Sports Knee Injuries, Symptoms And What To Do

The ligaments of the knee may be stretched (strained), partially torn (sprained), or completely torn (torn ligament). Unlike the ankle, torn ligaments in the knee need to be repaired surgically as soon as possible after the in-jury occurs. If surgery is delayed, the operation is more difficult and less likely to be successful. For this reason, the approach to knee injuries is more cautious than for ankle injuries. If there is any possibility of a torn ligament, go to the doctor. Fractures in the area of the knee are less common than around the ankle and need to be cared for by a doctor.

Significant knee injuries usually occur during a sports activity, when the knee is more likely to experience twist-ing and side contact; these are responsible for most ligament injuries. (Deep knee bends stretch knee ligaments and may contribute to knee injuries; they should be practiced cautiously, if at all.) Serious knee injuries occur when the leg is planted on the ground and a blow is received to the knee from the side. If the foot cannot give way, the knee will. There is no way to totally avoid this pos-sibility in athletics. The use of shortlOr spikes and cleats help, but elastic knee supports and wraps give virtually no protection.

When ligaments are completely torn, the lower leg can be wiggled from side to side when the leg is straight. Compare the injured knee to the opposite knee to get some idea of what amount of side-to-side motion is normal. Your examination will not be as skilled as that of the doc-tor, but if you think that the motion may be abnormally loose, see the doctor.

If the cartilage within the knee has been torn, the normal motion of the knee may be blocked, preventing it from being straightened. Although a torn cartilage does not need immediate surgery, it de-serves prompt medical attention. The amount of pain and swelling does not in-dicate the severity of the injury. The ability to bear weight, to move the knee through the normal range of motion, and to keep the knee stable when wiggled is more important. Typically, strains and sprains hurt immediately and continue to hurt for hours and even days after the injury. Swelling tends to come on rather slowly over a period of hours, but may reach rather large proportions. When a ligament is completely torn, there is in-tense pain immediately, which subsides until the knee may hurt little or not at all for a while. Usually, there is signifi-cant bleeding into the tissues around the joint when a ligment is torn so that swelling tends to come on quickly and be impressive in its quantity. The best pol-icy when there is a potential injury to the ligament is to avoid any major activ¬ity until it is clear that this is a minor strain or sprain. Home treatment is in-tended only for minor strains and sprams.

Home Treatment

RIP is again the key word-rest, ice, and protection. Rest the knee and elevate it. Apply an ice pack for at least thirty minutes to minimize swelling. If there is more than slight swelling or pain, despite the fact that the knee was immediately rested and ice was applied, see the doctor. If this is not the case, apply the ice treatment on the khee for thirty minutes and then off for fifteen minutes for the next several hours. Limited weight bearing may be attempted during this time with a close watch for increased swelling and pain. Heat may be applied after twenty-four hours. By then, the 'knee should look and feel relatively normal, and after seventy-two hours this should clearly be the case. Remember, however, that a strain or sprain is not completely healed for four to six weeks and requires protection during this healing period. Elastic bandages will not give adequate support but will ease symptoms a bit and remind the patient to be care¬ful with the knee.

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Cuts, Puncture Wounds and Lacerations Treatment

Most cuts and lacerations affect only the skin and the fatty tissue beneath it. Usually they heal without permanent damage. However, injury to internal structures such as muscles, tendons, blood vessels, ligaments, or nerves presents the possibility of permanent damage. Your physician can decrease this likelihood.

It may be difficult for you to determine whether major blood vessels, nerves, or tendons have been damaged by cuts and lacerations. Bleeding that cannot be controlled with pressure, numbness or weakness in the limb beyond the wound, or inability to move fingers or toes normally call for ex-lamination by a physician.

Signs of infection such as pus oozing from the wound, fever, extensive redness and swelling will not appear for at least twenty-four hours. Bacteria need time to grow and multiply in cuts and lacerations. If these signs do appear, a physician must be consulted.

Stitching (suturing) of cuts and lacerations is a ritual in our society. The only purpose in suturing a wound is to pull the edges together to hasten healing and minimize scarring. Stitches are not recommended if the wound can be held closed without them, since they injure tissue to some extent.

See the doctor if the edges of the cuts and lacerations cannot be kept together, if signs of infection are present, or if the cut and laceration is not healing well within two weeks. Stitching must be done within eight hours of the injury, because germs begin to grow in the wound and can be trapped under the skin, causing it to fester.

Cuts and lacerations on the face, chest, abdomen, back or oral laceration is potentially more serious than hand laceration or one on the legs or arms (extremities). Cuts on the trunk or face should be examined by a physician unless the injury is very small or shallow. A call to the doctor's office will help you decide if the doctor's help is needed.

Facial cuts and lacerations in a young child who drools are often too wet to treat with bandages, so the doctor's help is usually needed. Because of potential disfigurement, all but minor facial wounds should be treated professionally. Stitching is often required in young children who are apt to pull off bandages, or in areas that are subject to a great deal of motion, such as the fingers or joints. Cuts in the palm that become infected can be difficult to treat, so do not attempt home treatment unless the cut is shallow.

Home Treatment For Cuts and Lacerations

Cleanse the cuts and lacerations. Cleaning the wound is very vital to laceration repair. Soap and water will do, but be vigorous. Hydrogen peroxide (3%) may also be used. Make sure that no dirt, glass, or other foreign material remains in the laceration wound. Antiseptics such as Mercurochrome and Merthiolate are unlikely to help, and some are painful. Iodine will kill germs, but it is not really needed and 'is also painful. (Betadine is a modified iodine preparation that is pain-less but costly). Make sure that you make steps to prevent laceration infection.

The edges of a clean, minor cuts and lacerations can usually be held together by "butterfly" bandages or, preferably, "steristrips"-strips of sterile paper tape. Apply either of these bandages so that the edges of the wound join without "rolling under."

See the doctor if the edges of the wound cannot be kept together by laceration stitches, if signs of infection appear (pus, fever, extensive redness and swelling), or if the cut is no-healing well within two weeks.

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What Do If You Have Ankle Sprain

Ankle sprain is one of the most common injuries, not only for the athletes but actually, by non athletic type of people. Women who wear high heels are one of the most prone to ankle sprain. Even the simplest imbalance of posture could make your ankle swell. If you have ankle injury, the first thing you should do is to see to prevent swelling. You have to rest you legs, put ice and elevate it right away. In doing this, you could reduce the swelling of your ankle sprain, fasten it’s healing process. After that, you need to put bandage around your ankle.

Elastic (Ace) bandages are periodically used by any family. You will probably need both a narrow and a broader width. If problems are recurrent, the one piece devices designed specifically for the knee and ankle are sometimes more convenient. All of these bandages primarily provide gentle support, but they also act to reduce the swelling. Elastic bandages should be used if they make the injured part feel better. The support given is minimal and reinjury is possible, despite the bandage. Thus, it is not a substitute for a splint, a cast, or proper adhesive type dressing when these are needed. Perhaps, the most important function of these bandages is as a reminder to you that you have a problem so that you re less likely to reinjure the part.

Support should be continued well past the time of active discomfort to allow complete healing and to help prevent injury; this usually requires about six weeks. During the latter part of this period, use of the bandages maybe discontinued except during activities that will likely stress the injured part. Remember, that reinjury is still possible while these bandages are being used.

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Achilles Tendinopathy: An Injury For Life?

It is no accident that the Achilles tendon is so named. The term for the thick sinewy tendon running down from calf to foot is a permanent reminder of its vulnerability. The Achilles heel, for those whose Greek mythology needs a little recap, derives from the legend in which Achilles’ mother, the sea nymph Thetis, dipped her baby son into the River Styx to render him invulnerable, protecting him against his many foes. He became a great hero, but was finally felled by an arrow through his heel – the spot where his mother had held him while she dipped him in the river and therefore his sole spot of vulnerability. Thus we have “Achilles’ heel” to indicate someone’s weak spot….

It is, and for all athletes should be, a constant reminder to treat the Achilles with great respect. If you don’t, as our writers in SIB underline this month, you could gain an injury for life.

Remember just a few short months ago, the sad images of the wonderful Chinese hurdler Liu Xiang, as he hobbled away from the track, bowing out of his Olympic challenge? It turns out that Liu had been battling with his Achilles tendinopathy on and off for years, and it had flared up at exactly the wrong moment.

It’s not just Olympic hurdlers who are at risk. As our authors write: “Achilles tendinopathy is a common injury in running, jumping, tennis and other racquet sports, and in team sports such as football. It has a lifetime cumulative incidence of 50% among elite endurance athletes.”

Which all adds up to a lot of Achilles injury.

All the more surprising then, that it has taken a long time for sports medicine to get to grips with the true nature of tendinopathies. We have come a long way from the days when we talked in terms of swollen tendons (tendinitis) being treated with a hot pack and stretching. Yet, even though we know much more about what is going on, neither the science nor the prescriptions are as yet definitive. So the sports therapist needs to remain on top of this subject.

As Chris Mallac explains in our in-depth coverage in the new SIB, there are two good reasons why an Achilles tendinopathy is no short-term injury:

* it is adaptive changes within the tendon -- new collagen growth and blood vessel invasion – that cause the pain, so by the time the athlete is aware of the problem, most of the damage has already been done;
* the damaged tissue will be functionally weaker and will remain permanently “Type 3” collagen; thus it is more susceptible to reinjury than the original Type 1 collagen fibres it replaces.

Our spotlight on Achilles tendinopathy this month brings you a clear explanation of exactly what medical science now knows about this injury and the pain it causes, as well as Chris’s practical advice for therapists on how to manage their athletic clients’ rehab. Once you’ve read SIB on tendinopathies, you’ll never again talk about “tendinitis” or recommend simple calf stretches as the way to go. Chris Mallac’s practical guide covers aspects such as:

* essential information the therapist should share with their client
* why morning stiffness is such a pain for Achilles tendinopathy
* why ice beats heat for relief
* why and how eccentric-loading exercises work in rehab…
* …and the limitations of this treatment
* self-massage techniques for the injured client

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