U.S. Department of Health and Human Services
Table of Contents
This booklet is for athletes at all ages and levels, for people who exercise, as well as for health care professionals, coaches, and others who want to find out more about sports injuries. This booklet describes the different types of sports injuries, how they can be treated and prevented, and recent treatment advances from research. It also highlights risk factors and contains a resource list. If you have further questions after reading this booklet, you may wish to discuss them with a health care professional.
In recent years, increasing numbers of people of all ages have been heeding their health professionals' advice to get active for all of the health benefits exercise has to offer. But for some people-particularly those who overdo or who don't properly train or warm up-these benefits can come at a price: sports injuries.
Fortunately, most sports injuries can be treated effectively, and most people who suffer injuries can return to a satisfying level of physical activity after an injury. Even better, many sports injuries can be prevented if people take the proper precautions.
This booklet answers frequently asked questions about sports injuries. It discusses some of the most common injuries and their treatment, and injury prevention. The booklet is for anyone who has a sports injury or who is physically active and wants to prevent sports injuries.
It is for casual and more serious athletes as well as the trainers, coaches, and health professionals who deal with sports injuries.What Are Sports Injuries?
The term sports injury, in the broadest sense, refers to the kinds of injuries that most commonly occur during sports or exercise. Some sports injuries result from accidents; others are due to poor training practices, improper equipment, lack of conditioning, or insufficient warmup and stretching.
Although virtually any part of your body can be injured during sports or exercise, the term is usually reserved for injuries that involve the musculoskeletal system, which includes the muscles, bones, and associated tissues like cartilage. Traumatic brain and spinal cord injuries, (relatively rare during sports or exercise) and bruises are considered briefly in the Appendix. Following are some of the most common sports injuries.
Sprains and Strains
A strain is a twist, pull, or tear of a muscle or tendon, a cord of tissue connecting muscle to bone. It is an acute, noncontact injury that results from overstretching or overcontraction. Symptoms of a strain include pain, muscle spasm, and loss of strength. While it's hard to tell the difference between mild and moderate strains, severe strains not treated professionally can cause damage and loss of function.
Knee injuries can range from mild to severe. Some of the less severe, yet still painful and functionally limiting, knee problems are runner's knee (pain or tenderness close to or under the knee cap at the front or side of the knee), iliotibial band syndrome (pain on the outer side of the knee), and tendonitis, also called tendinosis (marked by degeneration within a tendon, usually where it joins the bone).
Knee injuries can result from a blow to or twist of the knee or from running to hard, too much, or without proper warmup.
More severe injuries include bone bruises or damage to the cartilage or ligaments. There are two types of cartilage in the knee. One is the meniscus, a crescent-shaped disc that absorbs shock between the thigh (femur) and lower leg bones (tibia and fibula). The other is a surface-coating (or articular) cartilage. It covers the ends of the bones where they meet, allowing them to glide against one another. The four major ligaments that support the knee are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL). (See diagram.)
Knee injuries can result from a blow to or twist of the knee; from improper landing after a jump; or from running too hard, too much, or without proper warmup.
Compartment syndrome may be caused by a one-time traumatic injury (acute compartment syndrome), such as a fractured bone or a hard blow to the thigh, by repeated hard blows (depending upon the sport), or by ongoing overuse (chronic exertional compartment syndrome), which may occur, for example, in long-distance running.
Shin splints are primarily seen in runners, particularly those just starting a running program. Risk factors for shin splints include overuse or incorrect use of the lower leg; improper stretching, warmup, or exercise technique; overtraining; running or jumping on hard surfaces; and running in shoes that don't have enough support. These injuries are often associated with flat (overpronated) feet.
Achilles Tendon Injuries
The most common cause of Achilles tendon tears is a problem called tendinitis, a degenerative condition caused by aging or overuse. When a tendon is weakened, trauma can cause it to rupture.
Achilles tendon injuries are common in middle-aged "weekend warriors" who may not exercise regularly or take time to stretch properly before an activity. Among professional athletes, most Achilles injuries seem to occur in quick-acceleration, jumping sports like football and basketball, and almost always end the season's competition for the athlete.
Achilles tendon injuries are common in middle-aged "weekend warriors" who may not excercise regularly.
Acute fractures: Acute fractures can be simple (a clean break with little damage to the surrounding tissue) or compound (a break in which the bone pierces the skin with little damage to the surrounding tissue). Most acute fractures are emergencies. One that breaks the skin is especially dangerous because there is a high risk of infection.
Stress fractures: Stress fractures occur largely in the feet and legs and are common in sports that require repetitive impact, primarily running/jumping sports such as gymnastics or track and field. Running creates forces two to three times a person's body weight on the lower limbs.
The most common symptom of a stress fracture is pain at the site that worsens with weight-bearing activity. Tenderness and swelling often accompany the pain.
Regardless of the specific structure affected, sports injuries can generally be classified in one of two ways: acute or chronic.
Whether an injury is acute or chronic, there is never a good reason to try to "work through" the pain of an injury. When you have pain from a particular movement or activity, STOP! Continuing the activity only causes further harm.
Some injuries require prompt medical attention (see "Who Should I See for My Injury?"), while others can be self-treated. Here's what you need to know about both types:
When to Seek Medical Treatment
To learn about treating sports injuries, see "How Are Sports Injuries Treated?".
When and How to Treat at Home
While severe injuries will need to be seen immediately in an emergency room, particularly if they occur on the weekend or after office hours, most sports injuries can be evaluated and, in many cases, treated by your primary health care provider.
Depending on your preference and the severity of your injury or the likelihood that your injury may cause ongoing, long-term problems, you may want to see, or have your primary health care professional refer you to, one of the following:
Although using the RICE technique described previously can be helpful for any sports injury, RICE is often just a starting point. Here are some other treatments your doctor or other health care provider may administer, recommend, or prescribe to help your injury heal.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
To reduce inflammation and pain, doctors and other health care providers often recommend taking an overthe-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil,1 Motrin IB, Nuprin), ketoprofen (Actron, Orudis KT), or naproxen sodium (Aleve). For more severe pain and inflammation, doctors may prescribe one of several dozen NSAIDs available in prescription strength.2
1. Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
2. Like all medications, NSAIDs can have side effects. The list of possible adverse effects is long, but major problems are few. The intestinal tract heads the list with nausea, abdominal pain, vomiting, and diarrhea. Changes in liver function frequently occur in children (but not in adults) who use aspirin. Changes in liver function are rare in children using the other NSAIDs. Questions about the appropriate use of NSAIDs should be directed toward your health care provider or pharmacist.
Though not an NSAID, another commonly used OTC medication, acetaminophen (Tylenol), may relieve pain. It has no effect on inflammation, however.
With most injuries, getting the part moving will speed healing.
With most injuries, early mobilization-getting the part moving as soon as possible-will speed healing. Generally, early mobilization starts with gentle range-of-motion exercises and then moves on to stretching and strengthening exercise when you can without increasing pain. For example, if you have a sprained ankle, you may be able to work on range of motion for the first day or two after the sprain by gently tracing letters with your big toe. Once your range of motion is fairly good, you can start doing gentle stretching and strengthening exercises. When you are ready, weights may be added to your exercise routine to further strengthen the injured area. The key is to avoid movement that causes pain.
As damaged tissue heals, scar tissue forms, which shrinks and brings torn or separated tissues back together. As a result, the injury site becomes tight or stiff, and damaged tissues are at risk of reinjury. That's why stretching and strengthening exercises are so important. You should continue to stretch the muscles daily and as the first part of your warmup before exercising.
When planning your rehabilitation program with a health care professional, remember that progression is the key principle. Start with just a few exercises, do them often, and then gradually increase how much you do. A complete rehabilitation program should include exercises for flexibility, endurance, and strength; instruction in balance and proper body mechanics related to the sport; and a planned return to full participation.
Throughout the rehabilitation process, avoid painful activities and concentrate on those exercises that will improve function in the injured part. Don't resume your sport until you are sure you can stretch the injured tissues without any pain, swelling, or restricted movement, and monitor any other symptoms. When you do return to your sport, start slowly and gradually build up to full participation. For more advice on how to prevent injuries as you return to active exercise, see the "Tips for Preventing Injury" box.
Most of these therapies are administered or supervised by a licensed health care professional.
If a professional athlete dislocates a joint or tears a ligament, it makes the news. But anyone who plays sports can be injured. Three groups-children and adolescents, middleaged athletes, and women-are particularly vulnerable.
Children and Adolescents
Young athletes are not small adults. Their bones, muscles, tendons, and ligaments are still growing and that makes them more prone to injury. Growth plates-the areas of developing cartilage where bone growth occurs in growing children are weaker than the nearby ligaments and tendons. As a result, what is often a bruise or sprain in an adult can be a potentially serious growth-plate injury in a child. Also, a trauma that would tear a muscle or ligament in an adult would be far more likely to break a child's bone.
Because young athletes of the same age can differ greatly in size and physical maturity, some may try to perform at levels beyond their ability in order to keep up with their peers.
Contact sports have inherent dangers that put young athletes at special risk for severe injuries. Even with rigorous training and proper safety equipment, youngsters are still at risk for severe injuries to the neck, spinal cord, and growth plates. Evaluating potential sports injuries on the field in very young children can involve its own special issues for concerned parents and coaches. Some helpful hints are presented in the Appendix.
Female athletes have higher injury rates than men in many sports, particularly basketball, soccer, alpine skiing, volleyball, and gymnastics. Female college basketball players are about six times more likely to suffer a tear of the knee's anterior cruciate ligament (ACL) than men are, according to a study of 11,780 high school and college players. Information on injuries collected since 1982 by the National Collegiate Athletic Association shows that female basketball and soccer players have a much higher incidence of ACL injuries than their male counterparts.
Previous assumptions that methods of training, risks of participation, and effects of exercise are the same for men and women are being challenged. Scientists are working to understand the gender differences in sports injuries.
While poor conditioning has not been related to an increased incidence of ACL injuries specifically, it has been associated with an increase in injuries in general. For most American women, the basic level of conditioning is much lower than that of men. Studies at the U.S. Naval Academy revealed that overuse injuries were more frequent in women; however, as women became used to the rigors of training, the injury rates for men and women became similar.
Aside from conditioning level, other possible factors in women's sports injuries include structural difference of the knee and thigh muscles, fluctuating estrogen levels caused by menstruation, the fit of athletic shoes, and the way players jump, land, and twist. Also, "the female triad," a combination of disordered eating, curtailed menstruation (amenorrhea), and loss of bone mass (osteoporosis), is increasingly more common in female athletes in some sports. Its true prevalence is unknown, but it appears to be greater in athletes, adolescents, and young adults, especially in people who are perfectionists and overachievers.
Scientists trying to better understand sports injuries in women met in June 1999 for a workshop sponsored jointly by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American Academy of Orthopaedic Surgeons. The workshop proceedings were published in a book titled Women's Health in Sports & Exercise, edited by William Garrett, M.D., Ph.D., and Gayle Lester, Ph.D. The book may be purchased from the American Academy of Orthopaedic Surgeons (www.aaos.org).
Anyone who exercises is potentially at risk for a sports injury and should follow the injury prevention tips. But additional measures can be taken by groups at higher risk of injury.
What parents and coaches can do:
What children can do:
Today, the outlook for an injured athlete is far more optimistic than in the past. Sports medicine has developed some nearmiraculous ways to help athletes heal and, in most cases, return to sports. Following are some procedures that have greatly advanced the treatment of sports injuries:
Because arthroscopy uses tiny incisions, it results in less trauma, swelling, and scar tissue than conventional surgery, which in turn decreases hospitalization and rehabilitation times. Problems can be diagnosed earlier and treated without serious health risks or more invasive procedures. Furthermore, because injuries are often addressed at an earlier stage, operations are more likely to be successful.
Targeted Pain Relief
Recent advances in treating sports injuries are likely to be just the beginning. Watch for developments in these areas in the not-too-distant future:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
NIAMS provides information about various forms of arthritis and rheumatic disease and bone, muscle, joint, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS Web site.
American Academy of Orthopaedic Surgeons (AAOS)
The academy provides education and practice management services for orthopaedic surgeons and allied health professionals. It also serves as an advocate for improved patient care and informs the public about the science of orthopaedics. The orthopaedist's scope of practice includes disorders of the body's bones, joints, ligaments, muscles, and tendons. For a single copy of an AAOS brochure, send a self-addressed stamped envelope to the address above or visit the AAOS Web site.
American Academy of Pediatrics
The American Academy of Pediatrics (AAP) and its member pediatricians dedicate their efforts and resources to the health, safety, and well-being of infants, children, adolescents, and young adults. Activities of the AAP include advocacy for children and youth, public education, research, professional education, and membership service and advocacy for pediatricians.
American College of Sports Medicine
The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. Nearly 18,500 members throughout the U.S. and the world are dedicated to promoting and integrating scientific research, education, and practical applications of sports medicine and exercise science to maintain and enhance physical performance, fitness, health, and quality of life.
American Medical Society for Sports Medicine (AMSSM)
The society fosters a collegial relationship among dedicated, competent sports medicine specialists and provides a quality educational resource for members, other sports medicine professionals, and the public.
American Orthopaedic Society for Sports Medicine
The society is an organization of orthopaedic surgeons and allied health professionals dedicated to educating health care professionals and the general public about sports medicine. It promotes and supports educational and research programs in sports medicine, including those concerned with fitness, as well as programs designed to advance our knowledge of the recognition, treatment, rehabilitation, and prevention of athletic injuries.
American Physical Therapy Association
The association is a national professional organization of physical therapists, physical therapist assistants, and physical therapy students. Its objectives are to improve physical therapy practice, research, and education to promote, restore, and maintain optimal physical function, wellness, fitness, and quality of life, especially as it relates to movement and health.
National Athletic Trainers Association
The association enhances the quality of health care for athletes and those engaged in physical activity. It also advances the profession of athletic training through education and research in the prevention, evaluation, management, and rehabilitation of injuries.
Traumatic Brain and Spinal Cord Injuries
Several types of traumatic injuries can affect the head and brain. A skull fracture occurs when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. This can cause bruising of the brain tissue, called a contusion. A contusion can also occur in response to shaking of the brain within the confines of the skull. Damage to a major blood vessel within the head can cause a hematoma, or heavy bleeding into or around the brain. The severity of a TBI can range from a mild concussion to the extremes of coma or even death.
What to do: For anything more than the most superficial injury, call for emergency medical assistance immediately. Observe symptoms so that you can report when help arrives. Do not allow the person to continue the activity. In more serious cases, do not move the person unless there is danger.
Spinal cord injury (SCI) occurs when a traumatic event results in damage to cells in the spinal cord or severs the nerve tracts that relay signals up and down the spinal cord. The most common types of SCI include contusion (bruising of the spinal cord) and compression (caused by pressure on the spinal cord). Other types include lacerations (severing or tearing of nerve fibers) and central cord syndrome (specific damage to the cervical region of the spinal cord).
What to do: In some cases, drugs called corticosteroids can minimize cell damage from a spinal cord injury. To be effective, they must be given within 8 hours of the injury. For this reason, it is important to call for emergency medical assistance immediately. Any person suspected of sustaining such a spinal cord injury should not be moved unless it is absolutely essential to keep the airway open so the person can breathe or to maintain circulation.
For more information, visit the Web site of the National Institute of Neurological Disorders and Stroke at www.ninds.nih.gov/health_and_medical/disorders/sci.htm or call (800) 352-9424.
What to do: Put the muscle in a gentle stretch position and begin using the RICE method to start the healing process. For more severe bruises, consult a doctor.
Here are some "on-the-field" tips for helping a young child who has been injured:
The NIAMS gratefully acknowledges the assistance of the American Academy of Orthopaedic Surgeons, Des Plaines, IL; the American Physical Therapy Association, Alexandria, VA; William E. Garrett, Jr., M.D., Ph.D., University of North Carolina; Jo A. Hannafin, M.D., Ph.D., Hospital for Special Surgery, New York, NY; Lynn Haverkof, M.D., the National Institute of Child Health and Human Development, NIH; Cato T. Laurencin, M.D., Ph.D., University of Virginia, Charlottesville, VA; Gayle Lester, Ph.D., NIAMS, NIH; the National Institute of Neurological Disorders and Stroke, NIH; and James S. Panagis, M.D., M.P.H., NIAMS, NIH, in the preparation and review of this booklet. Special thanks also go to the individuals who reviewed this publication and provided valuable assistance. Mary Anne Dunkin was the author of this booklet.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at www.niams.nih.gov. The NIH Osteoporosis and Related Bone Diseases-National Resource Center , also a part of the U.S. Department of Health and Human Services' National Institutes of Health (NIH), provides patients, health professionals, and the public with an important link to resources and information on metabolic bone diseases, including osteoporosis, Paget's disease of the bone, osteogenesis imperfecta, and hyperparathyroidism. Additional information can be found on the Resource Center's Web site at www.osteo.org.
This booklet is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed. Additional copies of this booklet are available from the
U.S. Department of Health and Human Services
NIH Publication No. 04-5278
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