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Injuries and treatment

If you play a contact sport, regularly work out in the gym, or do any activity that places stress on your joints, the chances are you'll pick up an injury at some point.

Injury can affect your bones, muscles, joints or the connective tissues that hold them together - the tendons and ligaments. Most of the time the cause of your injury can be established and a recurrence prevented, so it needn't stop your fitness programme for long. But it's vital you don't ignore injuries and simply 'soldier on' as this can make them much worse and leave you with a chronic condition that's far harder to treat.

Here are some of the commonest causes of injury, the quickest route to rehabilitation, and the experts who can help.

What causes injury?
One common cause of injury, especially in contact sports, is trauma in other words, a broken bone, a twisted knee, a sprained ankle.

Traumatic injuries are usually the result of impact and collisions, and typically occur suddenly, so generally there's not much you can do to prevent them (although in most games or sports one of the aims of the rules is to reduce the risk of injury, so following the rules should make you safer).

But other injuries occur over time, and as a result of identifiable problems, and so are preventable in many cases.

The risk factors that lead to injury are usually classified as being extrinsic (outside the body) or intrinsic (personal to your body).

Typical extrinsic factors include:

Excessive load on the body. The tissues of the body are capable of withstanding considerable stress: more than three times your weight can go through the body even when jogging slowly. But tissues that aren't accustomed to such forces won't have adapted to withstand them and are likely to be injured when they're applied. When deciding how often, how hard and for how long to exercise, you need to consider the impact on your muscles and joints. Build up gradually to avoid injury.

Poor technique. A number of so-called 'overuse injuries' are related to sports or exercise technique. Indeed, some injuries are even popularly named after their sport (for instance, tennis elbow). Often it's the repetition of an action with faulty technique that results in excessive load on tissues and subsequent injury.

Poor or inappropriate equipment, especially footwear and, in some sports, headgear. If your activity involves impact (things such as running and jumping) then wearing proper footwear that supports your feet and cushions your body from shock is vital. Your need for specialist footwear or other sports equipment may be determined in part by intrinsic factors such as 'over pronation' (see below).

Failure to warm up and warm down. Many of the body's tissues (particularly muscle) respond better to loading when they're warm. The warming-up process should include whole body exercise that increases blood flow to muscles and makes them more responsive. At the end of every training session, you should also warm down, bringing your body back down to normal, usually through low intensity activity, followed by flexibility exercises.

Intrinsic injury risk factors include things such as the shape and structure of the major joints. For example, feet that 'pronate' (roll inwards) or have a weak arch often contribute to lower leg, shin and knee conditions in runners, as do 'knock knees' (genu valgus) or 'bow legs' (genu varus).

Other injury risk factors include:

Leg length discrepancy
Muscle weakness or imbalance
Limited flexibility
Joint laxity - not being able to control and stabilise joints throughout their full range of motion
Being overweight - this increases the load on muscles, tendons, ligaments and joint structures during weight-bearing activities

What should I do if I get injured?
Obviously a serious trauma injury, such as a broken bone or ruptured ligaments, will require immediate medical attention, but most injuries are not so dramatic, and some may even respond simply to rest.

When you get injured, there is typically swelling, redness, tenderness and increased temperature. This inflammatory response is how the body tries to heal itself it is the body's attempt to dispose of blood (from torn tissue) and damaged cells.

Excessive swelling (oedema) can interfere with the initial healing process, so it's important in the early first aid treatment of sports injury to help limit this swelling. The acronym NICER is a useful reminder:

N = non-steroidal anti-inflammatory drugs, such as ibuprofen, which reduce inflammation and swelling, and alleviate pain (remember to check the label for contraindications).
I = ice, or cold therapy, since this decreases pain and limits the extent of the swelling. Ice should never be placed directly against the skin. The time for which a tissue should be cooled depends upon the site and severity of the injury.
C = compression, usually in the form of a compression bandage. This mechanically limits the amount of swelling by restricting the amount of space in and around the injury.
E = elevation. This also helps control swelling since fluid is drained more effectively from the injury.
R = restricted activity. To allow the healing process to proceed, the injured area must be rested initially.

Who's the best person to treat my injury?
If your injury is minor not much more than a little stiffness or soreness it may be that you have simply been doing a little too much too soon and the affected area just needs rest.

However, there may be underlying reason for the soreness, extrinsic or intrinsic, and it never pays to ignore an injury, especially when it may be very easy to locate its cause.

Start with a sports physiotherapist if the problem seems to be related to sport, or you've had it before, or with your GP, who may then suggest you see one or more of various therapists. You could be referred for:

Physiotherapy - this covers a well-established group of treatments or techniques, frequently involving physical manipulation of the affected area. It's offered in hospitals, on the high street, in doctors' surgeries, and often in gyms and sports centres. Physiotherapy is a very broad term and many physiotherapists specialise in a particular area of the body, so you may need some guidance in choosing the right therapist for you. Physiotherapy is available on the NHS, but these days you usually have to wait weeks and months. If you can decide to see a physio privately, you can refer yourself directly.

Podiatry - podiatrists specialise in diagnosis and treatment of disorders affecting the foot and lower limb. They can provide relief of painful symptoms and also preventive care for people with conditions that may affect the health of their feet. A podiatrist might prescribe and manufacture orthoses - specialist insoles that can address problems like pronation by holding the foot in a stable position and preventing it rolling inwards. Podiatry is rarely offered on the NHS, so you'll probably have to pay to see a podiatrist privately.

Osteopathy - this is a complementary therapy that focuses on musculo-skeletal problems. It concentrates primarily on problems with muscles, joints and nerves and employs a range of physical and manual techniques. In the UK it's considered a complementary therapy, so access to osteopathy on the NHS is limited, but some osteopaths work alongside GPs, and GPs are permitted to refer patients to them. You can also go to see them privately without referral.

Chiropractic - chiropractors use physical manipulation to treat problems with joints, bones and muscles, and the effects they have on the nervous system. Chiropractors place particular emphasis on the spine, which is why they tend to be associated with treating bad backs. Like osteopathy, chiropractic is only available as an NHS treatment in some areas, depending on the policy of the local primary care trust, or you can see them privately without referral.

If you do go directly to a therapist outside the NHS, it's important to check they're a regulated practitioner, and whoever you see for treatment on the NHS or not needs to have skills relevant to your specific problem, which is why it's best to find someone based on reliable recommendation or, best of all, GP referral.



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