Danica Bonello Spiteri is a doctor who specialises in sport related injuries. However, it is not only the sportsperson who requires such specialist treatment, but also the sedentary person who may struggle considerably, particularly from a musculoskeletal perspective. Danica has a large following of Vida readers who regularly get in touch with her to ask for help and advice. She tackles some common problems encountered regularly.
Problems and complaints Specialist advice
Avoiding the surgeon’s knife
I am 62 years of age and I have been having problems with knee pain for the past few years. I was told I have knee osteoarthritis and cartilage problems. I have now been recommended to have an arthroscopy to ‘clean out my knee’. I am not too keen on surgery, but I’m in great pain. Are there any other options?
AS, 62, female, Msida.
Knee osteoarthritis occurs in everyone as we age, and is part of the ‘growing older’ process. Osteoarthritis is when extra bits of bone start to grow at the edge of our normal bone, along with wear and tear of cartilage. Nowadays the option of going for arthroscopy is reserved for a very selected few cases. Evidence also shows that if it is performed unnecessarily, there will be no benefit in terms of pain and function. When dealing with knee problems, the feet need to be assessed for abnormalities, the muscles around the knee joint need to be strong and well balanced to help with movement co-ordination patterns. The hip and back are also examined to ensure that there is no radiation of pain from there. Once these issues have been addressed, the pain from knee osteoarthritis can also be treated by various injections, such as corticosteroid injections or hyaluronic acid injections to help alleviate pain and enable good function. Such injections can be repeated as required. Utilising such injections is also a safer option than ingesting repeated amounts of oral tablets on a daily basis and may provide greater pain relief with minimal side effects.
Dealing with an injury that won’t heal
I am 37 years old and enjoy an occasional game of football with friends. About two years ago I twisted my ankle during a game and could not walk. I had an x-ray taken, which was normal and no fractures, but my ankle was very swollen and bruised for quite a while. Since then, I have had ankle problems. It keeps swelling, especially after a day standing up at work, and I get pain in it during cold weather. I also keep going over my ankle when I play football and it makes the pain and swelling worse.
ET, 37, male, San Gwann
It seems that you have injured the ligaments that hold your ankle joint. A clinical examination of your ankle joint is required, which will include addressing problems such as stability and balance within the ankle, as this may have also been affected during your initial injury. An ultrasound examination may be indicated to assess the integrity of your ligaments. If pain and swelling are a problem, a corticosteroid injection may be required to stop the inflammatory process. Ideally such issues are dealt with in the immediate period following the ankle injury for the best outcome, as if they are not addressed from the outset, repeated twisting ankle injuries keep recurring. This is unfortunately what you are experiencing. However, better functioning of the ankle and less pain and swelling is still achievable in your case.