Sports Injuries

April 2009

Handout on Health: Sports Injuries

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.

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.

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?

 What's 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?

 Who Is at Greatest Risk for Sports Injuries?

 What Can Groups at High Risk Do to Prevent Sports Injuries?

 What Are Some Recent Advances in Treating Sports Injuries?

 What Advances Might We Expect in the Future?

 For More Information

 Appendix

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

 Tips for Preventing Injury

Appendix

 Traumatic Brain and Spinal Cord Injuries

 Bruises

 Sports Injuries in Young Children: Tips for Caregivers

What Are Sports Injuries?

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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 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.

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 weight-bearing capacity, the knee is the most commonly injured joint. Each year, more than 5.5 million

people visit doctors for knee problems.

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 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 surfacecoating (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

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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

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 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

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 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's the Difference Between Acute and Chronic 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.

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Regardless of the specific structure affected, 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

 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 "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 "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 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

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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 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:

 Orthopaedic surgeon: A doctor specializing in the diagnosis and treatment of the musculoskeletal system, which includes bones,

joints, ligaments, tendons, muscles, and nerves.

 Physical therapist/physiotherapist: 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 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.

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

"The Body's Healing Process" box). 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 (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

1Brand 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.

2Like 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.

Immobilization

Immobilization is a common treatment for sports injuries that may be done immediately by a trainer or paramedic. Immobilization involves

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 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.

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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 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.

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.

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 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 commonly used in rehabilitating sports injuries include:

 Electrostimulation: Mild electrical current provides pain relief by preventing nerve cells from sending pain impulses to the brain.

Electrostimulation may also be used to decrease swelling, and to make muscles in immobilized limbs contract, thus preventing

muscle atrophy and maintaining or increasing muscle strength.

 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.

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Most of these therapies are administered or supervised by a licensed health care professional.

Who Is at Greatest Risk for Sports Injuries?

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, middle-aged athletes, and women—are particularly vulnerable.

Children and Adolescents

Although playing sports can improve children's fitness, self-esteem, coordination, and self-discipline, it can also put them at risk for sports

injuries: some minor, some serious, and still others that may result in lifelong medical problems.

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 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.

Adult Athletes

More adults than ever are participating in sports. Many factors contribute to sports injuries as the body grows older. The main one is that

adults may not be as agile and resilient as they were when they were younger. It is also possible that some injuries occur when a person tries

to move from inactive to a more active lifestyle too quickly.

Women

More women of all ages are participating in sports than ever before. In women's sports, the action is now faster and more aggressive and

powerful than in the past. As a result, women are sustaining many more injuries, and the injuries tend to be sport specific.

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.

Although 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).

What Can Groups at High Risk Do to Prevent Sports Injuries?

Anyone who exercises is potentially at risk for a sports injury and should follow the injury prevention tips. But additional measures can be

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taken by groups at higher risk of injury.

Children

Preventing injuries in children is a team effort, requiring the support of parents, coaches, and the kids themselves. Here's what each should

do to reduce injury risk.

What parents and coaches can do:

 Try to group youngsters according to skill level and size, not by chronological age, particularly during contact sports. If this is not

practical, modify the sport to accommodate the needs of children with varying skill levels.

 Match the child to the sport, and don't push the child too hard into an activity that she or he may not like or be physically capable of

doing.

 Try to find sports programs where certified athletic trainers are present. These people, in addition to health care professionals, are

trained to prevent, recognize, and give immediate care to sports injuries.

 See that all children get a preseason physical exam.

 Don't let (or insist that) a child play when injured. No child (or adult) should ever be allowed to work through the pain.

 Get the child medical attention if needed. A child who develops any symptom that persists or that affects athletic performance should

be examined by a health care professional. Other clues that a child needs to see a health professional include inability to play

following a sudden injury, visible abnormality of the arms and legs, and severe pain that prevents the use of an arm or leg.

 Provide a safe environment for sports. A poor playing field, unsafe gym sets, unsecured soccer goals, etc., can cause serious injury to

children.

What children can do:

 Be in proper condition to play the sport. Get a preseason physical exam.

 Follow the rules of the game.

 Wear appropriate protective gear.

 Know how to use athletic equipment.

 Avoid playing when very tired or in pain.

 Make warmups and cooldowns part of your routine. Warmup exercises, such as stretching or light jogging, can help minimize the

chances of muscle strain or other soft tissue injury. They also make the body's tissues warmer and more flexible. Cooldown exercises

loosen the muscles that have tightened during exercise.

Adult Athletes

To prevent injuries, adult athletes should take the following precautions:

 Don't be a "weekend warrior," packing a week's worth of activity into a day or two. Try to maintain a moderate level of activity

throughout the week.

 Learn to do your sport right. Using proper form can reduce your risk of "overuse" injuries such as tendinitis and stress fractures.

 Remember safety gear. Depending on the sport, this may mean knee or wrist pads or a helmet.

 Accept your body's limits. You may not be able to perform at the same level you did 10 or 20 years ago. Modify activities as

necessary.

 Increase your exercise level gradually.

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.

 When jumping, land with your knees bent.

 Do warmup exercises not just before vigorous activities like running, but also before less vigorous ones such as

golf.

 Don't overdo.

 Do warmup 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 five 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.

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 Strive for a total body workout of cardiovascular, strength training, and flexibility exercises. Cross-training reduces injury while

promoting total fitness.

Women

Increased emphasis on muscle strength and conditioning should be a priority for all women. Women should also be encouraged to maintain a

normal body weight and avoid excessive exercise that affects the menstrual cycle. In addition, women should follow precautions listed above

for other groups.

What Are Some Recent Advances in Treating Sports Injuries?

Today, the outlook for an injured athlete is far more optimistic than in the past. Sports medicine has developed some near-miraculous 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:

Arthroscopy

Most doctors agree that the single most important advance in sports medicine has been the development of arthroscopic surgery, or

arthroscopy. Arthroscopy uses a small fiberoptic scope inserted through a small incision in the skin to see inside a joint. It is primarily a

diagnostic tool, allowing surgeons to view joint problems without major surgery. Depending on the problem found, surgeons may use small

tools inserted through additional incisions to repair the damage, such as a torn meniscus or a torn ligament that fails to heal naturally. Using

arthroscopy, for example, a surgeon may reattach the torn ends of a ligament or reconstruct the ligament by using a piece (graft) of healthy

ligament from the patient or from a cadaver.

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.

Tissue Engineering

When joint cartilage is damaged by an injury, it doesn't heal on its own the way other tissues do. In recent years, however, the field of sports

medicine and orthopaedic surgery has begun to develop techniques such as transplantation of one's own healthy cartilage or cells to improve

healing. At present, this technique is used for small cartilage defects. Questions remain about its usefulness and cost.

Targeted Pain Relief

For people with painful sports injuries, new pain-killing medicated patches can be applied directly to the injury site. The patch is an effective

method of delivering pain relief, especially for many people who prefer to put their pain medication exactly where it's needed rather than

throughout their entire system.

What Advances Might We Expect in the Future?

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:

 The need for surgery may decline as improved rehabilitation techniques lead to a more "natural" progression to recovery for more

musculoskeletal injuries.

 Technical advances and new imaging methods will lead to better ways to diagnose and treat injuries.

 Scientists will gain a better understanding of the role of nutrition in inflammation and healing. Such knowledge could lead to

improvements in treatment.

 Tissue engineering will become more commonplace. Studies of musculoskeletal tissue engineering are yielding promising results.

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

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Email: NIAMSinfo@mail.nih.gov

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

NIAMS, a component of the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services, conducts

and supports medical research on the causes, treatment, and prevention of diseases of bones, joints, muscles, and skin; trains

scientists to carry out this research; and disseminates information on research progress to improve public health.

 American Academy of Orthopaedic Surgeons (AAOS)

6300 North River Road

Rosemont, IL 60018-4262

Phone: 847-823-7186

Toll Free: 800-824-BONE (2663)

Fax: 847-823-8125

Email: pemr@aaos.org

Website: http://www.aaos.org

The academy provides education and practice management services for orthopaedic surgeons and allied health professionals,

including those who treat children. 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 its Web site.

 American Academy of Pediatrics

141 Northwest Point Boulevard

Elk Grove Village, IL 60007-1098

Phone: 847-434-4000

Fax: 847-434-8000

Website: http://www.aap.org

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

P.O. Box 1440

Indianapolis, IN 46206-1440

Phone: (317) 637-9200

Fax: (317) 634-7817

Website: http://www.acsm.org

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)

11639 Earnshaw

Overland Park, KS 66210

Phone: (913) 327-1415

Fax: (913) 327-1491

Website: http://www.amssm.org

The American College of Sports Medicine is a sports medicine and exercise science organization with nearly 18,500 members

throughout the U.S. and the world. The college is 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 Orthopaedic Society for Sports Medicine (AOSSM)

6300 N. River Road, Suite 500

Rosemont, IL 60018

Phone: 847-292-4900

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Email: aossm@aossm.org

Website: http://www.sportsmed.org

This is a national association of orthopaedic surgeons who specialize in sports medicine.

 American Physical Therapy Association

1111 North Fairfax Street

Alexandria, VA 22314-1488

Phone: 703-684-APTA (2782)

Toll Free: 800-999-APTA (2782)

TTY: 703-683-6748

Fax: 703-684-7343

Website: http://www.apta.org

The association is a national professional organization representing physical therapists, allied personnel, and students. Its objectives

are to improve research, public understanding, and education in the physical therapies.

 National Athletic Trainers Association (NATA)

2952 Stemmons Freeway, #200

Dallas, TX 75247

Phone: 214-637-6282

Toll Free: 800-TRY-NATA (800-879-6282)

Fax: 214-637-2206

Website: http://www.nata.org

The National Athletic Trainers’ Association is a professional organization composed of certified and licensed athletic trainers.

NATA’s mission and that of its research foundation is to enhance the quality of health care provided by certified athletic trainers and

to advance the athletic training profession. Athletic trainers are unique health care providers who specialize in injury prevention,

assessment, treatment and rehabilitation of injuries and illnesses. They provide physical medicine and rehabilitation services under

the direction of physicians.

Appendix

Traumatic Brain and Spinal Cord Injuries

Traumatic brain injury (TBI) occurs when a sudden physical assault on the head causes damage to the brain. A closed injury occurs when

the head suddenly and violently hits an object, but the object does not break through the skull. A penetrating injury occurs when an object

pierces the skull and enters the brain tissue.

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 super-ficial 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

http://www.ninds.nih.gov/disorders/sci/sci.htm or call 800–352–9424.

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Bruises

A bruise, or muscle contusion, can result from a fall or from contact with a hard surface, a piece of equipment, or another player while

participating in sports. A bruise results when muscle fiber and connective tissue are crushed; torn blood vessels may cause a bluish

appearance. Most bruises are minor, but some can cause more extensive damage and complications.

What to do: Put the muscle in a gentle stretch position and begin using the RICE method (see “When and How to Treat at Home” to

start the healing process. For more severe bruises, consult a doctor.

Sports Injuries in Young Children: Tips for Caregivers

Here are some "on-the-field" tips for helping a young child who has been injured:

 Minor injuries are fairly common in young children; severe injuries are not.

 A young child's self-esteem and enjoyment of a sport can be influenced by an adult's reaction when the child is injured.

 Judging the intensity and finding the site of the pain in a preschool child may not be easy. The child's perception of severity,

influenced by his/her temperament and developmental level, may not match reality. The child's response to an injury may also reflect

his/her prior experiences or the experiences of a friend or family member who has had an injury.

 Don't judge a child's reaction to an injury based on the child's age, sex, or size. Young children may vary greatly in their physical and

mental development, temperaments, and reactions to and tolerance of pain and stress.

 Acknowledge the child's feelings (pain, fright, and/or anxiety), provide emotional support, and convey a sense of protection and

caring.

 Treat children with respect. Never ridicule or belittle them in front of their peers, as this may be harmful to their developing selfesteem. Reassure the child that he/she will be cared for and the injury will be evaluated.

 Inappropriate overconcern can have negative effects and may lead to a more frightened child or eventually to a more vulnerable child.

Parents may have difficulty remaining objective about their child's injury. On the other hand, parental knowledge of their child's

temperament and typical reaction to pain can be immensely helpful to others trying to evaluate the severity of the injury.

 Question the child simply and directly. An authoritative approach, gentle but firm, will be reassuring for some youngsters.

 Listen to the injured youngster and get his/her reaction to reentering a sport or activity. Sometimes hidden fears will be expressed that

can be addressed by a caregiver who listens. A child's mental health and development are as important as his/her physical health.

 Time, ice, and a caring attitude will help to minimize many simple traumatic injuries.

Acknowledgments

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; Lynne Haverkos, 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

http://www.niams.nih.gov/Health_Info/Bone/defualt.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/

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For updates and questions about statistics, please contact

Centers for Disease Control and Prevention's National Center for Health Statistics

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

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

NIH Publication No. 09–5278

Many of our publications are available in print. Would you like to order publications on musculoskeletal disorders to be mailed to you? Visit our online

order form.

NIH...Turning Discovery into Health

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