For athletes who may sometimes be baffled by science, here is the first part of a non-technical injury guide
There is no real difference between injuries caused during sporting activities and those caused in the home or working environment. They are all diagnosed in the same way, eg, sprain, strain, bruising, contusion, fracture, etc. The differences occur in the attitude of the injured person and the professional treating them. Most non-sporting people are happy to have a diagnosis made, followed by rest. The usual advice then is, 'Take it easy,' 'Don't overdo it,' 'It will get better given time' and, if necessary, 'Have some physiotherapy'. For sports people, this is the same as saying 'You will never play again!' What they want is a diagnosis that says 'You will be fit to play at the weekend.' It is this attitude that makes treating sports persons both rewarding and, at the same time, exasperating. If they are told that icing a pulled muscle for 10 minutes three times a day will speed up their recovery, they will probably ice it for one hour six times a day. Quite often they are their own worst enemies and actually slow down their rate of healing.
Injuries can happen to all types of tissues in the body. These tissues are:
» muscles and tendons
» joint capsules and ligaments
» bones and periosteum
» blood vessels
» connective tissue
All these tissues can be injured in one of two ways:
1. Traumatic - instant injury, specific incident - direct impact from a kick, or a blow, or a sudden forceful action, or uncoordinated movement, which causes an overstretching of the tissues.
If muscle tissue is involved, it is usually called a STRAIN.
If a joint, or ligamentous tissue is involved, it is usually called a SPRAIN.
2. Overuse - develops over a period of hours, days, or weeks, as a result of unaccustomed or repetitive activities. Tissues commonly affected are tendons, periosteum (a layer of tissue that covers the surface of a bone) and bone. These injuries often begin as a minor irritation. Pain often feels better when the tissues have been warmed up and moved and it is often, therefore, ignored.
As the tissues become more irritable then the pain becomes worse. Carrying on with exercise does not allow healing, so the original problem then develops into a long-term, overuse injury (chronic), which then becomes difficult to treat.
Underlying causes of overuse injuries:
» sudden increase in activity
» lack of general fitness and flexibility
» incorrect technique while performing an activity
» poor design of work area
» unsuitable equipment or training surface
The most common reasons for overuse injury are:
TOO MUCH TOO SOON TOO OFTEN
When a tissue is injured/damaged there is pain, swelling, bleeding and possibly bruising, which is visible evidence that blood vessels are damaged. The body's response is inflammation. The inflammatory process is the first stage of healing for the tissue and is a protective reaction triggered by damage to the soft tissues; swelling is slower in developing. Immediate swelling indicates that there is bleeding directly into the affected area.
Signs of inflammation are pain, heat, redness, swelling and loss of movement. This is sometimes difficult to differentiate from infection but usually, if an area is infected, the person will possibly feel unwell, have a fever or experience night sweats.
The inflammatory response is usually rather excessive compared to the amount of damage done. Applying compression over the damaged area helps to prevent excessive inflammatory response. The inflammation continues for five days or more, but if it is not treated effectively, the inflammatory response can continue, which will delay healing. This, in turn, can lead to loss of flexibility, strength and function. Early and appropriate self-treatment can enhance the recovery process.
As early as 12-24 hours post injury the repair process starts, with the laying down of scar tissue and the incorporation of new blood vessels. Depending on the nature of the injury, the repair process can continue for weeks, even months.
Scar tissue is the basis of repair to damaged tissues. It is made of collagen fibres, which have the ability to contract as the fibres mature. If these fibres are not exercised regularly, this will inevitably lead to a reduction in flexibility of the tissues that can cause pain, stiffness and weakness. To avoid this, exercise as soon as possible within a pain-free range, to stretch and strengthen the healing tissues. Movements that gently stretch the scar tissue along the lines of force of the affected tissue will lead to a stronger repair.
Most coaches/trainers/players know the RICE recipe for treating injuries. I do not think there has been any change to this for several years now:
R - Rest
I - Ice
C - Compression
E - Elevation
This is important for the first 24-48 hours, depending on the severity of the injury.
Rest - you might assume that rest speaks for itself but that is not always the case. How many players, injured on a Saturday afternoon, decide that the rest starts on Sunday after a lively Saturday evening on the town?
Ice offers an immediate measure for relieving pain, reducing internal bleeding and bruising and controlling swelling in injured tissues. It can be applied by rubbing ice cubes over the injured area while dabbing the skin dry at intervals. When the skin has turned pink (or darkened if dark-skinned) you should stop, to avoid the risk of over-cooling the skin or an 'ice burn'. You can also use a bucket, or bowl, of iced water to immerse a hand or foot. A wet towel containing ice cubes can be wrapped around the injury. If an ice pack or pack of frozen food is used, the skin must be protected with oil or a wet towel. 'Dry' ice applied directly can pull the skin off when it is removed.
Never apply ice to someone with circulatory deficiency, or if their skin sensation is reduced for some reason. Ice treatment can cause skin breakdown if used badly. There is no set time for application and some skin is more sensitive than others; skin colour changes indicate that the correct effects have been achieved. A good rule of thumb is to apply ice for 10 minutes on, 10 minutes off and then 10 minutes on again. Three to four times daily should be sufficient.
Compression - use an elasticated bandage to cover the entire affected area and leave no exposed area where the swelling can stagnate. If possible, apply the bandage a good 4 to 5 inches above and below the injured area. Do not apply too tightly.
Elevation - if a lower limb is affected, keep this above the groin as gravity aids the re-absorption of the swelling.
After 24-48 hours replace RICE with MICE (Movement replaces Rest).
M - movement and some guidelines for exercising
Perform the movement once, which can cause some discomfort but should not cause pain.
Continue the movement a few times to assess the levels of the discomfort/pain. If there is only discomfort at the end of the movement, it is usually safe to continue. If there is pain on repetition and/or pain is still constant and felt half an hour after exercising, then the movement is too vigorous or has started too early. Stop and RICE for a further 24 hours, then start again.
Just to clarify types of pain, these can be divided into constant and intermittent:
l Constant pain is when it is felt at all times and in any position.
l Intermittent pain usually happens only at certain times of the day, or in certain positions.
Constant pain is usually caused by the initial change to the tissues and the beginning of the inflammatory response. This should fade to intermittent pain once the repair process is under way. The pain is usually felt when the healing tissues are stretched. It is very important not to push intermittent pain too hard, as this will slow down the healing process and, in some cases, start the inflammation all over again.
Pain can also be referred from the damaged area and be felt in another area. Sometimes, for instance, a pain in the thigh, buttock or calf, has been referred from a back injury. If this pain does not go away after a couple of days then the person will probably need to see a doctor and be referred for physiotherapy.
It is important to remember that, if there is any doubt, a member of the medical profession should be consulted, be it your own doctor or a suitably qualified physiotherapist. The most important thing they can help you with is a diagnosis of the problem and advice that will be necessary to achieve the optimum speed of recovery.