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Athletic Training

Persistent injuries

09/01/2006

Question:

I am a fit 38 yr old male. I was involved in a motorcycle accident 6 months ago, when I was hit by a car, resulting in me being thrown over the handlebars. Since then I have been unable to participate in sports (running, light soccer etc). I received injuries to the neck, upper back, mid-lower back, right arm, right calf, right achilles, left knee. I recall landing on my left side, though most of the "strains" and continued pain is on the right side.

I have received chiropractor work which appeared to relieve the initial neck and back muscular stiffness. I also receieved some 15 ultrasound and massage treatments to my right calf and achilles. This got rid of the muscular pain, however has made no impact on the achilles injury at all. An MRI has shown no damage evident on the achilles. The pain I have in the achilles is the same now as immediately following the accident. I am also now suffering pain on the inside of my right knee to top of shin (below the knee joint and not on the soft tissue). This has been constant for several weeks now and is not the result of any further accident / sport etc. It feels like someone has kicked me direct on the bone. Any light exercise reults in it feeling like the knee may buckle. My doctor suggests it it is tendonitis. However, I believe this is the wrong area for this, as it would be more central, on soft tissue and not be constant ache. In addition I continue to have the same strain in the upper right arm as following the accident.

I reside in Bermuda, where the expertise does not seem to be available to provide expert diagnosis on these problems. I would be grateful for any thoughts or advice from you or your colleagues.

Kind Regards (and thanks).

Answer:

It sounds like you've had a pretty rough time of it after your accident.  Obviously, without examining you, it is pretty difficult to determine a course of treatment, and I am not able to offer specific advice for your problems other than to offer the following generalities.

It is not terribly uncommon to have ongoing muscle pain and weakness after a traumatic injury like yours, particularly when the injuries are to numerous areas of the body. With numerous traumatic muscle injuries, it is fairly common to experience a condition called rhabdomyolysis.  This is a breakdown of muscle tissue. 

Acutely, severe rhabdomyolysis can sometimes be fatal and cause renal (kidney) failure, and this is always a concern with numerous severe muscle injuries (especially with crush injuries). In your case, I'm guessing that you probably had some widespread but not life threatening muscle tissue breakdown following the accident.  This typically can result in pain and disability when you try to put these muscles back into use.  Fortunately, it usually does get better with some rehabilitative exercise.  I'd recommend seeing an athletic trainer or physical therapist if one is available in your area. 

It is certainly possible that you may also have tendinitis (inflamed tendon) or tendinosis (tendon degeneration). Both are common following muscle injuries, and both usually respond to rehabilitative exercise and anti-inflammatory medications. The catch is that medications alone typically are not all that effective.  Usually you have to use medication and rest to get the inflammation under control and then work through rehabilitative exercises gradually until you restore function.  If you push too hard or just use the medication without rest and rehab, these types of problems tend to not go away very well.

There is a group of tendons that attach along the antero-medial (front -inside) edge of the tibia (shin bone) just below the knee.  These include a knee flexor muscle, a hip adductor muscle, and a muscle that both flexes and rotates the upper leg bone.  Tendonitis here is not uncommon, nor is bursitis (inflammation of the fluid filled sac that acts as a pad for these tendons). Either can significantly impact how you walk or run, and pain/weakness in them can make you feel like your knee will buckle.  Again, working with a therapist or athletic trainer in your area would be a good place to start.

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Response by:

Mark  A Merrick, PhD, ATC Mark A Merrick, PhD, ATC
Associate Professor at the School of Allied Medical Professions
College of Medicine
The Ohio State University