Sports Injuries – A Guide

Injuries and disability caused by sporting activities and exercising

Introduction
Symptoms of sports injuries
Causes of sports injuries
Treating sports injuries
Preventing sports injuries

Introduction

Sports injuries can happen as a result of:

• not warming up properly before exercising more vigorously,
• pushing too hard for your current level of fitness, or
• using inadequate equipment.

To reduce the risk of being injured while exercising, ask a qualified health professional or sports coach for training and safety advice.

Before starting a new exercise programme or taking up a new sport, it is also a good idea to visit your GP for a check-up and fitness assessment.

See Useful links for more information and advice about how to exercise safely.

Types of sports injury

Sport injuries can be acute or chronic.

• Acute sports injuries occur as a result of a sudden impact or awkward movement. Examples include a cut to the skin or a sprained ankle.
• Chronic sports injuries develop over time, often due to continual use of the same joints or muscle groups.

Chronic sports injuries can occur due to bad technique or occasionally structural abnormalities, such as an inherited bone or muscle problem.

Chronic sports injuries should be investigated by a medical professional to determine the cause and to prevent the injury getting worse.

Some common sports injuries include:

• sprains,
• strains,
• cuts and bruises,
• bone fractures and breaks,
• tendonitis (inflammation of a tendon),
• blisters, and
• head injuries.

See the Symptoms section, above,for more information about common sports injuries.

Symptoms of sports injuries

Sports injuries can occur almost anywhere on the body. Some of the most common sports injuries and their symptoms are described below.

Sprains

A sprain is where one or more of your ligaments is stretched, twisted or torn. Ligaments are strong bands of tissue around joints. Theyconnect one bone to another and help keep your bones together and stable.

Sprains often occur in ligaments around jointsin the ankle or knee.The joint is not dislocated or fractured. The symptoms of a sprain include:

• pain,
• inflammation (swelling),
• bruising, and
• restricted movement in the affected area.

Sprains are common injuries in many sports and, if necessary, can be treated with rest and anti-inflammatory medication.

The BMA Guide to Sport Injuries	The Anatomy of Sports Injuries: Your Illustrated Guide to Prevention, Diagnosis and Treatment	Sports Injuries: A Self-Help Guide

Strains

A muscle strain is where muscle tissues or fibres are stretched or torn. A muscle strain is sometimes referred to as ‘pulling a muscle’.

Tendons can also be strained. A tendon is the tough, narrow tissue at the end of a muscle that connects it to the bone.

Strains are caused by a muscle that is overstretched or that over-contracts. Symptoms of a strain include:

• pain,
• muscle spasm, and
• a loss of strength in the muscle.

Strains are common to many sports, particularly those involving running, jumping or rapid changes of direction.

See Useful links for more information about sprains and strains.

Torn anterior cruciate ligament

The anterior cruciate ligament (ACL) is one of the four ligaments in your knee. It can be torn if you suddenly stop or change direction, or land incorrectly from a jump.If you tear your ACL, you may hear a pop, or crack, at the time you are injured.

An ACL tear is a fairly common sports injury; 20% of all sports related knee injuries involve the ACL. The symptoms of a torn ACL include:

• a lot of pain in your knee,
• instability in your knee, so that you are unable to put much weight on it,
• inflammation (swelling) in your knee, and
• not having the full range of movement in your knee and, in particular, not being able to straighten your leg.

Depending on how badly torn your ACL is, you may need to have reconstructive surgery to repair it.

Tennis elbow

Tennis elbow (epicondylitis) is a painful condition that affects the outside of the elbow. It is caused by strenuous overuse of the muscles and tendons of the forearm and around the elbow joint.

The symptoms of tennis elbow include:

• swelling around the outer edge of the elbow (because the tendon is inflamed),
• tenderness around the elbow, and
• pain when moving the elbow.

Tennis elbow is caused by repetitive movement of the muscles in the lower arm. It can be treated with anti-inflammatory medication, an elbow splint to support the arm or a cortisone injection.

See the Useful links section for more information about tennis elbow.

Golfer’s elbow

Golfer’s elbow has similar symptoms to tennis elbow. However, due to the difference in arm movement in golf, the inflammation (swelling) occurs on the inside of the elbow, rather than on the outside.

Tendonitis

Tendonitis is inflammation (swelling) of a tendon. Symptoms of tendonitis include:

• swelling, redness and pain at the injured area,
• restricted movement of the affected area, and sometimes
• a change in appearance of the affected area, such as a lump or a visible change in position of a limb.

Tendonitis is a fairly common injury that can result from a strain or tear in a tendon. Tendonitis can occur in the tendons around the shoulder, elbow, wrist, finger, thigh, knee or the back of the heel (Achilles tendonitis).

Blisters

Blisters are small, fluid-filled swellings that form in the upper layers of skin when the outer layer of skin becomes damaged. Fluid collects under the damaged layer of skin, cushioning the tissue underneath and protecting it from further damage

The clear fluid that forms inside blisters is called serum. Serum is the part of the blood that remains after the red blood cells and clotting agents have been removed.

Blisters are a common minor injury caused by friction on soft skin. Endurance athletes, such as long-distance runners, sometimes develop blisters on their feet. Rowers are at risk of developing blisters on the palms of their hands.

Sore shins

Sore shins (sometimes known as shin splints)cause pain along the inside of the shin bone. The shin bone runs down the front of the lower leg between the knee and the ankle.

Sore shins are caused by inflammation (swelling) and tiny fractures (micro-fractures) in the surface of the bone. The main symptoms of sore shinsare aching, throbbing or tenderness along the inside of the shin (which sometimes radiates to the outside).

Sore shins are a common injury in any sport that involves running and are often caused by doing too much training too soon. They can also be caused by running on hard surfaces or by running in shoes that do not have enough foot and ankle support.

Runner’s knee

Runner’s knee (chondromalacia) is one of the most common types of knee injury. It develops when the cartilage underneath the kneecap softens or wears away, causing inflammation (swelling) at the back of the kneecap.

If you have runner’s knee, you will experience soreness and discomfort beneath or to one side of your kneecap. It can also cause a grating sensation in your knee. Runner’s knee is caused by the repeated impact of running on hard surfaces.

Head injuries

Head injuries can occur when a person receives a blow to their head during contact sports, such as rugby, boxing, ice hockey and football.

A head injury can sometimes cause concussion (mild, reversible brain damage which can last a few seconds or a few hours). Someone with concussion requires medical treatment. The signs of concussion are:

• loss of consciousness,
• light-headedness,
• dizziness,
• nausea, and
• sickness.

Repeated or severe blows to the head, such as those sustained in boxing, can sometimes result in permanent brain damage. Severe knocks to the head cause the brain to bang against the inside of the skull,leading to brain damage.

Causes of sports injuries

Acute sports injuries, like cuts and sprains, are usually the result of accidents, such as a sudden impact or an awkward movement. This sort of injury can be difficult to avoid.

However, many sports injuries are avoidable because they are often the result of:

• not warming up properly,
• poor technique,
• not using equipment correctly,or
• not taking the proper safety precautions for your sport.

Who is at risk of getting a sports injury?

Competitive athletes, such as sprinters, long-distance runners, gymnasts and rugby players, have a high risk of injury due to the intense nature of their training and the overuse of specific muscle groups.

Children are also at risk of sports injuries because they are still developing physically. For example, the female shape changes significantly during puberty (usually between ages 10 and 16). As the hips widen, exercise can put pressure on different parts of the legs and feet, which can sometimes lead to injury.

Sport specific injuries

The repetitive and aggressive movements used in many sports can result in a number of different types of injury to different parts of the body. Outlined below are injuries that are specific to some common sports.

Athletics

Runners are at risk of getting a variety of muscle strains, particularly to the legs, lower back and lower half of the body. Ankle and ligament damage is also common, as well as Achilles tendon ruptures and calf tendon tears.

The sudden movement and intense power required by throwers, such as shot putters and discus throwers, can cause upper body injuries. The upper limbs, usually the shoulders, elbows and wrists, are particularly susceptible to injury.

Jumping events, such as the long jump and triple jump, can cause stress injuries to the lower limbs and spine. Competitive athletes who participate in jumping events are at risk of developing overuse injuries to the tendons and ligaments of the knees and Achilles.

Cricket

Head injuries are common in competitive cricket due to the fast bowling techniques that are used. Bowlers are also at risk of getting back and spine injuries, including muscle strains and stress fractures. Knee ligament and cartilage damage is also possible.

Football

As football is increasingly becoming a contact sport, fractures, cuts and bruises are common injuries. Other possible injuries include boot stud injuries, ankle sprains and knee ligament and cartilage damage due to repeated twisting actions.

Gymnastics

Gymnasts can develop serious injuries if their training is not properly supervised and appropriate safety equipment is not used. In gymnastics, the body is often contorted into new shapes, so injuries during training are particularly common.

Spinal injuries are the biggest risk to gymnasts. High-impact landings from substantial heights can injure the spine, as can repeated hyperextension (backbends). This can lead to the development of serious conditions, such as spondylolysis and spondylolisthesis (damage to the vertebrae of the back). These conditions require surgical treatment.

Racquet sports

Racquet sports include badminton, tennis and squash. Injuries are often caused by players falling on to hard surfaces and include cuts, bruises and fractures.

Eye injuries are a particular risk during racquet sports, such as squash, where the ball travels at high speed. There is also a risk of lower and upper body muscle strains, particularly for competitive players.

Treating sports injuries

You should not continue to exercise when you feel pain, regardless of whether your sports injury is acute (occurs suddenly) or chronic (long-term).

If a particular movement or activity hurts, stop doing it and seek medical advice. Continuing to exercise while you are injured may cause further damage and prolong your recovery time.

When to seek medical treatment

If you sustain a severe injury while doing a sporting activity, such as a deep cut or concussion from a blow to the head, visit your nearest accident and emergency (A&E) department.

If the injury does not require immediate medical attention but causes severe pain, swelling or numbness, or if you cannot place any weight on the affected area, visit your GP or local NHS walk-in centre.

RICE therapy

If your injury does not require medical treatment, for example a mild sprain or other minor muscle or ligament damage, you can treat it at home using RICE therapy. RICE stands for:

• Rest: avoid regular exercise and reduce daily physical activity. Using crutches or a walking stick may help if you are unable to put weight on your ankle or knee.
• Ice: apply an ice pack to the affected area for 10 to 30 minutes. Do not allow the ice to touch your skin directly as this may cause a cold burn. Before applying ice, wrap it in a towel or put a towel over the injured area.
• Compression: apply pressure (compression)using elastic compression bandages. This may help to limit swelling.
• Elevation: keep the injured leg, knee, arm, elbow or wrist raised above the level of the heart as this may also help reduce swelling.

After 48 hours of RICE therapy,stop compression and try moving the injured area. If, after this time, your symptoms are worse,get advice from a healthcare professional.

Additional treatment

RICE therapy can be useful for any sports injury, but severe injuries may require additional treatment.

Pain relief

Pain relief (analgesics), such as paracetamol, can be used along with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to help ease the pain caused by sprains and fractures, and to help reduce any inflammation (swelling).

Ibuprofen is not recommended for people who have a peptic ulcer (an ulcer anywhere in the digestive system or stomach) or for those who have had one in the past. Ibuprofen is also not recommended for people with severe heart failure.

Ibuprofen should be used with caution if you have certain conditions, such as asthma, kidney or liver disease or mild to moderate heart failure. Speak to your GP or pharmacist if you are unsure whether you should take ibuprofen.

Children under 16 should not take aspirin.

Immobilisation

Immobilisation is a treatment that helps prevent further damage by reducing movement.

Immobilisation also reduces pain, muscle swelling and muscle spasm, as well as speeding up the healing process by encouraging blood to flow directly to the injured area.

A sling can be used to immobilise an arm or shoulder. A splint or cast made of plastic or fibre glass will protect injured bones and soft tissue.

Following a knee injury or knee surgery, a leg immobiliser, made from foam rubber,may be used to keep the knee in a fixed position and prevent it bending.

Cortisone injections

In the case of severe or persistent inflammation (swelling), a cortisone injection may be recommended. As well as reducing inflammation, it will help prevent long-term muscle and ligament damage.

If you have a cortisone injection, a fine needle will be used to inject the steroid cortisone into the tender area. It will usually be combined with an anaesthetic so it is not painful.

Most people who have a cortisone injection find that their pain improves significantly or disappears completely within four weeks of treatment. For some people, pain relief is temporary and the pain returns after a few weeks. In such cases, two or three steroid injections may be needed over the course of a few weeks.

The risk of developing side effects after a cortisone injection is small, although you may experience some increased discomfort at the site of the injection for up to 48 hours.

Surgery

Most sports injuries do not require surgery. However, very severe injuries, such as torn connective tissue or badly broken bones,may require corrective surgery.

Rehabilitation

Rehabilitation is an important partof treating sports injuries. A rehabilitation programme aims to return the injured body part to normal function by gradually introducing it to movement and exercise.

With most sports injuries it helps to mobilise (move) the injured part as soon as possible to help speed up the healing process.Gentle exercises should improve the area’s range of motion.As movement becomes easier and pain decreases, stretching and strengthening exercises can be introduced.

During the rehabilitation process, do not attempt to do too much too quickly. Start by doing frequent repetitions of a few simple exercises before gradually increasing the amount you do. Avoid painful activities and do not return to your sport until you have no pain and full strength and flexibility have returned to the injured area.

A health care professional, such as a physiotherapist or sports injury specialist, can help you devise a suitable rehabilitation programme and advise you about which exercises you should do and the number of repetitions.

Other treatments

Anumber of other treatments may help if you have a sports injury.

• Physiotherapy: a range of treatments, including manipulation, which improve the range of motion and return the functioning of injured areas to normal.
• Massage: using the hands to apply pressure to the affected area and encourage blood to flow to the site of the injury to help the healing process.
• Ultrasound: high-frequency soundwaves penetrate deep into the muscle to stimulate blood flow and speed up recovery.
• Heat treatment (thermotherapy):use ofhot compresses, heat pads and heat lamps to reduce pain and promote blood flow to the injured area. Heat treatment should not be used during the first 48 hours after injury.
• Cold treatment (cryotherapy):use ofice packs to numb the affected area and reduce inflammation (swelling). Cold treatment is usually only used during the first 48 hours following an injury.

Preventing sports injuries

Due to the intensity and frequency of their training, it can be difficult for competitive athletes to avoid sports injuries.

However, for most other people, sports injuries are usually the result of accidents that could have been prevented. Follow the simple guidelines below to help prevent injury.

Warm up

It is very important to warm up properly before starting to exercise more vigorously.

A proper warm-up routine should last for a minimum of 10 minutes. Start with a few minutes of gentle exercise, such as walking or jogging, to get the blood flowing to your muscles. Gradually increase the pace until you are running briskly.

Once your muscles are warm, do some gentle stretching exercises, paying particular attention to the muscle groups that you will be using, for example legs for running and arms and shoulders for racquet sports. Only begin more vigorous activity after you have warmed up thoroughly.

Don’t overdo it

If you are starting a new exercise programme, it is very important that you don’t overdo it. If you have not exercised for a long time, strenuous activity coulddo more harm than good.

Be realistic and honest with yourself about what you can achievewith your current level of fitness. Once your fitness improves, you will be able to increase your level of activity.

A qualified fitness instructor or personal trainer will be able to give you advice about the correct amount of activity for your current fitness level. If you have never exercised before or it is a while since you last exercised, it is a good idea to see your GP for a health check-up before you start a new exercise programme.

Avoid dehydration

Always drink plenty of water when exercising to prevent dehydration. If you become dehydrated, your physical and mental fitness will be impaired.

Aim for one glass of water for every 20 minutes of exercise. This should be in addition to drinking the recommendedsix toeight glasses (1.2 litres) of water a day. If you are exercising in warm weather or participating in endurance sports, you will need to drink more.

Don’t drink large amounts of water over a short period of time because that could lead to a serious condition called hyponatremia (see box, right).

Use the right technique

To avoid a sports injury, always use good technique. Using the proper technique for your sport can help reduce the risk of overuse injuries, such as tendonitis and stress fractures.

If you are unsure about the correct technique, a qualified sports coach will be able to provide you with coaching and advice. If you are exercising in a gym or a leisure centre, ask a fitness instructor or member of gym staff for guidance.

Use the proper equipment

Head guards and helmets are particularly important for sports where the head is vulnerable to injury, such as rugby, boxing, cricket, cycling, skiing, snowboarding and motorsports. Helmets protect the skull and brain from injuries caused by impacts to the head, greatly reducing the risk of serious head injuries.

For some sports, particularly those that involve person-to-person contact, protective equipment is essential. For boxing and rugby, gum shields and protective head gear are particularly useful for avoiding injury.When playing cricket, helmets, boxes (to prevent groin injuries), shin pads and gloves will help prevent injury.

For sports that involve running, well-fitting, cushioned and supportive footwear is essential to prevent injuries to muscles, joints and tendons. As everybody runs differently, it is very important that running shoes are appropriate to your build and running style. If you are unsure, visit a specialist running shop to get advice about the correct footwear for you.

Cool down

When you have finished exercising, make sure you cool down properly with five to 10 minutes of light aerobic activity, such as easy running, jogging and walking.

A gentle cool down will help remove the waste products that have built up in your muscles, leaving you with less muscle stiffness and soreness afterwards. Some gentle stretching, focusing on the muscle groups you have used during exercise, may also help.