Q: Hockey is my favourite game and I play at the University level. Recently while practicing on the field, my opponent’s hockey hit my wrist, resulting in a sharp pain and swelling. Please help me suggesting a good doctor to go for a cure. My age is 23 years. —Khurram Hidayati

A: Hockey is considered as a contact sport in which there are injuries related to aggressive movements in the field. Direct hits on the wrist are very common which result in injuries varying from soft tissue injuries to fractures around the wrist joint. Persistent pain and swelling suggests that there is an injury which requires investigations. Management varies from plaster and splint application to surgical interventions depending upon extent of injury. It is recommended that you visit an Orthopedic surgeon with special interest in sports injures management. You need complete examination of your wrist along with some radiological investigations to manage accurately and send u back to the field.

Dr. Muhammad Sufyan

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

Assistant Professor & Consultant| Department of Orthopaedic Surgery

Liaquat National Hospital & Medical College

Q: I play cricket regularly. I am 26 years of age. Recently, in a foreign sports magazine I read that the cricket academies in Australia, apart from improving the game, work on “mental toughness” of a player. They train them to be “mentally strong”. Can you please explain me what does “mental toughness” mean, and what are its benefits in improving the game? —Sohail Aziz Khan

A: Behavioral sports psychology is rapidly growing area. It is an evidence based approach to enhance a player performance. In the last three decades tremendous advances have been made in this area. Several journals and associations are devoted to this topic.

This means that today’s exercise and sport have a scientific, educational and clinical foundation. The sport coaches keep up with the latest developments in this area. The coach helps the team to improve skills and also help them psychologically to perform in this highly competitive sport.

This area is of great interest for the lay public too. Several self-help books are available that can help you in enhancing your performance. In the end sports even for professional player is always a joy and passion.

Dr. Ayesha Quraishy

Diplomate American Board of Psychiatry

Head of Department, Assistant Professor | Department of Mental Health

Liaquat National Hospital & Medical College

Q: Recently while playing volleyball, the ball hit my nose. Since then at times my nose bleeds, and I experience a severe pain. Please suggest what to do? My age is 19 years. —Abdul Rehman Abro

A: The nose is an integral part of middle third of face. Nasal trauma may be associated with injuries to face, jaws and eyes. Mostly nasal injuries are blunt.

In isolated nasal injuries plain X-ray nose is not required.

X-rays/CT scan done with injuries to jaws, orbits or skull.

Common clinical presentation:

· Epistaxis

· Block nose

· Pain

· Swelling around nose

· Occasionally clear watery discharge-CSF

Management:

General assessment.

Assess level of consciousness and exclude any associated head injury or other facial injuries like orbit or jaws. Nasal bleeding. Visible bleeding site is cauterized. In severe bleeding, nasal packing is done. Septal Hematoma. Urgent drainage is required.

If not treated, it can become an abscess and can cause nasal deformity. Shape of nose. Initially there is swelling around the nose and shape of nose cannot be assessed. The patient is seen after a week. If there is change in shape of the nose then the patient has fracture nasal bone and must be reduced within 7 to 10 days of the injury.

· CSF Rhinorrhea.

· CSF leak i.e. clear watery discharge from the nose and must be treated early.

Any laceration or wound on the nose should be stitched.

Prof. Dr. Shakil Aqil

DLO (London), FRCS (Glasgow)

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

Liaquat National Hospital & Medical College

Q: I am an athlete, participating in 200 meters race and 400 meters hurdles. To keep myself fit I do few exercises as advised by our coach. What I would like to ask is that is it true that even the minor injuries will be very painful in old age? Is there any remedy to it? I am 24 years old. —Amir Raza Choudry

A: You are a professional athlete. As you said that you are running at a fast pace. You don’t have any injury but you are worried for your later age. Good thinking.

Once you get older problem will occur only if you will sustain injuries in your career, whether it is a major injury or multiple small injuries which sports men don’t even bother about.

The most common injuries which can have long term sequelae are brain and nerve injuries, a major muscle rupture which has caused fibrous healing, injury to the joint cartilage which can later lead to arthritis, tendon injuries due to over use can cause late tendinopathies.

For runners, most important thing is to do good warm up, wear standard shoes and equipment according to your requirements. Do not push your self during training beyond limits as this causes accumulation of lactic acid in muscles and can lead to damage. Consult a doctor immediately whenever you sustain an injury and discuss about the consequence of that injury. Take time off from training when advised by sports physician.

Dr. Nasir Ahmed

MCPS (Surg), FCPS (Tr & Orth)

Assistant Professor & Consultant | Department of Orthopaedic Surgery

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.)