Sports Injuries Treatment

What Causes Sports Injuries

Sports injuries fall into two groups, and the distinction drives everything we do. Acute injuries happen in a single moment: an ankle rolls, a hamstring tears mid-sprint, a shoulder is driven into the ground. Overuse injuries build over weeks or months when a tissue is loaded faster than it can adapt. Runner's knee, Achilles tendinopathy, shin splints, IT band syndrome, plantar fasciitis and most shoulder and elbow tendon problems are overuse injuries. In our practice the overuse group is far larger.

Cambridge produces a specific mix. Runners on the Charles River loop add mileage quickly in spring after a winter on the treadmill, and the flat, repetitive surface lets the same tissue absorb the same load stride after stride. Cyclists commuting across the Longfellow or the Mass Ave bridge ride in a fixed posture that tightens the hip flexors and loads the neck and low back. The climbing gyms around Somerville and Cambridge send us finger, elbow and shoulder problems from people who climbed hard three days a week within a month of starting. Rowers on the river load the low back and ribs. Rec league soccer, hockey and basketball produce the acute injuries: sprains, contusions and the occasional disc or shoulder injury from a collision.

Underneath most overuse injuries is a mechanical reason the tissue was overloaded. A hip that does not extend fully makes the hamstring and low back work harder on every stride. A stiff upper back forces the shoulder to overreach. An old ankle sprain that was never rehabbed changes how the knee tracks. Dr. Bromberg's job is to find that reason, not just treat the sore spot, because treating the sore spot alone gets you back to the same injury in a few months.

How We Diagnose It at 201 Broadway

The history comes first. Dr. Bromberg asks what you were doing when it started, what changed in the weeks before (mileage, shoes, a new route, a new coach, a new job with less sleep), whether there was a single moment of injury or a slow build, and what makes it better and worse now. For an acute injury he wants to know whether you heard or felt a pop, whether it swelled within hours, and whether you could keep going.

The exam then works from the painful area outward. He checks the injured joint for swelling, tenderness over specific structures, range of motion and stability, using the standard orthopedic tests for the ligaments and tendons involved. He tests strength on both sides and compares them. Then he looks at the chain above and below the injury: for a knee, that means the hip and the foot; for a shoulder, the neck and the upper back; for an elbow, the shoulder and the wrist. He watches you move, walking or doing a single leg squat, and for runners he looks at how you land. A neurological screen is included whenever there is numbness, tingling, weakness or pain that travels, because a pinched nerve in the neck or low back can masquerade as a shoulder or hamstring problem.

Imaging is ordered when it would change the plan. Suspected fracture after an acute injury, a joint that gives way or locks, a tendon that may have ruptured, or an injury that is not responding to several weeks of appropriate care all warrant an X-ray or MRI at an area imaging center, with the results reviewed by Dr. Bromberg. Most overuse injuries do not need imaging to begin treatment.

The separation he is making at the first visit is between a tissue that is strained and will heal with the right load, a tissue that is partially or fully torn and needs an orthopedic opinion, a joint that is unstable, and pain that is coming from somewhere else entirely.

How We Treat Sports Injuries

Treatment addresses the injured tissue and the mechanical reason it was overloaded, at the same time. The mix shifts depending on the stage of the injury.

Active Release Technique is the core of soft tissue care for athletes here, and it is the reason many runners and climbers find us. Injured muscle and tendon heal with scar tissue that binds adjacent layers together and shortens the tissue. ART applies specific pressure to that adhesion while you move the muscle through its length, releasing it. For a hamstring strain, an IT band problem, a tight calf or a forearm overloaded by climbing, it restores motion that stretching alone does not. Our post on how ART works goes into more detail.

Adjustments restore motion to joints that have stiffened and are forcing other tissues to compensate. For runners that is often the sacroiliac joints, the hips and the ankle. For cyclists and climbers it is the upper back and neck. For throwing athletes it is the upper back and the ribs. Restoring joint motion changes how force travels through the body and takes load off the injured area.

Rehab is where the lasting change happens. Dr. Bromberg prescribes specific loading exercises for the injured tissue (eccentric calf raises for Achilles tendinopathy, hip abductor work for runner's knee, scapular stabilization for climbers) and progresses them as the tissue tolerates more. He also gives you a return-to-sport plan with real numbers: how far to run this week, when to add speed, when to climb at full grade again.

For athletes rebuilding muscle after a layoff, EMSculpt NEO is an option. It is FDA-cleared, doctor-supervised, and uses electromagnetic stimulation to produce muscle contractions that are not achievable voluntarily. It is a supplement to rehab, not a replacement for it, and Dr. Bromberg will tell you plainly whether it fits your situation. More on all of this in our post on chiropractic care for runners and athletes.

What Your Visits Look Like

The first visit covers the history and exam above, a clear explanation of what Dr. Bromberg thinks is injured and why, and usually a first treatment the same day. Bring your running shoes if you are a runner, and be ready to describe your training in specifics. If you have had imaging elsewhere, bring the report. No referral is needed.

Follow-ups are focused and move quickly. He rechecks the tender spots and the strength tests, treats with ART and adjustments as needed, and advances your rehab. Early in an acute injury visits are closer together, often two a week, because the tissue is changing fast. Overuse injuries are usually seen once or twice a week. A typical plan for a single overuse injury runs four to eight visits over four to eight weeks, though a long-standing problem, or an athlete with several compensations stacked on top of each other, takes longer. Dr. Bromberg sees every patient at every visit; there are no technicians.

Progress is measured against your sport, not just your pain. He tracks range of motion and strength on both sides, the pain-free distance or load you can handle, and specific milestones such as a full-depth squat, a pain-free hop test or a climbing session without forearm pain the next day. If those numbers stall, the plan changes. No prepaid packages; care is reassessed on real progress.

Most athletes keep training in some form throughout. Complete rest is rarely the answer. The plan usually swaps the aggravating activity for one the tissue can tolerate, then builds back.

What to Expect: Outcomes and Timelines

Acute muscle strains and mild sprains generally improve within two to four weeks with the right loading and soft tissue work. Overuse tendon problems are slower because tendon remodels slowly; Achilles, patellar and elbow tendinopathies commonly take eight to twelve weeks to resolve fully, and you will usually feel better well before the tissue is actually ready for full load. That gap is where re-injury happens, and it is why the return-to-sport plan has numbers in it.

What slows recovery: returning to full training too early, ignoring the rehab exercises between visits, continuing the activity that caused the injury at the same volume, poor sleep and under-fueling, and an untreated mechanical cause elsewhere in the chain. Age matters too. Tendon in a 45-year-old heals more slowly than in a 25-year-old, and the plan accounts for that.

The plan changes when the evidence says it should. If an injury that should be improving is not, Dr. Bromberg re-examines rather than repeating the same treatment. That may mean imaging, a change in approach, or a referral. He refers to orthopedics when he suspects a full-thickness tendon or ligament tear, a labral tear in the hip or shoulder, a meniscus tear that is locking the knee, or a stress fracture. He refers to a sports medicine physician when an injection or a medical workup for bone health would help. He coordinates with physical therapists, coaches and athletic trainers when a patient is already working with them.

The realistic goal is not just getting back to your sport, but getting back without the thing that caused the injury still in place. That second part is what the follow-up visits are for.

When to See Someone Else First

Some sports injuries belong in urgent care, the emergency room or an orthopedic office before they belong here. Go there first if you have:

• An obvious deformity, a bone that looks out of place, or a joint you cannot move at all after an impact
• Inability to bear weight on the leg for four steps immediately after the injury
• Rapid, large swelling of a joint within an hour or two, which can mean bleeding inside the joint
• A pop followed by immediate weakness, such as being unable to rise onto your toes (Achilles) or lift the arm (rotator cuff or biceps)
• A knee that locks and cannot be straightened
• Numbness, tingling or weakness that is getting worse, or any change in bowel or bladder control after a back injury
• A head impact with confusion, vomiting, loss of consciousness or a worsening headache
• A hot, red, swollen joint with fever, which can be infection rather than injury

Once a fracture, full tear or head injury has been ruled out, most of what remains is exactly what we treat, and a sprain, strain or overuse injury that is seen early recovers faster than one that has been nursed along for two months. Call (617) 494-1166 or walk in Monday, Wednesday or Friday. We are a 6-minute walk from the Kendall/MIT Red Line station.