For a person who engages in athletic activities, nothing strikes more fear in them than the topic of sports injuries. The very words either sends vivid memories of a previous injury or anxiety of the "what if?". People who are fortunate enough not to have a lot of experience with sports injuries are not familiar with a lot of the more common ones. And once an injury has been sustained, what can be done for it for the initial and long term care? This paper seeks to help answer some of these questions.

In our practice, some of the more common injuries that we see are in the knee. With the knee being extremely weak in terms of its bony arrangement, most of its stability is gained through ligaments (which connect bone to bone) and tendons (connect muscle to bone). Its two primary motions are flexion and extension, but there is a little movement into rotation and to a lesser degree some lateral (sideways) motions. It is also because of this design that the knee is so vulnerable to injury. Once the knee has been subjected to stresses greater than what it was designed to, injury can occur. This also explains why activities that require a lot of cutting and pivoting have such a higher incidence of knee injury.

One of the more common knee injuries is a sprain of one or more of the stabilizing ligaments. A sprain is stretching a ligament further than it can tolerate and subsequently causing varying degrees of tear. This usually happens as a result of a planted foot and either a twist, a hyperextension, and/or an outside force directed at the knee with the foot planted. Pain is usually immediate and there will be some feelings of apprehension or an inability to bear weight on that leg.

One of the more commonly injured ligaments is the anterior cruciate ligament (ACL). This is considered the key guide wire in the knee joint and is crucial for guiding the tibia in a normal path along the end of the femur. Often the athlete remembers hearing a 'pop' as the injury occurs and there are instant feelings of instability or giving way.

The other three major ligaments of the knee joint that are more commonly injured are: the medial collateral ligament (MCL) which prevents the knee from moving medially, the lateral collateral ligament (LCL) which prevents lateral movement, and the posterior cruciate ligament (PCL) which criss-crosses with the ACL and prevents backwards movement of the tibia on the femur. As mentioned above, sprains to any of these ligaments illicits symptoms which are similiar with respect to feelings of instability, apprehension or inability to bear weight, and immediate pain.

Initial care and treatment of sprains to the knee joint consists of ice for 20 minutes every 1-2 hours, elevation above the level of the heart to reduce swelling, crutch use so as to not exacerbate the injury, and immediate follow-up with an orthopaedic surgeon for an accurate diagnosis. Because of the relatively poor blood supply to the ligaments of the knee, they are unable to repair themselves like muscles or tendons. They do, however, lay down collagen-based scar tissue which needs to be used regularly in order for it to form strong tissue. Early, protected weight bearing is emphasized as well as prescribed range of motion and strengthening exercises.

Another area in the knee joint where injuries are commonly sustained is to the cartilage of the knee. There are two major kinds of cartilage in the knee: articular and meniscus. Articular cartilage covers the end of the tibia (shin) and the femur (thigh) and acts as a shock absorber and bone protector. The menisci are two disc shaped wedges which float between the tibia and femur and act as stabilizers as well as shock absorbers.

Injury to the meniscus is more common than to the soft articular surfaces and typically results as a result of a twist or torque to the knee. Pain and feelings of catching or "locking" are common and are the result of the torn menisci flipping in and out of the joint space--much like trying to close a door with a marble in the door jam. Pain, swelling and apprehension with walking will typically resolve within a week or two, but sensations of locking, buckling or giving out will be much more apparent as activity level increases. Because of the poor vascularity to the menisci, they are unable to repair themselves and typically need surgical intervention to repair or take out the torn piece. Depending on the work that is done, return to activity takes anywhere from a few weeks to a few months.

The shoulder is another common area where athletic injuries occur. They are of an acute (happens as the result of one episode) or chronic (occuring over a longer period of time) nature and can be very debilitating. A skier falling on an outstretched arm or a volleyball player being blocked unexpectedly during a spike are examples of acute injuries. Chronic injuries would be a baseball pitcher with a painful shoulder after playing three games in a row or a tennis player with symptoms after a few very long matches.

The shoulder is a complex ball and socket joint which relies on muscles and tendons, and to a lesser degree the capsule and ligaments for stability (Fig. 2). What surrounds the ball and socket is the joint capsule which holds it all together. Over the top of the shoulder structure is the acromion process which forms an "arch" under which pass tendons and bursa sacks (fluid filled sacks which lubricate the surrounding tissue). Behind it all is the scapula or shoulder blade which floats on the rib cage and is controlled entirely by muscle movement. Surrounding all of this are the rotator cuff, pectoralis, deltoid, bicep/tricep and trapezius muscles (to name a few) which control joint motion.

Some of the more common injuries to the shoulder that we see in our clinic muscle strains, capsule tears, bursitis/tendonitis, and separated and dislocated shoulders. Muscle strains can be the result of acute, explosive injury or a chronic condition that can be attributed to faulty mechanics or overuse. Partial or complete tears of any of the rotator cuff musculature is very debilitating and warrants immediate attention so as to not exacerbate symptoms. Ice, rest from activities that reproduce pain, and if range of motion is limited, prompt referral to a physician is imperative. Muscles and tendons have good healing capabilities, but proper guidance through a rehabilitation program is essential.

Capsule tears can also be of an acute or chronic nature. Acute episodes of capsule tears are the result of excessive torque placed upon the joint, usually in a rotational manner. Chronic tears can be the result of too much stress on the joint over a prolonged period of time. For example, baseball pitchers, javelin throwers, and gymnasts are vulnerable to capsular lesions because of their activity. Conservative treatment consists of strengthening of the surrounding structures in such a way that does not aggravate the area. Treatment should also be symptomatic and consist of icing when inflammed, modification of activities that exacerbate symptoms, and rest when irritated.

Bursitis/tendonitis are chronic conditions that signal overuse and/or poor mechanics. Poor posture, anatomical disposition, muscle imbalance, and faulty overhead lifting mechanics are some of the causes of these conditions. Once the bursa sack and/or tendon has been impinged under the acromion arch repeatedly, it becomes inflammed. Once it is inflammed, it becomes easier to impinge and the cycle continues. Postural education, stretching of chest muscles, and strengthening of upper back muscles all aid in reducing symptoms. As always, modification of aggravating activities is essential to allow for proper healing.

Two other common injuries that we see in our facility are separated and dislocated shoulders. A separated shoulder is typically done by falling or getting hit on the apex of the shoulder, tearing the ligament that holds the clavicle (collarbone) to the acromion. As with any sprain, there are varying degrees of tears. The level of dysfunction is directly related to the degree of tear, which means that the more disability following the injury typically means it is more severly injured.

Shoulder dislocations, on the other hand, is when the ball comes out of the socket joint. This is followed by immediate disability and usually some attempt to relocate it by themselves. This injury should be promptly seen by a physician. Proper reduction of the dislocation is imperative so that no further injury to the surrounding tissue, nerves, and blood supply occurs. The shoulder is typically protected in a sling for 1 - 2 weeks following injury. During this time, wrist, forearm, and elbow exercises are performed and gentle range of motion exercises of the shoulder are prescribed to decrease stiffness.

So, what can be done to prevent such injuries from occuring? Research clearly shows that getting on a good strength and flexibility program can reduce the risk of injury. The stronger and more agile you are makes you more responsive to avoid vulnerable situations. A good weightraining and stretching program that focuses on the major muscle groups three days per week is usually sufficient. Other examples would be step-aerobics, a stretch cord resistance program, and yoga classes.

The better conditioned you are aerobically also aids in preventing injuries sustained as a result of fatigue. Cardiovascular training in the form of cycling, running, swimming, or stair machines improves endurance. This translates into the ability to play that extra set of tennis or take those last few runs skiing.

Another tip to aid in prevention of injuries is to train and perform activities with a partner or group. There is no better way to get feedback on faulty mechanics or poor technique than if someone is able to critique you. Maybe your golf swing needs more back rotation and follow through. Or perhaps you rotate your hips and knees too much when you are cycling. A good training partner would jump at the chance to volunteer tips knowing that they will receive the same.

The most difficult of all injury prevention techniques is self-discipline--knowing when enough is enough. A significant number of injuries are sustained near the end of an activity when fatigue begins to set in and balance becomes compromised. Next time, consider listening to that voice in your head that says: "I am feeling a little fatigued. Do I really need to play that last game of hoops?".