Today sports and physical exercises became part of everyone’s life. To avoid sedentary lifestyle or to give identity to own, everyone is involved in these tasks. The youngsters or teenagers are especially attached to it. As we are concerned with physical activities and sports we must be aware about the injuries caused by them too. In sports, one might be on a risk to get the injury depending upon the type of sport he is playing or the activity, he is accomplishing. For example a sport like chess, there is minimal or no chance of injury but on another side sports like rugby, or wrestling has higher chances of injuries. The extent of injury may vary from a minor soft tissue injury to major trauma like fractures, multiple trauma or even head injuries.
There are certain injuries which are extremely common according to the sport type. For example a player of football team usually gets lower limb injuries and a bowler may get shoulder injuries. Our joints are anatomically designed in such a way so that they can bear a significant level of stress but as they get a level higher than that, injuries occur. A repeated strain injuries of soft tissues are also common.
Although there are so many causes but common causes of sports injuries include:
1. Overpressure on muscles or other soft tissue structures.
2. Shear pressure on bones
3. Improper stretching before playing
4. Lack of adequate strengthening of muscles according to the type of sport
5. Faulty biomechanics while playing
6. Faulty foot wears
7. Faulty training in sport
8. Lack of attention after drugs usage
9. Improper medical care after previous trauma
10. Compulsion of playing after a minor trauma
Type of sports injuries: generally we classify these injuries into 2 categories: Acute and Overuse.
Acute injuries contain fractures, dislocations or subluxations (partial disarticulation of bones), muscle strain, ligament ruptures, capsule tears, nerve injuries and skin wounds.
Overuse injuries contain stress fractures, tendon inflammations, ligament inflammations, entrapment of nerves and blisters or callus in skin.
Symptoms: In acute conditions pain and swelling are prominent. With these, inability to move the part is also common. If there is head injury the symptoms may vary from no significant alteration to death. Loss of consciousness, bleeding from ears, nose and nerve injuries are common too.
In overuse injuries, as they occur from repeated stress or repeated pressure on a single soft tissue structure, persistent pain and swelling are seen. The; pain may be so disturbing to hamper the activities or someone may has to completely restrict the sports activities. With this, entrapment of nerves is common too which causes tingling sensations, paresthesias or weakness of muscles.
Diagnosis: there are many methods of diagnosing a sport injury but on the ground it is diagnosed clinically and the management is also done accordingly. Generally to diagnose a condition outside the field, the same medical procedures are used. For example:
1. Fractures: X-ray, CT-scan
2. Stress fractures: Bone scan, ultrasonography
3. Soft tissue rupture or inflammation: MRI scan, ultrasonography
4. Nerve conduction: NCV, strength-duration curves etc.
5. Manual tests like palpation, special tests for soft tissue structures, range of motion and muscle strength.
Besides that several other tests like 3-d scans, colour Doppler or biochemical tests may be done based on the type of injury.Prevention:
The best is to prevent the injury. The measure of prevention depends upon the specific needs of the sports.
1. To prevent these injuries one must be under guidance or coaching while playing the sports or doing physical activities or exercises in gym.
2. A sound and well designed exercise protocol must be incorporated which includes definite sessions of warm-up, stretching and cooling-down.
3. Prior evaluation of muscle strength and body structure must be done.
4. If there is any previous injury, measures to be taken to heal it first.
5. Selection of sportswear like shoes and clothes must be adequately done.
6. Break-ups and rest must be included.
7. Balanced diet with full of proteins and fibers must be a part.
8. If there is anatomical mal-alignment of the posture, it must be corrected.
9. Faulty biomechanics must be corrected while playing the sport.
10. Time to time consultations with medical consultants is must.
11. Psychological assessment, team spirit and Love for sport must be checked.Management:
Before starting any management in sports injury, it is mandatory to do the proper assessment and evaluation of injury. This helps in detection of extent of injury and selection of management methods. The assessment consists of palpation, range of motion, muscle power. In case of head injuries, this may follow evaluation of consciousness level, scar level on head, alteration in behaviour or memory etc. The management depends upon several factors like age, sex, type of sport, extent of injury and need of play. But yes, the treatment of acute conditions follows the same principle of ‘RICE’. Although some medical specialists have made it ‘PRICE’.
The protection is provided through splinting or bandaging or through orthotic supports.
The rest is provided for adequate time depending upon the type and extent of injury.
The ice is applied through cooling sprays, ice-packs, ice-cold water or through literal application of ice cubes on the part. The cold therapy is given within 48 hours several times in a day to prevent swelling and to reduce the pain.
Compression is also provided to reduce the swelling and to support the injured part. This may be provided through bandages, taping, or orthotic supports.
Elevation is also done to reduce the swelling in the injured part.
After 48 hours, reassessment is done to provide the further management. After the period of 48 hours, hot fomentation may be provided which promoted healing of the injured part. With this exercises like stretching may be started depending upon the type and extent of injury. Further rehabilitation is designed through a physiotherapist or physiatrist who incorporates stretching, strengthening, balancing, coordination exercises and sport specific training.
For Overuse or chronic problem, the base line treatment is physiotherapy and drugs. The medicines like non steroidal anti inflammatory drugs, muscle relaxants and local application ointments and sprays are beneficial. In physiotherapy, modalities like diathermy, ultrasonic therapy, interferential therapy, TENS and many others provide significant relief from the ailments. With these posture correction exercises, balancing exercises and coordination exercises are provided very often. In case of mal-alignment of posture, specific muscle strengthening is incorporated. Sometimes orthotic supports like silicon arch pad or spinal supports are needed.
In later articles, specific sports injuries would be discussed with their causes and managements.
Article Compiled By:
Dr. Sachin Goyal
Consultant Physiotherapist & Cranio-Sacral Therapist.
B.P.T., M.P.T(Ortho), C.C.S.T., M.I.A.P.
Ex. Physio (I): Bara Hindu Rao Hospital, Delhi.
Physiotherapist in Darya Ganj, Delhi.
Role of Physiotherapy in Diabetes
Diabetes mellitus - a clinical syndrome characterized by polydypsia, polyphagia and polyuria. The prevalence of diabetes is rising all over the world due to population growth, aging, urbanisation and an increase of obesity and physical inactivity. Unlike in the West, where older persons are most affected, diabetes in Asian countries is disproportionately high in young to middle-aged adults. The International Diabetes Federation (IDF) estimates the total number of people in India with diabetes to be around 50.8 million in 2010, rising to 87.0 million by 2030.
The Diabetes Prevention Project demonstrated that lifestyle modification, including intensive exercise, is more effective in preventing diabetes than pharmacological therapy, and highlighted the role of trained professionals in motivating people to follow lifestyle interventions.
Physiotherapists are able to help people, to plan an individualized exercise programme in order to maintain good blood glucose control and achieve optimal weight.
Furthermore, physiotherapy leads to metabolic improvements even in the absence of weight loss, reducing the frequency of cardiovascular events and improving life expectancy. Effective exercise counseling ensures both cardiorespiratory and musculoskeletal fitness. This helps people with diabetes improve their quality of life, and contributes to overall control of blood glucose. The use of alternative therapies, such as yoga, can contribute to the achievement of optimal cardio-respiratory health.
Physiotherapists can help people to maintain good blood glucose control and achieve optimal weight.
While most any exercise is healthy for people with diabetes, let's look at some specific types of exercise and their benefits:
Strength Training and Type 2 Diabetes
The latest findings show that exercise such as strength training has a profound impact on helping people manage their diabetes. In a recent study 16 weeks of strength training produced dramatic improvements in sugar control that are comparable to taking diabetes medication. Additionally, the study volunteers were stronger, gained muscle, lost body fat, had less depression, and felt much more self-confident.
Aerobic Fitness and Type 2 Diabetes
Any activity that raises your heart rate and keeps it up for an extended period of time will improve your aerobic fitness. Aerobic exercise helps decrease the risk of type 2 diabetes and helps those with diabetes to better manage their blood sugar levels. Besides the health benefits, exercise is fun and boosts your mood. It's hard to feel stressed when you're walking on a treadmill or swimming laps in a pool.
Type 2 Diabetes and Exercise Tips
·To reduce the risk of hypoglycemia if you have diabetes, follow a regular routine of exercising, eating your meals, and taking your medicines at the same time each day.
·Prolonged or strenuous exercise can cause your body to produce adrenaline and other hormones that can counteract the effects of insulin and cause your blood sugar to rise. If you are participating in strenuous exercise (exercising at your maximum capacity) or prolonged exercise (lasting for several hours or more), your insulin and/or oral diabetic medicine or your calories may need to be changed. Talk to your health care provider about how to adjust your medicine.
· Be careful exercising when your medicine is reaching its peak effect.
· Depending on the time of exercise, reducing your dose of either long-acting insulin or short-acting insulin may be necessary. Your doctor can recommend how to make this adjustment.
· Exercise with someone who knows you have diabetes and knows what to do if you have a low blood-sugar reaction.
· Wear a medical identification tag (for example, MedicAlert) or carry an identification card that states you have diabetes.
· Check your sugars before, during and after exercise and always carry a small carbohydrate snack such as a fruit or fruit drink since low blood sugars can occur.
Physiotherapy offers various effective non-pharmacological approaches for pain relief. Transcutaneous electrical nerve stimulation (TENS) involves electrical nerve stimulation through the skin, sending a painless current to specific nerves. The mild electrical current generates heat that serves to relieve stiffness, improve mobility, and relieve pain.
Interferential therapy (IFT) uses the strong physiological effects of low frequency electrical stimulation of nerves.
TENS and IFT are considered gold-standard therapies for the relief of neuropathic pain, and have proven benefits in the management of painful diabetic neuropathy, edema (build-up of fluid in tissue) and resistant foot ulcers. TENS has been shown to be most effective against burning and stabbing pain, but comparatively less efficient for the relief of painfully sensitive skin and restless legs syndrome.
Other modalities, such as ultrasonic therapy and hot wax, are useful for specific conditions in both people with diabetes and people without the condition.
Physiotherapy can play an important role in preventing and managing foot problems.
Understanding the importance of correct gait and posture, along with the basic principles of off-loading when required, can prevent or stabilize a number of foot complications. In people with tropic ulcers, for example, which are typical in people with diabetes-related foot problems, the effective use of crutches or foot splints can ensure early healing.
Back pain is a major concern in an individual’s life. Almost every person in his life time experiences the back pain. The non organic causes predominated with about 70% cases. These includes the bad posture, faulty ergonomics and improper activities. While on another side organic causes like spinal trauma, degenerative diseases of spine, spondylo- arthropathies, spinal deformities or metabolic bone diseases account for major concerns.
MAJOR CAUSES -
The major cause of the back pain in adolescents and adults may be disc prolapsed due to which patient can experience the pain along with radicular symptoms. Tingling sensations and numbness dominates if it is lateral or para central protrusion. The pain radiates along the nerve course which is compressed.
The second common cause is degeneration of spine in which there can be spinal stenosis also. Also, there may or may not be radicular symptoms with tingling sensation and numbness. This problem is majorly of older age but it can be occur in early ages also.
The spinal infection for example the tubercular spine is also in the categories of major causes. The pars spinal abscess leads to destruction of the spine and other spinal components.
Other than these the pain can be referred from other systems like reproductive systems, alimentary system of neurological systems.
The major symptoms which anyone can experience with back pain are numbness, tingling sensations, radicular pain, vascular changes, referred joint pains, muscle spasms, para spinal tightness, and autonomic changes.
Some conditions can mimic the back pain or can get worse in presence like diabetes mellitus, thyroidism, paralysis, malnutrition or any other metabolic conditions.
HOW TO PREVENT-
The best way to prevent the back pain is regular exercises. Exercises may include specially back and core strengthening. Along with that regular cardio respiratory exercises like walking, jogging or cycling help. But the exercises should be perform in a supervision of a physical trainer or a physiotherapist. The improper exercise may lead to strain or sprain.
WHAT ELSE YOU CAN DO?
Besides that proper nutrition and balanced diet should be a part of your diet.
Following a good ergonomics at your work place is essential to prevent the back pain. Consult a physiotherapist or occupational therapist for good ergonomics.
If you are facing back pain currently, go to an orthopedicain or a physiotherapist for help. In acute stages, pain killers and muscle relaxants may be necessary.
NOT TO DO -
Do not take medicine on your own.
Correct diagnosis is essential and should be a part of therapy. Physiotherapy may include the hot and cold therapy with supervised exercises and postural care.Don’t delay if you are experiencing the back pain. Visit to your physiotherapist today….!
Alternative therapies like acupuncture and craniosacral therapies also help to a great extent.
COMPILED BY -
Dr. Sachin Goyal
Consultant Physiotherapist & Cranio-Sacral Therapist.
B.P.T., C.C.S.T., M.I.A.P.
Ex. Physio (I): Bara Hindu Rao Hospital, Delhi.