15 Sports injury and assessment
15 Sports injury and assessment
About this unit
While participation in sport and exercise activity
has a lot of positive aspects, such as improving
fitness levels, being involved in a social group
who share common interests, etc., it also has a
negative aspect in the form of potentially getting
injured. This unit will identify different types
of sports injuries and how they can occur. It will
consider both physiological and psychological
responses to injury and rehabilitation and then
go on to explore the possible cause of the injury,
which is called the aetiology of the injury. Once a
cause has been diagnosed, ways to prevent future
injuries will be examined. Finally, the unit will
explore a range of treatment and rehabilitation
procedures that can be considered for people
who have suffered from a sport or exercise-
related injury.
Key term
Aetiology is the cause or set of causes that
results in an injury or condition.
Learning aims
The aims of this unit are to:
A Understand acute and overuse injuries, their
associated signs and symptoms and mechanism
of injury
B Examine the physiological and psychological
responses to injury and rehabilitation
C Investigate aetiology of sports injuries and
their associated prevention strategies
D Explore common treatment and rehabilitation
methods.
How will I be assessed?
The sports injury and assessment unit will be
assessed by assignments that have been designed
internally by your tutors. It is likely that there will
be three assignments for you to complete where
you will be able to apply the knowledge you have
learnt to a range of sport and exercise activities.
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 Level 3 Sport and Exercise Science

How will I be graded?

Table 15.1 shows the grading criteria for this unit. To achieve a pass grade you must meet all the P criteria;
to achieve a merit grade you must achieve all the P and all the M criteria; to achieve a distinction grade
you must achieve all the P, M and D criteria.

Pass Merit Distinction

Learning aim A: Understand acute and overuse injuries, their

associated signs and symptoms and mechanism of injury

A P1 Discuss acute and overuse A M1 Assess acute and

injuries, including signs and overuse injuries, including
symptoms. signs, symptoms and examples A B D1 Evaluate injury
of mechanisms of injury. mechanisms and the
associated physiological and
Learning aim B: Examine the physiological and psychological
psychological responses to
responses to injury and rehabilitation
injury and rehabilitation,
B P2 Explain how the body B M2 Assess the physiological using specific examples.
responds physiologically and the and psychological responses
mind psychologically to sports to sports injuries, with regards
injuries. to stages of injury including
rehabilitation, using specific
examples.

Learning aim C: Investigate aetiology of sports injuries and their associated prevention strategies

C P3 Explain how extrinsic and C M3 Assess gait analysis C D2 Evaluate the sequence
intrinsic risk factors including and injury, considering of prevention model,
gait analysis contribute to sports preventative measures justifying the different stages,
injuries, and identify how they for intrinsic and extrinsic using specific examples.
can be prevented, using specific risk factors, using specific
examples. examples.
Learning aim D: Explore common treatment and rehabilitation methods

D P4 Apply appropriate D M4 Apply appropriate D D3 Justify the

protocols when performing a
range of treatment methods to
four contrasting scenarios.
D P5 Design an appropriate
rehabilitation programme for a
specific sports injury, identifying
factors that may affect
rehabilitation.
Table 15.1 Assessment criteria
protocols in a confident
and effective manner when
performing a range of
common treatment methods
to four contrasting scenarios.
D M5 Design a detailed safe
and appropriate rehabilitation
programme for a specific
sports injury, including
adaptations and alterations.
rehabilitation programme
design, including
consideration of factors that
may affect rehabilitation,
future recommendations and
considerations.

2

A Understand acute and overuse
injuries, their associated signs
and symptoms and mechanism
of injury ( A P1 , A M1 , A B D1 )
For this learning aim you will need to be able to
discuss each injury with regards to mechanisms
of injury and signs and symptoms and be able to
make reference to specific sporting examples.
A1 Acute injuries
An acute injury is an injury that occurs from taking
part in one exercise or sporting session.
Bone fractures
A fracture is the technical term for a broken bone.
The sign of a fracture is swelling or bruising over the
bone, or deformity in the area around the fracture.
The injured person will feel pain in the area of the
fracture and will have loss of function around the
injured area. Fractures happen whenever a bone is hit
with enough force to make it break, creating either a
small crack or, in a serious fracture, a complete break.
There are a number of different types of fracture.
Transverse
Transverse fractures are usually the result of a
direct blow or force being applied at a sideways
angle to the bone. The resultant shape of the bone
ends helps transverse fractures stay in alignment
more easily than those of other fractures, where the
resultant ends do not line up so readily.
Figure 15.1 A transverse fracture
Spiral
Spiral fractures are also known as oblique fractures.
They usually occur as a result of a twisting
movement being applied about the long axis of the
bone, for example, the foot being held trapped by
football boot studs while the leg twists around it.
Figure 15.2 A spiral fracture
15 Sports injury and assessment
Comminuted
A comminuted fracture is where there is splintering
of the bone so that the bone is broken into a number
of pieces. This type of fracture can take longer than
others to heal, and is usually caused by direct trauma.
Skin
Bone
Figure 15.3 A comminuted fracture
Open
An open fracture is also called a compound fracture.
It is generally a more serious type of injury because
the bone breaks through the skin. The break causes
considerable damage to surrounding tissue and can
cause serious bleeding if a large artery is ruptured.
It also exposes the broken bone to the possibility of
infection, which can interfere with healing.
Figure 15.4 An open fracture
Articular cartilage
Normal synovial joint function requires a smooth-
gliding cartilage surface on the ends of the bones.
This cartilage also acts to distribute force during
repetitive pounding movements, such as running
or jumping. Cartilage injury can result in locking,
localised pain and swelling around the affected
area. It appears as a hole in the cartilage surface. As
cartilage has minimal ability to repair itself, it needs
treatment in order to minimise the deterioration to
the joint surface.
Osteochondral
This type of injury is where the cartilage covering
the end of the bone is torn. It can occur when a
person twists their joint badly or from direct impact
to the inner or outer part of the joint.
Meniscal tear
A meniscus is a piece of cartilage that acts to protect,
cushion and stabilise a joint. The meniscus can be
torn from a bad twist of the joint which can leave the
meniscus loose in the joint causing it to lock.
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 Level 3 Sport and Exercise Science
Joint
Dislocation
Dislocation is the displacement of a joint from its
normal location. The dislocated joint will look
deformed and the injured person will feel a great
deal of pain around the injury. A dislocation occurs
when a joint is over-stressed, which makes the bones
that meet at that joint disconnect. This usually causes
the joint capsule to tear, together with the ligaments
holding the joint in place. Most dislocations are
caused by a blow or a fall. If a person has dislocated
a joint then it will usually look out of place,
discoloured and/or misshapen. Movement is limited,
and there is usually swelling and intense pain.
Subluxation
A subluxation is when one or more of the bones of
the spine moves out of position and creates pressure
on, or irritates, the spinal nerves. A person with a
subluxation will feel a great deal of pain around the
affected region and will have very limited movement
in their spine. This interferes with the signals
travelling along these spinal nerves, which means
some parts of the body will not be working properly.
Figure 15.5 A subluxation
Ligament sprain/tear
A sprain is a stretch and/or tear to a ligament and
is often caused by a trauma that knocks a joint
out of position, and over-stretches or ruptures
the supporting ligaments. Sprains often affect the
ankles, knees or wrists. A person suffering from a
sprain will have swelling around the affected area
and restricted movement around the affected joint.
There are three degrees of ligament sprain:
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Grade I
Grade I sprains commonly exhibit the following
symptoms:
● few ligament fibres are torn
● mild pain
● little swelling
● some joint stiffness.
Grade II
Grade II sprains commonly exhibit the following
symptoms:
● minimal to moderate tearing of the ligament
fibres
● moderate to severe pain
● swelling and stiffness.
Grade III
Grade III sprains commonly exhibit the following
symptoms:
● total rupture of the ligament
● severe pain
● severe swelling.
With a Grade III sprain, shortly after the injury,
most of the localised pain will disappear. This is a
result of the nerve endings being severed, which
causes a lack of feeling at the injury site.
From the explanations above you can see that pain
and swelling are the two most common symptoms
associated with a ligament sprain. You can also
expect some bruising to occur at the injury site.
The associated swelling and bruising is the result
of ruptured blood vessels and this in turn will
produce heat – or inflammation.
Muscle strain/tear
A strain is a twist, pull and/or tear to a muscle
or tendon, and is often caused by overuse, force
or over-stretching. If a tear in the muscle occurs,
surgical repair may be necessary. A person
suffering from muscle strain may have bruising
and swelling around the area, and there will
be restricted movement around the affected
area. Muscle strains can be classified into three
categories: first degree strain, second degree strain
and third degree strain.
 15 Sports injury and assessment

Grade I whether the haemotoma is inter muscular or intra

Grade I strains commonly exhibit the following muscular.
symptoms:
● few muscle fibres are torn Key terms
● mild pain
Inter means between.
● little swelling
Intra means within.
● some muscle stiffness.
Grade II
An intermuscular haemotoma is less severe than
Grade II strains commonly exhibit the following
an intramuscular haemotoma. An intermuscular
symptoms:
haemotoma is when the blood loss from the torn
● minimal to moderate tearing of the muscle muscle fibres can escape from the damaged muscle
fibres and flow around the surrounding tissues. However,
● moderate to severe pain an intramuscular haematoma is where the blood
● swelling and stiffness. cannot flow out of the muscle fascia which causes
increased pressure in the muscle, resulting in
Grade III
more pain and reduced mobility with a longer
Grade III strains commonly exhibit the following
recovery time.
symptoms:
● total rupture of the muscle
● severe pain Perimysium Epimysium
● severe swelling.
From the explanations above you can see that pain
and swelling are the two most common symptoms
associated with a muscle strain. You can also Intramuscular haematoma
expect some bruising to occur at the injury site.
The associated swelling and bruising is the result
of ruptured blood vessels and this in turnEpimysium
Perimysium will
produce heat – or inflammation.

Haematoma
A muscle haematoma is bruising of the muscle
tissue and occursIntramuscular haematoma
due to direct trauma, commonly
a blow to the outer part of the thigh or back of the
calf. A person with this type of injury will feel pain
in the affected area, and swelling and bruising may
be present.
This injury is commonly referred to as a ‘dead
leg’ – it is a bruising of muscle tissue caused by the
muscle being squashed between the object causing
the impact and the underlying bone. The muscle
fibres are squashed and associated capillaries
are torn. This results in bleeding into the area
with resultant haematoma formation. Usually the
haematoma formed is fairly small. But in some
circumstances the bleeding may be extensive and
can cause a ‘pressure problem’ depending on
Intermuscular haematoma
Figure 15.6a–b An intramuscular haematoma and an
intermuscular haematoma
Cramps
A muscle cramp is when the muscle contracts
involuntarily, remains contracted and feels
painful. There are a number of reasons why
people are thought to get muscle cramps
including dehydration, fatigue and low calcium or
potassium levels in the body. A person suffering
from cramp will be in a great deal of pain in the
affected area, which may well stop them from
taking part in sport for a short period of time. The
person will usually be holding the affected area,
however, there are no obvious signs that a person
has cramp.

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 Level 3 Sport and Exercise Science

Acute compartment syndrome Laceration

This often occurs in response to other injuries such as
a fracture. The condition is where the injured tissue
swells and blocks the blood flow and nerve impulses
that lead to that tissue. This condition must be treated
quickly otherwise it will lead to the tissue in that area
dying (necrosis) which can lead to loss of function
of the affected area. A person suffering from this
syndrome will be in a great deal of pain and have
restricted movement in the affected areas, however,
there may not be any visible signs of this condition.
Tendon
Tendons attach muscle to bone.
Partial and complete tear
A damaged tendon can be partially or completely
torn. A partial tear means that the muscle that is
attached to the tendon will still function but to
a limited degree; a complete tear means that the
tendon is no longer joined to the muscle so the
muscle will not function.
This is a tearing of the skin and layers of tissue
beneath it. There is often a lot of bleeding with
this type of injury and it will often require
stitches. This type of injury can occur in sport
from an impact with an external object, such as a
hockey stick.
Puncture wound
This type of wound is from an object piercing
the skin which creates a small hole in the skin.
Depending on how deep the puncture wound is
will determine how severe it is – the deeper the
wound goes the more tissue will be damaged and
the more severe the injury.
Contusion
A contusion is the technical term for a bruise.
Contusions are often produced by a blunt force,
such as a kick, fall or blow. The result will be pain,
swelling and discoloration.

Tendonitis
This is inflammation of a tendon and can occur
from overuse. A person suffering from tendonitis
may have swelling in the affected area and pain on
movement of the affected area.

Bursa – traumatic bursitis

Bursas are synovial fluid filled sacs located in
synovial joints to reduce friction in the joint. Bursitis
is where the bursas are inflamed which results in
pain and restricted movement around the joint
where the bursa is located.

Traumatic bursitis occurs from a direct impact, such

as a kick to the knee in football.

Skin
The skin covers the whole of the body providing
protection to the internal structures of the body. As
this organ is continually in contact with the outside
world, it is the most injured of all the human organs.
Abrasion
An abrasion is when the surface of the skin is
grazed so that the top layer is scraped off, leaving a
raw, tender area. This type of injury often occurs as
a result of a sliding fall.
Figure 15.7 Contusion (bruising)
A2 Overuse injuries
Overuse injuries occur as a result of repeated
participation in a particular sporting or exercise
movement which places stress on specific areas
of the body. The injuries can occur due to the fact
the body part has not had sufficient time to heal
between training sessions.

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Bone
Stress fracture
A stress fracture is an overuse injury. It occurs
when muscles become fatigued and are unable
to absorb added shock. Eventually, the fatigued
muscle transfers the overload of stress to the bone,
causing a tiny crack called a stress fracture. Stress
fractures usually occur because of a rapid increase
in the amount or intensity of training. The impact of
an unfamiliar surface or incorrect trainers can also
cause stress fractures.
Figure 15.8 A stress fracture
Osteitis
This is a condition where there is inflammation of
the bone making it ache and feel painful.
Apophysitis
This condition can occur as an overuse injury in
younger athletes. The apophysis is the site on a
bone where a tendon inserts. Repetitive stress to
the area can injure the area which leads to pain
and inflammation of the area called apophysisis.
Osgood-Schlatter disease is an example of an
apophysitis occurring at the tibia where the patella
tendon attaches at the knee.
Articular cartilage
Chondropathy is the term given to cartilage that
is diseased and is no longer able to perform its
function. This means the ends of the bones where
the articular cartilage is located will be painful
when performing certain movements and some
swelling around the joint may occur, leading to
restricted movement in the area.
Joint
Synovitis
This condition is from inflammation of the synovial
membrane within a joint which produces swelling
and pain within the joint. There may be swelling
around the affected area and restricted movement
around the affected joint.
15 Sports injury and assessment
Osteoarthritis
Osteoarthritis is where there is break down of the
cartilage in the joint and the bone underneath that
cartilage. The joints with osteoarthritis will feel stiff
and can ache. The affected joint with osteoarthritis
can also make a crunching noise when it is moved
which is called crepitus.
Ligament
Overuse of a specific body part can lead to
inflammation of the ligaments that are crossing
over the joints involved. Inflammation leads to pain
and swelling in that area.
Muscle
Chronic compartment syndrome
This condition can also occur as an overuse injury
from repeated stress to a muscle or group of
muscles.
Muscle focal thickening
Repeated trauma to a muscle is thought to lead to
muscle adhesions in the muscle tissue itself, which
leads to specific areas of the muscle becoming
thicker. This may lead to localised pain in the
area of the thickening and may be felt by a sports
therapist.
Tendon – tendonitis, tendinosis and
tendinopathy
Tendinopathy is the term used for a tendon injury
or disease.
Many injuries will cause some inflammation so
when you see the term itis added to an area of the
body this means the area is inflamed, e.g. tendonitis
means that a tendon is inflamed.
Key term
Itis means inflammation.
Tendonitis is usually an overuse injury which
leads to an inflammation of the tendon as a result
of micro tears to the tendon itself. However, many
people who are diagnosed with tendonitis actually
have tendinosis. Tendinosis is degeneration of the
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 Level 3 Sport and Exercise Science
tendon’s collagen as a result of overuse. This means
that the tendon has not had adequate time to heal
after an exercise session so that there is reduced
amounts of collagen in the tendon. The collagen is
also made up of immature fibres and the collagen
that is there is not aligned. The blood vessels in
a person suffering from tendinosis are also not
aligned properly leading to reduced blood flow to
that area. All of this leads to reduced strength and
reduced healing properties of the tendon.
Paratenonitis can also occur from overuse and is an
injury to the Achilles tendon involving pain over
the Achilles tendon area. The paratenon is the outer
sheath of the Achilles tendon which can become
inflamed from overuse.
Tenosynovitis is where the fluid filled sheath that
surrounds all other tendons except the Achilles
tendon becomes inflamed.
Bursa
Bursitis can also occur as an overuse injury
when a joint is used frequently without time to
repair itself.
Skin
Blister
A blister is a fluid filled sac that is a result of friction
or a burn. The feet are usually most susceptible to
getting blisters from footwear repetitively rubbing
on an area of the skin on the foot. A person with a
blister will have a bubble of clear fluid under their
skin around the affected area and the area will
usually feel painful.
Callus
A callus is a thickened area of skin that has been
exposed to repetitive friction or pressure. A callus
can occur on the hands of weight lifters who lift
weights repetitively with calluses occurring around
the area that grips the weight.
A3 Mechanisms of injury
Kinematics
Kinematics are a description of movement that
resulted in the sports injury without reference
to the forces that produced the injury. Within
kinematics, there are five primary variables:
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1 Timing of the movement – This is how long
the force takes place when performing the
movement which produces the sports injury.
This is often a very short space of time.
2 Position or location – This is how the body or
the body part is positioned when the person
gets injured. For example, the person may have
a flexed elbow and abducted shoulder as in
playing a tennis and preparing to hit the ball.
3 Displacement – This describes how something
has moved away from its starting position.
4 Velocity – This is different from speed as
it focuses on the change in position, or
displacement, that a body or object has
undergone. It is calculated by dividing
displacement by the time taken in seconds:
displacement in metres (m)
Velocity =
time taken in seconds (s)
5 Acceleration – An increase in the magnitude of
rate of change of velocity.
The greater the velocity, acceleration and
displacement involved in sustaining a sports injury,
the greater the severity of injury. For example, if
a football player is tackled by an opposing team
member who runs at them at full sprint and
attempts to make contact with the ball but actually
kicks the player in the knee, the injury sustained is
going to be much more severe than if the opposing
team member tackled them from a standing start
as they would have less velocity and acceleration
compared to the sprinting tackle.
Kinetics and forces
This is the assessment of movement with respect
to forces involved. A force is something that
can start or stop a movement, speed up or slow
down a movement or change the direction of the
movement. Force is measured in newtons (N) and is
a product of mass and acceleration.
Force = mass × acceleration
The force on the body is what actually causes the
sports injury; kinematics examines how the force
is applied. However, kinetics explores the different
types of forces that can produce sports injuries.
There are a number of different forces involved in
kinetics which include:

● Gravity – This is the force that pulls us to
the ground and is often a cause of injury
when people lose their balance, trip, etc. and
fall downwards towards the ground. The
impact of hitting the ground can then result in
sports injury.
● Ground action forces – When we are standing
still we will be applying a force on the ground
or surface underneath our feet. The force is
produced by our mass and gravity acting on
our mass. A person of a greater mass will
apply a greater force on the ground. The forces
produced by the athlete on the ground will
produce forces that are equal and opposite.
This force will be upwards into the athlete’s
body and is described as a reaction force,
or in this case a ground reaction force, as
it is produced by the surface the athlete is
standing on. When the athlete starts to move
two things will happen. Firstly, the direction
of the force will change as the athlete’s foot
will push downwards at a different angle.
Secondly, the size of the force will increase
as their foot is being accelerated towards the
ground by muscular contractions and the
effect of gravity. This means that the size of
the reaction forces will increase as well. The
human body is designed to deal with reaction
forces as our bones can bend slightly and our
joints are cushioned by cartilage; however,
if the reaction forces do become too great
then damage can be done to the structures of
our body.
● Impact of objects – When an object makes
contact with the body, the impact force of this
object can result in an injury. For example,
if a hockey ball hits a person’s face, the
impact of this ball will result in injury to that
person’s face.
● Compression forces exerted on long bones
in lower extremities – The body undergoes
compressive loads frequently in sport; when
running the body can experience two and
a half times its own body weight which can
increase to up to five times body weight during
landing, say from a volleyball smash or a
basketball lay-up.
15 Sports injury and assessment
● Ligament forces acting on joints – The
ligaments attach bone to bone and keep the
joints in place. If the force acting on the joints
from the ligaments is too large it can result in
injury to the bones or ligaments in that joint.
● Musculotendinous forces – Tendons
attach muscle to bone. If the force from the
tendon is greater than the muscle tissue is
able to withstand, it can result in muscle or
tendon injuries.
Newton’s laws
Newton’s first law
Newton’s first law, the law of inertia, states that:
A body will maintain a state of rest or constant
velocity unless acted on by an external force that
changes its state.
Once a body or object is in motion it is resistant to
change its direction and velocity. It will only do
so if it comes into contact with a second body or
object and it will then be accelerated, decelerated
or diverted. If you think about when you kick a
football it will continue in a straight line until it
comes into contact with another player’s foot that
either stops it, deflects it or increases its velocity in
the direction that you kicked it.
Newton’s second law
Newton’s second law examines the relationships
between force, mass and acceleration. The size of a
force is measured in newtons (N) while the mass
of an object is a measure of how much matter it
contains in kilograms (kg). The law of reaction states:
A force applied to a body causes an acceleration
of that body of a magnitude:
Proportional to the force, in the direction of the
force, and inversely;
Proportional to the body’s mass.
This means that if a ball is struck it will travel in the
direction that the force has been applied in. When
you serve in badminton, the shuttlecock will travel
towards your opponent in the direction that you hit
it at a velocity dependent on how much force you
applied to the shuttlecock. If you applied twice as
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 Level 3 Sport and Exercise Science
much force to the shuttlecock it would accelerate
twice as quickly as the slower shuttlecock and
have twice as much velocity. This is because its
acceleration is proportional to the size of the force
applied on the shuttlecock.
However, if the shuttlecock was twice as heavy
and an equal force was applied to the shuttlecock
during the serve, it would only accelerate at half
the velocity of the lighter shuttlecock. This is an
example of an inverse relationship. The relationship
between force, mass and acceleration can be
expressed as:
Force = mass × acceleration
Newton’s third law
Newton’s third law of motion states that for
every action there will be an equal and opposite
reaction. When this is used in the context of forces it
states that:
When one body exerts a force on a second body,
the second body exerts a reaction force that is
equal in magnitude and opposite in direction on
the first body.
This means that if a force is applied by the body
on another object or surface then that object or
surface will apply an equal force that pushes back
on the athlete. If you think about when you are
running, every time your foot strikes the ground
a force of equal size is sent back up your leg – the
force is equal and opposite to the force created by
your body weight landing on the ground through
your foot. This force is called a ground reaction
force (see page 9) and can cause damage if you
are wearing inappropriate footwear or have poor
running technique.
Consideration of external force (load)
When a person is injured in sport from an external
force, there are seven aspects of how the force was
applied in order to understand what sort of injury
the person may have sustained.
1 How – what happened and what caused
the injury?
2 Where – which area of the body is affected?
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3 Direction – from which direction did the load
come from that caused the injury?
4 Time period for application
5 How often – was it a single force or a
repetitive force?
6 Constant or varied – was the amount of force
the same or did it vary in intensity?
7 How quickly applied – how long was the force
applied for?
Tissue deformation
When a force is applied to a body part, the body
tissue in and around that area will undergo
deformation. This means that the tissue will
become damaged as it gets bruised or it may even
break as in a fracture or ligament tear. The degree
of tissue deformation will determine the severity of
the injury.
Rotation injuries
These sorts of injures can be quite common in
sports. They can occur in such instances where
a sports performer with studded boots plants
their foot on the ground, the studs hold the foot
in place. However, if the player then starts to
turn, there is a turning force experienced by the
lower leg as the foot is resisting the movement
from being fixed to the ground by the studs. This
can result in a twisting force acting on the lower
limb called torsion which can result in injury. The
factors that will determine the severity of this
injury include:
● Mass – Mass is the amount of matter that
makes up an object; the greater the mass, the
more severe the injury.
● Inertia – This is an object’s resistance to
movement, usually the greater the mass of an
object the greater the inertia will be.
● Torque – The turning effect produced by a
force is called the torque. This is equal to the
product of the force and the distance between
this force and the axis of rotation. This distance
is referred to as a moment arm because a
torque is sometimes called a moment of force.
Torque is measured in Nm.

Activity ( A P1 , A M1 , A B D1 ) be applied to most sports injuries:
1 Select and name five acute injuries and two
overuse injuries.
2 Explain each injury, including the signs and
symptoms of each injury and the different
aspects of acute and overuse injuries,
differentiating between the two. You should
also identify the common signs and symptoms
of the two specific injuries selected. Common
signs and symptoms could include general
signs of acute or overuse, as well as signs
specific to the chosen injury.
3 Provide an assessment of each injury by
including the signs and symptoms and examples
of mechanisms of injury for each injury.
Mechanisms of injury should be considered
with regards to the role of biomechanics and
sports injuries. From these examinations, you
should arrive at a conclusion for each chosen
injury. Support your conclusions with examples
of annotated diagrams and pictures.
A Check your understanding
1 Describe four different types of fracture.
2 Explain the difference between a grade I and
a grade III ligament tear.
3 Describe five different acute or overuse injuries.
4 Identify the five primary variables in the
mechanisms of injury.
5 Describe Newton’s laws of motion, providing
sporting examples of each.
6 Explain why a football player may experience
rotational injuries in their lower leg.
7 Analyse a sports injury of your choice
providing details of the signs, symptoms and
mechanisms of the injury.
B Examine the physiological and
psychological responses to injury
and rehabilitation ( B P2 , B M2 ,
A B D1 )
B1 Physiological response to injury
The repair of injured soft tissue such as muscle
actually commences within the first 24 hours
following the injury.
15 Sports injury and assessment
There are three general stages of injury which can
1 Phase 1 – The inflammatory phase (0 to 72
hours after injury)
2 Phase 2 – The proliferative phase (tissue
formation) (72 hours to 21 days after injury)
3 Phase 3 – The maturation (remodeling) phase
(21 days after injury).
The severity of the injury will dictate stages 2 and
3 of the above model; this means that less severe
injuries will reach stage 3 sometimes before day 21,
and more severe may take longer than 21 days.
Phase 1 – the inflammatory phase
One of the first signs that soft tissue is injured is
the sign of swelling. When the injured area starts
to swell, it will feel painful. This is due to swelling
creating pressure on the nerves surrounding the
damaged tissue. The swelling occurs because the
surrounding blood vessels are ruptured allowing
blood to bleed into the area and tissue fluid to
gather around the injury site. The injured area
will usually look red because the blood vessels
surrounding the injury site dilate, which also has
the effect of making the injured area feel hot. The
injured area will show a reduced function or a
total inability to function because of the pain and
swelling. This is the body’s way of preventing
further movement from occurring, which could
result in more damage to the injured area. The level
of the above signs and symptoms will be directly
related to the degree of the injury – the greater
the degree of damage, the greater the effects of
inflammation will be.
Phase 2 – the proliferative phase (tissue
formation)
During this phase, 48 to 72 hours after injury and
even up to 21 days after injury, the repair is carried
out with vigour by the body. The body’s clotting
mechanism seals the ends of the torn blood vessels
so that further blood plasma cannot escape into
the surrounding tissues. During this phase, the
swelling starts to reduce in size and the injured
area no longer feels warm to the touch.
As the immediate effects of injury subside the
healing/repair process begins.
11
 Level 3 Sport and Exercise Science
This consists of:
● ABSORPTION of swelling
● REMOVAL of debris and blood clot
● GROWTH of new blood capillaries
● DEVELOPMENT of initial fibrous scar tissue.
After 12 hours and for the first 4 days, the cells
soon become active and new capillary blood vessel
buds form and gradually grow to establish a new
circulation in the area.
With the new blood supply, the debris of dead cell
tissues and the initial blood clot that was formed
is cleared.
Phase 3 – the maturation (remodeling)
phase
The damaged tissue is repaired by scar tissue. It is
important to remember that scar tissue has ‘plastic’
properties.
Key term
Plastic properties means it can be stretched and
moulded.
Scar tissue is not elastic like muscle. It will form in
a haphazard formation of ‘kinks and curls’ and will
contract or shorten if not carefully stretched daily
for many months after the injury.
Figure 15.9 Scar tissue
There is a great need for the new scar tissue to form
in parallel ‘lines’ to give it strength.
Correct ‘stretching’ causes the scar tissue to line up
along the line of stress of the injured structure.
Therefore, injured muscles or ligaments should be
carefully mobilised and stretched daily (beginning
5 days after the initial injury).
The ‘stretching’ will ensure that the scar is
‘moulded’ to the desired length and improve the
strength of the healed area (scar) and thus reduce
a recurrence of damage to the scarred area and
injured structure.
12
Other tissues that are frequently damaged
during sport are ligaments and tendons. These
are also soft tissue and are primarily made of
collagen. Ligaments connect bone to bone and
tendons connect muscles to bone. Ligaments and
tendons can adapt to changes in their mechanical
environment due to injury, disease or exercise. A
ligament or tendon is made up of fascicles.
Each fascicle contains the basic fibril of the ligament
or tendon, and the fibroblasts, which are the cells
that make the ligament or tendon.
Unlike normal ligaments, healed ligaments are
partly made up of a different type of collagen,
which has fibrils with a smaller diameter and is
therefore a mechanically inferior structure. As a
result, the healed ligament often fails to provide
adequate joint stability, which can then lead to
re-injury or a chronically lax (permanently slightly
unstable) joint.
B2 Psychological response to injury
The psychological responses to injury should
be considered, as these will have an impact on
the person’s overall response to getting injured
and how they cope with their treatment and
rehabilitation.
The response to injury varies from individual to
individual. It may vary within an individual alone
dependent on when the injury occurs – at the start
of a training session, middle of a season or during a
major competition.
The reaction initially is negative in the main but
positive attitudes can be formed. For example,
it may give an individual more personal time to
spend with family and friends, or time to develop
new skills such as coaching, or to work on other
aspects of their performance. Generally, though, the
reaction is negative.
In reality, while some individuals struggle with the
negative feelings that they experience, most cope
without great difficulty, particularly if the injury is
not too severe.
Grief response model
The typical grief response model shows that people
react to injury with the following emotions:
 15 Sports injury and assessment

1 denial injury, an individual can become depressed

2 anger
3 bargaining
4 depression
5 acceptance.
Denial – After the initial shock is over, many
athletes tend to play down the significance of the
injury and think that it is not very severe and that
everything will be fine.
Anger – However, as the injury becomes more
apparent, denial is often replaced by anger directed
towards themselves or towards other people.
The responses can vary in intensity depending
on situational and personal factors but can be
especially strong in individuals whose self-
concept and personal identity are based on being
‘an athlete/a player/a competitor’. The loss of this
identity due to the inability to perform can cause
much distress.
Bargaining – Following anger, the injured athlete
might try bargaining or rationalising to avoid the
reality of the situation. A runner may promise to
train extra hard on return to training.
Depression – By confronting reality, and realising
and understanding the consequences of the
at the uncertainty of the future. An injured
individual who belongs to a team may start to
feel isolated from the ‘group’ and this in turn can
lead to depression. It must be noted, however,
that depression is not inevitable and has not
always been observed during the grief reaction
in research studies. Tension and helplessness
are then generated as the individual becomes
frustrated at not being able to continue as normal
with training or playing. Again, the isolation that
injury causes, from a normal routine or from being
with ‘the team’, can be difficult for some people
to accept.
Acceptance – Finally, the individual starts to move
towards an acceptance of the injury and adaptation
of lifestyle while injured. The focus is then turned
to rehabilitation and a return to sports activity.
This stage tends to mark the transition from an
emotional stage to a problem-coping stage as
the individual realises what needs to be done to
aid recovery.
The timescale for progression through these
stages can vary considerably depending on the
individual and the severity of the injury, and
setbacks during rehabilitation can lead to further
emotional disturbance. In cases of very serious

Case study

Read the case study and then answer the questions that follow.
Carla is a talented 17-year-old long jumper who has just competed in the school’s county championships.
However, during her second jump, she felt a sharp pain down the back of her left hamstring. She thinks
she may have heard a small ‘pop’ as well. She had to pull out of the jump and hobbled through the sand.
She was not able to take any further part in the competition. When she goes to see a physiotherapist the
next day, she feels pain and tenderness as he presses on the back of her left hamstring; there is also some
bruising around the site of the injury. She finds that it is very painful when she bends her knee and also
her hip. She is still a bit shaken up by the injury and feels very upset about getting injured, particularly as
she has a national event coming up in a month’s time in which she is desperate to compete. She asks the
physiotherapist if she will be fit in time and he says he cannot answer that. She starts to get very worried
and secretly thinks that she will rest for a couple of days and then start training again. But when she starts
to think about jumping again, it makes her feel anxious.
Think about it
1 From your reading of the case study and knowledge of muscle injuries, what physiological responses
will Carla be experiencing?
2 From your reading of the case study, describe the psychological responses Carla is experiencing.
3 Explain the physiological and psychological responses that Carla will be experiencing.
4 Analyse the physiological and psychological responses that Carla will be experiencing.

13
 Level 3 Sport and Exercise Science
injury and ones in which the emotional reactions
are prolonged, the skills of a clinical psychologist
might be required.
It must be stressed that this process may not be a
linear one for all individuals who experience some
of these feelings.
Motivations and goal-setting strategies have
been shown to help some people. This is
possible if a coach, trainer or parent can help an
injured individual recover sensibly, effectively
and more positively by encouraging them to
follow professional advice relating to physical
rehabilitation. You can also reassure them that the
feelings they are experiencing are not uncommon.
The channelling of a positive attitude can ease the
rehabilitation for not just the injured player but also
those around them!
Cognitive appraisal model
This model was devised by Brewer (1994) and
provides an outline of a sports performer’s response
to getting injured and suggests that the sports
performer sees their injury as a stressor. The sports
performer then evaluates how the injury will affect
them in relation to:
1 Situational factors which include:
● Sports-related factors, such as if the injury
is going to prevent them from competing
in a big game that is coming up in the next
few months.
● Environmental factors, such as if they are
going to be able to get the support they need
to rehabilitate after the injury.
2 Personal factors, such as the sports performer’s
ability to withstand pain.
3 Cognitive appraisal which includes how a
sports performer evaluates the injury in relation
to how it will affect their life and goals.
4 Emotional response which is how the
performer feels about the injury, their future
and how it affects their mood.
5 Behavioural response which is what the
performer does in response to the injury, such
as following the rehabilitation without missing
a session.
14
Personal factors Situational factors (injury
(psychological related and social/environment
and/or historical characteristics such as
characteristics) stressful life events)
Cognitive appraisal
(interpretation of injury)
Emotional response
(e.g. anger, depression)
Behavioural response
(adherence
to rehab programmes)
Figure 15.10 The cognitive appraisal model
Three categories of response
Three categories of how a sports performer reacts
to sustaining a sports injury have been suggested
by Udry et al. (1997). How the performer progresses
through each stage will vary significantly
depending on the severity of the injury and the
mental and emotional state of the athlete.
First response category – injury relevant
information processing stage
In this stage the sports performer is keen to find out
as much as possible about their injury in relation to
what it is, how it can be treated, what needs to be
done to treat it, how long will it take to recover, etc.
The sports performer will usually be in a negative
state of mind as they have gone from being injury
free and able to participate in their sport to being
injured which is preventing them doing something
that they love, and for professional athletes, it could
have an impact on their income.
Second response category – emotional
upheaval and reactive behaviour stage
During this stage the sports performer will
become emotionally upset or agitated. They may
want to remove themselves from the company of
other people while they try to deal with what has
happened to them. They may also be in denial

about how severe the injury is and how long it will
take them to recover.
Third response category – positive outlook
and coping stage
At this point the sports performer has accepted their
injury and the fact that they will need treatment
and rehabilitation to get back to participating in
their sport. They will be more positive at this stage
and be more focused on their recovery.
Stress injury model – Williams and
Anderson 1998
This model suggests that how a sports performer
will deal with a stressful event will be affected by:
● Personality factors which includes their
attitude to risk taking, competitive trait anxiety,
resilience, achievement and motivation.
● The available coping resources and behaviours
which is how a person deals with the stressors
and how they cope with them. The coping
resources include social support from friends,
team mates, family, coach and medical
professions. These people can offer emotional
support to listen to the performer and provide
comfort; informational support by their coach
or therapist telling them that they are doing
well, and tangible support which provides
materials support in the shape of help with
injury treatment and rehabilitation.
Integrated model – Wiese-Bjornstal 1998
This model takes into account a number of factors,
including:
● Pre-injury factors such as personality, coping
resources and history of stressors
● Personal factors
● Situational factors.
Each of these factors will influence the emotional
and behavioural response to the recovery and
rehabilitation process.
To demonstrate the interrelationship of these
factors, if a javelin thrower that has injured their
shoulder for the third time is a perfectionist (pre-
injury factor), then they would set themselves a goal
be ready to go back into competition in a short time
frame, and as such, would put a lot of effort into
15 Sports injury and assessment
their rehabilitation programme (personal factors).
If they are then not meeting their expected results
in the time frame they have given themselves,
they will become frustrated and then depressed,
as they will start to feel that they will not be
ready to compete in a significant upcoming event
(situational factors). This can then lead to them not
taking part in the rehabilitation sessions and so
delay their recovery time.
Stress response
Physiological changes
When a person is stressed, their body responds by
releasing adrenaline. This is a hormone released
during times of stress which gets the body ready
for action (known as the ‘fight or flight response’),
so that if a person is in danger, they are able to
fight in response to the dangerous situation, or are
ready to run away quickly from the danger. The
effects of adrenaline include making the heart beat
faster, increasing the blood pressure, increasing
the breathing rate, increasing the sweating rate,
increasing the muscle tension, and decreasing the
digestive activity.
Attention changes
When a person is stressed there are changes to their
ability to pay attention in the normal way, and they
cannot concentrate on the activity or sport, as they
are worrying about something else. Their field of
vision is narrowed, which means they are not able
to see in their peripheral vision.
B3 Psychological factors associated
with sport injury rehabilitation
adherence
Psychological/social factors affecting
rehabilitation:
● Personal factors, e.g. pain tolerance, mental
toughness, self-motivation, independence.
● Situational factors, e.g. belief, process and
procedures, environment, social support.
Psychological techniques used to
enhance rehabilitation adherence
A number of methods can be used to speed up the
rehabilitation process and ensure the athlete follows
the rehabilitation programme fully.
15
 Level 3 Sport and Exercise Science
Goal setting
This plays a key role in rehabilitation as it can
increase the amount of effort an athlete puts into
their rehabilitation programme. They will have a
number of goals to focus on, including:
● A performance goal – which is a goal to achieve
specific performance objectives and is not
related to other athletes’ abilities.
● A process goal – this is where the athlete
focuses on what actions they must carry out in
order to perform well; this may be to do with
working hard during rehabilitation sessions.
● An outcome goal – this is a goal that focuses on
being able to perform a specific outcome, such
as being able to run with a football.
For each of these goals the principles are the same,
the goals must be SMART:
Specific – the goal has to state exactly what needs to
be done
Measureable – you must be able to measure if the
goal has been reached
Achievable – the goal has to be something that the
athlete is able to do within the time frame given
Relevant – the goal has to be important to the
athlete and their recovery process
Time-bound – a specific time frame needs to be
given for completion of the set goal.
Motivational interviewing
This is where a sports therapist talks with the
athlete in a form of interview. This focuses on
helping to support the athlete to gain their own
intrinsic motivation to adhere to the rehabilitation
programme and change behaviour, so that they feel
confident that they can work through their injury
and get back to playing their sport within a specific
time frame. The process is goal-oriented to support
the athlete to return to play.
Social support
A sports therapist provides social support to
an injured athlete; however, friends and family,
team mates and the athlete’s coach are also
vital in providing social support to the athlete.
These people can all influence the athlete in
16
their motivation to adhere to their rehabilitation
programme and help to reduce their stress levels.
The team mates should be made aware that the
injured athlete may feel isolated so it is important
for them to maintain contact. Support from other
athletes that have been injured is also beneficial to
the athlete in their recovery process.
Education
The athlete should be made fully aware of what to
expect while they are injured and what is involved
in the rehabilitation programme. This is even
more important if it is the first time the athlete
has been injured, as they will have very little or
no knowledge of what to expect. When an athlete
is educated in what the whole process involves,
they are more likely to commit to the rehabilitation
programme and understand the emotions and
difficulties that they may experience during the
rehabilitation period.
Imagery
This can be used to aid the healing process and
helps the athlete to carry out sports-related practices
while they are injured. There are different types of
imagery that can be used, including:
● Healing injury, where the athlete uses images
of the physiological healing process in their
mind, such as increased blood flow to the
injured area.
● Pain injury, where the athlete creates images of
factors that are causing pain and then creates
pain-reducing images to help them to deal with
the pain.
● Relaxation imagery, where the athlete creates
calming images in their mind, such as lying on
a beach by the sea.
● Performance imagery, where the athlete creates
images of them performing a specific sporting
skill correctly.
Self-talk
An injured athlete may have negative thoughts
about themselves and their injury. This may have
the effect of reducing their pain threshold and
feeling the pain of the injury to a greater degree
than if they had positive thoughts. These increased
feelings of pain can then lead to a decrease in

activity levels and reduced motivation to work
hard or not at all during rehabilitation sessions,
which will have the effect of increasing the
rehabilitation period. An athlete should learn to
carry out positive self-talk to help them to deal
with their emotional response to injury, which
in turn will help to increase their motivation in
their rehabilitation programme and help to reduce
the rehabilitation period.
Coping resources
There are three main types of coping resources
that an athlete can use to try to deal with their
sports injury:
● Avoidance coping – this is where the athlete is
not able to acknowledge that there is a problem
and they are in denial about the fact that
they are injured. This is sometimes known as
wishful thinking.
● Emotion-focused coping – this is where the
athlete uses different forms of support using
emotion to help them to cope, such as using
imagery or social support.
● Problem-focused coping – this is where the
athlete considers ways to deal with the problem
in order to cope with their injury, such as goal
setting or gathering information about their
injury in order to help them to understand their
injury better.
Psychological factors associated with
the return to sport
When an athlete is ready to return to sport, they
may feel a number of stressors act on them, making
them uneasy about returning to sport. These
include:
● Physical stressors – This is the main concern
of many athletes returning to sport as many
may feel worried that when they play the sport
again they will get injured. They may worry
about increasing their fitness so that they are
match-fit. Athletes may also find that they
make adjustments to their sporting techniques
in order to take off any excess pressure from
their injured body part.
● Social stressors – When an athlete has had
time off from playing with their team due to
15 Sports injury and assessment
injury, they may feel isolated from the team,
which could affect the team dynamics when
they return to playing with their team mates.
They may also feel that there is pressure from
family or friends for them to return to sport, as
these people know that the athlete loves their
sport and was upset when they were not able
to play through the injury. This may result in
them putting undue pressure on the athlete to
return to play sooner than they are physically
or psychologically ready. An athlete may also
experience being beaten in their sport by
competitors that they could beat before they
were injured, which places negative social
comparisons on the athlete so affecting their
self-confidence.
● Performance stressors – This is where the
athlete does not have the same ability in their
sport as they did before they were injured and
they have fallen behind in terms of progress
compared to other athletes in the same
programme. It may result in them not being
picked for the team or squad which negatively
affects the athlete’s ability to return to their
sport after injury.
A sports therapist should be aware of each of these
psychological factors that can affect an athlete on
their return to sport and help the athlete to come
to terms with these stressors, as well as supporting
them in dealing with each potential stressor.
A sports therapist can do this through a number
of methods:
● help the athlete to have realistic expectations
about what they can expect to achieve during
specific time frames
● use goal setting techniques to help the
athlete see that they are progressing in a
positive way
● ensure the athlete returns to sport when they
feel they are ready, rather than listening to what
other people think is best for them
● encourage the athlete to talk and spend time
with other athletes that have been injured
● try to ensure the athlete maintains contact with
their team mates while they are not able to
participate in the sport.
17
 Level 3 Sport and Exercise Science
B Check your understanding
1 Explain the three phases of the physiological
response to an injury of your choice.
2 Describe the grief response model.
3 Describe the cognitive appraisal model.
4 Describe how personal factors affect
rehabilitation.
5 Explain three different psychological
techniques that can be used to enhance
rehabilitation adherence.
Activity
1 Write a report that provides an explanation,
assessment and evaluation of how:
a) the body responds physiologically to sports
injuries
b) a person’s mind responds psychologically to
sports injuries.
Your explanation should include the three
phases: inflammatory, proliferative and
maturation. Stages should all be clearly
addressed, with a sound explanation of what
occurs in each phase. Your assessment could
address different aspects of the responses,
how they interrelate and the extent of
importance.
Meeting distinction criteria
To achieve the AB.D1 criterion, you will need
to carefully consider the injury mechanisms and
the physiological and psychological responses
to them. You will need to make a judgement
as to the relevance and/or significance of the
mechanisms of the injuries and the associated
physiological and psychological responses. You
will need to include in your evidence both the
injury and rehabilitation phases. You should
clearly break down the theory related to the
physiological and psychological subject areas
and from these draw conclusions that are
supported with well-considered examples.
The information presented will need to be
factually correct and you should ensure you
use concise written language and correct
terminology.
18
Distinction activity
Provide an evaluation of how two sports
performers of your choice have each responded
to different injuries. You should include in your
answer an evaluation of:
• the mechanisms of the injury
• the associated physiological responses to the
injury and rehabilitation
• the associated psychological response to the
injury and rehabilitation.
C Investigate aetiology of sports
injuries and their associated
prevention strategies ( C P3 ,
C M3 , C D2 )
C1 Aetiology and prevention
Intrinsic risk factors
An intrinsic risk factor is a physical aspect of the
athlete’s body that can cause an injury. There are
many different types of intrinsic risk factors.
Muscular
Muscle imbalance
A muscle imbalance means that one muscle in
an antagonistic pair is stronger than the other.
This is often seen in footballers who have strong
quadriceps muscles from extending their knee to
kick the ball, but their hamstring muscles are not
as strong. This can result in knee injuries because
the hamstring muscles are not strong enough to
put a brake on the kicking action of the knee. As
a result, when a striker goes to score a goal they
can over-kick, so that their knee hyperextends and
gets injured.
Muscle weakness
Where muscles are weakened from not being
given sufficient time to rest to adapt to training
they are more prone to injury as the muscle is not
able to withstand as much force when it is in a
weakened state.
Leg length discrepancy
A number of people are born with one leg slightly
longer than the other. If there is a large difference

between the two legs, this can affect the person’s
running technique, which may then place more
strain on one side of the body, which would make
the person more likely to sustain injuries after long
periods of exercising.
Lack of flexibility
Generalised muscle tightness and restricted
range of movement
Reduced flexibility can result from muscle tightness
after having not stretched after exercise. After
taking part in sport and exercise the muscles
remain in a slightly contracted state. If the muscles
are not stretched out they will gradually get
shorter which will result in a person becoming less
flexible as their range of motion will be reduced.
This means that if a person tries to reach out and
stretch to a greater degree than they are able to, the
muscle tissue will likely tear and the person will
suffer from a muscle strain. Ligaments and tendons
can also have reduced flexibility if a person does
not stretch regularly after taking part in sport and
exercise, which can lead to ligament or tendon
injuries if a person overstretches while playing or
during participation in sport or exercise.
Focal areas of muscle thickening
Repeated trauma to a muscle is thought to lead to
muscle adhesions in the muscle tissue itself, which
leads to specific areas of the muscle becoming
thicker. This may lead to localised pain in the
area of the thickening and may be felt by a sports
therapist.
Restricted range of movement
When a person has reduced flexibility the range
of movement in their joints can be reduced which
means they more be more likely to injure the
muscles, tendons or ligaments around the joint
when taking part in sport or exercise.
Individual variables
A variety of individual variables will affect the
potential for intrinsic risk of getting injured.
● Age – As a person gets older, their joints and
muscles become stiffer and therefore more
prone to injury.
● Fitness level – The fitter a person is the less
likely they are to get injured as their body has
gradually adapted to the sport and exercise
15 Sports injury and assessment
that the person has taken part in so it is able to
withstand the stresses encountered rather than
getting injured.
● Growth and development – Children who
take part in strength-training can damage
their growth plates at the end of their bones
which could result in growth problems, so
it is important that the child has the correct
lifting techniques and should aim to lift lighter
weights with a high number of repetitions
rather than try to increase muscle bulk.
● Gender – Research suggests that males and
females should not take on the same volume
of training as elite female athletes perform
optimally at a training volume that is around
10% to 15% lower than that observed in elite
male athletes. If the volume of training is
increased for a female it often does not improve
performance and can lead to over-training.
This is due to the hormone testosterone which
is responsible for aiding muscle growth
and tissue repair. As training results in the
breakdown of tissues, males are able to recover
much more quickly from training than females
because of this hormone.
● Size – The size of a person can help to
determine which sports they may or may not
be more suited to. A person who is quite small
with low muscle mass would not be suited to
a sport such as rugby which requires physical
contact to tackle other players; a smaller
person would be more likely to get injured
during these tackles if they are playing against
larger players.
● Body composition – A person with a high
muscle mass will weigh more than a person
of a similar height with less muscle mass. This
means high impact sports such as running
may cause more damage to their body from the
impact. Similarly, if a person is overweight with
high levels of body fat then the excess weight
can increase the impact on the body from high
impact sports.
● Previous injury history – Where a person
has been injured before can often be a site for
further injury as the injured area can remain
weakened and therefore more prone to
further injury.
19
 Level 3 Sport and Exercise Science
Normal Scoliosis Kyphosis
Figure 15.11 Postural defects
Postural defects
The shape of the spine can produce postural defects
which can leave some people more prone to injury.
● Lordosis – excessive inwards curvature of the
lower spine.
● Kyphosis – excessive inward curvature of the
upper spine.
● Scoliosis – excessive sideways curvature of
the spine.
Malalignment
Malalignment means bad alignment and this can
occur in different parts of the body.
● Pes planus – This causes flat feet from the loss
of the medial longitudinal arch of the foot.
● Pes cavus – This is a high arch of the foot.
● Rearfoot varus – This is where the whole foot
is inverted in relation to the ground.
● Tibia vara – This condition is a growth
disorder which leads to the lower leg angling
inwards which makes the leg look bowlegged.
● Genu valgum – This is where the knees turn
inwards, also known as ‘knock-kneed’.
● Genu varum – This is outward turning of the
knees which is also more commonly known as
bowlegged.
● Patella alta – This condition is where the
person’s patella is located high on the knee joint
and is more likely to get dislocated.
● Femoral neck anteversion – This is where
the neck of the femur is rotated inwards to a
greater degree than normal.
20
Lordosis
● Tibial torsion – This is inward twisting of the
tibia and can cause the feet to turn inwards.
Psychological factors
According to Williams and Anderson’s (1998)
stress injury model, sports performers are more
likely to get sports injuries if they exhibit the
following factors:
● History of stressors – A stressor is something
that causes a person stress; getting injured
while playing sport would be a stressor as well
as everyday life, such as arguments with a
friend or family member, workload, etc.
● Personality characteristics – How a person
views situations can determine how at risk
they are of getting a sports injury. If the
performer views a particular game or event as
threatening then they may be more at risk of
getting injured. Locus of control, competitive
trait anxiety, resilience and risk taking are
also factors to take into account, and these are
explored in more detail in Unit 3.
● Poor coping resources – This is how a person
deals with a stressor. A person that is able to
cope more readily with stressful situations is
less likely to get injured.
● Personal factors – These include a variety
of different things, such as pain tolerance,
mental toughness, self-motivation and
independence.
If a sports performer has a history of stressors,
views the games as threatening and has poor
coping resources they will view participating in

that sport as more stressful than other players.
This will produce physiological and psychological
reactions from the performer. They may tense their
muscles and find it difficult to relax, they may also
find it hard to concentrate on the game as they are
more concerned with their own safety. This can
then affect the performer’s technique and focus
on the game which makes them more at risk of
getting injured.
Extrinsic risk factors
An extrinsic risk factor is something external to the
body that can cause an injury.
Training errors
If a sport performer’s training programme is
not appropriate it can lead to sports injuries, in
particular overuse injuries. The following are ways
that the training programme may be inappropriate
for a sports performer:
● excessive volume
● excessive intensity
● rapid increase
● sudden change in type
● training when still experiencing excessive
fatigue
● having inadequate rest time or recovery
between each training session
● using a faulty technique when training.
Coaching
Poor coaching/leadership
Inappropriate instruction given by a coach or
a trainer is an obvious way in which sports
participants can easily become injured. It is vital
that all instruction given is done so by someone
who has an up-to-date depth of knowledge about
the sport and is able also to communicate this
appropriately and effectively. It is essential that
the rules and regulations for the sport, as given by
the specific governing body, have been correctly
interpreted and are appropriately enforced.
Likewise, during training activities it is important
that the information given by the coach/trainer
is reliable, therefore many governing bodies have
coaching schemes that are constantly reviewed so
that coaching qualifications can be maintained at
the highest and safest of standards.
15 Sports injury and assessment
Communication
It is important for sports performers to
communicate well with their team mates and coach
so that these are aware of any concerns, weaknesses
or injuries before playing.
Ensuring adherence to rules (foul play) and
governing body guidelines
It is important for sports performers to follow the
rules of the sport in which they are participating
as some of these rules are there to help to prevent
injuries. For example, in football, a player should
only aim to kick the football when going in for a
tackle so that they try to avoid kicking the other
player’s legs.
Incorrect technique – lifting and handling
equipment
The technique of performing an action or specific
sport skill is usually dictated by the guidance
that the sports participant has received from the
PE teacher, coach, trainer or instructor. But it is
very easy for individuals to start to slip from
these standards if they are not reinforced at
the right time. If correction does not occur the
participant can soon start to adopt bad habits
in terms of skill level and performance. This
can in turn lead to injury problems. An obvious
example is weightlifting, where back injuries
particularly occur due to incorrect and bad or
poor technique.
Environmental factors
Conditions
The environment in which we perform sports
can also have a big impact on the likelihood of
sustaining an injury. The environment encompasses
the area in which a sport is played, so if you are
playing basketball the environment would consist
of the sports hall, and include the playing surface,
the lighting and the temperature. If the lighting
was poor, a player may be more likely to misjudge
attacking or defensive moves and injure themselves
or another player.
Other environmental conditions include the
climate, such as if it is hot or cold, as these can
have an impact on the risks of injury. For example,
in cold conditions, muscle tissue is less pliable, so
a person is more likely to have a muscle strain in
21
 Level 3 Sport and Exercise Science
these conditions. Humid weather means that heat
loss from sweating is reduced, which can lead to
overheating, as well as more slippery conditions
underfoot if the surface is damp.
Wet weather can lead to slippery surfaces outside,
which increase the risk of slipping and falling over.
Surfaces
The surface on which a sports performer plays can
result in an increased risk of injury; for example, a
person who runs on hard surfaces may be at more
risk of getting an overuse injury such as shin splints
compared to if they ran on a softer surface which
resulted in less pressure forces being exerted on
the body. A cambered ground is where there is an
arched surface, such as in an indoor athletics track,
which arches upwards on the bends. This can be a
risk as it can lead to imbalances on the foot, which
can lead to ligament sprain or muscle sprain.
Weather effects on surfaces
If the surface of a playing area is wet, a sports
performer would be more likely to slip over because
the surface becomes much more dangerous when
it is wet.
Clothing and footwear
The use of appropriate clothing can also be an issue.
Certain sports require, as stipulated by the respective
governing body of the sport, certain pieces of
protective clothing, such as shin pads for football,
and pads, gloves and helmets for cricket and hockey.
Other sports, by their very nature, need to have
clothing which is very flexible and allows a full
range of movement. For example, gymnasts wear
clothing which allows them to perform complex
movements on the floor and on specialised
equipment. If restrictive clothing was worn this
could greatly reduce the range of movement
allowed and therefore cause injury.
Correct footwear for the correct surface that
the sport is to be played on is a must. There is
a phenomenal array of specialised footwear for
all sports, including running, basketball, tennis,
squash, gymnastics, football and rugby. All these
specialised pieces of footwear are made to be
supportive to the player and totally suitable for the
surface required for the sport. Football has grass,
artificial turf and sports hall floors as its main
22
playing areas and there are specialised shoes and
boots for each surface. However, although a sports
person may be wearing the correct footwear, certain
types of footwear make a person more susceptible
to injury. For instance, the studs on a footballer’s
or rugby player’s boot can make the wearer more
susceptible to leg injuries because the studs plant
the foot in the ground, so if the person is turning
on a planted foot they are more likely to twist their
knee.
Incorrect footwear can also be a factor in causing
a person to injure themselves while playing sport.
For example, a marathon runner needs a lot of
cushioning in their trainers to absorb the repeated
impact of running. If they were to wear trainers
with little padding they would be much more likely
to sustain an overuse sport injury.
Safety hazards
It is very important that regular safety checks are
carried out by sports performers and/or coaches
to ensure everything is in working order. Before
participation in sport, equipment checks and pitch
inspections should be carried out as well as risk
assessments. Safety checklists and records should
be completed as proof that these safety checks have
been carried out.
Misuse of equipment
If equipment is not used appropriately it can lead
to injury. This is evidenced in gyms where every
person that uses the gym has to take part in an
induction process to show them how to use the
equipment to prevent incorrect use which could
lead to injury.
Inadequate nutrition and hydration
If a sports performer has not had appropriate
nutrition or is dehydrated they may become
fatigued more easily and are therefore more prone
to getting injured when taking part in sport.
Social factors
The attitudes and influences of coaches and team
managers can affect sports performers’ attitudes to
safety. If sports leaders are very safety conscious
and aware and make the performers aware of
potential risks then the performers are more
likely to follow safety guidelines to reduce the
risk of injury.
 15 Sports injury and assessment

C2 Gait analysis body continues to move forwards and the foot

A person’s gait is their method of walking or
running. Abnormal biomechanics associated with
gait are often not from injury but can be from a
variety of other factors. However, an abnormal
gait can lead to chronic injuries. Therefore, an
understanding of normal gait and abnormal gait
helps to prevent injuries from occurring.
Walking gait
The walking gait includes three phases:
1. The stance phase – within this phase there
is contact with the ground, mid stance and
propulsive.
2. The swing phase – this includes follow-
through, forward swing and foot descent.
3. The double support phase.
During the stance phase the foot is always in
contact with the floor; however, during the swing
phase, the foot has left the floor.
Stance phase
During this phase the heel makes contact with
the floor which is also known as heel strike. The
flattens on the floor which is known as the mid
stance phase. The heel then lifts off the floor
and then the toes push off the floor to propel the
body forwards.
Swing phase
During this phase the leg accelerates forwards
during the follow-through phase up to a point
and then remains at a constant speed as it
passes the other leg and then starts to decelerate
as it is lowered to the ground during the foot
descent phase.
Double support phase
During this phase there is a very short period of
time when both feet are in contact with the ground
before one foot starts to leave the ground and enter
the swing phase.
Running gait
The running gait also includes three phases:
1 Stance phase
2 Flight phase
3 Swing phase.

Contact with Propulsive Follow-through Forward swing Foot descent Double

the ground Support phase

Figure 15.12 The complete walking gait cycle

Stance phase Flight phase Swing phase

Figure 15.13 The complete running gait cycle

23
 Level 3 Sport and Exercise Science
Stance phase
During this phase the foot is in contact with the
ground.
Flight phase
During this phase both feet have left the ground.
Swing phase
During this phase the leg accelerates forwards.
The main difference therefore between walking and
running is the fact that during running, both feet
have left the ground for a period of time, whereas in
walking, there is always one foot in contact with the
ground and there is also a point in the cycle when
both feet are in contact with the ground.
Factors to consider
In gait analysis, a number of factors are examined
to try to determine if the person has any concerns
with their gait which may lead to or have
produced injuries.
● Duration – the length of time the foot is
in contact with the floor, the stride length
(distance travelled) and stride rate (number of
strides taken in a specific distance). The longer
the stride length and the faster the stride rate,
the faster an athlete will travel.
● Motion and position – this is how the body
moves and is usually tracked by the centre of
mass. The centre of mass of a person’s body
is usually just below waist height. Cameras
will be used to track how the centre of mass
travels when a person is walking and running.
Unsafe range Safe range
Over-pronation Pronation Neutral
(right foot)
Figure 15.14 Over-pronation to over-supination
24
The main aim is to have as little upward and
downward movement as possible from the
centre of mass as this is unwanted movement –
the main aim of walking and running is to
move in a horizontal direction so any vertical
movement is wasted energy.
● How change in speed affects change in gait –
the faster a person walks or runs the more this
will affect their gait.
● Footwear – the choice of footwear can have
an impact on a person’s gait as the footwear
can control how the foot lands on the ground.
This, therefore, affects how the rest of the
body reacts to the way the foot is placed on
the ground.
Gait abnormalities
Any forces placed on the body from issues with a
person’s gait can lead to injury.
Some of the most common concerns with gait
abnormalities are to do with the feet.
● Pronation – there may be some pronation in
a person’s foot, however, too much pronation
can lead to injuries. This is where the foot rolls
inwards due to some collapse in the arch on
the inside.
● Supination – there may be some supination in
a person’s foot, however, too much supination
can lead to injuries. This is where the foot rolls
outwards due to some collapse in the arch of
the foot to the outside.
Unsafe range
Supination Over-supination
 15 Sports injury and assessment

Pelvic tilts (a) (b)

The position of the pelvis can also affect a
person’s gait.

Anterior pelvic tilt – the pelvis can be angled so

that the front of the pelvis drops forwards and the
back of the pelvis tilts upwards.

Posterior pelvic tilt – the pelvis can tilt in the other

direction with the front of the pelvis tilted upwards
and the back of the pelvis tilted downwards.

(c) (d)

(e) (f)

Figures 15.15 and 15.16 Anterior pelvic tilt and

posterior pelvic tilt

Structural abnormalities
The way the skeleton is held together in relation
to ligaments and bone growth can result in some
structural abnormalities in the body which can
affect a person’s gait.
● Forefoot varus – this is where the bones at the
front of the foot are in an inverted position in
relation to the heel.
● Forefoot valgus – this is where the bones of the
front of the foot are in an everted position in
relation to the heel.
● Rearfoot varus – this is where the entire foot is
inverted in relation to the ground.
● Rearfoot valgus – this is where the entire foot is
in the everted position in relation to the ground.
● Bowed legs – this is where the legs form a bow
Figures 15.17–15.22 Structural abnormalities:
shape moving away from each other at the knees. a) forefoot varus; b) forefoot valgus; c) rearfoot varus;
● Knock knees – this is where the knees move d) rearfoot valgus; e) bowed legs; f) knock knees
inwards to each other.

25
 Level 3 Sport and Exercise Science
Associated lower limb injuries
These structural abnormities can lead to specific
lower limb injuries due to issues with the
person’s gait.
● Plantar fasciitis – this results in pain in the
person’s heel and at the bottom of their foot
and is thought to occur from inwards rotation
of the foot from over-pronation of the foot or
other structural abnormalities that lead to this
inward rotation.
● Achilles tendinopathy – this causes
stiffness and pain in the Achilles tendon
and can occur from repeated injury to the
Achilles tendon.
● Medial shin pain – this is pain towards
the inside of the shins and can occur from
overuse of shin splints as a result of increasing
the duration or frequency of running in a
training programme or repeated running on
hard surfaces.
● Patellar tendinopathy – the tendon that
holds the patella in place can become over
used and start to wear away from repeated
jumping movements.
● Patellafemoral pain – this is a pain at the
front of the knee that can result from wearing
down of the cartilage under the patella,
which can be due to the fact the patellar is not
properly aligned.
● Stress fracture – this is a small break in a bone
due to repeated use so the bone is not able to
take the stress any longer.
● Hamstring strain – when the hamstrings
are tight due to reduced flexibility; they
are more likely to get torn when a person
overstretches.
● Iliotibial Band Syndrome (ITBS) – this
produces pain on the outside of a person’s
knee as a result of friction on the iliotibial
band on the side of the knee. This can occur
from overuse, especially from extended
running.
● Calcaneal bursitis – bursas are synovial fluid-
filled sacs located in synovial joints to reduce
friction in the joint. Bursitis is where the bursas
26
are inflamed resulting in pain and restricted
movement around the joint where the bursa
is located. In this incidence, the bursas are
located in the heel which results in restricted
movement of the foot.
● Blisters – a blister is a fluid-filled sac that is a
result of friction or a burn. The feet are usually
most susceptible to getting blisters from
footwear repetitively rubbing on an area of the
skin on the foot.
● Bruising – this occurs from direct trauma
caused by the muscle being squashed
between the object causing an impact and
the underlying bone. The muscle fibres are
squashed and associated capillaries are torn.
This results in bleeding into the area with
resultant haematoma formation.
Footwear
The footwear a person chooses can have a
significant impact in reducing the risk of them
getting injured due to the structural abnormalities
in their body.
Referral for orthoses
Orthoses are devices that can be fitted to a person
to correct a biomechanical alignment concern or
correct a structural abnormality. They are designed
to meet the person’s specific needs and are custom
made for that person. The person will then wear
these orthoses in their footwear to correct the area
of concern. These can usually be worn in most
footwear and are used for walking, running and
playing sport.
Common footwear considerations
When selecting footwear, a person should consider
their own requirements in relation to gait concerns
or any structural abnormalities, as well as the sport
that they are going to be wearing the footwear for,
as these will all affect the selection of footwear for
that person.
If the person has over-pronation or over-supination,
most modern trainers will be able to provide some
support for either of these concerns and help to
balance the inward or outward roll of the foot by
the trainer and lining inside the trainer.

Activity: Do your feet
pronate or supinate?
1. Carefully place your foot in a bowl of water.
2. Step onto a piece of paper so that you can see
your footprint.
3. Look at the footprint that is left on the piece
of paper – repeat this process with your
other foot.
If your footprint shows:
• All of the sole of your foot with little to no
curve on the inside – this means that you have
low arches and your feet will tend to over-
pronate. You can also check your shoes – if
there is extra wear of the outside of the heel
of your shoe this will confirm that there is
some over-pronation in your foot. This means
that you will need a trainer that helps to
support over-pronation with a motion-control
feature and maximum support.
• Only a portion of the front of your foot and
heel, with a very narrow connection between
the two – this shows that you have high
arches and you tend to supinate. You can also
check this by looking at your shoes and seeing
if they are worn mainly on the outside edge
of the shoe. The type of trainer you will need
will be designed to help to prevent supination
and be cushioned, with a soft midsole.
• The front of your foot and heel with a
distinct curve joining the two – this shows
that you have a neutral arch, and the inside
and outside of your shoes will not show any
difference in wear. You will need a stability
trainer, which will have the right mix of
cushioning and support.
Normal arch Flat arch High arch
neutral pronation over-pronation under-pronation
(supination)
Figure 15.23 Footprints showing neutral
pronation, over-pronation and under-pronation
(supination)
15 Sports injury and assessment
C3 Preventative measures
Principles of injury prevention
The sequence of prevention model for sports
injuries was developed by Van Mechelen et al. (1992)
and Van Tiggelen et al. (2008). These are used as a
framework to reduce the incident of injury.
The sequence prevention model includes the
following steps:
1. Establishing the
extent of the injury
problem (incidence,
severity)
2. Establishing the
4. Assessing its
aeitology and
effeciveness by
repeating step 1
mechansims of
sports injury
3. Introducing
preventative
measures
Figure 15.24 Sequence prevention model
The first two steps:
1. Establishing the extent of the injury problem
and
2. Establishing the cause, origin and mechanisms
of the sports injury
Should be carried out via a research-based
approach to fulfilling information requirements for
each step. Initially, the risk factors involved should
be investigated in line with intrinsic and extrinsic
risk factors. Gait analysis should also be considered
as a potential mechanism for sports injury. This
has all been covered in sections C1 and C2 in this
unit. Step 3 introduces preventative measures
which are covered in this section of the chapter.
You will need to understand the limitations of the
actual implementation of preventative measures in
step 3, and be able to assess the effectiveness of the
introduction of any preventative measures in step 4,
as methods of assessment cannot be addressed.
27
 Level 3 Sport and Exercise Science
Preventative measures (Step 3 principle)
Role of the coach
The coach should have up-to-date knowledge of
the sport/performer so that they are fully aware
of the performer’s ability and fitness levels. This
will ensure they don’t push them too hard and
concentrate training on specific components of
fitness, skills, techniques or specific body areas.
● Qualifications – The coach should have
appropriate qualifications to coach at the level
that they are coaching as well as regular CPD
to keep up to date with latest research on
coaching practice.
● Adapt coaching style to performer’s ability/
age/fitness level – A coach should take into
account all of these factors to ensure that the
coaching they are providing is personalised
and appropriate to each sports performer they
are working with.
● Communication – They should have good
communication skills so that the sports
performer knows exactly what is expected
from them, what they are to do and how they
should do it.
Equipment and environment
Prior to any sporting activity the following should
be carried out:
● Equipment should be checked to make sure
it is full working order. The equipment should
also be appropriate to the sport, such as correct
footwear.
● Risk assessments should be carried out to
make sure the activity is appropriate for the
participants and the environment.
● Appropriate surfaces – These should be
checked to make sure they are free from
hazards and appropriate for the activity.
● Protective equipment – This should be worn
by sports performers to help to reduce injury,
such as gum shields in rugby.
● Sport-specific equipment – Equipment
required for specific sports, such as shin pads
for football, should be in place.
● Assessment of environment conditions – The
playing surface should be checked to ensure it
is fit for purpose and the weather conditions
28
should be checked to make sure they are
appropriate for the planned activity, i.e. that it
is not too hot or too cold.
Performer preparation
The sports performer has a responsibility to ensure
they can help to reduce the chance of sustaining a
sports injury.
● Warm-up/cool-down – Before taking part in
sport it is important to warm the body up to
reduce the risk of injury. The warm-up should
increase the blood flow to the muscles and
increase the range of movement permitted at
joints. After taking part in sport it is important
to gradually return the body to resting levels
by carrying out a cool-down which helps with
venous return and removal of lactate.
● Stretching – This helps to reduce the risk
of muscle strains from overstretching while
playing sport. Stretching before participation
helps to increase the pliability of muscles
meaning that there is less chance of straining
a muscle. After taking part in exercise, it
is important to stretch to try to maintain a
person’s flexibility.
● Sports massage – Where possible, sports
performers should have sports massage to help
to keep muscles relaxed and reduce the tension
in muscles.
Appropriate training
● Principles of training – The coach and sports
performer should ensure that when training
they follow the principles of training including
the FITT principles, as well as the additional
principles of training including rest and
recovery and variation in order to help to
reduce the risk of overuse injuries.
● Training methods – Different training methods
can be used to help to add variation to the
training programme and reduce the risk of
overtraining related injuries.
● Strength and conditioning – Many sports
performers would also benefit from taking
part in this to help their body to withstand the
demands of training and increase the strength
of body structures, to allow them to withstand
greater stress and therefore be less likely to
get injured.
 15 Sports injury and assessment

● Core stability – This helps with posture and
helps a person to carry out sporting techniques
appropriately.
Correction of biomechanical abnormalities
There are a variety of ways biomechanical
abnormalities can be corrected, such as:
● Referral to strength and conditioning coach –
they can concentrate on the areas of the body
that require an increase in strength and provide
exercises to work on these areas.
● Core stability – increased core stability will
help to correct posture.
● Stretching – this will help to increase flexibility
in areas of the body that have reduced flexibility.
● Referral to podiatrist for shoe modification –
this can help to correct any biomechanical
issues with the foot.
● Leg length – it is not unusual to have legs that
are slightly different lengths, however, the larger
the difference between the lengths of the legs
the greater the chance of injury. Orthoses can be
used to help to correct this issue.
and during a game as well as to help them to
cope with winning or losing, help them to relax
and prepare themselves for future events.
C Check your understanding
1 Identify what is meant by aetiology.
2 Choose a sport that you take part in or enjoy
watching.
Linked to this sport:
a) describe five intrinsic risk factors that could
result in sports injury
b) describe five extrinsic risk factors that could
result in sports injury.
3 Describe how the role of the coach should
help to prevent injuries.
4 Explain how water on
a) a football pitch
b) a sports floor
may result in sports injuries.
5 Describe factors that should be included in a
risk assessment.
6 Explain why a sports performer should warm-
up and cool-down when taking part in sport.

Other measures
Other factors can be brought in to help prevent
injury which include:
● Taping and bracing to any area of weakness
(see learning aim D1 on page 33 for more
information on other treatments).
● Nutrition to help with recovery after exercise such
as ensure glycogen stores are full and also ensuring
the sports performer is appropriately hydrated.
● Adequate recovery to allow the body to adapt
to the training.
● Psychological intervention to support the
mental state of a sports performer and help them
to maintain optimal measures of arousal before
Activity
Write a report that can be given to sports
performers that take part in a sport of your
choice that:
1 Explains, assesses and evaluates how extrinsic
and intrinsic risk factors can contribute to
sports injuries.
2 Assesses and evaluates how preventative
measures can be used to help to prevent
sports injuries in your selected sport.
You should use specific examples in your response
and show that you understand the interrelationship
of risk factors and preventative strategies.

Meeting distinction criteria

To meet the C.D2 criterion, you will need to present a careful consideration of the sequence of sports injury
prevention model. Within your evidence you will need to examine the strengths, weaknesses and relative
significance of each stage, providing justification of each place in the model. You will need to explore the
risk factors which may contribute to sports injuries and their associated prevention strategies. You should
also make judgements about all aspects of the prevention model for sports injuries, drawing conclusions
from it and supporting these conclusions with a range of specific, well-considered examples. The information
will need to be factually correct and you should use concise written language and correct terminology.

29
 Level 3 Sport and Exercise Science

After this, the secondary survey is carried out

Distinction activity which requires the first aider to talk to the injured
To avoid sports injuries there are a number of person to find out what happened and work out
methods a sports person can include in their what sort of injury they have sustained.
training programme, such as ways to minimise
intrinsic and extrinsic risk factors. They should also Emergency/immediate treatment
analyse their walking and running gait in order to It is necessary to establish what is wrong with the
help prevent injuries occurring due to structural person. If they are lying on the ground you should
abnormalities.
follow the guidelines below.
Provide an evaluation of the sequence of
1 Assess the situation – Identify any risks to
prevention model which includes the methods
outlined earlier, which can be used by yourself and to the casualty.
athletes to avoid getting injured. You should 2 Make the area safe – such as turning off an
provide justification of the four different electric switch.
stages of the prevention model, using specific
examples. 3 Assess the casualty – Talk to them first to see if
they respond – they may just be asleep.
If they do not respond, speak to them with a
D Explore common treatment and louder voice, asking them if they are all right. If
you still receive no response, gently shake them.
rehabilitation methods ( D P4 , If the person is not injured but is unconscious,
D P5 , D M4 , D M5 , D D3 ) then they should be placed in the recovery
position.
D1 Treatment methods and the
Treatment of an unconscious casualty
need for medical referral
First aid
First aid is the immediate treatment given to an
injured person. When a suitably qualified person
arrives on the scene they then take over the care
of the person. Anyone with some knowledge of
first aid can have a huge impact on the health of
an injured person, so it is always useful to know
some basics. By completing a recognised first
aid qualification you will gain a very good basic
knowledge of what to do in an emergency situation.
It is not in the scope of this book to cover all aspects
of first aid because practical work is required to
Figure 15.25 The recovery position
complement the theoretical principles of first aid.
Therefore, this section will only cover some very This position helps a semiconscious or
basic aspects of first aid. unconscious person breathe and allows fluids
to drain from the nose and throat so that they
Primary and secondary survey
do not choke. The casualty should not be moved
The primary survey is the first thing a first aider
into the recovery position if you suspect that
does to find out if someone has a life threatening
they have a major injury, such as a back or neck
injury or condition.
injury and give first aid if appropriate. Establish
If there are any life threatening conditions these if the person is conscious and then check their
need be dealt with first and are outlined in the ABC; this would be thoroughly covered in a first
emergency/immediate treatment section. aid course:

30

● Airway – they have an open airway
● Breathing – they are breathing
● Circulation – check their circulation by
assessing if they have a pulse.
1 Summon qualified assistance – try to get help
as soon as possible.
2 Deal with the aftermath – complete accident/
incident report.
If you follow a first aid course you will be taught
how to:
● check the ABC
● open a person’s airway
● deal with them if they are not breathing by
giving them artificial resuscitation
● check if a person has a pulse and how to
administer cardiac compressions if they
do not.
Prevention of infection
If the person has an open wound, then it is
important to try to prevent any infection from
getting into the wound. Using sterile bandages
and dressings is the best course of action to treat
an open wound, but if these are not to hand,
then clean clothing may be the only option
available to help to stop the bleeding of an
injured person.
Shock
When a person is suffering from shock, there
is not enough blood going to the major organs
of the body. Shock can be caused by number of
things, including burns, electric shock, allergic
shock or severe injuries. A person suffering
from shock will usually have cool, moist skin, a
weak, rapid pulse and shallow breathing. Other
symptoms may include nausea, vomiting or
trembling. The treatment for a conscious casualty
suffering from shock is to reassure them, then try
to find and treat the cause of shock, e.g. control
any bleeding. Keep the casualty lying down and
check for neck, spine, head or abdomen injuries.
If there are none of these injuries then the feet
should be raised so that they are higher than the
casualty’s head.
15 Sports injury and assessment
Bleeding
A person may suffer from external bleeding,
which is usually obvious to the first aider as blood
flows out from the site of injury. Internal bleeding,
however, is not so obvious – it is not visible as the
blood is flowing out of the injury site into the body.
The first aider should ensure they are adequately
protected when dealing with a casualty who is
bleeding, in order to ensure they do not expose
themselves to any blood-borne viruses such as HIV.
External bleeding should be treated in the following
manner:
● lay casualty down
● apply direct pressure with a gloved hand
or finger to the site of bleeding; as soon as
possible, place a clean dressing over the wound
● elevate and rest the injured part when possible
● seek medical assistance.
Internal bleeding is difficult to diagnose, but some
of the potential signs and symptoms are:
● coughing up red frothy blood
● vomiting blood
● faintness or dizziness
● weak, rapid pulse
● cold, clammy skin
● rapid, gasping breathing.
The treatment for a person you suspect has internal
bleeding is as follows:
1 lay the casualty down
2 raise the legs or bend the knees
3 loosen tight clothing
4 urgently seek medical assistance
5 give nothing by mouth
6 reassure the casualty.
Risk assessment
These should be carried out before participation in
any sport by the sports coach or leader to help to
ensure the safety of participants. A risk assessment
is about identifying hazards and assessing the risks
associated with them.
A hazard is something that is dangerous, and
therefore has the potential to affect someone’s
safety or cause an injury.
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 Level 3 Sport and Exercise Science
Most sport and outdoor pursuit activities contain
many hazard factors that could affect a person’s
general health. Therefore, the participants
must ensure that they remain safe and avoid
the possibility of injury or even death. This is
normally the responsibility of the person leading
the session.
An example of a hazard could include:
● broken glass on a football pitch
● a strong current in the sea (kayaking).
Key term
Risk is the possibility of something bad
happening.
A risk is linked to the chance of somebody being
harmed by the potential hazard. Risks are often
categorised into how likely they are to happen.
Something that is a low risk means that the likelihood
of it happening are low, whereas something that is
high risk means that it is likely to happen.
After you have highlighted the hazard the easiest
way is to use the following formula to assess the
potential problems that may arise.
LIKELIHOOD × SEVERITY
LIKELIHOOD – Is it likely to happen?
1 Unlikely
2 Quite likely
3 Very likely.
SEVERITY – How badly someone could be injured.
1 No injury/Minor incident
Likelihood × Severity Is the risk worth taking?
1 Yes, with caution
2 Yes possibly, with caution
3 Yes possibly, with extreme caution
4 Yes possibly, with extreme caution
6 No
9 No
Table 15.2 Risk assessment chart
32
2 Injury requiring medical assistance
3 Major injury or fatality
For example, broken glass on a park football pitch.
Likelihood of happening: 2. Quite likely
Severity: 2. Injury requiring medical assistance.
By multiplying the likelihood against the severity
you will be able to set a chart that looks at the
potential problems and make a decision on whether
you want to take the risk or whether it is too much
of a hazard.
2x2=4
Table 15.2 provides an example of such a chart.
Control measures
Control measures help reduce the likelihood of an
accident happening. These could include having
safety goggles, where a person is at risk of getting
something in their eye. Having eye wash solution
close could also help somebody if they were to
get something in their eye. Cleaners often put up
warning signs when they are mopping floors. This
is a control measure to alert people that the floor
may be wet and helps reduce the risk of injury, by
bringing attention to the hazard. Control measures
can also be known as precautions.
Safety equipment
Specialist equipment is also used in sport to help
minimise the risk of injury. This can include
protective clothing, accessories and equipment.
Cyclists will wear helmets in case they fall
off, while a batsman would wear protective
equipment such as a box and helmet to prevent
What measures should be
considered/taken prior to activity?

injury from the ball. Safety ropes are often used
in climbing and abseiling to minimise the risk of
potential danger.
Accident reporting procedures/form
Health and safety is the responsibility of everyone.
In the workplace, everyone should be responsible,
however, in sports activities it is often the
responsibility of the instructor, coach or leader. If
an accident happens or there is a near miss, it needs
to be reported and documented, so that it can be
looked at, dealt with accordingly and hopefully
stopped from happening again.
PRICED
If a person has suffered from a soft tissue injury
such as a strain or a sprain, then ensuring that they
follow the PRICED (protect, rest, ice, compression,
elevation, diagnosis by professional) regime will
help to limit the severity of their injury.
● Protect – the injured body part from
further injury.
● Rest – As soon as a person has injured
themselves they should be told to discontinue
their activity. Further activity could cause
further injury, delay healing, increase pain and
stimulate bleeding.
● Ice – An ice pack or cold compress should be
applied to the injured area. This will help to
reduce the swelling and pain of the injury.
● Compression – Gentle pressure should be
applied to the injury site by surrounding the
area with padding, a compressive bandage or a
cloth. Compressing the injured area will reduce
blood flowing to the injury site and also help
to control swelling by decreasing fluid seeping
into the injured area from adjacent tissue. After
applying a compression bandage, the casualty’s
circulation should be checked by squeezing
the nail beds of the injured limb. If blood is
seen to return to the nail bed on release, the
compression bandage is not too tight. The
compression bandage should be reapplied after
24 hours in order to maintain compression over
the injury site.
● Elevation – The injured area should be
supported in a raised position above the level
of the heart in order to reduce the blood flow to
15 Sports injury and assessment
the injury, which will further help to minimise
swelling and bruising at the injury site.
● Diagnosis by professional – The injured
person should then be referred to a medical
professional to give a full diagnosis and refer
for appropriate treatment if required.
SALTAPS
The sooner an injury is treated then the greater
the chances of a complete recovery and the faster
the rehabilitation. The immediate treatment can be
summarised by the acronym SALTAPS.
SALTAPS is a set procedure for examining an
injured person and attempting to diagnose the
type and the degree of injury. It stands for: see, ask,
look, touch, active movement, passive movement,
strength testing.
● See – the injury occur and the mechanism
of injury.
● Ask – the casualty what is wrong and where
they have pain.
● Look – for signs of bleeding, deformity of
limbs, inflammation, swelling and redness.
● Touch – the injury or close to the injury for
signs of heat, tenderness, loss or change of
sensation and pain.
● Active movement – ask the casualty to
move the injured area. If they are able to,
ask them to move it through its full range
of movements.
● Passive movement – try to move the injured
site only if a good range of movement is
available.
● Strength – if the casualty has been taken
through the steps above with no pain, use
resisted movements to assess loss of function.
For example, with an injured ankle you would
assist the casualty to their feet, then ask them
to stand unaided, then progress the test to
walking and running.
Other treatments
Bandaging and taping
These are carried out in order to prevent injury,
or to treat or rehabilitate an injured joint. Both are
performed in order to increase the stability of a joint
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 Level 3 Sport and Exercise Science
when there has been an injury to the ligaments that
normally support the joint. They limit unwanted
joint movement, support the injury site during
strengthening exercises and protect the injury site
from further damage.
Taping involves the use of adhesive tape (e.g. zinc
oxide tape), whereas bandaging uses strips of
cotton and/or specialised pressure bandages. Their
purpose is to restrict the joint movement to within
safe limits. Taping should not be carried out if the
joint is swollen or painful, or if there are any lesions
around the taping area. The person who applies the
taping/bandaging should be careful to ensure that
they do not bind the injury site too tightly so that
circulation is affected.
It should also be noted that some individuals have
an allergic reaction to some types of tape, such
as zinc oxide. Ideally, they should be asked about
this possibility before application of the tape. For
any uncertainty, an underwrap can be applied to
provide a protective barrier between the skin and
the tape. Unfortunately this can impair the tape’s
performance as tape also provides a proprioceptive
response mechanism by having its contact directly
with the skin. It reminds the individual that it is
there to protect and maintain a joint within a range
of movement.
The use of tape may well provide support and
comfort for a sports person, however the benefits of
use over approximately 20 minutes are diminished
due to the material properties. This said, it is often
used for time periods well beyond the 20 minute
mark and its proprioceptive response declines
after this amount of time. The psychological value
of tape is valuable for a lot of players at all levels
of competition, to the extent that it may even be
applied to an injury that has fully recovered so
the player still feels ‘comforted’ by the application
of the tape!
Bandaging can be used to create pressure around
the injury site in order to restrict swelling.
Sling
A sling is used with an injury to the arm, hand or
shoulder. It is used to immobilise the joint and to
elevate the area to promote healing.
34
Splints
A fracture should be immobilised in order to
prevent the sharp edges of the bone from moving
and cutting tissue, muscle, blood vessels and
nerves. The injured body part can be immobilised
using splints or slings. If a casualty has an open
fracture, the first aider should never attempt to
push the bones back under the skin. A dressing
should be applied to the injury site to protect the
area and pressure should be applied in order to
try to limit the external bleeding. A splint can
be applied, but should not be placed over the
protruding bone.
Cryotherapy (use of ice)
Cooling an injured body part to minimise the
swelling and bruising of an injured area and to
reduce pain is essential. When a person sustains a
soft tissue injury, blood vessels are torn and blood
cells and fluid escape into the spaces among the
muscle fibres. By cooling the injury site, the local
blood vessels are constricted, so blood flow to the
area is reduced. The application of something that
is cold to the injured area not only has the effect
of decreasing the flow of this fluid into the tissues
but also helps to slow the release of chemicals that
cause pain and inflammation. Cold also decreases
the feeling of pain by reducing the ability of the
nerve endings to conduct impulses.
Because cold reduces bleeding and swelling within
injured tissue, it is best used immediately after
injury has occurred for up to 48–72 hours.
Ice bags (plastic bags with ice cubes in, a bag of
frozen vegetables or chemical cold packs) can be
used. Never apply ice directly onto the skin. The
injured area should be covered with a cloth towel
in order to prevent direct contact of the ice with the
skin, which could cause a blister or ‘ice burn’. The
cold application should be applied to the injured
area for no more than 10 minutes. During this time
the person’s skin will pass through four stages of
sensation, which are:
1 cold
2 burning
3 aching
4 numbness – as soon as the skin feels numb the
cold therapy should be stopped.

The cooling procedure should be repeated every
two waking hours.
There are a number of methods of cold treatments
(cryotherapy) on the market, including ice and gel
packs, ice bath immersion and cans of spray.
Thermal therapy (use of heat)
The application of heat to an injury site will act
to dilate the local blood vessels, thus increasing
the blood flow to the area. This type of treatment
should only be given in the sub-acute stage in order
to aid in the healing process. The increased blood
supply will have the effect of absorbing the swelling
and removing the dead cells from the injury site. It
will also help to increase the growth of new blood
vessels in the area and help scar tissue to form. The
application of heat to muscles allows them to relax
and aid in pain relief.
Heat treatment would not be suitable during
the early stages of injury, on an open wound or
where tissues are very sensitive, such as the genital
region.
The Lewis Hunting reaction (also known as
contrast bathing or hot/cold therapy)
This is the process by which alternating treatments
of both hot and cold therapy are applied to the
injury site and should be applied during the sub-
acute phase. The application of a hot treatment will
increase the blood flow to the area then, when this
is followed by a cold treatment, the blood flow to
the area will decrease and take with it the debris
from the injury site. The injured site should be
immersed in alternating hot and cold water for
periods ranging from one to four minutes, with
increased time initially in the cold water.
Medical referral
Where an unqualified person treats someone
with a sports injury, the casualty should always
be referred to a medical professional. The nature
of the injury and access to medical professionals
will determine who the most appropriate
person will be.
Qualified first aider
Some sporting events have qualified first aiders on
site, and most workplaces have to have a qualified
first aider. Where this is the case, you should refer
15 Sports injury and assessment
the injured person to the qualified first aider who
will decide the next steps for injury treatment.
St John Ambulance
St John Ambulance first aiders are volunteers
who are qualified to administer immediate first
aid. These people are often present on site at large
events and are there to help people at the event
should they need first aid assistance.
Emergency services
If a person is injured and you believe the injury
requires professional attention, you must ensure
that someone calls for an ambulance. If you are
dealing with a casualty by yourself, minimise the
risk to them by taking any vital action first (check
their airway, breathing and circulation), then make
a short but accurate call.
1 Dial 999 and ask for an ambulance.
2 Give your exact location.
3 Give clear details of the accident and the
severity of the injuries your casualty has
sustained.
4 Give the number, sex and approximate age of
the casualty.
If you ask someone else to make the call, always ask
them to report back to you to confirm that the call
has been made.
When the paramedics arrive, tell them as much as
possible about how the casualty has behaved, such
as if they were unconscious, if they needed artificial
resuscitation, and so on.
Local accident and emergency departments can also
be used, and in some cases, such as non-life-threating
injuries (and if the person is able to move), it may be
quicker to drive the injured person to the local A and
E department rather than wait for an ambulance.
Some doctor’s surgeries have a minor injuries clinic
which could also be the better option to go to if the
person has only a minor injury to deal with.
General practitioner
A doctor can assess an injury and provide some
treatment, however, they will also need to make a
judgement on if a specialist therapist needs to be
seen and if they believe that the injury requires
specialist attention they can refer the sports person
to a specialist therapist.
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 Level 3 Sport and Exercise Science
Specialist therapist, e.g. physiotherapist,
sports therapist
The type of injury will determine which specialist
therapist will be able to help. A physiotherapist is a
person who supports the rehabilitation process after
an injury and is available on the NHS. A sports
therapist will also be able to rehabilitate a person
after an injury, but they usually only take private
appointments. A doctor can advise which specialist
would be most appropriate based on the nature of
the injury.
A radiologist deals with fractures and will be
responsible for taking an x-ray of the area where
there is a suspected facture to confirm if this is
indeed the case.
D2 Principles of rehabilitation
Treatment and rehabilitation will be based
on accurate assessment diagnosis by a
qualified person.
For rehabilitation to occur we must first ensure
an accurate and immediate diagnosis is gained
in order to help establish effective treatment and
rehabilitation management of an injury. Therefore
it is essential that an appropriately qualified person
diagnoses the injury as early as possible after
it occurs. This may include a sports therapist, a
physiotherapist, a doctor or some other suitably
qualified person.
The diagnosis relies on accurate information given
by either the injured person or someone who saw
the injury happen. The smallest of details can
make a difference to how accurate a diagnosis
can be. So all information, including information
regarding the environment, previous injury history,
as well as the actual injury event is very important
to communicate.
The five stages of rehabilitation
There are numerous ways in which to classify
injury and its management. The following is a
commonly accepted role model for injury treatment
and management.
There are five identifiable phases of post-injury
management, which is sometimes called the
stepladder approach to rehabilitation.
36
PHASE 1 Acute phase (up to 72 hours post-injury)
PHASE 2 Sub-acute phase (3–10 days)
PHASE 3 Early rehabilitation stage
Active rehabilitation stage
Mobilising exercises for joint range
Strengthening exercises
PHASE 4 Late rehabilitation stage
PHASE 5 Functional rehabilitation/training stage
Table 15.3 The five identifiable phases of post-injury
management
Phase 1: Acute
The aim of treatment at this stage is to:
● Control any bleeding and swelling (maintain
sterile cover and cold compress, elevate)
● Relieve pain (cold compress and elevation)
● Protect from further damage (advise that
they avoid using the injured part as much
as possible)
● Give advice for home treatment (do not wear
compression bandages throughout the night,
correct use of ice, PRICED, etc.).
Phase 2: Sub-acute
During this stage the injury should be in the early
stages of recovering:
● Absorption of swelling
● Removal of debris/dead cells from the area
● Growth of new blood vessels
● Development of scar tissue.
The use of treatments such as contrast bathing,
elevation and massage and passive exercises, e.g.
non-weight bearing exercises, will help to disperse
the products of inflammation. The joint should
be moved through its pain-free range in order to
increase the range of movement of the joint, help to
strengthen and lengthen the muscles around the
injury and also to help the scar tissue to form in
alignment. Throughout these exercise the person
should feel no pain.
Contrast bathing as well as the use of heat
packs may also aid the healing process. It may
be necessary to use walking aids, etc. to protect
from further injury or the use of bandages for
added support. The use of strengthening exercises

specific to the injured area will help the tone of
muscle and for joint injuries it will encourage
stability around a joint. Attention to scar tissue
development is essential during this stage.
Phase 3: Early rehabilitation phase
Before starting active rehabilitation it is important
to make sure that the following applies to the
injured part:
● There is no significant inflammation
● There is no significant swelling
● While there may be some joint stiffness, there is
some range of movement free from pain
● There is the ability to undertake some weight-
bearing.
Initially, the range of movement needs to be
improved as there may have been some weakening
of muscles through injury. For every week of
immobilisation, a person may lose up to 20% of
their muscle strength. Therefore it is important to
start to encourage movement first through non-
weight-bearing exercises and then to progress to
weight-bearing activities.
The use of supports may still be necessary in the
early part of this stage.
Prolonged immobilisation will lead to stiffness
of the joints in the injury area and a decrease
in ligament strength. However, if the injured
area is mobilised early on in the rehabilitation
process, re-growth of the damaged tissues is
encouraged and sports ability and skills are
maintained.
A selection of exercises used for the injured part
should be encouraged on a regular basis as well as
continuing to exercise the rest of the body without
undue pressure on the injury.
Care should be taken to avoid over exercising which
may result in more damage and therefore a delay in
rehabilitation.
The two main types of exercises that should be
utilised throughout this stage are:
1 Mobilisation activities – to improve the range
of movement and reduce joint stiffness.
2 Strengthening activities – to help stability of
joints and strengthen the weakened muscles.
15 Sports injury and assessment
Phase 4: Late rehabilitation phase
This is similar to the early rehabilitation phase,
but with a greater emphasis on the strengthening
activities.
Phase 5: Functional rehabilitation
The aim of treatment at this stage is to:
● improve balance and movement co-ordination
● restore specific skills and movement patterns to
pre-injury level
● provide psychological reassurance of function.
Progression to this phase is dependent on the
ability to repeatedly be able to perform the exercises
set at phase 4 in the rehabilitation programme.
Aim and goals of rehabilitation
Rehabilitation is the restoration of the ability to
function in a normal or near-normal manner
following an injury. It usually involves reducing
pain and swelling, restoring range of motion and
increasing strength with the use of manual therapy
(massage and manipulation), therapeutic methods
such as ultrasound and an exercise programme.
If a sports person does not rehabilitate their injury
effectively, they are much more likely to sustain
another injury to the same area.
It should be taken into consideration that as well
as the physical rehabilitation of the player, the
psychological rehabilitation may also need to be
considered. The trauma of the injury itself and
the resulting exclusion from training/coaching
sessions, competitions, matches, after competition
social aspects can be very difficult for some
individuals to come to terms with. This alone can
force injured players to try to start playing again
much too soon in some cases.
Rationale
A rationale for treatment has to be in place, based
on the formulated hypothesis by the qualified
professional working with the patient as to why the
injury occurred.
Principles of rehabilitation
ATCISIT
There are a number of principles of rehabilitation
and one of these is ATCISIT.
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 Level 3 Sport and Exercise Science
This stands for:
Avoid aggravation – which means the process
should avoid causing any further injury to the
affected area.
Timing – this has to take into account the different
phases of injury repair and the fact that the
rehabilitation programme should take place as soon
as possible after injury.
Compliance – the injured person must be compliant
with the rehabilitation programme or it will not be
successful.
Individualisation – this has to take into account the
fact that each person will respond differently to an
injury, so what works for one person may not work
for another.
Specific sequencing – the rehabilitation programme
should follow a specific sequence of events which
is determined by how quickly the body is able to
respond to the injury with the healing process.
Intensity – the intensity of the rehabilitation
programme should be sufficient to challenge the
injured person but not cause further injury.
Total patient – the injured person as a whole should
be considered, not just their injured area; the rest
of their body and mind must be factored into the
rehabilitation process.
SAID
SAID is a principle that stands for Specific
Adaptation to Imposed Demand. This means
that the body will respond in relation to the type
of stresses placed on it and adapt accordingly.
Therefore, if a person takes part in weight training,
their muscles will respond by adapting to grow in
size to meet the requirements of the demand put
on them.
Therefore, the rehabilitation programme has to
be specific to the needs of the individual in order
to recover from the injury and also prevent the
chances of the person suffering from the same
injury in the future.
Pain-free
The rehabilitation programme should be as pain-
free as possible, as when the injured person is
38
experiencing pain, there is the possibility that the
injured area is getting aggravated and creating a
greater degree of injury rather than recovery.
Progression of rehabilitation
Each rehabilitation phase that involves taking part
in exercises and activities should be planned in line
with the following considerations:
● Type of activity – how strenuous the activity is.
● Duration of activity – an appropriate length
of time should be given so that the activity
promotes appropriate stress to performer to
produce a rehabilitation effect.
● Frequency of activity/rest – appropriate
rest periods should be built into the activity
or exercise to ensure that the performer is
physically ready to carry out the process again.
● Intensity of activity – the activity or exercise
has to be of an appropriate intensity; too
high an intensity could damage the injured
area, too low an intensity could have no
rehabilitation effect.
● Complexity of activity – if the activity is
difficult the sports performer may need time to
learn what needs to be done and how to do it.
Acute – Phase 1
Play/exercise should cease as soon as injury occurs.
‘Playing on through the pain’ is not the best
advice. Immediate treatment should be given as
specified earlier.
Very little exercise should be performed during
this stage as the aim of the treatment is to control
the bleeding and swelling and protect the injured
body part from further damage. PRICED is
recommended at this stage for up to 72 hours.
Sub-acute – Phase 2
Contrast bathing and massage are used during
this phase along with stretching. Stretching the
injured body part is very important during this
stage in order to help ensure that the new tissue
is laid down in the correct orientation. If there are
any signs that the injured body part is not ready
to commence this stage, such as heat or swelling
around the injury, then stretching should not be
started. When stretching, the person should have
their injured body part made as warm as possible.

This can be done through use of a thermal heat
pack or a soaking in a hot bath. Stretches should be
held (static stretches) to the onset of discomfort for
15 to 20 seconds. However, a person should never
stretch to the extent that they are in pain.
Stretching should be performed for short periods of
time and frequently throughout the day.
Early rehabilitation – Phase 3
Strengthening exercises that can be used during this
stage start with isometric exercises. This is where
the muscle contracts but no joint movement occurs.
Once these have been carried out and no pain has
been felt, concentric muscle contractions can be
carried out. This is where the muscle shortens, for
example the biceps shortening in a biceps curl.
If the person has injured their leg(s), initially all the
strength-training exercises should be carried out in
a non-weight-bearing position, so the injured body
part should not take the weight of the body. Instead,
the person should be sitting down, lying down or
standing on their good leg.
Late rehabilitation – Phase 4
Once this type of muscle contraction can be carried
out with no pain, eccentric muscle contractions can
be performed. This involves the muscle lengthening
under tension. An example of this is the quadriceps
muscle lengthening as the knee flexes into the
sitting position.
This stage involves partial weight bearing if the
performer has injured their leg, where the arms
are used to help support the body weight. Lastly,
the exercises can be carried out with the full body
weight on the injured body part.
Functional rehabilitation – Phase 5
Initially this stage should involve the very basic
elements of the sports person’s usual sport. For
example, a footballer would start with running
on the spot or in a straight line. Then they would
progress to running up and down hills, then on a
diagonal and changing direction. This would then
progress to skill training and involve training the
various ball skills required. Once they are able to
complete these exercises with no problems, they can
commence full training and eventually be ready for
competitive play.
15 Sports injury and assessment
During the process of rehabilitation the
following factors are taken into account at
each stage:
● The type of activity – this will vary at different
stages in the programme.
● Duration of activity – this will increase as the
programme progresses.
● Frequency of activity and rest – activity periods
will increase and rest periods will decrease as
the programme progresses.
● Intensity of activity – this will increase as the
programme progresses.
● Complexity of activity – the complexity of
the activity will increase as the programme
progresses.
● Regain full range of motion – this will happen
towards the end of the programme.
● Restore muscle strength – this will gradually
happen as the programme progresses.
● Normalise biomechanics – this will happen
towards the end of the programme.
● Restore high speed – this will happen towards
the end of the programme.
● Restore full power – this will happen towards
the end of the programme.
● Restore proprioception and agility – this will
happen towards the end of the programme.
At the end of the programme the athlete should be
ready to return to sport fully fit and able to play
the sport.
Monitoring the rehabilitation programme
During the rehabilitation programme a number
of factors should be monitored to see how
the sports performer is progressing and to
determine when they are ready to move on to
the next part of the stage or the next stage of
the programme.
Factors to be monitored – these include:
● Making sure the sports performer is carrying
out the exercises/activities correctly.
● Pain levels should be assessed so that the
performer is not in undue pain when carrying
out the rehabilitation programme.
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 Level 3 Sport and Exercise Science

● The posture of the sports performer should be

monitored when carrying out exercises and
activities and also when they are at rest to
make sure their posture is not being affected by
the injury.
● Mood state should be monitored to ensure the
sports performer is focused and motivated to
complete the rehabilitation programme.
● Consideration of adverse effects – this is
where the injury is not healing as quickly as
anticipated or the rehabilitation is not going
as well as planned due to physiological or
psychological factors. Figure 15.26 A CPM device

● Documentation and recording of information –

all aspects of the rehabilitation programme
should be monitored and recorded so that
both the sports therapist and sports performer
can see the progress that is being made. This
will motivate the sports performer and also
inform the sports therapist of how quickly the
performer is responding to the treatment, to
inform what exercises and activities should be
carried out and at what intensity for each stage
of the programme.
D3 Methods of rehabilitation
Methods to improve joint range of motion
A range of different exercises can be used for
rehabilitation to improve the range of movement of
a joint. It is important to try to get the joint moving
as soon as possible – if it is left immobile it can
become stiff and harder to move, prolonging the
rehabilitation process.
Each activity is carried out in the following stages:
1 continuous passive motion
2 passive mobilisation
3 passive exercises
4 active exercises
5 active assisted exercises.
Continuous passive motion (CPM) – this is where
a CPM device is used which moves the body part
through a controlled range of movement. The sports
performer does not put any effort into moving
the body part themselves; the CPM device is
responsible for moving the body part.
Passive mobilations – this is where the sports
therapist moves the body part and starts to mobilise
the joint, moving through ranges of motion that are
causing minimum pain to the sports performer.
Passive exercises – the sports therapist moves the
body part(s) to carry out different exercises, such as
moving the knees from side to side, or holding them
up for a period of time. Again, the sports performer
is not responsible for moving the body part as the
therapist moves the body part, causing as little pain
to the sports performer as possible.
Active exercises – the sports performer is now
responsible for moving their body part(s) and uses
their muscles to carry out set exercises to help to
rehabilitate the injured area.
Active assisted exercises – the sports therapist
will now be involved in assisting the active
exercises by offering resistance to make the muscles
work harder or helping to increase the range of
movement that the body part moves in.
Methods to improve musculotendinous
flexibility
There are a range of different methods of flexibility
training: active stretching, passive stretching and
PNF (proprioceptive – pronounced ‘prope-rio-
ceptive’ – neuromuscular facilitation) training.
Active stretching involves holding a stretch for
around 30 to 60 seconds, e.g. sitting down with your
legs out straight in front of you and reaching to
touch your toes.

40

Passive stretching involves relaxing the body and
having a partner gently push or pull the body or
limb into a stretched position.
Proprioceptive neuromuscular facilitation (PNF)
stretching is an advanced type of stretching in
order to develop the length of the muscle:
● The muscle is stretched to the point of bind by
the sports therapist.
● At this point, the therapist asks the sports
performer to contract the muscle and push
against them at about 40–50% effort.
● This contraction is held for 10 seconds.
● When the muscle is relaxed the sports therapist
will stretch the muscle further.
● Again a contraction is applied and then the
muscle is re-stretched.
● This is done three times.
This is a more effective way of developing the
length of the muscle as the contraction will actually
cause the muscle to relax more quickly and more
deeply which helps to increase the rate at which
flexibility can be increased.
Methods to improve muscle conditioning
Strength exercises
Strength needs to be built up gradually using
resistance to increase muscle strength. Initially
resistance can be in the form of the therapist using
their body to oppose the movement of the sports
performer. The sports performer can also perform
isometric contractions which are where the muscle
doesn’t change length but is contracting.
Isotonic contractions are where the muscle
changes length and include concentric contraction
where the muscle gets shorter and eccentric
contraction where the muscle gets longer while
contracting.
Isokinetic contractions are where the muscle
changes length but maintains the same speed;
to perform this type of contraction it requires a
specialised piece of equipment.
Isometric contractions are where the muscle does
not change in length so no movement is created, but
the muscle still creates tension.
15 Sports injury and assessment
Power exercises
These types of exercise should be performed
gradually and at the later stage of the rehabilitation
programme as they may cause further injury if
performed at too high an intensity or too soon.
Plyometric training will develop power which is
producing strength at speed. It usually involves
moving your body weight very quickly through
jumping or bounding, such as jumping onto boxes
and over hurdles. Some other examples are:
● Depth jumping
● Vertical jumps and standing long jump
● Medicine ball throws
● Hopping
● Bounding
● Squat and jump
● Press-up and clap.
It is a very strenuous type of training and the
sports performer much have developed their
strength before performing plyometrics. The
sports performer should be fully warmed up
before taking part in these exercises and ideally
a sprung floor or a soft surface should be used
to help to cushion the impact on landing. As the
person progresses through their rehabilitation
programme, the speed of these plyometric exercises
can be increased.
Endurance exercise
Muscular endurance is the ability of a muscle,
or a group of muscles, to continue performing
contractions. In order to improve muscular
endurance, it is necessary to exercise the specific
muscle groups for periods of time. If the sports
performer is ready to use resistance equipment to
increase their muscular endurance, they should use
low weights and high repetitions (12 or more) for
two or three sets.
Methods to improve neuromuscular control
Proprioception and balance
Proprioception is how the body works out where
each body part is in relation to each other. To help
to improve proprioception, exercises that require
balance can be used, such as balance boards or
stability trainers.
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 Level 3 Sport and Exercise Science
challenge the sports performer to ensure that they
have appropriate levels of each component of fitness
required for their selected sport which will reduce
the risk of re-injury.
Figure 15.27 A balance board
Co-ordination
This is the ability to use different parts of the
body so they can complete a movement smoothly
and efficiently. In order to complete a range of
sporting skills and techniques good co-ordination
is required. The sport that the sports performer
usually takes part in will determine the types of
method used to help to improve co-ordination but
examples include running while throwing, passing,
heading or catching a ball.
Methods to improve skill acquisition/
functionality
Exercises
Lastly, to help the sports performer to return
to full functionality so that they are ready to
take part and compete in their selected sport,
the final part of the rehabilitation programme
includes exercises that combine strength, power,
endurance, flexibility and neuromuscular control
and which use muscle groups that are specific for
that particular sport.
This will include skills practices such as passing
and shooting drills. Other exercises will be set to
42
D Check your understanding
1 Describe the emergency treatment that
should be carried out if a person is found
lying on the ground.
2 Explain what PRICED stands for.
3 Explain what SALTAPS stands for.
4 Assess when a casualty would require:
• Bandaging
• Taping
• A sling
• A splint.
5 Explain when hot and cold therapy is used as
a form of treatment.
6 Explain the five stages of rehabilitation.
Activity
1 With a partner, demonstrate that you are able
to carry out the correct protocols to treat four
different sports injuries.
2 For a sports injury of your choice, design a
rehabilitation programme including factors
that may affect rehabilitation, adaptations
and alterations and justification of the
programme with recommendations and
considerations for the future.
Your programme should have a clear aim and
rationale, show logical progression through
the five stages of injury, applying methods,
principles and progressions and address
all areas including: joint range of motion,
flexibility, muscle conditioning, neuromuscular
control and skill acquisition/functional
exercises.
All aspects of methods of rehabilitation
should be included and detailed, including
a statement regarding the consequences of
inadequate rehabilitation. Adaptations and
alternative exercises should be included and
documented where possible. The programme
that you produce should be safe and show
progression.

Meeting distinction criteria
To meet the D.D3 criteria, you will need to
give reasons to justify your rehabilitation
programme design, as well as future
recommendations and considerations. You
will need to address the appropriateness
of the scenario that you select and why the
programme is appropriate for meeting the aims
and goals. You will need to apply theoretical
knowledge of principles and methods of
rehabilitation to the practical design of the
programme. The information that you present
will need to be factually correct and you should
use concise written language and correct
terminology. The importance of sports injury
management will need to be considered with
regard to its role in helping sports performers
prevent or overcome common sports injuries.
The importance of many factors in the
management process will also need to be
considered, including aetiology, mechanism
of injury, gait analysis, injury prevention,
immediate treatment and rehabilitation.
You will need to provide judgements and
conclusions will need to be drawn about the
role of sports injury management in preventing
or overcoming sports injuries. You will also need
to use research evidence to support carefully
considered reasoning in your assignment.
Distinction activity
Scenario
A football player who plays for their college
team and is hoping to be signed up for a semi-
professional team has sustained a sports injury.
They were playing football and turned to kick
the ball, but their football boot studs kept their
foot planted on the ground. This resulted in
their leg turning but their foot remaining still.
The football player heard a crack before they
fell to the ground. They have severe pain in their
lower leg and have, in fact, fractured their tibia
and fibula.
You will need to design a rehabilitation
programme for this sports performer. Include in
your programme justification for each part of it,
including consideration of factors that may affect
the sport performer’s rehabilitation. You should
also provide future recommendations for the
sports performer and considerations to help them
to prevent future sports injuries.
15 Sports injury and assessment
Further Reading
Anderson, M.K., Hall, S.J. and Parr, G.P. (2008).
Foundations of Athletic Training: Prevention,
Assessment and Management. U.S., Lippincott
Williams & Wilkins.
Brukner, P. and Khan, K. (2007). Clinical Sports
Medicine (Third Edition). Australia, McGraw Hill.
Cartwright, L.A. and Pitney, W.A. (2005).
Fundamentals of Athletic Training (Second
Edition). Champaign, Human Kinetics.
Oxford, U.K., Kolt, G.S. and Snyder-Mackler, L.
(2005). Physical Therapies in Sport and Exercise
(Second Edition). Australia, Elsevier Limited.
Norris, C. (2004). Sports Injuries: Diagnosis
and Management (Third Edition). London,
Butterworth and Heinemann.
Shultz, S.J., Houglum, P.A. and Perrin, D.H.
(2005). Examination of Musculoskeletal Injuries
(Second Edition). Champaign, Human Kinetics.
Useful websites
nsmi.org.uk
Sports Medicine Information – provides
information with regards to sports injury,
classification, signs and symptoms, mechanisms
and injury prevention.
PhysioRoom.com
PhysioRoom – provides sports injury information
including signs and symptoms and prevention.
sportsinjuryclinic.net
Sports Injury Clinic – provides extensive
information with regards to sports injures,
prevention and rehabilitation.
stopsportsinjuries.org
The American Orthopaedic Society for Sports
Medicine – provides sport-specific injury and sport-
related information on injuries including coach,
athlete, parent and healthcare provider’s resources.
References
Gledhill, A., Mackay, N., Forsdyke, D. and
Randerson, K. (2011). Foundations in Sports
Therapy. London, Heinemann.
Brukner, P. and Khan, K. (2007). Clinical Sports
Medicine (Third Edition). Australia, McGraw Hill.
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