No pain, no gain is an exercise motto that promises great rewards for the price of hard and painful work. It suggests that professionals especially athletes have to endure a lot of pain to achieve their goals. But it’s easier said than done. Pain can cause a lot of problems. In this week’s column, our panel of experts deals with this issue alongside other queries.

Q: I am a table tennis player, 35 years of age. My right thigh muscle pulled during a match and since then I find it very difficult to play due pain and discomfort. Please suggest me specialist doctor. –Ahmed Bilgirami

A: The most common cause of thigh pain in competitive sports is hamstring strain. The common reasons for hamstring strain or injury can be categorised as primary or secondary.

Primary:

• Poor timing-intermuscular coordination and eccentric strength in the hamstring muscles during the swing phase of sprinting.

• Previous hamstring strain is a very good indicator of potential for future injury.

Secondary:

• Poor running mechanics.

• Improper warm-up.

• Inappropriate training loads.

• Playing surfaces. A wet slippery surface will put more strain on the hamstring due to slipping.

How is a hamstring strain diagnosed?

Pulled hamstrings are graded 1, 2 or 3 depending on severity.

Ultrasound scan and MRI are able to identify the location and extent of your hamstring tear.

Grade 1 Hamstring Strain; tightness in the back of the thigh but will be able to walk normally.

Grade 2 Hamstring Strain; walking pattern will be affected. Sudden twinges of hamstring pain during activity will be present.

Grade 3 Hamstring Strain; a tear to half or all of the hamstring muscle. You may need crutches to walk.

Hamstring Physiotherapy Treatment

Your physiotherapy treatment will aim to:

• Reduce hamstring pain and inflammation.

• Normalise your muscle range of motion and extensibility.

• Strengthen your knee muscles and hamstrings.

• Strengthen your lower limb muscles: calves, hip and pelvis muscles.

• Improve your game speed, proprioception, agility and balance.

• Improve your technique and function eg. running, sprinting, jumping, hopping and landing.

• Minimise your chance of hamstring re-injury.

Dr. Nasir Ahmed

MCPS (Surg), FCPS (Tr & Orth)

Consultant | Department of Orthopaedic Surgery

Liaquat National Hospital & Medical College

Q: I play Badminton regularly. Recently I noticed that my left heal aches while I play. The pain increases as the game progress, and ultimately it becomes unbearable, resulting in quitting the court. Please advise what to do. I am 28 years old. –Hasnain Mustafa

A: Badminton is one of the most thrilling sport activities which require 100 percent fitness and full energy to achieve maximum results. If any player has even a minute injury he won’t be able to perform his best because of the nature of the game.

In your problem there are multiple probabilities which might cause this problem which may be soft tissue due to some ligament injury or articular surface defect. In ligament injury it might be sprain or any tear or may be related to your shoe wear which is causing you pain. Your foot biomechanics has pivotal role in your issue which needs to be assessed also. Systemic derangement of minerals or biochemicals which may also be the cause. You need thorough assessment and full investigation of your issue for its diagnosis and then best management by Sport Medicine Orthopedic Surgeon to get best treatment of your issue.

Dr. Muhammad Kazim Rahim

MD, FCPS (Ortho) AO Fellow (Germany), Sports medicine Fellow (IRI) (France), Hip and Knee Arthroplasty Fellowship (PAS, Pak)

Assistant Professor | Department of Orthopaedic Surgery

Liaquat National Hospital & Medical College

Q: My daughter is 17 years old and plays basketball. She complains lower abdomen pain while she plays. Please suggest me which specialist doctor to visit. –Worried mother

A: Your daughter seems to be suffering from a condition termed as Exercise Related Transient Abdominal Pain (ETAP). This is something common in athletes both new and old. There are multiple causes for it and almost none of them are of very serious nature. She needs to have a thorough history and examination done by a general surgeon who will rule out the abdominal causes and refer to any other specialty if required.

Dr. Faisal Siddiqui

FCPS, FRCS

Assistant Professor | Department of General Surgery

Liaquat National Hospital & Medical College

Q: I am 36 years old. I play squash regularly. My question is why my wrist hurts while I play, and this severe pain continues for at least a couple of hours after finishing the game. Please help. –Hassan Javed Khan.

A: Squash is a sport in which there is very high speed, vigorous movement of wrist joint. As a result of these sudden movements there are chances of developing overuse injuries of tendons and ligaments around the wrist resulting in swelling of the tendons. This results in soreness of the wrist which starts after the game and continue for days. Repeated stress around the ligaments causes an imbalance between the bones of wrist resulting in pain. It is advisable to visit a sports specialist to undergo complete evaluation of your wrist joint which may include some investigations in order to advice you proper treatment so that you can continue playing squash.

Dr. Muhammad Sufyan

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

Assistant Professor | 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.)

– Khalid Hussain