Critical question 1: How are sports injuries classified and managed?
Soft Tissue Injuries
Soft tissue injuries occur frequently and are commonly experienced by athletes in all sports. The severity of these injuries will depend of the type of damage caused to the internal structure of the body. According to the 2014 AFL injury report, hamstring strains are the most common type of injury seen in the AFL.
Tears, Sprains and Contusions
A soft tissues tears can occur after excessive stretching of the tissue or due to an excessive external force, which may cause severing.
There are three types of tears in soft tissue:
Sprains occur when the joint capsule and its connecting ligaments are stretched beyond the normal range of motion. This type of injury is also described as a torn ligament fibre. Ligaments are designed to be rigid and relatively in-elastic, connecting bone to bone and providing stability to the joint. Sprains are often assessed as either grade 1 (small or slight tear), grade 2 (partial tear), or grade 3 (a complete rupture).
Injuring this area can cause damage to the stability of the joint, leading to pain, swelling and the inability to complete normal movements. It is important that athletes seek proper rehabilitation management to regain stability, strength and reduce any scar tissue that has formed. This can be a slow process.
Strains occur when the muscle fibres or tendons are overstretched or torn to some degree. This type of injury can be quite painful and will often result in bruising around the injured site. Tearing a hamstring by sprinting is an example of a strain. Strains can also be categorised as a grade 1, 2 or 3, depending on the severity of the injury and the number of fibres affected.
Contusions are caused by a direct force or blow to an area of soft tissue on the body. For example, when an opponent’s knee strikes into the quadriceps of another player during a game of soccer. Contusions are typically described as corks, bruises or haematomas and these type of contact injuries can result in internal bleeding.
Skin abrasions, Lacerations and Blisters
Skin abrasions occur when a force impacts the skin, causing superficial damage, no deeper than the epidermis layer of skin, although there may be slight bleeding. An example of this is when a Netballer falls over on the court. The hard surface (i.e. the force) in conjunction with the athlete’s momentum causes the skin to scrape and/or split. If the netballer has fallen on an outside court, foreign materials, such as dirt, may lodge itself into the abrasion. Treatment will involve thorough cleaning and the application of a non-stick dressing to keep the abrasion clean.
A laceration is an irregular tear in the skin, which leaves an open wound. Extra care is required for this type of cut to ensure the prevention of further infection. Any laceration that measures over 1 cm must be referred to a doctor, particularly in the case of a mouth or head injury.
When fluid collects underneath the epidermal (or surface) layer of the skin and consistent rubbing occurs, blisters will form. Wearing in new shoes, extended use of equipment or an activity that requires high intensity and quick changes of direction can often result in blistering. The best treatment for blisters is rest although second skin dressings can also be applied.
The inflammatory response is initiated when the body is injured. The purpose of this process is to protect the body and fight against any damaging substances, rid the site of dying or dead tissue cells and aid in the regeneration and repair tissue cells.
There are 3 phases of inflammatory response:
Phase 1 – The inflammatory stage:
During this phase blood flow increases to the area causing pain and swelling around the site of injury. This phase is characterized by a lack of movement and damage to the cells and surrounding tissue area.
Phase 2 – The repair and regenerative stage:
The second phase starts after the initial 48 hours and can last anywhere from 3 days to 6 weeks. During this stage damaged tissue is broken down, fibres are repaired and scar tissue forms
Phase 3 – The remodelling/ repair stage:
The final phase can take months as scar tissue production is increased and replacement tissue is strengthened.
The inflammatory response can last for up to five days, depending on the severity of the injury. It is important to seek immediate treatment for all soft tissue injuries to prevent any further damage and manage any pain the athlete may be suffering from.
Over time, treatment of these injuries can help to restore strength and flexibility, regain function, ensure the return the athlete back to their sport and prevent any reoccurrence of the injury.
When providing immediate treatment of skin injuries gloves, antibacterial wipes, sterile bandages should be used to control and avoid infection. Pressure, elevation and rest can help to control bleeding.
The RICER principle (Rest, Ice, Compression, Elevate, Referral) outlines the full range of methods which should be immediately applied to manage soft tissue injuries:
Rest: It is important to make the athlete as comfortable as possible. This may involve lying down to decrease blood flow to the injured site.
Ice: Ice, or a cold pack, should be applied to the injured site to reduce swelling, pain and vasoconstriction of blood vessels.
Compression: A firm bandage wrapped over the injured site, as well as above and below the injury, will constrict and reduce the swelling.
Elevation: The injured site must be raised above the level of the heart to restrict blood flow and reduce bleeding, swelling and pain.
Referral: After initial treatment it is essential to refer the athlete to a qualified professional (i.e. doctor/physio) so they can diagnose the injury as early as possible, provide further treatment and suggest rehabilitation plans.
Use of the HARM acronym is an effective way to remember strategies to avoid:
Heat, Alcohol, Running, Massage