Guernsey’s top sporting injuries

Here’s his top five of the sporting injuries that islanders have come to him with since he set up the Orthopaedic & sports injury clinic at the MSG almost two years ago  

Jim says, ‘If you get an injury, early assessment and diagnosis is paramount to ensure quick recovery and a return to sport. This could be just a physical assessment by a sports injury specialist, or it include imaging, from x-ray, ultrasound, CT or MRI, all of which can be arranged at the first appointment. 

‘Avoiding injuries is about keeping yourself fit to participate in the sport you enjoy, rather than using the sport to keep fit. This doesn’t mean you have to go to a gym, but keeping your muscles strong has been shown to prolong activities (and quality of life) as we get older and reduces the risk of injury. This could be through simply enjoying walks or cycling or taking part in Pilates or yoga classes.’ 

1 - Shoulder injuries typically from swimming (especially sea swimming), padel, tennis and badminton 

These tend to be due to overuse of your rotator cuff or biceps tendon which causes either impingement, or pain from the ACJ (the acromio-clavicular joint). 

Impingement – you’re likely to feel pain radiating from your shoulder to the outside or front of your upper arm and pain on overhead movements. Impingement can be due to the outside rotator cuff muscles rubbing under your shoulder blade or irritation of the biceps tendon at the front of your shoulder – this can also cause a “flicking” sensation if the biceps attachment into the shoulder joint itself is damaged. 

ACJ – you’re more likely to feel pain on top of your shoulder where the collar bone meets the shoulder blade. Altered shoulder blade control causes rubbing of the two joint surfaces against each other. 

Sometimes the two conditions can give the same painful symptoms, but treatment for the two is completely different, so an accurate, early diagnosis is important. 

2 - Shoulder injuries that are not dealt with early or are caused by contact sports such as rugby and martial arts  

For these, you’re likely to feel pain in the front, back or on top of your shoulder towards your neck. This is due to your rotator cuff losing control of your upper arm in the socket, so when you move your arm, it presses against the biceps tendon at the front, causing pain. 

Moving your upper arm forward causes everything at the back of your shoulder to be stretched forward, so trying to take your arm back behind you pinches the soft tissue at the back of your shoulder causing that pain. 

All this causes you to move your shoulder differently to still achieve higher ranges of movement. You then get overuse of the neck muscles that help to lift the shoulder blade, causing the pain on the top of the shoulder closer to the neck. This muscle overactivity can cause headaches if not treated early. 

3 - Ankle injuries common in all sports where you jump and land, twist, or change direction. 

These are commonly treated with balance and simple strength exercises, but this can lead to recurrent injuries, often going over on your ankle again, because full movement of the joint between the ankle and heel bone has not been restored.  

If you lose the ability for the heel bone to move outwards when your foot hits the ground, if you land more to the outside of the foot, you have no choice but for the ankle to roll inwards, spraining it again.  

Ensuring you regain the movement of this joint in the early phases of the injury greatly reduces the risk of repeat injuries and is less painful when you return to sport. 

4 - Cartilage (meniscal) injuries in the knee  

There are two types:  

Acute injury, normally from twisting the knee, so most sports where you jump and land, twist or change direction. Tears to the cartilage cause pain and limit the movement of your knee. Early diagnosis is important if surgery needs to be considered. 

Degenerate tears to the cartilage. The cartilage pads (menisci) dry out as we get older (past mid-20s!). Constant impact makes them susceptible to small tears within the pad itself. This is more common in sports such as padel, tennis, badminton and running. They generally settle with time, but this can take six months and can be very painful in the short term. Early diagnosis is very important, in case surgery needs to be considered. Normally, if very painful, or taking time to settle, a guided steroid injection over the pad at the site of the tear settles the pain, making the rehab easier and speeding up your return to sport. 

5 - Knee ligament injuries – common in most sports involving rotation and change of direction.  

The two most common ones are:  

Inside (medial) knee ligament. The medial ligament is damaged when your knee is forced inwards while your foot is still in contact with the floor. The ligament has a good blood supply and most tears will heal with time. Severe tears may need bracing, so early diagnosis is important to avoid a permanently lax ligament.  

Complete ruptures normally need surgery. The deep fibres of the medial ligament attach to the inside cartilage pad, so a deep ligament tear can also damage the cartilage pad, hence the need for an accurate early diagnosis. If undiagnosed, knee pain often does not settle by itself and may need a guided injection or surgery. 

The ACL (anterior cruciate ligament) in the middle of the knee is normally damaged when your knee buckles. The knee often swells within the hour because the blood vessel that goes through the ACL ruptures, bleeding into the joint. As your knee buckles, it can also damage the medial ligament and the medial cartilage pad.  

In rare cases, the outside of the bottom part of the knee joint can fracture. More often there is just bruising into the bone. It is advisable to allow this to settle before any surgery, giving you time to start on early balance and strengthening, which is important to speed post-surgery recovery. The ACL has a lot of sensors that help to provide stability to the knee, and they will be damaged along with the ligament. Balance training is very important in providing early stability to the knee and avoiding further damage.  

Even at elite, professional levels, recovery from an ACL reconstruction takes at least six months. Recreational athletes tend to need 12 to 18 months. The key to a speedy recovery is doing the right exercises at the right time. So, although after the first six to eight weeks following surgery most treatment is exercise-based, you need regular supervision of the correct progressions at the right time.