Sports and Exercise Injuries and Training to Avoid Them

Sports and Exercise Injuries and Training to Avoid Them

    Sports and Exercise Injuries and Training to Avoid Them

    All activities carry some risk, even crossing the road. Sports and exercise are no exception. It is estimated that over 10 million sports injuries occur each year. Many of them are a result of accidents, but a significant proportion are from repetitive stresses and strains on joints, muscles, tendons, and ligaments. These can occur as a result of overuse or overtraining, wrong techniques, poor equipment, or even unbalanced muscle development. This chapter reviews some of the more common injuries, their causes, and how they might be avoided.

    Common Sports Injuries

    • Sports injuries come in a variety of forms, depending on the cause of the damage.
    • Sprains are caused by sudden twists or wrenches of the joints, especially the ankles, knees, or wrists.
    • Strains result from force, overuse, and overstretching muscles or tendons.
    • Contusions are caused by a severe blow or force, as when kicked or punched.

    Fractures of bones are either simple, compound, or stress/hairline fractures. In simple and compound fractures, the breakage is usually complete; part of the bone may even penetrate through the skin. In stress and hairline fractures, a fine crack runs partially or completely through the bone. Simple and compound fractures are normally caused by the impact of sudden force, whereas hairline fractures are generally associated with overuse and stress.
    Injuries to joints are among the most common sports injuries. This is largely because joints bear the brunt of the force applied by muscle contractions against resistance. Although the surfaces of joints are cushioned by cartilage, their resilience deteriorates with continuous use. Wear and tear of or damage to the cartilage causes the opposing surfaces of the joints to roughen and grate against each other, making the joint prone to arthritis and bursitis. 
    Arthritis—that is, inflammation of a joint—results in pain, stiffness, and swelling. In bursitis, the bursa, a fluid-filled sac that surrounds the joint, becomes inflamed, resulting in pain.
    When joints are subjected to large force, they can get twisted out of position. People who play sports that involve sudden changes in direction and acceleration, such as soccer, squash, and tennis, are prone to knee injuries.
    Incorrect training that results in or encourages imbalanced development of the quadriceps can cause a misalignment of the patella or kneecap, sometimes referred to as “runner’s knee.” Wrong technique in leg-extension exercises, especially if external weights are used or if exercises are carried out incorrectly using a machine, is another cause of knee injuries.
    Bone injuries include stress fractures such as shin splints. Overuse and overtraining are usually the main causes, aided and abetted by weight-bearing activities such as running on hard surfaces while wearing footwear that provides inadequate cushioning for the force sustained by the lower leg, especially the tibia and toes. Poor biomechanics (flat or highly arched feet, or an abnormal gait) and styles of running can also cause shin splints. Repeated stress on the foot can result in a benign growth of bone, called a spur, which can be intensely painful. For example, continued stress on the heel bone can result in calcification of the ligaments originating from it, causing a spur to form at the insertion of the Achilles tendon.
    Muscle injuries are common. They range from bruises, resulting from external forces that rupture small blood vessels, to cramps and spasms as a result of inadequate warm-up, dehydration, or fatigue. Injuries can also result from a rekindling of previous damage, such as strains or muscle tear, due to overtraining or overstretching. 
    A sudden contraction of the hamstring, especially following inadequate warm-up and preparatory stretching, can result in a torn or pulled muscle. A pulled muscle can also be caused by any imbalances in muscle strength, for example, very strong quadriceps and relatively weak hamstrings. Muscle injuries can also arise when movement is constrained by tightness in the joints. The inability of the hip joint to open up to its full range of movement can tear the adductor muscles when unexpectedly wide movements are made with the leg.
    Tendon injuries, in contrast to muscle injuries, are relatively rare, although they can be very serious and painful. Tendons can be ruptured or become inflamed, resulting in tendonitis. Overuse, exercise on uneven terrain, and tight tendons are possible causes for the rupture of the Achilles tendon. The Achilles tendon is a strong fibrous tissue that connects the gastrocnemius, the muscle in the back of the lower leg, to the heel bone. Abrupt footwork and repeated stress can cause the tendon to snap (see below). Stretching the calf muscles and Achilles tendon helps prevent this.
    Poor training and biomechanics can cause inflammation of the iliotibial band, the group of fibrous tissues that connects the gluteal muscles and the tensor fascia lata muscle to the tibia, just below the knee. This manifests itself in a pain in the lower outer thigh or the side of the knee. A common cause of this injury is running on only one side of cambered roads. The slope creates a sideways tilt in the pelvis, causing consistent stress to the iliotibial band. Unbalanced muscles, such as tight gluteals or quadriceps, can make the situation worse.
    Injuries to the Foot Tendons
    Injuries to the Knee Ligament
    Ligaments can be injured, but the symptoms are often manifested in the form of joint pains or joint instability, because ligaments join bone to bone. Ligaments do not heal easily. An extreme example of a ligament injury is when it becomes over-stressed and snaps. The anterior cruciate ligaments (see illustration above) are located in the center of the knee, running from the back of the femur to the front of the tibia. They function as a stabilizer, holding the tibia and femur in place. If excessive force is applied when the knee is bent, the ligament can be injured. In extreme cases, the ligament may tear and snap. The result is a fall and extreme pain and swelling around the knee.

    Safe Training

    In any discussion of the topic, repeated stress and overtraining emerge as major factors in sports injuries. Poor biomechanics, poor training methods, the wrong use of equipment (including inappropriate footwear), and muscular imbalance are among the others. The principles of good training address these major areas, most of which have already been covered elsewhere in the book.

    Selected Major Sports and Exercise Injuries

    (Source: The British Medical Association. Complete Family Health Encyclopaedia. London: Dorling Kindersley, 1996; Troop, N., Seato, S. Handbook of Running. London: Pelham Books, 1997.)
    Moderation is essential in exercise. The body needs adequate rest in order to recover from exertion and to perform well. Exhaustion results in poor coordination, poor performance, and injuries. The principle of overload involves building up greater endurance and strength by progressively giving the body more than its normal workload. This prompts the skeletal muscles, both fast- and slow-twitch, to adapt and develop. They can only do so, however, if the muscles are not injured or overused. Rest days are essential. It takes the body about 24 hours to restore glycogen levels, the primary source of energy for working muscles.
    It is important to ensure that the movements that constitute the exercise or sport are executed well. Special attention should be paid to joints, because they take the bulk of the force. Keeping the knees soft when landing after a jump is essential to reduce impact on the knees. Athletes need to be aware of how they walk and run to ensure that their feet land correctly. In running, the heel strikes the ground, the arch flattens to absorb some of the impact, and then the foot rolls inward, allowing the ball of the foot to touch the ground while the heel lifts up. This inward-rolling motion, called pronation, allows the push to move forward and helps absorb the shock of landing. Flat feet tend to overpronate, that is, to roll inward excessively, causing injuries to the lower leg. High arches in the feet can lead to underpronation, causing the ankle to take the shock. Correct footwear can reduce these problems. It is also important not to land on the toes or the ball of the foot when running.
    The hip joint and the small of the back, especially the fifth lumbar, are subjected to considerable pressure and stress in some floor exercises. In abdominal curl-ups, for example, it is important to ensure that the small of the back is supported and not arched. Stabilize the hips by drawing the knees up and engaging the iliopsoas muscle to act as a synergist muscle. Correct breathing and engagement of the transverse abdominus, two practices I have repeatedly stressed in this book, contribute greatly to a safer and more effective workout.
    Excessive flexion presents another problem. For example, when lunging forward on one leg to stretch the leg extended behind, it is important to align the knee of the front leg above the ankle. If the knee goes beyond the ankle, the entire weight is shifted toward the front and excessive pressure is exerted on the knee and ankle. Dropping the buttocks below knee level when doing squats can be another cause of extreme flexion. The figures below and on the next page provide examples of poor movements and positions that can injure joints.
    In floor push-ups (see illustrations on the next page), poor alignment of arms and inadequate stomach control can cause lower-back and shoulder injuries. In “V” sit-ups (see illustration on the next page), employing excessive leverage when raising the trunk stresses the lower back. Frequently, people raise their body by pushing out the stomach muscles, which over time leads to the development of bulging stomach muscles.
    It is important to warm up and stretch before and after the completion of an activity. Stretching before the activity helps improve performance by loosening the muscles and stretching the tissues of the connective fibers. Reduced muscle tightness decreases the incidence of muscle strain and tear.
    Extreme Knee Flexion
    Deep Knee Squat
    Poorly Executed “V” Sit-up and Full-length Push-up
    Balanced muscle development is extremely important because any imbalance can injure a weaker opposing-muscle group. Shin splints are often caused by a weak tibialis anterior relative to a strong gastrocnemius; hamstring pulls can result from overdeveloped quadriceps; and weak abdominal muscles pass all the effort of body support to the back, stressing the erector spinae. Cross-training is useful in balancing muscle development, especially when a sport or exercise discipline focuses on particular muscle groups or on a limited range of the five principles of fitness (see Chapter 2 for a discussion of these).
    When training to develop muscular strength and endurance, the movements should be slow and controlled. Avoid large or vigorous movements. When stretching, avoid ballistic stretches. The body should be taken to its natural joint range, but extreme movements that cause discomfort and pain should be avoided.

    Treatment for Sports Injuries

    The recommended first aid for all injuries, including strains, sprains, and fractures, is indicated by the acronym RICE. This stands for Rest, application of Ice, Compression, and Elevation of the injured part above the level of the heart. Rest or ceasing the activity helps prevent further damage; ice helps reduce bleeding and swelling; compression reduces swelling; and elevation assists in the drainage of fluid from the injured part. Do not, however, try to treat your own injuries.
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