recognizing different sports injuries

fractures

(broken bones) occur as a result of extreme stresses and strains placed on bones. Before discussing fractures, a brief discussion of bone anatomy is necessary.

grade 3 muscle strain

A complete rupture of a muscle has occurred in the area of the muscle belly at the point at which muscle becomes tendon or at the tendinous attachment to the bone. There is significant impairment to or perhaps total loss of movement. Initially, pain is intense but quickly diminishes because of complete nerve fiber separation.

periosteum

A dense, white, fibrous membrane, the periosteum,covers long bones except at joint surfaces. Interlacing with the periosteum are fibers from the muscle tendons. Throughout the periosteum on its inner layer exist countless blood vessels and osteoblasts (bone-forming cells). The blood vessels provide nutrition to the bone, and the osteoblasts produce bone growth and repair.

dislocation treatment

A first-time dislocation should always be considered and treated as a possible fracture. Once it has been ascertained that the injury is a dislocation, a physician should be consulted for further evaluation. However, before the athlete is taken to the physician, the injury should be properly splinted and supported to prevent any further damage. Dislocations should not be reduced immediately, regardless of where they occur. Ideally the athlete should get an X-ray to rule out fractures or other problems before reduction, although a physician will often reduce a dislocation without getting an X-ray. Inappropriate techniques of reduction may only exacerbate the problem. Return to activity after dislocation or subluxation is largely dependent on the degree of soft tissue damage.

grade 2 muscle strain

A number of muscle fibers have been torn, and active contraction of the muscle is extremely painful. Usually a depression or divot can be felt somewhere in the muscle belly at the place at which the muscle fibers have been torn. Some swelling may occur because of capillary bleeding; therefore, some discoloration is possible.

ligament sprains

A sprain involves damage to a ligament or joint capsule that provides support to a joint. A ligament is a tough, relatively inelastic band of tissue that connects one bone to another.

myofascial trigger points

A trigger point is an area of tenderness in a tight band of muscle. In the athlete, painful or active trigger points most often develop because of some mechanical stress to the muscle. This stress could involve either an acute muscle strain or static postural positions that produce constant tension in the muscle. Trigger points occur most typically in the neck, upper back, and lower back. Palpation of the trigger point produces pain in a predictable distribution of referred pain. The pain may also cause some restricted range of motion. Pressure on the trigger point produces a twitch or a jump response from the pain. Pain is increased by passive or active stretching of the involved muscle. However, stretching may be used in the treatment of myofascial trigger points.

joint structure

All synovial joints are composed of two or more bones that articulate with one another to allow motion in one or more planes. The articulating surfaces of the bone are lined with a very thin, smooth, cartilaginous covering called an articular, or hyaline, cartilage. All joints are entirely surrounded by a thick, ligamentous joint capsule. The inner surface of this joint capsule is lined by a very thin synovial membrane that is highly vascularized and innervated. The synovial membrane produces synovial fluid, the functions of which include lubrication, shock absorption, and nutrition of the joint. The articular capsule, ligaments, outer aspects of the synovial membrane, and fat pads of the synovial joint are well supplied with nerves. The inner aspect of the synovial membrane, cartilage, and articular disks, if present, have nerves as well. These nerves, called mechanoreceptors, provide information about the relative position of the joint and are found in the fibrous capsule and ligaments. Some joints contain a thick fibrocartilage called a meniscus. Finally, the main structural support and joint stability is provided by the ligaments, which may be either thickened portions of a joint capsule or totally separate bands. The anatomical position of the ligaments partly determines what motions a joint is capable of making. If a joint is forced to move beyond normal limits or planes of movement, injury to the ligaments is likely to occur

osteoarthritis

Any mechanical system wears out with time. The joints in the body are mechanical systems, and wear and tear, even from normal activity, is inevitable. The most common result of this wear and tear, a degeneration of the articular or hyaline cartilage, is referred to as osteoarthritis. The cartilage may be worn away to the point of exposing, eroding, and polishing the underlying bone

degeneration

Any process that changes the mechanics of the joint eventually leads to degeneration of that joint. Degeneration is a result of repeated trauma to the joint and to tendons, ligaments, and fasciae surrounding the joint. Such injuries may be caused by a direct blow or fall, by pressure of carrying or lifting heavy loads, or by repeated trauma to the joint as in running or cycling.

tendinitis

Any term ending in the suffix -itis means inflammation is present. Tendinitis means inflammation of a tendon. During muscle activity a tendon must move or slide on other structures around it whenever the muscle contracts. If a particular movement is performed repeatedly, the tendon becomes irritated and inflamed. This inflammation is manifested by pain on movement, swelling, possibly some warmth, and usually crepitus. Crepitus is a crackling sound. It is usually caused by the tendon 's tendency to stick to surrounding structure while it slides back and forth. This sticking is caused primarily by the chemical products of inflammation that accumulate on the irritated tendon.

signs and symptoms of a fracture

Both types of fractures can be serious if not managed properly. Signs and symptoms of a fracture include obvious deformity, point tenderness, swelling, and pain on active and passive movement. There may also be crepitus (popping or a grating sound on movement). The only definitive technique for determining whether a fracture exists is to have it X-rayed.

muscle guarding

Following injury, the muscles that surround the injured area contract to, in effect, splint that area, thus minimizing pain by limiting movement. Quite often this "splinting" is incorrectly referred to as a muscle spasm. The terms spasm and spasticity are more correctly associated with increased tone or contractions of muscle that occur because of some upper motor neuron lesion in the brain. Thus, muscle guarding is a more appropriate term for the involuntary muscle contractions that occur in response to pain following musculoskeletal injury

healing process: phase 2

During the fibroblastic phase of healing, proliferative and regenerative activity leading to scar formation and repair of the injured tissue occurs. The period of scar formation, referred to as fibroplasia, begins within the first few hours following injury and may last for as long as 4 to 6 weeks. During this period, many of the signs and symptoms associated with the inflammatory response subside. The athlete may still indicate some tenderness to touch and usually complains of pain when particular movements stress the injured structure. As scar formation progresses, complaints of tenderness or pain gradually disappear.

the importance of inflammation in healing

For most people, the word inflammation has negative connotations. However, inflammation is an essential part of the healing process. Once a structure is damaged or irritated, inflammation must occur to initiate the healing process. Signs and symptoms of inflammation include pain, swelling, warmth, loss of function, and perhaps redness.8 Inflammation is supposed to be an acute process that ends when its role in the healing process has been accomplished. However, if the source of irritation (e.g., the repetitive movements that cause stress to the tendon) is not removed, then the inflammatory process becomes chronic rather than acute. When this situation occurs, an acute condition may become a chronic disabling problem.

if the bursitis gets worse

If excessive movement or perhaps some acute trauma occurs around the bursae, they become irritated and inflamed and begin producing large amounts of synovial fluid. The longer the irritation continues or the more severe the acute trauma, the more fluid is produced. As fluid continues to accumulate in the limited space available, pressure increases, causing pain in the area. Bursitis can be an extremely painful condition that may severely restrict movement, especially if it occurs around a joint. Synovial fluid continues to be produced until the movement or trauma producing the irritation is eliminated.

myositis ossificans

If the same area, or more specifically, a muscle, is bruised over and over again, small calcium deposits may begin to accumulate in the injured area. These pieces of calcium may be found between several fibers in the muscle belly, or calcium may build up to form a spur, which projects from the underlying bone. These calcium formations may significantly impair movement and are referred to as myositis ossificans.

nerve injuries

In athletics, nerve injuries usually involve either compression or tension. Nerve injuries, as with injuries to other tissues in the body, can be acute or chronic. Trauma directly affecting nerves can produce a variety of sensory responses, including hypoesthesia (diminished sense of feeling), hyperesthesia (increased sense of feelings such as pain or touch), or paresthesia (numbness, prickling, or tingling, which may occur from a direct blow or stretch to an area)

healing of a fracture

In most instances, the fracture of a bone requires immobilization for some period in a cast. In general, fractures of the long bones of the arm and leg require approximately 6 weeks of casting, and the smaller bones in the hands and feet may require as little as 3 weeks of either casting or splinting. In some instances, immobilization may not be required for healing. Of course, complications such as infections may lengthen the time required for both casting and rehabilitation. For a fracture to heal, osteoblasts must lay down extra bone formation, called a callus, over the fracture site during the immobilization period. Once the cast is removed, the bone must be subjected to normal stresses and strains so that tensile strength may be regained before the healing process is complete. Cells called osteoclasts function to reshape the bone in response to normally applied stresses and strains.

why is the healing process post-injury important?

It is essential to have some understanding of both the sequence and time frames for the various phases of healing, realizing that certain physiological events occur during each of the phases. Any interference with the healing process during a rehabilitation program will likely slow return to full activity. The healing process must have an opportunity to accomplish what it is supposed to. At best, you can only try to create an environment that is conducive to the healing process. Little can be done to speed up the process physiologically, but many things may be done during rehabilitation to impede healing.

tendinosis

Of all the overuse problems associated with sport activity, chronic overuse injuries involving a tendon are the most common. Tendinosis refers to a chronic tendon injury, due to overuse, in which there is no inflammation. The suffix -osis means there is chronic degeneration without inflammation. It is likely that inflammation occurred in the initial stages of injury, but the tendon does not heal properly, causing pain and disability. Most of the chronic problems that we have with tendons are correctly referred to as tendinosis

muscle soreness prevention

Muscle soreness may be prevented by beginning exercise at a moderate level and gradually progressing the intensity of the exercise over time. Treatment of muscle soreness usually also involves static or PNF stretching activity. It can also be treated with ice

muscle strain rehabilitation

Muscle strains can occur in any muscle and usually result from some uncoordinated activity between muscle groups. Grade 3 strains are most common in the biceps tendon of the upper arm or in the Achilles heel cord in the back of the calf. When either of these tendons tears, the muscle tends to bunch toward its attachment at the bone site. Grade 3 strains involving large tendons that produce great amounts of force must be surgically repaired. Smaller musculotendinous ruptures such as those that occur in the fingers may heal by immobilization with a splint. Regardless of the severity of the strain, the time required for rehabilitation is lengthy. In many instances, muscle strains are incapacitating, making rehabilitation time for a muscle strain even longer than for a ligament sprain. Incapacitating muscle strains occur most frequently in the large, force-producing hamstring and quadriceps muscles of the lower extremity. The treatment of hamstring strains requires a healing period of 6 to 8 weeks and a considerable amount of patience. Trying to return to activity too soon often causes reinjury to the area of the muscle that has been strained, and the healing process must begin again

avulsion fracture

Occasionally occurs in which an attached tendon or ligament pulls a small piece of bone away from the rest of the bone.

common irritation with bursitis

Occasionally, a bursa or synovial sheath completely surrounds a tendon, allowing more freedom of movement in a tight area. Irritation of this synovial sheath may restrict tendon motion. All joints have many bursae surrounding them. The three bursae that are most commonly irritated as a result of various types of physical activity are the subacromial bursa in the shoulder joint under the distal clavicle and acromion process; the olecranon bursa on the tip of the elbow; and the prepatellar bursa on the front surface of the patella. All three of these bursae produce large amounts of synovial fluid, affecting motion at their respective joints.

where can you develop osteoarthritis

Osteoarthritis most often affects the weight- bearing joints: the knees, hips, and lumbar spine. Also affected are the shoulders and cervical spine. Although many other joints may show pathological degenerative change, clinically the disease only occasionally produces symptoms in them. Any joint that is subjected to acute or chronic trauma may develop osteoarthritis.

muscle soreness

Overexertion in strenuous muscular exercise often results in muscular pain. All active people at one time or another have experienced muscle soreness, usually resulting from some physical activity to which they are unaccustomed. The older a person gets, the more easily muscle soreness seems to develop.

stress fractures

Perhaps the most common fracture that results from physical activity is a stress fracture. Unlike the other types of fractures subluxation (sub-lucks-ashun) A bone is forced out of alignment but goes back into place. that have been discussed, the stress fracture results from overuse rather than acute trauma. Common sites for stress fractures include the weight-bearing bones of the leg or foot. In either case, repetitive forces transmitted through the bones produce irritations of the periosteum and fatigue fractures of the underlying bone. The pain usually begins as a dull ache, which becomes progressively painful day after day. Initially, pain is most severe during activity. However, when a stress fracture develops, pain becomes worse after the activity is stopped. The biggest problem with a stress fracture is that often it does not show up on an X-ray until the osteoblasts begin laying down bone. At that point, a small white line appears on the X-ray. If a stress fracture is suspected, it is best to stop the activity for a period of at least 14 days and then slowly and gradually allow the athlete to get back into the activity that initially produced the stress fracture. Stress fractures do not usually require casting; however, if they are not handled correctly, they may become true fractures that must be immobilized.

rehabilitation of sprains

Rehabilitation of grade 3 sprains involving surgery is a long-term process. The greatest problem in the rehabilitation of grade 1 and grade 2 sprains is restoring stability to the joint. Once a ligament has been stretched or partially torn, inelastic scar tissue forms, prevent- ing the ligament from regaining its original tension. To restore stability to the joint, the other structures surrounding that joint, primarily muscles and their tendons, must be strengthened. The increased muscle tension provided by strength training can improve stability of the injured joint.

grade 1 muscle strain

Some muscle fibers have been stretched or actually torn. There is some tenderness and pain on active motion. Movement is painful, but full range of motion is usually possible.

nerve injuries: repair

Specialized tissue, such as nerve cells, cannot regenerate once the nerve cell dies. In an injured peripheral nerve, however, the nerve fiber can re- generate significantly if the injury does not affect the cell body. For regeneration to occur, an optimal environment for healing must exist. Regeneration is slow, at a rate of only 3 to 4 mm per day. Damaged nerves within the central nervous system regenerate very poorly compared to nerves in the peripheral nervous system.

grade 2 sprain

There is some tearing and separation of the ligament fibers, with moderate instability of the joint. Moderate to severe pain, swelling, and joint stiffness should be expected.

bone structure

The gross structure of the long bones includes the diaphysis, epiphysis, articular cartilage, and periosteum

3 phases of the healing process

The healing process consists of three phases: the inflammatory response phase, the fibroblastic repair phase, and the maturation-remodeling phase. Although the phases of healing are often discussed as three separate entities, the healing process is a continuum. Phases of the healing process overlap one another and have no definitive beginning or end

grade 1 sprain

There is some stretching and separation of the ligamentous fibers, with minimal instability of the joint. Mild to moderate pain, localized swelling, and joint stiffness should be expected.

healing process: phase 1

The inflammatory response phase begins immediately following injury. The inflammatory response phase is perhaps the most critical phase of the healing process. Without the physiological changes that take place during the inflammatory process, the later stages of healing cannot occur. The destruction of tissue produces direct injury to the cells of the various soft tissues. During this phase, phagocytic cells clean up the mess created by the injury. Injured cells release chemicals that facilitate the healing process. As indicated previously, this phase is characterized symptomatically by redness, swelling, tenderness, increased temperature, and loss of function. This initial inflammatory response lasts for approximately 2 to 4 days following initial injury.

how to prevent myositis ossificans

The key to preventing the occurrence of myositis ossificans from repeated contusions is to protect the injured area with padding. If the area is properly protected after the first contusion, myositis may never develop. Protection and rest may allow the calcium to be reabsorbed, eliminating any need for surgery. The two areas that seem to be the most vulnerable to repeated contusions during physical activity are the quadriceps muscle group on the front of the thigh and the biceps muscle on the front of the upper arm. The formation of myositis ossificans in these or any other areas may be detected by X-rays.

treating tendinosis

The key to the treatment of tendinosis is rest. If the repetitive motion causing irritation to the tendon is eliminated, the inflammatory process will allow the tendon to heal

healing process: phase 3

The maturation-remodeling phase of healing is a long-term process. This phase features a realignment or remodeling of the scar tissue according to the tensile forces to which that scar is subjected. With increased stress and strain, the collagen fibers that make up the scar realign in a position of maximum efficiency parallel to the lines of tension. The tissue gradually assumes normal appearance and function, although a scar is rarely as strong as the normal uninjured tissue. Usually after about 3 weeks, a firm, strong, contracted, non vascular scar exists. The maturation phase of healing may require several years to be totally complete.

muscle strain

The muscle is composed of separate fibers that are capable of simultaneous contraction when stimulated by the central nervous system. Each muscle is attached to bone at both ends by strong, relatively inelastic tendons that cross over joints. If a muscle is overstretched or forced to contract against high loads or heavy resistance, separation or tearing of the muscle fibers occurs. This damage is referred to as a strain. A muscle strain may be differentiated from a ligament sprain by having the athlete actively contract the injured muscle. If there is pain with active contraction but not with passive movement, this is indicative of a muscle strain.

osteoarthritis symptoms

The symptoms of osteoarthritis are relatively local. Osteoarthritis may be localized to one side of the joint or may be generalized about the joint. One of the most distinctive symptoms is pain, which is brought about by friction that occurs with use and which is relieved by rest. Stiffness is a common complaint that occurs with rest and is quickly loosened with activity. This symptom is prominent upon rising in the morning. Joints may also show localized tenderness, or grating that may be heard and felt.

grade 3 sprain

There is total tearing of the ligament, which leads to instability of the joint. A grade 3 sprain can result in a subluxation or even dislocations. Initially, severe pain may be present, followed by little or no pain as a result of total disruption of nerve fibers. Swelling may be great, and the joint tends to become very stiff some hours after the injury. In some cases, a grade 3 sprain with marked instability requires surgical repair. Frequently, the force producing the ligament injury is so great that other ligaments or structures surrounding the joint may also be injured.

type 1 muscle soreness

This type of muscle pain is acute-onset muscle soreness, which accompanies fatigue. It is transient and occurs during and immediately after exercise.

type 2 muscle soreness

This type of soreness involves delayed muscle pain that appears approximately 12 hours after injury. This delayed-onset muscle soreness (DOMS) becomes most intense after 24 to 48 hours and then gradually subsides so that the muscle becomes symptom-free after 3 or 4 days. DOMS is described as a syndrome of delayed muscle pain leading to increased muscle tension, swelling, and stiffness and to resistance to stretching. DOMS is thought to result from several possible causes. It may occur from very small tears in the muscle tissue, which seems to be more likely with eccentric or isometric contractions. It may also occur because of disruption of the connective tissue that holds muscle tendon fibers together.

treating tenosynovitis

Treatment for tenosynovitis is the same as for tendinitis. Because both conditions involve inflammation, anti-inflammatory drugs may be helpful in chronic cases.

treating tendinitis

Unfortunately, athletes find it difficult to totally stop activity and rest for 2 or more weeks while the tendinitis subsides. The athlete should substitute some form of activity, such as bicycling or swimming, to maintain present fitness levels while avoiding continued irritation of the inflamed tendon. In runners, tendinitis most commonly occurs in the Achilles tendon in the back of the lower leg; in swimmers, it often occurs in the muscle tendons of the shoulder joint. How- ever, tendinitis can flare up in any activity in which overuse and repetitive movements occur.

neuritis

a chronic nerve problem, can be caused by a variety of forces that usually have been repeated or continued for a long time. Symptoms of neuritis can range from minor nerve problems to paralysis. More serious injuries involve the crushing of a nerve or complete division (severing). This type of injury may produce a lifelong physical disability, such as paraplegia or quadriplegia, and should therefore not be overlooked in any circumstance.

acute injury

are caused by trauma

muscle cramps

are extremely painful involuntary muscle contractions that occur most commonly in the calf, abdomen, or hamstrings, although any muscle can be involved. The occurrence of heat cramps is related to excessive loss of water and, to some extent, several electrolytes or ions (sodium, chloride, potassium, magnesium, and calcium) that are essential elements in muscle contraction

greenstick fractures

are incomplete breaks in bones that have not completely ossified. They occur most frequently in the convex bone surface, keeping the concave surface intact. The name is derived from the similarity to such fractures to the break in a green twig taken from a tree

bursae

are pieces of synovial membrane that contain a small amount of fluid (synovial fluid).

chronic injuries

can result from overuse such as the injuries that occur with the repetitive dynamics of running, throwing, or jumping.

comminuted fractures

consist of three or more fragments at the fracture site. They can be caused by a hard blow or a fall in an awkward position. From the physician's point of view, these fractures impose a difficult healing situation because of the displacement of the bone fragments. Soft tissues are often interposed between the fragments, causing incomplete healing. Such cases may need surgical intervention

spiral fractures

have an s-shaped separation. They are fairly common in football and skiing, in which the foot is firmly planted and the body is suddenly rotated

contusions

is another word for a bruise. The mechanism that produces a bruise involves an impact from some external object that causes soft tissues (i.e., skin, fat, and muscle) to be compressed against hard bone underneath. If the blow is hard enough, capillaries are torn, which allows bleeding into the tissues. Minor bleeding often causes a bluish -purple discoloration of the skin that persists for several days. The contusion may be very sore to the touch, and if damage has occurred to muscle, pain may be experienced on active movement. In most cases, the pain ceases within a few days, and discoloration disappears usually in a few weeks.

subluxation

is like a dislocation except that in this situation a bone comes partially out of its normal articulation but then goes right back into place. Subluxations most commonly occur in the shoulder joint and in the knee cap (patella)

epiphysis

is located at the ends of long bones. It is the growth area of the bone in adolescents. An injury to the epiphysis may affect growth of the long bones in younger athletes. The ends of long bones are covered with a layer of articular cartilage that covers the joint surfaces of the epiphysis. This cartilage provides protection during movement and cushions jars and blows to the joint.

closed fracture

is one in which there is little or no movement or displacement of the broken bones.

tendinopathy

is the least often used term. The suffix -pathy does not imply any specific type of pathology. Thus, tendinopathy is a more general term that refers to either tendinitis or tendinosis.

diaphysis

is the main shaft of the bone. It is hollow, cylindrical, and covered by compact bone.

tenosynovitis

is very similar to tendinosis in that the muscle tendons are involved in inflammation. However, many tendons are subject to an increased amount of friction because of the tightness of the space through which they must move. In these areas of high friction, tendons are usually surrounded by synovial sheaths that reduce friction on movement. If the tendon sliding through a synovial sheath is subjected to overuse, inflammation is likely to occur. As with tendinitis, the inflammatory process produces by products that are "sticky " and tend to cause the sliding tendon to adhere to the synovial sheath surrounding it. Tenosynovitis occurs most commonly in the long flexor tendons of the fingers as they cross over the wrist joint and in the biceps tendon around the shoulder joint.

transverse fractures

occur in a straight line, more or less at right angles to the bone shaft. A direct outside blow usually causes this injury

bursitis

occurs around joints, where there is friction between tendon and bone, skin and bone, or muscle and other muscles. Without some mechanism of protection in these high-friction areas, chronic irritation would exist.

dislocations

occurs when at least one bone in a joint (articulation) is forced completely out of its normal and proper alignment and must be manually or surgically put back into place or reduced. Dislocations most commonly occur in the shoulder joint, elbow, and fingers, but they can occur wherever two bones articulate. In dislocations, deformity is almost always apparent; however, it may be obscured by heavy musculature, making it important for the examiner to routinely palpate, or feel, the injured site to determine the loss of normal contour. Comparison of the injured side with the uninjured side often reveals asymmetry.

oblique fractures

similar to spiral fractures. They occur when one end receives sudden torsion or twisting and the other end is fixed or stabilized

open fracture

there is enough displacement of the fractured ends that the bone actually breaks through surrounding tissues, including the skin. An open fracture increases the possibility of infection.

linear fracture

those in which the bone splits along its length. they are often the result of jumping from a height and landing in such a way as to apply force or stress to the long axis

importance of treatment for subluxations and dislocations

will likely result in a rupture of the stabilizing ligaments and tendons surrounding the joint. In other cases, the force may separate growth plates (epiphysis) or cause a complete fracture of a long bone. These possibilities indicate the importance of administering complete and thorough medical attention to first-time dislocations. It has often been said, "Once a dislocation, always a dislocation." In most cases this statement is true, because once a joint has been either subluxated or completely dis- located, the connective tissues that bind and hold it in its correct alignment are stretched to such an extent that the joint is extremely vulnerable to subsequent dislocations.