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General Principles

Sports injuries are caused by trauma of different degree. For simplification we divide injuries into traumatic injuries, caused by large forces (macrotrauma), and overuse syndromes, caused by repetitive micro-trauma.

Traumatic Injuries

Acute traumatic injuries are common in athletics.

The frequency of traumatic injuries varies greatly between sports. Contact sports, such as soccer, ice hockey, team handball, wrestling, American football and rugby, tend to have higher rates of traumatic injuries.

The cause and severity of a traumatic injury are usually obvious. The athlete will experience rapid onset of pain and swelling will begin to develop but requires several hours to reach its maximum. For this reason, the best time to examine a traumatic injury is immediately after it has occured, before the swelling makes the athlete unable to tolerate the pain associated with exploration of the injured area.

Initial control of swelling can contribute greatly to a quick return to sport. Once these early interventions have been completed, an assessment is made as to whether further advice is needed from a doctor and what appropriate action is to be taken.

Overuse Syndromes

Overuse syndromes are difficult to diagnose and treat. These injuries become increasingly common as both participation in sports in general and the intensity and duration of the trainings increase.

Overuse injuries are generally caused by repetitive overloading, resulting in microscopic injuries to the musculoskeletal system, Tissues can withstand great loads but there is a critical limit to this capacity, which varies greatly between individuals and according to the frequency of load. Tissues may be made more susceptible to injury by intrinsic factors such as malignment of the leg, muscle imbalance and other anatomical problems and extrinsic factors such as training errors, faulty technique, incorrect equipment and surfaces and poor conditions.

The actual frequency of injury due to overuse is unknown, but it is estimated that 25-50% of athletes visiting sports medicine clinics have sustained an overuse injury. The age of occurrence of overuse injuries also varies: they are most common in top-level athletes aged 20-29 years, but are also seen in noncompetitive athletes aged 30-49 years. In adults, overuse injuries are more prevalent after 2 years of regular daily training. Some sports carry a greater risk: 80% of overuse injuries are reported to occur in endurance sports such as long-distance running or in individual sports requiring skilled technique and repetitive movements, such as tennis, gymnastics and weightlifting; of these injuries, 80% occurred in the lower extremities of the body, most frequently at the knee (28%) and at the ankle, foot and heel (21%). For most overuse injuries, the underlying problem is an inflammatory response. overuse injuries in tendons are often secondary to degeneration.


Inflammation is the body’s response to tissue injury cause by pressure, friction, repeated load or overload and external trauma. Trauma is associated with bleeding, which causes swelling and increased pressure. Both extrinsic and intrinsic factors (see above) contribute to the inflammatory reaction in tendon sheaths, tendon and muscle attachments, bursae and the periosteum. Overuse injuries can result from various combinations of frequency and loading, such as:

  • normal load at high frequency/many repetitions;
  • heavy load at normal frequency;
  • heavy load at high frequency

Inflammation also occurs in response to bacterial infections. It both confines and combats such infections as well as stimulating healing. Whatever the nature of the underlying cause, the inflammatory response leads to impaired and painful mobility of the affected part and thus enforces rest. If it affects gliding surfaces, such as those of tendons and their sheaths, crepitus or ‘creaking’ may develop. If inflammation goes unchecked, scar tissue will develop and early intensive treatment is therefore recommended.

The most important step in the management of inflammation is the removal or reversal of its cause. Next in importance is the reduction of swelling so as to relieve pain, improve mobility and encourage healing. Symptoms typical of inflammation include the following:

  • swelling caused by accumulation of fluid;
  • redness caused by increased blood flow;
  • local rise of temperature, caused by increased blood flow around the injured area;
  • tenderness on touching the affected area
  • impaired function of the affected part due swelling and tenderness

Inflammation often begins insidiously and initially pain and stiffness may decrease or even disappear after warm-up. Usually, however the pain returns and intensifies during continued activity and unless a rest break is taken, there is a great danger of entering the ‘pain cycle’ where continued activity leads to further injury, inflammation and pain. Unless the cycle is interrupted, chronic pain results and can be extremely difficult to treat.


The sensation of pain originates in free nerve endings which end blindly between the tissue cells, These pain receptors are present in most tissues, but are especially numerous in the skin. Pain is a mechanism to alert us to injury so that we can rest appropriately.

Different types of pain that may be experienced include acute pain caused by a fracture, aching pain caused by chronic inflammation, continuous pain such as heartburn, pounding pain such vascular com promise, referred pain caused by nerve entrapment and burning pain. the type of pain can be a pointer to the correct diagnosis. The most common types encountered in sports injuries are acute pain, and the chronic, dull ache experienced following activities or during the night due to chronic inflammatory problems. Pain can be effectively treated with medication, but it will not go away until its cause has been removed.

Pain should be interpreted as a warning sign of tissue injury and should lead to a modification of activity or resting the injured tissue.

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