1.0 Introduction
2.0 Examples of injury scenarios.
4.0 Conclusion
5.0 Bibliography
This report aims to look at how physiological factors influence injuries
in sport. Some examples of possible injuries will be given, including
identification, classification, treatment and other factors relevant to
each case. An appropriate fitness level for sports is an important
factor in preventing injury. This role of fitness will be discussed
in the context of a specific sport, in this case, rock and ice Climbing.
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In the case of any injury, be it sustained within sport or in an everyday accident, prompt diagnosis, identification and treatment are vital to a speedy recovery. The following scenarios will be looked at under four main points.
An immediate reaction by most to these symptoms would be to diagnose a Hamstring tear. This injury is caused when the hip and knee move out of phase, thus tearing the muscles in the back of the upper leg. Tears like this are especially common when the hamstrings are tight, with no reserve elasticity, such as over stretching, or overexertion with an inadequate warm-up.
However, there are some things that should be checked before assuming the injury is caused by a hamstring tear. A hamstring tear will feel tender to the touch, and may be bruised. There may also be bruising over the back of the knee. Movements such as bending, e.g. touching toes, will be painful. However, pains in this area are not always due to a hamstring tear, let us not jump to conclusions. If when leaning back, or when running your hands down either side of the leg, there is no pain, then the problem may lie in the lower back, like in Sciatica, caused by pressure on the sciatic nerve which runs down the back of the leg. It may also be a muscle spasm. This can sometimes happen in response to a knee injury, restricting movement of the damaged joint.
For the sake of argument, let us say that our diagnosis of a hamstring injury is correct. From the statement of events we can make the following assumptions; since the sprinter “pulled up”, and did not collapse, screaming in pain, it implies that this is not a total tear, severing both muscles. An injury with a total tear is not only extremely painful, but the muscle adopts an abnormal shape from the bunching of the fibres due to the fact that there is no resistance.
An injury to this area can take from 2 to 12 weeks to heal depending on a variety of factors. Since this is not a total rupture, healing time would be estimated to be between 4 and 6 weeks. Immediate treatment should comprise R.I.C.E. (Rest Ice Compression Elevation). This will limit bleeding, swelling and provide some support until a medic can examine the injury. In the longer term, physiotherapy can aid recovery. A PT would employ techniques such as deep friction or massage and effluages. Although uncomfortable, if not painful, this breaks up scar tissue within the muscle, returning it to near its pre injury state. Ultrasound is an example of how modern technology is advancing in medical terms. This also breaks up scar tissue by bombarding the damaged are with high frequency sound waves. In conjunction with these therapies, light exercise should be undertaken to aid the strengthening of the muscle. This should not commence until the tear has healed sufficiently, as there is no set time limit on how quickly a tear heals, this will only be able to be determined with frequent visits to the medic. The exercise should start off light, to regain basic operating strength and flexibility, allowing more comfortable walking and everyday tasks. The load should be gradually be increased in accordance with the physio’s recommendations, until full sprint capacity can be attained. The exercise period of rehab should last for approximately 2-4 weeks.
Unfortunately for some, these injuries do not always heal as comfortably
and as quickly as they should. This could be due to a number
of factors. Since this injury is caused by a muscle tear, the most
obvious, potential complication is a haematoma. This is a blood bruise,
caused by blood flowing from the torn fibres. Haematoma can be described
as being intermuscular, or intramuscular; intermuscular haematoma is when
the blood flows from a tear within the muscle belly, and does not escape
to the outside, causing painful swelling, and also slows down recovery
as the pressure keeps the torn fibres apart. Intramuscular haematoma
is caused, again by blood flowing from the tear, but in this instance,
the blood escapes to the surrounding tissues, and is not confined to the
damaged area. One of the problems caused by this is that the site
of the bruise is not necessarily the site of the injury, as gravity acts
on the blood, pulling it down the leg. If a serious haematoma is
not adequately treated, it can in some rare cases, lead to myositis ossificans,
“charley-horse”. This is a heterotopic bone formation, where the
scar tissue, if left, calcifies, and ossifies. This impairs movement,
and increases the chance of a recurrence of an injury in this area.
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In this case, we can again make assumptions as to the injury and severity from the description above. The fact that the footballer hobbled to the line implies that, as with the hamstring, the injury is not of the worst degree. As it is only the outside of the ankle that is painful, this narrows down the number of possibilities as to the exact nature of the injury. By landing awkwardly, the footballer has almost certainly “gone over” on his ankle, to the outside of his foot. This is indicative of an outer ankle sprain. A sprain is a “Tearing or stretching of the ligaments that hold together the bone ends in a joint, caused by a sudden pull” (Encyclopaedia of family health)
A sprain can be classified into three types. A Mild or 1st degree sprain, where there is no functional loss of performance. This is where there is a partial tear of the ligament, but without any weakening of the joint as a whole. Tears like this usually comprise less than 50% of the width of the ligament. A Moderate or 2nd degree sprain shows a definite loss of strength, where there is an actual tear in the ligament, but where the strength of the ligament has not been entirely lost, in this case, up to 75% of the width of the ligament could be torn. In this case despite some weakness, there is no abnormal motion, but a loss of stability will be noticed. Severe (3rd degree) sprains occur where there has been a complete tear or rupture of the ligament. this results is total loss of function.
Judging by the description of this injury, the footballer would appear to be suffering from a moderate tear of ligament. Symptoms such as this usually require medical attention, however, although there is not complete loss of function, treatment should still take into consideration, protection. This is the first point in treatment, to protect the ankle from further injury. R.I.C.E. should also be applied, to reduce swelling and minimise any bleeding that may occur. The subject should rest for between 10 to 24 hours, without putting any weight on the ankle. During this time, the ankle should be wrapped in compression bandage, and an ice pack applied. Pain killing drugs such as Hyaluronidase and procaine may be administered by local injection. As the drugs take effect, the patient will feel the symptoms lessen, but on no account should he attempt to walk!. At this point, even mild stresses, combined with the injury already sustained, could result in a complete, 3rd degree tear. After the 24hrs has passed, the ankle should be splinted and strapped in the normal position. This will allow the patient to become mobile, but only with the use of crutches. After the swelling goes down, some days after, the split and strapping could be replaced with a cast. Some might say that a cast in this sort of injury is unnecessary, but as the patient will be able to walk more efficiently and with less pain, the cast does have advantages. The cast should be worn for 1-2 weeks. After the cast is removed, strapping the ankle will protect the still weak ligaments from further injury. The strapping should be worn until all symptoms have subsided, this can be around 6 weeks. After the removal of the cast, some strength and mobility exercises could be administered to minimise loss of strength. Initially, exercises such as standing on one leg are sufficient, as these require some strength, and by inducing balancing, also improve stability. this should be practised every day. Standing on tip toes, is a simple, yet effective means for improving strength and stability, not only to the ankle, but to the calf muscles, which would, by this time, be under used. Many practitioners and PT’s prescribe a wobble board for injuries such as this. this wooden hemisphere mounted on a disc, promotes balance, and stability. Once some strength has been regained, some dynamic exercising should be carried out to further strengthen the damaged area. Some examples of these are, dorsiflexion with an (approximately) 1 Kg weight, lift and lower under control, and side stepping; by simulating a movement similar to that of the actual injury, the ligament can be strengthened around the area needing it most.
The most obvious complication in an injury of this sort is the athlete’s
own impatience at wanting to get out and play again. Due to the relatively
low blood flow in the ligaments, they are notoriously slow to heal.
Premature use of this ankle could result in complete avulsion.
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An ache of this sort is indicative of a chronic over use injury. In this case, it is likely to be what has become known as “tennis elbow”. This is probably the most common injury to the elbow joint. Despite its name, and the occurrence in this case, this injury can affect any sportsperson engaged in constant flexion/extension with a gripped hand, foe example in canoeing, tenpin bowling, and sometimes even in fishing. The classic tennis elbow is termed epicondylitis, although other conditions that can bring on similar symptoms are radial ulnar synovitis, strain in the aponeurosis, and radial humeral bursitis.
Epiconylitis is an overuse injury, and can be caused by bad technique. Symptoms include pain on the outside of the elbow, weakness in the wrist, making movements like opening doors, and lifting plates hard and painful. It can be prevented to some extent by a number of methods. By improving technique, and improving footwork, the ball can be placed and hit more precisely, hence less twisting effect on the wrist. The whole body should be used to hit the ball, again taking all the force away from the wrist. It is worth noting that although a tennis ball is relatively light, hitting it at a speed of say 30miles/hr (50km/hr) is roughly equivalent to lifting a 25 kg weight (Sports Injuries, their prevention and treatment; Dr lars Peterson, Dr Per Renstrom, 1986) A wet ball is a heavy, dead ball. By keeping the balls dry, it requires less force, and thus taking some strain away from the area. A tightly strung racket, although maybe faster, dissipates the shock and vibration less efficiently than a more loosely strung racquet, therefore, the forces are again transmitted straight to the joints. The problems arise in area of the lateral epicondyle, which is on the outside of the elbow. This is the site of origin of the muscles which actuate the fingers and wrist. In this case, the injury can be identified as chronic as the symptoms subside with continuation of the training. this is due to the fact that increased blood flow, and the release of endorphins reduce the feeling of pain.
The athlete should quite simply, rest. Following RICE is advisable, although compression isn’t a factor as there is usually very little swelling. taping the wrist may help, as it aids the muscles in supporting the hand under load. Ideally, complete rest should be prescribed with no use of the arm at all. This, however, is not always possible. Active rest may be pursued, that is to rest the arm, yet continue with other exercise such as running or cycling, to maintain overall fitness. As the symptoms subside, some training may follow, such as Isometric training, in three positions, wrist fully flexed, neutral position and fully straightened. The joint should be unloaded, and this exercises should be carried out as often as possible during the day, up to about 30 times per day. When these exercises cause no pain, they can be continued, but using light loads to increase the resistance, and strength build up. A doctor may prescribe pain killers, or antiinflammatories. Ultrasound can be used to advantage, and a true tennis elbow can often heal spontaneously, but with continued loading, the symptoms can persist for many years. A gap of 8-10 weeks should be allowed after treatment, before returning to the game.
One of the most common complications with tennis elbow, is that since
it often becomes chronic, people play through it. As the ache lessens
as the game goes on, the player can often think it was say stiffness, and
its “okay now”. This can lead to further damage, and in some cases,
permanent retirement from the game if not treated.
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It seems obvious that this cyclist has fractured one or both of the bones in his forearm. It is hard to determine the extent of the damage without X-ray, which will be required for diagnosis of treatment. RICE should be administered Without the Compression as this would cause considerable discomfort. Immediately after the incident, the arm should be splinted to immobilise it, and to protect it from further trauma. This fracture, assuming it is a simple break, would be repaired under closed reduction. Once reduced, the bone is immobilised in a cast to allow the fragments to fuse. In some cases, the bones require an external frame attached to pins within the bones to hold the parts in place.
The time for fractures to heal varies considerably, but 6-8 weeks is a conservative estimate to allow complete bone strength to be regained. Physiotherapy plays a large part in rehabilitating a fracture patient. Because of the complete immobility, there is often a loss of muscle bulk. After the cast is removed, some light strength building exercises should be prescribed to maintain and improve arm strength to its previous level. However, as this is a cyclist, there is nothing to stop him from continuing training, if not on the road, on an exercise bike or some similar training apparatus.
Most fractures heal relatively easily, however there can be complication
leading to delays in the healing process. Sometimes, because of damaged
vessels, blood supply to the bone may be reduced, slowing the healing process.
In the case of a commutated fracture, if the fragments are too small, or
impossible to obtain, the ends of the bones may be too far apart. This
would require a bone graft. In some cases the is what is called “Monteggia’s
fracture”. This is where the bone is not only broken, but is also
dislocated from the joint. Again, this adds obvious complications.
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There are four important components of fitness with regard to injury
in climbing.
· Endurance
· Strength
· Flexibility
· Speed
Endurance delays fatigue, in many sports fatigue leads to deterioration in technique, and hence injury. In climbing the result of overly fatigued arms is rather more catastrophic, resulting in possibly loss of grip. This type of fatigue is predominately muscular, more than cardiovascular. To maintain a full range of movement to carry out the gymnastic moves required by some modern sport climbs, flexibility is very important. Unfortunately in climbing the most gymnastic moves tend to be the crux moves, or the hardest point. That is not the time to find that flexibility is lacking. To get you up a climb of any grade, strength is of paramount importance, with some degree of speed is desirable. Having the strength to lift up oneself, and the speed to reach a position before fatigue sets in, are again of great importance in climbing.
In climbing there is also scope for overuse injuries. The main
problem here is in the hand and wrist. A Survey carried out in 1995,
by Johnston, Ensor, McIntosh and James showed that 19% of those surveyed
had evidence of a digital pulley injury, 50% had tendonitis in an upper
extremity, like in the shoulder, and 11% had evidence of carpa tunnel syndrome.
Meyers and Haas(1995) put these injuries down to a number of factors.
In climbing, the hands are used as tools, with much weight placed on the
fingers and distributed through the wrist, elbows and shoulders.
The repetitive movements of climbing, most of which ape some sort of pull
up, result in “Cumulative trauma” to the upper limbs. This is where
a bad training technique has an effect on fitness and injury. If
the climbers had had adequate rest between climbs, and decreased training
when pain was present, it would alleviate numerous physiological problems.
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It is apparent from research done, that physical, and psychological
fitness play a large part in both prevention and rehabilitation from injury.
However, there seems to be more of a case for promoting correct training
techniques and educating athletes to the dangers of overtraining, and overuse,
than for simply repairing the damage ignorance has done.
In the words of Euan Lowe “prevention is better than the cure”, even
though this prevention need not necessarily be physical.
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Treatment of injuries to athletes; Don H O’Donoghue, 3rd Edition, W B Saunders 1976
Sports injuries, their prevetnion and treatment; Dr Lars Peterson & Dr Per Renstrom, Dunitz, 1986
Clinical Sports Medicine: Rehabilitation of shoulder and elbow injuries
in tennis players; T S Ellenbecker,Jan 1995,14(1):87-110
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