Sports Injuries

Gordon Hoare has put the following information together and is happy for people to contact him directly for help or advice.
Gordon Hoare 5th Dan
Tel: 01403-253782

Different sports have different classic injuries and problems, some of which are listed below.

  • Football – Ankle, Knee, Groin
  • Rugby – Neck, Shoulder, Knee
  • Tennis – Shoulder, Groin
  • Golf – Elbow, Lower Back
  • Judo – Neck, Shoulder
  • Karate – Split Ends, Chipped Nail Varnish!

Contrary to popular belief karate does not appear to be a dangerous sport as it is closely controlled and supervised and in British Wadokai we adopt the latest safe systems of exercise and training. Karate also does not use a limited part of the body or bias one side of the body but promotes good all round all over body fitness and co-ordination.

This column is not intended as a diagnosis / help line but my own thoughts on the human body, its wonder, how we take it for granted, abuse it, how we can help it and some of the problems people have come to me with and what we have done to resolve them. We all get twinges and aches from time to time but if you have a significant problem that is causing you concern get expert competent advice AND FOLLOW IT.

Introduction

The human body is a very complex collection of millions of cells all interlinked to make up the most amazing mechanism which can sense energy in the form of light, heat, movement and sound. It can detect by touch and react by movement and noise. It can adapt to its environment and learn. It can perform the most incredible tasks and is required to function non-stop for year after year. Unlike our precious cars we usually do not look after it. I like to compare our body to a car. The car has evolved over one hundred years, adapted to new technology and demands and we demand ever more of it. We get our car regularly serviced and if we detect a fault developing we get it checked at the garage. Our bodies have also evolved but not over 100 years but over millions, changing slowly through generations to adapt to changing environments and demands. Unfortunately, now the environment is changing so rapidly and the demands we place on our bodies are so great that our bodies cannot evolve changes to suit.

There are those that suggest we have not adapted well from walking on all fours to being upright even though this occurred over a long time span. So is it any wonder that we are having problems in today’s world with all these changes, the modern diet, exposure to the vast array of chemicals around us and the way we now live our lives.

Self Help

Even though the body is such a complex mechanism it is remarkably reliable. Sadly some people are born with faults in their body which give them a life of struggle, but most of us are blessed with a body that is in good order and functions well. If we respected our body we would normally look forward to a long and active life. Unfortunately, we tend to like harmful things like tobacco, alcohol, sweets, and junk food, all of which in excess have been shown to increase the risk of health problems. The same applies to the way we use our bodies. It is generally recognised that no exercise is bad for you and sensible regular balanced exercise is beneficial both in maintaining healthy joints and limbs but more importantly in keeping the heart in good shape. My own feeling is that the other extreme of excessive exercise is also bad for you. If you train for a marathon you are recommended to have days off to allow the body to recover otherwise you start to develop problems and increase the risk of injury. I have also read of athletes who have trained excessively from a young age and by the time they get to middle age they have major physical problems. I know of a fitness instructor who was a super fit ballet dancer and taught aerobics constantly and has now had to give it up because his joints are painful and he is forever suffering from muscle damage.

Using the car analogy again I believe our bodies are like cars and have an expected life span which we can shorten by abuse and neglect or we can preserve or even extend with care and regular servicing.

Basic Care

With the car, if it develops a problem, we know that if we ignore it the trouble is unlikely to go away and the car may let us down at the wrong moment. What do we do? We take our car to a specialist at a garage, we are asked what is wrong and then the mechanic keeps swapping and fitting new bits until the problem disappears and we are happy to pay hundreds of pounds to be back on the road.
If our body develops a problem we often ignore it and expect it to get better or the problem to just disappear. Amazingly because the body has an incredible ability to self diagnose and self heal it often does get better without help but occasionally very reluctantly we have to resort to seeking specialist assistance and if we have to pay for this, even if it is much less than a garage bill, we resent spending the money.

The most common sign that all is not well is pain. This is the body’s warning signal that there is a problem and its own defence mechanism to get us to stop doing the action that has created the problem or causes the pain.

Unfortunately, the body has also evolved a brain and this says “ignore the pain, it will go away”, or “I am in a match tomorrow and I am far too important to the team to stop so I will play and then think about it”, or “if I carry on through the pain, it will go away”. Often it does go away because the body assumes that as you have ignored its warning it must be a life threatening fight and flight situation and generates body chemicals to mask the symptoms and allow further action. It is only when you stop that you find out the cost of ignoring the warning, usually with even greater pain.

One very extreme case may illustrate this. A client was playing in the last match of the season when he got a twinge in his hip. As the game was vital and he so important to it, he carried on until his body failed. The complete muscle detached from the bone. He was carried off, had to have major surgery to repair the damage and has since suffered great pain in the scar damaged tissue, and of course it has restricted what he can do now. Fortunately this sort of reaction is rare but serves to illustrate the risk of ignoring the warning signs.

Identifying the Problem

Again using the car analogy if it develops a problem we take it to a garage where we are asked what is wrong to try to identify the problem.

Unfortunately, unlike the car we cannot just keep swapping parts until we find the cause of the problem and replace the faulty component, we have to work with what we have and try to help it heal.

Analysis

When we get help we will be asked “What did you do just before the problem developed?” “What is your job?” “What exercise do you take?” “What movement causes the problem?” and so on. This is not just to try and build a picture of how the problem has developed and pin point what may be wrong to try and suggest a treatment to relieve the symptoms but also to recognise how the problem was caused and what changes can be made to our lives to prevent a reoccurrence, as it is no good treating the symptoms if you do not find the cause of the problem.

Once the problem has been identified a discussion is had with the client to suggest a course of action to relieve the symptoms and to prevent the problem recurring.

In my field this often involves the use of infrared, ultrasound, soft tissue manipulation and with suggested exercises and stretches and most importantly a recommendation not to train for two or three weeks to allow the damage to heal. The client will leave hopefully with the problem more or less eased, probably due to the exercises / stretches the first night even possibly the next morning but then is too busy and anyway they have to be down the Dojo / gym or on the field as they are adrenaline junkies and must have the exercise and anyway the pain will go once they start training!!! (What? Me cynical???) Then they return next week saying it was OK for two or three days but has returned and they need another treatment. Great more business!!!!

Types of Injury

  • Chronic or Traumatic
  • Chronic conditions usually start off as something minor such as a twinge but gradually build up and then become a persistent problem.
  • Traumatic conditions occur very suddenly such as twisting the ankle and causing a sprain.

Sprain or Strain?

  • Sprain is injury to a ligament.
  • Strain is injury to a tendon or a muscle.

Both these conditions are typically caused by over stretching of the relevant part. Ligaments support and stabilise joints while still allowing movement but are not very elastic so if stretched by overloading often by outside force the fibrous tissue can tear. If the tear is partial it can heal with care, but it does so slowly and if the ligament heals longer than it was it may cause instability of the joint. A total rupture may require surgical repair. Tendon or muscle fibre is more elastic than ligament fibre but can be torn by over exertion such as a sudden sprint or over extended leg or arm techniques often when warm ups have been missed or cut short. Again a partial tear should heal satisfactorily but care is required to avoid the build up of scar tissue, which could restrict muscle function. Again total rupture will probably require surgical intervention.

Most sports require performers to do full warm ups to avoid or limit the risk of injury. The classic footballers warm up where they run on to the field, do a strange sprint on the spot for two to three seconds, do a bouncing stretch on each leg and then are ready for the game is a receipt for disaster, but good for business..

It is generally believed that the warm up allows the heart to get adjusted to the duty expected of it, opens up the blood vessels to allow the passage of more blood loaded with oxygen and nutrients to feed the working muscle tissue and encourages changes in the joint capsule and the synovial fluid within it to protect the joint during the forthcoming period of stress.

Fitness

Fitness for training or training for fitness?

I was one of many people that took up karate to get fit, but have realised that you need to be fit to do karate. In our club our warm ups are different each week and vary from joint flexibility right through to full stamina work and are also tailored to suit the type of training to be undertaking. Some clubs expect the student to warm up beforehand so that directly the class starts you can get down to karate training. Whilst this would be ideal I feel that I like to know that the students have warmed up properly and anyway the juniors especially have no idea of what constitutes effective exercises and stretches so I feel it is essential that we give them that guidance.

Injury Treatment

Instructors are usually trained in basic first aid and in our club virtually all the senior students have been on the course. The basic things taught on the course are, do not move a seriously injured casualty, how to ring 999, CPR, control of bleeding and protecting yourself from infection whilst treating the casualty. I am not going to cover how to deal with major traumas as you will have rung 999 and hopefully they have responded. In the Dojo we hope you will have, at worst, minor knocks scrapes, blisters and possibly the odd strain.

The basic thing taught in first aid will cover these and are, of course, with a minor open wound clean it and cover it to prevent infection, with a sprain it is the classic RICE.

  • REST, sit down and take the load off of the injury
  • ICE, ice wrapped in a cloth applied to the injury may reduce the swelling and relieve the pain
  • COMPRESSION, carefully applied compression (elastic bandage) may reduce the swelling and provide support.
  • ELEVATION, elevating the injury will lower the body fluid pressure at the site and help reduce swelling.

After the initial application of appropriate first aid the student may then begin to think of the follow up treatment. Most soft tissue injuries are relieved by the RICE treatment and it is not appropriate to carry out further treatment in the first 24 hours. After 48 hours other treatments may be beneficial.

Follow Up Treatment

The following are some typical problems and the treatments that were agreed between therapist and client. It is important that it is realised that this is not a self-help column and that whilst symptoms may be similar to yours the treatment may not be appropriate to you as your circumstances may be different. It is essential that if you have a problem you see a competent expert in that field, (not a mate down the pub that says, “I had that, drunk ten pints, tripped over the pub door step, broke my arm and never noticed it again!).

The areas to be covered

    • Ankle
    • Calf
    • Knee
    • Quad
    • Ham
    • Hip
    • Low Back
    • Abdominal's
    • Shoulders
    • Neck
    • Elbow
    • Wrist

If anyone has suggestions for other areas (have already had one for "shin splints") I will do my best.