The Victorian Department of Health (2021) states that injury affects Australians of all ages [1]. It is the greatest cause of death between the ages of 1 and 44 years and leaves many with serious disabilities or long-term conditions. The leading causes of injury are falls, attempted suicides, transport, drowning and poisoning. For this blog, we’ll be talking about injuries through falls, workplace injuries and sporting injuries. Injury results in over 2,000 deaths and over 400,000 hospitalisations each year in Victoria. This costs the state over $730 million in direct hospital costs. The numbers of injuries treated each year by GPs, rehabilitation professionals and other allied health practitioners is unknown, but would also be substantial. Therefore, it is important that we have the skills to prevent these injuries from happening as best as we can.
Research shows that risk factors to injuries include:
· Proprioception
· Strength
· Range of movement
· Movement skill
Studies have found an association between poor balance and ankle and knee ligament injuries. In addition, it has been found that improving balance reduces the incidence of ankle and knee injuries [2].
In comparison, range of movement does not have as much of an impact on injuries as proprioception does. Studies have found that poor hamstring flexibility does not relate to hamstring injury risk [3]. Similarly, there is limited evidence showing an association between hip range of motion and groin injury [4]. However, an association was found between quadriceps flexibility and hamstring injuries in Australian rules football players. Players with greater flexibility were 70% less likely to suffer a hamstring injury [5].
There is a direct correlation between weakness of muscles and injuries. Hip abduction weakness relate to impaired postural control which may lead to an increased risk of ankle sprains [6]. Gluteal muscle strength and the angle of the knee influenced squat strength which were all influenced the risk of knee injuries [7]. If you were weak in any of these areas, you are more likely to suffer a knee injury.
Studies have also found a connection between movement skill and injuries [8]. It is important that people have correct movement patterns when working and playing sport to reduce the risk of injury. Those who have an increased trunk lean, hip adduction and knee valgus are more at risk for injury. Improving landing and running mechanics by reducing trunk lean, hip adduction and knee valgus will likely reduce injury risk.
To manage an injury, use the acronym PEACE & LOVE:
Protection: restrict movement for 1-3 days. This will help to minimise bleeding, prevent distension of injured fibres, and reduce the risk of aggravation. Rest should be minimised as prolonged rest can weaken the tissue. Pain signals should guide the period of protection.
Elevation: elevating the limb higher than the heart promotes the interstitial fluid to flow out of the tissue.
Avoid anti-inflammatory drugs: inflammation is an important phase of recovery as it helps to repair damaged soft tissues. Therefore, preventing inflammation with medications may negatively affect long-term tissue healing, especially when higher doses are used.
We also want to avoid ice in treating an acute injury as ice can disrupt inflammation, the formation of new blood vessels, blood supply, delay neutrophil and macrophage infiltration (which helps with inflammation), as well as increase immature muscle fibres which will increase the chance of muscle weakness.
Using ice is not all bad. Ice should only be used as an analgesic and only used in the first 24 hours after injury. As stated by Wang and Ni (2021), “the cold application on acute muscle fibre injuries should not last long and needs to be controlled precisely to avoid harming the neuromuscular muscle function”.
Compression: using pressure on an injury in the form of taping or bandages helps to limit swelling and tissue haemorrhage. Despite conflicting studies, compression seems to reduce swelling and improve quality of life.
Education: an active approach to recovery has proved to have many benefits after an injury. Therapists should educate patients on these benefits as well as the condition and load management as this will help avoid overtreatment.
After the first few days have passed, soft tissues need LOVE
Load: it is important to take an active approach and introduce movement and exercise early on in recovery as soon as symptoms allow. This will promote repair, remodelling and builds tissue tolerance in the injured muscle.
Optimism: research shows that optimistic patients often have better outcomes and prognosis. Catastrophising, depression and fear can act as barrier to recovery, so it is important to have an optimistic outlook.
Vascularisation: pain-free aerobic exercise should start a few days after injury. This helps to boost motivation and increase blood flow to the injured structures. It has also been found to improve physical function, supports a return to work and reduce the need for pain medication.
Exercise: evidence shows that the use of exercise reduces the risk of a recurrent injury. Exercise is important early after injury as it helps to restore mobility, strength, and proprioception. Pain should be avoided to ensure optimal repair during the subacute phase of recovery and should be used as a guide for exercise progression [9, 10, 11].
References
[1] Department of Health. Injury prevention. 2021. https://www.health.vic.gov.au/preventive-health/injury-prevention [2] Trojan TH, McKeag DB. Single leg balance test to identify the risk of ankle sprains. British journal of sports medicine. 2006 Jul 1;40(7):610-3. [3] Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. British journal of sports medicine. 2017 Aug 1;51(16):1189-94.
[4] Whittaker JL, Small C, Maffey L, Emery CA. Risk factors for groin injury in sport: an updated systematic review. British journal of sports medicine. 2015 Jun 1;49(12):803-9. [5] Gabbe BJ, Finch CF, Bennell KL, Wajswelner H. Risk factors for hamstring injuries in community-level Australian football. British journal of sports medicine. 2005 Feb 1;39(2):106-10. [6] Gafner SC, Hoevel V, Punt IM, Schmid S, Armand S, Allet L. Hip-abductor fatigue influences sagittal plane ankle kinematics and shank muscle activity during a single-leg forward jump. Journal of Electromyography and Kinesiology. 2018 Dec 1;43:75-81
[7] Cronström A, Creaby MW, Nae J, Ageberg E. Modifiable factors associated with knee abduction during weight-bearing activities: a systematic review and meta-analysis. Sports Medicine. 2016 Nov;46(11):1647-62. [8] Bramah C, Preece SJ, Gill N, Herrington L. Is there a pathological gait associated with common soft tissue running injuries?. The American journal of sports medicine. 2018 Oct;46(12):3023-31
[9] Wang, Z & Ni, G 2021. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases, 9(17), pp. 4116-4122.
[10] Scialoia, D & Swartzendruber, A 2020. The RICE Protocol is a Myth: A Review and Recommendations. The Sport Journal, pp. 1-19.
[11] Dubois, B & Esculier, J-F 2022. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med, 52(2), pp. 1-5.