Sports Injuries

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Sports injuries

Definition

A sports injury is any bodily damage sustained during participation in competitive or non-competitive athletic activity. Sports injuries can affect bones or soft tissue (i.e., muscles, ligaments, tendons).

Description

Sports injuries are identified as either acute or chronic. Acute sports injuries are characterized by the sudden appearance of symptoms, usually associated with a single traumatic incident. Signs and symptoms of acute sports injuries include pain , swelling, and deformity in the affected area, and in the case of joint injuries, limited ability to move the joint. Common acute sports injuries include sprains and strains , contusions (i.e., serious bruises), joint dislocations, bone fractures , and concussions.

Chronic sports injuries, also called overuse injuries, are identified with more gradual onset and are caused by repetitive light trauma to soft tissue or bone. Typically, pain and swelling worsen during athletic activity but decrease after the activity is stopped. Overuse injuries include tendonitis, bursitis , shin splints, and stress fractures.

The United States Consumer Product Safety Commission (CPSC) estimates that, in 1998, there were over one million sports injuries among persons 35–54 years old. Moreover, the number of sports injuries in this age group increased by one-third between 1991 and 1998. The CPSC believes that the rise in injuries is because of increased sports participation among baby boomers.

The CPSC National Electronic Injury Surveillance System also reports that over 3.5 million sports injuries in children younger than age 15 are treated at hospitals and clinics annually. Children are particularly vulnerable to sports injuries because their bones, muscles, and connective tissue have not fully matured, and because they have not yet developed mature neuromuscular coordination.

Causes and symptoms

Acute sports injuries are caused by excessive force applied to bone or soft tissue during sports activity. These injuries are commonly associated with falls and high-speed collisions. Specific signs and symptoms depend on the nature of the impact and the body region affected.

Acute sports injuries

SOFT TISSUE INJURIES. Soft tissue injuries occur typically in the knee, shoulder, and ankle. In the knee, tears of the anterior cruciate ligament (ACL) and of the meniscus (i.e., cartilage in the knee) are common. A twisted knee, a sudden directional change, or a misaligned landing from a jump can cause these knee injuries. With the ACL tear, a "pop" in the knee is frequently felt at the time of the injury. This popping sensation is accompanied by pain and weakness in the knee. A tear of the meniscal cartilage is identified by pain over the area of the meniscus area underneath the edge of the patella, or kneecap), and the pain intensifies if a finger is gently pushed on the edge of the kneecap. The athlete is also often unable to fully extend the knee. With both ACL and meniscus tears, there is swelling several hours after the injury occurs.

In the shoulder, strains of the rotator cuff tendons and dislocation of the shoulder are frequently seen. Tendon strains are associated with overly vigorous throwing movements, and are characterized by the patient complaining of pain if the arm is rotated against resistance. Shoulder dislocations are identified by deformity in the shoulder joint, and pain and lack of mobility in the joint area.

Ankle sprains are the most common injury in sports that require running and jumping. Ankle sprains occur when ligaments in the ankle have been stretched or torn. There is typically swelling and tenderness, and in more serious cases, the athlete is unable to put much weight on the foot of the injured ankle.

SKELETAL INJURIES. Fractures are breaks in the bone due to collisions or falls, and commonly appear in the leg and arm. Symptoms include pain, swelling, and bruising at the site of the fracture. There is also weakness in the limb and an inability to bear weight on the limb. With open fractures, bone fragments protrude through the skin.

BRAIN INJURIES. Brain injuries cause more deaths than any other type of sports injuries. A common brain injury is the concussion , an injury caused by the impact of the brain against the interior surface of the skull . Concussions often follow a blow to the head or a very rapid acceleration of the head. Loss of consciousness is an important symptom in brain injuries. Other signs and symptoms of concussion include headache, vomiting, delayed motor or verbal responses, partial loss of vision , memory loss, lack of coordination, or erratic and inappropriate behavior.

Chronic sports injuries

Chronic or overuse injuries are caused by repetitive stress to soft tissue or bone and typically result from a sudden increase in the duration or intensity of athletic activity. In some cases, chronic injuries can be a precipitating factor in acute injuries such as strains and sprains.

SOFT TISSUE INJURIES. Tendonitis, or inflammation of the tendon, is one of the most common overuse injuries and often affects the joints at the elbow, knee, shoulder, and foot. In the elbow joint, tendonitis is known

as golfer's elbow or tennis elbow, and is often caused by poor technique. Shoulder tendonitis is caused by repetitive overhead motions and is common in swimming and in sports requiring throwing motions. In the foot, inflammation of the Achilles tendon (i.e., in the heel area) is caused by biomechanical misalignments, inadequate stretching, sudden increases in training, and athletic play on hard or banked surfaces. Symptoms of tendonitis include pain, redness, swelling, and warmth of the affected area. These symptoms diminish when athletic activity is stopped. Bursitis, an inflammation of the connective tissue of joints, is also common in the knee.

SKELETAL INJURIES. Stress fractures are tiny breaks in the bone caused by repetitive forces. Stress fractures frequently affect the leg, foot, and ankle after training has been suddenly intensified or the sport has been played on hard surfaces. Other risk factors of stress fractures are osteoporosis and eating disorders, which tend to weaken bone. Symptoms of stress fractures include pain when weight is placed on the leg or foot, with pain increasing after athletic activity. There may be swelling and point tenderness (i.e., pain when a small region of the affected area is lightly pushed).

Diagnosis

Acute injuries are usually self-evident, as they are associated with a specific traumatic event. After the trauma, the physician performs a physical examination of the athlete to identify the specific injury. In the case of suspected joint or skeletal injuries, a radiological technician will take x-rays, and the radiologist will confirm or rule out a dislocation, bone fracture, or soft tissue injury.

With overuse injuries, the physician conducts a physical examination and uses signs, symptoms, and training history to diagnose the injury. If a stress fracture is suspected, a bone scan or magnetic resonance imaging (MRI) of the area may be performed.

Treatment

For sports injuries, Protection-Rest-Ice-Compression-Elevation (PRICE) is the standard of treatment. PRICE specifies the elements of first-line treatment. Depending on the type of injury, protection may mean immobilizing the affected area with a brace, tape, or wrap, or simply avoiding activities that aggravate the injury. Rest means refraining from activities that prevent recovery from injury; in many cases, cross-training is considered rest because it exercises areas that do not affect the injury. Ice should be used to relieve pain and swelling. Compression, with tape or elastic wraps, is used to limit swelling and stabilize the area. Elevation, where the injured body part is placed above the level of the heart , is also used to prevent swelling.

Some clinicians use the extended PRICE-MM (i.e., Medication and Modalities) regimen, which includes therapeutic use of medication and modalities (i.e., rehabilitation). Nonsteroidal anti-inflammatory medicines such as ibuprofen (e.g., Advil, Motrin) and naproxen (e.g., Naprosyn) have traditionally been used for pain management with sports injuries. Injections of corticosteroids are sometimes used to control inflammation and pain, but since these injections reduce the strength and flexibility of soft tissue, corticosteroids are used sparingly, primarily for specific overuse syndromes.

The goal of modalities, as in modes of rehabilitation therapies, is to return the athlete to the sport as quickly and as safely as possible. Rehabilitation can begin as soon as the physician permits, typically after internal bleeding has stopped. Modalities include cold and heat therapies, therapeutic ultrasound, range of motion exercises, and resistance exercises.

In serious cases of acute and overuse injuries, PRICE-MM may not be sufficient, and surgery may be required to repair injuries.

Prognosis

For most sports injuries, the PRICE-MM regimen should be sufficient to restore the athlete to the previous level of performance. The prognosis is good as long as the rehabilitation has successfully restored the strength and flexibility of the injured area, and the athlete takes care to prevent recurrence of the injury, suspending activity and undertaking appropriate therapy if pain recurs. With some serious injuries, the athlete will not be able to return to the sport or return to the previous level of activity in that sport.

Health care team roles

In school and youth sports, the nurse is often the first health care provider to evaluate acute injuries and is often responsible for some first aid of wounds and injuries until a physician can attend to the athlete. In school settings, since the nurse is in more frequent contact with children, he or she can advise on general measures to prevent injuries such as warm-up and stretching. In clinical settings, the nurse takes a detailed medical and training history that can help the physician diagnose the injury.

The athletic trainer is often on call for emergency care of acute sports injuries and performs first aid on the injured athlete. He or she specializes in sports activities and can give more specific advice for overall conditioning, training, and treatment of the athlete. The athletic trainer also serves as a liaison between the athlete and coaches, parents, and physicians.

Prior to student participation in athletic activity, the the preparticipation physical examination is performed by the physician to assess the patient's fitness for the sport. If the athlete is injured, a diagnosis of the injury is made by the physician and a prescription for appropriate treatment is given. Medical and radiological tests are conducted by technologists. The results assist in determination of the physician's diagnosis. For rehabilitation, the patient may be referred to a physical therapist. For serious injuries requiring surgery, the patient may be referred to an orthopedic surgeon.

Prevention

Many acute and overuse sports injuries are caused by increases in training intensity that put too much physical stress on the athlete's body. This often happens for in amateur athletes who do not sustain regular training regimens and overdo their workouts when they do train. These injuries can be prevented with a variety of training and educational regimens.

For youths and adults, the physical exam can be used to identify weaknesses that may predispose the athlete to injury, and that should be developed prior to engaging in athletic activity. Pre-season conditioning programs that slowly increase intensity level are useful in developing the athlete's level of fitness in preparation for the sports season. Flexibility training, strength training, and cross training have also been shown to prevent injuries by improving the body's resilience.

Finally, education can be effective in preventing certain common sports injuries. The athlete can be shown how to wear protective gear correctly, how to perform the correct throwing, swinging, blocking, or tackling motion to prevent injury, and how to adjust body biomechanics in the event of an unpreventable fall. Although not all sports injuries can be prevented, the damage from many injuries can be minimized with appropriate training.

Resources

BOOKS

Bull, Charles R, ed. Handbook of Sports Injuries. New York: McGraw-Hill, 1999.

Stiles, Bradford H. "Common Sports Injuries." In Conn's Current Therapy 2000, edited by Robert Rakel. Philadelphia: W.B. Saunders, 2000, pp. 974-8.

ORGANIZATIONS

American Academy of Orthopaedic Surgeons. 6300 N. River Road, Rosemont, IL 60018. (800) 346-AAOS. <http://www.aaos.org>.

American Orthopaedic Society for Sports Medicine. 6300 N. River Road, Rosemont, IL 60018. <http://www.intelli.com/vhosts/aossmisite/html/main.cgi?sub=2>.