Injuries

Signs and Symptoms

 Pain
 Swelling
 Heat
 Redness
 Loss of function
 Depends on severity of injury
 Treatment
 R.I.C.E. and possible NSAIDs
 Range of Motion (Stretching!)
 Strength and Endurance
 Neuromuscular Control & Balance
 Functional and Sports Specific Progressions
 Maintain Cardio Fitness

 All depend on severity.

 Begin rehab as soon as possible.
 What are the two categories of acute
muscle injuries?

 Contusions
 Strains
How does one receive a contusion?

Sudden traumatic blow to the body

 What is typical in cases of severe
contusions?
a. the athlete reports being struck by a hard
blow
b. the blow causes pain and a transitory
paralysis caused by pressure on and shock
to the motor and sensory nerves
c. palpation often reveals a hard area,
indurated because of internal hemorrhage
d. ecchymosis, or tissue discoloration, may
take place
What is a strain?

A stretch, tear, or rip in the muscle or

adjacent tissue such as the fascia or
muscle tendon
How are strains most often produced?

Abnormal muscular contraction

 What is the cause of abnormal muscular
contraction?
It is fault in the reciprocal coordination of the
agonist and antagonist muscles take place. The
cause of this fault or un-coordination is a
mystery. However, possible explanations are
that it may be related to:
 a mineral imbalance caused by profuse sweating
 to fatigue metabolites collected in the muscle
itself
 to a strength imbalance between agonist and
antagonist muscles.
What is a grade 1 (or 1st degree or
1°) strain?

Slight over-stretching to mild tearing

(20%) of the muscle fibers. It is
accompanied by local pain, which is
increased by tension in the muscle,
and a minor loss of strength. There is
mild swelling, ecchymosis, and local
tenderness.
What is a grade 2 (or 2nd degree or
2°) strain?

Moderate tearing (20% - 70%) of the

muscle fibers. It is similar to a grade
1, but has moderate signs and
symptoms (moderate loss of strength,
moderate swelling, ecchymosis, and
local tenderness).
What is a grade 3 (or 3rd degree or
3°) strain?

Has signs and symptoms that are

severe (severe swelling, ecchymosis,
and local tenderness) with a loss of
muscle function and, commonly, a
palpable defect in the muscle.
What does a tendon attach?

Muscle to bone
What does a ligament attach?

Bone to bone
What is a cramp?

A painful involuntary contraction of a

skeletal muscle or muscle group.
Cramps have been attributed to
what?

A lack of water or other electrolytes in

relation to muscle fatigue.
What is a spasm?

A reflexive reaction caused by trauma

of the musculoskeletal system
 List and define the two types of
spasms or cramps:

a. clonic – alternating involuntary

muscular contraction and relaxation in
quick succession

b. tonic – rigid muscle contraction that

lasts a period of time.
 What are the four specific indicators of
possible overexertion?

a. acute muscle soreness

b. delayed muscle soreness
c. muscle stiffness
d. muscle cramping
 List and define the two types of muscle
soreness:
a. Acute-onset muscle soreness – which
accompanies fatigue. This muscle pain is
transient and occurs during and immediately
after exercise.
b. Delayed-onset muscle soreness (DOMS) –
becomes most intense after 24 to 48 hours
and then gradually subsides so that the
muscle becomes symptom-free after 3 or 4
days. (This second type of pain is described
as a syndrome of delayed muscle pain
leading to increased muscle tension, swelling,
stiffness, and resistance to stretch).
 What are the possible causes for
delayed-onset muscle soreness?

 It may occur from very small tears in

the muscle tissue, which seems to be
more likely with eccentric or isometric
contractions.
 It may also occur because of disruption
of the connective tissue that hold
muscle tendon fibers together.
What is muscle stiffness?

Muscle stiffness does not produce pain.

It occurs when a group of muscles have
been worked for a long period of time.
The fluids that collect in the muscles
during and after exercise are absorbed
into the bloodstream at a slow rate. As
a result, the muscle becomes swollen,
shorter, and thicker and therefore
resists stretch.
 What can be done to assist in reducing
muscle stiffness?

 Light exercise
 Massage
 Passive mobilization
What is muscle guarding?

Following injury, the muscle that

surrounds the injured area contract, in
effect, splint that area, thus minimizing
pain by limiting movement. (Quite often
this splinting is incorrectly referred to
as a muscle spasm)
 The suffix “itis” means inflammation:
 Myositis/Fasciitis - inflammation of the
muscle tissue
 Tendinitis – inflammation of a tendon
 Tenosynovitis - Inflammation of the
synovial sheath surrounding a tendon
 Bursitis – inflammation of the bursa
 Periostitis – inflammation of the bone
covering
 What are the major acute injuries that
happen to synovial joints?

 Sprains
 Subluxations
 Dislocations
What is a sprain?

Stretching or total tearing of the

stabilizing connective tissues
(ligaments)
What is a grade 1 (or 1st degree or 1°)
sprain?

Slight over-stretching to mild tearing

(20%) of the ligament. It is
characterized by some pain, minimum
loss of function, mild point tenderness,
little or no swelling, and no abnormal
motion when tested.
What is a grade 2 (or 2nd degree or 2°)
sprain?

Moderate tearing (20% - 70%) of the

ligament. There is pain, moderate loss
of function, swelling, and in some cases
slight to moderate instability.
What is a grade 3 (or 3rd degree or 3°)
sprain?

It is extremely painful, with major loss

of function, severe instability,
tenderness, and swelling.
What is a subluxation?

Partial dislocations in which an

incomplete separation between two
articulating bones occurs.
What is a dislocation (luxation)?

Total disunion of bone apposition

between articulating surfaces
 What are several factors that are
important in recognizing and evaluating
dislocations?

 Loss of limb function

 Deformity
 Swelling
 Point tenderness
What is an acute bone fracture?

A partial or complete interruption in a

bone’s continuity
What is a stress fracture?

Rhythmic muscle action performed over

a period of time at a sub-threshold level
causes the stress-bearing capacity of a
bone to be exceeded
 What are the typical causes of stress
fractures in sports?

 Coming back into competition too soon

after an injury or illness
 Going from one event to another
without proper training in the second
event
 Starting initial training too quickly
 Changing habits or the environment

Injury
Groin Strain (Hip)
Quadriceps Strain (Thigh)
Hamstring Strain (Thigh)
Gastrocnemius Strain (Leg)
Achilles Tendon Strain (Ankle)
Achilles Tendon Rupture (Ankle)
Longitudinal Arch Strain
Metatarsal Arch Strain
Patellar Tendon Rupture
Strains
Mechanism of Injury (Etiology)
Running, Jumping, Twisting (ER)
Sudden stretch from knee flexion
Sudden stretch from knee extension
Quick starts & stops, jumping,
sudden knee extension.
Usually after ankle sprains or sudden
excessive ankle dorsiflexion.
Sudden pushing-off action of the
forefoot with the knee being forced
into complete extension.
Repetitive contact with a hard
playing surface. It may appear
suddenly or slowly over time.
Excessive pronation and weak
intertarsal ligaments will allow the
foot to abnormally spread resulting
in a fallen arch
Sudden powerful contraction of the
quadriceps
Signs & Symptoms Treatment
Typical Typical, May need crutches,
compression wrap during activity
Typical Typical, May need crutches,
compression wrap during activity
Typical Typical, May need crutches,
compression wrap during activity
Typical Typical, heel wedge, compression
wrap during activity
Typical Typical, heel lift, compression wrap
during activity
Typical, hears a pop, indentation at RICE, X-ray to rule out fracture,
site, positive Thompson’s Test possible surgical repair,
immobilization for 4 to 6 weeks,
begin rehab. Heel lifts in both shoes
Typical Typical, Reduce weight bearing
activity, possible arch support taping
Typical Typical, orthotic or pad to elevate
the fallen arch.
Typical, Defect can be palpated, Typical, surgery
athlete cannot extend the knee,
swelling, initial significant pain
followed by a feeling that the injury
is not serious
 Strains
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment

Elbow strain Excessive resistive motion, repeated Typical Typical

microtears
Lumbar strain Sudden extension on an overloaded, Typical Typical
unprepared, or underdeveloped
spine, usually in combination with
trunk rotation; chronic strain,
commonly associated with faulty
posture that involves excessive
lumbar lordosis.
Neck and Upper Back strain Turn the head suddenly or forced Typical, muscle guarding and Typical, possible soft cervical collar
flexion, extension, or rotation reluctance to move the neck in any
direction
Cervical sprain (Whiplash) Turn the head suddenly or forced Typical, muscle guarding and Typical, X-rays to rule out fracture.
flexion, extension, or rotation, but reluctance to move the neck in any and possible soft cervical
much more violently than the direction; this pain may persist much
cervical strain longer than that of the cervical
strain.
 Sprains
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment

Hip Sprain Sudden stretch from knee flexion Typical Typical, May need crutches

MCL Sprain (Knee) Direct blow (valgus force), severe Typical, positive valgus stress test Typical, May need crutches
outward twist
LCL Sprain (Knee) Direct blow (varus force) Typical, positive varus stress test Typical, May need crutches

ACL Sprain (Knee) Direct blow, rotation, hyperextension Typical, positive anterior drawer test, Typical, crutches, immobilization,
positive Lachman’s test physician referral, possible surgery

PCL Sprain (Knee) Direct blow, knee flexion, landing on Typical, positive posterior drawer Typical, crutches, immobilization,
a flexed knee test physician referral, possible surgery

Inversion (Lateral) Ankle Sprain Foot inversion, plantar flexion, Typical, positive anterior drawer test, Typical, possible crutches, possible
adduction positive Talar tilt test immobilization, possible physician
referral, possible surgery

Eversion (Medial) Ankle Sprain Foot pronation, hypermobility, Typical, positive anterior drawer test, Typical, possible crutches, possible
depressed medial longitudinal arch positive Talar tilt test immobilization, possible physician
referral, possible surgery
Syndesmotic (High) Ankle Sprain External rotation, forced dorsiflexion Typical Typical, may take months to heal

Sprained Toes or Turf Toe Force against an unyielding object Typical, Valgus & Varus Stress Tests, Typical, tape
Anterior & Posterior Drawer Tests
Acromioclavicular (AC) Sprain Direct Impact Typical Typical, immobilization, possible
physician referral
 Sprains
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment

Elbow sprain Hyperextension or valgus forces Typical Typical

Wrist sprain Fall on hyperextended wrist; any Typical Typical

abnormal, forced movement of the
wrist
Finger sprain Fall on hyperextended wrist; any Typical Typical
abnormal, forced movement of the
wrist
Finger fractures Direct trauma or violent twisting Typical Typical

Lumbar sprain Forward bending and twists while Typical Typical

lifting or moving some object

Sacroiliac sprain Twisting with both feet on the
ground, stumble forward, fall
backward, step too far down and
lands heavily on one leg, or bends
forward with the knees locked while
lifting
Typical, associated muscle guarding. Typical, Bracing may be helpful. Joint
Possible asymmetry with the ASIS should be mobilized to correct
and/or PSIS, difficulty with forward existing asymmetry
bending, straight leg raising
increases pain after 45º, as well as
side bending toward the painful side.
 Bursitis
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment

Trochanteric Bursitis Repetitive Typical, pain may radiate to the knee Typical, May need crutches, NSAIDs
causing a limp and analgesics.
Patellar Bursitis Continual kneeling, overuse Typical, ballotable Typical, eliminate the cause, NSAIDs

Shoulder bursitis Overuse Typical, positive impingement test Typical

Olecranon Bursitis Direct force, overuse Typical Typical

 Dislocations and Subluxations
Injury
Shoulder dislocation/subluxation
Elbow dislocation
Lunate Dislocation
Finger dislocations/subluxations
Lumbar Vertebrae Dislocation
Cervical dislocation
Mechanism of Injury (Etiology)
Forced abduction, external rotation,
direct blow
Fall on the outstretched hand with
the elbow in a position
hyperextension; or a severe twist
while it is in a flexed position.
Forced hyperextension
Direct trauma or violent twisting
Compression fracture may occur as a
result of hyperflexion of the trunk;
falling from a height and landing on
the feet or buttocks; direct impact
from a sudden blow
Violent flexion and rotation of the
head
Signs & Symptoms Treatment
Typical, possible deformity, unable to Typical, Immediate immobilization,
touch opposing shoulder (Apley’s RICE, pillow under the arm for
scratch test comfort, physician referral, x-rays to
rule out a fracture
Typical, Rupturing or tearing most of Typical, sling, physician referral
the stabilizing ligaments, profuse
hemorrhage and swelling. Severe
pain and disability, possible radial
head fracture.
Typical, difficulty in executing wrist Typical, possible physician referral
and finger flexion. There may be
numbness or even paralysis of the
flexor muscles because of lunate
pressure on the median nerve
Typical Typical
Typical Typical, X-ray, physician referral, put
athlete on a spine board
Point tenderness, restricted C-spine, Physician referral
movement, cervical spasm, cervical
pain and pain in the chest and
extremities, numbness in the trunk
and/or limbs, weakness or paralysis
in the trunk and/or limbs, loss of
bladder and/or bowel control

Injury
Hip Contusion (Hip Pointer)
Quadriceps Contusion
Joint Contusion
Shin contusion
Calcaneal Contusion
Finger contusions
Rib contusion
Contusions
Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Direct blow Typical, spasms, transistory Typical, physician referral to r/o
paralysis, unable to rotate the trunk fracture, 1 to 2 days bed rest, ice
or to flex the thigh without pain massage, ultrasound, NSAIDs
Direct blow Typical, transitory loss of function Typical, RICE with the knee in
flexion, NSAIDs
Direct blow Typical Typical, possible physician referral,
return to activity with protective
padding when initial pain and
irritation subsides.
Blow to the anterior aspect of the Typical, rapid hematoma formation, Typical, NSAIDs and analgesics,
lower leg. can be associated with compartment maintaining compression is critical
syndrome or fracture. (may have to aspirate hematome),
ROM exercises and PRE within pain
limits, doughnut padding and
orthoplast shell for protection.
Occurs by impact from running or Typical Typical, moderate activity with the
jumping protection of a heel cup or doughnut
may resume if pain when walking
has subsided by the 3rd day, shock
absorbent footwear shoe be worn.
Direct trauma Typical Typical
Direct blow Typical, Sharp pain during breathing, Typical, possible bed rest and
point tenderness, pain when the rib cessation of sports activities
cage is compressed

Injury
Femoral Stress Fractures
Acute Femoral Fracture
Patellar Fracture
Acute Leg Fracture
Tibia or Fibular Stress Fracture
Ankle Fracture (misnomer)
Fractures
Mechanism of Injury (Etiology)
Repetitive
Direct Trauma
Direct or indirect trauma
Direct traumatic blow
Repetitive or Overuse
Forced abduction or planting in
combination with forced internal
rotation, trauma.
Signs & Symptoms
Typical, Groin pain along with an
aching sensation in the thigh that
increases with activity and decreases
with rest. Standing on one leg may
be impossible
Typical, pain over the fracture site,
deformity
Typical, Hemorrhage and joint
effusion
Typical, Soft tissue insult and
hemorrhaging, intense pain and
disability, leg appears hard and
swollen.
Typical, positive percussion or
compression test, positive x-ray or
bone scan
Typical, possible deformity
Treatment
Typical, Rest, for 2 to 5 months, x-
rays and possible bone scan,
swimming
Ice, Treat for shock, verify
neurovascular status, splint,
physician referral
Typical, physician referral
Splint and ice, refer to a physician
Typical, NSAIDs, no activity for at
least 14 days, possible cast and/or
crutches, weight bearing when pain
subsides, correct biomechanics,
running may resume when the
athlete is completely pain free.
Typical, x-ray examination, a walking
cast or brace may be applied once
swelling is reduced, for 6 to 8 weeks,
PNF exercises, isometrics (during
immobilization), PRE, and balance
activites up to 4 weeks.
 Fractures (cont.)
Injury Mechanism of Injury (Etiology)
Talus Fracture Occurs either laterally from a severe
inversion and dorsiflexion force or
medially from an inversion and
plantar flexion force with external
rotation of the tibia on the talus.
Calcaneal Fracture Occurs most often after a jump or
fall from a height. An avulsion
fracture can also occur with this
injury
Calcaneal Stress Fracture Occurs from repetitive impact during
heel strike and characterized by a
sudden onset of constant pain in the
plantar-calcaneal area.
Jone’s Fracture Inversion and plantar flexion of the
foot, direct forces, or repetitive
stress.
Signs & Symptoms
Typical, History of repeated trauma
to the ankle, feels pain on weight
bearing, complaint of snapping or
catching, intermittent swelling,
anteromedial or anterolateral joint
line of the talar dome is tender when
palpated.
Typical, inability to bear weight
Typical, Feels pain on weight
bearing, pain tends to continue after
exercise stops, bone scan may be
required.
Typical, Immediate swelling and pain
over the 5th metatarsal, high non-
union rate, coarse of healing is
unpredictable.
Treatment
Typical, X-ray is essential for an
accurate diagnosis, non-surgical
management for a non-displaced
sub-chondral compression fracture,
protective immobilization, non-weight
bearing progression to full weight
bearing depending on symptoms, if
conservative treatment fails surgery
may be required, expect to resume
activity 6 to 8 months after surgery.
Typical, X-ray is essential for an
accurate diagnosis, non-surgical
management for a non-displaced
fracture, protective immobilization,
non-weight bearing progression to
full weight bearing depending on
symptoms,
Typical, Conservative management
for the first 2 to 3 weeks, rest, active
ROM exercises of the foot and ankle,
non-weight bearing cardiovascular
exercises, may resume activities
within pain limits when pain
subsides, must wear a cushioned
shoe.
Typical, Crutches with no
immobilization, gradually progress to
full weight bearing as pain subsides,
return to activity is possible in 6
weeks, non-union may cause re-
fracture to occur.
 Fractures (cont.)
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment

Metatarsal Stress Fracture (March
Fracture)
Phalanges
Clavicular Fracture
Scapular Fracture
Fracture of the Humerus
Most commonly involves the shaft of
the 2nd metatarsal (March fracture).
Occurs in the runner suddenly
changing training patterns, such as
increasing mileage, running hills, or
running on a harder surface. An
atypical condition such as a
structural forefoot varus, hallux
valgus, or a short 1st metatarsal will
predispose to a 2nd metatarsal
stress fracture. A stress fracture of
the 5th metatarsal at the insertion of
the peroneous brevis tendon can
occur, but should not be confused
with a Jones fracture.
Occurs by either kicking an object,
stubbing a toe, or being stepped on.
Dislocations are less common than
fractures.
Fall on the outstretched, a fall on the
tip of the shoulder, or direct impact.
Direct impact or force transmitted
through the humerus to the scapula.
Direct blow or fall on the
outstretched arm
Typical
Typical, deformity. Stiffness and
residual pain may last for several
days
Typical, Clavicle appears slightly
lower than the opposite side.
possible deformity
Typical, Pain during shoulder
movement
Typical, inability to move arm
Typical, Bone scan is the best way to
detect this injury, 3 or 4 days of
partial weight bearing after two
weeks of rest, return to running
should be gradual, orthotics can help
to reduce stress
Typical, buddy tape, possible
physician referral
Typical, Sling and swathe, treat for
shock, X-ray, immobilization for 6 to
8 weeks. After immobilization, begin
gentle isometrics and mobilization
exercises. May require surgery.
Typical, Sling, x-ray, begin overhead
strengthen in 1 week.
Typical, Sling and swathe, treat for
shock, physician referral,
immobilization for 6 to 8 weeks

Injury
Forearm fracture
Colle’s Fracture
Scaphoid (Navicular) Fracture
Hamate fracture
Lumbar Vertebrae Fracture
Cervical fracture
Rib Fracture
Fractures (cont.)
Mechanism of Injury (Etiology)
Direct trauma or fall on the
outstretched arm
Fall on an outstretched armforcing
the radius and ulna into
hyperextension, or falling on the
backward hand
Force on the outstretched arm
Fall or from contact from a sports
implement
Compression fracture may occur as a
result of hyperflexion of the trunk;
falling from a height and landing on
the feet or buttocks; direct impact
from a sudden blow
Axial loading; sudden forced
hyperextension
Direct or indirect trauma, violent
muscular contractions
Signs & Symptoms Treatment
Typical, Audible pop or crack Typical, sling, physician referral
Typical, Possible silver fork Typical, sling, physician referral
deformity, and possible median
nerve damage
Typical Typical, splint, physician referral
Typical Typical, splint, physician referral
Typical Typical, X-ray, physician referral, put
athlete on a spine board
Point tenderness, restricted C-spine, Physician referral
movement, cervical spasm, cervical
pain and pain in the chest and
extremities, numbness in the trunk
and/or limbs, weakness or paralysis
in the trunk and/or limbs, loss of
bladder and/or bowel control
Typical, Sharp pain during Typical, physician referral, rest and
inspiration, possible crepitus during immobilization
palpation

Injury
Osgood-Schlatter
Larsen Johansson
Patellar Tendinitis
(Jumper’s or Kicker’s Knee)
Runner’s (Cyclist’s) Knee
Achilles Tendinitis
Tendinitis
Mechanism of Injury (Etiology)
repetitive stress at the tibial
tuberosity
repetitive stress at the inferior
patellar pole
Repetitive running, jumping, and
kicking
Repetitive, overuse
Excessive tensile stresses placed on
it during repetitive movements and
presents with a gradual onset.
Signs & Symptoms
Typical, hemorrhage, gradual
degeneration, severe pain when
kneeling, running, or jumping, point
tenderness
Typical, hemorrhage, gradual
degeneration, severe pain when
kneeling, running, or jumping, point
tenderness
Typical, Pain and tenderness at the
posterior, inferior patellar pole
Typical, Malalignment and structural
asymmetries of the foot and lower
leg. Contributes to iliotibial band
friction syndrome and pes anserinus
tendonitis or bursitis
Typical, uphill running and hill
workouts aggravate the condition,
weak gastrocnemius-soleus complex,
morning stiffness, discomfort walking
after prolonged sitting, tendon is
warm and painful upon palpation,
palpable crepitus with active plantar
and dorsiflexion, pain on passive
stretching, chronic inflammation.
Treatment
Typical, reduce irritating activities,
cast may be required, isometric
strengthening for quads and
hamstrings
Typical, reduce irritating activities,
cast may be required, isometric
strengthening for quads and
hamstrings
Typical, thermal agents, ultrasound,
brace (counter-force) massage
Typical, Correction of foot and leg
alignment problems, RICE, proper
warm-up and stretching, avoidance
of aggravating activities, NSAIDs.
Typical, may be resistant to quick
resolution, address structural faults
(i.e. footwear, orthotics, etc.)
ultrasound to increase blood flow,
friction massage may be helpful,
strengthening of the gastrocnemius-
soleus unit. May be resistant to quick
resolution, address structural faults
(i.e. footwear, orthotics, etc.) RICE,
ultrasound to increase blood flow,
friction massage may be helpful,
strengthening of the gastrocnemius-
soleus unit.

Injury
Anterior Tibialis Tendinitis
Posterior Tibialis Tendinitis
Peroneal Tendinitis
Wrist tendinitis
Tendinitis (cont.)
Mechanism of Injury (Etiology)
Common when running downhill for
extended periods of time.
Overuse injury among runners with
hypermobility or pronated feet
Problem in athletes with pes cavus
where the foot tends to excessive
supinate.
Repetitive pulling movements
Signs & Symptoms
Typical
Typical, Swelling of the medial
malleolus area, edema and point
tenderness behind the medial
malleolus area, pain can become
more intense during resistive
inversion and plantar flexion
Typical, Pain of the lateral malleolus
area when rising on the ball of the
foot, tenderness behind the lateral
aspect of the calcaneous distally
beneath the cuboid.
Typical
Treatment
Typical, avoid hills
Typical, non-weight bearing short-leg
cast with the foot in inversion may
be used, Low Dye taping or orthotic
can be used to correct pronation.
Typical, tape with elastic tape,
appropriate warm-up and flexibility
exercises, Low Dye taping or orthotic
can be used to prevent excessive
supination.
Typical
 Chondramalacia
(Patellofemoral Arthralgia)
 Etiology:
 Abnormal patellar tracking
 Signs & Symptoms:
 Pain in the anterior aspect while running, walking,
ascending stairs, and squatting. Recurrent swelling,
grating sensation during flexion and extension,
patellar grind test produces crepitus.
 Treatment:
 Avoid irritating activities, pain-free isometric exercise
to strengthen the quads, anti-inflammatories,
orthotics to correct pronation and reduce tibial
torsion, possible surgery.
Patellofemoral Stress Syndrome (PFSS)
(Patellofemoral Arthralgia)
 Etiology:
 Hamstrings, gastrocnemius, IT band, or lateral
retinaculum tightness; increased Q angle, foot
pronation, patella alta, VMO insufficiencies
 Signs & Symptoms:
 Tenderness over the patellar lateral facet, swelling,
dull ache in the center of the knee, patellar
compression will elicit pain and crepitis, positive
apprehension test
 Treatment:
 Strengthen VMO; stretching for hamstrings,
gastrocnemius, and IT band; orthotics and/or taping to
correct alignment
 Cramps and Spasms
 Etiology:
 Excessive loss of fluids through
sweating, inadequate muscle
coordination.
 Signs & Symptoms:
 Pain, tonic contraction.
 Treatment:
 Athlete should relax, gradual stretching,
ice or gentle ice massage.
 Medial Tibial Stress Syndrome
 Etiology:
 Repetitive microtrauma, weak leg muscles, inadequate footwear,
inappropriate training, malalignment problems.
 Signs & Symptoms:
 Grade 1: pain after activity
 Grade 2: pain before and after activity, but does not affect
performance
 Grade 3: pain before, during, and after activity, affects
performance
 Grade 4: constant pain that makes performance impossible
 Pain is along the lower medial anterior tibialis.
 Treatment:
 Physicians referral to rule out other problems, RICE, NSAIDs and
analgesics, ice massage, modify activity, correct biomechanics,
orthotics and/or arch taping.
 Lateral Epicondylitis
(Tennis Elbow)
 Etiology:
 Repetitive microtrauma, hyperextension activities
 Signs & Symptoms:
 Aching pain over the region during and after
exercise, pain worsens with continued activity,
weakness in the hand and wrist
 Treatment:
 RICE, NSAIDs and analgesics, immobilization,
strengthening and stretching exercises, correct
biomechanics, counterforce brace
 Medial Epicondylitis
(Pitcher’s Elbow, Racquetball Elbow,
Golfer’s Elbow, Javelin-Thrower’s Elbow)
 Etiology:
 Repeated forceful extension of the wrist and valgus torques
of the elbow.
 Signs & Symptoms:
 Pain, possible radiating pain, point tenderness, mild
swelling, AROM produces pain.
 Treatment:
 RICE, NSAIDs and analgesics, immobilization (sling),
strengthening and stretching exercises, correct
biomechanics, counterforce brace. For severe cases, splint
and complete rest for seven to 10 days.
 Carpal Tunnel Syndrome
 Etiology:
 Repetitive wrist flexion, direct trauma
 Signs & Symptoms:
 Sensory or motor deficits; tingling, numbness, and
paresthesia over the thumb, index and middle
fingers, and palm of the hand; muscular weakness
 Treatment:
 RICE, immobilization, and NSAIDs. Surgical
decompression may be necessary
 de Quervain’s Disease
(Hoffman’s Disease)

 Etiology:
 Constant wrist movement
 Signs & Symptoms:
 Aching pain which may radiate into the hand
or forearm, positive Finklestein’s test; point
tenderness and weakness during thumb
extension and abduction; there may be a
painful snapping and catching of the tendons
 Treatment:
 Immobilization, rest cryotherapy, NSAIDs,
ultrasound, ice massage
 Wrist Ganglion

 Etiology:
 Appears slowly after a wrist sprain
 Signs & Symptoms:
 Occasional pain with a lump at the site. Pain
increases with use
 Treatment:
 RICE, pressure with a felt pad, ultrasound, possible
surgical removal
 Sciatica
 Etiology:
 Torsion or direct blow to the back causing inflammation
or compression of the sciatic nerve
 Signs & Symptoms:
 Pain may be abrupt or gradual, produces a sharp
shooting pain that follows the nerve pathway along the
posterior and medial thigh; there may be tingling and
numbness along its path; nerve may be extremely
sensitive to palpation; straight leg raises intensifies pain.
 Treatment:
 Rest is essential. Stretching of a tight piriformis muscle
may decrease symptoms; NSAIDs and RICE, surgery may
be necessary.
 Brachial Plexus Neurapraxia
(Burner or Stinger)
 Etiology:
 Stretching or compression of the brachial plexus
 Signs & Symptoms:
 Burning sensation, numbness, tingling, and pain
extending from the shoulder down to the hand with some
loss of function of the arm and hand that lasts for several
minutes.
 Treatment:
 RICE; strengthening exercises; Athlete may return to full
activity once symptoms have completed resolve and there
are no associated neurological symptoms.