Feel the burn: Tackling sports injuries

Andy Murray ruled himself out of the French Open because of an unspecified back issue. Picture: Getty

Andy Murray ruled himself out of the French Open because of an unspecified back issue, while his old mucker Rafa Nadal has just returned to the tennis circuit after taking time out due to troublesome knees. Heptathlete Katarina Johnson-Thompson had to pull out of competition last month with an ankle injury.

In football, Sunderland and Scotland striker Steven Fletcher missed the remainder of the season after suffering ankle ligament damage in the World Cup qualifier against Wales in March, and Chelsea captain John Terry missed the Europa League final against Benfica, also with an ankle injury.

It’s not restricted to the pros either. Physiotherapists are reporting a revolving door of patients who have pushed themselves too far or trained too hard for marathons or taken up a summer fitness regime without preparing properly. We all want that beach body, but no swimwear looks great paired with a knee brace.

The majority of sports injuries, says Darren Cornforth, of Physis physiotherapists, are caused by either overuse or traumatic overload. “Trauma is a sudden, explosive overload of a tissue’s capabilities,” he explains. “That would happen, for example, if someone hasn’t been doing anything over the winter and then tries to play sport.”

In the case of overuse injuries, tissue doesn’t fail in a spectacular way but, rather, gradually. “The rate at which you started the activity might have been too intense,” suggests Cornforth, “you are doing it too aggressively, too frequently, and you’re not getting the chance to rest – things like tendon injuries and inflammed soft tissues are caused by overuse.”

The temptation is always to push the body to its limits but he advises a graded plan. Include rest days and listen to your body. “Sometimes you have to realise that it requires preparation and physical fitness,” he says.

Don’t just do the activity you’re training for either, adds Will Sturgeon, of Will Power Personal Training. Diversify a bit. “Training outwith your discipline strengthens ligaments, tendons, the little muscles,” he says. “So when you intensify your training, you have allowed for the extra strain on those stabilising muscles.”

Always warm up properly too. “Muscles are a bit like Blu-tac,” says Sturgeon. “When they’re warm they’re able to stretch, but when they’re cold they’re less flexible.”

It’s also importants to appropriate clothing. Make sure shoes and other kit are up to the job. And if it’s cold out there, don’t go out in tiny shorts and a vest – the muscles need to be warm to work properly, and cool down quickly when standing still.

Many issues can be relieved with the use of a brace or support, but Sturgeon warns against getting too used to it. “Prolonged wear will not allow the ligaments to strengthen because they’re being strengthened externally. Eventually the body will rely on it and never be able to operate without it.”

Ultimately, and frustratingly for anyone seriously into their sport, the best response to any kind of injury is rest and, if necessary, physiotherapy.

Twitter: @Ruth_Lesley

www.facebook.com/willpowerpersonaltraining; www.physis.uk.com

Injury rotator cuff

Common cause weight lifting

“This is more common than any other injury I see,” says Sturgeon. “The rotator cuff muscles are deep in the shoulder – not really touchable in any way – but they get impact in day-to-day life, opening doors, you name it, the shoulders are working.” Caused by overuse or incorrect gym posture, it is best treated with a period of rest, physiotherapy and anti-inflammatory medication. In extreme cases it may require surgery.

Injury quadriceps strain

Common cause football

“This could be caused by a kick or a sudden sprint,” says Cornforth. As with all soft tissues, repairing the injury will require a degree of rest or modification. Once you’ve applied a few basic principles (PRICE and HARM) and there’s no improvement you may need assessment from a physiotherapist.

Injury Illiotibial band friction syndrome (ITB)

Common cause running, swimming

The ITB is the band that runs down outside of thigh and crosses the knee. “If you have a loose foot that pronates in and you have lots of excessive movement,” says Cornforth, “or you have weakness at the hip, the hip/knee alignment gets repeatedly twisted and that causes irritation at the side of the knee.” It could also be caused by wearing the wrong footwear. For prevention, ensure you stretch properly after exercise (cross one leg over the knee while seated and lift the opposite knee to feel the stretch at the underside of bottom, then repeat on the other side) and do some hip-strengthening exercises. Once it happens, rest, let the pain settle and then work out why you got it in the first place.

Injury tennis elbow

Common cause repeated gripping activities

such as tennis

Often a result of enthusiastic armchair players hitting the courts in the weeks following Wimbledon, the injury is similar to golfer’s elbow, but at the other side of the joint. It can take months of rest for the tendons to heal properly; but pain can be treated with an ice compress, anti-inflammatory medication or topical painkillers. A physio may prescribe some form of manipulation, strengthening exercises or use of a brace.

Injury hamstring strain

Common cause football

This is usually a result of lack of flexibility and strength in the muscle, so Cornforth advises following the same steps as for calf strain. After between five and seven days, it is then safe to use heat – a hot bath, for instance – and massage.

Injury calf strain

Common cause running

“This tends to be caused by a sudden jump or sudden push-off,” says Cornforth. “Apply the PRICE rules – protection, rest, ice, compression OR (not and) elevation – then avoid HARM – heat, alcohol, return to sport, massage – for between five and seven days.

Injury Achilles tendonopathy

Common cause running, football

Symptoms include pain in the achilles area of the heel, perhaps a lump in the mid-section that isn’t too bad when standing but stiff and sore when you get up in the morning. You may even still be able to run on it when warmed up. But ignore it at your peril because an injured achilles could lead to a snapped one, which means agony and inactivity for up to six months. Rest is the first option and a physio may recommend a heel-raise, a programme of stretches or strapping up the calf to rest the achilles. But a strengthening regime helps most.

Injury hairline fractures in the foot

Common cause running

“It’s quite easy to run through a hairline fracture,” says Sturgeon, but a sign that something could be wrong is a sharp pain in the lateral side of the foot. Only a scan will properly diagnose it. Prescription: rest up and allow it to heal.

Injury tibialis anterior

Common cause running

This is the muscle that runs from the big toe to the knee, and the injury might be mistaken for shin splints. The insertion of the shin muscles become inflammed due to repetitive impact and it feels like a dull throb, usally most acute while running uphill. Ease discomfort by stretching post-exercise (while standing, point the toe towards the ground then drive the knee down and feel the stretch at the front of the foot). A deep-tissue massage will also provide relief. Then modify the activity and make sure you have appropriate footwear.