Sports Injuries

The treatment and management of sports injuries has become a multi-faceted and highly visible aspect of sports science. Sports medicine is a distinct area of professional study within the broader field of medical science because sports injuries frequently engage concepts not relevant to the treatment of any other type of physical injury.

An injury is defined as any form of harm or hurt sustained by the human body, no matter how it may have been caused. An injury may be precipitated through one's own actions, such as a sprained ankle sustained while playing basketball, or through the impact of an environmental force, such as heat or cold. Injuries may be accidental, they may be caused by the deliberate actions of a third party, or the harm may be self-inflicted. The body makes no physiological distinction between sport and non-sport injuries; the body responds to any damage sustained to a tissue, bone, organ, or system no matter how the injury was caused.

When employed as an adjective to describe a type of injury, the term sports is defined as any game, competition, exercise or training program that requires physical activity. At one time, sports injuries were deemed to be only those that occurred in the course of competition. Injuries sustained while the athlete is practicing are equally sports injuries.

Sports injuries are best understood as a part of a cycle or a continuum of physical activity. Sports injuries do not occur in a vacuum, where the injury leads in a progressive fashion to treatment and then recovery. Sports injuries occur against a complex backdrop that includes the athlete's level of ability, the athlete's experience in the sport, general health and fitness history, and the athlete's desire to return to the sport after recovery. The background factors will often dictate the approach taken by an athlete and medical personnel to treatment and rehabilitation.

Injuries are a fact of a sporting life. In most sports, it is not a question of if an athlete will ever sustain an injury, but rather when an injury will occur and to what degree of severity. Athletic injuries may result from participation in the sport itself, as with a boxer sustaining a concussion as a result of absorbing an opponent's punch to the head, or a basketball player sustaining a tear of her anterior cruciate ligament (ACL) in a knee. Alternatively, participation in a sport may reveal the existence of a pre-existing or underlying physical condition.

Examples of a sports injury acting as an agent that exposes a pre-existing physical condition include the presence of an unequal leg length in a runner; unequal leg length contributes to the unequal foot strike forces that commonly result in a stress fracture of the tibia. Other latent physiological conditions that are revealed by exercise include weaknesses in the cardiovascular system, such as an irregular heart beat.

There are a number of sports where the typical participant in the activity brings a particular mental outlook to the sport that carries with it a greater likelihood of injury. An example is the training approach adopted by many endurance athletes, such as marathoners and triathletes, one that is often expressed as "no pain, no gain." At its most basic articulation, this approach advances the proposition that if the athlete is not suffering to some considerable degree in workouts, the athlete will never achieve competitive success. Numerous studies have confirmed that such athletes fall victim with far greater frequency than any other to overuse and over-training injuries, such as stress fractures and serious joint damage. It is a significant challenge to dissuade an athlete with this fundamental training mindset from this approach with the intent of reducing their personal risk of injury.

In a similar way, the external mental pressures that may be directed towards an athlete often contribute to an over zealous approach to training that results in a sports injury. The parental pressure upon a young athlete to excel, or the similar pressure directed from coaches towards athletes may create a mindset that makes the likelihood of injury greater.

The chief distinction in the treatment of sports injuries as opposed to the injuries sustained in the general population is the extent and the purpose of the rehabilitative treatment directed to each. The medical profession, whether in general practice or in a sports specialty, has an over riding obligation to treat any debilitating physical condition. The imperative behind sports injury treatment is a combination of speed, a desire to return the athlete to action as quickly as possible, and to work towards the prevention of a similar injury in future. In professional sport, there is usually an additional factor, the often significant financial incentive for both a team and an individual athlete to make a speedy recovery.

An example of the speed that typically attaches to both the diagnosis and the commencement of treatment of a sports injury is found in the nature of the diagnostic tools employed by the treating medical personnel—x rays, magnetic resonance imaging (MRI) technology, and computer tomography (CAT) scans. Most professional sports teams and many collegiate programs, such as the elite Division I schools participating in National Collegiate Athletic Association (NCAA) competition in the United States have immediate access to these tools.

Arthroscopic surgery is the single most important development in sports injury treatment since 1980. The arthroscope is a small surgical device equipped with a camera that permits the surgeon to examine the interior of an injured joint through a small incision. Arthroscopic procedures revolutionized the treatment of injuries to the knee, elbow, and shoulder, as the surgeon was not required to perform an invasive procedure to achieve a modest surgical objective.

Many technological advances in arthroscopic techniques since 1980 have been driven by the desire to fully rehabilitate an athlete to their former athletic productivity and income generating potential. The now standard operation to repair the elbow ulnar cruciate ligament (UCL), often damaged as a result of the stresses inherent in baseball pitching, was first developed by Dr. Frank Jobe, a California sports medicine orthopedic specialist, in 1973. Many arthroscopic procedures used in shoulder and knee repair were initiated by American sports medicine expert James Andrews, commencing in the mid-1980s.

The frequency of sports injuries is often described in terms of an injury rate, a term that carries different meanings in different contexts. As an example, the National Football League has often had attributed to it a 100% injury rate, meaning that every player in the league is in injured at one time or another during a season. However, the expression of an injury rate in such broad terms is misleading if the data does not make reference to other factors, such as the severity of the injuries sustained, the days lost or games missed by an injured players, and in what context the injury occurred (preseason training camp, practice, games, or in the player's personal off season conditioning program).

In 2003, a comprehensive study into the incidence of sports injuries was undertaken in the United States entitled the SuperStudy of Sports. The study was directed to the establishment of clear definitions of sport injury. In addition to considerations of classifying severity of injury, the study sought to demarcate the boundary between sport and non-sport activities. As an example, a 15-year-old boy who falls from his skateboard and fractures his wrist has sustained a sports injury; his mother who accidentally trips over the same skateboard and falls in her driveway, breaking her wrist, has not sustained a sport injury.

The SuperStudy set out four general classifications of sport injury, where each class of injury is tied to the amount of time the athlete was required to spend away from the sport due to injury.

A Level I injury will not interrupt the athlete's participation in the sport or activity, and there is no subsequent problem resulting from the injury. Examples of Level I injuries include a soccer player with a bruised shoulder that does not affect his or her mobility. A Level II injury is one that requires the athlete to miss at least one training session or competitive event, but no more that 1 month of activity (practices or competitions).

A Level III injury can sideline the athlete for a minimum of 1 month of activity. A Level IV injury has the same definition as a Level III occurrence, except that the athlete was require dot obtain medical treatment at a hospital emergency room, undergo surgery or other medical intervention.

The European Community authorized a sports injury study that employed a similar methodology in 2004.

In most sports, it is not a question of if an athlete will ever sustain an injury, but rather when an injury will occur and to what degree of severity.
The rehabilitation undertaken to recover from a sports injury will often engage a number of allied professionals. To correct or protect an injured joint or structure, orthotics and other protective devices may be constructed to assist the athlete in achieving optimal physical function. The physical work required of the athlete to return to their pre-injury fitness often requires the athlete to learn a variety of stretching and flexibility exercises to rebuild or to improve an existing range of motion in a joint. This rehabilitation is often supervised by either a physiotherapist, an athletic trainer, or both.

In some cases, the most profound consequences of a sports injury are psychological. In many sports, the difference between success and failure is razor thin; if the athlete has lost consequence or acquired doubts as to their abilities to perform as a result of the injury sustained, the mental training will become as important as physical rehabilitation. This phenomenon is often observed in athletes who race in high speed or other inherently dangerous circumstances. Alpine skiing, particularly the down hill event, is one where if the athlete makes a complete physical recovery from an injury, but cannot mentally sustain the willingness to ski to the very edge of physical control, the skier is unlikely to regain their top racing form.

The ability of an athlete to psychologically recover from an injury is sometimes as demanding a process as the physical rehabilitation. There is an extensive body of academic material on this aspect of sports injury recovery alone. When one distills the various psychological approaches to this problem, the result is that the athlete must be encouraged to participate as they did before the injury, as opposed to participating in such a fashion that their goal is to avoid the circumstance that lead to their injury.

SEE ALSO Musculoskeletal injuries; Sport Performance; Sports Medical Conditions; Sports Medicine Education.