Strains & Sprains
Participation in sporting or physical activities can injure the soft tissues of your body. Even simple every day activities, if repetitive, can damage the ligaments, tendons and muscles. The soft tissue injuries you are likely to experience include sprains, strains, contusions, tendonitis, bursitis and stress injuries. These can all be the result of either a single episode or repetitive low energy injury.
This would include falls, sudden twists or direct blows to the body or repeated overuse in athletes or workers.
A sprain is a simple stretching of a ligament. A ligament is a strong band of tissue which connects one bone to another to keep the joints stable. The most commonly injured areas are your ankles, knees and wrists. Typically, a twisted or sprained ankle happens when your foot turns inwards, putting extreme tension on the outer ligaments of the ankle.
Most sprains heal with time and rest, but the recovery period is faster with rest, ice, compression and elevation. Often, sprains require a period of bracing or strapping and very severe sprains may require surgery if the ligaments are torn altogether.
A strain can be considered either a simple stretching of a muscle or tendon, or a partial or complete tear in the muscle tendon combination. Since tendons connect muscles to bones to allow the body to move around, a strain often occurs from a sudden movement of the body. For most strains the treatment is the same as a sprain, followed by a simple exercise program to restore mobility and strength, but serious muscle or tendon tears may need surgical repair.
A contusion is a bruise caused by a direct blow to the muscle tendon or ligament. Blood vessels burst within the area and blood collects around the injured area and discolours the skin, causing bruising. Most contusions are mild and respond well when treated with ice and rest and then a stretching programme.
In rare instances, bone may form within the muscle and is called heterotopic ossification. If your symptoms persist beyond a few weeks, medical care should be pursued.
Inflammation or irritation of a tendon or the tendon sheath is called tendonitis. Inflammation is usually an attempt at a healing response to some form of injury, and is almost always accompanied by swelling, heat, redness and pain. Most often, a series of small stresses that repeatedly aggravate the tendon cause tendonitis rather than a single episode. In the early phases of tendonitis, the treatment is rest to eliminate stress, anti-inflammatory medications, steroid injections in the region rather than into the tendon, splinting and exercise to correct muscle imbalance and improve flexibility. If the inflammation persists, it may cause damage to the tendon itself and this may eventually need surgical intervention.
A bursa is a fluid-filled stack which reduces friction between different areas of the body. This is most commonly between a bone and tendon or muscle and allows the tendon to slide smoothly over the bone. When the bursa becomes irritated, it produces excess fluid and becomes swollen. The swelling and irritation is caused bursitis and often is associated with pain.
Most bursitis is relieved by rest, but medications or injections can sometimes be used as well.
The body is continually remodelling itself. If a bone is overused and stressed, tiny breaks in the bone occur at the point of remodeling, which do not heal themselves properly. This is called a stress fracture. The earlier symptoms are pain and swelling in the region of the stress fracture and this fracture may not be seen on initial routine X-rays. The bones of the lower leg and foot are particularly prone to stress fractures and a bone scan or MRI may be required to make the diagnosis.
The injury is best treated by rest, activity modification and may require more significant intervention such as cast immobilisation or eventually surgery.
Stress injuries can be the result of poor muscle balance, lack of flexibility, or because of weakness in soft tissues caused by previous injury. Injuries to muscle, bone, ligaments and tendons may require a prolonged amount of time to heal in spite of appropriate care. It is important to be patient with exercises and to consult a doctor and physiotherapist for ongoing treatment and a return to your prior activities. An exercise programme is usually required to restore function in a graduated fashion. This usually includes a thorough stretch before and after the exercise workout and stopping prior to fatiguing. As an athlete, you should pay close attention to your body’s warning signs and stop exercising before an injury happens.