Sports Injury

Muscle & Joint Injuries

Muscle & Joint Injuries

Sports Injury is the name given to a group of injuries commonly associated with sport and activity. Injuries can occur during any activity, however, when dealing with sports men and women it is particularly important to tailor the Rehabilitation of that injury to the specific sport or activity of their choice. This is where experience in Sports Physiotherapy is vital.

 

Treating injuries is fairly simple once you understand the injury and healing process, however, Rehabilitating a sports man or women back to a top-level requires expertise and understanding of complex Biomechanics and movement analysis.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hamstring Tears/Pulled Hamstring/Hamstring Strain

CAUSE

Sprinting, or high velocity leg activity such as hurdling or kicking a ball.

 

SYMPTOMS

Symptoms differ depending on the grade.

 

Grade I: Not necessarily a sudden pain. Becomes noticeable after activity. When running or stretching, tightness can be felt in the back of the thigh. May be no significant pain on resisted knee bending. May have no signs of bruising or swelling.

Grade II: Sudden pain during activity. Could be some bruising and swelling. Straightening the leg fully may be difficult. Could find it difficult to walk for a few days. Could be painful to bend knee against resistance.

Grade III Including Avulsion Fracture: Severe sudden pain and swelling during activity. Bruising will almost always develop within a few days. Difficulty walking, unable to straighten knee, and unable to bend knee with any force.

 

TREATMENT

Treatment differs depending on the grade.

 

Grade I: Short period of rest, Sports Massage, Knee Mobilisation, Strengthening

Grade II: PRICE, 3 to 4 weeks rest, Sports Massage, Knee Mobilisation, Strengthening program

Grade III Including Avulsion Fracture: PRICE, up to 12 weeks rest, Surgery if there has been an Avulsion Fracture, Sports Massage, Knee Mobilisation, Strengthening Program

 

 

Groin Tears/Adductor Tears/Groin Strains/Pulled Groin

CAUSE

Lunging left and right, changing direction quickly, twisting quickly on leg, and high velocity leg activity such as kicking.

 

SYMPTOMS

Symptoms differ depending on the grade.

 

Grade I: Not necessarily a sudden pain. Becomes noticeable after activity. When running or stretching, tightness can be felt in the groin. No significant pain on whilst squeezing the legs together. No signs of bruising or swelling.

Grade II: Sudden pain during activity. Could be some bruising and swelling. Opening the groin or taking the leg out to the side may be painful, i.e. getting out of a car. Waling may cause pain. Pain when squeezing the legs together.

Grade III Including Avulsion Fracture: Severe sudden pain and swelling during activity. Bruising will almost always develop within a few days. Difficulty walking, unable to open leg out the side, unable to bring the leg in with any force.

 

TREATMENT

Treatment differs depending on the grade.

 

Grade I: Short period of rest, Sports Massage, Knee Mobilisation, Strengthening

Grade II: PRICE, 3 to 4 weeks rest, Sports Massage, Hip Mobilisation, Strengthening program

Grade III Including Avulsion Fracture: PRICE, up to 12 weeks rest, Surgery if there has been an Avulsion Fracture, Sports Massage, Knee Mobilisation, Strengthening Program

 

 

Calf Tears/Pulled Calf Muscle/Calf Sprain/Gastrocnemius Tear

CAUSE

Sprinting, running up hill, sudden acceleration, carrying a heavy weight, landing heavily from a jump.

 

SYMPTOMS

Symptoms differ depending on the grade.

 

Grade I: Not necessarily a sudden pain. Becomes noticeable after activity, usually running. When running or stretching, tightness can be felt in the calf. No significant pain when standing on tip toes. No signs of bruising or swelling.

Grade II: Sudden pain during activity. Could be some bruising and swelling. Pointing and pulling back toes will cause pain. Walking will be difficult especially when pushing off with toes. Standing on tip toes will be painful.

Grade III: Severe sudden pain and swelling during activity. Bruising will almost always develop within a few days. Difficulty walking and unable to go onto tips toes. In severe cases the calf muscle can be bunched up near the knee.

 

TREATMENT

Treatment differs depending on the grade.

 

Grade I: Short period of rest, Sports Massage, Ankle Mobilisation, Strengthening program

Grade II: PRICE, 3 to 4 weeks rest, Sports Massage, Ankle Mobilisation, Strengthening program

Grade III: PRICE, up to 12 weeks rest, Sports Massage, Ankle Mobilisation, Strengthening Program

 

 

Calf Tightness/Tight Calf Muscles

CAUSE

Overuse of the calf muscles through running, sport, or activity. May also be related to Biomechanical problems.

 

SYMPTOMS

Similar to Grade I calf tears. Tightness during and after activity, usually running. Stretching the calf may feel painful and tight, usually on the inside of the calf muscle.

 

TREATMENT

Rest from activity at least 4 weeks. Sports Massage, Ankle Mobilisation, Support Socks, Biomechanics Assessment, Technique Analysis, Orthotics/Insoles, Strengthening Program

 

 

Upper Trap Tightness/Tight Upper Traps/Tight Shoulder Muscles

CAUSE

Postural changes, static postures, repeated use of shoulder and neck muscles e.g. weight lifters, rugby forwards.

 

SYMPTOMS

Aching neck muscles, tightness when looking left or right, or tilting the head left or right. Can cause headaches into the front of the eyes or base of the skull.

 

TREATMENT

Postural exercises and advice, Sports Massage, Cervical Manipulation, Acupuncture, Stretching program.

 

 

Muscle Cramp

CAUSE

Can be common in calf, thigh, and hamstring muscles. The underlying cause of Muscle Cramps is unclear. However, cramps are usually associated with fatigue, tiredness, poor hydration, and poor electrolyte balance.

 

SYMPTOMS

Sudden cramping or spasm in a muscle. Usually last no more than a few minutes. Can leave the area tender and tight after, and can occasionally cause small muscle tears.

 

TREATMENT

Stretching and Sports Massage is the quickest way to relieve Muscle Cramp.

 

 

Ankle Ligament Sprain/Lateral Ligament Injury/Twisted Ankle/Sprained Ankle/Inversion Injury

CAUSE

Sudden inward twisting of the ankle. Common when running on uneven surfaces, or changing direction quickly.

 

SYMPTOMS

Symptoms can differ depending of the grade of injury:

 

Grade I: Mild pain over the outside of your ankle. No joint instability afterwards, i.e. excessive movement. Mild swelling and bruising around the outside of the ankle. Some stiffness in the days that following and may have some difficulty running or walking.

Grade II: Much more painful due to moderate tearing of the ligament fibres. Will be some instability in the joint. Very painful to walk for the first few days, unable to run either. More extensive swelling and bruising in the ankle.

Grade III Including Avulsion Fracture: Severe pain due to total rupture of the ligament. Significant instability in the joint. Severe swelling and bruising. Where you are still unable to weight bare through the ankle after 1 week, there may have been an avulsion fracture.

 

TREATMENT

Treatment differs depending on the grade:

 

Grade I: PRICE, Sports Massage, Ankle Mobilisation, Balance Exercises, and Strengthening Program

Grade II: PRICE, Sports Massage, Ankle Mobilisation, Balance Exercises, Strengthening Program, can benefit from Ankle Support.

Grade III Including Avulsion Fracture: PRICE, Sports Massage, Ankle Mobilisation, Balance Exercises, Strengthening Program, can benefit from Ankle Support. Surgery or immobilisation may be required for Avulsion Fractures.

 

 

Achilles Tendonitis

CAUSE

Abnormal biomechanical stress and overuse. Sudden change in training intensity, terrain, or frequency. Change in footwear. Common in running, football, rugby, and other high impact sports.

 

SYMPTOMS

Pain and tenderness in the Achilles Tendon, usually just above the heal bone. This is usually worse first thing in the morning, or following periods of inactivity. With activity and movement pain usually subsides fairly quickly. However, pain and tenderness is usually worse following sport and exercises, particularly the morning after.

 

TREATMENT

Rest from activity, sport, or exercises. When symptoms have settled in the morning, i.e. there is no longer pain for the first few steps out of bed, exercise and sport can resume gradually. Sports Massage, Ankle Mobilisation, and Acupuncture can all be used. Specific strengthening and conditioning programs are helpful as well as Biomechanical Assessment and potential correction with Orthotics. In severe cases, or where treatment is not effective, surgery may be required.

 

 

Runners Knee/ITB Syndrome

CAUSE

Repeated knee bending and straightening whilst weight bearing. Usually caused by running, or walking with a heavy load. Always has a secondary Biomechanical cause.

 

SYMPTOMS

Pain anywhere along the ITB, but usually over the knee joint line. Burning or deep aching pain following a few minutes of exercise or activity. Usually gets worse during activity and can settle with rest.

 

TREATMENT

PRICE, Sports Massage, Knee/Hip Mobilisation, Acupuncture and Dry Needling, Stretching Program, and Knee Rehabilitation. In severe cases, or where treatment is not effective, steroid injections may be helpful.

 

 

Jumpers Knee/Patella Tendinitis/Patella Tendinopathy

CAUSE

Can be caused by any high impact sport or activity including running, football, hockey, basketball, tennis, etc. Repeated loading of the knee causes the Patella Tendon to become irritated. There is always an underlying Biomechanical Cause.

 

SYMPTOMS

Pain just under the kneecap on the Patella Tendon. This is most often present during the initial part of exercise or activity, and following sport and exercise. Symptoms can include a deep burning or aching pain. Pain can also be felt over the tendon when the knee has been bent for a long period, or when moving to a standing position after a long period of sitting down.

 

TREATMENT

Rest is essential. Sometimes this can be up to 12 weeks. Sports Massage, Knee Mobilisation, Acupuncture, Biomechanics Assessment, Orthotics, and Knee Rehabilitation are all effective forms of treatment. In severe cases, injections and surgery may be necessary.

 

 

ACL Injury/ACL Rupture/Anterior Cruciate Ligament Injury

CAUSE

Twisting or turning the knee whilst the foot is planted, especially whilst the knee is in a valgus (knocked knee) position. Landing on the knee whilst twisting, or suddenly slowing down from a sprint whilst change direction can also cause an ACL Rupture.

 

SYMPTOMS

Sudden excruciating pain in the knee. A popping or snapping sound can also be heard. There is usually immediate swelling, although this is not always present. Following an ACL Injury the knee is unstable especially when trying to twist or turn.

 

TREATMENT

Surgery is almost always the most effective treatment for Anterior Cruciate Ligament Tears. Usually grafts can be taken from the Patella tendon or Hamstrings tendons. Recently donor grafts have also been used. The Rehabilitation period following ACL repair is very important, however, it may be a lengthy process taking anywhere from 3-9 months. Sports Massage, Knee Mobilisation, Gait Re-education, Balance Exercises, Knee Rehabilitation, General Strengthening, Biomechanical Assessment, and Functional Rehabilitation are all helpful aspects of effective treatment.

 

 

MCL Injury/Medial Collateral Ligament Sprain

CAUSE

Direct blow to outside of knee causing knee to bend inwards (valgus stress). MCL Injuries can also be caused by twisting or turning on the knee whilst the foot is planted.

 

SYMPTOMS

Symptoms can vary depending on the grade of injury:

 

Grade I – Specific onset of mild pain over the inside of the knee. No swelling or instability. Some pain when twisting or turning, and when changing direction whilst running.

Grade II – Specific onset with significant pain and swelling in the knee. Because the tear is more extensive, there is usually mild to moderate instability in the knee following the injury. Twisting and turning on the knee results in clunking and instability.

Grade III – Pain can vary from significant to minimal. There is significant movement in the knee and there may be a popping noise during the injury. There will be significant instability especially when twisting or turning. Swelling and bruising may be present. Often this type of injury coincides with more serious meniscal or ACL rupture.

 

TREATMENT

Treatment will depend of the grade of injury:

 

Grade I – PRICE, Sports Massage, Knee Mobilisation, Knee Strengthening and Rehabilitation

Grade II – PRICE, Sports Massage, Knee Mobilisation, Knee Strengthening and Rehabilitation. Knee Supports and Braces can also provide support and protection during the healing process.

Grade III – PRICE, Sports Massage, Knee Mobilisation, Knee Strengthening and Rehabilitation. Knee Supports and Braces can also provide support and protection during the healing process. In sever cases Surgery may be required.

 

 

Torn Meniscus/Torn Cartilage/Meniscal Injury/Knee Cartilage Tear

CAUSE

Traumatic twisting on the knee, usually with the foot planted and in a bent position. Meniscal Injuries can also occur gradually over time due to degenerative changes.

 

SYMPTOMS

Pain and swelling in the knee. This is usually immediately with traumatic injuries. Degenerative Meniscal Tears will present with slight swelling, but little pain other than general aching. If a part of Meniscal Cartilage becomes loose, or gets in the way of normal knee movement, the knee joint can lock in position with little or no movement. This usually occurs as the knee bends and tries to straighten.

 

TREATMENT

Most Meniscal Injuries require surgery if you are to regain optimum function. This is normally via arthroscopy and the rehabilitation program usually lasts between 4-12 weeks. Rehabilitation and treatment following surgery is important for a good recovery. Treatments can include Sports Massage, Knee Mobilisation, Knee Strengthening, and Functional Rehabilitation. Conservative management for degenerative or small Meniscal Tears, or pre operative Rehabilitation involves the same Physiotherapy treatments.

 

 

Sportsman’s Hernia/Sports Hernia/Athletic Pubalgia/Gilmore’s Groin/Groin Disruption

CAUSE

Injury to the lower abdominal wall caused by repetitive twisting. More common in football players.

 

SYMPTOMS

Symptoms for a Sportsman’s Hernia are not clear-cut. They are often mis-diagnosed due to the way they mimic other conditions. Essentially clients will complain of an aching groin pain, occasionally in both sides. This pain can radiate into the testicles and is made worse by high impact twisting and turning sports, i.e. football. The pain is usually tolerable but is unchanged by conventional treatment techniques. Players can often continue to play with a Sportsman’s Hernia, however, at some state it will usually require surgery.

 

TREATMENT

Rest can be effective at reducing symptoms, however, if there has been a tear in the lower abdominal wall then surgery is usually required in order to repair the tear. Post surgery treatment and rehabilitation last between 4-8 weeks and involves Sports Massage, Manipulation/Mobilisation of the Hip and Lower Back, Core Strengthening and Functional Rehabilitation.

 

 

Shin Splints/Medial Tibial Stress Syndrome

CAUSE

Overloading of the shin muscles due to sudden increased activity, Biomechanical abnormalities, and muscle imbalance. Common in those who take up running or who suddenly increased either the frequency or intensity of training, or who change the terrain in which they train on, i.e. playing on harder pitches over winter.

 

SYMPTOMS

Pain over the lower inside third of the shinbone. This pain is usually noticeable at the begging of exercises, however, it may decrease slightly towards the end of exercise. Pain is usually at its worst the day after sport or activity. Pushing into the muscles on the inside of the lower shin is usually very painful as well.

 

TREATMENT

Rest is essential, as is daily application of ice. Be careful not to cause an ice burn by wrapping the ice in something before applying it to the skin. In addition, Sports Massage, Ankle Mobilisation, and Shin/Calf supports can all be used to reduce symptoms.

 

 

Broken Metatarsal/Metatarsal Fracture

CAUSE

Metatarsal Fractures are a common foot injury. Several high profile players have suffered Broken Metatarsals over the past few years including Wayne Rooney, David Beckham, Ashley Cole and Seven Gerrard. Increased activity or Biomechanical stress can cause small stress fractures to develop commonly in either the second or fifth Metatarsals.

 

SYMPTOMS

Symptoms usually develop over a period of around 2-3 weeks. At its worse, pain in the foot becomes severe and it is difficult to walk. Pain can often be felt on the front of the foot over the affected Metatarsal. The foot can also become swollen and bruised.

 

TREATMENT

Ice packs are usually effective at treating the acute signs of Metatarsal Fractures. However, effective treatment requires immobilisation for a period of 4-8 weeks, depending on the severity. Following this, Sports Massage, Ankle and Foot Mobilisation, Biomechanical Assessment, and Functional Rehabilitation are all important parts of achieving a full recovery.

 

 

Tennis Elbow/Lateral Epicondylitis

CAUSE

As the name suggest, Tennis Elbow or Lateral Epicondylitis is an injury commonly associated with racquet sports, however, in reality, it can affect anyone given the right circumstances. Essentially tennis Elbow is an Overuse Injury affecting the common extensor Tendons in the arm, i.e. the muscles that extend the wrist. Repeated wrist extension causes a chronic breakdown of the Tendons leading to inflammation and scar tissue formation.

 

SYMPTOMS

Pain on wrist extension, especially when movement is resisted. There can also be pain when lifting or carrying heaving objects. Pressing into the outside of the elbow will almost certainly reproduce symptoms. Over time, grip strength as well as strength in the wrist and elbow reduces. Activities that require repeated wrist movement will be painful, e.g. Tennis, Squash, and Golf. Pain can be worse first thing in the morning and following exercise.

 

TREATMENT

Tennis Elbow usually responds very well to Physiotherapy. It is usually advisable to undergo a course of Physiotherapy before any other treatment intervention is considered. Treatment is aimed at improving the underlying quality of the inflamed and scared soft tissue and therefore involves Sports Massage, Mobilisation, Stretching, Sports Specific Rehabilitation, and Acupuncture. Modification of activity and rest from irritating activities is also necessary if Tennis Elbow is to settle adequately.

 

Where conservative management does not completely relieve the symptoms, injections can be used to reduce the effects of inflammation and stop scar tissue formation. In extreme cases, Debridement surgery may be required.

 

Physiotherapy treatment usually last between 6-12 weeks and may require up to 12 session to fully Rehabilitate the injury. Having said this, symptoms are usually significantly better after just a few treatments.

 

 

Golfers Elbow/Medical Epicondylitis

CAUSE

Golfers Elbow or Medical Epicondylitis presents in exactly the same way as Tennis Elbow, the only difference being that symptoms are located over the inside part of the elbow. In Golfers Elbow the Tendon that attaches the wrist flexors breaks down becoming inflamed and accumulating scar tissue. Again it has been associated with golfers due to the repetitive wrist flexion associated with particular styles of golf swing. Being an Overuse Injury like Tennis Elbow, Golfers Elbow can affect anyone given the right circumstances.

 

SYMPTOMS

Pain on wrist flexion, especially when movement is resisted. There can also be pain when lifting or carrying heaving objects. Pressing into the inside of the elbow will almost certainly reproduce symptoms. Over time, grip strength as well as strength in the wrist and elbow reduces. Activities that require repeated wrist movement will be painful, e.g. Golf, Rock Climbing, and Throwing. Pain can be worse first thing in the morning and following exercise.

 

TREATMENT

Golfers Elbow usually responds very well to Physiotherapy. It is usually advisable to undergo a course of Physiotherapy before any other treatment intervention is considered. Treatment is aimed at improving the underlying quality of the inflamed and scared soft tissue and therefore involves Sports Massage, Mobilisation, Stretching, Sports Specific Rehabilitation, and Acupuncture. Modification of activity and rest from irritating activities is also necessary if Golfers Elbow is to settle adequately.

 

Where conservative management does not completely relieve the symptoms, injections can be used to reduce the effects of inflammation and stop scar tissue formation. In extreme cases, Debridement surgery may be required.

 

Physiotherapy treatment usually last between 6-12 weeks and may require up to 12 session to fully Rehabilitate the injury. Having said this, symptoms are usually significantly better after just a few treatments.

 

 

Biceps Tendon Rupture

CAUSE

Rupture of the Biceps Tendon (usually long head) can be caused by both Overuse Injury and sudden trauma. Biceps Tendon Rupture through Overuse Injury is more common in the over 40s and results from sustained elbow and shoulder activity. It can also occur in sports such as Swimming and Tennis due to their repetitive natures. Overtime the Tendon becomes Chronically inflamed and scarred leading to pore quality soft tissue and a reduced potential transmit stress.

 

Traumatic Biceps Tendon Ruptures usually occur during some sort of fall or whilst trying to lift something too heavy. Weight lifters and Body Builders have been known to rupture their Biceps Tendon whilst performing Bicep Curls.

 

SYMPTOMS

Irrespective of whether a Biceps Tendon Rupture has been caused by an Overuse Injury or a Traumatic Injury, the onset of symptoms remains the same. There is usually a sudden, sharp pain in the upper arm near the shoulder. This can be coupled with a popping or snapping sound. Usually this is followed by severe cramping in the Biceps Muscle itself. Bending the elbow and rotating the forearm are usually difficult if not impossible, particularly if required to do so under any force. Pain in usually present in the upper part of the arm, however, pain can also be present down the entire length of the upper arm. Bruising will usually develop quickly and the tail tail ‘Popeye’ sign may appear. This is where the Biceps Muscle bunches up giving the ‘Popeye’ like characteristic.

 

TREATMENT

Please refer to Tendon Ruptures for the standard treatment protocol for Biceps Tendon Ruptures.

 

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