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SPORTS INJURIES

What’s the cause?

Types and causes of injuries include:

• Sprain: a sudden or violent twist or wrench of a joint causing the stretching or twisting of ligaments, and often rupture of blood vessels with haemorrhage to the tissues.
• Strain: injury to a muscle, often caused by overuse, resulting in swelling and pain.
• Fracture: a break in a bone or cartilage.
• Dislocation: displacement of one or more bones at a joint.
• Bruise (contusion): usually caused by blunt impact. Capillaries are damaged, allowing blood to seep into surrounding tissue. Bruises are normally minor but painful, and easily recognised by their characteristic blue or purple colour in the days following the injury.

What are the signs and symptoms?

There are two types of sports injury: acute, which occur suddenly while playing or exercising, and chronic; these occur as a result of prolonged or repeated sports or exercise activity. Signs and symptoms of acute injury include: sudden, severe pain; swelling; inability to place weight on a limb, hand or foot; extreme tenderness in the area involved; extreme weakness in a leg or arm; a bone or joint visibly out of place. Chronic injury signs and symptoms include: pain when playing or exercising; dull ache at rest; swelling.

Red flags – when to refer

• Severe pain, swelling or numbness
• A limb cannot bear weight
• A limb, hand, foot or digit is immobilised
• An old injury hurts or aches
• An old injury swells
• A joint feels abnormal or unstable.

Treatment

If an injury is minor, the RICE (rest, ice, compression and elevation) method can be used to relieve pain, reduce swelling and speed healing. Treatment should be started as soon as possible after the injury has occurred and continued for at least 48 hours, as follows:

• Rest: reduce regular activities. Take the weight off an injured foot, ankle or knee. Use of a crutch may help.
• Ice: put an ice bag or cold pack to the injured area for 20 minutes 4–8 times a day. A plastic bag filled with crushed ice and wrapped in a towel can be used. Remove the ice after 20 minutes to avoid cold injury.
• Compression: put even pressure on the injured area by binding, to help reduce swelling. A crêpe or stockinette bandage can be used.
• Elevation: put the injured area on a pillow, at a level above the heart, to reduce oedema.

OTC treatments

• Oral and topical analgesics can be used to treat musculoskeletal pain.
• The main oral analgesics are paracetamol and the NSAIDS aspirin, diclofenac and ibuprofen; use of these was described in the Symptom Management Checklist on headache in the November 2013 issue.
• Topical NSAID preparations containing benzydamine, diclofenac, felbinac, ibuprofen and salicylic acid are available without prescription. They act directly at the affected site, avoiding the systemic adverse effects and side-effects of oral administration. Evidence indicates that topical NSAIDs are effective over short periods for musculoskeletal conditions, are as effective as oral NSAIDs and have a very low incidence of adverse effects.

Topical NSAIDs are licensed for the treatment of backache, rheumatic and muscular pain, sprains and strains, including sports injuries, and for pain relief in non-serious arthritic conditions. They are generally well tolerated, although side-effects associated with oral NSAIDs can occur, especially if large amounts are applied.

Topical NSAIDs (except benzydamine) are contraindicated in patients sensitive to aspirin and other NSAIDs, and they are not recommended for use by pregnant or breastfeeding women or for children under 14 years of age. Clinically significant drug interactions are unlikely. Presentations include creams, gels, mousses and sprays.

• Rubefacients are compounds that produce local vasodilation and create a sensation of warmth, exerting an analgesic effect by masking the perception of pain. Massaging enhances their effect and also helps to disperse local tissue pain mediators.

Most rubefacient preparations are mixtures of several ingredients, including salicylates, nicotinates and counterirritant substances from natural sources, such as capsicum oleoresin, turpentine oil, camphor and menthol. Limited evidence has shown that rubefacients may be effective for acute pain, but moderately to poorly so for chronic pain. Products containing salicylates should be avoided by people sensitive to aspirin.

BACK PAIN

What’s the cause?

In many cases of lower back pain no cause can be determined. Contributory factors are general lack of fitness, and occupational and psychological factors. There are two main causes in cases where a mechanical cause can be identified:

• Soft-tissue injury: strain of spinal muscles and ligaments (lumbago, fibromyalgia)
• Trapping of a nerve root, usually the sciatic nerve, due to a slipped intervertebral disc (sciatica).

How common is it?

Pain in the lower back is extremely common: 60–80 per cent of the population suffers from back pain at least once in their lifetime and about 40 per cent of adults claim to have suffered from it for more than one day in the last year. It is most common in the 45–59 age group. It occurs more or less equally in men and women. 90 per cent of acute episodes of back pain resolve within six weeks.

What are the signs and symptoms?

Soft-tissue injury is often brought on by an event involving lifting or twisting. Pain may spread right across the back at the level of the top of the pelvic girdle, or may run vertically on one side of the spine. It may radiate to the buttock or thigh. Pain and restriction of movement may cause the patient to adopt a posture of leaning forward or to one side. The patient is otherwise well.

Nerve root pain Pain is felt in the lower back and often radiates down one leg, sometimes as far as the foot. Pain can be intense and burning, is constant and made worse by movement. The sufferer limps and is unable to flex the hip very far, making sitting and climbing stairs uncomfortable. Gait is stiff and awkward and the patient may hold themself rigid to avoid movement.

Red flags – when to refer

• If backache is not related to movement
• Pain in the upper back not obviously due to muscle or ligament strain
• If associated with other symptoms of illness
• If associated with neurological symptoms such as numbness or tingling in legs or feet
• Problems with bowel or bladder function
• Severe pain at night
• Cyclical low-back pain in women in the middle or second half of menstrual cycle
• No improvement with over-the-counter medication after a week.

OTC treatments

As for sports injuries (see above).

Additional advice

• Avoid stooping, bending, lifting and sitting on low chairs until the back is better.
• Stay as active as possible and continue normal daily activities. Rest with sciatica, but not bedrest for simple back pain.
• Increase physical activities over a few days or weeks.
• Backaches are rarely caused by a serious illness and usually go away in a few days.
• Stay at work or return to work as soon as possible.