Sports Injuries

Definition

Sports injuries result from acute trauma or repetitive stress associated with athletic activities. Sports injuries can affect bones or soft tissue (ligaments, muscles, tendons).

Professional dancers are increasingly recognized as performing athletes, and many of the treatments and preventive measures utilized in sports medicine are now applied to dance-related injuries.

It is also important to remember that many types of injuries that affect athletes may also occur in workers in certain occupations; for example, many people in the building trades develop tennis elbow or golfer's elbow. The principles of sports medicine can be applied in the treatment of most common musculoskeletal injuries.

Description

Adults are less likely to suffer sports injuries than children, whose vulnerability is heightened by immature reflexes, an inability to recognize and evaluate risks, and underdeveloped coordination.

In 2002, about 20.3 million Americans suffered a sports injury. Of those, 53% were minor enough to be self-treated or left untreated. However, about 10 million Americans annually receive medical attention for their sports-related injuries. That equates to almost 26 per 1,000 people. The highest rate is among children age five to 14 years old (59.3 per 1,000 people). As many as 20% of children who play sports get hurt, and about 25% of their injuries are classified as serious. Boys aged 12 to 17 are the highest risk group. More than 775,000 boys and girls under age 14 are treated in hospital emergency rooms for sports-related injuries.

Injury rates are highest for athletes who participate in contact sports, but the most serious injuries are associated with individual activities. Between one-half and two-thirds of childhood sports injuries occur during practice, or in the course of unorganized athletic activity.

Baseball and softball are the leading causes of sports-related facial trauma in the United States, with 68% of these injuries caused by contact with the ball rather than player-player collision or being hit by a swung bat.

Types of sports injuries

About 95% of sports injuries are minor soft tissue traumas.

The most common sports injury is a bruise (contusion). It is caused when blood collects at the site of an injury and discolors the skin.

Sprains account for one-third of all sports injuries. A sprain is a partial or complete tear of a ligament, a strong band of tissue that connects bones to one another and stabilizes joints.

A strain is a partial or complete tear of:

• muscle (tissue composed of cells that enable the body to move)
• tendon (strong connective tissue that links muscles to bones)

Inflammation of a tendon (tendinitis ) and inflammation of one of the fluid-filled sacs that allow tendons to move easily over bones (bursitis ) usually result from minor stresses that repeatedly aggravate the same part of the body. These conditions often occur at the same time.

SKELETAL INJURIES. Fractures account for 5-6% of all sports injuries. The bones of the arms and legs are most apt to be broken. Sports activities rarely involve fractures of the spine or skull. The bones of the legs and feet are most susceptible to stress fractures, which occur when muscle strains or contractions make bones bend. Stress fractures are especially common in ballet dancers, long-distance runners, and in people whose bones are thin.

Shin splints are characterized by soreness and slight swelling of the front, inside, and back of the lower leg, and by sharp pain that develops while exercising and gradually intensifies. Shin splints are caused by overuse or by stress fractures that result from the repeated foot pounding associated with activities such as aerobics, long-distance running, basketball, and volleyball.

A compartment syndrome is a potentially debilitating condition in which the muscles of the lower leg grow too large to be contained within membranes that enclose them. This condition is characterized by numbness and tingling. Untreated compartment syndrome can result in long-term loss of function.

BRAIN INJURIES. Brain injury is the primary cause of fatal sports-related injuries. Concussion, which is also called mild traumatic brain injury or MTBI, can result from even minor blows to the head. A concussion can cause loss of consciousness and may affect:

• balance
• comprehension
• coordination
• hearing

• memory
• vision

Causes and symptoms

Common causes of sports injuries include:

• athletic equipment that malfunctions or is used incorrectly
• falls
• forceful high-speed collisions between players
• wear and tear on areas of the body that are continually subjected to stress

Symptoms include:

• instability or obvious dislocation of a joint
• pain
• swelling
• weakness

Diagnosis

Symptoms that persist, intensify, or reduce the athlete's ability to play without pain should be evaluated by an orthopedic surgeon. Prompt diagnosis often can prevent minor injuries from becoming major problems, or causing long-term damage.

An orthopedic surgeon should examine anyone:

• who is prevented from playing by severe pain associated with acute injury
• whose ability to play has declined due to chronic or long-term consequences of an injury
• whose injury has caused visible deformities in an arm or leg.

The physician will perform a physical examination, ask how the injury occurred, and what symptoms the patient has experienced. X rays and other imaging studies of bones and soft tissues may be ordered.

Anyone who has suffered a blow to the head should be examined immediately, and at five-minute intervals until normal comprehension has returned. The initial examination measures the athlete's:

• awareness
• concentration
• short-term memory

Subsequent evaluations of concussion assess:

• dizziness
• headache
• nausea
• visual disturbances

Treatment

Treatment for minor soft tissue injuries generally consists of:

• compressing the injured area with an elastic bandage
• elevation
• ice
• rest.

Anti-inflammatories, taken by mouth or injected into the swelling, may be used to treat bursitis. Anti-inflammatory medications and exercises to correct muscle imbalances usually are used to treat tendinitis. If the athlete keeps stressing inflamed tendons, they may rupture, and casting or surgery is sometimes necessary to correct this condition.

Orthopedic surgery may be required to repair serious sprains and strains.

Controlling inflammation as well as restoring normal use and mobility are the goals of treatment for overuse injuries.

Athletes who have been injured are usually advised to limit their activities until their injuries are healed. The physician may suggest special exercises or behavior modifications for athletes who have had several injuries. Athletes who have been severely injured may be advised to stop playing altogether.

Prevention

Every child who plans to participate in organized athletic activity should have a pre-season sports physical. This special examination is performed by a pediatrician or family physician who:

• carefully evaluates the site of any previous injury
• may recommend special stretching and strengthening exercises to help growing athletes create and preserve proper muscle and joint interaction
• pays special attention to the cardiovascular and skeletal systems.

Telling the physician which sport the athlete plays will help that physician determine which parts of the body will be subjected to the most stress. The physician then will be able to suggest to the athlete steps to take to minimize the chance of getting hurt.

Other injury-reducing game plans include:

• being in shape
• knowing and obeying the rules that regulate the activity
• not playing when tired, ill, or in pain
• not using steroids, which can improve athletic performance but cause life-threatening problems
• taking good care of athletic equipment and using it properly
• wearing appropriate protective equipment

On a larger scale, sports injuries are becoming a public health concern in America. Prevention efforts include wearing protective devices (such as bicycle helmets and pads when skating or skateboarding), and educating both children and adults about safety. Other preventive efforts include changes in the rules of the game or sport to minimize injuries. For example, wearing goggles will be mandatory in women's lacrosse as of 2005 in order to reverse the rising rate of eye and other facial injuries in that sport. Research also continues on improving equipment. For example, thick rubber insoles can help prevent against repetitive injuries from running, but scientists recently observed that they can add to injuries in sports such as soccer, where athletes need to make quick changes of direction. On the other hand, recent improvements in the design and construction of football helmets have been credited with a significant decline in the frequency and severity of head injuries among football players.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Common Sports Injuries." Section 5, Chapter 62 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Bak, M. J., and T. D. Doerr. "Craniomaxillofacial Fractures during Recreational Baseball and Softball." Journal of Oral and Maxillofacial Surgery 62 (October 2004): 1209-1212.

Bernhardt, David T., MD. "Concussion." eMedicine July 6, 2004. 〈http://www.emedicine.com/sports/topic27htm〉.

Chaudry, Samena. "Insoles Help Prevent Sports Injuries." Student BMJ May 2003: 137.

Conne, J.M., J.L. Annest, and J. Gilchrist. "Sports and Recreation Related Injury Episodes in the U.S. Population." Injury Prevention June 2003: 117.

Koutedakis, Y., and A. Jamurtas. "The Dancer as a Performing Athlete: Physiological Considerations." Sports Medicine 34, no. 10 (2004): 651-661.

Levy, M. L., B. M. Ozgur, C. Berry, et al. "Analysis and Evolution of Head Injury in Football." Neurosurgery 55 (September 2004): 649-655.

Matz, S. O., and G. Nibbelink. "Injuries in Intercollegiate Women's Lacrosse." American Journal of Sports Medicine 32 (April-May 2004): 608-611.

Rupp, Timothy J., MD, Marian Bednar, MD, and Stephen Karageanes, DO. "Facial Fractures." eMedicine August 29, 2004. 〈http://www.emedicine.com/sports/topic33.htm〉.

ORGANIZATIONS

American Academy of Orthopedic Surgeons. 6300 North River Road, Rosemont, IL 60018-4262. (800) 346-2267. 〈http://www.aaos.org〉.

American Academy of Otolaryngology—Head and Neck Surgery. One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. 〈http://www.entnet.org〉.

American College of Sports Medicine (ACSM). 401 West Michigan Street, Indianapolis, IN 46202-3233. (317) 637-9200. Fax: (317) 634-7817. 〈http://www.acsm.org〉.

Institute for Preventative Sports Medicine. P.O. Box 7032, Ann Arbor, MI 48107 (313) 434-3390. 〈http://www.ipsm.org〉.

Sports injuries

Definition

Sports injuries result from acute trauma or repetitive stress associated with athletic activities. Sports injuriescan affect bones or soft tissue such as ligaments, muscles, and tendons.

Description

Children are more likely to suffer sports injuries than adults since a child's vulnerability is heightened by immature reflexes, an inability to recognize and evaluate risks, and underdeveloped coordination.

In 2002, about 20.3 million Americans suffered a sports injury. The highest rate is among children age 5 to 14 years (59.3 per 1000 people). As many as 20 percent of children who play sports get hurt, and about 25 percent of their injuries are classified as serious. Boys age 12 through 17 are the highest risk group. More than 775,000 boys and girls under age 14 are treated in hospital emergency rooms each year for sports-related injuries. Between one half and two thirds of childhood sports injuries occur during practice or in the course of unorganized athletic activity.

Types of sports injuries

About 95 percent of sports injuries are minor soft tissue traumas. The most common sports injury is a bruise (contusion). It is caused when blood collects at the site of an injury and discolors the skin.

Sprains account for one third of all sports injuries. A sprain is a partial or complete tear of a ligament, a strong band of tissue that connects bones to one another and stabilizes joints.

A strain is a partial or complete tear of a muscle (tissue composed of cells that enable the body to move) or a tendon (strong connective tissue that links muscles to bones).

Inflammation of a tendon (tendinitis) and inflammation of one of the fluid-filled sacs that allow tendons to move easily over bones (bursitis) usually result from minor stresses that repeatedly aggravate the same part of the body. These conditions often occur at the same time.

SKELETAL AND BRAIN INJURIES Fractures account for 5 to 6 percent of all sports injuries. The bones of the arms and legs are most apt to be broken. Sports activities rarely involve fractures of the spine or skull. The bones of the legs and feet are most susceptible to stress fractures, which occur when muscle strains or contractions make bones bend. Stress fractures are especially common in ballet dancers, long-distance runners, and in people whose bones are thin.

Shin splints are characterized by soreness and slight swelling of the front, inside, and back of the lower leg and by sharp pain that develops while exercising and gradually intensifies. Shin splints are caused by overuse or by stress fractures that result from the repeated foot pounding associated with activities such as aerobics, long-distance running, basketball, and volleyball.

A compartment syndrome is a potentially debilitating condition in which the muscles of the lower leg grow too large to be contained within membranes that enclose them. This condition is characterized by numbness and tingling . Untreated compartment syndrome can result in long-term loss of function.

Brain injury is the primary cause of fatal sports-related injuries. A concussion can result from even minor blows to the head. A concussion can cause loss of consciousness and may affect balance, comprehension, coordination, hearing, memory, and vision.

TREATMENT Treatment for minor soft tissue injuries generally consists of compressing the injured area with an elastic bandage, elevation, ice, and rest.

Anti-inflammatory medications, taken by mouth or injected into the swelling, may be used to treat bursitis. Anti-inflammatory medications and exercises to correct muscle imbalances are often used to treat tendinitis. If the athlete keeps stressing inflamed tendons, they may rupture, and casting or surgery is sometimes necessary to correct this condition. Orthopedic surgery may be required to repair serious sprains and strains .

Controlling inflammation as well as restoring normal use and mobility are the goals of treatment for overuse injuries. Athletes who have been injured are usually advised to limit their activities until their injuries are healed. The physician may suggest special exercises or behavior modifications for athletes who have had several injuries. Athletes who have been severely injured may be advised to stop playing completely.

Preschool

Appropriate athletic activities for children of this age are dance, beginning gymnastics (primarily tumbling), and swimming. The most common injuries are sprains and strains of soft tissue such as muscles and tendons.

School age

No matter what the form of specific training or sport activity, stretching and flexibility drills should be included in any pre-participation or warm-up program, even in the very young. Many studies have documented a very low incidence of injury in the total spectrum of youth sporting endeavors, according to the American Orthopaedic Society for Sports Medicine (AOSSM).

The occurrence of injury in the pre-puberty athlete has been documented as being much lower than in the post-puberty athlete, and lower in post-puberty than in the young adult. This is probably due to the fact that the younger athlete has a lower ratio of kinetic energy to body mass, which means the more immature the physical body, the lower the speed and power.

Since the magnitude of injury is almost always directly related to energy expended in a traumatic event, the younger athlete is less likely to get injured than his older counterpart. The athletic injuries that do occur are usually minor contusions and sprains. Fractures, dislocations, and major ligament injuries can happen but are more common in older age groups. Scientific studies have failed to document a significant increase in injuries to the growth areas of bones in young athletes. Only in extreme cases, such as young gymnasts in intense training for long periods of time, are some athletes at risk for growth plate injuries.

CONTACT VERSUS NON-CONTACT SPORTS The most notable examples of contact sports practiced in the United States are football, ice hockey, wrestling, and basketball. In each of these sports the athlete's body is used to physically control the opponent and, thus, to influence the play of the game. Using the body in this manner creates the opportunity for injury.

The majority of injuries in these contact sports are bruises and scrapes. The more significant injuries such as fractures, dislocations, or major ligament damage occur in the post-pubescent athlete. Parents should be responsive to complaints of pain and discomfort from athletes in all age groups and be aware that any athlete who is not playing up to skill level may be suffering from a significant injury.

In non-contact sports, major fractures, dislocations, or soft-tissue injuries are usually associated with accidental rather than intended collisions. Minor sprains, muscle pulls, blisters, and overuse syndrome are commonly seen injuries in non-contact sports, according to the AOSSM.

The overuse syndrome is usually related to sports requiring repetitive, high-stress motion such as tennis, swimming, track, golf, and baseball. Injury occurs as a result of constant repetition of a particular movement. Stress fractures, shin splints, and tendonitis are examples of overuse injuries.

The treatment in each case entails early recognition of the problem, followed by abstinence from competition or at least a decrease or change in training until the affected area is totally symptom free. Training intensity and duration can then increase again. Return to the previous level of training should be gradual and well planned. If the symptoms of overuse persist beyond a few days of rest or if they recur, a physician should evaluate the athlete.

Common problems

Common causes of sports injuries include athletic equipment that malfunctions or is used incorrectly, falls by athletes, forceful high-speed collisions between players, and wear and tear on areas of the body that are continually subjected to stress. Symptoms include instability or obvious dislocation of a joint, pain, swelling, and weakness.

Parental concerns

Every child who plans to participate in organized athletic activity should have an annual pre-season sports physical. This special examination is performed by a pediatrician or family physician who carefully evaluates the site of any previous injury, possibly recommends special stretching and strengthening exercises to help growing athletes create and preserve proper muscle and joint interaction, and pays special attention to the cardiovascular and skeletal systems.

Telling the physician which sport the athlete plays helps the physician determine which parts of the body are subjected to the most stress. The physician then is able to suggest to the athlete steps to take to minimize the chance of getting hurt.

Other injury-reducing game plans include:

• being in shape
• knowing and obeying the rules that regulate the activity
• not playing when tired, ill, or in pain
• not using steroids, which can improve athletic performance but cause life-threatening problems
• taking good care of athletic equipment and using it properly
• wearing appropriate protective equipment

When to call the doctor

A physician, pediatrician, sports medicine physician, or orthopedic surgeon should evaluate symptoms that persist, intensify, or reduce the athlete's ability to play without pain. Prompt diagnosis often can prevent minor injuries from becoming major problems or causing long-term damage.

A doctor should examine anyone who has the following symptoms:

• people who are prevented from playing by severe pain associated with acute injury
• people whose ability to play has declined due to chronic or long-term consequences of an injury
• people whose injury has caused visible deformities in an arm or leg.

The physician will perform a physical examination, ask how the injury occurred, and what symptoms the patient has experienced. X rays and other imaging studies of bones and soft tissues may be ordered. Anyone who has suffered a blow to the head should be examined immediately, and at five-minute intervals until normal comprehension has returned. The initial examination measures the athlete's awareness, concentration, and short-term memory. Subsequent evaluations of concussion assess dizziness , headache , nausea , and visual disturbances. In most cases, a physician should be consulted for athletes with head injuries.

Resources

BOOKS

Bahr, Roald, et al. Clinical Guide to Sports Injuries. Champaign, IL: Human Kinetics Publishers, 2003.

Griffith, H. Winter, and David A. Friscia. Complete Guide to Sports Injuries. Oakland, CA: Body Press, 2004.

Metzl, Jordan D., and Carol Shookhoff. The Young Athlete. New York: Little, Brown, 2003.

Shannon, Joyce Brennfleck. Sports Injuries Information for Teens. Detroit, MI: Omnigraphics, 2003.

PERIODICALS

Friedman, Manfred. "Sports Injury Prevention and Trauma." The Exceptional Parent 32, no. 7 (July 2002): 78–82.

Hyman, Mark. "Young Athletes, Big-League Pain: Year-Round Play and Dreams of Going Pro are Sidelining Kids with Serious Injuries." Business Week (July 7, 2004): 142.

Lord, Mary. "Dangerous Games: Sports Injuries Among Children." U.S. News & World Report (April 8, 2002): 44.

Noonan, David. "When Safety is the Name of the Game: Every Year Millions of Young Athletes End Up in the Hospital. What Parents and Kids Can Do to Prevent Sports Injuries." Newsweek (Sept. 22, 2003): 64.

"Preventing Sports Injuries (Guide for Patients)." Contemporary Pediatrics 20, no. 9 (September 2003): 121.

ORGANIZATIONS

American College of Sports Medicine. 401 W. Michigan St., Indianapolis, IN 46202. Web site: <www.acsm.org>.

National Youth Sports Safety Foundation Inc. One Beacon St., Suite 3333, Boston, MA 02108. Web site: <www.nyssf.org>.

WEB SITES

"A Guide to Safety for Young Athletes." American Academy of Orthopaedic Surgeons, February 2002. Available online at <www.orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=34&topcategory=Sports%20%2F%20Exercise> (accessed October 14, 2004).

"Sports Injuries." Medline Plus, 2004. Available online at <www.nlm.nig.gov/medlineplus/> (accessed October 14, 2004).

Ken R. Wells

KEY TERMS

Anti-inflammatory —A class of drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, used to relieve swelling, pain, and other symptoms of inflammation.

Bursitis —Inflammation of a bursa, a fluid-filled cavity or sac. In the body, bursae are located at places where friction might otherwise develop.

Cardiovascular —Relating to the heart and blood vessels.

Compartment syndrome —A condition in which the blood supply to a muscle is cut off because the muscle swells but is constricted by the connective tissue around it.

Concussion —An injury to the brain, often resulting from a blow to the head, that can cause temporary disorientation, memory loss, or unconsciousness.

Kinetic energy —The energy that the body has because of its motion.

Repetitive stress injury —An injury resulting from a repeated movement such as typing or throwing a ball.

Tendinitis —Inflammation of a tendon (a tough band of tissue that connects muscle to bone) that is often the result of overuse over a long period of time.

Sports injuries

Definition

A sports injury is any bodily damage sustained during participation in competitive or non-competitive athletic activity. Sports injuries can affect bones or soft tissue (i.e., muscles, ligaments, tendons).

Description

Sports injuries are identified as either acute or chronic. Acute sports injuries are characterized by the sudden appearance of symptoms, usually associated with a single traumatic incident. Signs and symptoms of acute sports injuries include pain , swelling, and deformity in the affected area, and in the case of joint injuries, limited ability to move the joint. Common acute sports injuries include sprains and strains , contusions (i.e., serious bruises), joint dislocations, bone fractures , and concussions.

Chronic sports injuries, also called overuse injuries, are identified with more gradual onset and are caused by repetitive light trauma to soft tissue or bone. Typically, pain and swelling worsen during athletic activity but decrease after the activity is stopped. Overuse injuries include tendonitis, bursitis , shin splints, and stress fractures.

The United States Consumer Product Safety Commission (CPSC) estimates that, in 1998, there were over one million sports injuries among persons 35–54 years old. Moreover, the number of sports injuries in this age group increased by one-third between 1991 and 1998. The CPSC believes that the rise in injuries is because of increased sports participation among baby boomers.

The CPSC National Electronic Injury Surveillance System also reports that over 3.5 million sports injuries in children younger than age 15 are treated at hospitals and clinics annually. Children are particularly vulnerable to sports injuries because their bones, muscles, and connective tissue have not fully matured, and because they have not yet developed mature neuromuscular coordination.

Causes and symptoms

Acute sports injuries are caused by excessive force applied to bone or soft tissue during sports activity. These injuries are commonly associated with falls and high-speed collisions. Specific signs and symptoms depend on the nature of the impact and the body region affected.

Acute sports injuries

SOFT TISSUE INJURIES. Soft tissue injuries occur typically in the knee, shoulder, and ankle. In the knee, tears of the anterior cruciate ligament (ACL) and of the meniscus (i.e., cartilage in the knee) are common. A twisted knee, a sudden directional change, or a misaligned landing from a jump can cause these knee injuries. With the ACL tear, a "pop" in the knee is frequently felt at the time of the injury. This popping sensation is accompanied by pain and weakness in the knee. A tear of the meniscal cartilage is identified by pain over the area of the meniscus area underneath the edge of the patella, or kneecap), and the pain intensifies if a finger is gently pushed on the edge of the kneecap. The athlete is also often unable to fully extend the knee. With both ACL and meniscus tears, there is swelling several hours after the injury occurs.

In the shoulder, strains of the rotator cuff tendons and dislocation of the shoulder are frequently seen. Tendon strains are associated with overly vigorous throwing movements, and are characterized by the patient complaining of pain if the arm is rotated against resistance. Shoulder dislocations are identified by deformity in the shoulder joint, and pain and lack of mobility in the joint area.

Ankle sprains are the most common injury in sports that require running and jumping. Ankle sprains occur when ligaments in the ankle have been stretched or torn. There is typically swelling and tenderness, and in more serious cases, the athlete is unable to put much weight on the foot of the injured ankle.

SKELETAL INJURIES. Fractures are breaks in the bone due to collisions or falls, and commonly appear in the leg and arm. Symptoms include pain, swelling, and bruising at the site of the fracture. There is also weakness in the limb and an inability to bear weight on the limb. With open fractures, bone fragments protrude through the skin.

BRAIN INJURIES. Brain injuries cause more deaths than any other type of sports injuries. A common brain injury is the concussion , an injury caused by the impact of the brain against the interior surface of the skull . Concussions often follow a blow to the head or a very rapid acceleration of the head. Loss of consciousness is an important symptom in brain injuries. Other signs and symptoms of concussion include headache, vomiting, delayed motor or verbal responses, partial loss of vision , memory loss, lack of coordination, or erratic and inappropriate behavior.

Chronic sports injuries

Chronic or overuse injuries are caused by repetitive stress to soft tissue or bone and typically result from a sudden increase in the duration or intensity of athletic activity. In some cases, chronic injuries can be a precipitating factor in acute injuries such as strains and sprains.

SOFT TISSUE INJURIES. Tendonitis, or inflammation of the tendon, is one of the most common overuse injuries and often affects the joints at the elbow, knee, shoulder, and foot. In the elbow joint, tendonitis is known

as golfer's elbow or tennis elbow, and is often caused by poor technique. Shoulder tendonitis is caused by repetitive overhead motions and is common in swimming and in sports requiring throwing motions. In the foot, inflammation of the Achilles tendon (i.e., in the heel area) is caused by biomechanical misalignments, inadequate stretching, sudden increases in training, and athletic play on hard or banked surfaces. Symptoms of tendonitis include pain, redness, swelling, and warmth of the affected area. These symptoms diminish when athletic activity is stopped. Bursitis, an inflammation of the connective tissue of joints, is also common in the knee.

SKELETAL INJURIES. Stress fractures are tiny breaks in the bone caused by repetitive forces. Stress fractures frequently affect the leg, foot, and ankle after training has been suddenly intensified or the sport has been played on hard surfaces. Other risk factors of stress fractures are osteoporosis and eating disorders, which tend to weaken bone. Symptoms of stress fractures include pain when weight is placed on the leg or foot, with pain increasing after athletic activity. There may be swelling and point tenderness (i.e., pain when a small region of the affected area is lightly pushed).

Diagnosis

Acute injuries are usually self-evident, as they are associated with a specific traumatic event. After the trauma, the physician performs a physical examination of the athlete to identify the specific injury. In the case of suspected joint or skeletal injuries, a radiological technician will take x-rays, and the radiologist will confirm or rule out a dislocation, bone fracture, or soft tissue injury.

With overuse injuries, the physician conducts a physical examination and uses signs, symptoms, and training history to diagnose the injury. If a stress fracture is suspected, a bone scan or magnetic resonance imaging (MRI) of the area may be performed.

Treatment

For sports injuries, Protection-Rest-Ice-Compression-Elevation (PRICE) is the standard of treatment. PRICE specifies the elements of first-line treatment. Depending on the type of injury, protection may mean immobilizing the affected area with a brace, tape, or wrap, or simply avoiding activities that aggravate the injury. Rest means refraining from activities that prevent recovery from injury; in many cases, cross-training is considered rest because it exercises areas that do not affect the injury. Ice should be used to relieve pain and swelling. Compression, with tape or elastic wraps, is used to limit swelling and stabilize the area. Elevation, where the injured body part is placed above the level of the heart , is also used to prevent swelling.

Some clinicians use the extended PRICE-MM (i.e., Medication and Modalities) regimen, which includes therapeutic use of medication and modalities (i.e., rehabilitation). Nonsteroidal anti-inflammatory medicines such as ibuprofen (e.g., Advil, Motrin) and naproxen (e.g., Naprosyn) have traditionally been used for pain management with sports injuries. Injections of corticosteroids are sometimes used to control inflammation and pain, but since these injections reduce the strength and flexibility of soft tissue, corticosteroids are used sparingly, primarily for specific overuse syndromes.

The goal of modalities, as in modes of rehabilitation therapies, is to return the athlete to the sport as quickly and as safely as possible. Rehabilitation can begin as soon as the physician permits, typically after internal bleeding has stopped. Modalities include cold and heat therapies, therapeutic ultrasound, range of motion exercises, and resistance exercises.

In serious cases of acute and overuse injuries, PRICE-MM may not be sufficient, and surgery may be required to repair injuries.

Prognosis

For most sports injuries, the PRICE-MM regimen should be sufficient to restore the athlete to the previous level of performance. The prognosis is good as long as the rehabilitation has successfully restored the strength and flexibility of the injured area, and the athlete takes care to prevent recurrence of the injury, suspending activity and undertaking appropriate therapy if pain recurs. With some serious injuries, the athlete will not be able to return to the sport or return to the previous level of activity in that sport.

Health care team roles

In school and youth sports, the nurse is often the first health care provider to evaluate acute injuries and is often responsible for some first aid of wounds and injuries until a physician can attend to the athlete. In school settings, since the nurse is in more frequent contact with children, he or she can advise on general measures to prevent injuries such as warm-up and stretching. In clinical settings, the nurse takes a detailed medical and training history that can help the physician diagnose the injury.

The athletic trainer is often on call for emergency care of acute sports injuries and performs first aid on the injured athlete. He or she specializes in sports activities and can give more specific advice for overall conditioning, training, and treatment of the athlete. The athletic trainer also serves as a liaison between the athlete and coaches, parents, and physicians.

Prior to student participation in athletic activity, the the preparticipation physical examination is performed by the physician to assess the patient's fitness for the sport. If the athlete is injured, a diagnosis of the injury is made by the physician and a prescription for appropriate treatment is given. Medical and radiological tests are conducted by technologists. The results assist in determination of the physician's diagnosis. For rehabilitation, the patient may be referred to a physical therapist. For serious injuries requiring surgery, the patient may be referred to an orthopedic surgeon.

Prevention

Many acute and overuse sports injuries are caused by increases in training intensity that put too much physical stress on the athlete's body. This often happens for in amateur athletes who do not sustain regular training regimens and overdo their workouts when they do train. These injuries can be prevented with a variety of training and educational regimens.

For youths and adults, the physical exam can be used to identify weaknesses that may predispose the athlete to injury, and that should be developed prior to engaging in athletic activity. Pre-season conditioning programs that slowly increase intensity level are useful in developing the athlete's level of fitness in preparation for the sports season. Flexibility training, strength training, and cross training have also been shown to prevent injuries by improving the body's resilience.

Finally, education can be effective in preventing certain common sports injuries. The athlete can be shown how to wear protective gear correctly, how to perform the correct throwing, swinging, blocking, or tackling motion to prevent injury, and how to adjust body biomechanics in the event of an unpreventable fall. Although not all sports injuries can be prevented, the damage from many injuries can be minimized with appropriate training.

Resources

BOOKS

Bull, Charles R, ed. Handbook of Sports Injuries. New York: McGraw-Hill, 1999.

Stiles, Bradford H. "Common Sports Injuries." In Conn's Current Therapy 2000, edited by Robert Rakel. Philadelphia: W.B. Saunders, 2000, pp. 974-8.

ORGANIZATIONS

American Academy of Orthopaedic Surgeons. 6300 N. River Road, Rosemont, IL 60018. (800) 346-AAOS. <http://www.aaos.org>.

American Orthopaedic Society for Sports Medicine. 6300 N. River Road, Rosemont, IL 60018. <http://www.intelli.com/vhosts/aossmisite/html/main.cgi?sub=2>.

OTHER

National Library of Medicine, Medline Plus Health Information on Sports Injuries. <http://www.nlm.nih.gov/medlineplus/sportsinjuries.html>.

Genevieve Pham-Kanter

Sports Injuries

Definition

A sports injury is any bodily damage sustained during participation in competitive or noncompetitive athletic activity. Sports injuries can affect bones or soft tissue (i.e., muscles, ligaments, tendons).

Description

Sports injuries are identified as either acute or chronic. Acute sports injuries are characterized by the sudden appearance of symptoms, usually associated with a single traumatic incident. Signs and symptoms of acute sports injuries include pain, swelling, and deformity in the affected area, and in the case of joint injuries, limited ability to move the joint. Common acute sports injuries include sprains and strains, contusions (i.e., serious bruises), joint dislocations, bone fractures, and concussions.

Chronic sports injuries, also called overuse injuries, are identified with more gradual onset and are caused by repetitive light trauma to soft tissue or bone. Typically, pain and swelling worsen during athletic activity but decrease after the activity is stopped. Overuse injuries include tendonitis, bursitis, shin splints, and stress fractures.

The United States Consumer Product Safety Commission (CPSC) estimates that, in 1998, there were over one million sports injuries among persons 35-54 years old. Moreover, the number of sports injuries in this age group increased by one-third between 1991 and 1998. The CPSC believes that the rise in injuries is because of increased sports participation among baby boomers.

The CPSC National Electronic Injury Surveillance System also reports that over 3.5 million sports injuries in children younger than age 15 are treated at hospitals and clinics annually. Children are particularly vulnerable to sports injuries because their bones, muscles, and connective tissue have not fully matured, and because they have not yet developed mature neuromuscular coordination.

Causes and symptoms

Acute sports injuries are caused by excessive force applied to bone or soft tissue during sports activity. These injuries are commonly associated with falls and high-speed collisions. Specific signs and symptoms depend on the nature of the impact and the body region affected.

Acute sports injuries

SOFT TISSUE INJURIES. Soft tissue injuries occur typically in the knee, shoulder, and ankle. In the knee, tears of the anterior cruciate ligament (ACL) and of the meniscus (i.e., cartilage in the knee) are common. A twisted knee, a sudden directional change, or a misaligned landing from a jump can cause these knee injuries. With the ACL tear, a "pop" in the knee is frequently felt at the time of the injury. This popping sensation is accompanied by pain and weakness in the knee. A tear of the meniscal cartilage is identified by pain over the area of the meniscus area underneath the edge of the patella (kneecap), and the pain intensifies if a finger is gently pushed on the edge of the kneecap. The athlete is also often unable to fully extend the knee. With both ACL and meniscus tears, there is swelling several hours after the injury occurs.

In the shoulder, strains of the rotator cuff tendons and dislocation of the shoulder are frequently seen. Tendon strains are associated with overly vigorous throwing movements, and are characterized by the patient complaining of pain if the arm is rotated against resistance. Shoulder dislocations are identified by deformity in the shoulder joint, and pain and lack of mobility in the joint area.

Ankle sprains are the most common injury in sports that require running and jumping. Ankle sprains occur when ligaments in the ankle have been stretched or torn. There is typically swelling and tenderness, and in more serious cases, the athlete is unable to put much weight on the foot of the injured ankle.

SKELETAL INJURIES. Fractures are breaks in the bone due to collisions or falls, and commonly appear in the leg and arm. Symptoms include pain, swelling, and bruising at the site of the fracture. There is also weakness in the limb and an inability to bear weight on the limb. With open fractures, bone fragments pro-trude through the skin.

BRAIN INJURIES. Brain injuries cause more deaths than any other type of sports injuries. A common brain injury is the concussion, an injury caused by the impact of the brain against the interior surface of the skull. Concussions often follow a blow to the head or a very rapid acceleration of the head. Loss of consciousness is an important symptom in brain injuries. Other signs and symptoms of concussion include headache, vomiting, delayed motor or verbal responses, partial loss of vision, memory loss, lack of coordination, or erratic and inappropriate behavior.

Chronic sports injuries

Chronic or overuse injuries are caused by repetitive stress to soft, tissue or bone and typically result from a sudden increase in the duration or intensity of athletic activity. In some cases, chronic injuries can be a precipitating factor in acute injuries such as strains and sprains.

SOFT TISSUE INJURIES. Tendonitis, or inflammation of the tendon, is one of the most common overuse injuries and often affects the joints at the elbow, knee, shoulder, and foot. In the elbow joint, tendonitis is known as golfer's elbow or tennis elbow, and is often caused by poor technique. Shoulder tendonitis is caused by repetitive overhead motions and is common in swimming and in sports requiring throwing motions. In the foot, inflammation of the Achilles tendon (i.e., in the heel area) is caused by biomechanical misalignments, inadequate stretching, sudden increases in training, and athletic play on hard or banked surfaces. Symptoms of tendonitis include pain, redness, swelling, and warmth of the affected area. These symptoms diminish when athletic activity is stopped. Bursitis, an inflammation of the connective tissue of joints, is also common in the knee.

SKELETAL INJURIES. Stress fractures are tiny breaks in the bone caused by repetitive forces. Stress fractures frequently affect the leg, foot, and ankle after training has been suddenly intensified or the sport has been played on hard surfaces. Other risk factors of stress fractures are osteoporosis and eating disorders, which tend to weaken bone. Symptoms of stress fractures include pain when weight is placed on the leg or foot, with pain increasing after athletic activity. There may be swelling and point tenderness (i.e., pain when a small region of the affected area is lightly pushed).

Diagnosis

Acute injuries are usually self-evident, as they are associated with a specific traumatic event. After the trauma, the physician performs a physical examination of the athlete to identify the specific injury. In the case of suspected joint or skeletal injuries, a radiological technician will take x rays, and the radiologist will confirm or rule out a dislocation, bone fracture, or soft tissue injury.

With overuse injuries, the physician conducts a physical examination and uses signs, symptoms, and training history to diagnose the injury. If a stress fracture is suspected, a bone scan or magnetic resonance imaging (MRI) of the area may be performed.

Treatment

For sports injuries, Protection-Rest-Ice-Compression-Elevation (PRICE) is the standard of treatment. PRICE specifies the elements of first-line treatment. Depending on the type of injury, protection may mean immobilizing the affected area with a brace, tape, or wrap, or simply avoiding activities that aggravate the injury. Rest means refraining from activities that prevent recovery from injury; in many cases, cross-training is considered rest because it exercises areas that do not affect the injury. Ice should be used to relieve pain and swelling. Compression, with tape or elastic wraps, is used to limit swelling and stabilize the area. Elevation, where the injured body part is placed above the level of the heart, is also used to prevent swelling.

Some clinicians use the extended PRICE-MM (i.e., Medication and Modalities) regimen, which includes therapeutic use of medication and modalities (i.e., rehabilitation). Nonsteroidal anti-inflammatory medicines such as ibuprofen (e.g., Advil, Motrin) and naproxen (e.g., Naprosyn) have traditionally been used for pain management with sports injuries. Injections of corticosteroids are sometimes used to control inflammation and pain, but since these injections reduce the strength and flexibility of soft tissue, corticosteroids are used sparingly, primarily for specific overuse syndromes.

The goal of modalities, as in modes of rehabilitation therapies, is to return the athlete to the sport as quickly and as safely as possible. Rehabilitation can begin as soon as the physician permits, typically after internal bleeding has stopped. Modalities include cold and heat therapies, therapeutic ultrasound, range of motion exercises, and resistance exercises.

In serious cases of acute and overuse injuries, PRICE-MM may not be sufficient, and surgery may be required to repair injuries.

Prognosis

For most sports injuries, the PRICE-MM regimen should be sufficient to restore the athlete to the previous level of performance. The prognosis is good as long as the rehabilitation has successfully restored the strength and flexibility of the injured area, and the athlete takes care to prevent recurrence of the injury, suspending activity and undertaking appropriate therapy if pain recurs. With some serious injuries, the athlete will not be able to return to the sport or return to the previous level of activity in that sport.

Health care team roles

In school and youth sports, the nurse is often the first health care provider to evaluate acute injuries and is often responsible for some first aid of wounds and injuries until a physician can attend to the athlete. In school settings, since the nurse is in more frequent contact with children, he or she can advise on general measures to prevent injuries such as warm-up and stretching. In clinical settings, the nurse takes a detailed medical and training history that can help the physician diagnose the injury.

The athletic trainer is often on call for emergency care of acute sports injuries and performs first aid on the injured athlete. He or she specializes in sports activities and can give more specific advice for overall conditioning, training, and treatment of the athlete. The athletic trainer also serves as a liaison between the athlete and coaches, parents, and physicians.

Prior to student participation in athletic activity, the preparticipation physical examination is performed by the physician to assess the patient's fitness for the sport. If the athlete is injured, a diagnosis of the injury is made by the physician and a prescription for appropriate treatment is given. Medical and radiological tests are conducted by technologists. The results assist in determination of the physician's diagnosis. For rehabilitation, the patient may be referred to a physical therapist. For serious injuries requiring surgery, the patient may be referred to an orthopedic surgeon.

Prevention

Many acute and overuse sports injuries are caused by increases in training intensity that put too much physical stress on the athlete's body. This often happens for amateur athletes who do not sustain regular training regimens and overdo their workouts when they do train. These injuries can be prevented with a variety of training and educational regimens.

For youths and adults, the physical exam can be used to identify weaknesses that may predispose the athlete to injury, and that should be developed prior to engaging in athletic activity. Pre-season conditioning programs that slowly increase intensity level are useful in developing the athlete's level of fitness in preparation for the sports season. Flexibility training, strength training, and cross training have also been shown to prevent injuries by improving the body's resilience.

Finally, education can be effective in preventing certain common sports injuries. The athlete can be shown how to wear protective gear correctly, how to perform the correct throwing, swinging, blocking, or tackling motion to prevent injury, and how to adjust body biomechanics in the event of an unpreventable fall. Although not all sports injuries can be prevented, the damage from many injuries can be minimized with appropriate training.

Resources

BOOKS

Bull, Charles R, ed. Handbook of Sports Injuries. New York: McGraw-Hill, 1999.

Stiles, Bradford H. "Common Sports Injuries." In Conn's Current Therapy 2000, edited by Robert Rakel. Philadelphia: W. B. Saunders, 2000, pp. 974-8.

ORGANIZATIONS

American Academy of Orthopaedic Surgeons. 6300 N. River Road, Rosemont, IL 60018. (800) 346-AAOS. 〈http://www.aaos.org〉.

American Orthopaedic Society for Sports Medicine. 6300 N. River Road, Rosemont, IL 60018. 〈http://www.intelli.com/vhosts/aossmisite/html/main.cgi?sub=2〉.

OTHER

National Library of Medicine. Medline Plus Health Information on Sports Injuries. 〈http://www.nlm.nih.gov/medlineplus/sportsinjuries.html〉.

Sports Injuries

The treatment and management of sports injuries has become a multi-faceted and highly visible aspect of sports science. Sports medicine is a distinct area of professional study within the broader field of medical science because sports injuries frequently engage concepts not relevant to the treatment of any other type of physical injury.

An injury is defined as any form of harm or hurt sustained by the human body, no matter how it may have been caused. An injury may be precipitated through one's own actions, such as a sprained ankle sustained while playing basketball, or through the impact of an environmental force, such as heat or cold. Injuries may be accidental, they may be caused by the deliberate actions of a third party, or the harm may be self-inflicted. The body makes no physiological distinction between sport and non-sport injuries; the body responds to any damage sustained to a tissue, bone, organ, or system no matter how the injury was caused.

When employed as an adjective to describe a type of injury, the term sports is defined as any game, competition, exercise or training program that requires physical activity. At one time, sports injuries were deemed to be only those that occurred in the course of competition. Injuries sustained while the athlete is practicing are equally sports injuries.

Sports injuries are best understood as a part of a cycle or a continuum of physical activity. Sports injuries do not occur in a vacuum, where the injury leads in a progressive fashion to treatment and then recovery. Sports injuries occur against a complex backdrop that includes the athlete's level of ability, the athlete's experience in the sport, general health and fitness history, and the athlete's desire to return to the sport after recovery. The background factors will often dictate the approach taken by an athlete and medical personnel to treatment and rehabilitation.

Injuries are a fact of a sporting life. In most sports, it is not a question of if an athlete will ever sustain an injury, but rather when an injury will occur and to what degree of severity. Athletic injuries may result from participation in the sport itself, as with a boxer sustaining a concussion as a result of absorbing an opponent's punch to the head, or a basketball player sustaining a tear of her anterior cruciate ligament (ACL) in a knee. Alternatively, participation in a sport may reveal the existence of a pre-existing or underlying physical condition.

Examples of a sports injury acting as an agent that exposes a pre-existing physical condition include the presence of an unequal leg length in a runner; unequal leg length contributes to the unequal foot strike forces that commonly result in a stress fracture of the tibia. Other latent physiological conditions that are revealed by exercise include weaknesses in the cardiovascular system, such as an irregular heart beat.

There are a number of sports where the typical participant in the activity brings a particular mental outlook to the sport that carries with it a greater likelihood of injury. An example is the training approach adopted by many endurance athletes, such as marathoners and triathletes, one that is often expressed as "no pain, no gain." At its most basic articulation, this approach advances the proposition that if the athlete is not suffering to some considerable degree in workouts, the athlete will never achieve competitive success. Numerous studies have confirmed that such athletes fall victim with far greater frequency than any other to overuse and over-training injuries, such as stress fractures and serious joint damage. It is a significant challenge to dissuade an athlete with this fundamental training mindset from this approach with the intent of reducing their personal risk of injury.

In a similar way, the external mental pressures that may be directed towards an athlete often contribute to an over zealous approach to training that results in a sports injury. The parental pressure upon a young athlete to excel, or the similar pressure directed from coaches towards athletes may create a mindset that makes the likelihood of injury greater.

The chief distinction in the treatment of sports injuries as opposed to the injuries sustained in the general population is the extent and the purpose of the rehabilitative treatment directed to each. The medical profession, whether in general practice or in a sports specialty, has an over riding obligation to treat any debilitating physical condition. The imperative behind sports injury treatment is a combination of speed, a desire to return the athlete to action as quickly as possible, and to work towards the prevention of a similar injury in future. In professional sport, there is usually an additional factor, the often significant financial incentive for both a team and an individual athlete to make a speedy recovery.

An example of the speed that typically attaches to both the diagnosis and the commencement of treatment of a sports injury is found in the nature of the diagnostic tools employed by the treating medical personnel—x rays, magnetic resonance imaging (MRI) technology, and computer tomography (CAT) scans. Most professional sports teams and many collegiate programs, such as the elite Division I schools participating in National Collegiate Athletic Association (NCAA) competition in the United States have immediate access to these tools.

Arthroscopic surgery is the single most important development in sports injury treatment since 1980. The arthroscope is a small surgical device equipped with a camera that permits the surgeon to examine the interior of an injured joint through a small incision. Arthroscopic procedures revolutionized the treatment of injuries to the knee, elbow, and shoulder, as the surgeon was not required to perform an invasive procedure to achieve a modest surgical objective.

Many technological advances in arthroscopic techniques since 1980 have been driven by the desire to fully rehabilitate an athlete to their former athletic productivity and income generating potential. The now standard operation to repair the elbow ulnar cruciate ligament (UCL), often damaged as a result of the stresses inherent in baseball pitching, was first developed by Dr. Frank Jobe, a California sports medicine orthopedic specialist, in 1973. Many arthroscopic procedures used in shoulder and knee repair were initiated by American sports medicine expert James Andrews, commencing in the mid-1980s.

The frequency of sports injuries is often described in terms of an injury rate, a term that carries different meanings in different contexts. As an example, the National Football League has often had attributed to it a 100% injury rate, meaning that every player in the league is in injured at one time or another during a season. However, the expression of an injury rate in such broad terms is misleading if the data does not make reference to other factors, such as the severity of the injuries sustained, the days lost or games missed by an injured players, and in what context the injury occurred (preseason training camp, practice, games, or in the player's personal off season conditioning program).

In 2003, a comprehensive study into the incidence of sports injuries was undertaken in the United States entitled the SuperStudy of Sports. The study was directed to the establishment of clear definitions of sport injury. In addition to considerations of classifying severity of injury, the study sought to demarcate the boundary between sport and non-sport activities. As an example, a 15-year-old boy who falls from his skateboard and fractures his wrist has sustained a sports injury; his mother who accidentally trips over the same skateboard and falls in her driveway, breaking her wrist, has not sustained a sport injury.

The SuperStudy set out four general classifications of sport injury, where each class of injury is tied to the amount of time the athlete was required to spend away from the sport due to injury.

A Level I injury will not interrupt the athlete's participation in the sport or activity, and there is no subsequent problem resulting from the injury. Examples of Level I injuries include a soccer player with a bruised shoulder that does not affect his or her mobility. A Level II injury is one that requires the athlete to miss at least one training session or competitive event, but no more that 1 month of activity (practices or competitions).

A Level III injury can sideline the athlete for a minimum of 1 month of activity. A Level IV injury has the same definition as a Level III occurrence, except that the athlete was require dot obtain medical treatment at a hospital emergency room, undergo surgery or other medical intervention.

The European Community authorized a sports injury study that employed a similar methodology in 2004.

The rehabilitation undertaken to recover from a sports injury will often engage a number of allied professionals. To correct or protect an injured joint or structure, orthotics and other protective devices may be constructed to assist the athlete in achieving optimal physical function. The physical work required of the athlete to return to their pre-injury fitness often requires the athlete to learn a variety of stretching and flexibility exercises to rebuild or to improve an existing range of motion in a joint. This rehabilitation is often supervised by either a physiotherapist, an athletic trainer, or both.

In some cases, the most profound consequences of a sports injury are psychological. In many sports, the difference between success and failure is razor thin; if the athlete has lost consequence or acquired doubts as to their abilities to perform as a result of the injury sustained, the mental training will become as important as physical rehabilitation. This phenomenon is often observed in athletes who race in high speed or other inherently dangerous circumstances. Alpine skiing, particularly the down hill event, is one where if the athlete makes a complete physical recovery from an injury, but cannot mentally sustain the willingness to ski to the very edge of physical control, the skier is unlikely to regain their top racing form.

The ability of an athlete to psychologically recover from an injury is sometimes as demanding a process as the physical rehabilitation. There is an extensive body of academic material on this aspect of sports injury recovery alone. When one distills the various psychological approaches to this problem, the result is that the athlete must be encouraged to participate as they did before the injury, as opposed to participating in such a fashion that their goal is to avoid the circumstance that lead to their injury.

see also Musculoskeletal injuries; Sport Performance; Sports Medical Conditions; Sports Medicine Education.