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.
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.
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.
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.
intake is essential in avoiding cramp, dehydrations and heat exhaustion.
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 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.
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.
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.
of ice application
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.
application of ice, however, can cause vasodilation, increased
swelling, pain, and tissue destruction.
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.
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.
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.
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.
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.
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.
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.
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
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.