Welcome home to Selangor FC - RGMC!

 A big welcome back to all readers of 'old-school' blogging! I've reclaimed this blog after more than a decade and decided to provide some lasting input on sports and musculoskeletal injuries.  

From my 13 year journey to the west (Doha, Qatar), I've decided to return home. You will see more about professional football, runners, swimmers, cyclists, musculoskeletal pain syndrome, and my favourite topic, shockwave therapy. Many thanks to Aspetar Hospital, National Sports Institute, National Sports Council, MASM, ISMST, AMSSM, and AFC for providing a platform of development for me. 

A big thank you for the management of Selangor Football Club for providing this avenue to continue to allow me to serve the footballers and members of the public. 

I am now available at RGMC in Section 5, Shah Alam, Selangor. Call us at 016-6251936 for appointments. The set up here has access for diagnostic, focal shockwave, injections, dietician, physiotherapy, strength and conditioning, etc. 
. 
 

When you know you have a Torn ACL? (Part II)

Here's what happens when he tells me that the previous video wasn't clear enough for some to visualise the laxity.

When you know you have a Torn ACL?

Here's how a soccer player demonstrates his loose ACL ligament 'without moving a limb'.

Foot contusion from soccer

A recreational soccer player came to me showing off his bruised left foot 2 weeks ago. He told me he was kicked by an opponent and had difficulty sprinting fully although he was a forward.

I examined him and found that he only had slight difficulty toeing-off while running and was able to do resisted ankle dorsiflexion. Besides the RICE treatment, he was given an anti-inflammatory gel e.g. Reparil and 5 days of Cox-2 selective NSAIDS as he has previous history of gastric pain. He was advised him to avoid full sprints and jumps for the next week. If he was to play, he needs to tape his ankle and foot to avoid the full plantarflexion (to allow pain-free range of motion). I expect him to be better within 1 to 2 weeks.

Flexor Carpi Ulnaris tendinopathy in Goalkeeper

Lance (not his real name) is a badminton and futsal athlete who deflected a fast soccer ball during play 10 months ago. He was given a physiotherapy and wrist brace for several months but he could not resume competitive play due to Ulnar-sided wrist pain. He could not palm-off the ball (hyperextended wrist) and do forceful wrist skills (e.g. lob, flick, repetitive jabbing and smashing) with the badminton racquet.

He had tenderness over the Triangular Fibrocartilage Complex (TFCC) and along the Flexor Carpi Ulnaris tendon, pain with wrist hyperextension and resisted flexion of the hyperextended wrist joint. He also had laxity of the Distal Radio-ulna Joint.



He did not want to do further investigations (plain X-rays, Ultrasound scan and possibly an MRI) despite being advised so. We proceeded to teach him how to tape his wrist and forearm to give him a pain-free range of motion while allowing explosive powerful smashes (badminton) and some goalkeeping. He was given some Theraband exercises and proprioceptive exercises using a soccer ball for balance.

I expect him to take at least 6 - 8 weeks to return to normal play. However, if he is keen on competitive soccer, he would require further investigations and possibly, surgery to rectify the TFCC and DRUJ injury.

Interesting links:
TFCC Injuries
Ulnar-sided wrist pain

Right forefoot contusion

Dave played soccer 2 days ago and had slight right forefoot pain during the match but completed the game despite the pain. The pain worsened in the evening and he was given a hot ointment (Methyl Salicylate) by his mother. He faithfully massaged his right foot with the ointment and found that the foot was swollen (the light shade in the picture). He limped into my clinic yesterday and I thought that he had had a fall and or suffered from a stress fracture of one of his metatarsal bones.


He had oedema and tenderness of the softhis 5th metatarsophalangeal joint and both 4th and 5th metatarsal bones.

He was given some RICE treatment, Arnica Comp gel and 5 days of NSAIDS to reduce the swelling and pain. He is expected to get much better and I will review his injury once the swelling subsides over the next 48 hours.



Interesting links:-
Jones Fracture

Ankle Posterior Impingement

Ms Ann (not her real name) is an elite level badminton athlete who came with complaints of pain in the back of both ankles with net-play and jumping smashes since 3 months duration. To her dismay, she still had the pain despite taking a month off from training. These symptoms are also common in gymnasts and dancers who do repeated jumps and en-pointe. Soccer players have been reported to have similar symptoms in literature.

I examined her ankles and found that she had tenderness and bogginess (oedema) of the posterior aspect (back) of her ankle joint (between the Achilles tendon insertion and the calcaneal and talus bones). She had pain when I compressed her hindfoot with her foot plantarflexed (Impingement test). If he jumped repeatedly on the spot, it would give her the same pain. She also had tenderness of her Achilles tendon insertion (Insertional tendinopathy) and associated hindfoot varus.

I have advised her to do some calf stretching with the knees bent slightly and knees straightened. She was also taught to tape her ankle to prevent full plantarflexion. She was planned for an X-ray to rule out Os Trigonum or fracture of the lateral tubercle of Talus. An MRI of the ankle would identify bone bruising, tendon and joint capsule inflammation.

Ultrasound guided corticosteroid has been shown to benefit most athletes with capsule or tendon inflammation. Most of these athletes are symptom free after 2 weeks and return to play within 4 weeks rehabilitation. A selected few with persistent symptoms, os trigonum or a possible nerve entrapment may require arthroscopic surgical intervention.

Find out more about the injury here:-
Posterior Ankle Impingement in Professional Soccer Players: Effectiveness of Sonographically Guided Therapy
MRI features of foot and ankle injuries in ballet dancers

Sudden Deaths in Soccer: Are we doing anything about it?

There is an interesting write up of the series of sudden deaths in soccer by The Star (Malaysia) on Thursday August 30, 2007.

A history of sudden deaths in football

# Aug 28, 2007: Spain and Sevilla defender Antonio Puerta (pic) died on Tuesday following a heart attack, becoming the latest footballer to die suddenly while playing.

# April 11, 2006: Colombian teenager Victor Alfonso Guerrero, 17, died during a training session for the reserve side of Colombian First Division club Envigado FC. He collapsed and lost consciousness, and died on the way to hospital.

# June 25, 2005: Hugo Cunha, a 28-year-old midfielder with Portuguese top flight side Uniao Leiria, died while playing a match with friends. Cunha suffered a heart attack and was unable to be resuscitated by the emergency services.

# Oct 27, 2004: Brazilian Serginho, 30, collapsed during a Brazilian First Division match between his club Sao Caetano and Sao Paulo and later died. His death caused a huge controversy after the autopsy revealed that his heart weighed 600 grams, twice the normal size. Sao Caetano, the club’s president and the doctor were sanctioned by Brazil’s sporting authorities.

# Jan 25, 2004: Benfica’s Hungarian international striker Miklos Feher, 24, collapsed during a Portuguese Premier League match against Vitoria Guimaraes and never regained consciousness. The autopsy revealed he had suffered from a heart malformation.

# June 26, 2003: Cameroon international Marc-Vivien Foe died while playing against Colombia in the semi-final of the Confederations Cup. The Manchester City player collapsed in the centre circle and all efforts to save him failed. An autopsy revealed he had a disorder of his heart’s electrical system.

# December 2002: Macedonian defender Stefan Toleski died of a suspected heart attack. He collapsed halfway through the first half of his side FK Napredok’s league match against Kumanovo and later died in hospital.

# February 2000: John Ikoroma, a 17-year-old Nigerian youth international, suffered a heart attack during a friendly in the United Arab Emirates. He was in a trial match for Al-Wahda against Kazakh club Astona when he collapsed 20 minutes before the final whistle. He died in hospital.

# 1997: Emmanuel Awanegbo, a Nigerian playing in Germany, died after only 12 minutes of play. The death was attributed to cardiac arrest.

# 1995: Amir Angwe, 29, a striker for the Julius Berger Club of Nigeria, collapsed a minute before the end of an African Cup Winners’ Cup semi-final match with Maxaquene of Mozambique. Doctors believe he died of a heart attack.

# 1989: Nigerian international Samuel Okwaraji, who had signed as a professional for AS Roma in Italy after stopping his university studies in Rome, died during a World Cup qualifier between the Super Eagles and Angola.

This is a reminder to all who conduct sporting competition that efforts are needed to prevent the occurence of sudden deaths in elite athletes. Although elite athletes are routinely screened for medical conditions, some are done without exercise stress test. Some have in the past linked such deaths to fatigue, severe dehydration, doping, alcohol and illicit drugs. In some parts of the world, soccer and field hockey tournaments are still held without cardiac resuscitation equipment to give some hope of saving the athlete in the event of sudden cardiac arrest.

What are we doing to prevent sudden cardiac deaths in our sport?

Left Thumb Contusion and Fracture

Ahmed is a recreational volleyball and soccer goalkeeper at the club level. He accidentally hit the ball trying to save it yesterday and the injury caused severe pain and swelling of the distal part of his thumb.

He came with his painful swollen thumb (despite RICE treatment the previous day) and it was really tender and bruised at the tip and base of distal phalanx. There was a small hematoma in the finger pulp. His thumb movements were still intact.








His plain X-rays showed a minute fracture fragment of the base of the distal phalanx and a non-displaced fracture of the tip. An ultrasound of his finger tendons may be required if he had a suspected extensor tendon rupture. I placed his finger in a splint and advised him to return in 2 weeks.

Champion Youth Cup - Malaysia 2007

The Champions Youth Cup 2007 kicks off on the 8th August 2007 with 16 youth teams of the world’s greatest clubs at 4 different venues (Alor Setar, Kuantan, Melaka, Kuching).

The Under 19 age group tournament and aims to:

* Offer football a fresh and unique spectacle.
* Offer the next generation of stars an opportunity to compete against each other.
* Demonstrate their commitment to youth and to the development of the stars of tomorrow.
* Support the communities that have supported them and assist the development of football in Asia.

12 teams are from European, 2 teams from South America, the hosts, Malaysia and a host invitee team from Asia.

The tournament will take place in a league/knock-out cup format with a total of 34 matches over 10 match days. The 2007 preliminary rounds take place between the 8th and 13th August 2007, Quarterfinals are from 14th to 15th August 2007, Semifinals on the 17th August 2007 and the finals on the 19th August 2007.

See you there!!!

Champions Youth Cup 2007
Match Fixtures
Ticket Booking
Shop

Hamstring Strain

Raju (not his real name) is an ex-International hockey player who suddenly suffered from a sharp pain in the back of his right thigh while sprinting towards the 'D'. He thought that it was just a muscle cramp and wanted to play. I ran on the pitch and took him off. He tried to stretch himself but he could not due to the pain. He refused to be strapped and wanted to go into play again but he could hardly straighten his leg.

I quickly iced his hamstring and wrapped it with crepe bandage. After 10 minutes, I reviewed the injury and found that he could hardly lift leg against gravity. Upon palpation, I found out that he had a deep tenderness along the sides of the semimembranosus tendon (musculotendinous junction).

He was advised to obtain an Ultrasound scan to determine the extent of damage (partial tear). He was advised to continue RICE treatment and asked to continue treatment of his Sacroiliac Joint Dysfunction. We also advised him to warm-up, stretch and drink-up (rehydrate with sports drinks or water) adequately.

It should take him at least 6 - 8 weeks to recover adequately with rehabilitation exercises. However, he would be reviewed every 2 weekly do assess his progress. He would also require a fitness test before return to sport.

Flexor Hallucis Longus (FHL) Partial Rupture

Samson (not his real name) is a club soccer player who felt a sharp pain his right ankle injury during competition last Saturday. He felt pain in the inner aspect of the right ankle and could not 'push-off' to run or sprint after that. He used RICE treatment immediately after injury. The next morning he noticed a bluish discolouration of his hindfoot (see photo) due to dependent hematoma.

He saw me 2 days later and I had him dorsiflex his ankle and curl his toes downward against resistance (to strecth his FHL tendon). He grimaced in pain. He also had pain doing heel-lifts. I suspected a mild strain of his Tibialis Posterior tendon too.

He was seen by an experienced physiotherapist who told him he would be 'out-of-action' for at least a month. I told him that could be accurate but encouraged him to do some isometric exercises (without pain) and keep his fitness level by doing some aqua-jogging. He was prescribed some theraband resistance exercises and told to follow-up with his physiotherapist for electrotherapy.

For most practical purposes, he would need an ultrasound to evaluate the extent of the FHL partial rupture. Tendon partial ruptures may often require at least 12 weeks rehabilitation exercise followed by progressive return to play.

Leg Contusion after kick!

A futsal player came in walking this morning. He showed me his swollen right leg and I thought it was just a contusion (soft tissue injury). He was able to do heel-raises and even hop on the injured leg!

After careful examination, I found a defect in his right tibial bone (as he received the kick from the midline outward). I took a marker to delineate the defect (see picture). I gave him some NSAIDS, Arnica Comp gel and told him to apply RICE treatment. He was also sent for an X-ray but it came back normal. He was told to return for a review in 1 week's duration.

He should have been wearing his shin guard!

Champions Youth Cup Malaysia 2007

16th March 2007 – 14 of the world’s greatest football clubs will play in a single tournament and all in one place – when Malaysia hosts the Champions Youth Cup Malaysia 2007 from 5th to 19th, August 2007. The inaugural event is supported by the Ministry of Youth and Sports, the Ministry of Tourism and is backed by the FA of Malaysia (FAM).

Four groups of four teams will play round robin matches in Alor Star, Kuantan, Melaka and Kuching with the knockout stages and the final to be held in Kuala Lumpur.

“The tournament shows that Malaysia matters to these clubs – a two weeks football festival of the world’s greatest clubs, the world’s finest young players and 34 matches across seven venues,” said Jonatan Price, chairman of UK-based Gifted Group Limited.

“The clubs make a huge investment in these players through their academy structures and Malaysians will enjoy a very special privilege because for the first ever, these clubs will be introducing their next generation of stars to a world wide television audience as a prelude to them playing in the Champions League and the Copa Libertadores.”

Among the more notable players to have matured from the various development programmes of these clubs are Franz Beckenbauer (Bayern Munich), Johan Cruyff (Ajax Amsterdam), Zico (Flamengo) and Lionel Messi (Barcelona).

In the meantime Datuk Azalina Othman Said, the Minister for Youth and Sports said that the organisation of the Champions Youth Cup Malaysia 2007 is subjected to the approval from FIFA as well as the Asian Football Confederation (AFC).

The official draw for the tournament will be held in Malaysia on 19th April, 2007.

THE PARTICIPATING TEAMS

AC Milan (Italy),Ajax Amsterdam (Holland),Arsenal (England),Boca Juniors (Argentina),Barcelona (Spain),Bayern Munich (Germany),Chelsea (England),Flamengo (Brazil),Juventus (Italy),Inter Milan (Italy),MALAYSIA,Manchester United (England),Paris St. Germain (France),PSV Eindhoven (Holland),Porto (Portugal),Qatar,(adapted from FAM website);

We want to hear your comments and your support for this affair! I have enclosed the official website for further information. You may also find more information about tourism in Malaysia at Tourism Malaysia. Join us to make this championship a success.