Principles of Management of Sports Injuries

Sports injuries can be broadly classified into 2 big groups overuse injuries and traumatic injuries. Traumatic injuries are fairly straight forward in their origin. Overuse injuries are a result of exercise induced micro-damage accumulating past the point where the body is able to repair, hence manifesting as clinical injuries. Another common cause of injury is too soon too fast. This usually happens when an athlete starts on a new exercise programme and experts unrealistic progress, advancing faster than the body's ability to cope resulting in injury.

A rule of thumb of increment would be about 10 per cent increase per week in your exercise regime. Some more gifted athelets may be able to advance faster than this but this is a safe margin for most. I like to draw an annalogy between progress in exercise and the snake and ladde board game. All of us like to make leaps and bounds in our exercise progress, not unlike the ladder in the boundgame, however, be ever mindful of the ugly snake waiting quietly at the corner, like an injury, which will undo your progress ad return you to square one.

What Should I Do When I am Injured?

The management of sports injuries can be approached from 1 angles, the acute on field management and definitive treatment. Acute on the field management includes moving the casualty to a safe place. ABCs of resuscitation if necessary and RICE therapy. RICE therapy is an acronym for Rest, Ice, Compression and Elevation. The injured body part must be allowed to rest to facilitate recovery.

The body intrinsic natural response to injury is pain and it is primarily protective. No pain no gain does not apply here! Ice is useful to encourage blood vessels to contract and therefore reduce the amount of bleeding and hence swelling. Swellings around the joint have been shown to be inhibitive to muscles contraction, another inbuilt protective reflex. Compression in the form of bandages is useful to limit a laurniquet! Finally elevate the injured part to facilitate circulation and minimize swelling.

Now, What's Next?

The first principle in the management of sports injuries is to get an accurate diagnosis. Simple as it may sound, it is often overlooked. How many of you are guilty of self medication without a proper diagnosis, only to seek attention later and realize it is not a muscle pull as you had thought. An accurate precise diagnosis, sometimes necessitating diagnostic aids such as ultrasound and MRI is the key foundation to the management of any sports injuries. It forms the roadmap to a formulation for recovery and treatment plans. So see your doctor and find out what's wrong first!

The next step is to relieve pain and swelling. This is an important step to contain the damage and to facilitate the body repair mechanisms. This may entail the use of medications, physiotherapy etc. Rehabilitative exercise may be initiated at this point to facilitate return of range of motion exercises. Treatment goals are clearly identified and a team approach is adopted. Sports medicine is one specially where a team comprising of coach, trainer, team physician, sports therapist and the sports orthopedic surgeon works together to draft cut a recovery plan for the patient.

Having diagnosed the problem, the next and probably the most difficult step is to identify the root cause. Sports injuries are notoriously difficult to eradicate because they keep recurring. The reason behind is that the athlete keeps infliciting the same injury on himself when he return to the sports after you have treated him. How? Well, the answer lies in understanding the biomechanics and nature of the game and the demand it places on the body.

All example would be the relationship between cricket bowlers and shoulder injuries. The bowler uses an overhead throw with a fairly straight arm, placing tremendous stress on the shoulder joint. A firm understanding of the bowler technique will help to pick up bowling technique errors which can help to prevent a recurrence besides just treating the shoulder injuries.

Although in the management of sports injuries, therapy and medications form the main pillar of treatment, in selected cases surgery may be required. One of the big advances in the surgical management of sports injuries have been the use of keyhole surgery. The advantage of keyhole surgery is the damage to unaffected tissues is extremely smaller, facilitating much faster recovery and return to sports. In addition, the results are just as good if not better than conventional open surgical techniques. Such techniques are widely applied to many parts of the body like the knee, shoulder, wrist, ankle and the spine.

Finally, the last tenet of sports injury management is a gradual and safe return to sports. Remember the snake and ladder board game! Realistic goals should be set and pace yourself. A common misconception is to pick up where you last left off, i.e. before you get injured 6 months ago. I would suggest dropping to at least 50% of where you left off and build up gradually.

In summary, accurate diagnosis with a team approach to the management of sports injuries will put many athletes on the road to recovery. Identification of root causes either in techniques or training programmes will minimize recurrences and finally a graduated but safe return to sorts.

Submitted By
The author is a Consultant Orthopedic Sports Surgeon, Island Sports Medicine and Surgery, Gleneagles Medical Centre.
Dr Jee-Lim Tan, MBBS, FRCSFA, FRCS (GLAS), Dip Sport Med (CASM), FAMS

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