Sports Injuries
Whether you’re a runner, play sport or just train in the gym, it’s not uncommon to get an injury from time to time. Injuries come in many forms: a pulled muscle, sprained ligament, rolled ankle, or tendon issues such as tendonitis. I see them quite regularly in those patients who enjoy an active lifestyle. I’ve experienced this myself, having come back from numerous shoulder, neck and upper back problems that at one point left me unable to do a single push-up. I know what it’s like to have an injury and experience the frustrations they can cause. Most injuries can be managed and rehabbed so you can get back to doing what you enjoy.
The sports injuries I see the most
Most commonly, people will come to see me with one of the following:
- A pulled or strained muscle – whether it’s a hamstring, calf, groin, low back or shoulder. Sometimes they appear suddenly, other times they may come on over a bit of time.
- A rolled or twisted joint – typically this is the ankle or knee while running, playing a sport or in the gym. They can be sore to put weight on or when putting load through the joint.
- Overuse injuries – these usually appear without any obvious initial cause and can feel like an ache. It might be the kind of pain that eases as you warm up and goes away while working out but then comes back afterwards. The problem is often a tendon, and the most common places I see it are the shoulder, knee, elbow or Achilles.
There are many other types of injuries and these are just a few of what I commonly see.
Why sports injuries happen
The most common reason for an injury is down to load. A tissue or joint has been asked to do more than it was ready for, either all in one go or over a period of time, and the injury is the result.
Sudden injuries, such as pulled muscles or sprained ligaments, are a single abrupt overload that stretches or stresses a muscle, tendon or ligament beyond what it could handle. This can happen in all sorts of ways, such as sprinting, jumping, landing awkwardly, slipping or being tackled. Our body is great at healing and repairing itself. Most strains and sprains will recover well when the right approach is taken to look after them and load them back up appropriately. There are different grades of strain and sprain depending on how bad it is, the worse your grade of injury, the longer it will take to recover.
Overuse injuries happen over a longer period of time without a single starting point. They’re the result of a bit too much volume, weight (in the gym), or not enough rest, meaning the tissues don’t get enough time to adapt. Tendons are the most common tissues that suffer from overuse, and this includes conditions like tendonitis, or tendinopathy. The tendon becomes irritable to this overuse and it then takes a while to calm down and build back its tolerance.
How I assess and treat sports injuries
Assessment
My assessment follows the same full process I use with every patient. When assessing your injury I will:
- Ask about when it started, whether it was sudden or gradual, what you were doing, what makes it worse or better and how it’s limiting your training or sport.
- Assess how your injured joint behaves when you move it, when I move it and some specific tests for the muscles, tendons and ligaments.
- Check for any signs of significant injury that might need a referral for a scan, specialist or just someone better placed to deal with complex injuries.
- Assess how you move more generally across all your joints, since an injury in one area may be influenced by how things are moving further away.
Treatment
Once we’ve determined what type of injury you have, and that it’s one I can help with, we’ll put a treatment plan together usually consisting of:
- Hands-on manual therapy to ease any pain, guarded or protective muscle spasms, improve quality and range of movement and address any compensation patterns your body has adopted that may hinder recovery.
- Advice on the appropriate rehab protocol for your injury type. In the early stages, this might include brief periods of rest to allow things to heal and calm down.
- Specific graded exercises to improve range of motion and rebuild the strength and tolerance in your muscles and joints, and give you the confidence back in your ability to move and play your sport.
I’ll give a lot of practical advice on how to manage the injury. The specific approach will differ if it’s a muscle strain versus a tendon irritation. Since there are many different injury types all with their own recovery timelines, it’s impossible to give an accurate estimate without fully assessing you. I always suggest that if progress isn’t being made within three to six sessions, we’ll either change the plan or consider if someone else is better placed to help, to avoid you coming back when we’re not getting anywhere.
If you’ve got an injury that’s getting in the way of your training or sport, let’s put a plan together to help.
What to expect
While there are some generally accepted timeframes for certain injury types, they will largely depend on the severity and how well they’re rehabbed. A minor muscle strain may settle over a few weeks whereas tendon issues will require more patience and may run into months rather than weeks, as they adapt more slowly than muscle. The more you adhere to the recovery process, including adequately tapering where required and loading back up appropriately, the quicker we can get you back to your sport.
A lot of injuries recur because once the pain subsides, we typically go back to our sport as we were before, without building back the tolerance and load appropriately. I can’t make any concrete promises on how long things will take, given the variable nature of injuries. I’ll be up front with you on the estimated timeline for your injury and the best way to approach the recovery, including the rehab programme, so you know what to expect from the start. I’ll also let you know when it is something that may be best seen by someone else, so I’m not wasting your time and getting in the way of you returning to your sport as quickly as possible.
When I’m the right person, and when I’m not
While I can treat a lot of sports injuries, I’m not always best placed to help with all types and I’d rather be straight with you about that early than drag your recovery along unnecessarily. If you might benefit more from a sports-specific physiotherapist who sees your injury type every day, I’ll suggest that. I’d much prefer you get seen by the right person to help you. Part of my assessment process is also screening for things that might need a scan, or surgical opinion. While this is quite rare, it can happen. I have a network of professionals locally who I trust and can refer you to them when it’s the more appropriate path for you.
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about sports injuries
I start with a thorough assessment to find out what kind of injury you have, how significant it is and then come up with a plan to manage it. My aim is to help you recover and get you back to your sport without re-injury. Practically, this means advice on the rehab process, when to rest or taper activity, manual hands-on techniques to aid recovery, and exercises to build back load, tolerance and strength.
There is far more overlap than difference between a good osteopath and physiotherapist. Both will assess your injury thoroughly, use a mixture of hands-on treatment and take you through a graded exercise programme to build back strength and tolerance so you’re able to get back to your sport with confidence. While I can help with a lot of sports injuries, sometimes a physiotherapist who deals with certain injuries day in, day out, is better placed to help. If that’s the case, I’ll be up front and refer you to them.
In the very early stages (days rather than weeks), rest is fine for an injury. However, simply resting until the pain has gone is not the best way to overcome injury and reduce chances of it recurring. We need to mix initial rest with graded exercises to build back tolerance and strength, so you’re able to withstand your sport or activity without as much re-injury risk.
Some of the sports medicine thinking has moved away from using ice or anti-inflammatories as routine, particularly the use of anti-inflammatories, as they can reduce part of the important inflammatory process that is crucial to tissue healing and repair.1 It’s a debated area and one that probably benefits from nuance rather than dogma. I’ve no problem recommending ice to patients as it can offer good pain relief, for example. As part of my assessment process I’ll discuss what is best for you in the early stages of your injury and what the current evidence suggests.
Most injuries can be diagnosed from the history and examination. A scan will typically be reserved for when there are suspected injuries to bones, such as a fracture, or severe ruptures. If I feel you’d benefit from a scan, I’ll tell you and advise you on what type of scan you need and how to get it.
Does this all sound familiar?
Let’s take a look.
If you’ve experienced a strain, sprain or other injury that is affecting your running, training or sport, let’s figure out what’s going on and what can be done about it.