Sports Injuries and Rehab

Participation in sports or exercise is an important step in maintaining  your health. Exercise strengthens your heart, bones, and joints and  reduces stress, among many other benefits. Unfortunately, however,  injuries during participation in sports are all too common. Often, these  injuries occur in someone who is just taking up sports as a form of  activity, doesn’t use proper safety equipment, or becomes overzealous  about the exercise regimen.

Although bones can sometimes be fractured with acute sports injuries,  the most commonly injured structures are the muscles, tendons, and  ligaments. Tendons attach muscles to bones, and ligaments attach one  bone to another.

An acute twisting or over-extension of a joint can lead to tears of  muscles and tendons, called “strains,” and tears of ligaments result in  “sprains.” These tears range from mild to severe. In mild injuries, just  a few fibers are torn or stretched. Severe injuries, where there is a  tear through the full thickness of the structure, are most often  considered unstable injuries and frequently require surgical  intervention. The intervertebral disc, a ligament between the vertebrae  of the spine that works as a shock absorber, can also be torn, resulting  in a disc bulge and/or herniation.

Ankle sprains most often involve tears of one or more of the ligaments  along the outside of the ankle. Knee ligaments, including the larger  external supportive ligaments and the smaller internal stabilizing  ligaments, can also be torn. The cartilage on the back of the patella  (knee-cap) can also become eroded from overuse, leading to a condition  termed chondromalacia patella.

In those who are training too much, overuse of a particular joint or  joints in the body can result in pain and dysfunction. These injuries  are called “overuse syndromes.” A common overuse injury is tendinosis,  also called tendinitis. In this condition, the tendon becomes inflamed  from repetitive use. In the shoulder, the rotator cuff (a complex of  muscles that stabilizes and moves the shoulder) becomes inflamed,  resulting in rotator cuff tendinitis. Tennis elbow is another form of  tendinitis that occurs along the outside of the elbow, most commonly in  tennis players. In golfer’s elbow, the tendons on the inside of the  elbow are affected.

Some athletes may experience a stress fracture, also called a fatigue  fracture. This type of fracture occurs when an abnormal amount of stress  is placed on a normal bone. This might occur in a runner who rapidly  increases the amount of mileage while training for a race. Stress  fractures also occur in people who begin running as a form of exercise  but overdo it from the start, rather than gradually progress to longer  distances.

One final common injury is worth mentioning, and that is shin splints.  This overuse injury is caused by microfractures on the front surface of  the tibia (shin bone). This is most often seen in runners, although  other athletes can also be affected.

Sports injuries are most often diagnosed from the history of the  activity that brought on the pain, along with a physical examination. In  some cases, x-rays are necessary to rule out a fracture. Magnetic  resonance imaging (MRI) and diagnostic ultrasound are also used in  finding soft-tissue injuries, like tendinitis and sprains.

Fractures require the application of some stabilizing  device, such as a cast, after the bone is put back into position.  Rarely, surgical intervention is required. There is a relatively  standard treatment protocol for most of the other overuse types of  injuries. This protocol involves the following:  

• Rest - Generally no more than 48 hours of rest  and/or immobilization is needed, depending on the severity of the  injury. In most cases, the sooner the person becomes active after an  injury, the more rapid is the recovery. In fact, long-term  immobilization can sometimes be harmful to recovery. Your doctor of  chiropractic will guide this process, as too early a return to activity,  choosing the wrong type of activity, or excessive activity can be  detrimental.
• Ice or heat - Ice or heat can be helpful with pain reduction and tissue healing.
• Compression - Compression of the area may  reduce the amount of swelling from the injury. Your doctor of  chiropractic will determine if this will be beneficial in your case.
• Elevation - Elevation of the injured arm or leg above the level of the heart is thought to be helpful in reducing swelling.
• Pain relievers - Recent research has  demonstrated that some nonsteroidal anti-inflammatory drugs may actually  slow the healing process by restricting the body’s natural healing  mechanisms, so they should be used sparingly.
• Joint manipulation - Recent research has shown  us that, in some cases, joint manipulation can be helpful with pain  reduction and more rapid recovery. Your doctor of chiropractic will  determine if this procedure will be helpful in your case.

In many cases, sports injuries can be prevented. Proper conditioning and  warm-up and cool-down procedures, as well as appropriate safety  equipment, can substantially reduce injuries. Understanding proper  techniques can also go a long way toward preventing injuries. Sufficient  water intake is also an important preventive measure.

Fractures can be recognized by acute pain and tenderness, along  with swelling and possible bruising over the fracture site, often with  visible deformity of the affected bone. It is a myth that if someone can  move the joint near the pain, there is no fracture. Stress fractures  generally result in a slower onset of pain that is made worse with  activity. 

Strains most commonly cause pain at the site of the injured  tendon, particularly where it inserts into the muscle or bone. The  muscle itself may also be painful. There may be some weakness and even  muscle spasm. Pain is most severe with movement of the affected muscle  or tendon. The area is also tender to the touch. 

In sprains, pain and tenderness are felt over the affected  ligament. Swelling of the joint, along with bruising, is also common, as  is a reduced range of joint motion. If there is excessive motion and/or  a visible deformity in the joint, this most often signifies a more  serious, full-thickness ligament tear. 

Tendinitis causes pain, tenderness, and swelling over the tendon,  which is made worse by the motions that stress the tendon. There is  also generally restricted range of motion, particularly in the direction  of the tendon itself. 

Chondromalacia patella results in knee pain, particularly behind  the patella, along with a grinding or grating sensation. The pain is  most often felt when running on an incline.