Sports Injuries
Playing With Pain
From WellnessOptions magazine
www.wellnessoptions.ca
Recreational exercise and sports have been accepted by the general public as important for our physical and psychological well-being. Many new types of physical activities have evolved in recent years, ranging from bungee jumping, in-line skating, snowboarding, paragliding, to windsurfing.
Excessive, exhausting and even punishing forms of physical training and exercise are being undertaken. All of these activities carry with them the risk of injury due to inappropriate preparation; poor training; external factors such as training surfaces and footwear. For example, statistics in the United States reveal that about 20 million weekend athletes and another 10 million school children experience sports injuries each year. For runners, the incidence of injuries has been reported to range from 25% to 75% depending upon various intrinsic and extrinsic factors.
Risk Factors for Sports Injuries
Intrinsic Risk Factors
- Age
- Body Size and Composition (weight, body fat)
- Physical Fitness
- Bone Density and Structure
- Gender (sex hormones, menarche age)
- Muscle Flexibility and Strength
Extrinsic Risk Factors
- Environmental Factors (terrain, surface, weather)
- Equipment (footwear, clothing)
- Type of Activity
- Intensity and Amount of Activity
- Warm-up and Stretching
Types of Injuries
“Exercise-induced injury is as diverse as life itself and can be caused by acute violent impact, chronic overuse, eccentric muscle work, or strenuous exhausting exercise.” The most common categories include:
Muscle strains or pulls These produce searing pain in a muscle during strenuous exertion. They are caused by an actual tear through part or all of a muscle or tendon (fibrous tissue connecting muscle to bone). The pain subsides to a dull ache and the injured area generally swells and discolours. Bad sprains can result in severe weakness and decreased mobility. It could take from 3 weeks to 3 months for the new muscle fibres to knit and return to their original size and strength.
Stretch-induced partial or complete tears or ruptures of the muscle-tendon unit are more serious and require immediate attention. Rest and chilling are the universal treatments for such injuries. One should stop the activity immediately. Muscle contusions will also damage muscle structure and function, with delayed onset muscle soreness resulting in pain, stiffness, and impaired function.
“Playing with pain” or “walking off” an injury generally produces further harm, even if the pain does not get worse immediately. This will prolong healing and produce scar tissue that may cause permanent weakness or disability.
Joint sprains
Sprains of the ankle or knee are a result of partial or complete ruptures of a ligament (fibrous connective tissue) holding a joint together. Sharp pain occurs when the joint is moved, accompanied by quick swelling. Ligaments heal slowly and recovery from serious sprains could require 6 to 10 weeks.
Even then, however, the joint may not be completely stable and pain-free for as long as several months.
Overuse injuries
These include swimmer’s shoulders, runner’s knee, tendonitis, shin splints, fasciitis, and bursitis consisting of inflammation of tendons and other tissues. They are characterized by chronic, gradually building pain rather than sudden trauma. They are due to simple wear and tear that irritates joints and tendons.
Osteoarthritis
People who have participated in regular, vigorous, high level, competitive sports as adolescents, young adults, or throughout life, appear to be at risk of developing arthritis.
Osteoarthritis is a gradual degeneration of the cartilage covering the bone ends in our joints. This produces pain, swelling, stiffness, and reduced joint mobility.
The continuous stresses involved in excessive physical activity and sports injuries increase the risk of developing osteoarthritis. In particular, runners and others who take part in high-impact and track and field sports face the greatest risk. They may eventually need hip replacement surgery. Swimming and cycling, on the other hand, do not stress the hip joint.
Immunosuppression
The functional state of the immune system can be altered by both strenuous and exhausting exercise. Muscles injured in this way can induce exercise myopathy, muscle soreness, muscle stiffness, weakness, pain and signs of inflammation. This can lead to cytoskeletal damage, resulting in substantial tissue injury and clinical signs of transient immunosuppression. This damage is accompanied by free-radical production, which intensifies the problem.
Inflammation accompanying injury is a sign that the immune system has been activated with an anti-inflammatory response. But an anti-inflammatory response is also immunosuppressive, which can be an undesirable complication. For example, the susceptibility to viral infections can be increased days and weeks following strenuous and exhaustive exercise, primarily in the form of upper respiratory tract infections.
Mediating factors
Age: There is little evidence to suggest that age has any bearing on the risk of sports injury. Although bone density decreases with age thus reducing the bone resistance to mechanical impacts, younger men universally are involved in more accidents than older men. This could be related to the amount and intensity of their activities.
Body Morphology: Although low bone density might be a factor in stress fractures due to weakened bone strength, there is little evidence of a greater risk of fractures in people with lower bone densities, except in women. No strong relationship between body size or composition and the risk of stress fractures has been demonstrated.
Gender: Females with menstrual disturbances appear to be at greater risk of sports injuries. Menstrual disturbances are more prevalent in female athletes than in the general female population. These include delayed menarche, anovulation, oligo and amenorrhoea. The incidence of such disturbances among female athletes varies from ballet (52%), gymnastics (100%), distance running (65%), swimmers (31%), and team sports (17%).
Stress fractures appear to be more frequent in female athletes with such disturbances, with a 2 to 4 times greater relative risk compared to males. Lower estrogen levels associated with such conditions may have a negative effect on bone strength and retention of calcium in the bones. There is some evidence that oral contraceptive pills, which provide an exogenous source of estrogen, reduce the risk of stress fractures in runners.
Training Levels: Bone stress injuries often occur after increasing the level of physical training activity. This occurs more frequently among individuals who are out of condition. Running is associated with more leg stress injuries than walking, as it produces a much greater (up to 6-fold) impact load on the skeletal bones. Jumping-type sports such as basketball, volleyball, and ballet dancing, produce impact loads 6-fold higher than walking, with an increased risk of tibia strains and fractures. Types of Sports Injuries
- Joint and Ligament Sprains
- Muscle or Tendon Strains
- Contusions and Bruising
- Dislocation of Knees and Shoulders
- Fractures of Bone
- Abrasions
- Lacerations (open wounds) Infection or Inflammation
- Concussions
- Back Injuries
Preventive measures for avoiding sports injuries
- Physical conditioning and preparation
- Appropriate activity and training level
- Warm-up/cool-down before and after exercise
- Proper protective equipment, such as proper shoes
- Alternate different sports activities
Treatment
- Harvard Health Publications promote a program for early treatment of sports injuries:
- Protect injured tissues from further injury
- Rest injured tissues and allow them time to heal
- Do not play with pain
- Ice the injury as soon as possible to reduce swelling and inflammation
- Compress the injured area with elastic bandage to reduce swelling and inflammation
- Elevate injured limb to prevent fluid accumulation and to reduce swelling and inflammation
- Also, seek the care and advice of sports medicine specialist
References:
Northoff, H. et al. /Exercise Immunology Review (1995)1:1-25
Saxon L, Finch C, Bass S. Sports Medicine 28: 123-135, 1999
Wolman RL and Harries MG. Clinical Sports Medicine 1989, vol 1, 95-100
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