Coaches Corner

** 95% of sports injuries are due to minor trauma involving soft tissue injuries: bruises, muscle pulls, sprains, strains, and abrasions.
** 6% of athletic injuries constitute a fracture
** 55% of athletic injuries occur in the knee
** 20% of athletic injuries occur at the shoulder
** 7% of athletic injuries occur at the elbow
** 10% of spinal injuries occur during sport

Injuries among athletes fall into two basic categories: overuse injuries and acute injuries, with both types including injuries to the soft tissues and bones.

• Overuse injuries are caused by a series of small injuries to the same area of the body causing minor fractures, minimal muscle tears or progressive bone deformities (i.e. shin splints).
• A sudden trauma (i.e. ankle sprain & hamstring strain).

HAMSTRING INJURIES

Conditions that predispose an athlete to an acute hamstring injury are:

• Inadequate warm-up/stretching
• Poor lower back flexibility
• Abnormal biomechanics (i.e., anterior pelvic tilt/abdominal muscle weakness).

Conditions that result in chronic hamstring injuries are:

• Improperly rehabilitated acute injury
• Poor hamstring flexibility
• Small amounts of muscle trauma repeated over a long period (distance running).

SHIN SPLINTS

This term is used to describe pain along the shin (tibia) and is commonly seen as an overuse injury in runners. It usually develops gradually over a period of weeks to months, but may occur after a single excessive bout of exercise. The pain is usually noticeable when exercise starts, then decreases or goes away as exercise continues. It is worse after exercise stops or the following morning.

The cause of shin splints

• Training errors:
  Too much exercise without appropriate rest. Exercise programs dictate a slow, progressive increase in volume and intensity over a long period of time. A sudden jump in volume overloads your ability to heal during rest, and injury may result. It has been advised to start the exercise program slowly and build by no more than 10% per week (total volume). Often, every third or fourth week is light to allow for recuperation and healing.
• Abnormal Biomechanics:
  Overpronation of the foot during running tugs on the muscular attachments to the tibia, resulting in inflammation. The condition leading to this are: tight calf muscles & flat arches. Correction of abnormal biomechanics is crucial because if not addressed, the problem will come back. Uneven wear when comparing one shoe to another may signal abnormal motion in one leg. A good arch support is important, sometimes orthotics are required. * Running shoes lose 30-40% of their shock absorbing capabilities after 500 miles. The tread may look fine, but the capacity to prevent injury is not.

ANKLE SPRAIN

Sprains are injuries to ligaments, the tough rope-like fibers that connect bone to bone. Ankle sprains often occur when the ankle twists, turns, or "rolls in" during sports activities, stepping off a curb, or when walking on uneven ground.

First degree: stretching of the ligament, no tear.

• Mild to moderate swelling and pain
• A stable joint (doesn't feel loose or wobbly)
• Normal range of motion

Second degree: partial tear of the ligament.

• A popping or tearing feeling at the time of the injury
• Moderate to severe pain and swelling
• Purple discoloration from bruising
• Restricted ankle movement because of pain

Third degree: complete tear of the ligament.

• A pop or snap felt or heard at the time of the injury
• Severe pain, swelling, and bruising
• An unstable joint (feels wobbly or loose)
• Significant decrease in range of motion and inability to walk because of pain
• A grating sound or feeling
• A bulge at the site of a complete tear
• Change in sensation, such as numbness or tingling

HAND, WRIST, AND SHOULDER INJURY

Occupational Therapists (OT’s) assist in the treatment of a variety of athletic injuries to the hand, wrists and shoulder as a result of participation in sports activities and adapt equipment as in needed to promote greater participation in sporting events

The athlete may have fractures of the carpal bones or ruptured ligaments that often accompany falling on the outstretched hand or excessive force to the wrist or fingers that occurs while catching a ball, or making a tackle.

*When an injury occurred OTs can first treat the injury of the upper extremity, also fabricate braces and supports to help protect the athletes joints and muscles allowing them to participate with more success.

-Treatment and bracing, which may include splint fabrication are completed to:

1. Control pain and edema
2. Protect the muscles and joints from further strain.
3. Assist in promoting strength which is within the normal range.
4. Assist the athlete in recovering a normal sequence of motion and timing.

-Precautions to be aware of while using splints and braces which have been fabricated:

1. Splints should be fabricated from material that protects the player but does not cause injury to opposing players.
2. Watch for a skin rash under a splint, which may occur from perspiration. A stockinet liner may be needed to absorb perspiration or holes may be made in the splint at random intervals.
3. Examine splints frequently for signs of structural fatigue.
4. Watch for edema or skin redness under or around the splint.
5. Always have the person report any pain or numbness associated with splint or brace.
6. Be aware of athletic rules regarding the use of protective splints on the playing field.

Common injuries often associated with sporting events:

1. The person may have "Jersey Finger" which occurs when an athlete grabs an opponent’s jersey and forcibly extends the small joint of the finger, most commonly the ring finger.
2. The person may have "gamekeeper’s thumb," which is a complete or partial ligament at the base of the thumb caused by excessive flexion, often caused from falling on an outstretched hand.
3. The person may have mallet finger injury, which occurs when a ball strikes an extended fingertip forcing the tip of the finger into the flexed position while the extensor mechanism is actively extended.
4. The person may have nerve compression injuries to the median or ulnar nerves, such as carpal tunnel syndrome from repeated wrist motion and grasp.

RECOVERY TIME/RETURN TO SPORT

This time can vary depending on the severity of the injury. The damaged area gains a good deal of strength in only twenty days as more scar tissue is laid down. However this is followed by the maturation stage where scar tissue contracts or shrinks to bring the damaged tissues back together. The athlete may experience a feeling of stiffness at the stage rather than pain. If you have returned to sport at this stage there is potential for re-injury. Therefore it is important to include a program of strengthening and stretching so the tissues can maintain adequate length for normal function. The maturation process has been reported to take over 6 months so the stretching program should be a long-term process even though the athlete is back to full activity.

CRITERIA FOR RETURN TO SPORT

• Full range of motion
• Normal strength
• Normal flexibility
• No pain
• No medications

SIGNS THAT MAY SIGNAL A VISIT TO THE DOCTOR

• Inability to play / participate in the sport following an acute or sudden injury.
• Decreased ability to play / participate in the sport because of chronic or long- term complications following an injury.
• Visible deformity of the athlete's arm or leg.
• Severe pain from acute injury which prevents use or the arm or leg.

TREATMENT OF SPORTS INJURIES

Many athletes believe they should "work through the pain." Prompt treatment however can often prevent a minor injury from becoming worse. Here are a few tips to help you assist the natural healing process and overcome common problems that may otherwise lead to a re-injury or chronic long-term injury:

• Response: respond to the injury by stopping the activity or pattern of movement which either causes pain or in which the function is limited. Absolute rest if there is pain with walking and daily activities. Relative rest is rest on a constant level while the other techniques (see below) are performed until healing occurs. Then a gradual increase in workouts is permitted.
• Medication: Non-sterodial ant-inflammatory medications (such as Motrin or Advil) help to decrease inflammation, and thereby pain and swelling, at the injury site.
• Ice: crushed ice in a plastic bag wrapped in a damp towel, place over the injured area for 10min. Do not place an ice bag or ice pack directly over the skin as this can result in a burn. Repeat every 2 hrs for the first 48 - 72 hrs, or until the area no longer looks or feels hot. This is primarily to slow down the circulation of blood through the damaged blood vessels to reduce leakage and secondly to reduce the rate of the chemical reactions which produce pain.
• Compression: an ace bandage can be used to secure the ice bag. Begin wrapping from the point farthest from the heart (distally) and wrap toward the center of the body (proximally). This is primarily to prevent i. bleeding ii. excessive swelling iii. build up of fluids around the injury site which we normally remove by activity.
• Elevation: Throughout the day rest the limb on a chair or bench. to assist in the removal of excess fluid from the injury site by the use of gravity.
• Endurance: While you are resting your injury, you should maintain your endurance by "crosstraining." This includes choosing another form of exercise, which does not stress the injured area (i.e. stationary cycling after an elbow injury.
• Movement: Work at establishing a full range of motion as soon as possible after an injury. This will help maintain flexibility during healing and prevent scar tissue formed by the injury from limiting future performance.

Additional medical treatment might include taping, bracing, casting, orthotics, physical therapy, medication, or surgery. If an ankle injury is left untreated, a person may have long-term pain, limited movement, deformity and recurrent ankle injuries.

• The current research doesn't recommend long term use of ankle bracing.
• A combination of tape and bracing can be beneficial for athletes who choose to participate despite pain and limited range of motion.
• An ankle brace should always be reapplied at half time of the athletic event.

INJURY ASSESSMENT CLINIC

A physical therapist is available Monday through Friday 8am - 5pm for sports related injury consultation. Treatment of the injury can occur following physical referral and parental consent.