Common Injuries

Question 1

Typical OVERUSE Injury
* … process is often under way for a … before the athlete notices …

Types of Overuse Injuries

Bone - Bone … reaction, … fracture, …/Periostitis, Apophysitis, Enthesopathy
Tendon - …
Joint/Ligament - … overuse injury, … degeneration, Synovitis, Chondropathy
Muscle/Fascia - D…, F…, Chronic compartment syndrome
Nerve - Altered … sensitivity
Bursa - …

Answer 1

Typical Overuse Injury
* Pathological process is often underway for A LONG TIME before the athlete notices symptoms, PAIN

Types of Overuse Injuries

Bone - Bone stress reaction, Stress fracture, Osteitis/Periostitis, Apophysitis, Enthesopathy
Tendon - Tendinopathy
Joint/Ligament - Labrum overuse injury, Ligament degeneration, Synovitis, Chondropathy
Muscle/Fascia - DOMS, Fasciitis, Chronic compartment syndrome
Nerve - Altered neuromechanical sensitivity
Bursa - Bursitis

Question 2

• Growth plate = growth cartilage → a … part of the bone
• Epiphyseal growth plate, … (located at …)
• Apophyseal growth plate, … (site where…)
• Less resistant to … loading → … risk of injury

Apophysitis
* Apophysitis is a … injury
* …. stress on these areas can cause irritation and inflammation

• Some common types of apophysitis include:
• … Disease (calcaneus), 8-14yrs
• Osgood-Schlatter Disease (…), 10-15yrs
• Little … (medial epicondyle), 8-15yrs

Answer 2

• Growth plate = growth cartilage → a vulnerable part of the bone
• Epiphyseal growth plate, EPIPHYSIS (located at end of the bone)
• Apophyseal growth plate, APOPHYSIS (site where tendons/ligaments attach the bone)
• Less resistant to repetitive loading → Increased risk of injury

Apophysitis
* Apophysitis is a traction injury
* Repetitive stress on these areas can cause irritation and inflammation

• Some common types of apophysitis include:
• Sever’s Disease (calcaneus), 8-14yrs
• Osgood-Schlatter Disease (tibial tuberosity), 10-15yrs
• Little League Elbow (medial epicondyle), 8-15yrs

Question 3

EXAMMMMM

Sever’s disease vs achilles tendon enthesopathy

• Sever’s disease is an inflammation of the heel bone’s growth plate in children and adolescents, caused by the Achilles tendon pulling on the bone during growth spurts,
• Achilles tendon enthesopathy is a broader term for inflammation at the tendon’s attachment to the bone, which can affect children and adults, but is more common in adults

Question 4

Synovitis of the knee is the … of the …, which can cause …, stiffness, and limited …

Treatment:
… modification
… management
P…

Chondromalacia patella is the breakdown of … on the … of the kneecap (patella)

Answer 4

Synovitis of the knee is the inflammation and swelling of the synovial membrane lining the knee joint, which can cause pain, stiffness, and limited movement

Treatment:
Load modification
Pain management
Physiotherapy

Chondromalacia patella is the breakdown of cartilage on the underside of the kneecap (patella)

Question 5

Fasciitis
* Inflammation of …
* Plantar …
* Cause: …, improper footwear, or … issues (e.g., pes planus, pes cavus)
* Risk higher after …
* Typically treated …

acute compartment syndrome - …

Chronic Compartment Syndrome
* …-induced condition
* … impact activity (e.g., running), overloading
* Swelling and … pressure causing reduced … and …
* Most commonly in the ….
* The … has four compartments, and any one or all of them can be affected
* Aching, burning, tightness, numbness, weakness
* Typically treated …
* … modification, technique, alignment, … and …

Answer 5

Fasciitis
* Inflammation of fascia
* Plantar fasciitis
* Cause: overuse, improper footwear, or biomechanical issues (e.g., pes planus, pes cavus)
* Risk higher after period of inactivity
* Typically treated conservatively, stretching, calf muscle

ACS - direct blows, bleeding inside the muscle,, contusion or fracture direct blow, cause pressure on tissues on nerve

Chronic Compartment Syndrome
* Exercise-induced condition
* Repetitive impact activity (e.g., running), overloading
* Swelling and increased pressure causing reduced blood flow and pain
* Most commonly in the lower leg
* The lower leg has four compartments, and any one or all of them can be affected
* Aching, burning, tightness, numbness, weakness
* Typically treated conservatively
* Load modification, technique, alignment, stretching and strength

Question 6

Bursitis
* Inflammation of …
* Cause: …/… movements, prolonged pressure
* Pain during …, swelling of bursa
* Typically treated …
* Severe cases: …

Risk Factors for Overuse Injury

• Intrinsic factors
• … injury
• Malalignment
• Leg length …
• Muscle …
• Muscle …
• Lack of flexibility
• Sex
• BMI
• Genetic factors
• Extrinsic factors
• Training load …
• Foot…
• E…
• Environmental …
• … nutrition

Treatment of Overuse Injuries
Treatment is not only managing the injury.
Essential is to address the … that are contributed to the … of injury !!

Answer 6

Bursitis
* Inflammation of bursa
* Cause: overuse/repetitive movements, prolonged pressure
* Pain during movements, swelling of bursa
* Typically treated conservatively
* Severe cases: corticosteroid injections

Risk Factors for Overuse Injury
* Intrinsic factors
* Previous injury
* Malalignment
* Leg length discrepancy
* Muscle imbalances
* Muscle weakness
* Lack of flexibility
* Sex
* BMI
* Genetic factors

• Extrinsic factors
• Training load errors
• Footwear
• Equipment
• Environmental conditions
• Inadequate nutrition

Treatment of Overuse Injuries
Treatment is not only managing the injury.
Essential is to address the factors that are contributed to the development of injury !!

Question 7

Low Back Pain in Adult Athletes
General population:
Lifetime prevalence …% → Up to 20-30% can become persistent

Athletes:
Lifetime prevalence …% → Time-loss from sport, limitations to performance, decreased quality of life, high costs of treatment

Non-Specific LBP
* Complex combination of … and … risk factors
Specific diagnosis of LBP→ only in …% of patients

Risk Factors for LBP
** Previous … **
* Family … of LBP
* Anatomical … of the spine
* Improper technique
* Sleep deficits
** … use **
* … the structures of the spine
* Stress

Answer 7

Low Back Pain in Adult Athletes
General population:
Lifetime prevalence 85% → Up to 20-30% can become persistent

Athletes:
Lifetime prevalence 1-94% → Time-loss from sport, limitations to performance, decreased quality of life, high costs of treatment

Non-Specific LBP
* Complex combination of intrinsic and extrinsic risk factors
* Specific diagnosis of LBP→ only in 15% of patients

Risk Factors for LBP
* Previous back injury
* Family history of LBP
* Anatomical structure of the spine
* Improper technique
* Sleep deficits
* Nicotine use
* Overloading the structures of the spine
* Stress

Question 8

Degenerative Disc Disease (DDD)
* Heavy … to the spine
* Intervertebral disc …
* …, stiffness, reduced …
* Radiating pain to the …, n…, t…, weakness

DDD: Diagnosis and Treatment
* History, physical and neurological examination
* Imaging (e.g., x-ray, MRI)
* Conservative treatment
* Physiotherapy = core strength, flexibility
* Pain management

Answer 8

Degenerative Disc Disease (DDD)
* Heavy stress to the spine
* Intervertebral disc wears down
* Pain, stiffness, reduced ROM
* Radiating pain to the arms or legs, numbness, tingling, weakness

DDD: Diagnosis and Treatment
* History, physical and neurological examination
* Imaging (e.g., x-ray, MRI)
* Conservative treatment
* Physiotherapy = core strength, flexibility
* Pain management

Question 9

Avulsion Fracture
* …
* Sudden …, pop, swelling, loss of …
* Most common locations
* … &…
* High risk sports e.g., gymnastics, soccer, …, …
* Mechanism, inspection, palpation, x-ray, MRI
* Conservative or surgical treatment

Mechanisms
* … avulsion fracture
* … avulsion fracture
* … avulsion fracture

Answer 9

Avulsion Fracture
* Tendon or ligament pulls off a piece of bone from attachment point
* Sudden pain, pop, swelling, loss of function
* Most common locations
* ASIS & Ischial Tuberosity
* High risk sports e.g., gymnastics, soccer, track, football
* Mechanism, inspection, palpation, x-ray, MRI
* Conservative or surgical treatment

Mechanisms
* ASIS avulsion fracture
* AIIS avulsion fracture
* IT avulsion fracture

Question 10

Ankle Sprain
… sporting injury
Around 80% of ankle injuries are … caused by sudden …/…

Lateral Ankle Sprain
* Lateral structures put under stress
* … (…) ligament
* … (…) ligament
* … (…) ligament
* Peroneal tendons

Grade I: … rupture of …, … or …
Grade II: … rupture of … ligaments or … rupture of … ligaments
Grade III: … rupture of … ligaments

Mechanism of Lateral Ankle Sprain
* Sudden excessive …
* Sudden excessive …
* 130 – 180 ms after initial foot contact

Diagnosis and Treatment
* History and physical examination (Palpation) * X-ray * Weight bearing after 24-48 hours (using crutches or brace)

• Grade I and II: …, …
• Grade III: …
• Early functional treatment
• Progressive exercise therapy

Answer 10

Ankle Sprain
Most common sporting injury
Around 80% of ankle injuries are ligamentous caused by sudden inversion/supination

Lateral Ankle Sprain
* Lateral structures put under stress
* Anterior talofibular (ATF) ligament
* Posterior talofibular (PTF) ligament
* Calcaneofibular (CF) ligament
* Peroneal tendons

Grade I: partial rupture of ATF, PTF or CF
Grade II: total rupture of one of the three ligaments or partial rupture of two ligaments
Grade III: total rupture of two ligaments

Mechanism of Lateral Ankle Sprain
* Sudden excessive supination
* Sudden excessive inversion
* 130 – 180 ms after initial foot contact

Diagnosis and Treatment
* History and physical examination (Palpation) * X-ray * Weight bearing after 24-48 hours (using crutches or brace)

• Grade I and II: brace, taping
• Grade III: cast
• Early functional treatment
• Progressive exercise therapy

Question 11

Medial Ankle Sprain
* Medial structures put under …
* … ligament
* Sometimes combination with malleolar fractures or syndesmosis injury
* Tibialis posterior and toe flexor tendons
* Excessive …

Diagnosis and Treatment
History and physical examination (palpation) X-ray
Brace, sometimes … arch support
Functional treatment in the same manner that for … ankle ligament injuries

Prognosis is good, but healing takes about … as long (or more) than for … ankle sprains

Prevention of Recurrent Ankle Sprains
- what do braces work for?
- one year after ankle sprain is … higher
- Exercises Balance training programs …%
- NMT programs 50%

Answer 11

Medial Ankle Sprain
* Medial structures put under stress
* Deltoid ligament
* Sometimes combination with malleolar fractures or syndesmosis injury
* Tibialis posterior and toe flexor tendons
* Excessive eversion

Diagnosis and Treatment
History and physical examination (palpation) X-ray
Brace, sometimes medial arch support
Functional treatment in the same manner that for lateral ankle ligament injuries

Prognosis is good, but healing takes about twice as long (or more) than for lateral ankle sprains

Prevention of Recurrent Ankle Sprains
- taping, brace support, only for recurrent injuries
- one year after ankle sprain is 10x higher. Recurrent injury risk is so high
- Exercises Balance training programs 36%
- NMT programs 50%

Question 12

Syndesmosis Injury
* High ankle sprain
* … l trauma
* Sprain of … ligaments that connect the …
* Partial or complete rupture of …
* Sometimes rupture of … ligament

Mechanism of High Ankle Sprain
* Forced …
* High-risk sports: …, …, …

Diagnosis and Treatment
* Diagnosis: History & Physical examination (palpation); X-ray, MRI
* Partial rupture – … (… weeks or more)
* Complete rupture – … (… weeks)
* Progression of rehabilitation when near …

Sprained Ankle Complications
Increased risk for … injuries
An unstable … (chronic ankle instability)
Ankle joint …
Persistent …

Answer 12

Syndesmosis Injury
* High ankle sprain
* External rotational trauma
* Sprain of syndesmotic ligaments that connect the tibia and fibula
* Partial or complete rupture of syndesmosis
* Sometimes rupture of anterior tibiofibular ligament

Mechanism of High Ankle Sprain
* Forced external rotation
* High-risk sports: Downhill skiing, football, rugby

Diagnosis and Treatment
* Diagnosis: History & Physical examination (palpation); X-ray, MRI
* Partial rupture – Walking cast/boot (2 weeks or more)
* Complete rupture – surgery, cast/boot (6 weeks)
* Progression of rehabilitation when near pain free

Sprained Ankle Complications
Increased risk for recurrent injuries
An unstable joint (chronic ankle instability)
Ankle joint osteoarthritis
Persistent pain

Question 13

Chronic Ankle Instability
* Instability from …
* Feeling that the ankle is giving way of the … side
* Treatment
* Brace
* Balance and strength
* Surgery

Chondral Injury, Osteochondral Injury or Osteochondral Fracture
what and what
* Usually occur in association with …
* Recurrent …, … and/or locking
* MRI
* Conservative treatment (CI & OCI): …/… and rehabilitation
* RTS … months
* Surgery (OCF, sometimes CI and OCI)
* RTS … months
→ Ankle joint …

Answer 13

Chronic Ankle Instability
* Instability from repeated inversion trauma
* Feeling that the ankle is giving way of the lateral side
* Treatment
* Brace
* Balance and strength
* Surgery

Chondral Injury, Osteochondral Injury or Osteochondral Fracture
CARTILAGE AND BONE
* Usually occur in association with ankle sprains
* Recurrent pain, stiffness and/or locking
* MRI
* Conservative treatment (CI & OCI): Cast/brace and rehabilitation
* RTS 2-6 months
* Surgery (OCF, sometimes CI and OCI)
* RTS 6-12 months
→ Ankle joint osteoarthritis