How to cope with common injuries while practicing medicine

By Rosemary Black, for MDLinx
Published March 20, 2019

Key Takeaways

Heel pain that has derailed your workouts and slowed you down in the office or hospital. Shoulder pain that limits your ability to conduct physical exams or perform surgery.  Neck pain that can make it difficult to lean over those patient charts or prescriptions  

Annoying-but-not-dire health conditions like shin splints and heel pain can be frustrating, as they adversely affect not just your work life—let’s be honest, being a doctor can be physically demanding—but your personal life, too. If you are used to coping with stress by working out, for instance, an annoying health condition that can take what seems like forever to go away can really take a mental toll.

Here’s a look at four common health conditions—and what you can do about them.

Heel pain (plantar fasciitis):

Pain at the bottom of your heel that is often attributed to a heel spur is most often caused by degeneration of the plantar fascia, the thick band of connective tissue on the bottom of your foot, explained Ettore Vulcano, MD, chief, Foot and Ankle Surgery, Mount Sinai West, and assistant professor of orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.

Typically, those afflicted with plantar fasciitis complain of pain when they get out of bed or after sitting for a while. Many feel that the more they use the foot, the less it hurts, he said.

“We don’t know why plantar fasciitis happens because there does not seem to be a true risk factor,” said Dr. Vulcano. “Young and old people, very active people, and total couch potatoes get plantar fasciitis.”

The most common cause of heel pain, plantar fasciitis accounts for some 10% of runner-related injuries and 11% to 15% of all foot symptoms requiring medical care. It is believed to occur in some 10% of the general population.

One treatment is to stretch your calf, which can make it less tight, he said, and recommended stretching for 5 to 10 minutes twice a day. Or, give yourself an aggressive massage of the calf. If the pain is persistent and bad enough to merit a doctor’s visit, you may get a night splint.

“It’s a funny looking boot that you wear at night, and it stretches your calf and plantar fascia as you sleep,” said Dr. Vulcano. “It’s almost like doing physical therapy while you sleep.”

Another option is a silicone heel pad—look online or in a surgical supply store.

If none of these approaches work, Dr. Vulcano recommends a single cortisone injection into the plantar fascia.

“But don’t get more than one,” he warned. “Three or more injections can result in rupture of the fascia.”

Daniel Latt, MD, PhD, associate professor, Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, likes this stretch:

“Stand up, put your hands on the wall, and slide your leg straight back until your ankle is at its maximum bend,” he said. “Now straighten your knee and you will feel the stretch in the top of your calf muscle behind your knee. It stretches the tight muscle that leads to plantar fasciitis.”

About 80% of patients feel substantially better in 6 weeks.

“If not treated, it can last for years,” said Dr. Vulcano. “Other times, it just heals on its own.”

Dr. Latt added that plantar fasciitis can take 3 to 6 months to heal. “So, if running bothers it, consider swimming or biking instead. Avoid activities that irritate it but continue to be active.”

Shin splints (medial tibial stress syndrome):

You can blame your shin splints on worn-out footwear, not enough cushioning or support in your shoes, or having a particularly high arch in your foot, said Dr. Vulcano.

“Typically, I see it in runners, especially if they are training for a marathon, and in dancers and even in people in the military,” he noted.

The majority of patients with shin splints range in age from 20 to 40 years old, and while this is not a life-threatening condition, you DO have to take it easy.

The treatment is rest, ice, and anti-inflammatories.

“Ice is underestimated for its efficacy but it is extremely valuable as an anti-inflammatory,” Dr. Vulcano said.

When you start feeling better, don’t jump right back into your prior exercise routine, he advised. And when you do, consider cross training.

“Start off slow and build up,” he advised. “It may be okay to run, but alternate with less intense activities like cycling.”

To help prevent shin splints, wear good shock absorbing shoes (thin-soled shoes are not as good).

Typically, shin splints should clear up anywhere from just a few days to a few weeks. If you have pain for longer than this, you may need to get a second opinion in case it’s a fracture.

Text neck (axial neck pain):

Typically, neck pain is associated with overuse activities, said Saad Chaudhary, MD, a spine surgeon, The Mount Sinai Hospital, New York, NY, and assistant professor of orthopedics, Icahn School of Medicine at Mount Sinai.

“In this day and age, most of us are on our handheld devices looking down,” he said. “When you keep your head down, you cause an increased amount of stress on the cervical disks and stretch out the ligaments and muscles that normally maintain an upright posture and stabilize the neck area.”

To get rid of the neck pain caused by this condition, maintain good posture and do some simple exercises. Here is one of his favorites: Tilt your head back and look up at the ceiling, then bring you head back to a neutral position looking straight ahead. Repeat for a count of 10 to 12 times, and do this 3 to 4 times a day. For variation, lace your fingers together behind your head and provide some added resistance, Dr. Chaudhary suggested.

Also, keep in mind that your neck and upper back are closely related, so make sure your upper back and shoulder muscles get plenty of exercise, too. If the neck pain becomes persistent (lasting more than 2 to 3 weeks) or there is associated arm pain, numbness or tingling, you should see a spine specialist for an evaluation, he suggested.

Wrist tendonitis (De Quervain’s tenosynovitis)

One of the most common wrist conditions, wrist tendonitis affects more women than men and involves the thumb side of the wrist, explained Steven Beldner, MD, co-director, New York Hand & Wrist Center, Lenox Hill Hospital, New York, NY. “We see it in a lot of surgeons as they are doing repetitive motions over and over,” he says. “It also can happen from spending a lot of time on the computer.”

In affected individuals, the tunnel in the hand where the tendons run becomes narrow due to thickening of the soft tissues causing hand and thumb pain, especially with forceful grasping or twisting.

The condition affects about 0.5% of men and 1.3% of women, with individuals in their forties and fifties the most likely to be affected.

The treatment involves warm heat and possibly putting the hand in a splint to keep it from moving, and a cortisone shot, if necessary. “In 5% to 10% of people, the condition doesn’t resolve so they may need to undergo a surgical procedure, but it resolves in most people,” said Dr. Beldner.

Frozen shoulder (adhesive capsulitis):

Frozen shoulder, which affects up to 1 in 20 people, is an inflammation of the capsule that holds the shoulder together. This capsule keeps the ball and socket joint stable, explained Paul Cagle, MD, shoulder surgeon, Mount Sinai West, and assistant professor of orthopedics, Icahn School of Medicine at Mount Sinai.

“When this capsule becomes inflamed, it becomes thick and stiff, and a person’s range of motion decreases,” he said. “The treatment for it is stretching, so that this inflamed capsule becomes thin and flexible again.”

Typically, frozen shoulder happens after minor trauma, explained Michael Feldman, MD, director of sports medicine, and associate professor of orthopedic surgery, University of Arizona.

Because of pain in the initial phases of adhesive capsulitis, those affected favor their arm and don’t move it as much. Before long, motion is lost, and over the next 4 to 8 weeks, whatever caused the initial inflammatory problem resolves, but the stiffness and resultant pain persist.

“This condition is more common in the 40- to 60-year-old age range,” said Dr. Feldman. “And from 2% to 5% of the population is affected. It is difficult for physicians who develop this problem as it restricts their range of motion, making some components of performing a physical exam and/or surgery difficult.”

Physical therapy is the treatment for frozen shoulder. It can require anywhere from weeks to months for a frozen shoulder to resolve.  

While it’s acting up, frozen shoulder can make it difficult to reach into a closet, do your hair, or do anything that requires you to lift your hands over your head, Dr. Feldman says.

“Although not the most serious shoulder problem, it can be the most painful because we are asking people to push through the pain to regain their motion,” he said. “With therapy for a frozen shoulder, it’s no pain, no gain.”

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