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SPORTS INJURIES DIAGNOSIS & TREATMENT

the healing process, but too much inflammation and swelling is counter- productive.

PAIN AND MUSCLE ACTION Pain inhibits muscle action, so reducing pain will allow the muscle to work more effectively and protect the joint better. Ice is an excellent analgesic for muscle and joint pain! Applying an ice-pack for 10 minutes every hour is usually sufficient but you must remember to place something between the skin and the ice to prevent ice-burn eg. a damp cloth. The coldness also limits bleeding, by causing vessels to contract and by facilitating clotting. Compression of the ice-pack works even better. eg. Cryo- Cuff™) and elevation of the affected limb also helps considerably. How long should these measures

be taken for? Usually ice is applied for 10–20 minutes every hour. The painful limb should be rested for 24-48 hours. Compression can be used for a week. Get the patient to elevate the limb for as long as possible. This simple treatment regimen

certainly works, but the biggest problem is getting non-elite sports people to do these things themselves, when there is no medical or physio help at hand to push home the message.

INJURY REPAIR The pathology of repair is outside the scope of this article, but you will find plenty of information about it in Spector and Axford’s Introduction to General Pathology (1). In brief, the repair process involves encouraging all tissues to regain their function as well and as quickly as possible. The recovery phases of the repair process overlap (see Fig. 2). This will depend on how much damage needs to be repaired. There are three levels of damage possible in ligaments, muscles and tendons: n Mild: partial tear; slight loss of function; pain. n Moderate: incomplete tear; pain; loss of function due to pain. n Complete: complete tear; often no pain; function affected by loss of structure.

Different considerations apply to

the rehabilitation of injuries to muscles, ligaments and tendons.

Muscle rehabilitation www.sportEX.net

Once the initial inflammatory process has stopped, maintain the length of the muscle by gentle movement and stretching exercises to maintain ROM – but avoid high impact. A strong muscle needs to be able to reach FROM without being stretched chronically. The blood supply to the muscle is variable, usually at or near its peak when it has been injured. This increased blood flow helps the tissues repair, but it is very important to use ice to reduce any blood loss. Remember, heat and massage should not be used on injured muscles within 48 hours of the injury because there is a risk of myositis ossificans occurring after 12–18 months. Start with exercises that are not too stressful, such as eccentric movements, then isometric contractions, then concentric contractions. Avoid gravity whenever possible, then slowly add its effects in. Strong, well-rehabilitated muscles protect the joint, sometimes better than they did before the injury.

Ligament rehabilitation Ligaments are usually slower to repair than muscles as they have a smaller (but more constant) blood supply. As they are bone-connectors as well as having a role in joint proprioception, their integrity when healed is paramount. They need to be exactly the right length to allow the best proprioception and to activate muscle action for protecting the joints, and strong enough to initiate that protection and hold the joint together. Early return to sport may be possible for people with ligament injuries. Proprioceptive taping may be helpful. Like rubbing an injured area, the sensations and tactile pressure of the tape have soothing effects that last for as long as the tape remains on the area. The tape also gives clear feedback, so preventing painful or improper posturing. The skin sensation augments the initiation of proprioception alongside the injured or weakened ligaments. However, taping is not a substitute for good rehabilitation exercises.

Tendon rehabilitation Tendons do not get acutely injured as often as ligaments and muscles. The rotator cuff of the shoulder and the Achilles tendon are exceptions. Overuse injury and compromised tendons (weakened by overuse or

A CHANGE HAS CAUSED THEIR INJURY

steroid abuse, for example) may however lead to acute injury, often involving complete rupture and very large forces. These are emergencies that invariably require secondary care. Rehabilitation usually starts with surgical repair

CONCLUSIONS This summary of diagnosing and managing different sorts of musculoskeletal injuries is an overview to a series of complementary articles, each of which will look in more depth at specific joints. The next article will focus on the shoulder and will cover its anatomy and biomechanics, the most common injuries (including overuse injuries) and their causes and rehabilitation, including appropriate exercises.

References

1. Spector TD and Axford JS. Introduction to General Pathology. Churchill Livingstone 1999. ISBN 978-0443048845.

THE PATIENT MAY NEED SOME CONVINCING THAT

Dr Simon Kay, MBBS MRCGP DRCOG DIPL and MSc Sports medicine, member of FSEM BASEM BMAS SOC and Honoury Education Fellow Exeter University. Simon is a full-time

GP/Sports Physician, Yorkshire Missionary in Devon. He has been a GP for 25 years and is an ex-keen rugby player. He become interested in sports injuries since injuring his knee in 1988 and completed his Diploma in Sports Medicine in 1997, followed by his MSc in 2006. Since 1999 he has added acupuncture, SOM teaching, manipulation, podiatry teaching and sports therapy teaching to his repertoire. He teaches students, GPs and sports therapists and has been medical officer to various rugby clubs notably Halifax RUFC and Exmouth RFC, England SW U18 Rugby, and now Exmouth ABA. For more information visit www.sports-doctor.co.uk

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