Chapter 5. Sport-by-sport guide to technical injuries
Although there are many injuries that are common to many sports, some problems are specific to certain sports. Using this sport-by-sport rundown, you can spot the peculiarities of your own sport and be better prepared to avoid injuries – or to recognize them, if you or your team-mates are unlucky enough to suffer them.
Injuries that have already been explained in the Top-to-Toe Guide (Chapter 3) are in bold. Injuries such as Quads expansion, Lower patella pole, Jumper’s knee and Osgood Schlatter are all caused by too much training or too much power being applied to the knee. These are referred to as overload injuries. Patella pain, Plica, Patella facet pain are caused by the kneecap not moving properly in the thighbone (femur) grooves and are referred to as tracking problems. The fault may be caused by the foot, knee or hip.
ARCHERY
Archers are not prone to serious injuries, but can avoid annoying ones by using equipment tailored to their needs. The bow must, of course, be the correct weight because too heavy a draw-weight (bow weight) can be tiring and can produce overuse muscle injuries in the upper body and arms. Finger tabs should suit the individual. Shoulder impingement during archery suggests that the draw shoulder is being shrugged.
Tennis elbow can occur in the arm holding the bow when the wrist is extended through the draw before locking it into the support position. Although this may help the draw, it is technically incorrect and could mean the draw-weight is too heavy.
Biceps strain from using too heavy a draw-weight heals after a proper rest, but suggests that the shoulder blade muscles are not being used to draw. Check technique with coach and resume training with a lighter bow.
BADMINTON
At the very top level, this is one of the most physically demanding sports. Footwear is important, as many matches are played on firm, composition floors rather than sprung wooden surfaces. Properly padded shoes absorb shock and help prevent blisters and forefoot strains. However, the soles should not be as thick or high as athletic shoes, which become unstable for this quick change-of-direction sport. The knee on the racket-hand side is susceptible to great stresses, both overload and tracking. Although pain is common in the wrists and shoulders, this is often due to poor footwork. Striking the shuttle when in an awkward, off-balance position strains the joints. Correct technique not only makes shots more effective, but also avoids injury.
A/C joint injury could ruin a season since overhead shots cause the condition to flare up. As below-the-shoulder shots are pain free, try squash during the lay-off period and seek medical advice.
Painful arc/rotator cuff or subacromial space injuries need to be diagnosed accurately if the technical fault is to be corrected. They are caused by hitting too hard with a ‘flying’ shoulder or smashing from too far behind the head; the best way to treat them is to reduce the power of the shot and hit with the wrist. Check with a coach that you are not smashing face on and that your feet are correctly positioned. Early cortisone injections are of value, and in severe cases, fitness can be maintained by playing squash.
Tennis elbow is common, especially in doubles, where the net player has to angle forehand interceptions. If the grip is too tight (using the thumb and index finger), the wrist is not released enough to angle the shot, so the elbow is jammed straight, flaring the elbow joint, radiohumeral joint. Check your grip and technique with a coach; try a thicker grip and hold with the 3rd, 4th and 5th fingers. Another cause of tennis elbow is the tendency to come face on to the smash, before whipping the shot with the wrist.
Incorrect lunging can cause severe lower back, hamstring and Achilles tendon problems. Stretching and strengthening of these areas is important to minimize problems. Sufferers from adductor muscle strain should avoid overstretching sideways when building back into competition; extra coaching on footwork is required. The ‘round the head’ shot may inflame the sartorius muscle. With problems following sudden twisting injuries, seek early medical advice.
See: Unstable knee and Rapid swelling.
A pull-off fracture of the thigh is produced by repeated lunging, which loads the quads; this is common in growing youngsters. Seek medical advice. Players suffering from quads overload should avoid reaching over the knee during training to pick up drop shots. Only play shuttlecock above the waist until pain free and reduce quads training; build via doubles to singles.
Impingement injuries of the ankle occur in the trail leg from deep lunging, so check footwork. Turn trail foot out sideways (as fencers do) rather than lunge over a toes-forward straight foot. Plantar fasciitis is common on non-sprung floors, and even half-rising on the toes when preparing to smash may hurt. Heel cups, shock-absorbing wedges and strapping may help; check heel cup of shoe is stable. Concentrate on pattering for fitness while running is painful. Achilles tears are reported to be quite common.
BASEBALL/SOFTBALL
Baseball players rarely look as fit as they could and should be. In a game involving sudden moves after long periods of inactivity, hamstrings are likely to go in the sprint for first base, while groin pulls occur in attempting awkward ground balls. Thorough warm-ups and stretching are vital. The most publicized injury is pitcher’s elbow, which covers a multitude of sins caused by slightly different techniques and throws. Fast snapping of the elbow into extension, especially if the wrist cock is maintained throughout delivery, as in the change-up and fastball, causes olecranon fossa, olecranon fracture and triceps strain.
A radiohumeral joint sprain can be flared by pitching the screwball, so avoid overusing this delivery if it is causing problems. Golfer’s elbow, a type of pitcher’s elbow, is an overuse injury, caused by trying to gain more speed on the fastball by pitching the curveball or slider. Both release the cocked wrist through delivery, and three-quarter action increases the risk plus a possible ulnar ligament strain.
Little league elbow/pull-off fracture is the same injury in a growing child. One of the problems of the sport is overenthusiastic youngsters (or worse, youngsters encouraged by overenthusiastic parents) damaging themselves by repeatedly throwing fastballs. It is possible that the three-quarter action (more common in beginners) plays a part. As the bones are still growing, any elbow injury must be treated seriously and examined by a medical expert. There is the risk that growth may be permanently impaired. Most pitching by youngsters is supervised to control the number of pitches per week, and many coaches forbid the throwing of curveballs. A diary to record the number of pitches each week is essential and should not be abused by sneaking in extra practice sessions. Technique, accuracy and control should be encouraged rather than speed. As soon as a youngster says, ‘It hurts when I throw,’ stop play, seek medical advice.
If throwing is painless sidearm but painful overarm, chances are that it is a shoulder separation/A/C joint injury if there has been a shoulder problem from a fall or from sliding into base. Shoulder impingement/subacromial space/bursa injury can occur when fielders attempt to throw too hard overarm; throw side or underarm. Treat early with cortisone injections. Underlying rotator cuff damage or weakness will need specific rehabilitation as these muscles not only generate power and control shoulder position, but also stop the arm following the ball. Most shoulder work developed in gyms does not strengthen these rotator cuff muscles. Consult a qualified fitness coach. Good lower body strength can help the upper body by generating the extra power.
Jammed fingers are common. See a doctor if they are out of line. Tape a jammed finger to a healthy one for support. Mallet or baseball finger is more serious, as the tip of the finger droops and cannot be straightened. This needs splinting by a doctor. Techniques for sliding into base are important, but few agree on a correct method and all can produce a hip pointer. Putting the full weight of the body at speed onto an ankle that is resisted by a rough surface is asking for trouble. One school of thought suggests sliding head first into second and third base. As the catcher is a pretty solid object, feet first is advisable at home plate. Whether your coach accepts this or not, everyone agrees that indecision is the worst decision!
BASKETBALL/HANDBALL/NETBALL/VOLLEYBALL
As the hands have to deal with a large ball, mallet finger, sprained thumb and dislocated finger injuries are inherent problems, so strapping the joints is both beneficial and preventive. Feet, knees and ankles are a problem when these sports are played on firm surfaces, so footwear must be well padded to reduce risk from jumping and landing, checking and changing direction.
Rapid checking and explosive jumping both produce knee overload injuries. During rehabilitation, practice stationary throws, building into lay-ups as the pain settles. However, if pain starts again during practice then you should stop. Return to static shooting to avoid any delay to healing. All these games, which involve twisting side to side, can produce adductor strains and footballer’s groin ( conjoined tendon). If your adductor muscle is not settling, seek experienced medical advice. Jumper’s leg is an overload problem, but a persistent jumper’s ankle may be due to a small bone (os trigonum), which causes problems in these sports and may need surgery. Handballers are particularly susceptible to shoulder-throwing injuries such as shoulder impingement, subacromial space, painful arc ( rotator cuff) and, following falls, shoulder separation/A/C joint.
BOWLING (TEN PIN)
Scarcely the most energetic sport, yet it still produces some peculiar afflictions, such as bowler’s elbow, a strain of the elbow joint, from the sheer weight of the ball. Check the weight and correct drilling of holes in a personalized ball if you are a frequent participant as the ligaments of the fingers (particularly 3rd and 4th) may be sprained. Thumb irritation and calluses are common among regular bowlers. Cover sore areas and sand down calluses. Trying to increase the spin on the ball may cause the whole arm to finish across and in front of the body, straining the shoulder.
Even transporting half a dozen competition balls around can cause shoulder and elbow problems; try using a special wheeled trolley. Bowler’s toe afflicts as many as a third of all bowlers due to the stress placed on the big and second toes of the trailing foot on delivery. Check footwear to avoid misshapen toes, thickened toenails and calluses. Overload injuries to the knees can occur if doing too much, too soon.
BOWLS
Another gentle sport, where only the onset of old age, together with arthritis, dictates a change of technique. This is especially so for the knee. Concentration on the neutral back position on delivery will prevent further problems.
BOXING
Apart from the obvious pummelling to the head, hands and upper body, there is damage peculiar to the sport such as cut eyes. Dilute adrenaline may be used during the bout, but it is essential that early pressure and ice are applied and (if needed) sutures rather than adhesive stitches to give the best results. The suturing (stitching) should be under the skin, with great care being taken to approximate the edges of the wound. Enzyme creams minimize scarring, but 3 weeks are needed for skin to regain its normal strength, even if it appears to be healed much sooner, so always use head guards for sparring. A shortsighted boxer should be aware that there is a proven connection between high short sightedness, myopia, and an increased likelihood of a detached retina. Laser correction does not alter this risk. Hands, especially the metacarpals, may suffer fractures or subluxation.
Do not dehydrate for fights to ‘make the weight’. A 5% weight loss by dehydration causes a 20–30% drop in work rate; accelerated fatigue causes loss of head and neck control, so a punch to the head can rotate the brain. Neck muscles always require strength work. After a Knockout/KO, amateur boxers are not allowed to fight again for 28 days (first time), 84 days (second time) and 1 year (third time). However, better management of the problem is by psychoneurological testing, which should be performed on each boxer before every fight. No boxer should return to fighting until the test is normal. Regular brain (CT or MRI) scans are now part of professional boxing. The risk of going back too soon is punch drunkenness (brain damage).
CANOEING AND KAYAKING
Basic safety drill must always be understood, even by the best swimmers. Hypothermia (see Chapter 1 Some sensible tips) is a risk: Be prepared. Although wildwater paddlers know about the risks, leisure paddlers often forget how cold paddle splashes can be. Use a body wetsuit in cold conditions, or in a high wind on holiday.
Paddler’s wrist ( De Quervain) is common in kayakers, who feel pain on the lower end of the forearm when extending the wrist and hand in a claw position (as if paddling or rowing). This can be prevented by testing a variety of paddle shapes, which can alter the techniques required.
Biceps tendinitis can also occur, more often in the shoulder than the elbow, due to overuse because of pulling too much on one arm without pushing with the other. Check with a coach in case your pull/twist technique is faulty because specially shaped paddles may ease the problem. Tennis elbow is often caused by lack of forearm strength to take strain, as well as faulty technique. Consult a coach.
Novice canoeists can suffer housemaid’s knee from kneeling, or calluses on the bones one sits on (ischial tuberosity), so use a polystyrene pad lined with sheepskin as protection and give the knee a chance to adapt by short and frequent training sessions early on.
CRICKET
The apparent lack of athleticism in some cricketers is matched only by that of baseball players. The better sides have a sensible attitude to stretching and fitness and the limited-over games have produced much fitter cricketers. Over a long day, dehydration can lessen a player’s effectiveness. (See: Dehydration, page 16). Although concentration over hours can be helped by chewing gum, a number of batsmen have inhaled gum and nearly died. Apart from the obvious dangers and discomforts threatened by the use of a hard ball, for which increasing protective armour is used, cricketers suffer shoulder, back and knee problems.
A/C joint strain is a classic example of an injury that prevents over arm bowling or throwing, though side and underarm efforts are pain free. Hard throws from the boundary reflare the injury, so either field closer or be satisfied with threatening a hard throw – and then, return underarm. Cortisone injections may be required. With the subacromial bursa, the overarm bowling action is painless, but hard overarm throws hurt. Treat with cortisone injections and throw in sidearm or underarm. Off-season throwing drills and rotator cuff strengthening are essential, but regular sidearm throwing with the body ‘front on’ can produce a golfer’s elbow. Any catching sport, especially with a hard ball, risks fractured, dislocated and mallet fingers.
Bowlers’ backs suffer, and this is usually from the facet joints. Bowler’s back, however, is a stress fracture with pain on the opposite side to the bowling arm and worse in extension. Bowling action should be front on or side on, but a mixed action is most likely to cause this stress fracture. Check with coach. Some limit, such as a bowling diary, should be placed on children and young cricketers to reduce the number of fast balls bowled.
Overload knee problems are common in close fielders but usually occur (for right-arm bowlers) in the left leg at delivery. Lower patella pole is more common with inswing bowlers, who are balanced on the left knee for a fraction longer on delivery. The answer could be to cut down on speed and concentrate on away swingers until pain free. The quick single played to the leg off the back foot may induce calf or Achilles problems. Stress fractures occur in the shins of many bowlers. Reduction in pace and number of deliveries, plus mechanical correction such as orthotics, are the only effective treatment.
CYCLING
The bicycle itself governs many of the aches and pains suffered by cyclists, and correct fitting of frame size by a professional is essential. The pedal arcs, saddle and handlebars can be adjusted, so that anyone of any size can have a proper fit.
Saddle to the handlebars: Use your forearm to measure this. With your elbow touching the front of the saddle, your outstretched fingers should touch the midpoint of the handlebars. A low back pain from a creeping disc is not uncommon. Recreational cyclists with this problem should not use drop handle bars. Try to keep the back less bowed, lengthen frame or use tribars to flatten and obtain neutral back position.
Saddle height: To find the correct height, sit on the saddle with your leg straight (not stretched). Your heel should be on the pedal, with the pedal at its lowest point.
Handlebar height: The handlebars should be level with the saddle. If you are not comfortable even after the adjustments, you may have too small or too big a bicycle. If a frame is too small or the handlebars too low, this can cause compression or ‘springing’ over the lower ribs. A coach can work out a better position.
As riders lean forward in the racing position, acid can tip out of the stomach causing heartburn. Stomach gas can press on the diaphragm, so take antacids (or oil of peppermint on a sugar lump) before races. Aches and pains occur in the bottom, because of a poorly positioned saddle or even tight, uncomfortable clothing. Boils are common if dirty clothing is worn or if a body hair has grown back into the skin, causing infection.
Long-distance riders have unusual problems, confined only to cycling, including a numb penis or persistent erection. This is due to pressure on certain nerves or veins and should be reported to a doctor if the condition persists after a saddle adjustment has been made.
Hand pain often occurs in novices, but gloves and padded handlebars help. Beware numbness in the 4th and little fingers as this means the ulnar nerve is being pinched at the butt of the hand. Numbness in the thumb 1st and 2nd fingers could be Carpal tunnel syndrome. Check grip on handlebar.
Knees and ankles suffer from overuse in a sport that demands riders put ‘miles in their legs’. The only sensible solution is to cycle using easier gears and reduce mileage, building back up slowly to high gears. Avoid climbing hills until high gears on the flat are pain free. Tracking problems can occur at the knee, especially if knees do not stay vertically in line over the feet. Raising the saddle may help, but check forefoot with orthotics expert as wedge in shoe may rebalance foot. Clip-on toe catch must have ‘play’ within it as totally fixed foot can stop natural compensation.
DIVING AND TRAMPOLINING
Diving headfirst into water is the most common cause of para- and tetraplegia. If you do not know the depth of the water or whether obstacles exist, always slide into the water feet first. Divers are usually carefully coached, graduating from exercise to exercise. There are relatively few impact injuries from hitting the board or breaking the fingers on reverse or inward dives; even rarer are head injuries from spinning above the board and hitting it coming down. Blood on the board should be cleaned with bleach or antiseptic. The dilutional factor as well as the chlorine in the pool should eliminate any danger of infection to others. More frequent are strains and sprains of the hand, thumb, wrist, shoulders and neck in highboard diving, where divers hit the water repeatedly at 60 mph/100 kmph. Backache from piked somersaults is common, due to the twist movement and arching of the back, while beginners may get facet pains from being forced into hyperextension. Manipulation may help. Some incidence of Osgood–Schlatter has been noted amongst young divers on take off or ‘springing’ the board too frequently.
Trampolining looks like great fun but must be supervised at all times. Surprisingly, a large number of injuries are suffered in folding and unfolding the powerful, spring-loaded beds. This is not a job for children!
In trampolining, painful joint instability (ankle and knee) is common, and many accidents among youngsters occur due to the G (gravity) forces exerted that make them black out for a moment, lose control and land awkwardly. In spite of an emphasis on safety, there are still a worrying number of accidents in the sport, and medical experts in many countries recommend that trampolining should not be a school sport because of the inherent competitiveness that it often encourages. Awkward neck injuries may cause tetraplegia, so catchers should be on duty at all four sides of the trampoline. Worn equipment, especially at beaches, etc., is very dangerous. The rebound from the trampoline can produce overload knee problems. See: Head warning (page 51).
EQUESTRIAN SPORTS
Most injuries are from bites, kicks and falls, with falls producing most of the injuries. These should be dealt with by first-aid principles and anyone involved in riding should take a first-aid course.
Regular competitors should have a psychoneurological baseline to assess recovery from any concussion. Point-to-point racing with its enthusiastic amateur jockeys and highly trained horses has a very high severe injury and death rate (see: Head warning, page 51). As thigh strength is so important, training the quads muscles while off the horse is invaluable. Tracking knee problems may prove particularly troublesome for those wanting to ride competitively and will need medical help. Some adjustment of stirrup length might help. Adductor muscle strains and acute tears can occur when jumping. Indeed, bony spurs are reported in the muscles of riders. Any technical faults can lead to strains and, if they unbalance the horse, result in falls and poor dressage. It is particularly important when the rider is recovering from an injury not to rush back onto the horse. Get yourself fully fit again or take the consequences of unbalancing the horse.
FENCING
Endurance, strength and flexibility are all required to get to the top. Equipment must be checked frequently (especially masks) because any defect can result in injury. However blunt a sword may look, the lunging force behind it is considerable, and penetration of a face mask can be fatal. Look for signs of rusting on your face mask (caused by regularly breathing on it) and always strap on gear properly. If you are an occasional fencer, increase your range of movement by stretching properly. In competition, repeated bouts are tiring, because fencing suits result in high fluid loss. High-glucose fluids, special fluid energy drinks or plain water will maintain fluid balance and blood sugar levels and put off fatigue. Knee problems from lunging can be both tracking or overload.
FOOTBALL, AMERICAN
In a sport where size and speed are the dominant factors, it is vital to learn the correct way to block and tackle, or risk an injury. A big, powerful runner may well cause injuries purely because at the school, or even at college level, there is an inequality of size. Awkward falls are almost inevitable. Ligament sprains result from twisting, sidestepping movements. Using knee braces to prevent injury does not seem as successful as wearing braces on the ankles. Major improvements in helmet design give more protection, while supportive collars have reduced neck injuries, but stingers and burners are still a problem. Because size and strength are so important, many injuries are triggered in the gym due to overenthusiasm in training, producing overuse injuries from excessive weight training.
Jersey finger is common to other sports too. A quick grab at a player as he rushes by can result in a tear of the tendons and will require surgery to the top joint of the finger. Adductor strains that do not settle may be footballer’s groin ( conjoined tendon), which requires experienced medical advice. Falls on the shoulder often cause shoulder separation or A/C joint disruption and shoulder dislocation can occur in tackles.
See: Soccer.
GOLF
