Overview
Each year, about one person in every 25 will seek medical help for a "sports"
injury, but not all of those injuries are sustained while playing sports.
Any repetitive physical activity, even walking, can injure muscles and joints.
People who participate in sports are more likely than others of the same age
to have muscle and tendon injuries and bone fractures. This certainly doesn't
mean you should avoid sports - the health benefits far outweigh the cost in
terms of sports injuries.
Causes
Sports injuries are most commonly caused by poor training methods, structural
abnormalities, weakness in muscles, tendons, ligaments, and unsafe exercising
environments. The most common cause of injury is poor training. For example,
muscles need 48 hours to recover after a workout. Increasing exercise intensity
too quickly and not stopping when pain develops while exercising also causes
injury.
Everyone's bone architecture is a little different, and almost all of
us have one or two weak points where the arrangement of bone and muscle leaves
us prone to injury. In injuries to the ankles, legs, knees and hips, for instance,
common predisposing factors are:
- uneven leg length
- excessive pronation (flat feet)
- cavus foot (over-high arches)
- bowlegged or knock-knee alignment
Uneven leg length may lead to awkward running and increases the chance of
injury, but many people with equal-length legs suffer the same effects by
running on tilted running tracks or along the side of a road that is higher
in the centre. The hip of the leg that strikes the higher surface will suffer
more strain.
Pronation is the inward rolling of the foot after the heel strikes the ground,
before the weight is shifted forward to the ball of the foot. By rolling
inwards, the foot spreads the shock of impact with the ground. If it rolls too
easily, however, it can place uneven stress on muscles and ligaments higher
in the leg.
While an overly flexible ankle and foot can cause excessive pronation, a
too-rigid ankle will cause the effects of cavus foot. Although the arch
of the foot itself may be normal, it appears very high because the foot doesn't
flatten inwards when weight is placed on it. Such feet are poor shock absorbers
and increase the risk of fractures higher in the legs.
Bowlegs or knock knees add extra stress through knees and ankles over time,
and may make ankle sprains more likely.
Other structural conditions that make sports injuries more common include:
- lumbar lordosis - forward curve in the lower spine
- forward tilted pelvis
- patella alta - a kneecap that's higher than usual
- high Q angle - kneecap displaced to one side, as with knock knees
Having some muscles that are very strong and others that are weak can lead
to injury. If your quadriceps (front thigh muscles) are very strong,
it can increase the risk of a stretched or torn hamstring (rear thigh muscle).
Tight iliotibial bands may be the cause of knee pain for many athletes
in running sports.
Overuse injuries are caused by repeated, microscopic injuries to a part
of the body. Many long distance runners experience overuse injuries even
after years of running. For road runners, the surface is hard and sometimes
uneven, and the running movements are repetitive. In addition, there are usually
both up- and downhill elements, and these increase the stress on tendons and
muscles in the lower leg. You will more likely develop running injuries if you
wear the wrong shoes or sneakers. You should use footwear that doesn't allow
side-to-side movement of the heel, and that adequately cushions the foot.
People who play racquet sports tend to injure their upper body. The
need to firmly grasp the racquet and the shock of impact with the ball can cause
various injuries to the tendons of the wrist and elbow, such as "tennis
elbow," which may extend into the muscles of the forearm. In addition,
the human arm really isn't designed to handle strenuous activity above the head.
Tennis is a leading cause of rotator cuff (shoulder joint) tendinitis.
This is potentially one of the most difficult sports injuries. If you continue
to play tennis when you have a sore shoulder, the rotator cuff tendons can fray
or tear and may require surgery.
Symptoms
There are several common sports injuries.
Shin splints - Shin splints have a number of causes and may occur on
the outside or the inside of the shin. With anteriolateral shin splints,
pain around the front of the shin starts immediately when your heel strikes
the ground awkwardly. In posteromedial shin splints, the pain is felt
on the inner part of the shins and is worse when you stand on your toes. If
you keep running on a regular basis when you have a shin splint, the pain tends
to spread toward the knee. Tests are often required to understand the exact
nature and cause of shin splints.
Achilles tendinitis - The Achilles tendon (the tough sinew that
attaches the calf muscle to the back of the heel bone) is most likely to be
damaged if you participate in running or jumping sports. The injured Achilles
tendon feels tender when squeezed between the fingers. Pain is usually at its
worst in the morning and improves with walking. Vigorous exercise will increase
the pain for a bit, then improve it. However, you should never exercise a damaged
Achilles tendon without the supervision of a sport medicine physician or therapist,
or until it's healed.
Lumbar strain - The standard weightlifter's injury can also occur in
sports that involve sudden twisting of the back, such as golf and baseball.
Sudden lower back pain appears with twisting or lifting. It may seem fairly
minor for an hour or two, but carrying on the exercise will usually bring a
sudden deterioration with extreme pain and back spasms.
Lateral and medial epicondylitis - More commonly known as backhand and
forehand tennis elbow. Backhand tennis elbow can also occur with overuse of
a screwdriver, but tennis may be more problematic because not only are you gripping
hard, but there are also repetitive shocks being transmitted to the flexed wrist
tendons. Forehand tennis elbow is also common in golfers, baseball players,
and people who have to lug heavy suitcases around. You feel pain when you flex
the wrist backward (lateral tendons) or forward (medial tendons).
Metatarsal stress fracture - The second to fourth toes are vulnerable
to breakage if you push off with your toes when sprinting or running long distances.
Army cadets doing running and marching drills are likely to suffer stress fractures
during training camps. Dancers and gymnasts experience stress fractures because
of frequent jumping. The front of the foot starts hurting during exercise, and
the pain usually stops when you finish. With each subsequent bout of exercise,
the pain appears earlier and earlier, and gets steadily worse. The fracture
can take up to three months to fully heal.
Any injured tendon can undergo permanent changes if you continue to exercise
it without letting it heal. The normal tendon material can be replaced with
inflexible fibrous material in a process called mucoid degeneration.
The ligament attaching it to the bone can tear, there may be steady bleeding,
and the bone can even change shape where it meets the tendon, forming a spur
that may cause pain on movement. In the worst-case scenario, pain can become
constant whether you're moving or not, and the affected parts become permanently
weak.
It's vital to follow doctor's advice about rest. If you cannot see a doctor,
don't exercise the affected area until you're sure it's healing.
Treatment
Treatment of sports injuries is based on the RICE principle:
- Rest
- Ice
- Compression
- Elevation
Rest stops new injury and bleeding. Ice eases pain and reduces
inflammation by constricting the blood vessels. Elevation and compression
limit the amount of swelling and fluid accumulation around the injured area.
Ice should be crushed to better conform to your shape. It should be
placed in a bag that is wrapped around the injury. First, put a towel between
the bag and the skin. Then, wrap a bandage around the icebag, not so tight as
to cut off blood flow. Ice only constricts blood vessels for about 10 minutes,
after which they "rebound." For very new or traumatic injuries you
should leave the ice in place for only 10 minutes at a time, removing it for
the same period. Alternate like this for an hour or two, keeping the injury
elevated all the time.
You should carry out this procedure several times during the first day or so
after injury. Following this, ice can be used for longer periods to better reduce
swelling and pain. You can apply ice for up to 30 minutes several times a day.
Packages of frozen peas or corn are excellent ready-made ice packs. If the injury
is in the leg or ankle, don't try to stand up the first day, and do your best
to keep it elevated as much as possible.
If there's some other exercise you can perform that doesn't stress your
injured part, you can do that to remain fit, but don't try to use the injured
part until healing is well along. Then you can start light exercises to
get it back in shape. In the long run, you may want to exercise it more to make
it stronger, in order to prevent repeat occurrences. A doctor or physiotherapist
might recommend specific exercises to strengthen particular muscles and tendons.
Other treatments include surgery and steroid injections. Surgery is
an extreme measure and one you're unlikely to need if you treat injuries with
respect. Steroid injections can relieve pain but may delay healing. They can
be safely used once or twice, but should never be used as a cure-all or a first
resort.
There are two ways you can prevent sports injuries. One is by using the
right equipment. This means properly-fitting, sport-specific shoes and may
mean orthotics (shoe inserts) to control excessive movement of the foot.
Orthotics may reduce the width of your footwear, so you may need new shoes.
Helmets, face masks, and protective padding made to regulation and worn as instructed
prevent many serious sport injuries.
Correct technique is important to prevent injury. For example, tennis
players should avoid racquets with excessively narrow shafts and try to perform
backhand and forehand shots with their whole arm and shoulder rather than just
the wrist. Racquet strings shouldn't be too tight. Wet, heavy balls are more
likely to cause problems, as is hitting the ball off-centre.
The second way of preventing injury is by warming up and cooling down with
adequate stretching. The best medical evidence suggests that warming up
definitely makes the muscles stronger and more injury resistant. Stretching
improves muscle performance but not injury resistance, so it is most effective
after exercise. Don't stretch so far that it becomes painful. Cooling down may
help prevent dizziness from blood pooling in dilated (widened) leg veins, but
it doesn't help muscle soreness the next day, which is caused by injury to the
fibres.
All strenuous exercise involves microscopic damage to individual muscle
fibres. Exercise works because they tend to heal stronger than before. You
must give them 48 hours to heal. You shouldn't vigorously exercise the same
muscle in two successive days, as you'll be damaging it faster than it can heal.
If you want to exercise every day, you should either work on different muscle
groups on alternate days or do "strength-training" exercises one day
and cardiovascular exercises the next. Following these recommendations should
allow you to enjoy regular and injury-free exercise.
Other tips:
Your own description of what happened normally makes the nature of the injury
fairly clear to a doctor or sports injury specialist. There are also a number
of standard tests for sports injuries; they all involve flexing the joint or
tendon in question. In tennis elbow, for example, you are asked to place your
forearm on a table and to flex your wrist forwards or backwards while the doctor
restrains your hand. Depending on the nature of the injury, there's the option
of X-rays and other scans, but these are usually only necessary in severe injuries
and fractures.
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