ATHLETIC EDGE
Sports Medicine
Sports Injury Prevention & Rehabilitation
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Athletic Edge - Sports Injuries

The following pain and injury information is provided for informational purposes only. We recommend consulting a doctor or medical professional if you are in pain, or before performing any rehabilitation, stretching, or strengthening exercises.

Sports Injuries


Publication Date: April 2009


This booklet is for athletes at all ages and levels, for people who exercise, as well as for health care professionals, coaches, and others who want to find out more about sports injuries. This booklet describes the different types of sports injuries, how they can be treated and prevented, and recent treatment advances from research. It also highlights risk factors and contains a resource list. If you have further questions after reading this booklet, you may wish to discuss them with a health care professional.

Introduction

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. 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?
  • What's the Difference Between Acute and Chronic Injuries?
  • What Should I Do if I Suffer an Injury?
  • Who Should I See for My Injury?
  • How Are Sports Injuries Treated?
  • Who Is at Greatest Risk for Sports Injuries?
  • What Can Groups at High Risk Do to Prevent Sports Injuries?
  • What Are Some Recent Advances in Treating Sports Injuries?
  • What Advances Might We Expect in the Future?
Information
  • Common Types of Sports Injuries
  • The Body's Healing Process
  • Tips for Preventing Injury

What Are Sports Injuries?
The term sports injury, in the broadest sense, refers to the kinds of injury that most commonly occur during sports or exercise. Some sports injuries result from accidents; other 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 as well. Following are some of the most common sports injuries.

Sprains and Strains
A sprain is a stretch or tear of a ligmaent, 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 worse 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. Although 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
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 doctors for knee problems.

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 (IT Band Syndrome - pain on the outer side of the knee), and tendinitis, 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 femur (thigh) and the tibia and fibula (lower leg bones). The other is a surface-coating, called 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).

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
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
Although 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
An Achilles tendon injury results from a stretch, tear, or irritation to the tendon connecting the calf muscle to the back of the heel. These 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 of the athlete.


Common Types of Sports Injuries
  • 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
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 weigh 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
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 require medical treatment.

The Shoulder Joint
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?
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
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?


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 medial attention, 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.

When and How to Treat at Home


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 healthcare 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 can 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 bad, 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 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, the help decrease swelling.

The Body's Healing Process

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?

Although 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.


Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

The moment you are injured, chemicals are released from damaged tissue cells. This triggers the first stage of healing: inflammation. 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, ketoprofen, or naproxen sodium. For more severe pain and inflammation, doctors may prescribe one of several dozen NSAIDs available in prescription strength.


Immobilization

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 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 ban 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 rubber covered with fabric, leg immobilizers enclose the entire leg, fastening with Velcro straps.
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 injuries 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, resistance or 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.

Rest
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
Other therapies commonly used in rehabilitating sports injuries include:
  • Electrostimulation: Mild electrical current proved 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 pressure, rubbing, and manipulation soothe tense muscles and increase blood flow to the injury site.
These therapies are administered or supervised by a licensed health care professional.

Who Is at Greatest Risk for Sports Injuries?

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

Although playing sports can improve children's fitness, 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 to keep up with their peers.

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 nick, 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.

Adult Athletes
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
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 ten dot be sport specific.
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 challeneged. Scientists are working to understand the gender difference in sports injuries.
Although 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?
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
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:
  • 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 cool downs 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. Cool down exercises loosen the muscles that have tightened during exercise.
Tips for Preventing Injury

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 keep 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
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
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?
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
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
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

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?

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. Studies of musculoskeletal tissue engineering are yielding promising results.

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 to start the healing process.

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 development level, may not match reality. The child's response to an injury may also reflect his/her previous experience or the experience 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 about 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.
Acknowledgements & Resources & References
NIAMS, 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; Lynne Haverkos, 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. Mary Anne Dunkin was the author of this booklet.

Other sources of medical information provided on this site:

Vanderbilt University
Proaxis Physical Therapy
American Physical Therapy Association
American Academy of Orthopaedic Surgeons
WebMD
PhysioAdvisor




The following pain and injury information is provided for informational purposes only. We recommend consulting a doctor or medical professional if you are in pain, or before performing any rehabilitation, stretching, or strengthening exercises.



Foot & Toe Injuries
  • Turf toe
  • Stress fractures
  • Metatarsal fracture
  • Tarsal tunnel syndrome
  • Medial calcaneal nerve entrapment
  • Inflammation of the extensor tendons of the toes
  • Bunions -
  • Inflammation or rupture of peroneus brevis tendon.
  • Morton's Syndrome
  • Lisfranc's injury (fracture / dislocation)
  • Navicular Stress Fracture
  • Stress fracture of the talus
  • Plantar fascia strain
  • Pes cavus (claw foot)
  • Blisters
  • Inflammation of flexor tendons of the toes
  • Tibialis posterior tendinopathy
  • Plantar fasciitis (heel spur)
  • Bruised heel (Fat pad contusion)
  • Bursitis under the calcaneus bone
  • Calcaneal stress fracture
  • Tarsel tunnel syndrome
  • Achilles bursitis (Retrocalcaneal bursitis)
  • Medial calcaneal nerve entrapment




Lower Leg & Ankle Injuries
  • Ankle sprain / sprained ankle
  • Soccer ankle
  • Tibialis posterior syndrome
  • Peroneal tendon dislocation
  • Impingement of the ankle
  • Pott's fracture / ankle fracture
  • Stress Fracture of the Medial Malleolus
  • Medial (deltoid) ligament sprain
  • Sinus Tarsi Syndrome
  • Achilles Tendon
  • Total rupture of the achilles tendon (achillies strain).
  • Partial rupture of the achilles tendon.
  • Acute achilles tendinitis
  • Chronic achilles tendinitis
  • Achilles bursitis (Retrocalcaneal bursitis)
  • Haglund's Syndrome - see Achilles bursitis.
  • Apophysitis calcanei / Sever's disease
  • Calf strain (pulled muscle)
  • Tight calf muscles
  • Deep Vein Thrombosis
  • Contusion of the calf muscles
  • Cramp
  • Posterior compartment syndrome
  • Lateral compartment syndrome
  • Stress Fracture of the (tibia) lower leg
  • Stress Fracture of the fibula
  • Shin splints / Periostitis
  • Anterior Compartment Syndrome
  • Inflammation of the tendon sheath of the Tibialis Anterior



Knee Injuries
  • Acute knee injuries
  • Anterior cruciate ligament sprain
  • Fat Pad Impingement
  • Posterior cruciate ligament sprain
  • Rupture of hamstring tendons / tendon strain
  • Lateral Meniscus Tear / cartilage tear
  • Lateral Cartilage Meniscus Abnormality
  • Lateral Ligament Sprain
  • Medial Ligament Sprain
  • Medial Cartilage Meniscus Injury
  • Articular Cartilage damage
  • Osteochondritis dessecans
  • Patella Dislocation
  • Overuse knee injuries
  • Patella pain syndrome / CMP (Chondramalacia patellae)
  • Patellofemoral Instability
  • Patella / Synovial Plica
  • Runner's Knee (Iliotibial band syndrome)
  • Lateral Cartilage Meniscus Inflammation
  • Inflammation of Quadriceps insertion at the Patella (tendinitis)
  • Jumpers knee (patella tendon inflammation / rupture)
  • Baker's cyst (Popliteal cyst)
  • Inflammation of hamstring tendons / tendinitis
  • Pre-patella bursitis / Housemaids knee
  • Osgood Schlatters disease
  • Knee arthritis
  • Osteoarthritis of the knee



Thigh Pain - Front & Back
  • Rupture of hamstring muscles / hamstring strain
  • Hamstring contusion
  • Tight hamstring muscles
  • Hamstring Tendinitis at the muscles origin
  • Rupture of quadriceps muscles (pulled muscle / thigh strain)
  • Contusion of quadriceps muscles (dead leg / charley horse)
  • Rupture of rectus femoris muscle
  • Inflammation of rectus femoris tendon
  • Rupture of adductor muscles (Groin strain) 
  • Glimore's groin
  • Inflammation of adductor muscles or tendon (tendinitis / tendinopathy)
  • Myositis Ossificans
  • Hernia
  • Ostitis Pubis
  • Inflammation of iliopsoas muscle
  • Rupture of iliopsoas muscle
  • Stress Fracture of the Femur



Hip Injuries
  • Hip bursitis
  • Stress fracture of the femur
  • Slippage of the epiphysis at neck of femur
  • Perthes' disease
  • Inflammation and calcification of the greater trochanter
  • Inflammation of the hip joint (synovitis)
  • Labral Tear



Buttocks
  • Piriformis syndrome
  • Inflammation of the sacroiliac joint
  • Iliolumbar ligament sprain
  • Referred pain from the lumbar spine
  • Myofascial Pain and Trigger Points
  • Sciatica
  • Inflammation of the muscle attachments to the greater trochanter
  • Ischiogluteal Bursitis
  • Ankylosing Spondylitis / Bechterew's Disease
  • Hamstring Tendinitis at the muscles origin



Lower back
  • Lower back pain
  • Muscle strains in the low back
  • Facet Joint Pain
  • Weak back
  • Sciatica
  • Scoliosis
  • Lordosis
  • Sponylolysthesis
  • Spinal Stenosis
  • Paravertebral Trigger Points



Upper back & neck
  • Pain in the neck which does not radiate
  • Pain in the neck which radiates to the shoulders and arms
  • Muscle ruptures in the back
  • Inflammation of muscle attachments to the spine
  • Scheuermann's disease
  • Tight muscles in the upper back and neck



Shoulder
  • Fracture of the clavicle
  • Fracture of the neck of the humerus
  • Frozen Shoulder / Adhesive capsulitis
  • Dislocation of the A.C. joint
  • Dislocation of the sterno-clavicular joint
  • Dislocated Shoulder
  • Impingement syndrome
  • Rotator cuff injuries / rotator cuff strain
  • Rupture of the supraspinatus tendon
  • Inflammation of the supraspinatus tendon
  • Subacromial bursitis
  • Inflammation of the subscapularis tendon 
  • Deltoid muscle strain (front)
  • Deltoid muscle strain (back)
  • Pectoralis major muscle / tendon strain
  • Pectoralis major tendon inflammation
  • Rupture of the long head of the biceps
  • Inflammation of the long head of the biceps
  • Winged Scapula



Elbow
  • Tennis elbow
  • Entrapment of the radial nerve
  • Bursitis of the elbow (student elbow)
  • Golfers / Throwers elbow
  • Inflammation of the biceps tendon
  • Entrapment of the ulnar nerve
  • Inflammation and rupture of the triceps tendon
  • Elbow Hyperextension Injury
  • Medial Elbow Ligament Sprain


 
Wrist & Forearm
  • RSI - Repetitive strain injury
  • Bursitis in the wrist.
  • Carpal tunnel syndrome
  • Dislocation of the carpal bones
  • Muscle & tendon inflammation
  • Fractured Scaphoid
  • Fracture of the distal radius
  • Fracture of the hook of the hamate
  • De Quervain's Tenosynivitis
  • Ganglion Cyst
  • Distal Radial Epiphysis Injury



Hand & Finger

  • Metacarpal fractures
  • Dupuytren's contracture
  • Sprained thumb
  • Sprained finger



Head Injuries
  • Facial Injuries
  • Headaches
  • Concussion



General Medical Conditions
  • Bone and Soft Tissue Tumors
  • Fibromyalgia
  • Heat injuries
  • Chronic fatigue
  • DOMS - delayed onset muscular soreness
  • Arthritis