LO3 - how to respond to injuries

Chronic injuries are also known as overuse injuries and result from continuous stress on an area for example running for long periods of time or hitting a tennis ball again and again. This type of injury tends to develop gradually over a period of time and types include tendonitis (for example Achilles tendonitis), shin splints, tennis elbow and golfer’s elbow.

Chronic injuries can also be injuries related to children such as severs disease and Osgood Schlatter’s disease.

Injuries related to poor posture also are considered chronic such as rounded shoulders.

Acute Injuries are often caused as a result of a sudden or instant trauma to the body, so the injury happens straight away for example being hit in hard rugby tackle or by piece of equipment such as a ball or stick. Acute injuries result in immediate pain and in swelling of the injured area with a loss of function.

Types include:

• Soft tissue injuries (sprains and strains)
• Fractures (open or closed)
• Concussion
• Cuts (abrasions/grazes)
• Contusions (bruises)

Soft tissue injuries include muscular, ligament and tendon injuries.

The most common types of muscle injuries are muscle strains (tears) and contusions.

Muscle strains occur when a muscle is unable to cope with a force that is applied to it. Some or all of the fibres within the muscle tear or rupture. For example, a strain may occur when a novice skier’s ski slips out from under their body. Their groin muscles may not be able to cope with the forces on the muscles when they try to pull the leg back under them so they can remain balanced.

A contusion is a crush injury to the muscle. The term ‘dead-leg’ is frequently used to describe a contusion to one of the quadriceps muscles after a blow to the leg.

The recommended treatment for muscle strains is rest, ice, compression and elevation (R.I.C.E). After a few days, massage can be used to help speed up recovery.

Ligament sprains occur when there is a tear or rupture of the fibres of a ligament. Common sprains occur the ankle or wrist, as the ligaments around these joints are frequently injured during childhood and adolescence. Ligament sprains usually occur when extreme force is applied to this tissue; often from twisting when sprinting or when being tackled whilst playing contact sports like rugby and football.

The treatment for minor sprains is R.I.C.E. and it is important not to immobilise a ligament injury and to put minor stress on the injured tissue so it heals correctly. This is why people are not always provided with crutches for an ankle ligament strain.

Ligaments with complete ruptures cannot be repaired so other tissues are used to replace it. Anterior cruciate ligament (ACL) ruptures are one of the most common ligament injuries in football, rugby, volleyball and a few other sports. It is possible to reconstruct (with surgery) this ligament with a synthetic tissue however; grafts from the hamstring and patella tendon are thought to be more successful.

Tendonitis is a common overuse tendon injury. Tendonitis is more common in some sports (e.g. ‘tennis elbow’) and is caused when the tendon’s connective tissue becomes inflamed.

Tendonitis often causes enough pain to prevent a performer from full participation in training and competing in their sport. Treatment includes resting and icing the sore tendon. Anti-inflammatory drugs are prescribed for some, and in severe cases cortisone injections may be given by a doctor. Occasionally surgery may be required to ‘shave off’ parts of a bone where the tendon rubs so it has a smooth path to glide.

Overuse injuries include tennis elbow, golfers elbow and shin splints.

Fractures occur frequently in combat sports, such as boxing and kick-boxing; and contact sports, such as rugby and football.

Fractures occur from a blow or impact, or when a bone experiences great torsion forces (twisting forces). There are various types of fractures, some more serious than others. For example in compound (Open) fractures the bone breaks and punctures through the skin. This often results in ruptured blood vessels, large blood loss and possibly shock. A closed (simple) fracture is when the broken bone stays within the skin.

In most cases, fractures are immobilised by placing the damaged limb in a cast. In most fractures the two parts of the bone will be lined up with each other, so the healing process leads to the bone taking the same shape as it had before the fracture. However, sometimes the bones are not lined up and surgery is required to manipulate the bones, so they will heal in the correct position.

A concussion is a head injury that can occur from a blow to the head for example a clash of heads in football.

Abrasions, i.e. grazes and cuts can occur in sport such as when falling over on hard surface or as a result of an impact with another object. A contusion, or bruise is a crush injury to the muscle or a blow to an area of the body . The term ‘dead-leg’ is frequently used to describe a contusion to one of the quadriceps muscles after a blow to the leg.

Blisters are caused by caused by friction (rubbing) or burning the most common blister injuries in sport occur on the foot and heel due to poorly fitting footwear. Other risks that increase the chances of a blister (from shoe rubbing) is not wearing socks, wet feet (sweaty feet), large amounts of use such as running long distances.

Treatment includes:

• Cleaning the blister and sterilising the area.
• Not popping it, instead leave it to heal naturally.
• Cover it with a plaster or bandage.
• If infected seek medical advice.

Cramp is a painful sensation experienced through a sudden muscle contraction or over shortening of the muscle. Cramp is caused by dehydration and lack of salt in the muscles.

Injuries related to children include sever's disease and Osgood Schlatter’s disease.

Osgood Schlatter's disease occurs in the knee and tibia (shin) is often linked to growth spurts and causes swelling in upper part of the shin/knee. It most commonly occurs in teenagers (who play sport) when bones growing quicker and at different rates than muscles. Sever's disease is often linked to repetitive stress to the heel and the Achilles tendon at the back of the heel pulls at the heel bone

The first step in dealing with a sporting injury is to follow SALTAPS, an on-field assessment routine (See, Ask, Look, Touch, Active, Passive, Strength).

• See - Did you see injury occur and what happened
• Ask - How they feel with questions about the injury. Ask where the pain is coming from and how badly it hurts.
• Look - Are there obvious signs of injury (such as bleeding, bruising, swelling, deformity) or compare it to other limbs, to see how bad it is.
• Touch - Gently palpate the injury to find source of pain and feeling for tenderness.
• Active - Can the player move the limb on their own (with or without pain), can they perform non-weight bearing movement?
• Passive - Someone else (coach, physio, medic etc.) moves the limb/joint to full extent; taking movement further than active movement. The players reactions are noted during this phase.
• Strength - Can they hold or apply their own weight on the injured limb? Is the player able to stand-up following injury? This is the point a decision is made whether they can they play on.

RICE (Rest, Ice, Compression, Elevation)

Rest – avoid regular impact upon or use of the injured limb or area. This reduces pressure on the limb. It is suggested not to put weight on it and reduce your daily physical activity or even stop the activity. Rest is important to prevent further injury

Ice – apply an ice pack or similar for example frozen peas, to the affected area for 10–30 minutes. This reduces swelling and pain

Compression – use of elastic bandages or tape to reduce swelling. This also gives support to the injured area.

Elevation – keep the injured leg, knee, arm, elbow or wrist raised above the level of the heart. This reduces blood flow to the injured area.

Massage

Encourages and increases the flow of blood (into the affected body part). Increases flexibility (in the affected body part) which helps to relax or loosen muscles. This relieves tension and tightness. Massage can help manage and relieve pain, manage DOMS and reduce muscle soreness. It is also used to break down scar tissue.

Taping

It provides support and keeps muscles and joints in place. This reduces mobility and prevents movement; which reduces pain.

Bandaging

Could be used to cover or stem bleeding, reducing the risk of infection from a cut by keeping cut/injury clean. It is used to support the injured area such as a sprain or strain, keeping it still and stable. This prevents or controls swelling, similar to compression of the injured area. It can also be used to help keep an ice pack or splint in place.

Sling

This keeps an area of the body (e.g. arm) held in a position, where there is least discomfort. It keeps it still or supports injured area or immobilises injured area so the performer cannot use it similar to Rest; this prevents further damage. The elevation of the injury will reduce swelling by raising it above the heart.

An Emergency Action Plan (EAP) is required so that people participating in a sport know that they are going to be safe. It is also there so that the coaches know what to do in the event of an emergency. There are plans that have been practiced in advance in case of an emergency.

Benefits of having an EAP include:

• reduced risk of minor or more serious injuries occurring when someone partakes in sport.
• Minor issues can be addressed before they develop into something more major as people (both coaches and players) know what to do in the event of a problem.
• It covers how to respond to players with medical issues such as asthma, epilepsy and diabetes.

An EAP is broken into 3 phases:

1. Emergency personnel for example a first responder, first aider, coach, doctor, medic, nurse, medical team, physiotherapist.
2. Emergency communication such as telephone 999, call emergency numbers, contact the emergency services.
3. Emergency equipment including a first aid kit, evacuation chair, wheelchair and stretcher.