In this week’s Get Fit segment we get expert advice about a variety of sports-related injuries like pulled hamstring, anxiety disorders and knee pains

Q: I am 18 years old. Three months ago I started taekwondo training with daily stretching of thigh muscles and flexors. A month ago I pulled my leg straight up my head to show my brother. But due to no warm up, it caused strain in my gracilis muscle or inner thigh just near the pubic bone. If I avoid stretching legs, the pain diminishes but if I do exercise my kicks and stretching, the pain appears again. Can my gracilis muscle be repaired or I will have to discontinue my taekwondo? -Mohammad Ali (Lahore)     

A: Dear Muhammad Ali, the injury you have sustained is called pulled hamstrings. It commonly happens when the muscle fibers are abruptly stretched due to lack of warmup. Gracilis is just one muscle in the whole group of muscles which form the hamstrings. Depending upon the severity it also involves groin muscles and it is very common to get pains near your pubis and hip region. The treatment depends upon the severity of injury. Initial management includes rest, ice, compression, and elevation (known as RICE) along with anti-inflammatory medications and physical therapy. The body repairs the torn tissues in approximately 4 to 6 weeks. Uncommonly it requires a surgical repair. Considering your age it is recommended to get yourself properly evaluated and get proper management so that you can continue with your taekwondo training.

Dr. Muhammad Sufyan

FCPS (Ortho) AO Fellow (Germany), Sports Medicine Fellowship (Singapore)

Assistant Professor | Department of Orthopaedic Surgery

Liaquat National Hospital & Medical College

Q: I am a car rally driver. My age is 39. Each year I participate in Karachi to Chitral rally. Last year, I met an accident and my car was broken and I also sustained a few injuries. With complete rest and with the passage of time, I am fully recovered. Lately when I started driving again, I found out that a certain element of fear grip me and I become hyper, up to a level that I stop the car and ask my co-driver to take the driving seat. Is it an element of fear or I am not fit physically? Need your advice. -Mirza Yaqoob Baig (Karachi)          

A: What you are describing is an anxiety state that is in response to the accident that you were involved in last year. In general terms, it is a fear response to a specific situation, in your case, driving in the rally. It certainly does not mean that you are physically unfit or for that matter mentally weak.

The first step involves a consultation with a psychiatrist. This will help clarify additional symptoms and allow for a formal diagnosis to be made. This will also provide an opportunity to discuss further management with the psychiatrist and a mutually agreed treatment plan. Given the limited information, you are most likely suffering from one of the many anxiety disorders such as Specific Phobia or Panic Disorder. Another diagnosis that is specifically caused by a traumatic incident is Post Traumatic Stress Disorder (PTSD). Again the key is appropriate diagnosis and selecting the correct treatment.

The treatment for most anxiety disorders and PTSD is a combination of medications and psychotherapy. In fact the best results are obtained when medications are combined with therapy. There are many Trauma Focused Cognitive Behavioral therapies for which your doctor will refer you to trained psychologist. These are time-limited, requiring 16-20 hour long sessions. Medications, if needed, will be prescribed by your psychiatrist, and they are quite effective with minimal side-effects. Medications don’t work overnight, and most require 4-6 weeks for full efficacy. The effective medication will need to be continued for at least one year to minimize chance of elapse.

Dr. Mehmood A. Rehman

M.D, Diplomat of American Board

Consultant, Assistant
Professor

Department of Mental Health

Liaquat National Hospital & Medical College

Q: I am 42. I am member of a trekking team, and on every Sunday, we go on hill trekking trip on Margalla. Two week ago while ascending on a hilly track, I started developing a pain in my right knee. After a while the knee joint pain became unbearable and I had to call-off the walk. Since then, while brisk walking, or climbing a flight of stairs, the knee pain exaggerates, making me a kind of ‘disable’ person. Please advice, whether I go to an Orthopedic doctor, or are there any knee-joint specialist I should see? -Asghar Khawaja (Islamabad)

A: It feels great to know we have such an athletic team in Pakistan for such exhaustive sports activity. Climbing uphill requires a lot of energy, stamina and muscle build to achieve success and to attain your goal. In your scenario it looks like exertion and exhaustion and perhaps a patello-femoral problem which is causing you anterior knee pain. You need to consult your Orthopedic Sports Injury doctor to rule out any knee related sports injury and to further assess the reason of this knee pain. He will then advice you accordingly to relieve you from this painful condition.

Dr. Muhammad Kazim Rahim

MD, FCPS (Ortho) AO Fellow (Germany), Sports medicine Fellow (IRI) (France), Hip and Knee Arthroplasty Fellowship (PAS, Pak)

Assistant Professor | Department of Orthopaedic Surgery

Liaquat National Hospital & Medical College

Q: I play football regularly in my college. We have long practice sessions every alternate day. I play on a centre-forward position, and I practice headers to push the ball into goal post. Eighty percent of my time during the practice session is spent taking the ball on my head and guiding it to goal. Lately, I feel that my eye sight is getting weak. It’s becoming difficult for me to read the road sign boards, or the road signs. Is this something to do with my ‘football headers’? A friend of mine told me that I might have hurt some nerve which has something to do with my eye sight. I am 19 years old? -Qamar Khan (Karachi)

A: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease caused by repeated head injuries. CTE often gets worse over time and can result in dementia. Most documented cases have occurred in athletes involved in contact sports such as boxing, American football, professional wrestling, ice hockey, rugby and football. Rates of disease have been found to be about 30% among those with a history of multiple head injuries.

Symptoms include attention deficit hyperactivity disorder confusion, disorientation, dizziness, and headaches. Second-stage symptoms include memory loss, social instability, impulsive behavior, and poor judgment. Third and fourth stages include progressive dementia, movement disorders, hypomimia, speech-impediments, sensory-processing-disorder, tremors, vertigo, deafness, depression and suicidality.

Currently, CTE can only be definitively diagnosed by direct tissue examination after death, including full and immunehisto chemical brain analyses. Abnormal p-tau accumulation in “neurons, astrocytes, and cell processes in an irregular pattern at the depths of the cortical sulci” is the most specific feature of CTE and required for pathological diagnosis.

There is no specific treatment. No cure currently exists for CTE. Treatment is supportive as with other forms of dementia. Those with CTE-related symptoms may receive medication and non medication related treatments.

Prof. Dr. Salman Yousuf Sharif

FRCS (SN), FRCS (Eng)

Head of the Department | Department of Spinal And Neurosurgery

Liaquat National Hospital & Medical College

(All the specialists on our experts’ panel are associated with Liaquat National Hospital. Please send your queries at khalidhraj@gmail.com or Anjum.Rizvi@lnh.edu.pk.)