​Ankle, knee, hip and shoulder injuries can be frustrating and painful. It's not always clear which injuries require rest, and which may need a doctor's attention.

In a recent webinar, Nicholas Godby, MD; Michael Palmer, MD; Namdar Kazemi, MD; Robert Kulwin, MD; and Abbey Scherer, DPT, CIDN, discussed what you should know about some of the most common orthopedic injuries.

Keeping your ankles active

Your ankles see a lot of wear and tear. Understanding the different types of ankle injuries is important so you know when to seek treatment.

Ankle sprains

Ankle sprains are common and affect two to three million people each year in the U.S., says Dr. Kulwin.

While athletics cause about half of all ankle sprains, not all are sports-related.

“Sometimes you're just walking down the street, and you hit a curb funny," Dr. Kulwin says. “You may look around, make sure no one saw, then move on. But your injury could be significant."

The recommended treatment for ankle sprains typically starts with rest, ice, compression and elevation (RICE). Bracing and rehab may also be part of the treatment approach for ankle sprains. Doctors often prefer these approaches over wearing a walking boot (sometimes called an air cast).

“Getting your ankle moving early can help, although sometimes a boot is needed, particularly for higher grade sprains that leave someone very sore and swollen."

While most ankle sprains will improve with time, some can lead to weeks of persistent ankle pain. Ongoing pain could be a sign of a bigger problem.

• Chronic instability—A persistent feeling that your ankle will “give out"
  
• Impingement—Swollen soft tissue
• Osteochondral defect—A chip in the cartilage and bone in your ankle joint
• Peroneal tendon tear—A tear in one of the tendons behind the outer ankle bone

Ankle fractures

Ankle fractures (breaks) can range from simple to more complex. 

A stable fracture, for example, can be treated without surgery. A more complex fracture may require surgical intervention.

“If you have a nice stable, simple fracture and your ankle joint is still lined up, I'll typically treat that with just weight bearing as tolerated in a boot," Dr. Kulwin says. “In general, with these fractures, if you can put weight on it, that usually means you're OK to do so."

Dr. Kulwin says physical therapy is also part of the treatment plan for simple ankle fractures. Recovery takes about eight to 10 weeks. It's common to experience some swelling and soreness for four to six months after injury.

Unstable fractures, he says, likely need surgery and take longer to heal.

“This kind of fracture is going to be non-weight-bearing for about six to eight weeks," Dr. Kulwin says.

Even when you begin putting weight on the joint, you may still have a slight limp or struggle going up and down stairs.

Achilles tendon ruptures

An Achilles rupture is a tear in the tendon connecting your calf to your heel. Doctors and sports trainers often overlook Achilles ruptures because many people can still walk after their injury.

Some describe an Achilles rupture as an unexplained feeling of being hit or kicked. Early diagnosis is crucial. Delaying treatment can complicate recovery and increase the likelihood of needing surgery.

Dr. Kulwin says most higher Achilles ruptures (those around your ankle bone or further up your calf) can be managed without surgery, especially if you get a quick diagnosis and begin rehabilitation immediately. Ruptures closer to your heel almost always require surgery.

Healthy hips and knees

You need healthy hips and knees for bending, twisting and jumping. But, Dr. Palmer says both areas are at risk for injury.

Early intervention, proper diagnosis and appropriate treatment strategies are crucial for managing hip and knee injuries, particularly in athletes.

Common hip injuries

Hip injuries can happen at any age. Some common hip injuries include:

• Hamstring injuries—Your hamstring runs from your buttocks down the back of your thigh. Hamstring injuries range in severity from low-grade sprains to complete tears. People who have experienced severe hamstring tears describe a snapping or popping feeling. These tears lead to difficulty walking and may also cause swelling or bruising. Hamstring tear treatment varies based on the severity of the injury. In some circumstances, surgery may be the best treatment option.

• Hip impingement—Hip impingement happens when your hip's ball and socket don't fit together correctly. Hip impingement can lead to groin pain, especially during physical activity. Without treatment, hip impingement can cause cartilage damage or arthritis. Treatment for hip impingement ranges from rest and physical therapy to surgery.

• Snapping hip—Snapping hip happens when a tissue or tendon snaps over the moving bone of your hip. Snapping hip is often treated first with physical therapy and stretching. Doctors may recommend surgery if symptoms don't improve.

• Sprinter fractures—Sprinter fractures are less common than other hip injuries and primarily affect younger people. They are a tear at the top of the hip flexor muscle near the top of the hip socket. These injuries usually happen when you change direction suddenly, or they can occur when running quickly. Rest is often the first line of treatment for sprinter fractures, though you may require surgery in more severe cases.

Common knee injuries

Athletes and non-athletes experience knee injuries. Some common knee injuries include:

• ACL tears—Your anterior cruciate ligament (ACL) runs down the center of your knee and connects your thigh bone to your shin bone. ACL tears are common, Dr. Palmer says. Research from the last decade shows doctors perform about 100,000 ACL surgeries each year in the U.S.

• Cartilage injuries—Cartilage injuries in your knee don't heal naturally and can lead to arthritis and symptoms like pain, catching and locking. Technological advances have improved the ability to repair or replace damaged cartilage, either through regrowing cartilage or transplanting it and bone from a donor.

• Meniscus tears—Your meniscus acts as a shock absorber in your knee. Meniscus tears can happen during an activity (acute traumatic tear), or your meniscus can wear down over time (degenerative damage). Meniscus tear treatment typically involves surgically repairing the tear or removing the torn portion.

Strong shoulders

The shoulder joint, in general, is not very stable, says Dr. Kazemi.

“It's like a golf ball on a golf tee," he says. “Most of its stability comes from surrounding muscles and tendons."

Dr. Kazemi treats a range of shoulder injuries, including:

• Acromioclavicular (AC) separations—AC separations involve injury to ligaments connecting the clavicle (collarbone) to the scapula (shoulder blade). Doctors grade AC separations based on their severity. Lower-grade injuries may not require surgery, while higher grades typically do.
  
  
• Clavicle fractures—Clavicle fractures are common in activities like skiing and biking. Some clavicle fractures require you to wear a sling. More serious clavicle fractures may need surgery.
  
  
• Proximal humeral fractures—Proximal humeral fractures are injuries to the upper arm near the shoulder joint. Not all proximal humeral fractures require surgery. When surgery is needed, surgeons may repair the shoulder using pins, screws or plates. More severe cases require shoulder replacement.
  
  
• Shoulder dislocation—Shoulder dislocations happen frequently, often during traumatic events or in people with loose joints. Young people, especially young males, have a high risk of recurrent dislocations. If your doctor cannot move your shoulder back into place, your injury may require surgery.

Nonsurgical treatments for ankle, knee, hip and shoulder injuries

Dr. Godby says nonsurgical treatments are possible for many orthopedic injuries. Rest is the top recommendation.

“Lots of people show up with pain somewhere and say, 'It hurts when I do this,'" Dr. Godby says. “To that, I'd say, 'Don't do that.'

“But many athletic people don't want to rest, even though that's often the first and sometimes the only thing they need. If you are doing something that's injuring your body, stop doing it."

If your injury requires more than rest, some nonsurgical treatment options include:

• Braces or stabilizing devices
  
• Complementary/alternative treatments (including chiropractic care, massage and acupuncture)
• Dry needling (thin needles inserted into muscle trigger points)
• Ice or heat therapy
• Injections
• Medications (including steroids, pain relievers and muscle relaxers)
• Nerve blocks and ablations (destroying pain-causing tissue)
• Physical therapy.

Dr. Godby says it is also essential to consider and address other factors that can negatively impact your recovery, including:

• Obesity
  
• Smoking
• Uncontrolled diabetes
• Unrealistic expectations about the recovery process.

Easing into activity and minimizing your risk for future injuries

Scherer, a physical therapist, says that by going slow, you can safely ramp up your activity and minimize your risk for future injuries. Beyond knowing your body, your training level and your goals, Scherer says, you can also engage in progressive overload training.

Progressive overload training helps you to develop strength and muscle mass gradually.  

“Try to increase the weight you're lifting 10 percent weekly to minimize your risk of injury," says Scherer.

Scherer says to follow these guidelines when returning to exercise and strength training:

• Shoot for 150 minutes of moderate cardiovascular activities each week. Good options include dancing, walking, hiking, rowing, or jumping rope.
  
• Exercise each muscle group two times weekly.
• Use proper technique when lifting weights or performing body resistance activities and allow one to two days to recover.  

Make your joint and spine health a priority

To maintain good joint and spine health, it's important to prioritize injury prevention, promptly address injuries and follow personalized treatment plans.

To talk with an orthopedic expert from The Christ Hospital Health Network, call 513-995-6758.

For after-hours orthopedic or sports injuries, our specialists are ready to provide a diagnosis and treatment plan at our Orthopedic After-Hours Clinic. Avoid the wait times of an emergency room visit while receiving specialized care, all in one location. No appointment necessary. Walk-ins are always welcome.