SPORT INJURIES

Acute vs Overuse Injuries

Introduction

There are basically two types of injuries;

• acute injuries

• overuse injuries
Acute Injuries

• Acute injuries are usually the result of a single, traumatic event.

• Common examples include wrist fractures, ankle sprains, shoulder

dislocations, and hamstring muscle strain.
Overuse Injuries

• Due to repetitive submaximal loading of the musculoskeletal system

when rest is not adequate to allow for structural adaptation to take
place.

• It can involve the muscle-tendon unit, bone, bursa, neurovascular

structure and physis
Bone

Acute Overuse

Bony fracture Stress fracture

Bony crack Par Interarticularis

Apophyseal damage : point where two or more

bones join in the spine.

• Pressure apophyseal

• Traction apophyseal
• Creation of mineralization of the callus can take 4 – 16 weeks to
complete.

• Adequate strength usually develops by 6 months.

Treatment

• Calcium

Advice

• No alchohol

• No long term NSAIDs

Articular Cartilage

Acute Overuse
Splitting the cartilage layer
Osteoporosis
Cartilage depression into
Osteochrondritis Dissecans (is
subchondral bone
a joint disorder in which cracks form in the articular

cartilage and the underlying subchondral bone)

Fissuring Meniscus tear

Onset of swelling: 2 – 6 hours

Healing period: 6 – 8 weeks

Treatment:

• NSAIDs: ibuprofen, naproxyn, methylpredsolone

• Corticosteroid

• Surgery
Joints

Acute Overuse

Swelling Effusion

Disruption Capsular adhesion

Labrum rupture

Laxity
Healing process: varies

Treatment:

• NSAIDS, joint aspiration, arthroscopy.

• strapping,

• Strengthening exercises
Ligaments

Acute Overuse

Overstretch / strain Laxity

Rupture Joint instability

Healing duration:

• 7 – 10 day for minor damage

• 3 – 6 weeks for more severe to fully strong and complete on normal

activities
Operative

• Post Cruciate Ligament: 9 – 12 months

• Medial Collateral Ligament: 6 – 9 months (partial)

Treatment

• No support of review on benefit using brace for sprained ligament

(Pietrosimone et al., 2008).

• For grade I-II a non operative active treatment; RICE, isometric and
isotonic exercises and proprioceptive training.
• Early activities (healing time shorter and complete, ligament appear
stronger)(Woo et al, 1987; Frank et al, 1992).
Muscles

Acute Overuse

Mild / moderate Strain Moderate / severe strain

Rupture Rupture / torn

• Mild-to-moderate strains can be successfully treated at home with
ice, heat, and anti-inflammatory medications.

• Severe strains or tears may require medical treatment.

• Ultrasound, isometrics strengthening exercises, stretching exercises.

Tendon

Acute Overuse

Rupture (complete/partial) Tendinopathy – tendon injury

Tendinosis

Tendon impingement
• Tendon Healing: 10 weeks.

• Slow healing due to lower metabolic rate compare to muscles, oxygen

consumption only 13% of skeletal tissue.

• Why lower metabolic rate? Due to lack of blood supply

Treatment (Knobloch et al., 2007; Ohberg & Alfredson, 2002)

• Polidocanol (to reduce neovascularisation by approximately 25%)

• Short rest

• Eccentric resistance loading (Therabands) of the forearm for 12 weeks

(6 x 15 reps/day)
Bursa

Acute Overuse

Overuse bursitis
• Treatment: PRICEM (Protection, RICE, Medication)

• Ultrasound, pain management

Nerve

Acute Overuse

Spinal Cord Injuries Nerve Impingement (Carpal Tunnel

Syndrome / Cubital Tunnel Syndrome)

(Neuropraxia / Axontmesis / Neurotmesis) Thrombosis

Thoracic Outlet Syndrome

Assessment: Neurodynamic Testing

Treatment:

• Protection the tissue during inflammation

• NSIAIDs, ice, resting, elimination of the aggravating activity, physical

and manual therapy
Skin

Acute Overuse

Laceration Scars
• Healing duration:

• Treatment: antiseptics,

• Scar: scar mobilization