Sports Injuries: A guide to Recovery

When you have sustained an injury, it can be a daunting time. You may be wondering what you have done and how you can best manage it to get back on your feet as quickly as possible and return to normal function. This is where Physiotherapy can help you.

We are qualified and highly experienced at the assessment of any musculoskeletal condition, the management for and the expertise to get you back to the highest level of function in a timely fashion.

During any acute injury, at the level of your tissues, there will be a level of disruption. Some of the tissues in the area, whether ligaments, tendons or muscles may have sustained a degree of tearing or compression. As a result, we experience pain and swelling local to the area of concern.

The best management for your acute injury at this stage is to cease participation immediately and to follow the following steps:

  1. Apply ice to the area. This may take form of an ice pack, a bag full of ice and water or melting an ice cube directly over the skin (but not over a wound). Apply the ice until the area feels very cold, but not painful;
  2. Apply some form of compression. If you have sustained an injury to your foot, it may be best to leave your shoe on to support the foot and to minimise the swelling. If you have a leg injury, then donning a pair of compression tights will assist you in relation to swelling;
  3. Keep the area elevated. If you have an injury to the hand, wrist, ankle or knee, elevating the limb above the level of the heart will help to reduce the swelling and fluid around the injured area; 1
  4. Avoid applying heat to the area. This will promote bleeding to the area, which in turn will increase the swelling and pain of the injury;
  5. Avoid running or excessive movement to the area. This will increase the blood flow to the area and increase the bleeding, pain and swelling;
  6. Do not consume alcohol. This will expand the blood vessels and lead to increased bleeding, that will slow down the injury process

It is important to follow these steps as soon as you have sustained your injury. The sooner you act, the higher the chance of enabling your body to move on to the next stage of healing. If you have great concerns about your injury, it is integral that you liaise with your Physiotherapist or Doctor as soon as possible.  If you require the fitting of crutches or a sling, general guidance and/or reassurance, it is crucial to make that phone call straight away.

If you have a deep skin tear, a gross deformity at the area of the injury, excessive and uncontrolled pain, it is critical to seek the medical attention at the Emergency Department of your nearest hospital.  You will be able to receive adequate pain relief, attention to any wounds and imaging, if required.

Once you have survived of the first 24 to 48 hours, it is important to meeting with your Physiotherapist. They will be able to assess you, determine the type and severity of the injury and devise an appropriate rehabilitation plan.

From this point, your Physiotherapist will seek to minimise the pain, swelling and inflammation of the area and commence work to restore normal movement. These factors will involve a combination of many treatment modalities including hands on treatment, taking you through certain movements and exercises, taping techniques or bandaging, fitting of a brace or walking aides, etc. You will also receive a program that you will be advised how often to partake in, to actively assist in the recovery process.

Any soft tissue injury can take a minimum (with minimal tissue disruption) of three weeks to recover and upwards of six weeks.  This will typically be the case if you have a very complex injury, or it involves structures that have a poor blood supply or under a great load in the body (such as the intra-vertebral discs or a nerve) 3. It is important to be aware of things that you can do to reduce the risk of delays or setbacks. During each of your consultations, your Physiotherapist will continue to progress your program, to put gradually increasing stress on the scar tissue that is healing, to help lengthen it and strengthen it.

When your body is ready, you will be given progressive exercises to help strengthen the area and the surrounding structures, to ensure your body is not compensating for the original injury. These compensatory strategies are an easy habit in which to fall, and can be very difficult to break.  Your body may have other mechanisms that require attention during your rehabilitation, such as your balance, or components of your balance.  You should be regularly taken through mini-assessments of each component that has been affected by the injury, to ensure there is reasonable progress and an adjustment of your exercises and home program to match accordingly.

During the recovery progress, your Physiotherapist will continually liaise with you, as to your goals for returning to particular levels of function, aspirations with your sporting, social and working environments.  They will also make recommendations for the steps you can take to reduce the chance of injuring yourself again.

If you would like more information, or have a question about your recovery, be sure to speak with your treating Physiotherapist today.

Written By Sophie Halsall-McLennan, Fresh Start Physiotherapy

  1. Website: https://www.ausport.gov.au/__data/assets/pdf_file/0005/380426/SP_32434_Incident_Management.pdf
  2. website: sma.org.au/resources-advice/injury-fact-sheets/soft-tissue-injuries
  3. website: highered.mheducation.com/sites/dl/free/0078022649/…/Prentice15e_Chap10.pdf

 

About The Author

Sophie Halsall-McLennan is the owner of Fresh Start Physiotherapy and has a special interest in Hand Therapy and Shoulder Rehabilitation.  She has a Bachelor of Physiotherapy from Charles Sturt University, over 13 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a lecturer at Deakin University.

What is Femoroacetabular Impingement (FAI)?

Hip impingement, also known as femoroacetabular impingement (FAI), is a condition where there is abnormal contact between the femur bone (femoral head) and the socket of the hip joint (acetabulum) during certain movements of the hip.

The resulting impact can lead to damage of the cartilage inside the hip joint. This may in turn lead to premature arthritis.

FAI is traditionally described as due to either an abnormality of the shape of the ball of the femur (CAM deformity) or of the acetabular socket (PINCER deformity). Movement of the hip joint is complex, and more recent research has demonstrated that the overall 3-dimensional shape and orientation of the hip should be considered to properly evaluate and treat clinical impingement.

Symptoms:

Patients with FAI often experience pain in the groin with deep flexion (bending) or rotation of the hip during certain activities. There may also be inflammation of the tissues surrounding the hip such as on the outer side of the hip (trochanteric bursitis), the groin muscles (adductor tendonitis) or inflammation of tendons in front of the hip, especially if the condition has been around for some time. Eventually, as the damage continues, the patient may begin to develop more arthritic symptoms such as a stiffness and a dull ache in the groin. Hip-related pain is not always felt directly over the groin. It may also be felt on the outer aspect of the thigh, the buttock or traveling down the leg.

Investigations:

Patients who have symptoms suggestive of hip impingement are usually investigated with x-rays of the hip first. Further investigations could include a CT scan and special MRI scan. The CT scan is performed to study the bony detail of the hip and the MRI is used to assess the cartilage, labrum and other soft tissue structures in and around the hip.

Treatment:

Non-surgical Treatment for FAI:

Treatment of femoroacetabular impingement symptoms often begins with conservative, non-surgical methods. Physiotherapy treatment may involve soft tissue work to relieve tight muscles around the hip, however the majority of treatment is rehabilitative based, to try strengthen the deep hip stabilizing muscles. The aim is to improve the stability and function of the hip. At Port Melbourne Physiotherapy & Pilates we commonly treat patients with hip/groin pain with a structured Pilates program aimed at strengthening the hip and pelvic muscles.
Rest, activity modifications and selective use of non-steroidal anti-inflammatory medication are often helpful in alleviating early symptoms. An injection of the hip joint with anaesthetic can provide some relief as well as diagnostic information in patients with symptoms which are unresponsive to treatment.

Surgical Treatment for FAI:

For patients not responding to conservative management, Femoroacetabular Impingement (FAI) can be addressed with surgery to improve the shape of the hip.
The aim is to correct the bony deformity before there is irreversible joint damage. In many cases this can be done by hip arthroscopy (keyhole surgery).

If you’d like further information on FAI or if you feel your symptoms match the description above, speak to your physio about what treatment options are available for you and whether further investigations are required.

This post was written by Sheree Freedman – Physiotherapist/ Director at Port Melbourne Physiotherapy & Pilates

Common Knee Injuries and How To Treat Them

In this post we will focus on knee injuries, and what treatment may be required to get back to living your barefoot lifestyle!

Common knee injuries can occur through daily movements and activities, whether it be a car ride, sport or landing differently on your knee. Three common knee injuries we will look at are ACL, PCL and Meniscus tear which cause discomfort and potential long term effects if not treated properly.

Common Injuries

Meniscus tear: Damage to the meniscus, can be caused by awkward pivoting on the knee, direct blow to the knee or in some cases repeated squatting with poor technique. Symptoms include pain in certain ranges of movement, a feeling of something ‘catching’ or ‘locking’ in the knee

Medial collateral or lateral collateral ligament tear: Damage to these ligaments typically occur from changing direction. This can be when the foot stays planted or a direct blow to the inside (LCL) or outside (MCL) of the knee. Symptoms include localised pain, swelling and feeling of instability.

ACL tear: Depending on the severity of the injury, the ACL could be strained, partially torn or completely ruptured. Damage to the ACL is often caused by pivoting/change of direction when the foot remains planted (most common). Damage can also be caused by hyperextension (eg knee being pushed past straight) which can occur when the foot remains planted, and the body pushed sideways (eg in a contact sport).

Symptoms include an audible popping noise at time of injury, significant pain and swelling immediately or a feeling of instability. Due to the mechanisms of injury, it is not uncommon for an ACL tear to occur with meniscus damage and medical collateral ligament damage (known as the “unhappy triad”).

PCL tear: PCL tears are much less common than ACL ruptures, as they are stronger and larger ligaments. A PCL tear can occur from direct force to the shin, while the knee is flexed (such as knee hitting the dashboard in a car accident). This is the most common cause of PCL injury. Another common PCL tear can occur from falling onto a bent a knee, with hyper extension causing damage to the PCL.

Symptoms are often similar but far  less severe than an ACL tear.

Treatment
If you have suffered an acute knee injury, or are feeling pain and discomfort in your knee/s then the following can help to reduce pain and inflamation,

Settle inflammation down:
Relative rest (don’t do anything painful, but don’t do nothing- aim to gently keep your knee moving); ice for 20 minutes every few hours; no alcohol; discuss anti-inflammatory medication options with your doctor or pharmacist

  • Consult your doctor or physio to determine if imaging is necessary. There are clinical tests that can help determine if any of these structures are damaged. Your physio or doctor should talk you through each test and your results. If there is any concern, an MRI (magnetic resonance image) will often be recommended for more certainty
  • If damage is detected on imaging, then your doctor will likely refer you to an orthopaedic surgeon (specialist doctor) to determine the best management for your injury (ie surgery or physio)
    Whether your injury requires surgery or not, we suggest popping in to see one of our physio’s to get you back to doing what you love, sooner!

This article was originally posted on barefootphysiotherapy.com.au. It has been re-published with the permission of the author.

Not All Hamstring Strains Are Equal

Hamstring Strains Are Most Frequently A Sprinting Injury

The winter sports season is upon us, meaning physiotherapists all around Melbourne will be dealing with athletes having suffered hamstring strains. AFL and soccer are sports with notoriously high numbers of hamstring strains the majority of which occur during high speed running.

70% of hamstring injuries in elite football players occur during high-speed running (sprinting) and the rest with stretching, sliding, twisting, turning, passing, jumping and overuse.

Predictors Of Poor Recovery With Hamstring Strains

Poor prognostic predictors regarding hamstring strains and athletes returning to play following hamstring injury (referring to hamstring injuries that are likely to take longer than average to recover) include:

  • Suffering a stretching type injury such as reaching for a ball with an outstretched leg or bending to pick up a ball whilst on the move are injuries that have on average 84% longer return to play times than contraction injuries (contraction injuries referring to hamstring strains occurring during regular sprinting motions).
  • The area where the peak point of pain is to touch on the back of the thigh. The closer to your sit bones (the ischial tuberosity) the peak pain point is felt the longer the recover times.
  • Location of swelling. Similar to the location of peak pain, the closer any swelling present is to the ischial tuberosity the poorer the prognosis.
  • Most weekend warriors will not require an MRI for an acute hamstring strain but another predictor of poor prognosis found was the length of swelling upon MRI. The longer the area of swelling visualized on imaging likely indicates a longer return to play time frame.
  • These findings although relating to the professional footballer (soccer player) can arguably be applied to the weekend warrior. Notably the professional athlete may have both more resources and motivation to aid their return to play but these can be considered useful guidelines for the armature sportsman to help with estimating a safe return to play.

Return To Play In 23 Days

45% of athletes return to play in 23 days following sustaining a hamstring strain. Individuals variations will always exist and many variables come in to play such as pre injury status, adherence to any physiotherapy guided protocols… But it is nice to have a bench mark to aim for and the realization that with the majority of hamstring strains the sportsperson is likely to miss 2-3 matches based on having weekly games.

It is easy to see improving recovery times by just a few days could be the difference between missing only two matches verses three or more. In a short season every game missed through injury is significant so adherence to physiotherapy advice and protocols can help you play more matches during the season which is what being a weekend warrior is all about, getting out there and having a run.

Loading Over Stretching With Hamstring Strains

With hamstring strains rehabilitation programs based on exercises primarily involving high loads at long muscle-tendon lengths were found by Askling CM, et al to be the most effective at reducing the time to return to play.

The idea is that rehabilitation in a controlled graduated fashion should attempt to mirror the particular situation that lead to the injury. Where rehabilitation of acute hamstring injuries should build on attaining eccentric loading at long muscle lengths (the phase of contraction that occurs as the muscle lengthens is considered an eccentric contraction).

Eccentric loading and loading muscles towards their end of range can put strain on healthy tissue let alone muscle tissue recovering from injury so guidance with such rehabilitation techniques is crucial for successful outcomes.

Professionally Guided Management Makes The Difference

If you have sustained a hamstring strain having a physiotherapist assess your injury to help gauge a working return to play time frame and set up a rehabilitation protocol. Can help you return to play quicker and reduce the likelihood of any recurrence.

Reference: 2013 Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Askling CM, et al Br J Sports Med 2013.

Written by Hayden Latimer. Hayden’s practice is based in Sydney, he is the owner of Sydney Physio Clinic. Prior to opening https://www.sydneyphysioclinic.com.au/ Hayden has worked as a physiotherapist around the world for over 15 years.

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Sophie Halsall-McLennan is a mother of two, has a passion for rowing, skiing, classical ballet and spending time with her family.

Staying continually up-to-date with the latest evidence-based practice, including treatments and rehabilitation programs keeps Sophie at the forefront of Physiotherapy. With these skills and knowledge, she can equip her clients with the best available information and treatment.

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