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SPORTS INJURIES “Injuries may be forgiven, but not forgotten.” -Aesop

Most Common Sports Injuries Groin Sprains Shin Splints Neck Stains Lower Back Injury Pulled Muscles Fractured bones Rotator Cuff tendinopathy Tennis Elbow Ankle Sprain Runner’s Knee Achilles Tendiopathy Knee Ligament rupture

Most Common Causes of Injury Failure to Warm UP Over training Excessive loading on the body Not taking safety precautions An Accident Inappropriate equipment Poor Exercise Technique Reoccurring injury Genetic Factors Muscle weakness or imbalance Lack of flexibility Joint laxity

SIGNS of injuries SHARP Swelling Heat Altered function Red Painful

Treatment P.I.E.R principle Pressure Ice Elevation Restriction/Rest

Sprains Relate to ligaments Tendons are strained. Pulls are associated with muscles Overuse or successive force- stretches or tears- tissues that connects bone

3 Categories (or Grades) of Injuries: 1st degree – mild, least severe, a couple days to heal if treated properly *overstretched 2nd degree- moderate but more severe, physiotherapy may be needed * partial tear 3rd degree- most severe, surgery, physiotherapy, up to 12 months to recover *complete tear or rupture

Ankle Sprain Most Common: Plantar Flexion or Inversion Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament Tibiofibular ligament (severe injury) Inversion sprain

The Ankle Joint – Medial View  Eversion sprains  Occurs to the deltoid ligament

The Ankle Joint – Lateral View Tibia Fibula Posterior tibiofibular ligament Lateral malleolus Anterior tibiofibular ligament Anterior talofibular ligament Calcaneus Posterior talofibular ligament Calcaneofibular ligament

Ankle Sprain 1 st Degree – inversion stress with foot in mild plantar flexion, stretching the anterior talofibular ligament 2 nd Degree – tear anterior talofibular ligament, stretch and tear the calcaneofibular ligament 3 rd Degree – grade III injury, varying degrees of injury to anterior talofibular, calcaneofibular, and posterior talofibular ligaments and joint capsule

Symptoms and Signs 1 st Degree2 nd Degree3 rd Degree Mild pain Point tenderness Localized swelling (anterior talofibular ligament) Partial tearing sensation felt Swelling at point tenderness at sprain site Complete tear/rupture Snap/Pop sound Severe pain Tenderness and swelling over entire lateral area Tearing of three ligaments

Treatment 1 st Degree2 nd Degree3 rd Degree PIER Limit weight- bearing activities Wrap when weight bearing No swelling – circumduction activites Weight bearing – tape Exercises PIER X-ray Crutches 5-10 days Plantar and dorsiflexion exercises (if pain free) 1-2 weeks weight bearing Taping with walking Motion exercises Cold / heat application PIER X-ray Walking cast after swelling After circumduction exercises Progressive program of strengthening Joint Laxity: no end point

Anterior Cruciate Ligament (ACL) Considered to be the most serious ligament injury to the knee Causes: Direct blow to knee Single-plane force –lower leg is rotated while the foot is fixed Sharp cutting motion Hyperextension from a force in front of knee Non-contact

Females and ACL Injuries Extrinsic factors Level of conditioning, skill acquisition, playing style, amount of preparation and practice, environmental considerations, types of equipment used Intrinsic factors Femoral intercondylar notch size, ACl size, ACL laxity, lower extremity anatomic malalignment (ie. Q- angle) ** possible reasons why females are more likely to suffer noncontact ACL injuries

Q-angle - Quadriceps angle Formed in the frontal plane by a linedrawn from: the centre of the patella to the anterior superior iliac spine, and from the centre of the tibial tuberosity to the centre of the patella extending up the thigh If angle created by the intersection of these two lines above the patella is greater than twenty degrees, this puts the individual at greater risk of experiencing knee injury

Q-angle and ACL tears Width of the pelvis determines size of Q-angle women have a wider pelvis than men, the Q-angle tends to be greater The forces are concentrated on the ligament each time the knee twists increasing the risk for an ACL tear Proper stretching and strengthening is important

Symptoms and Signs Experience a pop Immediate disability Knee feels like it is “coming apart” Rapid swelling at joint line Positive anterior drawer sign pivot-shift test, jerk test, and flexion-rotation drawer test may be positive Decreased proprioception

Treatment PIER Weight bearing support Physiotherapy Surgery? Depends on athlete’s age, type of stress applied to knee, amount of stability present, techniques available to surgeon May involve joint reconstruction, with transplantation of some external structure

Achilles Tendon Rupture Sports with stop and go action Usually a result of sudden pushing-off action of the forefoot with the knee being forced into complete extension

Symptoms and Signs Feel a sudden snap (felt like something kicked him/her in lower leg) This will often be accompanied by a loud crack or bang. Immediate pain Point tenderness, swelling, discoloration There may be a gap felt in the tendon. Toe raising impossible Usually occurs 2-6cm proximal to its insertion onto the calcaneus Treatment - Surgical repair

Rotator Cuff Tear Involve one or four muscles Supraspinatus, infraspinatus, teres minor, and subscapularis Supraspinatus, infraspinatus, and teres minor share a common tendinous insertion on the greater tubercle of the humerus

Shoulder Dislocation Normal Dislocated

Dislocation Bone displaced from position Damage to joint (synovial) capsule and ligaments between bones, muscles and tendons could tear Signs: deformed joints, painful to move or touch, joint is unusable

Shoulder Dislocation Humerus “pops out” of the glenoid fossa Usually a result of a hit or fall resulting in a tear to the glenohumeral ligament and joint capsule Treatment should be done by a professional Injury to the brachial plexus (vital nerves) and blood vessels if not done properly

Shoulder Dislocation Inferior Dislocation Anterior Dislocation

Separation Bones held by ligaments tear or separate from each other Shoulder separation Tearing of acromioclavicular ligament union of clavicle to acromion) Result from falls directly on shoulder (contact from another player or tumble on shoulder)

Shoulder Separation Shoulder separations are classified as either 1st (mild), 2nd (moderate), or 3rd (severe) degree sprains. A 3rd degree AC joint sprain is the most severe with the result being what is termed a “stair step” deformity. This is when the end of the clavicle appears elevated because the ligament connecting the bones is completely torn.

Torn Cartilage  Cartilage is avascular  Takes time to heal  Often use arthroscopy: surgical procedure where incision made to allow a small fibre optic camera in to assess damage

Shin splints Overuse without adequate recovery Pain along medial or lateral side of tibia along shaft Caused by tearing of interosseous membrane (between tibia and fibula) or periosteum (lining of bone) Causes: change in training regimen (frequency, duration or intensity), training surface (hard), poor shoes Can develop into stress fractures

Biceps Tendinitis Overuse injury Adequate rest is not given to the biceps brachii muscle when it has been worked or overloaded Pain on the proximal end of biceps Flexion of shoulder and elbow painful

Tendinitis Inflammation of a tendon caused by irritation due to prolonged or abnormal use “itis” means an inflammation to that particular organ or tissue

Hematoma A collection of pooled blood in the thigh within a relatively constricted area. Example: thigh - probably accompany all serious contusions of the thigh they are difficult to diagnose because of the large muscle mass in the thigh may become calcified and form a hard lump in the quadriceps muscle. This lump is called osteomyositis ossificans and may cause stiffness or a bump in the muscle that may be very long lasting.

Signs & Symptoms Swelling at the injury site. Feeling of tenseness to touch Tenderness. Redness that progresses through several colour changes-- purple, green-yellow, yellow--before it completely heals.

Treatment PIER anti-inflammatory medicine prescribed by your healthcare provider. wearing an elastic thigh wrap when you return to sports having prescribed physical therapy (including deep tissue treatments - ultrasound or electrical stimulation). Complications: infection could develop in the wound, the signs and symptoms might be increasingly severe pain, a fever of 101 degrees or more, swelling with surrounding redness, and pus.

Groin Strain Caused by strenuous stretching movements of the legs Also sometimes with overuse of the adductor muscles Symptoms: mild discomfort, pain against resistance, swelling and bruising in inner thigh Usually take 4-6 weeks to heal but could be upwards of 8 weeks

Patellofemoral Pain Syndrome Causes: muscle weakness, muscle imbalance, tight tendons, abnormal movement of the kneecap Signs and Symptoms: pain at front of knee, pain on pressure on knee, walking up stairs, running, swelling around kneecap, grinding or grating Should see improvement over the few weeks of treatment, looking at 4-6 months of recovery time completely

Patellofemoral Pain Syndrome Treatment & Rehabilitation: Rest the joint or cut back on the intensity of activity (ex- reduce practice or training schedule) Strengthen the Quadriceps muscles (they support the knee) Wear a knee brace or sleeve during activity Wear an arch support or orthotic to prevent overpronation Replace old shoes, which have been worn down from pronation Anti-inflammatory drugs can be taken to reduce pain Rehabilitation can last anywhere from one to eight weeks depending on the severity of the injury. Typically, athletes can continue their regular activities if the level of pain allows them to participate.

Osgood Schlatter Disease Description: condition of the knee where the tibial tuberosity becomes inflamed. The patellar tendon inserts on the tibial tuberosity and through overuse can tug away at the bone, causing pain and inflammation. Symptoms: Pain around one or both knees, Pain when straightening the leg through the knee joint or full squat, Tibial tuberosity is swollen, Skin over tibial tuberosity is red, painful and inflamed, Pain when jumping or squatting

Osgood Schlatter Disease Causes: Growth spurt: this condition tends to affect teenage children directly after a growth spurt. In addition, children that are active and engage in sports are at an increased risk. Treatment and Rehabilitation: Strengthening the quadriceps and hamstring groups Avoiding physical activities that require frequent knee bending for two-four months Wearing a knee brace or knee sleeve to restrict movement Anti-inflammatory drugs may be taken to control pain and inflammation Increasing flexibility in the quadriceps and hamstring muscles

Sports Injury Facts More than 3.5 million children ages 14 and under receive medical treatment for sports injuries each year. Injuries associated with participation in sports and recreational activities account for 21 percent of all traumatic brain injuries among children in the United States. Overuse injury, which occurs over time from repeated motion, is responsible for nearly half of all sports injuries to middle-and high-school students. Immature bones, insufficient rest after an injury and poor training or conditioning contribute to overuse injuries among children. Most organized sports related injuries (62 percent) occur during practices rather than games. Despite this fact, a third of parents often do not take the same safety precautions during their child's practices as they would for a game. A recent survey found that among athletes ages 5 to 14, 15 percent of basketball players, 28 percent of football players, 22 percent of soccer players, 25 percent of baseball players and 12 percent of softball players have been injured while playing their respective sports. Children ages 5 to 14 account for nearly 40 percent of all sports-related injuries treated in hospital emergency departments. The rate and severity of sports-related injury increases with a child's age.