Q: I am 28 years old and play cricket regularly. I am a fast bowler and like all the renowned fast bowlers I also practice rigorously to improve my speed. Lately, I have noticed that while practicing in the nets, I develop a sharp pain in my rib cage. The pain reduces once I finish the bowling practice. Please advise which doctor I should visit for the cure? — M. Ayub Shaikh

A: This pain may also result from serratus anterior myofascial pain syndrome (SAMPS). SAMPS can be difficult to diagnose and is often done so by exclusion - meaning your doctor has to rule out other sources of pain. It often manifests as chest pain, but can also cause arm or hand pain. It’s a rare myofascial pain syndrome.

The serratus anterior muscle spans the upper eight or nine ribs. This muscle helps you rotate or move your scapula (shoulder blade) forward and up. Sometimes it’s referred to as the “boxer’s muscle.

Serratus anterior pain can be caused by several different medical conditions and lifestyle factors.

The most common causes include:

• Tension

• Stress

• Overuse

• Minor Injuries

Serratus anterior pain is common in sports with repetitive motions, such as swimming, tennis, or weightlifting.

Issues with the serratus anterior most often results in pain in the chest, back, or arm. These issues can also make it difficult to lift your arm overhead or have a normal range of motion with the arm and shoulder.

You should call your doctor immediately if you experience:

• Difficulty Breathing.

• Dizziness.

• A high fever with a stiff neck.

• Worsening pain in the back or chest that doesn’t improve with rest.

• Pain that interferes with your sleep or daily activities.

Serratus anterior pain can sometimes radiate to other parts of the body. Your doctor may order imaging tests like an MRI scan or X-ray for muscle pain.

Treatment:

• Rest: Try to rest the muscle.

• Ice: Apply a towel-wrapped ice pack to the sore part of the muscle for 20 minutes at a time

• Compression: You may find it difficult to apply compression to the serratus anterior.

• Elevation: This isn’t applicable to the serratus anterior.

Serratus anterior pain can be uncomfortable, but it typically resolves on its own without significant treatment.

Dr. Syed Mahmood Ul Haq 

FRCS

 Head of Department,  Assistant Professor & Consultant | Department of Thoracic Surgery Liaquat National Hospital & Medical  College

Q: I am an athlete and participate in 100 meters, 200 meters and 400 meters races. Lately, while on the track my shin muscle pulls and because of the severe pain, I have to discontinue. I seek your advice and help. —Ashfaq Hussain

A: Unfortunately this is a very common complaint among athletes, particularly in distance runners.

Shin pain in athletes generally involves one or more clinical perspectives like pathological bone stress, vascular insufficiency, inflammation and muscular strain/tendinopathy.

As a professional athlete you have to understand the biomechanics of running and sprinting. The tightness in calf muscles occurs because hard training restricts doraiflexion and also causes internal rotation of the tibia which may lead to excessive pronation of the foot. Chronic ankle sprains or repeated overuse tendon injuries cause ankle instability. So proper foot wear and correct placement of the foot during running is very essential before undergoing any sort of training or competition.

Initially use standard painkillers to manage acute pain. For two weeks after the injury undertake only low intensity exercises including heel and toe raises. Single leg standing and soft tissue mobilization is also helpful in this stage.

Move towards cross-training after 4 to 6 weeks with low-impact exercises, including swimming, cycling and deep-water running, to maintain strength and for conditioning.

In advanced stages, after 3 months you can emphasize on power training. Thus includes tuck jumps, rocket jumps, forward lunges with weight, line hops, cross hops and short sprints of 50 meters.

Syed Hasan Abbas Rizvi

Senior Manager & Principal School of Physical Therapy & Rehabilitation Liaquat National Hospital & Medical  College

Q: During a cricket match, I was fielding at the cover position. To field the ball I approached the ball and an odd bounce on the field resulted in the ball hitting my area just above the right eye brow. The area swelled and gentle messaging helped in improvement in the swelling but I am feeling that my right eye’s vision is affected and things appear a bit blur. Please help me to overcome this ailment. —Qasim Bilgirami

A: You gave a history of cricket ball injury to the area just above the eyebrow and you also said that your vision is getting blurred.

Now the most important thing to do is to see an ophthalmologist or retinal specialist to examine the retina.

Blurred vision/dark spot immediately after injury could be the swelling in retina, which typically subsides without any complication but sometimes it could be blood in eye or retinal tear or more serious retinal detachment. These conditions require prompt treatment and could cause loss of vision if untreated.

Dr. Ata Ur Rehman

MCPS, FCPS

Associate Professor & Consultant | Department of Ophthalmology Liaquat National Hospital & Medical  College

Q: Recently, I have joined a martial arts club. I am 22 years old, and am lean and thin by physique. I noticed that most of the trainees are muscular and well-built. Some people say they use different food supplements for muscle development. Can you please advise me some food supplements for me to develop my muscles? —Zain Yousuf

A: As a martial artist you need to plan your meals very sensibly which beside providing energy and hydration for training and performance require specific focus on achieving your desired body composition and weight. Practically speaking because of high level of physical training carbohydrates and proteins intake is highly important.

At times specially formulated nutritional supplements for weight gain and to cater to any specific goal may be useful for you to attain peak performance and physical conditioning. But care must be taken that diet must not contain surplus calories as it may result in excessive weight gain. Therefore, requirement from food categories depend entirely on your goals you want to achieve.

To sum up before adapting any weight gain strategy you should contact a qualified professional who will guide you about nutrition support products as well as to ensure that effective methods of weight gain are being followed.

Ms. Munazza Haq

Chief Dietitian

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.)