Steroids & Other Sports Medicine Issues

Date:
7/30/2009 | 12:00 pm

Sports seasons are in full swing. Many of us sit at our desks all week and then launch ourselves into a variety of sports on Saturday and Sunday. It’s no wonder our muscles are strained – or worse a break or other injury occurs. Do you have questions regarding sports injuries such as concussion, sprains, strains, or conditioning for your weekend activities? Our assistant director of sports medicine, R. Robert Franks, D.O., will be answering your questions.

Dr. Franks is a native of South Jersey. He received his medical degree from the University of Medicine and Dentistry-School of Osteopathic Medicine at UMDNJ-SOM/Kennedy Health System in Stratford, N.J. in 1999. He completed his residency in Family Medicine at UMDNJ-SOM/Kennedy Health System in Stratford, N.J. in 2002. Dr. Franks received his Fellowship training in Primary Care Sports Medicine at the University Hospitals Health System/Horizon Orthopaedic in Cleveland, Ohio in 2003. He is Board Certified in Family Medicine from the American Board of Osteopathic Family Physicians and holds a Certificate of Added Qualification in Sports Medicine from the American Board of Osteopathic Family Physicians.

Dr. Franks’ specialty is in the area of medical orthopaedics and sports medicine. He has published works on topics including maxillofacial injuries in athletics, weight loss and wrestling, and performance enhancing substances, which led to his involvement with the New Jersey Governor’s Task Force on Steroid Use and Prevention.

Dr. Franks has served as team physician for various high schools throughout southern New Jersey, southeastern Pennsylvania and Ohio; and also Haverford College, the Philadelphia Wings, and the Cleveland Indians baseball organization. He also is currently the school physician for the Haddon Township School District. He recently was named Medical Director of the Certified Athletic Training Program at Eastern University.

I think I've got a rotator cuff tear. What do you think is the best option for treatment? Dave from Moorestown

7/30/2009 12:00:51 PM

R. Robert Franks, Jr., D.O.: Dave, I am reading that you have a rotator cuff tear.  You are asking what is the best option for treatment.  People with rotator cuff tears usually go one or two routes, either surgically or nonsurgically.

As physicians, we make the determination as to whether patients have a surgical intervention or nonsurgical intervention depending on many things.  Not having any more details some of the general ideas we normally use are as follows:

• Young people who have very physical jobs or are in sports and are having a functional deficit from rotator cuff pathology we usually think more about doing surgery.
• Older people who do not have physical jobs or are willing to make lifestyle changes so that the rotator cuff is not stressed, often times we can do nonoperative intervention.
• Nonoperative intervention would consist of possibly doing cortisone injections, physical rehabilitation, anti-inflammatory medicines, icing and monitoring for progression of this conservative treatment.
• If conservative treatment fails there is always the option of doing surgical intervention.

My 20yr old daughter just finished a consult with an orth. surgeon.  She has a labral tear in her hip.  She is in the military.  She was told she has a 50/50 chance of the surgery being successful because she is so active and the scope may not get through all the muscle to repair the tear.  She was recommended to just get out of the Army.  This is very devastating to her. She is a very fit person and not overweight by any means. Is this possible?? Tina from Natchitoches, LA

7/30/2009 12:03:03 PM

R. Robert Franks, Jr., D.O.: The Cooper Bone and Joint Institute has one of the leading extensive hip arthroscopy programs in this region. Again not knowing the details of the case and assuming that your daughter is very fit (not overweight and young at 20 years old), chances are she does not have any kind of arthritis in the hip. Arthritis in the hip or degenerative change in the hip is usually what precludes someone from getting labral repair within the hip.

Since you daughter probably has a healthy hip joint it is very possible that she would do very well with a labral repair via arthroscopy. Of course her doctor’s recommendation is really the way that you need to go, but in the absence of osteoarthritic change or degenerative joint any other comorbid pathology within the hip, a labral tear in a healthy 20-yearold usually responds fairly well to arthroscopy.

No surgery can be guaranteed but statistics are in your daughter’s favor for resolution with surgical intervention.

Dr Franks, I tore my leteral meniscus in my left knee about 5 years ago. They could not repair it so they removed it. I reinjured the same knee playing basketball a few months ago. I got an MRI and Xray but both doctors could not confirm if i retore the meniscus or if the last tear is coming up in the MRI. They did confirm I am developing Arthritis in my knee, i guess from lack of cartilage and bones rubbing together. I guess my question is whether or not surgery would help relieve pain in my knee? I still play but do not have the lateral movement I use too before I reinjured my knee. Any suggestions? Santo from Spring Lake Heights

7/30/2009 12:04:49 PM

R. Robert Franks, Jr., D.O.: Santo, It is more likely than not that when you had your surgery five years ago you had a partial lateral meniscectomy, which means they took out part of the meniscus.

Today, surgeons try not to remove the entire meniscus because of the complications we are seeing in middle age and older patients due to arthritic changes. Losing the cartilage, which is the shock absorber to the top and bottom bone of the knee, causes increased contact with the tibia and femur which leads to arthritis. Since you are missing part of your cartilage it seems like based on what you are telling me that you did develop arthritis within your knee. If you are not the surgeon of record, it is often times difficult to differentiate whether or not you are looking at postsurgical change from what was done to the meniscus previously or a new tear on MRI.

If you are not having mechanical symptoms such as locking, catching or buckling you can try conservative treatment first such as cortisone injection, physical rehabilitation, anti-inflammatory medicine, ice and see how you progress. If you are successful and you are doing okay with this treatment then you get to keep what meniscus you have and can slow down the arthritic change that you already have. If you start having mechanical symptoms and continual lack of movement a diagnostic arthroscopy could tell you exactly what is wrong with the meniscus and if need be you can have further removal of the pathological piece of meniscus.

Again, we do not know your case in specifics but in general this is always a conservative treatment plan for someone who has had a previous meniscectomy and is already developing arthritis.

I have had Posterior Tibial Tendonitis for several months. The discomfort has gotten better, but hasn't gone away. Will the discomfort ever go away? Is this condition something that a physical therapist should treat? Sue from Sicklerville

7/30/2009 12:07:12 PM

R. Robert Franks, Jr., D.O.: Sue, thanks for your question. Posterior tibial tendinitis once you get it is sometimes difficult to get rid of. Your discomfort will go away but it is something that physical rehabilitation can help you with. The number one reason that ankles don’t get better is lack of rehab.

Some other things that can be done are using inserts in your shoes, a modality treatment called iontophoresis (which is using a little bit of cortisone in along the tendon sheath via an electrical pad), icing, bracing and orthotics. I definitely would recommend physical rehabilitation.

Dr. Franks, my son plays soccer. He is 11 years old and sometimes complains of headaches after rough soccer games or practices. One of the mothers stated that he might have a concussion. Is this a possibility and what do I need to do? Barbara from Garnet Valley

7/30/2009 12:09:51 PM

R. Robert Franks, Jr., D.O.: Barbara, athletes get headaches for many different reasons during competition. We usually associate concussion with a hit to the head or a hit to the chest or neck that radiates up into the head. If there is no contact than more likely than not the headaches are for another reason. It can be a comorbid medical condition that your son has. It can be due to the heat or not eating enough or staying hydrated during practice and games.

Sometimes athletes even develop a headache because of anxiety associated with participation. He should probably have a full medical workup if these headaches continue and if they are definitely due to contact that your son has had then he certainly needs to be seen by a medical professional before he goes back to playing.

If I have a slight cartilage tear in my knee and continue physical activity, will the tear get worse? John from philadelphia

7/30/2009 12:13:04 PM

R. Robert Franks, Jr., D.O.: John, anytime we have a tear in a cartilage and we continue to engage in activity thre is always the potential for it to "tear a little more" if we dont address the initial tear. This is usually as the result of more degeneration if the knee is arthritic or from a new trauma if the tear is caused by trauma. Usually, however, in the absence of new trauma the damage is already done. If you have mechanical symptoms - ie locking, catching, buckling, it is important that you address this small tear now so that it does not interfere with your lifestyle, activity, or cause increased pain.

Why does anyone take steroids? All they do is hurt your body, so from my point of view, no one should take them.  Is there ever a medical reason to take steroids? Thanks! Donald from East Camden

7/30/2009 12:20:54 PM

R. Robert Franks, Jr., D.O.: Donald, thank you for your question. The main reason most people take steroids is so that they can reach a competitive advantage over another opponent. Its effects can make an athlete stronger and more aggressive. These days’ people take it as much to look better, as far as body image is concerned with becoming more muscular, as much as they do it for performance enhancement in sports.

We know from scientific research that abuse of steroids can harm the body. It can cause damage to the important organs and also cause roid rage which has caused people to do things that are secondary to aggression in which they would not normally do.

However there are reasons that people should take steroids. Taking steroids medically is usually due to a medical condition which is managed by a physician. Steroids in this case are always taken by prescription.

My 16 year old daughter has suffered 2 concussions in the last year. They were minor - she was conscience each time. She wants to play field hockey this fall. Do I need to buy her a new mouth guard or something? thanks Linda from Blackwood

7/30/2009 12:24:51 PM

R. Robert Franks, Jr., D.O.: Linda, we have greatly changed the way we treat concussions in the United States over the last several years. The most important thing to know about your daughter’s concussions is whether or not she had loss of consciousness, which you say she was conscious each time and whether or not she had posttraumatic, which is loss of memories after the impact or retrograde amnesia which is loss of memory before the impact that she had.

If both concussions are minor and she has completely recovered and an adequate amount of time has passed to allow her complete mental and physical rest and she does not have symptoms with exertion and is not taking any medicines for concussion or headache and cognitively she is doing well, she should be allowed to play. A new mouthguard will not prevent concussion but it can decrease some of the shock that goes up from the jaw and below up into the head. Of course the helmet certainly would help provided it is fit properly to prevent against any further concussive incidents. This is true for any sport.

As a parent, what do I need to be aware of or look for regarding steroids with my son? He is 16 years old, playing football and has been in the weight room all summer. While he is improving on his strength, I am concerned with making sure this is all healthy. I know this is improving his self esteem, but I want to make sure I'm on top of the education. Lisa from Southern New Jersey

7/30/2009 12:28:02 PM

R. Robert Franks, Jr., D.O.: In looking for signs of steroid abuse in any athlete you are going to look for rapid weight gain and muscle production in an athlete. You are going to look for more aggressive behavior. You are going to look for acne across the chest, back and body. You are also going to look for diminution of the testicles. These are some of the outright signs of steroid abuse.

Other signs of steroid abuse could be the development of breast tissue in males or the deepening of voice or increasing of body hair and decreasing of the breast in females. Once someone gets started with steroids it is very difficult to get them to stop, not only because of the physical issues involved but also because it is very difficult for the athlete to have a change in the body image that they have become accustomed to as a result of the steroids.

If your son is exhibiting this symptomatology then he should be seen by a physician who specializes in steroid abuse and withdrawal from steroids. He will need a complete workup including laboratory work and it should be remembered that weaning from steroids is usually a multi disciplined activity including not only a family doctor but also a sports medicine doctor familiar with steroid withdrawal as well as possible use of an endocrine specialist and possible psychiatry and psychology.

I read somewhere that you were a wrestler in NJ as well as in college. How do you feel about all of the unnecessary stipulations on wrestlers today surronding weight loss, steroids, and allowing them to move freely from one level to the next? John from Paulsboro

7/30/2009 12:31:09 PM

R. Robert Franks, Jr., D.O.: Yes, John I was a wrestler for Highland Regional High School in South Jersey as well as the University of Pennsylvania. I am also a physician for USA Wrestling. I would not necessarily call the changes in the sport of wrestling unnecessary.

There have been numerous studies that have shown that when wrestlers drop too much weight too quickly there are deleterious effects to them not only physically but mentally. The new changes that involve the hydration and weight certification process is done to prevent this as well as not allow the wrestler to lose too much weight which would leave them at an unhealthy weight and does not allow them to lose too much weight too fast too soon. The new program allows for them to lose weight in a controlled manner at a safe pace to get where they need to be and stay at a healthy weight.

Steroids in the State of New Jersey are not tolerated in any sport. In fact, New Jersey has one of the strictest set of rules concerning steroid use and abuse at the high school level. Athletes can be randomly tested at any time during their sports championships and run the risk of disqualification or team sanctions if they are found to be abusing steroids. Thus, it is imperative not only from the health point of the athlete and competitive standpoint not to use and abuse steroids.

My upper right arm feels like I pulled a muscle - is it ok to keep exercising that muscle (i.e. machines at the gym)? Bonnie from berlin

7/30/2009 12:33:18 PM

R. Robert Franks, Jr., D.O.: Bonnie, without knowing what muscle we are talking about or what machine you injured yourself on, it is hard to tell you whether it is safe to continue exercising. I often tell folks that if pain from exercise doesnt resolve in one or two weeks they should seek medical attention.

This may be because what we believe to be a simple strain of a muscle can really be a more serious issue. For example, pain in the upper arm when located in a certain area is really rotator cuff pain. Continuing to do the same exercises in the presence of a potential problem with the rotator cuff, can make this pain worse. If you have had this pain more than one to two weeks, you should see a physician and hold doing that exercise for now.

Doctor, my son recently complained about heel pain on the back of his heel. Now almost each night after practice or game he complains of pain. He has been playing baseball, soccer, and basketball this year and is in great shape. He was not kicked or anything to cause this pain. Is there some type of shoes he should be wearing? Molly from Voorhees

7/30/2009 12:36:03 PM

R. Robert Franks, Jr., D.O.: It sounds like, without examining your son, that he is suffering from something called calcaneal apophysitis or Sever’s disease. My guess is that in not giving your son’s age that he is probably on the cusp of adolescence.

We used to refer to this as growing pains.

Essentially as we grow our soft tissue can’t keep up with the over expanding bones in the pre-adolescent and adolescent age group and the short Achilles tendon pulls on the growth plate in the heel at the same time your son is playing impact sports. He is traumatizing the growth plate at the heel.

Physical rehabilitation, rest, stretching, special inserts and proper fitting athletic shoes can definitely help with this condition.

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