© Jamie Chung / trunkarchive.com
March 19, 2023
Robert Emich
A little carelessness, a bit of overconfidence, an unfortunate step. Most sports injuries could be avoided if not for human folly. A discussion about Runner's Knee, tennis elbow, & more.
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There is probably hardly any sports injury that Prof. Dr. Andreas Imhoff, the former medical director of the Department of Sports Orthopedics at the Rechts der Isar Hospital in Munich, has not already seen. Photos and framed jerseys with thank-you notes from famous athletes adorn the hallway to his office. But not only Schweinsteiger, Klose, Boateng & Co have been and continue to be successfully treated here.
Whether shoulder or ankle, knee, elbow or hip, amateur athletes are also treated with high competence in the only German-speaking university clinic for sports orthopedics, which the Swiss native began to establish more than 25 years ago. And this is not only due to the team's expertise, but also to its "sportsmanship."
Professor Imhoff, what are the most common sports-related orthopedic ailments or injuries?
This is, of course, highly seasonal for us. In winter, these are mainly ski injuries due to falls. But also due to collisions, which have increased significantly in recent years, primarily because the slopes are better prepared. Many people ski much too fast today, beyond their means, and do not think about braking. The result is severe injuries to the head, pelvis, and spine. The classic fibula fracture or twisted knee has become rarer because the equipment has become much better.
And the classic ACL tear?
It still occurs very often, especially when skiing off-piste. This often happens because people are not so well trained. Interestingly, most ACL injuries occur during slow skiing, such as getting off the lift or during very slow turning movements. If the corresponding muscles are missing, pure gravitational forces act, tearing the ligament, but it can also lead to injuries to the meniscus or cartilage.
Older people, for example, often injure themselves surprisingly while cross-country skiing. They say to themselves, "I am not as steady on skis anymore, so I'll do a bit of cross-country skiing now." But due to lack of preparatory training, they fall and injure themselves even then.
Many probably also think that they no longer need as much stamina as they might have in the past, thanks to better equipment.
Yes, that certainly adds up. If you do almost nothing all year and then hit the slopes with the kids – that's the typical case, the 35- or 40-year-old mother or father with two little ones, because the weather is so nice – some quickly reach their limits.
And in summer – where do the greatest risks of injury lurk?
In terms of numbers, it's primarily soccer, of course.
Even in amateur areas?
Especially there, less so in the professional area. Again a classic: Saturday evening with colleagues or the company team kicking around a bit, that's the dangerous part. The lack of preparation, the lack of training, just picking up a ball and playing a bit – that's when accidents happen.
What are the common injuries in this regard?
Cruciate ligament. Ankle sprains are also quite common. But these are more for runners and joggers, for example, when you suddenly twist your ankle in the terrain. The Achilles tendon is also at risk, which is more of a concern for tennis players. You make a lunge and then the Achilles tendon tears. Or the hamstring tendon of the back thigh muscles, which are these muscles that start at the top of the buttocks and go to the knee. Just the day before yesterday, we had another case like that: jogging here on the Isar shore, slipping, making a lunge, and then it tears.
It really tears off?
Yes, these are two finger-width tendons. We have a few patients every week. In a way, you could call it a luxury problem. Older people – we’re talking about 45 and up – want to be active and play sports. Sometimes something tears that wouldn’t tear in a 20-year-old. Many of these tendon tears are degenerative. So slow tears. Just like fabric, the material gradually becomes brittle and can tear if the movement is a bit stronger.
Is there any prevention against this degenerative porosity or do you have to accept it as you get older?
A good question. Of course, we want to stay young, but unfortunately, our tissue just gets older, you can already see that on the skin – it’s no longer as elastic, it gets wrinkles. And that’s how it is with the tissue in the body. The tendons become more and more brittle and are then more prone to injury. There is already a cure – but healing is always a repair. If you have a scar, it remains a scar. That sounds very negative now, but you can do something about it by staying flexible and doing sports. Even a low level is good. Because if you don’t move at all, the muscles atrophy. Then the tendons don’t renew either.
Another classic: The so-called tennis elbow is also quite common, right?
Yes, you could write a whole chapter about it! Tennis elbow is something special because all the extensor muscles of the upper arm go to this one point on the elbow. This happens because when playing tennis, or even at a desk with a computer mouse, all these muscles are relatively asymmetrically under tension. So it's an overload on one point that leads to micro-tears and chronic inflammation of the tendon attachment.
This is common in tennis players, but ultimately it also occurs in many monotonous jobs. On the inside, it has been named golfer's elbow because golfers make these repetitive movements. Basically the same problem: Large muscle groups converge at one point. We have such pinpoint overloads at the shoulder, knee - and everywhere they have special names, for example, it's called runner's knee at the knee.
Although you very rarely hear of professional tennis players having tennis elbow.
Yes, that's true. A very important point, because it can also be treated prophylactically, for example through stretching exercises. There are even specific apps for this now.
Do you have the impression that sports injuries have increased or rather decreased?
I think they have increased because many more people play sports today. When I think of my parents – they went skiing and did a bit of hiking, but otherwise did nothing. Today it's almost like a trend to do a lot of sports. Every weekend on a mountain, every day in the gym... The extent of this can also be seen in the enormous growth of the sporting goods industry.
Isn't it also true that people sometimes take on too much due to the improvement of materials, but also because of the supposed role model effect in social media?
Yes, that's absolutely right. But I also believe that we're dealing with something deeply human. Everyone tries to do what they can. People just try to explore the limits – what's possible? Just now the cycling season has begun again – road cycling and mountain biking – and now the number of accidents is increasing again. Especially with e-mountain bikers, we have a new group of patients.
In what way?
Because now older people are also getting up the mountains with them. These are usually rather unathletic people who wouldn't have dared to do this before because they would have had to pedal up with their own pure muscle power. Going up isn't the problem, but coming down uninjured is. Such an e-bike weighs 25 kilograms, and controlling it and especially braking in time on off-road terrain is not easy. Falls with sometimes serious injuries are the result.
Is there actually a general difference between the genders when it comes to sports injuries?
Good keyword. Women's football is, for example, much more dangerous in terms of injury risk than men's football. This is due to a small anatomical difference, a kind of bottleneck in the female knee joint. This is responsible for a higher rate of cruciate ligament injuries in women. For me, the most dangerous sports are those with a lot of body contact, like ice hockey, for example. The worst is English or Australian football – direct contact, without any protection.
In American football, the players wear protective vests, pads, helmets, and neck braces, but the British and Australian rugby players wear nothing. There's no player who hasn't been seriously injured at least once. But because so much value is placed on tradition, no one considers changing it. What I find much more worrying is the issue of children's competitive sports.
Where are the dangers?
Especially in the ambition of some parents who push their children to high performance – keyword proxy careers. It's clear that top-level sports today begin in early youth. But children don't know any boundaries, they don't even know what's good and what's less good for them. If an ACL tears in a 10 or 11-year-old, it can of course be repaired. But maybe it would be wise not to continue right away in the same way. Maybe better to wait until the child is fully grown. Some parents don't understand that everything in a child is still softer and more deformable, the growth plates are still open. This lays the foundation for later irreparable joint damage.
