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Although some sports injuries are traumatic and have an obvious start point, like a sprained ankle or pulled muscle, many have a long insidious history and may have been lurking in the background for a while before making themselves apparent. These problems often are due to a combination of poor strength, mobility or control and poor load management. Even small increases in running mileage, weight lifted or time spent climbing, on top of a body that isn’t prepared for those changes can result in an injury.
The correct management of a sports injury can be as much about advising the correct strength and conditioning approach and educating what appropriate increments of exercise load, as it is about any manual (hands on) treatment. Here are some examples of some common presentations.
Case study 1
A 35 year old lady with Achilles tendon pain arrives for assessment following an 8 week history of pain. She has returned to running about 6 months ago following the birth of her second child and has not been running regularly for a few years prior to that. She has managed a slow and steady progression to about 8- 10 km 2-3 times a week. Pain started roughly around the time her half marathon training went up from her regular 10k runs to 12-14 k runs.
When I assess her movement, I see that her ability to keep her hips and knees in good alignment is limited and her calf strength on the affected side is quite poor.
This is a common enough presentation. Poor strength and control leads to pain when load (distance) is increased beyond what is normal for this individual. We have good evidence that even a 10% increase in weekly mileage is enough to cause a significant increase in injury risk.
Case study 2
A 20 year old male football player limps in with a sprained ankle. He turned his ankle 2 weeks ago whilst landing following a jump to head a ball. This isn’t the first time it has happened. He did it 6 months ago and never felt he properly recovered from it. Nevertheless, he returned to play and had got away with it until now. As the damaged ligament healed and pain reduced, a severe deficit in balance and local ankle strength was identified. Once addressed, pain, strength and sporting function improved. Most importantly, so did his confidence in his ability.
Case study 3
A 52 year old male recreational climber presents with right sided shoulder pain following a particularly strenuous climbing move caused a sudden onset of pain 1 week ago. Previous shoulder niggles over the years have always coincided with the increase in training load that occurs when preparing for a week away climbing. These episodes of pain appear to be getting worse. Examination shows that his biceps tendon is sore on loading and his shoulder blade control is compromised on the effected side. A reduction in training load and improvements in shoulder blade control served to much improve his pain and allow him to continue his training