • Feeling pain and stiffness in the hip area
  • Increased pain occurring due to movement or compression
  • Redness and swelling.
  • Difficulty or inability of moving hip due to pain
  • Sharp and intense pain in the start
  • Gradual dulling of the pain
  • Clicking or snapping of the hip
  • Increased Pain due to mobility
  • Bruising and rashes
  • Sharp and stinging pain during exercising
  • Tenderness in the hip or groin
  • Pain in the lower back
  • Pain in buttocks
  • Pain radiating along the leg
  • Groin and pelvic pain
  • Shuffling and limping
  • Difficulty in maintaining an erect posture

Risk factors for Iliopsoas Syndrome

Age is not the important risk factors of iliopsoas bursitis and iliopsoas tendinitis. Apart from that the type of sports and the strength of tendons and muscles also have a significant amount of determining the impact on the risk of iliopsoas bursitis and iliopsoas tendinitis. Sex is also a significant risk factor, and females are more prone to iliopsoas bursitis and iliopsoas tendinitis. There may be several other risk factors involved in iliopsoas bursitis and iliopsoas tendinitis, such as:

  • Overuse and overexertion
  • Bone spurs
  • Type of sports: Runners, athletes, dancers, soccer players
  • Calcium deposition
  • Previous injury or trauma of the hip
  • Underlying issues related to hip and spine, such as arthritis and scoliosis.
  • different types of arthritis
  • The difference in the lengths of the legs

Diagnosis of Iliopsoas Syndrome

The diagnosis for iliopsoas bursitis and iliopsoas tendinitis can be a thorough procedure in certain cases. The patient is also mostly able to tell if the pain is muscular or if it’s in the bone. Nonetheless, the primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain, the inability of movement, bone condition, and swelling. Medical history also plays an important role here. The doctor may also carefully examine by moving the leg, hip and the joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an X-ray diagnostic test to identify the bone condition, an ultrasound test or an MRI (magnetic resonance imaging) test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound can sometimes help the doctor to locate and study the internal structures to see any possible damage.

Treatment for iliopsoas bursitis and iliopsoas tendinitis

The treatment for iliopsoas bursitis and iliopsoas tendinitis is rather simple in most cases as the condition is commonly not very severe. Surgery is avoided unless absolutely necessary, and the resting is considered to be an effective treatment method. The patient can recover from iliopsoas bursitis and iliopsoas tendinitis within a month only by resting. However, there are certainly several other things that you can do to ensure effective and speedy treatment and recovery.

The cause, as well as the severity of the condition, is very important for the treatment of iliopsoas bursitis and tendinitis. If the condition is mild, you can take proper rest and keep your joints relaxed. Several home remedies and traditional methods can be very effective, and in most cases, you may not need to see a doctor. The inflammation can be reduced by taking anti-inflammatory drugs and icing the swollen area to alleviate the symptoms of pain and swelling. Similarly, you need to bring some changes to your daily routine and the types of the activities that you’re involved in. This can effectively reduce the irritation caused to bursitis. Furthermore, you can make sure of aids like crutches and a cane to support yourself rather than putting your body weight and the pressure on your injured area. This will not only be protective, but it will also speed up the recovery from the pain and other symptoms. For complementing the treatment for effective results, you can try other available options such as medicines that are aimed at reducing inflammation. This can be more beneficial than taking the simple painkillers. Other than this, you may go for other NSAIDs and over the counter drugs, like acetaminophen and aspirins. In severe cases, if the condition is not tolerable, you can administer corticosteroid injections with the prescription of your doctor. Combining more than one treatment options can improve the effectiveness of the treatment overall. In terms of physical therapy, you should aim for strengthening and stretching exercises. These would be advised by your therapist depending on the types that are suitable for you. If you are practicing them on your own, you should discontinue them if it is enhancing the symptoms or cause more pain. The approach should be to stretch the hip flexor muscles. It is important to note that these conditions can be coupled with an infection as well. Therefore, you may need an antibiotic course after the diagnosis if your doctor finds a possible infection. Apart from that, surgery will not be required in a majority of cases. Some simple and effective measures for the treatment of iliopsoas bursitis and iliopsoas tendinitis are:

  • Resting as much as possible
  • Icing the painting area
  • Anti-inflammatory medication
  • Exercising, stretching, friendly workouts
  • Physical Therapy
  • Gradually start physical activities.
  • Surgery as a last resort, if no results and symptoms persist after the treatment.

When the signs start showing improvement, the patient can gradually get back to carrying out their everyday activities that require physical exertion. The specialist or doctor will make sure of when you are in a condition to get back to continue with everyday activities. The patient should phase into the regular lifestyle by first of all trying light exercises and gradually improving on the difficulty. At the same time, you should ensure that you do not do anything that can cause jerking of the hip. It is best to avoid sports for a while after the injury. Sports should be avoided for a long time after the injury, even when the patient recovers, as it can severely increase the risk of reversing the healing.

Impingement Syndrome

What is Impingement Syndrome?

Impingement syndrome is a condition of the shoulder common in sports injuries that are characterized by pain inability of movement, weakness and limited mobility of the shoulder. There are several medical names for this condition, such as supraspinatus syndrome, painful arc syndrome and sub-acromial impingement. In more common terms it is also referred to as thrower’s shoulder and swimmer’s shoulder, given its strong association with these sports. The impingement syndrome is a result of irritation of rotator cuff muscle and the inflammation of proximal tendons.

Causes of Impingement Syndrome

The patient’s condition in Shoulder impingement is caused due to overuse, the repetition of the movement of shoulders and raising and stretching the arm due to which the tendons can impinge. That is why the condition is also referred to as rotator cuff impingement; these movements can include overhead movement, overuse of the joint and other similar activities. People involved in a variety of sports are vulnerable to this condition. Shoulder impingements may be very painful accompanied by the disability to continue sports for a while. The condition makes it very difficult for the patient to sleep, and they may get up from sleep several times during the night due to the shoulder pain. It’s also difficult to get a comfortable lying position where the shoulder doesn’t pain. The pain can get worse with moving the shoulder joint in certain angles, and it can be extended towards the rest of the arm. It can also make the usual everyday activities a challenge for the patient due to the pain, such as combing the hair.

Shoulder impingement affects the area where the upper arm is connected strongly in the socket, and this connection is strengthened by the group of tendons and muscles called the rotator cuff. Injury to this group of muscles can result in a dull pain in the shoulder. And the condition can easily get exacerbated while making the pain worse with time. Therefore, proper care, especially with the right sleeping position, is required to treat the condition in a timely manner and not cause further damage.

Signs and symptoms of Impingement Syndrome

The symptoms of the frozen shoulder may vary from patient to patient depending on the severity of the condition and the time period for which the problem has existed. The symptoms start to build up gradually, and the problem can span for a while. Pain, weakness, stiffness, and lack of mobility are the most important symptom of shoulder impingement which can be aggravated by the movement. The pain can either be chronic or develop gradually over a long term, or it can be due to a sudden injury or blow. Difficulty or complete loss of movement ability is also experienced by the people suffering from shoulder impingement. One such condition is known as adhesive capsulitis when it happens to the shoulder. This condition is separately characterized as the frozen shoulder. As a result, the shoulder gets frozen and cannot be moved. Occasionally the patient may also experience swelling, redness, and warming of the injured area. The symptoms you should generally look for are the following:

  • Feeling pain and stiffness
  • Increased pain with overhead movement
  • Increased pain occurring due to movement or compression
  • The feeling of grinding upon movement
  • Difficulty or inability of moving joint due to pain
  • Popping sensation upon movement
  • Sharp and stinging pain during exercising

Risk factors for Impingement Syndrome

As a general rule, the overall resilience and strength of the patient is a very detrimental factor. If the muscles are wrong, the injury is likely to be less severe. Apart from that, the strength of the muscles can also be affected by growing age, especially after the age of forty years. Therefore, age is another important risk factor. The type of sports that a person is involved in is also detrimental to the risk. Sports like tennis, swimming, baseball, soccer, and golf are the high-risk sports. The professional practices, as well as the medical history of the patient and his family, is also very detrimental.

Diagnosis of Impingement Syndrome

Initially, the patient is examined for certain physical symptoms of pain, weakness, and stiffness. A medical history of the patient is also helpful in the examination and diagnosis. The doctor may also carefully examine by moving the shoulder joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound will help the doctor to locate and study the internal structures to see any possible damage.

Once the doubt is established, the doctor may administer different tests for verifying the impingement syndrome. These tests include the Hawkins-Kennedy Test, and the impingement test, in which lidocaine is injected to notice the improvement in the symptoms of pain and movement. If there are positive signs, the condition is considered to be an impingement syndrome.

Treatment for Impingement Syndrome

A multi-disciplinary treatment can be administered for impingement syndrome. Since the nature of the condition is inflammatory, a number of oral anti-inflammatory medicines can be used for effective reduction of the symptoms. The drugs that are most commonly used for impingement syndrome are ibuprofen, aspirin, and naproxen. There are potential side effects of these medicines as they are administered for a long period of up to 2 months on a daily basis. Impingement syndrome can be persistent in certain cases, and it can take a lot of time to recover from it even by effective treatment methods fully. These medicines may include some over the counter drugs. However, you should not use any of these on a long-term basis without the prescription of a doctor and without careful supervision of a specialist. The side effects may vary from person to person, and if the side effects are enhanced too much, you may have to stop the medicines. The most common side effects of these medications are bleeding and stomach problems. These medicines are given to target and treat the symptoms that are expressed in impingement syndrome, and there are no preferred or specialized medicines for this problem. The effectiveness of these medicines may also differ in each person. Therefore, a number of different medicines may be used one after another after a gap of 12 to 15 hours depending on the response of each medicine. If one medication does not show any results for you, the doctor may go for the other medicine. This is continued until the results are noticeable.

If these medications and drugs do not show any significant improvement in the condition, then your doctor may go for cortisone based injectables as a secondary treatment option. Cortisone is a substance that has effective anti-inflammatory properties, and it can show results quicker. The reason it is used as a secondary treatment option is that it can cause weakness of the tendons and the muscles as a side effect if it is frequently used. Therefore, it is used only when it is absolutely necessary.

Apart from medicines, the treatment of impingement syndrome may also involve exercises and physical therapy on a regular and daily basis. The most important exercises include stretching. Warm showers are also useful as you may be able to move the stiff and painful joint during a shower. Along with light exercises, you should also ensure that you do not participate in the activities that involve repetitive movement and exertion of your arm. Above activities should be especially avoided in this regard. The best exercising practices will be guided and introduced to you by your physical therapist. The physical therapy will be aimed at stretching and strengthening of the muscles through exercises.

If the condition is not improving with these measures, the doctor may go for another diagnosis and carry out some tests, such as arthrogram, Ultrasound, and MRI as differential tests. It will help the specialist understand if there is a need for surgery, or if there has been severe tearing.

In most cases, the patients are able to recover from impingement syndrome with the help of exercises, physical treatment, and therapy, therapeutic approaches, preventive measures, and injectables. It is important to ensure that the injured area should be given enough time to rest so that inflammation can be capped.

Treating the impingement syndrome with the therapeutic approaches, however, poses a number of side effects that you must be aware of. The patient may suffer from digestion problems, headaches, nausea, and stomach related problems. A useful measure would be to take your medicines after the meals to avoid severe side effects. Apart from these side effects, a person may also suffer from ulcers, bleeding, and constipation. However, these are the less common side effects.  You can also adapt to an anti-inflammatory lifestyle and eat the foods that encourage the healing process. One of the highlight substance that you can use in your foods is turmeric or curcumin.

In case of a surgical procedure, you may go through a process of shoulder manipulation under the effect of anesthesia. If the shoulder is dislocated due to acute trauma, it will be fixed to relief the muscles and tendons that are stretching because of it. The damaged tissue or any adhesive particles are removed from the shoulder joint with the help of tube insertion. Physically, you can also administer the heat and cooling procedure which can help reduce the inflammation, swelling, and pain. A gentle massage can also be helpful in some cases if the area is not sensitive to touch. The improved circulation and blood flow due to the massage will help reduce the inflammation and enhance the healing.

Iliotibial band syndrome

What is Iliotibial band syndrome?

Iliotibial band syndrome (ITBS or IT band syndrome) is an overuse injury of the connective tissues that are located on the lateral or outer part of thigh and knee. It causes pain and tenderness in those areas, especially just above the knee joint.

Iliotibial Band Syndrome is a common medical condition in sports people and athletes that is characterized by an overuse injury of the Iliotibial Band. It happens due to the rubbing and the friction of the muscles against the knee bone. The Iliotibial Band is also referred to as IT Band, and this condition is also abbreviated as ITBS in medical terms. The Iliotibial Band is located in the outer and lateral region of the thigh, and it extends to the knee. This is basically a band of soft and firm connective tissues. The condition can cause mild to severe pain along with other symptoms like tenderness above the knee. The Iliotibial Band is stretched from the pelvis, crawls through the hip region and extends towards the knee. It mainly serves the purpose of keeping the knee stabilized when a person is walking, moving, running, stretching and exercising.

Signs and symptoms of Iliotibial band syndrome

The symptoms and signs for IT Band Syndrome can vary from person to person depending on the severity of the condition. In less severe cases the patient may experience a sudden discomfort just above the knee during a walk or run. The pain may go once the patient rests for a short while. For some people, the pain is not experienced suddenly and may build up gradually with time. In most cases, IT Band Syndrome cases include a stinging sensation in the knee along with the loss of control over the knee muscle, which may destabilize the knee. In severe cases, the movement of the knee joint is severely limited due to the pain, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling. Some of the other most common symptoms can include:

  • Thickening of the tissue in the proximal region
  • Burning sensation
  • Increased pain with the passage of time
  • Pain due to the striking of the foot on the ground
  • Persisting pain in the IT Band
  • Pain in the tibia upon compression

Causes of Iliotibial band syndrome

The most common cause of an IT Band Syndrome is the turning and the wrong training habits, imbalance of the muscles, and sudden displacement. As a result, the knee can be pushed out of its normal and natural position, and it can cause muscular and tendon damage. Such unexpected movements are very common in sports that involve a lot of running and the use of legs. These tearing of the muscles can be very painful at times and could be accompanied with other symptoms such as bruising and the swelling of the area. Although it’s mostly the tendons, ligaments, and muscles that are damaged or injured due to IT Band Syndrome, it can also damage other structures, such as the blood vessels, the knee by displacing it, and cartilages. There are several risk factors involved, such as the types of sports, etc. however, it can occur in people of all ages.

Some of the other most common causes for IT Band Syndrome include:

  • Walking on uneven or hard surfaces
  • Wearing the wrong sized or kind of shoes
  • Rigorous sports activities and feet movements
  • Twisting of feet, ankle and knee muscles
  • Turning suddenly during a play
  • A sudden strain due to kicking
  • Running and stopping suddenly
  • Continuing sports after mild strains and pain.
  • Microtraumas
  • Wrong diagnosis of a previously occurring pain.
  • Repeated minor injuries
  • Overuse of the muscles
  • Long training hours
  • Sitting in the lotus position for long hours
  • Prolonged running on an uneven surface
  • Uphill and downhill running
  • Climbing and descending stairs again and again
  • Not stretching and warming up before workout and running
  • Hiking for long hours
  • The weakness of abductor’s muscles and other tendons

Treatment & Rehabilitation for Iliotibial band syndrome

There are several ways to treat the IT Band Syndrome. The treatment may vary depending on the severity of the injury and the type of the underlying cause of ITBS. In terms of physical treatment, the traditional RICE therapy is widely used for IT Band Syndrome treatment. As a secondary relief, a number of painkillers and anti-inflammatory drugs can be used, such as naproxen, ibuprofen, and aspirins. The medicines should be carefully administered as it can interfere with other prescriptions for underlying health conditions. The main approach often remains to be 1) complete rest and 2) foam roller massage.

Physical therapy and home remedies have a number of ranked approaches, including stretching exercises, massages and foam roll. It can improve the injury condition and reduce the symptoms of pain and swelling. Usually, you do not need to visit a doctor. However, you may consider seeing a physical therapist if the symptoms are not being addressed by the home remedies. The physical therapist will focus on stretching and stretching exercises to improve the flexibility and reduce the friction between the rubbing structures in case of IT band Syndrome. The inflammation scarring and breaking down of structures is caused due to this increased friction.

A number of other options are also available, such as therapeutic ultrasound techniques, such as phonophoresis, which can reduce the irritation and soothe the softer tissues around the knee. Medicine is administered through the skin to reach the inflamed tissues directly. Sometimes electricity can be used instead of the medicine in this treatment, which is commonly known as iontophoresis.

A physical therapist would require to measure some parameters to ensure a good exercise regimen for you, including your ability to balance, your flexibility and the analysis of your gait. Certain aids and footwear accessories may also be used to reduce the problems associated with position and posture.

In case if the anti-inflammatory medicines are not showing positive results, the doctor may also have administered corticosteroid medicines on you which are directly delivered to the inflamed area with the help of injections. This can show a quick and effective response, but there are several side effects associated with it.

Surgery is rarely required for the problems associated with IT band syndrome. However, if an operative procedure is required, the doctor may administer an arthroscopic procedure to diagnose the condition of the inflammation and the scarring. This can be subsequently treated with the same procedure. The inflamed structure of IT Band is removed through the surgery. Apart from arthroscopy, the doctor may also operate to cut a triangular part from the IT band which will help to increase the length of the band. Surgery requires a rigorous examination of pre-surgical considerations that may be associated with the pain to ensure zero mistakes.

Biomechanical analysis

Identifying the cause is also an effective way to pursue treatment. A specialist or an expert, such as a podiatrist can help in to identify any foot or underlying muscular problem that is causing muscular stress and rotation.

Foam Roller

A foam roller can help massage and stretch the IT Band muscles while removing any ties and knots of the tendons. It can also help reduce the friction and massage the impacted area. It should be continued even after the pain is gone.

Overtraining Syndrome in Athletes

What is Overtraining Syndrome?

Overtraining Syndrome is a common medical condition experienced by people who are involved in sports and athletics. As the name suggests, Overtraining Syndrome is developed as a result of excessive training for a prolonged time more than the threshold capacity of the body. As a result, the athlete’s body undergoes serious damage in a number of ways. This usually happens to sports people when they do overstrain before a big competition or an occasion. Instead of benefiting from putting so much effort into it, the health and wellbeing are usually reversed, and it may take some time for the patient to recover from the damage caused due to Overtraining. This is also very common in sports people and gymnasts and usually happens when people overestimate their body’s potential and end up training themselves to the point of damaging consequences. Sometimes the symptoms of Overtraining Syndrome may also appear due to an inadequate amount of rest and not let your body recover from the previous workout. Technically, our body does not grow and become strong after a workout. In fact, our body grows strong after we have completely rested and recovered from our last workout. Rest is the point in time where our body grows and become stronger. Therefore, it’s essentially important that proper gap must be maintained between two consecutive workout sessions and enough rest and sleep is received. Otherwise, the results can reduce the performance, end up with pain, weakness and backfire the entire motive of the athlete. It may also take place due to overloading. It’s important here to maintain the right balance between resting, recovery, and overloading. The consequences will not only reduce strength but also cause pain.

Signs and Symptoms of Overtraining Syndrome 

There can be a number of different symptoms associated with Overtraining Syndrome and may vary from person to person depending on the severity of the condition and the strength of the athlete or sports person before the Overtraining Syndrome. Pain is the most important symptom of Overtraining Syndrome which can be aggravated by the movement. The pain can either be chronic or develop gradually over a long term, or it can be due to a sudden injury or blow in most cases. Difficulty or complete loss of movement ability is also experienced by the people suffering from Overtraining Syndrome. Occasionally the patient may also experience swelling, redness, and warming of the injured area. A range of symptoms may be experienced based on the severity in terms of physical, mental as well as emotional symptoms. It greatly depends on the person suffering from it. However. Here are some of the most common symptoms that are experienced by people suffering from Overtraining Syndrome:

  • Lethargy and exhaustion
  • Lack of vitality and energy
  • The feeling of being washed-out
  • Pain in any part of the body
  • Specific pains in joints and muscles
  • Stiffness in the impacted region
  • Difficulty in movement
  • Lack of willingness to do little things
  • Drastic reduction in performance
  • Soreness in the legs
  • General Pain in different body parts
  • Persistent headaches
  • Difficulty in falling asleep
  • Restlessness
  • Weakened immune system resulting in infections
  • Depression and anxiety
  • Becoming prone to injuries
  • Irritability and mood swings
  • Reduction in stamina
  • Lack of interest and enthusiasm
  • Not feeling hungry at times

This condition of Overtraining Syndrome is comparatively different from other sports injuries, as it impacts the body in various ways, including emotional, mental and physical symptoms. Most of the body’s energy starts being utilized in the recovery of the patient which can impact the efficiency of other functions and body processes.

Diagnosis of Overtraining Syndrome

The diagnosis of overtraining can be relatively different from other injuries caused due to sports activities. Usually, the symptoms are quite clear to the patient. The first stage of diagnosis could be a physical examination and the symptoms that the patient is suffering from. It can take it easier to diagnose the exact underlying cause behind the overtraining syndrome. There are a number of different ways through which you can identify and objectively measure the possibility of overtraining syndrome. Firstly, if there are people around you who are noticing that you’re working too hard on yourself, they’re most probably right. So, don’t ignore such comments if they’re coming from genuine people. One telling method for testing this syndrome is to measure the rate of your heart over the span of equal intervals. The measure for the speed as well as the aerobic heart rate can be measured and noted down. If you experience a lack of stamina along which increased heart rate at rest, there is a significant possibility of overtraining syndrome. The heart rate can be measured in the morning as well, which will show an increased figure if the problem persists. Another test for the condition is known as orthostatic heart rate test which can help in determining the overtraining syndrome. This test includes a number of steps, which are:

  • Laying down and relaxing for ten minutes in the morning preferably
  • Note down your heart rate right after that
  • Stand up for fifteen seconds and then take another record for heart rate. Then take another after 90 seconds, and the fourth one after two minutes.

People who are suffering or about to suffer from overtraining syndrome will show a striking increment of ten beats per minute on the fourth measure compared to the first one, unlike the normal athletes that don’t experience any significant change. This can indicate that the patient is or is about to suffer from overtraining syndrome, is exhausted, experiencing fatigue and he’s not resting properly. This test along with the other measured trends can give a good idea about the condition of the patient.

Psychological tests are also known to be the most effective methods for understanding and diagnosing the overtraining syndrome. As we discussed before, the overtraining syndrome can also have emotional and mental consequences, which can give a good measure of the condition. Usually, the patient may experience reduced mental capability and confused mental state. The patient may also experience emotional trauma, depression, anxiety, unenthusiastic thoughts, negative feelings, mental fatigue, irritability and anger, and other such symptoms.

Treatment for overtraining syndrome

There can be a number of different ways in which you can alleviate the symptoms of overtraining syndrome. It Although it’s not an extremely dangerous condition, it is a very common problem, and you may want to take medication if you need assistance. Depending on the severity of the condition you and your doctor can choose the right treatment option for you. Since it is a common problem, you can solve it by using a number of different self-treatment options. Some of the most effective approaches are as follows:

Complete Rest

The very reason for overtraining syndrome is not resting enough. Once you get it, you need to take complete rest for a while and pause your sports activities. The condition can develop over time, and it takes longer to treat a more prime condition. Therefore, you must actively monitor it for early detection. In mild cases, you only need to rest for 3 to 5 days. In moderate cases, you may rest a little longer than a weak. The best way to know if you have rested enough is to test for movement and pain.

Cross training

Even though resting the over-trained part is important, in mild cases, you can utilize that time to train other parts of your body in moderation. You do not have to train too much as you need to preserve some of your body’s energy to treat itself. This is a dangerous line because if you overstrain yet another area of your body you increase the risk of developing a secondary condition of parasympathetic (PSN) and sympathetic nervous system (SNS).

Utilize for spot train

While you are giving time to your over-trained area to recover, you can use that time to strengthen and train the weaker and undertrained areas. This is the time for practicing preventive measures and avoiding overtraining and other injuries in future.

Early treatment

You do not want to delay your treatment even for a day. Once the mild symptoms start to show you should immediately stop the workout and training and start your treatment. The more you ignore it, the more it will get persistent and difficult to treat.

Pain Management

You need to be active in terms of managing your pain. You don’t want to make it worse if you are continuing your daily activities. For that, you can use the foam roller as well as gentle massages from a specialist or physical therapist. They can also teach you how to massage the area yourself and how you can use the foam roller.

Acupuncture

Acupuncture is an old but gold therapy for the treatment of pains and inflammatory conditions. You can easily incorporate the acupuncture technique in your treatment plan. This is known to improve the conditions associated with different body structures such as the nerves, muscles, tendons and other structures.

Healthy diet

We are what we eat, and when we train to consume our muscles and body tissues, they need to grow again. Our food is what provides us nutrition, energy and the development of our muscles. By eating healthy we do not only wipe out the chances of damage, but we also provide the raw material for the rebuilding of our muscles after we have damaged them.

More water and supplements

Drinking more water will ensure proper detoxification of the muscles and improved nutrition and healing. You should also couple it with supplements that can boost up the healing power of your body. You can try supplements that include organic glucosamine and chondroitin. Apart from these, you can try a natural treatment that can reduce inflammation and boost up the healing capacity of our body, such as curcumin.

These factors will determine the type of pain the treatment method is chosen to be administered. The most common treatment methods that are used for overtraining syndrome including resting, keeping yourself hydrated at all times, getting a relaxing massage or a sports massage, and start with the cross training. Rest is certainly the most necessary and most effective treatment for this condition. You should also ensure that you relax physically, mentally and emotionally. Don’t hesitate to pamper yourself for a while and do what you feel like doing. Massages also work great in this condition. This can include sports massages as well as relaxing massages, as you are trying to allow your body to relax as much as possible and get into the resting phase. Massaging the sore muscles can also help a great deal. Also, eat foods that fight inflammation and have healing properties. Hot baths can also help you relax mentally, and alleviate the pain and soreness, so don’t hesitate to try a sauna. Massages, on the other hand, can increase the overall blood flow in the region and help speed up the recovery. Apart from this, you can also try cross-training as it can significantly help you relax physical and mental symptoms. Apart from these measures, you should also ensure that the exercises and physical activities are significantly minimized, and immunity building foods should be consumed. Nutrition also has a lot to do with the treatment of overtraining syndrome.

Prevention of Overtraining Syndrome

It’s easy to overestimate your body’s capabilities as we don’t feel the symptoms as long as our body is warm during the work out in most cases. However, the best way to go about with the preventive measures for overtraining is to make sure that you monitor and track your activities as well as training sessions to keep a bird’s eye view on what’s happening. Writing and noting it down can do more good that you think it can. Once you have your records, acting smart and increasing your workout regime gradually is the right approach. It’s difficult to precisely tell the exact measures and the time schedules since it has a broad scope and it’s different for each sportsman or athlete. Some people have more capacity than others. Keeping track of your activities will ensure that you don’t work more than you’re supposed to work each day, even when you feel like you’re perfectly fine and can take, let’s say another hour of rounds. Also keep a keen eye on the symptoms and the warning signs as discussed above, as it will help you understand if you’re at the verge of developing the overtraining syndrome, and help you protect yourself from it promptly. Keep a healthy nutrition regime and rest well on the rest days. Also, avoid monotonous training and keep yourself hydrated. Also stay away from stress and depression as it can have serious physical consequences. If you have a previous injury in the leg, save yourself from heavy training even for the arms, as your body’s entire energy is concentrated on recovering you from the injury of your leg, and overburdening your body with a heavy workout at that point can cause problems.

Overuse Syndrome

What is Overuse Syndrome?

Overuse syndrome is a very common medical condition in the sports injury regime. It is experienced by most people involved in sports that require repetitive and overuse of certain parts of the body. The term overuse syndrome can go synonymously with terms like repetitive strain injury or chronic injury. An easy way to understand this syndrome is to classify injuries in two types. The first one being acute injuries, which takes place suddenly due to an accident or a single, instantaneous trauma or an injury caused due to hitting or a heavy blow. The second type of injury could be an injury which chronically takes place by gradual micro traumas or symptoms building up over a period due to repetitive unnoticeable injuries. In the end, the impact and symptoms combine to develop a serious condition. Overuse syndrome can be considered as the second type of condition that we have just discussed. It can further be classified into different types, such as occupational overuse syndrome (OOS), or sports overuse syndrome. Here, we will specifically talk about the sports-related overuse syndrome.

Sports-related overuse syndromes can occur in a variety of ways, to some different locations and body parts, causing some different conditions, over some different time periods. This is because the overuse syndrome has such a broad scope. It can happen to your muscles, or to your bones, to your tendons, or to the ligaments and other tissues. The injury can cause damage to the blood vessels or put pressure on your nerves, and it can impact certain organs or other bodily structures. There is a variety of conditions, and consequently a variety of different symptoms. However, certain symptoms are characteristic to this condition and may be used to diagnose and identify overuse syndrome. This condition due to its various forms can be mistaken as other conditions, such as overtraining syndrome as previously discussed which has certain, but not all symptoms of this condition. In some cases, it can become an underlying cause of a completely different sport-related injury, such as runner’s knee, ankle strains, shoulder dislocation, Achilles tendinitis, jumper’s knee, wrist fractures, tennis elbow, golfer’s elbow, swimmer’s shoulder, shin splints, and hamstring muscle strains. Although it may sound like a rare condition, overuse syndrome is more common in sports-related people compared to acute injuries and sudden traumas.

These conditions can develop over a long period with mild or very subtle symptoms, which is why it’s normally ignored and left unnoticed. However, these micro symptoms can eventually build up into something more serious and dangerous. Just like the onset of this condition is slow, the offset and recover are also usually slow.

Causes of Overuse Syndrome

The human body is capable of enduring a lot of pressure despite being fragile. We often take it from granting the way it protects us every day from millions of germs trying to attack us. Similarly, we have a natural defense mechanism to endure physical stress. Just like germ attacks strengthen our immunity, physical stress can strengthen our body and physical features. However, when the germs are too much and more than the capacity of our body and immune system, we fell sick despite our defense system. Similarly, when we overuse a certain part of our body despite having a body’s natural endurance, we can get that part damaged. Additionally, if we keep increasing the pressure and stress gradually, the body will slowly get used to it, and eventually, the body becomes stronger than before.

That’s how this whole thing works, and it’s important for us to understand this process to avoid overdoing. So basically the primary cause of overuse syndrome is the overuse and repeated use of a particular muscle, bone or tendon. Our body gets stronger through a process is known as remodeling. This process includes both production and destruction of tissues in our body. Therefore, it needs time to occur. If the tissues are not given enough break time after the destruction of tissues to recover and make new tissues, and if we continue which the exercise at the same time, it will create a condition in which the breakdown or destruction process becomes faster than the healing and generation process. As a result, overuse syndrome is developed.

Risk Factors for Overuse INJURIES

There are some factors involved in the risk of overuse syndrome. These include the errors in the training practices and effectiveness of the exercise, the capacity of an individual and their behavior. Some of the most important risk factors are:

  • lack of strength of the bones, tissues, ligaments, tendons, and muscles
  • deficiency of vitamins, calcium and other minerals
  • wrong practices and training effects
  • repetitive and careless movement of a single area
  • Higher frequency of repetition with shorter intervals.
  • Older age
  • The type of sports
  • Continuing sports after a long break
  • Enthusiastically overworking
  • Pushing for forced performance
  • Working beyond capacity intentionally or unintentionally
  • improper technique
  • lack of flexibility of different areas of the body
  • alignment and balance issues in certain people
  • the unsymmetrical and disproportionate body structure
  • incomplete recovery from the previous injury

Diagnosis of Overuse Syndrome

Pain and swelling are the initial signs that are observed during the primary diagnosis. The overall condition of the injured area is also examined by the doctor carefully. The doctor may also carefully examine by moving the knee joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the Ultrasound will help the doctor to locate and study the internal structures to see any possible damage.

Treatment for Overuse Syndrome

There are some ways in which the underlying overuse syndrome can be treated. However, the treatment option is chosen after the diagnosis depending upon the location, type, condition, severity and several other factors. We have previously discussed in detail about numerous specific overuse injuries resulting from an overuse syndrome. Here are some general ways for going about the treatment of overuse syndrome.

  • drastically reduce or change  the workout, its frequency, and its intensity
  • Practice cross-training to allow the recovery and relaxing time by alternating hard and easier workouts.
  • Improve your technique and remove training errors.
  • Try temperature changes, and heat and cooling treatment
  • do stretching and warming up before sessions and workouts
  • Use ICE as discussed in detail for the specific cases.
  • OTC Drugs, painkillers and anti-inflammatory medications upon need.
  • Physical Therapy
  • Massages
  • Acupuncture technique
  • See a doctor is the conditions persist.

Preventive measures for Overuse Syndrome

Stretching of the muscles is a good way to stop and treat overuse syndrome. However, it’s not recommended in all situations. The stretching can be done by softly allowing the muscles to move and function in the proper way they’re meant to function. The prevention is usually more about common sense and some knowledge, and the patient can understand what is needed to be done with a little knowledge and interaction with the pain. Massage oil can be used for the prevention.

  • Warming up and cooling down
  • Keeping yourself hydrated at all times
  • Avoid overexertion and fatigue
  • Keep electrolytic balance
  • Keep up with vitamins and minerals
  • Take healthy nutrition
  • Ensure proper intervals and rest time

Plantar fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is a medical condition which is very common in people who are involved in sports and athletic activities. Plantar fasciitis is a condition that characterized by pain and inflammation in the fibrous tissue which is also known as plantar fascia. The fibrous tissue is located at the bottom side of your foot, and it helps to connect the heel bone of our feet to our toes. The condition can be in most cases severely painful and inflammatory. The pain caused due to plantar fasciitis can be very troubling, and it can also cause disturbances to our day to day life, resulting in problems with the exercise regime as well as sports training, also making it difficult for you to walk in certain cases. It may be due to inflammation of the muscles, ligaments, tendons, nerves, and tissues. Bearing any weight, even of your own can cause you problems and make the condition even worse. It can be a result of spraining and repetitive injury or trauma. The condition can also cause other characteristic symptoms, such as redness, stiffness, and swelling. The condition can also put pressure on the nerves that are located near the area. People involved in sports are the most vulnerable ones. However, other people may also experience plantar fasciitis.

Severe pain and stabbing pain can be experienced due to excessive and prolonged sitting, or early in the morning. It can also make it difficult to walk and to climb stairs. Usually resting is recommended along with other treatment options. Plantar fasciitis is the largest ligament in our body. It can be caused due to another underlying health condition in certain cases. The condition can also be mistaken with quite a similar condition called Baxter’s neuritis, which is due to nerve entrapment in the heel. If the condition remains persistent for more than a year, then it transforms into a more severe and chronic condition known as plantar fasciosis.

Causes for Plantar Fasciitis

There are some different causes of plantar fasciitis. The most important and common causes are indicated below:

  • Too much tension and stress on the bowstring
  • Tearing of the fascia
  • Overuse injuries
  • Repetitive trauma
  • Microtrauma
  • Irritation and inflammation
  • Sudden jerking and a heavy blow
  • Thin soled shoes or worn-out shoes
  • Tightened Achilles tendons
  • Being flat-footed
  • Wrong walking and running positions and angles

Risk factors for Plantar Fasciitis

There are several risk factors involved with plantar fasciitis. Some of the most important ones are:

  • Age. Plantar fasciitis is most common between the ages of 40 and 60.
  • Wrong shoes: wearing the wrong sized shoes, too flat or high heels
  • Types of sports: certain sports poses a greater risk of plantar fasciitis.
  • Type of exercise: Certain exercises may cause too much pressure and stress on the heel area. Such as dancing, running, jumping, soccer and other similar sports.
  • Foot types: Certain people have a flat-foot type, which increases the risk of getting plantar fasciitis problem. An arch is usually a good thing.
  • Being overweight can also increase the risk of plantar fasciitis in most people as it increases the pressure and weight put on the heel.
  • Standing for prolonged hours can significantly increase the risk of inflammation in the heels and cause a condition like plantar fasciitis.

Treatment for Plantar Fasciitis

Some different treatments can be administered to alleviate the symptoms and treat the condition of plantar fasciitis. The most effective ways to treat the condition includes.

Resting

Resting is the single most effective treatment for plantar fasciitis as it can allow your heel the time to recover from the underlying cause. Make sure that you rest your feet as much as possible, as a wrong pressure and movement can reverse the healing and make the condition worse. You should completely avoid walking around and bearing any weights for a while. Furthermore, icing can help alleviate the symptoms of pain and swelling, while speeding up the healing process at the same time. Plantar fasciitis is a common orthopedic condition of inflammation of feet, and the doctor may administer some different treatment options available for it.

Steroid injectables 

The doctor may administer steroid drugs if the pain is not getting suppressed from the painkillers OTCs and NSAIDs. The substance is directly injected into the inflamed plantar fascia. This can effectively reduce the pain on a temporary basis for a month. Besides being a temporary solution, the treatment also has some different side effects.

Physical therapy

You may need physical therapy in case if the treatment with medicines, ice, and rest is not showing significant results. Your physical therapist will administer some designated treatment exercises. He will also guide you with the strengthening and stretching exercises of Achilles tendon, muscles of the lower leg and plantar fascia. He may also practice ultrasonography, contrast baths and massages to ensure better results.

Shock-wave therapy

As a name suggests, the therapy is administered to shock the plantar fascia area with the shock sound waves. It is done for simulation and enhancement of blood flow and circulation in the inflamed area. The waves can also reduce the pain as the nerves get stunned due to the shock caused by these waves. This literally “shocks” your plantar fascia with sound waves. It stimulates blood flow in the foot and helps the tissue heal. It also stuns your nerves to stop the pain.

Tenex procedure

It’s an operative procedure which involves cutting through a small area of skin. It’s a short procedure and only takes minutes to complete. The ultrasound technique is used through the cut area to remove the inflamed tissues. Upon successful completion of this treatment, the patient can get back to normal activities in a couple of weeks.

Icing

Icing can help alleviate the symptoms of pain and swelling while speeding up the healing process at the same time.

Anti-inflammatory foods and drugs

Also, eat foods that fight inflammation and have healing properties. Turmeric, also known as curcumin is also a magic ingredient which has amazing healing properties. Apart from that, you can use anti-inflammatory drugs which can alleviate the symptoms.

Devices

Certain aids and devices can be used for the treatment of plantar fasciitis when the conventional treatments are not giving any significant results. In the case of plantar fasciitis, devices like night splints, braces, crutches, and special footwear may be used.

Soft tissue Injuries

What is a Soft Tissue Injury?

We all are to experience injuries at some point in life. People who are involved in sports have a greater risk of getting several injuries during their career. While most injuries aren’t serious and easily treatable, certain injuries can cause serious and permanent damage. Depending on how delicate the injured area, muscles and tissues are, the lighter blow can have a greater impact. Sometimes little things that we hardly notice may end up developing a greater health condition. Soft tissues can be defined as the tissues that usually serve the purpose of the surrounding, supporting and connecting other tissues, organs, bones and structures inside our body. This group of soft tissues may include the nerves, tendons, muscles, fascia, and tendons. There may be other structures included in this group as well, such as blood vessels, fibrous tissues, synovial membranes and the fats. Wearing and tearing of soft tissues can be relatively easier and may cause severe problems. Sports injuries can easily cause damage to these soft tissues. Although some people may not consider it a remarkable problem, in most cases the OTC drugs and painkillers may not be sufficient to treat this problem.

Causes of Soft Tissue Injury?

A blow, hard hit or trauma to the tendons, ligaments, and muscles can cause soft tissue injuries. The condition is characterized by pain, swelling, and other similar symptoms. Soft tissue injuries can result from some different causes, including anything that can potentially damage the tendons, ligaments, muscles and other structures. It usually results in pain and can be accompanied by some different symptoms. Some of the most common causes of soft tissue injuries in the field of sports could be:

  • Falling
  • Bruising
  • Heavy blow
  • Bursitis
  • Twisting of muscles
  • Sudden trauma
  • Tendonitis
  • Sprains
  • Strains
  • Contusions
  • Bruises (contusions)
  • Stress injuries
  • Leg displacement or foot displacement while running.
  • Wrong posture and legs movement
  • Sudden jerking
  • Heavy hit

Signs and Symptoms of Soft Tissue Injury

Soft tissue injuries can cause acute symptoms. Pain is the most important symptom of Soft tissue injuries which can be aggravated by the movement. The pain can either be chronic or develop gradually over a long term, or it can be due to a sudden injury or blow in most cases. Difficulty or complete loss of movement ability is also experienced by the people suffering from Soft tissue injuries. Occasionally the patient may also experience swelling, redness, and warming of the injured area. The symptoms you should generally look for are the following:

  • Feeling pain and stiffness
  • Increased pain occurring due to movement or compression
  • Difficulty or inability of moving in certain cases
  • Sharp and intense pain in the start
  • Gradual dulling of the pain
  • Increased Pain due to mobility
  • Bruising and rashes
  • Sharp and stinging pain during exercising
  • Tenderness
  • Discomfort
  • Redness
  • Weakness
  • Instability
  • The inability of function due to severe tearing

The degrees of soft tissue injuries

There are different grades for soft tissue injuries such as strains and sprains, similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three grades are:

Degree 1

This is characterized by less than moderate pain, while the patient retains the ability to feel and move the injured area.

Degree 2

This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.

Degree 3

This is characterized by severe pain, while the patient loses the ability to feel and move the injured area.

Treatment for Soft Tissue Injuries

There are several ways to treat the Soft Tissue Injuries. The treatment may vary depending on the severity of the injury and the type of the underlying cause of Soft Tissue Injuries.

Graston Technique

Graston technique breaks up the jam and adhesions which enhances the circulation and blood flow to the inflamed and injured plantar fascia. It involves special instruments that are used for a high-pressure therapy. It is used for the treatment of some other injuries, such as lumbar strain, carpal tunnel, and Achilles tendon apart from Plantar Fasciitis. It can improve the range of movement and reduce the symptoms.

Pain reduction

Severe pain is associated with soft tissues injuries in most cases. To reduce the symptoms and alleviate the pain, various approaches can be taken, such as over the counter drugs, painkillers, anti-inflammatory medicines, and other natural substances. The doctor may also use mechanical treatment options such as TENS machine for alleviating the pain.

Full Range Movement

Soft tissue injury treatment involves the recovery of the full range movement of the injured area. This is usually done by the administration of a complete physical therapy treatment plan. It includes a range of different exercises depending on the type of injury and the area that is damaged.

Proprioceptive Retraining

In cases of soft tissue injuries, the pathway of nerves can also get damaged which can result in severe pain. This can inhibit a person’s ability to move the injured area voluntarily. This condition is referred to as proprioception. Some different exercises may be practiced to recover this problem.

Heat or Ice

Heating the injured area can significantly reduce the symptoms of pain and improve the range of movement. It also enhances the blood flow and circulation in the injured area. Similarly, icing the injured area can alleviate swelling, inflammation, and pain. It should be administered repetitively for a few days to see results.

Following these treatments, a person should keep up with the rest and R.I.C.E protocol for the treatment of soft tissue injuries. Resting will ensure that the condition does not get worse and further injuries are prevented. Similarly, depending on the location of the injury, a person can use bandages and elastic bands under the supervision of an expert.

Active Release Techniques

Active Release Technique (ART) is a useful technique that can be implemented in case of overused muscles resulting in soft tissue injuries. It is beneficial both for the treatment of chronic as well as acute conditions. It can be used in case of muscle tearing, hypoxia condition, and other acute damages. An expert examines the condition with his hands and uses manual tension to stretch and lengthen the muscle. The specialist works when the muscles of the injured location are active.

Trigger Point Dry Needling

Dry needling technique is also useful in case of soft tissue injuries. It uses a sterile and ultra-sharp dry needle to alleviate the pain in the inflamed area. The technique is completely different from the conventional acupuncture. It utilizes the trigger points that are bands of muscles which are stimulated. As a result, pain and tension are reduced, and the circulation of the blood is increased in these areas. Acupuncture and massages can also be useful in alleviating the symptoms and reaching similar results.

Training Correction

Most of the soft tissue injuries are associated with wrong and improper training habits and practices. Your treatment plan should also include a proper corrective action plan regarding training. You may want to reduce or eliminate certain specific things that you do during your sports period. Your physical therapist can guide you by witnessing your practices to differentiate good practices from bad practices.

Medication

Some drugs can be effective in reducing the symptoms and alleviating the pain that is caused by it. You can use anti-inflammatory drugs, corticosteroid injectables, and cortisone injections. In mild cases, you should completely avoid heavy medication and stick to the usual over the counter medicines.

Soft Tissue Injuries are usually treated by non-surgical procedures unless the injury is extremely severe. Nonetheless, the treatment method depends on the severity, degree and the type of injury.

Preventive Measures for Soft Tissue Injury

There are some precautionary measures that you can take to prevent soft tissue injuries. Stretching of the muscles is a good way to stop and treat soft tissue injuries. However, it’s not recommended in all situations. In repeated injuries, the stretching can be done by softly allowing the muscles to move and function in the proper way they’re meant to function. That should be achieved through physical therapy. The prevention is usually more about common sense and some knowledge, and the patient can understand what is needed to be done with a little knowledge and interaction with the pain.

  • Warming up and cooling down
  • Wearing proper sports gears
  • Properly using the equipment
  • Taking rests and breaks frequently
  • Gradually increasing the intensity of the workout
  • Strengthening muscles and making them more flexible
  • Communicate with your body and understand what it’s telling you
  • Keeping yourself hydrated at all times
  • Avoid overexertion and fatigue
  • Keep electrolytic balance
  • Keep up with vitamins and minerals
  • Take healthy nutrition
  • Ensure proper intervals and rest time

Dehydration

What is Dehydration?

Dehydration is a common medical condition that occurs in people associated with sports and athletics. It is a condition that is characterized by excessive loss of water content and the fluids from the body due to perspiration, heatstroke and other similar reasons. The condition may sound a mild one. However, in certain cases, it can be severe and extremely dangerous. Sometimes this condition can cause life-threatening symptoms, and it must be addressed on urgent bases. 70 percent of our body consists of water content. Similarly, each cell of our body also has a lot of water content. Dehydration can even remove water from our cells, causing them to dry out and die. It can also raise our body temperature to strike and shooting degrees which can be extremely dangerous. People involved in outdoor sports are at great risk of dehydration. During rigorous activities, our body burns a lot of energy, due to which excess heat is produced. As a result, perspiration works as a natural function of our body to remove the heat content along with the water and cool down our body. Too much perspiration can deprive us of the water content of our body, and that is what happens during the sports activities. Athletes and sportsmen can easily forget to keep up with their fluids intake, and they may need urgent medical attention. However, if action is taken promptly, it’s easy to alleviate the impact of dehydration by quickly increasing the fluid intake to cover the loss.

Symptoms of Dehydration

The most important symptom of dehydration in sports people can be thirst and vertigo. However, in some cases, the patient may not feel thirsty due to the thoughtful attention towards the play. The symptoms can be sudden and urgent action is required. The most common symptoms that are experienced by sports people and athletes during dehydration are:

  • drying of the mouth
  • Increased Thirst
  • No thirst
  • Lethargy and exhaustion
  • Feeling dizzy
  • darker urination
  • feeling headaches
  • reduced or no sweating
  • The sinking of the eyes
  • dry skin and shriveled skin
  • Hypotension
  • Faster heart rate
  • Feeling feverish
  • Increased body temperature without fever
  • Hallucination
  • Loss of consciousness

Causes of Dehydration

There are many different causes of dehydration, such as:

  • Diarrhea
  • Sweating
  • Vomiting
  • Diabetes
  • Frequent urination
  • Burns

Anything that causes the water to leave our body in excess quantities can cause dehydration. All these causes aren’t related to sports directly. However, they can be indirectly related. Nonetheless, the most relevant cause of dehydration in sports people is sweating and forgetting to drink enough water. Sometimes certain areas may not have access to drinking water such as in case of adventure sports, which is another reason for not drinking water leading to dehydration.

Risk factors for Dehydration

Several factors may increase the risk of dehydration in sports people, such as:

  • Higher altitudes.
  • endurance sports like marathons
  • chronic illnesses 
  • Adrenal gland disorders.
  • Age: more common in older people
  • kidney disease
  • cystic fibrosis
  • Diabetes
  • alcoholism

Complications of Dehydration

Dehydration can lead to certain complications resulting in secondary conditions, such as:

  • It may result in seizures due to electrolyte imbalance
  • Reduced volume of blood
  • It can cause kidney related issues
  • heat stroke

Diagnosis of Dehydration

The primary diagnosis includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The doctor may also carefully examine the medical history of the patient. A rational assessment and examination are also performed to see the characteristic symptoms. The mental examination aims to look for symptoms such as:

  • Confusion
  • Disorientation
  • Irritability
  • Physical Symptoms which are expected to be found include:
  • Increased Heartbeat
  • Hypotension
  • Reduced sweating
  • Reduced elasticity of the skin.

Once these tests are done, and the doubt is established, the doctor may test for dehydration. In most cases, the dehydration can be quickly recovered by giving fluids. Therefore, these tests may not be required. Nonetheless, the diagnostic tests for dehydration may include:

Blood tests

Several indicators are observed in the blood sample of the patient, such as electrolytic imbalance and the function of the kidney.

Urine Test

A urine test can tell if a person is suffering from dehydration.

Treatment of Dehydration

The single most important and effective treatment of dehydration is recovering the lost fluids and water content. Along with this purpose in mind, electrolyte recovery should also be kept as primary importance, since an electrolyte imbalance can result in serious consequences. The treatment for dehydration varies greatly with several factors, such as age, the reason and cause behind dehydration, the severity, and the type. However, those cases are not relevant to sports-related dehydration. For people involved in sports, the best way to recover from dehydration is cool water. Athletes should also always keep electrolytic drinks along with them all the time. Perspiration and sweating can also take away certain salts from our body that works as electrolytes. That’s why this approach remains to be very useful. Nonetheless, this isn’t a condition which can be taken lightly. The patient should at once be sent for emergency treatment. As small as it may sound, dehydration is a problem which is also capable of taking lives. In severe and urgent cases, the fluids and electrolytes are directly administered intravenously in the vein for quicker response.

Nosebleed

  

Nosebleeds are one of the most commonly occurring medical condition when it comes to sports and athletics. This can be a result of an injury in most cases. However, there can be other causes depending on the person who may vary from patient to patient. A sudden and acute injury or trauma, such as a heavy blow or a fracture of the nose can cause nose bleeding. Other minor injuries can also result in a nosebleed without much of an effort.

Symptoms of Nosebleed

Blood loss is the primary and characteristic symptoms of nosebleeds. Apart from that, the patient may or may not experience pain depending on the part injured and the severity of the condition. Sometimes it could be due to a heat stroke, a heat build-up or something similar. Blood can be lost from either of the nostrils, or it can also occur from both of them at the same time. Usually, the color of the blood is bright, indicating oxygenated blood. However, it is also likely to lose darker blood from the nose. The blood can run down and out from the nostrils, or it can go into the throat from the respiratory passage. Blood in the throat can also cause nausea and even vomiting to most people due to repulsive taste.

Causes of Nosebleed

Most of us have experienced or witnessed a nosebleed at some point in our life. Common sense correctly tells us that nosebleeds related to sports injuries would primarily be due to trauma, a high impact hit, a heavy blow, a fracture or any form of injury that may cause a rupture of the vessels carrying the blood or bleeding due to some other reason. These are the most common causes of bleeding from the nose in the sports niche. Certain health conditions can also cause bleeding from the nose. However, it’s less likely for the people involved in sports. These health conditions may include infection, fever, problems with heights, side effects of medication, sinusitis, cold, and diabetes.

Treatment for Nosebleed

Nosebleed in most cases is not a very serious or life-threatening condition unless the trauma has caused damage to the brain as well. The treatment is relatively simpler compared to other conditions. The type of treatment administered greatly depends on the diagnosis and the underlying cause of the nose bleeding. Therefore, in severe cases, a diagnosis becomes very important, and the patient should rush to the hospital or seek medical assistance at once. After the diagnosis, the doctor will assign to you an easy to follow the treatment plan that you can practice at home. The very first response should be immediate first-aid care to alleviate the symptoms and stopping the bleeding at once. All the athletes and sports people must be well versed in the first-aid responses of various kinds. In case of a bleeding nose, you need to prevent the blood from running down the throat and also to cause the bleeding to stop. To achieve this, you should sit down while pinching your nose right below the end of the bone. At the same time, you should lean to the front to prevent the blood from entering your throat. Keep your nose pinched for a while. Check every five minutes if the bleeding is stopped. However, continue at least until four checks in severe cases even if the bleeding has stopped. You should also avoid being hard on your nose and don’t breathe or blow from your nose out of discomfort. Also, avoid moving your head and try your best to rest for a while. In severe cases, such as a fracture, you must go to the doctor and get the treatment. There are also some different factors and things that you should take care of to properly stop the bleeding from the nose. Some of these steps include:

  • Pinch tightly with your forefinger and the thumb, not too tightly to hurt the injured area.
  • Make sure that you don’t lean back as an attempt to stop bleeding and keeping the blood in.
  • You can also use a nasal gel or antiseptic inside your nose to prevent infection.
  • Get enough rest afterward
  • While most people try to do that out of confusion, it’s common sense to understand that it won’t happen. You can’t stop the flowing blood by leaning back, and it will enter your throat, and you will end up puking which can put further pressure on the injured nose.

Preventive measures for Nosebleeds

You don’t have to have a nosebleed to start thinking about preventing it from happening the next time. As an athlete or a sportsman, you should always be aware of this possible danger that you can face at any point in your game or career. Here are some of the effective preventive measures you can keep in mind to avoid yourself from getting a nosebleed

  • Extreme weight lifting or similar exertions can burst your thinner blood vessels resulting in a nosebleed
  • Avoid picking and irritating your nose
  • Avoid nose blowing
  • After the injury, avoid unnecessary drugs like aspirin for a few days
  • Use an antiseptic gel
  • Always act according to your doctor’s advice
  • Practice preventive measures during your training

Achilles tendon injury

What Is an Achilles tendon Injury?

An Achilles tendon injury is a common medical condition experienced by many people involved in sports and athletics. However, people who aren’t involved in sports can also suffer from Achilles tendon injury. Achilles tendon is the largest tendon in the entire human body. It starts from the heel and extends towards the calf area. If you touch the back of your ankle, you will be able to feel it as a flexible extension of tendons stretching from the top of your heel. Injury of this tendon is quite normal, and the condition can be mild or severe. Usually, the common symptoms are a pain, burning a stiffness in the leg with the limitation of mobility. The tearing can be partial or complete.

Causes

Some different things can cause Achilles tendon injury. Some of the most common causes associated with Achilles tendon injury  are:

  • Pivoting
  • Speeding up and slowing down at once
  • Dancing
  • Baseball
  • Basketball
  • Tennis
  • Soccer
  • Athletics and gymnastics
  • Running
  • Football
  • Softball
  • Volleyball

The most common situation that leads to this problem is when you lift your foot before you start running. Depending on how fast you want to run, this lift can put serious pressure on the Achilles tendon which can result in an injury and trauma ranging from mild to moderate and severe in certain cases. This situation is most commonly seen during the sprinting as the runner starts the run. Risk factor associated with Achilles tendon injury is age, which puts the people over the age of 30 years under high risk of Achilles tendon injury. Also, males are more prone to getting Achilles tendon injury compared to females. Other causes and risk factors associated with Achilles tendon injury include:

  • Having flat feet which causes the stretching of tendons as the arch of the foot touches the ground while taking the steps. The condition is also known as fallen arches.
  • Side effects of certain medication and antibiotics can cause Achilles tendon injury in some people and greatly increase the risk.
  • Wearing high heels is physiologically very unhealthy and puts the ladies at high risk of developing Achilles tendon injury or a related condition.
  • Tightness in the muscles of the legs as well as the tendons due to certain reasons. Tearing can occur if these muscles and tendons are too tight.

Symptoms

There are some different symptoms that people with Achilles tendon injury may experience through the span of the injury. However, it greatly varies from patient to patient and the condition and severity of each case. In less severe cases the patient may experience a sudden discomfort in the ankle and heel area during a walk or run. In most cases, ACL cases include a sudden pain emerging from the ankle along with the loss of control over the proximal muscles. In severe cases, the movement of the foot is severely limited, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling. Other symptoms associated with the condition may include

  • A quick and intense pain behind the ankle after receiving a tight stretch.
  • Muscles are clenching or cramping in the calf area in certain cases.
  • Tenderness in the area of the injury
  • A tugging feeling or sensation of loss of strength in the foot.
  • Inability to continue kicking, jumping or sprinting.
  • Snapping and popping sound
  • Inability to move normally without limping.
  • Continual, severe discomfort in the lower leg area.

Symptoms are usually made worse when a person with an Achilles tendon injury attempts to move their knee and the ankle joint when traveling upstairs, or attempting to run, jump, or kick.

Secondary symptoms of an Achilles tendon injury wound include tightness, soreness, and stiffness after long periods of not moving, including when waking up after a long sleep.

Achilles tendon injury‘s chief symptom is a pain at the back of the foot above the heel. However, there are several other symptoms associated with the condition. These include:

  • pain that seems to come on suddenly
  • increasing pain when you lift your foot
  • pain when stretching your foot joint
  • Muscle spasms at your calf.
  • tenderness to the touch at the back of your ankle
  • swelling or bruising

You may feel this pain when running or walking.

The pain associated with hip flexor strain is quite specific. You may notice:

  • Pulling sensation in the back of the ankle
  • Muscle spasms
  • Weakness
  • Tenderness upon touching the area
  • Swelling or inflammation
  • A limp while walking
  • A visible muscle deformity, in cases of severe tears 

Diagnosis

The diagnosis is initialized by the doctor in which primary parameters are observed at first. This includes the patient’s medical history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain, tenderness and other symptoms. In the lying position or knelt position, the doctor may squeeze the calf muscle to see if the tendon is still connected or if it is torn.

The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. If the Achilles tendon is damaged, the movement of the foot and calf become difficult and painful for the patient.

Once the initial examination is performed, and the doubts are reduced, the doctor may follow up with diagnostic procedures. The techniques used in this case are radiographic investigations, ultrasonography and if necessary, the doctor may also use MRI scans to find out the exact location of the damage.

From acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine position, and the movement and flexion of the leg are examined.

Treatment

Mild condition and in some cases moderate injuries can also heal naturally after rest and proper care. In severe cases, more attention is needed. Nonetheless, in either scenario, it’s important to take certain measures to ensure a speedy recovery and healing of the patient from Achilles tendon injury. The treatment can be administered in different ways. Here is the most effective approach for the treatment of this problem.

  • Cut down on physical activities as much as possible
  • Maintain a regular stretching habit to lengthen your calf muscles under expert supervision.
  • Avoid sports or change the sports which don’t involve the injured area.
  • Use ice on a regular basis for up to a week.
  • Always keep your foot elevated when sitting or lying
  • Use aids, such as crutches and braces.
  • Use footwear accessories and proper shoes
  • Keep up with a proper physical therapy
  • To alleviate pain, use over the counter drugs and anti-inflammatory medicines.
  • Wear shoes with a heel or use an addon insole.

Apart from these approaches, there are other treatment options available. Some state or the art and advanced treatment options are platelet-rich plasma technique, steroid injections, and ART.

If the non-surgical treatments are not working out for you, you may require surgery. Surgery is a better option than leaving the problem unattended. If the problem is ignored, it can cause a rupture which worsens the symptoms. A surgical procedure is required and administered in which the injured area is exposed by opening the skin, and the torn tendons can then be put into place by the physical administration of suturing and sewing. For the surgery of Achilles tendon injury, you may undergo an open repair surgery. It involves an incision in the heel bone and sewing the torn or ruptured tendon back on its place. Otherwise, you may undergo another method that involves the use of needles for putting the ruptured tendons in the right place. It can also prevent the reversing of the condition which is more common in non-surgical options. The healing process is accelerated with the help of the surgical procedure, and people who require to get back on their feet sooner can do so. Since surgical procedures are more invasive, there are risk factors that are associated with surgical procedures, such as a chance of getting an infection, bleeding, damaging the nerves accidentally during the surgery, clotting of the blood, anesthesia, scarring, and breakdown of the skin. Another unfavorable reason is the high cost associated with the surgery. Enthusiastic and competitive sports people and athletes sometimes go through surgical processes to heal and regain their abilities. In certain cases, delayed diagnosis can turn the Achilles Tendon Injuries into a more severe condition, in case of which surgery may be required on an emergency basis to treat the patient.

Here is a quick to-do list for the treatment:

  • Resting as much as possible
  • Icing the painting area
  • Using compression bandages
  • Anti-inflammatory medication
  • Exercising, stretching, friendly workouts
  • Gradually start physical activities, don’t rush.
  • Wearing and using a heel lift.
  • Use special shoes or accessories to aid the injured ankle
  • Keep up with physical therapies and stretching
  • Exercise regularly but only the right ones
  • Surgery as a last resort, if no results and symptoms persist after the treatment.

Preventive Measures for Achilles tendon Injury?

Even though Achilles tendon injury is mostly due to accidental causes, you can certainly prevent the condition because it’s mostly due to the patient’s ignorance and mistakes. Here are some of the most effective things you can do to protect yourself from Achilles tendon injury:

  • Be careful at the start of your sprinting
  • Don’t push up on your toes with too much pressure
  • Avoid uphill running
  • Learn proper preventive measures in the training
  • Reduce training errors with practice
  • Wear the right kind of shoes with the right size
  • Don’t overdo your workout and avoid getting the overuse syndrome.

Recovery from Achilles tendon injury

In most cases, a rehab therapy results in complete recovery from Achilles tendon injury. Physical therapies along with the RICE treatment can effectively treat the condition and get the patient back on the ground. However, there is a chance of healing process getting reversed if proper measures are not taken and if healing has not completed. Therefore, it’s essential to let your injured muscles recover completely by following the protocol provided by the doctor to eliminate the chances of getting repetitive injuries, chronic conditions, and permanent damage. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area, the type of causes of the Achilles tendon injury and other factors. For your part in effective recovery, you should avoid the normal routine activities according to your doctor’s advice. Depending on the severity, the Achilles tendon injury can take from a few weeks to a couple of months of time to recover. Achilles tendon injury are painful. Therefore, usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time.  A regular visit to the doctor will ensure that it’s time to go ahead. Here are some other indications for a patient who has recovered from an Achilles tendon injury condition:

  • Ability to move the leg and foot easily and freely similar to the other healthy foot
  • No pain in walking, running, jumping or jogging
  • Regaining the lost strength and overcoming the weakness caused by the injury

Turf Toe

What is a Turf toe?

As the name suggests, a Turf toe is a condition that usually occurs in people involved in certain types of sports that makes use of the feet extensively. The condition is characterized by inflammation and pain in the muscles and tendons related to the area that serve connective purposes, specifically for the big toe. Usually, it’s a minor condition, but it may be very painful at times. It can be a result of overexertion and hyperextension of the big toe. In certain cases, it can result in partial or complete tearing of the ligaments that are associated with the area and which are responsible for the connection of basal and metatarsal phalanx, while in other cases it can be a sprain in these ligaments. People involved in certain sports are more at risk of developing such a condition of a Turf toe, such as wrestlers, dancers, and gymnasts. Footballers and soccer players are also at high risk, as the condition can develop as a result of the big toe being pushed suddenly or repetitively. The condition can develop acutely due to a sudden trauma, or in a continuous manner due to repetitive microtraumas.

Causes of Turf Toe

The condition of a Turf toe is due to the straining of the ligament that connects the two bones in the two and remains responsible for the movement of that down in an up and down motion. These bones are located in behind the toenail and help in providing the leverage during the movement such as running or walking. They also work as the shock absorbents and absorbs the shock on the feet caused by our weight. While we take steps during the walk or while we run, the pressure is transferred from our heel to our toes as we pull our foot up. If the pressure is more or if the angle becomes shorter due to overstretching or an accidental fall, the ligaments there can be severely stretched and pulled. This can result in a sprain, wearing or tearing of these ligaments as the toe is bent beyond its permissible limits. 

The most common cause of a Turf toe injury is the turning and the twisting of the toe joint due to displacement. As a result, the toe is pushed out of its normal and natural position, and it can cause muscular and tendon damage. Such unexpected movements are very common in sports that involve a lot of running and the use of legs. These tearing of the muscles can be very painful at times and could be accompanied with other symptoms such as bruising discoloration and the swelling of the area. Although it’s mostly the tendons, ligaments, and muscles that are damaged or injured due to a Turf toe injury, it can also damage other structures, such as the blood vessels and cartilages. There are several risk factors involved, such as the types of sports, etc. however, it can occur in people of all ages.

Some of the other most common causes for a Turf toe injury include:

  • Walking on uneven or hard surfaces
  • Wearing the wrong sized or kind of shoes
  • Rigorous sports activities and feet movements
  • Twisting of feet and toe muscles
  • Stretching of the toe
  • Bending of the toe beyond the normal limits
  • Turning suddenly during a play
  • Worn out shoes that don’t provide adequate support
  • A sudden strain due to kicking
  • Running and stopping suddenly
  • Continuing sports after mild strains and pain.
  • Wrong diagnosis of a previously occurring pain.
  • Repeated minor injuries
  • Overuse syndrome
  • Microtraumas

The onset of a Turf toe injury is usually an acute one, meaning that it is normally caused due to a sudden injury caused during the sports activities. It’s more commonly experienced in players who are involved in sports on artificial and hard surfaces compared to the ground and grace. However, people on the soil and ground can also experience the same condition.

Symptoms of Turf Toe

A-Turf toe injury can result in some different symptoms, and it may vary from person to person depending on the severity of the condition and the type and location of the injury. However, the most common symptoms that indicate that the patient has a Turf toe injury are the following:

  • Bruising on the skin
  • Discoloration of the injured area
  • Tenderness of the injured area
  • inability to walk
  • Mild to severe pain due to muscular damage
  • inability to move the toe joint
  • limitation of mobility
  • swelling on foot or around the toe
  • the stiffness of the injured area
  • Quick and intense pain in the toe joint after receiving a tight stretch.
  • Muscles clenching or cramping
  • A tugging feeling or sensation of loss of strength in the foot.
  • Inability to continue kicking, jumping or sprinting.
  • Snapping and popping sound
  • Inability to move normally without limping.
  • Continual, severe discomfort in the foot

However, since toe is prone to some different sports-related injuries, it is easy for a person to mistake it with some other underlying condition which can cause a lot of trouble in the future for the patient. Therefore, it is strongly recommended that once such symptoms start to show up after an injury, the patients should reach out to their doctors as soon as possible for the examination of the condition.

Diagnosis for a Turf Toe

The diagnosis of a turf toe will start when the doctor inquires to the patient about their condition, the symptoms, their professional and personal activities, the type of footwear that they use, the type of their participation in the sports they’re involved in and their history.  The diagnosis further includes a physical examination in which the patient is checked for any apparent symptoms of pain and swelling. The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. The doctor may also carefully examine by moving the toe joint in different positions to see if the movement is limited and painful. Numbness is also considered to be an indication. After a physical examination, the doctor may need to carry out a diagnostic test if the doubt persists. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. X-ray test will be able to analyze the bone condition, while the CT scan will help the doctor to locate and study the internal structures to see any possible damage. In certain cases, the diagnostic test may also make use of electromyogram for the determination of possible condition.

By acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely and the severity of it. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine position, and the movement and flexion of the hip and legs are examined. The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain and tenderness.

Treatment for a Turf Toe Condition

Mild conditions of a Turf Toe injury can be treated with proper rest. To speed up the healing and recovery process, further actions can be taken. For this purpose, some different treatments can be administered to alleviate the symptoms and treat the condition of a toe turf injury. The treatment of the injury depends on the grade of the severity, and the approach may vary for grade 1, grade 2 and grade 3 injuries. Here is a complete description of various treatment options used for Toe Turf injuries in order of the severity of the condition.

  • Apply the complete P.R.I.C.E protocol on a regular basis.
  • Use OTCs and NSAIDs to alleviate the symptoms
  • Take proper measure for protecting the toe from further damage
  • Use turf toe plate and Morton’s extension
  • Limit or completely inhibit mobilization.
  • Practices exercises for increasing range of movement
  • Do not underestimate grade 1 injuries, as they can gradually worsen
  • Take rest as much as possible
  • Incorporate anti-inflammatory foods in your diet
  • Use ice on the proximal area of injury
  • Quit sports for a while
  • Change footwear or use add-ons to adjust
  • Practice progression exercises
  • Use crutches, cane or other aids
  • Keep up with your Physical therapy

Special shoes

The shoes that we wear has a lot to do which our feet health. Although wearing the right type of shoe with a complementing sole can reduce the chances of getting a toe turf injury, you can make use of special shoes in case if you already have it. Special medicated shoes can ensure that no further damage is done in the case of a toe turf injury and it also ensures a quicker recovery. Also, avoid walking on the hard surfaces. If you can’t, your medical shoes will help you reduce the pressure on the sensitive and injured toe if you walk on hard surfaces. These shoes are specially designed to take care of the problem of a toe turf injury. There can be an internal padding and special design to wrap around your injured feel and the shape of your feet. Apart from that you can also use similar accessories and add them to your shoes.

Dedicated shoes are specially designed to take care of this problem. They are soft from the inside because of cushioning and wraps around the shape of your foot properly. You can also use the inner cushion or cups for your shoes that come as an accessory.

Preventive measures for a Toe Turf

There are some precautionary measures that you can take to prevent a turf toe injury. The prevention is usually more about common sense and some knowledge, and the patient can understand what is needed to be done with a little knowledge and interaction with the pain. Several preventive measures should be understood and exercised in the fields. The best way to go about it is to practice them during the training until they become your reflexes. The prevention measures can be classified as primary and secondary preventions, and both of them are very important. The risk factors associated with a turf toe injury should also be addressed and taken care of, including the patient’s history of a turf toe injury, the strength of the muscles and the previous injuries. The patients who have experienced previous injuries are two times more susceptible to experience it again upon a heavy blow. Apart from these things, here are the most effective measures you can take to reduce your chances of a turf toe injury:

  • Wearing proper sized and shaped shoes
  • Avoiding worn out shoes
  • Wearing proper sports gears
  • Properly using the equipment
  • Taking rests and breaks frequently
  • Avoid too much repetitive stretching
  • Strengthening muscles and making them more flexible
  • Communicate with your body and understand what it’s telling you
  • Keeping yourself hydrated at all times
  • Avoid overexertion and fatigue
  • Keep electrolytic balance
  • Keep up with vitamins and minerals
  • Take healthy nutrition
  • Ensure proper intervals and rest time
  • Completing the rehabilitation therapy for any previous turf toe injury
  • Practice strengthening exercises
  • Taping and using a bandage to wrap toe but not too tightly
  • Avoid further damage by braces and right shoes.
  • Stretching and warm up
  • Careful on the uneven and hard surfaces
  • Don’t do overexertion and stop when your body tells you to stop.
  • Say no to high heels

Recovery for turf toe

A turf toe injury is prone to get reversed in the absence of proper care, and recurring injuries can also take place. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area and other factors. Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. For effective recovery, you should get back to the normal routine activities slowly and gradually according to your doctor’s advice. Once you start using your muscles and bones again, it will complement the complete healing of the injured parts. If the patient were healthy before the injury, the recovery would usually be faster. However, due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the injury can take from 3 weeks to a few months of time to recover.

Tommy John Surgery (UCL Injury)

What is Tommy John surgery?

Tommy John surgery is a relatively new type of surgery that is becoming more and more common for the treatment of sports injuries specifically for UCL injuries. The treatment surgery is named after Tommy John, who was a population baseball player from the Major League since he was the first one to go through this treatment. The surgery is specifically done for the treatment of Ulnar Collateral Ligament injuries usually caused in sports people and athletes. The injury is specific to the elbow area. People who are involved in sports and athletics which makes excessive use of the arm and elbow are more at risk of developing this problem. Ulnar Collateral Ligament is a type of ligament that is found in the inner region of the elbow. The function of this ligament is to ensure that the elbow joint remains stable. If the ligament gets damaged, dislocation of the elbow can take place. It is also important for its connective purposes, as it’s a connective ligament that joins the long bone of the upper arm with the elbow, known as humerus bone with the bones in the forearm, known as the ulna.

The injuries in the Ulnar collateral ligament (UCL) takes place due to chronic micro-traumas in most cases. Repetitive overuse of the elbow and putting stress and pressure on the elbow joint repetitively can cause damage to the internal ligament of the elbow. It’s usually a result of overhead movement of the arm, which is characteristic of certain sports such as cricket, volleyball, baseball, and tennis. People involved in these sports are more at risk of developing Ulnar collateral ligament (UCL) injuries. Given its effective treatment through surgery, the injury is also named after Tommy John, and it’s known as Tommy John injury. Apart from the surgical procedures, the injury of the Ulnar collateral ligament (UCL) can also be treated with the help of physical therapy and rehabilitation process, which can improve the range of movement and alleviate the symptoms to ensure quick and speedy recovery. The condition is characterized by inflammation and pain in the ligament and the proximal area that serve connective purposes on the arm and the elbow. It specifically functions to enjoin the forearm with the elbow. The inner area of the elbow is affected which causes an extending pain towards the forearm. The condition may be mild or severe, and it may be treated easily or require prolonged caring. The painful condition and inflammation are developed due to the overuse and overexertion of the muscles of the arm. This mostly happens in athletes, in cases where the overuse of the arm, too much rotating, gripping and flexing of the wrist can result in inflammation. As a result, the ligaments can be damaged, degenerated and get torn. Nonetheless, the name doesn’t imply that it’s only experienced by sportsmen. In fact, anyone can experience this type of inflammation of ligaments. The initial symptoms of an Ulnar collateral ligament (UCL) injury may vary from person to person and depends on the severity of the condition. However, some common symptoms that occur soon after the onset of the injury are usually tightness and pain in the elbow area. In certain cases, the post-treatment symptoms may reverse the treatment and cause recurring injuries in the absence of proper care from the patient.

Symptoms for UCL

The patients suffering from ulnar collateral ligament (UCL) injuries can experience several symptoms that can indicate the injury and the severity of the injury. The patient can usually experience sharp and sudden pain and symptom of soreness in the elbow region due to the straining. While the symptoms may vary from patient to patient, some of the most commonly observed symptoms of ulnar collateral ligament (UCL) injuries are:

  • A pop sound or feeling experienced at the time of the injury
  • Internal swelling in the elbow region as well as the extended part of the arm
  • Stiffness in the elbow region
  • Difficulty in movement
  • Limitation of the full range movement of the elbow joint
  • Bruising can occur at the injured area
  • Discoloration in certain cases
  • Tingling sensation from the arm extending towards the hand, causing tingling in the last two fingers
  • Weakness in gripping of the arm
  • Soreness in the affected region
  • Numbness and tingling sensation in the arm
  • Swelling in the injured area
  • Dislocation of the elbow in certain cases
  • Instability of the elbow due to the damaged ligament
  • Reduced athletic and sports performance of the patient
  • Pain in the affected area of the injury which can spread towards the wrist through the forearm.
  • Difficulty and pain in the movement of the elbow
  • The difficulty, pain, and weakness in the movement of the wrist
  • Tenderness inside of the elbow and extending along the forearm
  • Difficulty in doing everyday things, such as pouring coffee, shaking hands, moving the arm, and typing on the keyboard.

Treatment Options for Ulnar collateral ligament (UCL) injuries

Despite the effective Tommy John Surgical option, natural and non-invasive treatments are usually recommended for ulnar collateral ligament (UCL) injuries. The right approach to treat this condition is the treatment of the causes instead of alleviating the symptoms of the condition. It could include a personal treatment plan, healthy diet plan, changes to the lifestyle and exercising regime. Due to the overuse and overexertion, the painful and inflammatory condition can be specifically treated. Ulnar collateral ligament (UCL) injuries are usually experienced by people involved in the different profession, and it’s most commonly found in the people within the age group of 30 to 50 years old.  Moreover, it’s experienced by people that practice golf, swimming, painting, tennis, rowing, and baseball. Due to the improper use of the technique, gripping and moving repetitively, and throwing and lifting improperly, ulnar collateral ligament (UCL) can get damaged and injured.

The type of injury and the severity of it will determine the right and effective type of the treatment for ulnar collateral ligament (UCL) injuries. However, some of the common and most effective minimally invasive and non-surgical treatment options available are given below:

Using physical Aids to prevent further damage

Complete P.R.I.C.E. protocol

Acupuncture and massage therapies are known to be effective for UCL injuries

Receive a complete course of physical therapy and rehabilitation program

Changing lifestyle and eating habits

Achieving immobilization with the help of devices

Use corticosteroid injections in severe case

Correcting the Training practices

The corrective action plan is important to ensure that your training habits are not the reasons for your UCL injuries. After consulting a physical therapist, you should give up on the practices that you have been doing wrong all along.

Platelet Rich Plasma (PRP)

This relatively new technique is effective for the treatment of Ulnar collateral ligament (UCL) injuries, and it can provide a quick fix in minimum time. It uses the centrifuge technique to concentrate the platelets from your blood which is injected in the area of injury. So far this innovative technique is effective.

Cortisone injections 

Cortisone injections are used to handle the cases which are not cured with the milder treatment options. Although it is an effective way to recover the inflammatory conditions, it is not used as a first choice due to its side effects regarding weakening the tissues and muscles.

Surgery

Tommy John surgery is the most popular and effective option for most UCL injuries. Despite being invasive, it can enable you to get back to your sports and continue playing.

Recovery for the ulnar collateral ligament (UCL) injuries

Usually, the pain is the best indicator to figure out how much more time it will take to recover as you experience a reduction in the degree of pain with time. Recovery time varies greatly from patient to patient depending on the severity of the condition, the strength of the injured area and other factors. It can take anywhere from a week to many months. For effective recovery, you should get back to the normal routine activities slowly and gradually according to your doctor’s advice. Once you start using your muscles and bones again, it will complement the complete healing of the injured parts. If the patient were healthy before the injury, the recovery would usually be faster. However, due to so many factors, it is not possible to precisely tell the time frame. Depending on the severity, the injury can take up to 6 months of time to recover.

Posterior cruciate ligament Injury

Introduction

PCL or Posterior cruciate ligament injury is one of the most common injuries of the knee, commonly experienced by the sportsmen and athletes. The condition can be very painful, and the patient could need knee surgery to get it back to normal. However, each case differs and it depends on the severity of the condition.

What is Posterior Cruciate ligament?

The knee joint is a meeting point of three important bones, the tibia, patella, and the femur. Due to the natural knee cap placement, the joint usually remains protected. Four ligaments are also attached to the bones and the joint, which can be classified as cruciate ligaments and collateral ligaments. The cruciate ligaments are present on the inside and intercept each other. The upper intercepting ligament is termed as anterior while the one below is called the posterior cruciate ligament. The Posterior cruciate ligament (PCL) protects the femur and tibia and keeps them stable. Even though the Posterior cruciate ligament (PCL) is greater in strength and stability as compared to the Anterior cruciate ligament (ACL), the Posterior cruciate ligament (PCL) can get injured and even torn in a similar fashion as Anterior cruciate ligament injuries and tear.

Posterior cruciate ligament (PCL) injury

Posterior cruciate ligament (PCL) injury and a sprain is a result of injuries to the meniscus, knee structure, ligaments and articular cartilage that is present in the area. These injuries can be graded and classified into three main types, depending on the severity of the injury and type of injury. There are different Types of Posterior cruciate ligament (PCL) injury similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three types are:

Type 1: This is characterized by less than moderate pain, while the patient retains the ability to feel and move the injured area.

Type 2: This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.

Type 3: This is characterized by severe pain, while the patient loses the ability to feel and move the injured area.

Type 4: This is characterized by severe pain, while the patient loses the ability to feel and move the injured area. In this condition, other proximal ligaments and structures also get damaged.

Causes of Posterior cruciate ligament (PCL) injury

The most common cause of Posterior cruciate ligament (PCL) injury is an accidental injury. Other causes include severe hit, falling on the knee directly, stopping too quickly during a run, and quickly moving in different directions. Women as found to be more prone to Posterior cruciate ligament (PCL) injury due to the tenderness of muscles and ligaments, while men may also experience tearing and spraining.

Posterior cruciate ligament (PCL) injury is more common in people who are involved in cycling, running, athletics, football, soccer, and hockey. The most common reason is the sudden change in the training practices and the exercise regime of the players, or accidental injuries caused during the running.

If an injury causes a sudden weakness and disability, you should see a doctor as soon as possible. The most common cause in sports for this injury is a hard hit, heavy blow or contact sports. As a result, the wearing and tearing can take place in the femur and patella. There are several other causes and risk factors associated with the condition of Posterior cruciate ligament (PCL) injury. The injury can be a result of the wrong kind and size of the shoes which may put pressure on the muscles up along the legs. Other factors are also important such as the intensity of the hit. Overtraining and intense training all also among the most common causes of this condition.

Other causes include:

  • Falling on the knee when it is bent
  • Striking of knee against a hard surface
  • Running several steps
  • Suddenly stopping while running
  • Legs stretching
  • Leg displacement or foot displacement while running.
  • Wrong posture and legs movement
  • Sudden jerking
  • Heavy hit
  • Hard blows

Signs and symptoms of the Posterior cruciate ligament (PCL) injury

The onset of the condition can be gradual over time, or it can be acute due to a sudden injury. Depending on the severity, the signs and symptoms can vary. In less severe cases the patient may experience a sudden discomfort in the knee during a walk or run. Diffuse peripatellar pain is experienced in this condition around the kneecap. In most cases, it’s difficult for the patient to identify the exact location of the pain. The patient may feel and experience a grinding feeling with the movement of the knee. Prominent sound and friction occurring due to knee joint movement are also experienced. The patient may also feel a clicking feeling or sound occurring due to movement of the knee. A feeling and a sound of popping in the knee joint upon movement may also occur. In such cases, the injury includes a pop sound from the knee along with the loss of control over the knee muscle. In severe cases, the movement of the knee joint is severely limited, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling. The patient can experience discomfort while walking, bending knees and while sitting. The everyday activities such as walking up or down the stairs can also become a challenging task. Depending on the type of Posterior cruciate ligament (PCL) injury, the signs and symptoms can vary. In severe cases, the movement of the knee joint is severely limited, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling.

Diagnosis for Posterior cruciate ligament (PCL) injury

As we have previously discussed, the diagnosis for the Posterior cruciate ligament (PCL) injury is not always very simple and sometimes require a compound approach. Therefore, a differential diagnosis is commonly carried out for Posterior cruciate ligament (PCL) injury. The diagnosis of Posterior cruciate ligament (PCL) injury is complicated and difficult, which is the reason why it can be easily mistaken as another syndrome, such as, Osgood–Schlatter disease. Prepatellar bursitis, Sinding-Larsen, and Johansson syndrome, plica syndrome and patellar tendinitis. There isn’t any single best method for the diagnosis of the Posterior cruciate ligament (PCL) injury, as the muscle damaged and the conditions can vary among different patients greatly, and many other diseases, problems, and health conditions can result in a similar kind of a pain in the knee. Therefore, a differential diagnosis is administered to eliminate the possibilities of other conditions.

The diagnosis is initialized with a careful examination of the patient’s history as well as the physical examination. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case.

Once the initial examination is performed, and the doubts are reduced, the doctor may follow up with diagnostic procedures. The techniques used in this case are radiographic investigations, X-Ray Tests, the differential diagnosis, and sonographic evaluations. If necessary, the doctor may also use MRI scans to find out the exact location of the damage.

From acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine or elevated position, and the movement and flexion of the knee and legs are examined.

The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain, tenderness of the femur and patella area. The diagnosis also includes the identification of the grading and category for the condition.

Treatment for the Posterior cruciate ligament (PCL) injury

Non-surgical procedures are reported to be successful in most cases of PCL injuries. Surgery is a viable option. However, natural and non-invasive treatments are usually recommended for Posterior cruciate ligament (PCL) injury. Posterior cruciate ligament (PCL) injury is usually experienced by people involved in the different profession and its most commonly found in the people within the age group of 30 to 50 years old.  It could include a personal treatment plan, healthy diet plan, changes to the lifestyle and exercising regime. Due to the overuse and overexertion, the painful and inflammatory condition can be specifically treated. The treatment of PCL injuries and PCL tears depend on the severity and condition of the injury. However, various treatment options are advised for all grades of PCL tears. For instance, RICE rule is an initial treatment response for all grades of PCL sprains. Rest must be ensured for the injured area as well as the whole body. Joint immobilization is also important for which aids and braces can be used. To reduce the swelling ice gives effective results. Compression bandages are also used by the patients. The doctor will prescribe you to keep your common and injured area elevated to increase the blood circulation and boosting recovery. Certain anti-inflammatory OTCs and NSAIDs are also prescribed by the doctor, such as ibuprofen and aspirin to relieve pain and other symptoms. After administration of this initial treatment, a closer examination will suggest the right kind of treatment. In case it is a grade one or grade two PCL injury, the knee may get splinted and you will be subjected to a rehabilitation program. It will include straightening of the muscles that are surrounding the knee joint to improve the position and remove the splint. The rehab will also ensure that you do not get a secondary injury.

PRP Technique

The innovative PRP technique can be effectively used for the treatment of Posterior cruciate ligament (PCL) injury. It is a non-surgery procedure that stimulates the healing by injection of concentrated platelet-rich plasma into the affected area. This therapy is used for grade 1 and grade 2 PCL injuries.

If it is a Grade three PCL sprain, the condition will be much more severe, and the treatment criteria will be different. These cases usually involve the complete PCL tears where the PCL is pulled out or torn from the bones. Sometimes this tearing also pulls away a piece of bone with it. The condition is very painful and requires a proper initial treatment protocol. Afterward, surgery is performed to reattach the torn PCL back to its place either by sewing or which the help of a screw.  For this purpose, a part of the ligament is taken from the proximal area of the patient’s injured leg, which is known as the donor site. This donor tissue is referred to as an autograft or allograft depending on the area from where it is taken. This surgical procedure usually adopts the technique of arthroscopy and a camera lens. Once the surgery is completed, and the reconstruction is achieved, long and steady braces are used to hold the knee and the leg at a certain position until it is healed to avoid further tearing.

Surgical treatment for PCL Tears

In certain severe cases, surgery may be required to fix the problem. It becomes critical when the patient requires immediate recovery, when the injury persists, or when the injury keeps bending and displacing the knee. The surgery may also be required if multiple ligaments are injured. In the surgical procedure, the damaged ligament is removed and replaced by another tissue known as a graft, which allows it to heal and recover. The graft may be taken from a donor area which is usually another area of the knee. However, rehabilitation is still required after the surgery. The surgery is minimally invasive and reconstructs the damaged ligament.

Surgery is usually prescribed to the Posterior cruciate ligament (PCL) patients, as it can effectively recover the patients bringing them back to the normalized knee condition. However, if the patient isn’t involved in heavy activities, such as jumping, running, too much manual work, or sports, the alternative treatment options can be administered.

The surgical treatment is initiated after a delay of around one month. This is usually done to monitor the healing speed of the patient and let the swelling and bleeding reduce. This also gives an idea of the persistence of the injury. Physiotherapies are essentially involved in the post-operative rehabilitation therapy. The recovery highly depends on the consistent care and physiotherapeutic treatment, without which the recovery may be delayed or reversed. It’s important to note that the surgical treatment also requires few to several months of rehabilitation therapy and the sportsmen can return to the playgrounds after a year. The process starts with light exercises and later on the focus is gradually shifted towards enabling the full-range movement of the knee joint. Flexing and bending your muscles too much should be avoided, and the gradual increase in the exercising routine should be practiced. The rehabilitation therapy also uses aids like crutches and braces to improve the protection level and prevent pressure, jerking and stress.

Preventive Measures for Posterior cruciate ligament (PCL) injury

It’s important to stick to proper training and exercising methods to avoid getting a Posterior cruciate ligament (PCL) injury due to a training accident. Sportsmen and athletes should also be mindful of the possibility of a knee injury and should be aware of measures to prevent the knee from severely damaging in case of an accident. Should be aware of measures to prevent the knee from severely damaging in case of an accident. Another effective way of preventing Posterior cruciate ligament (PCL) injury is to strengthen the core muscles by exercising. Some exercises such as hamstring can help increase the strength and endurance of leg muscles. Stronger legs can also help to reduce the pressure on the knee due to falling. Athletes and sportsmen must also practice techniques of jumping, cutting, pivoting, proper knee positioning and landing to prevent injury from sudden falling.

Skier’s Thumb

What is Skier’s Thumb?

Skier’s Thumb injuries can be defined as the injuries that are caused to the soft tissues and the ligament of the thumb that results in palpation, pain and other symptoms. The proximal ligaments are damaged due to trauma or repetitive micro-traumas in typical cases. The condition is also referred to as the Gamekeeper’s thumb or an ulnar collateral ligament (UCL) tear. Depending on the severity of the condition, the ulnar collateral ligament (UCL) can get damaged, sprained or even torn in severe cases. In the majority of the cases, the ulnar collateral ligament (UCL) injury can result in an avulsion. Ulnar collateral ligament (UCL) injury or Skier’s thumb injury is caused to the soft tissues known as ligaments. Soft tissues can be defined as the tissues that usually serve the purpose of the surrounding, supporting and connecting other tissues, organs, bones and structures inside our body. This group of soft tissues may include the nerves, tendons, muscles, fascia, and tendons. There may be other structures involved in this group as well, such as blood vessels, fibrous tissues, synovial membranes and the fats. Wearing and tearing of soft tissues can be relatively more comfortable and may cause severe problems. Ulnar collateral ligament (UCL) has the function of connecting the bones of the thumb to one another, and it also aids in the movement of the bone joints in the thumb. The name of this injury was tossed as gamekeeper’s thumb in 1955 when the first classified case was recorded. Apart from sudden and acute trauma, it can be caused due to repetitive movement and twisting of the thumb. Since this injury is quite common in people involved in Skiing, it was later termed as the Skier’s thumb injury. Many people involved in other sports are also at risk of developing this condition as a result of an injury. The treatment choice for this is based on the severity of the situation and the damage caused by the injury.  The Ulnar collateral ligament (UCL) injury can take place in the form of a sprain, partial tearing, or in certain severe cases complete tearing of ligament and its avulsion from the bone. In such cases, a surgical procedure may be required to fix the problem and recover the patient. If surgery is avoided in cases of severe damages, the stability of the ligament with the thumb can be compromised, and the recovery can be slowed down. As a result, it can result in a permanent deterioration of the grasping function of the thumb. Physical therapy and a process rehabilitative process are essential to ensure that the treatment gives best results. In most cases, people can continue with their sports activities after proper treatment.

Skier’s Thumb Causes

 A blow, hard hit or a trauma to the ligaments, and tendons can cause Skier’s Thumb injuries. The most common cause is bending of the thumb backward with too much force which can damage or completely tear the ligament. The condition is characterized by pain, swelling, and other similar symptoms. Skier’s Thumb injuries can result from some different causes, including anything that can potentially damage the ligament. It usually occurs in pain and can be accompanied by some different symptoms. Some of the most common causes of Skier’s Thumb injuries in the field of sports could be:

  • Falling
  • Bending the thumb backward
  • Bruising
  • Heavy blow
  • Bursitis
  • Twisting of muscles
  • Sudden trauma
  • Tendonitis
  • Sprains
  • Strains
  • Sudden jerking
  • Heavy hit

Signs and Symptoms for Skier’s Thumb injuries

Skier’s Thumb injuries can cause acute symptoms. Pain is the most important symptom of Skier’s Thumb injuries which can be aggravated by the movement. The pain can either be chronic or develop gradually over a long term, or it can be due to a sudden injury or blow in most cases. Difficulty or complete loss of movement ability is also experienced by the people suffering from Skier’s Thumb injuries. Occasionally the patient may also experience swelling, redness, and warming of the injured area. The symptoms you should generally look for are the following:

  • Feeling pain and stiffness
  • Swelling of the injured thumb
  • Increased pain occurring due to compression
  • Difficulty or inability of moving thumb in some instances
  • Blue or black discoloration of the injured thumb
  • Losing the ability to grip and grasp
  • Increased pain due to movement
  • Pain spreading towards the wrist
  • Sharp and intense pain in the start
  • Gradual dulling of the pain
  • Bruising and rashes
  • Sharp and stinging pain while using the thumb
  • Tenderness
  • Discomfort
  • Redness
  • Weakness
  • Instability
  • The inability of function due to severe tearing

The degree of Skier’s Thumb injuries

There are different grades for Skier’s Thumb injuries such as strains and sprains, similar to other injuries, depending on the severity of the injury, condition and the symptoms occurring in the patient. The three grades are:

Degree 1

This is characterized by less than moderate pain, while the patient retains the ability to feel and move the injured area.

Degree 2

This is characterized by moderate pain, while the patient partially retains the ability to feel and move the injured area.

Degree 3

This is characterized by severe pain, while the patient loses the ability to feel and move the injured area.

Diagnosis for Skier’s Thumb injuries

The physician will first determine whether or not the patient has other limb-threatening injuries and then evaluate the thumb in more detail. After that, an examination of the physical condition and the patient’s medical history will be conducted. The specialist will ensure if the patient is suffering from damage to other injuries that can threaten the function of the limb. A close evaluation of the thumb is carried out. The doctor may take his time to move the muscles, and check for pain, swelling, palpations, tenderness and other physical symptoms. The condition is also tested by a squeeze procedure, in which the injured part of the patient is squeezed to check for pain, tenderness and other symptoms.

The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. If the Thumb is damaged, the movement of the thumb joint becomes difficult and painful for the patient. Along with the history check the doctor may go through an interview with the patient and inquire about several medical facts related to the patient based on the following subjects:

  • The exact time of the injury
  • Reason and cause of the injury
  • If the thumb was stressed or bent more than normal limits
  • The time it took after the injury to show symptoms of swelling and pain
  • The exact position of the thumb and hand during an injury

The questions based on the medical history may include:

  • Previous incidences of similar traumas
  • Natural hand orientation of the patient
  • Any underlying conditions
  • Previous events of fracturing the hand bones
  • Any allergies to different treatments
  • Any history of the surgical procedure of the hand

Once the initial examination is performed, and the doubts are reduced, the doctor may follow up with diagnostic procedures. The techniques used in this case are X-ray tests, and if necessary, the doctor may also use MRI scans to find out the exact location of the damage.

By acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely. This phase includes thorough examination and assessment of every individual and unique case. The physical examination may include:

Laxity testing: the tip of the thumb is moved sidewards while holding it from the base to see the angle of movement which is compared to the angle of the excellent thumb’s movement.

Checking for fractures and tenderness.

Assessment of the three central nerves of the hand to see if they’re correctly functioning

Treatment for Skier’s Thumb injuries

There are several ways to treat the Soft Skier’s Thumb injuries. The treatment may vary depending on the severity of the injury and the type of the underlying cause of Skier’s Thumb injuries. Most cases of skier’s thumb injuries are treated with non-surgical procedures. The treatment can be classified as the first aid initial response treatment and the long-term treatment. Initial response differs for severe cases. For mild to moderate injuries, the long-term treatment plan also differs from severe cases, as it is more focused on the rehabilitation therapy instead can surgery and operative procedures. 

After the proper diagnosis of the condition, a careful evaluation of the seriousness of the issue is conducted by the doctor for skier’s thumb injury. The immediate response includes icing, rest and painkillers. Various drugs are available in the market that can be used for pain relief and reduce the inflammatory conditions. Typically, the NSAIDs are used at the initial stages of the treatment. Splints are used to immobilize and stabilize the thumb as a movement may worsen the condition. These are usually put on for a couple of months to ensure that the healing is assisted with the help of this aid. There are a variety of different designs for splints available in the market. You may require a particular design and type depending on your condition. The doctor will analyze the condition of your thumb injury and decide the right design for you accordingly. Physical therapy especially associated with the thumb is practiced under the supervision of a specialist. You may require this therapy during the time of immobilization period. This will include some different exercises to improve and enable full range movement and prevent stiffness during the time of immobilization. It is also essential to strengthen the ligaments to avoid secondary injuries. Physical therapy along with a proper immobilization tool will be able to effectively cure around 90 percent of total cases of skier’s thumb. Once treated. You must only get back to using your thumb in your everyday activities gradually. The gradual progression is essential to prevent any further damages and to reverse the entire treatment. If the condition of skier’s thumb persists after all the useful treatment options, you may opt for surgery to avoid the risk of chronic instability. You can also couple up your approach with energizing and vitalizing foods that can improve the healing ability of the body. If the pain is disturbing you, you can try putting rice in the area of injury around the splint, but make sure that you do not take it off.

Non-surgical procedures usually treat Skier’s Thumb injuries unless the injury is extremely severe. Nonetheless, the treatment method depends on the severity, degree and the type of injury. In case if the surgery is needed, you will be sent to the relevant orthopedic surgeon and a reexamination will take place. If you’re a fit candidate for the surgery, the surgeon will aim at repairing your damaged or torn ligament by suture anchor. In simple words, this treatment requires the torn ligament to be sewed back to the right place which helps it heal faster and speeds up the recovery. It also removes the chances of dislocation of the ligament which can impact the functionality and the movement of the thumb. A lightweight cast is used after the surgery to keep the thumb firmly in the right place to let the ligament heal properly. This cast needs to be worn for a while until your doctor advises you to take it off. In case there is a secondary fracture along with Skier’s Thumb injury, then a fracture stabilization is also carried out in the same procedure.

Preventive Measures for Skier’s Thumb injuries

There are some precautionary measures that you can take to prevent Skier’s Thumb injuries. Stretching of the muscles is an excellent way to build resilience against Skier’s Thumb injuries. In repeated injuries, the stretching can be done by softly allowing the muscles and ligaments to move and function in the proper way they’re meant to function. That should be achieved through physical therapy. The prevention is usually more about common sense and some knowledge, and the patient can understand what is needed to be done with a little knowledge and interaction with the pain.

  • Wearing proper sports gears
  • Properly using the equipment
  • Taking rests and breaks frequently
  • Learn preventive measures for accidents during play
  • Gradually increasing the intensity of the workout
  • Always hold your weights in a confident and right way
  • Strengthening ligaments and making them more flexible
  • Communicate with your body and understand what it’s telling you
  • Ensure proper intervals and rest time
  • Keeping yourself hydrated at all times
  • Avoid overexertion and fatigue
  • Keep electrolytic balance
  • Keep up with vitamins and minerals
  • Take healthy nutrition

Meniscus Tear Injury

A Meniscus Tear Injury is a common medical condition experienced mostly by people involved in sports characterized by rupturing and tearing or a single or multiple fibrocartilage strips known as menisci. In most cases of torn cartilage, the cause remains to be the damage or tearing of the meniscus. The most common tearing occurs at the top of tibiae. Specific activities such as squatting, walking, running and other activities of sports can cause this tearing. Regarding sports injuries, acute traumas and overexertion remain to be a prevalent cause. It could occur due to the twisting and bending of the knee and cause degenerative conditions. 

Meniscus Tear Injury can result in swelling and pain in the knee joint. It can either occur as an acute condition or as a chronic condition developed by repetitive microtraumas. Some other symptoms can also be expressed varying from patient to patient, which includes motion locking, clicking, pop sound, and catching. The pain can increase as the load is put on the knee. In severe cases, Meniscus Tear can also be accompanied with the damage to other proximal ligaments such as ACL and MCL ligaments, which can result in a common condition known as an unhappy triad. The meniscus cartilage serves to protect and cover the knee joint which is the largest joint in our body, against the stress that is caused to it due to bending, running, climbing and walking. Hyper-flexing of the knee also results in tearing of the meniscus. Some different treatment methods may be used for the recovery of a torn meniscus. Physical therapy in case of Meniscus Tear Injury is very effective regarding strengthening the muscles, recovering the injury and stabilizing the knee joint. In severe cases or when other treatment options do not show significant results, then a surgical procedure may be required to treat the problem.

What causes a meniscus to tear?

The most common cause of a Meniscus Tear Injury is the turning and the wrong training habits, forcefully twisting and turning, suddenly stopping while running, imbalance of the muscles, and sudden displacement. It can also be caused due to the grinding of the femur against the tibia. As a result, the ligaments can get seriously damaged due to friction and rubbing, and knee can be pushed out of its normal and natural position, and it can cause muscular, ligament and tendon damage. Such unexpected movements are very common in sports that involve a lot of running and the use of legs. These tearing of the muscles can be very painful at times and could be accompanied with other symptoms such as bruising and the swelling of the area. Although it’s mostly the fibrocartilage that is damaged or injured due to Meniscus Tear Injury, it can also damage other structures, such as the blood vessels, ligaments, tendons, the knee by displacing it, and nerves. There are several risk factors involved, such as the types of sports, etc. however, it can occur in people of all ages.

Some of the other most common causes for Meniscus Tear Injury include:

  • Lifting heavy weights
  • Walking on uneven or hard surfaces
  • Wearing the wrong sized or kind of shoes
  • Squatting
  • Kneeling
  • Rigorous sports activities and feet movements
  • Twisting of feet, leg and knee muscles
  • Turning suddenly during a play
  • A sudden strain due to kicking
  • Running and stopping suddenly
  • Continuing sports after mild strains and pain.
  • Microtraumas
  • Wrong diagnosis of a previously occurring pain.
  • Repeated minor injuries
  • Overuse of the muscles
  • Long training hours
  • Sitting in the lotus position for long hours
  • Prolonged running on an uneven surface
  • Uphill and downhill running
  • Climbing and descending stairs again and again
  • Not stretching and warming up before workout and running
  • Hiking for long hours
  • The weakness of cartilage and muscles
  • Obesity and overweight
  • Older age
  • The reduced supply of blood

Signs and symptoms

The symptoms and signs of Meniscus Tear Injury can vary from person to person depending on the severity of the condition. In less severe cases the patient may experience a sudden discomfort in the knee during a walk or run, or sometimes no symptoms at all. The pain may go once the patient rests for a short while. For some people, the pain is not experienced suddenly and may build up gradually with time. In most cases, Meniscus Tear Injury cases include a stinging sensation in the knee along with the loss of control over the knee muscle, which may destabilize the knee. In severe cases, the movement of the knee joint is severely limited due to the pain, and gradually physical signs start showing up, which may include severe pain, muscular tenderness, and swelling. Some of the other most common symptoms can include:

  • Thickening of the tissue in the proximal region
  • Burning sensation
  • Increased pain with the passage of time
  • Pain due to the striking of the foot on the ground
  • Persisting pain in the Meniscus
  • Pain in the tibia upon compression
  • Weakness and feeling of the knee giving away
  • Increased pain due to running and walking
  • Popping sound or feeling
  • Tearing and disability of movement
  • Tenderness of muscles
  • Pain in adduction movement and closing the legs
  • Popping or snapping feeling
  • Locking of the knee

Diagnosis

As the initial response, the doctor will first of all look at the patient’s condition. In later phases, the doctor may demand a medical record of the patient and ask to get certain tests done. The doctor may do a few things, such as moving the muscles and checking for pain, swelling, palpations, tenderness and other physical symptoms. The doctor may also test the condition by using the traditional squeeze procedure, in which the injured part of the patient is squeezed to check for pain, tenderness and other symptoms. In the lying position or knelt position, the doctor may squeeze the proximal region to see if the function is disabled.

The medical history also has a lot to tell about the condition, and it’s essential for an effective treatment of the patient in this case. If the Meniscus is damaged or torn, the movement of the foot and calf become difficult and painful for the patient.

Once the initial examination is performed, and the doubts are reduced, the doctor may follow up with diagnostic procedures. The techniques used in this case are radiographic investigations, ultrasonography and if necessary, the doctor may also use MRI scans to find out the exact location of the damage. Depending on the individual case and the severity of the condition, the doctor may conduct an MRI (magnetic resonance imaging), an ultrasound test or an X-Ray Test. For the examination of tendons, muscles, and ligaments, MRI will provide sufficient evidence for possible damage. An X-ray test will be able to analyze the bone condition.

By acquired results, a careful evaluation is performed by the doctor to ensure the condition of the patient precisely. This phase includes thorough examination and assessment of every individual and unique case. The patient is laid in a supine position, and the movement and flexion of the leg are examined.

Arthroscopy is also another widely used technique for the diagnosis of Meniscus Tear Injury. Previously it was used more than it’s used today for diagnosis due to advancement and further.

non-invasive methods for diagnosis. However, this option is still used for the surgical procedure in several severe cases of Meniscus Tear Injury. In this diagnosis, a small tube which has a scope is inserted inside of the knee structure to analyze and see the precise location of the damage and the condition. Once it is analyzed, the arthroscopic surgery may be used to treat the damage caused due to Meniscus Tear Injury. In this diagnosis, a small tube which has a scope is inserted inside of the knee structure to analyze and see the precise location of the damage and the condition.

Treatment Options for Meniscus Tear Injury

Despite the effective surgical option of arthroscopy, natural and non-invasive treatments are usually recommended for Meniscus Tear Injury. Meniscus Tear Injury is usually experienced by people involved in the different profession and its most commonly found in the people within the age group of 30 to 60 years old and above. The treatment of the causes is important for the cure of meniscus tear injuries. It could include a treatment plan, healthy diet plan, changes to the lifestyle and exercising regime. The most important factor is the physical therapy and rehabilitation that comes into play. In severe cases, the long-term treatment may also include a surgical fixture. The problem can occur due to the overuse and overexertion. Moreover, it’s experienced by people that practice sports that involve feet and legs such as soccer, running, jogging, football, basketball, and others. Due to the improper use of the technique, twisting and moving repetitively, and running and lifting improperly, Meniscus can get damaged and injured.

The treatment choice depends on the grade and severity of the condition of Meniscus Tear Injury. However, some of the common and most effective minimally invasive and non-surgical treatment options available are given below:

The initial treatment takes the approach of protection, rest, ice, compression, and elevation.

After the first aid, you must make sure that you rest your knee as much as possible. The traditional PRICE protocol is administered for all grades of meniscus tear injuries. You can also use crutches and braces to ensure immobilization and improved healing. You must also avoid lifting any kinds of weight. At the hospital or home, you will be required to keep your leg elevated whenever you’re sitting or lying down. The swelling can be reduced by using ice on the injured area regularly for a few days. Each session of icing should be done for 30 minutes, and four sessions are recommended throughout the day. Compression bandages can also be used to alleviate the inflammatory condition. The medication will be initially prescribed traditionally. These medicines would include non-steroid anti-inflammatory drugs and pain relievers. You should also avoid walking as it requires you to put full weight on the legs. If it is painful, you may use crutches or a cane. Physical therapy will follow the traditional initial treatment in the long run. This will ensure that you do not experience stiffness due to lack of mobility. In case of severe injuries and complete tearing, you will be required to have surgery along with the post-operative rehab therapy.

For grade 3 injuries, an arthroscopic surgical procedure is mostly in practice. It is reported to show effective results in most grade 3 cases. You will be given pre-operation instructions that should be followed. It will also require a deeper examination with more tests. Arthroscopic surgery is a widely used technique for the treatment of Meniscus Tear Injury. In this surgery, a small tube which has a scope is inserted inside of the knee structure to analyze and see the precise location of the damage and the condition. Once the condition is fully analyzed, the arthroscopic surgery may be done to treat the damage caused due to Meniscus Tear Injury. This can help ensure speedy recovery and faster healing of the cartilage. Another surgical procedure known as microfracture surgery can also stimulate the healing and growth of new cartilage. In this treatment, new holes are drilled in the bone. However, it is not workable for meniscus cartilages, and it doesn’t produce stronger cartilage.

The surgery may take into consideration certain previously underlying health conditions, such as an infection, fever, cold, fever, wounds and other issues. A small incision will be made on the knee to let the arthroscope enter the damaged area. The instruments will be passed through the arthroscope to cut out the damaged part or repair a complete tear by screw or sewing procedure. The surgery may take 1 to 2 hours to complete, and you will be able to go home the same day. Post-operative care will be crucial, and a rehab follows up will be required. It may take a few months to recover from rehab in severe cases. Meanwhile, you can gradually go about your daily activities while using the crutches and canes. For some patients, there may be an underlying risk associated with the surgery. This may vary from person to person, and you should have a detailed discussion with your doctor regarding the possible risk factors.

Summary of Sports Injuries

Sportsmen and athletes can be susceptible to different injuries. The most effective way to keep yourself safe as a sportsman is a prevention through proper training and natural treatment methods. Almost all people involved in sports experience sports-related injuries at some point in their life. The most common types of sports injuries among all of these are Shin splints, Ankle Sprains, Tennis Elbow, Groin Pull, Knee injuries, Hamstring Strain, and ACL tearing. RICE treatment therapy (Rest, Icing, Compression and Elevation) is an effective therapeutic method for the treatment of most injuries. Severe cases may require surgery or steroid injectable, but these treatment methods should be the last resorts. Proper diagnosis of the treatment is important to ensure the effectiveness of the treatment. Some risk factors are associated with sports injuries, and the most common factors are the strength of your muscles and bones and the age group. Learning about sports injuries can not only protect you from injuries but also keep you healthy while protecting your entire career as a sportsperson.

References

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Health, V. (2018). Hip Flexor Strain – The Complete Injury Guide.

William Morrison, M. (2018). Hip flexor strain: Symptoms, causes, and treatment.

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Sport Injury Treatments by MedicineNet.com. (2018).

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Benjamin Wedro, F. (2018). Rotator Cuff Injury Symptoms, Tests, Treatment, Healing Time & Pictures.

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Tennis Elbow vs. Golfer’s Elbow: The Causes, Symptoms and Treatments | North Jersey Orthopaedic and Sports Medicine Institute. (2018).

Tennis Elbow vs. Golfer’s Elbow: Causes, Symptoms & Treatments. (2018).

Rotator cuff injury – Symptoms and causes. (2018).

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Haddad, A. (n.d.). 3 Common Shoulder Sports Injuries.

Non-Surgical Treatments for Tennis and Golfer’s Elbow Pain. (n.d.).

Wheeler, T.  (2017) Hamstring Strain.   Web MD

Payne, J. (2018, January 03). Hamstring Injuries | Causes and Treatment.

Hamstring Muscle Injuries – OrthoInfo – AAOS. (2015)

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Hochschuler, S. H. (2016). What You Need to Know About Sciatica.

What Are Shin Splints? Web MD.

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Shin Splints. (2018). Sports Injury Clinic

Groin Strain: Symptoms, Treatments, and Recovery Time. (2018) Health Line

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Groin Strain: Symptoms, Treatments, and Recovery Time. (2018)

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Rotator Cuff Massage Therapy CEU

Rotator Cuff Anatomy, Physiology, & Injuries Lesson

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Rotator Cuff Anatomy, Physiology, & Injuries

RELATED ANATOMY

Four muscle-tendon units make up the rotator cuff: the supraspinatus, infraspinatus, subscapularis, and teres minor. The shoulder comprises a complex of four articulations including the glenohumeral joint, scapulothoracic joint, sternoclavicular joint, and acromioclavicular joint that, under normal conditions, move in synchrony, affording smooth, unhindered motion of the arm. An intricate relation exists between the osseous elements and the surrounding muscles and ligaments. The tissues of the shoulder can be grouped into four separate and contiguous layers that alternate between muscular and fibrous elements.

  • Layer 1, the most superficial level, includes the deltoid and pectoralis major muscles.
  • Layer 2 is a continuous fascial layer that extends circumferentially from anterior to posterior and incorporates the clavipectoral and posterior scapular fascia.
  • Layer 3, again a muscular layer, includes the rotator cuff
  • Layer 4, the deepest level, comprises the fibrous capsular elements.

This classification can contribute to a better understanding of the shoulder’s complex anatomy and safeguard against deviation from internervous planes during surgical procedures. The four muscles that comprise the rotator cuff take their origin from the body of the scapula and envelope the humeral head as they insert along the tuberosities of the proximal humerus. The musculotendinous cuff is firmly adherent to the underlying glenohumeral capsule and provides circumferential reinforcement except at the rotator interval and axillary recess. The rotator interval is a triangular area that is made up of fibrous elements and bordered by the upper margin of the subscapularis tendon and anterior aspect of the supraspinatus. Within the interval lie the coracohumeral ligament, the biceps tendon, and the superior glenohumeral ligament. The coracohumeral ligament is seen superficially, whereas the superior glenohumeral ligament reflects around the biceps tendon and serves as an internal pulley at the floor of this space. The coracohumeral and superior glenohumeral ligaments take origin from the lateral base of the coracoid and superior labrum, respectively. In one report, through gross anatomic study, variability was observed at the insertion of the coracohumeral ligament. Seventy-four percent of specimens demonstrated a predominant insertion into the rotator interval; in the remainder, the first attachment was to the supraspinatus tendon. Multiple functions have been attributed to the coracohumeral ligament, and most notably, they include limitation of external rotation in the adducted arm and restraint against inferior translation. The intraarticular boundaries of this space can be easily visualized arthroscopically and are marked by the glenoid rim, the upper subscapularis tendon, and the intraarticular portion of the biceps tendon. The axillary recess, which also lacks muscular or tendinous coverage by the rotator cuff, demonstrates capsular redundancy at the inferior aspect of the joint. This tissue laxity affords regular arm abduction, whereby patulousness or contracture can mediate joint instability or restriction of motion.

Vascularization of the rotator cuff muscles depends mainly on three sources: the thoracoacromial, suprahumeral, and Subscapular arteries. The four rotator cuff muscles are often considered as distinct separate musculotendinous units that directly overlie the joint capsule and insert onto the proximal humerus. Clark and Harryman performed gross anatomic and histologic studies in cadaveric specimens to better define the relationship between the rotator cuff tendons and their underlying capsular elements. The fibers of the rotator cuff tendons interdigitate and fuse, forming a common insertion on the tuberosities of the humerus. The fibers of subscapularis and infraspinatus interdigitate with respective fibers of the supraspinatus. Microscopically, the rotator cuff complex is stratified into five distinct layers that also receive reinforcement from the coracohumeral ligament and is contiguous with the glenohumeral capsule.

 

The Subscapularis Muscle

Anteriorly, the subscapularis muscle takes its origin from the anterior aspect of the scapula and inserts onto the lesser tuberosity of the humerus. It is the largest and most powerful of the rotator cuff muscles with its origin occupying greater than 90% of the anterior scapular surface. As the multipennate muscle funnels laterally toward its insertion, it has a dual innervation from both the upper and lower subscapular nerves that arise from the posterior cord of the brachial plexus. The upper subscapular nerve innervates a greater portion of the muscle. Although commonly considered to be an internal rotator of the shoulder, its contribution to arm abduction and humeral head depression has also been emphasized. The subscapularis bursa lies between the subscapularis tendon and neck of the scapula. It is found just inferior to the coracoid process and protects the tendon as it courses along the scapular neck and coracoid. The bursa communicates with the glenohumeral joint capsule and can harbor intraarticular loose bodies. Zlatkin and colleagues described three areas of capsular insertion along the anterior glenoid neck. A type I capsule is inserted adjacent to the anterior glenoid labrum, whereas types II and III are inserted progressively more medial on the scapular neck. This categorization likely reflects the variation in morphology and size of the subscapular bursa, which can be readily identified on coronal magnetic resonance images (MRIs). While a predisposition to anterior glenohumeral instability in patients with a medial capsular insertion has been suggested, no controlled studies elucidating this issue have yet been conducted

The Infraspinatus and Teres Minor Muscles

The infraspinatus and teres minor muscles make up the posterior portion of the rotator cuff. The infraspinatus is triangular and is often inseparable from the teres minor. They take origin from the infraspinatus fossa and dorsolateral border of the scapula, respectively, and insert onto the greater tuberosity of the humerus. The suprascapular nerve innervates the infraspinatus, and the axillary nerve supplies the teres minor. These muscles externally rotate the humerus and stabilize the glenohumeral joint in concert with the subscapularis and supraspinatus muscles. The infraspinatus has a pennate muscle architecture with a central raphe that should not be confused with the intermuscular interval between it and the teres minor.

   

The Supraspinatus Muscle

The supraspinatus originates from the suprascapular fossa and inserts along the greater tuberosity of the humerus. It receives its innervation from the suprascapular nerve, which arises from the upper trunk of the brachial plexus. This muscle contributes to glenohumeral compression during active shoulder motion and assists the deltoid in effecting humeral abduction. The supraspinatus is situated between the humeral articular surface and the acromial arch, where a synovial cavity protects it on either side. Among the three portions of the supraspinatus, the anterior portion is more resistant to tearing than midway and posterior portions. The subacromial and subdeltoid bursae are found superficial to the tendon and separate it from the deltoid muscle. The bursa varies in size and extends laterally from the subacromial space to the proximal humeral metaphysis. The suprascapular nerve arises from the upper trunk of the brachial plexus and courses through the suprascapular notch just medial to the base of the coracoid process. It supplies the supraspinatus muscle before passing through the spinoglenoid notch, where it finally provides neural innervation to the infraspinatus. Warner and associates have highlighted the path and variational anatomy of the suprascapular nerve as it enters the posterior aspect of the shoulder. Eighty-four percent of 31 specimens revealed one or two branches of the nerve to the supraspinatus muscle. In 84% of specimens, the first branch originated either under the transverse scapular ligament or 1 mm distal to it. In 3%, the first motor branch originated proximal to the ligament and passed superficial to it. The infraspinatus muscle revealed three to four branches in approximately one-half of the specimens. Bigliani and coworkers measured the distance of the nerve from fixed scapular landmarks and observed that it lay an average of 1.8 cm (range 1.4 to 2.5 cm) from the midposterior glenoid rim to the base of the scapular spine. The distance of the nerve from the supraglenoid tubercle to the base of the scapular spine measured an average of 2.5 cm (range 1.9 to 3.2 cm). These observations emphasize the caution required for surgical management of shoulder disorders such as mobilization of a torn and retracted rotator cuff, arthroscopic portal placement, transglenoid drilling, and neurolysis of an entrapped suprascapular nerve.

The Deltoid Muscle

Superficial to the subacromial and subdeltoid bursae lies the deltoid muscle. It is composed of three heads (anterior, middle, and posterior) that vary in structure and function. The muscle has an extensive origin, arising from the distal one-third of the clavicle, the acromion, and the lateral one-third of the scapular spine. It converges distally to insert on the deltoid tuberosity of the mid-diaphysis of the humerus. The Axillary nerve innervates it. Its broad origin, which is derived from the mobile scapula and clavicle, affords the deltoid a mechanical advantage by allowing the muscle to maintain its resting length at various arm positions. Furthermore, the bipennate structure of the large middle head contributes to abduction strength through contraction of its fibers at an angle to the line of pull, which also serves to maintain muscle fiber resting length and improve efficiency.

In contrast, muscles with a parallel fiber arrangement, such as the anterior and posterior deltoid, by their structural configuration, result in considerably decreased strength during contraction. Differences in activity of the three portions of the deltoid relative to arm position have been observed through electromyographic analysis. The anterior and middle heads remain active at all angles of abduction and in multiple planes (coronal, scapular, and parasagittal), whereas the posterior deltoid, also an important shoulder extensor, contributes to elevation when the arm is above 110 degrees. Moreover, when the arm is in abduction, the posterior deltoid functions as a dependent external rotator, for which its clinical importance is increased in patients with massive rotator cuff tears extending into the infraspinatus and teres minor tendons.

ROTATOR CUFF FUNCTION

The complex interaction of the rotator cuff and surrounding muscles is largely responsible for the shoulder’s considerable range of motion and the preservation of glenohumeral joint stability. Although debate continues over a few functions of the rotator cuff, the preponderance of data supports its role as a dynamic stabilizer, providing humeral depression, humeral rotation, abduction, and joint compression. Its role in “dynamization” or tensioning of the glenohumeral ligaments in the midranges of motion remains unclear and will require validation with further study. Furthermore, the rotator cuff has an integral part in maintaining force couples in multiple planes, whereby its absence could potentially result in abnormal kinematics, an unstable fulcrum, and abnormal humeral head excursion. The rotator cuff comprises a group of muscles that are considerably smaller in size and cross-sectional area when compared with the more superficial structures, such as the deltoid, pectoralis major, latissimus dorsi, and trapezius. Also, because they lie deep in the shoulder and near the center of rotation of the glenohumeral joint, these muscles are collectively unable to generate the same degree of torque as the larger and more superficial structures. And therefore the complete torque of the rotator cuff is produced by muscles Supraspinatus and deltoid, collectively.  In part, the relatively shorter lever arm, or distance of the muscle from the center of rotation, accounts for observable differences in generated force. Consequently, given its anatomic architecture, maintenance of a stable glenohumeral fulcrum during active arm motion is one function that is both important and well suited to the rotator cuff. A normal-functioning rotator cuff achieves dynamic stability through multiple mechanisms. It acts through direct joint compression as well as through asymmetric contraction and “steering” of the humeral head into the glenoid during active motion. Compression is achieved through the perpendicular vector of pull by the humeral head into the glenoid that serves to minimize tendencies toward joint subluxation. Multiple forces pass across the shoulder during an active motion to achieve the desired arm position. Force couples across the shoulder remain integral to maintaining normal function, especially when placed in a perspective of the minimally constrained design of the glenohumeral joint. Force couples in various planes exist that can be defined as the action of two opposing muscle groups required to achieve a given movement. Inman and associates initially described force couples involving the glenohumeral joint. They noted that the deltoid muscle acts to pull the humeral head in a cephalad direction, while the subscapularis, infraspinatus, and teres minor act as a functional unit counteracting the deltoid and effecting depression of the humeral head. Other biomechanical studies have highlighted the role of the infraspinatus and subscapularis in the maintenance of normal glenohumeral kinematics. In one cadaveric investigation, the isolated absence of an applied supraspinatus force appeared to have no appreciable difference on humeral head migration when measured radiographically in the anteroposterior plane. The absence of force generated by the infraspinatus, teres minor, and subscapularis, on the other hand, increased superior humeral translation because the deltoid was unopposed. Burkhart expanded on the importance of force couples in preserving normal kinematics in patients with rotator cuff tears. He noted that balanced forces in both the coronal and transverse planes afforded normal glenohumeral motion patterns as long as anterior and posterior portions of the cuff were preserved beyond a critical threshold. The location, as opposed to the size of the tendon tear, was suggested to be a more significant determinant in resultant glenohumeral kinematics. The rotator cuff contributes strength to the arm. Howell and coworkers noted that, after selective blockade of the suprascapular and axillary nerves in normal volunteers, the supraspinatus and deltoid muscles contribute equally to measured torque in the abduction. These findings are comparable with other reports on selective blocking of the axillary nerve in which it was noted that approximately 60% of the strength in the abduction was attributable to the deltoid muscle. Compromise of the rotator cuff or deltoid function in such individuals could be expected to result in a progressive loss of muscle force with arm elevation and early fatigability. The infraspinatus has also been implicated as a contributor to arm elevation. Otis and associates reported decreases in abduction and external rotation torque of up to 45% and 75%, respectively, after selective paralysis of the infraspinatus muscle. These findings contrast with one electromyographic (EMG) study that demonstrated silent electrical activity in the infraspinatus when it was elevated to 120 degrees. To clarify the collective role of the infraspinatus, teres minor, and subscapularis, Sharkey, and coworkers, in a cadaveric biomechanical investigation, evaluating the contribution of these muscles to force in the abduction. Because the tendons of the subscapularis and infraspinatus insert both above and below the humeral center of rotation, it is conceivable that portions of these muscles may act as arm abductors as well as humeral head depressors. Their data suggested that the combined contractions of these muscles contribute to arm abduction and that the magnitude of their contribution was similar to that of the supraspinatus. Otis and colleagues provided further indirect evidence of the functional relation of the rotator cuff and deltoid to humeral elevation. By calculation of changes in moment arms and measurement of muscular excursion in cadaveric specimens, they demonstrated that both the infraspinatus and subscapularis contribute to the abduction. Changes in rotation further affected the capacity of either muscle to augment elevation in the scapular plane. Internal and external rotation enhanced the ability of the upper portions of the infraspinatus and subscapularis, respectively, to abduct the arm. The data help to partly explain how a supraspinatus defect may not necessarily limit functional abduction of the arm.

Examination of the shoulder for rotator cuff disease

The examination of patients with rotator cuff problems has undergone substantial advancement in the past few years, and there is an increasing appreciation of the importance of integrating the history, physical examination, and imaging findings for determination of the diagnosis. Knowledge about the clinical relevance and limitations of the physical examination of the shoulder is critical for identifying what the examination does and does not reveal. Examination of the shoulder presents unique challenges: it differs from the examination of other joints in several ways. First, unlike the examination of the knee or ankle, the distribution of pain in the shoulder area often does not narrow the diagnosis. Second, the shoulder is a joint with several moving parts. Shoulder movement includes both glenohumeral and scapulothoracic motion. Both components of total motion must be considered for an accurate examination. Third, the shoulder is covered by large muscles that make palpating specific structures difficult. Fourth, imaging studies can be challenging to interpret. As an example, magnetic resonance imaging (MRI) studies often identify abnormalities that are unrelated to the patient’s symptoms.

History and presentation

Rotator cuff tendons can be injured by an acute, traumatic event or by a gradual process of unknown cause. The degree of trauma required to produce a rotator cuff injury is quite variable. Common mechanisms of injury include falling on the shoulder or an outstretched arm, lifting heavy luggage into the overhead bin of an airplane, pulling a lawn mower cord, or simply reaching out and away from the body. The patient will often feel a tear, rip, or pop. Although rotator cuff tears typically do not cause ecchymosis, patients with a bleeding diathesis may have bruising, particularly on the anterior or lateral aspects of the shoulder. Chronic injuries are typically more insidious in onset. In most cases, the individual cannot recall a specific injury. Rather, there is a gradual increase in shoulder pain and loss of function, a process that we describe to patients as “wearing a hole in the seat of your trousers.” This injury pattern increases linearly with age and studies have shown that more than half of asymptomatic individuals may have some form of rotator cuff abnormality. Various theories have been proposed to explain why the rotator cuff tissue fails. Impingement of the rotator cuff against an acromial spur, attrition secondary to cell senescence, vascular compromise, genetic predisposition, tension overload of the tendons, and differential stress within the layers of the tendons have all been implicated. What is clear is that, as the tendon becomes thinner and weaker, less force is required to tear it. This explains the common clinical presentation of a patient who was completely asymptomatic with an attritional tear, but then experiences a minor trauma and develops a much larger and ultimately symptomatic tear. As the causes can be varied, it is important to obtain an accurate history of not only the specific inciting event but also any history of previous shoulder problems. Similarly, it is important to determine whether the patient’s main complaint is pain, weakness, loss of motion, loss of function, or a combination thereof. Unfortunately, no one pain pattern is diagnostic of rotator cuff disease. Typically, patients with rotator cuff pathology complain of lateral shoulder pain, but a pain in this location is not specific for rotator cuff injury. Other causes of lateral shoulder pain include cervical radiculopathy, visceral pain, angina, and, less commonly, acromioclavicular joint pathology. Patients with rotator cuff abnormalities often have pain and weakness when using the arm above shoulder level or when lifting objects with the arm extended away from the body. Circular motions with pressure down on the hand, such as wiping a countertop or painting, can cause pain, which typically radiates into the deltoid region.

Physical examination

The physical examination of the patient with rotator cuff pathology should be part of a more comprehensive upper extremity examination. The examination starts with observation. The patient should change into a gown or other such attire that permits observation of the anterior and posterior aspects of the upper extremity. The appropriately attired patient should be examined for atrophy, deformity, or scapular winging. These abnormities are more readily detected when one shoulder is compared with the other. Atrophy of the supraspinatus and/or infraspinatus fossa is often indicative of a large, long-standing rotator cuff tear. Color changes or excessive swelling suggests vascular conditions such as deep venous thrombosis or arterial comprise. The next step is to perform a brief vascular and neurological examination. The arm should be inspected for edema, stasis, swelling, and color changes. Capillary refill and pulses should be evaluated. This is particularly important in patients who have complaints of coldness or cramping in their hands. The neurological assessment includes an assessment of light touch sensation and should be performed in all areas corresponding to the distribution of the peripheral nerves and cervical spinal levels. The most reliable method of performing this part of the examination is to touch the same area on each upper extremity simultaneously and ask the patient whether the sensation is the same on each side. A difference indicates that the patient has some nerve involvement, and additional investigation of those symptoms is warranted. Similarly, it is relatively easy to assess upper extremity strength and motor function. Deltoid, biceps, triceps, wrist flexors, wrist extensors, and interosseous muscle strength should be assessed, graded on a scale of 1–5. If the patient is weak, neurological causes should be included in the differential diagnosis. A thorough upper extremity evaluation should always include an assessment of the joints above and below the area where the patient experiences pain. Shoulder abnormalities frequently coexist with cervical and other upper extremity pathology. Referred pain from neck pathology can be radicular and/or non-radicular. Compressive neuropathies distal to the shoulder can present as a “double-crush” phenomenon and produce pain more proximally.

The range of motion evaluation

An assessment of both active and passive range of motion is an important part of the examination. Subtle changes in the range of motion can be helpful in making a diagnosis. Patients with a painful arc of active motion between 90° and 110° of forward elevation often have rotator cuff pathology. Shoulder stiffness (manifested as a loss of passive range of motion) can be indicative of adhesive capsulitis. The patient may present to the clinic with a chief complaint of pain. On further evaluation, however, the loss of motion becomes apparent. For this reason, patients with adhesive capsulitis are not uncommonly diagnosed with rotator cuff tendinopathy. Indeed, in our experience, this is the most common misdiagnosis.

Elevation

The active elevation is always assessed in two positions: in the plane of the body (abduction) and front of the body (flexion). The clinician should observe the raising motion for bilateral symmetry, to determine whether there is a glitch in the motion on one side compared with that on the other. Particular attention should be directed to shoulder blade motion. Shoulder blade asymmetry during active forward elevation, best appreciated when viewed from the back, is termed “scapular dyskinesis,” and is indicative of muscle weakness. When detected, scapular dyskinesis should prompt a careful evaluation of muscle strength and nerve function. If the patient lacks active elevation, the clinician should attempt to gently elevate the extremity a bit further. If the additional elevation is obtained with this passive motion, the previous inability to fully elevate the arm usually indicates a stiff or weak shoulder as opposed to a globally stiff or globally “adherent” shoulder. If the passive motion is unsuccessful in elevating the arm beyond the point of active elevation (i.e., there is a firm endpoint beyond which additional motion is not possible), then stiffness is the primary problem.

Painful arc

Some patients experience pain only in certain segments of elevation, most commonly between 70° and 120° (the painful arc).  This pattern is characteristic of rotator cuff conditions, but, alone as an isolated finding, is not diagnostic. Additional demographic and/or examination findings are needed to establish the diagnosis of a rotator cuff disorder.

Drop-arm sign

This examination maneuver can be accomplished in one of two ways. The patient raises (with or without assistance) the arm above shoulder level to approximately 70° or 80° and is then asked to either hold it against gravity (without assistance) or gradually bring the arm down to the side. It is important that the examiner is careful not to let the arm fall or descend too quickly in an uncontrolled manner because it can be very painful for the patient. If the patient has trouble maintaining elevation, or if the arm falls to the side, the finding is known as a positive drop-arm sign. This sign may indicate a profound problem secondary to paralysis (neurogenic cause), or massive rotator cuff damage (i.e., large supraspinatus tear or tears of multiple tendons), or both. That said, the inability to maintain elevation may result from pain alone, which must be considered in the differential diagnosis.

Shrug sign

Another non-specific sign of shoulder dysfunction is the shrug sign. This test is performed by asking the patient to hold the arms parallel to the floor. If this task cannot be done, or if there is asymmetry of the shoulders when performing the test, the patient’s shoulder is stiff, weak, or both. This test was originally proposed as an indicator of rotator cuff dysfunction, but, because it can be positive for a wide variety of shoulder conditions, it simply indicates the presence of some abnormality.

Rotation

To test for rotation, the patient is asked to hold the arms at 90° of elevation. The examiner then moves the arm into the external and internal rotation. Both shoulders are examined, and any differences in the rotation are noted. If the patient’s shoulder is stiff for any reason, there will be a firm endpoint as the ligaments of the shoulder reach their maximum length. Any movement beyond this point will cause pain, or the patient will have to move the scapula or the whole body to accommodate the associated stress. In some athletes, particularly those who have been playing or used to play overhead sports (such as tennis), there will more external rotation and less internal rotation in the dominant than the non-dominant shoulder. This is a normal finding in athletes who play overhead sports unless pain accompanies it. If pain accompanies the loss of motion, the condition is referred to as a glenohumeral internal rotation deficit. Although this phenomenon may be associated with pain in tennis players or swimmers, it is typically not a cause of shoulder pain in patients with rotator cuff disorders. In another test for external rotation of the shoulder the patient holds the arms at the side with the elbows flexed 90° so that the elbows touch the sides of the body. The examiner then compares both sides as the patient rotates the arms externally. Loss of external rotation in this position (i.e., not with the arm elevated as above) is a general sign of a shoulder abnormality. Any asymmetry indicates shoulder stiffness but does not identify the cause of the stiffness. To further test internal rotation, the patient is asked to place the hand up the back with the thumb up. Each arm is done sequentially, and the motions are compared. If one side is different from the other, this asymmetry indicates that the patient’s shoulder is stiff or weak, or both, but this test does not identify the cause.

Strength testing

Probably the most helpful portion of the examination of the shoulder with which to formulate the diagnosis of rotator cuff disease is strength testing. These examinations are quite simple and easy to perform. To perform them correctly, and to prevent the patient from compensating with muscles other than the one being tested, the practitioner needs to understand the functional anatomy of the upper extremity.

In abduction

One of the myths of rotator cuff disease is that people need the rotator cuff muscles to have full elevation of the shoulder of motion and function in the presence of full-thickness tears of the rotator cuff, the shoulder is usually weak on manual muscle testing, with weakness when using the arm above shoulder level or when lifting objects away from the body.

Supraspinatus testing

Although no strength test will completely isolate the supraspinatus muscle and tendon, any weakness with forwarding elevation suggests injury to this muscle. For the first test in determining shoulder strength, the patient is asked to elevate the arm to ear level fully. If the patient has a normal deltoid muscle and yet cannot lift the arm against gravity (in other words the patient has a positive “drop-arm sign” as described above), then the weakness is most likely the result of some abnormality in the supraspinatus muscle or tendon. The second test for supraspinatus is performed by asking the patient to elevate the arms to a position parallel to the ground. The arms should be brought forward approximately 30° from the plane of the body (this position is called the “plane of the scapula” because the scapula sits at a 30° angle to the thorax) and, with the patient’s elbows flexed, the examiner pushes down on the arms as the patient resists the pressure. Having the patient flex the elbows decreases stress on the shoulder and allows for a more accurate assessment. This is especially important in the presence of pain or for patients with rotator cuff abnormality, for whom the extended elbow position can be very painful. If the arm gives way with this test, the examiner can infer that the weakness is the result of pain alone or injury to supraspinatus itself. If the patient’s shoulder is not weak when this test is performed with the elbows flexed, then the test can be repeated with the elbows extended. This maneuver is commonly referred to as Jobe’s test. The test can be performed equally effectively with the thumbs down (“empty can” position), the thumbs up (“full can” position), or the thumbs in neutral. The examiner pushes down on the arm at the wrist and asks the patient to resist. The test is positive for weakness in abduction when the patient cannot hold the arm in this position against resistance.  Although weakness in abduction is frequently indicative of rotator cuff pathology, it is important to remember that this is not always the case. Other causes of weakness in abduction include nerve injury, biceps tendon injury, and pain from a labral tear. Besides, many patients do not experience shoulder weakness with smaller rotator cuff tears. For this reason, strength testing is not sensitive for partial-thickness rotator cuff tears or asymptomatic tendinopathy of the rotator cuff.

In external rotation

Testing the strength of the shoulder when in external rotation is another important way to assess rotator cuff function. As with strength testing in abduction, shoulder weakness in external rotation is often, but not always, indicative of rotator cuff pathology.  Strength testing in external rotation is performed by asking the patient to bend the elbows to 90° while keeping them close to the body. It is important that the patient does not lift the arms away from the body because doing so engages the compensatory abductors and other muscles. The examiner then asks the patient to resist an internal rotation force. The test is considered positive if the patient cannot maintain the arm in the starting position.

Tests of the subscapularis tendon

Although full-thickness tears of the subscapularis tendon are not as common as tears of the supraspinatus and infraspinatus tendons, they produce fairly consistent findings on physical examination. Partial tears of the subscapularis tendon are relatively common and often do not result in significant physical impairments. In contrast, complete tears of subscapularis can produce profound weakness of internal rotation of the shoulder. Over the past few decades, clinicians have devised more accurate methods of detecting subscapularis pathology.

Lift-off test

Many believe that the best test for the subscapularis tendon is the lift-off test. To perform this test, the patient places one hand behind the back in the low lumbar region. The patient is then instructed to lift the hand off the back. The procedure is repeated with the opposite hand. The test is considered positive if the patient cannot lift the hand away from the back. A positive test indicates that the subscapularis tendon is probably completely torn from its insertion site on the proximal humerus.

Belly press sign

The belly-press sign is another helpful test for subscapularis function. When performing the test, the patient places the palm of one hand on the abdomen and then brings the elbow forward, away from the body. The patient is then asked to press the hand into the abdomen. The procedure is repeated with the opposite hand. The test is positive when the wrist flexes as the hand is pushed into the abdomen or when there are marked differences between the two extremities. A positive test usually indicates a full-thickness subscapularis tear.

Superior subluxation of the humeral head

In a patient with large rotator cuff tears, shoulder motion can be impaired to the degree that the humeral head may subluxate from the glenoid when the patient attempts to elevate the extremity. In such instances, as the patient attempts to elevate the arm, the head of the humerus slides out of the glenoid and produces a prominence in the anterior and superior aspects of the shoulder. The shoulders in such patients are often extremely weak in abduction and external rotation. Active motion is extremely limited, but a passive range of motion is preserved. This situation is commonly seen in patients for whom surgery for a large rotator cuff tear failed.

Lag signs

Lag signs are shoulder examination tests that are predicated on the observation that the muscles must have a certain amount of strength to hold the arm in one position. When present, these signs typically reflect that either the muscle being tested is extremely weak or the tendon being tested has a very large tear that includes the whole tendon.

External rotation lag sign

The external rotation lag sign indicates a full-thickness, large supraspinatus rotator cuff tear. The test is performed by having the patient position the arm at 15–20° abduction and the elb