Sports Medicine for Sports Injuries

Prevention

Each year nearly 3,000,000 sports injuries occur. Sadly, many of these injuries are preventable with some common sense precautions. Simply put, if we are not properly prepared and conditioned for an activity we are more likely to be injured. It truly is the case for “an ounce of prevention”.

Each sport has its own unique demands upon our body’s structural integrity. For example, some sports like powerlifting, football and golf impose tremendous loads on the spine, creating a high incidence of low back injuries. Others such as Olympic weightlifting, swimming and gymnastics subject the shoulder to great torsional strain, explaining the associated high incidence of shoulder injuries. In many cases, the key to both injury prevention and treatment is understanding how each sport activity is optimally performed. In other words your doctors, trainers and physical therapists need to be familiar with the sports related mechanisms of injury.

Our spine mechanics warrant special attention, as it is serves not only as the primary loadbearing axis of our body, but also as the locomotive engine. Consequently, if the spine is not functioning properly not only is it vulnerable, but it renders both the arms and legs prone to injury occurrence. Keeping the spine strong and flexible in bending both front to back and side to side, as well as in rotation, is critical for optimizing sports performance and mitigating the risk of injury.

Warming up before workouts, events and competitions is another key strategy in minimizing injury occurrence. A proper warm-up routine enhances blood flow and aids flexibility; essential to preventing damage to our musculoskeletal system. Our blood is literally our life force, delivering oxygen and nutrients, while removing harmful waste and toxins. Consequently, activities which improve blood flow can both help prevent and treat injuries.

Lack of preventative measures render place many “weekend warriors” in harm’s way, as they suddenly go full bore in sports participation with little or any preparation. Sports doctors commonly see these kinds of injuries with an overambitious New Year’s resolution of increased activity or following an impulsive burst of sports activities brought on by “spring fever” (often after a long winter of “riding the couch”).

Our body has amazing built-in protective mechanisms – – listen to the them as they are the harbingers of injury. Those warning signs include thirst, fatigue, pain, impaired movement and overheating.

Treatment

Treatment needs to be predicated on the cause. Your healthcare team should understand the mechanism leading to your injury and do the necessary detective work to reveal the smoking gun, or anatomically specific diagnosis. Consider that a delay in diagnosis may often unnecessarily prolong recovery time and treatment. Goal oriented sports medicine is focused on establishing a diagnosis as soon as possible, to expedite the recovery process including: resolution of pain, optimizing function and preventing reinjury. This combination ensures the quickest and safest return to play.

Many mild common sports injuries can initially be addressed by applying the PRICE method. Specifically: 1) Protect the injured area from further damage (e. g. splint, tape, crutch), 2) Restrict activity which is offensive to the injury, 3) Ice, 4) Compression and 5) Elevation. The latter three are combined to decrease swelling and inflammation.

You should seek medical attention if: 1) there are any signs of bleeding or infection, including refractory drainage from a wound, discoloration beyond mild bruising and excess swelling or pressure sensation, 2) loss of strength or loss of sensation, 3) impaired weight bearing on the affected limb, 4) deformity of the injured body part and 5) failure to respond to the PRICE method within a few days.

The injured area requiring treatment is often related to a specific sports activity or maneuver.  Let’s take a look at some well-known athletic injuries and share some treatment advice, including the role their sports activities play.

Common sports related injuries include: muscle strains, tendon damage, ligament tears and cartilage degeneration. Occasionally nerve injuries (including paralysis) can occur.

Muscle strains can affect any muscle, but often involve the pelvis and thighs. Some examples include hip flexor strains, groin pulls, and hamstring strains. These most often result from the combination of sports related loading of the muscle to failure combined with a predisposed muscle imbalance. For example, a hip flexor strain occurs when the muscle on the front side of the hip is overloaded. This overuse injury is especially observed in sports involving jumping, kicking and sprinting; including figure skating, dance, martial arts, cycling, soccer and track and field. Tight hip flexors combined with weakness of the opposing muscles and improper rotation through the spine and pelvis are typical predisposing factors. Tearing of the muscular fibers usually presents as groin pain and soreness which is worsened with lifting the thigh or bending at the waist. Treatment begins with basic measures aimed at optimizing the healing environment for the torn muscle fibers. Measures including: ice, fluid mobilization and protective equipment (e.g. taping and gait aids) to minimize the load on the stressed fibers. Pending the response to initial treatment as well as the injury severity, more aggressive measures such as instrument assisted massage, image guided anti-inflammatory injections, regenerative medicine treatment (using the patient’s own immunological tissue such as growth factors in stem cells) and rarely surgery may be indicated. Stretching, muscle balancing and proper sports specific movement patterning should be addressed in all cases. MRI or ultrasound are useful in gauging injury severity, particularly when concomitant bone damage is suspected. Return to play decisions are based on severity, response to treatment and functional status; varying from days to weeks.

Tendons are the connective tissue bands attaching muscle to bone. Tennis elbow, golfers elbow and shin splints are well recognized sports related tendon injuries. Similar to addressing muscle strains, treatment depends on the injury severity, the athletes goals and potential treatment risks. All treatment algorithms must address the underlying muscle imbalance to guard against recidivism.

Ligaments attach bone to bone. The ACL (anterior cruciate ligament) is one of the major ligaments of the knee, stabilizing it front to back and in rotation. While some athletes can function with deficient ACL’s, understandably, many ACL injuries (particularly severe or full thickness tears) can be devastating. For example, the knee may become highly unstable if left untreated, leaving the athlete unable to cut, pivot or turn. Moreover further damage to the knee may occur, as the shifting bones trap and damage the meniscus and leading to early osteoarthritis. Again, depending on the severity and the functional goals of a given athlete conservative care with bracing, taping and proper rehab may be a consideration. Rehabilitation protocols beyond the acute phase must include: balance training, proper technique with changing directions and landing from jumps, muscle balancing (of the quadriceps, hamstrings, and hip muscles), core strength and sports specific training.

Prior to surgical intervention athletes should have a keen understanding of the risks. For example, less than 50% of athletes return to the same level play within 2 to 7 years after undergoing ACL surgical reconstruction. Most athletes do not regain their normal sense of balance even one year out from surgery. There is also a 3 to 6% risk of re-tearing a reconstructed ACL.

Nerve injuries may manifest as numbness, pins and needles, electric shock or burning sensation, discoloration or swelling, change in temperature or sensation and weakness. Burners or stingers occur when the when the head and neck are forcefully rotated or bent, stretching or compressing the nerves, which run from the neck to the fingers. This explains the resultant burning or stinging sensation running down the arm. To no surprise, burners or stingers occur most frequently in contact sports as football, hockey or wrestling. Offensive and defensive lineman are the most at risk group, owing to be tremendous forces imparted on the neck during blocking and tackling. This same group are also at risk for developing sciatica, back pain radiating down the back of the leg toward the foot. In young to middle age athletes sciatica most often results from a bulging disk in the back compressing the adjacent nerve (a nerve which supplies the sciatic nerve in the leg). Athletes whose sport requires prolonged positioning in a flexed forward posture, combined with trunk rotation seem to be most vulnerable. That’s why in addition to lineman, it also presents in cyclists, golfers, hockey and tennis players. Figure skaters represent an at risk group, because of the imbalanced, torsional loading of the spine upon landing their jumps repeatedly on the same leg. Appropriate treatment measures for nerve injuries range from conservative measures (as anti-inflammatory or nerve pain medications combined with physical therapy), minimally invasive image guided anti-inflammatory injections (to diminish nerve swelling or entrapment), as well as the occasional need for surgical intervention.

Summary While most sports injuries can be treated conservatively, the key to long-term success in most cases lies in understanding simple preventative measures. Weakness, evidence of instability, abnormal sensation, excess swelling or skin discoloration and deformity are all signs which warrant seeking medical attention. Rapidly establishing the cause and understanding injury mechanisms are vital elements in the sports medicine toolkit.

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