Contact team sports such as soccer and rugby, equine sports and skiing have the highest rate of injuries, closely followed by cricket, cycling and fencing. Then come racquet sports, athletics, gymnastics, water sports, mountaineering and the other winter sports, in that order. Surprisingly, the traditional combat sports (judo, boxing, karate) and aerial sports (parachuting, hang gliding, bungee jumping) have a relatively low injury rate, but when an injury does occur it tends to be more serious.
Only about half of all sports related injuries are treated by a qualified professional, and then only because of a pitchside osteopath, chiropractor or physiotherapist (Scottish Med J, 1982; 27: 189 and Sports Medicine and Soft Tissue Trauma, 1989; 1: 4-5). Musculo skeletal inflammatory disorders and soft tissue injuries account for over 80 per cent of sports injuries and their self treatment can lead to chronic injuries, or worse. Sportsmen and sportswomen often treat themselves with NSAIDs (non steroidal anti inflammatory drugs). Deaths from self poisoning through NSAID ingestion are at an epidemic 4,000 plus per annum (G R McLatchie, Essentials of Sports Medicine, Edinburgh: Churchill Livingstone, 1995: 145-147). This amounts to 77.8 per million prescriptions.
Lotions can be effective. Arthrosenex ointment (Brenner, FRG) is a combination of labrador tea oil, rhododendron oil, arnica oil, camphor oil, melissa oil, vitamins A and E, saffron tincture and orange oil (K Langbein, H-P Martin, & H Weiss, Bittere Pillen: Nutzen und Risiken der Arzneimittel-Ein kritischer Ratgeber, Vienna: Verlag Kiepenheuer & Witsch, 1986: 216). In controlled trials, this ointment stopped the injury exuding while simultaneously mobilising natural defence mechanisms.
A linen bag filled with hayseed (Flos graminis), sweet vernal grass seed (Anthozanthum odoratum) and woodruff (Asperula odorata), now available ready filled, makes a superb hot pack for use in bruising and muscle injuries. It retains heat for a long period and can be used several times before it needs replacing or refilling. A hayseed bag is immersed in a small pot of boiling water, and left for about 10 minutes. Then the excess water is squeezed out and the bag is covered in a flannel cloth, which helps retain the heat and makes it bearable on the skin. It should be applied at 42¡C (107.6¡F). These hayseed hot packs have been shown to provide beneficial local heat treatment, which is effective on joints, muscles or tendons, after trauma injuries.
Non pulsed ultrasound therapy has been shown to be more or less ineffective in the relief of pain (Pain, 1995; 63: 85-91). But pulsed ultrasound, which does not have a thermal effect, is effective on acute lesions if it is applied at an early stage (Physiotherapy, 1978; 64: 105).
The most effective massage for soft tissue lesions are effleurage (firm stroking in the direction of venous and lymphatic return), petrissage (a localised kneading action) and deep circular and transverse frictions accurately applied to the lesion. If used before exercise, this will delay the onset of muscle soreness.
In overuse injuries, relief is obtained by transverse friction at a right angle to the tendon. Massage to break down adhesions in muscle, ligaments, tendons and connective tissue is uncomfortable initially, but the pain generally settles after treatment. The part should then be actively mobilised (though not overused), which reduces the risk of new adhesions forming.
Light or deep pressure, muscle stretching, manually deflecting the muscle mass from its usual position with the hand or fingers by oscillatory motions, traction that attempts to increase the distance between the muscle’s origin and insertion are all appropriate mobilisation techniques.
Harald Gaier is a registered naturopath, homoeopath and osteopath.
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Professional strapping or splinting provides physical support for the injured part, limits pain, assists or resists specific movements, and will allow the injured area to come gradually into use. It also helps relieve anxiety. Most common sites for use are ankle, knee, elbow and hand.
The application of cold packs, or cryotherapy, provides pain reduction, vascular constriction in the area, and a decrease in the metabolic rate of the cells undamaged by the initial trauma which are at risk from hypoxia due to vascular disruption (Arch Physical Med Rehab, 1964; 45: 233-238 and M Copeland-Griffiths, Dynamic Chiropractic Today, Wellingborough, Northants: Thorsons, 1991: 83, 170 and 181).
Blisters and haematomas should be aseptically aspirated, but the roof of the blister or haematoma must be left as it will act as a biological dressing (Arch Dermatol, 1968; 97: 717-721). To reduce the likelihood of reaccumulation of extravasated blood in a haematoma, a protective compress dressing (made of 15ml mother tincture of Digitalis purpurea to 500ml of water; or 10g of fresh Digitalis leaves to 1 litre of water) should then be applied (Med Klinik, 1965; 60(50): 2028). An ointment of Hypericum perforatum can be applied to the blistered area to reduce discomfort and speed the healing process (Lehrbuch der Phytotherapie, Gothenburg: ab Arcanum, 1988: 296-297).
Minor strains, where there is muscle fibre damage only but the muscle sheaths remain undamaged, need cooling followed by a compress of nettle spirit (made from both Urtica urens and dioica) or a moist Arnica montana dressing (15ml mother tincture to 500ml cold water). Onion compresses, made from finely chopped onion mixed with some water and a little salt, are very useful for pain relief (Lehrbuch der Phytotherapie, Gothenburg: ab Arcanum, 1988, p 345). Medium strains, where there is partial rupture of sheaths as well as fibre damage, need additional professional strapping to allow the affected part to come gradually into use. Controlled, early mobilisation can lead to successful rehabilitation. Major strains, that involve complete rupture, need hospital treatment.
Sprains are overstretch injuries to ligaments and tendons. Complete ruptures, which are often surprisingly pain free, need surgery. Excessive motion of a joint is evident and the examiner may feel a gap. It is the partial tears that are excruciatingly painful. Treatment is as for minor strains that is, cooling and a compress or moist dressing. But rest is essential and achieved best by a fortnight in a splint.
Heat collapse occurs in any sportsman or sportswoman who feels unwell or collapses with a rectal temperature of more than 38¡C (100.4¡F). The victim needs tepid sponging, fluids to drink and their legs elevated. Studies have shown that oral rehydration with saline is as effective as intravenous rehydration (J Appl Physiol, 1997; 82: 799-806).
Two other studies show that caffeine consumed in a carbohydrate electrolyte solution during exercise does not cause diuresis or adversely affect bodily hydration status (Int J Sports Med, 1997; 18: 40-46) and a meal plus water can be more effective than a sports drink alone in restoring whole body water balance (Eur J Appl Physiol, 1996; 73: 317-325).
Hypothermia is diagnosed when the rectal temperature is below 35¡C (95¡F). A slowing of pace, stumbling and cramps are usually followed by euphoric confusion. This occurs most commonly when mountaineering. Victims needs shelter from the wind and cold, and warmth, say, by using a shared sleeping bag. Camphora 1DH, three doses to be given at 15 minute intervals (J H Clarke, The Prescriber: A Dictionary of the New Therapeutics, Rustington, Sussex: Health Science Press, 1972: 134).A hot bath will quickly restore body temperature. If there is some frostbite, but no gangrene, the affected parts should be slowly rewarmed and dressed with cotton wool dressings. Gangrenous parts require amputation.
Haemorrhaging should be treated with strict rest, reassurance, avoidance of excitement and all stimulants, and, whenever the haemorrhage is external, the application of pressure for 20 minutes. Sterile cellulose alginate (made from seaweed) Achillea millefolium 3CH should be administered (W Boericke, Homoeopathic Materia Medica, New Delhi: B Jain, 1990: 444), with the possible addition of Menadione (vitamin K3).
In the case of oligaemic shock due to haemorrhage, or plasma or electrolyte loss blood flow is increased to vital centres by raising the foot of the stretcher or couch. The patient should be allowed to lie undisturbed, kept warm and given fluids by mouth, where possible. Stimulants and alcohol should be avoided. Hypericum perforatum lDH should be given every four hours (Arzneimittel-Forschung, 1971; 21: 1999).
Septic conditions should be treated with Echinacea angustifolia , 20 drops, every two hours, and larger doses (Zeitschrift fuer Phytotherapie, 1981; 5: 166). To be used locally at the same time as a cleansing and antiseptic wash, it has been shown to be a broad spectrum bacteriostatic as well as producing a comprehensive resistance enhancing effect. Pyrogenium (Pyrexin) 6CH administered intercurrently every four hours can also be considered.