chapter 18. Lower limb injuries
MJ Shelly and IP Kelly
INTRODUCTION
The lower limb is frequently injured during sport. Fortunately, most injuries are minor and the player can play on. However, it is important to recognise the serious injuries and treat them appropriately. We have divided the lower limb into three areas (Fig. 18.1):
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| Fig. 18.1 |
• Groin, hip and thigh area
• Knee and leg area
• Foot and ankle area
We will discuss the various problems that can occur in each zone.
What should I check for?
Speak to the player
• Ensure that the player is conscious and can speak to you in complete sentences (see the ABC chapter (p. 21))
Problem identification
• Ask the player what happened. Get details of the injury:
• ‘How did you land?’
• ‘Did you feel/hear a crack?’ (?Broken bone)
• ‘Where is the pain? Point to the sore area’
• ‘Does the pain go anywhere or does it stay in the same place?’
• ‘Has anything like this happened before?’
Observe
• Is the lower limb obviously deformed? (?Broken bone)
• Is the player holding their leg in a particular way?
• Is there any swelling of the limb? (?Sprained ankle/twisted knee)
• Is there any obvious bleeding?
• Compare to the opposite limb
Rule out serious injury
Remember – pain in the legs can come from a back injury.
• Can you move your legs? (If not, this indicates a potential back injury: see Ch. 7)
• Any strange sensation/numbness in the legs? (If yes, treat as a back injury)
• Can you see bone sticking out through the skin? (Red Zone Injury)
• Can you see blood spurting out from a wound? (Red Zone Injury)
Touch for tenderness
Always wear protective gloves.
• Feel the injured/painful area
• Is it swollen? Is it very sore to touch? (Does the player wince?)
• Can you feel anything broken or unusual?
Skills assessment
• Get the player to move the affected limb
• Get the player to stand up and put weight on sore leg
• If player is unable to bear weight on injured leg (Amber Zone Injury), remove from field immediately and continue assessment on sideline
• Get player to walk/run a few metres – watch for a limp
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GROIN, HIP AND THIGH
The groin covers the area between the abdomen and the thigh. Serious injuries to the hip are rare, but must be dealt with quickly and efficiently. The thigh is a commonly injured area and injuries here can lead to a player being substituted.
Red Zone
• Broken hip bones
• Hip dislocation
• Broken thigh bone
Amber Zone
• Groin strain
• Hamstring tear
• ‘Dead leg’ (severely bruised thigh muscles)
Green zone
• Muscle cramp
• Blow to the hip bones (hip pointer)
• Pain in pubic area (osteitis pubis)
• Minor muscle strains/bruised thigh muscles
Broken hip/dislocated hip/broken thigh bone
This can occur suddenly. It is usually the result of a very forceful blow to the hip or a fall from a height.
What should I check for?
• The player will complain of severe pain in the hip or thigh
• The player’s leg on the injured side may be shortened – rolled out to the side
• The player will not be able to put weight on the injured leg
• It will be extremely sore when the leg is moved
What should I do?
Talk to the player
• Reassure the player
Remove from the field of play
• Remove the player from the field on a stretcher, with the legs in a splint. See Chapter 10
Emergency transfer to hospital
• Do not bend the leg – if it is painful to weightbear, the player should be lifted
Treatment
What should I check for?
Speak to the player
• Reassure the player
• ‘What happened?’
• ‘Are you in pain?’
• ‘Did you hear/feel a crack?’
Problem identification
• Identifying the problem should be obvious. The player will point to the injured hip/thigh
• The player will be in severe pain
• The player may have heard or felt a snap or crack
• The player may have felt the hip pop out
Observe
Rule out serious injury
• Ensure that the player is conscious; if not, go to the ABC chapter (p. 21)
• Make sure the player can move the opposite leg and has normal feeling – rule out a spinal injury
• Pain in the leg may come from the back
• Ask the player to gently bend up their hip
• Gently roll the injured leg from side to side at the ankle
• If the hip is broken, this will be painful
• Feel over the hip for tenderness
Skills assessment
• If the above tests are not painful, ask the player to stand up
• Place the injured leg on the ground. The player will not be able to weightbear
What should I do?
Talk to the player
• Reassure the athlete, explain what is happening
Remove the player safely from the field of play
• If a neck injury is suspected, the player should have spine and back stabilization prior to transfer
• If there are minor injuries to the leg, the player should be supported off
• If there are major injuries (e.g. broken bone) a stretcher is needed)
• Any neck or spine injuries – ambulance
• Broken bones/dislocation – quickest possible means
Avoid further injury
• Immobilize the injured leg
• Ensure no neck injury or other injury
• Any player who cannot perform basic skills runs the risk of doing more damage and should not continue
Treatment
• Immobilization techniques
• Application of ice
• Application of compressive bandage (if necessary)
• Administration of painkillers (by trained personnel only)
• Remove player from the field
• Player must be fully assessed on the sideline to decide whether he/she can return to play or needs to be substituted
Groin strain
Very common injury especially in soccer.
What should I check for?
• Player will ‘pull up’ while running – might have a painful limp
• There will be tenderness in the upper inner thigh
What should I do?
• Ask player to walk/run a few metres – try and gauge whether the player can continue
• This player is unlikely to continue – substitute and apply ice to affected groin (RICE principle – see Fig. 9.6, p. 64)
• Refer for specialist assessment and opinion
Hamstring tears
These are very common injuries that occur suddenly while a player is running/straining. The player commonly ‘pulls up’ and starts to limp.
What should I check for?
• Player will ‘pull up’ while running (Fig. 18.5) – may have a painful limp. A hamstring tear feels like being shot in the back of the leg
• Player will complain of pain and swelling behind knee
What should I do?
• Get player to run a few metres – if severe pain – substitute player
• Apply ice to affected area (RICE principle)
• Refer for specialist assessment and treatment
Severe thigh muscle bruise – ‘dead leg’/‘dead backside’
This is a very common injury. It is very painful and frequently prevents a player continuing in a game. It is caused by a direct blow to the thigh (Fig. 18.6).
What should I check for?
• Player will complain of pain in the affected thigh
• There may be swelling and evidence of bruising
• The muscle commonly feels very hard and painful to touch
What should I do?
• Ask player to walk/run a few meters
• Rub affected area and apply cold spray
• The player may try to run it off. Observe closely
• If unable to continue – apply ice to affected area (RICE principle)
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