Sports Injuries - Diagnosis, Treatment and Prevention

• Sports are inherently beneficial for all of us. However, overexertion while engaging in these activities can lead to injuries in muscle groups and joints throughout the body, especially joints that are responsible for an already heavy workload, such as the knees or ankles.
• All sporting activity should be halted for the 6 hours following an injury, while heat compression techniques should be avoided for 48 hours after sustaining an injury.
• For injuries that have been unresponsive to medicated treatment alongside physiotherapy, or for injuries that are deemed severe at the outset, doctors may consider arthroscopic surgery. This is a minimally invasive technique with rapid rehabilitation times. The arthroscope is inserted through a tiny incision that is nearly invisible when compared to incisions from traditional surgery. This makes arthroscopic surgery both highly effective and extremely efficient.

Playing contact sports can lead to muscle, ligament, and joint injuries. Injuries to these areas can seriously affect their functioning capabilities, disturbing the player’s daily life or reducing the ability to carry out standard tasks. Such injuries can be classified into the following two groups:

• Contact injuries occur in sports involving at least 2 players or during team sports that involve contact or collisions. Physical contact can lead to injuries to muscles and ligaments as they are forced out of position or torn. The most common sports where this type of injury occurs are football, basketball, and rugby.
• Non-contact injuries happen to an individual in isolation and can be the result of an erratic movement such as jumping or falling that leads to a twisting of the body. This can result in muscles, ligaments, and joints becoming injured or torn.

Sports injury severity can be categorized into 4 distinct levels:

• Grade 1: Muscle injuries that do not involve any tearing. This may cause slight pain but leave function largely unaffected.

• Grade 2: Muscle injuries that involve slight tearing and are painful to the touch. These may also involve pain or bruising but movement and use is mostly unaffected.

• Grade 3: Moderate muscle tears that significantly impinge upon movement and result in noticeable bruising.

• Grade 4: Severe muscle tears that cause joint dislocation and extreme pain. These injuries significantly affect the patient’s daily life as the use of the injured limb is drastically reduced leading to difficulty even ascending or descending steps. This type of injury generally requires surgical treatment.

Treatment for grade 1-3 injuries depends on the individual’s muscle and joint situation. If sufficient support can be provided to the injured limb, the individual may be able to lead a relatively normal life. However, injured athletes who are reliant on the injured limb may require surgery to repair the damage and restore function.

Strains:

These injuries are caused by overstretching muscles. This can occur suddenly and result in the blood vessels surrounding the muscle being torn. However, strains can also occur as a result of sustained and consistent muscle usage, known as overuse strains. This includes, for example, weight training with weights that are too heavy or repeated exercises that cause muscular bruising to occur. Common examples include hamstring and quadricep strains.

Sprains:

These are injuries to the tendons or joints, such as a torn Achilles tendon or sprained ankle, and include most of the injuries to the ankles and knees. The sports most commonly responsible for injuries to the ankles and knees are those which involve contact or collisions, such as football. Individual sports that involve whole body movement as well as joint twisting and rotation, such as golf, can also cause this type of knee or ankle injury.

Knee injuries:

These refer to injuries to the joint itself as well as areas affecting the large ligaments and muscle groups that work together with the joint, such as the quadriceps and hamstring. If any of these moving parts sustain damage or are unable to function as before, it can lead to knee instability. Knee joints consist of 4 large ligaments: lateral collateral ligament, medial collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Injuries or tears to any of these ligaments can result in dislocation that prevents the patient from being able to engage in sports until it is fully healed.

The meniscus in the knee, which is responsible for reducing friction and impact in the knee when jumping, descending steps, and jogging, is also prone to damage. The 4 levels of injury mentioned previously are also used to describe any injury affecting this section of the knee. Additionally, the synovial fluid that lubricates the joint can also be injured, making it another factor to consider when diagnosing a knee injury.

Runner’s knee:

This type of injury tends to affect runners, who may feel a pain in and around the patella. This occurs particularly when ascending or descending steps, or when standing up after sitting down for an extended period. The causes of such an injury can be associated with running up and down steps when training or increasing distance in a training regime before the body is prepared to do so, and can cause issues affecting muscle groups, such as core body muscles and quadriceps, or flat footedness.

Back injuries:

Athletes who are frequently required to rotate their body at the hips, core, shoulders, or arms, such as when playing golf, may cause overstretching in the back muscles and lumbar vertebrae movement injuries. This is why most golfers tend to experience back pain at some point.

Swollen muscles:

Muscle inflammation, tears, or bleeding can be caused by a collision or bruising and can affect any muscle group within the body.

Rupture of the Achilles tendon:

The Achilles tendon is located at the back of the foot and connects the heel to the calf to support ankle movement. Sports that place the Achilles at the greatest risk of injury are those that involve jumping, such as badminton, basketball, and football.

Fractures:

Bone fractures can occur in the ankle, knee, or any other joint.

Dislocation:

Joint dislocation, such as of the knee or shoulder, are common injuries affecting athletes.

Rotator cuff injuries:

This injury is most common among athletes who play sports reliant on constant shoulder movement, such as tennis and badminton. These repeated actions can easily lead to an overuse injury or joint impingement that can result in a torn muscle.

An initial assessment of any injury should include checking for swelling or pain and determining whether movement is impinged. Basic first aid can be administered according to the principles of PRICE, as follows:

• Protect: This means protection from, or reduction in, the risk of collision injuries through use of a helmet, knee pads, or elbow pads.
• Rest: Stop to rest the injured part of the body immediately, particularly during the initial 6 hours following the injury. However, most sports or exercise injuries require rest for at least 48 hours before attempting to move the affected limb.
• Ice: Cool compression can reduce blood loss in the affected area of tissue, as well as decrease pain and inflammation by slowing down circulation to the injured area. Cool compression should be applied for between 10–20 minutes, with rests of 5 minutes between each compression. This process can be repeated either until swelling has been reduced or 2–3 times per day. To perform cool compression, use an ice pack that can maintain its low temperature for between 45–60 minutes and wrap it with a cloth to avoid direct contact with the skin. If an ice pack is unavailable, or if the injured area is larger than a single ice pack can cover, a bag of ice or cool cloth can be used instead. Another option is a cooling spray, which can temporarily reduce pain in areas where the skin is relatively thin, such as on the chin, knuckles, or ankles.
• Compression: Wrapping the injury with a bandage is aimed at reducing blood flow to the area. For this reason, the bandage must be made from a flexible yet thick material and wrapped tightly around the affected limb. The bandage should also be wrapped around the top and bottom of the injured area. For the best results, it should be used together with cold compression.
• Elevation: Elevating the injured limb higher than the heart should improve circulation to the heart and help reduce pressure buildup resulting from liquid secreted by damaged cells, thus decreasing inflammation. For leg or ankle injuries, lying down with the leg or ankle raised up on a pillow or sitting with the ankle resting on a chair should be sufficient. If the injury is severe, this elevation should be continued for 24–48 hours.

• Medication: Pharmaceutical management may be used to reduce pain and inflammation. NSAIDs or morphine-based medication are useful for severe pain, as are intravenous drugs, topical creams, and pain relief patches. Treatment for normal bruising is generally administered in the form of muscle relaxant medication or anti-inflammatories together with rest.
• Physiotherapy: The main goal of physiotherapy is to reduce pain. Physiotherapy is suitable for ligament or cartilage injuries. Such treatment may be administered alongside the use of a cast or to treat muscle weakness prior to surgery.
• Surgery: Surgery may be required if medicated treatment and physiotherapy have been unsuccessful, or if the injury is more severe, such as complete ligament tears that have destabilized the joint and urgent cases, including dislocation and severe joint fractures. Fortunately, most sports injuries are now treatable through arthroscopic procedures. This surgical technique reduces disruption to nearby muscle groups and accelerates rehabilitation times. Additionally, arthroscopic surgery only requires tiny incisions that are almost invisible compared to more traditional forms of surgery, thus increasing efficacy and efficiency. Orthopedic surgeons will be in charge of deciding which technique to use after considering the patient’s unique situation and type of injury. However, while arthroscopy is currently the most popular form of surgical treatment, there are still occasions where traditional surgery may be required. For example, the implantation of devices or equipment used to stabilize and strengthen an injured limb cannot be achieved using arthroscopic techniques.

• When your injury is incapacitating.
• If an injury becomes chronic and constant pain is affecting your daily life.
• In cases where the pain has become unbearable.

• Use appropriate sports equipment, such as good quality training shoes.
• Wear protective clothing, such as a helmet, elbow pads and knee pads.
• Be sure to warm up before playing, and cool down afterwards to help the body return to its pre-exercise state.
• Train regularly.
• Eat a healthy and nutritious diet.
• Take additional vitamins and nutrients where necessary.
• Drink plenty of water to prevent dehydration.

It is undeniable that playing sports and exercising increases the risk of injury. However, preventive techniques should be employed to reduce this risk, whether that risk is from contact with other players or your own movements. If you are injured, be sure to seek the appropriate medical treatment from a specialist in sports injuries because damage left untreated can easily develop into a chronic condition. A specialist will be able to suggest ways to rehabilitate the injury, which can help restore normal function or even help you return stronger than before.

The FitLAB team at Bangkok’s Samitivej Hospital includes professionally trained specialists in treating sports injuries using the latest medical grade technologies. Our team consists of doctors, physiotherapists, and sports scientists, all highly trained and experienced in their field. Their first-hand understanding of the field of sports and exercise has helped them provide care for over 1,500 professional and amateur athletes (data from 2014–2019).

This care includes advice on the prevention of injury, suggestions on how to avoid repeat injuries, the creation of fitness assessment programs, injury treatments that are not solely reliant on surgery, recommendations on lifestyle adjustments to reduce usage of certain limbs, medication advice, and physiotherapy utilizing the latest equipment designed to rehabilitate and strengthen muscles. Patients requiring surgery can now undergo minimally invasive arthroscopic surgery. This technique reduces rehabilitation times, and provides surgeons a clearer view of the injury’s pathological state compared with traditional forms of open surgery. This means treatment is more accurate and efficient than ever. In addition, the rehabilitation following such procedures can often result in patients developing strength and endurance in their muscles that they previously found difficult to achieve. Even when surgery is not required, the experience and expertise of our team can be relied upon to diagnose each unique injury before creating a tailored rehabilitation program. This includes the use of specialized equipment and the latest medical grade technologies to enable a speedy return to the sports or physical activities the patient enjoyed prior to their injury.

• Assistant Prof. Visal Kantaratanakul, M.D., specializing in rehabilitation medicine and Director of the Rehabilitation Center
• Akkarapol Klaiput, M.D., specializing in rehabilitation medicine and Director of the Samitivej Active Performance Medicine Center (SMAP)
• Phattarapon Atimetin, M.D. specializing in rehabilitation medicine
• Suramet Sirijaruwong, M.D., specializing in rehabilitation medicine
• Benjapol Benjapalakorn, M.D., specializing in sports physiotherapy
• Akanis Srisukwattana, M.D., specializing in sports cardiology
• Norasak Suvachittanont, M.D., specializing in sports cardiology
• Thanakorn Sasayanan, specialist consultant for physiotherapy and sports medicine

• Associate Prof. Cholawish Chanlalit, M.D., specializing in orthopedic surgery, sports medicine, and arthroscopic surgery, head consultant at the Arthroscopic Surgery Center (ASC)
• Associate Prof. Chathchai Pookarnjanamorakot, M.D., specializing in orthopedics and orthopedic sports medicine
• Wichian Jiraboonsri, M.D., specializing in orthopedics and orthopedic sports medicine
• Pirapat Ruchiwit, M.D., specializing in orthopedic surgery
• Suwicharn Bamrungchaowkasem, M.D., specializing in arthroscopic surgery and sports medicine
• Chayanin Angthong, M.D., specializing in arthroscopic foot and ankle surgery
• Thitinut Dilokhuttakarn, M.D., specializing in arthroscopic hand and wrist surgery
• Naraphong Hangsaphuk, M.D., specializing in arthroscopic knee surgery