Education And Debate

ABC of Sports Medicine Nature, prevention, and management of injury in sport

BMJ 1994; 308 doi: (Published 21 May 1994) Cite this as: BMJ 1994;308:1356
  1. R G Hackney

    Nature of injury

    Unfortunately, injury is inevitable for some of those who participate in sporting activity. Injuries may occur as a result of an acute episode of trauma, such as a fractured tibia in a footballer. Overuse injuries are caused by repeated episodes of microtrauma that individually are insufficient to give rise to macroscopic injury. When healing mechanisms are overcome, however, the end result can be as serious as a fractured neck of femur from a completed stress fracture. The nature of the injury depends on many interrelated elements, but they can be divided into those caused by intrinsic and those caused by extrinsic factors.

    Intrinsic factors are concerned with the makeup of the individual person. Preparation and training can alter some of these constituents, which should always be considered in the management of individual people.

    Intrinsic factors in the causation of injuries

    • Age, sex, body weight and composition, and muscle power (for example,imbalance of agonist versus antagonist)

    • Muscle stiffness or weakness

    • Congenital joint hyperlaxity or conversely poor flexibility

    • Malalignment - for example, forefoot varus, hyperpronation, pes cavus, tibia vara, patella baja/alta, genu varum/valgum, femoral anteversion leg length discrepancy, etc

    Extrinsic factors in injury are those derived from external forces. These range from a clumsy tackle inflicting a sudden violent force on a limb to footwear and the surface being used.

    Extrinsic factors in the causation of injuries

    • Training methods and competition (high volume and increase in intensity of training, sudden changes in training method, poorly designed training techniques, ineffective rules of the sport, violent play, or ill-timed contact)

    • Surfaces (change from running on grass to synthetic track, increased incidence of anterior cruciate ligament injuries on synthetic grass)

    • Equipment (poor footwear, old or unsuitable training shoes, poorly adjusted bindings on ski-boots, heavy wet footballs, poor landing surfaces for jumpers)

    • Environment (cold weather with inadequate warm up leads to reduced elasticity and stiffness, hot and humid weather can …

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