Sports Injuries and Effective Treatment - An Overview

Mr. D.A. Dube

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, and lack of conditioning, or insufficient warm up and stretching.

Injuries can be classified in two basic categories:

1) Traumatic injuries are sudden happenings, in which you know something has gone wrong, and you feel the immediate effects of the injury, perhaps pain, swelling, bruising, or an open wound. The traumatic injury can be extrinsic, or due to some external cause, like a direct blow, a sudden twist as you changes direction, or a fall. It can also be intrinsic, without an obvious cause, like the sprinter's sudden hamstring strain in a race, or the squash player's Achilles tendon rupture.

2)Overuse injuries are subtler, because they come on simply as a gradually increasing pain, directly associated with a particular, usually repetitive, activity. Tennis elbow and runner's shin soreness are examples of overuse injuries.

Sprains and Strains¹:

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 ankles² (Figure1), knees (Figure2), 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.

Figure1: Lateral View of the Ankle.                         Figure2: Lateral View of the Knee.

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, non-contact injury that results from overstretching or over contraction. Symptoms of a strain include pain, muscle spasm, and loss of strength. While it's hard to tell the difference between mild and moderate strains, severe strains not treated professionally can cause damage and loss of function.

Knee Injuries³

Because of its complex structure and weight-bearing capacity, the knee is the most commonly injured joint (Figure1). Each year, more than 5.5 million people visit orthopedic surgeons 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 (pain on the outer side of the knee), and tendenitis (Figure3), also called tendinosis (marked by degeneration within a tendon, usually where it joins the bone).

Figure3: Tennis Elbow (Tendinitis).

More severe injuries include bone bruises or damage to the cartilage or ligaments. 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 warm-up.

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:

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, warm-up, or exercise technique; over training; 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:

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. 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.

Bone injuries and detection:

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 weight on the lower limbs.

Open fractures: An open fracture occurs when an arm or a leg twists in such a way that the broken bone ends tear through the skin, causing an open wound. In a closed fracture the skin is not broken; this type of fracture is much more common than an open fracture. An open fracture brings with it a chance of infection and also severe bleeding.

Dislocations:

When the two bones that come together to form a joint become separated, the joint is described as being dislocated. A violent force tears the ligaments that hold the bone in place at a joint, and the joint will no longer function. A dislocated joint is an emergency situation that requires medical treatment. The joint most frequently dislocated is the shoulder (Figure3). Dislocations of the knees, hips, and elbows are uncommon.

 Figure4: The Shoulder Joint

An x ray is the best way to assess the extent of damage to a bone, muscle or joint. However, you may be able to judge how serious the injury is by its appearance. The area may be red, bruised, swollen, twisted, or have bumps, ridges or hollows. The area may be painful to touch as well as to move, or the victim may be unable to move it. If you compare an injured body part with an uninjured one, you may be able to locate any abnormalities; this works well with an arm, a leg, a shoulder, a knee...you get the idea. Sometimes the victim may have heard a snap, crackle or a pop when the injury occurred, or he or she may feel bones grating. Also, the victim's hands and fingers or feet and toes may tingle or feel numb.

Tennis elbow⁴:

Tennis elbow is an overuse injury. It's caused by repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist (Figure4). The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears in the tendons that attach the forearm muscles to the bone at the outside of your elbow. As the name tennis elbow indicates, playing tennis — particularly, repeated use of the backhand stroke with poor technique is one possible cause of the condition. However, many other common arm motions can cause tennis elbow injury including — using a screwdriver, hammering, painting, raking, weaving and others.

Figure5: Tennis Elbow

Signs and symptoms of tennis elbow may include

• Pain that radiates from the outside of your elbow into your forearm and wrist
• Pain when you touch or bump the outside of your elbow
• Pain when you extend your wrist
• A weak grip
• A painful grip during certain activities, such as shaking hands or turning a doorknob

The pain often gets worse over weeks or months. Sometimes you may feel pain even when your arm is still.

Throwing Injuries in the Elbow⁵:

Injury occurs when repetitive throwing creates an excessively strong pull on the tendons and ligaments of the elbow. The young player feels pain at the knobby bump on the inside of the elbow. Little Leaguer's elbow can be serious if it becomes aggravated. Repeated pulling can tear ligaments and tendons away from the bone. The tearing may pull tiny bone fragments with it in the same way a plant takes soil with it when it is uprooted. This can disrupt normal bone growth, resulting in deformity.

A less common condition called osteochondritis dissecans is also caused by excessive throwing, and may be the source of the pain on the outside of the elbow. Muscles work in pairs. In the elbow, if there is pulling on one side, there is pushing on the other side. As the elbow is compressed, the joint smashes immature bones together. This can loosen or fragment the bone and cartilage. The resulting condition is called osteochondritis dissecans.

Facial Sports Injuries⁶:

Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include swelling and bruising, such as a black eye, pain or numbness in the face, cheeks or lips, double or blurred vision, nose bleeds changes in teeth structure or ability to close mouth properly.

Upper Face⁷

When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision.

Nasal Injuries⁸

The nose is one of the most injured areas on the face. One should seek medical attention in the case of breathing difficulties, deformity of the nose, persistent bleeding, and cuts.

Throat Injuries⁹

The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck is warning signs of a serious injury and the injured person should receive immediate medical attention.

Prevention Of Facial Sports Injuries

The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:

Be sure the playing areas are large enough that players will not run into walls or other obstructions.

·Cover unremoveable goal posts and other structures with thick, protective padding.

·Carefully check equipment to be sure it is functioning properly. Require protective equipment - such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.

·Prepare athletes with warm-up exercises before engaging in intense team activity.

·In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes - check the path of travel, making sure there are no obstructing fences, wires or other obstacles.

Treatment of sports injuries:

Immediate treatment for almost all acute athletic injuries is Rest, Ice, Compression, and Elevation (RICE). Rest is instituted immediately to minimize hemorrhage, injury and swelling. Ice causes dermal vasoconstriction and helps limit inflammation and reduce pain. Compression and elevation help limit edema.

The injured part should be elevated. A bag that is chemically cooled or filled with chipped or crushed ice (which will conform better than ice cubes to body contours) should be placed on a towel over the injured part. An elastic bandage should be wrapped over the ice bag and around the injured part, loosely enough to permit blood flow. After 10 min, the wrapping and the ice bag should be removed, but the injured part should be kept elevated. After a further 10 min, the ice bag and the wrapping should be replaced. Ten minutes with and without ice should be alternated for 60 to 90 minutes. This procedure can be repeated several times during the first 24 hours.

Pathology of ice application

Cold limits swelling by vasoconstriction and reduction in capillary permeability. It helps to limit pain by reducing impulse transmission from pain receptors. It limits muscle spasm by reducing impulse transmission from tendon receptors to muscles. It limits tissue destruction by decreasing cellular metabolism. Prolonged application of ice, however, can cause vasodilatation, increased swelling, pain, and tissue destruction.

Supports and splints

In most injuries, pain is greatly reduced if the injured part is immobilized correctly. Supportive bandaging or splinting reduces stress, prevents painful movements, and helps control the swelling that is produced when tissues of any kind are damaged. Inflatable splints are a very convenient method of providing a comfortable, removable, adjustable support to a led or an arm.

Splints and bandages should never be tight, as they can constrict the blood flow and cause further damage. To check the circulation, you should press on the thumb-nail or toe-nail on the bandaged limb, to see whether the blood returns to the nail immediately after the pressure has turned it white. If the blood return is sluggish, the bandage must be loosened or removed immediately. It is best not to use non-stretch strapping as a first-aid binding.

Applying heat

Whereas cold therapy can be applied immediately to an injury, and continued through the rehabilitation phases for as long as there is swelling, bruising and pain, heat should only be applied, if at all, in the recovery phases of rehabilitation. Applying heat draws blood to the skin under the heat source. This tends to increase internal bleeding or fluid exudates (swelling) in an immediate injury. Therefore heat is not appropriate in first-aid. Heat is used later on to relieve muscle tension, promoting relaxation.

Creams

Massage, like heat, aggravates the situation when an injury has just happened. Any cream applied must be laid gently on the skin and allowed to soak in. If you rub it in, not only do you risk increasing internal bleeding, but you could stimulate blood clotting and bone formation in torn muscle fibers.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)¹⁰

The moment you are injured, chemicals are released from damaged tissue cells. This triggers the first stage of healing: inflammation (see "The Body's Healing Process" box). Inflammation causes tissues to become swollen, tender, and painful. Although inflammation is needed for healing, it can actually slow the healing process if left unchecked.

To reduce inflammation and pain, doctors and other health care providers often recommend taking an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, 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.

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. Though not an NSAID, another commonly used OTC medication, acetaminophen (Tylenol), may relieve pain. It has no effect on inflammation.

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.

Surgery

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, 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, a scar tissue forms, which shrink 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 warm-up 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:

• Electro stimulation: Mild electrical current provides pain relief by preventing nerve cells from sending pain impulses to the brain. Electro stimulation 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/thermo therapy: 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.

Treatment for tennis elbow¹¹

Initial treatment of tennis elbow usually involves self-care steps including rest, icing the area and use of acetaminophen (Tylenol, others) or over-the-counter anti-inflammatory medications, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others). These medications aren't recommended for long-term use because they can cause serious gastrointestinal problems.

Treatment options for throw elbow injuries¹²

Left untreated, throwing injuries in the elbow can become a complicated condition. Younger children tend to respond better to nonsurgical treatments.

• Rest the affected area.
• Apply ice packs to bring down any swelling.
• If pain persists after a few days of complete rest of the affected area, or if pain recurs when throwing is resumed, stop the activity again until the child gets treatment.
• Refine throwing technique.

Surgery is occasionally necessary, especially in girls older than 12 years and boys older than 14 years.

Summary:

Millions of people around the world participate in sports & physical activities, at different levels, on regular basis. Sports and physical activities of almost any kind are usually considered beneficial for the individual as well as for society. As a whole certain amount of exercise is an important element in health promotion.

The potential risk for the injuries in sports seem to increased for all levels of athlete with increasing participation, intensities and demands, as well as longer training periods. Injuries occurring in sports and physical activities are most commonly mild or moderate and sometimes serious in nature. The other athlete and/or the team often experience an injury as a disaster. The incidence of injury level s need to be reduced and can be achieved by concentrating more on preventing measures.

The problems need to be identified and described in terms of incidence and severity of sports injuries. The etiological risk factors and mechanisms, which play a part in reoccurrence of sports injuries, also have to be identified. Finally it is important to introduce measures that are likely to reduce the future risk and/or severity of injuries in sports and physical activities. Common Types of Sports Injuries are 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. . Now a day’s various steroidal performance enhancement drugs which are banned by world anti-doping agency (WADA) are used by athletes to improve their efficiency and stamina to become successful in their respective sports. This article reveals various newly developed drugs and therapies which are approved by WADA. The information provided here not only helps the physician but also the sports person to recognize signs and symptoms of injury. In the conclusion, we are expecting that proper presentation of various aspects of injuries may help the every person associated with sports to avoid lethal effect of injuries.    

References:

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7. Cassen JH. Ocular trauma. Hawaii Med J 1997;56: 292-4.
8. Ellis E III, Scott K. Assessment of patients with facialfractures. Emerg Med Clin North Am 2000;18:411-48.
9. Cummings CW, ed. Otolaryngology—head & neck surgery. 3d ed. St Louis : Mosby, 1998:871.
10. R. A. Scherrer, in Anti-inflammatory Agents, Vol. 1, R. A. Scherrer and M. W. Whitehouse, Eds. , New York, Academic Press, 1974, p. 33.  
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About Authors:

Mr. D.A. Dube
Research Student, Padm. Dr. D.Y. Patil College of Pharmacy Akurdi- 44.
E-mail:- darshan_dube@yahoo.com
Ph.no. :- (M) +91-09960824246. Fax .no:- 020-27656141.

Prof.S.V.Deshpande,
Head, Department of Pharmaceutical Chemistry, Padm. Dr. D.Y. Patil College of Pharmacy Akurdi- 44.
E-mail:- svdeshpande69@yahoo.co.in; Ph. no:- (M) +91-09890945432

Mr.V.S.Soundale,
Research Student, Padm. Dr. D.Y. Patil College of Pharmacy Akurdi- 44.
E-mail:- vikram_soundale@yahoo.co.in; Ph.no:- (M)+91-09960968268

Prof.P.R.Mahaparale,
Head, Department of Pharmaceutics, Padm. Dr. D.Y. Patil College of Pharmacy Akurdi- 44.
E-mail:- prmahaparale@yahoo.com; Ph.no:- +91-09822623781

Prof.R.S.Telekone,
Faculty, Department of Pharmaceutical Chemistry, Padm. Dr. D.Y. Patil College of Pharmacy Akurdi- 44.
E-mail:- rajeshtelekone@yahoo.co.in; Ph.no:- +91-09373565673.

Mr.A.S.Kulkarni,
Research Student, Padm. Dr. D.Y. Patil College of Pharmacy Akurdi- 44.
E-mail:- adityakulkarni_2@hotmail.com; Ph.no:- +91-09960991408