News & Articles

Dead Leg

A very common injury in contact sports is the aptly named “dead leg”. This injury is also known as a “charley horse”, a “cork thigh” or a “quads contusion”. What a dead leg is essentially is a traumatic blow to the quadriceps muscle, which is the muscle at the front of your thigh, or to the iliotibial band, which is a layer of very strong tissue on the outside of your thigh. The impact crushes the muscle against the underlying bone and causes bleeding with varying levels of muscle and tissue damage. Many people who sustain a dead leg attempt to continue playing in an effort to “run it off”. This is not very sensible as all it does is cause an increase in the bleeding in the muscle making recovery much slower and running the risk of possible permanent disability. While dead legs are a very common injury what most people do not realise is that a dead leg can also be a serious injury. The quadriceps muscle is a very big muscle and had a large blood supply. Because of this a lot of bleeding can occur and this increases even more if the muscle is being exercised at the time of the injury. If the bleeding is deep in the muscle a pocket of blood forms called a haematoma. Usually the body reabsorbs this blood over time but occasionally they do not disappear and require surgical removal.  If the trauma is of a large enough force and damages a blood vessel the bleeding can be severe enough to cause one of the compartments in the thigh to fill with blood. This rarely occurs but can be very serious. The most important thing to do with a dead leg is to control the bleeding. This is done by stopping activity immediately and icing the area. This decreases the amount of blood going to the area and minimises bleeding. It’s best to ice for 20 minutes every hour in the initial stages. The area should also be compressed with an elastic bandage. The importance of it being elastic lies in the fact that it can expand slightly if the bleeding continues which is very important to stop tissue and nerve damage. Apart from ice, rest, elevation and compression it is important to begin gently contracting the muscle with the knee straight and holding the contraction for a few seconds. It’s important that it’s done pain-free. This serves to have a pumping effect on the bleeding and helps the body get rid of it. It also prevents muscle wasting. It’s vital in the first 48 hours of a dead leg not to stretch the injury or do any form of massage on it. This can lead to a problem called myositis ossificans developing. This is potentially a very serious condition in which bone can develop within the muscle and can require surgery. The dead leg is a common injury and will heal properly in most instances if the correct measures are taken. If neglected, however, it can have serious repercussions. For further information contact the chartered physiotherapists at Sportsplus Physiotherapy and Rehabilitation Clinic, 25 Quintin’s Way, Nenagh, 067-42837.
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Shin Splints

The term “shin splints” refers to a group of problems that manifest as pain down the front of the lower leg between the knee and the ankle. This pain is usually exacerbated by exercise and eases with rest. People who are on their feet for long periods, who partake in long distance runs and people who wear inappropriate footwear are more predisposed to the condition but occurrences have been recorded in a wide variety of sports, in dance and in general activity. Of this group of pathologies medial tibial stress syndrome (MTSS) is the most common accounting for an estimated 15% of all running injuries. It’s an overuse injury identified by pain down the inside of the shin. It usually follows a pattern in the initial stages of pain at the start of exercise which eases as the exercise goes on and returns once the exercise is over. As the condition progresses, the pain can be present for the duration of the exercise, eventually making it impossible to exercise at all. This condition affects women more than men and can arise for a variety of reasons including taking on too much activity too quickly, incorrect footwear, exercising on hard surfaces and biomechanical problems. Treatment for this condition involves rest from the exercise that causes pain, correction of foot position if required, massage and stretching of the leg muscles, and icing with or without anti-inflammatories to settle inflammation. Stress fractures are another cause of shin pain and occur in bones that are subjected to repetitive trauma to an extent that causes the bone to fail. What happens is that the bone cells are broken down at a faster rate than the body can lay down new ones and, over a period of time, the bone can develop microfractures. Stress fractures present initially the same way as MTSS described above. As time passes this pain worsens and is eventually present during daily activities. The best way to diagnose a stress fracture is with a bone scan. Treatment of a stress fracture is with rest and anti-inflammatories but more severe cases may require casting or a walker boot. Females are much more prone to sustaining stress fracture than males. The third condition which I want to tell you about that can cause shin pain is compartment syndrome. The lower leg is divided into 5 compartments which are separated by inelastic dividers called fascia. Muscles are contained in each of these compartments. During exercise if the pressure in any of these compartments increases beyond a certain level blood flow to the muscles is impeded and pain, cramping, burning or numbness can occur. Compartment syndrome is diagnosed by testing the pressures with a device that uses a needle inserted into each compartment immediately following exercise. Severe cases may require surgery. The bottom line is don’t take shin pain for granted. Although it may not be stopping you exercising at present you could be heading for a much more serious problem down the tracks. The important thing is to get an accurate diagnosis initially to determine which condition is causing your “shin splints” and to treat it appropriately. For further information contact the chartered physiotherapists at Sportsplus Physiotherapy and Rehabilitation Clinic, Quintin’s Way, Nenagh, 067-42837.
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RICE

The RICE protocol is commonly used to treat sports injuries in the first 48 hours following injury. Ligaments, tendons and muscles are referred to as the bodies ‘soft tissues’. When soft tissues get injured through whatever means they bleed to different extents depending on the blood supply to that particular tissue and the structures around it.  An inflammatory reaction is also triggered in the area. These two events combine to cause swelling.  If this swelling is not controlled it can further contribute to tissue damage by causing what is known as secondary hypoxic injury. What this means is that the tissue is denied its supply of oxygen and this is not good news! The aim if the RICE protocol is to control swelling and minimise further tissue damage. It does this by reducing blood flow from blood vessels around the injury and decreasing fluid coming from the damaged cells. If done correctly and in time it can considerably shorten recovery from injury.  Before anyone runs for the Uncle Bens it should be explained that RICE stands for Rest, Ice, Compression and Elevation. Each of these plays an important role in immediate injury management as follows. Rest, you would imagine, should be the first thing someone with an injury does but unfortunately this word does not feature in the vocabulary of most GAA players. Rest infers that the injured party immediately stops what they are doing in an effort to prevent further damage. All too often the first reaction of the injured person is to try to play on for a few minutes and see how it goes. Just because the pain may settle a little as someone plays on with an injury this does not mean that the injury is suddenly disappearing. It means that you are over-riding the pain stimulus through physical and mental processes. If the rest part of RICE is not adhered to the injury will be inevitably prolonged. Ice is the most widely used treatment modality for acute sports injuries. It can be applied in various ways which include an ice pack, a cryocuff, submerging the area and using carbon dioxide gas. These methods all have the same aim which is to reduce the temperature of the injured tissues. This causes the blood vessels to narrow which reduces the amount of blood going to the injury site which in turn reduces the swelling. Ice also reduces the pain by over-riding the nerve endings that transmit pain. Ice reduces muscle spasm and decreases the chances of cell death by slowing the metabolism of the injured cells. Ice should be applied for 20 minutes every two hours for the first 48 hours following injury. Icing for longer runs a risk of cell death so should be avoided. Compression following injury is actually a more important component of RICE than ice. Compression applied properly helps minimise swelling. It is really important not to apply compression too tightly as this too can cause further damage by cutting off circulation completely. Compression should only be applied using an elastic bandage so it can expand slightly if the swelling continues. The ideal scenario is to compress the area with something such as a cryocuff which allows the area to be cooled at the same time. The final component in RICE is elevation. This also aims to reduce swelling by raising the area above the level of the heart to minimise blood flow to it using gravity. This can also decrease pain by decreasing the pressure on the area. The injured area should be elevated as much as possible during the first 48 hours following injury. In an ideal world an injured player will come off immediately when injured, will have an ice bag and an elastic bandage in their gear bag, will compress and elevate the area as much as possible for the first 48 hours and will ice the area for 20 minutes every two hours following the injury. Recent research has suggested that avoiding anti-inflammatory medication for the first 48 hours following injury is also a good idea as it impedes the initial healing reaction.
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It’s all in his head

It would seem to me that Ireland has an amazing number of psychologists circulating at present and that most of them arrange to meet at GAA matches every weekend, (and I’m not talking about the four men in white coats that stand beside the goals). You’ll rarely attend a game during which you won’t hear, “his head isn’t right”, “that lad has nothing upstairs” or “all he needs is a shot of the magic bottle”.  Could it be that people are becoming more aware of the role of psychology in sport? Psychology is an aspect of sport that has been growing rapidly over the past few years and one which has many facets. It can help athletes manage their emotions in pressure situations, help them bounce back from defeat and teach them how to handle success. It can facilitate relaxation, motivation, leadership and goal setting.  Psychology can improve technique and performance through visual imagery. It plays a major role in helping athletes maximise their potential as individuals while working as part of a team. One of the areas that psychology overlaps with physiotherapy is in the area of injury management. Every athlete, whether competitive or recreational, will experience injury of some level at some stage.  While it is important to treat the physical aspect of the injury it is also important to address the psychological aspect. For professional athletes any injury that rules them out of their routine of training and playing can be extremely traumatic and can raise issues of loss of self worth and identity. On the other hand, injury to the recreational athlete can be equally traumatic for different reasons. It can remove them from their social circle and can rob them of their mechanisms for stress relief. Many factors can influence how somebody copes with injury. These can include previous injury, the severity of the injury, the position of the athlete on the squad, the type of sport, the reaction of team management and team mates, and the social structure of friends and family around the athlete at the time. Whether the injury is mild or severe, or whether the athlete is recreational or professional the individual’s mechanism to deal with the injury is similar. It is extremely important for the physiotherapist working with the athlete to be aware of this if the athlete is to recover optimally. It is also important for the athlete to be aware of how they react to injury and, it can also be beneficial for those close to the athlete to be aware of the coping mechanisms that occur in response to injury. Scientists have discovered that the coping mechanism that people employ to deal with serious injury is very similar to that used by people when grieving or dealing with a serious loss. There are five stages identified that an individual will go through. The first is denial and isolation. This manifests as a reluctant to accept the injury. The athlete may be reluctant to talk about the injury and may withdraw from friends and family. The athlete can feel very alone in this stage and a support structure is very important. The second stage is anger. This is where the finger begins to be pointed either at themselves for allowing the injury to happen or at others for their part in it. This can be an extremely difficult time for all concerned. The third stage is one of desperation. The athlete will try to speed up their return to sport by bargaining with anyone in a position to change their circumstances. Statements such as, “Just let me play the first 20 minutes”, or “I promise I’ll rest for two weeks after the match” are common at this stage. This is also the stage where an athlete may seek several different opinions on their injury in an attempt to get a better prognosis. The fourth stage is depression. The athlete enters a state of self-pity and can only focus on the negative aspect of the injury. A sense of dread fills them. Athletes often worry about never being able to return to their level of sport or never getting the chance to play in another final again. Positivity is the most important thing for the athlete at this stage. Coaches, team mates, friends, family and therapists all have an important role to play here. The fifth and final stage of the process is acceptance. The athlete finally realises the reality of the situation and can begin to focus on rehabilitation. An athlete can spend different amounts of time in each of the five stages depending on the maturity of the athlete and how well informed the athlete is of the injury. It is imperative to educate the athlete in all aspects of the injury and the rehabilitation involved. The athlete needs to be involved in planning the rehab and goal setting. If the athlete feels that they have a level of control in the situation they will reach the acceptance stage much more quickly. By addressing the mental aspects of injury much of the stress involved can be removed from the athlete. This facilitates an optimal recovery in terms of time out of sport and the physical and mental state of the athlete returning to sport.
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The Dreaded Cruciate

While, the events of Sunday September 5^th 2010 are last year’s news at this stage and a new leaf has been turned in Tipperary hurling, they will live long in the memories of Tipperary people at home and abroad. From an injury perspective, the three weeks leading up to the final brought the previously little known but widely dreaded anterior cruciate ligament (ACL) injury to centre stage. Not since Tiger Woods’ knee injury or Michael Owen’s hamstrings has an injury generated such widespread discussion and speculation across all sections of society. People who had undergone surgery and rehabilitation for six months or more had wondered why they had bothered and conspiracy theories were more plentiful than this weeks election flyers. So what is this ligament? What’s its function? Why does it get injured? What should one do if it does get injured, and most importantly, what can we do to prevent it getting injured? Ligaments join bone to bone and so they contribute to the stability of joints. The ACL is one of the four main ligaments of the knee and it joins the tibia (leg bone) to the femur (thigh bone). It attaches to the front part of the flat top of the leg bone and goes upwards and backwards to attach to the bottom of the thigh bone above. Where it attaches is important because how it is positioned means that it stops the leg bone sliding forwards on the thigh bone, twisting too much on the thigh bone and also stops your knee from straightening too far. A recent study on inter-county Gaelic football and hurling players shows that 12% of all injuries sustained were knee injuries. ACL injuries were the most severe in that players missed most time from sport with this injury. The ACL is torn most commonly in people between the ages of 14-29 years, probably because it is during these years that people are most active in sport. Several studies across several sports show that females are much more prone to sustaining ACL injury than males. The reasons for this are not fully understood. If the ACL tears, there are two ways to manage it. The first is surgery. This is usually done in cases where the individual is younger and wants to get back to participating in sports that involve twisting and turning. The surgeon replaces the ACL with a tendon, from under the kneecap or from the hamstring muscle group, and the athlete embarks on a long road of rehabilitation which can take from six months to a year depending on the sport. The other option is to undergo intensive physiotherapy and to try to build up the muscles around the knee, especially the hamstrings, so that they can provide extra stability around the knee and compensate for the deficient cruciate. This is usually done in more sedentary people and while it avoids costly surgery, the individual is much more likely to develop osteoarthritis in the knee due to the instability. ACL prevention programs are increasingly important in reducing both the occurrence of the injury and the costs involved in surgical management and rehabilitation to clubs. An example is the Santa Monica ACL prevention program which has been shown to reduce the injury in female soccer players. This program is a 15 minute training program done three times each week which focuses on different aspects of training. Programs need to incorporate warm up, stretching, strengthening, agility drills, balance work, plyometrics (jump training) and cool down. It would be a wise move for all squads to incorporate this into training sessions, especially for sports such as hurling, football, soccer and basketball, and especially for female athletes! For further information contact the chartered physiotherapists at Sportsplus Physiotherapy and Rehabilitation Clinic, Quintin’s Way, Nenagh. 067-42837.
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Injury prevention in GAA by John Casey MISCP MScSportsMed.

It’s the time of the year again when the dust is settling from club AGMs, the sales of boots is one of the few sales booming and GAA players are beginning to refuse the after dinner apple-tart.  Minds, if not bodies, are turning towards preparation for preseason training and texts with times and venues are beginning to circulate. The one thing uniting players from all clubs is that everyone is looking forward to a fresh 2011, starting with a clean slate and resolving to build on 2010s experiences. The importance of a good preseason program has been well documented.  It serves to prepare the body for games by promoting weight loss, muscle strengthening, flexibility, speed, stamina and power.  It also conditions the mind to be able to concentrate for the complete duration of a game and facilitates players in making correct decisions under fatigue and under pressure.  A solid, uninterrupted preseason program is vital to attain optimal performance in peak season.  As experienced players will tell you, there are few things more frustrating than an injury in the preseason period, as time out means being less well prepared when championship comes round. In my view many of the injuries sustained in preseason are avoidable. This can be done in two ways. Firstly the preseason program has to be uniformly progressive and very well planned. It must start at a low level and be ramped up slowly. The body adapts to stresses put on it but if the stress is too much, tissues will become overloaded and break down.  The difficulty with GAA preseason programs is that you may get 20 or more players training and all may be at different levels of fitness.  So with that in mind, and to keep all players injury free, the program must be either set at a level that accommodates the most challenged player, or be structured so that it allows players to work at their own intensity. The second way to avoid injury is to ensure that any weaknesses or asymmetries that exist in your body are addressed prior to embarking on a pre-season program. These may exist due to a previous injury which has not been rehabilitated fully or as a result of postural or occupational stresses. Imbalances in terms of strength, flexibility or movement can be easily identified by appropriately qualified health professionals through what’s known as a musculoskeletal screening process. This screening process can range hugely from a quick physical and functional assessment to an in-depth biomechanical analysis depending on the individual and level of sport the individual is competing at. Screening needs to also take into consideration past medical history and injury history, occupational stresses, playing position and stresses from other sports or activities the individual may be involved in.  Analysing the screening results allows a program of exercises to be drawn up aimed at addressing the individual issues the player may have, thus allowing full participation in preseason training with minimal risk of injury. These measures ensure that the days of recurrent injuries such as hamstring tears and ankle sprains are a thing of the past and that players are truly beginning 2011 with a clean slate. As gaelic games are evolving the focus must change from injury management to injury prevention. If you require any further information feel free to talk to the chartered physiotherapists at Sportsplus Physiotherapy & Rehabilitation Clinic, Quintin’s Way, Nenagh 067-42837.
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