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Fundamentals Nutrition Weight Loss Fit Adults Fit Kids Sports Injuries
  Fitness > Sports Injuries >  << Previous|Next >>
  Basic Principles of Sports Medicine/Rehab

In general, after a sports-related injury, the goal of the postinjury therapeutic period is to address pain, inflammation, stiffness, muscle weakness, and muscle spasm. These elements of the injured state can exist individually, but more commonly they are interrelated. Injury causes tissue inflammation, which in turn leads to pain, which may cause muscle spasm and joint stiffness.

Breaking this inflammation-pain-spasm cycle is crucial to an individual's early return to activities. There are certain treatment techniques and therapeutic modalities that can make it a smoother transition. Selection of the appropriate technique or modality is determined by the type of injury, its severity, and the goals of the individual.

Injuries can be classified in two basic categories:

1) Traumatic injuries are sudden happenings, in which you know something has gone wrong, and you feel the immediate effects of the injury, perhaps pain, swelling, bruising, or an open wound. The traumatic injury can be extrinisc, or due to some external cause, like a direct blow, a sudden twist as you change direction, or a fall. It can also be intrinsic, without an obvious cause, like the sprinter's sudden hamstring strain in a race, or the squash player's Achilles tendon rupture.

2) Overuse injuries are more subtle, because they come on simply as a gradually increasing pain, directly associated with a particular, usually repetitive, activity. Tennis elbow and runner's shin soreness are examples of overuse injuries.

The way to avoid traumatic injuries is to minimize risk factors. The environment must be safe, so if the floor is wet or the pitch waterlogged, the game should be cancelled. Equipment should be checked: are the posts of the wrestling ring properly padded? Is there a crack in the shaft of your squash racket? Safety gear, like helmets, mouthguards, padded vests, groin boxes, and shin pads, must be worn when appropriate.

Avoiding overuse injuries involves allowing your body to adapt to repetitive stress. If you make any sudden change in your training routine, some part of your body may show the signs of overwork. Increasing training has to be a gradual process, building up in easy stages, allowing recovery days from hard training, and rest days if fatigue or pain set in. For any exercise session, you should always warm-up and warm-down thoroughly, and shower as soon as you finish, to avoid stiffness. Your warm-up should consist of four parts, and should last for about fifteen minutes. You should do passive stretching for your muscles; ballistic bouncing movements for your joints; 'pulse-warmers', consisting of six to ten sets of half-minute intervals of hard exercise, like sprints or squat-thrusts; and finally, skill rehearsal, in which you practise specific movements relating to your sport. Any equipment you use must be the right size and weight for you. Your sports shoes must fit you properly.

Your diet plays an important part in your fitness and wellbeing. Carbohydrates are especially important for sportsmen. You should not exercise on an empty stomach, but you must wait up to four hours before exercising after a heavy meal.

Your fluid intake is essential in avoiding cramp, dehydrations and heat exhaustion.

Common sense, and the self-discipline of knowing when to stop, or when not to start, a session of physical activity are two essential factors in avoiding any kind of injury. Illness, fatigue, pain and suffering are warnings that you should not be taking exercise. If you disregard them, you are taking unacceptable risks with your health and wellbeing.

Acute Injuries
Common acute injuries among young athletes include contusions (bruises), sprains (a partial or complete tear of a ligament), strains (a partial or complete tear of a muscle or tendon) and fractures. But not all injuries are caused by a single, sudden twist, fall, or collision. A series of small injuries to immature bodies can cause minor fractures, minimal muscle tears, or progressive bone deformities, known as overuse injuries.

As an example, "Little League Elbow" is the term used to describe a group of common overuse injuries in young throwers involved in many sports, not just baseball. Other common overuse injuries occur in the heels and knees with tears in the tissue where tendons attach to the leg bone or the heel bone.

Contact sports have inherent dangers that put young athletes at special risk for severe injuries. Even with rigorous training and proper safety equipment, youngsters are at risk for severe injuries to the neck, spinal cord, and growth plates. However, following the rules of the game and using proper equipment can decrease these risks.


Immediate treatment for almost all acute athletic injuries is Rest, Ice, Compression, and Elevation (RICE). Rest is instituted immediatley to minimize hemorrhage, injury and swelling. Ice causes dermal vasoconstriction and helps limit inflammation and reduce pain. Compression and elevation help limit edema.

The injured part should be elevated. A bag that is chemically cooled or filled with chipped or crushed ice (which will conform bette than ice cubes to body contours) should be placed on a towel over the injured part. An elastic bandage should be wrapped over the ice bag and around the injured part, loosely enough to permit blood flow. After 10 min, the wrapping and the ice bag should be removed, but the injured part should be kept elevated. After a further 10 min, the ice bag and the wrapping should be replaced. Ten minutes with and without ice should be alternated for 60 to 90 mi. This procedure can be repeated several times during the first 24h.

Pathology of ice application
Cold limits swelling by vasoconstruction and reduction in capillary permeability. It helps to limit pain by reducing impulse transmission from pain receptors. It limits muscle spasm by reducing impulse tranmission from tendon receptors to muscles. It limits tissue destruction by decreasing cellular metabolism.

Prolonged application of ice, however, can cause vasodilation, increased swelling, pain, and tissue destruction.

Supports and splints
In most injuries, pain is greatly reduced if the injured part is immobolized correctly. Supportive bandaging or splinting reduces stress, prevents painful movements, and helps control the swelling which is produced when tissues of any kind are damaged. Inflatable splints are a very convenient method of providing a comfortable, removable, adjustable support to a led or an arm.

Splints and bandages should never be tight, as they can constrict the blood flow and cause further damage. To check the circulation, you should press on the thum-nail or toe-nail on the bandaged limb, to see whether the blood returns to the nail immediately after the pressure has turned it white. If the blood return is sluggish, the bandage must be loosened or removed immediately. It is best not to use non-stretch strapping as a first-aid binding.

Applying heat
Whereas cold therapy can be applied immediately to an injury, and continued through the rehabilitation phases for as long as there is swelling, bruising and pain, heat should only be applied, if at all, in the recovery phases of rehabilitation. Applying heat draws blood to the skin under the heat source. This tends to increase internal bleeding or fluid exudate (swelling) in an immediate injury. Therefore heat is not appropriate in first-aid. Heat is used later on to relieve muscle tension, promoting relaxation.

Creams
Massage, like heat, aggravates the situation when an injury has just happened. Any cream applied must be laid gently on the skin and allowed to soak in. If you rub it in, not only do you risk increasing internal bleeding, but you could stimulate blood clotting and bone formation in torn muscle fibres.

Rehabilitation Principles

There is never any point in trying to exercise through, or 'run off', the pain of an injury. When you have pain relating to a particular movement or activity, continuing the activity only causes further harm to the damaged tissues. After doing any necessary first-aid measures, your next priority is to obtain an accurate diagnosis of what damage has been done.

In general, the pattern of recovery for tendon and muscle injuries is passive stretching to regain lost flexibility, followed by specific restrengthening exercises concentrating on the injured muscle group, building up to a final stage of functional exercises, in which the injured muscle group works in co- ordination with its surroundig muscles.

Stretching the injured muscles remains an important routine for some time after you have recovered from the injury, to prevent any danger of the muscles becoming tight and then being re-injured. You have to continue stretching the muscles daily, and as the first part of your warm-up before exercising.

For joint injuries, the pattern of rehabilitation usually consists of strengthening exercises for the muscles round the joint, to regain stability, followed by exercises to regain the joint's mobility, leading to the final stage of functional dynamic exercises.

When you plan your programme of rehabilitation exercises, remember that progression is the key principle. Start with little, but often, then gradually increase the amount you do. If you are stretching a muscle group, do two or three stretching exercises at a time, about every hour, if possible, and then try to increase the number of exercises, perhaps doing one or two longer stretching sessions each day. Try to build up to three sets of ten repetitions of each exercise, then increase the number of exercises you do, and then add in gradually increasing weights.

Throughout the rehabilitation process, you must avoid painful activities, and concentrate on the exercises directed towards improving function in the injured part. You must not resume your sport until you are sure you can stress the injured tissues without any reaction of pain, swelling, or limitation of movement. When you do resume your sport, you must start with little, and gradually build up to full participation.

Reference Source 23,91




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