Exercise Injuries Doctor Q&A

Exercising regularly is a necessity for healthy living and ageing. In fact, exercise can actually be 'medicine' to some illnesses. However, if the body is not properly warmed up and cooled down before and after exercise, or if there is overuse and trauma to a specific part of the body, exercise injuries can result.

As the featured doctor for our "Ask the Specialist" forum, Adj Asst Prof Ivy Lim, Consultant with the Singapore Sport & Exercise Medicine Centre (SSMC) at Changi General Hospital (CGH), a member of the SingHealth group, will address your concerns about exercise injuries.

This As​k The Specialist forum has closed. Thank you for your interest and participation.

1. Question by S****
Hi Doc
I’ve experienced knee pain for several months and have since stopped exercising. However despite taking a break for half a year and taking glucosamine, the knee pain did not subside and now I even experienced occasional knee pain even while walking.
Appreciate your advice. Thanks. 

Answered by Adj Asst Prof Lim:
Dear S****,
There are many causes of knee pain. Sometimes, just stopping exercise may not be ideal as the lack of activity may actually result in muscle weakness and weight gain, causing more issues to the joints. 

I will advise you to see a sport & exercise medicine doctor for further evaluation of your knee pain. In some cases, further imaging such as x-rays and MRI may be needed. It is also possible that you may need physiotherapy for your condition.

2. Question by P*******
Hi Dr Lim,
I'm having heel pain on both my legs and its getting more often recently. I tried to treat it with ice pad in the evening but it will come back again the next day.

Pain is at the base on my heels. I did some googling and suspect it could be Plantar fasciitis torn and inflamed. What should I do? And how I can treat it? Is it due to my workout? I used to do Zumba and running. Can I still do my regular run and workout?
Appreciate your advice.

Answered by Adj Asst Prof Lim:
Dear P*******,
One of the most common conditions causing pain at the base of the heels is plantar fasciitis. Plantar fasciitis can be due to several reasons, such as inappropriate footwear, tight plantar fascia and/or calves, prolonged standing and so on. Typically the pain is worst first step in the morning or after prolonged sitting, though some patients also experience pain after prolonged activity.

For a start, other than applying ice to the area, you can try to massage the foot arch area with an iced bottle/can or tennis ball to relieve the tightness of the plantar fascia. You can also stretch your plantar fascia prior to getting out of bed or the chair. Proper footwear is also important, so make sure you wear well-cushioned shoes. Wearing cushioned slippers at home also helps to reduce the pain. 

If the above measures do not work, you may want to see a sport & exercise physician for further evaluation, as your pain may be due to other conditions. You may also need further treatment such as physiotherapy, podiatry and shockwave therapy.

You can find more information on our website: http://www.csmc.sg/common_sports_injuries/foot_plantar_fasciitis.html

3. Question by C*******
I will like to ask about sprains. I sprained my right ankle about 4 weeks ago during a football game. It still hurts when I point my toes towards the ground (plantar flexion?).
I want to find out on how to rehabilitate my injured ankle and when is it okay to resume exercising again.
Thank you.

Answered by Adj Asst Prof Lim:
Dear C*******, 
The most common ankle sprain is due to an inversion injury, where the ankle rolls such that the sole points inwards. Many of these sprains heal well with no residual issues. However, in some cases, even if the ligament was sprained and not torn, there may be problems such as stiffness or laxity of the ankle, loss of joint position sense, weakness or recurrent sprains. Thus if you have pain on plantar flexion, I will suggest to see a sport & exercise medicine doctor to see if there are issues such as joint stiffness following injury, and a course of physiotherapy may be required to get you back to full activity and sports. 

4. Question by w*******
The best way to deal with exercise injuries-joint and knee pain plus pressure, from running on top with old age? Supplements, doctor to consult, things to note?

Answered by Adj Asst Prof Lim:
Dear w*******,
There are many causes of joint and knee pain from running. Sometimes it is a structural problem such as tears, other times it may be an overload or overuse injury. Just resting alone may not solve the problem, as pain may recur once the same load is applied e.g. when returning to the activity. I will advise seeking advice from a sport & exercise medicine doctor to see what the cause of the pain is and to formulate a targeted treatment plan.

5. Question by d**********
I am 61 years old and I have been doing squats and deadlifts (olympic bar but light weights) on and off for about 3 years. Three weeks ago, I experienced some pain in my lower back and eased back on the exercises. The pain has subsided. Is it advisable to seek medical treatment or can I gradually work up to my normal weight? Is it possible to injure my back seriously if I continue with squats and deadlifts? The pain also coincides with a period of long sitting at a desk so I am not sure if that is a factor. 

A general question: How does one know if his limits have been reached? It should not be by increasing the weights until some pain or injury occurs - that would be too late!

Answered by Adj Asst Prof Lim:
Dear d**********, if there is currently no pain at all during your activities, you may want to try doing light weights and gradually work the intensity up. However, if there is any discomfort still, do seek further medical advice to see if it is safe to continue with your exercise. You can also consider doing your exercise under a trained personnel to ensure your form and technique are not affected by the pain. 

Often, overuse injuries are preceded by symptoms such as tightness or discomfort, so if you face any of these symptoms, consider seeing a sport and exercise medicine practitioner or a physiotherapist to assess if you need to undergo any therapy to reduce your risk of injury. In addition, inadequate rest, improper technique, and increasing intensity/resistance too rapidly are also risk factors for injury, thus it is important to keep these in mind when undergoing exercise.

6. Question by o*********
Dear Doc,
I am 49 years old, very obesity for 20 years, done my ACL left knee for 10 yrs long, now back pain on and off for almost 3 years with physiotherapy. Beginning of Jan 19, I have a strain on my back again and this time I can't move or stand straight. The pain is from my back, butt and shooting pain to the leg - calf area. I can't stand straight, I need to bent and cycle around instead of walk to KTPH for Doctor. After which, I have my physiotherapy once every month and for a few months, I cannot see any results. On and off, I try to do the exercise, the pain went off sometimes. Then, share pain comes again the next day.  I took pain killer if need to. What should I do?

I am not interested to go back KTPH for Otheopadic doctor. And I am thinking of giving up with physio too. I read a lot of back and knee issue. I know the exercise but do so much also cannot see any results, as pain still there.
Currently, when my left knee is weak and tight, without strengthening exercise, my back will be affected. -misalignment.  MRI done for back stated that it was de-generation. Should I go for spine doctor? or corticosteroid injection? what should I do?

Answered by Adj Asst Prof Lim:
Dear o*********, there are many reasons for back pain, which may or not be entirely related to spine or disc degeneration. You may want to see a spine surgeon or pain specialist to see if your condition is suitable for injection or other interventions. Many of the physiotherapy exercises are aimed at improving strength, flexibility and control of your muscles and body, and need to be done over a period of time for results to be seen. Also, there is a detraining effect i.e. muscle will lose their strength and flexibility once exercise training is stopped, so I will encourage you to continue your physiotherapy exercises to maintain their benefit.

About Adj Asst Prof Ivy Lim

Adj Asst. Prof Ivy Lim received her Bachelor of Medicine and Bachelor of Surgery from the National University of Singapore, and obtained her Master in Family Medicine in 2010 before commencing advanced training in sports medicine. She is the first locally trained female sports physician and is also a qualified family physician.

In 2018, SingHealth established the SingHealth Duke-NUS Sport & Exercise Medicine Centre (SDSC), The SDSC aims to provide integrated, multidisciplinary care that pushes the frontiers of clinical service, research and education in the field of Sport & Exercise Medicine (SEM) across SingHealth institutions. Dr Lim has been appointed as the Service Chief (CGH) for SDSC.

Dr Lim's clinical interests include sports injuries, pre-participation screening, sports safety, exercise in women and the role of physical activity in chronic disease management. She is active in the executive committee of Sports Medicine Association Singapore, and is currently a member of the Institutional Review Board of Singapore Sports Institute.

Dr Lim has provided medical coverage for several sports events, including soccer and triathlon. She was the chief equipment officer for the 2011 OSIM Singapore International Triathlon, Chief Medical Officer for the ONE Fighting Championship, medical delegate for the 2015 and 2018 Asian Fencing Championships, and team physician for Team Singapore in the 8th ASEAN Para Games 2015. Dr Lim is a member of the Fencing Confederation of Asia Medical Commission, the first and only Singaporean to be appointed.

Ref: M19