Causes of Sports Injuries

Individuals who engage in various types of physical activities such as sports and
exercise  have a higher risk of getting injured as compared to those who practice a
sedentary lifestyle. However, the potential benefits of an active lifestyle outweigh the
risk of suffering an injury.

Most of the injuries are preventable and awareness of the risk factors will help in
reducing the risk. Furthermore, vigilance and safety measures can dramatically reduce
the occurrence of injuries.

Injuries are damaged tissues or organs which occurs when it encounters trauma or

physical force that is greater than what it can be resist or absorb. The tissues are able to
withstand varying degrees of stress and strain but it will break down if it experiences an
impact that is stronger than what it can tolerate.
Acute
Factors influencing the ability of our Structure Function
Injury
tissues or organs to effectively resists or Ligaments Stabilize joints Sprain
absorb forces include inherent Attaches muscles
Tendons Strain
abnormality, age, technique, fitness level, to bones
equipment, and environmental aspects. Muscles Creates
Strain
movements
Tissues and organs react to the impact Anchor for
Bones Fracture
and direction of the force. muscles
Fulcrum for
Joints Dislocation
·         Tensile forces  are those that act movement
away from the center of the sctructure, causing a pull or stretch.

·         Compressive forces  impact the center causing it to bend or fold.

·         Shear forces  are opposing forces toward the different ends of the structure
causing it to twist.

The mechanism of how the force was applied is just as important as its impact. The bone
is strong in resisting compressive strength while muscle-tendon units are strong at
resistring tensile forces. An individual who engages in various types of strenous activities
will expose his/her body to these forces which could result to an injury.
Aside from the knowledge of the knowldege of the forces that cause injury, it is
important to understand the ability of the structure to resists or absorb forces. Injuries in
sports and fitness commonly affect the musculoskeletal structures. The ligaments,
tendons, muscles, and bones inherent strength that helps withsatnd strong forces.

The strength properties of each musculoskeletal structure vary according to the density
of collagen ang elastin fibers present.  Its ability to withstand sudden or acute forces
also depends on the structure. In general, sports injuries can be classified into
two: acute and chronic/overuse.

·         Acute injuries – have signs and symptoms (e.g., pain and swelling) that manifest
immediately after force application.

·         On the other hand, the signs and symptoms of chronic or overuse injuries occur
after a long period of exposure to the force.

Sprains, trains, fractures, dislocation, and wounds are example of acute injuries. An
excessive stretching force can cause the fibers of the ligament, muscle, or tendon to
break. An overstretched ligament is called a sprain.

·         Sprains can be classified as mild, moderate, or severe, depending on the loss of

function and the number of torn fibers.

A similar classification is used for a strained muscle.

·         Strain is also caused by excessive stretching that causes tears in the muscle-
tendon unit.

·         Fractures are breaks in the continuity of the bone. It usually occurs as a result of

high impact forces that cause the bone to bend or twist.

·         Dislocations are bones that are pushed out from their joint capsule.

·       How do overuse injuries occur?  How are they classified?

Overuse injuries are common among individuals who have been training for a long
period of time with minimal rest and recovery between sessions. During the training, the
musculoskeletal structures receive higher loads than what it is used to. However, the
body has the ability to heal and recover from this, given enough recovery time and
nutrition. Some individuals that train too hard and too soon are not able to cope with
the increased demand resulting to microscopic injuries. These microscopic injuries will
accumulate over time, resulting to overuse or chronic injury.  Overuse injuries include
stress fractures (bone), tendinopathy (muscle-tendon unit),  osteoarthritis (joint), and
bursitis (fluid filled sac).

There are 3 types of overuse injuries according to severity:

·         Stage I

·         Stage II

·         Stage III

Athletes with stage I injury complain of pain only after the activity, game ort training
session, while athletes with stage II injury complain during and after an activity but do
not feel it during rest. However, in stage III, the athlete feels pain whether at rest or play.

CATEGORY FIBER DAMAGED LOSS OF FUNCTION

Mild  (First Degree) Minimal Tear Pain when moved
Moderate Partial Tear Pain at rest and when moved

(Second Degree)
Severe (Third Degre) Complete Tear Complete loss of function
Classification of Sprains and Strains according to Severity

·       Are certain individuals at more risk of getting injured? What factors increase the
risk of injury?

It is widely accepted that people engagging in sports or fitness training have a higher
risk of getting injured. Children and older people are also at a higher risk because of
poor motor controland weak musculoskeletal structures. There are certain characteristics
or factors that increase the likehood of injury. These risk factors increase the
susceptibility of the individual to injury but it does not cause the injury.

Risk factors are classified as:

·         non – modifiable (i.e., age, gender)

·         modifiable (i.e., tournament rules, apparel)

Some experts classify risk factors as:

·         instrinsic (i.e., individual factor)

·         extrinsic ( i.e., environmental factor)

The most common instrinsic risk factor is muscle imbalance between muscle pairs (i.e.,
quadriceps – hamstrings) where the muscle becomes a little too tight. Since women in
general have wider hips, a high Q angle in the quadriceps is a common risk factors
among them. A high Q angle has been associated with acute injuries to the knee joint.

According to several studies, obese individuals and those with poor fitness level have a
higher risk of getting injured. Studies also show that injuries are associated with age.
Fractures and otheracute injuries are common among the youth awhile overuse injuries
are common individuals.

Aside from instrinsic factors or characteristics inherent to the individual, there are other
factors related to the environment or extrinsic factors. These include the use of
protective equipment and footwear, coaching experience and qualification, rule
modification, and use of a structured warm-up before the game. The evidence for these
factors is not consistent and there is a need for more high quality research (i.e.,
randomized control trials) to validate their impact on injury prevention.

·       Why does a body part swell after getting injured?

During acute injuries the body will initiate the healing process through inflammatory
response. The inflammatory response removes the damaged tissue by increasing bloddd
flow and activiating the lymphatic system to the injured site. Swelling occurs due to fluid
accumulation as a result of increased blood flow and blood vessel permeability. Aside
from swelling, inflammation is also characterized by pain, redness, and warmth. The
muscles surrounding the area contract to guard the injured site and prevent
aggravation. During inflammation, sperial cells remove the damaged tissue to provide a
foundation where new tissue can grow.

 
The laying down of new cells and blood vessels in the injured site is the actual repair
phase. The repair phase can last for several days and months, depending on the type of
the injury. The new tissue does not have the stregth of the original tissue and it is still
prone to re – injury. It is during the last phase or the maturation phase that the tissue
will become stronger as it aligns itself to provide maximal resistance to tensile forces.

The entire healing process takes several months to a year to complete. There are factors
that may prolong the healing period such as too much swelling, limited blood supply,
pld age, and weak muscle strength. It is important that proper care is given to the injury
to minimize delay and maximize stregth of new tissue. Chronic injuries undergo a similar
healing process but special attention should be given to determine its cause (i.e., muscle
imbalance, faulty equipment, poor technique). Individuals should refrain from training
until the cause of the injury is identified, to avoid recurrence.

INJURY TYPE OF INJURY COMMON CAUSE OF

INJURY
SPRAIN Acute Twisting or pulling force
STRAIN Acute Pulling force during rapid
acceleration
FRACTURE Acute Falling or breaking a fall
DISLOCATION Acute Falling or breaking a fall
STESS FRACTURE Overuse Repetitive high impact stress
TENDINOPATHY Overuse Repetitive movement using
poor technique
OSTEOARTHRITIS Overuse Repetitive high impact stress
BURSITIS Overuse Repetitive movement using
poor technique
Common Causes of Acute and Overuse Injuries

WHAT ARE THE MOST COMMON ACUTE INJURIES?

SPRAIN

·         Are overstretched ligaments. The ligaments stabilize and limit joint mobility. When
the joint is forced into a position that is beyond its normal range, it will overstretch the
ligament. The most common sprains are located at the lower limbs such as the ankle
and knee because they are subjected to stress daily. Morever, sports participation
increases the likelihood of twisting the knee and ankle. An individual usually feels a
popping sound when a knee ligament is completely torn. A completely torn ligament
may need surgical reconstruction before the athlete is allowed to play again. A sprained
joint will take several days or months to heal, depending on the severity.

·         A commonly sprained ligament is the anterior cruciate ligament (ACL). The ACL

is a connective tissue that helps stabilize the knee every time the muscle contracts. The
sprained ligament can have minimal tears or it can be completely ruptured. The injury
commonly occurs when the knee twits while weight is placed on it due to improper
landing after a jump, running too fast or without proper warm-up. It is common in
soccer, basketball, and volleyball. It is also more common in females than in males. The
injury usually takes several weeks or months to recover depending on its severity.
Surgery is recommended for individuals wbo suffer a complete ACL rupture especially if
they still want to pursue the same level of physical activity.

STRAIN

·         Is a twist, pull, or tear of muscle or tendon ( a cord of tissue that connects the
muscle to bone). It is also an acute, non-contact injury that results from overstretching
or over contraction.

·         Sometimes, a muscle would contract and generate a force that is significantly

higher that what it usually does. The forceful contraction rapidly pulls the muscle-
tendon unit, which can result and calf muscle. An individual who suffers a strain will feel
a sudden sharp pain at the muscle belly. The muscle will be painful to touch and
movement will be weak. Some types of strains involve the complete rupture of the
muscle-tendon unit and this requires surgery before the athlete is allowed to play. The
healing process usually takes six to eight weeks.

FRACTURE

·         The most common fractures are located at the upper limbs such as the hand and
forearm. Fractures are more common in growing bones because it is less dense. There
are also a higher number of fractures in the upper extremities because it is not as strong
and compact as the bones in the lower extremities.

·         Fractures in the upper limb occur when individuals support their weight using
their hands when they fall os slip. There are different types of fractures and the healing
preriod is between three weeks to several months, depending on the severity of the
injury. It is normally treated with immobilization by attaching a fixator or a cast.

DISLOCATION
·         Commonly occurs in joints that allow greater range of motion. The most common
dislocations are located at the upper limcs such as the shoulder and elbow. These joints
are commonly affected when an individual usus his/her hand to support his/her weight
when he/she falls.

·         When the bone is pushed out of the proper alignment, the injury will cause a
deformity and constant pain. Furthermore, the individual will not able to move the
affected limb. The pain will be relieved once the bone is respositioned.

CONCUSSION

·         Are life-threatening injuries because they disrupt the normal function of the brain.
A severe blow to the head could cause the blood vessels in the brain to rupture. As the
blood leaks out of the ruptured blood vessels, it will accumulate inside the skull.

·         As the volume of blood increases the pressure inside the skull starts to build up.
The accumulated blood will put pressure on the brain, blocking the blood supply to
different areas of the brain. If the condition is not resolved immidiately the brain starts
to die. It is important for the individual to go to a medical facility as soon as possible so
the injury will not worsen.

WHAT ARE THE MOST COMMON CHRONIC INJURIES?

STRESS FRACTURE

·         Commonly occur among runners who train for long periods without adequate rest
periods. According to a study, running athletes who averaged more than 65 kilometers a
week have a higher risk to stress fracture. The repetitive workload creates microtrauma –
as thick as a strand of hair – in the bone and gets bigger over time. The usual area
affected is the shinbone. The individual feels a dull aching pain that worsens over time.
This type of fracture does not require immobilization but the individual has to stop
exercise for around four weeks to give it time to heal.

 
TENDINOPATHY/TENDINITIS

·         The most common overuse injury in sports involves the muscle-tendon unit called
TENDINOPATHY or TENDINITIS. It isually due to muscle imbalance between muscles
pairs. The most common site of tendinits in the upper limb involves the muscle – tendon
units around the elbow (i.e., jumper’s knee). The pain usually eases during activity but
will worsen afetr playing. The individual should maintain fitness but avoid activities that
utilize the injured muscle-tendon unit. The recovery period usually takes three weeks to
several months.

·         Many overuse injury in sports involve the muscle-tendon units surrounding the
elbow such as the Little League Elbow, an injury brought about by repetitive stress due
to poor throwing stress due to poor throwing techniques. It is common among
adolescent baseball players. The risk to this injury is higher among adolescents who
throw more than 200 pitches every week. It is recommended that the athlete avoid
throwing activities for several weeks and use corrective exercises to strengthen the
injured area.

OSTEOARTHRITIS

·         Is the wear and tear of a joint that results to its deteriation. The friction deteriates
the cartilage that protects the bones from rubbing against each other. The knee joint is
the common site for the degenerative changes that occur in the cartilage. An individual
feels pain and a grinding sensation as it worsens. The condition further aggravates when
the individual is overweigh or obese. The recovery period takes several months because
of poor blood supply to the area. In severe cases, doctors may recommend surgery to
replace the joint.

BURSITIS

·         The bursa  is a sac – like musculoskeletal structure that provides support and

cushioning to the joint. It protects commonly used joints such as the shoulders and the
knee from a repetitive mechanical stress (i.e., friction). This injury is common in
swimmers and runners. The inflammation of the bursa interrupts the surrounding
structures, causing pain during the movement. The recovery period usually takes two
weeks to a month.

 
·       Can heat illnesses lead to a life-threateing condition?

Heat illnesses (e.g., cramps, stroke) are due to excessive dehydration and high body
temperature commonly attributed to training in poor weather conditions. Adverse or
poor weather conditions like too much heat prevent the body to cool down through
perspiration. If the body cannot dissipate the heat, the core body temperature increases
beyond the tolerable limit. The risk of suffering seizures and other memdical conditions
increase when the body temperature reaches 40 degrees Cesius.

The most life-threatening case of heat illness is heat stroke. This condition is likely to
occur if an athlete trains outdoor for several hours and air temperature is above 35
degrees Celsous and the relative humidity is above 80%.

In this weather condition, the body would try to cool itself by increasing blood flow to
areas close tot he skin. The heat is passed to the sweat formed on the skin and as it
evaporates, the body body passes the heat tot he environment. However, when the air
temperature is high, the body is not able to effectively pass the heat into the
environment. In addition, the seat will not evaporate when the relative humidity is high.
These weather conditions traps the heat inside the body that can lead to drastic drop in
blood pressure which can result to death.

Sports Injury Prevention Tips

More sports injuries can be prevemted with adequate preparation and proper
knowledge. The strategies can minimize the occurance of these injuries:

To reduce the risk of injury:

·         Take time off. Plan to have at least 1 day off per week and at least one month off
per year from training for a particular sport to allow the body to recover.

·         Wear the right gear.  Players should wear appropriate and properly fit protective
equipment such as pads (neck, shoulder, elbow, chest, knee, shin),
helmets, mouthpieces, face guards, protective cups, and eyewear. Young athletes
should not assume that protective gear will prevent all injuries while performing more
dangerous or risky activities.

·         Strengthen muscles. Conditioning exercises during practice strengthens

muscles used in play.
·         Increase flexibility. Stretching exercises after games or practice can increase
flexibility. Stretching should also be incorporated into a daily fitness plan.

·         Use the proper technique. This should be reinforced during the playing season.

·         Take breaks. Rest periods during practice and games can reduce injuries and
prevent heat illness.

·         Play safe. Strict rules against headfirst sliding (baseball and softball), spearing
(football), and checking (in hockey) should be enforced.

·         Do not play through pain.

·         Avoid heat illness by drinking plenty of fluids before, during and after exercise or
play; decrease or stop practices or competitions during high heat/humidity periods;
wear light clothing.

·         If children are jumping on a trampoline, they should be supervised by a

responsible adult, and only one child should be on the trampoline at a time; 75% of
trampoline injuries occur when more than one person is jumping at a time.

SUMMARY

Participation in sports and fitness training increases the risk of an individual to injury. Most of
the injuries affect the musculoskeletal structures such as bones, joints, muscles, tendons and
ligaments. The symptoms of an injury  occur right after the impact or after several months. When
the pain is felt immediately, the injury is classified as acute, whereas in overuse injury, the pain
is felt after a long period. Sprains and fractures are examples of acute injuries. Osteoarthritis and
tendinopathies are examples of overuse injuries. An inflammatory response will depend on the
severity of the injury. It is important to prevent injuries from occurring as the new tissue is not as
strong as the original structure. There are several ways to preventing sports and training injuries
such as proper techniques, proper attire, and appropriate environmental conditions. Poor weather
conditions can predispose an individual from suffering a heat illness such as cramps and heat
stroke.

Sports Injury Management

Is injury evaluation the same as diagnosis?
Injury evaluation is NOT the same as diagnosis. The doctor is the only person allowed to
diagnose the condition of a patient. Evaluation happens in the field while the diagnosis
process accounts all the information needed to see a holistic picture of the cause and
severity of the injury such as patient’s history, comprehensive physical examination,
special tests, and diagnostic tests (e.g., MRI, X-ray), among others. On the other hand,
the goal of the injury evaluation process is to rule out the presence of a severe injury or
a life-threatening condition, how to transport the patient, and the appropriate first aid
while transporting the patient.

The coach or athletic trainer should have a background on injury evaluation and
management to bridge the gap between the playing field and the hospital. The first part
of the evaluation is called the primary survey. This is the quick evaluation if there are
life-threatening injuries present. The evaluation needs to consider if the patient should
be moved or transported immediately to a medical facility. For example, a trainer might
be able to identify the presence of a dislocation but would not be in the position to
identify if there are other related injuries such as nerve impingement.

How could a life-threatening condition be determined?

The coach or trainer has to perform a primary survey to determine if the injured athlete
is in a life-threatening condition. There are two tell-tale signs: unconsciousness and not
breathing. If the injured athlete is breathing but unconscious, do not move the body
unless the neck and back is stabilized to prevent complications. Call the attention of the
emergency services (e.g., doctor or ambulance) and monitor the vital signs (i.e.,
breathing) of the patient until medical help arrives. If the injured athlete is unconscious
and not breathing, alert the emergency medical services and perform cardiopulmonary
resuscitation (CPR) until the medical help arrives.

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many

emergencies, including a heart attack or near drowning, in which someone's breathing
or heartbeat has stopped. The American Heart Association recommends that everyone
— untrained bystanders and medical personnel alike — begin CPR with chest
compressions.

It's far better to do something than to do nothing at all if you're fearful that your
knowledge or abilities aren't 100 percent complete. Remember, the differences between
you’re doing something and doing nothing could be someone's life.

Here's advice from the American Heart Association:

·         Untrained. If you're not trained in CPR, then provide hands-only CPR. That means
uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive
(described in more detail below). You don't need to try rescue breathing.

·         Trained and ready to go. If you're well-trained and confident in your ability,
check to see if there is a pulse and breathing. If there is no breathing or a pulse within
10 seconds, begin chest compressions. Start CPR with 30 chest compressions before
giving two rescue breaths.

 Before you begin

Before starting CPR, check:

·         Is the environment safe for the person?

·         Is the person conscious or unconscious?

·         If the person appears unconscious, tap or shake his or her shoulder and ask
loudly, "Are you OK?"

·         If the person doesn't respond and two people are available, have one person call
911 or the local emergency number and get the AED, if one is available, and have the
other person begin CPR.

·         If you are alone and have immediate access to a telephone, call 911 or your local
emergency number before beginning CPR. Get the AED, if one is available.

·         As soon as an AED is available, deliver one shock if instructed by the device, then
begin CPR.

Remember to spell C-A-B (A-B-C)

Airways (Open the airway)             

Chest compressions
Rescue breathing

The American Heart Association uses the letters C-A-B — compressions, airway,
breathing — to help people remember the order to perform the steps of CPR.

FIRST AID FOR SPORTS INJURIES

When it comes to chronic injuries, you may still apply the first 2 treatment methods
(Rest and Ice). But most chronic injuries can only be resolved with the use of medication
and physical therapy.

 In the short term, anti-inflammatory medication may help to cope with pain and
inflammation associated with the injury. In the longer term, however, your healthcare
provider may send you to a physical therapist to do some gentle stretching and
strengthening exercises.

 The prevention of injury recurrence is the most important aspect of managing overuse
injuries during sports. The majority of overuse injuries involve muscle fatigue due to a
lack of strength or endurance. As a result, the muscle tightens and may undergo
structural damage followed by muscle spasms and shortening.

This indirectly leads to muscle weakness so that a recurrence of the injury occurs easily.
Recurrence of overuse injuries will continue until broken by active treatment
interventions.

 Some simple ways you may avoid chronic sports injuries include ensuring you always
use proper gear, warming up and cooling down before and after exercising, and making
sure never to overexert yourself.

Types of Bandaging
Principle of R.I.C.E

As soon as possible after an injury, such as a knee or ankle sprain, you can relieve pain
and swelling and promote healing and flexibility with RICE—Rest, Ice, Compression, and
Elevation.

·         Rest. Rest and protect the injured or sore area. Stop, change, or take a break from
any activity that may be causing your pain or soreness.

·         Ice. Cold will reduce pain and swelling. Apply an ice or cold pack right away to
prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more
times a day. After 48 to 72 hours, if swelling is gone, apply heat to the area that hurts.
Do not apply ice or heat directly to the skin. Place a towel over the cold or heat pack
before applying it to the skin.

·         Compression. Compression, or wrapping the injured or sore area with an elastic

bandage (such as an Ace wrap), will help decrease swelling. Don't wrap it too tightly,
because this can cause more swelling below the affected area. Loosen the bandage if it
gets too tight. Signs that the bandage is too tight include numbness, tingling, increased
pain, coolness, or swelling in the area below the bandage. Talk to your doctor if you
think you need to use a wrap for longer than 48 to 72 hours; a more serious problem
may be present.

·         Elevation. Elevate the injured or sore area on pillows while applying ice and
anytime you are sitting or lying down. Try to keep the area at or above the level of your
heart to help minimize swelling.

Prevention of sports injuries

You can reduce your risk of sports injuries if you:

·         Warm up thoroughly by gently going through the motions of your sport and
performing slow, sustained stretches.

·         Wear appropriate footwear.

·         Tape or strap vulnerable joints, if necessary.

·         Use the appropriate safety equipment, such as mouth guards, helmets and pads.

·         Drink plenty of fluids before, during and after the game.

·         Try to avoid exercising in the hottest part of the day, between 11 am and 3 pm.

·         Maintain a good level of overall fitness, particularly in the off season (in the
months between playing seasons for a sport).

·         Cross-train with other sports to ensure overall fitness and muscle strength.

·         Ensure training includes appropriate speed and impact work so muscles are
capable of the demands of a game situation.

·         Don’t exert yourself beyond your level of fitness. Gradually increase intensity and
duration of training.

·         Use good form and technique.

·         Cool down after sport with gentle, sustained stretches.

·         Allow adequate recovery time between sessions.

·        

SUMMARY

Many sports injuries can be prevented by adequate preparation and knowledge of the
environment. In cases where sports occur, the first responder is advised to remain calm and act
fast. The immediate action should be directed at evaluating the injury. The first phase of the
condition, alert the medical services and perform CPR while waiting for the doctor to arrive. The
second phase of evaluation is conducted once the individual is stable. It aims to determine the
nature of injury in order to guide the first responder in deciding whether or not the person should
be transported to a medical facility. Musculoskeletal injuries needs to be immobilized before
moving the patient to minimize aggravation. Acute soft tissue injuries are managed by following
the RICE principle. Overuse injuries are managed differently from acute injuries. Early
recognition of injuries are important to decrease the risk  of complications and increase the
survival rate.
Have regular medical check-ups.