- Acute injury – initial treatment
- Ligament sprain/tear
- Muscle Strains
- Tendon injuries
- Bone Injury
WE HAVE A RANGE OF TREATMENT OPTIONS AVAIABLE
The most common ligament injuries seen are the lateral ligament of the ankle which is injured when the ankle inverts (rolls outward) under load, the medial collateral ligament of the knee on the inner aspect typically injured in a tackle when the lower knee is forced inwards stretching the ligament, and the anterior cruciate ligament which can be injured when the knee is hyperextended or rotated.
Ligament injuries can be graded dependant on severity, and this can help with prognosis. Grade I sprains involve only a few fibres of the ligament with no loss of joint stability; Grade II sprains show some joint instability when the ligament is stressed as it involves a considerable portion of fibres being torn. Grade III sprains show gross instability as the ligament will be completely torn.
Our management of grade I and II injuries will initially follow the D.R. I.C.E. procedure outlined above. Early mobilisation will be started when safe to do so to prevent joint stiffness. Soft tissue massage will also be used to assist mobilisation of the repairing tissues. A graduated muscle strengthening programme will be used to provide extra support and stability to the injured area.
Proprioceptive (balance) training and functional (sport specific) training will also be necessary before a safe return to sport. Treatment of grade III injuries may require surgical repair of the torn ligament or protective bracing.
Pain will be felt on active contraction with no loss of strength. Grade II involves a significant number of fibres, will also have pain on contraction and strength and movement will be affected. A grade III injury is a complete tear of the muscle.
It is possible for muscle pain to be referred from a more proximal joint or structure. For example pain in the posterior thigh could be as a result of a hamstring injury, of nerve impingement in the lumbar spine, referred pain from the Sacro-iliac joint or from gluteal and Piriformis muscles in the buttock. Similarly pain from the hip joint can be felt in the quadriceps region.
Diagnosis should be sought as early as possible. Treatment of muscle strain will initially be D.R. I.C.E. to control swelling and inflammation. Subsequent treatment will include soft tissue massage and stretching to promote efficient scar formation without compromising flexibility. A graduated muscle strengthening programme will be required to ensure the muscle regains full muscle strength. This will involve some sport specific conditioning of the muscle affected to ensure it can safely cope with the demands of your sport.
An essential part of our management of muscle injury will be to address any predisposing factors that may have led to injury. These include any muscle imbalances that may cause overactivity and shortening in some muscle and weakness and lengthening in other groups.
Stability training is frequently used by our physiotherapists to rectify imbalances as part of a rehabilitation programme. Technique and biomechanical factors can cause injury and our clinicians and/or coaches will address these. Impaired neural mobility, poor muscle flexibility, previous injury can also predispose an athlete to muscle injury. Training factors such as inadequate warm up or cool down, sudden increase in intensity or frequency should also be considered.
Tendinitis is a term commonly used to describe overuse injuries affecting tendons. They are among the most common sports injuries, commonly affecting the patella tendon and Achilles tendon of runners and sports involving weight bearing exercise (most sports!). Rotator cuff tendons of the shoulder can also be affected in sports involving repetitive arm motion (swimming, throwing, bowling, racket sports) as can the flexor and extensor tendons of the elbow, causing golfers or tennis elbow. Tendinitis may involve inflammation of the tendon sheath (paratendinitis). Degeneration of the tendon may also be present (tendinosis).
Management of tendinitis must address the factors leading to “overuse”. Detailed assessment of the athlete is required to identify the factors. They maybe extrinsic such as equipment (footwear, racket grip) training (intensity, frequency, duration). Technique, e.g. poor running technique [link to running biomechanics] or stroke technique in tennis can lead to overstrain of tendons. Intrinsic factors include posture, alignment, muscle imbalance, flexibility, and stability.
Rest or modification of activity maybe required allowing symptoms to settle. Soft tissue massage and mobilisation will be used where there is thickening or tightness of the tendons. Once symptoms have settled then a graduated strengthening programme will be started. Finally sport specific training should take place before a return to full activity.
Stress fractures are common sports injuries. They commonly affect the metatarsals or tarsals in the foot, or tibia in the lower leg in runners, dancers, and footballers. They are also seen in the bones of the arm in throwers and racket sports. The diagnosis of stress fractures is often a clinical one following a detailed history. X-rays and bone/MRI scan may be necessary to confirm diagnosis. Treatment will require rest from the causative activity. Immobilisation may also be required.
Following a period of immobilisation, a rehabilitation programme should be instigated to restore joint and soft tissue mobility, regain muscle strength and proprioception. Progress can then be made to functional and sport specific training before returning to sports activity.