Post- ACL reconstruction with OA 12 years later

It's often not possible to prevent osteoarthritis from developing in the operated knee after more than a decade of the Anterior cruciate ligament reconstruction. This active gentleman who regularly trains and keeps his lower limb muscles in shape and runs on the pitch often came by asking what he could do as his knee did not feel much difference despite doing a recent Hyaluronic acid injection (high molecular weight) 2 months ago. 

Thankfully, he did not have much joint effusion but a quick ultrasound of the knee joint revealed multiple osteophytes in between the kneecap and the femur, and slightly fewer osteophytes with narrowing of the inner joint space (medial). He did not want to pursue a surgical 'clean-up' offered by his surgeon yet. We then embarked on a 15 minute session identifying the painful lesions and using the osteophyte breaking effect of focal shockwave where is was causing impingement. 

He survived the session and felt relief when it felt that his affected knee felt lighter and was able to squat and lunge with much ease. I informed him that he would need to still avoid high impact training and running on tar roads. I will see him again and review his response to make sure he allows time for the joint to heal with proper rehabilitation. He will still see his surgeon for follow-up if he is not better, but perhaps a little later. 

Foot bone contusion

 Getting a collision of the foot isn't a great thing to have. This chap limped in to see me with a slight swelling on his left foot. He thought it was fine as he was able to jog 6km in his sports shoes. However, he was concerned that he wasn't able to play football. His initial X-rays ruled out a fracture and the ultrasound scan ruled out tendon involvement. (One may resort to do an MRI if there is a high index of suspicion of a stress fracture especially if he has prodromal pain). We resorted to focal shockwave to sort out any bone oedema. He felt much better and was hopeful to play soon. Whatever it is, he would still need to have full pain-free function to execute all the football skills when he goes back to sports specific rehabilitation next week. 

Acromioclavicular Joint Arthrosis

 Had a young player come by with Right shoulder pain and restriction of overhead movement recently. His main complaint was he couldn't scratch his back unlike previously. Apparently he slept wrongly and woke up with the pain the next day. He had a Diclofenac sodium injection (Non-steroidal Anti-Inflammatory Drug) from a local doctor and felt better. However, there was some residual pain which lasted for 2 months. He was still able to play competitively but needed kinesiotaping. 

We did an ultrasound scan to find out that the had sclerotic changes and bursitis at his Right Acromioclavicular joint. Upon discussing the options of treatment, he decided that he would try focal shockwave treatment instead of intra-articular corticosteroid injection. 

 He left without the kinesiotape and with the possibility of full overhead movement and was able to scratch his back. Will see him again after 2 weeks to see how he is, but it will be highly unlikely that he will need another treatment so soon. 

Challenging injuries and chronic pain in professional footballers - is there a way out?

 As I was preparing for my talk for the AFC Medical Conference, I had the opportunity to get the help of a fellow researcher and statistician from Aspetar to evaluate the data of my shockwave work in footballers. We realised that some footballers do suffer from nagging injuries which lingered on after months. Some of them continue to play but some may seek regular recovery work or rehabilitation with their medical team. Being inside and outside of the dressing room where the players prepare, it is clear that at times they would prefer to have these problems sorted out. 

From 2015-2024, we noted that such footballers were referred with the following injuries for focal shockwave therapy. These injuries include Achilles tendinopathy, ankle impingement, knee focal cartilage defect, plantar fasciopathy, patella tendinopathy and foot fracture / stress injury. Details of the findings will be available in the lecture "Pursuit for return to play with focal shockwave in challenging football injuries" on 23rd July 2025.  

Starting Heart Screening as early as 12 years in football

 FIFA recommends youth football players to be screened for risks of developing "Sudden Cardiac Death" from as early as 12 years old. This is vital if the player has a history of heart symptoms like chest pain, palpitation, collapse or unexplained fainting, breathlessness and / or family history of  sudden cardiac death, collapse or unexplained seizure or fainting, or inherited heart disease. If you or your child or player is participating in competitive football, it is vital for him / her to undergo cardiac screening before participating in football. Please check with the local club / football association / hospital.   

See the following recommendations for cardiac screening with your medical practitioner / cardiologist including taking personal and family history, general physical examination (rule out Marfan's syndrome), resting Blood pressure, auscultation of the heart for abnormal murmurs. 

It is vital for all training or competition grounds to have an Emergency Action Plan involving trained medical staff or volunteers with ready access of an Automated External Defibrillators (AED). This will make a huge difference in terms of survival if a player collapses during training or match on the pitch due to sudden cardiac arrest. You may speak to your football association, host or competition organiser to ensure this. 

Read more about it here. *The author believes it is the concerted effort and responsibility of every parent, player, coach, official, medical staff, organising committee to ensure player preparticipation evaluation, training for medical staff and volunteers, and a working accessible AED during training / competition*  

Shoulder myofascial pain syndrome

Ever though that computer bag is just too heavy? You might just be right. 

Had a chap walk in to relieve his misery which had been troubling him for a few days. We looked at his posture and he had a lower affected painful shoulder with an elevated other shoulder. The movements of both shoulders were not well coordinated. 

He felt some pain doing shoulder shrugs and retraction. He had pain on palpation of his trapezius and levator scapula. He was started on physiotherapy and underwent focal shockwave with joint mobilisation. 

He was given the advice to carry his bag on both shoulders, resume rhomboid and trapezius strengthening along with regular stretching exercises. Will see him again soon to review his progress. 

Plantar fasciitis in 2025

Patients (even athletes) often come with heel pain (see photo), getting out of bed just as they start walking or after getting up from prolonged sitting. Walking barefoot makes things worse and going into a pair of comfortable shoes 👟 with a heel cushion or heel lift helps. I've had this on several occasions myself, but got better after doing frequent calf raises.

 

Sports medicine physicians have started to diagnose this both with physical examination and imaging (X-ray and Ultrasound scan) for better clarity. 

Clinically, the patient may have palpation pain at the bottom of the heel (inner part more common), and occasionally also at the back of the heel (Achilles tendon). The doctor would often examine the whole plantar fascia and calf for other signs of stiffness and pain. 

A quick prescription of silicone heel cup and taping by your physiotherapist would work wonders along with calf stretching and strengthening exercises. If pain persists, you could see your doctor who could prescribe further exercises, shockwave therapy or a local Platelet rich plasma or corticosteroid injection. You may seek further evaluation with your foot and ankle surgeon if 6-12 weeks of supervised physiotherapy does not resolve the pain. 

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. 
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Biceps partial tear

A bodybuilder felt a snap in his biceps muscle while doing his upper body workout in the gym. He immediately felt a sharp pain and weakness in the arm adjacent to the elbow. He discontinued his training session for the day.

A day after the incident, he could not extend his elbow fully and had pain at the myotendinous junction of the biceps muscle. The was a noticeable defect in the muscle compared to the other side. He was advised rest from upper limb exercises and RICE treatment was given. Kinesiotape was applied to prevent elbow extension.

A week after the incident, there was significant bruising seen and the pain had mostly subsided. He was still advised against full extension of his elbow.

At day 10 post-injury, there was some bruising as the athlete started some minimal biceps curled in flexion. He was advised to do just isometric exercises and ice after exercises.

At 14 days post-injury, the site of injury was pain-free and he had full range of motion. He required careful monitored strengthening of the upper limb for at least 4 t0 6 weeks while protecting the biceps muscle.

2011 Prohibited List (mobile) - World Anti-Doping Agency

2011 Prohibited List (mobile) - World Anti-Doping Agency has been available since 1st September 2010. Both athletes and coaches should be aware of the various subtances prohibited by sports which could still be inadvertently used by some ignorant medical personnel, personal trainers and nutritionists. One should also be aware of Therapeutic Use Exemption and Monitoring Programme. ADAMS continue to play a major role in the coordinating the athletes data via Athlete Whereabouts notification which has been made available on SMS in US, France and UK.

If you are savvy in social media, you may find some useful interaction on facebook, twitter or youtube.

Downloads of the Prohibited list, Monitoring Program, Summary of Modifications and Explanatory Notes.

Slipping Rib Syndrome (12th Rib Syndrome)

This basketballer suffered from loin pain at the tip of the Right 12th rib and along the 11th intercostal space after feeling at 'pull' during competition. The pain persisted despite taking oral NSAIDS but reduced slightly with ice application. Similar injuries have been seen previously in martial arts, dancers, boxers and swimmers.

We ruled out fracture by clinical examination and X-rays and progressed to do some PNF stretching and strengthening exercises. An ultrasound scan was not done as we did not suspect a torn muscle. His symptoms subsided significantly after the first visit and was resolved within the next 2 weeks. He was told to strengthen his intercostal muscles and oblique abdominal muscles with rotary torso and stomach crunch exercises. Kinesiotaping was applied to provide a controlled lateral rotation and back extension while reducing pain.

Read articles in swimmers and non-athletes.

Plantar Fascia Rupture

This gentleman suddenly felt a snap followed by sharp pain in the hindfoot (medial tubercle of calcaneus) while playing badminton. He could only place his weight on his forefoot and had to use a pair of crutches to walk.

He was diagnosed with a partially ruptured plantar aponeurosis and told to use a pair of running shoes with a silicone gel pad. However, he was not allowed to bear weight due to the severe pain. His X-rays did not indicate any signs of fracture of the calcaneus.

After vigourous RICE treatment over the next few days and the use of oral Cox-2 inhibitor, the pain reduced significantly and he was able to walk with less pain. He was treated with ultrasound for several sessions and started with toe and foot exercises. We encouraged him to go into the swimming pool for hydrotherapy to maintain his aerobic fitness. He would require at least another 2 to 4 weeks before he can return to training.

Singapore 2010 Youth Olympic Games

The Singapore 2010 Youth Olympic Games will be held on the 14 August 2010 - 26 August 2010 in 17 competition venues in Singapore.

Participants: 3,600 young athletes between 14 - 18 years of age, 5,000 young athletes and officials.

The organisational aspect: 205 National Olympic Committees, 1,200 media representatives, 20,000 local and international volunteers and 370,000 spectators.

Highlights: 26 sports and culture & education programmes. You can find out who the athletes are here and keep updated with the results. Also join in the Celebration at Marina Bay.

If you are interested to get some exciting and fun-filled moments, get your tickets and be there early!

National Basketball League 2010

Here are some photos of basketball injuries taken by the press (Lim Chee Sen) during the National Basketball league 2010. Most of the tournament was covered by St John's Ambulance or Red Crescent volunteers with ambulances on standby for emergencies.

Another player twisted his ankle after accidentally tripping over another player's foot. He was back to play the semifinals after vigorous physiotherapy and rehabilitation exercises.

This player suffered from a scalp laceration after jumping over another player and suffered from a scalp laceration from the elbow of the player. He had a 2.5 cm scalp laceration which had to be sutured at a local hospital. The coach ensured that untrained personnel were not allowed to intervene until the doctor arrived to ensure that there were no cervical spine (neck) injuries.

Laceration wounds seen just adjacent to the eyebrows due to accidental elbow defensive manouvre. Apply pressure to the wound immediately with sterile gauze to control bleeding of the wound. Once the wound stops bleeding apply an adhesive plaster to hold the edges of the laceration and send the player to the doctor.



Player caught in an awkward position during a challenge by opposing player. He suffered from a lateral ligament complex ankle sprain and was duly iced to prevent swelling and reduce pain. Keep ankle elevated while icing it and ensure that he is examined by his team doctor as soon as possible.


You can read more about the event here.

Muay Thai thumb sprain

An elite Muay Thai fighter came with a swollen and painful thumb after hurting his thumb when he accidentally hit the side the head of his opponent during a professional bout. Treated it aggressively with RICE therapy, electrotherapy and rehabilitation exercises and he returned to fight again in 2 weeks duration. He had a protective taping for the fight and managed well.