By Saanichton Physiotherapy
17 Mar, 2016
Back Pain, Fitness, Foot Ankle Pain, Hip Pain, IMS, Neck Pain, Physiotherapy, Preventative Therapy, research, Running, Sports Injury, Sports Therapy, Training
Handout on Health: Sports Injuries
This publication is for athletes at all ages and levels, for people who exercise, as well as for health care professionals, coaches, and others who want to find out more about sports injuries. This publication describes the different types of musculoskeletal sports injuries, how they can be treated and prevented, and recent treatment advances from research. It also highlights risk factors and contains a resource list. If you have further questions after reading this publication, you may wish to discuss them with a health care professional.
Introduction
In recent years, increasing numbers of people of all ages have been heeding their health professionals’ advice to get active for all of the health benefits exercise has to offer. But for some people—particularly those who overdo or who don’t properly train or warm up—these benefits can come at a price: sports injuries.
Fortunately, most sports injuries can be treated effectively, and most people who suffer injuries can return to a satisfying level of physical activity after an injury. Even better, many sports injuries can be prevented if people take the proper precautions.
This publication answers frequently asked questions about sports injuries. It discusses some of the most common injuries and their treatment, and injury prevention. The publication is for anyone who has a sports injury or who is physically active and wants to prevent sports injuries.
It is for casual and more serious athletes as well as the trainers, coaches, and health professionals who deal with sports injuries.
•What Are Sports Injuries?
•What’s the Difference Between Acute and Chronic Injuries?
•What Should I Do if I Suffer an Injury?
•Who Should I See for My Injury?
•How Are Sports Injuries Treated?
•Who Is at Greatest Risk for Sports Injuries?
•What Can Groups at High Risk Do to Prevent Sports Injuries?
•For More Information
•The Shoulder Joint
Appendix
•Traumatic Brain and Spinal Cord Injuries
•Bruises
•Sports Injuries in Young Children: Tips for Caregivers
What Are Sports Injuries?
The term “sports injury,” in the broadest sense, refers to the kinds of injuries that most commonly occur during sports or exercise. Some sports injuries result from accidents; others are due to poor training practices, improper equipment, lack of conditioning, or insufficient warm-up and stretching.
Although virtually any part of your body can be injured during sports or exercise, the term is typically reserved for injuries that involve the musculoskeletal system, which includes the muscles, bones, and associated tissues like cartilage. Traumatic brain and spinal cord injuries (relatively rare during sports or exercise) and bruises are considered briefly in the appendix at the end of this publication. Following are some of the most common sports injuries.
Sprains and Strains
A sprain is a stretch or tear of a ligament, the band of connective tissues that joins the end of one bone with another. Sprains are caused by trauma such as a fall or blow to the body that knocks a joint out of position and, in the worst case, ruptures the supporting ligaments. Sprains can range from first degree (minimally stretched ligament) to third degree (a complete tear). Areas of the body most vulnerable to sprains are ankles, knees, and wrists. Signs of a sprain include varying degrees of tenderness or pain; bruising; inflammation; swelling; inability to move a limb or joint; or joint looseness, laxity, or instability.
A strain is a twist, pull, or tear of a muscle or tendon, a cord of tissue connecting muscle to bone. It is an acute, noncontact injury that results from overstretching or overcontraction. Symptoms of a strain include pain, muscle spasm, and loss of strength. Although it’s hard to tell the difference between mild and moderate strains, severe strains not treated professionally can cause damage and loss of function.
Knee Injuries
Because of its complex structure and weight-bearing capacity, the knee is a commonly injured joint.
Knee injuries can range from mild to severe. Some of the less severe, yet still painful and functionally limiting, knee problems are runner’s knee (pain or tenderness close to or under the knee cap at the front or side of the knee), iliotibial band syndrome (pain on the outer side of the knee), and tendinitis, also called tendinosis (marked by degeneration within a tendon, usually where it joins the bone).
More severe injuries include bone bruises or damage to the cartilage or ligaments. There are two types of cartilage in the knee. One is the meniscus, a crescent-shaped disc that absorbs shock between the thigh (femur) and lower leg bones (tibia and fibula). The other is a surface-coating (or articular) cartilage. It covers the ends of the bones where they meet, allowing them to glide against one another. The four major ligaments that support the knee are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL). (See illustration “Lateral View of the Knee.”)
Knee injuries can result from a blow to or twist of the knee; from improper landing after a jump; or from running too hard, too much, or without proper warm-up.
Compartment Syndrome
In many parts of the body, muscles (along with the nerves and blood vessels that run alongside and through them) are enclosed in a “compartment” formed of a tough membrane called fascia. When muscles become swollen, they can fill the compartment to capacity, causing interference with nerves and blood vessels as well as damage to the muscles themselves. The resulting painful condition is referred to as compartment syndrome.
Compartment syndrome may be caused by a one-time traumatic injury (acute compartment syndrome), such as a fractured bone or a hard blow to the thigh, by repeated hard blows (depending upon the sport), or by ongoing overuse (chronic exertional compartment syndrome), which may occur, for example, in long-distance running.
Shin Splints
Although the term “shin splints” has been widely used to describe any sort of leg pain associated with exercise, the term actually refers to pain along the tibia or shin bone, the large bone in the front of the lower leg. This pain can occur at the front outside part of the lower leg, including the foot and ankle (anterior shin splints) or at the inner edge of the bone where it meets the calf muscles (medial shin splints).
Shin splints are primarily seen in runners, particularly those just starting a running program. Risk factors for shin splints include overuse or incorrect use of the lower leg; improper stretching, warm-up, or exercise technique; overtraining; running or jumping on hard surfaces; and running in shoes that don’t have enough support. These injuries are often associated with flat (overpronated) feet.
Achilles Tendon Injuries
An Achilles tendon injury results from a stretch, tear, or irritation to the tendon connecting the calf muscle to the back of the heel. These injuries can be so sudden and agonizing that they have been known to bring down charging professional football players in shocking fashion.
The most common cause of Achilles tendon tears is a problem called tendinitis, a degenerative condition caused by aging or overuse. When a tendon is weakened, trauma can cause it to rupture. (See illustration “Lateral View of the Ankle.”)
Achilles tendon injuries are common in middle-aged “weekend warriors” who may not exercise regularly or take time to stretch properly before an activity. Among professional athletes, most Achilles injuries seem to occur in quick-acceleration, jumping sports like football and basketball, and almost always end the season’s competition for the athlete.
Common Types of Sports Injuries
•Muscle sprains and strains
•Tears of the ligaments that hold joints together
•Tears of the tendons that support joints and allow them to move
•Dislocated joints
•Fractured bones, including vertebrae.
Fractures
A fracture is a break in the bone that can occur from either a quick, one-time injury to the bone (acute fracture) or from repeated stress to the bone over time (stress fracture).
Acute fractures: Acute fractures can be simple (a clean break with little damage to the surrounding tissue) or compound (a break in which the bone pierces the skin with little damage to the surrounding tissue). Most acute fractures are emergencies. One that breaks the skin is especially dangerous because there is a high risk of infection.
Stress fractures: Stress fractures occur largely in the feet and legs and are common in sports that require repetitive impact, primarily running/jumping sports such as gymnastics or track and field. Running creates forces two to three times a person’s body weight on the lower limbs.
The most common symptom of a stress fracture is pain at the site that worsens with weight-bearing activity. Tenderness and swelling often accompany the pain.
Dislocations
When the two bones that come together to form a joint become separated, the joint is described as being dislocated. Contact sports such as football and basketball, as well as high-impact sports and sports that can result in excessive stretching or falling, cause the majority of dislocations. A dislocated joint is an emergency situation that requires medical treatment.
The joints most likely to be dislocated are some of the hand joints. Aside from these joints, the joint most frequently dislocated is the shoulder. (See illustration “The Shoulder Joint.”) Dislocations of the knees, hips, and elbows are uncommon.
What’s the Difference Between Acute and Chronic Injuries?
Regardless of the specific structure affected, sports injuries can generally be classified in one of two ways: acute or chronic.
Acute Injuries
Acute injuries, such as a sprained ankle, strained back, or fractured hand, occur suddenly during activity. Signs of an acute injury include the following:
•sudden, severe pain
•swelling
•inability to place weight on a lower limb
•extreme tenderness in an upper limb
•inability to move a joint through its full range of motion
•extreme limb weakness
•visible dislocation or break of a bone.
Chronic Injuries
Chronic injuries usually result from overusing one area of the body while playing a sport or exercising over a long period. The following are signs of a chronic injury:
•pain when performing an activity
•a dull ache when at rest
•swelling.
What Should I Do if I Suffer an Injury?
Whether an injury is acute or chronic, there is never a good reason to try to “work through” the pain of an injury. When you have pain from a particular movement or activity, STOP! Continuing the activity only causes further harm.
Some injuries require prompt medical attention (see the section “Who Should I See for My Injury?”), while others can be self-treated. Here’s what you need to know about both types:
When to Seek Medical Treatment
You should call a health professional if:
•The injury causes severe pain, swelling, or numbness.
•You can’t tolerate any weight on the area.
•The pain or dull ache of an old injury is accompanied by increased swelling or joint abnormality or instability.
To learn about treating sports injuries, see the section “How Are Sports Injuries Treated?”
When and How to Treat at Home
If you don’t have any of the above symptoms, it’s probably safe to treat the injury at home—at least at first. If pain or other symptoms worsen, it’s best to check with your health care provider. Use the RICE method to relieve pain and inflammation and speed healing. Follow these four steps immediately after injury and continue for at least 48 hours.
•Rest. Reduce regular exercise or activities of daily living as needed. If you cannot put weight on an ankle or knee, crutches may help. If you use a cane or one crutch for an ankle injury, use it on the uninjured side to help you lean away and relieve weight on the injured ankle.
•Ice. Apply an ice pack to the injured area for 20 minutes at a time, four to eight times a day. A cold pack, ice bag, or plastic bag filled with crushed ice and wrapped in a towel can be used. To avoid cold injury and frostbite, do not apply the ice for more than 20 minutes. (Note: Do not use heat immediately after an injury. This tends to increase internal bleeding or swelling. Heat can be used later on to relieve muscle tension and promote relaxation.)
•Compression. Compression of the injured area may help reduce swelling. Compression can be achieved with elastic wraps, special boots, air casts, and splints. Ask your health care provider for advice on which one to use.
•Elevation. If possible, keep the injured ankle, knee, elbow, or wrist elevated on a pillow, above the level of the heart, to help decrease swelling.
The Body’s Healing Process
From the moment a bone breaks or a ligament tears, your body goes to work to repair the damage. Here’s what happens at each stage of the healing process:
At the moment of injury: Chemicals are released from damaged cells, triggering a process called inflammation. Blood vessels at the injury site become dilated; blood flow increases to carry nutrients to the site of tissue damage.
Within hours of injury: White blood cells (leukocytes) travel down the bloodstream to the injury site where they begin to tear down and remove damaged tissue, allowing other specialized cells to start developing scar tissue.
Within days of injury: Scar tissue is formed on the skin or inside the body. The amount of scarring may be proportional to the amount of swelling, inflammation, or bleeding within. In the next few weeks, the damaged area will regain a great deal of strength as scar tissue continues to form.
Within a month of injury: Scar tissue may start to shrink, bringing damaged, torn, or separated tissues back together. However, it may be several months or more before the injury is completely healed.
Who Should I See for My Injury?
Although severe injuries will need to be seen immediately in an emergency room, particularly if they occur on the weekend or after office hours, most sports injuries can be evaluated and, in many cases, treated by your primary health care provider.
Depending on your preference and the severity of your injury or the likelihood that your injury may cause ongoing, long-term problems, you may want to see, or have your primary health care professional refer you to, one of the following:
•An orthopaedic surgeon is a doctor specializing in the diagnosis and treatment of the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.
•A physical therapist/physiotherapist is a health care professional who can develop a rehabilitation program. Your primary care physician may refer you to a physical therapist after you begin to recover from your injury to help strengthen muscles and joints and prevent further injury.
How Are Sports Injuries Treated?
Although using the RICE technique described previously can be helpful for any sports injury, RICE is often just a starting point. Here are some other treatments your doctor or other health care provider may administer, recommend, or prescribe to help your injury heal.
A key part of rehabilitation from sports injuries is a graduated exercise program designed to return the injured body part to a normal level of function.
With most injuries, early mobilization—getting the part moving as soon as possible—will speed healing. Generally, early mobilization starts with gentle range-of-motion exercises and then moves on to stretching and strengthening exercise when you can without increasing pain. For example, if you have a sprained ankle, you may be able to work on range of motion for the first day or two after the sprain by gently tracing letters with your big toe. Once your range of motion is fairly good, you can start doing gentle stretching and strengthening exercises. When you are ready, weights may be added to your exercise routine to further strengthen the injured area. The key is to avoid movement that causes pain.
As damaged tissue heals, scar tissue forms, which shrinks and brings torn or separated tissues back together. As a result, the injury site becomes tight or stiff, and damaged tissues are at risk of reinjury. That’s why stretching and strengthening exercises are so important. You should continue to stretch the muscles daily and as the first part of your warm-up before exercising.
When planning your rehabilitation program with a health care professional, remember that progression is the key principle. Start with just a few exercises, do them often, and then gradually increase how much you do. A complete rehabilitation program should include exercises for flexibility, endurance, and strength; instruction in balance and proper body mechanics related to the sport; and a planned return to full participation.
Throughout the rehabilitation process, avoid painful activities and concentrate on those exercises that will improve function in the injured part. Don’t resume your sport until you are sure you can stretch the injured tissues without any pain, swelling, or restricted movement, and monitor any other symptoms. When you do return to your sport, start slowly and gradually build up to full participation. For more advice on how to prevent injuries as you return to active exercise, see the box “Tips for Preventing Injury.”
Rest
Although it is important to get moving as soon as possible, you must also take time to rest following an injury. All injuries need time to heal; proper rest will help the process. Your health care professional can guide you regarding the proper balance between rest and rehabilitation.
Other Therapies
Other therapies used in rehabilitating sports injuries include:
•Electrostimulation: Mild electrical current provides pain relief by preventing nerve cells from sending pain impulses to the brain. Electrostimulation may also be used to decrease swelling, and to make muscles in immobilized limbs contract, thus preventing muscle atrophy and maintaining or increasing muscle strength.
•Cold/cryotherapy: Ice packs reduce inflammation by constricting blood vessels and limiting blood flow to the injured tissues. Cryotherapy eases pain by numbing the injured area. It is generally used for only the first 48 hours after injury.
•Heat/thermotherapy: Heat, in the form of hot compresses, heat lamps, or heating pads, causes the blood vessels to dilate and increase blood flow to the injury site. Increased blood flow aids the healing process by removing cell debris from damaged tissues and carrying healing nutrients to the injury site. Heat also helps to reduce pain. It should not be applied within the first 48 hours after an injury.
•Ultrasound: High-frequency sound waves produce deep heat that is applied directly to an injured area. Ultrasound stimulates blood flow to promote healing.
•Massage: Manual pressing, rubbing, and manipulation soothe tense muscles and increase blood flow to the injury site.
Who Is at Greatest Risk for Sports Injuries?
If a professional athlete dislocates a joint or tears a ligament, it makes the news. But anyone who plays sports can be injured. Three groups—children and adolescents, middle-aged athletes, and women—are particularly vulnerable.
Children and Adolescents
Although playing sports can improve children’s fitness, self-esteem, coordination, and self-discipline, it can also put them at risk for sports injuries: some minor, some serious, and still others that may result in lifelong medical problems.
Young athletes are not small adults. Their bones, muscles, tendons, and ligaments are still growing and that makes them more prone to injury. Growth plates—the areas of developing cartilage where bone growth occurs in growing children—are weaker than the nearby ligaments and tendons. As a result, what is often a bruise or sprain in an adult can be a potentially serious growth-plate injury in a child. Also, a trauma that would tear a muscle or ligament in an adult would be far more likely to break a child’s bone.
Because young athletes of the same age can differ greatly in size and physical maturity, some may try to perform at levels beyond their ability to keep up with their peers.
Contact sports have inherent dangers that put young athletes at special risk for severe injuries. Even with rigorous training and proper safety equipment, youngsters are still at risk for severe injuries to the neck, spinal cord, and growth plates. Evaluating potential sports injuries on the field in very young children can involve its own special issues for concerned parents and coaches. Some helpful hints are presented in the appendix.
Adult Athletes
More adults than ever are participating in sports. Many factors contribute to sports injuries as the body grows older. The main one is that adults may not be as agile and resilient as they were when they were younger. It is also possible that some injuries occur when a person tries to move from inactive to a more active lifestyle too quickly.
Women
More women of all ages are participating in sports than ever before. In women’s sports, the action is now faster and more aggressive and powerful than in the past. As a result, women are sustaining many more injuries, and the injuries tend to be sport-specific.
Female athletes have higher injury rates than men in many sports, particularly basketball, soccer, alpine skiing, volleyball, and gymnastics. Female college basketball players are about six times more likely to suffer a tear of the knee’s anterior cruciate ligament (ACL) than men are, according to a study of 11,780 high school and college players. Information on injuries collected since 1982 by the National Collegiate Athletic Association shows that female basketball and soccer players have a much higher incidence of ACL injuries than their male counterparts.
Previous assumptions that methods of training, risks of participation, and effects of exercise are the same for men and women are being challenged. Scientists are working to understand the gender differences in sports injuries.
Although poor conditioning has not been related to an increased incidence of ACL injuries specifically, it has been associated with an increase in injuries in general. For most American women, the basic level of conditioning is much lower than that of men. Studies at the U.S. Naval Academy revealed that overuse injuries were more frequent in women; however, as women became used to the rigors of training, the injury rates for men and women became similar.
Aside from conditioning level, other possible factors in women’s sports injuries include structural difference of the knee and thigh muscles, fluctuating estrogen levels caused by menstruation, the fit of athletic shoes, and the way players jump, land, and twist. Also, “the female triad,” a combination of disordered eating, curtailed menstruation (amenorrhea), and loss of bone mass (osteoporosis), is increasingly more common in female athletes in some sports.
What Can Groups at High Risk Do to Prevent Sports Injuries?
Anyone who exercises is potentially at risk for a sports injury and should follow the injury prevention tips in the box “Tips for Preventing Injury.” But additional measures can be taken by groups at higher risk of injury.
Children
Preventing injuries in children is a team effort, requiring the support of parents, coaches, and the kids themselves. Here’s what each should do to reduce injury risk.
What parents and coaches can do:
•Try to group youngsters according to skill level and size, not by chronological age, particularly during contact sports. If this is not practical, modify the sport to accommodate the needs of children with varying skill levels.
•Match the child to the sport, and don’t push the child too hard into an activity that she or he may not like or be physically capable of doing.
•Try to find sports programs where certified athletic trainers are present. These people, in addition to health care professionals, are trained to prevent, recognize, and give immediate care to sports injuries.
•See that all children get a preseason physical exam.
•Don’t let (or insist that) a child play when injured. No child (or adult) should ever be allowed to work through the pain.
•Get the child medical attention if needed. A child who develops any symptom that persists or that affects athletic performance should be examined by a health care professional. Other clues that a child needs to see a health professional include inability to play following a sudden injury, visible abnormality of the arms and legs, and severe pain that prevents the use of an arm or leg.
•Provide a safe environment for sports. A poor playing field, unsafe gym sets, unsecured soccer goals, etc., can cause serious injury to children.
What children can do:
•Be in proper condition to play the sport. Get a preseason physical exam.
•Follow the rules of the game.
•Wear appropriate protective gear.
•Know how to use athletic equipment.
•Avoid playing when very tired or in pain.
•Make warm-ups and cool-downs part of your routine. Warm-up exercises, such as stretching or light jogging, can help minimize the chances of muscle strain or other soft tissue injury. They also make the body’s tissues warmer and more flexible. Cool-down exercises loosen the muscles that have tightened during exercise.
Tips for Preventing Injury
Whether you’ve never had a sports injury and you’re trying to keep it that way or you’ve had an injury and don’t want another, the following tips can help.
•Avoid bending knees past 90 degrees when doing half knee bends.
•Avoid twisting knees by keeping feet as flat as possible during stretches.
•When jumping, land with your knees bent.
•Do warm-up exercises not just before vigorous activities like running, but also before less vigorous ones such as golf.
•Don’t overdo.
•Do warm-up stretches before activity. Stretch the Achilles tendon, hamstring, and quadriceps areas and hold the positions. Don’t bounce.
•Cool down following vigorous sports. For example, after a race, walk or walk/jog for 5 minutes so your pulse comes down gradually.
•Wear properly fitting shoes that provide shock absorption and stability.
•Use the softest exercise surface available, and avoid running on hard surfaces like asphalt and concrete. Run on flat surfaces. Running uphill may increase the stress on the Achilles tendon and the leg itself.
Adult Athletes
To prevent injuries, adult athletes should take the following precautions:
•Don’t be a “weekend warrior,” packing a week’s worth of activity into a day or two. Try to maintain a moderate level of activity throughout the week.
•Learn to do your sport right. Using proper form can reduce your risk of “overuse” injuries such as tendinitis and stress fractures.
•Remember safety gear. Depending on the sport, this may mean knee or wrist pads or a helmet.
•Accept your body’s limits. You may not be able to perform at the same level you did 10 or 20 years ago. Modify activities as necessary.
•Increase your exercise level gradually.
•Strive for a total body workout of cardiovascular, strength training, and flexibility exercises. Cross-training reduces injury while promoting total fitness.
Women
Increased emphasis on muscle strength and conditioning should be a priority for all women. Women should also be encouraged to maintain a normal body weight and avoid excessive exercise that affects the menstrual cycle. In addition, women should follow precautions listed above for other groups.
Sports Injuries in Young Children: Tips for Caregivers
Here are some “on-the-field” tips for helping a young child who has been injured:
•Minor injuries are fairly common in young children; severe injuries are not.
•A young child’s self-esteem and enjoyment of a sport can be influenced by an adult’s reaction when the child is injured.
•Judging the intensity and finding the site of the pain in a preschool child may not be easy. The child’s perception of severity, influenced by his/her temperament and developmental level, may not match reality. The child’s response to an injury may also reflect his/her prior experiences or the experiences of a friend or family member who has had an injury.
•Don’t judge a child’s reaction to an injury based on the child’s age, sex, or size. Young children may vary greatly in their physical and mental development, temperaments, and reactions to and tolerance of pain and stress.
•Acknowledge the child’s feelings (pain, fright, and/or anxiety), provide emotional support, and convey a sense of protection and caring.
•Treat children with respect. Never ridicule or belittle them in front of their peers, as this may be harmful to their developing self-esteem. Reassure the child that he/she will be cared for and the injury will be evaluated.
•Inappropriate overconcern can have negative effects and may lead to a more frightened child or eventually to a more vulnerable child. Parents may have difficulty remaining objective about their child’s injury. On the other hand, parental knowledge of their child’s temperament and typical reaction to pain can be immensely helpful to others trying to evaluate the severity of the injury.
•Question the child simply and directly. An authoritative approach, gentle but firm, will be reassuring for some youngsters.
•Listen to the injured youngster and get his/her reaction to reentering a sport or activity. Sometimes hidden fears will be expressed that can be addressed by a caregiver who listens. A child’s mental health and development are as important as his/her physical health.
•Time, ice, and a caring attitude will help to minimize many simple traumatic injuries.
More
By Saanichton Physiotherapy
11 Mar, 2016
Back Pain, Fitness, Foot Ankle Pain, Hip Pain, Knee Pain, Manual Therapy, Neck Pain, Orthotics, Physiotherapy, Posture, Preventative Therapy, research, Sports Injury, Sports Therapy
Cycling regularly brings enormous and varied benefits for your health at all ages, whether riding for recreation, as a serious competitor, or racing to win the Tour de France.
And physiotherapists can use their knowledge and expertise to provide guidance on cycling posture and the set up of your bike to ensure you enjoy those benefits in a pain-free way.
But as with any sport, there are common injuries that cyclists incur that may require the help of a physiotherapist. Broadly, these injuries fall into two main categories: overuse and traumatic.
Overuse injuries most commonly includes knee pain, back pain, and Achilles tendon problems.
Cycling is a highly repetitive sport – an average cyclist might perform well over 5,000 revolutions an hour so it is quite understandable how small problems can become bigger issues over time.
Traumatic injuries are most commonly as a result of accidents from falls and crashes.
Cycling is a very safe sport, but as with anything it pays to be aware of your own abilities, to be aware of the environment around you, and to take appropriate safety precautions such as wearing a helmet.
The position you sit in on a bike can be incredibly important, especially when viewed in the context of cycling being so highly repetitive.
Inappropriate bicycle set up can often involve factors such as the seat being too high or too low, the position of the foot on the pedal causing too much load into the foot or ankle, and incorrect distance from the seat to the handlebars can put the body into a position that leads to excessive strain on joints of the shoulders, neck and lower back.
Below, Eric Clarke of The Association of Chartered Physiotherapists in Sports and Exercise Medicine sets out what some of the more common cycling related injuries are and how a physiotherapist can get you back in the saddle.
Fractured collarbone
This is the most common fracture seen in cycling and usually happens when cyclists fall onto the point of the shoulder, referring the impact along the collarbone and causing it to break. The break can be very painful and is usually diagnosed by an x-ray.
How does physiotherapy treat a fractured collarbone?
Pain relief and immobilisation with a sling will be the first course of action. Sometimes, the position of the fracture may require surgery to insert a small plate to hold the bone in place whilst it heals.
The affected arm should remain in a sling for about four weeks, but during this time a physiotherapist can provide guidance on exercises that ensure the shoulder joint does not stiffen.
As the bone heals and the pain recedes, the physio can provide further exercises that focus on improving mobility, posture and strength to enable a return to the saddle for the cyclist.
This is very important as cyclists take a lot of weight through the arms, more than is commonly thought.
Scaphoid fracture
The scaphoid is a small bone on the thumb side of the wrist that can fracture when a rider puts a hand out to break a fall.
Scaphoid fractures often do not show up on an immediate x-ray but will usually present in a follow-up 10-14 days later.
How does physiotherapy treat a scaphoid fracture?
Sometimes the bone will need surgery, but in most cases the wrist will be immobilised in a cast for at least six weeks to allow the bone to heal naturally.
Once the cast has been removed, a physio will guide the person through a series of exercises designed to regain strength in the forearm, wrist and hand.
This is very important as a cyclist needs good strength to control the brakes and gears, as well as to comfortably take weight through the wrist and control the steering of the bicycle.
Muscle contusion and bony bruises
This is where a muscle or bony prominence – most often around the hip and thigh – gets bruised in a fall.
The impact of the fall can cause damage to the muscle or bone causing swelling and visible bruising, and often limits the amount of movement in that area.
How does physiotherapy treat a muscle contusion?
It’s important to apply ice as soon as possible and continue that for short periods over the first 24-48 hours.
Any cuts and grazes should be cleaned and dressed to prevent infection. More serious wounds, or wounds that have debris in them, should be seen to by a doctor.
During the day time, you should try to gently move the joint or muscle to prevent stiffness and to help reduce swelling.
Knee pain
What is it?
Knee pain is the most common pain seen in cyclists and is usually due to the highly repetitive motion of the knee flexing as the pedal goes round.
A knee normally moves over the toes as the pedal goes around, but excessive sideways motion of the knee, or poor bicycle set up can accentuate the forces going through the knee and lead to inflammation or wear and tear on the various structures around the knee.
A seat that is too high may lead to excessive strain on the ilio-tibial band (IT band) which a strong fibrous band that runs down the side of the thigh from the hip to the outside of the knee.
A seat that is too low can cause pain under or around the knee cap due to prolonged time spent pushing whilst too bent.
How does physiotherapy treat knee pain?
The physio will firstly assess the knee to diagnose the problem and advise treatment as suitable for the particular problem.
Once the diagnosis has been determined, a programme of rehabilitation involving manual therapy, stretching and strengthening exercises will be developed to alleviate the symptoms and enable the cyclist to return to cycling.
A physiotherapist experienced in assessing bicycle set up will also look at the look at the position of the cyclist when riding to determine the root cause of the problem and may make suggestions to alleviate the strains on the knee resulting from the position on the bike, such as small changes to seat position.
Neck pain
This is generally caused by poor posture in the saddle or too much time spent in a bad position, reduced flexibility in the upper back, or a fault with the set-up of the bike itself that can exacerbate the problem.
The pain can spread around the region and sometimes can also lead to numbness or tingling in the arms.
How does physiotherapy treat neck pain?
A physiotherapist will assess the neck to produce a diagnosis and once this has been determined, a programme of rehabilitation involving manual therapy, stretching and strengthening exercises will be developed to alleviate the symptoms and enable the cyclist to hold a better posture in the saddle.
The physio will also look at the position of the cyclist when riding to determine the root cause of the problem.
If the position on the bike is causing the issue, then changes to such things as the saddle height or the handlebar position may be suggested.
Lower back pain
This is very common among cyclists because the back is held in a ‘flexed’ position for long periods.
For many non-elite cyclists, it is also worth noting that the main cause of back pain may be the many other lifestyle activities such as prolonged sitting at work or heavy lifting, and that cycling is merely a factor that aggravates the problem.
A sustained flexed position can compress the discs of the spine or place an excessive strain on muscles and ligaments which over time can lead to pain.
The pain itself can sometimes spread from the back to the buttocks, and along the leg.
How does physiotherapy treat back pain?
A physio will assess the cyclist’s posture both on and off the bike to see which aspects are contributing to the problem.
If the position in the saddle is causing the problem, they may suggest changes which can reduce the strain on the back or make cycling more comfortable.
Manual therapy, mobility exercises and stretching will be used to improve movement, not only in the back but also in the gluteals, hamstrings, hip flexors and thighs where tightness could be a contributing factor.
Core strength should be developed to help the cyclist maintain a good position in the saddle and to support the back during longer periods on the bike.
Achilles pain
Often called Achilles tendonitis, this is characterised by pain in the Achilles tendon which runs down the back of the leg from the calf to the heel, and can develop inflammation and other problems through overuse.
How does physiotherapy treat Achilles pain?
Pain management through icing and reduced loading will be the initial approach, coupled with a rehabilitation program of specific exercises to help encourage repair of the damaged fibres in the tendon and strengthen the calf muscles.
The physio may also look at taping the affected area to allow a return to cycling.
Foot pain
Some cyclists suffer pain as a result of the constant pressure being applied through the front of the foot during pedalling.
This can be pain of the soft tissues under the forefoot, but sometimes may involve damage to the nerves which run between the toes.
How does physiotherapy treat foot pain?
As this condition is often caused by the wrong footwear or incorrectly positioned cleats, the physio will assess the cyclist’s position in the saddle and look specifically at how the cyclist pushes through their feet.
Adjustments may be made based on those results and the pain should ease.
If this is not sufficient to alleviate the problem, sometimes inserts inside the shoe may help control the foot position enough to spread the pressure to other parts of the foot.
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By Saanichton Physiotherapy
08 Mar, 2016
Back Pain, Fitness, Foot Ankle Pain, Hip Pain, Manual Therapy, Massage Therapy, Physiotherapy, Preventative Therapy, research, Sports Injury, Sports Therapy, Training
High profile events like the Olympics bring the hope that witnessing and celebrating dedicated athletes at the top of their game, will inspire young people to take up sport and physical activities that help them develop confidence, lead more satisfying lives, and not least, secure long-term health by reducing their risk for developing chronic illness like diabetes, obesity, cancer and cardiovascular diseases.
But unfortunately, if they don’t take appropriate measures, young athletes can instead, end up in pain, on a different path to poor health, due to avoidable sport injury.
James R. Andrews, a former president of the American Society for Sports Medicine (AOSSM), said in May this year, the US has experienced a tremendous rise in the number of young people taking up sport. Estimates show 3.5 million children aged 14 and under receive medical treatment for sport-related injuries, while high-school athletes account for another 2 million a year.
“This makes sports the leading cause of adolescent injury. Along with time away from school and work, these injuries can have far-reaching effects,” said Andrews.
This article looks at some of the common and less common injuries in young athletes. It then reviews a new project that is tracking injuries in Olympic athletes, introduces some ideas about avoiding and minimizing injury, and finishes with a list of tips for preventing sport injury in children. Common Sport Injuries According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which is part of the National Institutes of Health in the US, the most common sport injuries are due to accidents, poor training practices or using the wrong gear or equipment. People can also hurt themselves because they are not in shape, or because they don’t warm up or stretch enough.
Some injury experts in the US have said they are also seeing more and more young athletes injured because of overuse and doing too much, and this may partially explain the growing numbers that drop out of sport by the eighth grade. The most common sports injuries are:
Knee injuries,
Sprains and strains,
Swollen muscles,
Achilles tendon injuries,
Pain along the shin bone, and
Fractures and dislocations.
While injuries in young athletes are similar to the ones that affect adults, they can’t always be treated in the same way because their bodies are not fully developed.
Take for example knee injury.
Knee following treatment for anterior cruciate ligament injury
One type of knee injury is damage to the anterior cruciate ligament (ACL). This is a severe injury that occurs most often in athletes who play football and other contact sports.
Twenty years ago, doctors were seeing few children or adolescents with ACL injuries. Today, these injuries are more common because youngsters are taking up sports earlier, and pushing themselves more competitively.
Another reason for the rise in young people with ACL injury, say researchers from the Hospital for Special Surgery (HSS) in New York City, is that more and more young athletes are specializing in one sport, putting them at risk of injuries normally only seen in professional athletes.
But this type of knee injury in young people is a particular concern because it is not easy to repair in growing bodies, for instance ACL reconstructive surgery that works well in adults can potentially cause uneven limb length or other deformities in growing bodies. That is why often the best course has been “benign neglect”. However, clinicians are beginning to realize that not operating can also lead to problems, such as early arthritis.
There are alternatives to conventional ACL reconstructive surgery, that have lower risk of damage in growing bodies, such as the All-Inside, All-Epiphyseal ACL Reconstruction (AE), but this is not commonly available.
Clinicians are calling for more research to be done into sports injuries in younger people. Back and Neck Injuries Back and neck injuries are much less common in young athletes, but when they occur, they can cause enormous frustration. The athlete must complete a comprehensive and demanding rehabilitation program before returning to competitive sport: in some cases, they may never return to their given sport.
Most back and neck injuries in athletes are sprains of ligaments or strains of muscles. Aside from trauma, these are usually due to athletic overuse, improper body mechanics and technique, being out of condition, or not stretching enough. The athlete will complain of back pain when active and performing, and will feel relief when resting.
But, occasionally, a more serious condition can have similar symptoms. Because of this, proper treatment of back and neck injuries in young athletes should always include a good evaluation by a doctor, using imaging studies when necessary.
According to the North American Spine Society, the more serious back and neck injuries include:
Spondylolysis and spondylolisthesis: a particular type of defect in the vertebra of the spine (spondylolysis), and where one vertebra slips relative to another (spondylolisthesis). A common cause of back pain in young athletes, particularly gymnasts because they have to twist and hyperextend their spines.
Stinger (also called “burner” or “nerve pinch”): where forcing the head back and to the side compresses a nerve of the spinal cord in the neck, or where forcing the head sideways away from the shoulder over-stretches the nerves in the neck and shoulder. Most common in football and wrestling, the injury often goes unreported because symptoms can resolve suddenly and quickly. Can recur and lead to persistent pain or arm weakness if not treated.
Disc injury: a common cause of back pain in adult athletes, much less so among young athletes, it may or may not be associated with sciatica (shooting pain down the leg). Careful diagnosis, including MRI scans, can help to rule out other possible causes that can mimic disc injury in young bodies that are still growing.
Scheuermann’s Disease or juvenile kyphosis: another common cause of back pain in young athletes during puberty that occurs in the mid- as opposed to the lower-back, and leads to a roundness of the back that worsens to a dome shape on bending forwards. Exercises are often not enough to correct this disease, and if wearing a brace does not relieve the pain, surgery may be required, after which it is unlikely the athlete will be able to resume their given sport.
Research on Olympians: the Injury and Illness Performance Project (IIPP) Although you can’t completely eliminate injury and illness, you can look at ways to reduce the risks. This is the purpose of an ambitious and comprehensive national multisport study called the Injury and Illness Performance Project (IIPP).
Beijing 2008 was the first time the International Olympic Committee gathered data on multisport injury, and the Great Britain (GB) squad showed itself to be the best prepared, recording the lowest average injury rate.
Shortly after Beijing, the UK Sport Research & Innovation Team and the English Institute of Sport (EIS) set up the country’s first national multisport injury and illness epidemiological study of its kind.
The project started collecting and examining data in 2009 and is still ongoing. Medical and coaching staff from sports national governing bodies send in detailed information about the occurrence of injury and illness in athletes, and their exposure to risk in training and competition.
Rod Jaques, Director of Medical Services at EIS, says it is important to understand the nature of illness and injury incidence before putting in place new treatments.
14 Olympic sports are involved in the study, each with their own set of data on injury incidence, illness prevalence, and associated risk factors. And each sport has a specific set of recommendations for reducing the risk of injury or illness.
Injury-related results from the project show that since 2009:
67% of interruptions to training for British athletes from Olympic sports have been because of injury.
43% of athletes will get at least one injury per season, some will have several.
On average, each injury results in a loss of 17 days of training, and 1 missed competition.
The rate and severity of injury during training is lower than during competition.
Overall, injuries to the knee, shoulder, hip and lumbar spine present the greatest risk, and the greatest number of total days lost.
EIS Sports Physician Kate Strachan says that the project is a powerful tool because you can turn to an athlete and say, “you have lost X days due to injury last season”. This is just as important to take notice of as making sure you have the best kit and training environment and coach.
Paul Jackson, another EIS Sports Physician, works with pentathletes. He says the information on the link between some lower limb injuries and training load has helped them change injury prevention drills. For some pentathletes, “this means not running and fencing on the same day,” he adds.
Debbie Palmer-Green, a Research Scientist at the EIS, says the project signifies a new approach that views injury and illness as “performance threats”. Prehab to Avoid Rehab Prehab, short for prehabilitation, is a relatively new idea in sports medicine and therapy. It is a personalized exercise program that is individually designed for athletes to help them prevent injury in their given sport.
(There is also another use of the term prehab that refers to improving patients’ fitness before undergoing surgery so they make a quicker recovery and can withstand the inactivity that often follows the procedure).
Athlete at physiotherapy
A prehab programme is becoming a regular part of an athlete’s training routine
The aim of prehab is to avoid injury by compensating for the repetitive movements and stresses of regular, often daily, training. In some respects, you can view athletic training for peak performance in a sport as a form of repetitive strain, with the potential to result in injury in much the same way as computer operators can get occupational injuries like carpal tunnel syndrome and shoulder problems.
With repetitive use, muscles become tight, the body develops imbalances in strength and muscle coordination. These happen naturally during activity, but because training is repetitive, they become repeatedly reinforced with each workout, unless that workout also incorporates some compensating activity, such as in a prehab routine.
A common problem in athlete training is that many athletes and coaches follow the traditional methods of upper and lower body lifting, or basic sprinting and lifting exercises, as a way to develop strength outside of the specific sport drills. But this can leave the core weak in comparison. A prehab program in this case would start with core stability, perhaps focusing on hips, stomach and back core.
Once the basic core program is in place and working, the prehab is updated to include more subtle and focused movements that increase dynamic stability and improve skills in the given sport.
To ensure the best chance of success with prehab, the athlete should start practising it before injury occurs. But unfortunately the usual route to prehab is via injury. A typical scenario is the athlete injures him or herself, goes to a sport therapist or specialist trainer for rehabilitation (rehab), and the therapist then persuades them to sign up for prehab to stop it happening again.
Another way to keep prehab useful and working for the athlete, is to ensure it continually evolves with the needs and changing fitness and ability of the individual. The exercises should be progressive and re-evaluated regularly. There is also the important need to challenge and motivate the athlete, and stop them becoming bored, or habituated to the program.
A successful prehab program is one that forms a regular part of an athlete’s training routine. The therapist needs to have a detailed knowledge of the athlete’s sport, their strengths and weaknesses, and be able to have frank, open conversations with the individual.
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Kegel exercises, also known as pelvic floor exercises or Kegels, are exercises that can be done to strengthen the muscles situated beneath the bladder, bowel and uterus.
Performing pelvic floor exercises can benefit males and females alike and can be carried out at almost any time. These exercises are of particular benefit to people who are affected by urinary incontinence or bowel problems.
Contents of this article:
What are pelvic floor muscles? Symptoms and causes of dysfunction
How to do pelvic floor exercises
Fast facts on Kegels
Here are some key points about Kegel exercises. More detail and supporting information is in the main article.
Pelvic floor exercises are also known as Kegels
Kegel exercises can be carried out while sitting down, standing up, walking and lying down
Kegels can also be carried out during pregnancy and following childbirth
The pelvic floor is comprised of many different muscles
Symptoms of pelvic floor dysfunction include urinary leakage and difficulty emptying the bowel
The pelvic floor can be weakened by gynecological and prostate surgery
The pelvic floor muscles can also be weakened by chronic sneezing caused by allergies
Performing Kegels while urinating could lead to bladder infection
Kegel exercises may improve sexual performance in males.
What are pelvic floor muscles?
The pelvic floor muscles are a vital set of muscles that assist both men and women maintain urinary and fecal continence, impact orgasm, provide stabilization to connecting joints, aid in pelvic, venous and lymphatic drainage and, when working in conjunction with the abdominal and back muscles, provide spinal stabilization.
In addition to the aforementioned functions, the pelvic floor muscles aid in controlling abdominal pressure during movements that cause a strain – during exercise, for example.
The pelvic floor is comprised of several different muscles:
Bulbocavernosus
Ischiocavernosus
Superficial transverse perineal
External anal sphincter (EAS)
Compressor urethera
Uretrovaginal sphincter
Deep transverse perineal
Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus
Coccygeus/ischiococcygeus
Piriformis
Obturator internus.
Symptoms of pelvic floor dysfunction
Fast facts about uterine prolapse
One study found that women in the US have an 11% lifetime risk of uterine prolapse
Women with a high body mass index have an increased risk of uterine prolapse.
Learn more about uterine prolapse
There are a variety of symptoms associated with pelvic floor dysfunction, many of which are vague and associated with other medical conditions.
Symptoms associated with pelvic floor dysfunction include:
Urinary incontinence (leaking) with laughing, coughing, sneezing or exercising
Urinary urgency or frequency
Difficulty with bladder or bowel emptying
Accidental flatulence
Pelvic pain
Painful intercourse
Organ prolapse.
Causes of pelvic floor dysfunction
Pelvic floor dysfunction occurs when the pelvic floor muscles are weakened, stretched or too tight. Pelvic floor muscles can be weak from an early age, gradually weaken over time or be weakened by a single event.
As with many other medical conditions, there are certain situations and conditions which place a person at a higher risk for developing pelvic floor dysfunction.
Pelvic floor dysfunction can result from a variety of factors, ranging from childbirth to chronic sneezing.
Factors that can increase the risk of pelvic floor dysfunction include:
Pregnancy and childbirth
Menopause
Overuse or underuse of the muscle groups
Back pain
Constipation or straining with bowel movements
Being overweight or obese
Heavy lifting
Conditions such as asthma and allergies that cause chronic coughing or sneezing
Injury to the pelvis
Surgery such as gynecological or prostate surgery.
Elite athletes such as runners and gymnasts have an increased risk of pelvic floor dysfunction, as have older individuals as their muscles weaken over time.
How to do Kegels
Both men and women can benefit from performing exercises to work and strengthen the muscles of the pelvic floor. Pelvic floor dysfunction can be greatly improved with regular exercises targeting these muscle groups.
Kegel exercises for females
How to do a proper Kegel is vital to the success of the treatment. These exercises can be done anywhere and at any time and are beneficial in strengthening the muscles of the pelvic floor.
Your health care provider or physical therapist can instruct you on how to perform a proper Kegel while in their office, at which time proper technique can be evaluated. Pelvic floor exercises can also be done during pregnancy and after childbirth.
At times, a technique called biofeedback may be necessary. During biofeedback treatment, a device will monitor proper muscle contraction, the strength of the pelvic floor and timing of Kegels. Biofeedback reinforces proper technique of the exercises.
Kegel exercises can be carried out discreetly in any location; even while at work in an office.
In order to perform a proper Kegel, you will need to:
Relax the abdomen, chest, thighs and buttocks
Tighten the pelvic floor muscles, as if you are attempting to stop urinating, and hold for 5-10 seconds. If you are able to feel an upward movement and tightening of the vagina, anus or bladder, you have successfully completed a Kegel.
Take a 5-10 second break and repeat for three sets, 10 times per day. The ultimate goal is to hold the contraction for 10 seconds each time the exercise is performed.
To be sure you have correctly identified the pelvic floor muscles and performed a Kegel, some women find it helpful to insert a finger into the vagina and perform the Kegel; if performed correctly, the muscles will tighten and move upward.3. Additionally, some women may also benefit from using a weighted vaginal cone, attempting to hold the cone in place within the vagina while performing a Kegel exercise.3,4
It is not advised to frequently perform Kegel exercises when urinating; this technique can increase the risk of incomplete bladder emptying and urinary tract infections.
Additionally, Kegels should be done as recommended; overexercising of the pelvic floor muscles can worsen pelvic floor dysfunction symptoms due to muscle fatigue. Positive results can be expected within a few weeks to months of Kegel exercise practice
Kegel exercises for males
Men are not immune to the effects of a weak pelvic floor and may benefit from performing Kegel exercises. As well as improving bladder and bowel control, pelvic floor exercises may also improve sexual performance.
The surgical removal of the prostate (radical prostatectomy) is another factor that can weaken the pelvic floor muscles.
It may be necessary to have a health care provider offer proper instruction or biofeedback techniques; biofeedback will use sensors placed in the anus to provide a visual graph showing muscle contraction and relaxation.
A man is smiling and sitting down.
Men can also benefit from performing Kegel exercises if they have a weak pelvic floor.
Additionally, it may be helpful to self-identify the muscles of the pelvic floor used during a Kegel. In order to do this, men can insert a finger into the rectum while tightening and relaxing the pelvic floor muscles (as if you were holding or stopping the urine stream).3
In order to perform a Kegel properly, you will need to:
Relax the muscles of the abdomen, thighs and buttocks while breathing normally
Locate the pelvic floor muscles as above
Tighten the pelvic floor muscles as if you are attempting to stop urinating, hold for 3 seconds and then relax for 3 seconds. Repeat in sets of 10, three times per day.
As above, it is not advised to frequently perform Kegel exercises when urinating; this technique can increase the risk of incomplete bladder emptying and urinary tract infections.
Additionally, Kegels should be done as recommended; over-exercising of the pelvic floor muscles can worsen pelvic floor dysfunction symptoms due to muscle fatigue. Positive results can be expected within a few weeks to months of Kegel exercise practice.
Speak with your health care provider if you have symptoms of or are at risk of developing pelvic floor dysfunction, or if you need additional instruction on how to perform pelvic floor exercises. At times, evaluation with a pelvic floor physiotherapist may be recommended.
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