Skin may be cut or burned (by friction or by the sun). Bear in mind that cuts and scratches sustained on the sports field are likely to become infected, so you should always wash them thoroughly before applying any dressing. Make sure that your tetanus immunisation is always up to date. There is a layer of fat under the skin and, if the blood vessels in this are damaged, blood leaks into the tissues and creates the characteristic purple colour of a bruise.
Swelling and pain are natural defence mechanisms by which the body immobilises the injured part. Tissue damage is usually accompanied by some bleeding and the injury often triggers the production of tissue fluid, resulting in a swelling. The damage and swollen tissue stimulate nerve endings in the area, causing pain. In addition the swelling makes the injured part feel stiff, preventing you from using it. This allows repair processes to begin work and stops you from inflicting any further damage.
The bleeding and tissue fluid make the area feel warm and reddened – in other words, it becomes inflamed. The main aim of treatment for soft tissue injury is to reduce this inflammation and so speed up your recovery.
Injuries to muscles produce symptoms ranging from a ‘minor twinge’ when you move, which settles with time, to severe pain and fear brought on every time you do a particular exercise or movement. A pull or strain means that a few muscle fibres have been torn. A tear or rupture is more severe and is usually caused by a direct blow, such as a kick on the thigh. There may be bleeding, swelling and possibly a ‘dead leg’ caused by pressure on nerves. If you have severe symptoms of this kind, you should see a doctor on the day of the injury.
Putting an ice pack over the injured part will help relieve pain and swelling initially, then you need to apply a bandage and go to your local accident and emergency department if necessary.
Infection after muscle injury is very uncommon but sometimes cysts form inside the muscle if the bleeding has not settled adequately. These require medical treatment. A more common problem is shortening of the muscle as a result of formation of fibrous tissue which is less elastic than the muscle fibres themselves. This is why rehabilitation after any muscle injury must include stretching exercises to restore length and flexibility.
Thigh muscle injuries must be treated with particular respect or you may end up needing prolonged rest or surgical treatment. It’s not a good idea to massage a thigh muscle injury because, in some cases, this will increase the size of the blood clot within it. This may become hardened and calcified or even form a lump of abnormal bone.
Tendons, ligaments, cartilage and bursae
Tendons, ligaments, Cartilage and Bursae:
Tendons can become inflamed with overuse: a condition known as tendonitis. The tendon becomes swollen, red and tender to the touch and hurts when you move it. You’re most at risk of developing tendonitis if you perform one activity or movement regularly and intensely: runners get it in the Achilles’ tendon and racket players in the wrist, for example. As well as rest, treatment usually includes some method of changing the way the tendon moves: for example, wearing a heel pad in Achilles’ tendonitis. Treatment with non-steroidal analgesic drugs can also be helpful while the pain is severe and, if the problem does not clear up, you may need to have an injection of local anaesthetic and hydrocortisone into the covering of the tendon or possibly an operation to decompress the tendon.
Tendons can also be partially or completely torn. In a partial tear there is significant pain and discomfort and if the tear is complete you may be able to feel a gap in the tendon.
Ligaments can be stretched, leading to partial or complete tears. The word sprain is usually applied to minor tears of ligaments. These injuries result from twisting or wrenching of the affected joints. A complete tear will cause excessive pain, swelling, bruising or abnormal movement of the joint.
Bursae may become inflamed if they are constantly put under pressure and cartilage may be torn in more serious joint injuries. The knee joint contains the medial meniscus and the lateral meniscus – specially shaped cartilage at the top end of the tibia (the larger leg bone) – which can be torn by a fast, twisting action of the knee. This is a common football injury.
Always see a doctor for anything other than a minor injury, but first aid should follow what’s called the RICE principle.
Treating of Injuries:
R = Relative rest
Some injuries may need complete rest because they are so serious but very often you will need only to limit your activities, cut back on training or change to another type of exercise. This is what is meant by relative rest and it allows you to maintain physical fitness while the injury heals.
I = Ice applied to the injured part
Ice reduces the amount of bleeding and bruising by cooling the blood vessels under the skin, making them constrict. It also has an anaesthetic effect, so it can relieve pain. When applying ice you must be careful not to burn the skin by direct application for too long. Either wrap the ice in a flannel or use a proper ice pack.
Ice is an important component of treatment of an acute injury, but don’t use an ice pack for longer than a period of 24 to 48 hours, during which you should apply it intermittently until the initial swelling goes down. Once the worst symptoms have subsided, usually after a week or so, there are many useful over-the-counter heat treatments for warming up the affected area. They are also worth using as part of your pre-match warm-up if you have a recurring injury.
C = Compressive bandaging
This is particularly effective in a limb injury. After you’ve applied an ice pack to the affected area several times for periods of 10 to 30 minutes, bandage it firmly if you can. This will also help to prevent further bleeding and swelling.
E = Elevation
Elevating the injured part allows the tissue fluid to drain away and will also help to reduce the size of the swelling and therefore relieve pain.