Welcome to the common injury page of my web-site.

I often carry out presentations to various organisations talking to people regards types of injury, best practice to follow when injuries happen, how to avoid injury, nutrition and many other subjects and am often asked what to do and how to cope with common injuries that can and often do happen to people of all ages from all sports and all abilities.

I will try and tackle some of the more "common injuries" that do not always require a visit to your Doctor or Physiotherapist.

OPEN WOUNDS.

Open wounds are very common among sports people, particularly those who play contact sports such as Football, Rugby and Hockey. Riders and Cyclist, who are likely to sustain falls on to hard surfaces are also vulnerable.

The way in which a wound is inflicted determines its nature and extent,and the possibilities include cuts, contusions, lacerations, gashes, puncture wounds, and abrasions. Some wounds may only affect the outer layers of skin or they can damage tendons, muscles, blood vessels and nerves.

The healing of a wound is delayed by the presence of dirt and infection, bleeding, gaps between the wound edges and disturbance of the injured tissue. Treatment aims to eliminate these factors.

TREATMENT

In order to stop bleeding the sports person or your coach/trainer should :

-elevate the injured part. In most cases of limb injury, supporting the limb in a raised position with the injured sports person lying on his back or side is sufficeient to stop the bleeding;

-apply direct pressure. With one hand on each side of the wound, press the wound edges together while the injured limb is kept elevated, with the help of a third person if necessary. The risk of contamination of the wound is obviosly reduced if the wound surfaces themselves are not touched. It is also strongly advised to use medical gloves for the athletes and your own protection. Should the injured person be alone, he should stop the bleeding by pressing directly on the wound with his hand;

-apply a pressure bandage as soon as first-aid supplies have been obtained. The wound edges should be brought into opposition as described above, and, when necessary, a folded pad or clean handkerchief can be bandaged in place to increase the pressure on the area.

A tourniquet should never be used and even a pressure bandage must not be kept in position for more than 10 - 20 minutes. If a pressure bandage has been necessary to stop the bleeding, a doctor should be consulted.

CLEANING

Superficial wounds which have been contaminated by dirt must be cleaned carefully within 6 hours, otherwise they will become infected as bacteria begin to multiply and penetrate tissues. It is essential that all dirt is removed, especially from abrasions on the face, as retained material can cause disfiguring scars. Heavily contaminated abrasions should be cleaned thoroughly for several minutes with soap and water and a soft nail-brush. They should be rinsed with plain water, or a saline solution, and covered with a sterine dressing. If fluid seeps through the dressing it should be changed daily. If a doctor is consulted he may prescribe medicated dressings to help facilitate healing. Small superficial abrasions heal best if well-cleaned and left undisturbed.

Deep wounds include skin, underlying connective tissue and possibly also tendons, muscles, blood vessels and nerves. The wound edges often gape apart and bleeding can be considerable. Puncture wounds caused by studs or spiked shoes can be trecherous and should always be treated by a doctor. Wounds to the sole of the foot require padding to distribute load when walking.

Deep wounds must be cleansed with extreme care, and, when damage is exensive, it is somtimes necessary for the doctor to excise dead tissue. A sound rule is that wounds which are not treated within 6 hours should be considered infected.

Some wounds - those which are deep, those which bleed profusely and those whose edges do not lie readily in opposition with each other - need to be stitched by a doctor. Stitching too, should preferably be done within the first 6 hours of injury.

Infected wounds are characterized by pain, swelling, redness of the skin and local tenderness. Infection can spread from the wound to the lymph glands via the lymph channels ( lymphatics ). Infection in the leg, for example, spreads to the glands in the groin ( I have seen this happen with something as simple as a grass burn ). When this happens, the lymphatics appear as red streaks in the skin and other symptons, such as fever and general malaise, commonly occur. The affected lymph glads are swollen and tender. The condition should always be treated by a doctor who will prescribe antibiotics in addition to any other treatment. A period of bed rest may be necessary during the acute illness.

YOU SHOULD REFRAIN FROM TRAINING, MATCHES OR COMPITITION DURING THE COURSE OF AN INFECTION.

BLISTERS.

Blisters on the feet are the scourge of athletes, and blisters on the hands can be a problem for skiers, cricketers, rowers, tennis, badmington and squash players. Once a blister is broken it becomes a painful open wound.

TREATMENT.

Blisters should be treated in the following way:

- When there is any suggestion of a blister forming, a break from exercise should be taken in order to prevent further irritation. The problem area can then be protected with adhesive plaster. Avoid creases in the plaster which would encourage rather than prevent blister formation;

- Once a blister has formed, its surface should be retained intact as it acts as a barrier against bacteria. Never break a blister deliberately. Large blisters can be punctured at their edges by a Physiotherapist with a sterile needle. The blister can be protected from pressure by means of a piece of special medical foam.

- If a blister breaks naturally, it is important to clean it carefully with soap and water or antiseptic solution. A sterile non-adherent dressing or, later, a bandage is used to cover the wound.

PREVENTIVE MEASURES.

Blisters can be prevented by the following measures:

- All equipment should be designed for use in training as well as in competition. Footwear, in perticular, should be worn in.

- Socks should be free from holes, dry, clean and of the right size so that they do not crease. They should be changed frequently.

- Hygiene should be meticulous. The feet should be washed daily.

- Sensitive skin areas can be protected with plasters applied  firmly and directly to the skin before exercise.

It cannot be stressed too strongly that blisters can be avoided if preventive measures are applied. They may seem trivial but they can necessitate long breaks from training, especially if they become infected.

FRICTION (GRASS) BURNS.

If an athlete falls during training or compitition on a synthectic surface or dry grass, he runs the risk of sustaining friction burns. As a rule, the burn affects only the outer layer of skin and in its mildest form causes only superficial redness which needs no treatment, but if contact is hard it may result in an abrasion. If blisters appear in the skin, they should be covered with a clean dressing; if the skin is broken, the wound should be cleansed and dressed as soon as possible by methods already described, in order to prevent infection

TREATMENT AND PREVENTION.

The athlete or trainer should:

- Prevent friction burns by making sure that the correct equipment and clothing for the protection of vulnerable areas is used;

- Reduce friction during falls by rubbing exposed parts with greasy ointment (vasalin).

- Treat frictional burns by cleaning the wound carefully with soap and water and dressing with medicated compresses held in place with a bandage.

Remember, untreated grass burns can lead to infection. I you have any on your lower limbs and you feel pain in your groin area, consult your Doctor at once.

MUSCLE CRAMP.

Muscle cramp affects most people at some time in their lives. Athletes may suffer cramp in a muscle during or after strenuous exertion such as a game of football or a long distance race.

CAUSES.

- During protracted exercise, vast amounts of fluid can be lost from the body. This dehydration predisposes to muscle cramp, though the exact connection is not known.

- The type of cramp which affects footballers towards the end of a game is probably caused by changes in the musculature resulting from earlier muscular bleeding, small muscle ruptures or the athletes general state of health.

- The precise causes of cramp are not clear, but any factors which impair circulation should be considered. These include close fitting socks, shoes laced too tightly, sock tie ups too tight, varicose veins and infections.

PREVENTION AND TREATMENT.

The athlete should:

- Prevent cramp by good basic training and warm-up exercises, by using the correct equipment and by ensuring that his body has adequate fluid and salt reserves;

- Break off his sporting activity when he has acute cramp and contract the muscle which exerts an effect opposite to the one affected with cramp. For example, if cramp in the calf muscle draws the foot downwards, the foot should be raised carefully, with the knee bent, until it is at right angles to the leg. The movement should not be forced and the affected muscle should be massaged.

If an athlete suffers persitant cramp despite preventive measures, he would be wise to seek a medical examination in order to exclude any specific problems.

STITCH.

Sports people who have not warmed up properly somtimes feel a sharp pain in the upper part of the abdomen a few minutes after they have started to run. It may be located on the right or the left and is more frequent when sporting activity is undertaken immediately after a meal. The pain may be made worse by deep exeration and relieved by deep insiration.

The real causes of stitch are essentially unknown though some studies indicate that a pulely mechanical effect may trigger it. The connective tissue which anchors the abdominal organs bears a much greater load just after a meal and physical activity at this time could cause strain and minor internal bleeding. Other possible causes are lack of a sufficent supply of oxygen to the diaphragm or pain arising from the internal abdominal organs, such as the spleen and the liver, as blood flow is redistributed.

TREATMENT.

The athlete should:

- Avoid training and compitition for at least 3 hours after main meals;

- Run bent forward or stop so that the stitch has time to disappear before the training is resumed.

NOSEBLEEDS.

A nosebleed is caused by a rupture of one or more blood vessels in the nose, and is common in lots of sports.

TREATMENT.

The athlete should;

- Sit upright if possible;

- Place thumb and index finger over the nose and pinch the nostrils together for about 10 minutes after which the bleeding will have stopped in nine out of ten cases. Keep the head bent forward rather than backwards, spit out any blood that enters your mouth.

- Put a ball of cotten wool or a compress in the nostril for about 1 hour. Make sure that it cannot be inhaled and do not forget to remove it;

- See a doctor if the bleeding continues in spite of the above measures.

A broken nose should be suspected when bleeding occurs after a blow. Fractures of nasal bones occur in sport. The injury is not particularly serious but sometimes requirs treatment so that the fracture can be re-aligned, bearing in mind the future appearence and funtion of the nose.

I hope this information is of some use to some of you.

If you have any sugestions regards anything else you would like me to include on this page, please feel free to email me with your request physiohernebay@yahoo.co.uk

01227 366648