Prevention and cure

A successful athlete is one who is able to prevent injuries or treat them promptly. By Dr. R. Gandhi.

Injuries are common in the field of sports. Every sportsperson would have suffered some injury in his or her career. A successful athlete is one who is able to prevent these injuries or treat them promptly. A majority of India’s top sports performers are unable to reach their optimum levels because of their inability to deal with injuries in a correct manner.

The following varied factors cause injuries: 1. Recklessness, 2. Foul or illegal play, 3. Poor playing area/equipment, 3. Inappropriate body size/strength, 4. Lack of fitness, 5. Defective protective gear, 6. Poor footwear/sports gear, 7. Incomplete recovery from injury/inadequate rehabilitation, 8. Lack of warm-up and 9. Poor supervision.

Children are more vulnerable to injuries and the reasons for that are: 1. Physically weaker and skeletally immature, 2. Less co-ordinated, 3. Slower reaction times and 4. Metabolically less efficient.

The common type of sports injuries are: 1. Dislocations 8 %; 2. Fractures 11 %; 3. Bleeding 16 %; 4. Joint injuries 20 %; 5. Ligament sprain 32 % and 6. Bruising 36 %.

The common areas of injury are: 1. Ankle 32%, 2. Neck 4%; 3. Head 10%; 4. Back 11%; 5. Finger 15%; 6. Leg 24% and 7. Knee 30%.

Sports injuries are classified as follows: 1. Micro trauma (over-use sports injuries) that includes stress fractures, tendinitis, bursitis and apophysitis; 2. Macro trauma (acute sports injuries) that encompasses contusions, sprains, strains, fractures and dislocations.

The road to recovery

Tissue Healing: It is a three-phase process comprising inflammation, repair and remodelling. The length of the phases depends on the nature of the injury and which tissue is involved. Each phase has specific treatments to encourage healing.

Inflammatory phase: The goal during this stage is to prevent new tissue disruption. Important points to be noted are: 1. RICE: rest, ice, compression and elevation; 2. Cooling to re-warming ratio of 1:2; 3. Ultrasound and electrical stimulation; 4. Maintain condition of non-injured areas if at all possible; 5. No exercise and allow some passive movement of injured area.

Repair phase: This phase is characterised by: 1. Replacement of tissue no longer viable after injury; 2. Reduction in inflammatory cells, new tissue and scar tissue formed; 3. New capillaries formed and 4. Collagen fibres laid out randomly as structure for repairs and not optimal for strength.

The goal of repair phase is: 1. To prevent excessive muscle atrophy and joint deterioration of the injured area; 2. Avoid disruption of collagen mesh; 3. Non-movement can cause adhesions in the collagen mesh; 4. Maintain condition of uninjured areas; 5. Perform some exercise with injured area only if therapists indicate it and exercises are pain-free.

Remodelling phase: In this recovery stage, new collagen and scar tissue align themselves along lines of stress and there is perceptible increase in tissue strength though not as strong as before. The goal of remodelling phase is to optimise tissue function — 1. Apply progressive amounts of stress to injured area which helps collagen align and grow; 2. Exercise should progress from ones used in repair phase and 3. Additional, sport-specific exercises as function returns and gradually increase movement speed.

Return-to-Activity Phase: Return to normal activity should be based on therapist recommendations. There should be functional capacity tests — assess functional limitations in injured limb as a whole. Several injury/sport specific rehab/return plans exist.

Post-injury Programming: Examine the goals of rehabilitation to determine if the athlete has satisfied all of them. Eg: Back to a certain % of original strength. The programme should be determined based on the athlete’s needs as per the specific sport, for instance: pulled hamstring in marathon runner vs pulled hamstring in Olympic lifter. Most critically, the communication lines must be kept open with the therapists.

The author is a national coach with the senior national athletic camp at the SAI Southern Centre, Bangalore.