|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
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'
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
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
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.