PATIENT INFORMATION - Common Injuries & Conditions

Strain: Muscle Trauma

Muscle strain is an injury caused by excessive force or amount of muscle contraction, or an excessive amount of stretch, placed on muscle tissue. Muscle “pull” and “tear” are common lay terms used to describe what is technically classified as a muscle strain. Muscle strain involves the disruption of the fibrous tissue that comprises the muscle. Muscle strains are often graded with regards to severity based on strength and flexibility tests, as well as findings on observation and palpation. A muscle strain may occur as the result of a traumatic incident (acute), or in association with repetitive loading over a period of time (overuse or chronic).
A variety of factors may contribute to muscle strain including inadequate muscle endurance, inadequate muscle strength, limited flexibility, inadequate warm-up, improper skill performance/technique, improper training progression, or inadequate rehabilitation following a prior injury. Following injury, muscle tissue will have limitations in strength and flexibility. In other words, the tissue will have a reduced ability to produce force, or to tolerate force placed upon the tissue. These factors have significant implications with regards to injury management, rehabilitation, and return to sport. Thorough, early and ongoing assessment of the muscle tissue status, as well as adherence to tissue healing guidelines, aid in directing proper care and rehabilitation of this injury.

Sprain: Ligament Trauma
Ligament sprain is an injury caused by excessive force or stretch placed on a ligament structure. Ligaments hold the bones and joints in position. They protect the joints from abnormal or excessive movements. Ligament “pull” and “tear” are common lay terms used to describe what is technically classified as a ligament sprain. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the ligament fibers. When excessive force is applied to the tissue structures, you may even hear a "pop."
If you have sprained a ligament in the past, you may continue to sprain it if the ligament did not have time to completely heal. If the sprain happens frequently and pain continues for more than four weeks to six weeks, you may have a chronic ligament sprain. Possible complications of ligament sprains include abnormal proprioception (joint position awareness). There may be imbalance and muscle weakness that increases the risk of re-injury. If this happens over and over again, a chronic situation may persist with instability, a sense of the joint giving way (gross laxity) and chronic pain. This can also happen if you return to work, sports or other activities without letting the ligament heal and become appropriately rehabilitated.

Fracture: The Breaking Point
Fracture is an injury caused by excessive force or impact placed on a bone structure. “Broken” and “cracked” are common lay terms used to describe what is technically classified as a bone fracture. To understand why bones break, it helps to know what bones do and what they are made of. The bones of the body form the human frame, or skeleton, which supports and protects the softer parts of the body. Bones are living tissue. They grow rapidly during one's early years, and renew themselves when they are broken. Bones have a center called the marrow, which is softer than the outer part of the bone. Bone marrow has cells that develop into red blood cells that carry oxygen to all parts of the body and into white blood cells that help fight disease.
Because of their unique structure, bones can bear large amounts of weight. Bones are rigid, but they do bend, or "give" somewhat when an outside force is applied to them. When this force stops, bone returns to its original shape. For example, if you fall forward and land on your outstretched hand, there's an impact on the bones and connective tissue of your wrist as you hit the ground. The bones of the hand, wrist and arm can usually absorb this shock by giving slightly and then returning to their original shape and position. If the force is too great, however, bones will break, just as a plastic ruler breaks after being bent too far. The severity of a fracture usually depends on the force that caused the fracture. If the bone's breaking point has been exceeded only slightly, then the bone may crack rather than breaking all the way through. If the force is extreme, such as in an automobile collision, the bone may shatter. If the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an "open" fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.

Because fractures hurt and make it difficult if not impossible to use the part of the body that is injured, most people call a doctor or seek emergency care quickly. In some cases, however, a person can walk on a fractured bone in the leg or foot, or use a fractured arm. Just because you can use your hand or foot does not mean that you do not have a fracture. If you think a bone may be broken, you should seek medical help immediately. A medical examination and x-rays are usually necessary to tell for sure and to ensure proper treatment. It is very important to control the movement of a broken bone. Moving a broken or dislocated bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone. Also, if there is an open wound it should be covered by a clean cloth or bandage on the way to further medical treatment. X-rays can help the physician determine whether there is a fracture, and if so, what type of fracture it is. If there is a fracture, the doctor will restore the parts of the broken bone to their original positions. "Reduction" is the technical term for this process. All forms of treatment of broken bones follow one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. Broken bone ends heal by "knitting" back together with new bone being formed around the edge of the broken parts. Treatment methods such as splinting, casting or surgery can lead to a completely healed, well-aligned bone that functions well. Remember that the method of treatment depends on the type and location of the fracture, the seriousness of the injury, the condition and needs of the patient, and the judgment of the physician and the patient.

Successful treatment of a fracture also depends greatly on the patient's cooperation. A cast or fixation device may be inconvenient and cumbersome, but without one a broken bone can't heal properly. The result may be a painful or poorly functioning bone or joint. Exercises during the healing process and after the bone heals are essential to help restore normal muscle strength, joint motion and flexibility. Help your broken bone heal properly by following your physician’s advice. Preventing broken bones: Even though healthy bones are very strong, any bone will break if the force applied against it is great enough. Bones that are weakened by disease or misuse may break more easily than healthy bones.

To develop and maintain healthy bones, a person needs adequate amounts of calcium and proper exercise. Because of the way bones are made, calcium is very important in the growth, development, and maintenance of strong bones. Adequate amounts of calcium are necessary as a child grows and for the adult as well. Women, in particular, must have enough calcium in their diet. The female hormone estrogen regulates the use of calcium in women's bodies. Following menopause, when women produce far less estrogen, calcium regulation is more difficult. So it is very important that women make their bones as strong as possible before menopause, through weight-beating exercise and adequate calcium in their diets. In some women after menopause, bones fracture very easily because they have been weakened by calcium depletion. Because of the way bones are made, they also get stronger with regular but not excessive exercise. If a person is active, bones will become stronger and more dense. The bones of an inactive person are often not as strong and may fracture more easily than those of an active person. For this reason, older people should try to remain physically active.

Contusion: Is it more than just a Bruise?
Contusions occur when a direct blow or repeated blows from a blunt object strike part of your body, crushing underlying muscle fibers and connective tissue without breaking the skin. You can also get a contusion by falling or jamming part of your body against a hard surface. “Bruise” is a common lay term used to describe what is technically classified as a contusion. Contusions are second only to strains as a leading cause of sports injuries.
Athletes must be sure to wear properly fitted and well maintained protective gear to aid in limiting the occurrence of contusions. Most contusions are minor and heal quickly without taking you out of the game. But severe contusions can cause deep tissue damage and lead to complications and/or keep you out of sports for months. These factors have significant implications with regards to injury management, rehabilitation, and return to sport.
Thorough, early and ongoing assessment of the tissue status, as well as adherence to tissue healing guidelines, aid in directing proper care and rehabilitation of this injury. You may be able to return to contact sports when you get back your full strength, motion and endurance. When the doctor says you are ready to return to play, he or she may want you to wear a customized protective device to prevent further injury to the area that had a contusion. Depending upon your sport, you may get special padding made of firm or semi-firm materials. The padding spreads out the force of impact when direct blows from blunt objects strike your body. Getting prompt medical treatment and following your doctor's advice about rehabilitation can help you avoid serious medical complications that occasionally result from deep muscle contusions.

Compartment syndrome
In certain cases, rapid bleeding may cause extremely painful swelling within the muscle group of your arm, leg, foot or buttock. Build-up of pressure from fluids several hours after a contusion injury can disrupt blood flow and prevent nourishment from reaching the muscle group. Compartment syndrome may require urgent surgery to drain the excess fluids.

Myositis Ossificans

Young athletes who try to rehabilitate a severe contusion too quickly sometimes develop myositis ossificans - a condition in which the bruised muscle grows bone instead of new muscle cells. Symptoms may include mild to severe pain that does not go away and swelling at the injury site. Abnormal bone formations can also reduce your flexibility. Vigorous stretching exercises may make the condition worse. Rest, ice, compression and elevation to reduce inflammation will usually help. You may need to do gentle stretching exercises to improve flexibility. Surgery is rarely required.

Instability: Joint Control
Joint instability occurs when abnormal or excessive movement is present in a joint. Common lay terms include “loose” jointed or “lax” joints. Injuries associated with joint instability are dislocations (complete disarticulation) or subluxations (partial disariculation). A joint dislocation will require medical attention to reduce the dislocation (ie. put the joint back in place) if the joint does not spontaneously reduce following injury. Joint instability is characterized by an inability to maintain the appropriate position of adjacent joint surfaces. For example, the shoulder is a ball and socket joint structure similar to a golf ball resting on a tee. For optimal function, the ball needs to remain on the tee. Similarly, the shoulder must maintain its position for optimal function. Loss of this optimal position due to trauma or joint disease may lead to dislocation/subluxation of the joint.
Lack of stability of a joint often relates to the anatomical components of the joint. Factors contributing to joint instability may include intra-articular (joint) disease (ie. osteoarthritis) and poor integrity of extra-articular structures (surrounding supportive tissue) such as joint capsule, ligaments, and muscles. If any of these structural elements are impacted by an injury, the inherent stability of the affected joint may be hindered. Joint instability can be the result of specific or repetitive trauma or injury (ie. football tackle), or may be atraumatic (no specific injury) associated with an individual’s genetic or inherent predisposition to joint instability (ie. generally lax supportive structures). Thorough evaluation, treatment and rehabilitation by qualified medical professionals is key in managing joint instability.