Chapter 13: Recognizing
Different Sports Injuries
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• No matter how much time is spent on
injury prevention sooner or later an injury
occurs
• Either acute or chronic in nature
• Acute injuries
– Result of trauma
• Chronic
– Caused by repetitive, overuse activities
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Acute Traumatic Injuries
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Fractures
• Result of extreme
stress and strain on
bone
• Anatomical
Characteristics
– Dense connective
tissue matrix
– Outer compact tissue
– Inner porous
cancellous bone
including Haversian
canals
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– Gross Structures
• Diaphysis -shaft - hollow and cylindrical
- covered by compact bone
• Epiphysis - composed of cancellous bone and
has hyaline cartilage covering
• Periosteum - dense, white fibrous covering
which penetrates bone via
Sharpey’ fibers
- contains blood vessels and
osteoblasts
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• Acute bone
fractures –
– partial or complete
disruption that can be
either closed or open
(through skin)
– serious
musculoskeletal
condition
– Presents with
deformity, point
tenderness, swelling
and pain on active and
passive motion
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– Load Characteristics
• Bones can be stressed or loaded to fail by
tension, compression, bending, twisting and
shearing
• Either occur singularly or in combination
• Amount of load also impacts the nature of the
fracture
• More force results in a more complex fracture
• While force goes into fracturing the bone,
energy and force is also absorbed by adjacent
soft tissues
• Some bones will require more force than others
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• Healing of a Fracture
– Generally require immobilization for some
period
• Approx. 6 weeks for bones of arms and legs
• 3 weeks for bones of hands and feet
– Fracture healing requires osteoblast activity to
lay down bone and form callus
– Following cast removal, normal stresses and
strains will aid in healing and remodeling
process
• Osteoclasts will be called on to assist in re-shaping
of bone in response to normal stress
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• Stress fractures
• No specific cause but with a number of possible
causes
– Overload due to muscle contraction, altered stress
distribution due to muscle fatigue, changes in surface,
rhythmic repetitive stress vibrations
• Begins with a dull ache and progressively
becomes worse over time
– Initially pain during activity and then progresses to pain
following activity
• Early detection is difficult, bone scan is useful, xray is effective after several weeks
– Due to osteoblastic activity
• If suspected – stop activity for 14 days
• Generally does not require casting
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• Dislocations and Subluxations
– Dislocation
• At least one bone in a joint is forced completely out
of normal and proper alignment
• High level of incidence in fingers, elbow and
shoulder
– Subluxation
• Partial dislocations causing incomplete separation
of two bones
• Often occur in shoulder and females (patella)
– S&S of dislocations
• Deformity – almost always present
– Occasionally obscured by heavy musculature = requires
palpation to determine normal contours
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• Other factors associated with dislocations - 1) loss
of limb function, 2) swelling and point tenderness
– Additional concerns
• Avulsion fractures
• Growth plate separation
• “Once a dislocation, always a dislocation”
– Treatment
• Dislocations (particularly first time) should always
be considered and treated as a fracture until ruled
out
• X-ray is the only absolute diagnostic technique
• Return to play often determined by extent of soft
tissue damage
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Ligament Sprains
• Sprain
– Damage to a ligament (provides support to a
joint)
• Synovial joint characteristics
•
•
•
•
•
•
2 or more bones
Capsule or ligaments
Capsule is lined with synovial membrane
Hyaline cartilage
Joint cavity with synovial fluid
Blood and nerve supply with muscles crossing
joint
• Mechanoreceptors within joint structures provide
feedback relative to position
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• Some joint will have
meniscus (thick
fibrocartilage) for
shock absorption
and stability
• Ligaments
– Thickened portions
of the capsule or
totally separate
bands
– Dictates partially
the motions the
joint
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• Sprains
• Result of traumatic joint twist that causes stretching
or tearing of connective tissue
• Graded based on the severity of injury
– Grading System
• Grade I - some pain, minimal loss of function, no
abnormal motion, and mild point tenderness, slight
swelling and joint stiffness
• Grade II - pain, moderate loss of function, swelling,
and instability, some tearing of ligament fibers and
joint instability
• Grade III - extremely painful, inevitable loss of
function, severe instability and swelling, and may
also represent subluxation
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© 2007 McGraw-Hill Higher Education. All rights reserved.
– Restoration of joint stability is difficult with
grade I and II injuries
• Must rely on other structures around the joint
– Rely heavily on muscles surrounding joint
• Ligament has been stretched/partially torn causing
development of inelastic scar
– Ligament will not regain original tension
• Increased muscle tension due to strength training
will improve joint stability
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• Contusions
– Result of sudden blow to body
– Can be both deep and superficial
– Hematoma results from blood and lymph flow
into surrounding tissue
• Minor bleeding results in discoloration of skin
– May be painful to the touch and with active
movement
– Must be cautious and aware of more severe
injuries associated with repeated blows
• Calcium deposits may form with fibers of soft
tissue
• Myositis ossificans
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– Prevention relies on protection and padding
• Particularly when dealing with myositis ossificans
– Protection and rest may allow for calcium reabsorption
• Surgery would not be necessary to remove
– Quadriceps and biceps are very susceptible
to developing myositis ossificans
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Muscle Strains and Injuries
• Causes
– Stretch, tear or rip to muscle or adjacent
tissue
• Muscle Strain Grades
• Grade I - some fibers have been stretched or
actually torn resulting in tenderness and pain
on active ROM, movement painful but full range
present
• Grade II - number of fibers have been torn and
active contraction is painful, usually a
depression or divot is palpable, some swelling
and discoloration result
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• Grade III- Complete rupture of muscle or
musculotendinous junction, significant
impairment, with initially a great deal of pain
that diminishes due to nerve damage
– Tendon ruptures
• Large tendon ruptures will require surgery
• Rehabilitation
– Lengthy process regardless of severity
– Will generally require 6-8 weeks
– Return to activity too soon may result in reinjury
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© 2007 McGraw-Hill Higher Education. All rights reserved.
• Muscle Guarding
– Following injury, muscles within an effected
area contract to splint the area in an effort
to minimize pain through limitation of
motion
– Involuntary muscle contraction in response
to pain following injury
• Not spasm which would indicate increased tone
due to upper motor neuron lesion in the brain
• Muscle Cramps
– Painful involuntary contraction
– Attributed to dehydration/electrolyte
imbalance
– May lead to muscle or tendon injuries
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• Muscle Soreness
– Overexertion in strenuous exercise resulting
in muscular pain
– Generally occurs following participation in
activity that individual is unaccustomed
– Two types of soreness
• Acute-onset muscle soreness - accompanies
fatigue, and is transient muscle pain experienced
immediately after exercise
• Delayed-onset muscle soreness (DOMS) - pain
that occurs 24-48 hours following activity that
gradually subsides (pain free 3-4 days later)
– Potentially caused by slight microtrauma to muscle or
connective tissue structures
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– Prevent muscle soreness through gradual
build-up of intensity
– Treat with static or PNF stretching and ice
application within 48-72 hours of insult
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Nerve Injuries
• Two main causes of injury
– compression and tension
• May be acute or chronic
– Causes pain and can result in a host of
sensory responses (pinch, burn, tingle,
muscle weakness, radiating pain)
• Injuries can range from minor to severe
and life altering
• Healing process is very slow and long
term
– Optimal environment is critical
– CNS vs. PNS repair © 2007 McGraw-Hill Higher Education. All rights reserved.
Chronic Overuse Injuries
• Importance of Inflammation in Healing
– Essential part of healing process
• Must occur following tissue damage to initiate
healing
– Signs and Symptoms
• Pain, redness, swelling, loss of function and
warmth
– If source of irritation is not removed then
inflammatory process becomes chronic
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• Tendinitis
– Most common overuse problem in sports
– Gradual onset, with diffuse tenderness due to
repeated microtrauma and degenerative
changes
– Obvious signs of swelling and pain
• May also experience crepitus (due to chemical
products of inflammation)
– Key for treatment is rest and removal of causal
factors
• Work to maintain fitness but avoid activities that
aggravate condition
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• Tenosynovitis
– Inflammation of synovial sheath
– In acute case - rapid onset, crepitus, and
diffuse swelling
– Chronic cases result in thickening of tendon
with pain and crepitus
– Often develops in long flexor tendons of
fingers
– Treatment is similar to that of tendinitis
– NSAID’s may also be of some assistance
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• Bursitis
– Bursa
• Fluid filled sac that develops in area of friction
– Sudden irritation can cause acute bursitis,
while overuse and constant external
compression can cause chronic bursitis
• Results in increased fluid production, causing
increases in pressure due to limited space around
anatomical structures
– Signs and symptoms include swelling, pain,
and some loss of function
– Three most commonly irritated
• Subacromial, olecranon, and prepatellar bursa
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• Osteoarthritis
– Wearing away of hyaline cartilage as a
result of normal use
• Changes in joint mechanics lead joint
degeneration (the result of repeated trauma to
tissue involved)
• May be the result of direct blow, pressure of
carrying and lifting heavy loads, or repeated
trauma from an activity such as running or
cycling
– Commonly affects weight bearing joints but
can also impact shoulders and cervical
spine
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– Symptoms include pain (as the result of
friction), stiffness, prominent uprising in the
morning, localized tenderness, creaking,
grating, and often is localized to one side of
the joint or generalized joint pain
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• Myofascial Trigger Points
– Develop due to mechanical stress
• Either acute strain or static postural positions
producing constant tension in muscle
• Typically occur in neck, upper and lower
back
• Signs and Symptoms
– Pain with palpation, with predictable pattern
of referred pain which may also limit motion
– Pain may increase with active and passive
motion of involved muscle
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Importance of the Healing
Process Following Injury
• Essential to possess understanding of
both sequence and time frame for various
phases of healing process
• Interference with healing process will
delay return to full activity
• Work to create optimal healing
environment
– Little can be done to speed the process, while
much can be done to impede it
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• Inflammatory Response Phase
– Begins immediately following injury – critically
important
• Without the inflammatory phase the other phases
will not occur
– Phagocytosis occurs to clean the injured area
– Chemical mediators are released to facilitate
healing
– Symptomatically presents with the following
• Redness, swelling, warmth, tenderness and loss of
function
– Stage lasts 2-4 days following injury
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• Fibroblastic Repair Phase
– Proliferative and regenerative activity occurs
resulting in scar formation (fibroplasia)
• Occurs within initial hours of injury and continues
up to 4-6 weeks
– S&S of inflammatory phase subside
• Athlete will still experience some tenderness and
pain with motion
• With increasing development of the scar
complaints of pain and tenderness will decrease
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• Maturation-Remodeling Phase
– Long-term process
– Re-alignment of scar tissue according to
tensile forces acting on tissue
• Re-align to position of maximum efficiency (parallel
to lines of tension)
– Tissue gradually resumes normal appearance
and function
– After 3 weeks
• Firm, strong, contracted, nonvascular scar exists
– Maturation may take several years to be
totally complete
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.