INJURIES
Treatment of Injuries
The overall management of most sports injuries is based on 6 principles:
1 Minimize the extent of the initial damage;
2 Reduce any associated pain and inflammation;
3 Promote healing of the damaged tissue;
4 Maintain or restore flexibility, strength, proprioception and overall fitness during the healing phase;
5 Functionally rehabilitate the injured athlete to enable return to sport;
6 Assess and correct any predisposing factors to reduce the likelihood of recurrence.
The Soft Tissue Injury Process
The most important time in the treatment of soft tissue injuries is the 24 hours immediately following the injury. Therefore, treatment should start immediately!!!
The Effects of Acute Injury
When soft tissue such as muscle, tendon or ligament are injured, blood vessels are usually torn and damaged too which can bleed for up to 24-72 hours depending on the severity of the injury. This causes blood to accumulate around the damaged tissues. This compresses adjoined tissue which causes tissue anoxia and further damage.
Swelling and increased pressure may inhibit the healing of damaged tissues, causing pain and leading to muscle spasm and disuse.
Immediately: Pain occurs as a result of damage and compression to nerve endings as well as the release of chemicals.
Subsequently: Inflammation will occur, the signs of which include redness, heat, pain, swelling and reduced function
Consequently, every effort should be made to reduce the amount of bleeding and swelling at the site of injury. Pain relief and protection from further damage also need to be considered. The most appropriate method of doing this is summarized by the letters PRICE.
P Protection
R Rest
I Ice
C Compression
E Elevation
Protection
The injured player must refrain from all activities in order to protect themselves from further injury.
Rest
Rest is a valuable contributor to the healing process. The injured player should cease activity immediately following injury. Continued active movement of the injured part will result in increased bleeding and swelling.
For example, with a thigh contusion (dead leg), bleeding will be increased by contraction of the quadriceps muscle during running. In more serious injuries, the injured part may need to be rested completely with the use of crutches for a lower limb injury or a sling for upper limb injuries.
Movements that do not produce pain at the site of injury should be performed to maintain mobility of the rest of the body. It is important to get the correct balance between resting the injured area and early mobilization.
Ice
The application of ice immediately after injury results in reduction of pain and causes local vasoconstriction (contraction of blood vessels that narrows/decreases the diameter of the blood vessels) thus reducing bleeding and swelling. Ice reduces the metabolic rate of tissue, thus lowering demands on oxygen and nutrients. Ice may also decrease inflammation and muscle spasm.
Ice can be applied in a number of forms. Crushed ice can be wrapped in a moist cloth or towel and placed around the injured area. It is held in place by a crepe bandage. Other methods include reusable frozen gel packs and instant ice packs that do not need pre-cooling but rely on chemical reaction to provide instant cold. A bag of frozen peas is a cheap but effective method.
Ice is usually applied for 12 minutes every 'waking hour'. Precaution must be taken when using ice. It is important to protect the skin over the site of injury from an 'ice burn' by wrapping the ice in a damp towel or cloth.
Never apply heat e.g. hot bath/Deep Heat, as this will increase swelling and pain, and do not apply ice to open wounds as this may cause infection.
Compression
Compression offers counter-pressure to the injured site, reducing underlying blood flow and controlling swelling. The patient's circulation should be checked at regular intervals using the 'capillary refill test'.
The player's nail bed of the toes or fingers are squeezed and then released. The blood can be seen returning to the nail bed on release. The compression bandage can be worn for up to 24 hours before reapplication. It also serves to protect the injured area from further damage through immobilization.
Compression should be applied with care, as too much pressure can be harmful. Any loss of sensation at the injured part should alert the player that the mode of compression is too restrictive.
Elevation
The limb should be placed in an elevated position above the level of the heart, so that gravity can assist with the return of blood and fluid to the heart and decrease blood pressure. This reduces the opportunity for the formation of further swelling and aids the drainage of existing fluid to the general circulation via the lymphatic system.
The majority of the limb should be above the level of the heart. Pain-free, active (very low level) non-weight bearing movements can be performed in elevation to assist drainage by the use of a 'muscle pump' action. Static (isometric) exercises are useful for this purpose.
Rhythmical movements of the uninjured joints of the body are advisable to promote blood and lymph circulation e.g. non-weight bearing foot and ankle exercises when the knee has been injured. Anti-inflammatory medication may be taken but only when prescribed by a qualified physician
Things to avoid in the acute stage of injury include heat, alcohol, rub/liniment, running and massage (vigorous). Each of the factors above can increase the symptoms and severity of the injury.
You should follow the PRICE procedure to help promote healing for up to 72 hours following injury. However, if you sustain an injury, you should notify both your coach and the physio as soon as possible to make an appointment.
