SPORTS INJURIES in foot-ball players

Dr.A.K.Venkatachalam MS, DNB, FRCS, MCh.Ortho

Consultant Orthopaedic surgeonKnee & Shoulder clinic, Besant nagar,

Malar Hospital, Venkataeswara hospital,www.kneeindia.com, & www.shoulderindia.com

What Are Sports Injuries?• Injuries that occur during

sports or exercise

• The field is a vast one

What are the causes?

a) Accidents b) Improper trainingc) Improper equipmentd) Lack of conditioninge) Insufficient warm up

& stretching

Areas of body injured in sports

Organs and tissues involved• Injuries that involve the

musculo skeletal system like the bones, muscles, tendons, cartilages.

• Injury to the spinal cord & brain are rare.

• Cardiac arrest has occurred on the field recently in the Dempo footballer/

Common type of sports injuries

Muscle sprains and strains Tears of the ligaments that hold joints

together Tears of the tendons that support joints and

allow them to move Dislocated joints Fractured bones, including vertebrae

Outcome after Sports injuries

• Many sports injuries can be prevented if proper precautions are taken.

• They can be treated effectively as sports persons are predominantly young.

• Most people who suffer injuries can return to a satisfying level of physical activity after an injury if treated properly.

First aid after any sports injury- RICE - Traditional method

• Protection- bracing or taping the area.

• Rest• Ice never directly, but in a

thin towel • Compression or Crepe

bandage• Elevation• R-( Referral) Later the

player should be referred to an Orthopaedic surgeon for treatment

MEAT method is better• Movement• Exercise• Analgesics medication

NOT Brufen but Enzymes like Papaya ( Chymoral)

• Treatment is the best way to heal torn ligaments and tendons.( Surgical / rehabilitation / brace)

1. Screening

Warm up cool down & Stretch

Physical conditioning

Technique

Fair play

Protective equipmentHydration & Nutrition

Injury reporting

Injury management

screening

Job of the team physician to declare fitness of players

Prevention of sports injuries

Stretch & Warm up before sports

Warm up & Stretch

• Minimum warm up for 15 minutes before any sport

• Appropriate cool down at the end of the game.

• Do a light jog around the field until perspiration just starts before the sport

• Stretching exercises for whole body. Pay special attention to body areas that will twist & move suddenly

Stretching

• Hold the stretch for 20 seconds, relax and repeat

• Stretch frequently- daily if you want flexibility

• It will take 6 – 8 weeks to improve flexibility

Back stretch

Calf muscle stretch

TFL stretch

Rectus stretch

Hamstring stretch

Gastro stretchSoleus stretch

Conditioning

Physical exam before any game Year round conditioningPre- season training to start 6 – 8 weeks before sports seasonConditioning- aerobic exercises, sports specific exercises, skills for sport

Develop muscular strength

Strength training

• General strength• Sport specific training• Twice a weekKeep large core muscles in goodcondition (abdomen,spine, trunk)

Sports injuries by region and joint

Shoulder injuries

Games in which Shoulder injuries occur

• Cricket• Volley ball• Swimming• Tennis• Badminton• Baseball • Javelin throw

Main problems

• Rotator cuff tears• Labral tears• Instability• Fractures and dislocations• Internal impingement• Overuse injuries

Shoulder has great range of mobility

• Price of mobility is instability

Rotator cuff tear

Repeated acts of throwing can lead to shoulder problems

Shoulder dislocations types

• Anterior ( most common) occurs after trauma

• Posterior• Multi directional (atraumatic)

Shoulder dislocation

Multi directional instability

Fall on the elbow

• Possible injuries• Shoulder dislocation,• Dislocation of acromio

clavicular joint• Fractured clavicle• Brachial plexus injury

Treatment of shoulder dislocations

• Initial treatment- Reduction

• Immobilization in external rotation as shown here

• Surgery is the best option for recurrent dislocations- open or arthroscopic stabilization

Advantages of shoulder arthroscopy

• Outpatient treatment of various conditions possible

• Small incisions• Less pain• Faster rehabilitation• Faster return to work• Return of full range of movement important

for some sports like fast bowlers, Volley ball

Knee injuries

• The bones of the knee can be damaged in sports or accidents, but the soft tissues are damaged more commonly.

• Knee Anatomy from front

Anatomy of the Knee from the back

Commonly injured structures of the knee in football

• Menisci or semi-lunar cartilages ( natural shock absorbers) inner or outer

• Anterior cruciate ligament( ACL)

• Medial collateral ligament ( MCL)

• Articular cartilage.

Ligaments • Bind one bone to

another• Made of “ Collagen”

connective tissue• Get blood supply from

site of attachment to bone.

• Inside ligaments of knee cannot heal after a tear.

Ligaments of the knee

• ACL- Anterior cruciate ligament

• PCL-Posterior cruciate ligament

• Medial collateral ligament

• Lateral collateral ligament

ACL( anterior cruciate ligament)

• ACL- Anterior cruciate ligament

Function of the normal ACL

- Prevents sliding to the front of the leg bone( tibia) off the end of the thigh bone.

Intact ACL prevents forward sliding

Ruptured ACL allows the leg bone to slide forward

Mechanism of Anterior cruciate ligament (ACL) injury

• Non contact type- 70% common in Foot ball, basket ball, rugby, volleyball

• Contact type- 30 %.

Mechanism of ligament injuries-1

Non- contact ACL injury occurs 70 % of the time

• Common in Foot ball, rugby, basket- ball and volley- ball.

• Leg is straight--- Quadriceps is fully contracted. This increases the force applied to the ACL. Foot is fixed to the ground. Player changes direction, decelerates, or lands off balance. This pinches the ACL against the inter-condylar notch, tearing the ACL.

Non contact ACL INJURY- MECHANISM- TWISTING OF BONES IN OPPOSITE

DIRECTIONS

Mechanism of ligament injuries-2Contact type ACL injury 30 %

• Blow to the outside of the knee causing inner collapse. Rarely blows from the front or the inside can also rupture the ACL.

• ACL is the commonest injured ligament and is most important for knee stability.

Torn and absent ACL

Arthroscopic view of knee

Symptoms of an ACL injury

• “Popping” sound heard or felt in the knee at the time of rupture by the patient.

• Knee swells up due to rapid accumulation of blood.

• Player will be unable to continue the game • Knee will feel unstable. • Swelling may take up-to three or four

weeks to settle down.

Treatment of ACL injuries• Not possible to suture the torn ACL (anterior

cruciate ligament)• If you want to give up sports and place low

demand on your knee then you do not need surgery.

• Treatment will then consist of crutches, a “Knee brace”, and physical therapy for rehabilitation.

• If you plan to have an active life style, then you need surgery.

• Surgery is called “ACL Reconstruction”

A

C

L

RECONSTRUCTION

How can you prevent an ACL injury

• Complete protection is impossible.• Strengthening and conditioning programs

are your best ally.• In female athletes some training of

hamstring muscles and modification of landing technique is useful.

Cartilage injuries of knee Two types of cartilage

inside the kneeA) Meniscal cartilages Which are “C” shaped

shock absorbers between the thigh and leg bones.

B) Articular cartilage- which forms the lining of bones. Allows smooth friction less motion of joints.

Meniscal injuries (tears)

• Occur when they are trapped between the bones for e.g.: in a tackle when a defender attacks from the back with the knee bent . Knee rotates but the foot stays fixed to the ground.

• The inner( medial) meniscus is torn more often as it is fixed.

Meniscal tears cont’d

Symptoms- Initially well localized pain and swelling within the knee. Pain is on the inside or outside of the knee.

Later “locking” or “catching” can occur.Excess fluid forms within the joint which

remains slightly bent.

Torn meniscus-

• A movable fragment results from a tear which can get trapped between the bones and may need surgical treatment.

• Surgical treatment- possible to suture the torn meniscus if seen early and the tear is located within a suitable portion of the meniscus.

• Removal if otherwise. Partial removal is better than complete removal.

Articular cartilage• Bluish smooth elastic

tissue at the ends of the long bones.

• Acts as a natural shock absorber

• Allows frictionless movement of the joint

• Loss of cartilage leads to osteo-arthritis

Articular cartilage injuries

Articular cartilage injury

• At first it is localized. • Cannot heal on its own. • Occur along with ACL injury or Meniscal

injury.• Can lead & progress to arthritis later.• If seen at the time of ACL surgery, better to

treat these also in a young active patient.

Outcome after knee injuries

• Injury to the structures usually occurs in combination rather than isolated injuries in sports.

• Not sufficient to deal with injury to one tissue in isolation and ignore the other structures.

• Untreated combined injuries of ACL & menisci can lead to early osteoarthritis.

Surgical treatment is a good and safe option to postpone arthritis

in the injured kneeMinimally invasive arthroscopic

surgery deals with all components of the injury through key hole incisions

Knee arthroscopic surgery (Key hole surgery)

Ankle injuries• Sprain occurs to the outer ligament of the ankle.• Ankle sprain are the most frequent injury in sports.• Mechanism- Rolling of the foot inwards so that the

ligament on the outer side of the ankle is stretched.• Individuals with a previous history of ankle sprain are

more likely to develop an ankle sprain again.• Ankle fractures- more common in skating, skiing, Rugby,

Foot-ball• Open reduction and internal fixation is required to get a

good result.

Ankle sprains

Treatment

• Rest • Ice • Compression• Elevation

1. Screening

Warm up cool down & Stretch

Physical conditioning

Technique

Fair play

Protective equipmentHydration & Nutrition

Injury reporting

Injury management

Cricket

• Common injuries are bruising, fractures and sprain

• Bowlers are prone to overuse injuries of the back and shoulders.

• Blow to the face, fingers or hand during fielding is the most common injury and results in fractures and bruising.

• Adult cricketers sustain upper limb injuries while children sustain injuries to head and face.

Injuries in fielders• Hamstring strains occur when stooping suddenly

to field a ball at the beginning and end of the day.

• Being struck by a hard ball at close in positions on muscles can cause muscular damage.

• A fall on the shoulder while catching or saving a boundary can predispose to injuries of the shoulder.

• Acromio-clavicular dislocation refers to the separation of the clavicle and an undue prominence of the collar bone.

Problems in batsmen

• Those who play long innings can develop tightness of the anterior spinal muscles.

• Risk of injury to the body parts while facing fast bowlers is mitigated by wearing protective gear.

• Use of heavy bats can lead to Tennis elbow.

The fast bowler

• TV replays show stresses on the feet and ankles as he releases the ball.

• Stresses dissipated absorbed in Follow through action.

• Stress imposed on the spine can lead to stress fractures and a type of instability due to discontinuity of the arch of a vertebra.

Shoulder injuries in fast bowlers

• Older bowlers can develop partial or complete tears in the rotator cuff.

• Constant throwing like action in bowling also predisposes to “Internal impingement” which is a rubbing of the rotator cuff under the glenoid labrum.

The spinner

• Overuse injuries of the wrists, fingers, elbow and shoulder may present as arthritic type aches and pains at the end of the season.

SPORTS INJURIES in foot-ball players

Dr.A.K.Venkatachalam MS, DNB, FRCS, MCh.Ortho

Consultant Orthopaedic surgeonKnee & Shoulder clinic, Besant nagar,

Malar Hospital, Venkataeswara hospital,www.kneeindia.com, & www.shoulderindia.com

Wicket keeper’s woes

• Stooping constantly can lead to stretched ligaments

Prevention of cricket injuries

• Preparation- Pre participation screening• Warm up and stretching before the day’s

play• Training before the season

Good techniques Safety tips for cricket

• Good preparation• Physical Training before the season.• Warm up and stretching before the game• Fast bowlers should have screening

before selection.• Good techniques- restrict the number of

overs of fast bowlers in each session.• Avoid dehydration by drinking fluids.

Safety equipment• Gloves, padding, leg guards, guards, helmets, elbow and

forearm guard, chest guard are all essential when facing fast bowling.

• Close in fielders should have leg guards, helmets and guards.

• Protective gear must be worn during practice as well as during a game.

• Seek professional help for appropriate cricket shoes.• Other tips- Wear broad spectrum hat, sunglasses, sun

screen when appropriate.• When injury occurs, all cricketers should receive

appropriate treatment and rehabilitation before return to the game.

1. Screening

Warm up cool down & Stretch

Physical conditioning

Technique

Fair play

Protective equipmentHydration & Nutrition

Injury reporting

Injury management

Foot ball injuriesPeculiar features of Foot

ball- • Stop -start nature of the

game• Unpredictability of what

other players may do while tackling

• Sudden deceleration and change in direction to get past a defender

• High loads imposed on the knee joint & twisting movements can occur at the knee joint.

Meniscal and ACL Injuries are most common

• ACL reconstruction must for return to active football or any other contact sport.

• Meniscal surgery- suture or transplant when totally damaged.

Prevention of football injuries

• Pre season training-6 – 8 weeks before season.• Warm up, stretching, cool down after the game.• Good foot wear with spikes.• To totally avoid ligament injuries is not possible-

muscular conditioning and training can help.• Female footballers can strengthen hamstrings

and modify landing techniques.• Avoid rough play

Badminton injuries

• Uncommon• Mainly injuries to the Tendo achilles,

quadriseps tendon and are of over use type.

1. Screening

Warm up cool down & Stretch

Physical conditioning

Technique

Fair play

Protective equipmentHydration & Nutrition

Injury reporting

Injury management

Volley ball and Tennis

• Internal impingement – friction between the structures when the arm is taken backwards to strike the ball or throw.

• Prevention- strengthen the scapular muscles and rotators of the shoulder

Enjoy your game & stay fit for life

Dr.A.K.Venkatachalamwww.kneeindia.com

www.shoulderindia.com