A. Common Sports Injuries and their Treatments

The Foot And Ankle

More than 5.3 million visits are made to physicians’ offices each year because of foot and ankle problems, including 1.6 million visits for ankle sprains and 950,000 visits for ankle fractures. Consider this:

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Heat Injury
Athletes participating in sports events or practice sessions during intense heat are the most susceptible to heat injury. Athletes who do not drink enough fluids during the intense heat also are prone to heat injury.

There are many forms of heat injury. The mildest form of heat injury is heat cramps which occurs when athletes do not drink enough fluids when exercising. Heat exhaustion is a more serious injury, triggered by excessive sweating and inadequate fluid replacement; the body is unable to supply the increased blood volume needed by the brain, skin and the muscles in extreme heat. The result is dizziness, weakness, and fainting. The most serious form of heat injury is life-threatening heatstroke. Heatstroke occurs when the body's sweating mechanism shuts down, the skin become hot and dry, and the body is depleted of fluids.

Prevention:
Fluid replacement is essential in preventing heat injury. Appropriate physical conditioning and becoming adjusted with the climate also are important. Recognition of the early symptoms of heat injury by athletes is critical. The longer the athlete waits, the more severe the heat injury.
 

If you believe someone is suffering from overexposure to heat, immediately seek medical care. Until help arrives, you should move the victim to a shaded area; remove any excess clothing; wet and fan the body; and elevate the legs and buttocks.

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The Knee
About 10.8 million visits are made to physicians’ offices because of a knee problem. It is the most often treated anatomical site by orthopaedic surgeons.

There are many components to the knee making it vulnerable for various types of injuries. Many injuries are successfully treated conservatively, while others require surgery to correct.

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thighbone (femur) which rotates on the upper end of the shinbone (tibia), and the knee cap (patella) which slides in a groove on the end of the femur. The knee also contains large ligaments which help control motion by connecting bones and bracing the joint against abnormal types of motion. Other parts of your knee, like cartilage, serve to cushion your knee or help it absorb shock during motion.

Common Injuries:
 
Many athletes experience injuries to their knee ligaments. Of the four major ligaments found in the knee, the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) often are injured in sports. The posterior cruciate ligament (PCL) also is frequently injured.
 
Changing or twisting direction rapidly, slowing down when running, and landing from a jump are often the causes of tears in the ACL. Athletes participating in skiing and basketball and athletes wearing cleated shoes, such as football players, are susceptible to ACL injuries.
 
Injuries to the MCL usually are caused by contact on the outside of the knee. These types of blows to the knee often are encountered in contact sports such as football.
 
The PCL can be injured during a sports activity when the athlete receives a blow to the front of the knee or makes a simple misstep on the playing field. Athletes engaging in contact sports such as football or soccer are susceptible to a PCL injury.
 
Other Injuries other than ligament injuries...
 
Torn knee cartilage is experienced by many people. When people talk about torn knee cartilage, they usually are referring to a torn meniscus. The mensicus is a tough, rubbery cartilage that is attached to the knee's ligaments. It acts like a shock absorber. In athletic activities, mensicus tears usually occur when twisting, cutting, pivoting, decelerating, or being tackled. Direct contact is often involved.
 
Treatment:
 
There are a variety of methods used by orthopaedic surgeons to treat knee injuries in athletes. The most important advice is to seek treatment as soon as possible. A common method used by orthopaedic surgeons to treat mild knee injuries is R.I.C.E.-rest, ice, compression, and elevation. Rest the knee by staying off it or walking only with crutches. Apply ice to control swelling. Use a compressive elastic bandage applied snugly but loosely enough so that it does not cause pain. Finally, keep the knee elevated.

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The Shoulder
Nearly six million people a year go to the doctor’s office for a shoulder sprain, strain, dislocation or other shoulder problem.

Shoulder injuries can be caused by sports activities that involve excessive overhead motion like swimming, tennis, pitching and weightlifting. People involved in everyday activities like washing walls, hanging curtains, and gardening also can get shoulder injuries due to excessive overhead arm motion.

Athletes are especially susceptible to shoulder problems. A shoulder problem can develop slowly in athletes through repetitive, intensive training routines.

Warning Signs of Shoulder Injuries:
 
If you are experiencing pain in your shoulder ask yourself these questions:
If you answer "yes" to any one of these questions, you should consult an orthopaedic surgeon for help in determining the severity of the problem.
 
 
Common Injuries:

Instability
Sometimes, one of the shoulder joints moves or is forced out of its normal position. This condition is called instability, and can result in a dislocation of one of the joints in the shoulder. Individuals suffering from an instability problem will experience pain when they raise their arm. They also may feel as if their shoulder is slipping out of place.

Impingement
Impingement is caused by excessive rubbing of the rotator cuff and the top part of your shoulder blade called the acromion. Impingement problems can be sustained when participating in a sports activity that requires excessive overhead motion. If you do not seek medical care for the inflammation in your shoulder, it could eventually lead to a more serious injury.

The rotator cuff is one of the most important components of the shoulder. It is comprised of a group of muscles and tendons that hold the shoulder joint in place. The rotator cuff provides individuals with the ability to lift their arm and reach overhead. If injured, it can become difficult for people to recover the full shoulder function needed to properly participate in the sports activity.

Treatments:
Early detection is the key to preventing serious shoulder injuries. Many times, orthopaedic surgeons will prescribe a series of exercises aimed at strengthening shoulder muscles. Anti-inflammatory medication also may be prescribed to reduce pain and swelling.

Here is a series of shoulder exercises aimed at helping individuals strengthen their shoulder muscles and prevent injuries.

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Sprains and Strains
Sprains and strains are among the most common injuries in sports.
 
A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments stabilize and support the body's joints. For example, ligaments in the knee connect the upper leg with the lower leg, enabling people to walk and run.
 
A strain is a twist, pull and/or tear of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone.
 
Causes:
 
A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments. Typically, this injury occurs when an individual lands on an outstretched arm; slides into a base; jumps up and lands on the side of the foot; or runs on an uneven surface.

Chronic strains are the result of overuse - prolonged, repetitive movement - of muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction.

Risk Factors:
 
All sports and exercises, even walking, carry a risk of sprains. The anatomic areas most at risk for a sprain depend on the specific activities involved. For example, basketball, volleyball, soccer, and other jumping sports share a risk for foot, leg, and ankle sprains. Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains. So do sports that feature quick starts (hurdling, long jump, running races, etc.). Gymnastics, tennis, rowing, golf-sports that require extensive gripping-have a high incidence of hand strains. Elbow strains frequently occur in racquet, throwing, and contact sports.
 
Signs of a Sprain:
 
While the intensity varies, pain, bruising, and inflammation are common to all three categories of sprains-mild, moderate, severe. The individual will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone. This loosening makes the joint nonfunctional. A moderate sprain partially tears the ligament, producing joint instability, and some swelling. A ligament is stretched in a mild sprain, but there is no joint loosening.
 
Signs of a Strain:
 
Typical indications include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual. Some muscle function will be lost with a moderate strain, where the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle/tendon is stretched or pulled, slightly. Some common strains are:

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Stress Fractures
One of the most common injuries in sports is a stress fracture. Overcoming an injury like a stress fracture can be difficule, but it can be done.
 
A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture.
 
Causes:
 
Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).
 
Medical studies have shown that female athletes seem to experience more stress fractures than their male counterparts. Many orthopaedic surgeons attribute this fact to a condition referred to as "the female athlete triad"-eating disorders (bulimia or anorexia), amenorrhea (infrequent menstrual cycle), and osteoporosis. As a female's bone mass decreases, the chances of getting a stress fracture increase.
 
Most stress fractures occur in the weightbearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg.
 
Studies have also shown that athletes participating in tennis, track and field, gymnastics, and basketball are very susceptible to stress fractures. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete risks developing a stress fracture.
 
Treatment:
 
The most important treatment is rest. Individuals need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.
 
If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Reinjury also could lead to chronic problems where the stress fracture might never heal properly.
 
Here are some tips developed by the American Academy of Orthopaedic Surgeons to help prevent stress fractures:

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B. Prevention

Start With a Check-Up
If you've been sedentary a long time, you should get a medical examination before launching into an exercise program. A physician can give you precautions if you have any pre-existing conditions, such as a high cholesterol level or high blood pressure, that would make some exercises dangerous. Although it doesn't take the place of a check-up by your doctor, your Chiropractor or Personal Trainer has an easy, at-home evaluation to help you assess your physical condition and risk factors.

Vary your exercise
To avoid overuse injuries that arise from repetitive exercise, vary your exercises from day to day and season to season. By choosing sports that vary the area and activities of joints and muscles, you're not likely to overstress any one of them. Mixing it up is especially important if your sport of choice is traumatic to your joints, such as basketball, jogging or aerobics.

Varying your exercise also strengthens opposing muscle groups, which reduces the chance of injury. For example, serious walkers and runners inevitably build strong hamstrings, but they tend to have weak quadriceps.

This imbalance can cause a variety of problems. The hamstring can exert tension on the tendons and ligaments around the knee, for example, causing inflammation. By including exercises that build the quadriceps, such as weight training, cycling, rowing or calisthenics, this imbalance can be avoided. Besides, no matter how much you love running, swimming or biking, each may become tedious if done without a break. By mixing up your choice of exercise, you can avoid tedium and overuse injuries.

Exercise year-round
Your exercise program should include strength, flexibility and aerobic training. By staying strong, flexible and in good cardiovascular shape all four seasons, you're less likely to injure yourself during any one season. Emphasize strength, flexibility, and conditioning to avoid injury.
 
Muscles serve a vital role in stabilizing joints. Year-round conditioning strengthens muscles to prevent unwanted or extreme movements. The knee joint, for example, relies upon all the muscles around it to provide stability. Strengthening the muscles around the knees can help prevent some injuries.
 
Some athletes believe that participation in a sport during the season maintains cardiovascular fitness year-round. Depending on the sport, this may not be true. Baseball is an example because playing does not provide aerobic conditioning. If you participate in a specific seasonal sport, incorporate an aerobic exercise program into your fitness routine year-round. Your goal should be to condition yourself year-round so that you are able to participate effectively and enjoy your sport. In other words, you should be in shape to play the sport--not play the sport to get in shape.

Train for your sport
Part of maintaining year-round conditioning is to prepare your body for your sport of choice. This includes training the muscle groups and energy systems (i.e. anaerobic versus aerobic) required for the sport. For example, a runner would want to work on general lower extremity muscle flexibility and strength in addition to aerobic conditioning, whereas a defensive back in football would want to ensure that foot speed and agility are optimal, along with excellent short burst (anaerobic) capability. Everyone who exercises regularly should be tuned into the condition of their bodies and recognize subtle changes like aches, pain or stiffness, favoring one part of the body over another, or fatigue. These signs won't always be obvious but it's wise to become attuned to these signals because they may help you avoid injury. Also, be sure that you train using the appropriate equipment and protective gear.
 
An important aspect of pre-season conditioning is training at an intensity that is below the competitive level. You're more likely to maintain and enjoy a conditioning program that is comfortably-paced and progresses in intensity, frequency and duration as the competitive season nears.
 
Your pre-season goals may include increasing speed, agility, balance, coordination and your ability to concentrate and relax. Interval training, which involves short periods of activity (i.e. stair-climbing, weight lifting, calisthenics or other exercise activities such as sprinting), can build speed and strength. This type of training involves working hard for short periods in the middle of an aerobic workout. Running bursts of 50 yards of so after every mile during a long running session constitutes interval training. You can slowly increase the number of sprints in the workout, as well as the distance and speed of the sprints.
 
Interval training can help you prepare to participate in activities that require intense effort such as sprinting during soccer games. If you're just starting an interval training program, ease into each activity to help prevent injury, and keep your intervals short to avoid fatigue and overuse injuries.

Develop mental skills
Mental preparedness for sport and exercise should be part of your pre-season and year-round conditioning regimen. Your mind, as well as your body, needs to be conditioned.

Your mental conditioning program helps you relax and focus. Several methods to practice are relaxation techniques, mental rehearsal and imagery. Studies have shown that there are a number of psychological factors that may predispose you to an acute injury.
 
Each of us has an optimal arousal level that works to enhance our athletic performance. However, if you are overly aroused by the importance you place on an event, "psyched-out," or if the environmental conditions in which you must perform are not ideal, your psychological state could detract from your performance and put you at risk for injury. If you are already injured and are still attempting to engage in activity, this too can be a distraction that puts you at greater risk.
 
Too much arousal causes increased muscle tension and attentional deficits, which detract from your coordination and flexibility, and increase the risk of sprains, strains and other injuries. Fear of competition, fear of failure and other distractions have caused many athletes to lose their focus, and to make errors that lead to injury.
 
These emotions can make you more vulnerable to injury, so it is vital to develop mental concentration and relaxation skills that help you cope with life's stresses. How you respond to competitive stress may be a predictor of how likely you are to be injured. Further sports psychology research is needed to clarify and define in measurable terms the psychological factors that are linked and influence athletic injury.

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C. Contraindicated Exercises

1. Hyperextension - straightening a joint past it's normal position

2. Hyper flexion - bending a joint more than normal

3. Repeatedly rising on the toes and heels may weaken the long arches of the feet.

4. Staying on toes - press heels to the floor to prevent shin splints.

5. Isometric exercises should not be performed by those with high blood pressure or heart trouble. If done for stabilization of the trunk, BE SURE you breathe.

6. Avoid hyperventilation - Over breathing - forced, rapid, or deep breathing

7. Dehydration - excessive loss of water from the body, usually through one of the following:

8. Avoid moving arms/legs rapidly from water to air or vice versa. An exercise should keep arms in the water or keep arms out of the water for that exercise.

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