SPORTS INJURIES

EPIDEMIOLOGY

In the U.S., about 30 million children and teens participate in some form of organized sports, and more than 3.5 million injuried each year. Almost one-third of all injuries incurred in childhood are sports-related injuries. By far, the most common injuries are sprains and strains.

No data is available on prevalence of sport injuries of Pakistan.

The following statistics are from the National SAFE KIDS Campaign and the American Academy of Paediatrics:

Injury rates:

• More than 3.5 million children ages 14 and younger get hurt annually playing sports or participating in recreational activities.
• Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury.
• Sports and recreational activities contribute to approximately 21 percent of all traumatic brain injuries among American children.
• Almost 50% of head injuries sustained in sports or recreational activities occur during bicycling, skateboarding, or skating incidents.
• More than 775,000 children, ages 14 and younger, are treated in hospital emergency rooms for sports-related injuries each year. Most of the injuries occurred as a result of falls, being struck by an object, collisions, and overexertion during unorganized or informal sports activities.⁽¹⁾

SIGN AND SYMPTOMS:

Common signs and symptoms of sports Injuries are:

PAIN: Tenderness of a joint can help indicate the source of pain after an injury. Aspects of pain including the location of tenderness, the depth of pain, and the type of pain experienced can help to determine the possible cause of pain and injury. In the very early stages after injury, patient may not notice swelling or any restriction in ability to move. Tenderness when pressure is applied, however, can be an important indicator that a serious injury has occurred.

SWELLING: Swelling is a sign of inflammation, body's effort to respond to injury and initiate the healing response of the immune system. While swelling is not necessarily a bad thing, it can cause discomfort. There are a few types of swelling:

• Effusion: Swelling within a joint
• Oedema: Swelling in the soft tissues
• Hematoma: Swelling due to bleeding into the soft tissue

Limiting swelling allows body to progress healing to the next stages of the response to injury.

STIFFNESS: The ability to move is a good sign of the severity of injury of a joint.

While pain can be difficult to quantify, the mobility of a joint, or lack of, is typically very clear. It is easy to compare the mobility of the uninjured extremity to the joint of concern. Joints that lack full mobility should generally be rested until motion is restored before resuming sports activity.

INSTABILITY: An unstable joint feels loose or like it wants to buckle or give out. This is often a sign of a ligament injury, as the injured joint is not adequately supported after it has been damaged. This is a common sign of an ACL tear in the knee.

Less Common Signs of Sports Injuries

WEAKNESS: Pain that limits the strength of the injured area can be due to weakness. However, weakness can also signify structural damage to a muscle or tendon that prevents the normal function of the extremity.

NUMBNESS AND TINGLING: Numbness or tingling is a sign of nerve irritation or injury. Sometimes nerves are directly damaged, other times a nerve can be irritated by surrounding swelling or inflammation.

DIAGNOSTIC TESTS:

Many doctors use specific tests to identify and diagnose a sports injury; some common examples of tests are listed below:

KNEE INJURIES:

CARTILAGE TEARS: Doctors will apply pressure to the knee to identify any tenderness above or surrounding the damaged cartilage; they may also flex the knee when the patient is lying flat and listen out for a clicking or popping noise when the knee bends (this is also known as McMurray’s test). Ege’s test may also be carried out; this involves the patient squatting; a popping or clicking noise may be heard when the knee bends.

LIGAMENT DAMAGE: There are several different tests used for detecting a ligament tear or strain (these include the Lachman test, the anterior draw test and the dial test); most are used to identify cruciate ligament damage. Most tests involve applying pressure to the knee joint, moving the knee and bending the knee; the nature of the injury can usually be determined by the movement or positioning of other parts of the leg and the extent and location of pain.

SHOULDER INJURIES:

Rotator cuff injuries are the most common cause of shoulder pain and can usually be identified by observing and feeling the shoulder joint during a number of different movements. Often a doctor will feel the area in order to identify any swelling or anatomical abnormalities. Injuries usually inhibit movement so a limited range of movements or pain resulting from specific movements can often be used to diagnose a specific type of injury. Strength tests may also be used to identify weakness in the joint.

DIAGNOSTIC TESTING:

Diagnostic testing includes methods which help doctors to identify specific injuries; common examples of these tests include x-rays, CT scans, ultrasound and MRI scans.

DEXA SCANNING (BONE DENSITY SCANNING):

All women, but particularly female athletes, are at risk for developing osteoporosis or bone loss. DEXA, which stands for "dual energy X-ray absorptiometry," is the most commonly used test for measuring bone mineral density, as wells as one of the most accurate ways to diagnosis osteopenia or osteoporosis.

DEXA scans are more accurate than standard X-rays, as a person would need to lose 20-30 percent of their bone density before it would show up on an X-ray. DEXA requires less radiation exposure than CAT scans or radiographic absorptiometry.

ELECTRODIAGNOSTIC EVALUATION:

An electrodiagnostic evaluation can help diagnose pain, numbness or weakness involving the peripheral nervous system and muscles. Consisting of non- or minimally-invasive procedures, the evaluation delivers small electrical impulses to affected body regions. Test results provide information about the ability of muscles to respond to stimulation and the rate at which an electrical impulse moves through nerves, aiding the development of treatment options.

The first part of the evaluation is called the nerve conduction study, which examines how information is sent that allows to do things such as walk or reach and hold objects. The speed and number of nerve fibers are evaluated. The second part of the evaluation is called the electromyography or ‘EMG.’ An EMG analyzes the health of the muscles and the nerves that control the muscles both.

TREATMENT OPTIONS:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as aspirin, ibuprofen or etoricoxib reduce swelling and pain. Another common drug is acetaminophen. It may relieve pain, but it will not reduce swelling.
• Immobilization Immobilization is a common treatment for sports injuries. It keeps the injured area from moving and prevents more damage. Slings, splints, casts, and leg immobilizers are used to immobilize sports injuries.
• Surgery In some cases, surgery is needed to fix sports injuries. Surgery can fix torn tendons and ligaments or put broken bones back in place. Most sports injuries don't need surgery.
• Rehabilitation (Exercise) Rehabilitation is a key part of treatment. It involves exercises that step by step get the injured area back to normal. Moving the injured area helps it to heal. The sooner this is done, the better. Exercises start by gently moving the injured body part through a range of motions. The next step is to stretch. After a while, weights may be used to strengthen the injured area. As injury heals, scar tissue forms. After a while, the scar tissue shrinks. This shrinking brings the injured tissues back together. When this happens, the injured area becomes tight or stiff. This is when patient is at greatest risk of injuring the area again. Stretching should be done every day. Always stretch as a warmup before play or exercise.
• Rest Although it is good to start moving the injured area as soon as possible, it is also suggested to take time to rest after an injury. All injuries need time to heal; proper rest helps the process.
• Other therapies include mild electrical currents (electrostimulation), cold packs (cryotherapy), coolant cream / sprays (like menthol), heat packs (thermotherapy), sound waves (ultrasound), and massage.⁽²⁾

PRECAUTIONS:

Instruct patients on following prevention which can help to avoid sports injuries:

• Don't bend your knees more than half way when doing knee bends.
• Don't twist your knees when you stretch. Keep your feet as flat as you can.
• When jumping, land with your knees bent.
• Do warmup exercises before you play any sport.
• Always stretch before you play or exercise.
• Don't overdo it.
• Cool down after hard sports or workouts.
• Wear shoes that fit properly, are stable, and absorb shock.
• Use the softest exercise surface you can find; don't run on asphalt or concrete.
• Run on flat surfaces.
• Strive for a total body workout of cardiovascular, strength-training, and flexibility exercises.

FOR CHILDREN:

• Be in proper condition to play the sport.
• Get a physical exam before you start playing sports.
• Follow the rules of the game.
• Wear gear that protects, fits well, and is right for the sport.
• Know how to use athletic gear.
• Don't play when you are very tired or in pain.
• Always warm up before you play.
• Always cool down after you play. ⁽²⁾

REFERENCES:

1. hopkinsmedicine.org/healthlibrary/conditions/pediatrics/sports_injury_statistics_90,p02787/
2. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse National Institutes of Health