CCSF Athletic Trainers
Sports Injuries Brochure • About This Brochure
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Information
Boxes
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Illustrations
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Appendix
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U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases |
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Introduction
[return]
In recent years,
increasing numbers of people of all ages have
been heeding their health professionals' advice
to get active for all of the health benefits
exercise has to offer. But for some people—particularly
those who overdo or who don't properly train
or warm up—these benefits can come at
a price: sports injuries.
Fortunately, most
sports injuries can be treated effectively,
and most people who suffer injuries can return
to a satisfying level of physical activity
after an injury. Even better, many sports
injuries can be prevented if people take the
proper precautions.
This booklet answers
frequently asked questions about sports injuries.
It discusses some of the most common injuries
and their treatment, and injury prevention.
The booklet is for anyone who has a sports
injury or who is physically active and wants
to prevent sports injuries.
It is for casual
and more serious athletes as well as the trainers,
coaches, and health professionals who deal
with sports injuries.
What
Are Sports Injuries? [return]
The term sports
injury, in the broadest sense, refers to the
kinds of injuries that most commonly occur
during sports or exercise. Some sports injuries
result from accidents; others are due to poor
training practices, improper equipment, lack
of conditioning, or insufficient warmup and
stretching.
Although virtually
any part of your body can be injured during
sports or exercise, the term is usually reserved
for injuries that involve the musculoskeletal
system, which includes the muscles, bones,
and associated tissues like cartilage. Traumatic
brain and spinal cord injuries, (relatively
rare during sports or exercise) and bruises
are considered briefly in the Appendix.
Following are some of the most common sports
injuries.
Sprains and
Strains [return]
A sprain is a stretch or tear of a ligament, the band
of connective tissues that joins the end of
one bone with another. Sprains are caused
by trauma such as a fall or blow to the body
that knocks a joint out of position and, in
the worst case, ruptures the supporting ligaments.
Sprains can range from first degree (minimally
stretched ligament) to third degree (a complete
tear). Areas of the body most vulnerable to
sprains are ankles, knees, and wrists. Signs
of a sprain include varying degrees of tenderness
or pain; bruising; inflammation; swelling;
inability to move a limb or joint; or joint
looseness, laxity, or instability.
A strain is a twist, pull, or tear of a muscle or tendon,
a cord of tissue connecting muscle to bone.
It is an acute, noncontact injury that results
from overstretching or overcontraction. Symptoms
of a strain include pain, muscle spasm, and
loss of strength. While it's hard to tell
the difference between mild and moderate strains,
severe strains not treated professionally
can cause damage and loss of function.
Knee Injuries [return]
Because of its complex structure
and weight-bearing capacity, the knee is the
most commonly injured joint. Each year, more
than 5.5 million people visit orthopaedic
surgeons for knee problems.
Lateral
View of the Knee
Knee injuries can
range from mild to severe. Some of the less
severe, yet still painful and functionally
limiting, knee problems are runner's knee
(pain or tenderness close to or under the
knee cap at the front or side of the knee),
iliotibial band syndrome (pain on the outer
side of the knee), and tendonitis, also called
tendinosis (marked by degeneration within
a tendon, usually where it joins the bone).
More severe injuries
include bone bruises or damage to the cartilage
or ligaments. There are two types of cartilage
in the knee. One is the meniscus, a crescent-shaped
disc that absorbs shock between the thigh
(femur) and lower leg bones (tibia and fibula).
The other is a surface-coating (or articular)
cartilage. It covers the ends of the bones
where they meet, allowing them to glide against
one another. The four major ligaments that
support the knee are the anterior cruciate
ligament (ACL), the posterior cruciate ligament
(PCL), the medial collateral ligament (MCL),
and the lateral collateral ligament (LCL).
(See diagram.)
Knee injuries can
result from a blow to or twist of the knee;
from improper landing after a jump; or from
running too hard, too much, or without proper
warmup.
Compartment
Syndrome [return]
In many parts of the body, muscles
(along with the nerves and blood vessels that
run alongside and through them) are enclosed
in a "compartment" formed of a tough membrane
called fascia. When muscles become swollen,
they can fill the compartment to capacity,
causing interference with nerves and blood
vessels as well as damage to the muscles themselves.
The resulting painful condition is referred
to as compartment syndrome.
Compartment syndrome may be
caused by a one-time traumatic injury (acute
compartment syndrome), such as a fractured
bone or a hard blow to the thigh, by repeated
hard blows (depending upon the sport), or
by ongoing overuse (chronic exertional compartment
syndrome), which may occur, for example, in
long-distance running.
Shin Splints [return]
While the term "shin splints"
has been widely used to describe any sort
of leg pain associated with exercise, the
term actually refers to pain along the tibia
or shin bone, the large bone in the front
of the lower leg. This pain can occur at the
front outside part of the lower leg, including
the foot and ankle (anterior shin splints)
or at the inner edge of the bone where it
meets the calf muscles (medial shin splints).
Shin splints are primarily seen
in runners, particularly those just starting
a running program. Risk factors for shin splints
include overuse or incorrect use of the lower
leg; improper stretching, warmup, or exercise
technique; overtraining; running or jumping
on hard surfaces; and running in shoes that
don't have enough support. These injuries
are often associated with flat (overpronated)
feet.
Achilles Tendon Injuries
[return]
A stretch, tear, or irritation
to the tendon connecting the calf muscle to
the back of the heel, Achilles tendon injuries
can be so sudden and agonizing that they have
been known to bring down charging professional
football players in shocking fashion.
The most common cause of Achilles
tendon tears is a problem called tendinitis,
a degenerative condition caused by aging or
overuse. When a tendon is weakened, trauma
can cause it to rupture.
Achilles tendon injuries are
common in middle-aged "weekend warriors" who
may not exercise regularly or take time to
stretch properly before an activity. Among
professional athletes, most Achilles injuries
seem to occur in quick-acceleration, jumping
sports like football and basketball, and almost
always end the season's competition for the
athlete.
Lateral
View of the Ankle
[return]
Common
Types of Sports Injuries [return]
- Muscle sprains and strains
- Tears of the ligaments
that hold joints together
- Tears of the tendons that
support joints and allow them to move
- Dislocated joints
- Fractured bones, including
vertebrae.
Fractures [return]
A fracture is a break in the
bone that can occur from either a quick, one-time
injury to the bone (acute fracture) or from
repeated stress to the bone over time (stress
fracture).
Acute fractures: Acute
fractures can be simple (a clean break with
little damage to the surrounding tissue) or
compound (a break in which the bone pierces
the skin with little damage to the surrounding
tissue). Most acute fractures are emergencies.
One that breaks the skin is especially dangerous
because there is a high risk of infection.
Stress fractures: Stress
fractures occur largely in the feet and legs
and are common in sports that require repetitive
impact, primarily running/jumping sports such
as gymnastics or track and field. Running
creates forces two to three times a person's
body weight on the lower limbs.
The most common symptom of a
stress fracture is pain at the site that worsens
with weight-bearing activity. Tenderness and
swelling often accompany the pain.
Dislocations [return]
When the two bones that come
together to form a joint become separated,
the joint is described as being dislocated.
Contact sports such as football and basketball,
as well as high-impact sports and sports that
can result in excessive stretching or falling,
cause the majority of dislocations. A dislocated
joint is an emergency situation that requires
medical treatment.
The
Shoulder Joint
[return]
The joints most likely to be
dislocated are some of the hand joints. Aside
from these joints, the joint most frequently
dislocated is the shoulder. Dislocations of
the knees, hips, and elbows are uncommon.
What's
the Difference Between Acute and Chronic Injuries? [return]
Regardless of the specific structure
affected, sports injuries can generally be
classified in one of two ways: acute or chronic.
Acute Injuries
Acute injuries,
such as a sprained ankle, strained back, or
fractured hand, occur suddenly during activity.
Signs of an acute injury include the following:
- Sudden, severe pain
- Swelling
- Inability to place weight
on a lower limb
- Extreme tenderness in an
upper limb
- Inability to move a joint
through its full range of motion
- Extreme limb weakness
- Visible dislocation or
break of a bone.
Chronic Injuries
[return]
Chronic injuries
usually result from overusing one area of
the body while playing a sport or exercising
over a long period. The following are signs
of a chronic injury:
- Pain when performing an
activity
- A dull ache when at rest
- Swelling.
What
Should I Do if I Suffer an Injury? [return]
Whether an injury is acute or
chronic, there is never a good reason to try
to "work through" the pain of an injury. When
you have pain from a particular movement or
activity, STOP! Continuing the activity only
causes further harm.
Some injuries require prompt
medical attention (see "Who
Should I See for My Injury?"), while others
can be self-treated. Here's what you need
to know about both types:
When to Seek Medical
Treatment
You should call a health professional
if
- The injury causes severe
pain, swelling, or numbness
- You can't tolerate any weight
on the area
- The pain or dull ache of
an old injury is accompanied by increased
swelling or joint abnormality or instability.
To learn about treating sports
injuries, see "How Are Sports
Injuries Treated?"
When and How to Treat at
Home [return]
If you don't have any of the
above symptoms, it's probably safe to treat
the injury at home—at least at first.
If pain or other symptoms worsen, it's best
to check with your health care provider. Use
the RICE method to relieve pain and inflammation
and speed healing. Follow these four steps
immediately after injury and continue for
at least 48 hours:
- Rest. Reduce regular
exercise or activities of daily living as
needed. If you cannot put weight on an ankle
or knee, crutches may help. If you use a
cane or one crutch for an ankle injury,
use it on the uninjured side to help you
lean away and relieve weight on the injured
ankle.
- Ice. Apply an ice
pack to the injured area for 20 minutes
at a time, four to eight times a day. A
cold pack, ice bag, or plastic bag filled
with crushed ice and wrapped in a towel
can be used. To avoid cold injury and frostbite,
do not apply the ice for more than 20 minutes.
(Note: Do not use heat immediately after
an injury. This tends to increase internal
bleeding or swelling. Heat can be used later
on to relieve muscle tension and promote
relaxation.)
- Compression. Compression
of the injured area may help reduce swelling.
Compression can be achieved with elastic
wraps, special boots, air casts, and splints.
Ask your health care provider for advice
on which one to use.
- Elevation. If possible,
keep the injured ankle, knee, elbow, or
wrist elevated on a pillow, above the level
of the heart, to help decrease swelling.
The
Body's Healing Process [return]
From
the moment a bone breaks or a ligament tears,
your body goes to work to repair the damage.
Here's what happens at each stage of the
healing process:
At
the moment of injury: Chemicals are
released from damaged cells, triggering
a process called inflammation. Blood vessels
at the injury site become dilated; blood
flow increases to carry nutrients to the
site of tissue damage.
Within
hours of injury: White blood cells
(leukocytes) travel down the bloodstream
to the injury site where they begin to tear
down and remove damaged tissue, allowing
other specialized cells to start developing
scar tissue.
Within
days of injury: Scar tissue is formed
on the skin or inside the body. The amount
of scarring may be proportional to the amount
of swelling, inflammation, or bleeding within.
In the next few weeks, the damaged area
will regain a great deal of strength as
scar tissue continues to form.
Within
a month of injury: Scar tissue may
start to shrink, bringing damaged, torn,
or separated tissues back together. However,
it may be several months or more before
the injury is completely healed.
Who Should
I See for My Injury? [return]
While severe injuries will need
to be seen immediately in an emergency room,
particularly if they occur on the weekend
or after office hours, most sports injuries
can be evaluated and, in many cases, treated
by your primary health care provider.
Depending on your preference
and the severity of your injury or the likelihood
that your injury may cause ongoing, long-term
problems, you may want to see, or have your
primary health care professional refer you
to, one of the following:
- Orthopaedic surgeon: A doctor specializing in the diagnosis and
treatment of the musculoskeletal system,
which includes bones, joints, ligaments,
tendons, muscles, and nerves.
- Physical therapist/physiotherapist: A health care professional who can develop
a rehabilitation program. Your primary care
physician may refer you to a physical therapist
after you begin to recover from your injury
to help strengthen muscles and joints and
prevent further injury.
How Are
Sports Injuries Treated? [return]
Although using the RICE technique
described previously can be helpful for any
sports injury, RICE is often just a starting
point. Here are some other treatments your
doctor or other health care provider may administer,
recommend, or prescribe to help your injury
heal.
Nonsteroidal
Anti-Inflammatory Drugs (NSAIDs) [return]
The moment you are injured,
chemicals are released from damaged tissue
cells. This triggers the first stage of healing:
inflammation (see "The Body's
Healing Process" box). Inflammation causes
tissues to become swollen, tender, and painful.
Although inflammation is needed for healing,
it can actually slow the healing process if
left unchecked.
To reduce inflammation and pain,
doctors and other health care providers often
recommend taking an over-the-counter (OTC)
nonsteroidal anti-inflammatory drug (NSAID)
such as aspirin, ibuprofen (Advil1,
Motrin IB, Nuprin), ketoprofen (Actron, Orudis
KT), or naproxen sodium (Aleve). For more
severe pain and inflammation, doctors may
prescribe one of several dozen NSAIDs available
in prescription strength.2
1 Brand
names included in this booklet are provided
as examples only, and their inclusion does
not mean that these products are endorsed
by the National Institutes of Health or any
other Government agency. Also, if a particular
brand name is not mentioned, this does not
mean or imply that the product is unsatisfactory.
2 Like
all medications, NSAIDs can have side effects.
The list of possible adverse effects is long,
but major problems are few. The intestinal
tract heads the list with nausea, abdominal
pain, vomiting, and diarrhea. Changes in liver
function frequently occur in children (but
not in adults) who use aspirin. Changes in
liver function are rare in children using
the other NSAIDs. Questions about the appropriate
use of NSAIDs should be directed toward your
health care provider or pharmacist.
Though not an NSAID, another
commonly used OTC medication, acetaminophen
(Tylenol), may relieve pain. It has no effect
on inflammation, however.
Immobilization [return]
Immobilization is a common treatment
for sports injuries that may be done immediately
by a trainer or paramedic. Immobilization
involves reducing movement in the area to
prevent further damage. By enabling the blood
supply to flow more directly to the injury
(or the site of surgery to repair damage from
an injury), immobilization reduces pain, swelling,
and muscle spasm and helps the healing process
begin. Following are some devices used for
immobilization:
- Slings, to immobilize
the upper body, including the arms and shoulders.
- Splints and casts,
to support and protect injured bones and
soft tissue. Casts can be made from plaster
or fiberglass. Splints can be custom made
or ready made. Standard splints come in
a variety of shapes and sizes and have Velcro
straps that make them easy to put on and
take off or adjust. Splints generally offer
less support and protection than a cast,
and therefore may not always be a treatment
option.
- Leg immobilizers,
to keep the knee from bending after injury
or surgery. Made from foam rubber covered
with fabric, leg immobilizers enclose the
entire leg, fastening with Velcro straps.
Surgery [return]
In some cases, surgery is needed
to repair torn connective tissues or to realign
bones with compound fractures. The vast majority
of sports injuries, however, do not require
surgery.
Rehabilitation (Exercise)
A key part of rehabilitation
from sports inju ries is a graduated exercise
program designed to return the injured body
part to a normal level of function.
With most injuries, early mobilization—getting
the part moving as soon as possible—will
speed healing. Generally, early mobilization
starts with gentle range-of-motion exercises
and then moves on to stretching and strengthening
exercise when you can without increasing pain.
For example, if you have a sprained ankle,
you may be able to work on range of motion
for the first day or two after the sprain
by gently tracing letters with your big toe.
Once your range of motion is fairly good,
you can start doing gentle stretching and
strengthening exercises. When you are ready,
weights may be added to your exercise routine
to further strengthen the injured area. The
key is to avoid movement that causes pain.
As damaged tissue heals, scar
tissue forms, which shrinks and brings torn
or separated tissues back together. As a result,
the injury site becomes tight or stiff, and
damaged tissues are at risk of reinjury. That's
why stretching and strengthening exercises
are so important. You should continue to stretch
the muscles daily and as the first part of
your warmup before exercising.
When planning your rehabilitation
program with a health care professional, remember
that progression is the key principle. Start
with just a few exercises, do them often,
and then gradually increase how much you do.
A complete rehabilitation program should include
exercises for flexibility, endurance, and
strength; instruction in balance and proper
body mechanics related to the sport; and a
planned return to full participation.
Throughout the rehabilitation
process, avoid painful activities and concentrate
on those exercises that will improve function
in the injured part. Don't resume your sport
until you are sure you can stretch the injured
tissues without any pain, swelling, or restricted
movement, and monitor any other symptoms.
When you do return to your sport, start slowly
and gradually build up to full participation.
For more advice on how to prevent injuries
as you return to active exercise, see the "Tips for Preventing Injury"
box.
Rest [return]
Although it is important to
get moving as soon as possible, you must also
take time to rest following an injury. All
injuries need time to heal; proper rest will
help the process. Your health care professional
can guide you regarding the proper balance
between rest and rehabilitation.
Other Therapies [return]
Other therapies commonly used
in rehabilitating sports injuries include:
- Electrostimulation: Mild electrical current provides pain relief
by preventing nerve cells from sending pain
impulses to the brain. Electrostimulation
may also be used to decrease swelling, and
to make muscles in immobilized limbs contract,
thus preventing muscle atrophy and maintaining
or increasing muscle strength.
- Cold/cryotherapy: Ice packs reduce inflammation by constricting
blood vessels and limiting blood flow to
the injured tissues. Cryotherapy eases pain
by numbing the injured area. It is generally
used for only the first 48 hours after injury.
- Heat/thermotherapy: Heat, in the form of hot compresses, heat
lamps, or heating pads, causes the blood
vessels to dilate and increase blood flow
to the injury site. Increased blood flow
aids the healing process by removing cell
debris from damaged tissues and carrying
healing nutrients to the injury site. Heat
also helps to reduce pain. It should not
be applied within the first 48 hours after
an injury.
- Ultrasound: High-frequency
sound waves produce deep heat that is applied
directly to an injured area. Ultrasound
stimulates blood flow to promote healing.
- Massage: Manual
pressing, rubbing, and manipulation soothe
tense muscles and increase blood flow to
the injury site.
Most of these therapies are
administered or supervised by a licensed health
care professional.
Who Is
at Greatest Risk for Sports Injuries? [return]
If a professional athlete dislocates
a joint or tears a ligament, it makes the
news. But anyone who plays sports can be injured.
Three groups—children and adolescents,
middle-aged athletes, and women—are
particularly vulnerable.
Children and Adolescents
[return]
While playing sports can improve
children's fitne ss, self-esteem, coordination,
and self-discipline, it can also put them
at risk for sports injuries: some minor, some
serious, and still others that may result
in lifelong medical problems.
Young athletes are not small
adults. Their bones, muscles, tendons, and
ligaments are still growing and that makes
them more prone to injury. Growth plates—the
areas of developing cartilage where bone growth
occurs in growing children—are weaker
than the nearby ligaments and tendons. As
a result, what is often a bruise or sprain
in an adult can be a potentially serious growth-plate
injury in a child. Also, a trauma that would
tear a muscle or ligament in an adult would
be far more likely to break a child's bone.
Because young athletes of the
same age can differ greatly in size and physical
maturity, some may try to perform at levels
beyond their ability in order to keep up with
their peers.
Injuries
in Kids, by Sport [return]
Children
aged 5 through 14 sustained an estimated
2.38 million sports and recreational injuries
annually from 1997 through 1999. By sport,
this number includes the following:
| Pedal cycling |
332,000 injuries |
| Basketball |
261,000 injuries |
| Football |
243,000 injuries |
| Playground equipment |
219,000 injuries |
| Baseball/softball |
185,000 injuries |
Source: National Health Interview Survey
Contact sports have inherent
dangers that put young athletes at special
risk for severe injuries. Even with rigorous
training and proper safety equipment, youngsters
are still at risk for severe injuries to the
neck, spinal cord, and growth plates. Evaluating
potential sports injuries on the field in
very young children can involve its own special
issues for concerned parents and coaches.
Some helpful hints are presented in the Appendix.
Adult Athletes [return]
More adults than ever are participating
in sports. Many factors contribute to sports
injuries as the body grows older. The main
one is that adults may not be as agile and
resilient as they were when they were younger.
It is also possible that some injuries occur
when a person tries to move from inactive
to a more active lifestyle too quickly.
Women [return]
More women of all ages are participating
in sports than ever before. In women's sports,
the action is now faster and more aggressive
and powerful than in the past. As a result,
women are sustaining many more injuries, and
the injuries tend to be sport specific.
Injuries
in Adults, by Sport [return]
Adults
age 25 and over sustained an estimated 2.29
million sports and recreational injuries
annually from 1997 through 1999. By sport,
this number includes the following:
| Recreational sports* |
370,000 injuries |
| Exercising |
331,000 injuries |
| Basketball |
276,000 injuries |
| Pedal cycling |
231,000 injuries |
| Baseball/softball |
205,000 injuries |
Source: National Health Interview Survey
*Includes racquet sports, golf, bowling,
hiking, and other leisure sports.
Female athletes have higher
injury rates than men in many sports, particularly
basketball, soccer, alpine skiing, volleyball,
and gymnastics. Female college basketball
players are about six times more likely to
suffer a tear of the knee's anterior cruciate
ligament (ACL) than men are, according to
a study of 11,780 high school and college
players. Information on injuries collected
since 1982 by the National Collegiate Athletic
Association shows that female basketball and
soccer players have a much higher incidence
of ACL injuries than their male counterparts.
Previous assumptions that methods
of training, risks of participation, and effects
of exercise are the same for men and women
are being challenged. Scientists are working
to understand the gender differences in sports
injuries.
While poor conditioning has
not been related to an increased incidence
of ACL injuries specifically, it has been
associated with an increase in injuries in
general. For most American women, the basic
level of conditioning is much lower than that
of men. Studies at the U.S. Naval Academy
revealed that overuse injuries were more frequent
in women; however, as women became used to
the rigors of training, the injury rates for
men and women became similar.
Aside from conditioning level,
other possible factors in women's sports injuries
include structural difference of the knee
and thigh muscles, fluctuating estrogen levels
caused by menstruation, the fit of athletic
shoes, and the way players jump, land, and
twist. Also, "the female triad," a combination
of disordered eating, curtailed menstruation
(amenorrhea), and loss of bone mass (osteoporosis),
is increasingly more common in female athletes
in some sports. Its true prevalence is unknown,
but it appears to be greater in athletes,
adolescents, and young adults, especially
in people who are perfectionists and overachievers.
Scientists trying to better
understand sports injuries in women met in
June 1999 for a workshop sponsored jointly
by the National Institute of Arthritis and
Musculoskeletal and Skin Diseases and the
American Academy of Orthopaedic Surgeons.
The workshop proceedings were published in
a book titled Women's Health in Sports
& Exercise, edited by William Garrett,
M.D., Ph.D., and Gayle Lester, Ph.D. The book
may be purchased from the American Academy
of Orthopaedic Surgeons (www.aaos.org).
What
Can Groups at High Risk Do to Prevent Sports
Injuries? [return]
Anyone who exercises is potentially
at risk for a sports injury and should follow
the injury prevention tips.
But additional measures can be taken by groups
at higher risk of injury.
Children [return]
Preventing injuries in children
is a team effort, requiring the support of
parents, coaches, and the kids themselves.
Here's what each should do to reduce injury
risk.
What parents and coaches
can do:
- Try to group youngsters according
to skill level and size, not by chronological
age, particularly during contact sports.
If this is not practical, modify the sport
to accommodate the needs of children with
varying skill levels.
- Match the child to the sport,
and don't push the child too hard into an
activity that she or he may not like or
be physically capable of doing.
- Try to find sports programs
where certified athletic trainers are present.
These people, in addition to health care
professionals, are trained to prevent, recognize,
and give immediate care to sports injuries.
- See that all children get
a preseason physical exam.
- Don't let (or insist that)
a child play when injured. No child (or
adult) should ever be allowed to work through
the pain.
- Get the child medical attention
if needed. A child who develops any symptom
that persists or that affects athletic performance
should be examined by a health care professional.
Other clues that a child needs to see a
health professional include inability to
play following a sudden injury, visible
abnormality of the arms and legs, and severe
pain that prevents the use of an arm or
leg.
- Provide a safe environment
for sports. A poor playing field, unsafe
gym sets, unsecured soccer goals, etc.,
can cause serious injury to children.
What children can do: [return]
- Be in proper condition to
play the sport. Get a preseason physical
exam.
- Follow the rules of the game.
- Wear appropriate protective
gear.
- Know how to use athletic
equipment.
- Avoid playing when very tired
or in pain.
- Make warmups and cooldowns
part of your routine. Warmup exercises,
such as stretching or light jogging, can
help minimize the chances of muscle strain
or other soft tissue injury. They also make
the body's tissues warmer and more flexible.
Cooldown exercises loosen the muscles that
have tightened during exercise.
Tips
for Preventing Injury [return]
Whether
you've never had a sports injury and you're
trying to keep it that way or you've had
an injury and don't want another, the following
tips can help.
- Avoid bending knees past
90 degrees when doing half knee bends.
- Avoid twisting knees by
keeping feet as flat as possible during
stretches.
- When jumping, land with
your knees bent.
- Do warmup exercises not
just before vigorous activities like running,
but also before less vigorous ones such
as golf.
- Don't overdo.
- Do warmup stretches before
activity. Stretch the Achilles tendon,
hamstring, and quadriceps areas and hold
the positions. Don't bounce.
- Cool down following vigorous
sports. For example, after a race, walk
or walk/jog for five minutes so your pulse
comes down gradually.
- Wear properly fitting shoes
that provide shock absorption and stability.
- Use the softest exercise
surface available, and avoid running on
hard surfaces like asphalt and concrete.
Run on flat surfaces. Running uphill may
increase the stress on the Achilles tendon
and the leg itself.
Adult Athletes [return]
To prevent injuries, adult athletes
should take the following precautions:
- Don't be a "weekend warrior,"
packing a week's worth of activity into
a day or two. Try to maintain a moderate
level of activity throughout the week.
- Learn to do your sport right.
Using proper form can reduce your risk of
"overuse" injuries such as tendinitis and
stress fractures.
- Remember safety gear. Depending
on the sport, this may mean knee or wrist
pads or a helmet.
- Accept your body's limits.
You may not be able to perform at the same
level you did 10 or 20 years ago. Modify
activities as necessary.
- Increase your exercise level
gradually.
- Strive for a total body workout
of cardiovascular, strength training, and
flexibility exercises. Cross-training reduces
injury while promoting total fitness.
Women [return]
Increased emphasis on muscle
strength and conditioning should be a priority
for all women. Women should also be encouraged
to maintain a normal body weight and avoid
excessive exercise that affects the menstrual
cycle. In addition, women should follow precautions
listed above for other groups.
What
Are Some Recent Advances in Treating Sports
Injuries? [return]
Today, the outlook for an injured
athlete is far more optimistic than in the
past. Sports medicine has developed some near-miraculous
ways to help athletes heal and, in most cases,
return to sports. Following are some procedures
that have greatly advanced the treatment of
sports injuries:
Arthroscopy [return]
Most doctors agree that the
single most important advance in sports medicine
has been the development of arthroscopic surgery,
or arthroscopy. Arthroscopy uses a small fiberoptic
scope inserted through a small incision in
the skin to see inside a joint. It is primarily
a diagnostic tool, allowing surgeons to view
joint problems without major surgery. Depending
on the problem found, surgeons may use small
tools inserted through additional incisions
to repair the damage, such as a torn meniscus
or a torn ligament that fails to heal naturally.
Using arthroscopy, for example, a surgeon
may reattach the torn ends of a ligament or
reconstruct the ligament by using a piece
(graft) of healthy ligament from the patient
or from a cadaver.
Because arthroscopy uses tiny
incisions, it results in less trauma, swelling,
and scar tissue than conventional surgery,
which in turn decreases hospitalization and
rehabilitation times. Problems can be diagnosed
earlier and treated without serious health
risks or more invasive procedures. Furthermore,
because injuries are often addressed at an
earlier stage, operations are more likely
to be successful.
Tissue Engineering [return]
When joint cartilage is damaged
by an injury, it doesn't heal on its own the
way other tissues do. In recent years, however,
the field of sports medicine and orthopaedic
surgery has begun to develop techniques such
as transplantation of one's own healthy cartilage
or cells to improve healing. At present, this
technique is used for small cartilage defects.
Questions remain about its usefulness and
cost.
Targeted Pain Relief [return]
For people with painful sports
injuries, new pain-killing medicated patches
can be applied directly to the injury site.
The patch is an effective method of delivering
pain relief, especially for many people who
prefer to put their pain medication exactly
where it's needed rather than throughout their
entire system.
What
Advances Might We Expect in the Future? [return]
Recent advances in treating
sports injuries are likely to be just the
beginning. Watch for developments in these
areas in the not-too-distant future:
- The need for surgery may
decline as improved rehabilitation techniques
lead to a more "natural" progression to
recovery for more musculoskeletal injuries.
- Technical advances and new
imaging methods will lead to better ways
to diagnose and treat injuries.
- Scientists will gain a better
understanding of the role of nutrition in
inflammation and healing. Such knowledge
could lead to improvements in treatment.
- Tissue engineering will become
more commonplace. Early studies of cartilage
tissue engineering are now underway.
- Using gene therapy, doctors
may be able to modify particular cells to
induce repair of injured tissues.
Where
Can People Find More Information About Sports
Injuries? [return]
National
Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS)
National Institutes of Health [return]
1 AMS Circle
Bethesda, MD 20892-3675
Phone: (301) 495-4484 or (877) 22-NIAMS (free
of charge)
TTY: (301) 565-2966
Fax: (301) 718-6366
E-mail: niamsinfo@mail.nih.gov
www.niams.nih.gov
NIAMS provides
information about various forms of arthritis
and rheumatic disease and bone, muscle, joint,
and skin diseases. It distributes patient
and professional education materials and refers
people to other sources of information. Additional
information and updates can also be found
on the NIAMS Web site.
American
Academy of Orthopaedic Surgeons (AAOS) [return]
P.O. Box 1998
Des Plaines, IL 60017
Phone: (800) 824-BONE (2663) (free of charge)
www.aaos.org
The academy provides
education and practice management services
for orthopaedic surgeons and allied health
professionals. It also serves as an advocate
for improved patient care and informs the
public about the science of orthopaedics.
The orthopaedist's scope of practice includes
disorders of the body's bones, joints, ligaments,
muscles, and tendons. For a single copy of
an AAOS brochure, send a self-addressed stamped
envelope to the address above or visit the
AAOS Web site.
American
Academy of Pediatrics [return]
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone: (847) 434-4000
Fax: (847) 434-8000
www.aap.org
The American Academy
of Pediatrics (AAP) and its member pediatricians
dedicate their efforts and resources to the
health, safety, and well-being of infants,
children, adolescents, and young adults. Activities
of the AAP include advocacy for children and
youth, public education, research, professional
education, and membership service and advocacy
for pediatricians.
American
College of Sports Medicine [return]
P.O. Box 1440
Indianapolis, IN 46206-1440
Phone: (317) 637-9200
Fax: (317) 634-7817
www.acsm.org
The American College
of Sports Medicine is the largest sports medicine
and exercise science organization in the world.
Nearly 18,500 members throughout the U.S.
and the world are dedicated to promoting and
integrating scientific research, education,
and practical applications of sports medicine
and exercise science to maintain and enhance
physical performance, fitness, health, and
quality of life.
American
Medical Society for Sports Medicine (AMSSM) [return]
11639 Earnshaw
Overland Park, KS 66210
Phone: (913) 327-1415
Fax: (913) 327-1491
www.amssm.org
The society fosters
a collegial relationship among dedicated,
competent sports medicine specialists and
provides a quality educational resource for
members, other sports medicine professionals,
and the public.
American
Orthopaedic Society for Sports Medicine [return]
6300 N. River Road, Suite 500
Rosemont, IL 60018
Phone: (847) 292-4900
Fax: (847) 292-4905
www.aossm.org
The society is
an organization of orthopaedic surgeons and
allied health professionals dedicated to educating
health care professionals and the general
public about sports medicine. It promotes
and supports educational and research programs
in sports medicine, including those concerned
with fitness, as well as programs designed
to advance our knowledge of the recognition,
treatment, rehabilitation, and prevention
of athletic injuries.
American
Physical Therapy Association [return]
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone: (703) 684-2782 or (800) 999-2782 (free
of charge)
Fax: (703) 684-7343
www.apta.org
The association
is a national professional organization of
physical therapists, physical therapist assistants,
and physical therapy students. Its objectives
are to improve physical therapy practice,
research, and education to promote, restore,
and maintain optimal physical function, wellness,
fitness, and quality of life, especially as
it relates to movement and health.
National
Athletic Trainers Association [return]
2952 Stemmons Freeway
Dallas, TX 75247-6916
Phone: (800) TRY-NATA (800-879-6282) (free
of charge)
Fax: (214) 637-2206
www.nata.org
The association
enhances the quality of health care for athletes
and those engaged in physical activity. It
also advances the profession of athletic training
through education and research in the prevention,
evaluation, management, and rehabilitation
of injuries.
Appendix [return]
Traumatic
Brain and Spinal Cord Injuries [return]
Traumatic brain injury (TBI) occurs when a sudden physical assault
on the head causes damage to the brain. A
closed injury occurs when the head suddenly
and violently hits an object, but the object
does not break through the skull. A penetrating
injury occurs when an object pierces the skull
and enters the brain tissue.
Several types of traumatic injuries
can affect the head and brain. A skull fracture
occurs when the bone of the skull cracks or
breaks. A depressed skull fracture occurs
when pieces of the broken skull press into
the tissue of the brain. This can cause bruising
of the brain tissue, called a contusion. A
contusion can also occur in response to shaking
of the brain within the confines of the skull.
Damage to a major blood vessel within the
head can cause a hematoma, or heavy bleeding
into or around the brain. The severity of
a TBI can range from a mild concussion to
the extremes of coma or even death.
What to do: For anything
more than the most super-ficial injury, call
for emergency medical assistance immediately.
Observe symptoms so that you can report when
help arrives. Do not allow the person to continue
the activity. In more serious cases, do not
move the person unless there is danger.
Spinal cord injury (SCI) occurs when a traumatic event results
in damage to cells in the spinal cord or severs
the nerve tracts that relay signals up and
down the spinal cord. The most common types
of SCI include contusion (bruising of the
spinal cord) and compression (caused by pressure
on the spinal cord). Other types include lacerations
(severing or tearing of nerve fibers) and
central cord syndrome (specific damage to
the cervical region of the spinal cord).
What to do: In some
cases, drugs called corticosteroids can minimize
cell damage from a spinal cord injury. To
be effective, they must be given within 8
hours of the injury. For this reason, it is
important to call for emergency medical assistance
immediately. Any person suspected of sustaining
such a spinal cord injury should not be moved
unless it is absolutely essential to keep
the airway open so the person can breathe
or to maintain circulation.
For more information, visit
the Web site of the National Institute of
Neurological Disorders and Stroke at www.ninds.nih.gov/health_and_medical/disorders/sci.htm or call (800) 352-9424.
Bruises
A bruise, or muscle
contusion, can result from a fall or from
contact with a hard surface, a piece of equipment,
or another player while participating in sports.
A bruise results when muscle fiber and connective
tissue are crushed; torn blood vessels may
cause a bluish appearance. Most bruises are
minor, but some can cause more extensive damage
and complications.
What to do: Put the
muscle in a gentle stretch position and begin
using the RICE method (page 13) to start the
healing process. For more severe bruises,
consult a doctor.
Sports
Injuries in Young Children: Tips for Caregivers
Here are some "on-the-field"
tips for helping a young child who has been
injured:
- Minor injuries are fairly
common in young children; severe injuries
are not.
- A young child's self-esteem
and enjoyment of a sport can be influenced
by an adult's reaction when the child is
injured.
- Judging the intensity and
finding the site of the pain in a preschool
child may not be easy. The child's perception
of severity, influenced by his/her temperament
and developmental level, may not match reality.
The child's response to an injury may also
reflect his/her prior experiences or the
experiences of a friend or family member
who has had an injury.
- Don't judge a child's reaction
to an injury based on the child's age, sex,
or size. Young children may vary greatly
in their physical and mental development,
temperaments, and reactions to and tolerance
of pain and stress.
- Acknowledge the child's feelings
(pain, fright, and/or anxiety), provide
emotional support, and convey a sense of
protection and caring.
- Treat children with respect.
Never ridicule or belittle them in front
of their peers, as this may be harmful to
their developing self-esteem. Reassure the
child that he/she will be cared for and
the injury will be evaluated.
- Inappropriate overconcern
can have negative effects and may lead to
a more frightened child or eventually to
a more vulnerable child. Parents may have
difficulty remaining objective regarding
their child's injury. On the other hand,
parental knowledge of their child's temperament
and typical reaction to pain can be immensely
helpful to others trying to evaluate the
severity of the injury.
- Question the child simply
and directly. An authoritative approach,
gentle but firm, will be reassuring for
some youngsters.
- Listen to the injured youngster
and get his/her reaction to reentering a
sport or activity. Sometimes hidden fears
will be expressed that can be addressed
by a caregiver who listens. A child's mental
health and development are as important
as his/her physical health.
- Time, ice, and a caring attitude
will help to minimize many simple traumatic
injuries.
Acknowledgments
The NIAMS gratefully acknowledges
the assistance of the American Academy of
Orthopaedic Surgeons, Des Plaines, IL; the
American Physical Therapy Association, Alexandria,
VA; William E. Garrett, Jr., M.D., Ph.D.,
University of North Carolina; Jo A. Hannafin,
M.D., Ph.D., Hospital for Special Surgery,
New York, NY; Lynn Haverkof, M.D., the National
Institute of Child Health and Human Development,
NIH; Cato T. Laurencin, M.D., Ph.D., University
of Virginia, Charlottesville, VA; Gayle Lester,
Ph.D., NIAMS, NIH; the National Institute
of Neurological Disorders and Stroke, NIH;
and James S. Panagis, M.D., M.P.H., NIAMS,
NIH, in the preparation and review of this
booklet. Special thanks also go to the individuals
who reviewed this publication and provided
valuable assistance. Mary Anne Dunkin was
the author of this booklet.
The mission of the National
Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS), a part of the Department
of Health and Human Services' National Institutes
of Health (NIH), is to support research into
the causes, treatment, and prevention of arthritis
and musculoskeletal and skin diseases, the
training of basic and clinical scientists
to carry out this research, and the dissemination
of information on research progress in these
diseases. The National Institute of Arthritis
and Musculoskeletal and Skin Diseases Information
Clearinghouse is a public service sponsored
by the NIAMS that provides health information
and information sources. Additional information
can be found on the NIAMS Web site at www.niams.nih.gov.
The NIH Osteoporosis and Related Bone Diseases-National
Resource Center, also a part of the U.S. Department
of Health and Human Services' National Institutes
of Health (NIH), provides patients, health
professionals, and the public with an important
link to resources and information on metabolic
bone diseases, including osteoporosis, Paget's
disease of the bone, osteogenesis imperfecta,
and hyperparathyroidism. Additional information
can be found on the Resource Center's Web
site at www.osteo.org.
U.S. Department of Health and
Human Services
Public Health Service
National Institutes of Health
National Institute of Arthritis and Musculoskeletal
and Skin Diseases
NIH Publication No. 04-5278 |
