Sports Medicine

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Pathology of Injury & Repair

Prevention of Injuries
1. Tissue Damage

Some degree of tissue damage occurs in any injury. It is easy to appreciate how the overstretching of the muscle or ligament tissue may cause the tissue to be torn and therefore damaged. In other soft tissue injuries the crush injury resulting from the direct blow will cause a variable degree of tissue compression and stretching and hence, tissue damage. Healing must take place before recovery is complete in all soft tissue injuries.

2. Bleeding

All cells require a constant supply of oxygen and glucose which are carried to the cells by the blood. If muscle tissue is torn then blood capillaries with the tissue also must be torn at the time of Injury.

A consequence therefore is a degree of capillary bleeding. The degree of capillary bleeding depends on the amount of tissue damage.

3. Haematoma (Clot Formation)

The bleeding which occurs as a result of damage to the capillaries within the damaged tissue will form blood clots (Haematoma) within that tissue. Capillary bleeding will continue for a short period of time after the injury. If the clot is disturbed, then bleeding will continue, and the haematoma will be larger.

If there is damage to the capillaries, blood flow to other cells in the area is disrupted, and they will not gain the supplies of oxygen and glucose they need to survive. After the initial damage from the injury secondary injury will also occur around the area of the primary injury. This is known as a Secondary Hypoxic Injury which results in the cells dying from lack of oxygen

4. Oedema Formation

Swelling is caused by capillary bleeding and by oedema formation. Oedema is an accumulation of tissue fluid in the tissues. The tissue fluid is drawn into the area by the breakdown of tissue debris from the primary injury. Oedema formation may also cause further secondary hypoxic injury because of compression on the blood vessels decreasing circulation to the area, and by an increased distance between the blood vessels and tissue cells, which makes it more difficult for oxygen and nutrients to diffuse from the blood vessels to the tissues.


5. Removal of Blood Clot & Oedema

As a result of tissue damage a haematoma will form and some degree of oedema will occur within the tissue. To begin the healing process the body starts breaking down the haematoma. This begins to occur as soon as the haematoma has formed and continues until it has been completely removed. Tissue fluid forming the oedema is also slowly removed by the body. Both the haematoma and the oedema must be completely removed before healing can effectively occur.

6. Healing of Tissue

As the blood clot is being removed, the body begins to heal the tissue damage by the formation of Fibrous Scar Tissue. One of its features is that as it heals over the damaged tissue, it will contract in size thereby shortening the length of the affected muscle, ligament, etc. It is estimated that if proper precautions, such as R.I.C.E.R is taken, tissue repair generally starts around 72 hours after injury.

7. Regaining Function

Regaining function of the injured area begins as the haematoma is being removed and the Fibrous Scar tissue is being laid down. Different rehabilitation routines are used for different injuries.

Prevention of Injuries

Prevention of Injuries
Injuries which occur in sport can often be prevented. There are 8 main areas that can be considered.
1. Personal Health & Hygiene

Competitive physical activity places greater than normal stress upon the body, therefore a weak link is likely to reduce a performance or create injury. An Athletes need too:-

a. Have a good diet

b. Ensure that during practise and competitions they drink water

c. Not smoke as the carbon monoxide attacks the haemoglobin carrying capacity. e.g. 1 cigarette equals a reduction of oxygen carrying capacity by 4 - 5%

2. Fitness & Conditioning

It is important that an athlete be fit & has a conditioning programme which ensures all of the following areas are attended too:

a. Cardio-Respiratory Fitness (Endurance)

b. Muscular Strength

c. Muscular Endurance

d. Muscular Speed

e. Muscular Power

f. Agility

g. Co-ordination

h. Flexibility

* Pre-season Assessment



3. Warm Up & Warm Down

A warm-up increases body temperature & stretching of some tissues which leads to more efficient functioning. The warm-up should NOT be intensive & should NOT be prolonged beyond 15-20 minutes. A warm-down (cool-down) should reverse the warm-up. Aim to redistribute blood flow & disperse waste products from muscles. The warm-down should involve gross motor activity. e.g. jogging followed by stretching.

Types of stretching

a. Static - gradual lengthening of muscles till stretched then hold for 10-20 seconds

b. Ballistic/Dynamic - stretching to a point where tension is felt, then bounce till further stretched.

Note: this type of stretching is not recommended as this can result in injury

  4. Technique

Incorrect technique can cause injuries. i.e. unnecessary stress on bones, joints and muscles.

5. Equipment

Sports equipment is utilised to lesson chance of injuries:

a. Protective Equipment: helmets, mouthguards, box, etc

b. Footwear: Using correct footwear for sport, ensures that it fits correctly and 'break in' new shoes to avoid blisters and other problems.

c. Strapping: preventative or applied to previously injured joints.

6. Rules & Regulations

Rules will often ensure prevention of injuries, if strictly adhered too.

7. Environment

a. Physical Environment: ensuring it is safe as possible

b. Climatic Environment: if there is an increase in temperature an athlete should increase water intake, and other practises to decrease body heat. If there is a decrease in temperature, avoid if possible wearing wet clothing and ensure that extremities are covered.

8. Over Use Injuries

Over use injuries are chronic injuries resulting from repetitive stressful activities.


Tennis Elbow

Thrower's & Swimmer's Shoulder

Fibula Stress Fracture (known as Shin Splints)

Groin Strain (Athletics, Ball Sports, etc)