This week, our panel of experts answers your queries ranging from hamstring injury to overcoming PTSD.

Q: I am a cricketer. I am 19 years old. Though I have never experienced it, can you please give me some details about hamstring injury and how to avoid it? — Zohair Habib

A: A hamstring injury is a strain or tear to the tendons or large muscles at the back of the thigh.

The term "hamstring" refers to the group of three muscles that run along the back of your thigh, from your hip to just below your knee.

The hamstring muscles are not used much while standing or walking but by a sudden burst of movement or a quick change of direction. Cricketers are prone to hamstring strains because they may be required to sprint after a long period of standing relatively still. Bowlers may suffer more as the bowling action puts considerable pressure on the hamstrings and knees.

The three grades of hamstring injury are:

• Grade 1 – a mild muscle pull or strain (It may be painful to move leg, but the strength of the muscle should not be affected).

• Grade 2 – a partial muscle tear (swelling and bruising at the back of thigh and lost some strength in leg).

• Grade 3 – a complete muscle tear (very painful, tender, swollen, may have been a "popping" sensation at the time of the injury and unable to use the affected leg).

Recovering from a hamstring injury may take days, weeks or months, depending on how severe it is. A completely torn hamstring may take several months to heal and you'll be unable to resume training or play sport during this time.

Prevention:

Warm-up and cool down sessions will reduce the risk of injury; in cricket, where a match can be played for hours at a time, it is important to keep the muscles warm and the joints loose; this can be achieved by doing exercises throughout the game. Resting between activities will also reduce the risk of injury; bowlers should have a break after a certain number of overs.

Dr. Nasir Ahmed

Assistant Professor and Consultant Orthopedic Surgeon

Department of Orthopedic Surgery

Liaquat National Hospital and Medical College

Q: Last year while playing football the opponent's elbow hit my ribs. The pain was severe and I was taken from the ground. The doctor did few x-rays at a local hospital and declared me fit. My concern is that I still feel a pain in my ribs. Please advise what to do? — Turab Raza

A: Costal cartilage injuries are most common in younger patients, as significant trauma, frequently sports-related, is a typical cause. In our practice, the most frequent cause we see is a direct blow to the chest in football players. The most frequently reported site of injury is the 1st or 2nd rib, and injuries commonly occur at the front portion of chest.

Following trauma, rib fractures are often suspected, and typically are readily identified on plain chest x-ray. The clinical presentation of costal cartilage injuries, however, may be identical to that of rib fractures, but cartilage injuries are not detectable with plain chest x-ray unless considerable costal calcification is present.

Patients delay seeking treatment and present with persistent pain and swelling at the anterior chest. It has been speculated that chronic pain following a costal cartilage injury may be caused by an ineffective repair response to a cartilage fracture.

Treatment of costal cartilage fractures is typically conservative, consisting of rest, ice, and non-steroidal anti-inflammatory medications. Athletes are usually restricted from a return to the sport until pain has significantly subsided, and the length of time required varies from two weeks to several months. In professional athletes, rib protective clothing and anesthetic blocks may allow a more rapid return to play.

Dr. Syed Mahmood Ul Haq, FRCS

Head of Department, Assistant Professor | Department of Thoracic Surgery

Liaquat National Hospital and Medical College

Q: Two years ago, while swimming I had a cramp in my right shin muscle leaving me with severe pain. I was on a deep side of the pool. I was panicked which left me struggling for my life. The life guard rescued me. Later the pain vanished but I developed a fear for water. On a pool side or on a beach, I feel nausea and extreme fear of drowning just by looking at the water. Please help me to overcome this fear? — Iqbal Kaukab

A: What you are describing is probably post-traumatic stress disorder. This can happen after a life-threatening experience, which in your case is near downing.

Usual stress reaction has similar presentations as PTSD but it is resolved within a short period with no reoccurrences. It does not have any long term adverse effects on daily functioning or quality of life.

Getting timely help can prevent PTSD. This includes comfort given by family and friends some people find turning to faith helpful. This prevents using unhealthy means for examples drugs to seek comfort.

If PTSD is left untreated it can increase the risk of other mental disorders and lead to complications which include depression, anxiety and drug alcohol use and even suicidal thoughts.

I recommend that you consult a psychiatrist's who will formulate a treatment plan for you which will involve psychotherapy, and may include medications.

Factors that help in a good outcome include, good social support, lack of any prior traumatic experiences any prior psychiatric problems for e.g. any substance use and mood disorder can lead to poor outcome of the treatment.

Dr. Ayesha Quraishy

Diplomate American Board of Psychiatry

Head of Department, Assistant Professor

Department of Mental Health

Liaquat National Hospital and Medical College

Q: How many kilometers walk is essential for a person of my age (56 years), and a diabetes patient to keep myself fit? — Tufail Shah

A: Exercise and walking are excellent tools for controlling type 2 diabetes and improving health for people with Diabetes. Brisk walking workout can help in maintaining blood sugar levels as well as body weight. A 30 minutes’ walk at least five days per week in recommended by American Diabetes Association.

To walk for 30 minutes, with at least 20 continuous minutes at a brisk pace of 15 to 20 minutes per mile. You also need to protect your feet and prevent developing blisters. Check your feet before and after each walk because diabetic patient may not feel blister and hot spot, because of neuropathy.

You can use a treadmill for your walking workout and if you want to walk outside, you should look for a walking track where you can walk without interruptions.

If any Diabetic patient have some cardiac related issues then they should ask their doctor first to see if walking is the right exercise for them or not.

Dr. Aqiba Sarfraz

MCPS, FCPS Fellowship in Diabetes & Endocrinology

Head of Department, Assistant Professor | Department of Diabetes, Endocrinology And Metabolism

Liaquat National Hospital and 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.)