Chapter 13: Recognizing

Different Sports Injuries

McGraw-Hill/Irwin

2013 McGraw-Hill Companies. All Rights Reserved.

 No matter how much time is spent on

injury prevention sooner or later an injury
occurs
Either acute or chronic in nature
Acute injuries
Result of trauma

Chronic
Caused by repetitive, overuse activities

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Acute Traumatic Injuries

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Fractures
Result of extreme
stress and strain on
bone
Anatomical
Characteristics
Dense connective tissue
matrix
Outer compact tissue
Inner porous cancellous
bone including
Haversian canals
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 Gross Structures
Diaphysis -shaft - hollow and cylindrical
- covered by compact bone
Epiphysis - composed of cancellous bone and
has hyaline cartilage covering
Periosteum - dense, white fibrous covering
which penetrates bone via
Sharpey fibers
- contains blood vessels and
osteoblasts

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 Acute bone fractures

Partial or complete
disruption that can be
either closed or open
(through skin)
Serious musculoskeletal
condition
Presents with deformity,
point tenderness, swelling
and pain on active and
passive motion

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 Load Characteristics
Bones can be stressed or loaded to fail by
tension, compression, bending, twisting and
shearing
Either occur singularly or in combination
Amount of load also impacts the nature of the
fracture
More force results in a more complex fracture
While force goes into fracturing the bone,
energy and force is also absorbed by adjacent
soft tissues
Some bones will require more force than others

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 Healing of a Fracture
Generally require immobilization for some period
Approx. 6 weeks for bones of arms and legs
3 weeks for bones of hands and feet

Fracture healing requires osteoblast activity to

lay down bone and form callus
Following cast removal, normal stresses and
strains will aid in healing and remodeling process
Osteoclasts will be called on to assist in re-shaping of
bone in response to normal stress

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 Stress fractures
Number of possible causes

Overload due to muscle contraction

Altered stress distribution due to muscle fatigue
Changes in surface
Rhythmic repetitive stress vibrations

Progressively becomes worse over time

Initially pain during activity and then progresses to pain following activity

Early detection is difficult, bone scan is useful,

x-ray is effective after several weeks
If suspected stop activity for 14 days
Generally does not require casting

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 Dislocations and Subluxations

Dislocation
At least one bone in a joint is forced completely out of normal and
proper alignment
High level of incidence in fingers, elbow and shoulder

Subluxation
Partial dislocations causing incomplete separation of two bones
Often occur in shoulder and females (patella)

S&S of dislocations
Deformity almost always present
Loss of function
Swelling, point tenderness

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 Additional concerns
Avulsion fractures
Growth plate separation
Once a dislocation, always a dislocation

Treatment
Dislocations (particularly first time) should always be
considered and treated as a fracture until ruled out
X-ray is the only absolute diagnostic technique
Return to play often determined by extent of soft tissue
damage

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Ligament Sprains
Sprain
Damage to a ligament
Ligaments provide support to a joint

Synovial joint characteristics

2 or more bones
Capsule or ligaments
Capsule is lined with synovial membrane
Hyaline cartilage
Joint cavity with synovial fluid
Blood and nerve supply with muscles crossing joint
Mechanoreceptors within joint structures provide feedback relative to
position

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 Some joint will have

meniscus (thick
fibrocartilage) for shock
absorption and stability
Ligaments
Thickened portions of
the capsule or totally
separate bands
Dictates partially the
motions the joint

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 Sprains
Result of traumatic joint twist that causes stretching or tearing of
connective tissue
Graded based on the severity of injury

Grading System
Grade I - some pain, minimal loss of function, no abnormal motion,
and mild point tenderness, slight swelling and joint stiffness
Grade II - pain, moderate loss of function, swelling, and instability,
some tearing of ligament fibers and joint instability
Grade III - extremely painful, inevitable loss of function, severe
instability and swelling, and may also represent subluxation

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 Restoration of joint stability is difficult with

grade I and II injuries
Must rely on other structures around the joint
Rely heavily on muscles surrounding joint

Ligament has been stretched/partially torn causing

development of inelastic scar
Ligament will not regain original tension

Increased muscle tension due to strength training

will improve joint stability

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 Contusions
Result of sudden blow to body
Can be both deep and superficial
Hematoma results from blood and lymph flow into
surrounding tissue
Minor bleeding results in discoloration of skin

May be painful to the touch and with active movement

Must be cautious and aware of more severe injuries
associated with repeated blows
Calcium deposits may form with fibers of soft tissue
Myositis ossificans

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 Prevention relies on protection and padding

Particularly when dealing with myositis ossificans

Protection and rest may allow for calcium reabsorption

Surgery would not be necessary to remove

Quadriceps and biceps are very susceptible

to developing myositis ossificans

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Muscle Strains and Injuries

Causes
Stretch, tear or rip to muscle or adjacent tissue

Muscle Strain Grades

Grade I - some fibers have been stretched or actually
torn resulting in tenderness and pain on active ROM,
movement painful but full range present
Grade II - number of fibers have been torn and active
contraction is painful, usually a depression or divot is
palpable, some swelling and discoloration result

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 Grade III- Complete rupture of muscle or

musculotendinous junction, significant
impairment, with initially a great deal of
pain that diminishes due to nerve
damage

Tendon ruptures
Large tendon ruptures will require
surgery

Rehabilitation
Lengthy process regardless of
severity
Will generally require 6-8 wks. Return
to activity too soon may result in reinjury

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 Muscle Guarding
Muscles within an effected area contract to splint the area in an
effort to minimize pain through limitation of motion
Involuntary muscle contraction in response to pain following
injury
Not spasm which would indicate increased tone due to upper motor
neuron lesion in the brain

Muscle Cramps
Painful involuntary contraction
Attributed to dehydration/electrolyte imbalance
May lead to muscle or tendon injuries

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 Muscle Soreness
Overexertion in strenuous exercise resulting in muscular
pain
Generally occurs following participation in activity that
individual is unaccustomed
Two types of soreness
Acute-onset muscle soreness - accompanies fatigue, and is
transient muscle pain experienced immediately after exercise
Delayed-onset muscle soreness (DOMS) - pain that occurs 24-48
hours following activity that gradually subsides (pain free 3-4 days
later)
Potentially caused by slight microtrauma to muscle or connective tissue
structures

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 Prevent muscle soreness through gradual

build-up of intensity
Treat with static or PNF stretching and ice
application within 48-72 hours of insult

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Nerve Injuries
Two main causes of injury
Compression and tension
Resulting in radiating pain & muscle weakness
Stinger or burner

May be acute or chronic

Causes pain and can result in a host of sensory responses
Hypoesthesia
Hyperesthesia
Paresthesia

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 Injuries can range from minor to severe and life

altering
Neuritis
Chronic nerve problem caused by overuse or a variety of forces
Results in minor to severe problems

Crushing or severed nerve injury

Life long implications
Paraplegia/quadriplegia could result

Healing process is very slow and long term

Optimal environment is critical
CNS vs. PNS repair

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Chronic Overuse Injuries

Importance of Inflammation in Healing
Essential part of healing process
Must occur following tissue damage to initiate
healing

Signs and Symptoms

Pain, redness, swelling, loss of function and
warmth

If source of irritation is not removed then

inflammatory process becomes chronic
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 Tendinosis
Tendinosis refers to a chronic tendon injury without inflammation
Most common overuse problem in sports
Likely that pain occurred with initial stages of injury without
proper tendon healing

Tendinitis
Inflammation of the tendon
Crepitus
Crackling sound caused by sticking of tendon when sliding
Sticking occurs due to chemical products of inflammation

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 Management
Key for treatment
is rest and
removal of causal
factors
Work to maintain
cardiovascular
fitness using
means that dont
irritate inflamed
tendon

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 Tenosynovitis
Inflammation of synovial sheath
In acute case - rapid onset, crepitus, and
diffuse swelling
Chronic cases result in thickening of tendon
with pain and crepitus
Often develops in long flexor tendons of
fingers
Treatment is similar to that of tendinitis
NSAIDs may also be of some assistance

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 Bursitis
Bursa
Fluid filled sac that develops in area of friction

Sudden irritation can cause acute bursitis, while overuse

and constant external compression can cause chronic
bursitis
Results in increased fluid production, causing increases in
pressure due to limited space around anatomical structures

Signs and symptoms include swelling, pain, and some loss

of function
Three most commonly irritated
Subacromial, olecranon, and prepatellar bursa

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 Osteoarthritis
Wearing away of hyaline cartilage as a result of
normal use
Changes in joint mechanics lead joint degeneration
(the result of repeated trauma to tissue involved)
May be the result of direct blow, pressure of carrying
and lifting heavy loads, or repeated trauma from an
activity such as running or cycling

Commonly affects weight bearing joints but can

also impact shoulders and cervical spine

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 Symptoms include pain (as the result of

friction), stiffness, localized tenderness,
creaking, grating, and often is localized to one
side of the joint or generalized joint pain

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 Myofascial Trigger Points

Develop due to mechanical stress
Either acute strain or static postural positions producing constant
tension in muscle

Typically occur in neck, upper and lower back

Signs and Symptoms
Pain with palpation, with predictable pattern of referred pain which
may also limit motion
Pain may increase with active and passive motion of involved muscle

While stretching may increase pain, it can be incorporated into

the treatment process

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Importance of the Healing

Process Following Injury
Essential to possess understanding of both
sequence and time frame for various
phases of healing process
Interference with healing process will delay
return to full activity
Work to create optimal healing environment
Little can be done to speed the process, while
much can be done to impede it

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 Inflammatory Response Phase

Begins immediately following injury critically
important
Without the inflammatory phase the other phases will not
occur

Phagocytosis occurs to clean the injured area

Chemical mediators are released to facilitate healing
Symptomatically presents with the following
Redness, swelling, warmth, tenderness and loss of function

Stage lasts 2-4 days following injury

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 Fibroblastic Repair Phase

Proliferative and regenerative activity occurs
resulting in scar formation (fibroplasia)
Occurs within initial hours of injury and continues
up to 4-6 weeks

S&S of inflammatory phase subside

Athlete will still experience some tenderness and
pain with motion
With increasing development of the scar
complaints of pain and tenderness will decrease

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 Maturation-Remodeling Phase
Long-term process
Re-alignment of scar tissue according to tensile forces
acting on tissue
Re-align to position of maximum efficiency (parallel to lines of
tension)

Tissue gradually resumes normal appearance and

function
After 3 weeks
Firm, strong, contracted, nonvascular scar exists

Maturation may take several years to be totally complete

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