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February 2016

Handout on Health: Sports

Injuries

This publication is for adult athletes at all

levels, for people who exercise, as well as for

health care professionals, coaches, and

others who want to find out more about

musculoskeletal sports injuries. This

publication describes the different types of

musculoskeletal sports injuries and how they

can be treated and prevented. If you have

further questions after reading this

publication, you may wish to discuss them

with a health care professional.

Introduction

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.

What Are Sports Injuries?

What Is the Difference Between

Acute and Chronic Injuries?

What Should I Do If I Suffer an Injury?

Who Should I See for My Injury?

How Are Sports Injuries Treated?

For More Information

Illustrations

Lateral View of the Knee

Lateral View of the Ankle

The Shoulder Joint

Information Boxes

Common Types of Sports Injuries

The Body’s Healing Process

We want to hear from you

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Tips for Preventing Injury

Fortunately, most musculoskeletal 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.

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 warm-up and stretching.

Following are some of the most common

sports injuries.

Common Types of Sports

Injuries

Muscle sprains and

strains

Tears of the ligaments that

hold joints together

Tears of the tendons that

support joints and allow

them to move

Dislocated joints

Fractured bones, including

vertebrae.

Sprains and Strains

A sprain is a stretch or tear of a ligament, the

band of connective tissues that joins the end

of one bone with another. Sprains are caused

by trauma such as a fall or blow to the body

that knocks a joint out of position and, in the

worst case, ruptures the supporting

ligaments. Sprains can range from first

degree (minimally stretched ligament) to third

degree (a complete tear). Areas of the body

most vulnerable to sprains are ankles, knees,

and wrists. Signs of a sprain include varying

degrees of tenderness or pain; bruising;

inflammation; swelling; inability to move a

limb or joint; or joint looseness, laxity, or

instability.

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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. Although 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

Because of its complex structure and weightbearing capacity, the knee is a commonly

injured joint.

Lateral View of the Knee

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 tendinitis, also

called tendinosis (marked by degeneration

within a tendon, usually where it joins the

bone).

More severe injuries include bone bruises or

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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 illustration “Lateral View of the

Knee.”)

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 warm-up.

Compartment Syndrome

In many parts of the body, muscles (along

with the nerves and blood vessels that run

alongside and through them) are enclosed in

a “compartment” formed of a tough

membrane called fascia. When muscles

become swollen, they can fill the

compartment to capacity, causing

interference with nerves and blood vessels

as well as damage to the muscles

themselves. The resulting painful condition is

referred to as compartment syndrome.

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

Although the term “shin splints” has been

widely used to describe any sort of leg pain

associated with exercise, the term actually

refers to pain along the tibia or shin bone, the

large bone in the front of the lower leg. This

pain can occur at the front outside part of the

lower leg, including the foot and ankle

(anterior shin splints) or at the inner edge of

the bone where it meets the calf muscles

(medial shin splints).

Shin splints are primarily seen in runners,

particularly those just starting a running

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program. Risk factors for shin splints include

overuse or incorrect use of the lower leg;

improper stretching, warm-up, 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

An Achilles tendon injury results from a

stretch, tear, or irritation to the tendon

connecting the calf muscle to the back of the

heel. These injuries can be so sudden and

agonizing that they have been known to bring

down charging professional football players

in shocking fashion.

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.

Lateral View of the Ankle

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Fractures

A fracture is a break in the bone that can

occur from either a quick, one-time injury to

the bone (acute fracture) or from repeated

stress to the bone over time (stress fracture).

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.

Dislocations

When the two bones that come together to

form a joint become separated, the joint is

described as being dislocated. Contact sports

such as football and basketball, as well as

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high-impact sports and sports that can result

in excessive stretching or falling, cause the

majority of dislocations. A dislocated joint is

an emergency situation that requires medical

treatment.

The Shoulder Joint

The joints most likely to be dislocated are

some of the hand joints. Aside from these

joints, the joint most frequently dislocated is

the shoulder. Dislocations of the knees, hips,

and elbows are uncommon.

What Is the Difference Between

Acute and Chronic Injuries?

Regardless of the specific structure affected,

musculoskeletal sports injuries can generally

be classified in one of two ways: acute or

chronic.

Acute Injuries

Acute injuries, such as a sprained ankle,

strained back, or fractured hand, occur

suddenly during activity. Signs of an acute

injury include the following:

sudden, severe pain

swelling

inability to place weight on a lower

limb

extreme tenderness in an upper limb

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inability to move a joint through its full

range of motion

extreme limb weakness

visible dislocation or break of a bone.

Chronic Injuries

Chronic injuries usually result from overusing

one area of the body while playing a sport or

exercising over a long period. The following

are signs of a chronic injury:

pain when performing an activity

a dull ache when at rest

swelling.

What Should I Do If I Suffer an

Injury?

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 the section “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

You should call a health professional if:

The injury causes severe pain,

swelling, or numbness.

You can’t tolerate any weight on the

area.

The pain or dull ache of an old injury

is accompanied by increased swelling

or joint abnormality or instability.

To learn about treating sports injuries, see

the section “How Are Sports Injuries

Treated?”

When and How to Treat at Home

If you don’t have any of the above symptoms,

it’s probably safe to treat the injury at

home—at least at first. If pain or other

symptoms worsen, it’s best to check with

your health care provider. Use the RICE

method to relieve pain and inflammation and

speed healing. Follow these four steps

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immediately after injury and continue for at

least 48 hours.

Rest. Reduce regular exercise or

activities of daily living as needed. If

you cannot put weight on an ankle or

knee, crutches may help. If you use a

cane or one crutch for an ankle injury,

use it on the uninjured side to help

you lean away and relieve weight on

the injured ankle.

Ice. Apply an ice pack to the injured

area for 20 minutes at a time, four to

eight times a day. A cold pack, ice

bag, or plastic bag filled with crushed

ice and wrapped in a towel can be

used. To avoid cold injury and

frostbite, do not apply the ice for more

than 20 minutes. (Note: Do not use

heat immediately after an injury. This

tends to increase internal bleeding or

swelling. Heat can be used later on to

relieve muscle tension and promote

relaxation.)

Compression. Compression of the

injured area may help reduce

swelling. Compression can be

achieved with elastic wraps, special

boots, air casts, and splints. Ask your

health care provider for advice on

which one to use.

Elevation. If possible, keep the injured

ankle, knee, elbow, or wrist elevated

on a pillow, above the level of the

heart, to help decrease swelling.

The Body’s Healing Process

From the moment a bone breaks

or a ligament tears, your body

goes to work to repair the

damage. Here’s what happens at

each stage of the healing

process:

At the moment of injury:

Chemicals are released from

damaged cells, triggering a

process called inflammation.

Blood vessels at the injury site

become dilated; blood flow

increases to carry nutrients to the

site of tissue damage.

Within hours of injury: White

blood cells (leukocytes) travel

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down the bloodstream to the

injury site where they begin to

tear down and remove damaged

tissue, allowing other specialized

cells to start developing scar

tissue.

Within days of injury: Scar

tissue is formed on the skin or

inside the body. The amount of

scarring may be proportional to

the amount of swelling,

inflammation, or bleeding within.

In the next few weeks, the

damaged area will regain a great

deal of strength as scar tissue

continues to form.

Within a month of injury: Scar

tissue may start to shrink,

bringing damaged, torn, or

separated tissues back together.

However, it may be several

months or more before the injury

is completely healed.

Who Should I See for My Injury?

Although severe injuries will need to be seen

immediately in an emergency room,

particularly if they occur on the weekend or

after office hours, most musculoskeletal

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:

An orthopaedic surgeon is a doctor

specializing in the diagnosis and

treatment of the musculoskeletal

system, which includes bones, joints,

ligaments, tendons, muscles, and

nerves.

A physical

therapist/physiotherapist is a health

care professional who can develop a

rehabilitation program. Your primary

care physician may refer you to a

physical therapist after you begin to

recover from your injury to help

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strengthen muscles and joints and

prevent further injury.

How Are Sports Injuries Treated?

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.1

1All medicines can have side effects. Some

medicines and side effects are mentioned in

this publication. Some side effects may be

more severe than others. You should review

the package insert that comes with your

medicine and ask your health care provider

or pharmacist if you have any questions

about the possible side effects.

Nonsteroidal Anti-Inflammatory Drugs

(NSAIDs)

The moment you are injured, chemicals are

released from damaged tissue cells. This

triggers the first stage of healing:

inflammation (see box “The Body’s Healing

Process”). Inflammation causes tissues to

become swollen, tender, and painful.

Although inflammation is needed for healing,

it can actually slow the healing process if left

unchecked.

To reduce inflammation and pain, doctors

and other health care providers often

recommend taking an over-the-counter

nonsteroidal anti-inflammatory drug (NSAID)

such as aspirin, ibuprofen, or naproxen

sodium. For more severe pain and

inflammation, doctors may prescribe one of

several dozen NSAIDs available in

prescription strength.2

Though not an NSAID, another commonly

used OTC medication, acetaminophen, may

relieve pain. It has no effect on inflammation,

however.

2Warning: Side effects of NSAIDs include

stomach problems; skin rashes; high blood

pressure; fluid retention; and liver, kidney,

and heart problems. The longer a person

uses NSAIDs, the more likely he or she is to

have side effects, ranging from mild to

serious. Many other drugs cannot be taken

when a patient is being treated with NSAIDs,

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because NSAIDs alter the way the body uses

or eliminates these other drugs. Check with

your health care provider or pharmacist

before you take NSAIDs. NSAIDs should only

be used at the lowest dose possible for the

shortest time needed.

Immobilization

Immobilization is a common treatment for

musculoskeletal sports injuries that may be

done immediately by a trainer or paramedic.

Immobilization involves reducing movement

in the area to prevent further damage. By

enabling the blood supply to flow more

directly to the injury (or the site of surgery to

repair damage from an injury), immobilization

reduces pain, swelling, and muscle spasm

and helps the healing process begin.

Following are some devices used for

immobilization:

Slings, to immobilize the upper body,

including the arms and shoulders.

Splints and casts, to support and

protect injured bones and soft tissue.

Casts can be made from plaster or

fiberglass. Splints can be custom

made or ready made. Standard

splints come in a variety of shapes

and sizes and have Velcro straps that

make them easy to put on and take

off or adjust. Splints generally offer

less support and protection than a

cast, and therefore may not always

be a treatment option.

Leg immobilizers, to keep the knee

from bending after injury or surgery.

Made from foam rubber covered with

fabric, leg immobilizers enclose the

entire leg, fastening with Velcro

straps.

Surgery

In some cases, surgery is needed to repair

torn connective tissues or to realign bones

with compound fractures. The vast majority of

musculoskeletal sports injuries, however, do

not require surgery.

Rehabilitation (Exercise)

A key part of rehabilitation from sports

injuries is a graduated exercise program

designed to return the injured body part to a

normal level of function.

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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 exercises 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

warm-up 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 box “Tips for Preventing

Injury.”

Rest

Although it is important to get moving as

soon as possible, you must also take time to

rest following an injury. All injuries need time

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to heal; proper rest will help the process.

Your health care professional can guide you

regarding the proper balance between rest

and rehabilitation.

Other Therapies

Other therapies used in rehabilitating sports

injuries include:

Cold/cryotherapy: Ice packs reduce

inflammation by constricting blood

vessels and limiting blood flow to the

injured tissues. Cryotherapy eases

pain by numbing the injured area. It is

generally used for only the first 48

hours after injury.

Heat/thermotherapy: Heat, in the form

of hot compresses, heat lamps, or

heating pads, causes the blood

vessels to dilate and increase blood

flow to the injury site. Increased blood

flow aids the healing process by

removing cell debris from damaged

tissues and carrying healing nutrients

to the injury site. Heat also helps to

reduce pain. It should not be applied

within the first 48 hours after an injury.

Ultrasound: High-frequency sound

waves produce deep heat that is

applied directly to an injured area.

Ultrasound stimulates blood flow to

promote healing.

Massage: Manual pressing, rubbing,

and manipulation soothe tense

muscles and increase blood flow to

the injury site.

Most of these therapies are administered or

supervised by a licensed health care

professional.

Tips for Preventing Injury

Whether you’ve never had a

sports injury and you’re trying to

keep it that way or you’ve had an

injury and don’t want another, the

following tips can help.

Avoid bending knees past

90 degrees when doing

half knee bends.

Avoid twisting knees by

keeping feet as flat as

possible during stretches.

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When jumping, land with

your knees bent.

Do warm-up exercises not

just before vigorous

activities like running, but

also before less vigorous

ones such as golf.

Don’t overdo.

Do warm-up stretches

before activity. Stretch the

Achilles tendon,

hamstring, and quadriceps

areas and hold the

positions. Don’t bounce.

Cool down following

vigorous sports. For

example, after a race,

walk or walk/jog for 5

minutes so your pulse

comes down gradually.

Wear properly fitting

shoes that provide shock

absorption and stability.

Use the softest exercise

surface available, and

avoid running on hard

surfaces like asphalt and

concrete. Run on flat

surfaces. Running uphill

may increase the stress

on the Achilles tendon and

the leg itself.

More information on research is available

from the following websites:

National Institutes of Health (NIH)

Clinical Research Trials and You

was designed to help people learn

more about clinical trials, why they

matter, and how to participate.

Visitors to the website will find

information about the basics of

participating in a clinical trial,

first-hand stories from clinical trial

volunteers, explanations from

researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and

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conditions.

NIH RePORTER is an electronic tool

that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years and

access publications (since 1985) and

patents resulting from NIH funding.

PubMed is a free service of the U.S.

National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of

medicine, nursing, dentistry,

veterinary medicine, the health care

system, and preclinical sciences.

For More Information

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about available

resources in your language or another

language, please visit our website or contact

the NIAMS Information Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

American Academy of Orthopaedic

Surgeons

Website: http://www.aaos.org (con

información en español)

American Academy of Pediatrics

Website: http://www.aap.org

American College of Sports Medicine

Website: http://www.acsm.org

American Medical Society for Sports

Medicine

Website: http://www.amssm.org

American Orthopaedic Society for Sports

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Medicine

Website: http://www.sportsmed.org

American Physical Therapy Association

Website: http://www.apta.org (con

información en español)

National Athletic Trainers Association

Website: http://www.nata.org (con

información en español)

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in the

preparation and review of the original version

of this publication: American Academy of

Orthopaedic Surgeons, Rosemont, IL; the

American Physical Therapy Association,

Alexandria, VA; William E. Garrett, Jr., M.D.,

Ph.D., University of North Carolina, Chapel

Hill, NC; Jo A. Hannafin, M.D., Ph.D.,

Hospital for Special Surgery, New York, NY;

Lynne Haverkos, M.D., Eunice Kennedy

Shriver 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; National Institute of Neurological

Disorders and Stroke, NIH; and James S.

Panagis, M.D., M.P.H., NIAMS/NIH. Special

thanks also go to the individuals who

reviewed this publication and provided

valuable assistance. Mary Anne Dunkin was

the author of this publication.

The mission of the National Institute of

Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the U.S.

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 NIAMS 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 website at www.niams.nih.gov.

Information on bone and its disorders can be

obtained from the NIH Osteoporosis and

Related Bone Diseases ~ National Resource

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Center by calling toll free at 800–624–BONE

(2663) or by visiting

www.niams.nih.gov/Health_Info

/Bone/default.asp.

For Your Information

This publication contains information about

medications used to treat the health condition

discussed here. When this publication was

developed, we included the most up-to-date

(accurate) information available.

Occasionally, new information on medication

is released.

For updates and for any questions about any

medications you are taking, please contact

U.S. Food and Drug Administration

Toll free: 888-INFO-FDA

(888-463-6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

http://www.accessdata.fda.gov/scripts

/cder/daf/. Drugs@FDA is a searchable

catalog of FDA-approved drug products.

For updates and questions about statistics,

please contact

Centers for Disease Control and

Prevention, National Center for

Health Statistics

Toll free: 800-232-4636

Website: http://www.cdc.gov/nchs

This publication is not copyrighted. Readers

are encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

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Website: https://www.niams.nih.gov

NIH Publication No. 16–5278

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