Managing Sports Injuries

By Dr. Brian A. Casazza and Dr. Robert Wilder

Charlottesville is an active community. Running, golf, and tennis are extremely popular. Fitness center memberships continue to grow. Participation in organized sports (including soccer, basketball, baseball, softball and football) is expanding. Participants recognize how injury may interfere with activity, even ending a season. Proper injury management, therefore, is imperative.

Athletic and fitness related injuries can be divided into two classifications: acute/traumatic and overuse. Acute/traumatic injuries are easy to identify: a sudden twist of the ankle, a pop in the knee. Overuse injuries tend to be more subtle, developing over time, even weeks to months. By the time one develops symptoms related to an overuse injury, a significant amount of tissue damage or weakness may have already developed. An understanding of the causes of overuse injuries, prevention, and initial management strategies will help minimize the effects such injuries have on training and competition.

Overuse injuries result from repetitive microtrauma that leads to inflammation or tissue damage resulting in such injuries as tendonitis, ligament sprains, joint swelling, and stress fractures. Overuse injuries are usually multifactorial, with many contributing risk factors. Predisposing risk factors are conveniently divided into intrinsic and extrinsic causes. Intrinsic risk factors are physical abnormalities unique to an individual athlete. These include muscle weakness, inflexibility, and poor foot mechanics. Subtle abnormalities that have no significance while walking may lead to abnormal stress during the more challenging activities of sport and training. Extrinsic risk factors are related to one's training. Improper equipment, poor technique, and training errors including inadequate warm up, lack of stretching, and excessive activity can all contribute to injury.

The relationship of such risk factors to injury are illustrated by two principles: The principle of transition and the principle of "culprits and victims." The principle of transition states that an injury is most likely to occur when the athlete experiences a change in use of the involved part. This may include an increase in running mileage, a change in one' tennis or golf strokes, or even a change in playing surfaces or equipment. Recognizing the relationship of such a change, backing off, and reapproaching such activity more gradually will generally assist in increased participation.

The principle of victims and culprits states that the presenting injury, the "victim," results due to an inability to compensate for dysfunction in other sights, the "culprit's" as well. Such culprits include muscle weaknesses, inflexibilities, and poor biomechanics, which must be corrected in addition to treating the injury itself.

Applying the following principles of injury prevention and treatment should allow the athlete to continue training and enjoy a more successful season.

Follow a structured and consistent training program
Since injuries occur when we do too much too soon, it is important to resume activity gradually. Increase time of participation no more than 10 percent per week. Runners should incorporate progressively longer slow distance runs as well as shorter runs at faster than race pace. Participants in golf, tennis, and team sports should spend training sessions practicing strokes and skills prior to resuming competition. A well-designed training program also provides adequate rest.

Use proper footwear
Proper footwear helps limit shock and stress. Choose shoes designed for your specific sport. Running shoes should be replaced every 400 miles. Refrain from racing flats in training as these shoes are designed for fast running and do not provide the necessary support and shock absorbing qualities for daily training.

Allow time for proper warm up and cool down
Light activities such as jogging or easy sport activity and stretching prior to work out prepare the muscles by promoting local blood flow and flexibility while a cool down helps hasten recovery. Ten minutes of stretching before and after running or sport should be sufficient. Stretching should emphasize the major muscle groups as the legs including the thigh muscles (quadriceps, hamstrings), calf (gastroc soleus), and hip muscles. Golf, tennis, and baseball and softball players will want to stretch muscles in the shoulders and elbows as well. Stretching should be slow (30 seconds) and gentle, never bouncing. If time constraints limit your ability to follow this schedule, stretching should be performed at least once during the day.

Drink water before, during and after training
Water performs two important roles for the athlete. It maintains blood volume and cardiovascular function and ensures regulation of body temperature. Adequate hydration is therefore necessary for optimum training performance and recovery. If you wait until you feel thirsty to drink, you have waited too long. We recommend drinking 6 to 8 glasses of water each day with an additional 8 ounces for each 20 minutes of exercise. If training exceeds one hour, a diluted carbohydrate drink may help fluid replacement after the run. Loss of 1 percent body weight indicates dehydration; loss of 3 percent will significantly impair performance.

An athlete's diet should consist of roughly 60-70 percent carbohydrates which provides a more sustained energy release. Good sources of complex carbohydrates include bananas, bars, bagels, vegetables, breads, cereal and pasta. Avoid starchy foods and sweets, which are most readily converted to fat and provide little nutrition.

Treat injuries early
Following these guideline should assist in avoiding injury, making training more enjoyable. When a particular strain is experiences, examine your training with special attention to any recent changes. If any are present, back off from training, and approach the transition more gradually, making sure you are stretching and warming up properly.

To treat your injury, use ice on an injured area 3-4 times a day, 10-15 minutes each time. You may take over the counter anti-inflammatory agents as long as you are not sensitive to such medications. Athletes with a history of ulcers, kidney disease, allergies, or women who are pregnant should not however take anti-inflammatories. If you have not safely taken these medications in the past, consult your physician prior to starting. If pain persists more than one week, if there is swelling, or if you have altered your training pattern due to pain, a physician should be consulted.

Adjusting training and adding proper rehabilitation can often allow you to resume training quickly.

Dr. Robert Wilder is Director of Sports Rehabilitation in the Division of Spine and Sports Care at UVA., and a Fellow of the American College of Sports Medicine. An avid runner, Dr. Wilder has completed a number of marathons, including Boston. He is an active member of the Charlottesville Track Club.

Article from: The Charlottesville & Albemarle Observer, Volume XXII, Number 13, March 31, 1999 - April 6, 1999.