This week, our panel of columnists answers your queries on a wide range of issues including head injuries while playing football and muscle cramps

Q: I am 26 years old. I play football regularly. Last year in December during a match I attempted a “header” which successfully crossed the goal line but after few minutes I had nausea and pain in my head. I stopped playing and later took plenty of rest, but three or four times in a day I suffer nausea and an ache near the forehead area. Please advise which doctor I should visit? –Qamar ul Hassan.

A: Firstly congrats on scoring the goal. Headache after a header in football sometimes can cause a stretch of muscles or concussion in brain. This often is the cause of such pain. However, most of these issues are short lasting. It’s not right to have intermittent pain for such a long time. I am pretty sure it’s not a major problem but its better if you get it checked. An MRI brain with Cervical Spine may be helpful in guiding further treatment. Please visit a Neurosurgeon for further management.

Prof. Salman Yousuf Sharif

FRCS (SN), FRCS (Eng)

Head of the Department | Department of Spinal and Neurosurgery

Liaquat National Hospital & Medical

College

Q: I am a cyclist and participate in various cycling competitions. Lately, I have been experiencing severe pain in my tail bone during a ride. Please suggest how to get rid of this pain. –A. K Baloch

A: A number of different conditions can cause pain in the area of tail bone also known as coccyx. Coccydnia is a general term which is used for pain in the general area of coccyx.

It can occur due to multiple reasons including trauma or spontaneous inflammation of the tail bone.

Pain related to coccydynia mainly occurs when you sit on hard surfaces such as seat of your bicycle. It is very common condition faced by athletes involved in cycling (sitting on hard surfaces) and skate boarding (frequent falls).

I believe you should consult a neurosurgeon who will acquire relevant history and perform necessary physical examination. Radiological investigation such as X-ray and MRI maybe ordered if required.

Management includes sitting on ring/donut cushion, over the counter analgesic, physiotherapy. If the pain still persist than an injection at the coccyx can be injected by a neurosurgeon. Very rarely is surgery required.

Currently, start with conservative management as mentioned till you consult a specialist.

Dr. Saad Akhtar Khan

MBBS, FCPS, FEBNS

Assistant Professor & Consultant Neurosurgeon

Department of Spinal & Neurosurgery

Liaquat National Hospital & Medical

College

Q: I play cricket. I am 27 years. Few months ago during a match, while fielding, the ball hit my nose which gave me a severe pain and lots of bleeding. After about couple of hours the bleeding stopped but could not get rid of the pain. It is so difficult to breathe through my nose. Please help. -Zeeshan Shah

A: If there is injury to the nose and nasal bleeding, the initial step is first aid. With nasal bleeding one has to sit upright, bending slightly forward and pinch the nose with thumb and index finger. Most of the time bleeding stops with this simple method. If bleeding does not stop you have to go to the hospital emergency department. Even if the bleeding does stop you should visit a doctor with in twenty four hours to rule out septal heamatoma. (Collection of blood around nasal septal cartilage) which needs urgent attention.

If there is no septal heamatoma, your doctor will arrange a follow up visit after a week, when he will ask you about nasal obstruction and change in shape of the nose. If any of these symptoms are present, patient may need a procedure.

In patients who have pain over nasal bridge or nasal obstruction after months of injury, there are chances of non-union of fracture bone or deviated nasal septum. Both of these conditions can only be confirmed on examination. So in this case patient needs to visit an ENT surgeon for diagnosis and further management.

Dr. Ahmed Nawaz

MCPS, FCPS

Assistant Professor | Department of E.N.T-Head and Neck Surgery

Liaquat National Hospital & Medical College

Q: I am a gymnast, and go for a work out every day for two hours. Lately, I am suffering from acute cramps in my shoulder muscles and thigh muscles. Please suggest me a specialist doctor for the cure. –Azhar Hamid

A: Gymnasts require great strength, flexibility, endurance and compound skills for which it is essential to develop considerable power in upper extremity and thigh muscles.

While injuries are quite common in sports demanding high physical movement, muscle cramps need a deeper examination to identify the underlying problem. In case of even the slightest pain or cramps in the body, it is precautionary to stop extreme physical movements until the cause of the pain is ascertained. Shoulder and thigh are often prone to injuries during gymnastics, the reason being that both are designed for agility which requires extensive movement in multiple directions.

The first step to cure cramps is to get a full assessment by an orthopedic professional who will also identify its cause. For gymnasts, cramps mostly occur due to either a stability or mobility issue. The orthopaedic surgeon will perform a detailed examination including history taking, inquiring about type of pain you are experiencing, physical examination and specific testing to arrive at a definite diagnosis. They can also ask you for radiographic imaging.

In addition to the orthopedician, you can also consult a sports therapist who will help you in achieving an optimal level of physical activity without risking injury to the body. A sports therapist will guide you regarding activities and working out in the gym, and will also offer advice on different methods to alter your skills and training, so that you do not have to leave gymnastics altogether. The sports therapist will combine manual techniques along with an assisted and supervised exercise routine to help you become stronger and pain-free, thus enabling you to continue with gymnastics.

Syed Hasan Abbas Rizvi

Senior Manager & Principal

School of Physical Therapy & Rehabilitation

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.)

– Khalid Hussain