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.

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.

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’.
P- Protection
R- Rest
I- Ice
C- Compression
E- Elevation

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.