Type of sports injuries

 

 

 

 

 

 

 

What are the most common types of sports injuries?

    1. Sprains
    2. Meniscus tears
    3. Muscle injuries
    4. Tendonitis
      1. Tendinosis
      2. Jumper’s knee
      3. Swimmer’s shoulder
      4. Wrist tendinopathies
      5. Iliotibial band
      6. Goose foot
      7. Achilles tendon

5.- Periostitis and stress fractures

      1. Osteopathy of the pubis
      2. Stress fracture

6.- Plantar fasciitis
7.- Low back pain
8.- Ulnar neuropathy or Handlebar paralysis
9.- Cyclist’s perineal paralysis syndrome
10.- Cyclist’s knee
11.- Hot foot syndrome
12.- Overtraining (Athletics)
13.- Concussions (rugby, boxing)

1.- Sprains
A ligament is a tough, fibrous structure that joins two bony structures.

A sprain is an excessive stretching of the fibres of a ligament, which, due to an extreme movement, end up distending and breaking to a greater or lesser extent.

The incidence is high, affecting between 70-80% of football or basketball players[1], [2].

They present with severe pain and inflammation. Sometimes, if there is not a complete and adequate recovery, the stability between the bones that join the ligament suffers, reducing the stability of the joint, favouring relapses.

These are repetitive sprains, which are associated with muscle weakness and lack of performance.

Sprains can occur in any ligament in the body, but the most frequent sprains in sport are in the knee or ankle, and tend to be more frequent in the dominant leg. [3]

In the case of ankle sprains, a study showed that a significant proportion of athletes with ankle sprains still had symptoms more than three years later, due to the lack of stability.[4] 2.

2.- Meniscal tears
Menisci are fibrous structures that interpose themselves between two bony surfaces to help them fit together.

They are subjected to a great deal of stress, as they absorb the impacts that occur on bones and joints.

It has been reported that in the case of the knee, where we have two menisci, an inner and an outer meniscus, it is the inner meniscus that is most frequently injured.[5] Some people are predisposed to this condition.

Some people are predisposed to this type of injury, due to congenital or metabolic peculiarities.

Predisposing factors may also include anatomical features that limit proper congruence between the bony surfaces to be mated.

Sometimes, joint instability due to previous sprains may favour meniscal injuries.

For minor tears, treatment will be more conservative, but removal of the meniscus may be necessary.

The incidence of meniscal injuries leading to meniscectomy is 61 per 100,000 population.[6] For some authors these injuries are more common than others.

For some authors, these injuries are more frequent in women than in men, possibly because women have more ligamentous laxity.[7] In the case of the knee, meniscal meniscectomy is more common than men’s meniscectomy.

In the case of the knee, injuries tend to be more frequent in the dominant leg, which is usually subjected to more stress, especially in jumping sports such as basketball.

3.- Muscle injuries

Muscle injuries account for 30% of all sports injuries and are one of the main causes of activity interruption[8].

Muscle tears and ruptures are among the most frequent sports injuries.

They often lead to inactivity for several weeks.

They should be assessed by a specialist, who will direct treatment according to the extent of the injury and the muscle affected.

A decision will be made as to whether treatment should be surgical or conservative.

Muscle damage due to direct trauma must be specially assessed in case surgical repair is necessary.

As for indirect damage, due to chronic overload, the junction between the muscle and the tendon is usually the part that suffers most as it is subjected to more torsion mechanisms.

As a consequence, the microcirculation is affected and the muscle becomes stiff, less elastic, pulling on the tendons and periosteum, which can become inflamed, extending the injury.[9] Fibrillar ruptures of the fibrillar tendon are often the most common cause of injury.

Fibrillar tears of the calf muscles are particularly common in athletes, tennis players (tennis leg) and footballers.

The calf, soleus or plantar muscle will all result in traction on the Achilles tendon, producing secondary tendonitis, or even inflammation of its attachment to the calcaneus (calcaneal periostitis).

If chronic, these injuries can limit sporting activity for years[10].

Injuries to the thigh musculature are frequent, both to the quadriceps, on the anterior side, and to the hamstring musculature (on the inner side of the leg).

It has been described how important the relationship between these two muscular components is, since the limitation of one of them will end up overloading and limiting the other.[11].

4.- Tendonitis

Tendons are the structures that attach muscles to bones, transmitting the leverage necessary to perform movements.

Fibrotic lesions and shortening that limit muscle function can increase traction on the tendons, inflaming them and generating secondary tendinitis, limiting sporting activity and daily life, as their poor vascularity makes them resistant to treatment.

From a specialised point of view, it is important to distinguish between tendinitis and tendinosis.

4.1.-Tendinosis

Tendinitis implies the presence of inflammatory cells, and tendinosis is a degeneration of the tendon (generally due to overuse and poor training), whose vascularity and organisation of collagen fibres are affected without the presence of inflammatory tissue.[12] In recent years, there has been an increase in the number of tendinous lesions in the tendon, but the tendinous tendinous tendinous lesions have become more common in the past few years.

In recent years, the increase in sporting activity in general has increased this type of injury, secondary to overuse, poorly executed exercises or training with inappropriate equipment.[13] In the last few years, the increase in sports activity in general has increased this type of injury.

4.2.- Knee Tendonitis or Jumper’s Knee

Tendonitis of the knee, or “jumper’s knee” is common in athletes whose activity places a lever (eccentric load) on the patellar tendon, which is the tendon that connects the quadriceps (on the anterior aspect of the thigh) to the tibia.

Despite being one of the most powerful tendons in the body, its injuries are increasing, in line with the general increase in sporting activity. [14]

4.3.- Shoulder tendonitis or swimmer’s shoulder

Tendonitis of the shoulder is common in sports such as handball, ice hockey, or swimming (swimmer’s shoulder).

The complexity of the shoulder, which is actually a set of several joints perfectly coupled together, makes the injuries complex, with joint involvement of both tendons, muscles and the acromioclavicular joint (between the clavicle and the acromion). [15]

4.4.- Wrist tendinopathies

Wrist tendinopathies are the most frequent in relation to sports activities that overload the upper limb, such as tennis, handball, volleyball or gymnastics.

The most common are De-Quervain’s tenosynovitis, which affects the tendons that move the thumb away from the hand, followed by tenosynovitis of the extensor carpi ulnaris tendon, which pulls the hand outwards.

Other important tendinitis in this area include intersection syndrome, which affects the extensor tendons of the hand, extensor pollicis longus tendinitis of the thumb, and tenosynovitis of the flexor tendons (associated with carpal tunnel syndrome).[16] Intersection syndrome, which affects the tendons that move the thumb apart from the hand, is also known as tenosynovitis of the thumb.

4.5.- Iliotibial Cintilla

Iliotibial band syndrome is the most common overuse tendinitis of the knee.

The iliotibial band runs along the lateral aspect of the thigh, starting from the tensor fascia latae and gluteus maximus muscle and inserting into the outer aspect of the knee.

This injury is more common in runners and cyclists.

Repeated rubbing of the webbing against the external condyle of the femur leads to degeneration and/or inflammation (friction syndrome).[17]

4.6.- Goosefoot tendinitis

Goosefoot tendinitis is the inflammation of the tendons of the muscle insertion, which from the inner and posterior aspect of the thigh insert on the inner part of the tibia.

It is one of the most frequent pains in osteoarthritic knees, although it also occurs in sports activities that impact on the knee, especially in runners.[18].

4.7.- Achilles tendon

Tendinopathies of the Achilles tendon are among the most frequent in the world of sport.

This tendon is very powerful and connects the calf muscles to the heel.

Again, it will be important to have the extent of the injury assessed by a specialist to assess whether surgical repair is appropriate.[19] This is a very common condition.[19]

5.- Periostitis and stress fractures

The cause of discomfort due to periostitis is not really well known, although it is suggested that traction on the bone surface, where the tendons insert, ends up injuring the periosteum and the bone surface, which ends up inflamed.

It often affects the inner aspect of the tibia, where the tendons of the goosefoot insert, and is referred to as tibial stress syndrome, soleus syndrome or tibial periostitis.

It is common in runners and dancers, especially women. Its incidence is estimated to be between 4 and 35%[20].

5.1.- Osteopathy of the pubis

Other times, the tension and decompensation of the musculature produces traction and inflammation in the pubic bones and the joint of its symphysis, called osteopathy pubis or pubic symphysitis.

Osteopathy pubis is one of the most frequent periostitis, especially in football players.[21] If the tractions are very intense, the osteopathy pubis can be treated.

If the tractions are very intense, they can totally or partially detach part of the bone where the tendons are inserted.

5.2.- Stress fractures

These are the so-called stress fractures, which are more frequent in athletes, especially cross-country runners.

They are more common in women, especially in the lower limbs, especially in the tibia, fibula and metatarsals.

Imaging studies are essential for diagnosis. Especially magnetic resonance imaging[22].

6.- Plantar fasciitis or heel spurs

Also called calcaneal spur syndrome or painful heel syndrome.

It is the inflammation of the plantar fascia, which is the dense fibrous tissue that covers the sole of the foot protecting the musculoskeletal structures of the foot, jumping from the heel to the toes.

Its inflammation causes a sharp, stabbing and often very limiting pain, especially with the first few steps.

It affects both male and female athletes equally, whether professional or amateur.

It is a degenerative process that is related to factors such as the anatomical and functional particularities of each individual.

In runners, it is the most frequent ailment after goosefoot (medial tibial stress syndrome) and Achilles tendinitis.[23].

7.- Low back pain

Athletes may suffer low back pain secondary to repetitive mechanical overload.

It is generally considered that if the pain is exacerbated with an anterior tilt, it would come from the anterior compartment of the spine, such as the intervertebral disc, and if the pain increases when leaning backwards, it would come from the posterior compartment, such as the facet joints, which are those that join the vertebrae together.

But low back pain in athletes is often combined, as muscle shortening and tensions not only hurt in their own right, but can also compress the nerve roots leading from the spine (lumbar plexus).

Although the tonic should always be to apply the most conservative treatment possible, this is particularly relevant in the treatment of sportsmen and women, especially if they are professionals.[24].

8.- Ulnar neuropathy or Handlebar paralysis

It is also called handlebar paralysis, as it is frequent in cyclists, due to the overload and compression that occurs when the external part of the palm of the hand is supported and compressed by the handlebars of the bicycle.

This is the region of the ulnar nerve, and injury to it after a long ride, especially if there are long downhill rides, will result in an isolated lesion of the deep terminal motor branch of the nerve, causing the innervated area to become paralysed, with a sensation of cramping and lack of coordination.[25]

9.- Perineal paralysis syndrome of the cyclist

This pathology is due to the sustained compression of the pudendal nerves, which are the nerves that run forwards from the pelvic floor and innervate the perineal area.

The pelvic floor is the hammock of muscles, tendons and ligaments that lie on the floor of the pelvis and support the abdominal viscera.

Sustained overload on this area can lead to inflammatory processes and muscle tension which, in turn, can compress the path of the pudendal nerves.

The cyclist’s fit on the load areas, such as the handlebars and the saddle, is essential to avoid most of these pathologies.

With regard to the saddle, chafing, perineal folliculitis and furuncles, subcutaneous perineal nodules, pudendal neuropathy, male impotence, traumatic urethritis and a variety of vulvar trauma have been described.[26] 10.

10.- Cyclist’s knee

Mechanical overload on the knee can result in injury to the patellofemoral joint, which is the joint between the patella and the femur.

Several epidemiological studies have shown that knee injury pain is experienced by between 14.8 and 33% of cyclists who cycle for long periods of time.

Although the exact biomechanical mechanisms involved in this pathology are not clear, there is consensus that adjusting the distance between the saddle and the pedal seems to be fundamental to avoid this type of injury.[27] 11.

11.- Hot foot syndrome

The bicycle pedal is the point of application and transfer of all the cyclist’s energy on the bicycle.

So much load and so much repetition can cause injury to the toes, causing pain, both muscular and due to compression of the nerves running between the metatarsals, the deterioration of which will result in burning pain, radiating to the sole of the foot and toes.

A cohort study published in the Journal of Science and Cycling records a prevalence of painful feet of 53.9%.[28] 12.

12.- Over-training (Athletics)

It is now accepted that sporting activity leads to an increase in oxidative stress, which is the increase of free radicals in our cells.

To alleviate its negative effects, the body starts up the production of antioxidants, whose mission is to prevent these radicals from damaging us.

The more sporting activity, the greater the production of free radicals and the greater the stress on our cells.

There are many scientific studies that demonstrate the importance of a good diet for safe and effective sports performance.

It is thought that the intake of antioxidant supplements may be effective, but this is a contested concept, with some studies suggesting that long-term intake may also be detrimental.[29] In addition, to cope with sports-related problems, the use of antioxidant supplements may be necessary.

Furthermore, to address the problems of sports overtraining, a personalised nutritional plan needs to be put in place.

Protocols for sports rehabilitation, proper diet and systemic ozone therapy, which has been shown to be effective and safe in activating anti-inflammatory and antioxidant systems, need to be planned.

It is the only safe and very well tolerated element, with scientific evidence, as a regulator of the cellular oxidation-reduction balance, which is the key to recovery.[30].

13.- Concussions (rugby, boxing)

Confusion, forgetfulness, dizziness, blurred vision and headache.

This is the so-called concussive syndrome that has been described in boxers, whether amateur or professional.

Repeated microtrauma from punching has effects on the central nervous system.

Since the 1950s there has been concern about the long-term effects of the sport, with the production of chronic encephalopathy, substantiated by numerous pathological examinations of living boxers.

Safety measures have been stepped up in recent years, thanks to the concern of boxing authorities. [31]

References:

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[2] Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med 1986; 14: 465-71.

[3] Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc 1983; 15: 267-70.

[4] Hansen H, Damholt V, Termansen NB. Clinical and social status following injury to the lateral ligaments of the ankle. Acta Orthop Scand 1979; 50: 699-704.

[5] Smillie IS. Injuries of the Knee Joint Fourth edition, Baltimore, Williams & Wilkins, 1970.

[6] Baker BE, Peckham AC, Puppard F, Sanborn JC. Review of meniscal injury and associated sports. Am J Sport Med 1985; 13: 1-4.

[7] Ricklin P, Ruttiman A, Delbuono MS Meniscus Lesion, Practical Problems of Clinical Diagnosis, Arthrography and Therapy New York, Grune & Stratton, 1971.

[8] ElKhoury GY, Brandser EA, Kathol MH, Tearse DS, Callaghan JJ. Imaging of muscle injuries. Skeletal Radiol. 1996; 25: 3-11.

[9] De Carli, A., Volpi, P., Pelosini, I. et al. New therapeutic approaches for management of sport-induced muscle strains. Adv Therapy 26, 1072–1083 (2009).

[10] Dixon JB. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med (2009) 2:74–77.

[11] Martín-Martínez JP, Pérez-Gómez J, Carlos-Vivas J. The influence of fatigue in hamstrings:quadriceps ratio. A systematic review. Arch Med Deporte 2016; 33: 267-275.

[12] Karim M. Khan, Jill L. Cook, Jack E. Taunton & Fiona Bonar (2000) Overuse Tendinosis, Not Tendinitis, The Physician and Sportsmedicine, 28: 38-48.

[13] Renstrom P, Johnson R Overuse injuries in sports: A review. Sports Med 2: 316-333, 1985.

[14] Torstensen ET, Bray RC, Wiley JP. Patellar tendinitis: a review of current concepts and treatment. Clinical Journal of Sport Medicine 1994;  77-82.

[15] Stenlund B. Shoulder tendinitis and osteoarthrosis of the acromioclavicular joint and their relation to sports. Br J Sp Med 1993; 27: 125-130.

[16] Fulcher SM, Kiethaber TR, Stern PJ.  Upper-extremity tendinitis and overuse syndromes in the athlete. Clin Sports Med. 1998; 17: 433-448.

[17] Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Biundo JJ, Irwin RW, Umpierre E. Curr Op in Rheumatol 2001; 13: 146-149.

[18] Uson J, Aguado P, Bernad M, Mayordomo L, Naredo E, Balsa A, Martín-Mola E. Pes anserinus tendino-bursitis: what are we talking about? Scand J Rheumatol. 2000; 29: 184-6.

[19]Benazzo F, Todesca A, Ceciliani C. Achilles’ tendon tendinitis and heel pai 1997; 5: 179-188.

[20] Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012 Apr;31: 273-90.

[21] Gaudino F, Weber MA. Osteitis pubis oder Symphysitis pubis [Osteitis pubis or symphysitis pubis]. Radiologe. 2019; 59: 218-223.

[22] Fredericson M, Jennings F, Beaulieu C, Matheson GO. Stress fractures in athletes. Top Magn Reson Imaging. 2006; 17: 309-325.

[23] Petraglia F, Ramazzina I, Costantino C. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles Ligaments Tendons J. 2017; 7: 107-118.

[24] Sairyo K, Nagamachi A. State-of-the-art management of low back pain in athletes: Instructional lecture. J Orthop Sci. 2016; 21: 263-72.

[25] Burke ER. Ulnar Neuropathy in Bicyclists. Phys Sportsmed. 1981 Apr;9(4):52-6. doi: 10.1080/00913847.1981.11711055. PMID: 27442097.

[26] Mellion MB. Common cycling injuries. Management and prevention. Sports Med. 1991; 11: 52-70.

[27] Bini RR, Flores Bini A. Potential factors associated with knee pain in cyclists: a systematic review. Open Access J Sports Med. 2018; 9: 99-106.

[28] Uden H, Jones S, Grimmer K. Foot Pain and Cycling: a survey of frequency, type, location, associations and amelioration of foot pain. J Sci Cycling 2012; 1:28-34.

[29] Margaritis, I., & Rousseau, A. (2008). Does physical exercise modify antioxidant requirements? Nutrition Research Reviews, 21: 3-12.

[30] Smith NL, Wilson AL, Gandhi J, Vatsia S, Khan SA. Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Med Gas Res. 2017; 7: 212-219.

[31] Ryan AJ. Intracranial injuries resulting from boxing. Clin Sports Med. 1998; 17: 155-168.


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