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.

Tibialis Anterior Ganglion Cyst

Here's a photo of one of the recreational badminton athlete who found that he had a small swelling at the ankle. Upon examination, I found a 2cm X 2cm cystic swelling just before the insertion of the Tibialis Anterior tendon. An ultrasound scan should be done to confirm the findings.

Usually, the cyst is treated conservatively with a corticosteroid injection. Care should be taken to ensure that the tendon is not damaged in the process. Surgical excision may also be carried out. However, such lesions are known to recur.

Lee Chong Wei - Qualifies for Badminton Olympic Finals

Congratulations to Lee Chong Wei and coach Misbun Sidek for achieving the feat of qualifying for the Men's singles for the Beijing 2008 Olympics. He defeated South Korean Lee Hyun-il 21-18, 13-21, 21-13 in the semi-finals Friday at the Beijing University of Technology Gymnasium. Looking forward to see you play again on Sunday, Chong Wei. Malaysia will cheer on for you!

Right Hamstring Partial Tear in Badminton Player

A 37 yrs old male badminton recreational athlete came in last week after injuring his right thigh doing a 'split' while reaching for a net shot from the baseline 2 days earlier. He felt something snap and had pain lifting his thigh. He found it difficult to bend forward to reach for things due to the pain.

He hobbled onto the examination couch in pain. He was only able to flex his hip up to 40 degrees (Straight Leg Raising) and had a defect in the proximal attachment (see photos) of the semitendinosus muscle with a bulge distally. There was tenderness at the distal bulge of the semitendinosus muscle.

I sent him for an X-ray to rule out avulsion fracture and an MRI to assess the extent of the tear and hematoma. He was given Cox-2 Selective NSAIDS for pain and inflammation and advised to undergo RICE treatment regularly. (awaiting MRI films... )

Clinically, he has at least a grade II strain of the Right semitendinosus which would require at least 12 weeks rehabilitation before return to play. He may have difficulty regaining his full agility and power if he is an elite athlete vying for a place to represent the country in international competition.

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

Yonex 2008 All England Badminton Championships

The 98th All England Open Badminton Championships(also known as the 2008 Yonex All England Badminton Championships) will be held between the 4th and 9th March 2008. The prestigious tournament will be held in the the National Indoor Arena, Birmingham. It will be sponsored by Yonex for the 25th consecutive year.

I had the opportunity of joining the Malaysian team in 2000 as their Team Physician for the exciting tournament. Don't forget to catch Live action on Sky Sports or just go there to watch the tournament!

Useful links:
About All England Badminton Championships
Official All England Badminton Competition Website
Time-table
Visitor Information and Weather; Getting there and Maps
Booking online & Discounts
Badminton England website

PROTON MALAYSIA OPEN SUPER SERIES 2008

The Proton Malaysia Open Super Series 2008 will be held from the 15th January to 20th January 2008 featuring the top world ranked players (e.g. Lee Chong Wei, Bao Chunlai, Peter Gade and Taufik Hidayat). Once again the prestigious event will be held in the Putra Stadium, Bukit Jalil, Kuala Lumpur. The Malaysian Open offers a total purse of US$250,000. For the first tine, winners of the men's and women's singles will get an equal prize money of USD15,000 while the men's and women's doubles champions will get US$13,800 each.

The qualifying rounds started on the 15th January 2008 and Championship events started a day later. It would be interesting to see who will feature in the Semifinals (19th January 2008) and Finals(20th January 2008).

It was upsetting for the Chinese that women's singles top seed Xie Xingfang pulled out of the competition due to an elbow injury. Anita Kaur shocked 2005 Sea Games champion Adriyanti Firdasari of Indonesia by defeating her 16-21, 25-23, 21-19. There will be more surprises as the championship progresses.

All the best to the players for this tournament!

Important links:
Seeded Entries
Badminton Association of Malaysia Website: News Updates
Match Schedule and Results
Tickets
Players
BWF Rankings

Extensor Digitorum Brevis Ganglion Cyst

Mr Chin is an ardent 45 yrs old runner who plays badminton occasionally. Since 2 years ago he noticed a swelling on his right midfoot when he runs marathons or plays badminton more frequently. The swelling goes of after several weeks. I examined the swelling and found it to be non-tender, like a fluid-filled sac (cystic) and seem to arise from the fascia covering the Extensor Digitorum Brevis muscle (Inferior Extensor Retinaculum). This chap also has Hallux Valgus.

I told him that he could do an Ultrasound to confirm the diagnoses and a possible X-ray to rule out any bony anomaly which could cause the swelling. He was quite content as the swelling was usually painfree and decided to leave it alone for the time being.

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

PROTON-BWF World Badminton Championships: August 13-19, 2007

Badminton World Federation (BWF)is featuring the world's leading badminton players from China, Indonesia, Malaysia, South Korea, Denmark, England, (all top badminton nations of the world) and other member countries. The tournament will be played by the top 64 players in the world ranking (men's singles, men's doubles, women's singles, women's doubles and mixed doubles).The event would be held at the 15,000 capacity Putra Stadium, Bukit Jalil, Kuala Lumpur.

This tournament is definitely not to be missed!!!

Find out more at the links below:-
Proton-WBF Championships 2007 website
Live Scores
World Ranking

Severe low backache and stiffness

Mr Tan is an ardent badminton player who plays once a week for 1 to 2 hours in the St John's Institution hall (enclosed and no air-conditioning). He came in with severe backache yesterday (a day after playing with younger opponents) and wanted quick pain relief. His back was so stiff (stiffness was worse than the pain) that he had difficulty bending forwards and backwards. I was surprised when he informed me that he does not drink before the match or during the match and he only drinks a small bottle of 500ml after the session! He also never believed in warm-up or cool-down. No wonder he had severe muscle spasm in his both paraspinals and quadratus lumborum.

I gave him 5 days of NSAIDS* and a muscle relaxant injection but told him to rehydrate adequately for the next 48 hours. If symptoms did not improve, I would review his back condition in 3 days. He should try sports drinks e.g. Horley's Replace or Gatorade before, during play and after play to prevent recurrence. Even if you don't feel thirsty, you need to drink up!, I said.





Find out what the experts recommend:-
ACSM Position Stand on Exercise and Fluid Replacement
*US FDA Advisory on NSAIDS use

Achilles Tendinopathy

I remember treating 4 Korean women recreational athletes in the National Sports Institute a few years ago. They used to 'train' harder than some elite athletes often clocking up to 4 hours a day. A few of them suffered from Achilles tendon problems.

I had the opportunity to see another lady who was just as passionate about badminton. Ms Lee (not her real name) came with painful Achillles tendon (see photo) with localised swelling since 1-2 years duration. Her condition worsened over the past few months and she could not play badminton.



I found it rather interesting that she could not do a normal squat and had a thickened tendon an inch above the calcaneal bone attachment. It was certainly tender but more so along the inner side. As I palpated her calf muscles, she had spasm of her medial gastrocnemius causing her much pain stretching her calf muscle (see photo above)

She then told me that she had been playing on her toes thinking that her coach wanted her to literally 'play on her toes'! I was quite concerned that she was receiving various modalities of treatment but failed to undergo proper diagnostic or rehabilitative exercises. She was also an asthmatic on regular Inhaled Corticosteroid therapy provided by the Chest Physician (see Drug Saf, January 2005).

I quickly gave her some topical Arnica Comp gel to relieve the swelling, a mild Cox-2 selective NSAIDS (as she had gastric symptoms and could not tolerate non-specific NSAIDS) and some rehabilitation exercises. The rehabilitation exercises involved calf stretching and strengthening exercises, core stability exercises, hip and gluteal stretching, gluteal and hamstring strengthening and etc. I hope to see some progress in 2 weeks time but she will probably need at least 8-12 weeks before total recovery.

I would probably send her for an Ultrasound scan of her tendon or an MRI if she fails to recover adequately. If she was an elite athlete, she would have been scanned within the next few days to determine the prognosis. The ultrasound may reveal tears and degenerative changes e.g. calclfication.


If she continues to play without proper treatment she may have Achilles tendon rupture (see photo below). I would not recommend local corticosteroid injection for Achilles tendinopathy due to the risks of tendon rupture.

Athletes should also refrain from using Quinolone antibiotics due its toxicity on connective tissue increasing the risk of rupture especially in elderly. Arch Intern Med, August 2003.

Wrist injury in Badminton player (Scapho-lunate Subluxation)

Chris is a 16 years old club badminton player who fell on his right palm 6 weeks ago while playing singles competition. He tried to play in the doubles soon after but couldn't as the wrist started to swell and the pain was unbearable. He was seen by a doctor and his pain was on the ulna styloid. He could not do any lobs and smashing after that as he had pain on the back of the wrist (dorsum).

He did not have any problems with wrist range of movement. "Ouch!", he squealled when I palpated the lunate bone. There seemed to be more mobility of the bone adjacent to the scaphoid bone (see picture). After discussing with him, we decided to do an X-ray to rule out fracture of the lunate bone followed by an Ultrasound or MRI of the Right wrist to rule out scapholunate ligament tear.

Meanwhile, I told him to start pain-free strengthening exercises for his wrist and suggested he tape his wrist during play. He was not to do any 'lobs' and 'smashing' until we obtained the results from his X-rays and MRI.

Rotator-Cuff Injury

Ahmad has been playing for several weeks in preparation for a major badminton competition in 2 months time. His coach wanted him to perfect his skills with multi-shuttle drills involving lobs and smashes. He would be sore in the right shoulder tip after each training session. Moreso after repetitive smashing. His coach asked him to ice after training but yesterday despite icing his shoulder he had persistent pain and his smashes were getting weaker.

I saw him and found out that if he abducts his shoulder (brings his shoulder up on the sides) more than 90 degrees and rotates it backwards, he has some pain. He also has pain in front of his shoulder lifting his arm behing his back. He was able to do the empty can test (where he pushes his abducted shoulder upwards with the thumb pointing downwards)with some pain. Between 1 and 10, the painscore was 5-6.

Our radiology colleague did an ultrasound scan for him showing some inflammation of the rotator cuff and grade I strain of the supraspinatus tendon. He was lucky not to have any impingement demonstrated clinically or on X-rays.

We talked with the player and his coach and decided that he was going to concentrate on his footwork and aerobic fitness for 3 to 4 weeks. He was allowed to do skills without 'overhead' work. Part of his training programme would involve work with theraband and core stability. THe physiotherapist got him to do some 'car-wash' wiping movements diagonally to improve his shoulder proprioception (sense of position and balance).

Within 2 weeks his shoulder was feeling much better and he was able to swing his shoulders without pain. At 4 weeks he regained most of his strength and was able to smash even harder without pain.

Golfer's elbow (medial epicondylitis)

An 18 yrs old club-level badminton player came with the complaints of pain in his left elbow 2 weeks ago. It was during a local competition that he started having some dull aching pain until the final mixed doubles match that he could not tolerate the pain and had to avoid smashing. His coach had warned him that he needed treatment but he complained that the clinic was too far away and needed the sleep instead.

"I told you so", said coach Lim. He did however win the match as they were a better pair. The inner part of the elbow (medial epicondyle) was really sore and the forearm flexors (in front of the arm) was also in spasm. It was as if he had only trained on smashing and nothing else for a week. I wished he did not have 'cubitus valgus' which increased the risk of developing the injuries (cubitus valgus - elbow joint with the forearm turned outward).

Nevertheless, he was quite please after I sent him to the physiotherapist for some 'muscle release'. The following day the anti-inflammatory, muscle relaxants and 2 sessions off training helped relieve the pain and swelling. He could even carry his groceries and start some 'stroke-play'. I cautioned him that if he returned too soon to normal training and failed to complete his rehabilitation exercises he would be back very soon.

rate me on

authorati