What is Considered a Sports Injury?

A sports injury is any condition that is commonly associated with involvement in general fitness, recreational activities and training/competing in athletic events.  Sports injuries are either “Traumatic” or “Overuse”

in nature.  Traumatic injuries occur as a result of an immediate overload to your body and can be associated with a specific event.  An example would be, “Two weeks ago I stepped in a hole while running and twisted my ankle.”  Overuse injuries occur as a result of a repetitive overload to your body and are not associated with a single event.  An example would be, “The outside of my knee started hurting about 6 weeks ago but has gotten worse in the last two weeks.  It now hurts to run and go down stairs.”

Do I Have to be an Athlete to have a Sports Injury?

Sports injuries are commonly associated with athletes but you do not have to be an athlete to have a “Sports Injury.”  All you have to be is an active individual to sustain a sports injury.  They will occur chasing children, working around the house, moving furniture, getting back into working out, changing your workout program, playing a recreational sport, participating in endurance sports (running, triathlons, cycling).

How Common are Sports Injuries?

If you are active or participate in sports long enough, sustaining a sports injury is inevitable.  To give you an idea of how common sports injuries are, if you are active or participate in sports you have more than 80% chance of sustaining a sports injury within the next 12 months. 

What are the Most Common Sports Injuries?

Contrary to popular belief, the large majority of sports injuries are Overuse in nature.  The most common overuse sports injuries include, but are not limited to:

1. •Spinal Disc Herniation (Sciatica)

   

   
   

2. •Spinal Facet Syndrome (Pinched Nerve)
   

3. •Sacroiliac Dysfunction
   

4. •Iliotibial Band Syndrome
   

5. •Plantar Fasciitis (Heel Spurs)
   

6. •Shoulder Impingement Syndrome (Rotator Cuff Syndrome)
   

7. •Patellofemoral Syndrome (Runner’s/Jumper’s Knee)
   

8. •Lateral Epicondylitis (Tennis Elbow)
   

9. •Medial Epicondylitis (Golfer’s/Pitcher’s Elbow)
   

10. •Thoracic Outlet Syndrome
    

11. •Scapulothoracic Syndrome (Shoulder Blade Pain)
    

12. •Shin Splints
    

How Do I Recognize a Sports Injury vs. Muscular Soreness?

Sports injuries are easy to distinguish from muscular soreness by using the “Two Day Rule” of thumb.  Here is how you use it; if you are hurt the day after being active and it gets better over the next two days.  This is called “Delayed Onset Muscle Soreness” or DOMS in sports medicine.  It is your body’s normal response to doing something more than it is use to.  It is normal and natural for your body to recover within 48 hours (Two Days).  If you do not progressively heal and recover from your activity within two days or if it comes back with activity, it is more than DOMS.  It is a sports injury.

What is the Difference in a Sports Injury and Muscular Soreness?

DOMS is the soreness and stiffness associated with the normal repair and rebuild process of your muscles.  It is your body’s way to getting ready and preparing for the next time you do the same activity by becoming more fit.  You have had this experience before, the day after doing a new activity or changing up your workout.  Eventually, if you repeat this same activity over a 4-6 week period your muscles will no longer have DOMS and your fitness level with plateau as a result.  The difference with a sports injury is that there is an excessive overload placed not only on the muscles but also the tendons, ligaments, cartilage and bone, in which the body struggles to cope and repair from.  Excessive inflammation and tissue adaptations and compensations are the result of this excessive overload.  You can think of this as the difference between a fire in the fireplace and one that turns into a house fire.  Activities that cause DOMS are safe but activities that drive your body beyond DOMS are destructive to your body’s structural integrity.

What Causes a Sports Injury?

Sports injuries are caused either from an immediate overload or repetitive overload to the tissues in your body.  As we discussed previously, the majority of sports injuries arise from repetitive overloads.

How Does My Body Initially Respond to a Sports Injury?

Your body initially responds to a sports injury with inflammation, swelling and pain.  This is a call to your body’s repair cells to rush to the area to repair, heal, protect and eventually strengthen the tissue against reinjury.

How Does My Body Naturally Heal and Adapt to a Sports Injury?

Your body is incredibly intelligent when you abuse it.  Much like painful experiences in life, your body learns to avoid painful experiences from overload and overuse.  The initial Inflammatory Phase is meant to be painful and uncomfortable to alert, warn and eventually stop you from continuing to do what caused overload and damage in the first place.  The Inflammatory Phase is followed by the Repair Phase, where any damage is repaired and replaced with a less structurally sound, weaker tissue which will eventually be made more structurally sound and solid during the Remodeling Phase.  Each of these phases has their time frames for completion but you can get stuck in anyone of the phases if you reinjure or hamper the normal process and progression of healing.

Example of a Sports Injury Timeline: 

    Medial Collateral Ligament (MCL) Injury*

1. i.0 - 30 min:  Injury/Degeneration
   

2. ii.0 - 36 hrs:  Coagulation/Platelet Plug
   

3. iii.2 hrs - 2 wks:  Inflammatory Phase
   

4. iv.48 hr - 6 wks: Repair Phase
   

5. v.3 wks - 2 yrs:  Maturation/Remodeling
   

*6 wks:  Tensile strength of healing tissue “relatively” normal

More Details on Phases of a Sports Injury:

1. 

   I.Inflammation: This initial phase lasts 72 hours or more.  The sports injury irritates or tears body tissues, particularly the small blood vessels called capillaries.  This results in pain, swelling and damaged tissue in between healthy tissue.  With the oxygen-carrying capillaries damaged, an oxygen-poor (hypoxic) environment is created.  The immediate response is from cells that require little oxygen, such as mast cells, macrophages, and granulocytes (The immune system’s "clean-up crew").   Visible signs such as swelling, redness and pain may or may not be present at this time.
   
2. 

   II.Repair & Regeneration:  This phase lasts up to six weeks or more. The early part of this phase is concerned with capillary restoration and the cleanup of the debris.  Macrophages and granulocytes devour debris (similar to the cleaning crew on a construction site) as the capillary system regenerates and bring oxygen and nutrients back into the injured area.  Once there is available oxygen, collagen proteins are necessary to bridge the gaps in the soft tissue created by the injury and clean up.  Unfortunately, instead of being a strong, flexible criss-cross pattern of the original tissue, this repair tissue is characterized by a weaker, stiffer and more pain-sensitive, rope-like pattern (aka “scar tissue”).
   
3. 

   III.Remodeling: This final phase of healing lasts up to 12 months or more.  In this phase, collagen is remodeled to increase functional capabilities in the healing region.  It is important that controlled motion be introduced during this phase.  When motion is introduced, the collagen fibers will slowly arrange themselves more like the original pre-injury tissue.  Motion also minimizes the weakness, stiffness and pain-sensitivity of the healing tissue.  Each of the three types of motion has a role in the remodeling process: (1) Active Motion: You Move The Area, (2) Passive Motion: Someone Else Moves the Area and (3) Paraphysiological Motion: Getting the Joint to Move to End Range for Returning Full Flexibility.  The more complete the remodeling process, the less likely the you will suffer future aggravations or exacerbations of areas injured by the car accident.
   

What is R.I.C.E. Therapy and Why is it Not the Only Answer?

R.I.C.E. stands for Rest, Ice, Compression and Elevation.  R.I.C.E. is

beneficial because it helps keep the Inflammatory Phase from getting out of control.  If the inflammatory phase is a fire, R.I.C.E.  helps to keep it from burning the house down.  Rest means stop doing the activity that caused your inflammation (does not means stop all activity).  Ice is a fast and powerful anti-inflammatory.  Compression helps to squeeze the swelling and excessive fluid out of the region and Elevation helps keep the fluid from pooling up in your extremities.

What about NSAIDs or Cortisone?

NSAIDs are Non-Steroidal Anti-Inflammatory Drugs.  Examples of over the counter NSAID products are Advil and Motrin (ibuprofen), Aleve (naproxen) as well as Aspirin (acetylsalicylic acid).  Cortisone is a powerful anti-inflammatory steroid.  Both NSAIDs and Cortisone have wonderful anti-inflammatory effects if absolutely needed but come the hefty cost of slowing tissue healing time (longer recovery).  What does absolutely needed mean?  If R.I.C.E. is absolutely not working and the inflammatory phase is persisting longer than 2 days, then NSAIDs and Cortisone can be used as a last resort.  If that persist longer than necessary or normal we get greater breakdown and degeneration of tissue.  This is where NSAIDS or Cortisone comes in for as long as it takes to allow R.I.C.E. to start controlling the inflammation.  Most people will pop Advil regularly not knowing the downsides to full recovery.

What Happens if I Repetitively Overload My Body?

Just like you, your body is smart.  It learns very quickly to avoid painful situations and to keep them from occurring again.  This is where your body learns to adapt and overcome the repetitive overload.

How Does My Body Adapt in a Repetitive Overload Situation?

When your body is overloaded, muscles can fatigue and develop trigger points.  This is the most common adaptation to repetitive overload we see in our clinic.  A trigger point is a small, tender, nodule located inside a muscle.  Trigger points cause muscles to dysfunction by weakening the muscle.  When one muscle weakens, another muscle takes over and pulls the extra load.  It accomplishes this by overcompensating for the weaker muscle. 

When the over compensating muscle shortens and pulls harder, it shifts your normal biomechanics or body mechanical alignment.  When your biomechanics shift, it starts to overload another set of muscles.  Then the adaptation process occurs all over again. The weakness/overcompensation/biomechanical shift pattern is called the adaptation process or more commonly known as muscle memory.  Your muscles are memorizing the overload situation and trying to adapt, overcome and avoid the overload.  This would be a fortunate situation if that is all that occurred but unfortunately, this memorized pattern causes another overload situation to another set of muscles which caused another muscle memory pattern.  Sound like a domino effect?  You’re right, that is exactly what happens.  When these adapted muscle memory patterns persist long enough, they eventually cause wear and tear to the joint cartilage, which leads to joint degeneration.

Why is it That Overtime My Area of Pain Has Seemed to Move?

Have you ever noticed that your pain use to be on one area and then down

the road it shifted to another area.  This is a result of the domino like effect we were talking about earlier.  Most people will not connect the dots but if we question people enough, they eventually remember that long ago they use to have ankle pain and then started dealing with more shin splint pains, then knee, then hip, and eventually low back pain.  The song is really true!!!  “The Knee Bone’s Connected to the Thigh Bone!”

Why is it That I Seem to Be Getting More Prone to Injury?

With enough time passing and multiple muscle memory patterns setting up, your body becomes wound up.  Think about your body as a rubber band.  As you twist the rubber band at one end while the other is held stationary, it starts to spiral on itself.  Those spirals are muscle memory patterns.  If you keep twisting you will get kinks, which are overuse injuries.  If you keep going, eventually it snaps; that is when tissues tear and have to be surgically repaired.

Why is it That My Pain is No Longer Going Away on its Own?

Once your body adapts and learns these muscle memory patterns, they become hard-wired and locked in your biomechanical memory.  That means the strength, flexibility and biomechanics your body use to have is no longer possible.  You are locked into the “muscle memory” of your body unless you find the right combination of therapies to “unlock” and “reeducate” your muscles. You have to remember this pattern your body has gotten locked into is just like a combination lock.  If you have enough time, energy and money to try every combination possible, you will eventually figure out the combination to unlock your muscle memory adaptation patterns.  Most people will search, hunt, invest time and money into looking for the correct combination of therapies to unlock their body.  They will try their medical doctor, massage, acupuncture, yoga, Pilates, chiropractic and various self therapies (braces, wraps, foam rollers, bosu balls, etc).  Most of these professionals and therapies will only offer temporary, short-term results if nothing at all.  Most people are left frustrated and hopeless. 

Why is it That No One Has Been Able to Give Me an Accurate Description or Explanation of My Sports Injury?

Sports injuries are multifactor in nature.  That means there are “culprits” and a “victim”.  The culprits are the multiple causes or factors that cause injury to a specific tissue (the victim).  When you get a standard diagnosis it is identifying the victim and not the culprits.  A few examples are  IT Band Syndrome, Sciatica, Plantar Fasciitis, Rotator Cuff Syndrome, Tennis Elbow, Patellofemoral Syndrome, Shin Splints, etc.  All of these injuries have several culprits, which means there is no one “sliver bullet” that will fix these injuries.  There are multiple muscle memory adaptation patterns involved that caused the injury.  So to explain your injury means explaining how it worked its way from the ground up and locked up your biomechanics.  It means fitting all the puzzle pieces together until you can see the complete picture.  This means fitting pieces that once seemed unrelated but when brought closer together you see that they fit and go together.  Once you understand where your injury came from and the path it took, you can then plan an accurate road map to get your body back to where it once was.

Why is it That I Have Not Gotten Full Resolution with Long-Lasting Relief from My Sports Injury?

If all you do is treat the location of your symptoms, the “victim”, you will only have temporary relief at best.  Unlocking and reeducating the muscle memory adaptation patterns, the “culprits”, which restore proper and ideal biomechanics to your body,  is the only way to achieve long lasting relief and resolution form your sports injury.  Unfortunately, most treatments and therapies are focused on the victims and not the culprits.

What Do I Need to Do to Fully Resolve My Sports Injury?

To fully resolve your sports injury you need to find all of the culprits that are causing your sports injury.  Once all of the culprits are identified, then you can systematically set out eliminating these culprits one by one until you are completely free from dealing with these culprits.  Culprits can be overcompensating muscles, trigger points, myofascial adhesions, joint restriction, ligament laxity, biomechanical issues, abnormal flexibility, inadequate balance, lack of strength, lack of endurance, shoes, bike set up, running technique, sports technique, strength training technique, stretching technique, and the list can go on and on.  Each sports injury has its own unique list of culprits.  Once the culprits are identified, eliminated and reeducated, not only does the sports injury resolve immediately but also never returns.  It is officially unlocked from your body.

How Do I Find Professional Care That Will Fully Resolve My Sports Injury?

You must find someone who knows how to accurately diagnose the victim, your sports injury, plus the culprits of your sports injury.  They also must be able to explain it to you by fitting all of the puzzle pieces together so it makes an understandable complete picture of what is going on, why it is there and what needs to be done about it.  The best way to find this professional is to call their office and ask for a complimentary 15 minute phone consultation so you can ask them some questions to see if they are the right health care profession for your condition.

What Questions Should I Ask to Evaluate a Healthcare Professional (Print & Use as Check List)?

1. Do you specialize in Repetitive, Overuse Sports Injuries?
   

2. What is your background in treating these types of sports injuries?
   

3. Do you currently take care of these same injuries with any professional or collegiate athletes?
   

4. Are you currently an athlete yourself?  What sports are you personally training for and competing in right now?  In the past?
   

5. Do you understand what it feels like to have sports injuries?
   

6. What credentials do you hold as a sports injury specialist in your field?
   

7. For Medical Doctors:  Are you a “Fellow in the American College of Sports Medicine (FACSM)”?
   

8. For Osteopaths:  Are you a “Fellow in the American Osteopathic Academy of Sports Medicine (FAOASM)”
   

9. For Chiropractors:  Are you “Certified from the American Board of Chiropractic Sports Physicians (CCSP or DABCSP)”
   

10. For Podiatrist:  Are you a “Fellow in the American Academy of Podiatric Sports Medicine (FAAPSM)”
    

11. Other Important Credentials:  Certified Strength & Conditioning Specialist (CSCS), Certified Applied Kinesiologist (ICAK), Certified USA Triathlon Coach (USAT).
    

12. Do you teach for your profession in the field of sports injuries?  Who do you teach for?
    

13. Can you email me your professional resume (a.k.a. Curriculum Vita) so I can see your professional training and continuing education you have done?
    

14. Will you spend at least 45 minutes taking a compete history and examining my sports injury?
    

15. Will you evaluate and test for any nerve damage or nerve compression?
    

16. Will you evaluate and test for any orthopedic or degenerative conditions?
    

17. Will you be checking my structural alignment?
    

18. Will you be checking the biomechanics of my joints?
    

19. Will you be checking my flexibility and range of motion?
    

20. Will you be checking the functional strength of my muscles?
    

21. Will you be checking for muscular trigger points?
    

22. Will you be checking for muscular overcompensations?
    

23. Will you be checking for myofascial adhesions?
    

24. Will you be checking my shoes and giving me a shoe prescription that is accurate for my biomechanics?
    

25. Will you be taking X-Rays or MRI’s to confirm your diagnosis or rule out anything unexpected?
    

26. Will you be spending at least 30 minutes with me to explain and help me understand all of the results of your examination?
    

27. What happens if you are not the “Best” at treating my particular injury?
    

28. Will you be giving me a detailed written treatment plan with (1) the exact number of treatments, (2) what will be accomplished on each visit, (3) what I should expect and (4) the total cost of my care?
    

29. Do you have a goal or purpose for each treatment I receive?
    

30. Will I notice any results after my first treatment?  With every treatment?
    

31. How will you know if I am making progress?  How will I notice?
    

32. Will you be teaching me exercises and stretches that will keep this condition from ever coming back?
    

33. Will your exercises train and improve my balance, coordination, stability, strength and flexibility?
    

34. Will your exercises be given to me in a staged progression as to overcome the “Plateaus” and allow me to keep making progress and improvements in balance, coordination, stability, strength and flexibility?
    

35. Will you be making sure I am comfortable with and know these exercises and stretches?  Will you be making sure I am doing them correctly?
    

36. How will you know when I have “Arrived” (a.k.a. finished my care)?  How will you be sure I will not go back into having this injury again?
    

37. How confident are you about treating and fully resolving my condition?
    

38. Do you have a list of patients who are willing to talk to me about your care and your treatment methods?
    

39. Do you have patient testimonials I can read?
    

40. Will I have direct access to you through email and/or mobile phone in case I have questions or concerns?
    

41. Will I be able to schedule online appointments or check my appointment schedule after hours and on the weekends?
    

42. Do you guarantee all your care/results?  In other words, what will you do for me if I pay for and go through your care with little or no results?  What if I am not satisfied with your care, what will you do for me?
    

43. Do you have financing options for your care?  Is there a discount if I pay with cash or check?
    

What Should I Expect from My Healthcare Professional?

You should expect your healthcare professional to spend time listening to you, evaluating your condition and all of the possible causes, spend time explaining to you and helping you understand what is going on, what caused it, what can be done about it, how long it will take and how much it will cost.  You should feel well educated about your condition and understand it better than ever.  You should also be able to have direct access to your provider to ask them questions as you think of them (ask for their email address or mobile number).  You should ultimately feel confident in your provider’s knowledge of your condition, treatment plan and guarantee of resolution.

Where Can I Learn More About Specific Sports Injuries?

The Physician & Sports Medicine Journal:

1. •Managing Overuse Injuries: A Systematic Approach
   

2. •Overuse Injuries in Children and Adolescents
   

3. •Delayed-Onset Muscle Soreness: Work Out Now, Pay Later?
   

4. •Identifying and Treating Myofascial Pain Syndrome
   

5. •Overuse Tendinosis, Not Tendinitis:  Part 1: A New Paradigm for a Difficult Clinical Problem
   

6. •Overuse Tendinosis, Not Tendinitis:  Part 2: Applying the New Approach to Patellar Tendinopathy
   

7. •Hip and Pelvis Injuries in Runners
   

8. •Overtraining
   

9. •Overtraining Syndrome:  A Guide to Diagnosis, Treatment, and Prevention
   

10. •Overtraining Syndrome:  Why Training too Hard, too Long, Doesn't Work
    

11. •Knee Pain and Bicycling:  Fitting Concepts for Clinicians
    

eMedicine:

1. •Overuse Injury
   

AAPSM:

1. •Overuse Knee Injuries: Evaluation and Management
   

AOSSM:

1. •Overuse Injuries
   

Last Note:

We trust this report has provided some valuable information and insights into this complex, yet common topic.  We hope we have answered most of your questions.  We also trust that you have learned enough and have enough information at your disposal to make an informed and educated decision for yourself.  You know where we are, what we can do and how to get a hold of us.  We would be honored to help you if you ever need us.

Author:  Dr. J. D. Hasenbank, CSCS, CCSP - Sports Injury Specialist, Strength & Conditioning Coach & USA Triathlon Coach.  Founder of Spine & Sports Therapy and F.A.S.T. (Functional, Athletic, Sports Therapy).