Injury and rehabilitation

• Acute injuries are injuries that result from sudden stress to the body, associated with a traumatic event and can be soft or hard tissue.

  Common causes include overestimating ability, collision, fall, not warming up properly and being struck by an object/impact.
• Acute soft tissue injuries are damage to non solid structures of the musculoskeletal system, e.g ligaments, tendons and muscles.
• Strain (acute soft tissue injury):

  When muscles fibres overstretch/tear, grade 1 is a mild muscle pull/strain, grade 2 is a partial muscle tear and grade 3 is a complete muscle tear.

  Common - leg or back.

  Causes - muscle being stretched beyond its limit, muscle forced to contract too quickly or sudden intense exercise.

  Symptoms - swelling, bruising, redness, muscle spasms and weakness.
• Exercise induced muscle damage (acute soft tissue injury):

  Or delayed onset of muscle soreness (DOMS), microscopic tears in muscle fibres, experiences 24 to 72 hours after high intensity exercise.

  Common - at the start of new training regimes.

  Symptoms - pain/swelling for up to 72 hours after exercise
• Haematoma (acute soft tissue injury):

  A contusion/bruise where blood vessels have ruptured (severe ones can have deep tissue damage), damaged tissue leads to a haematoma.

  Cause - falling/direct impact from an object/player.

  Symptoms - swelling, discolouration, tenderness and pain.
• Acute hard tissue injuries are solid structures of the musculoskeletal system, e.g bone and cartilage.
• Fracture (acute hard tissue injury):

  A partial/complete break to a bone, simple/closed is a break through bone with little damage to surrounding tissue, open/compound is a complicated break that has broke through skin, displaced is when 2 parts of a broken bone move apart and comminuted is where a bone breaks into several pieces.

  Cause - excessive direct/indirect force

  Symptoms - pain, swelling, deformity and discolouration.
• Dislocation (acute hard tissue injury):

  Separation of 2 bones where they meet at a joint, surrounding tissue may be torn/overstretched.

  Common - shoulder

  Cause - direct/indirect force and pushing a joint past its extreme range of motion.

  Symptoms - visibly out of place, numbness, severe pain, loss of movement, swollen and bruised.
• Cartilage damage (acute hard tissue injury):

  A piece of articular cartilage breaks off and affects joint movement, causes a feeling of joint locking/catching, unable to self heal and can develop into osteoarthritis.

  Cause - twisting, sudden stop and changing direction.

  Symptoms - joint pain, swelling, stiffness and instability.
• Chronic injuries result from continuous stress to the body over time and can be soft or hard tissue. Common causes include repetitive impact, overuse/overtraining, inappropriate equipment, inappropriate kit/footwear and poor technique.
• Tendonitis (chronic soft tissue injury):

  Inflammation of a tendon.

  Common - shoulder, elbow, wrist and back of heel (tennis elbow and achilles tendonitis).

  Cause - overuse/repetitive movements without appropriate rest.

  Symptoms - burning, aching and tenderness.
• Shin splints (chronic soft tissue injury):

  Chronic shin pain, muscles pull away from attachment site along tibia, if left untreated and exercise continues this could cause a stress fracture.

  Cause - repeated overuse/loading, at risk if you have flat feet/have been running for less than 5 years/run on hard surfaces/are overweight.

  Symptoms - tenderness, inflammation and pain during exercise.
• Stress fracture (chronic hard tissue injury):

  Tiny crack in the surface of the bone.

  Common - in the tibia (lower leg), running, gymnastics and basketball.

  Cause - overtraining, unfamiliar surfaces, inappropriate footwear and intense workload.

  Symptoms - specific spots of pain during exercise which subsides at rest.
• Osteoarthritis (chronic hard tissue injury):

  Degenerative joint disease, wearing away of articular cartilage that covers the head of the joint.

  Cause - repetitive actions particularly high impact, being overweight and previous joint injury.

  Symptoms - pain, swelling, stiffness, grating feeling and inability to use joint normally.
• Concussion:

  Minor traumatic brain injury (TBI), brain injury that can cause serious symptoms requiring medical treatment.

  Cause - impact to head, fall and after a whiplash type injury (brain and head is shook quickly back and forth).

  Symptoms - convulsion, headache, nausea, dazed, confused and vomiting.
• Concussion protocol (6 R's)

  1. Recognise

  2. Remove

  3. Refer

  4. Rest

  5. Recover

  6. Return
• Recognise

  Learn signs/symptoms of a concussion in order to be able to recognise suspected concussion, players symptoms could be delayed or a player could refuse medical attention
• Remove


  Player must be removed from play if they have a suspected concussion, player could refuse to come off
• Refer


  Players should be referred to a qualified healthcare professional immediately, professional may not be present
• Rest

  Player must rest until symptom free then start gradual return to play, should be minimum 2 weeks full rest for under 18s, player may not rest or return to sport too quickly
• Recover


  Player is required to have full recovery and be symptom free before return to play is authorised, player might not want to stay off sport and could return too quickly
• Return


  Player must be symptom free and cleared in writing by a qualified healthcare professional in order to return to play, player might return too quickly to play and there could be problems with the note
• Extrinsic risk factors


  Risks or forces from outside of the body. These include incorrect technique, incorrect clothing, incorrect footwear, incorrect equipment and inappropriate intensity/duration.
• Incorrect technique

  • Not performing a sports skill correctly
  • Could cause tennis elbow
  • Solution is training sessions with a qualified instructor
• Incorrect clothing

  • Not wearing protective clothing
  • Could cause fracture or dislocation
  • Solution is wearing appropriate clothing for protection
• Incorrect footwear

  • Lack of sport specific footwear
  • Could cause a sprained ankle
  • Solution is wearing appropriate footwear
• Incorrect equipment

  • Not wearing protective gear
  • Could cause broken teeth
  • Solution is wearing appropriate gear
• Inappropriate intensity/duration


  • Not suitable for the athlete
  • Could cause strain/sprain or shin splints
  • Solution is using progressive overload to ensure exercise is appropriate
• Intrinsic risk factors are risks or forces from within the body. These include training effects (ineffective warm up/lack of flexibility) and individual variables (previous injury/age/postural and alignment defects).
• Training effects (ineffective warm up)

  • Increase risk of injury
  • Could cause hamstring strain
  • Solution is completing an effective warm up and cool down
• Training effects (lack of flexibility)

  • Lack of range of movement/poor joint stability
  • Could cause a strain
  • Solution is having a regular stretch programme
• Individual variables (previous injury)

  • Parts of the body are weaker
  • Could cause ankle sprain or dislocation
  • Solution is rehabilitation and physical support during exercise
• Individual variables (age)

  • Bones become more brittle and connective tissue is less elastic
  • Could cause a fracture/sprain/overuse injury
  • Solution is exercise with a similar age group and only do suitable activity
• Individual variables (postural/alignment defects)

  • Scoliosis is a S shaped bend in the spine
  • Could cause an overuse injury
  • Solution is follow medical guidelines from healthcare professionals
• Warm up

  1. Heart rate raising activity

  2. Dynamic stretches

  3. Sport specific drills
• Musculoskeletal effects of warm up

  • Increases muscle temperature to increase range of movement which reduces injury
  • Increases efficiency of muscle contractions causing an increased speed and force of contraction
  • Increase action of muscle pump to aid venous return
• Cardiovascular effects of warm up

  • Increases heart rate to increase oxygen supply to working muscles
  • Vascular shunt redistributes more oxygen to working muscles
  • Increase action of muscle pump
  • Increase oxygen that leaves haemoglobin and enters muscles
• Other effects of warm up

  • Increases enzyme activity to improve efficiency of energy systems
  • Increase volume of oxygen for gas exchange
• Cool down: moderate intensity activity and stretching. Speeds up EPOC process, decrease risk of DOMS and allows body to gradually recover from exercise.
• On field assessment of acute sport injury: SALTAPS

  1. See and stop

  2. Ask

  3. Look

  4. Touch

  5. Active movement

  6. Passive movement

  7. Strength testing