Lecture 10 Common Injuries Flashcards
Typical repetitive injury
- Pathological process is often under war for a period of time before the athlete notices symptoms
Repetitive injury
*Alternative nomenclatures
*Gradual onset injury
*Chronic injury
*Overuse syndrome
*Sports disease
*Cumulative trauma disorder
*Repetitive strain injury
*Overuse injury
Types of repetitive injuries in sport
Bone: Bone stress reaction, stress fracture, osteitis apophysitis, enthesopathy
Tendon: tendinopathy
Joint/ligament: labrum repetitive (overuse) injury, ligament degeneration, synovitis, chondropathy
Muscle/fascia: DOMS, fasciitis, chronic compartment syndrome
Bursa: Bursitis
Nerve: Altered neuromechanical sensitivity
Apophysitis
-Adolescents
- Pubertal growth
- overloads (or traction) the apothysitis- growth plate
- growth plate may pull away which may cause calcification on tissues
Enthesis
- Junction between tension and a bone
-fibrocartilage - enthesopathy: umbrella term for injury that affects connection points
Chronic compartment syndrome
- Exercise induced condition of muscle
- Repetitive impact activity (e.g., running), overloading
- Swelling and increased pressure causing reduced blood flow and pain
- Most commonly in the lower legs
- The lower leg has four compartments, and any one or all of them can be affected
- Aching, burning, tightness, numbness,
weakness - Typically treated conservatively
Risk factors for repetitive injury- intrinsic
- Previous injury
- Biomechanics
- Leg length discrepancy
- Muscle imbalance
- Muscle weakness
- Lack of flexibility
- Sex
- Body composition
- Genetic factors
Risk factors for repetitive injury- extrinsic
- Training load errors
- Surfaces
- Shoes
- Equipment
- Environmental conditions
- Inadequate nutrition
Treatment of repetitive injuries
- Treatment is not only managing the injury
- essential to address the factors that have contributed to the development of injury!!
Prevention of repetitive injuries
- Most repetitive injuries are avoidable
- strength training for the major muscle groups
- exercise regularly, cross-training, rest days, sleep, nutrition, proper equipment, correct from and technique
- Gradually increase training load
Medial tibial stress syndrome (MTSS)
- Running and jumping sports
- Risk factors
- Pain and inflammation along middle-
distal third of posteromedial aspect of
tibia - Diffuse pain, inside distal end of tibia
MTSS: diagnosis and treatment
- History and physical examination (palpation)
- alternative training
- correction of malalignment and training problems
- Exercise therapy: strength and flexibility
- Prognosis is good if treated early!
Tibial stress fracture
- Running and jumping sports
- Risk factors
- Significant pain during running, often disappears during rest, returns when athlete starts running again
- Focal pain, in a small area, stress fracture, females with abnormal menstrual cycles are prone to this more
Tibial stress fracture: diagnosis and treatment
- History and physical examination (Palpation & hop test)
- X-ray; MRI
- Crutches & Brace & Alternative training
- When pain free –> Progressive training
- Prognosis is good if diagnosed early
Low back pain (LBP)
General population: Lifetime prevalence 85%→ Up to 20-30% can become
persistent.
Athletes: Lifetime prevalence 1-94%
→ Time-loss from sport, limitations to performance, decreased quality of life, high costs of treatment
LBP in adult athletes
- Non-specific low back pain
- complex combination of intrinsic and extrinsic risk factors
Risk factors for LBP
- Previous back injury
- Family history of LBP
- Anatomical structure of the spine
- Improper technique
- Sleep deficits
- Nicotine use
- Overloading the structures of the spine
- Stress
Degenerative disc disease (DDD)
- Heavy stress to the spine
- Intervertebral disc degenerates
-> pain and other symptoms - height of disc can change, more loading of vertebrae and compression of nerve
DDD: diagnosis and treatment
- History, physical and neurological examination
- Imaging (e.g., x-ray, MRI)
- Conservative treatment = physiotherapy (exercise therapy, e.g., core strength, flexibility)
Ankle sprain
- Most common sporting injury
- Around 80% of ankle injuries are ligamentous cause by sudden inversion/supination
Lateral ankle sprain
- Lateral structures put under stress
- Anterior talofibular (ATF) ligament
- Posterior talofibular (PTF) ligament
- Calcaneofibular (CF) ligament
- Peroneal tendons
Lateral ankle sprain: Grades
- Grade I: partial rupture of ATF, PTF or CF
- Grade II: total rupture of one of the three ligaments or partial rupture of two
ligaments - Grade III: total rupture of two ligaments
Mechanism of lateral ankle sprain
- Sudden excessive supination
- sudden excessive inversion
- 130-180 ms after initial foot contact
lateral Ankle sprain: diagnosis and treatment
- History and physical examination (Palpation)
- X-ray
- Weight bearing after 24-48 hours (using crutches or brace)
- Grade I and II: brace, taping
- Grade III: immobilization
- Early functional treatment
- Progressive exercise therapy
Medial ankle sprain
- Medial structures put under stress
- Deltoid ligament
- Sometimes combination with malleolar fractures or syndesmosis injury
- Tibialis posterior and toe flexor tendons
- excessive eversion
Medial ankle sprain- diagnosis and treatment
- history and physical examination (palpations)
- X-ray
- brace, sometimes medial arch support
- functional treatment in the same manner that for lateral ankle ligament injuries
- prognosis is good, but healing takes about twice as long (or more) than for lateral ankle sprains
Syndesmosis injury
- High ankle sprain
- External rotational trauma
- Sprain of syndesmotic ligaments that connect the tibia and fibula
- Partial or complete rupture of syndesmosis
- Sometimes rupture of anterior tibiofibular ligament
Mechanism of high ankle sprain
- Force external rotation
- high-risk sports: downhill skiing, football, rugby
High ankle sprain: diagnosis and treatment
- Diagnosis: History & Physical examination (palpation); X- ray, MRI
- Partial rupture – Walking cast/boot (2 weeks or more)
- Complete rupture – surgery, cast/boot (6 weeks)
- Progression of rehabilitation when near pain free
Sprined ankle complications
- increased risk for recurrent injuries
- an unstable joint (chronic ankle instability)
- ankle joint osteoarthritis
- persistent pain
Chronic ankle instability
- Instability from repeated inversion trauma
- Feeling that the ankle is ‘giving way’ on the lateral side
- Treatment
- Brace
- Balance and strength
- Surgery
- may use tapping in certain sports
Osteochondral fractures and control injuries
Usually occur in association with ankle sprains
* Recurrent pain, stiffness and or locking
* MRI
* Cast/brace (6-8 weeks) and rehabilitation
* Surgery
* May progress to ankle joint osteoarthritis
