chapter 9. Strains, sprains and tears
J Walsh and SJ Eustace
Muscle
Muscles (Fig. 9.1) are composed of an upper (origin), middle (body) and lower section (insertion). Muscle injuries are usually caused by overstretching the muscle during sudden acceleration/deceleration (strain/tear) or from a direct blow to the muscle (bruise/contusion). The most commonly injured muscles are the hamstrings, the quadriceps (thigh) and the calf muscles.
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| Fig. 9.1 |
Tendon
Tendons (Fig. 9.1) are thick bands of fibrous tissue that attach muscles to bones. Tears to tendons are most likely to occur at the junction of the muscle with the tendon and usually occur without warning (typically in older athletes). The most commonly injured areas are at the ankle (Achilles tendon), thigh (quadriceps tendon), biceps and the shoulder (supraspinatus tendon).
Ligament
Ligaments (Fig. 9.2) are thick fibrous bands attaching bone to bone in moving joints. They help to stabilize joints during movement. Ligament injuries typically occur during sudden movements (especially twisting) of the joint involved and most frequently occur in the knee, ankle, shoulder, elbow and fingers.
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| Fig. 9.2 |
Red Zone
• Complete muscle rupture
• Complete tendon rupture
• Complete ligament rupture
Amber Zone
• Significant bruising (e.g. ‘Dead leg’)
• Incomplete tear to muscle
• Incomplete ligament tear
Green zone
• Muscle soreness
• Muscle cramp
• Minor bruising
• Mild tenderness over tendon (mild tendon strain)
• Mild tenderness over joint line (mild ligament strain)
What should I do?
Speak to the player
• ‘What happened?’
• ‘Where does it hurt?’
• ‘What kind of pain is it?’
• ‘Did you feel/hear a crack/snap?’
• ‘Does it feel like you have pulled a muscle?’
Problem identification
• Get player to point to sore area
Observe
• Look at the affected area for signs of swelling/redness/deformity
• Compare the affected area with the other side: Is there a difference?
• Ask the player to move the injured area on their own
• Does this cause pain?
• Does the injured area appear deformed? You must be aware of the possibility of an underlying fracture/complete tear requiring hospital transfer (Red Zone Injury)
Touch
• Touch the area to feel for warmth (indicates inflammation)
• Touching allows you to assess the extent of the pain
• Is there a specific point of tenderness?
• Does gentle movement of the joint cause pain? (Move the joint throughout its pain-free range of motion)
• Ask the player to move the joint themselves. If they can’t move the area without severe pain, the injury almost certainly falls into the red zone (Red Zone Injury)
Skills assessment
• Ask the player to stand and move the injured area in the same way they would while competing. For instance:
• with a lower limb injury, is the player able to stand unaided on the affected leg? (Getting the player to hop in a circle is a useful test for the lower limb)
• with an upper limb injury, can the player move their arm throughout its full range of motion, grip, push and pull against a heavy object?
What should I check for?
Talk to the player
• Does the player think they can continue? (‘Yes’ may actually mean ‘No’ in this situation)
• Reassure the player and explain what you are doing and why
Remove from the field of play
• Minor injuries (Green Zone) may be dealt with on the pitch
• Removing the player allows you to reassess the situation and make a less pressured and more informed decision on the sideline
• When an injury is identified, assess whether it is safe to remove the player from the pitch without additional splinting or assistance
• Do not remove a player from the pitch unless it is safe to do so
