Sports Injuries
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Appendix
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.
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.
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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.
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.
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).
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.
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.
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.
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
- 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.
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.
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
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.
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Regardless of the specific structure affected, sports
injuries can generally be classified in one of two ways: acute or
chronic.
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 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.
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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, while others can
be self-treated. Here's what you need to know about both types:
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.
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.
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.
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.
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)
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
(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
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.
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.
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, 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.
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 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.
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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.
While 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 in order to keep up with their peers.
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.
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.
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.
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).
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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.
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 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.
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.
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.
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.
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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:
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.
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.
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.
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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.
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National Institute
of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
American Academy
of Orthopaedic Surgeons (AAOS)
American Academy
of Pediatrics
American College of Sports Medicine
American Medical Society for Sports
Medicine (AMSSM)
American Orthopaedic Society
for Sports Medicine
American Physical Therapy Association
National Athletic Trainers Association
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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.
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.
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.
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