Spring Sports Injuries by Dorcas Eaves, M.D.

Spring sports are finally here!  Pain or injury will take the fun out of any sport.  I compiled a list of the most common injuries to help you and your family through the season safely.  This list includes treatment information and prevention tips.  Have fun and be safe!

HEAT PROSTRATION

Heat Stroke and Heat Prostration occur when the body cannot keep itself cool. When the body temperature rises too quickly and too high, illness and other medical conditions can occur. Heat Stroke is the more serious condition, but Heat Prostration is also significant.  Heat Prostration aka heat exhaustion occurs when the body is overheated by weather and/or physical exercise. The body’s temperature can reach up to 104 degrees.

SYMPTOMS:

• The skin may cool, flushed or clammy
• There may be excessive sweating, rapid pulse, headache, nausea and/or vomiting, dizziness, muscle and/or stomach cramps
• Elevated temperature, but less than 104 degrees

TREATMENT:

• Get the ill person out of the sun
• Replace the body’s fluids and salt by having the person drink lots of water, Gatorade, decaffeinated iced tea or juice
• Cool the person’s body with fans, cool towels, or sprays
• Keep the person out of the sun for the next 12-24 hours

PREVENTION:

• Avoid over exposure to extreme heat
• Wear sunscreen
• Drink plenty of water
• Limit physical exercise during high temperatures
• Wear light clothing

LEG SPRAINS and BREAKS

The most common types of injuries for all age groups are sprained or strained knee ligaments and/or muscles, torn cartilage in the knee, tendonitis, upper and mid leg fractures and ankle fractures.  

Sprained/Strained Knee Ligaments and/or Muscle:  A sprained or strained knee ligament/muscle is usually caused by a blow to the knee or a sudden twisting of the knee. This results in pain, swelling of the tissue of the knee and/or difficulty with walking. Your doctor may or may not order X-rays on the initial evaluation.

TREATMENT for mild symptoms:

• Non-steroidal anti-inflammatory i.e. Ibuprofen, Naprosyn
• Muscle strengthening exercises
• Brace for use during exercise
• Ice pack application to area to reduce swelling

Leg Break:  Immediate first aid treatment for a break consists of fracture stabilization, ice, elevation and evaluation by a physician. 

BLACK EYE

A Black Eye results from injury to the face or the head and is caused by blood and other fluids collecting in the space around the eye.  Most Black Eyes are relatively minor and many heal on their own.  As the Black Eye heals, the swelling around the eye decreases and the bruise gradually fades. The bruising will usually start out as a very dark purple and as is fades it may change to light purple, then greenish, then yellow before disappearing.

The most common cause of a Black Eye is a blow to the nose or forehead. The blow to the nose often causes both eyes to swell from the nasal injury and the fluid collects in the loose tissues around the eyelids.  A more serious cause of a Black Eye is head injury due to a Basilar Skull Fracture.  In this situation, the eyes have the appearance of “Raccoon’s Eye”. This is a more serious condition and should be evaluated by a medical professional in an emergency room.

TREATMENT:

• Ice to the site of injury for the first 3 days can decrease the amount of swelling

TO make certain there is no injury to the eye itself several simple maneuvers can be done:

1. Hold 1 finger in front of the individual and ask “How many fingers do you see”? The answer should be 1.
2. Ask the individual to follow your finger (one only) by only moving his/her eyes and not his/her head. Move the finger in front of the eye from left to right (or right to left) toward the ears then up and down (or down to up) toward the forehead and chin.
3. If the both eyes move in the same and equal distance in all directions, the probability of an eye injury is small.
4. If there is any discrepancy in the eye movement, the individual should be seen by a medical professional in an emergency room.

CONCUSSION

A concussion is a Traumatic Brain Injury that may cause headache, altered level of consciousness, or unconsciousness. It temporarily interferes with the way your brain works. It can affect memory, judgment, speech, balance, coordination, reflexes, and sleep patterns.

In baseball for example, concussions can be caused by a bad fall or being hit in the head with a hard ball which causes a significant jarring of the brain. Usually there is a loss of consciousness (black-out) but there are also some conditions in which a black-out does not occur.

Symptoms can range from mild to severe. The following list represents mild to moderate symptoms that should be closely monitored:

• Altered level of consciousness e.g. drowsy, hard to wake up or similar changes
• Confusion, feeling spacey or not thinking straight
• Headache
• Loss of consciousness
• Memory loss of the events before or immediately after the injury (amnesia)
• Nausea and vomiting
• Seeing flashing lights
• Feeling like you have lost time

If any of the following symptoms occur seek immediate medical care. These symptoms represent a medical emergency:

• Changes in alertness or consciousness
• Convulsions (seizures)
• Muscle weakness on one or both sides of the body
• Persistent confusion
• Persistent unconsciousness
• Repeated vomiting
• Unequal pupils
• Unusual eye movements
• Waking problems

FOOT PAIN and INJURIES

Although foot injuries can occur from a variety of causes, the most common cause is trauma. Other causes include (1) rapid or improper warm-up, (2) overuse, (3) intense workouts, (4) improper footwear, and (5) playing on hard surfaces.  The most common type of foot pain can develop around and be centered on the heel of the foot. Common causes of heel pain are ill-fitting shoes, rapid or improper warm-ups, over use, and intense workouts. Injury can be prevented by appropriate stretching exercises before playing.

COMMON HEEL AND FOOT INJURIES:

• Heel Spurs-these are pointed boney fragments that extend from the heel of the foot and point towards the toes. As the fragments become very painful as they tear through tissue and nerves in the foot and pain becomes more severe
• Tears in the Achilles tendon along the back of the heel and ankle from repetitive or excessive stress
• Plantar fasciitis- the plantar fascia ligament runs the length of the foot develops a tear and becomes inflamed

SYMPTOMS:

• Heel pain in the morning especially when putting weight on the extremity after sleeping
• Tenderness and swelling at the site
• Localized pain
• Numbness and tingling

TREATMENT:

• Adequate warm ups before sports participation
• Rest of the injured extremity
• Proper athletic shoes for the designated sport
• RICE and ice/cold to the site to decrease inflammation
• Orthotic shoe inserts

FRACTURED/CRACKED TEETH

In sports, teeth are susceptible to being hit. Dental injuries include broken teeth, teeth totally knocked out of the mouth, or teeth displaced by unexpected external forces. These dental accidents may be associated with swelling of the gum and oral tissue. Tooth fractures can range from minor (involving chipping of the outer tooth layers called enamel and dentin) to severe (involving vertical, diagonal, or horizontal fractures of the root).

TREATMENT:

Cold packs or ice cubes placed either inside the mouth, directly above the injured tooth, or outside on the cheeks or lips, can reduce pain and swelling before the patient reaches the dentist.  Dental X-rays are necessary in most instances to diagnose, locate, and measure the extent of tooth fracture.

PREVENTION:

• Face masks and mouth guards
• Aligning protruding front teeth by dental braces

DENTAL INJURIES AT A GLANCE:

• The most important variable affecting the success of reimplantation of a tooth that is knocked out is the amount of time that the tooth is out of its socket.
• Care should be taken to handle the knocked-out tooth only by its crown and not by its root.

JAW FRACTURES

Breaks are generally the result of a direct force or trauma to the jawbone.  Sports injury from balls or kicks, or from sliding or falling down during play, are also a common source of injury. Since baseballs are flying during a game, it is possible for the ball to hit the child’s jaw from the side or face forward.  Unfortunately, even mouth guards won’t provide protection.

SYMPTOMS:

• Jaw Pain
• Malocclusion (when teeth don’t fit together correctly) 
• Numbness of the lip or chin
• Unable to open jaw all the way, have problems speaking, or notice swelling of the jaw
• A cracked tooth or missing teeth
• Bleeding inside mouth
• Bruising under tongue
• Cut in the ear canal due to movement backward of the broken jawbone

TREATEMENT:

• Surgery

BACK INJURY

Back injury playing sports can occur from bending too low, jumping at angles, or hyper-extending your body.

CAUSES:

• Injury or overuse of muscles, ligaments, and joints
• Pressure on nerve roots in the spinal canal. This can be caused by a herniated disc, sometimes brought on by repeated vibration or motion (as during sport activity or when using a machine or lifting in the wrong way) or by a sudden heavy strain or increased pressure to the lower back
• Fractures of the vertebrae caused by a lot of force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head

SYMPTOMS:

• Persistent aching or stiffness anywhere along the spine, from the base of the neck to the hips
• Sharp, localized pain in the neck, upper back, or lower back – especially after lifting heavy objects or engaging in other strenuous activity
• Chronic ache in the middle or lower back, especially after sitting or standing for extended periods
• Back pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes
• Inability to stand straight without having severe muscle spasms in the low back

TREATMENT:

• Cold therapy for a short period (up to 48 h) should be applied to the affected area
• Sports activities, particularly those involving weight lifting and extreme movement of the spine, should be avoided as long as the patient’s pain persists

Symptoms usually decrease after 3 days, and they should subside between 1-6 weeks. A safe return to play is only possible when the patient does not feel pain or discomfort.  A return to play under pain medication is not recommended because the medication may take away the body’s natural warning signal to stop a painful and subsequently harmful action, thereby increasing the risk for aggravating the existing injury or causing re-injury.

SHOULDER PULL

A pulled shoulder occurs from catching high balls, throwing a ball to a base with all you’ve got, or from hitting so hard with a bat, it cracks.  A pulled muscle anywhere on the body is also known as muscle strain and occurs when the muscle is stretched too far and small tears occur within the muscle.

TREATMENT:

• Rest the injured body part from 1-5 days depending on the severity of the injury
• Ice– This will reduce the swelling, bleeding, and pain and should be applied early.  Alternatives to ice are frozen peas or frozen corn
• Anti-Inflammatory Medication– This will help reduce the inflammation, swelling and pain
• Gentle Stretching– Stretching and strengthening exercises are both preventative and treatment modalities. Strong muscles are less likely to be re-injured
• Heat– Helps to keep the muscles “fluid”
• Avoid Muscle Fatigue– Fatigued muscles are more prone to injury. Use caution as you experience muscle fatigue as the incidence of injury can be higher- even with the most experienced athletes
• Proper Warm Up– Warming up prior to any event will help to loosen muscles and decrease the probability of injury

PITCHER’S ELBOW

Pitcher’s elbow also known as medial epicondylitis (epee-kon-di-lie-tis) causes pain from the inside (medial) of the elbow to the wrist.  The wrist pain is caused by damage to the tendons. Think of the tendons as connectors from the lower arm (forearm) to the hand that allows you to bend your wrist. The most common cause of Pitcher’s Elbow is excessive force used to bend the wrist toward the palm of the hand with repeated hard-slamming throws. The most common symptom of Pitcher’s Elbow is pain along the palm side of the forearm from the elbow to the wrist on the same side as the little finger (pinky finger). The pain is felt when you bend the wrist toward the palm against resistance e.g. throwing a baseball.

TREATMENT:

• Stop the activity that causes the symptoms
• Seek immediate medical care
• Ice or cold pack applied to the area to decrease the inflammation
• LONG TERM TREATMENT:
• Exercises to strengthen the wrist
• Over-the-counter medications like Tylenol, Ibuprofen, Aleve
• Wrist brace
• In severe case steroid injections and/or surgery may be required

PREVENTION:

• Avoid overusing your arm
• Upper body and arm stretching routine
• Strengthening arm muscles
• Wait to age 14 to throw curve balls

References

Stanford Hospital & Clinics Sports Medicine

Foot Injury and Heel Injury www.heel-that-pain.com/injury.php; Athletic Foot Injuries Treatment & Management Timothy J Rupp, MD, FACEP, FAAEM, Medscape references

Andreasen, Jens O., et al. Traumatic Dental Injuries: A Manual. 2nd ed. Ames, IA: Blackwell 2003

Bautista, Donna, DDS  Dental Injuries MedicineNet.com: Dovgan,Joseph DDS, MS, PC, Cracked and Fractured Teeth: www.endodovgan.com

Sources: WebMD.com/back-pain/guide; eMedicineNet.com

www.ncbi.nlm.nih.gov/publichealth

Murr AH, “Maxillofacial Trauma” in Lalwani AK, ed., Current Diagnosis and Treatment in Otolaryngology-Head and Neck Surgery, Lange Medical Books/McGraw-Hill, New York, 2004, pp. 209-220.