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| Dr. Denis Bourke on Injury: | |
| Advice (I wished I had followed myself) for handling squash injuries |
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| By Dr. Denis L Bourke © 2004 , Baltimore MD 1.20.1999
You
just injured yourself playing squash! Should
you keep playing or stop? Do you need a doctor?
Maybe you are
at an out of town tournament or you do not have a regular primary
care physician to get you started. How do you find the right doctor?
How do you find a good doctor? I will try to give you some tips
that may help, but first some advice on how to avoid squash injuries.
PREVENTION
It is worth repeating some simple advice that you have most likely heard in several forms before and (maybe) thought need not apply to you: First,avoid playing with an unhealed injury. The chances are much greater that you will worsen the injury and, if not, at least prolong the recovery. Playing with a partially healed injury invariably throws off your body mechanics and increases the chances of an injury elsewhere. Second, always warm up before playing. Use some non-ballistic exercises to warm up. Warming up the lower back, the hamstring group, the groin muscles, and the calf muscles are especially important. The older you are the more important warming up is to prevent injuries as well as play better. For the 30 to 50 year old age group it is particularly important to warm up the calf muscles and Achilles tendon. This age group is at higher risk for Achilles tendon rupture which will cost you six or more months of misery. Third, stretch immediately after playing. That is, immediately after stepping off the court, not after that beer you were thinking about during most of the fifth game. Fourth, avoid too rapid a cool down. Put on some sweat pants and a jacket or get in a warm shower, sauna (best because you can take your beer with you), steam room, whirlpool, etc. Lastly, if you have an area that is frequently sore or repeatedly injured use the exercise machines to isolate and strengthen the muscle or muscles around the area. Get the advice of a qualified trainer if possible. Although there are no squash specific controlled studies to prove it, proper eye protection seem intuitively sensible. ATTENTION
FOR YOUR INJURY
OK, now you been injured. If you are like me you probably did not follow all the above advice, at least, not all the time. Either way you are going to get an injury some time or other. Before we start looking for our doctor, what should we do immediately. Injuries fall into several categories. First, obvious major injuries, say, a broken bone. Go to the emergency room now. Second, head injuries. If there was a loss of consciousness, some amnesia, or anything else peculiar, go to the emergency room now. Third, an injury to or very near the eye, go to the emergency room now and demand to be seen by an ophthalmologist. Fourth, you have broken the skin, a cut or laceration. Rinse the cut with plenty of water and wash it with soap or if an antiseptic is available use that. Cover the wound with a clean (sterile if possible) dressing. Generally, if the skin edges are more than an eighth of an inch apart sutures may be required otherwise steri-strips will do the job. The most common athletic injuries, however, are muscle, tendon, and ligament strains, tears, or ruptures. First aid can be critical in preventing complications or a prolonged recovery. For virtually all of these problems stop playing and apply ice immediately. Ice on for fifteen minutes off for five and repeat for one hour at least, two if possible. You want to prevent or minimize the swelling and inflammation that initiates the cycle of irritation, spasm, more inflammation and swelling, etc. Although some physicians would disagree, if there does not appear to be a major muscle rupture, I would take a nonsteroidal anti-inflammatory immediately to further interrupt the inflammation-irritation-spasm-inflammation cycle. FINDING A GOOD DOCTOREither you had a obviously serious injury or it is not getting better after a few days and you need a doctor. For most of these injuries an orthopedic surgeon is your best bet. Try to find one that has an interest in or specializes is sports medicine. Usually you can get a recommendation from another squash player or someone you know who has had a good experience with an orthopod. Be careful about recommendations suggesting a physician is good since he is the hospital department chairman. In most community hospitals, chairmanship is a political popularity contest and may have little to do with the quality of clinical care. In academic hospitals the dean picks chairmen based on organizational and administrative abilities and most importantly the ability to bring in research dollars - seldom is clinical acumen a major factor. Some chairmen are excellent physicians, but the former does not guarantee the latter. Also, check around before accepting a referral from your regular doctor. Especially in private practice, physicians tend to refer their patients to other physicians who they like or who they know will refer patients back to them. It is often simply a matter of survival in a very competitive business. Look for someone in the 40 to 60 age group. You want someone who is up on the latest techniques and treatments and who has some experience under his belt. Unless it is obvious you need surgery, the physician who advocates an initial trial of conservative therapy is probably your better choice. DIGGING FURTHER TO GET THE SPECIALIST YOU NEEDIf you have not had any luck with the above recommendations or referrals or you are not completely confident about the doctor you are seeing, there is another way to find a good physician. Who knows who the best physicians are? Most practicing physicians do not have the opportunity to actually observe other physicians in practice. They tend to base their opinions on various hearsay evidence and particularly on patient satisfaction. If patients are happy with the referral physician, the referring physician will tend to have a higher opinion and continue to send patients to the physician. However, patient satisfaction does not always translate to quality of care. Patients tend to be satisfied with doctors they like for whatever reason (his manner, his patience, his looks, his nurse, his fashionable waiting room, etc.) By and large patients are unsophisticated about the doctors actual knowledge and skill. The following technique will usually find one of the best specialists in the area. It works for any specialty, not just for finding the best sports medicine orthopod. Call the local teaching hospital and ask to speak to the chief orthopedic resident. Explain your problem and ask who he/she would recommend. The chief resident has been studying/practicing the specialty for four or five years and therefore is qualified and knowledgeable. During his residency he has been exposed to many or most of the local specialists. While in training he actually works day-to-day with the specialists; he can compare them. He knows who is up to date, who is knowledgeable, who is thoughtful, who is conscientious and who has the best technical skills. His information is first-hand and current. The chief resident will be finishing his training in a few months and going on in to practice, as often as not in some other locality. There is little incentive for him to recommend anyone but the person he actually thinks is the best. This is the technique I have used for myself on more than one occasion. I have not always gotten the most personable or likeable doctor, but in the end I have always felt that I have found one of the most knowledgeable and skilled specialists in the area. [ About the author ] |
