Dr. Richard Palmer

As sporting participants or observers, we often hear a variety of terms used to describe sport-related injuries. Terms such as sprains, strains and tears are used to describe our aches and pains following a weekend of play. Following a series of these activities, we may describe these conditions as tendinitis or bursitis.

But what do these terms actually mean? Can the terms we commonly hear be used interchangeably? Unfortunately, these terms have specific definitions, and are often misused in describing various injuries. To begin, we will define various tissues involved in injuries:

TENDON: A soft tissue that connects a muscle to a bone. Examples include the rotator cuff tendons (shoulder) and the patellar tendon (knee).

LIGAMENT:A soft tissue that connects a bone to another bone. Ligaments are responsible for providing stability to a joint. An example is the anterior cruciate ligament (knee).

BURSAE: Fluid filled sacs that decrease friction between a bony prominence and a tendon or muscle. Most joints contain one or more bursae.

CAPSULE: A thickening of tissue that surrounds a joint to provide stability, and help maintain joint congruence during movement.

CARTILAGE: Articular cartilage lines all joints in the body to decrease force loads, provide smooth movement, and to help control motion.

The following are terms used to describe soft-tissue injuries:

SPRAIN:A stretch or tear to a ligament and capsule when a joint is moved beyond its normal motion.

STRAIN: A stretch or tear to a muscle or tendon.

Sprains and strains are graded on severity:

1st Degree - A stretching and/or micro-tear of tissue
2nd Degree - A partial tearing of tissue
3rd Degree - A complete tear of tissue

TENDINITIS - An inflammatory condition of a tendon. This usually occurs gradually, secondary to related overuse. Muscular weakness will often result in breakdown of the tendon following related activity. Tendinitis pain is primaril y present with active or resisted movements which involve the muscle and tendon.

BURSITIS - An inflammation of a bursa following repeated movement. Both active and passive joint movement may elicit bursal pain.

TENOSYNOVITIS - An inflammation of a sheath covering a tendon. A crepitus, or grinding feeling, may be present in addition to pain with movement.

Inflammatory conditions of muscles and tendons are often associated with overuse syndromes . Repetitive acts (i.e. throwing, weight lifting, typing, etc.) can lead to muscular fatigue. As the muscle fatigues, it becomes less able to absorb the forces and demands being placed on it, thus more stress is placed on the tendons, and tendon/bone junctions. This repetitive microtrauma breaks down tissue over time resulting in the overuse condition. These syndromes are treated through a combination of specific strengthening and stretching activities, anti-inflammatory medications, and physical modalities.

Specific treatments to injuries vary depending on injury mechanisms, severity, and types. In general, a conditioning program specific to your activity demands will assist in preventing serious injury. Future topics will include more common athletic injuries, their prevention, and their treatment.

Ankle Sprains

By far the most common injury in basketball is the inversion ankle sprain. A "sprain" refers to over-stretching or tearing of a ligament. A " strain," on the other hand refers to an over-stretching or tearing of a muscle or tendon. A ligament is a connective tissue that connects bone to bone. An inversion ankle sprain occurs when the ankle turns in and too much force is placed on the ligaments holding the ankle bones together. The ligaments on the outside or lateral side of the ankle are small and thin.

This fact predisposes the lateral ankle to injury. Sprains usually occur when an athlete comes down on another players foot forcing the ankle to invert. There are three different degrees of ankle injury. A first degree sprain occurs when the ligaments are over-stretched. A second degree sprain occurs when approximately one half of the ligament tears. A third degree sprain occurs when the ligament tears completely. Depending on the type of sprain there will be different levels of swelling, discoloration and pain.

Another possible injury is an ankle fracture. There are two kinds of fractures. First, a bone fracture when a bone in the ankle breaks. Second, an avulsion fracture where the ligament is stronger than the bone and the ligament pulls a small piece of the bone away from the bone. Often the fracture will heal much stronger than an ankle sprain, depending on the type of fracture and the severity. The only way to detect an avulsion fracture is to see a sports medicine physician and get an X-ray. An X-ray is recommended if an athlete sprains an ankle for the first time. If the ligament was not previously sprained there is a greater chance of the ligament pulling a piece of the bone away from the bone and receiving an avulsion fracture. Even if the athlete has previously sprained an ankle and sustains a severe ankle sprain an x-ray can rule out a fracture.

In sports we know that injuries will occur. The fear of an injury should not prevent anyone from articipating in sports. The fear of an injury will only predispose an thlete to injury. Prevention s always the best policy. It is important to be in shape, increase trength, eat right, drink plenty f water, and always get plenty of sleep. These habits will help revent injury, but will not uarantee that an athlete will not sustain an injury.

The most important issue an athlete faces when an injury has occurred s the physical ehabilitation of the injury. As mentioned previously, once an injury ccurs, the chance of a econd injury occurring increases greatly, especially when it comes to nkle sprains. The initial reatment of an injury, depending on its severity, should be Rest, Ice, Compression,Elevation this treatment cam be remembered with the acronym R.I.C.E. this will prevent any further swelling of the area injured and allow for a more speedy recovery.

Once the initial swelling and pain have subsided, exercises need to be introduced. Many times the exercises are very specific to the injury so when an injury occurs it is recommended that the services of a Certified Athletic Trainer and/or Physical Therapist be sought. These professionals are highly trained in exercise methodology and will ensure the quickest recovery possible for the athlete. Strengthening the injured area will allow the tissues to heal as close to their original state as possible. Thus helping the athlete return as quickly as possible to the court.

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