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INTRODUCTION TO SPORTS INJURIES
(IT’S CAUSES, TYPES, REGION WISE COMMON INJURIES)
BY- DR. ANJALI RAI
JUNIOR RESIDENT
At the end, learner’s should be able to know about the:-
 Introduction to sports injury
 Causes of Sports Injury
 Classification of Sports Injuries
 Acute Injuries
 Overuse Injuries
 Soft Tissue Injuries
 Hard Tissue Injuries
 Region Wise Common Sports Injuries
INTRODUCTION
Everyday millions of people [of all ages] in the world participate in games and sports activities, from soccer
fields to softball diamonds and courts. It is called playing, but sports activity are more than play. Participation
in sports improves physical fitness coordination and self-discipline, and gives children/individual valuable to
learn teamwork.
Sports injury are the injury which occurs in athletic activities or physical exertion which results from acute
trauma or repetitive stress associated with athletic activities. It cans affect bones or soft tissues such as
ligaments, muscles and tendons
Sports injuries can be defined as the physical alignment that hinders a person sports performance and prevent
him/her from performing
SPORTS MEDICINE:
It has acquired the status of an independent speciality of medical sciences. Its basic aim is to prepare and
educate the athletes to achieve optimal physical efficiency with safety.
The main aim on the injury assessment and management Is to avoid the major injuries like death, brain injury
fracture etc and to provide primary care or immediate care to injury. 3
• CONCEPT AND DEFINATION OF SPORTS MEDICINE
1 ] Sports medicine is a branch of medical sciences that deals with the treatment of injuries
related to sports and games
2 ] It helps in preventing, diagnosing and treating the sports injuries
3 ] It lays stress on improving sports performance of sports persons
AIMS OF SPORTS MEDICINES
• To provide information to sports persons about sports injuries.
• To provide knowledge about causes of injuries due to improper conditioning, faulty techniques, improper
warming up, environmental factors and improper fitness.
• To provide treatment and rehabilitation for sports injuries. Medical treatments such as hydrotherapy,
electrotherapy, IR rays therapy etc are informed to sports persons.
• To provide knowledge about the preventive measures of sports injuries 5] To
concentrate on the causes of injuries
5
INCEDENCE AND PREVELANCE
• About 95% of sports injuries are minor soft tissue traumas
• Sprain accounts 1/3rd of all sports injuries
• Fracture accounts of 5% to 6% of all sports injuries
SPORTS INJURIES
There are many causes of sports injuries. The reason for injuries may be vary from individual to individual and game to game;-
• 1] trauma 9] psychological factors
• 2] endogenous factors 10] muscle imbalance
• 3] associated factors 11] climate conditions
• 4] lack of knowledge 12] faulty biomechanics
• 5] unscientific training 13] past injury
• 6] inadequate equipment 14] lack of physical fitness
• 7] carelessness 15] footwear a] rigid sole
• 8] over training b] heel counter loose
c] sole too flexible
d]absence of arch support
6
CAUSES OF SPORTS INJURIES
Rapid increase in the speed and the competitive nature of sports have resulted in an increase in the
incidence of sports injuries. Williams reported as far back as 1979 an incidence of sports injuries
between 5% and 10% of the attendance at the accident and emergency departments (Williams, 1979).
Except for sedentary games, the incidence of sports injuries is predominant in the lower limbs,
foot and ankle; injuries alone account for about 80–82%. Therefore, prevention as well as
management of foot and ankle injuries demands optimal care and competent management.
Major causative factors
■Inadequate conditioning of the body particularly cardiorespiratory and musculoskeletal systems
■Intermittent periods of lay off
■Overuse of a particular musculoskeletal complex related to the requirements of individual sports
(e.g., overhead shoulder movement of a cricket bowler)
Broadly, sports injuries can be classified into two major categories:
1.Traumatic, Extrinsic Or External Injuries: These occur mainly as a result of direct external trauma
(e.g., direct hit from an object used in a sport like cricket ball, or a fall). Traumatic injuries are common in
contact sports.
2.Non-traumatic, Intrinsic Or Internal Injuries: These occur as a result of indirect internal trauma due
to overuse of a particular tissue which is subjected to stereotyped repetitive movements in sports
The summation of a series of indirect micro traumas results in internal tissue injury (e.g., tennis elbow,
tenosynovitis, stress fracture). Fortunately, the majority of sports injuries are orthopedic and physiotherapy-
related injuries which respond favorably to adequate simple measures.
A physiotherapist must be aware of the injuries commonly met with in sports.
RISK FACTORS ;- Combination of risk factors including
1 INTRINSIC FACTORS
2 EXTRINSIC FACTORS
8
INTRINSIC AND EXTRINSIC RISK FACTORS
INTRINSIC EXTRINSIC
Age
Child/AdolescentAdult and Masters
Training Errors
Increased/Excessive Volume/Increased/Excessive
Frequency/ Intensity
Sudden change in type
Excessive fatigue, Inadequate recovery
•Physiology
•Lack of Flexibility Generalised muscle tightness
•Focal areas of muscle thickening
•Restricted joint range of movement Muscle Imbalance,Weakness and fatigue
Equipment
• Damaged
• Inappropriate
• Worn Out shoes
•Anatomical
•Size, Sex and Body Composition
•Poor Biomechanics/Malalignment Pes Planus and Pes Cavus Rearfoot
Varus, Tibia Vara
•Genu Valgum And Genu Varum Femoral neck anteversion
•Tibial torsion
Environmental Conditions
• Hot
• Cold
• Humid
Playing Surfaces
• Uneven vs Even
• Grass vs Concrete (soft, hard)
• Cambered
Leg length discrepancy & other
• Genetic factors Endocrine factors & metabolic factors
Psychological factors
Inadequate Nutrition
TYPES OF SPORTS INJURY
9
CLASSIFICATION OF SPORTS INJURY
ACCORDING TO THE CAUSE
• DIRECT INJURY
• INDIRECT INJURY
• OVERUSE INJURY
ACCORDING TO THE TISSUE INVOLVED
• SOFT TISSUE INJURY
• HARD TISSUE INJURY
11
Classification of sporting injuries (from Brukner and Khan's Clinical Sports Medicine)
SITE ACUTE INJURIES OVERUSE INJURIES
BONE Fracture
Periosteal contusion
Stress fracture Bone strain
Stress reaction Osteitis
Periostitis Apophysitis
ARTICULAR
CARTILAGE
Osteochondral/chondral fracture
Minor osteochondral injury/lesion
Chondropathy (e.g. chondromalacia)
JOINT Dislocation Subluxation Synovitis Osteoarthritis
SITE ACUTE INJURIES OVERUSE INJURIES
LIGAMENT Sprain/tear[grades1-3] Inflammation
MUSCLES Strain/tear (grades I - III)Contusion
Cramp
Compartment syndrome (acute)
Compartment syndrome (chronic)Delayed
onset muscle soreness (DOMS) Focal
tissue thickening/fibrosis
TENDON Tear[complete or partial] Tendinopathy
BURSA Traumatic bursitis Bursitis
ACUTE INJURIES
• Acute injuries occur due to sudden trauma to the tissue, with the symptoms of acute
injuries presenting themselves almost immediately. The principle in this instance is that the
force exerted at the time of injury on the tissue (i.e. muscle, tendon, ligament, and bone)
exceeds the strength of that tissue. Forces commonly involved in acute injury are either
direct or indirect. Acute injuries can be classified according to the site of the injury (e.g.
bone, cartilage, ligament, muscle, bursa, tendon, joint, nerve or skin) and the type of injury
(e.g. fracture, dislocation, sprain or strain).
• Injuries when there is sudden stress on the body with severe pain. Example – strained
back occur during activity.
12
NERVE Neuropraxia Nerve entrapment
Minor nerve injury/irritation
Adverse neural tension
SKIN Laceration
Abrasion Puncture
wound
Blister
Callus
13
Direct/Contact Injury
• A direct injury is caused by an external blow or force (extrinsic causes)
• A collision with another person e.g, during a tackle in rugby or football
• Being struck by an object e.g. a basketball or hockey stick
Indirect/Non-Contact Injury
• The actual injury can occur some distance from the impact site e.g. falling on an outstretched hand can result in a
dislocated shoulder
• The injury does not result from physical contact with an object or person, but from internal forces built up by the actions
of the performer, such as injuries that may be caused by over-stretching, poor technique, fatigue, and lack of fitness.
(e.g. muscle strain or ligament sprain)
Common Acute Injuries include:
1 Ankle sprain
2 Quadriceps strain
3 clavicular fracture
4 shoulder dislocation
14
OVERUSE INJURY
• Any repetitive activity can lead to an overuse injury. Overuse injuries occur over a period of time, usually due to
excessive and repetitive loading of the tissue, with symptoms presenting gradually. Little or no pain might be
experienced in the early stages of these injuries and the athlete might continue to place pressure on the injured site.
This prevents the site from being given the necessary time to heal.
* The principle in overuse injury is that repetitive microtrauma overloads the capacity of the tissue to
repair itself.
• At the microscopic level to the tissue that has been “stressed” during the repetitive workouts. During exercise, the tissues
(muscles, tendons, bones, ligaments, etc) experience excessive physiological stress.
• When the activity is over, the tissues undergo adaptation so as to be stronger to be able to withstand similar stress in
the future, if required. Overuse injury occurs when the adaptive capability of the tissue is exceeded and tissue injury then
develops.
• That is, in the over-zealous athlete there is not enough time for adaptation to occur before the next work out and the
cumulative tissue damage eventually exceeds a threshold for that tissue causing pain and tissue dysfunction.
• The adaptive capability of the tissue may be exceeded secondary to excessive repetitive forces
attributable to one or more commonly a combination of risk factors.
• Overuse injuries are a problem in many sports with athletes exposed to high training loads, tight
competition schedules and insufficient recovery thought to be particularly at risk; especially when
participating in sports involving repetitive movements or impacts.
• FOR EXAMPLE, approximately two-thirds of athletes, who trained between 20 and 35 hours per
week, sustained a performance-limiting overuse injury in athletics over a one year period. Similarly,
between 29% and 44% of elite volleyball players, who often perform over 500 jumps per week report
symptoms of jumper’s knee.
• Achilles tendinopathy is a common overuse injury in football, as the sport involves running and jumping
activities. In the English football league, there is an average of 3.5 Achilles tendon-related injuries per
week during the preseason and an average of one injury per week during the competition season.
• Also it is recognized that overuse injuries are common in elite sports, they also occur among
recreational athletes, young athletes, and even among sedentary individuals after transient increases in
activity level.
16
• MACROTRAUMA
It is a sudden blow on the healthy muscle and tissue of the body. It is also called one time injury. When
Macro trauma is not treated proper and the athlete continues to do activity, then it will turn into macro
trauma.
• MICROTRAUMA
It is over used injuries. It is generally given to repeated small injuries.
• MINOR INJURIES
Minor injuries such as bruises and cuts and these are common in the contact nature of sports.
• MAJOR INJURIES
These are those injuries which can affect the performance of the athlete like fracture, tear of ligament etc
TISSUE TYPE EXAMPLES
SOFT Ligaments, muscles
tendons , skin, deep fascia ,
fibrocartilage
HARD Bone,
joints,
articular cartilage
SPECIAL Brain, peripheral nerves, eyes, nose,
sinuses, organs, teeth , blood vessels
• HARD AND SOFT TISSUE INJURIES
HARD TISSUE injuries are bone injuries. And SOFT TISSUE injuries involve damage to skin
muscles tendons ligaments or cartilage.
18
SOFT TISSUE INJURIES
1.] LIGAMENT
 Joint stability is provided by the presence of a joint capsule of connective tissue, thickened at points of stress
to form ligaments, which attach at the ends to the bone. There are a number of different grading systems used
for the classification of ligament sprains, each has its own strengths and weakness. ligament injuries range
from mild injuries, involving the tearing of only a few fibers to a complete tear of the ligament, which may
lead to instability of the joint.
 The traditional grading system for ligament injuries focuses on a single ligament.
LIGAMENT TENDONS SKIN
MUSCLES
1.] Grade I Sprain
 Represents a microscopic injury without stretching of the ligament on a macroscopic level of Some Stretched
Fibers
 Clinical testing shows normal range of motion on stressing the ligament Mild - little swelling and
tenderness with little impact on function
2.] Grade II Sprain
 Macroscopic stretching, but the ligament remains intact.
 Involves a considerable proportion of the fibers and, therefore, stretching of the joint and stressing the ligament show increased
laxity but a definite endpoint.
 Moderate - moderate swelling, pain and impact on function, reduced proprioception ROM (range of motion) and instability
3.] Grade III Sprain
 Complete tear or rupture of the ligament with excessive joint laxity and no firm endpoint.
 Although they are often painful conditions, grade III sprains can also be pain-free as sensory fibers are completely
torn in the injury.
 Severe - complete rupture, extensive swelling, tenderness, loss of function and marked instability
• Common Ligament Injuries:- MCL injury knee, LCL injury knee, ACL injury knee , PCL injury knee , lateral
ligamentous injury, elbow ligamentous injuries
20
2.] TENDONS
Tendon are situated between bone and muscles and are bright white in colour, their fibro-elastic composition
gives them the strength required to transmit large mechanical forces. Normal tendons consist of tight parallel
bundles of collagen fibers . Each muscle has two tendons, one proximally and one distally.
The point at which the tendon forms an attachment to the muscle is also known as the Musculotendinous
Junction (MTJ) and the point at which it attaches to the bone is known as the Osteotendinous Junction (OTJ).
The purpose of the tendon is to transmit forces generated from the muscle to the bone to elicit movement. The
proximal attachment of the tendon is also known as the origin and the distal tendon is called the insertion.
Tendons have different shapes and sizes depending on the role of the muscle. Muscles that generate a lot of
power and force tend to have shorter and wider tendons than those that perform more fine delicate movements.
These tend to be long and thin.
• Tendon rupture
Acute injuries to tendons usually occur at the point of least blood supply, for example with the Achilles tendon it
is usually 2cm above the tendon insertion or at the musculotendinous junction. A complete tendon rupture
generally occurs without warning. Also, this type of injury usually occurs in older athletes without a history of
injury in that particular tendon. The most common tendons to rupture are the Achilles tendon and the
supraspinatus tendon .
• Tendinopathy
Tendinopathy refers to a chronic tendon injury with no implication about the aetiology (cause), Overuse
injuries are commonly seen in tendons. As a tendon is loaded and the strain increases, there is tissue
deformation and some fibers begin to fail. Ultimately, macroscopic tendon failure occurs. Tendon overuse
can not be explained as inflammation as research has shown that the histological findings in athletes with
overuse tendon injuries do not show signs of inflammation - (there are no inflammatory cells present in
surgical specimens). However, the following are seen with overuse tendon injuries:- degenerative
changes, changed fibril organization ,reduced cell count.
Athletes with overuse tendon pain may present with the following clinical features:-
• pain some time after exercise or the following morning upon rising
• can be painful at rest and initially becomes less painful with use
• athletes can run through the pain" or pain disappears when they warm-up
• pain returns after exercise when they cool down
• the athlete is able to train fully in the early stages of the condition - this may interfere with the healing
process
22
• localized tenderness and thickening upon examination
• swelling and crepitus may be present (although crepitus is usually a sign of associated tenosynovitis or
due to the water-attracting nature of the collage disarray)
• Tendinitis
This refers to inflammation of the tendon itself. There is little evidence to support this diagnostic label, though.
Tendinitis may occur in association with paratendinitis.
• Paratendonitis
This refers to inflammation of the paratenon, either aligned by the synovium or not . This is likely to occur in
areas where the tendon rubs over a bony prominence and the paratenon is directly irritated. A common
example is De Quervain’s tenosynovitis at the wrist.
• Common Tendon Injuries:- peroneal tendinopathy , medial Epicondylopathy , Rotator cuff
tendinopathy , Achilles tendinopathy
3.] MUSCLE
Skeletal muscle injuries represent a great part of all traumas in sports medicine, with an incidence from 10%
to 55% of all sustained injuries. They should be treated with necessary precaution since a failed treatment can
postpone an athlete’s return to the field with weeks or even months and cause re-occurrence of the injury.
Common Injuries:- Calf strain, rotator cuff tears, rupture long head of biceps
4.] SKIN
Skin injuries are common particularly in athletes playing contact sports. Underlying structures such as
tendons, ligaments, blood vessels and nerves are always at risk of injury and should also be considered with
any skin injury . Open wounds may include abrasions, lacerations, or puncture wounds
24
HARD TISSUE INJURIES
1.]Articular Cartilage
The ends of long bones are lined with Articular cartilage which provides a low friction gliding surface that acts
as a shock absorber and reduces peak pressures on the underlying bone. These are common injuries and there is
an increased risk of long term, premature osteoarthritis if not well managed. Articular cartilage can be damaged
through shear injuries such as dislocations, and Subluxation. Osteochondral injuries may be associated with soft
tissue conditions such as injuries to ligaments e.g. ACL . There are three classes of articular cartilage injuries;
1. Disruption of the deep layers with or without subchondral bone damage
2. Disruption of the articular surface only
3. Disruption of both the articular cartilage and subchondral bone
ARTICULAR
CARTILAGE
BONE JOINT FRACTURES
2.] BONE
A bone is a rigid organ that constitutes part of the vertebral skeleton. Bones support and protect the various
organs of the body, produce red and white blood cells, store minerals and also enable mobility as well as
support for the body. Bone tissue is a type of dense connective tissue.
3.] JOINT
• Dislocation
Dislocations are injuries to joints where one bone is displaced from another or a complete dissociation of the
articulating surfaces of the joint. A dislocation is often accompanied by considerable damage to the
surrounding connective tissue. Complications of dislocation can include nerve and vascular damage.
Dislocations occur as a result of the joint being pushed past its normal range of movement. Common sites of
the body where dislocations occur are the finger , shoulder and Patella.
• Subluxation
Subluxation is an injury to the joint where one bone is partially displaced from another or partial
dissociation of the articulating surfaces of the joint.
26
* Signs and symptoms of dislocation and subluxation include:-
A] Loss of movement at the joint
B] Obvious deformity, swelling and tenderness and pain
4.] Fractures
A fracture can result from a direct force, an indirect force or repetitive smaller impacts (as occurs in a stress
fracture) and can be classified as transverse, oblique, spiral or comminuted. Fracture complications include:
• Infection
Acute compartment syndrome Associated injury (e.g. nerve & vessels)
Deep venous thrombosis/pulmonary embolism Delayed union/non-union and mal-union
The signs and symptoms of a fracture include:
Pain and tenderness
Swelling and dis-colouration Restriction of movement Unnatural
movement Deformity
27
REGION WISE COMMON SPORTS INJURIES
REGION SPECIFICATION CAUSE INJURY[MODE] SPORTS
HEAD
Head injury Direct violent blast Fracture/dislocation of
the cervical spine
Contact
sports[boxing/diving]
NECK
whiplash Direct/indirect
violent jerky flexion–
extension
Fracture/dislocation
of the cervical spine
High speed contact
sports[motor race/fast
driving]
Burner and Stringer
syndrome
Direct trauma Forcing neck into
flexion and lateral flexion
nerve root compression,
brachial plexus
Contact sports
Cervical sprains and
strains
Indirect trauma
following jerky sudden
Posterior longitudinal
ligament is commonly
involved
Noncontact sports
[swimming/tennis/etc]
contact sports
[football/rugby/wrestli ng]
SHOULDER
Fracture and
dislocations
Direct hit or violent
indirect trauma
with violent fall on
outstretched hand
Anterior
dislocation/fracture of
the greater tuberosity or neck
are common
Contact
sports[boxing/wrestlli ng]
Recurrent anterior
dislocation
Indirect trauma,
fall with arm in
abduction and external
rotation
History of earlier
anterior dislocation or defect
in humeral head
Non contact sports
Dislocation of
acromioclavicular
joint Direct
Direct: impact on
the outer side;
indirect: fall on
Non contact sports
28
Bicipital tendinitis,
Supraspinatus
tendinitis, rotator cuff
syndrome
Indirect due to
repetitive
movements
Repeated friction
causing rupture of the
tendon or tendinitis
Sports involving
shoulder abduction or
overhead rotation
[bowling in cricket and
javelin throw]
Fracture of the
Clavicle
Direct fall on the
shoulder; indirect fall
on outstretched hand
Fracture of the
clavicle (junction of
middle and outer third)
Any sports involving
fall on the point of
shoulder
ELBOW Tennis elbow Indirect trauma due
to overuse of stressful
extension of elbow
Tendinitis of common
elbow extensor origin
Non contact sports
[tennis/cricket]
Golfer’s elbow
Indirect trauma due
to overuse of
repetitive stressful
flexion of elbow
Tendinitis of common
elbow flexor origin
Golf
Fracture/dislocation
Direct trauma,
indirect violent fall on
the outstretched hand
with elbow in slight
flexion
Usually posterior
dislocation is common,
fracture of coronoid
process of ulna may
occur
Sports involving
violent sudden fall
29
REGION SPECIFICATIONS CAUSE INJURY[MODE] SPORTS
WRIST
Carpal tunnel
syndrome
Indirect injury, due to
overuse of wrist joint
HAND
Tenosynovitis Indirect, due to overuse of
the wrist joint; occurs as a result of infection
Inflammation of the
synovial lining of
flexor tendons of the wrist
Mallet finger finger Direct hit on the tip
of the finger with hard object
Rupture of the
extensor tendon
Cricket taking a
catch
Fracture of the
MP, PID and DIP
joints
Direct hit – violent hit over
these joints
Trauma Cricket taking a
catch
TRUNK
Fracture of ribs Direct or indirect trauma Trunk twisting on
stationary feet
Contact sports
Abdominal sprain Indirect injury Overuse injury Contact sports
Low back pain 1] Wrong postural
mechanism, or postural defect; loss of joint
flexibility, IV instability 2] Muscular
weakness, tightness of hamstrings 3] Direct
injury to the back
Bony or soft tissue
sprain or strain
Weightlifting,
gymnastics , javelin
throw
HIP
Hip joint pain Overuse, indirect injury Training on hard
surface
Football, sprint ,
horse riding
Groin pain Overuse, indirect injury
due to adductor strain
Sudden external
rotation with leg in abducted
position
Football , sprint ,
horse riding
30
Thigh pain Direct blow or repeated
adductor strain
Quadriceps muscle
contusion
Football
Tensor fascia
Strain
Indirect overuse syndrome
or friction syndrome
Repetitive knee
flexion–extension
strain Overuse
syndrome
Running
Pain- symphysis
Pubis
Overuse of adductors r
loosing of symphysis pubis
Ligamentous strain Long jump, high
Jump
KNEE Fracture patella Direct hit or indirect
trauma due to excessive
quadriceps pull
Fracture of the
Patella
Ligamentous
Injury
Direct trauma causing
overstretching of the ligaments
Incidence of ACL
injury is more
common
Football /discuss
Throw
Meniscal injury Direct twisting injury to
the knee joint or indirect trauma
Tear, cysts, or
discoid menisci
Cricket, football
31
Patellar Indirect repetitive Jumping athletics
tendinitis trauma at the tendon
(Jumper’s knee) bone junction or
hamstrings tightness
Chondromalacia
patellae
Indirect overuse injury
Irritation of the under surface of
patella
Irritation of under
surface of patella
Jogging and
running
LEG
Calf strain Overuse strain to calf
muscle or violent push off thrust
Bracing lower leg
against ground reaction forces
of landing
Non contact sports
[running]
Hamstring
sprain
Indirect injury to the
hamstrings
Violent contraction of
hamstrings during push off
Jumping , cycling ,
hurdles , racing ,
sprinting
Shin soreness Indirect overuse injury Repetitive shock Runners taking
absorptive stress due to over strides or
overuse running over hard
surface
ANKLE
AND
FOOT
Inversion or
evertion strain
Indirect injury due to
violent inversion or eversion with
ankle joint relaxed in plantar
flexion
Fall from height and
repetitive overuse
Jumping , jogging
, running
with or without
fracture
Stress fracture
of tibia
overuse weight bearing
injury
Hairline fracture of the
upper or lower end of the
tibia, fibula or metatarsal
bones
32
REGION SPECIFICATIONS CAUSE INJURY[MODE] SPORTS
fractures of the fifth
metatarsal
Indirect overuse
injury to the fifth metatarsal ;
sudden twisting of ankle in
inversion
Weight bearing – results
injury to the fifth metatarsal sudden twisting of ankle
in inversion Avulsion fracture of the base of the fifth
metatarsal – Jones fracture – Dancer’s fracture
March fracture
March fracture A fatigue
fracture, indirect injury due to
sustained standing
Fracture occurs at the
second or third metatarsal bones in sustain standing
Medial tibial stress
syndrome
Indirect injury
due to periosteal inflammation
Periosteum gets inflamed
over the medial border of the distal one-third of tibia
(shin splints) due to overuse
Anterior
impingement
syndrome
Overuse
syndrome due to
repetitive excessive
dorsiflexion
Excessive dorsiflexion of
the ankle joint results in
impingement of the anterior tip of the tibia on the
neck of the talus
Posterior
impingement
syndrome
Overuse indirect
injury due to synovial or capsular
tissue against the tibia due to
repetitive plantar flexion
Posterior tubercle of the
OS calcis compresses the repetitive plantar flexion
33
Flexor hallucis
longus tendinitis
Indirect overuse,
putting extra
strain on flexor hallucis longus
Extreme repetitive plantar
flexion puts extra stress of
dynamic stabilization of medial foot and
ankle on flexor hallucis longus
Tenosynovitis Overuse causing
inflammation Deep toe flexors,
tibialis posterior of peronei are of the
synovial lining of the fibrous sheath
of deep toe flexors commonly
involved; overuse results in
synovial inflammation
Deep toe flexors, tibialis
posterior of peronei are of
REFRENCES
• Brukner and khan’s clinical sports medicine 4th edition
• Joshi and kotwal’s essentials of orthopedics and applied physiotherapy
• Joshi J B, Sherke V K, Dave PK. New objective physiotherapy approach to develop individual
skills
of an athlete. Physiotherapy J Ind Asso-Physiotherapists
• Wright D. T Eeilly Sports fitness and sports injuries Fitness testing after injury
• Frontera WR. Rehabilitation of Sports Injuries: Scientific Basis. Vol X of Encylopaedia of Sports
Medicine. An IOC Medical Comittee Publication in collaboration with the International
Federation of Sports Medicine.
• Human Kinetics. Excerpts. Employ the seven principles of
rehabilitation. http://www.humankinetics.com/excerpts/excerpts/employ-the-seven-principles-
of-rehabilitation (accessed 26 May 2016).
• Gray J. Phases of Rehabilitation after Injury: An Evidence-Based Literature Review. Bok Smart

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Introduction to Sports Injuries by- Dr. Anjali Rai

  • 1. INTRODUCTION TO SPORTS INJURIES (IT’S CAUSES, TYPES, REGION WISE COMMON INJURIES) BY- DR. ANJALI RAI JUNIOR RESIDENT
  • 2. At the end, learner’s should be able to know about the:-  Introduction to sports injury  Causes of Sports Injury  Classification of Sports Injuries  Acute Injuries  Overuse Injuries  Soft Tissue Injuries  Hard Tissue Injuries  Region Wise Common Sports Injuries
  • 3. INTRODUCTION Everyday millions of people [of all ages] in the world participate in games and sports activities, from soccer fields to softball diamonds and courts. It is called playing, but sports activity are more than play. Participation in sports improves physical fitness coordination and self-discipline, and gives children/individual valuable to learn teamwork. Sports injury are the injury which occurs in athletic activities or physical exertion which results from acute trauma or repetitive stress associated with athletic activities. It cans affect bones or soft tissues such as ligaments, muscles and tendons Sports injuries can be defined as the physical alignment that hinders a person sports performance and prevent him/her from performing SPORTS MEDICINE: It has acquired the status of an independent speciality of medical sciences. Its basic aim is to prepare and educate the athletes to achieve optimal physical efficiency with safety. The main aim on the injury assessment and management Is to avoid the major injuries like death, brain injury fracture etc and to provide primary care or immediate care to injury. 3
  • 4. • CONCEPT AND DEFINATION OF SPORTS MEDICINE 1 ] Sports medicine is a branch of medical sciences that deals with the treatment of injuries related to sports and games 2 ] It helps in preventing, diagnosing and treating the sports injuries 3 ] It lays stress on improving sports performance of sports persons AIMS OF SPORTS MEDICINES • To provide information to sports persons about sports injuries. • To provide knowledge about causes of injuries due to improper conditioning, faulty techniques, improper warming up, environmental factors and improper fitness. • To provide treatment and rehabilitation for sports injuries. Medical treatments such as hydrotherapy, electrotherapy, IR rays therapy etc are informed to sports persons. • To provide knowledge about the preventive measures of sports injuries 5] To concentrate on the causes of injuries
  • 5. 5 INCEDENCE AND PREVELANCE • About 95% of sports injuries are minor soft tissue traumas • Sprain accounts 1/3rd of all sports injuries • Fracture accounts of 5% to 6% of all sports injuries SPORTS INJURIES There are many causes of sports injuries. The reason for injuries may be vary from individual to individual and game to game;- • 1] trauma 9] psychological factors • 2] endogenous factors 10] muscle imbalance • 3] associated factors 11] climate conditions • 4] lack of knowledge 12] faulty biomechanics • 5] unscientific training 13] past injury • 6] inadequate equipment 14] lack of physical fitness • 7] carelessness 15] footwear a] rigid sole • 8] over training b] heel counter loose c] sole too flexible d]absence of arch support
  • 6. 6 CAUSES OF SPORTS INJURIES Rapid increase in the speed and the competitive nature of sports have resulted in an increase in the incidence of sports injuries. Williams reported as far back as 1979 an incidence of sports injuries between 5% and 10% of the attendance at the accident and emergency departments (Williams, 1979). Except for sedentary games, the incidence of sports injuries is predominant in the lower limbs, foot and ankle; injuries alone account for about 80–82%. Therefore, prevention as well as management of foot and ankle injuries demands optimal care and competent management. Major causative factors ■Inadequate conditioning of the body particularly cardiorespiratory and musculoskeletal systems ■Intermittent periods of lay off ■Overuse of a particular musculoskeletal complex related to the requirements of individual sports (e.g., overhead shoulder movement of a cricket bowler)
  • 7. Broadly, sports injuries can be classified into two major categories: 1.Traumatic, Extrinsic Or External Injuries: These occur mainly as a result of direct external trauma (e.g., direct hit from an object used in a sport like cricket ball, or a fall). Traumatic injuries are common in contact sports. 2.Non-traumatic, Intrinsic Or Internal Injuries: These occur as a result of indirect internal trauma due to overuse of a particular tissue which is subjected to stereotyped repetitive movements in sports The summation of a series of indirect micro traumas results in internal tissue injury (e.g., tennis elbow, tenosynovitis, stress fracture). Fortunately, the majority of sports injuries are orthopedic and physiotherapy- related injuries which respond favorably to adequate simple measures. A physiotherapist must be aware of the injuries commonly met with in sports. RISK FACTORS ;- Combination of risk factors including 1 INTRINSIC FACTORS 2 EXTRINSIC FACTORS
  • 8. 8 INTRINSIC AND EXTRINSIC RISK FACTORS INTRINSIC EXTRINSIC Age Child/AdolescentAdult and Masters Training Errors Increased/Excessive Volume/Increased/Excessive Frequency/ Intensity Sudden change in type Excessive fatigue, Inadequate recovery •Physiology •Lack of Flexibility Generalised muscle tightness •Focal areas of muscle thickening •Restricted joint range of movement Muscle Imbalance,Weakness and fatigue Equipment • Damaged • Inappropriate • Worn Out shoes •Anatomical •Size, Sex and Body Composition •Poor Biomechanics/Malalignment Pes Planus and Pes Cavus Rearfoot Varus, Tibia Vara •Genu Valgum And Genu Varum Femoral neck anteversion •Tibial torsion Environmental Conditions • Hot • Cold • Humid Playing Surfaces • Uneven vs Even • Grass vs Concrete (soft, hard) • Cambered Leg length discrepancy & other • Genetic factors Endocrine factors & metabolic factors Psychological factors Inadequate Nutrition
  • 9. TYPES OF SPORTS INJURY 9
  • 10. CLASSIFICATION OF SPORTS INJURY ACCORDING TO THE CAUSE • DIRECT INJURY • INDIRECT INJURY • OVERUSE INJURY ACCORDING TO THE TISSUE INVOLVED • SOFT TISSUE INJURY • HARD TISSUE INJURY
  • 11. 11 Classification of sporting injuries (from Brukner and Khan's Clinical Sports Medicine) SITE ACUTE INJURIES OVERUSE INJURIES BONE Fracture Periosteal contusion Stress fracture Bone strain Stress reaction Osteitis Periostitis Apophysitis ARTICULAR CARTILAGE Osteochondral/chondral fracture Minor osteochondral injury/lesion Chondropathy (e.g. chondromalacia) JOINT Dislocation Subluxation Synovitis Osteoarthritis SITE ACUTE INJURIES OVERUSE INJURIES LIGAMENT Sprain/tear[grades1-3] Inflammation MUSCLES Strain/tear (grades I - III)Contusion Cramp Compartment syndrome (acute) Compartment syndrome (chronic)Delayed onset muscle soreness (DOMS) Focal tissue thickening/fibrosis TENDON Tear[complete or partial] Tendinopathy BURSA Traumatic bursitis Bursitis
  • 12. ACUTE INJURIES • Acute injuries occur due to sudden trauma to the tissue, with the symptoms of acute injuries presenting themselves almost immediately. The principle in this instance is that the force exerted at the time of injury on the tissue (i.e. muscle, tendon, ligament, and bone) exceeds the strength of that tissue. Forces commonly involved in acute injury are either direct or indirect. Acute injuries can be classified according to the site of the injury (e.g. bone, cartilage, ligament, muscle, bursa, tendon, joint, nerve or skin) and the type of injury (e.g. fracture, dislocation, sprain or strain). • Injuries when there is sudden stress on the body with severe pain. Example – strained back occur during activity. 12 NERVE Neuropraxia Nerve entrapment Minor nerve injury/irritation Adverse neural tension SKIN Laceration Abrasion Puncture wound Blister Callus
  • 13. 13 Direct/Contact Injury • A direct injury is caused by an external blow or force (extrinsic causes) • A collision with another person e.g, during a tackle in rugby or football • Being struck by an object e.g. a basketball or hockey stick Indirect/Non-Contact Injury • The actual injury can occur some distance from the impact site e.g. falling on an outstretched hand can result in a dislocated shoulder • The injury does not result from physical contact with an object or person, but from internal forces built up by the actions of the performer, such as injuries that may be caused by over-stretching, poor technique, fatigue, and lack of fitness. (e.g. muscle strain or ligament sprain) Common Acute Injuries include: 1 Ankle sprain 2 Quadriceps strain 3 clavicular fracture 4 shoulder dislocation
  • 14. 14 OVERUSE INJURY • Any repetitive activity can lead to an overuse injury. Overuse injuries occur over a period of time, usually due to excessive and repetitive loading of the tissue, with symptoms presenting gradually. Little or no pain might be experienced in the early stages of these injuries and the athlete might continue to place pressure on the injured site. This prevents the site from being given the necessary time to heal. * The principle in overuse injury is that repetitive microtrauma overloads the capacity of the tissue to repair itself. • At the microscopic level to the tissue that has been “stressed” during the repetitive workouts. During exercise, the tissues (muscles, tendons, bones, ligaments, etc) experience excessive physiological stress. • When the activity is over, the tissues undergo adaptation so as to be stronger to be able to withstand similar stress in the future, if required. Overuse injury occurs when the adaptive capability of the tissue is exceeded and tissue injury then develops. • That is, in the over-zealous athlete there is not enough time for adaptation to occur before the next work out and the cumulative tissue damage eventually exceeds a threshold for that tissue causing pain and tissue dysfunction.
  • 15. • The adaptive capability of the tissue may be exceeded secondary to excessive repetitive forces attributable to one or more commonly a combination of risk factors. • Overuse injuries are a problem in many sports with athletes exposed to high training loads, tight competition schedules and insufficient recovery thought to be particularly at risk; especially when participating in sports involving repetitive movements or impacts. • FOR EXAMPLE, approximately two-thirds of athletes, who trained between 20 and 35 hours per week, sustained a performance-limiting overuse injury in athletics over a one year period. Similarly, between 29% and 44% of elite volleyball players, who often perform over 500 jumps per week report symptoms of jumper’s knee. • Achilles tendinopathy is a common overuse injury in football, as the sport involves running and jumping activities. In the English football league, there is an average of 3.5 Achilles tendon-related injuries per week during the preseason and an average of one injury per week during the competition season. • Also it is recognized that overuse injuries are common in elite sports, they also occur among recreational athletes, young athletes, and even among sedentary individuals after transient increases in activity level.
  • 16. 16 • MACROTRAUMA It is a sudden blow on the healthy muscle and tissue of the body. It is also called one time injury. When Macro trauma is not treated proper and the athlete continues to do activity, then it will turn into macro trauma. • MICROTRAUMA It is over used injuries. It is generally given to repeated small injuries. • MINOR INJURIES Minor injuries such as bruises and cuts and these are common in the contact nature of sports. • MAJOR INJURIES These are those injuries which can affect the performance of the athlete like fracture, tear of ligament etc
  • 17. TISSUE TYPE EXAMPLES SOFT Ligaments, muscles tendons , skin, deep fascia , fibrocartilage HARD Bone, joints, articular cartilage SPECIAL Brain, peripheral nerves, eyes, nose, sinuses, organs, teeth , blood vessels • HARD AND SOFT TISSUE INJURIES HARD TISSUE injuries are bone injuries. And SOFT TISSUE injuries involve damage to skin muscles tendons ligaments or cartilage.
  • 18. 18 SOFT TISSUE INJURIES 1.] LIGAMENT  Joint stability is provided by the presence of a joint capsule of connective tissue, thickened at points of stress to form ligaments, which attach at the ends to the bone. There are a number of different grading systems used for the classification of ligament sprains, each has its own strengths and weakness. ligament injuries range from mild injuries, involving the tearing of only a few fibers to a complete tear of the ligament, which may lead to instability of the joint.  The traditional grading system for ligament injuries focuses on a single ligament. LIGAMENT TENDONS SKIN MUSCLES
  • 19. 1.] Grade I Sprain  Represents a microscopic injury without stretching of the ligament on a macroscopic level of Some Stretched Fibers  Clinical testing shows normal range of motion on stressing the ligament Mild - little swelling and tenderness with little impact on function 2.] Grade II Sprain  Macroscopic stretching, but the ligament remains intact.  Involves a considerable proportion of the fibers and, therefore, stretching of the joint and stressing the ligament show increased laxity but a definite endpoint.  Moderate - moderate swelling, pain and impact on function, reduced proprioception ROM (range of motion) and instability 3.] Grade III Sprain  Complete tear or rupture of the ligament with excessive joint laxity and no firm endpoint.  Although they are often painful conditions, grade III sprains can also be pain-free as sensory fibers are completely torn in the injury.  Severe - complete rupture, extensive swelling, tenderness, loss of function and marked instability • Common Ligament Injuries:- MCL injury knee, LCL injury knee, ACL injury knee , PCL injury knee , lateral ligamentous injury, elbow ligamentous injuries
  • 20. 20 2.] TENDONS Tendon are situated between bone and muscles and are bright white in colour, their fibro-elastic composition gives them the strength required to transmit large mechanical forces. Normal tendons consist of tight parallel bundles of collagen fibers . Each muscle has two tendons, one proximally and one distally. The point at which the tendon forms an attachment to the muscle is also known as the Musculotendinous Junction (MTJ) and the point at which it attaches to the bone is known as the Osteotendinous Junction (OTJ). The purpose of the tendon is to transmit forces generated from the muscle to the bone to elicit movement. The proximal attachment of the tendon is also known as the origin and the distal tendon is called the insertion. Tendons have different shapes and sizes depending on the role of the muscle. Muscles that generate a lot of power and force tend to have shorter and wider tendons than those that perform more fine delicate movements. These tend to be long and thin. • Tendon rupture Acute injuries to tendons usually occur at the point of least blood supply, for example with the Achilles tendon it is usually 2cm above the tendon insertion or at the musculotendinous junction. A complete tendon rupture generally occurs without warning. Also, this type of injury usually occurs in older athletes without a history of injury in that particular tendon. The most common tendons to rupture are the Achilles tendon and the supraspinatus tendon .
  • 21. • Tendinopathy Tendinopathy refers to a chronic tendon injury with no implication about the aetiology (cause), Overuse injuries are commonly seen in tendons. As a tendon is loaded and the strain increases, there is tissue deformation and some fibers begin to fail. Ultimately, macroscopic tendon failure occurs. Tendon overuse can not be explained as inflammation as research has shown that the histological findings in athletes with overuse tendon injuries do not show signs of inflammation - (there are no inflammatory cells present in surgical specimens). However, the following are seen with overuse tendon injuries:- degenerative changes, changed fibril organization ,reduced cell count. Athletes with overuse tendon pain may present with the following clinical features:- • pain some time after exercise or the following morning upon rising • can be painful at rest and initially becomes less painful with use • athletes can run through the pain" or pain disappears when they warm-up • pain returns after exercise when they cool down • the athlete is able to train fully in the early stages of the condition - this may interfere with the healing process
  • 22. 22 • localized tenderness and thickening upon examination • swelling and crepitus may be present (although crepitus is usually a sign of associated tenosynovitis or due to the water-attracting nature of the collage disarray) • Tendinitis This refers to inflammation of the tendon itself. There is little evidence to support this diagnostic label, though. Tendinitis may occur in association with paratendinitis. • Paratendonitis This refers to inflammation of the paratenon, either aligned by the synovium or not . This is likely to occur in areas where the tendon rubs over a bony prominence and the paratenon is directly irritated. A common example is De Quervain’s tenosynovitis at the wrist. • Common Tendon Injuries:- peroneal tendinopathy , medial Epicondylopathy , Rotator cuff tendinopathy , Achilles tendinopathy
  • 23. 3.] MUSCLE Skeletal muscle injuries represent a great part of all traumas in sports medicine, with an incidence from 10% to 55% of all sustained injuries. They should be treated with necessary precaution since a failed treatment can postpone an athlete’s return to the field with weeks or even months and cause re-occurrence of the injury. Common Injuries:- Calf strain, rotator cuff tears, rupture long head of biceps 4.] SKIN Skin injuries are common particularly in athletes playing contact sports. Underlying structures such as tendons, ligaments, blood vessels and nerves are always at risk of injury and should also be considered with any skin injury . Open wounds may include abrasions, lacerations, or puncture wounds
  • 24. 24 HARD TISSUE INJURIES 1.]Articular Cartilage The ends of long bones are lined with Articular cartilage which provides a low friction gliding surface that acts as a shock absorber and reduces peak pressures on the underlying bone. These are common injuries and there is an increased risk of long term, premature osteoarthritis if not well managed. Articular cartilage can be damaged through shear injuries such as dislocations, and Subluxation. Osteochondral injuries may be associated with soft tissue conditions such as injuries to ligaments e.g. ACL . There are three classes of articular cartilage injuries; 1. Disruption of the deep layers with or without subchondral bone damage 2. Disruption of the articular surface only 3. Disruption of both the articular cartilage and subchondral bone ARTICULAR CARTILAGE BONE JOINT FRACTURES
  • 25. 2.] BONE A bone is a rigid organ that constitutes part of the vertebral skeleton. Bones support and protect the various organs of the body, produce red and white blood cells, store minerals and also enable mobility as well as support for the body. Bone tissue is a type of dense connective tissue. 3.] JOINT • Dislocation Dislocations are injuries to joints where one bone is displaced from another or a complete dissociation of the articulating surfaces of the joint. A dislocation is often accompanied by considerable damage to the surrounding connective tissue. Complications of dislocation can include nerve and vascular damage. Dislocations occur as a result of the joint being pushed past its normal range of movement. Common sites of the body where dislocations occur are the finger , shoulder and Patella. • Subluxation Subluxation is an injury to the joint where one bone is partially displaced from another or partial dissociation of the articulating surfaces of the joint.
  • 26. 26 * Signs and symptoms of dislocation and subluxation include:- A] Loss of movement at the joint B] Obvious deformity, swelling and tenderness and pain 4.] Fractures A fracture can result from a direct force, an indirect force or repetitive smaller impacts (as occurs in a stress fracture) and can be classified as transverse, oblique, spiral or comminuted. Fracture complications include: • Infection Acute compartment syndrome Associated injury (e.g. nerve & vessels) Deep venous thrombosis/pulmonary embolism Delayed union/non-union and mal-union The signs and symptoms of a fracture include: Pain and tenderness Swelling and dis-colouration Restriction of movement Unnatural movement Deformity
  • 27. 27 REGION WISE COMMON SPORTS INJURIES REGION SPECIFICATION CAUSE INJURY[MODE] SPORTS HEAD Head injury Direct violent blast Fracture/dislocation of the cervical spine Contact sports[boxing/diving] NECK whiplash Direct/indirect violent jerky flexion– extension Fracture/dislocation of the cervical spine High speed contact sports[motor race/fast driving] Burner and Stringer syndrome Direct trauma Forcing neck into flexion and lateral flexion nerve root compression, brachial plexus Contact sports Cervical sprains and strains Indirect trauma following jerky sudden Posterior longitudinal ligament is commonly involved Noncontact sports [swimming/tennis/etc] contact sports [football/rugby/wrestli ng] SHOULDER Fracture and dislocations Direct hit or violent indirect trauma with violent fall on outstretched hand Anterior dislocation/fracture of the greater tuberosity or neck are common Contact sports[boxing/wrestlli ng] Recurrent anterior dislocation Indirect trauma, fall with arm in abduction and external rotation History of earlier anterior dislocation or defect in humeral head Non contact sports Dislocation of acromioclavicular joint Direct Direct: impact on the outer side; indirect: fall on Non contact sports
  • 28. 28 Bicipital tendinitis, Supraspinatus tendinitis, rotator cuff syndrome Indirect due to repetitive movements Repeated friction causing rupture of the tendon or tendinitis Sports involving shoulder abduction or overhead rotation [bowling in cricket and javelin throw] Fracture of the Clavicle Direct fall on the shoulder; indirect fall on outstretched hand Fracture of the clavicle (junction of middle and outer third) Any sports involving fall on the point of shoulder ELBOW Tennis elbow Indirect trauma due to overuse of stressful extension of elbow Tendinitis of common elbow extensor origin Non contact sports [tennis/cricket] Golfer’s elbow Indirect trauma due to overuse of repetitive stressful flexion of elbow Tendinitis of common elbow flexor origin Golf Fracture/dislocation Direct trauma, indirect violent fall on the outstretched hand with elbow in slight flexion Usually posterior dislocation is common, fracture of coronoid process of ulna may occur Sports involving violent sudden fall
  • 29. 29 REGION SPECIFICATIONS CAUSE INJURY[MODE] SPORTS WRIST Carpal tunnel syndrome Indirect injury, due to overuse of wrist joint HAND Tenosynovitis Indirect, due to overuse of the wrist joint; occurs as a result of infection Inflammation of the synovial lining of flexor tendons of the wrist Mallet finger finger Direct hit on the tip of the finger with hard object Rupture of the extensor tendon Cricket taking a catch Fracture of the MP, PID and DIP joints Direct hit – violent hit over these joints Trauma Cricket taking a catch TRUNK Fracture of ribs Direct or indirect trauma Trunk twisting on stationary feet Contact sports Abdominal sprain Indirect injury Overuse injury Contact sports Low back pain 1] Wrong postural mechanism, or postural defect; loss of joint flexibility, IV instability 2] Muscular weakness, tightness of hamstrings 3] Direct injury to the back Bony or soft tissue sprain or strain Weightlifting, gymnastics , javelin throw HIP Hip joint pain Overuse, indirect injury Training on hard surface Football, sprint , horse riding Groin pain Overuse, indirect injury due to adductor strain Sudden external rotation with leg in abducted position Football , sprint , horse riding
  • 30. 30 Thigh pain Direct blow or repeated adductor strain Quadriceps muscle contusion Football Tensor fascia Strain Indirect overuse syndrome or friction syndrome Repetitive knee flexion–extension strain Overuse syndrome Running Pain- symphysis Pubis Overuse of adductors r loosing of symphysis pubis Ligamentous strain Long jump, high Jump KNEE Fracture patella Direct hit or indirect trauma due to excessive quadriceps pull Fracture of the Patella Ligamentous Injury Direct trauma causing overstretching of the ligaments Incidence of ACL injury is more common Football /discuss Throw Meniscal injury Direct twisting injury to the knee joint or indirect trauma Tear, cysts, or discoid menisci Cricket, football
  • 31. 31 Patellar Indirect repetitive Jumping athletics tendinitis trauma at the tendon (Jumper’s knee) bone junction or hamstrings tightness Chondromalacia patellae Indirect overuse injury Irritation of the under surface of patella Irritation of under surface of patella Jogging and running LEG Calf strain Overuse strain to calf muscle or violent push off thrust Bracing lower leg against ground reaction forces of landing Non contact sports [running] Hamstring sprain Indirect injury to the hamstrings Violent contraction of hamstrings during push off Jumping , cycling , hurdles , racing , sprinting Shin soreness Indirect overuse injury Repetitive shock Runners taking absorptive stress due to over strides or overuse running over hard surface ANKLE AND FOOT Inversion or evertion strain Indirect injury due to violent inversion or eversion with ankle joint relaxed in plantar flexion Fall from height and repetitive overuse Jumping , jogging , running with or without fracture Stress fracture of tibia overuse weight bearing injury Hairline fracture of the upper or lower end of the tibia, fibula or metatarsal bones
  • 32. 32 REGION SPECIFICATIONS CAUSE INJURY[MODE] SPORTS fractures of the fifth metatarsal Indirect overuse injury to the fifth metatarsal ; sudden twisting of ankle in inversion Weight bearing – results injury to the fifth metatarsal sudden twisting of ankle in inversion Avulsion fracture of the base of the fifth metatarsal – Jones fracture – Dancer’s fracture March fracture March fracture A fatigue fracture, indirect injury due to sustained standing Fracture occurs at the second or third metatarsal bones in sustain standing Medial tibial stress syndrome Indirect injury due to periosteal inflammation Periosteum gets inflamed over the medial border of the distal one-third of tibia (shin splints) due to overuse Anterior impingement syndrome Overuse syndrome due to repetitive excessive dorsiflexion Excessive dorsiflexion of the ankle joint results in impingement of the anterior tip of the tibia on the neck of the talus Posterior impingement syndrome Overuse indirect injury due to synovial or capsular tissue against the tibia due to repetitive plantar flexion Posterior tubercle of the OS calcis compresses the repetitive plantar flexion
  • 33. 33 Flexor hallucis longus tendinitis Indirect overuse, putting extra strain on flexor hallucis longus Extreme repetitive plantar flexion puts extra stress of dynamic stabilization of medial foot and ankle on flexor hallucis longus Tenosynovitis Overuse causing inflammation Deep toe flexors, tibialis posterior of peronei are of the synovial lining of the fibrous sheath of deep toe flexors commonly involved; overuse results in synovial inflammation Deep toe flexors, tibialis posterior of peronei are of
  • 34. REFRENCES • Brukner and khan’s clinical sports medicine 4th edition • Joshi and kotwal’s essentials of orthopedics and applied physiotherapy • Joshi J B, Sherke V K, Dave PK. New objective physiotherapy approach to develop individual skills of an athlete. Physiotherapy J Ind Asso-Physiotherapists • Wright D. T Eeilly Sports fitness and sports injuries Fitness testing after injury • Frontera WR. Rehabilitation of Sports Injuries: Scientific Basis. Vol X of Encylopaedia of Sports Medicine. An IOC Medical Comittee Publication in collaboration with the International Federation of Sports Medicine. • Human Kinetics. Excerpts. Employ the seven principles of rehabilitation. http://www.humankinetics.com/excerpts/excerpts/employ-the-seven-principles- of-rehabilitation (accessed 26 May 2016). • Gray J. Phases of Rehabilitation after Injury: An Evidence-Based Literature Review. Bok Smart