Q: I am 28 years old. I play snooker regularly. Lately, while bending on the table to play a shot, I felt a sharp pain at my back. It subsides otherwise, but whenever I am playing, this pain aggravates. Is it some kind of an injury? Please suggest a doctor. —Rashid Cheema

A: Lower back pain is a relatively common presentation in an Orthopedic Clinic especially in patients with activities requiring altered back postures.

While playing snooker the back is placed in an awkward position placing ligaments and the muscles at the risk of sprain and spasm, leading to lower back pain that can be a hindrance in carrying out activities of daily living.

The most important thing you need to do right now is to take rest, avoid any exertional activities, simple analgesia for pain relief and physiotherapy for strengthening of lower back musculature.

This will help you in the relief of pain, afterwards you should carry on with lower back strengthening exercises daily so that the muscles are able to tolerate the stress that comes with playing snooker daily.

Dr. Nasir Ahmed

MCPS (Surg), FCPS (Tr & Orth)

Assistant Professor & Consultant | Department of Orthopaedic Surgery

Liaquat National Hospital & Medical College

Q: While swimming the other day, the area below the shoulder blade had a cramp. It was so painful that I felt difficulty in coming out of the swimming pool. Can you please explain me what kind of a cramp was it, as I experienced it first time, and how to cure this. —Abdul Mujeeb Khan

A: Swimming is an activity which requires very high level of training for shoulder region. Swimmers should be very well versed in early morning practices, team workouts, and living healthy lifestyles. Poor stroke mechanics or decreased flexibility and strength may cause an overuse injury around the shoulder joint which ranges from mild muscle cramps to tears. You suffered a pain around your shoulder which suggests that there is a spasm of muscles. It is suggested that you get complete evaluation of your shoulder joint by an orthopedic surgeon with special interest in shoulder injuries so that you get complete examination along with proper treatment and rehabilitation in order to prevent this type of problem in future. By taking part in strength training you can improve your muscular endurance leading to better and more consistent stroke mechanics.

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 am 47 years old and recently suffered a heart attack. Now that I am recovered, my friends and cousins are planning to take me to an amusement park which has variety of water sports. Can I participate in any kind of water sport? —Saqib Sultan.

A: Heart attack can be a minor or major heart attack. After a minor heart attack, people can resume their normal activity after two weeks. Major heart attack can be complicated or non-complicated. In complicated cases, physical activity can be resumed after weeks to months depending on the condition of the patient. In uncomplicated cases, physical activity can be started after 10 days. The physical activity in amusement park needs moderate to severe exertion depending on the level of games. After a month of uncomplicated heart attack, a person can visit the amusement park. However, he or she should avoid some games which have more thrills like roller coaster and long water slides. Activities like light swimming, small to medium size water slides and jumping into the water can be enjoyed. As per precaution, these activities should be enjoyed with the empty stomach or 1.5 – 2 hours after meal.

Dr. Hafeez Ahmed

FCPS (Medicine) FCPS (Cardiology)

Head of Department, Associate Professor | Department of Cardiology

Liaquat National Hospital & Medical College

Q: I play cricket. Lately, while batting, and facing a fast bowler, a bouncer hit my jaw. Though I was wearing a helmet, but the impact of the ball was very shocking. Since then I have developed a fear of fast bowling, and I literally throw my wicket rather facing a fast bowler. Please help. I am 24 years old. —Nasim Khanzada.

A: What you are describing is an anxiety state that is in response to the fast bowling incident. In general terms, it is a fear response to a specific situation, in your case, facing fast balls.

Unfortunately the psychological scars have not completely healed. The symptoms that you described when you face a fast ball strongly suggest a diagnosis of Specific Phobia. The first step would be a complete psychiatric evaluation to confirm the diagnosis and to make sure that there are no additional conditions, such as another anxiety disorder such as Panic Disorder. If your anxiety symptoms are just triggered by playing cricket or even anticipating receiving a fast ball, then you are likely suffering from a specific phobia. If anxiety symptoms happen out of the blue, then this suggests a diagnosis of panic disorder. Once a psychiatric assessment is completed, and if the diagnosis is confirmed to be that of Specific Phobia, then your psychiatrist should refer you to a qualified psychologist for psychotherapy.

There are no medications that help specifically with this condition, and in fact, none are approved by the Food and Drug Administration (FDA) in the US. The treatment is primarily psychological. Cognitive-Behavioral Therapy (CBT) is effective for phobic disorders. This is a time-limited therapy, and the specific components will be guided by your psychologist. Briefly this involves developing a list of your fears, starting with the least anxiety provoking situation and culminating in your worst fears. Following this, the psychologist will instruct you in relaxation techniques followed by graduated exposure to the fearful situations as generated by you.

Dr. Mehmood A. Rehman

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.)