1. Chapter 13: Recognizing Different Sports Injuries

2. Either acute or chronic in nature Acute injuries Chronic
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

3. Acute Traumatic Injuries

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Dislocations and Subluxations
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

11. Additional concerns Treatment 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

12. Ligament Sprains Sprain Synovial joint characteristics
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

13. 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

14. Sprains Grading System
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

16. 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

17. 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

18. Prevention relies on protection and padding
Particularly when dealing with myositis ossificans
Protection and rest may allow for calcium re-absorption
Surgery would not be necessary to remove
Quadriceps and biceps are very susceptible to developing myositis ossificans

19. 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

20. Rehabilitation Tendon ruptures Lengthy process regardless of severity
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 re-injury

21. Muscle Guarding Muscle Cramps
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

22. 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 hours following activity that gradually subsides (pain free 3-4 days later)
Potentially caused by slight microtrauma to muscle or connective tissue structures

23. Prevent muscle soreness through gradual build-up of intensity
Treat with static or PNF stretching and ice application within hours of insult

24. Nerve Injuries Two main causes of injury May be acute or chronic
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

25. 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

26. 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

27. Tendinosis Tendinitis
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

28. Management Key for treatment is rest and removal of causal factors
Work to maintain cardiovascular fitness using means that don’t irritate inflamed tendon

29. 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
NSAID’s may also be of some assistance

30. 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

31. 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

32. 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

33. 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

34. 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

36. 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

37. 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

39. 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