Sports injuries
How to prevent injury
Contact team sports such as football, rugby and hockey have the highest rate of injury, followed by fencing, cricket and cycling. On average there are more than 30 injuries per 10,000 hours of play in football that require medical treatment on the field or attendance at an accident and emergency department. Combat sports such as boxing or judo have a lower rate of injury, but when accidents happen they may be devastating.
Injury prevention should be an essential part of every training programme. A first step towards this is a good understanding of how injuries occur in the first place. Recognising problems early and treating them skilfully increase the chance of a speedy recovery without complications. On occasions, it may even save lives.
The same processes of repair and healing take place in the body, almost irrespective of where the injury is. Different tissues heal at different rates, however, and some tissues heal less completely than others.
Technique
Many injuries can be prevented or at least minimised with forethought and preparation. For starters, it is essential to learn the correct technique for your particular sport, because doing it the wrong way can cause harm. This applies especially when using gym equipment with complicated computerised settings – get an instructor to take you through the equipment and watch you while you use the machine. Often using the correct technique not only prevents injury but improves your performance.
Fitness
Fitness also plays a role in preventing injury. Strong muscles ‘hold’ a joint tightly, whereas tired ones give way to sprains. However, the fitter an athlete is the more likely he or she is to push him- or herself, and the more susceptible he or she then becomes to injury. Finding the right balance can be difficult.
Equipment
The correct equipment for the sport is essential, both for optimum performance and to prevent accidents. Always wear adequate protection and support for vulnerable areas. Sports shops now carry a bewildering array of shoes for every possible activity. Although it is not necessary to buy the most advanced (and expensive) model, having the right shoe is important, so check that the one you’re buying is suitable for what you do. Leave room for thick socks which are essential for extra cushioning, even on the warmest days.
More and more people are adopting a sensible attitude towards head protection. It is now normal for everyday cyclists to wear helmets. Helmets are also common for batsmen in cricket, despite the controversy and allegations of ‘unmanliness’ they provoked when players first started wearing them. Steeplechasers also wear helmets, and it has been reported that head protection worn during boxing training has reduced the frequency of knockouts from 4 per cent to 0.3 per cent of fights.
Face and eye protection are worn in sports such as hockey, squash and fencing. Gumshields protect the teeth, and the best ones are custom-made for the wearer by a dentist. Any protection worn by children and teenagers should be regularly refitted. Fencers wear a body suit, which in women includes breast protection, and groin protection is recommended for men in sports such as cricket and karate.
Very rarely, the protective gear itself causes problems. Motor-racing helmets sometimes do not allow for proper circulation of air, and the wearer may become light-headed or even pass out. Goggles cause eye damage if they are pulled partly off and rebound against the face. Ill-fitting equipment may also cause more damage than it is worth so do choose carefully.
Recognise the dangers and prevent injury
Effective prevention of injury in sport and exercise depends on recognising the dangers in advance. There are three basic causes: trauma, overuse and environmental injury.
Trauma
This is a bodily injury, often found in contact and combat sports such as boxing, karate, football, rugby and hockey, and is usually caused by an opponent or by a piece of equipment such as a hockey stick.
INJURY ACTION PLAN
It is inevitable that some time during exercise or sporting activity you’ll either be injured yourself or witness an injury or accident. Follow these golden rules of injury management and prevention:
• Stay safe:
in team sports play by the rules. Always exercise or train within your limitations. Ensure that you get fit for your sport or activity and make progress gradually.
• Stay cool:
if you are injured don’t panic. Stop the game, if necessary, or stop whatever activity you’re doing. If someone else is injured, speak to him or her reassuringly and remain calm.
• Look and listen:
if another person is injured, find out what happened, where the pain is, whether he or she can stand up or walk. Look for any obvious deformities. Compare sides when a limb is involved. DO NOT examine a lacerated eye in case you damage the eyeball itself.
• Touch:
if you have an idea what has happened, gently use your hands to examine the injured part, comparing it with the other side of the body, head or limb.
• Get medical help:
if you feel you need a professional opinion make sure you send for a doctor early rather than late.
• Remember:
if someone has to go to hospital, do not give him or her anything to eat or drink in case a general anaesthetic is necessary.
Overuse
Overuse injuries are more common in aerobic activities which involve repeating a movement over a period of time. They are particularly common in racket sports, rowing and long-distance running, and tend to occur at specific sites such as the tendons around the ankle, knee, hip, shoulders and wrist. Looking after someone who has an injury of this kind may be more difficult as the person may try to carry on doing whatever caused it. This increases the risk of both recurrence and the development of a chronic (long-lasting) injury.
Environmental injury
This is caused by extremes of temperature, such as overheating while running on a hot day which can lead to dehydration, or hypothermia, which can be caused by immersion in water or the temperature conditions at high altitude and depth. Distance runners, climbers, skiers and participants in water sports are the high-risk groups.
Basic rules for preventing injury
• Try to assess the particular risks of your activity or sport
• Know what your body is capable of and how fit you are; stay within your limitations
• Set realistic targets; try to make exercise and sport fun
• If you are playing games know the rules and stick to them
• Use the best equipment that you can afford or that which is recommended by experts
• Do not train through the pain of an injury; take expert or professional advice early rather than late
• Wear appropriate protective clothing or training gear
• Do not train when you have a cold or flu-like illness
• Try to train with a partner irrespective of whether you are training for a sport or for good health
• Make sure you warm up and cool down adequately
Where to get help
If the injured person loses consciousness (no matter how briefly), they should be seen at an accident and emergency department (A&E). The same applies if they might have a broken or dislocated bone or if they need stitches or expert strapping.
If you’ve had a minor injury treated in A&E, you may have to see your own doctor for a follow-up examination or you may need to attend an outpatient clinic run by orthopaedic surgeons. A&E staff are trained to deal with common injuries, but will consult specialists for more major or unusual cases. About 10 per cent of people who see their GPs do so for joint problems or sports injury. Many of these fall into the category of ‘overuse’, such as back strain, tennis elbow or knee problems. Your GP may prescribe suitable strapping, rest and pain relief, and may refer you to a specialist clinic if appropriate.
Many people treat simple injuries on their own. Chemists now stock a good range of joint supports, which can be used on mild sprains or strains, and pain-killers such as paracetamol and anti-inflammatories such as aspirin or ibuprofen may help. You can also buy skin preparations, in the form of creams, gels or sprays without a prescription. These work by ‘irritating’ the skin to produce warmth, which is soothing for muscle pain, or have a mild pain-killing action.
Any injury that causes significant swelling or does not improve within a few days should be seen by a doctor.
Some injuries respond well to injection with a local anaesthetic and steroid preparation. Local anaesthetic acts to relieve the pain for a few hours and the long-acting steroid preparation reduces the irritation around the injury. This type of therapy is particularly appropriate for chronic injuries where there is point tenderness, that is, when you can point to the area that is particularly troublesome. Typical examples include tennis elbow and golfer’s elbow. One or two injections are enough to relieve the pain in most instances. The general rule of thumb is that no more than three injections of local anaesthetic and steroid should be given at the same site, because the risk of damage to tendons or ligaments (that is, rupture, tearing) increases with more frequent infections, as a result of a direct effect of steroids on these tissues. This type of injection should always be done by a doctor, preferably someone who has a specific interest in soft tissue/sports injuries.
There are a growing number of sport injury clinics within the National Health Service as well as within the private sector, and details of these can be obtained from your local hospital. Information on professionals within sports medicine, science and physiotherapy can be obtained from the Faculty of Sports & Exercise Medicine (see page 95), which details their qualifications and publications, their practical involvement in sport, their professional standing (which means at least three years’ involvement in sports medicine as a major component of their work) and their membership of various of the professional sports medicine and science bodies. These may include the British Association of Sport and Medicine (BASM), the British Association of Sport and Exercise Sciences (BASES), the Association of Chartered Physiotherapists in Sports Medicine (ACPSM), Sports Nutrition Foundation (SNF).
Physiotherapy
Physiotherapy ranges from treatments to reduce pain and stiffness, to helping an injured athlete regain strength and flexibility. Active limbs do not take well to enforced rest, and specific exercises and procedures prescribed by the physiotherapist can shorten your recovery period.
Physiotherapists are normally attached to health centres and hospitals, and referrals may be made by your GP or hospital specialist although an increasing number of NHS and private physiotherapy-led clinics are now open access – you just phone for an appointment. You may be sent to see a physiotherapist if you need help in rehabilitation after a period of extended rest or immobilisation, for example, in a plaster cast.
‘Physios’ also use a variety of treatments to relieve pain and to restore your ability to move normally as soon as possible. They may use heat, supplied by hot baths, gel packs, lamps or diathermy, to provide relaxation, reduce muscle spasm and ease pain. Ultrasound may promote healing of soft tissue injuries and reduce swelling. Massage may also reduce spasm and swelling.
