SPORTS
INJURIES
DIAGNOSIS, TREATMENT, AND PREVENTION
EVERYDAY
SPORTS
INJURIES
CONTENTS
LONDON, NEW YORK, MUNICH,
MELBOURNE, DELHI
INTRODUCTION 6
Senior Editors Gareth Jones, Ed Wilson
Editors Marcus Hardy,
David Summers, Joanna BITTEN OR SWALLOWED 55
Edwards, Nicola Munro TONGUE
Medical Editor Martyn Page NECK STRAIN AND 56
US Editor Jill Hamilton
SPORTS IN PROFILE WHIPLASH
US Medical Consultant Eric N. Dubrow, MD NECK NERVE INJURIES 58
Senior Art Editors Gillian Andrews, COLLISION TEAM SPORTS 16 LOW BACK PAIN AND SCIATICA 60
Phil Gamble
CONTACT TEAM SPORTS 18 SACROILIAC JOINT 62
Senior Designer Keith Davis
NET-BASED SPORTS 20 INFLAMMATION
Designers Joanne Clark, Tim Lane
Production Controller Ben Marcus
BAT- AND CLUB-BASED 22 PIRIFORMIS SYNDROME 64
SPORTS COLLARBONE FRACTURE 66
Jacket Designer Mark Cavanagh
Managing Editor Stephanie Farrow RACKET-BASED SPORTS 24 COLLARBONE JOINT 68
Managing Art Editor Lee Grifths RUNNING 26 INJURIES
Illustrators Philip Wilson, Debbie WEIGHTLIFTING AND 28 ROTATOR CUFF INJURIES 70
Maizels, Richard Tibbitts, POWERLIFTING SHOULDER JOINT 72
Mike Garland, Mark
Walker, Darren R. COMBAT SPORTS 30 INFLAMMATION
Awuah, Debajyoti BOARD-BASED SPORTS 32 SHOULDER JOINT INJURIES 74
Dutta, Phil Gamble
SKI-BASED SPORTS 34 SIMPLE RIB FRACTURE 76
First American Edition, 2010 SKATE-STYLE SPORTS 36 ELBOW BURSITIS 77
Published in the United States by
DK Publishing WATER SPORTS 38 ELBOW TENDON INJURIES 78
375 Hudson Street SWIMMING-BASED SPORTS 40 HUMERUS FRACTURE 80
New York, New York 10014
BICYCLING 42 FOREARM FRACTURES 82
11 12 13 10 9 8 7 6 5 4 3 2 1
EQUESTRIAN SPORTS 44 WRIST FRACTURES 84
176375Nov/2010
EXTREME SPORTS 46 WRIST DISLOCATION AND 86
Copyright 2010 Dorling Kindersley Limited
All rights reserved. SPRAIN
Without limiting the rights under copyright WRIST AND HAND TENDON 88
reserved above, no part of this publication may DISORDERS
be reproduced, stored in or introduced into a
CARPAL TUNNEL SYNDROME 90
retrieval system, or transmitted, in any form, or by
any means (electronic, mechanical, photocopying,
SPORTS INJURIES METACARPAL FRACTURE 91
recording, or otherwise), without the prior written
permission of both the copyright owner and
HAND AND FINGER TENDON 92
the above publisher of this book. INJURY LOCATOR 50 INJURIES
The information in this book is designed to help CONCUSSION 52 FINGER FRACTURE AND 94
you make informed decisions about your health and DISLOCATION
CHEEKBONE FRACTURE 53
tness, and exercise/rehabilitation program. It is not
intended as a substitute for professional advice from JAW FRACTURE AND 54 HIP FRACTURES 96
doctors and/or physical therapists. If you suspect you DISLOCATION TROCHANTERIC BURSITIS 98
have an injury or other medical problem you should
seek the approval of your physician and physical HIP LABRAL TEARS AND FAI 100
therapist before beginning any form of exercise.
The publisher, nor the author, nor anyone else
involved in the preparation of this book are engaged
in rendering professional advice or services to the
individual reader. For further safety advice (>>p.272).
Published in Great Britain by
Dorling Kindersley Limited.
A catalog record for this book is available
from the Library of Congress
ISBN 978-0-7566-5737-6
Printed and bound in Singapore by
Tien Wah Press Ltd.
Discover more at www.dk.com
BMA MEDICAL EDITOR
Dr. Michael Peters is Consulting Medical
Editor to the British Medical Association
(BMA) and Director of the Doctors for
Doctors Unit at the BMA, having previously
worked as a General Practitioner.
OSTEITIS PUBIS 102 FOOT LIGAMENT SPRAINS 156
GROIN STRAIN 104 MORTONS NEUROMA 157
HERNIAS 106 METATARSAL FRACTURE 158
CONSULTANT EDITORS
HAMSTRING INJURIES 108 TOE FRACTURE 159 Prof. Nicola Maffulli is the Center Lead
QUADRICEPS INJURIES 110 PLANTAR FASCIITIS 160 and Professor at the Centre for Sports and
PATELLA FRACTURE 112 Exercise Medicine at Queen Mary, University
PATELLAR DISLOCATION 114 of London, Barts and The London School of
PATELLOFEMORAL PAIN 116 Medicine and Dentistry, and was appointed
SYNDROME as an Orthopedic Consultant in 1996. He
PATELLAR BURSITIS 118 TREATMENT & chairs the Scientic Committee of the English
Football Association, and is an editorial board
OSTEOCHONDRITIS 120 REHABILITATION member of 10 sports medicine journals.
DISSECANS
KNEE TENDON INJURIES 122 Dr. Stephen Motto is a Sports and Musculo-
ANTERIOR CRUCIATE 124 FIRST AID skeletal Physician at London Bridge Hospital,
LIGAMENT INJURY FIRST AID ESSENTIALS 164 Honorary Lecturer at the Centre for Sports and
COLLATERAL LIGAMENT 126 MINOR INJURIES 165 Exercise Medicine, Queen Mary, University of
INJURIES London, and Clinical Tutor for the MSc in Sports
WOUNDS AND BLEEDING 166
and Exercise Medicine, University College,
POSTERIOR CRUCIATE 128 ENVIRONMENTAL INJURIES 168
London. In his 20-year career, he has worked
LIGAMENT INJURY BONES, JOINTS, AND MUSCLES 170 with the British International Rowing Team
MENISCUS TEAR 130 UNCONSCIOUSNESS 172 and was on the 1996 Olympics medical team.
ILIOTIBIAL BAND SYNDROME 132
LOWER LEG FRACTURE 134 Mr. Panos Thomas is a Consultant Orthopedic
CALF INJURIES 136 REHABILITATION EXERCISES Surgeon at the Whittington Hospital, London,
SHIN SPLINTS 138 MOBILITY EXERCISES 174 Director of the MSc in Sports and Exercise
COMPARTMENT SYNDROME 139 STRENGTH-TRAINING EXERCISES 192 Medicine at University College, London, and
ACHILLES TENDON RUPTURE 140 STATIC-STRETCHING EXERCISES 240 on the Executive of the British Orthopedic
ACHILLES TENDINOPATHY 142 Sports Trauma and Arthroscopy Association.
PROPRIOCEPTION EXERCISES 246
He advises several professional soccer clubs
ANKLE FRACTURE 144 PLYOMETRIC EXERCISES 254
and sports associations, and is editor of the sports
ANKLE SPRAIN 146 TESTING EXERCISES 260
orthopedic section of the electronic NHS Library.
HEEL BONE FRACTURE 148
RETROCALCANEAL BURSITIS 150 Scott Tindal is a physiotherapist with 10
TIBIALIS POSTERIOR 152 years experience of working with private
TENDINOPATHY GLOSSARY 264 clients and elite athletes, across a range of
SINUS TARSI SYNDROME 153 INDEX 266 sports, including rowing, cricket, and rugby
FOOT TENDON INJURIES 154 ACKNOWLEDGMENTS 272 union at both club and national level. Scott
holds an MSc in Sports and Exercise Medicine
from Queen Mary, University of Lond
on, anda BSc in Physiotherapyfrom the
University of Sydney, Australia.
6 INTRODUCTION
Whether you are keen to boost your fitness, play What is a sports injury?
competitively, or simply increase your general wellbeing, A sports injury is any form of stress placed upon your body
there are many good reasons to take part in sports. While during athletic activity that prevents it from functioning to
the benefits of any form of exercise should outweigh the the full, and which requires a period of recovery to allow
risks, at some point most people will experience an injury your body to heal. It usually affects your musculoskeletal
of some kind, ranging from minor strains and sprains to systemyour bones, muscles, tendons, and cartilage
more serious injuries, such as dislocations and fractures. and often results in pain, swelling, tenderness, and the
inability to use, or place weight on, the affected area.
Identifying the problem
Many minor injuries can be treated simply and effectively at Sports injuries can be divided into two types: acute, or
home, while more serious injuries may require professional traumatic, injuries, which occur as the result of a specific
help. Learning how to recognize the symptoms and identify impact or traumatic event; and chronic, or overuse, injuries,
your injury will guide you toward the most appropriate which result from wear and tear on the body and occur over
treatment, and, in turn, help you return to your chosen an extended period of time. Acute injuries include bone
activity more quickly. fractures, muscle and tendon strains, ligament sprains, and
bruising. They are common among players of collision or
contact sports, such as rugby, soccer, and ice hockey. Chronic
MOST COMMON SPORTS INJURIES injuries include tendinopathy, bursitis, and stress fractures;
Groin strains Rotator cuff tendinopathy
they are more common among participants in endurance
sports, such as long-distance running, and in people who
Shin splints Tennis elbow play individual sports involving repetitive movements, such
as swimming, tennis, gymnastics, and weight lifting.
Neck strain Ankle sprain
Overtraining, which Recurring injury, which Bones protect your internal organs and are connected
increases the risk of can weaken your body and together by ligaments to form the skeleton. Bone fractures
chronic injury by putting make it more susceptible and breakages often damage surrounding soft tissue.
continuous pressure on to other injuries.
your body. Joints are capsulesmade of cartilage, bursae, ligaments, and
Genetic factors, which are tendonsthat hold together two or more bones and facilitate
Excessive loading on intrinsic (belonging to you) movement. Partial or full dislocation of the joints can occur.
the body, which applies and inuence the shape
forces to your tissues for and structure of your joints. Cartilage is a brous connective tissue that forms smooth
which they are unprepared. surfaces over the ends of bones where they meet the joints,
Muscle weakness or allowing movement and absorbing impact and friction. Worn
Not taking safety imbalance, which can or torn cartilage is a common side effect of joint injuries, and
precautions, or ignoring lead to a loss of strength is commonly caused by trauma.
the rules of a sporting in your body.
activity, increasing the Bursae are small sacs of uid that reduce friction within some
risk of an accident. Lack of exibility, which joints, and are usually located where muscles and tendons slide
will decrease your range across bones. Bursitis is inammation due to overuse or infection.
An accident, often the of motion and limit some
result of an impact or of your bodys capabilities. Ligaments are brous, connective tissues that connect bones,
collision, and usually providing stability within joints and limiting movement of the
occuring suddenly. Joint laxity (a condition limbs. An overstretched or torn ligament is known as a sprain.
which, if you have it, you
Inappropriate equipment, should already be aware Tendons are brous, connective tissues that connect muscles
so your body may not be of), which can make it to bones, and help produce movement by enabling force to be
adequately supported or difcult for you to control exerted on the bones. Tendons can be strained or ruptured, and
protected from shock. and stabilize your joints. tendinopathy is pain caused by overuse or repetitive motion.
8 INTRODUCTION
AVOIDING INJURY
Depending on your age, and basic level of health, CHOOSING THE RIGHT GEAR
you should be able to enjoy exercise and sports to a fun
and rewarding degree. The benefits of exercise are well Ill-tting or unsuitable equipment increases the chances
documented: improved cardiovascular health leads to of injury. Consider the following tips when buying your gear:
a greater sense of psychological well-being and reduces Footwear should be suited to your chosen sport and must
the risk of heart disease, high blood pressure, and high provide sufcient support and cushioning for your feet and
cholesterol. However, regular exercise does carry the risk ankles. Seek specialist advice regarding footwear that is
of injury, so take steps to reduce the chances of suffering specic to your sport, and always try before you buy.
one in the first place, and familiarize yourself with first
Clothing should be constructed from a material suited to
aid in case injury strikes you or your teammates. the purpose, such as breathable fabric for warm-weather
sports or insulated fabric for cold- and wet-weather sports.
Assessing your fitness and tailoring your exercise
You should always visit a physician for a medical check-up Sport-specic equipment, such as rackets, skis, and bicycles,
should be custom-tted to your bodys dimensions and weight,
to assess how fit you are before you begin playing a new and suited to your level of ability.
sport. Starting from a low level of fitness, being overweight
for your height, or having a preexisting medical condition
or injury all increase the likelihood of your injuring yourself.
Get in shape before starting a new sport and talk to strengthso different physiques and attributes may be
a professional about the appropriate intensity, duration, suited to different sports. Seek professional advice on
and frequency of activity for your level of fitness. the best activities for your sport, such as strength training,
plyometric exercises, and circuit training, and learn the
To maximize your performance, formulate a training correct technique for each exercise. Build up your
regimen suited to the demands of your chosen sport. Each strength and stamina gradually.
sport calls for certain fitness requirementsfor example,
long-distance running requires stamina and endurance, Resting and fueling your body
while weight lifting necessitates a high level of muscle Allowing time for rest and recovery in your training
program is just as important as the exercise itself. Any type
KEY TRAINING TERMS of strenuous activity places physical stress upon the body,
leading to minor tissue damage. When sufficient time is
Weight: The weight to be lifted. allowed for your bodys natural repair processes to take
place, these stresses actually stimulate the body to adapt
Set: Groups of repetitions are organized into sets. You could,
and recover, resulting in increased fitness. However, training
for example, perform three sets of ten repetitions.
too often prevents your body from recovering sufficiently,
One-rep max (one-repetition maximum): The most impairing your fitness and increasing the likelihood of injury.
weight you can lift in a single repetition of a given exercise. Avoid exercise altogether if you are already injured, or
unwell or tiredor you may in fact delay your recovery.
% one-rep max: The percentage of your one-rep max that
a weight representsif the maximum weight you can lift in
one repetition is 220 lb (100 kg), a weight of 175 lb (80 kg) The final element of an effective exercise regimen is diet
represents 80% of one-rep max. and nutrition, which should be tailored to the requirements
of your training program. Glycogen is the fuel that your
ROM (range of motion): The distance and angle a joint can body burns during exercise, so you should eat food rich
be moved to reach its full potential.
in complex carbohydrates, such as whole grain bread and
pasta, in the hours prior to exercise. Small quantities of
AVOIDING INJURY 9
procedure ( p.170), is essential for stemming the bleeding
and reducing the swelling. For acute injuries, especially
allows them to reestablish their normal range of movement.
Perform only one or two stretches per muscle group, and hold
each position for 2030 seconds. Take care not to overstretch
those involving collisions or head injuries, first aid because this may inadvertently injure the muscle.
There are a number of things you can do to reduce taking into account your injury history and conducting
your chances of getting injured, but no matter how a clinical examination, your physician may be able to
careful you are, and how much you prepare for your diagnose and treat some minor injuries. However, if your
chosen sport, injuries can still occur. The good news physician feels that further treatment is appropriate, you
is that sustaining an injury doesnt have to dent your will be referred to an appropriate specialis
dreams of athletic success, or blow a hole in your
training program. While it is essential to give your Consulting a specialist
body sufficient time to healand you must accept Most sporting injuries affect your musculoskeletal system
that your level of activity will be disrupted to a certain your bones, ligaments, muscles, nerves, and tendons.
degreethere are plenty of professionals who can advise The treatment of such injuries belongs to the realm of
you on the best form of treatment, and can design a orthopedic surgeons and sports and exercise medicine
recovery program that is specifically suited your needs. physicians, who are sports physicians and surgeons with
specialist training in this field. Rheumatologists with sports
medicine experience and qualifications can also provide
Initial treatment musculoskeletal assessments. These specialists use a range
Acute injuries that involve some form of trauma or of surgical, medical, and physical means to investigate and
accident will usually require immediate first aid and restore function to the musculoskeletal system. After an
stabilization ( pp.16473), and possibly even hospital
treatment, depending on the severity of the injury. In
initial examination, they may use X-rays or scans to help
them diagnose the specific nature of your injury before
the case of serious injuries, a program of treatment deciding on an appropriate course of treatment. In more
will be instigated by the hospitals emergency room. serious cases, they may be called upon to mend broken
For injuries such as bone fractures, this treatment bones, remove torn cartilage, or operate on damaged
program may involve a surgeon setting the bone in joints using a minimally invasive procedure known as
a cast, a follow-up appointment at an orthopedic arthroscopic surgery.
clinic, and then a program of physical therapy.
Many of these physicians, including orthopedic surgeons,
For chronic injuries and those that do not require specialize in specific areas of the body, such as the back,
emergency treatment, your should schedule knees, or ankles and feet. Podiatrists are nonmedical
an appointment with your physician. After practitioners who can provide an assessment of foot
YO U R PAT H TO R E C O V E R Y 11
Physical therapy techniques you follow the step-by-step instructions given with each
Physical therapists use a variety of techniques to treat sports exercise closely. Effective communication between you and
injuries. Through massage and manipulation they can your physical therapist will also ensure that at every stage of your
relieve inflammation, reduce muscle pain and joint stiffness, rehabilitation you are receiving the very best treatment.
and encourage blood flow to and fluid drainage from
the affected area. They may also use a combination of There is one crucial component to your recovery from
electrotherapy, ultrasound, and the application of heat and injury that health specialists, despite their high levels of
cold to stimulate the nervous and circulatory systems to expertise, cannot provide: the will to succeed. If you apply
reduce pain and accelerate healing. However, in most cases the same determination for success in your chosen sport
the most important factor in the rehabilitation process to practicing the exercises in your rehabilitation program,
is a comprehensive program of remedial exercises. you will have every chance of making a full recovery in
as short a time as possible.
Your rehabilitation program
The exercises featured in the treatment and rehabilitation GETTING THE BEST FROM REHABILITATION
chapter of this book ( pp.162261) have been devised to
improve the mobility, flexibility, or strength of various parts Get in shape before starting a new activity or sport.
of the body. Your physical therapist will use exercises such as Alwaysstick to the exercises that have been
these to put together a program of exercises that become recommended for your training program.
progressively more challenging. A critical aspect of recovery
and progression is gauging when the injured area is strong Wear the right protective gear.
enough for you to move on to the next stage of the
Always warm up and cool down.
program. The physical therapist will perform ongoing
assessments using baseline objective markers that assess Make sure you use the correct technique.
whether you can complete a movement or exercise for
a specified duration, intensity, or number of repetitions. Keep hydrated.
with a final level of markers indicating whether you Dont exceed the recommended number of repetitions
or level of intensity.
are ready to return to full engagement in your chosen
sport or exercise. However, you should only follow a Dont overwork your bodyknow your limits.
rehabilitation program that has been tailored to your
specific needs and training history under the guidance Immediately stop what you are doing if you feel pain.
of an accredited physical therapist.
Make sure you have adequate rest between sessions.
A successful recovery Avoid exercise if you are already injured, or if you are
Key to your successful and speedy recovery from any sports unwell or tired.
injury is making sure you are using the correct technique
when performing every exercise, and diligently following Continue your program until you have nished it.
the guidance given to you by your physical therapist. It is Maintain a positive attitude and keep your spirits up.
important that you never exceed the number of repetitions
or levels of intensity that are recommended, and that
SPORTS
IN PROFILE
Understanding the physical demands of your chosen sport is key to
staying injury-free. This chapter examines the areas of your body that
are particularly vulnerable to injury across different sports, the kinds
of injuries that are most likely to occur, and gives examples of exercises
you can use to condition your body to help prevent them.
16 SPORTS IN PROFILE
Wrist, hand,
SPORTS SUCH AS and ngers
Football
Aussie rules football
Rugby league
Rugby union
Ice hockey
Gaelic football
Lacrosse
Hurling
INJURY HOTSPOTS
Head and face High-impact blows and collisions with other
players are a common cause of blood injuries ( p.166)
and concussion ( p.52).
Neck, spine, and back Intense pressure is placed on the neck
Thigh
Ankle, foot,
and toes
COLLISION TEAM SPORTS 17
STAYING FREE OF INJURY
MAINTENANCE TRAINING
Training programs for collision sports should be based
around total fitness; a good way to achieve this is by
combining strength-training circuits to develop power
with interval training to improve cardiovascular fitness.
Abdomen, hip,
Flexibility
and groin
The high-impact nature of
collision sports makes the
joints susceptible to strains
and sprains. Flexibility exercises,
such as wall sit presses ( p.185),
can help prevent this.
Abdomen, hip, and groin Rapid changes of
direction can lead to strains of the groin ( p.104). Strengthening
Hernias may also occur ( p.106).
Thigh Short sprints can strain the hamstrings
Many collision sports rely
on explosive power. Strength-
( p.108) and quadriceps ( p.110).
Knee Turning quickly, or sustaining a strong blow
training exercises, such as
power cleans ( p.238), are
to the knee, can cause damage to the ligaments a good way of developing this.
( pp.12429) and meniscal injuries ( p.130).
Leg High-impact contact can lead to fractures of
the tibia and fibula ( p.134). Pushing off to sprint
can cause strains to the calf and the toes, while
Power and stability
sudden changes in pace or direction can tear Twisting and turning leaves
the Achilles tendon ( p.140).
Ankle, foot, and toes Rolling over on the ankle
the joints susceptible to injury.
Stability exercises, such as box
while changing direction is a common cause of
jumps ( p.259), help boost
ankle ligament sprains ( p.144) and, in severe acceleration, and also improve
instances, can also cause fractures ( p.142). hip, knee, and ankle stability.
18 SPORTS IN PROFILE
Head
and face
SPORTS SUCH AS
Soccer
Thigh
Handball
Dodgeball
Field hockey
INJURY HOTSPOTS
Head and face Collisions between players may Wrist, hand, and fingers Using the hand to break a
cause blood injuries ( p.166) or concussion ( p.52). fall can cause dislocations or fractures of the wrist
Neck, spine, and back Sustained postures in some
sports, such as bending forward in hockey, can
( p.86 and p.84), and fingers and thumb ( p.94).
Abdomen, hip, and groin Constant changes of direction
lead to pain and stiffness in the neck ( p.56) and when playing these sports mean that adductor strains
lower back. These positions may eventually lead
( p.104) are common. The repeated kicking movement
to a slipped disk and sciatica ( p.60). required in soccer can lead to overuse injuries,
Shoulder and chest Falling onto an outstretched
hand or arm is common in many contact sports,
including osteitis pubis ( p.102).
Thigh Rapid acceleration and deceleration mean that
and may cause dislocation of the shoulder ( p.74)
strains of the hamstrings ( p.108) and quadriceps
or injuries to the joints of the collarbone ( p.68).
( p.110) often occur.
C O N TAC T T E A M S P O R T S 19
STAYING FREE OF INJURY
In contact sports, long-term training as well as pre-game
preparation are crucial for preventing injury. They demand
high levels of cardiovascular and muscular fitnessand
so a training program should take this into account.
Protective gear, such as shin guards, may also be worn.
TRAINING
Training programs for contact sports should focus on
total fitness. Circuit training with weights (to improve
strength and power) alongside interval training (for the
cardiovascular system) works very well.
Flexibility
Leg Contact sports require good
flexibility. Exercises such as stride
stretches ( p.244) help increase
range of movement as well as promote
good posture, which may reduce
pressure in the lower back.
Strengthening
Strength is essential for contact
Ankle, foot, sports. Strengthening the legs and
and toes
lower back with exercises, such as
straight-leg deadlifts ( p.197),
can improve performance and
prevent injury.
Knee Twists, turns, or awkward falls put a lot of strain
on the knees, and this can lead to ligament injuries
( pp.12429) or dislocations ( p.114).
Leg Impact from tackles can result in fractures of
Power and stability
Training for contact sports
the tibia and fibula ( p.134). Sudden acceleration
from standing can lead to tendinopathy or Achilles
should include the development
of explosive power. Exercises
tendon tears ( p.140). such as kneeling supermen
Ankle, foot, and toes Metatarsal fractures ( p.158)
can result from the foot being stood on, and rolling
( pp.22829) help by
strengthening core
over on the ankle may sprain the ligaments ( p.144). muscles in the back.
Toe strains are also common ( p.156).
20 SPORTS IN PROFILE
NET-BASED SPORTS
The frequent jumping and landing involved in net
based team sports, such as basketball, netball, and
volleyball, puts a great deal of stress on the hips,
knees, and ankles. As a result of these repeated
actions, injuries to the lower limbs are common.
The large amount of throwing involved can also
cause problems in the shoulder, elbow, and wrist.
Shoulder
and chest
INJURY HOTSPOTS
Neck, spine, and back Looking up at the basket Arm and
elbow
repeatedly can cause inflammation and pain in
the neck ( pp.5659). It can also give rise to poor
posture, again leading to neck pain.
Shoulder and chest Repetitive overhead movements
stress the muscles of the shoulder joints, and may
cause rotator cuff inflammation ( p.70), and shoulder
bursitis and impingement ( p.72).
Arm and elbow Repeated extension movements while
shooting can lead to pain and inflammation in the
tendons around the elbow ( p.78).
Wrist, hand, and fingers Falls and contact with
other players can cause dislocations or fractures
of the wrist ( pp.8487). Repetitive actions, such
as overhead shooting, may lead to strain injuries
of the wrist ( p.88).
Abdomen, hip, and groin Sharp changes of movement
when dodging past players may cause groin strains
( p.104) or hernias ( p.106).
Thigh The sprints and jumping that are involved in
Knee
Wrist, hand,
STAYING FREE OF INJURY
and ngers
In addition to the muscular strains that can be caused
by rapid acceleration and deceleration, the jumping
and landing in net-based sports require good stability
in the ankles and knees to reduce stress on the joints.
Supportive footwear can help with this.
TRAINING
Neck, spine, Players of net-based sports require stamina as well as
and back
quick bursts of power. A training program incorporating
plyometric exerciseswhich use explosive movements
SPORTS SUCH AS to develop power in the musclesis key to achieving
optimum performance and preventing injury.
Basketball
Netball Flexibility
Korfball
Running on hard surfaces places
Volleyball
stress on the lower body. Stretching
exercises, such as rotational walking
lunges ( p.181), are a good way of
preventing overuse injuries.
Abdomen, hip,
and groin
Strengthening
Power in the shoulders helps
prevent injury and improves
performance. Exercises, such as
Thigh
assist in developing this.
medicine ball throws ( p.216),
Shoulder
SPORTS SUCH AS and chest
Baseball
Softball
Rounders
Cricket
Golf
INJURY HOTSPOTS
Head and face Head injuries, such as skull fractures or concussion
( p.52), are a risk when standing in close proximity to the ball striker,
or facing a quickly delivered ball when batting.
Thigh
Neck, spine, and back Abrupt spinal twists can cause degeneration of the
disks ( p.60), lower back pain, and damage to the nerves in the neck ( p.58).
Shoulder and chest Lack of stability in the shoulder, or bad technique
when bowling or batting, can lead to rotator cuff injuries ( p.70),
shoulder bursitis ( p.72), or even subluxation ( p.74).
Arm and elbow Overuse of the forearm muscles, which attach to
Knee
TRAINING
A training regimen that concentrates on strengthening
the stabilizing muscles in the shoulder will help limit
shoulder problems, which can be a frequent occurrence
in these sports. Stretching the chest can help prevent
shoulder pain arising as a result of repeated throwing
or swinging motions.
Flexibility
Exercises to reduce tightness
Abdomen, hip, in the shoulder muscles, such
and groin
as pec stretches ( p.240),
will decrease the risk of tears
to the rotator cuff when
batting or throwing.
Thigh Serious bruising of the quadriceps, or dead
legs ( p.110), are a common injury if a fast-moving
ball makes contact with the thigh. This is a relatively Strengthening
common occurrence in sports such as baseball Strengthening the muscles that
and cricket. stabilize the shoulder joint will
Knee Frequent changes in direction when fielding improve performance and reduce
put a large amount of pressure on the knees; the risk of injuryexercises such
twisting the knee can tear the ligaments
( pp.12429) or cause meniscal injuries ( p.130). with this.
as standing Ys ( p.215) can help
RACKET-BASED SPORTS
Racket-based sports, such as badminton, squash,
and tennis, require excellent endurance of both the
cardiovascular and muscular systems. The knees and
the ankles are put under stress during accelerating
movements and quick changes of direction. Repeated
overhead movements of the arms during serves and Shoulder
and chest
smashes also put considerable strain on the upper limbs.
SPORTS SUCH AS
Tennis
Badminton
Squash
Raquetball
Wrist, hand,
and ngers
Table tennis
Abdomen, hip,
and groin
Knee
INJURY HOTSPOTS
Neck, spine, and back Sudden overhead movements can sometimes
cause a stiff and painful neck ( p.56). Reaching up to hit
a ball when serving can overextend the spine, causing lower-
Leg
back pain ( p.60), and possible spinal fractures.
Shoulder and chest Stress to the shoulder during repeated
overhead actions frequently causes pain and, over time,
can result in rotator cuff tears ( p.70). Shoulder bursitis
and impingement ( p.72) can also occur.
Arm and elbow Repeated use of the muscles that attach to
Ankle, foot,
and toes
the elbow can cause pain and inflammation on the outside
of the joint, a condition known as tennis elbow ( p.78).
Wrist, hand, and fingers The repetitive movements of the
wrist common in racket sports may cause carpal tunnel
syndrome ( p.90).
Abdomen, hip, and groin Quick changes of direction
are a common cause of adductor strain ( p.104).
R A C K E T- B A S E D S P O R T S 25
STAYING FREE OF INJURY
Racket sports rely on excellent stability around the outer
Neck, spine, limbs in order for a player to change direction quickly and
and back retrieve difficult shots. The body must also be accustomed
to powerful movements when hitting overhead shotsit
is therefore essential to have a good core stability for the
transference of power through the body.
TRAINING
Training programs for racket sports need to focus on
power and cardiovascular fitness. Interval training for
the cardiovascular system combined with plyometric
exercises for developing power should help with this.
Flexibility
Stretches that improve the
flexibility of the shoulder, such
as sleeper stretches ( p.245),
reduce stiffness and decrease
the risk of injury.
Strengthening
Strengthening exercises, such
Knee Lunging and bending movements of the
knee may cause inflammation of the patellar tendon
as lawnmowers ( p.190),
that mimic the movements used
( p.122) or the patellofemoral joint ( p.116).
In younger athletes, this may also lead to Osgood-
in racket sports, are important
for improving performance and
Schlatter Syndrome ( p.122).
Leg Rapid changes of pace exert the back of
reducing the risk of injury.
the leg and can cause calf strains or tears ( p.136).
Very occasionally, repeated use of the lower-leg Power and stability
muscles can cause a buildup of pressure in the Strengthening the lower body
limb, leading to a more serious condition called through exercises, such as sideways
compartment syndrome ( p.139).
hops and jumps ( p.257), increases
core stability and develops the power
Ankle, foot, and toes Rolling onto an ankle while
changing direction can result in severe ligament needed for quick changes in direction.
sprains ( p.144), and toe strains ( p.156).
26 SPORTS IN PROFILE
RUNNING
The strain placed on the lower limbs by
running means that short-, middle-, and
long-distance runners frequently suffer
injury. Unsuitable footwear, as well as
poor posture and technique, often lead
to overuse injuries, such as shin splints Neck, spine,
and back
and tendinopathies.
INJURY HOTSPOTS
Neck, spine, and back Repeatedly running on
hard surfaces places stress on the spine, and
may lead to herniated disks and sciatica ( p.60).
Weak core-stabilizing muscles can also lead to a
possible dysfunction of the sacroiliac joint ( p.62),
resulting in pain in the pelvic area.
Abdomen, hip, and groin Tightness around the hips
when running long distances can put stress on the
outside of the joint, leading to trochanteric bursitis
( p.98). Rapid contraction of the thigh muscles
during sprinting can also lead to acute groin
injuries ( p.104). Hernias ( p.106) are also
quite common in sprinters.
Thigh
Thigh Sprinting or running without an adequate
warm-up beforehand may cause strains or even
tears of both the hamstrings ( p.108) and the
quadriceps ( p.110).
Knee Running long distances, especially on hard
Knee
surfaces, puts a lot of stress on the knee joint. Tightness
in the iliotibial band ( p.132) can cause pain on
the outside of the knee while running. Patellar
tendinopathy ( p.122) causes pain in the front of the
knee, and is often the result of the body being unable
to cope with an increase in mileage.
Leg The repetitive action of lifting the toes while
running puts strain on the front of the shins, and
can cause medial tibial stress syndrome, or shin SPORTS SUCH AS
splints ( p.138).
Ankle, foot, and toes Pushing off from the toes Cross-country running
may cause tibialis posterior tendinopathy ( p.152),
resulting in pain on the inside of the ankle, and toe
Long-distance running
Middle-distance running
strain ( p.156). It can also lead to flat feet, which
puts more stress on the lower limbs when running.
Sprinting
RUNNING 27
STAYING FREE OF INJURY
Runners should concentrate on three key areas during
their training: increasing distance gradually (10 percent
each week as a guide); wearing appropriate footwear that
maintains optimal foot position, in order to put as little
stress as possible on the lower limbs; and following a
comprehensive strengthening and stretching program
in addition to running.
TRAINING
Obviously, cardiovascular fitness is a priority for runners.
However, following a core-strengthening program will
Abdomen, hip,
and groin
provide support for the lower back, reducing the risk of
herniated disks and sciatica.
Flexibility
Running on a hard surface can
damage the knees. Foam roller
exercises ( p.191), or a sports
massage, are a good way of
mobilizing the tissue on the
outside of the leg to help
reduce knee pain.
Strengthening
Performance can be improved,
and the risk of injury reduced,
by performing leg-strengthening
exercises, such as barbell squats
( p.192).
INJURY HOTSPOTS
Neck, spine, and back Overstraining during weight
training may cause spasms of the neck muscles
( p.56). The spine becomes heavily compressed,
which, when combined with inadequate spinal
stability and poor lifting technique, can cause
muscle strains ( p.56), joint fractures, or problems
with the spinal disks, such as a prolapsed disk ( p.60).
Shoulder and chest The shoulders are a frequent
Arm and
elbow
Flexibility
Lifting weights places stress on the
thigh. Stretches that increase mobility
in that area, such as hamstring lowers
( p.187), reduce the risk of
straining the hamstrings.
Strengthening
The legs generate much of the
power needed for lifting weights.
Exercises such as Romanian
deadlifts ( p.196) are excellent
for developing strength.
COMBAT SPORTS
Combat sports, such as boxing, judo, and
karate make tough demands on the body;
training is intense, and participation requires
good all-round fitness. Regardless of the fitness
of the participants, however, the aggressive Wrist, hand,
blows traded between opponents mean that and ngers
these sports always carry a serious risk of injury.
INJURY HOTSPOTS
Head and face High-impact strikes to the head
can cause injuries such as concussion ( p.52) and
jaw fractures ( p.54).
Neck, spine, and back Fractures to the cervical spine
( p.170) can be sustained by being thrown onto the
neck. Rapid twisting movements of the neck during
contact can result in neck strain ( p.56), causing
stiffness and pain.
Shoulder and chest Shoulders undergo stress when
wrestling opponents, and landing badly after being
thrown can result in posterior or anterior dislocations
( p.74), and sternoclavicular joint injuries ( p.68).
Direct blows to the ribs can cause bruising or
Abdomen, hip,
and groin
fractures ( p.76).
Arm and elbow Falling on an elbow or an outstretched
arm may cause fractures of the upper arm, radius, or
ulna ( pp.8083).
Wrist, hand, and fingers The wrist ( pp.8487) and
fingers ( p.94) are all vulnerable to dislocation or
fracture, either from a fall or a blow from an opponent.
Knee
in fractures to the tibia or fibula ( p.134).
Ankle, foot, and toes Ankle fractures can result from
direct impact to the joint, while ligament sprains as
a result of the ankle being twisted are a reasonably
common occurrence ( p.144). Ankle, foot,
and toes
C O M BAT S P O R TS 31
STAYING FREE OF INJURY
In addition to having the right protective equipment,
such as a groin guard, participants in combat sports
need to follow a training regimen that develops flexibility
and power, allowing them to cope with the blows they
receive from opponents, and the twisting actions and
potential strains.
TRAINING
Neck, spine, The joints are extremely vulnerable during combat sports,
and back so exercises to promote strength and flexibility are an
essential part of any training regimen. Interval training
to improve cardiovascular fitness is also important.
Shoulder
and chest
Flexibility
Exercises that improve mobility
of the hip, such as walking kick-outs
( p.185), are an effective way of
reducing the risk of muscle strain.
Arm and
elbow
Strengthening
Exercises such as push presses
SPORTS SUCH AS
( p.238) are good for increasing
all-round strength, which is
Boxing essential in combat sports,
Fencing both in terms of improving
Karate performance and avoiding injury.
Kung fu
Ju-jitsu
Kickboxing
SPORTS SUCH AS
Surng
Windsurng Knee
Snowboarding
Skateboarding
Kitesurng
INJURY HOTSPOTS
Head and face High-speed falls from a board onto Arm and elbow Fractures of the lower arm are
the head can cause concussion and possibly a common due to the impact of high-speed
fractured skull ( p.52).
Neck, spine, and back Falling directly onto the head
falls ( p.82).
Wrist, hand, and fingers Attempting to absorb
can put massive pressure on the spine; in severe the impact of a high-speed fall with an
cases, this may lead to neck fractures, while neck outstretched hand can lead to wrist sprains
serious falls.
strain and whiplash ( p.56) may result from less
and fractures ( pp.8487).
Abdomen, hip, and groin Direct trauma to
Shoulder and chest Falling directly onto an outstretched the hips caused by repeated falls may lead
arm can result in shoulder dislocation ( p.74), and
falls onto the hand can cause the acromioclavicular
to bursitis and inflammation ( p.98).
Abdomen, hip,
and groin
Ankle, foot,
and toes Strengthening
In board sports, the ankle absorbs
much of the impact from jumping
and landing, as well as from
controlling the board. Stability
exercises, such as hopping
Knee Repeated jumping movements put a lot of strain
( pp.25658), help develop
strength and improve
on the knee jointspain felt in the front of the knee
jumping actions.
as a result of numerous hard landings is a common
condition known as patellar tendinopathy, or jumpers
knee ( p.122). Injuries to the anterior cruciate ligament Power and stability
may also occur as a result of twisting ( p.124).
Ankle, foot, and toes Falls frequently cause twisting
Maintaining a stable body position
on the board requires good knee
motions of the ankle, leading to sprains or even and ankle stability. Stability exercises,
ruptures of the tendons ( p.144) if the force is
strong enough. This causes pain and swelling on help promote this.
such as hand clock drills ( p.248),
SKI-BASED SPORTS
Skibased sports frequently result in injury because Head
falls tend to occur at high speeds, and potentially from and face
SPORTS SUCH AS
Skiing Abdomen, hip,
Waterskiing and groin
Knee
Thigh
Ankle, foot,
and toes
INJURY HOTSPOTS
Head and face High-speed falls can lead to direct Elbow and arm Collisions with obstacles, or even other
trauma to the head. Collisions with other skiers,
skiers, can result in fractures to the upper ( p.80) and
or obstacles, can result in skull fractures ( p.52),
lower arm bones ( p.82).
concussion ( p.52), and jaw injuries ( p.54). Wrist, hand, and fingers Fractures of the wrist and hand
Neck, spine, and back Falling at high speeds can
result in direct impact to or twisting of the neck.
( p.84 and p.94), as the result of a fall, are common
injuries for skiers. Sprains to the finger ligaments
This can lead to neck strain ( p.56) or even fractures
( p.92) can occur if the ski pole, or tow-rope in
of the neck ( p.170). waterskiing, pulls against the hand.
Shoulder and chest Falling awkwardly on the upper
arm can cause both anterior and posterior dislocations
Abdomen, hip, and groin Adductor strains ( p.104)
may occur during turns, when the thigh muscles
of the collarbone ( p.68), and shoulder dislocations exert pressure on the outer ski to keep it in the
( p.74). More serious falls may result in collarbone correct position.
fractures ( p.66).
SKI-BASED SPORTS 35
STAYING FREE OF INJURY
Ankle injuries are a common problem in ski-based sports:
if the ankle is turned, and the bindings that hold the foot
in place fail to release, severe ligament damage can occur.
For this reason, the right equipment, along with a training
regimen that promotes good lower-limb stability, is essential
Neck, spine, for avoiding injury.
and back
Flexibility
The bent-knee position used in skiing
Wrist, hand, places a lot of stress on the thigh.
and ngers Stretches, such as quad stretches
( p.243), keep the muscles flexible,
and limit the risk of overuse
injuries of the knee.
Strengthening
Hamstring strength is crucial
in controlling the skis. Exercises
such as Nordic hamstring lowers
Thigh A bent-knee position puts huge stress on
( p.202) can help develop
this, reducing the chance
the quadriceps, and can cause tendinopathies or
of straining or tearing the
strains of these muscles ( p.110).
Knee Frequent twisting and turning places stress on
muscles when turning.
the knee ligaments, leading to tears or even ruptures
( pp.12429). If this happens at high speed, damage
may be sustained by more than one ligament.
Power and stability
Side-to-side movements are
Inflammation of the knee tendons may also occur common in skiing. Exercises
as a result of repeated twisting ( pp.12429).
Ankle, foot, and toes Twisting the ankle when
that mimic this movement,
such as sideways floor jumps
turning can cause sprains ( p.144) and even
( p.257), can improve stability
fractures ( p.142). of the hips, knees, and ankles.
36 SPORTS IN PROFILE
SKATE-STYLE SPORTS
Skate-style sports, such as ice-skating and roller-blading, Head
and face
put a large amount of stress on the lower limbs, and
falls, especially when skating at high speeds, can cause
serious injuries. Maintaining good stability and strength
throughout the entire body is an important factor
in limiting injury.
INJURY HOTSPOTS
Head and face A blow to the head as the result
of a fall is a frequent cause of concussion ( p.52),
and may result in fractures to the skull ( p.52) and
jaw ( p.54).
Neck, spine, and back Impact to the head, as the
result of a fall or a collision, may put strain on
the neck, leading to whiplash ( p.56) and possible
fractures ( p.170).
Shoulder and chest Falling on an arm stresses the
shoulder jointthis can cause dislocations ( p.74)
and tears of the rotator cuff ( p.70).
Arm and elbow High-speed falls onto an outstreched
arm can cause fractures of the radius and ulna ( p.82).
Wrist, hand, and fingers Using the hand to break a
Abdomen,
hip, and groin
fall can lead to fractures ( p.84), dislocations ( p.86),
or ligament sprains ( p.88) of the wrist, or the hand
and fingers ( pp.9295).
Abdomen, hip, and groin Repeated exertion of the SPORTS SUCH AS
groin muscles when skating can lead to strains of
the adductors ( p.104) or pelvic inflammation, such Ice-skating
as osteitis pubis ( p.102). Hernias are also a common Speed-skating
injury among skaters ( p.106).
Knee Falling on the knee or twisting it can often
Roller-skating
Roller-blading
lead to cartilage and ligament injuries ( p.120 and
pp.12429). Jumping also puts pressure on the
knee, and may cause tendon inflammation ( p.122).
Ankle, foot, and toes Falls can cause the ankle to roll,
and may lead to ligament injuries ( p.144) and ankle
bone fractures ( p.142).
S K AT E - ST Y L E S P O R TS 37
STAYING FREE OF INJURY
The risk of falling at speed means protective clothing
particularly a helmetis essential when participating in
skate-style sports. However, a training program that
emphasizes core stability will also reduce the risk of
injury and improve performance.
Arm and
elbow MAINTENANCE TRAINING
Training should concentrate on strengthening the
muscles of the lower limbs and pelvis, reducing the
risk of groin injuries. Core stability is also important
Wrist, hand, in allowing the pelvis to transfer power to the lower
and ngers limbs without placing too much strain on the body.
Flexibility
The pelvis transfers power through
the body during skating. Mobility
in this area, which can be helped
with stretches such as standing
gluteals ( p.243), is essential for
avoiding muscle strains.
Knee
Strengthening
Targeting the groin muscles
Ankle, foot, with strengthening exercises,
and toes such as long-lever adductor
drops ( p.199), helps limit the
risk of strain to these muscles.
WATER SPORTS
Water sports, such as kayaking and canoeing, put strain
on the shoulders, forearms, and wrists due to repeated
arm movements. Back pain is also a danger if good
technique and posture are not maintained.
Whitewater rafting
Rowing
Sculling
Arm and
elbow
INJURY HOTSPOTS
Neck, spine, and back Incorrect posture can lead Arm and elbow Pain due to overuse injuries, such
to muscle imbalance in the neck, causing pain
as tennis elbow ( p.78), can arise in the tendons of
and stiffness ( p.56). Back pain is also a common
occurrence when good posture is not maintained
the forearm and wrist, due to the repeated exertion
involved in paddling or rope work.
problems such as disk damage and nerve irritation Wrist, hand, and fingers Controlling an oar or paddle
( pp.5861) can arise. This can be a particular
problem if core strength is weak.
for long periods of time can place huge stress on the
hands and wrists, making ligament and tendon sprains
Shoulder and chest The positions adopted in water
common ( p.88 and p.92). Severe cases may result
sports put a large amount of stress on the shoulders,
and this can make the tendons vulnerable to
in carpal tunnel syndrome ( p.90).
Abdomen, hip, and groin Repetitive movement of
inflammation and overuse injuries ( pp.7275).
Weakness in the muscles that stabilize the shoulders,
the hips and thighs can cause groin strains ( p.104),
and labral tears and femoroacetabular impingement
as well as poor posture, may exacerbate this.
(FAI) in the hip ( p.98 and p.100).
WAT E R S P O R TS 39
STAYING FREE OF INJURY
These sports require good posture in order to limit
pressure and stress on the back, which can lead to
long-term problems. Excellent muscular endurance is
also needed to sustain activity in the upper and lower
limbs for long periods of time.
Shoulder
and chest
WARM-UP AND COOL-DOWN
A light warm-up should incorporate cardiovascular work,
such as gentle jogging, and some stretches that imitate the
movements used in water sports. To cool down, alternate
Wrist, hand, between jogging and walking until the heart rate is normal.
and ngers
Abdomen, hip,
and groin MAINTENANCE TRAINING
Knee
Due to the strain placed on the back, core-strengthening
exercises should be incorporated into a training program
Ankle, foot, to reduce the risk of injury.
and toes
Flexibility
The repeated movement of the hips
and thighs during water sports can
cause tension in the buttocks, leading
to pain in the legs. Stretches, such
as those for the piriformis ( p.241),
can help prevent this.
Strengthening
All water sports require strength
in the arms. Exercises such as
chin-ups ( p.207), which mimic
the movements used in these
Knee The repeated bending and driving motions sports, are a good way of
performed by the legs place strain on the knee developing this.
joints. This can cause patella problems such as
patellofemoral joint pain ( p.116).
Ankle, foot, and toes Rowing for long distances
Power and stability
puts strain on the Achilles tendon. This can lead to
long-term overuse problems, such as inflammation Core-muscle strength is essential
of the Achilles tendon ( p.140). for developing power and
reducing the risk of damage
to the back. Exercises such as
Swiss Ball jack-knives ( p.223)
can help develop this.
40 SPORTS IN PROFILE
SWIMMING-BASED SPORTS
Despite carrying a comparatively low risk of injury,
swimming-based sports do place significant strain
on the muscles, particularly the back and shoulders.
A flexible spine and good stability in the shoulder
joints is essential in avoiding injury.
Abdomen, hip,
Knee and groin
INJURY HOTSPOTS
Head and face Heavy contact between players during Arm and elbow The repeated strain placed on
water polo may cause concussion ( p.52) or cuts to the muscles in the arm by swimming strokes can
the face ( p.166). Due to the fast-paced nature of cause inflammation in the tendons of the elbow
water polo, there is also a risk of the eyes being
joint ( p.78).
struck or gouged by another player ( p.166). Wrist, hand, and fingers Blocking shots in water
Neck, spine, and back Twisting or turning the head
polo can lead to dislocation of the fingers ( p.94)
abruptly can cause neck strain ( p.56), and sudden
movements may result in a herniated disk around the
if they are pushed back beyond the point that the
joint can tolerate.
lower spine ( p.60). Long-term strain placed on the
back by swimming may also result in wear and tear
Abdomen, hip, and groin Repeated kicking actions
during swimming exert the muscles of the groin;
to the disks ( p.60).
Shoulder and chest Collisions when throwing the
as a result, inflammation of the tendons around
these muscles is a common condition in swimmers
ball in water poloif they impact the shoulder in
( p.98). Femoroacetabular impingement (FAI)
a vulnerable positioncan cause serious injuries,
( p.100) is also a relatively common problem.
such as dislocation ( p.74). Overuse injuries of the
shoulder can arise due to sustained pressure on the
Knee Pain on the inside of the knee often occurs
due to the stress placed on this region by kicking
joint from the repeated action of swimming strokes. actions. Degeneration of the joint can occur, and
This may cause problems with the rotator cuffs, such tendon damage due to overuse is a frequent
as partial or complete tears ( p.70), or impingement
problem ( p.122).
of the shoulder joint ( p.72).
SWIMMING-BASED SPORTS 41
STAYING FREE OF INJURY
Training programs for swimming should concentrate
on reducing the risk of muscular injury. Developing
SPORTS SUCH AS
strength in the shoulder joint is essential for shoulder-
Swimming blade stability.
Diving
Water polo
WARM-UP AND COOL-DOWN
Warm-ups should include shoulder stretches, ideally with
movements that mimic those in swimming, to develop joint
mobility. Slow laps and stretches help the body cool down.
MAINTENANCE TRAINING
Exercises that promote strength and endurance of the
back muscles, along with stretches for the chest and neck,
are vital components of a swimmers training program.
Flexibility
Neck, spine,
and back Mobility in the back is key
in avoiding muscle strain;
exercises such as lat stretches
Head
and face
( p.240) are a good way of
developing this.
Strengthening
Much of the power in swimming
strokes is generated through work
done by the shoulders. Exercises
Arm and
elbow
like side-lying Ls ( p.214) help
develop rotator-cuff strength,
reducing the risk of shoulder
impingement or tears
Wrist, hand, to the rotator cuff itself.
and ngers
BICYCLING
Long-distance bicycling, sprinting, and stunt bicycling,
such as BMX biking, all make different demands on the
body. Injuries can arise as the result of a fall, or the
overexertion of muscles. The different terrains on which
bicycling is performed also have an impact on the type
of injuries sustained.
to patellofemoral pain syndrome ( p.116).
Leg Sprint finishes stress the calf muscles,
BMX biking
and can cause strains ( p.136).
Ankle, foot, and toes Overuse of the calf muscles
may damage the Achilles tendon ( p.140).
Ankle, foot,
and toes
BICYCLING 43
STAYING FREE OF INJURY
A helmet is an essential piece of equipment for bicyclists,
whatever their discipline. Training to stay free of injury
Head is dependent on distance: for long-distance events,
and face muscular endurance is crucial, while sprint events require
power and strength. A bicyclists training program should
Neck, spine,
and back prepare the body for the specific demands made on it.
MAINTENANCE TRAINING
Shoulder Stretches for the legs and back limit the risk of overuse
and chest injuries to the muscles. Good posturesupported by
a strong pelvishelps minimize back pain.
Flexibility
Tightness in the iliotibial band
is a frequent problem for bicyclists.
Arm and elbow
Foam roller exercises ( p.191),
or a sports massage, are a
good way of mobilizing
the tissue on the outside
Wrist, hand,
of the leg to help reduce
and ngers knee pain.
Strengthening
Strong legs are essential for
improving bicycling performance
and avoiding injury. Exercises
such as good mornings
( p.208) are excellent for
developing leg strength.
EQUESTRIAN SPORTS
Neck, spine
The speed at which many equestrian and back
sports, such as show-jumping and polo,
Shoulder
are played means that the risk of serious and chest
injury is high. While a helmet offers
some protection when falling on the
skull, the height from which riders
fall makes the limbs and spine Abdomen, hip,
vulnerable to fracture. and groin
Dressage Leg
Show-jumping
Polo
Eventing
Horse-racing
Steeplechase
INJURY HOTSPOTS
Head and face Falling from a horse is common, Shoulder and chest Falls onto an outstretched hand
and can cause head injuries and concussion can fracture the collarbone or the acromioclavicular
( p.52). In polo, contact with the ball, or other
joint in the shoulder ( pp.6669), and cause shoulder
players, may lead to lacerations of the
dislocations ( p.74). A rider falling onto an
face ( p.166). obstacle, such as a jump, may suffer fractured
Neck, spine, and back Failed jumps that lead to falls
onto the head and neck can result in damage to the
ribs ( p.76), or even a punctured lung (although
this is uncommon).
spinal cord ( p.171). High-impact falls may result in Arm and elbow Falling, especially at high speed during
whiplash ( p.56), while falling on the back can cause a race, can result in injuries such as fractures of the arm
damage to the joints and disks of the spine ( p.60).
Riding for long periods can lead to back pain if
and elbow ( pp.8084).
Wrist, hand, and fingers Repeatedly gripping the reins
there is a weakness in the core muscles, due to firmly may lead to muscle strains of the wrist and thumb
compression of the spine. This may eventually
becoming strained ( p.88).
lead to degeneration of the spinal disks ( p.60).
EQUESTRIAN SPORTS 45
Head STAYING FREE OF INJURY
and face
A protective helmet is an essential piece of equipment
for preventing riding-related head and neck injuries.
Wrist, hand, However, a training program that emphasizes flexibility
and ngers is also an important factor in staying free of injury.
MAINTENANCE TRAINING
In equestrian sports, training programs should concentrate
on core strength and spinal stability. Stretches to loosen
the joints of the knees, hips, and back are also important,
because of long periods spent in a seated position.
Flexibility
Keeping the trunk and hips flexible
is key because maintaining good
posture and enduring impact when
riding places strain on these areas.
Stretches such as Lancelot stretches
( p.244) are good for this.
Strengthening
The muscles to the sides of the torso
can be strengthened with exercises
Abdomen, hip, and groin The groin muscles are
instrumental in stabilizing the rider on the horse.
such as side planks ( pp.22627).
These muscles help maintain
For this reason, they can become inflamed; strains good posture, reducing
to these muscles are also a risk ( p.104). The strain
placed on the hips may also lead to labral tears
the risk of back problems.
or femoroacetabular impingement ( p.100).
Knee Falling directly onto the knee can lead
Power and stability
to dislocations, or even fractures, of the patella
( pp.11215).
Lower leg Colliding with other horses during a
Core strength is crucial for taking
strain from the lower back while
polo match may lead to crushing injuries, such riding. Exercises such as prone
as fractures of the leg ( p.134).
planks ( p.225) help
develop this.
46 SPORTS IN PROFILE
susceptible to injury ( p.12429).
Ankle, foot, and toes Hard landings put pressure on
the ankle and foot, and may lead to plantar fasciitis
( p.160), an inflammation of the underside of the
foot. Twisting of the ankle can cause ligament
sprains ( p.144) and even fractures ( p.142).
EXTREME SPORTS 47
SPORTS SUCH AS STAYING FREE OF INJURY
Rockclimbing The amount of protective equipment available for
Parkour extreme sports is extensive; an instructor will advise
Skydiving individuals about their sport-specific requirements.
Ice-climbing However, total-body muscular conditioning is also
Mountaineering important to optimize performance and limit injuries.
Flexibility
Mobility in the leg helps minimize
the stress from jumping and
Knee
landing. Exercises such as pike
walks ( p.177) are a good way
of developing this.
Strengthening
Exercises that strengthen the
lower back, such as chin-ups
( p.207), are a great way of
guarding against injury in
extreme sports that require
gripping actions.
INJURY LOCATOR
FRONT
Concussion
Cheekbone
( p.52)
fracture ( p.53)
Jaw fracture and dislocation ( p.54)
Bitten or swallowed tongue ( p.55)
Collarbone
Collarbone
fracture ( p.66)
joint injuries ( p.68)
Rotator cuff injuries ( p.70)
Shoulder joint inammation
( p.72)
Shoulder joint injuries ( p.74)
Simple rib fracture ( p.76)
Hip
Trochanteric
fractures ( p.96)
bursitis ( p.98)
THIGH
Hip labral tears and FAI ( p.100)
Osteitis pubis ( p.102)
Quadriceps
injuries ( p.110)
Groin strain ( p.104)
Hernias ( p.106)
KNEE
Patella
Patellar
fracture ( p.112)
dislocation ( p.114)
ANKLE, FOOT, AND TOES Patellofemoral pain
Foot
tendon injuries ( p.154)
syndrome ( p.116)
Patellar bursitis ( p.118)
Foot ligament sprains ( p.156) Osteochondritis dissecans ( p.120)
Mortons neuroma ( p.157)
Metatarsal fracture ( p.158)
Knee tendon injuries ( p.122)
Anterior cruciate ligament
Toe fracture ( p.159)
Plantar fasciitis ( p.160)
injury ( p.124)
Meniscus tear ( p.130)
I N J U R Y LO C ATO R 51
BACK
Neck strain and whiplash ( p.56)
Neck nerve injuries ( p.58)
Low back pain and sciatica ( p.60)
Sacroiliac joint inammation ( p.62)
Piriformis syndrome ( p.64)
Elbow
bursitis ( p.77)
Elbow tendon injuries ( p.78)
Humerus fracture ( p.80)
Forearm fractures ( p.82)
Wrist
Wrist
fractures ( p.84)
dislocation and sprain ( p.86)
THIGH
Wrist and hand tendon
disorders ( p.88)
Hamstring
injuries ( p.108)
Carpal tunnel syndrome ( p.90)
Metacarpal fracture ( p.91)
Hand and nger tendon injuries ( p.92)
Finger fracture and dislocation ( p.94) KNEE
Collateral
Posterior
ligament injuries ( p.126)
cruciate ligament
injury ( p.128)
Iliotibial band syndrome ( p.132)
ANKLE, FOOT, AND TOES
Achilles tendon rupture ( p.140)
Achilles tendinopathy ( p.142)
Ankle fracture ( p.144)
Ankle sprain ( p.146) LOWER LEG
Heel bone fracture ( p.148)
Retrocalcaneal bursitis ( p.150)
Tibialis posterior tendinopathy ( p.152)
Lower
Calf
leg fracture ( p.134)
injuries ( p.136)
Sinus tarsi syndrome ( p.153) Shin splints ( p.138)
Compartment syndrome ( p.139)
52 SPORTS INJURIES
CONCUSSION
A forceful blow to the head can cause CONCUSSION
concussion: temporary disturbance of the brains
normal function. Even though there may be no Skull
obvious sign of injury, early medical attention
Brain
is important to rule out serious underlying
damage to the brain or skull. Area of
damage
CAUSES
Concussion is a risk in sports, such as rugby, that involve
forceful contact with other players, and those in which
the head is vulnerable to high-speed falls, such as bicycling.
Impact from a blow can jar the head, possibly bruising
the brain as it is shaken around within the skull.
After mild concussion, you should not resume any sport for SHORT TERM
Ifyou are diagnosed with concussion, your physician may:
MEDICAL
CHEEKBONE FRACTURE
Due to their prominent position, the CHEEKBONE FRACTURE
cheekbones are vulnerable to injury from
direct contact. In combat sports, for example, the
head is an object of attack, making cheekbone
fractures a relatively common occurrence. Skull
CAUSES
Fractures of the cheekbone are most frequently encountered
in contact sports such as rugby and football, and combat Eye
sports such as boxing or martial arts, in which direct, forceful socket
contact with other participants is inevitable. Sports in which
Cheekbone
hard objects, such as a ball in baseball or cricket, or a stick
or puck in ice hockey, may connect with the face also carry Fracture
a risk of cheekbone fracture.
LONG TERM
Until your cheekbone is fully healed, your physician may:
advise you to avoid activities that could result in reinjury.
54 SPORTS INJURIES
CAUSES
These injuries are usually caused by a direct blow to the jaw
or face, or a heavy fall. They are most common in sports
such as bicycling, motor sports, or boxing. Maxilla
IMMEDIATE
Ifyou think you may have fractured or dislocated your Temporo-
jaw, you should: seek medical attention. mandibular
joint
SHORT TERM
For a dislocation, your physician may: give you muscle
relaxants to aid relocation. bandage your jaw. For a minor
MEDICAL
MEDIUM TERM
After surgery, your physician may: leave the wires in
place for 68 weeks.
LONG TERM The mandible (lower jaw) is connected to the rest of the
After surgery, your physician may: monitor your progress skull by the temporomandibular joint. In a dislocation,
for several months to ensure your jaw is healing as expected. the mandible is unseated on one or both sides.
H E A D A N D FAC E I N J U R I E S 55
TREATMENT
IMMEDIATE
If you have bitten your tongue, you should: wash the
bite and press your tongue against the roof of your mouth
to stem the bleeding. apply ice to the wound. clean
the wound with antiseptic until fully healed. If the bite is
over 1 in (2 cm), you should: seek medical attention. If a Swallowed
persons tongue is obstructing his or her airway, you should: tongue
pull the lower jaw forward to release the tongue. use a
MEDICAL
nger to sweep the tongue away from the back of the mouth.
If a person is unconscious and has swallowed his or her Blocked
tongue, you should: seek immediate medical attention. airway
SHORT TERM
Ifyou have bitten your tongue, your physician may: Normal position
prescribe analgesic medication. prescribe antibiotics of the tongue
to prevent infection. suture the wound.
MEDIUM TERM
In a swallowed tongue, loss of consciousness may cause
If
you have had stitches for a bitten tongue, your
physician may: advise you to stick to a soft-food diet for
the muscles to relax, leading to the tongue opping
610 days, until the stitches dissolve or are removed. backward and blocking the airway.
56 SPORTS INJURIES
Base of
Neck strain affects the the skull
cervical spine (the top
section of the spine), which
connects the skull to the
thoracic spine (the middle Ligament
section of the spine). This
neck region is comprised
of seven bones, which are
surrounded by muscles, Strain
tendons, and ligaments.
Cervical
vertebra
Neck strain is a general term for strains of the neck and shoulder pain, stiffness, fatigue, blurring of your
muscles, tendons, and ligaments around the eyesight, and ringing in your ears, but a pain or tingling
in your shoulders that runs down your arm may be
cervical spine. Whiplash is a form of neck strain
symptomatic of damage to one of your vertebrae. Your
caused by violent jolting of the head back and physician will diagnose the condition via an assessment of
forth, usually as the result of a sudden impact. your symptoms and they may use an X-ray, CT scan, MRI
scan, or myelography to confirm the severity of the strain
CAUSES and to check for other conditions, such as spinal cord injury.
Neck strain is common in sports that involve some form
of impact or collision, from rugby to martial arts to diving. RISKS AND COMPLICATIONS
A fall or a sudden blow to, or twisting of, the neck can put Untreated, neck strain and whiplash can cause long-term
stress on the muscles, tendons, or ligaments connecting the pain, restricted movement of your neck, and sleep loss.
cervical vertebrae. Whiplash, a form of neck strain, is most Undiagnosed neck injuries may actually be a neck fracture
common in car accidents, but can also occur in contact or a symptom of a back injury, both of which are potentially
sports if a players head is suddenly forced backward, serious and could cause paralysis. As a consequence, you
forward, or sideways, or they receive a blow to the head. should always seek immediate medical attention if you
have injured your neck.
SYMPTOMS AND DIAGNOSIS
With neck strain, you may feel pain in your neck at the time WHEN WILL I BE FULLY FIT?
of injury, but this pain is likely to be minimal at first, with the You should make a full recovery in 46 weeks, though severe
pain worsening over the following 1272 hours. You may neck strain or whiplashwhere a tendon has ruptured, for
feel a crackling sensation and weakness in your neck, and examplecan take up to 6 months to heal, and may need
pain in your head. The symptoms of whiplash can include surgery. Only return to sports when you are fully pain-free.
NECK, SPINE, AND BACK INJURIES 57
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
Ifyou think you may If you are diagnosed with Once your injury has healed, If short- and medium-term
have strained your neck, neck strain or whiplash, your usually within 46 weeks, treatments fail, this may be a
you should: physician may: your physician may: sign of more serious damage
immobilize your neck advise you to rest for a day refer you to a physical to your neck muscles,
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range of demonstrate relatively perform any weights
therapist may: motion in your cervical and pain-free movement of exercises or training,
suggest various treatments, thoracic spine. your neck. without pain.
such as electrotherapy, to perform daily activities Your physical therapist may: demonstrate neck and
PHYSICAL THERAPY
reduce local inammation. without pain. test your grip strength. upper-limb strength; your
use soft tissue release Your physical therapist may: You may begin: injured side should have
therapy and manual therapy suggest exercises to target contact drills that are only 10% less ability than
to relieve symptoms. the deep, stabilizing muscles relevant to your sport, as your uninjured side.
You should now be able to: of your neck, once your pain allows. complete full neck bridging
return to daily activities with range of motion is restored. manual isometric exercises, such as isometric
only minimal discomfort.
You may begin:
You may begin:
exercises for balance and
exercises ( p.220)
upper-limb weights, such
bridging ( p.220), pain-free.
engage in progressively
exercises to test the range of control, such as scapular as dumbbell bench presses challenging contact activities
motion in your neck, thoracic
spine, and shoulders, such
circles ( p.251).
( p.210), as pain and swelling
allows; start at 50% of your
specic to your sport.
participate in full training.
as neck rotations ( p.174),
shoulder rotations ( p.175),
one-rep max; aim for 4 sets
x 812 reps.
and torso rotations ( p176),
as pain allows.
participating in noncontact
sports training.
58 SPORTS INJURIES
Ifyou think you may have a If you are diagnosed with If your trapped nerve fails In rare cases, if your mild-
trapped nerve or neck stretch a mild-to-moderate case to respond to physical therapy to-moderate trapped nerve
syndrome, you should: of trapped nerve or neck treatment your physician may: or neck stretch syndrome
stop activity. stretch syndrome, your give you an injection of fails to improve with
immobilize your neck physician may: corticosteroids to reduce nonsurgical treatment,
to prevent further damage recommend rest. inammation. your physician may:
( p.171). prescribe analgesic If you have had surgery, recommend surgery to relieve
MEDICAL
apply ice ( p.165).
seek medical attention.
medication.
refer you to a physical
your physician may:
refer you to a physical
nerve compression.
After surgery, your
therapist for treatment to therapist for treatment to physician may:
restore range of movement improve movement in refer you to a physical
and strength in your neck your neck (see table below). therapist for a program of
(see table below). rehabilitation (see table below).
If you are diagnosed with a
severe case of trapped nerve
or neck stretch syndrome, your
physician may:
recommend surgery to
relieve nerve compression.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range complete resistance holds perform any weights
therapist may: of motion in your cervical with a pulley (this should not exercises or training,
suggest various treatments, and thoracic spine (the top involve any movement of the without pain.
such as electrotherapy, to
reduce local inammation.
and middle sections of your
spine), and shoulder.
joint) ( p.220); aim for 3 reps
x 610 secs, without pain.
demonstrate neck and
upper-limb strength; your
use soft tissue therapy Your physical therapist may: Your physical therapist may: injured side should have
PHYSICAL THERAPY
and manual therapy to help suggest exercises to target test the power in your neck only 10% less ability than
relieve your symptoms. the deep, stabilizing muscles and upper limbs to check your uninjured side.
You may begin: of the neck, once your you are at full strength. lift upper-body weights
neck extensions range of motion is restored. You may begin: that are at least 80% of your
and exions ( p.175),
as pain allows.
You may begin:
exercises for balance and
upper-limb weights
exercises, such as assisted
one-rep max.
complete full isometric
control, such as scapular
circles ( p.251); aim for 5 sets
chin-ups ( p.207); start at
50% of your one-rep max;
bridging exercises ( p.220),
without pain.
x 10 repsand four-point aim for 4 sets x 812 reps, engage in progressively
kneels ( p.247).
exercises to strengthen the
as pain allows.
noncontact training.
challenging contact activities
specic to your sport.
muscles of your neck, such as participate in full training.
manual isometrics ( p.220),
neck extensions and exions
( p.175), and neck side
exions ( p.174).
60 SPORTS INJURIES
If you think you may have If your symptoms are mild, Ifyou are among the 10% After surgery, your
a slipped disk or sciatica, your physician may: of patients with true sciatica physician may:
you should: refer you to a physical due to a herniated disk, whose refer you to a physical
stop sports, but continue therapist to treat the spine symptoms fail to respond to therapist for a program of
with normal activities, if pain and restore movement (see nonsurgical treatment , rehabilitation (see table
allows. If the pain is severe, table below). your physician may: below).
MEDICAL
you may need to rest in bed If your symptoms are severe recommend surgery to
for 12 days. your physician may: remove the piece of disk
apply heat to alleviate spasm prescribe muscle relaxants or that is bulging out. This
in the surrounding muscles of strong analgesic medication. surgery is highly (90%)
your back. give you an epidural successful.
If your symptoms fail to injection to alleviate the pain.
respond to self-treatment, Once your pain has
you should: subsided, your physician may:
seek medical attention. refer you to a physical
therapist to treat your spine
and restore movement (see
table below).
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical perform daily activities with perform daily activities with demonstrate a full active
therapist may: reduced levels of pain and no pain or discomfort. range of motion in your pelvis
suggest various treatments, discomfort. complete moderate- to and lumbar spine.
such as electrotherapy, to Your physical therapist may: high-level core exercises, such demonstrate a normal
reduce local inammation. assess the length of your as extension holds, levels 23 degree of strength and
perform a full spinal and
pelvic assessment.
quadriceps, hamstrings,
gluteals, hip exors, and
( p.235), without pain.
You may begin:
exibility in your spine.
complete high-level core
use soft tissue therapy latissimus dorsi muscles, functional warm-up drills, exercises, such as curl-ups,
PHYSICAL THERAPY
bench presses ( p.210), as
pain allows; start at 50% of
drills without difculty.
participate in full training.
your one-rep max; aim for
4 sets x 812 reps.
62 SPORTS INJURIES
Ilium
Inamed
sacroiliac joint
Sacrum
Spine
The sacroiliac joints function as a shock feel worse when you exercise, and also after sitting in the
absorber for the body. They move very little same position for a while. You may suffer stiffness after
sitting or walking for long periods, and rolling over in bed
but are key in transferring weight from the
may be painful. Your physician will consider your medical
upper body to the legs, and enabling the body history, then carry out a physical examination. He or she
to twist when the legs are moving. Inflammation may also recommend tests such as blood tests, X-rays,
can occur due to injury or from wear and tear, or an MRI scan, to determine if either of your sacroiliac
and is a common cause of low back pain. joints are inflamed.
Ifyou think you may have Ifyou are diagnosed with Ifyour symptoms fail to As a last resort, if all
injured your sacroiliac joint, sacroiliac joint inammation, respond to physical therapy, other treatments fail,
you should: your physician may: your physician may: your physician may:
stop activity. prescribe analgesic prescribe a course of recommend surgery
rest. medication. corticosteroid injections to to fuse the joint.
seek medical attention. provide you with a sacroiliac reduce inammation and After surgery, your
belt, to support the joint. prevent scarring. physician may:
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range of complete moderate core demonstrate a full active
therapist may: motion in your sacroiliac joint, exercises, such as those using range of motion in your pelvis
suggest various treatments,
such as electrotherapy, to
lumbar spine, and thoracic
spine, without pain. without pain.
a Swiss ball ( pp.22224), and lumbar spine.
complete high-level core
reduce local inammation. You may begin: You may begin: exercises, such as kneeling
use soft tissue release
therapy and manual therapy
lower-limb bodyweight
exercises, such as hip hitchers
functional warm-up drills,
such as rotational lunges
supermen, level 3 ( p.229),
without pain.
PHYSICAL THERAPY
level 1 ( p.226).
level 2 ( p.221).
64 SPORTS INJURIES
PIRIFORMIS SYNDROME
The piriformis muscle helps the hip joint
PIRIFORMIS SYNDROME
rotate outward and abduct the thigh (move it
away from the body). Piriformis syndrome
occurs when the muscle compresses or irritates
Ilium
the sciatic nerve, causing pain in the buttocks
and along the back of the thigh, and is a rare
cause of the condition sciatica ( p.60). Sacrum
CAUSES
In most people, the sciatic nerve runs below the piriformis
muscle, but in around 15 percent of the population it runs Piriformis
right through the muscle. It is thought that people with muscle
this irregularity are predisposed to piriformis syndrome. Hip joint
The condition may also develop through incorrect gait when
walking or jogging, or by overexertion in sports that involve
sitting, such as rowing or bicycling, which can all result in
damage to the piriformis muscle.
Femur
SYMPTOMS AND DIAGNOSIS
You will feel pain deep in your buttocks that travels along
the sciatic nerve down the back of your leg. The pain will get Buttock
worse when you sit, climb stairs or steep slopes, or perform
squats. Your physician will usually be able to diagnose the
condition on the basis of your symptoms and a physical
examination, and may also arrange for you to have an X-ray
or MRI scan to rule out other causes of pain.
Sciatic nerve
RISKS AND COMPLICATIONS
Prolonged irritation of your piriformis muscle may cause
your tendons to become scarred and lead to chronic
symptoms such as persistent pain, reduced motion in your
hip joint, numbness in your foot, and difficulty walking.
Ifyou think you may If you are diagnosed with Ifyour symptoms fail to As a last resort, if all
have piriformis syndrome, piriformis syndrome, your respond to physical therapy, other treatment fails, your
you should: physician may: your physician may: physician may:
stop activity. prescribe analgesic give you an injection into recommend surgery to
minimize movement medication. your piriformis muscle and loosen your piriformis muscle
of the affected area. refer you to a physical surrounding tissue, of and help relieve pressure
MEDICAL
massage the affected area. therapist for treatment to corticosteroid, local on the sciatic nerve.
seek medical attention. relieve your symptoms and anaesthetic, or botulinum After surgery, your
restore strength and mobility. toxin (botox) to help alleviate physician may:
(see table below). your symptoms. refer you to a physical
therapist for a program
of rehabilitation (see
table below).
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical walk and sit with little or complete moderate- to demonstrate a full active
therapist may: no pain. high-level core exercises, such range of motion in your
suggest various treatments,
such as electrotherapy, to
You may begin:
low-level core exercises, without pain.
as side planks, level 2 ( p.226), pelvis and lower spine.
demonstrate a normal
reduce local inammation.
perform a full assessment
such as bridges ( p.236).
lower-limb bodyweight
Your physical therapist may:
continue to monitor your
degree of strength and
exibility in your spine.
of your spine, pelvis, and hips. exercises, such as hip hitchers spine to check its mobility. complete high-level core
use soft tissue release
( p.186) and box step-ups You may begin: exercises, such as curl-ups,
PHYSICAL THERAPY
COLLARBONE FRACTURE
COLLARBONE FRACTURE
Clavicle
Scapula
Head of the
humerus
Sternum
The clavicle (collarbone) makes up part of pins and needles in your arm and hand. Your physician will
the shoulder, and helps keep the shoulder make a diagnosis through a physical examination, and may
confirm the size and location of the break with an X-ray.
blade in the correct position. Fractures of the
collarbone, while serious in themselves, can RISKS AND COMPLICATIONS
also result in damage to the nerves and blood Occasionally, if it is very badly displaced, the bone may
vessels in this part of the body. fail to fuse properly while healing, leading to a deformity
in the shoulder. However, this is very rare. If you do not
CAUSES allow enough time for a fracture to heal before returning
Fractured collarbones are a feature of sports in which falls to sport, there is a risk of osteoarthritis.
onto the shoulder or direct blows to the collarbone are a
regular occurrence. They commonly occur when people fall WHEN WILL I BE FULLY FIT?
from a bicycle or a horse, either directly onto a shoulder or You may resume contact sports, or sports involving overhead
an outstretched arm, or when players collide during contact arm movement, after about 12 weeks in most cases, but this
sports such as football, rugby, and soccer. will depend on the individual. As a general rule, you should
be able to return to sports more quickly after surgery.
SYMPTOMS AND DIAGNOSIS
You will usually feel immediate pain along the length of your
collarbone. You will see and feel swelling, including a firm
lump around the fracture, especially if the bone ends are
displaced. There may also be redness and bruising around
your injury. Lifting your arm may be extremely painful and
you may need to support it. Occasionally, you may feel
SHOULDER AND CHEST INJURIES 67
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
Ifyou think you may have If you are diagnosed with Aftersurgery, your If you have had surgery,
fractured your collarbone, an undisplaced fracture (in physician may: your physician may:
you should: which the bone does not put your arm in a sling for monitor your progress
follow a RICE procedure separate), your physician may: around 36 weeks. for the 36 weeks while
( p.170). prescribe analgesic your arm is in a sling, with
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate no swelling complete upper-limb demonstrate a full active
therapist may: in the affected area. plyometrics, such as medicine range of motion in your
suggest various treatments,
such as electrotherapy, to
demonstrate a full range of
motion in your ngers, hand, without pain.
ball chest throws ( p.216), shoulder, and should not feel
apprehensive when this is
reduce local inammation. wrist, elbow, and shoulder. complete balance and tested by your physical
take your shoulder through put full weight on your control exercises for the therapist.
a series of movements (within shoulder, with minimal pain. shoulder, elbow and wrist, lift upper-body weights that
pain limits) to assess the range Your physical therapist may: such as four-point kneels are at least 80% of your
PHYSICAL THERAPY
CAUSES
Separations of the acromioclavicular joint are normally the
result of landing on the tip of the shoulder or falling on an
outstretched arm, while sternoclavicular joint separations
are usually the result of a heavy blow to the chest. Collarbone
joint injuries occur frequently in high-impact sports, such
as football, ice hockey, rugby, and martial arts; they are also
common in sports that carry a high risk of falling, such as
horseback riding, bicycling, and skiing.
Ifyou think you may have If you are diagnosed with Ifyour injury was mild to Ifyour injury fails to
a collarbone joint injury, a mild to moderate collarbone moderate and has failed to respond to physical therapy,
you should: injury, your physician may: respond to 68 weeks of rest, your physician may:
MEDICAL
put your arm in a supportive prescribe analgesic your physician may: recommend surgery
sling ( p.170).
apply ice to the affected
medication.
recommend rest.
refer you to a physical
therapist for treatment to
to realign the bones.
After surgery, your
area ( p.165).
seek medical attention.
put your arm in a sling for
68 weeks.
improve range of movement
(see table below).
physician may:
refer you to a physical
If you are diagnosed with therapist for a program
a severe collarbone injury, of rehabilitation (see
your physician may: table below).
recommend immediate
surgery to repair the joint.
Once your physician has You should now be able to: Your physical therapist may: You should now be able to:
referred you, your physical liftyour arm to 90 degrees perform another assessment demonstrate a full active
therapist may: exion and abduction. of your active range of motion range of motion in your
take your arm through a Your physical therapist may: to check for improvements in shoulder, without difculty
series of movements (within continue to assess the range your movements. or unnatural elevation of the
pain limits) to assess the range of motion in your shoulder. test the muscle function shoulder (hitching).
of motion in your jointthis This time you will be required of your injured shoulder; it complete upper-limb
will involve no effort from you to actively move the joint. should only have 30% less plyometrics, such as medicine
(passive range of motion).
suggest exercises to help
You may begin:
exercises to stretch the back
ability than your uninjured one.
You may begin:
ball chest throws ( p.216),
without pain.
you initiate control over of your shoulder, such as strengthening exercises, such lift upper-body weights that
PHYSICAL THERAPY
punch lunges ( p.182); aim
at distances relevant to your
sport, without pain.
pain allows. using an electrical muscle for 4 sets x 8 reps. complete sport-specic
bicycling 57 days after your stimulator on your posterior interval bicycling at a drills without difculty.
injury; aim for 20 minutes at shoulder muscle. moderate intensity. participate in full training.
85rpm, level 6, as pain allows. exercises for the shoulder upper-limb weights
kinetic chain exercises, blade, such as low rows exercises such as dumbbell
such as shoulder dumps
( p.182); perform these while
( p.209); aim for 4 sets x
10 reps.
bench presses ( p.210), as
pain allows; start at 50% of
wearing your sling. lower-limb exercises, such as your one-rep max and aim
leg presses ( p.195), with no
shoulder involvement.
for 4 sets x 812 reps.
interval bicycling at a
low-moderate intensity.
upper-limb weights exercises
with your uninjured arm.
exercises to promote
shoulder control, such as
lawnmowers ( p.190).
70 SPORTS INJURIES
Torn rotator
cuff tendon
Head of humerus
Muscles of the
rotator cuff
Tears to the rotator cuff often occur with cause pain when you lie on your shoulder. Your physician will
a sudden, overhead movement of the arm. check your range of movement and you may have an X-ray
to rule out fractures or bone spurs (malformations of the
Chronic tears and rotator cuff tendinopathy,
bone). You may be given an arthrogram (a dye is inserted
both caused by years of repetitive overhead into your shoulder joint before an X-ray, and if the dye leaks
arm actions, are more common. from the area, this indicates a tear in the tendon).
If you think you may have a Ifyou are diagnosed with Ifyour injury fails to respond After the sling and apparatus
rotator cuff injury, you should: a rotator cuff injury, your to nonsurgical treatment, your used to protect the repaired
stop activity. physician may: physician may: rotator cuff are removed, your
follow a RICE procedure prescribe analgesic recommend surgery (open physician may:
( p.170).
If the pain in your shoulder
medication.
advise you to rest your
surgery or keyhole surgery,
depending on the nature of
refer you to a physical
therapist for a program of
MEDICAL
has not subsided within 23 shoulder, allowing time your injury) to reattach the rehabilitation (see table
days, you should: for your injury to heal. tendon to the bone. below).
seek medical attention. When your symptoms have After surgery, your
subsided, your physician may: physician may:
prescribe a course of immobilize your arm in a
corticosteroid injections sling, to give the injury time to
to promote recovery. heal. You may also be given
refer you to a physical special apparatus to protect
therapist for treatment to the repaired rotator cuff.
help strengthen your muscles
and restore motion (see
table below).
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range of demonstrate almost a full demonstrate a full active
therapist may: motion in your elbow, wrist, active range of motion in range of motion in your
suggest exercises such and hand. your shoulder without any shoulder, and should not feel
as scapular clocks ( p.251),
to help you regain control
Your physical therapist may:
continue to test your passive
abnormal movement.
Your physical therapist may:
apprehensive when this is
tested by your physical
of your shoulder blade. range of motion; as your perform a muscle function therapist.
take your arm through a shoulder recovers you will test; your injured arm should complete upper-limb
series of movements (within be able to initiate these demonstrate only 20% less plyometrics, such as medicine
PHYSICAL THERAPY
pain limits) to assess the range movements yourself (your ability than your uninjured one. ball chest throws ( p.216),
of motion in your jointthis active range of motion). continue to test your without pain.
will involve no effort from you You may begin: shoulders range of motion. complete isokinetic testing
(passive range of motion).
You may begin:
exercises to stretch the back
of your shoulder, such as
You may begin:
strengthening exercises, such
( p.263 ), with internal and
external shoulder rotation for
bicycling 12 days after
the operation; aim for 20
sleeper stretches ( p.245).
lower-limb weight exercises
as standing Ys ( p.215); aim
for 4 sets x 8 reps below
both shoulders within 10%.
lift upper-limb weights that
minutes at 85rpm, level 6, with no shoulder involvement. maximum effort, and are at least 80% of your
as pain allows.
pool jogging in a sling; aim
using an electrical muscle
stimulator on the back of your
side-lying Ls ( p.214).
full-body exercises, such
one-rep max, without pain.
complete high-level running
to jog for up to 30 minutes.
resistance exercises for your
shoulder muscles.
exercises where one hand
as push-ups ( pp.22829);
aim for 4 sets x 8 reps.
at distances relevant to your
sport, without pain.
shoulder that involve no joint stays in contact with a surface, lower-limb weights; include complete sport-specic
movement 2 weeks after your such as scapular clocks upper limbs (not overhead). drills without difculty.
operation, such as shoulder
isometrics ( p.212); test it in
( p.251) and kneeling
supermen ( pp.22829).
upper-limb weights training,
such as dumbbell bench
participate in full training.
dumps ( p.182). such as ball handling.
72 SPORTS INJURIES
CAUSES
Shoulder bursitis is an inflammation of the bursae (fluid-filled
sacs) that act as cushions between bones and muscles in
the shoulder joint. Frozen shoulder, or adhesive capsulitis,
is a mild inflammation of the soft tissue in the joint. Both
conditions are linked to sports that put repetitive strain on the
shoulder, such as tennis and baseball. An associated condition,
impingement syndrome, is common in swimmers and tennis
players, and in sports involving overarm throwing. These strain
the tendons of the rotator cuff ( p.70), causing them to swell
and to be impinged by the joint. Humerus
Rotator cuff
SYMPTOMS AND DIAGNOSIS
Shoulder bursitis will be painful when you perform overhead
Damage to the muscles of the rotator cuff may cause
movements or put weight on your shoulder. You may the head of the humerus to move up, leading to reduced
have limited movement in your shoulder, loss of arm space in the shoulder joint, causing impingement.
strength, and swelling on the outside of your arm. With a
frozen shoulder you may have pain that worsens at night
or when you try to lift your arm, and reduced movement. SHOULDER BURSITIS
Symptoms of impingement syndrome include shoulder pain,
difficulty raising your arm, pain when reaching behind you, Muscle
and a grinding sensation on moving your shoulder. Your Inamed
physician will diagnose these conditions with an assessment shoulder bursa
of your symptoms, and by using X-rays, and MRI scans.
If you think you may have a If you are diagnosed with a If your frozen shoulder After surgery for any
frozen shoulder, you should: frozen shoulder, your fails to respond to of these injuries, your
apply heat and muscle physician may: nonsurgical treatment, physician may:
relaxant to loosen the joint. prescribe corticosteroids to your physician may: refer you to a physical
If you think you may have reduce the inammation. recommend surgery to therapist for a program
shoulder bursitis, you should: If you are diagnosed with remove adhesions. of rehabilitation (see
MEDICAL
stop activity. bursitis, your physician may: If your bursa becomes table below).
follow a RICE procedure prescribe corticosteroids to infected, your physician may:
( p.170).
apply heat.
reduce the inammation.
refer you to a physical
drain it.
recommend surgery to
If you think you may have therapist (see table below). remove it.
impingement syndrome, If you are diagnosed with If your impingement
you should: impingement syndrome, syndrome fails to respond
apply ice to the affected your physician may: to nonsurgical treatment, your
area ( p.165).
seek medical attention.
advise you to abstain from
repetitive shoulder movements.
physician may:
recommend surgery to
refer you to a physical release the impinged ligament.
therapist (see table below).
Once your physician has You should now be able to: Your physical therapist may: You should now be able to:
referred you, your physical demonstrate full cervical perform a muscle function demonstrate a full range of
therapist may: and thoracic spine movement. test: your injured shoulder motion in your shoulder, and
suggest various treatments, Your physical therapist may: should have only 20% should not feel apprehensive
such as electrotherapy, suggest exercises to improve less ability than your when this is tested by your
to reduce inammation. movement in your shoulder. uninjured one. physical therapist.
use soft tissue therapy to You may begin: You may begin: lift upper-body weights
release tight muscles, such as resistance exercises for strengthening exercises, that are at least 80% of your
PHYSICAL THERAPY
( p.245).
lower-limb weights with
in contact with a surface, such
as scapular clocks ( p.251);
do not lift weights over
your head.
for at least 1 week.
Ifyou think you may have If you are diagnosed with If you have not had surgery, Ifyour shoulder repeatedly
injured your shoulder joint, a shoulder joint injury, your after repositioning your dislocates or subluxates, your
you should: physician may: shoulder your physician may: physician may:
immobilize your shoulder assess the sensitivity around immobilize your arm in a recommend surgery to
( p.170).
seek medical attention.
your shoulder to check for
nerve damage.
sling for 23 weeks.
refer you to a physical
correct the problem.
After surgery, your
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate full cervical demonstrate almost a full demonstrate a full range of
therapist may: and thoracic spine movement. range of shoulder motion. motion in your shoulder,
suggest various treatments, Your physical therapist may: Your physical therapist may: initiating all movements
such as electrotherapy, perform various exercises perform a muscle function without pain (active range
to reduce local inammation. to help restore range of test; your injured arm should of motion). You should not
perform soft-tissue massage motion in your shoulder. demonstrate only 30% less feel apprehensive when this
to surrounding areas to help You may begin: ability than your uninjured one. is tested by your physical
PHYSICAL THERAPY
with pain relief. resistance exercises for continue to test the range therapist.
suggest exercises you can your shoulder in all directions, of motion in your shoulder. complete upper-limb
do in your sling that will help such as shoulder isometrics You may begin: plyometrics, such as medicine
build control in your shoulder
blade, such as lawnmowers
( p.212), as pain allows; aim
for 10 reps, lasting for 10
strengthening exercises,
such as standing Ys ( p.215);
ball chest throws ( p.216),
without pain.
( p.190) and shoulder
dumps ( p.182).
seconds each.
exercises for the shoulder
aim for 4 sets x 8 reps, below
maximum effort.
lift upper-limb weights
that are at least 80% of your
You may begin: blade in which one hand stays interval bicycling at a one-rep max, without pain.
using an electrical muscle in contact with a surface, such moderatehigh intensity. complete high-level running
stimulator on your shoulder
muscles to help maintain bulk.
as scapular clocks ( p.251);
aim for 10 sets x 10 reps.
lower-limb with upper-
limb weights; do not lift any
at distances relevant to your
sport, without pain.
lowmoderate interval full-body exercises, such as weights over your head. complete sport-specic
bicycling. First do this with a
sling, then continue without.
lawnmowers ( p.190), as pain
allows; aim for 4 x 8 reps, rst
upper-limb weight training,
such as dumbbell bench
drills without difculty.
participate in full training.
with a sling, then without.
lower-limb weights with
presses ( p.210), at 50% of
your one-rep max; aim for
no shoulder involvement. 4 sets x 812 reps.
stationary low-level skills,
such as ball handling.
low-level running.
76 SPORTS INJURIES
WHEN WILL I BE FULLY FIT? A rib fracture is a crack or split in any of the 12 pairs
With rest, your rib should heal within 36 weeks. You may of ribs, or in the cartilage that connects each of them
return to your sport when training causes no pain. Further to the sternum (breastbone).
injury to a fractured rib can prolong the healing time.
INTERMEDIATE STAGE
PHYSICAL THERAPY
ADVANCED STAGE
MEDIUM TERM You should now be able to: perform low-level running,
Your physician may advise you to: rest until the pain without pain. perform medium-level core exercises, such as
has eased.
curl-ups, levels 23 ( p.221), without pain. You may begin:
using upper- and lower-body weights. advanced-level
LONG TERM
Your rib should heal within 36 weeks, after which your
core-stability exercises, such as pulley chops, level 4 ( p.231).
ELBOW BURSITIS
The elbow bursa is a fluid-filled sac that
ELBOW BURSITIS
reduces friction at the point where tendons and
muscles move over bone. An injured bursa may
produce excess fluid, causing painful swelling.
Tricep
CAUSES
A blow to your elbow, from a hard object such as a hockey
stick, or from a fall, may cause a bursa to become inflamed. Tendon of
Repetitive use of the elbow, such as in swimming or tennis, the tricep
or bowling in cricket, may also cause inflammation.
WHEN WILL I BE FULLY FIT? As the elbow joint moves, the elbow bursa reduces friction
If your bursa has been drained, you may need a few days between the tip of the ulna (known as the olecranon
rest before feeling fit. After surgical removal of a bursa, you process) and adjacent tendons, such as that of the tricep.
will need at least 6 weeks to regain full fitness.
INTERMEDIATE STAGE
PHYSICAL THERAPY
SHORT TERM You should now be able to: demonstrate a full range
Ifthere is no improvement after 6 weeks, you should: seek of motion in your ngers, hand, wrist, elbow, and shoulder,
medical attention. Your physician may: prescribe antibiotics without causing swelling. You may begin: exercises such
MEDICAL
treatment to ease pain and restore movement (see table right). ADVANCED STAGE
You should now be able to: complete balance and
MEDIUM TERM control exercises for the shoulder, elbow, and wrist, such
If the bursitis persists, as a last resort your physician may:
recommend surgery to remove the bursa.
as four-point kneels ( p.247). Your physical therapist may
assess your grip strength.
WHEN WILL I BE FULLY FIT? Inammation can occur to the tendons which connect
You will be fully fit once you no longer have symptoms, the muscles of the inner forearm to a bump (the medial
which may take weeks or even months. If you need surgery, epicondyle) on the inside of the humerus.
it will take 46 months before you can return to sports.
ELBOW AND ARM INJURIES 79
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
If you suspect you have If you are diagnosed with Ifyour symptoms fail to When you have
an elbow tendon injury, an elbow tendon injury, your respond to nonsurgical recovered from surgery,
you should: physician may: treatment, your physician your physician may:
stop any activity that causes prescribe pain-relief may: refer you to a physical
you pain. medication. recommend surgery to therapist for a program of
immobilize your forearm prescribe a course of repair the damaged tissue. rehabilitation (see below).
MEDICAL
( p.170).
apply ice to the affected
corticosteroid injections to
relieve your symptoms and
After surgery, your
physician may:
area ( p.165) up to six times
a day for two days, 15 minutes
reduce the inammation.
refer you to a physical
advise you to rest for
around 6 weeks.
at a time. therapist for treatment to
If your symptoms do not reduce inammation and
respond to self-treatment, improve strength and motion
you should: (see below).
seek medical attention.
Your physical therapist may: You should now be able to: You should now be able to: You should now be able to:
suggest treatments to carry out daily activities with perform upper-limb demonstrate a full active
reduce local inammation, no pain. plyometrics, such as medicine range of motion in your
such as electrotherapy.
use soft-tissue massage to
demonstrate full range of
motion in your neck, shoulder, pain-free.
ball chest throws ( p.216), elbow, generating all
movements without pain.
help relieve your symptoms. elbow, and wrist. perform balance and control You should not feel
put strapping on your fully weight-bear on exercises for the shoulder, apprehensive when this is
forearm to ease the load on it. your arm. elbow, and wrist, such as tested by your physical
PHYSICAL THERAPY
assess your grip strength. You may begin: four-point kneels ( p.247). therapist.
assess the range of motion lower-limb bodyweight Your physical therapist may: lift upper-limb and
in your neck, shoulder, elbow exercises, such as single-leg retest your grip strength; lower-limb weights that
and wrist.
You may begin:
squats ( p.193).
eccentric wrist extensions
your injured arm should have
only 10% less ability than the
are at least 80% of your
one-rep max.
eccentric wrist extensions
( p.219); aim for 3 sets x 15
( p.219) with heavy dumbbell
(men: 15kg; women: 8kg); aim
uninjured arm.
You may begin:
complete sport-specic
drills without difculty.
reps twice daily and use for 3 sets x 15 reps. upper-limb weights
a light dumbbell. These strengthening exercises, exercises, such as dumbbell
should be painful.
core-stability and gluteal
such as side-lying Ls ( p.214),
below maximum effort;
bench presses ( p.210),
at 50% of your one-rep max;
exercises, such as dead bugs aim for 4 sets x 8 reps aim for 4 sets x 812 reps,
( p.225).
lower-limb weights that do
without pain. if pain-free.
lower-limb weights that
not involve the upper limbs. include the upper limbs, such
bicycling, running, and work
on a cross-trainer to maintain
as push presses ( p.238), as
pain allows.
overall tness.
80 SPORTS INJURIES
HUMERUS FRACTURE
Most fractures of the humerus (the upper
HUMERUS FRACTURE
arm bone) occur when an older person breaks
a fall with an arm extended. However, in a
sporting context, humerus fractures also
occur through heavy impact.
Shoulder
joint
CAUSES
Humerus fractures are often associated with contact
sports such as football, and can be caused by two athletes
colliding, resulting in a direct blow to the humerus. Humerus
fractures may also result from a fall onto an outstretched
arm. In sports such as rugby and football, in which multiple
collisions occur, fractures can be caused by one player falling Humerus
onto the outstretched arm of another, for example when a
scrum collapses.
Ifyou think you may If you are diagnosed with If your bones have been After surgery, your
have fractured your humerus, a simple fracture of the realigned without surgery physician may:
you should: humerus, your physician may: and have healed as expected, immobilize your arm in
immobilize your upper arm nonsurgically realign your physician may: a cast or sling for 6 weeks.
in a sling ( p.170). the affected bones and refer you to a physical refer you to a physical
MEDICAL
seek immediate medical immobilize your arm with therapist for treatment to help therapist for a program
attention. a sling, splint, or cast for improve your muscle strength of rehabilitation (see
around 6 weeks. and range of motion (see table below).
prescribe analgesic table below).
medication. If your bones have been
If your fracture is severe, realigned without surgery,
your physician may: but have failed to heal as
recommend immediate expected, your physician may:
surgery to repair the fracture. recommend surgery to fully
repair the fracture.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate 90 degrees demonstrate a near full range demonstrate a full range of
therapist may: exion and abduction in of motion in your shoulder. motion in your shoulder,
suggest various treatments, your shoulder, with good Your physical therapist may: generating all movements
such as electrotherapy, to shoulder blade control. perform a muscle function without assistance. You should
reduce local inammation. You may begin: test; your injured arm should not feel apprehensive when
recommend ultrasound exercises for the shoulder demonstrate only 20% less tested by your physical
to promote bone healing. blade where one hand stays in ability than the uninjured one. therapist.
perform various exercises contact with a surface, such as You may begin: complete upper-limb
PHYSICAL THERAPY
such as standing Ys ( p.215);
plyometrics, such as medicine
ball chest throws ( p.216),
You may begin: lower-limb weights aim for 4 sets x 8 reps, below without pain.
resistance exercises for your exercises with no upper maximum effort. lift upper-limb weights that
shoulder that involve no joint limb involvement, such interval cycling at are at least 80% of your
movement, such as pushing as 45-degree leg presses a moderate intensity. one-rep max, without pain.
both hands against a wall, or
holding a small dumbbell,
( p.195).
lowmoderate interval
lower- and upper-limb
weights exercises, such as
complete high-level running
at distances relevant to your
with your elbow at a right cycling, with a sling. straight-leg and single-leg sport, without pain.
angle for a few seconds,
repeating after a pause, as
deadlifts ( p.197). Do not lift
any weights over your head.
complete sport-specic
drills without difculty.
pain allows; aim for 10 reps x upper-limb weight training, participate in full training
10 secs; test in all directions. such as dumbbell bench for at least 23 weeks.
full-body exercises, such as
shoulder dumps ( p.182), as
presses ( p.210), at 50%
of your one-rep max; aim
do full contact training
drills, without pain.
pain allows; aim for 4 sets x for 4 sets x 812 reps.
12 reps, rst with a sling, then stationary low-level skills.
continue without. low-level running. You
should not feel any pain.
82 SPORTS INJURIES
FOREARM FRACTURES
In many sports, there is huge potential for
FOREARM FRACTURES
falling onto the forearm or for the forearm
to receive a powerful blow. Consequently,
the bones of the forearmthe radius and the Elbow joint
ulnaare vulnerable to fracture.
CAUSES
Fractures often occur in contact sports, where falls or direct
force on the forearm are common, or in sports such as
skateboarding or bicycling, where falls on hard surfaces,
Ulna
impacting the forearm, may occur. Fractures can also be
the result of overuse, particularly for tennis players or golfers.
A fracture of a forearm bone can be accompanied by
dislocation of the elbow or wrist ( p.86). Radius
The two bones of the forearm, the radius and the ulna,
run together between the elbow and the wrist. Forearm
fractures may involve one or both of these bones,
although isolated radial fractures are rare.
ELBOW AND ARM INJURIES 83
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
If you think you may have If you are diagnosed with If you have had nonsurgical After your cast has been
fractured your forearm, a simple forearm fracture, treatment, your physician may: removedwhether you
you should: in which the skin is not X-ray your arm to check have had surgery or notyour
elevate your arm. broken, your physician may: how your fracture is healing. physician may:
immobilize your arm in realign your broken bone If the position of your refer you to a physical
a sling ( p.170). and put your arm in a cast; bones is not correct, your therapist for a program
MEDICAL
seek medical attention. after a week, the position physician may: of rehabilitation (see
of the fracture will be recommend surgery to table below).
checked on X-ray. repair the fracture.
prescribe analgesic If you have had surgery,
medication. your physician may:
If an open complex forearm X-ray your arm to check
fracture, in which your skin is how your fracture is healing.
broken by your bone and the After surgery, your
fracture is displaced, is physician may:
diagnosed, your physician may: put your arm in a cast for
recommend surgery to up to 6 weeks.
repair the bone.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate an increased demonstrate an increased demonstrate a full active
therapist may: grip strength; aim for 30% grip strength; aim for 20% range of motion in your
suggest various treatments, difference between your difference between your elbow, generating all
such as electrotherapy, to injured arm and your injured arm and your movements without
reduce local inammation. uninjured one. uninjured one. assistance. You should not feel
perform various exercises You may begin: You may begin: apprehensive when this is
to help restore range of squeezing a ball in the strengthening exercises such tested by your physical
PHYSICAL THERAPY
movement in your elbow. hand of your injured arm. as standing Ys ( p.215); aim therapist.
assess your grip strength. isometric shoulder for 4 sets x 8 reps, below demonstrate grip strength
advise you to keep moving
your hand and ngers.
exercises ( p.212).
shoulder blade exercises
maximum effort.
full-body exercises, such
within 10% of that of the
uninjured arm.
You may begin:
low to moderate stationary
in which one hand maintains
contact with a surface, such as
as lawnmowers ( p.190); aim
for 4 sets x 8 reps, below
complete upper-limb
plyometrics, such as medicine
bicycling, with your sling.
scapular clocks ( p.251); aim
for 10 sets x 10 reps.
maximum effort.
moderate-high intensity
ball chest throws ( p.216),
without pain.
lower-limb weights with stationary bicycling, cross- lift upper-limb weights that
no shoulder involvement. training, and stepping. are at least 80% of your one-
upper-limb weights with upper-limb weights training, rep max, without pain.
your uninjured arm. such as dumbbell bench complete high-level running
moderate stationary
bicycling.
presses ( p.210), tricep
push-downs ( p.217), and
at distances relevant to your
sport, without pain.
hammer dumbbell curls complete sport-specic
( p.218); perform them at
50% of your one-rep max,
drills without difculty.
participate in full training.
and aim for 4 sets x 812 reps.
stationary low-level skills,
such as ball handling.
84 SPORTS INJURIES
WRIST FRACTURES
The wrist joint is composed of eight connecting
WRIST FRACTURES
bones, together with the lower ends of the radius
and ulna (the bones of the forearm). Wrist
fracturesespecially to the radius or ulnaare a Ulna
frequent injury among athletes because the arm
is instinctively used to break a fall. They can be
Radius
difficult to diagnose, however, since symptoms
are not always obvious.
CAUSES Fracture
Fractured wrists are linked with sports such as bicycling,
running, roller blading, or skateboarding, and are usually
caused by a fall onto an outstretched hand. A direct blow Scaphoid
bone
to, or twisting of the wrist, perhaps incurred during contact
sports such as rugby or football, are also common causes Fracture
of these injuries. Lunate
bone
SYMPTOMS AND DIAGNOSIS
You may experience pain, swelling, and tenderness in your
wrist, as well as difficulty bending it. You may also have a
visible deformity of your wrist, although some fractures are not
obvious; for example, a scaphoid bone fracture may have no
visible external signs, without even a bruise present. In some
cases you will only be aware of the fracture when the pain
becomes severe. A wrist fracture may also be accompanied
by a dislocation ( p.86). Your physician will examine your
wrist and you will have an X-ray or a CT scan to determine the
extent of your break and to ensure that you have not suffered
additional injuries, such as a fractured forearm ( p.80).
If you think you may have If you are diagnosed with If you have not had surgery After surgery:
fractured your wrist, you an undisplaced fracture (your and your injury has healed your arm will be put in
should: bones are still in the correct well, your physician may: a cast for about 4 weeks.
follow a RICE procedure position), your physician may: refer you to a physical After the cast is removed,
( p.170). immobilize your wrist in a therapist for treatment to your physician may:
MEDICAL
immobilize your arm in short arm cast for 46 weeks. improve strength and refer you to a physical
a sling ( p.170).
seek immediate medical
prescribe analgesic
medication for 12 weeks.
movement in your wrist
(see table below).
therapist for a program
of rehabilitation (see
attention. If you are diagnosed If you have not had surgery table below).
with a displaced or multiple and your injury has failed
fracture, your physician may: to heal as expected, your
recommend surgery physician may:
to repair your bones. recommend surgery
to reposition and repair
your bones.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate no swelling complete upper-limb demonstrate a full active
therapist may: in the affected area. plyometrics, such as mini range of motion in your whole
suggest various treatments,
such as electrotherapy, to
experience a full range of
motion in your ngers, hand, without pain.
trampoline throws ( p.216), arm, and should not feel
apprehensive when this is
reduce local inammation. wrist, elbow, and shoulder. complete balance and tested by your physical
advise you to wear a wrist fully weight-bear, control exercises for your therapist.
splint and compression without pain. shoulder, elbow, and wrist, complete ball skills,
bandage after your cast Your physical therapist may: such as scapular circles without pain.
PHYSICAL THERAPY
has been removed, to help assess your grip strength ( p.251). lift upper-body weights
alleviate symptoms. to establish a baseline marker Your physical therapist may: that are at least 80% of your
take your wrist through a for recovery. retest your grip strength; one-rep max, without pain.
series of movements (within You may begin: your injured arm should complete sport-specic
pain limits) to assess the range weight-bearing exercises, have only 10% less ability drills without difculty.
of motion in your jointthis such as four-point kneels than your uninjured one. participate in full training
will involve no effort from
you (passive range of motion);
( p.247), level 1. You may begin:
upper-limb weights
for at least 23 weeks.
CAUSES
Injuries to the wrist can occur in any sport in which falling
is a hazard, but are most common in skiing, snowboarding,
skating, soccer, bicycling, and gymnastics. Falling onto an
outstretched hand is the most common cause of dislocations Normal position
and sprains. When a bone is dislocated it becomes displaced of the lunate bone
or misaligned, making the joint unstable and affecting the
surrounding soft tissue. Sprains involve damage to the Dislocated
ligaments of the wrist, and are classed as mild, moderate, lunate bone
or severe, depending on how badly the ligaments are torn.
Most wrist dislocations involve the lunate bone, one of the
SYMPTOMS AND DIAGNOSIS carpal bones closest to the arm, which partially spans the
If you dislocate a bone in your wrist, you will feel pain and base of the ulna and the radius (the bones of the forearm).
there may be swelling, tenderness, and loss of movement.
When nerves and blood vessels are damaged, you may
experience numbness or paralysis in your wrist and hand. If WRIST SPRAIN
you have injured your ligaments, you will have bruising and
are likely to feel pain during weight-bearing or twisting actions.
Your physician will give you a physical examination and may
organize an X-ray to determine the severity of the injury and
to see whether you also have a wrist fracture ( p.84).
Ifyou think you may have If you are diagnosed with If you have not had surgery, After your cast is removed
dislocated or sprained your a mild wrist sprain, your and your wrist has healed as following surgery and your
wrist, you should: physician may: expected, your physician may: wrist is completely healed,
follow a RICE procedure bandage your wrist and refer you to a physical your physician may:
( p.170).
immobilize the injured area
recommend that you rest it.
prescribe analgesic
therapist for treatment to
build strength and help regain
refer you to a physical
therapist for a program
MEDICAL
with a splint or cast ( p.170).
seek medical attention.
medication.
If you are diagnosed with
mobility in your wrist (see
table below).
of rehabilitation
(see table below).
a dislocated wrist or a severe If you have had surgery,
sprain, in which the ligaments your surgeon may:
are badly damaged, your immobilize your wrist in
physician may: a cast for 48 weeks until it
recommend surgery to is fully healed.
realign your bone or repair
the damaged ligament in
your wrist.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate no swelling complete low-level ball complete high-level skills
therapist may: in the affected area. handling, without pain. that are relevant to your
suggest various treatments, demonstrate a full active You may begin: sport, without pain.
such as electrotherapy, to range of motion in your upper-limb and lower-limb complete sport-specic
reduce local inflammation. wrist, elbow, and shoulder, weights, as pain allows; start at drills without difculty.
take your wrist through a without pain. 80% of your one-rep max and participate in full training.
series of movements (within bear your full weight, aim for 4 sets x 812 reps. complete contact drills that
PHYSICAL THERAPY
pain limits) to assess the range without pain. upper-limb plyometrics that are relevant to your sport,
of motion in your jointthis Your physical therapist may: are relevant to your sport, pain-free and without feeling
will involve no effort from you assess your grip strength; such as medicine ball chest apprehensive.
(passive range of motion); as
your wrist recovers you will
your injured hand should
have only 10% less ability
throws ( p.216).
If you think you may have If a tendon disorder in your If your injury is healing as Ifyour injury fails to respond
a tendon disorder in your wrist or hand is diagnosed, expected, your physician may: to nonsurgical treatment, your
wrist or hand, you should: your physician may: refer you to a physical physician may:
stop any activity that put your wrist and thumb therapist for treatment to recommend surgery to
MEDICAL
causes pain. in a splint to immobilize them. relieve symptoms and widen the tendon tunnel.
follow a RICE procedure prescribe analgesic improve strength and After surgery, your
( p.170).
If your symptoms fail to
medication.
advise you to avoid
movement in your hand
(see table below).
physician may:
recommend you wear a
improve with self-treatment, repetitive thumb and hand If your injury fails to heal as cast or splint for 34 weeks.
you should: movements and to take expected, your physician may: refer you to a physical
seek medical attention. frequent breaks when give you an injection of therapist for a program
performing any activity corticosteroids to temporarily of rehabilitation (see
in which you have to use bring down the inammation. table below).
your hands and wrists.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate no swelling in complete upper-limb demonstrate a full active
therapist may: the affected area, even when plyometrics, such as mini range of motion when tested
suggest various treatments,
such as electrotherapy, to
performing daily activities.
demonstrate a full range of without pain.
trampoline throws ( p.216), by your physical therapist.
lift upper-body weights
reduce local inammation. motion in your neck, shoulder, complete shoulder, elbow, that are at least 80% of your
recommend a wrist splint elbow, and wrist, without pain. and wrist proprioceptive one-rep max, without pain.
and compression bandage bear your full weight, exercises, such as scapular complete sport-specic
to help alleviate symptoms.
take your wrist through a
without pain.
Your physical therapist may:
circles ( p.251).
Your physical therapist may:
drills without difculty.
participate in full training.
series of movements (within test your grip strength. retest your grip strength;
PHYSICAL THERAPY
WHEN WILL I BE FULLY FIT? The carpal tunnel is a narrow passage in the wrist. It houses
Carpal tunnel syndrome may clear up without treatment. If the median nerve, which runs down the arm, through the
you have surgery, you may need to rest your arm and hand carpal tunnel, to the hand and ngers.
for 46 weeks before you can take up your sport again.
TREATMENT
METACARPAL FRACTURE
Fracture of the metacarpals (the long bones
METACARPAL FRACTURE
in the hand) is a common sports injury. A heavy
impact may break one or more bones.
Metacarpal
bones
CAUSES
A direct blow to the back of the hand during combat sports,
such as martial arts, or contact sports, such as rugby, may
cause metacarpal fractures. Falling on the hand during
Fracture
noncontact sport may also lead to this injury.
WHEN WILL I BE FULLY FIT? The ve metacarpals are the long bones of the hand.
With nonsurgical treatment, a fracture should heal in about They lie between the carpal bones of the wrist and the
6 weeks. Recovery after surgery may take 68 weeks. You can phalanges (nger bones). All are vulnerable to injury.
return to your sport once you regain full use of your hand.
Ifyou are diagnosed with a simple fracture, your physician You should be able to: demonstrate no swelling and a full
may: nonsurgically realign your bones. immobilize your range of motion in the upper limb. fully bear your weight.
hand in a cast, splint, or brace for 6 weeks. For a severe
MEDICAL
CAUSES Middle
phalanx
Injury to the extensor tendons known as mallet finger
is common, especially in sports such as basketball, baseball, Tear
and cricket. If a ball moving at speed strikes the tip of the
finger it can tear the extensor tendon (which straightens the
Distal
end joint of the finger) away from the bone. A tiny fragment phalanx
of bone may be pulled away toothis is known as a mallet
fracture. In both cases, the tip of the finger droops down
and cannot be straightened. Injuries to the flexor tendons,
which enable the fingers to bend, are most common among
climbers and gymnasts, and are usually the result of using
The extensor tendons run along the back of each nger
too forceful a grip. This is known as a bowstring injury. and thumb, attached to the middle and distal phalanges,
allowing the ngers and thumbs to straighten.
SYMPTOMS AND DIAGNOSIS
When a tendon in your hand or finger has been injured
you will feel pain, swelling, and tenderness at the site of FLEXOR TENDON INJURY (BOWSTRING INJURY)
the injury. Your finger or hand may be deformed into a
bent position, or you may be unable to hold your finger Single exor
tendon of
or hand straight without using your other hand to help. the thumb
In a bowstring injury you may be unable to bend the fingers
of your injured hand, or it may hurt when you attempt to
do so. To diagnose your injury, your physician will carry out Tear
a physical examination and may suggest an MRI scan.
Ifyou think you have injured If you are diagnosed If you have not had surgery After surgery, your physician
a tendon in your hand, with mild to moderate mallet and your injury is healing as may:
you should: nger, your physician may: expected, your physician may: refer you to a physical
seek medical attention. put your nger in a advise you to wear a splint therapist for a program
splint for 6-8 weeks, at night for another 6 weeks, of rehabilitation (see
while the tendon heals. or whenever there is a table below).
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate no swelling complete upper-limb demonstrate a full active
therapist may: in the affected area. plyometrics, such as mini range of motion when tested
take your hand through a
series of movements (within
Your physical therapist may:
test your grip strength. without pain.
trampoline throws ( p.216), by your physical therapist.
lift upper-body weights that
pain limits) to assess the range You may begin: complete balance and are at least 80% of your
of motion in your jointsthis weight-bearing exercises, control exercises for the one-rep max, without pain.
will involve no effort from you
such as press-ups ( p.184), shoulder, elbow, and wrist, complete sport-specic
PHYSICAL THERAPY
(passive range of motion); as modied at rst to decrease such as four-point kneels drills without difculty.
your hand recovers you will
be able to initiate these
weight on the hand.
( p.247).
Your physical therapist may:
participate in full training
for at least 12 weeks.
movements yourself (active retest your grip strength;
range of motion). your injured hand should
advise you to try resistance have only 10% less ability
strengthening exercises for than your uninjured one.
your elbow and wrist that do You may begin:
not involve joint movement. upper-limb weights
exercises such as dumbbell
bench presses ( p.210),
as pain allows; start at 50%
of your one-rep max and
aim for 4 sets x 812 reps.
(You may need to modify
the lifts or use wrist straps.)
lower-limb weight exercises
that include the upper limbs,
such as push presses ( p.238),
as pain allows.
94 SPORTS INJURIES
CAUSES
Finger injuries are common in collision and contact sports
such as rugby and football, and in sports in which the hands
are exposed to injury, such as basketball, tennis, and cricket. Proximal
phalanx
The finger bones are particularly vulnerable to injury because
Middle
they do not have a thick, protective covering of soft tissue. phalanx
Falls onto hard surfaces, sudden contact with a balla cricket
Fracture
ball coming off a bat at speed directly striking the end of the
finger, for exampledirect blows (punches), and indirect
Distal
force applied to a finger by accidental collision with another phalanx
athlete may all cause a fracture or dislocation.
The ngers each have three phalangesthe proximal,
SYMPTOMS AND DIAGNOSIS middle, and distalwhile the thumb has two. A forceful
Fingers can be fractured or dislocated in many different impact can cause a fracture in any of these bones.
ways, but the symptoms are similar: you will experience
pain when touching your finger and have difficulty moving
it, as well as swelling, stiffness, and tenderness. Your finger FINGER DISLOCATION
may suddenly appear crooked. If your fracture is close to
Metacarpo-
the nail bed, a bruise may be visible under your nail. Knuckle phalangeal joint
joints are also often dislocated. Your physician will carry out Inter-
a physical examination and you will have an X-ray to confirm phalangeal
the severity of your fracture or dislocation. joint
If you think you may have If you are diagnosed with Regardless of whether After your splint or taping
dislocated or fractured your a mild-to-moderate dislocation you have had surgical or has been removed, your
nger, you should: or fracture, your physician may: nonsurgical treatment, physician may:
apply ice ( p.165).
immobilize your nger
manipulate your nger
back into its correct position,
your physician may:
leave your nger in a splint,
refer you to a physical
therapist for a program
MEDICAL
with a splint, or by taping then tape it to the adjacent or taped, for 46 weeks while of rehabilitation (see
it to the adjacent nger nger or place it in a splint it heals. table below).
( p.170).
elevate your arm to
for support.
prescribe pain-relief
If you have had surgery,
your physician may:
prevent swelling. medication. X-ray your nger while it
seek medical attention. If you are diagnosed with is splinted or taped to ensure
a severe fracture, your that it is healing as expected.
physician may:
recommend surgery to
realign and support the
broken fragments with
pins, plates, and screws.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate no swelling in complete upper-limb demonstrate a full active
therapist may: the affected area. plyometrics, such as mini- range of motion when tested
suggest various treatments,
such as electrotherapy, to
put full weight on your
hand, without pain. without pain.
trampoline throws ( p.216), by your physical therapist.
lift upper-body weights that
reduce local inammation. Your physical therapist may: complete balance and are at least 80% of your
advise you to wear a nger test your grip strength. control exercises for your one-rep max, without pain.
splint and compression shoulder, elbow, and wrist, complete sport-specic
bandage to help alleviate such as four-point kneels drills without difculty.
PHYSIOTHERAPY
( p.212) to build up
strength, as pain allows.
that include the upper limbs,
as pain allows. You may need
to modify the lifts or use
wrist straps.
96 SPORTS INJURIES
HIP FRACTURES
The hip is a ball-and-socket joint connecting
FEMORAL NECK FRACTURE
the femur (thighbone) to the pelvis. Fractures
to the neck of the femur are the most common
Pelvis
type of hip fracture. The area of the pelvis around
the hip joint is also susceptible to avulsion Acetabulum
fractures, in which a tendon or ligament pulls
Head of
away from the pelvis, taking a fragment of the femur
bone with it.
Fracture
CAUSES
Fractures of the neck of the femur may be caused by a
forceful blow, such as those experienced in collision sports,
including rugby or football, or by a heavy fall in sports such
as horseback riding. Avulsion fractures are usually caused by Femur
a rapid and powerful contraction of one of the quadriceps or
hamstring muscles in the thigh, and is most commonly seen
in sports that involve rapid acceleration and deceleration,
such as soccer or basketball.
In a femoral neck fracture, the head of the femur, which
SYMPTOMS AND DIAGNOSIS is held within the acetabulum (the socket of the pelvis),
If your fracture is the result of a blow, you will feel pain in becomes disconnected from the rest of the femur.
your hip immediately after the impact, and moving your
leg will cause you pain. If you have an avulsion fracture you
may feel a sudden pain in your hip when you accelerate, AVULSION FRACTURE
with the pain moving down the muscle that has pulled away
from the bone. Your physician will make a diagnosis through
Pelvis
a combination of physical examination and X-ray, to
determine the location of the fracture and its severity.
Ifyou think you may have If you are diagnosed with Once your avulsion fracture Itmay take up to a year to
fractured your hip, you should: an avulsion fracture of the has healed, your physician may: recover fully from a fracture in
stop activity. hip, your physician may: refer you to a physical which bone has broken. After
immobilize the joint advise you to rest until the therapist for treatment to surgery, when your fracture
MEDICAL
( pp.17071).
seek medical attention.
fracture has healed. This can
take up to 3 months.
regain strength and mobility
in the joint (see table below).
has healed, your physician may:
refer you to a physical
If you have a fracture in If you have had surgery, your therapist for a program
which bone is broken, physician may: of rehabilitation (see
your physician may: advise you to use crutches table below).
recommend surgery to for up to 6 weeks.
x the bone.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a near full perform low-level jogging, liftleg weights that are at
therapist may: range of motion in both hips. without pain or limping and least 80% of your one-rep
use manual therapy and soft You may begin: with a full range of motion in max, without pain.
tissue therapy to help relieve deep-water running and your hips. complete foot plyometrics,
your symptoms. swimming; aim for 2030 You may begin: such as jumps and hops
gently test the range of
motion in your hip; this will
minutes at high intensity
intervals. Avoid breaststroke
lower-limb bodyweight
exercises, such as step-up
( pp.25658), and speed drills
( pp.25253), without pain.
be guided by your pain limits.
You may begin:
for 46 weeks after surgery.
trying to walk normally
and holds ( p.250).
functional warm-up drills,
perform single vertical
and horizontal hops
PHYSICAL THERAPY
resistance exercises, such without a limp. such as pike walks ( p.177), ( p.261) and adapted
as squeezes, for the buttocks,
quadriceps, adductors, and
walking on a treadmill until
you can jog without pain.
full-body exercises, such as
punch lunges ( p.182), and
cross-over hops ( p.262);
your injured leg should have
hamstrings, as pain allows; bicycling and working low-level foot plyometrics, only 10% less ability than
aim for 10 reps x 10 secs on a cross-trainer and stepper, such as walking pop-ups your uninjured one.
every 23 hours.
gentle stretches of your hip
as pain allows; aim for 20
minutes at 85rpm, level 6.
( p.254).
lower-limb strength training,
complete a T-test ( p.263);
aim for 11 seconds if you are
exors, quadriceps, adductors,
hamstrings, internal and
core-stability and gluteal
exercises, such as single-leg
such as squats ( p.180), calf
raises ( p.204), and Nordic
male, and 15 seconds if you
are female.
external hip rotators, and calf
muscles, on both legs; aim
bridges ( p.236) and pilates
reformer exercises ( p.237).
hamstring lowers ( p.202);
start at 50% of your one-rep
complete high-level running
at distances relevant to your
for 2 reps x 30 secs on each Start with modied versions max and aim for 4 sets x sport, without pain.
muscle group, 34 times daily. and light resistance, and build 812 reps. complete sport-specic
gentle walking in the pool
to help regain your normal
toward a normal technique.
walk-jog drills ( p.252),
as pain allows, building to
drills without difculty.
participate in full training.
walking pattern. 10 lengths of a soccer eld,
walking with crutches, working up toward low-level
aiming to increase bodyweight running.
loading, as pain allows.
98 SPORTS INJURIES
TROCHANTERIC BURSITIS
TROCHANTERIC BURSITIS
Gluteus maximus
Inamed bursa
Greater trochanter
Femur
Trochanteric bursitis is an inflammatory around the bursa. Bending or extending your hip during
disorder that affects the greater trochanter, a walking or sports activities, for example, will cause burning,
or aches and pains at the top of your thigh. Your physician
bony point at the side of the hip. The condition
will diagnose your condition through physical examination
occurs when the bursa of the greater trochanter and may recommend an ultrasound or MRI scan to confirm
a fluid-filled sac that eases movement between the diagnosis.
the trochanter and the gluteus maximus
becomes aggravated by overuse. RISKS AND COMPLICATIONS
If you leave trochanteric bursitis untreated, and continue to
play sports, you will experience ongoing hip pain. The pain
CAUSES may stay at the same level of intensity, but in some cases it
This condition is associated with sports that involve a lot of could increase in severity.
running, quick changes of direction, or weight-bearing activity,
such as soccer, hockey, and track and field. All of these cause WHEN WILL I BE FULLY FIT?
repetitive friction between the greater trochanter of the femur In all but the most extreme cases of trochanteric bursitis, you
and the gluteus maximus, which can lead to inflammation of should recover quickly and be able to return to sports 12
the bursa. Biomechanical abnormalities, such as unequal leg weeks after treatment. If you have had surgery to remove
lengths, may also increase the likelihood of trochanteric bursitis. the bursa, you should be fully fit within 68 weeks.
Ifyou think you may Ifyou are diagnosed with Ifyour injury fails to respond If all other treatments have
have trochanteric bursitis, trochanteric bursitis, your to rest and/or physical therapy, failed, as a last resort your
you should: physician may: your physician may: physician may:
stop any activity that recommend that you give you a local anesthetic recommend surgery to
causes pain. continue to rest, avoiding and inject corticosteroids into remove the bursa.
MEDICAL
apply ice ( p.165).
seek medical attention.
any activities that could
iname your bursa.
the affected area.
recommend extracorporeal
After surgery, your
physician may:
prescribe analgesic shockwave treatment (EST), advise you to use crutches
medication. in which soundwaves are for up to 2 weeks.
refer you to a physical directed at the area of pain, to refer you to a physical
therapist for treatment to help speed up the healing process. therapist for a program
release the affected area and of rehabilitation (see
strengthen the hip muscles table below).
(see table below).
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical walk without pain. perform interval bicycling at liftleg weights that are at
therapist may: Your physical therapist may: a moderatehigh intensity, least 80% of your one-rep
suggest various treatments, assess your single vertical with little or no pain. max, without pain.
such as electrotherapy, to and horizontal hops complete low-level running, perform single vertical
reduce local inammation.
use manual therapy and
( p.261) and adapted
cross-over hops ( p.262)
without pain.
You may begin:
and horizontal hops
( p.261) and adapted
soft tissue therapy to help
relieve your symptoms.
to establish baseline scores.
You may begin:
lower-limb strength training
at 50% of your one-rep max;
cross-over hops ( p.262);
your injured leg should have
assess the intensity and core-stability exercises, aim for 4 sets x 812 reps only 10% less ability than
PHYSICAL THERAPY
duration of your training, such as dead bugs ( p.225). of barbell squats ( p.192), your uninjured one.
and correct these accordingly. functional warm-up drills, straight-leg deadlifts ( p.197), complete foot plyometrics,
perform a full biomechanical such as walking kick-outs and Nordic hamstring lowers such as jumps and hops
foot and ankle assessment to
judge if you need insoles or
( p.185), full-body exercises,
such as multidirectional lunges
( p.202).
( pp.25658), and speed drills
( pp.25253), without pain.
orthotics to support your
medial arch, or a correct
( p.249), and low-level foot
plyometrics, such as A-walks
complete high-level running
at distances relevant to your
footwear prescription.
You may begin:
( p.254).
low-level running and
sport, without pain.
complete sport-specic
self-massage of your sporting activities, as drills without difculty.
iliotibial band with a hard pain allows. participate in full training.
foam roller ( p.191); spend
6 x 30 seconds on each leg
interval bicycling and work
on a cross-trainer and stepper;
daily, even if it is painful. build to 20 minutes at 80rpm,
exercises to activate and level 6, as pain allows.
strengthen your gluteal stretches of your quadriceps,
muscles, such as single-leg adductors, hamstrings, soleus,
bridges ( p.236), clams
( p.187), and hip hitchers
gastrocnemius, and gluteal
muscles ( pp.17681; 18689;
( p.186), as pain allows. 24145). Aim for equal
stretches both sides.
100 SPORTS INJURIES
CAUSES
Labral tears occur in sports which involve sudden stops and
turns combined with jumping and landing, such as soccer,
rugby, tennis, or baseball, or sports that involve extreme Femur
movement, such as rowing or martial arts. A structural defect
of the acetabulum, often where it is too shallow, may lead
to tearing where there is trauma or overuse. Gymnasts are
particularly affected by this. Femoroacetabular impingement
Labral tears affect the labrum, a ring of cartilage that
(FAI) occurs as a result of the particular shape of the head of surrounds the acetabulum. The labrum holds the head
the femur and/or the acetabulum. of the femur in place while allowing exibility in the joint.
Ifyou think you may have a Ifyou are diagnosed with If your symptoms have After surgery, your physician
labral tear or FAI, you should: a hip labral tear or FAI, your failed to respond to 23 weeks may:
seek medical attention. physician may: of nonsurgical treatment refer you to a physical
advise you to rest. for either condition, your therapist for a program
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate almost a full demonstrate a full range liftleg weights that are at
therapist may: range of motion in your hip. of motion in your hip. least 80% of your one-rep max.
use manual therapy and walk without pain. You may begin: complete foot plyometrics,
soft tissue therapy to help You may begin: lower-limb bodyweight such as jumps and hops
relieve your symptoms.
test the range of motion
deep-water running and
swimming; aim for 2030
exercises, such as hip hitchers
( p.186), step-up and holds
( pp.25658), and speed drills
( pp.25253), without pain.
in your hip and spine, within minutes at high intensity ( p.250), and walking perform single vertical
pain limits.
You may begin:
intervals. Avoid breaststroke
for 46 weeks after surgery.
lunges ( p.180).
functional warm-up drills,
and horizontal hops
( p.261) and adapted
PHYSICAL THERAPY
( p.263); aim for 11 seconds
secs every 23 hours. pain allows; aim for 20 start at 50% of your one-rep if you are male, and 15
stretches for your hip exors, minutes at 85rpm, level 6. max and aim for 4 sets x seconds if you are female.
quadriceps, hamstrings,
adductors, internal and
box step-ups ( p.203); aim
for 3 sets x 15 reps.
812 reps of barbell squats
( p.192), Nordic hamstring
complete high-level running
at distances relevant to your
external hip rotators, core-stability and gluteal lowers ( p.202), and calf sport, without pain.
and calf muscles ( pp.17681;
18689; 24145), on both left
activation exercises, such as
single-leg bridges ( p.236);
raises ( p.204).
working on a rower; start at
complete sport-specic
drills without difculty.
and right sides; aim for 2 reps start with modied versions levels 34 for 10 minutes, at
x 30 secs on each muscle and light resistance, and build a comfortable pace. Increase
group, 34 times daily. toward a normal technique. your time by 1015% weekly.
walking in the pool and
gentle swimming (freestyle).
walk-jog drills ( p.252),
building to 10 lengths of a
eld, without pain, progressing
to low-level running.
102 SPORTS INJURIES
OSTEITIS PUBIS
OSTEITIS PUBIS
Sacrum
Coccyx
Degeneration of edges
of pubic bone
Inamed pubic
symphysis
Osteitis pubis is an inflammation of the pubic underlying conditions that might be the cause of the
symphysis (the cartilage joint between the pubic inflammation. You may also have an X-ray or MRI scan
to assess the severity of the disorder.
bones that form the front of the pelvis). The
disorder, which can occur when the pelvis is RISKS AND COMPLICATIONS
subjected to excessive or repetitive stress, causes If you spend insufficient time on rehabilitation, you may
pain and may also lead to bone degeneration. suffer from long-term pain as a result. Once the condition
becomes chronic, recovery time increases significantly and
CAUSES there is a greater risk of recurrence. Untreated, osteitis pubis
The condition is commonly associated with sports that may also cause erosion at the edges of your pubic bones.
involve a lot of running, sudden changes of direction, or
weight-bearing activity, such as soccer, hockey, tennis, WHEN WILL I BE FULLY FIT?
and track and field (marathon runners are particularly In most cases, you should have made a full recovery within
susceptible to osteitis pubis). Anatomical problems such 612 weeks, but recovery can take as long as 6 months,
as stiff hip joints or unequal leg length can also be a factor. depending on how long you have had the injury before
you receive treatment. The earlier you start treatment
SYMPTOMS AND DIAGNOSIS and rehabilitation, the sooner you will return to fitness.
The onset of symptoms may be sudden or gradual. You will
feel pain low down in your abdomen, in one or both sides
of your groin, and along the inside of your thigh. Exercise
will aggravate your symptoms. Your physician should be able
to diagnose osteitis pubis through physical examination, and
will search for hip problems, unequal leg length, or other
A B D O M E N , H I P, A N D G R O I N I N J U R I E S 103
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
Ifyou think you may have Ifosteitis pubis is diagnosed, If,once other causes are If the injury fails to respond
osteitis pubis, you should: your physician may: ruled out, your condition is to nonsurgical treatment (this
stop any activity that give you a corticosteroid attributed to overuse, your is rare), your physician may:
increases the pain. injection into, or around, the physician may: recommend surgery to
follow a RICE procedure pubic symphysis. If you have advise you to avoid any stabilize your pubis symphysis
MEDICAL
( p.170).
seek medical attention.
bone bruising on either side
of the joint, you may be given
activities that place stress
on your pelvis.
with a plate and screws.
After surgery your
another injection of physician may:
a specialized drug. advise you to refrain from
prescribe analgesic sport for up to 6 months.
medication. refer you to a physical
refer you to a physical therapist for a program
therapist for treatment to of rehabilitation (see
improve your core stability table below).
and strengthen your thigh
muscles (see table below).
Once your physician has Your physical therapist may: You should now be able to: You should now be able to:
referred you, your physical continue to assess your complete high-level liftleg weights that are at least
therapist may: adductor muscles and your sideways drills, such as 80% of your one-rep max,
use manual therapy and soft
tissue therapy to help relieve
pubic symphysis at each
session; you should feel
carioca sidesteps ( p.188).
perform upper-limb weights
without pain.
complete long-lever
your symptoms.
assess the intensity and
only minimal discomfort.
You may begin:
with no restrictions or pain.
Your physical therapist may:
adductor drops ( p.199)
starting with a 1kg (2 lb) load,
duration of your training, double- and single-leg continue to assess your aiming for 3 sets x 12 reps with
and correct these accordingly.
squats ( p.180): aim for adductors and your pubic an 11 lb (5 kg) load.
PHYSICAL THERAPY
perform various physical 4 sets x 20 reps of each. symphysis; you should feel complete foot plyometrics,
tests of your adductor muscles functional warm-up drills no discomfort when tested. such as jumps and hops,
and your pubic symphysis
in order to monitor your
such as walking kick-outs
( p.185), full-body exercises,
suggest slide-board
exercises ( p.200).
( pp.25659) and speed drills
( pp.25253), without pain.
recovery.
You may begin:
such as push-ups ( pp.228
29), and low-level foot
You may begin:
lower-limb strength training
complete a T-test ( p.263):
aim for 11 seconds if you
gentle stretches of your plyometrics such as at 50% of your one-rep max; are male, and 15 seconds
quadriceps, adductors, soleus,
hamstrings, gastrocnemius,
A-walks ( p.254).
upper-limb weight exercises,
aim for 4 sets x 812 reps
of barbell squats ( p.192),
if you are female.
complete high-level running
and gluteal muscles ( pp.176
81; 18389; 24045). Aim for
such as dumbbell bench
presses ( p.210); start at
straight-leg deadlifts ( p.197),
and Nordic hamstring lowers
at distances relevant to your
sport, without pain.
equal stretches on both sides.
isometric adductor squeezes
50% of your one-rep max.
adductor pulley exercises
( p.202).
short-lever adductor
participate in full training,
without pain.
( p.199) at a moderate effort;
aim for 10 reps x 10 secs at
( p.201); aim for 4 sets x
1520 reps.
manuals ( p.198); aim
for 3 sets x 15 reps.
You may begin:
high-level core-stability
0, 60, and 90 degrees of knee core-stability exercises, interval walking, jogging, exercises, such as side planks,
exion daily.
deep-water pool running;
such as dead bugs ( p.225),
side planks, level 1 ( p.226),
and bicycling, as pain allows.
core-stability exercises, such
levels 34 ( p.227), kneeling
supermen, level 3 ( p.229),
aim for 30 minutes at kneeling supermen, as side planks, levels 23 and extension holds,
high-intensity intervals.
levels 12 ( pp.22829),
and curl-ups ( p.221).
( pp.22627) and kneeling
supermen, levels 23 ( p.229).
level 3 ( p.235).
104 SPORTS INJURIES
GROIN STRAIN
The term groin strain, or adductor strain,
GROIN STRAIN
refers to the overstretching, tearing, or rupturing
of any of the five adductor muscles of the inner
thigh. In most cases, groin strains are minor
tears of a few muscle fibers, with the bulk of
the muscle remaining intact. Hip joint
CAUSES
Groin strain is frequently caused by strenuous stretching
movements of the legswhen sprinting or kicking a ball,
Pectineus
for exampleor by sudden changes in direction, which can
occur in a range of sports, such as soccer, hockey, or tennis.
Overuse of the adductor muscles can lead to inflammation Tear
in the groin (adductor tendinitis).
Adductor
SYMPTOMS AND DIAGNOSIS brevis
Depending on the severity of the strain, you may feel mild
discomfort to severe pain toward the top of your inner
thigh. You may also find it painful to pull your leg against
resistance, and there may be swelling and bruising on your Adductor
inner thigh. Your physician will diagnose the condition from longus
your medical history and a physical examination. You may be
given an ultrasound or MRI scan to confirm the diagnosis. Adductor
magnus
RISKS AND COMPLICATIONS
Groin strain usually heals without any problems. Although
stretching exercises are an important part of rehabilitation Gracilis
and treatment, overdoing them may result in your injury
taking a longer time to heal.
Femur
WHEN WILL I BE FULLY FIT?
Most groin strains take approximately 46 weeks to heal,
depending on the severity of your injury. However, you may
not regain full fitness for another 2 weeks. If you have had
surgery, your rehabilitation period is likely to be 36 months
Patella
or longer.
Ifyou think you may have If you are diagnosed with Ifyou have not had surgery, After surgery or
injured your groin, you should: a mild-to-moderate groin and your injury is not corticosteroid treatment,
follow a RICE procedure strain, your physician may: healing as expected, your physician may:
( p.170). prescribe pain-relief your physician may: refer you to a physical
MEDICAL
seek medical attention. medication. give you a corticosteroid therapist for a program
refer you to a physical injection to reduce of rehabilitation (see
therapist for treatment to inammation. table below).
improve muscle strength
(see table below).
If you are diagnosed with
a complete tear of the muscle,
your physician may:
recommend surgery to
repair the tear.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical perform isometric adductor perform isometric adductor lift leg weights that are at
therapist may:
use manual therapy and soft
squeezes ( p.199) with
minimal pain.
squeezes ( p.199) with no pain
and even greater power.
least 80% of your one-rep max.
complete long-lever
tissue therapy to help relieve
your symptoms.
Your physical therapist may:
assess the function of your
complete high-level
sideways drills such as
adductor drops ( p.199); start
with a 1 kg load and aim for
suggest you use crutches to
take the weight off your groin.
adductors. You should feel
minimal discomfort.
carioca sidesteps ( p.188).
lift upper-limb weights
3 sets x 12 reps with 5 kg.
complete foot plyometrics,
assess the strength of your You may begin: as you did before injury. such as jumps and hops
adductor muscles.
squats ( p.180) and
You may begin:
( pp.25657), and
PHYSICAL THERAPY
You may begin: single-leg squats ( p.193); lower-limb strength training, speed drills ( pp.25253),
gentle stretches of your aim for 4 sets x 20 reps of starting at 50% of your one-rep without pain.
quadriceps, adductors, soleus, each. Stop if you feel pain. max. Include barbell squats perform single vertical
hamstrings, gastrocnemius,
and gluteal muscles
functional warm-up drills,
such as walking lunges
( p.192) and Romanian
deadlifts ( p.196); aim for
and horizontal hops
( p.261) and adapted
( pp.17681; 18589; 24144).
Aim for equal stretches on
( p.180), full-body exercises,
such as lawnmowers ( p.190),
4 sets x 812 reps.
interval bicycling.
cross-over hops ( p.262);
your injured leg should have
both sides. and low-level foot plyometrics, short-lever adductor only 10% less ability than
low-intensity isometric
such as A-walks ( p.254). You
manuals ( p.198), aiming your uninjured one.
adductor squeezes ( p.199);
aim for 10 sets x 10 reps,
should not feel any pain.
upper-limb strength training.
for 3 sets x 15 reps; stop
if you feel pain.
complete a T-test ( p.263):
aim for 11 seconds if you are
exing your knee to 0, 60,
and 90 degrees.
Do not exert your injured
adductor.
walk-jog drills ( p.252),
building to 10 lengths of a
male, and 15 seconds if you
are female.
deep-water pool running, box step-ups; aim for 4 sets soccer eld; when you have complete high-level running
as pain allows; aim for x 6 reps. succeeded, move on to at distances relevant to your
2030 minutes of high adductor pulley exercises low-intensity running. sport, without pain.
intensity intervals.
low-level core-stability
( p.201); aim for 4 sets x 1520
reps. You should not feel pain.
high-level core-stability
exercises, such as Swiss
complete sport-specic
drills without difculty.
exercises, such as single arm
and leg raises ( p.224).
moderate-level core-stability
exercises, such as side planks
ball jack-knives ( p.223). complete full training for
2 weeks, without pain.
( pp.22627).
106 SPORTS INJURIES
HERNIAS
A hernia occurs when weakened or torn
INGUINAL HERNIA
tissues allow part of an organ to protrude from
its normal site. Hernias most often occur in the
abdominal or groin area, appearing either as an
inguinal hernia (detected as a bulge in the groin Inguinal
ring
or scrotum) or a femoral hernia (detected as a
bulge at the top of the thigh). Abdominal
wall
CAUSES Inguinal
Hernias are most commonly associated with sports that ligament
involve twisting and turning or bending actionssuch as
hockey, soccer, and tennis. When excessive pressure is Herniated
placed on the muscles of the abdomen or groin area, they section of
can weaken or tear, allowing part of the intestine to push intestine
through at the weak point.
Ifyou think you may have If you are diagnosed with Ifyour inguinal hernia fails If you have had keyhole
a hernia, you should: an inguinal hernia, your to respond to nonsurgical surgery for a hernia, your
stop activity. physician may: treatment, your physician may: physician may:
apply ice to the site of prescribe analgesic recommend surgery to advise you to rest for
the pain ( p.165). medication. repair the hernia. This may 23 weeks.
MEDICAL
seek medical attention. try to avoid the need for be laparoscopic (keyhole) If you have had open
surgery by referring you to or open surgery. surgery for a hernia, your
a physical therapist for physician may:
treatment to strengthen advise you to rest for
your abdominal muscles 23 weeks, and then refer
(see table below). you to a physical therapist for
If you are diagnosed with a program of rehabilitation
an abdominal hernia, your (see table below).
physician may:
recommend surgery to
repair the hernia. This may be
keyhole or open surgery.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical perform double- and complete high-level complete dynamic, high-
therapist may: single-leg squats, without sideways drills, such as carioca level ball skills, without pain.
assess your range of motion
in your hips and spine.
pain; aim for 3 sets x 20 reps.
Your physical therapist may:
sidesteps ( p.188).
do normal upper-limb
perform long-lever adductor
drops ( p.199); start with an
test the strength of your retest your adductor muscle weights, without pain. 11 lb (5 kg) load and aim for 3
adductor muscles. strength weekly; you should Your physical therapist may: sets x 12 reps with 11 lb (5 kg).
use manual therapy and soft feel only minimal discomfort. check your adductor muscle complete foot plyometrics
tissue therapy to help relieve You may begin: strength tests are pain-free. such as skips and jumps
PHYSICAL THERAPY
your symptoms. functional warm-up drills suggest you exercise with and speed drills, without pain.
You may begin:
gentle lower-limb stretches
such as walking kick-outs
( p.185), full-body exercises
a slide board ( p.200).
You may begin:
perform single vertical and
horizontal hops ( p.261)
of your quadriceps, adductors,
hamstrings, gastrocnemius,
such as lawnmowers ( p.190),
and low-level foot plyometrics
lower-limb strength training;
start at 50% of your one-rep
and adapted cross-over
hops ( p.262); your injured
soleus, and gluteal muscles;
aim for equal stretches on
such as A-walks ( p.254).
upper-limb weights
max and aim for 4 sets x 812
repetitions of good mornings
side should have only
10% less ability than your
both sides.
deep-water running, once
exercises that do not strain
your abdomen.
( p.208), calf raises ( p.204),
and Nordic hamstring lowers
uninjured side.
complete a T-test ( p.263);
your wounds have healed;
aim for 2030 minutes of
bicycling; aim for 20
minutes at 85rpm level 6.
( p.202).
walk-jog drills ( p.252), as
aim for 11 seconds if you
are a male, and 15 seconds
high-intensity intervals.
low-level core-stability
box step-ups ( p.203);
aim for 4 sets x 6 reps.
pain allows; build to 10 lengths
of a football eld; when you
if you are a female.
complete high-level running
exercises, such as bridges adductor pulley exercises have succeeded, move to at distances relevant to your
( p.236).
adductor lifts ( p.201).
( p.201); aim for 4 sets x
1520 reps.
low-intensity running.
low-level skills training.
sport, without pain.
complete sport-specic
Moderate-level core- high-level core training drills without difculty.
stability exercises, such as exercises, such as Swiss ball participate in full training for
pulley lifts, level 3 ( p.233).
donkeys ( p.222). at least 2 weeks, without pain.
108 SPORTS INJURIES
HAMSTRING INJURIES
Each of the muscles of the hamstrings is
HAMSTRING STRAIN
susceptible to strains and ruptures. Hamstring
injuries can vary in severity from fairly minor
contusions (bruises) and moderately serious
stretches and strains up to full-scale ruptures.
CAUSES
Contusions (bruises) are caused by heavy impact to the
muscle from a collision or a fall. Hamstring strains occur in
sports in which an athlete has to accelerate suddenly, or
when the muscles are subject to sudden, forceful stretching
or contraction: for example, in soccer, basketball, or running Tear
and jumping activities. Poor technique, muscle fatigue, and
an inadequate warm-up may also make the injury more
likely. In severe cases, excessive stretching of the muscle
against a force, for example during weight lifting or in a
rugby scrum, may cause complete rupture of the muscle.
( p.170), keeping your medication. weeks, or until the muscle of rehabilitation (see
hamstring stretched. refer you to a physical has healed. table below).
seek medical attention. therapist for treatment to
If you think you may have improve your muscle strength
a ruptured hamstring (you (see table below).
cannot walk unaided), If you are diagnosed with
you should: a ruptured hamstring, your
seek medical attention. physician may:
recommend surgery to
stitch the damaged tissue.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical go up and down stairs, complete high-intensity liftleg weights that are at
therapist may: without pain. sideways drills, such as least 80% of your one-rep
use soft tissue massage to
help relieve your symptoms.
perform single-leg bridges
( p.236) with your knee exed
carioca sidesteps ( p.188).
perform single-leg bridges
max, without pain.
complete foot plyometrics,
put strapping on your
hamstring to prevent you
at 60 degrees, without pain;
aim for 4 sets x 15 reps.
( p.236) with your knee exed
at 30 degrees. Aim for
such as jumps and hops
( pp.25659), and speed drills
from overexerting it. perform straight-leg raises 3 sets x 15 reps, stopping ( pp.25253), without pain.
suggest you continue
to use crutches until you can
( p.193) with the same ability
in each leg.
if you feel pain.
Your physical therapist may:
perform single vertical
and horizontal hops
PHYSICAL THERAPY
QUADRICEPS INJURIES
The four quadriceps muscles are involved in
QUADRICEPS STRAIN
walking, running, and straightening and bending
the leg. They are all susceptible to injury, as are the
tendons in the thigh. The severity of injuries to
these muscles ranges from contusions (bruises),
strains (small tears) of the tendon or muscle, to
ruptures (complete tears).
CAUSES
Quadriceps strains usually affect the rectus femoris muscle
and occur during sports that involve sprinting, jumping, or
kicking, such as soccer. In extreme cases, the force that these
activities place on the muscle cause it to rupture completely.
Sustaining a contusion, or bruise, is a common occurrence in Tear
contact sports, where a direct blow to the muscle can lead to
localized bleeding in the muscle and under the skin.
Rectus
femoris
SYMPTOMS AND DIAGNOSIS
Symptoms of strains and contusions vary depending on Vastus
the severity of your injury. You will usually feel pain and intermedius
tenderness, and perhaps some weakness in your leg. There
may also be bruising on your leg and some swelling. If you Contusion
have ruptured your quadriceps tendon, there may be an (bruise)
audible pop at the moment of injury. You will experience
pain and swelling, and you may feel a gap in your muscle at
the site of the rupture. You may also be unable to straighten
Vastus
your knee and find walking difficult. If you have a severe lateralis
contusion, an X-ray may be done to rule out bone damage.
If you have a suspected strain or rupture, diagnosis will be Vastus
medialis
made through physical examination; an ultrasound or MRI
scan may also be needed. Ruptures of the quadriceps and Quadriceps
patellar tendons ( pp.122-23) are, together, called ruptures
of the extensor mechanism of the knee.
tendon
Ifyou think you may have If you are diagnosed with Most quadriceps strains After surgery, your
injured your quadriceps, a serious contusion or strain, heal within 4 weeks, and physician may:
you should: your physician may: contusions within 48 weeks. put your leg in a cast
follow a RICE procedure advise you to continue with If your injury is healing as or brace for 46 weeks.
( p.170) for 24 hours with
your knee at maximum
RICE for up to 72 hours.
prescribe analgesic
expected, your physician may:
refer you to a physical
You will need crutches
for 68 weeks.
exion; see icing of medication. therapist for treatment to When you are able to
MEDICAL
quadriceps ( p.245). refer you to a physical improve muscle strength and walk without crutches,
immobilize your leg therapist for treatment elasticity (see table below). your physician may:
( pp.17071).
seek medical attention.
(see table below).
If a severely strained (partially
If your severely strained
(partially ruptured) tendon
refer you to a physical
therapist for a program
ruptured) tendon, is diagnosed, has failed to respond to of rehabilitation (see
your physician may: nonsurgical treatment, table below).
put your leg in a cast or your physician may:
brace for 46 weeks. recommend surgery
If a complete tendon to repair the tendon.
rupture is diagnosed, your
physician may:
recommend early surgery
to stitch the damaged tissue.
Once your physician You should now be able to: You should now be able to: You should now be able to:
has referred you, your physical go up and down stairs, run at low intensity without liftleg weights that are at
therapist may: pain-free. pain or swelling. least 80% of your one-rep
use soft tissue massage to complete single-leg squats perform high-level sideways max, without pain.
help relieve your symptoms.
suggest you continue
( p.193); aim for 3 sets x 10
reps at 90 degrees.
drills, such as carioca sidesteps
( p.188), without pain.
complete foot plyometrics,
such as jumps and hops
to use crutches until you You may begin: Your physical therapist may:
( pp.25758), and speed drills
PHYSICAL THERAPY
can walk normally without gentle stretches of your assess your single vertical ( pp.25253), without pain.
limping.
You may begin:
quadriceps ( p.243). Aim
for symmetry in both legs.
and horizontal hops
( p.261) and adapted
perform single vertical
and horizontal hops
practicing squats ( p.180);
aim for 3 sets x 20 reps. This
functional warm-up drills,
such as walking lunges
cross-over hops ( p.262)
to establish baseline scores.
( p.261) and adapted
cross-over hops ( p.262);
should cause minimal pain.
deep-water running; aim
( p.180), full-body exercises,
such as Swiss ball donkeys
You may begin:
moderate-to-high level
your injured leg should have
only 10% less ability than
for 2030 minutes, at
high-intensity intervals.
( p.190), low-level foot
plyometrics, such as A-walks
running at sport-specic
distances. You should not
your uninjured one.
complete a T-test ( p.263):
upper-limb weights
(non-weight-bearing)
( p.254), and low-level
sideways drills, such as carioca
feel any pain.
lower-limb strength training;
aim for 11 seconds if you
are male, and 15 seconds
1 day after the injury.
bicycling 12 days after the
sidesteps ( p.188), pain-free.
box step-ups ( p.203),
aim for 4 sets x 812 reps
of barbell squats ( p.192)
if you are female.
complete high-level running
injury, as pain allows. Aim for aiming for 4 sets x 6 reps. and Romanian deadlifts at distances specic to your
20 minutes at 85rpm, level 6. interval bicycling at
a mediumhigh intensity.
( p.196); start at 50% of
your one-rep max.
sport, without pain.
complete sport-specic
low-level running. low-level skills training. drills without difculty.
participate in full training.
112 SPORTS INJURIES
PATELLA FRACTURE
The patella (kneecap) covers the front of the
PATELLA FRACTURE
knee joint. Together with the femur (thighbone)
and quadriceps (front thigh muscles), it is
involved in bending and straightening the knee.
Fractures of the patella can vary in severity, from
a single crack to cracks in several places.
CAUSES
Fractures of the patella often occur in contact sports such
as soccer or rugby, in which it can be common for knees
to receive a direct blow, perhaps from a kick. The knees also
come under constant stress during these types of sports
Femur
as the result of explosive movement. This can cause the
quadriceps muscle ( p.110) to contract too heavily, putting
strain on the kneecap, and potentially causing a fracture.
Ifyou think you may If you are diagnosed with After surgery to repair or After your cast or brace
have fractured your patella, a minor fracture, your remove your kneecap, your has been removed, your
you should: physician may: physician may: physician may:
stop activity. immobilize your knee in immobilize your knee in advise you to use crutches
apply ice to the affected a cast for around 6 weeks. a cast for around 6 weeks. for 23 weeks.
area ( p.165). prescribe analgesic If your knee is healing as refer you to a physical
MEDICAL
seek medical attention. medication. expected after 23 weeks, therapist for a program
If you are diagnosed with your physician may: of rehabilitation (see
a severe fracture, your replace the plaster with table below).
physician may: a knee brace. Pain may continue, even after
recommend surgery to the injury is fully healed, in
repair your kneecap with pins which case your physician may:
and surgical wire. recommend using a brace
recommend surgery to to support your knee.
remove your kneecap, if it
is impossible to repair, to
prevent the onset of arthritis.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range perform single-leg squats liftleg weights that are at
therapist may:
suggest various treatments,
of motion in your hip, ankle,
and foot.
( p.193) with 90-degree
exion, without pain or
least 80% of your one-rep
max, without pain.
such as electrotherapy, to perform straight-leg raises apprehension. do foot plyometrics, such
help alleviate your symptoms.
You may begin:
( p.193) with your leg fully
extended, without pain.
perform step-up and
holds ( p.250), without pain.
as jumps and hops
( pp.25659), and speed drills
bending your knee, as bear your full weight, Your physical therapist may: ( pp.25253), without pain.
PHYSICAL THERAPY
pain allows; aim to achieve without pain. assess your single vertical perform single vertical
90-degree exion and
full extension.
You may begin:
lower-limb bodyweight
and horizontal hops ( p.261)
and adapted cross-over hops
and horizontal hops
( p.261) and adapted
non-weight-bearing hip
exercises, such as clams
exercises, such as single-leg
squats ( p.193).
( p.262) for baseline scores.
You may begin:
cross-over hops ( p.262);
your injured side should
( p.187).
using an electrical muscle
weight-bearing; aim to add
1520% of bodyweight every
interval bicycling at a
lowmedium intensity.
have only 10% less ability
than your uninjured side.
stimulator on your quadriceps,
hamstrings, and calf muscles,
12 weeks as pain, swelling,
and range of movement allow.
functional warm-up drills,
such as skating slide-boards
complete a T-test ( p.263):
aim for 11 seconds if you
to maintain bulk.
trying to walk normally
walking on a treadmill
(once your limp has gone)
( p.200), full-body exercises,
such as Swiss ball donkeys
are male, and 15 seconds
if you are female.
without a limp.
core-stability exercises,
until you can jog without pain.
stationary bicycling; aim for
( p.222), and low-level foot
plyometrics, such as A-skips
complete high-level
running at distances
such as single arm and leg
raises ( p.224).
20 minutes at 80rpm, level 6.
deep-water running; aim
( p.254).
lower-limb strength training;
relevant to your sport.
complete sport-specic
for up to 30 minutes at high start at 50% of your one-rep drills without difculty.
intensity intervals. max and aim for 4 sets x 812 participate in full training.
reps of barbell squats ( p.192).
stationary low-level training
and low-level running.
114 SPORTS INJURIES
PATELLAR DISLOCATION
The patella (kneecap) glides up and down a
PATELLAR DISLOCATION
groove (the femoral trochlear groove) in the
femur (thighbone) as the knee bends and
straightens. Sometimes the surrounding tendons
and ligaments are unable to hold the patella
in the groove, enabling it to dislocate (pop
out) or subluxate (partially dislocate), usually
outward or laterally.
Quadriceps
CAUSES tendon
Dislocation of the patella is associated with sports that
involve repetitive running, jumping, or kicking, such as
Femur
soccer. Such activities can lead to stress on the kneecap and
cause it to either fully or partially dislocate from the femoral
trochlear groove. Not running properly or wearing the wrong
Femoral
type of shoes can increase the likelihood of this happening. trochlear
A sharp blow to the kneecap can also dislodge the kneecap. groove
(normal
position of
SYMPTOMS AND DIAGNOSIS the patella)
You may feel pain in your knee, and there may be swelling
and stiffness in the area. You may hear creaking and crackling Dislocated
sounds when you move your knee, and you may feel it patella
catch. In more extreme cases, your knee may buckle under
your weight and your kneecap may slip off to one side. In
an acute dislocation, you may hear a pop and feel your
knee collapse suddenly. Your physician will usually make a Patellar
diagnosis through physical examination, but you may need tendon
an X-ray or MRI scan to pinpoint the position of the patella
and assess any damage to the surrounding tissue.
Ifyou think you may If you are diagnosed with When your symptoms have Ifyour kneecap continues
have dislocated your a dislocated kneecap, your subsided, your physician may: to be unstable, your
kneecap, you should: physician may: put a splint on your physician may:
stop activity. reduce your patella (relocate knee to reduce the lateral recommend surgery to
MEDICAL
follow a RICE procedure it), although in some cases movement of your kneecap, repair a damaged ligament
( p.170).
seek medical attention.
reduction may occur by itself.
prescribe analgesic
while still allowing some
movement of the knee.
or tendon in the knee.
After surgery, your
medication. refer you to a physical physician may:
immobilize your knee therapist for treatment to refer you to a physical
with an extension splint improve muscle strength and therapist for a program of
for 23 weeks. movement in your knee rehabilitation (see table
advise you to use crutches (see table below). below).
for 23 weeks.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range perform single-leg squats liftleg weights that are at
therapist may:
use an electrical muscle
of motion in your hip, ankle,
and foot.
( p.193) with 90-degree
exion, without pain
least 80% of your one-rep
max, without pain.
stimulator on your quadriceps, bear your full weight. or apprehension. complete foot plyometrics,
hamstrings, and calf muscles perform straight-leg raises perform box step-downs such as jumps and hops
to maintain muscle bulk.
You may begin:
( p.193) with your leg fully
extended, without pain.
( p.203) without pain
or apprehension.
( p.25659), and speed drills
( p.25253), without pain.
gluteal strengthening and
activation exercises, such as
You may begin:
lower-limb bodyweight
You may begin:
interval bicycling at a low
complete a T-test ( p.263):
aim for 11 seconds if you
PHYSICAL THERAPY
clams ( p.187). You should
not feel any pain.
exercises, such as single-leg
squats ( p.193).
medium intensity.
work on a cross-trainer
are male, and 15 seconds
if you are female.
bending your knee, as pain walking on a treadmill and stepper; build toward complete high-level running
allows; aim to achieve (once your gait is normal), 20 minutes at 80rpm, level 6. at distances relevant to your
90-degree exion, with until you can jog without pain. functional warm-up drills, sport, without pain.
full extension. stationary bicycling for 20 such as walking kick-outs complete sport-specic
weight-bearing; aim to add
1520% of bodyweight every
minutes at 80rpm, level 6.
deep-water running;
( p.185), exercises, such as
box step-ups ( p.203), and
drills without difculty.
participate in full training.
12 weeks as pain, swelling, aim for up to 30 minutes, low-level foot plyometrics,
and range of movement allow. at high intensity intervals. such as straight-leg scratches
trying to walk normally,
without a limp.
core-stability exercises,
such as dead bugs ( p.225).
( p.256).
lower-limb strength training;
static quadriceps exercises, weight-bearing gluteal start at 50% of your one-rep
such as straight-leg raises exercises, such as hip hitchers max and aim for 4 sets x 812
( p.193).
walking
in a pool and
( p.186). reps of Romanian deadlifts
( p.196).
swimming, as pain allows. stationary low-level skills,
such as ball handling.
low-level running. You
should not feel any pain.
116 SPORTS INJURIES
CAUSES Quadriceps
This condition can be caused by muscle weakness or tendon
imbalance, tight tendons, or abnormal movement of the
kneecap over the thighbone. Patellofemoral pain syndrome
Site of pain
can also be caused and aggravated by repetitive movements
of the knee.
If you think you may have Ifyou are diagnosed with If your condition is If your injury fails to respond
patellofemoral pain syndrome, patellofemoral pain syndrome, improving as expected, your to nonsurgical treatment
you should: your physician may: physician may: (this is rare), and a physical
stop activity. advise you to continue with refer you to a physical cause can be identied, your
rest your knee.
RICE ( p.170) for 4 weeks. therapist for treatment to physician may:
MEDICAL
follow a RICE procedure prescribe analgesic restore painless movement recommend surgery to
( p.170).
If your symptoms have
medication.
advise you to avoid
(see table below).
If your condition has not
smooth out the inside of the
patella or reduce lateral pull.
not responded after 2 weeks strenuous or painful activities improved after 6 weeks, your Once you have fully
of self-treatment, you should: until the pain subsides. physician may: recovered from surgery,
seek medical attention. advise you to use a look for other possible your physician may:
knee support. causes of knee pain. refer you to a physical
give you a corticosteroid therapist for a long-term
injection in your knee joint program of rehabilitation
to relieve pain. (see table below).
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical walk normally without complete high box step-ups liftleg weights that are at
therapist may:
suggest various treatments,
a limp.
You may begin:
( p.203); aim for 4 sets x 6 reps.
complete box step-downs
least 80% of your one-rep
max, without pain.
such as electrotherapy, to
practicing squats ( p.180)
( p.203); aim for 3 sets x do foot plyometrics, such as
reduce local inammation. with the electrical muscle 15 reps. jumps and hops ( pp.25659),
assess your lower spine, hip, stimulator strapped to You may begin: and speed drills ( pp.25253),
knee, and ankle. your leg; aim to squat low-level foot plyometrics, without pain.
perform an assessment of
your foot and ankle to see if
to 90 degrees.
box step-ups ( p.203);
such as A-walks ( p.254).
jumping, hopping, and
complete high-level running
at distances relevant to your
PHYSICAL THERAPY
you need insoles or orthotics aim for 3 sets x 15 reps. landing drills ( pp.25659); sport, without pain.
to support your medial arch, exercise on a cross-trainer stop if you feel pain. complete sport-specic
or different footwear. and stepper; build to 20 interval bicycling at drills without difculty.
use soft tissue massage to minutes at 80rpm, level 6. a mediumhigh intensity. participate in full training.
help relieve your symptoms. lower-limb strength training; increasing your running
put strapping on your patella aim for 4 sets x 812 reps of volume and intensity.
to reduce the strain on it.
You may begin:
barbell squats ( p.192) and
Romanian deadlifts ( p.196);
stretching the quadriceps, start at 50% of your one-rep
hamstrings, gastrocnemius, max. There should be no pain
iliotibial band, soleus, and and no increase in swelling.
gluteal muscles ( pp.17681;
18588; 24045). Aim for an
deep-water pool running;
aim for 30 minutes.
equal range of movement
on both sides.
walk-jog drills ( p.252) at
intervals; gradually build to
self-massage with a hard more jogging than walking.
foam roller; spend 6 x 30 core-stability exercises,
seconds on each leg daily.
using an electrical muscle
such as dead bugs ( p.225).
PATELLAR BURSITIS
Bursae are fluid-filled sacs that act as cushions
PATELLAR BURSITIS
to aid smooth joint movement. Each of the
three main knee bursae are susceptible to injury
and inflammation. When a knee bursa is inflamed,
Femur
movement of the knee joint becomes painful
a condition known as patellar bursitis.
Quadriceps
tendon
CAUSES
Trauma such as a direct blow or a fall onto the front of the
Suprapatellar
knee can rupture blood vessels, which then bleed into the bursa
prepatellar bursa at the front of the kneecap, causing swelling
and inflammation. Prepatellar bursitis is also linked with
friction and overuse. The infrapatellar bursa is located just
below the kneecap, and swelling here is usually connected
to inflammation of the adjacent patellar tendon, often Patella
caused by a jumping injury. Bursitis of the suprapatellar,
which is located above the kneecap, can be caused by Prepatellar
bursa
a heavy blow to the knee.
Ifyou think you may have If you are diagnosed Ifthe symptoms persist, In very rare cases, if the
patellar bursitis, you should: with patellar bursitis, your your physician may: injury is severe and fails to
stop activity. physician may: give you an injection of respond to nonsurgical
follow a RICE procedure prescribe analgesic corticosteroids directly into treatment, your physician may:
( p.170).
seek medical attention.
medication.
advise you to continue
the inamed bursa.
drain uid from the
recommend surgery to
completely remove the bursa.
MEDICAL
with ice treatment and rest. inamed bursa. After surgery, your
refer you to a physical physician may:
therapist for treatment to build refer you to a physical
strength in your knee (see therapist for a program
table below). of rehabilitation (see
If an infection is present, table below).
your physician may:
prescribe a course
of antibiotics.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range complete interval bicycling complete foot plyometrics,
therapist may: of motion in your hip, knee, at a moderatehigh intensity, such as jumps and hops
suggest various treatments,
such as electrotherapy, to help
and ankle, without pain.
You may begin:
without pain.
Your physical therapist may:
( pp.25659), and speed drills
( pp.25253), without pain.
reduce local inammation. bodyweight lower-limb assess your single vertical perform single vertical
perform a full biomechanical exercises such as box step-ups and horizontal hops and horizontal hops
foot and ankle assessment to
determine whether you need
( p.203), squats ( p.180), and
single-leg squats ( p.193).
( p.261) and adapted
cross-over hops ( p.262)
( p.261) and adapted
cross-over hops ( p.262);
PHYSICAL THERAPY
insoles or orthotics to support interval bicycling, and work for baseline scores. your injured side should
your medial arch, or a correct on a cross-trainer and stepper, You may begin: have only 10% less ability
footwear prescription. as pain allows; build toward lower-limb strength training; than your uninjured side.
You may begin:
straight-leg raises ( p.193).
20 minutes at 80rpm, level 6.
full-body exercises, such
start at 50% of your one-rep
max and aim for 4 sets x 812
complete a T-test ( p.263);
aim for 11 seconds if you
as lawnmowers ( p.190)
low-level foot plyometrics,
reps of barbell squats ( p.180),
straight-leg deadlifts ( p.197),
are male, and 15 seconds if
you are female.
such as A-walks ( p.254). and Nordic hamstring lowers
( p.202).
complete high-level running
at distances relevant to your
high-level, lower-limb sport, without pain.
exercises, such as box complete sport-specic
step-downs ( p.203). drills without difculty.
participate in full training,
for at least 1 week,
without pain.
120 SPORTS INJURIES
OSTEOCHONDRITIS DISSECANS
Osteochondritis dissecans of the knee occurs
OSTEOCHONDRITIS DISSECANS
when cartilage in the knee jointsometimes
with a section of bone attachedbreaks away.
Such a fragment may become lodged in the
joint, which can limit the range of motion
in the knee.
CAUSES
Osteochondritis dissecans can be caused by an injury or a
series of injuries to your knee, which are most likely to occur
Femur
in collision and contact sports such as rugby and soccer.
Impact or repetitive stress from running on a hard surface,
for example, can lead to cartilage tearing or fragmenting. Inferior
When the bone under your cartilage is injured, blood supply articular
surface of
may be restricted; this can lead to bone tissue dying, causing the femur
the cartilage to fragment and become dislodged. The condition
occurs most frequently in teenagers.
Site of
damage
SYMPTOMS AND DIAGNOSIS
The onset of symptoms is gradual. You may feel stiffness,
weakness, and occasional swelling in your knee. Pain may Loose
fragment
be located in the center of your knee, or it may be a general of cartilage
ache, and the movement of your knee will be restricted. and bone
When bending or straightening your knee, you may experience
a clicking or grating sensation within it and it may lock.
There may also be some tenderness at the lower end of your
thighbone. Your physician will assess your symptoms and
Tibia
recommend an X-ray to confirm the diagnosis.
Ifyou think you may have If you are diagnosed with If no bone fragments have After surgery, your
osteochondritis dissecans, osteochondritis dissecans, broken away, your knee physician may:
you should: your physician may: should heal naturally over advise you to restrict
stop any activity that immobilize your knee in a time. However, if your injury the amount of weight you
causes pain. cast or brace for 46 weeks. fails to respond to non-surgical place on your knee until it
follow a RICE procedure prescribe analgesic treatment, your physician may: is fully healed.
( p.170) medication. recommend surgery to After 12 weeks, if your
MEDICAL
immobilize your knee refer you to a physical repair the damaged bone. injury has healed as expected,
in a straight position therapist for treatment to your physician may:
( p.17071) and rest.
seek medical attention.
strengthen the muscles around
your knee (see table below).
refer you to a physical
therapist for a program
If bone in your knee has of rehabilitation (see
fragmented and broken table below).
away, your physician may:
recommend surgery to
remove any loose fragments
and repair the damaged bone.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical perform weight-bearing perform lower-limb strength liftleg weights that are at
therapist may: gluteal exercises, such as training, without pain and least 80% of your one-rep
suggest various treatments,
such as electrotherapy,
hip hitchers ( p.186).
You may begin:
with no increase in swelling.
Aim for 4 sets x 812 reps of
max, without pain.
complete foot plyometrics,
to reduce local inammation.
assess the length of your
functional warm-up drills
such as kneeling supermen
barbell squats ( p.192)
and Romanian deadlifts
such as jumps and hops
( pp.256259), and speed
PHYSICAL THERAPY
quadriceps, hamstrings,
hip exor, and calf muscles
( pp.228229), full-body
exercises such as lawnmowers
( p.196); start at 50% of
your one-rep max.
drills ( pp.252253),
without pain.
to check that they are
symmetrical.
( p.190), and low-level foot
plyometrics such as A-walks
perform high-level foot
plyometrics, such as A-skips
complete high-level
running at distances relevant
You may begin:
core-stability and gluteal
( p.254).
low-level running and
( p.254) and bounding
( p.259).
to your sport, without pain.
complete sport-specic
exercises, such as dead bugs sporting activities, as drills without difculty.
( p.225).
non-weight bearing
pain allows.
bicycling and working on a
participate in full training.
Site of pain
CAUSES
Patellar tendinopathy usually occurs in sports that involve Patellar
repeated jumping, such as volleyball, and it is often called tendon
jumpers knee. A rupture of the patellar tendon can be
caused by a sudden contraction of the quadriceps (the large Tibia
muscle at the front of the thigh), when landing hard from a
jump. Osgood-Schlatter syndrome affects teenagers, whose
bones grow rapidly: it causes the quadriceps to tighten and
The patellar tendon anchors the patella to the tibia.
may lead to inflammation and pain around the tibial tuberosity. Repeated stress on this tendon can cause small tears,
resulting in pain and swelling (tendinopathy).
SYMPTOMS
Patellar tendinopathy will cause pain and swelling at the
top of your shin. As with a rupture of your quadriceps tendon PATELLAR TENDON RUPTURE
Ifyou think you may If you are diagnosed with Ifyou have had surgery Ifpatellar tendinopathy fails
have a knee tendon injury, patellar tendinopathy or for a rupture of your patellar to respond to nonsurgical
you should: OSS, your physician may: tendon, your physician may: treatment after 612 months,
stop activity. prescribe analgesic immobilize your leg in your physician may:
follow a RICE procedure medication. a brace for 6 weeks. recommend surgery to
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical record an improved record a VISA-P score of 80 record a VISA-P score of 90
therapist may: VISA-P score. or above. or above.
assess your VISA-P score perform low-level bicycling feel only minimal morning feel no morning stiffness or
to determine the severity drills, without pain. stiffness or pain in your pain in your patella tendon.
of your condition. You may begin: patella tendon. lift leg weights that are at
use manual therapy and single-leg decline squats participate in normal sport least 80% of your one-rep
soft tissue therapy to help
relieve your symptoms.
( p.198) with an 11 lb (5 kg)
load (once pain-free using your
warm-ups with no discomfort
(strapping as required).
max, without pain.
perform single vertical and
PHYSICAL THERAPY
( p.209)
core-stability exercises,
( pp.22829), and low-level
foot plyometrics such as
eights ( p.253). at distances relevant to your
sport, without pain.
such as dead bugs ( p.225), A-skips ( p.254). complete sport-specic
pulley chops ( pp.23031), lower-limb weights drills without difculty.
and pulley lifts ( pp.23233). exercises, as long as they have participate in full training.
no knee-pushing movements. You should continue:
For example, try straight-leg a program of eccentric
deadlifts ( p.197), Nordic
hamstring lowers ( p.202), or
single-leg decline squats
( p.193)practise these at
single-leg bridges ( p.236). least once a week for a year.
124 SPORTS INJURIES
CAUSES
In general, knee ligament injuries commonly occur in
collision and contact sports, such as football and rugby:
when players tackle one another, causing impact on, or
Femur
twisting of the knee; or if athletes put abnormal strain on
the knee when running or jumping. The anterior cruciate
ligament may tear if the knee is twisted abnormally or if
the leg receives a direct blow, often to the tibia (shinbone),
when the foot is firmly planted in the ground, perhaps
during a rugby tackle. An awkward fall in a sport such as Lateral
skiing can also cause injury to this ligament. condyle
Tear
SYMPTOMS AND DIAGNOSIS
If you have strained or ruptured your anterior cruciate
ligament, you will have severe pain and swelling in your ACL
knee. You may also hear an audible pop at the time of
the injury. Your knee may feel unstable and painful when
you put weight on it, and you may not be able to straighten
it. Your physician will usually make a diagnosis from a
physical examination but may recommend an MRI scan
or X-ray to confirm. Tibia
Ifyou think you may have If you are diagnosed with If you have not had surgery, After surgery, your
sprained or ruptured your a mild ACL sprain, your and your injury is healing as physician may:
ACL, you should: physician may: expected, your physician may: place your knee in a
follow a RICE procedure prescribe analgesic refer you to a physical brace for up to 4 weeks,
( p.170). medication. therapist for treatment to help and possibly advise the
MEDICAL
immobilize your knee advise you to use crutches restore painless movement and use of crutches.
( pp.17071).
seek medical attention.
until the swelling and pain
have gone.
regain muscle strength and
balance (see table below).
Once your brace has been
removed, your physician may:
If you are diagnosed with If your symptoms have refer you to a physical
a ruptured ACL, your failed to respond to non- therapist for a program of
physician may: surgical treatment, your rehabilitation (see table
recommend physical physician may: below).
therapy to help strengthen recommend surgery to
your muscles prior to surgery. reconstruct the ACL using
advise surgery to repair the tendon tissue from another
ACL using tendon tissue from part of your body.
another part of your body.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical carry out daily activities demonstrate full range of liftleg weights that are at
therapist may: without pain. motion in your knee. least 80% of your one-rep
suggest exercises to help Your physical therapist may: complete high box step-ups max without pain.
you achieve full knee
extension (within 710 days)
check you have 120 degrees
exion and full hyperextension
( p.203), as pain allows; aim
for 4 sets x 6 reps (with a
complete foot plyometrics,
such as jumps and hops
and knee exion of 90
degrees (within 2 weeks).
of your knee (within 34 weeks).
You may begin:
viper band).
Your physical therapist may:
( pp.25658), and speed drills
( pp.25253). You should not
PHYSICAL THERAPY
You may begin: trying to walk normally assess your single vertical feel any pain, nor be
static quadriceps exercises,
such as straight-leg raises
without a limp.
walking on a treadmill and adapted cross-over
and horizontal hops ( p.261) apprehensive about
performing the exercises.
( p.193); aim for 4 sets x 10
repsmake sure your knee is
(once gait is normal) until you
can jog without pain.
hops ( p.262) to establish
baseline scores.
perform single vertical
and horizontal hops
completely straight.
single-leg stands ( p.246),
functional warmup drills,
such as Frankenstein walks
You may begin:
low-level foot plyometrics
( p.261), adapted cross-over
hops ( p.262) and triple hops
holding left and right for 30
seconds each.
( pp.177), and exercises such
as hip hitchers ( p.186).
such as A-walks ( p.254). Also
try jumps, hops, and landing
( p.262); your injured leg
should have only 10%
using an electrical muscle
stimulator on your quadriceps
box step-ups ( p.203);
aim for 3 sets x 15 reps.
drills ( pp.25659), pain-free.
low-level running; start
less ability than your
uninjured leg.
and calf muscles to maintain
muscle bulk.
bicycling and work on a
cross-trainer and stepper;
by walking and jogging at
intervals ( p.252), and then
complete a T-test ( p.263):
aim for 11 seconds if you are
upper-limb weights build to 20 minutes at 80rpm, begin running at lower than male, and 15 seconds if you
(non-weight-bearing) level 6. normal effort. Build to running are female.
10 days after your operation. lower-limb strength training; in different directions by complete high-level running
core-stability exercises, such
as dead bugs ( p.225).
aim for 4 sets x 812 reps of
barbell squats ( p.192) start at
performing T-drills ( p.263).
isokinetic machine exercises
at distances relevant to your
sport, without pain.
50% of your one-rep max.
balance exercises, such as
( p.263) at variable speeds;
there should only be 10%
complete sport-specic
drills without difculty.
hand clock drills ( p.248). difference on each side. participate in full training.
126 SPORTS INJURIES
Ifyou think you may have If you are diagnosed with If you have not had surgery After surgery, your
injured your MCL or LCL, a mild-to-moderate sprain and your injury is healing as physician may:
you should: of the MCL or LCL, your expected, your physician may: refer you to a physical
stop activity. physician may: refer you to a physical therapist for a program of
follow a RICE procedure put your knee in a brace therapist for treatment to rehabilitation (see table
MEDICAL
( p.170).
immobilize your knee
to stabilize it while it heals.
prescribe analgesic
improve strength and
movement in your knee (see
below).
( pp.17071).
seek medical attention.
medication.
advise you to use crutches
table below).
If you have had surgery,
for 23 weeks. your physician may:
If you are diagnosed with monitor your progress to
a severe ligament rupture, ensure that your injury is
your physician may: healing as expected.
recommend surgery to recommend that you wear
repair the ligament. a brace for up to 6 weeks.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical walk normally without demonstrate a full range of liftleg weights that are at
therapist may: a limp and with no motion in your knee. least 80% of your one-rep
suggest exercises, such as further swelling. complete box step-ups and max, without pain.
heel slides ( p.179), to help
you bend (ex) your knee to
Your physical therapist may:
assess your injured knee to
step-downs ( p.203) as pain
allows; aim for 4 sets x 6 reps.
complete foot plyometrics,
such as jumps and hops
90 degrees and straighten
(extend) it fully.
check your exion is within
10% of your uninjured leg,
Your physical therapist may:
test the ability of your
( pp.25658), and speed drills
( pp.25253), without pain.
You may begin: and that extension for both ligamentyou should not feel perform single vertical
PHYSICAL THERAPY
static quadriceps exercises, legs is identical. any pain, nor be apprehensive and horizontal hops
such as straight-leg raises
( p.193); aim for 4 sets x 10
You may begin:
low box step-ups ( p.203);
about being tested.
assess your single vertical
( p.261), adapted cross-over
hops ( p.262), and triple hops
repsmake sure your knee is
completely straight.
aim for 3 sets x 15 reps.
interval bicycling at a low and adapted cross-over
and horizontal hops ( p.261)
( p.262); your injured leg
should have only 10%
using an electronic muscle
stimulator 46 hours daily on
medium intensity.
work on a cross-trainer and
hops ( p.262) to establish
baseline scores.
less ability than your
uninjured one.
your quadriceps, hamstrings,
and calf muscles to maintain
stepper; build to 20 minutes
at 80rpm, level 6.
You may begin:
low-level foot plyometrics
complete a T-test ( p.263);
aim for 11 seconds if you are
muscle bulk.
core stability exercises,
functional warm-up drills,
such as kneeling supermen
such as A-walks ( p.254). Also
try jumping, hopping, and
male, and 15 seconds if you
are female.
upper-limb weights
such as dead bugs ( p.225).
( pp.22829) and full-body
exercises, such as lawnmowers
landing drills ( pp.25659).
You should not feel any pain.
complete high-level running
at distances relevant to your
(non-weight-bearing)
10 days after your injury.
( p.190).
lower-limb strength training;
a low-level running
program; start by walking and
sport, without pain.
complete sport-specic
basic proprioception
exercises, such as single-leg
aim for 4 sets x 812 reps
barbell squats ( p.180),
jogging at intervals ( p.252),
and then begin running at
drills without difculty.
participate in full training
stands ( p.246), aiming for
30 seconds.
starting at 50% of your
one-rep max.
lower than normal effort.
Build up to gure-eights and
for at least 12 weeks.
a walk-jog programme
( p.252).
shuttle-run drills ( p.253).
128 SPORTS INJURIES
Ifyou think you may have If you are diagnosed If you have not had surgery, After surgery, your physician
a PCL injury, you should: with a PCL injury, your and your injury is healing as may:
immobilize your knee physician may: expected, your physician may: place your leg in a brace
( pp.17071).
follow a RICE procedure
advise you to use crutches
until the pain and swelling
refer you to a physical
therapist for treatment to
for 23 weeks.
Once the brace has been
MEDICAL
( p.170). have gone. restore knee movement removed, your physician may:
seek medical attention. place your knee in a brace and regain muscle strength, refer you to a physical
to stabilize it while it heals, particularly for the quadriceps, therapist for a program of
and until the pain and and balance (see table below). rehabilitation (see table
swelling have gone. If, after a period of time, below).
If you are diagnosed with your PCL does not respond
a ruptured ligament, your to treatment and the knee
physician may: remains unstable, your
recommend surgery to physician may:
repair the ligament. recommend surgery
to repair the ligament.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical walk normally with no limp demonstrate a full range of liftleg weights that are at
therapist may: and no increased swelling. motion in your knee. least 80% of your one-rep
advise exercises to help Your physical therapist may: complete high box step-ups max, without pain.
you bend your knee to 90
degrees and straighten it fully.
assess your knees range
of motion; your injured
( p.203), as pain allows; aim
for 4 sets x 6 reps.
complete foot plyometrics,
such as jumps and hops
You may begin:
static quadriceps exercises,
knee should have only 10%
less ability than your
Your physical therapist may:
assess your single vertical
( pp.25659), and speed drills
( pp.25253), without pain.
such as straight-leg raises uninjured knee. and horizontal hops perform single vertical
PHYSICAL THERAPY
( p.193); aim for 4 sets x 10
repsensure that your knee is
You may begin:
deep-water running; aim
( p.261) and adapted
cross-over hops ( p.262)
and horizontal hops
( p.261), adapted cross-over
completely straight. for up to 30 minutes, at high to establish baseline scores. hops ( p.262), and triple hops
single leg stands ( p.246),
holding left and right for 30
intensity intervals.
warmup drills, such as
test the ability of your PCL
ligamentyou should not
( p.262); your injured leg
should have only 10%
seconds each.
using an electrical muscle
kneeling supermen ( pp.228
29) and full-body exercises,
feel any pain, nor feel
apprehensive at being tested.
less ability than your
uninjured one.
stimulator on your quadriceps such as pike walks ( p.177). You may begin: complete a T-test ( p.263):
and calf muscles to maintain box step-ups ( p.203); low-level foot plyometrics aim for 11 seconds if you are
muscle bulk. aim for 3 x 15 reps. such as straight-leg scratches male and 15 if you are female.
upper-limb weights
(non-weight-bearing)
cycling and work on a cross-
trainer and stepper; build to
( p.256). Also try jumps, hops,
and landing drills ( pp.256
complete high-level running
at distances relevant to your
10 days after your injury. 20 minutes at 80rpm, level 6. 59), if pain-free. sport, without pain.
core-stability exercises, such lower-limb strength training, a low-level running complete sport-specic
as pulley chops ( p.23031) such as barbell squats programme: start by walking drills without difculty.
and pulley lifts ( pp.23233).
( p.180); start at 50% of your
one-rep max and aim for
and jogging at intervals
( p.252), and then begin
participate in full training.
MENISCUS TEAR
Meniscus tears are among the most common
MENSICUS TEAR
knee injuries. Their severity can range from
minor tears that cause only slight discomfort
and grind away until they become smooth,
to more severe cases that inhibit the joints
function and may require surgery.
CAUSES
Meniscus tears are commonly associated with sports such as
basketball and soccer, and are usually the result of forceful
Femur
twisting of the leg when the foot is planted on the ground
and the knee is flexed. Sometimes a direct blow to the knee
can cause damage. Menisci become less resilient with age,
so simple rotation of the knee may be enough to cause
damage in older people.
Ifyou think you may have If you have been diagnosed If, after 34 weeks of After surgery, your
a meniscus tear, you should: with a meniscus tear, your nonsurgical treatment, your physician may:
stop activity. physician may: injury is healing as expected, refer you to a physical
follow a RICE procedure advise you to rest your knee your physician may: therapist for a program of
( p.170).
seek medical attention.
completely for 34 weeks.
advise you to use crutches.
refer you to a physical
therapist for treatment to
rehabilitation (see table
below).
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical fully ex and extend your demonstrate a full range liftleg weights that are at
therapist may: knee with minimal swelling. of motion in your knee with least 80% of your one-rep
use an electrical muscle You may begin: no swelling. max, without pain.
stimulator on your quadriceps, trying to walk with no limp. complete low-level foot complete speed drills
hamstrings, and calf muscles
to maintain muscle bulk.
a walk-jog programme
( p.252).
plyometrics, such as jumping
and hopping ( pp.256259),
( pp.252253), without pain.
perform single vertical
You may begin:
practicing squats ( p.180) without pain. and horizontal hops
PHYSICAL THERAPY
straight-leg raises ( p.193); with an electrical muscle Your physical therapist may: ( p.261), adapted cross-over
aim for 4 sets x 10 reps, stimulator strapped to your assess your single vertical hops ( p.262), and triple hops
ensuring that your leg is
completely straight.
leg; aim to squat to 90 degrees.
box step-ups ( p.203);
and horizontal hops ( p.261)
and your adapted cross-over
( p.262); your injured side
should have only 10%
single-leg stands ( p.246),
standing on your left and
aim for 3 sets x 15 reps.
lower-limb strength training, scores.
hops ( p.262) for baseline less ability than your
uninjured side.
right legs for 30 seconds each.
deep-water pool running,
as long as you have no pain
or increase in swelling. Start
You may begin:
high box step-ups
complete a T-test ( p.263);
aim for 11 seconds if you are
once your wounds have
healed; aim for 2030
at 50% of your one-rep max
and aim for 4 sets x 812 reps
( p.203), as pain allows;
aim for 4 sets x 6 reps.
male, and 15 seconds if you
are female.
minutes, at high-intensity
intervals.
of barbell squats ( p.192) and
Romanian deadlifts ( p.196).
You may use a viper band.
low-level running; start at
complete high-level running
at distances relevant to your
stationary bicycling for interval bicycling at a low 50-60% effort, building to sport, without pain.
20 minutes at 85rpm, level 6. medium intensity. 60-70% effort. Try gure- complete sport-specic
core-stability exercises,
such as dead bugs ( p.225).
work on a cross-trainer and
stepper, as pain allows; build to at 60-70% effort.
eight running drills ( p.253) drills without difculty.
participate in full training.
upper-limb weights (non- 20 minutes at 80rpm, level 6.
weight-bearing) 10 days after
the operation.
132 SPORTS INJURIES
CAUSES
This condition is common in sports such as running,
bicycling, or rowing, which can overuse the iliotibial band.
It is caused by repetitive rubbing of this tendon over the
outside of the femur (thighbone) close to the knee, and
Gluteus
repeated bending of the knee. This causes friction, followed maximus
by inflammation and pain in the tendon; inflammation of
the bursa (a fluid-filled sac) beneath the tendon can also
occur. Iliotibial band syndrome may also result from athletes
overtraining, from muscle imbalance, for example when
running repeatedly on an uneven surface, incorrect running
technique, and changes to a training routine.
Ifyou think you may have Ifyou are diagnosed Ifyour symptoms have not In very rare circumstances,
ITB syndrome, you should: with ITB syndrome, your improved within a month, if all nonsurgical treatment
stop any activity that causes physician may: despite rest and short-term fails, your physician may:
or increases the pain. advise you to rest. treatment, your physician may: recommend surgery to
follow a RICE procedure prescribe analgesic give you an injection of lengthen your ITB in order
MEDICAL
Once your physician You should now be able to: You should now be able to: You should now be able to:
has referred you, your physical perform weight-bearing complete low-level running, liftleg weights that are at
therapist may: gluteal exercises, such as without pain. least 80% of your one-rep
suggest various treatments,
such as electrotherapy, to without pain.
step-up and holds ( p.250), perform lower-limb strength
training, with no pain and no
max, without pain.
do foot plyometrics,
reduce inammation. Your physical therapist may: increase in swelling; aim for such as jumps and hops
assess the intensity and
duration of your normal
assess the length of your
quadriceps, hamstrings,
4 sets x 812 reps of Bulgarian
dumbbell split squats ( p.194)
( pp.25658), and speed drills
( pp.25253), without pain.
training program and correct hip exors, and calf muscles and Romanian deadlifts complete high-level running
accordingly. to check that they are
( p.196); start at 50% at distances relevant to your
PHYSICAL THERAPY
perform a foot and ankle symmetrical. of your one-rep max. sport, without pain.
assessment to see if you need You may begin: perform running drills, complete sport-specic
insoles or orthotics to support
your medial arch, or if you
functional warm-up drills,
such as overhead lunges and sprints.
such as T-drills ( p.263) drills without difculty.
participate in full training.
need different footwear.
use soft-tissue massage
( p.181), full-body exercises,
such as Swiss ball jack-knives
on your ITB, quadriceps,
hamstrings, and gluteals, to
( p.190), and low-level foot
plyometrics, such as straight-
help relieve your symptoms.
You may begin:
leg circles-out ( p.255).
low-level running and
self-massage of your sporting activities, as
iliotibial band with a hard pain allows.
foam roller ( p.191). Aim for
6 reps x 30 secs on each leg
bicycling, and working on
the cross-trainer and stepper,
daily, even if it is painful. as pain allows; build toward
core-stability and gluteal 20 minutes at 80rpm, level 6.
exercises, such as side planks
( p.226), to maintain your
overall tness; stop if you
feel any pain.
134 SPORTS INJURIES
CAUSES
Any strong force, direct or indirect, applied to the tibia and
fibula can cause a fracture. In contact sports, this may be the
impact of a direct blow to the leg by another player; it can
also occur if a players foot is firmly planted on the ground
and the leg is twisted. In skiing, when the binding attached Fracture
to the ski does not release in a fall and enough force is applied,
both bones will snap just above the top of the boot. Fracture
Ifyou think you may have If you are diagnosed with If you need surgery, but your After you have
fractured your leg, you should: a simple fracture, with no leg is too swollen to operate, recovered from surgery,
immobilize your leg soft tissue affected, your your physician may: your physician may:
( p.171).
avoid putting any weight
physician may:
put your leg in a cast and
immobilize your leg, either
in a splint or a cast, and delay
refer you to a physical
therapist for a program
on your leg. advise you to use crutches surgery until your soft tissue of rehabilitation (see
MEDICAL
seek medical attention. for at least 2 months. has recovered. table below).
prescribe analgesic If you have had surgery,
medication. your physician may:
If you are diagnosed with a advise you to keep your leg
more complicated fracture, elevated while it is healing,
with some damage to the soft to avoid swelling. It may be
tissue, your physician may: placed in either a splint or
recommend emergency a cast for several weeks.
surgery to realign the
bone fragments.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate full range of complete low-level running, liftleg weights that are at
therapist may: motion in your hip, knee, without pain. least 80% of your one-rep
suggest various treatments foot, and ankle, without pain. You may begin: max, without pain.
to help alleviate your put full weight on your leg, moderate- to high-level foot complete foot plyometrics,
symptoms. without pain. plyometrics, such as straight- such as jumps and hops
You may begin:
putting weight on your leg
You may begin:
walking on a treadmill
leg circles-in and -out
( p.255);
( pp.25658), and speed drills
( pp.25253), without pain.
PHYSICAL THERAPY
and trying to walk normally until you are able to jog interval bicycling perform single vertical
without limping. without pain. at a high intensity. and horizontal hops
stationary bicycling; aim for
20 minutes at 85rpm, level 6.
You may begin:
lower-limb bodyweight
lower-limb strength training;
start at 50% of your one-rep
( p.261), adapted cross-over
hops ( p.262), and triple hops
deep-water running; aim
for up to 30 minutes at
exercises, such as single-leg
squats ( p.193). You should
max; aim for 4 sets x 812
reps of barbell squats ( p.180).
( p.262); your injured side
should have only 10%
high-intensity intervals. not feel any pain. stationary low-level skills, less ability than your
core-stability exercises, functional warm-up drills, such as ball handling. uninjured side.
such as dead bugs ( p.225). such as kneeling supermen
( pp.22829), full-body
low-level running. complete high-level
running at distances relevant
exercises such as lawnmowers to your sport, without pain.
( p.190), and low-level foot
plyometrics, such as walking
complete sport-specic
drills without difculty.
pop-ups ( p.254).
interval bicycling at a low
participate in full training.
medium intensity.
a walk-jog drill ( p.252).
136 SPORTS INJURIES
CALF INJURIES
The group of muscles that make up the calf
CALF INJURIES
provide the power for extending the foot and
raising the heel. Explosive contractions of these Femur
muscles can cause strains and, less commonly,
Back of the
a rupture of the muscle fibers. knee
CAUSES
Calf muscle strains are common in sports like athletics or
soccer, which involve repeated explosive activities such
as sprinting or jumping; or in sports in which athletes push
against resistance, for example in weight lifting and in rugby.
In both cases an abrupt, forceful contraction occurs, causing
strain to the tendons or muscles. Ruptures of the calf usually
occur to the gastrocnemius muscle, and are the result of a
massive contraction of that muscle, usually when jumping,
landing, or accelerating.
Ifyou think you may have If you are diagnosed with Ifyou have had surgery for Ifyour injury has not healed
injured your calf, you should: calf strain, your physician may: a ruptured calf muscle, your after 6 months of nonsurgical
follow a RICE procedure prescribe analgesic physician may: treatment, your physician
( p.170).
seek medical attention.
medication.
advise you to rest until
put your leg in a cast for
68 weeks.
may:
recommend surgery to
the pain has subsided. advise you to use crutches, repair the muscle.
MEDICAL
refer you to a physical but to put as much weight After surgery, your
therapist for treatment to on your leg as you can bear. physician may:
stretch and strengthen the After your cast has been put your leg in a cast for
muscle (see table below). removed, your physician may: 68 weeks.
If a ruptured calf muscle is refer you to a physical advise you to use crutches,
diagnosed, your physician therapist for a program of but to put as much weight
may: rehabilitation (see table on your leg as you can bear.
recommend surgery below). After your cast has been
to repair the muscle. removed, your physician may:
refer you to a physical
therapist for a program of
rehabilitation (see table below).
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical go up and down stairs with complete high-level demonstrate a full active
therapist may: no discomfort. sideways drills, such as range of motion in your toe.
suggest raising and lowering
your foot at the ankle joint to
You may begin:
gentle calf stretches ( p.243);
carioca sidesteps ( p.188).
participate in normal
lift leg weights that are at
least 80% of your one-rep max.
test your range of motion, as aim for 2 reps x 30 secs, training warm-ups. complete normal foot
pain allows ( p.179).
You may begin:
4 times daily.
single-leg calf raises ( p.204)
You may begin:
low-level running; start at
plyometrics, such as jumps
and hops ( pp.25659), and
PHYSICAL THERAPY
resistance exercises that test over the edge of a step; aim 5060% effort, building to speed drills ( pp.25253),
the foot in a downward for 5 sets x 810 reps. 6070% effort. Also try without pain.
direction (but without actually
moving the joint), as pain
functional warm-up drills
such as walking lunges
gure-eight running ( p.253).
single vertical and horizontal
complete high-level running
at distances relevant to your
allows.
deep-water pool jogging
( p.180), full-body exercises
such as lawnmowers ( p.190),
hops ( p.261) and adapted
cross-over hops ( p.262);
sport, without pain.
complete sport-specic
for up to 30 minutes, as and low-level foot plyometrics your injured leg should drills without difculty.
pain allows. such as A-walks ( p.254). have only 10% less ability participate in full training
gentle interval bicycling and box step-ups ( p.203); aim than your uninjured one. for at least 12 weeks,
working on a cross-trainer for 4 sets x 6 reps. bent-knee eccentric calf without pain.
and stepper, as pain allows;
build toward 20 minutes at
interval bicycling at a
moderatehigh intensity.
drops ( p.205); aim for
3 sets x 15 reps.
80rpm, level 6. lower-limb strength training; straight-knee eccentric calf
core stability exercises, such start at 50% of your one-rep
drops ( p.205); aim for 4 sets
as dead bugs ( p.225). max and aim for 4 sets x 812 x 8 reps.
calf raises ( p.204); start
on a at surface, gradually
reps of barbell squats ( p.192)
and Romanian deadlifts
working toward the edge
of a step.
( p.196).
138 SPORTS INJURIES
SHIN SPLINTS
Shin splints is a general term that is often used
SHIN SPLINTS
to describe exercise-induced pain felt in the
front of the lower leg.
CAUSES
Shin splints may have various causes but it is usually a result
Tibia
of exercise. Failure to warm up properly before running, or an
abrupt increase in training intensity, can lead to shin splints,
as can running on hard or inclined surfaces, poor technique, Area of pain
or foot abnormalities that place stress on the leg. It can also
be caused by compartment syndrome (see opposite).
Fibula
WHEN WILL I BE FULLY FIT? The medical name for this inammatory condition is
You should be fully fit within 36 months. In rare cases, you medial tibial stress syndrome. Pain is felt at the front
may require surgery, in which case your recovery time will of the leg, over the inner part of the tibia (shin bone).
be 3 months.
TREATMENT
INTERMEDIATE STAGE
SHORT TERM You should now be able to: stretch both calf muscles
Ifyou are diagnosed with shin splints, your physician may: equally. perform moderate-intensity bibicycling, without
MEDICAL
prescribe analgesic medication. refer you to a physical pain. You may begin: warm-ups, such as walking lunges
therapist for treatment (see table right).
( p.180). full-body exercises, such as push-ups ( pp.22829).
low-level foot plyometric exercises, such as A-walks ( p.254).
MEDIUM TERM
Ifyour condition fails to respond to physical therapy and ADVANCED STAGE
your pain is severe, your physician may: recommend You should now be able to: perform low-level running,
surgery to relieve pressure on your calf muscles. without pain. You may begin: lower-limb weights training;
aim for 4 sets x 812 reps at 50% of your one-rep max.
LONG TERM
Aftersurgery, your physician may: recommend shock RETURN TO SPORT
wave therapy. refer you to a physical therapist for a You should now be able to: lift lower leg weights at 80%
program of rehabilitation (see table right). of your one-rep max. participate in full training, pain-free.
LOWER LEG INJURIES 139
COMPARTMENT SYNDROME
The muscles in the limbs are contained within
COMPARTMENT SYNDROME
compartments, comprised of connective tissue
and bone. An increase in pressure within one of
these is known as compartment syndrome.
Inamed tibialis
CAUSES anterior muscle
Compartment syndrome can be caused by a one-off injury,
such as a bone fracture or tearing of the muscle, which might
occur during contact sports, but is more often the result of
long-term overuse as a result of running. Inamed extensor
digitorum longus
muscle
SYMPTOMS AND DIAGNOSIS
You will feel intense pain that persists both at rest and during
Inamed extensor
activity. You may have weakness, tingling, or reduced sensation hallucis longus
in the limb. Your physician will make a diagnosis through a muscle
physical examination, and perhaps with an MRI scan.
WHEN WILL I BE FULLY FIT? This condition most commonly affects the anterior
If it is caught early, recovery rates for this condition are good (front) compartment of the lower leg. Swelling within the
and you should be able to return to your sport in 46 weeks. enclosed area may compress blood vessels and nerves.
If you have had surgery, recovery may take 13 months.
SHORT TERM
If you are diagnosed with compartment syndrome, your INTERMEDIATE STAGE
physician may: prescribe analgesic medication. refer you You should now be able to: exercise a full range of
MEDICAL
for compartment pressure testing. recommend surgery to movement in your hip, knee, and ankle. perform low-
relieve pressure in the inamed compartment. moderate level bicycling, without pain.
LONG TERM
plyometric exercises, such as hurdle jumps ( pp.25758).
Calcaneus
The Achilles tendon is the largest and strongest stiffness in your calf and heel, and be unable to stand on
tendon in the body. It plays an important role tiptoe. In the case of a complete rupture, you may also hear
an audible snap, as the tendon tears, and be able to feel a
in most sports and is particularly vulnerable
gap in your leg at the point of rupture. Your physician will
to overloading. Unsurprisingly, therefore, the make a diagnosis through an examination of the affected
Achilles is the most commonly ruptured tendon. area, and with an X-ray, MRI, or ultrasound scan.
Ifyou think you may Ifyou are diagnosed with After surgery, your Your physician may:
have ruptured your Achilles a ruptured Achilles tendon, physician may: referyou to a physical
tendon, you should: your physician may: put your lower leg and therapist for a program of
follow a RICE procedure recommend surgery to foot in a cast or boot for rehabilitation (see table below).
MEDICAL
( p.170).
seek medical attention.
repair the damaged tendon.
advise you to limit the
68 weeks, with your foot
pointing downward.
bending of your foot toward give you crutches, but advise
your leg (dorsiexion). you to put as much weight
on your foot as you can bear.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical walk in your boot with no demonstrate a normal walk, complete bodyweight bent-
therapist may: limp, fully weight-bearing, but continue to wear a 13 in and straight-knee eccentric
massage your calf,
2 weeks after the operation.
at 68 weeks.
You may begin:
(1 cm) heel raise.
Your physical therapist may:
calf drops ( p.205); aim for
4 x 8 reps at 100% bodyweight
advise that you remain with single-leg stands for more assess your single vertical as your extra load.
your foot in the boot at all than 30 seconds in sneakers and horizontal hops lift leg weights that are at
times, apart from when
performing your exercises,
on a hard oor ( p.246).
trying to walk normally with
( p.261) and adapted
cross-over hops ( p.262)
least 80% of your one-rep
max, without pain.
until at least 8 weeks after a 13 in (1 cm) heel raise in your for baseline scores. perform single vertical
PHYSICAL THERAPY
the injury. shoes (8 weeks after operation). You may begin: and horizontal hops
advise you to increase the
range of motion in your ankle
testing your ankles range
of motion, as pain allows.
lower-limb weights, keeping
your foot touching the oor.
( p.261) and adapted
cross-over hops ( p.262);
gradually over the 8 weeks, light resistance exercises, straight-knee eccentric calf your injured side should
but not to stretch the tendon.
You may begin:
such as pilates reformer
exercises ( p.237).
drops ( p.205); aim for 3 x 15
reps at 50% bodyweight.
have only 10% less ability
than your uninjured side.
resistance exercises for your
calf that involve no joint
calf raises ( p.204); start at
50% of your one-rep max and
functional warm-up drills,
such as Frankenstein walks
complete a T-test ( p.263);
aim for 11 seconds if you are
movement, as pain allows.
exercising your knees and
aim for 4 sets x 812 reps.
deep-water running, once
( p.177), full-body exercises,
such as punch lunges ( p.182),
male, and 15 seconds if you
are female.
hips to maintain mobility. 90 degrees of ankle exibility and low-level foot plyometrics, complete foot plyometrics,
bicycling in your boot, 24
weeks after your operation.
has been achieved.
interval cycling at a low
such as A-walks ( p.254).
walking on a treadmill until
such as jumps and hops
( pp.25659), and speed drills
Build toward 20 minutes medium intensity. you can jog without pain; ( pp.25253), without pain.
at 80rpm, level 6. work on a cross-trainer building up to low-level complete high-level
core-stability exercises, and a stepper; build up to running. running without pain.
such as dead bugs ( p.225). 20 minutes at 80rpm, level 6. complete sport-specic
drills and full training.
142 SPORTS INJURIES
ACHILLES TENDINOPATHY
ACHILLES TENDINOPATHY
Calcaneus
Achilles tendinopathy is a degenerative occur only when you are active, and this could prevent
condition characterized by pain and swelling you from participating in your sport. Alternatively, you may
experience pain even at rest; you may also have stiffness
in and around the Achilles tendon at the back
in your Achilles tendon and lower leg, particularly when
of the lower leg. getting up in the morning.
with the Achilles tendon can be caused, and worsened, WHEN WILL I BE FULLY FIT?
by wearing inappropriate footwear and sudden changes A full recovery from Achilles tendinopathy takes several
in training patterns. The lack of an effective warm-up may weeks at best. With prompt, appropriate treatment, you
also be a contributing factor. are unlikely to require surgery or suffer long-term problems,
but even if your symptoms improve, you are at risk of
SYMPTOMS AND DIAGNOSIS developing another bout of tendinopathy in the future.
The main symptom of Achilles tendinopathy is pain, which
can range from mildly uncomfortable to intense. You may
also have swelling and thickening around your tendon.
The presentation of the condition, and the type of pain
you may experience varies. In some cases, the pain may
A N K L E , F O O T, A N D T O E I N J U R I E S 143
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
Ifyou think you may Ifyou are diagnosed with Ifyour condition has not Ifinvestigations, such as MRI
have Achilles tendinopathy, Achilles tendinopathy, your responded to treatment, or ultrasound scans, reveal
you should: physician may: your physician may: areas of tendinopathy in your
follow a RICE procedure advise you to rest for recommend an MRI or Achilles, your physician may:
MEDICAL
( p.170).
seek medical attention.
510 days.
recommend you wear a
ultrasound scan to further
investigate the injury.
recommend ultrasound-
guided injections.
boot or brace to limit recommend surgery to
movement of your ankle repair the damaged tissues.
(dorsiexion).
prescribe analgesics.
refer you to a physical
therapist for exercises to
strengthen the tendon (see
table below).
Once your physician has You should now feel: You should now be able to: You should now be able to:
referred you, your physical minimal tendon pain and participate in team liftleg weights that are at
therapist may: stiffness when getting out warm-ups without discomfort. least 80% of your one-rep
recommend that you refrain of bed in the morning. You may begin: max, without pain.
from running for at least 2 You may begin: bent- and straight-knee perform single vertical and
weeks after the onset of pain.
You may begin:
bent- and straight-knee
eccentric calf drops ( p.205);
eccentric calf drops ( p.205);
aim for 3 x 15 reps, 2 times
horizontal hops ( p.261)
and adapted cross-over
bent- and straight-knee
eccentric calf drops ( p.205);
aim for 3 x 15 reps, 2 times
a day, loading with 11 lb
a day, aiming for 100%
bodyweight as your extra load.
hops ( p.262); your injured
side should have only 10%
aim for 3 x 15 reps, 2 times increments as they become walking on a treadmill until less ability than your
PHYSICAL THERAPY
a day; these exercises are only pain-free. you can jog without pain; uninjured side.
effective if they produce pain functional warm-up drills then begin low-level running. complete foot plyometrics,
in the Achilles tendon. such as walking lunges regular lower-limb weights. such as jumps and hops
seated upper-limb weights,
( p.205), kinetic chain
( p.25659), and speed drills
such as bench presses ( p.210) exercises, such as lawnmowers ( p.25253), without pain.
and shoulder presses ( p.211).
core-stability exercises, such
( p.190) and low-level foot
plyometrics, such as A-walks
complete high-level running
without pain.
as dead bugs ( p.225).
( p.254).
lower-limb strength training;
complete sport-specic
drills and full training.
start at 50% of your one-rep
max and aim for 4 sets x 812
reps of barbell squats ( p.180).
interval cycling at a low
medium intensity.
work on a cross-trainer and
a stepper; build up to 20
minutes at 80rpm, level 6.
144 SPORTS INJURIES
ANKLE FRACTURE
The ankle is one of the most commonly
ANKLE FRACTURE
injured parts of the body. Its complexity makes
it vulnerable to fractures, which can involve
any number of its constituent parts.
CAUSES
Ankle fractures are not always the result of high-speed impacts
and they can even occur during walking. However, sports
linked with ankle fractures tend to involve running and
changing directionin tennis, for exampleor jumping and
landing from a height; all of these can lead to fracturing of
the ankle. High-impact sports, such as rugby and soccer, can
also lead to fractures, either through forceful twisting of the
ankle or an impact to the side of the ankle, during a tackle, for
example, when the foot is firmly planted on the ground.
Ifyou think you may If you are diagnosed with a If your ankle is healing as After surgery, your physician
have fractured your ankle, mild fracture, your physician expected after 6 weeks in a may:
you should: may: cast, your physician may: place your leg in either a
stop activity. put your ankle into a splint refer you to a physical cast or a walking boot for at
immobilize the joint until the swelling goes down, therapist for exercises to least 6 weeks. You may also be
MEDICAL
( pp.17071). then replace it with a cast. strengthen the joint (see table given crutches to use. (Putting
follow a RICE procedure advise you to use crutches. below). weight on the injured leg will
( p.170).
seek medical attention.
prescribe analgesic
medication.
If your fracture has failed
to heal after 6 weeks in a
depend on the severity of
your injury.)
If you are diagnosed with cast, your physician may: Once your cast or walking
a fracture in which the bone recommend surgery to boot has been removed, your
has moved, your physician x the broken bones in the physician may:
may: correct place. refer you to a physical
reposition your ankle therapist for a program of
before putting on the cast. rehabilitation (see table below).
suggest surgery.
Once your physician has You should now be able to: Your physical therapist may: You should now be able to:
referred you, your physical demonstrate full range of assess your single vertical liftleg weights that are 80%
therapist may: motion in your hip, knee, and horizontal hops of your one-rep max.
suggest various treatments,
such as electrotherapy, to
and foot, without pain.
put full weight on your
( p.261) and adapted
cross-over hops ( p.262)
complete foot plyometrics,
such as jumps and hops
help alleviate your symptoms,
assess your ankle exibility
injured leg, without pain.
Your physical therapist may:
for baseline scores.
You may begin:
( pp.256259), and
speed drills ( pp.252253),
with knee-to-wall stretches check your ankle exibility; lower-limb strength training; without pain.
( p.243). your injured side should start at 50% of your one-rep perform single vertical
PHYSICAL THERAPY
You may begin: ex only 10% less than your max and aim for 4 sets x 812 and horizontal hops
weight-bearing; aim to add
1520% of bodyweight every
uninjured side.
You may begin:
reps of barbell squats ( p.192).
stationary low-level skills,
( p.261) and adapted
cross-over hops ( p.262);
12 weeks as pain, swelling, walking on a treadmill until such as ball handling. your injured side should have
and range of movement allow. you can jog without pain low-level running, pain-free, only 10% less ability than
trying to walk normally
without limping.
( p.252).
lower-limb bodyweight
with no increase in swelling.
low-level foot plyometrics,
your uninjured side.
complete high-level running
stationary bicycling; aim for exercises, such as single-leg such as walking pop-ups at distances relevant to your
20 minutes at 80rpm, level 6.
deep-water running; aim
squats ( p.193).
functional warm-up drills,
( p.254). sport, without pain.
complete sport-specic
for up to 30 minutes at high- such as kneeling supermen drills without difculty.
intensity intervals.
core-stability exercises, such
( pp.228229), full-body
exercises, such as lawnmowers
participate in full training.
as dead bugs ( p.225).
( p.190), and low-level foot
plyometrics, such as
A-walks ( p.254).
interval bicycling at a low
medium intensity.
146 SPORTS INJURIES
ANKLE SPRAIN
ANKLE SPRAIN
Tears
Ankle
ligaments
Ankle sprains are among the most common SYMPTOMS AND DIAGNOSIS
of all sports-related injuries. The ankle joint You may have pain, stiffness, and swelling around your ankle,
and you may not be able to bear weight on it. There may be
is designed to adapt to uneven terrain, but a
bruising that moves down your foot toward your toes in the
sudden or forceful twisting motion can result days following the injury. Your physician will do a physical
in damage to the ankle ligaments. In severe examination to diagnose a sprain and may arrange for an
sprains, the ligaments may be torn and the ankle X-ray to check for any other ankle injuries, such as a fracture.
dislocated. In some cases, the bones around the
ankle may also be fractured ( pp.144145).
RISKS AND COMPLICATIONS
If the damage to your ligaments is severe, you may be at risk
of permanent ankle instability and it is likely that you will
CAUSES sprain your ankle again. If you repeatedly sprain your ankle
The most common type of sprain occurs when the ankle you may need surgery to tighten the ligaments around the
turns over so that the sole of the foot faces inward (an joint. If you do not undergo proper rehabilitation you may
inversion sprain), causing the ligaments on the outside suffer from chronic pain and permanent instability, and there
of the ankle to stretch beyond their limit. In rare cases the is a risk that you will develop osteoarthritis in your ankle.
foot is forced outward (an eversion sprain), damaging the
ligaments on the inside of the ankle. Ankle sprains are most WHEN WILL I BE FULLY FIT?
common in sports that involve side-to-side movement, such With rest and treatment, a mild or moderate sprain should
as basketball and tennis, or where there is a high risk of your heal in a few weeks. With a severe sprain, you will need a
foot being stepped on by another player, such as in soccer. supervised period of rehabilitation of up to 3 months. If you
Running on uneven ground can also lead to sprains and have to undergo surgery, it may take up to 6 months before
inadequate footwear increases the risk of such injuries. you can take up your sport again.
A N K L E , F O O T, A N D T O E I N J U R I E S 147
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
Ifyou think you may If you are diagnosed with a If you have not had surgery After surgery, your
have sprained your ankle, mild-to-moderate ankle and your injury is healing as physician may:
you should: sprain, your physician may: expected, your physician may: put your ankle in a brace
follow a RICE procedure prescribe analgesic refer you to a therapist for and give you crutches for
MEDICAL
( p.170).
seek medical attention.
medication.
advise you to use crutches
treatment to restore range of
motion, strength, and
34 weeks.
refer you to a physical
and continue with RICE until exibility (see table below). therapist for a program of
the injury has healed. If your injury has failed to rehabilitation (see table below).
If you are diagnosed with respond to 2 weeks of
severe ligament damage, nonsurgical treatment you may
your physician may: have torn the ligament, in
recommend surgery to which case your physician may:
repair the ligament. recommend surgery to
repair the ligament.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate minimal demonstrate no swelling in liftleg weights that are at
therapist may: swelling, with a difference of your ankle. least 80% of your one-rep max.
suggest various treatments, 1 2 participate in warm-ups perform single vertical
2- 3 in (11.5 cm) between
such as electrotherapy, to
reduce inammation.
each ankle.
Your physical therapist may:
with no discomfort (strapping
your ankle as required).
and horizontal hops ( p.261)
and adapted cross-over hops
perform manual therapy
and soft-tissue release.
test your ankle exibility with
a knee-to-wall measurement
Your physical therapist may:
retest your ankle exibility
( p.262); your injured leg
should have only 10% less
advise you to try ankle
movements ( p.179) within
( p.243).
You may begin:
to check that your ankles are
within 10% of each others
ability than your uninjured one.
complete foot plyometrics,
PHYSICAL THERAPY
a range that you can tolerate, weight-bearing and trying to range of motion. such as jumping and hopping
without increasing pain or
swelling.
walk normally without a limp.
single-leg stands ( p.246),
assess your single vertical
and horizontal hops ( p.261)
( pp.25659), and speed drills
( pp.25253), without pain.
You may begin: as pain allows; aim to hold to establish a baseline score. complete high-level running
pool walking as a form of each leg for 30 seconds. You may begin: at distances relevant to your
resistance therapy; build up single-leg calf raises on a low-level running sport, without pain.
to deep-water pool running
when you are able.
both legs ( p.204); aim for
2 repetitions on each leg.
program; start at 5060%
effort, building to 6070%
complete sport-specic
drills without difculty.
core-stability exercises, walking on a treadmill effort as you feel able. Try participate in full training
such as dead bugs ( p.225).
single-leg stands ( p.246);
until you can jog without pain
( p.252).
gure-eight drills ( p.253) at
5060% effort, and shuttle-run
for at least 12 weeks.
( pp.22829), full-body
exercises, such as step-up and
holds ( p.250), and low-level
foot plyometrics, such as
A-walks ( p.254).
working on a cross-trainer,
stepper, or doing interval
bicycling; build toward 20
minutes at 80rpm, level 6.
148 SPORTS INJURIES
Fracture
Calcaneus
During walking, running, and jumping, the examination and from looking at your medical history. You
calcaneus (heel bone) supports all the weight may also be given an X-ray to determine the severity, extent,
and exact position of the fracture.
of the body. Of all the bones in the back of the
foot, the heel is the most commonly fractured. RISKS AND COMPLICATIONS
Leaving a fractured calcaneus untreated for too long can lead
CAUSES to severe swelling, which will delay healing. Swelling can also
Heel fractures are often connected with sports such as delay healing after surgery. In some severe cases, in which
the high jump or the long jump, in which there is a risk of the bone is fragmented, there may be complications such
a hard fallperhaps from a heightdirectly onto the heels. as malunion (when the bony fragments do not heal in the
Fractures of the heel can also be the result of sustained proper position). Very severe fractures can lead to ongoing
repetitive stress to the back of the foot, of the type found in problems such as chronic foot pain, especially when walking,
long-distance running, for example. running, or standing for long periods of time. People who
have had a heel fracture are also susceptible to osteoarthritis.
SYMPTOMS AND DIAGNOSIS
You may experience severe pain in your heel, as well as WHEN WILL I BE FULLY FIT?
swelling and tenderness, and squeezing your heel will If the fractured bone has not been knocked out of position
be painful. There may also be bruising. You may find that by the impact that caused the fracture, it should heal in
you develop a limp and find it difficult to put your weight around 12 weeks, but it may be another 812 weeks before
on your injured foot. In severe cases, you may be completely you can return to sports. If you have had surgery to repair
unable to walk. In very serious fractures, the broken bone the fracture, it may take 69 months or longer before you
may pierce the skin overlying your heel and be exposed. are fully fit and, in the worst cases, some patients are never
Your physician will make a diagnosis through physical able to return to sports.
A N K L E , F O O T, A N D T O E I N J U R I E S 149
TREATMENT
SEEK IMMEDIATE MEDICAL ATTENTION
Ifyou think you may If you are diagnosed If you have not had surgery, After surgery, your
have fractured your heel with a mild to moderate and your injury is healing as physician may:
bone, you should: fracture, your physician may: expected, your physician may: put your foot in a cast for
stop activity. prescribe analgesic refer you to a physical at least six weeks.
follow a RICE procedure medication. therapist for treatment to help advise you to avoid putting
MEDICAL
( p.170). immobilize your foot in restore full range of motion full weight on your foot for
seek medical attention. a cast and give you crutches and strength in your ankle and 23 weeks after the operation.
for 6 weeks. foot (see table below). refer you to a physical
If you are diagnosed with If you have not had surgery therapist for a program
a severe fracture, in which and your injury has failed to of rehabilitation (see
the bone has broken into heal as expected, your table below).
fragments, your physician physician may:
may: recommend surgery to
recommend surgery to repair the bone.
repair the bone.
Once your physician You should now be able to: You should now be able to: You should now be able to:
has referred you, your physical demonstrate a full range of complete moderate-high liftleg weights that are at
therapist may: motion in your hip and knee. intensity interval bicycling. least 80% of your one-rep
suggest various treatments, bear your full weight, Your physical therapist may: max, without pain.
such as electrotherapy, to without pain. assess your single vertical complete foot plyometrics,
reduce local inammation.
help you reintroduce
You may begin:
lower-limb bodyweight
and horizontal hops ( p.261)
and your adapted cross-over
such as jumps and hops
( pp.25659), and speed drills
weight-bearing, possibly
while wearing an aircast
exercises, such as squats
( p.180) and calf raises scores.
hops ( p.262) for baseline ( pp.25253), without pain.
perform single vertical
PHYSICAL THERAPY
boot, depending on your ( p.204). You may begin: and horizontal hops ( p.261)
physicians instructions. functional warm-up drills lower-limb strength training, and adapted cross-over hops
assess the intensity and
duration of your training,
such as Frankenstein walks
( p.177), full-body exercises
starting at 50% of your
one-rep max, without pain
( p.262); your injured side
should have only 10% less
and correct these accordingly.
perform a full biomechanical
such as lawnmowers ( p.190),
and low-level foot plyometrics
and with no increase in
swelling; aim for 4 sets x
ability than your uninjured side.
complete high-level running
foot and ankle assessment to
see if insoles or orthotics to
such as A-walks ( p.254).
bicycling and work on a
8-12 reps of barbell squats
( p.180) and Romanian
at distances relevant to
your sport, without pain.
support your medial arch, or
heel pads, would help you.
cross-trainer and stepper;
build toward 20 minutes
deadlifts ( p.196).
low-level running and
complete sport-specic
drills without difculty.
use manual therapy and at 80rpm, level 6. sporting activities, as participate in full training
soft-tissue therapy to help core stability exercises, pain allows. for at least 23 weeks,
relieve your symptoms.
advise stretching your
such as dead bugs ( p.225).
pilates reformer exercises
without pain.
RETROCALCANEAL BURSITIS
RETROCALCANEAL BURSITIS
Calcaneus
Retrocalcaneal bursitis is inflammation of the when you stand on tiptoes. A common symptom of
retrocalcaneal bursa (a slippery, fluid-filled sac) Haglunds syndrome, which is associated with a prominent
bony spur at the retrocalcaneal region, is pain at the back of
that cushions the Achilles tendon as it passes over
your heel. The pain worsens if you stand or walk for prolonged
the calcaneus (heel bone). In a related condition, periods. Your physician will make a diagnosis based on your
known as Haglunds syndrome, retrocalcaneal description of your symptoms and a physical examination.
bursitis occurs together with inflammation of
the Achilles tendon ( pp.142). RISKS AND COMPLICATIONS
If you leave either condition untreated, the bursa may
rupture, leaving your Achilles tendon vulnerable to further
CAUSES
Both retrocalcaneal bursitis and Haglunds syndrome are
friction, and possible rupture ( p.140). In Haglunds
syndrome, a bony spur often develops on the heel,
usually linked to sports that involve walking, running, or exacerbating the pain and inflammation.
jumping, where repetitive and excessive stress on the bursa
that cushions the Achilles tendon leads to inflammation. WHEN WILL I BE FULLY FIT?
Other contributing factors include wearing shoes that are If nonsurgical treatment is successful, retrocalcaneal
too tight or that do not cushion the foot sufficiently, and bursitis should improve after around 3 months, but it may
an incorrect gait when walking or running. take up to 6 months to regain full fitness. If you develop
Haglunds syndrome and conservative treatment is not
SYMPTOMS AND DIAGNOSIS successful, you may need surgery. If this is necessary, it
Both conditions will cause pain when running, walking, or may take you up to a year to recover fully.
jumping. You will feel tenderness in your heel, and there may
be redness and swelling in the area. The pain may intensify
A N K L E , F O O T, A N D T O E I N J U R I E S 151
TREATMENT
If you think you may have Ifyou are diagnosed with If your retrocalcaneal bursitis After surgery for either
retrocalcaneal bursitis or retrocalcaneal bursitis or fails to respond to nonsurgical condition, your physician
Haglunds syndrome, Haglunds syndrome, your treatment, your physician may:
you should: physician may: may: refer you to a physical
stop activity. prescribe analgesic recommend surgery to drain therapist for a program of
follow a RICE procedure medication. uid from the inamed bursa, rehabilitation (see table
( p.170). recommend special shoe or to remove the bursa. below).
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate a full range perform low-level running demonstrate a full range of
therapist may: of motion in your hip, knee, and running drills, motion in your ankle.
suggest various treatments, and ankle, without pain. without pain. lift leg weights that are at
such as electrotherapy and You may begin: You may begin: least 80% of your one-rep max.
possibly a night splint, to single-calf raises over a lower-limb strength training; perform single vertical
reduce local inammation.
advise you to gently move
step on both legs ( p.204);
aim for 4 sets x 15 reps; you
start at 50% of your one-rep
max and aim for 4 sets x 812
and horizontal hops
( p.261) and adapted
PHYSICAL THERAPY
overhead lunges ( p.181), and as pain allows.
such as push presses ( p.238), such as jumps and hops
( pp.25659), and speed drills
low-level foot plyometrics, ( pp.25253), without pain.
such as A-walks ( p.254).
low-level skills specic
complete high-level running
at distances relevant to your
to your sport, such as ball sport, without pain.
handling; you should not complete sport-specic
feel any pain. drills without difculty.
participate in full training.
152 SPORTS INJURIES
to a physical therapist for treatment (see table right). If your You should now be able to: bear your full weight
tendon is ruptured, your physician may: recommend surgery. with minimal discomfort. You may begin: lower-limb
MEDIUM TERM
bodyweight exercises, such as single-leg squats ( p.193).
WHEN WILL I BE FULLY FIT? The sinus tarsi is a tunnel bounded by the talus (an ankle
If you respond well to nonsurgical treatment you should bone) and the calcaneus (heel bone). It contains the cervical
be fit in around 46 weeks. If you need to have surgery, ligament and the roots of the inferior extensor retinaculum.
full recovery will take up to 3 months.
stop activity. follow a RICE procedure ( p.170).
seek medical attention.
therapist may: begin to mobilize your joint. take your
foot through movements to test its range of motion (passive).
PHYSICAL THERAPY
medication. put your ankle in a brace for 1 month. You may begin: calf raises ( p.204). upper-limb weights
MEDIUM TERM
that involve your legs, such as push presses ( p.238).
Ifyour symptoms persist, your physician may: refer you to ADVANCED STAGE
a physical therapist for treatment to strengthen your ankle (see You should now be able to: perform low-level running,
table right). prescribe a course of corticosteroids. without pain or instability. You may begin: barbell squats
LONG TERM
( p.192) at 50% of your one-rep max; aim for 4 sets x 812 reps.
CAUSES Tear
Extensor
Anyone who plays a sport involving jumping or running may digitorum Extensor
damage their foot tendons through overuse (hill running is brevis tendon hallucis
longus tendon
particularly hard on the extensor tendons). Trainers that fit
badly or are too tightly laced can also put excessive pressure
Inferior
on the foot. All of these factors can lead to inflammation of extensor
the tendons, a condition called tendinopathy. retinaculum
Ifyou think you may have If you are diagnosed Ifyour tendinopathy fails After you have had surgery,
injured a tendon in your foot, with tendinopathy, your to respond to physical therapy, and when your cast has been
you should: physician may: your physician may: removed, your physician may:
stop activity. prescribe analgesic give you an injection of refer you to a physical
follow a RICE procedure medication. corticosteroids to reduce therapist for a program of
( p.170). refer you to a physical inammation. rehabilitation (see table
MEDICAL
seek medical attention. therapist for treatment to After surgery on a ruptured below).
strengthen and stretch your tendon, your physician may:
calf muscles (see table below). put your foot in a splint
If you are diagnosed with for around 4 weeks.
a ruptured tendon, your advise you to use crutches
physician may: while your foot is in a splint.
recommend surgery to
repair the tendon.
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical demonstrate full range of complete low-level running, demonstrate full active
therapist may: motion in your hip, knee, without pain and with full range of motion.
suggest various treatments, foot, and ankle, without pain. range of motion in your lift lower-limb weights that
such as electrotherapy, to experience no morning foot and ankle. are at least 80% of your
reduce local inammation. pain or stiffness in your You may now begin: one-rep max, without pain.
assess the intensity and foot tendons. lower-limb strength training; complete foot plyometrics,
duration of your normal Your physical therapist may: aim for 4 sets x 812 reps of such as jumps and hops
PHYSICAL THERAPY
WHEN WILL I BE FULLY FIT? The metatarsophalangeal joint of the big toe is especially
Depending on the injury, a return to full fitness may take vulnerable to injury. Jamming the toe or subjecting it to
a few weeks to several months. If you need surgery to excessive stress can cause ligament tears.
repair a rupture, full recovery can take up to 6 months.
toe, your physician may: tape your toe. For a rupture your
physician may: recommend surgery to repair the ligament.
may begin: calf raises ( p.204); aim for 2 reps on each side.
ADVANCED STAGE
MEDIUM TERM You should now be able to: perform low-level jogging,
For mild sprains, once a splint or cast has been removed, without pain. You may begin: lower-limb strength
and for sand or turf toe, your physician may: refer you to a
physical therapist for treatment (see table right).
training, such as Romanian deadlifts ( p.196) and 45-degree
leg presses ( p.195), starting at 50% of your one-rep max.
MORTONS NEUROMA
Mortons neuroma is a condition affecting
MORTONS NEUROMA
one of the plantar nerves that run between
the metatarsal bones in the foot. Metatarsal
bone
CAUSES
Sports associated with repetitive stress on the ball of the
foot, such as running and jumping, may put pressure on
the metatarsals and cause one of the plantar digital nerves
to become pinched and to thicken.
Compressed
SYMPTOMS AND DIAGNOSIS nerve
You may experience pain, burning, or decreased sensation
between the toes, and numbness or cramping in the foot. Branch of the
plantar nerve
Standing in shoes may cause pain, which is relieved by
removing your shoes. Your physician will diagnose the
condition through physical examination and an MRI scan.
WHEN WILL I BE FULLY FIT? Branches of the plantar nerve run between the metatarsal
If you respond well to nonsurgical treatment you should bones of all the toes. Mortons neuroma most commonly
be able to return to sport in around 3 weeks. If you need affects the nerve between the third and fourth toes.
surgery it normally takes around 6 weeks to resume sport.
medical attention.
stop activity. follow a RICE procedure ( p.170). seek therapist may: mobilize your joint. massage the
thickened tissue. test your range of motion (passive).
You may begin to: weight-bear.
PHYSICAL THERAPY
SHORT TERM
Ifyou are diagnosed with Mortons neuroma, your physician INTERMEDIATE STAGE
may: recommend rest, with a gradual return to activity. You should now be able to: demonstrate full range of
MEDICAL
advise you on suitable footwear. give you a corticosteroid motion in your hip, knee, foot, and ankle without assistance
injection. prescribe analgesic medication.
(active). You may begin: single-calf raises ( p.204) over
a step; aim for 4 sets x 12 reps with no pain.
MEDIUM TERM
Ifyour injury fails to respond to nonsurgical treatment, your ADVANCED STAGE
physician may: recommend surgery to relieve pressure You should now be able to: perform low-level jogging,
on the nerve or to remove it.
without pain. You may begin: barbell squats ( p.192) at
50% of your one-rep max; aim for 4 sets x 812 reps.
LONG TERM
Aftersurgery, your physician may: refer you to a physical RETURN TO SPORT
therapist for a program of rehabilitation (see table right). You should now be able to: demonstrate full active range
of motion. complete sport-specic drills and train normally.
158 SPORTS INJURIES
METATARSAL FRACTURE
Fracture of the metatarsal bones is the most
METATARSAL FRACTURE
common type of foot injury in sport, and may
be caused by sudden trauma or overuse.
Metatarsal
CAUSES bones
Metatarsal fractures often occur during contact sports such
as rugby or soccer, usually from a blow to the foot. Stress
fractures are associated with running and jumping sports such
as athletics, as a result of repetitive trauma.
Phalanx
SYMPTOMS AND DIAGNOSIS
There may be pain, numbness, swelling, discoloration,
and deformity of your foot. You may not be able to bear
weight on it. Your physician will diagnose a fracture through
physical examination, X-ray, and possibly a CT scan. Fracture
SHORT TERM
If
you have an uncomplicated fracture, your physician may: INTERMEDIATE STAGE
put a cast on your foot. For a displaced fracture your You should now be: almost free of pain when your
MEDICAL
physician may: recommend surgery to repair the bone. metatarsal joint is touched. You may begin: interval
cyclingaim for 20 minutes at 80rpm, level 6. barbell squats
MEDIUM TERM
For an uncomplicated fracture, if your injury is healing as
( p.192); aim for 4 sets x 812 reps at 50% of your one-rep max.
expected, your physician may: refer you to a physical therapist ADVANCED STAGE
for treatment to stretch and strengthen the muscles (see table You should now be able to: perform moderate-level
right). If the injury fails to respond to nonsurgical treatment, interval cycling, pain-free. You may begin: foot plyometrics,
your physician may: recommend surgery to repair the bone.
such as walking pop-ups ( p.254). low-level running.
TOE FRACTURE
There are 14 toe bones (phalanges, singular
TOE FRACTURE
phalanx) in the foot, which can easily be
injured by kicking or stubbing the toe.
Distal
phalanx
CAUSES
Fractures often occur during sports such as rugby or soccer: Middle
through direct force from a fall, a blow or kick to the foot, phalanx
or the force of kicking something too hard; or by indirect
force, such as twisting your foot and putting strain on the toes.
Proximal
phalanx
SYMPTOMS AND DIAGNOSIS
Common symptoms of a toe fracture are pain, swelling,
Fracture
inability to bear weight on your foot, toe deformity, and
discomfort wearing shoes. Your physician will diagnose
a fracture through physical examination and an X-ray.
SHORT TERM
If your toe is not displaced, your physician may: tape it to INTERMEDIATE STAGE
the adjacent toe for 1 month. If you have a displaced or You should now be able to: demonstrate a full range
MEDICAL
joint fracture your physician may: recommend surgery. of motion in your hip, knee, foot, and ankle. You may
MEDIUM TERM
begin: warm-ups, such as walking lunges ( p.180).
sport-specic skills, such as ball handling.
Ifyour taped toe is healing as expected, your physician may:
refer you to a physical therapist for treatment to restore ADVANCED STAGE
range of motion (see table right). If your injury fails to You should now be able to: perform low-level jogging,
respond to taping, your physician may: recommend surgery.
pain-free. You may begin: barbell squats ( p.192); aim
for 4 sets x 812 reps at 50% of your one-rep max.
LONG TERM
After surgery, your physician may: tape your toe. refer RETURN TO SPORT
you to a physical therapist for a programme of rehabilitation You should now be able to: lift leg weights that are 80%
(see table right). of your one-rep max. complete sport-specic drills, pain-free.
160 SPORTS INJURIES
PLANTAR FASCIITIS
PLANTAR FASCIITIS
Calcaneus
Heel spur
Area of
Inammation
Plantar fascia
The plantar fascia is a thick band of tissue that SYMPTOMS AND DIAGNOSIS
stretches from the heel to the base of the toes, Plantar fasciitis causes pain on the underside of your heel
this is usually most intense first thing in the morning,
supporting the arch of the foot. Plantar fasciitis
although it can worsen through the day. Pain may stop
(also known as painful heel syndrome) is a chronic during exercise but will return afterward; you may also feel
condition in which the plantar fascia becomes pain after a prolonged period of rest. Heel spurs also cause
inflamed. Often, when an X-ray is taken of the pain in your heel, and there may sometimes be a grinding or
plantar fascia, a calcium depositknown as a clicking sensation at the point at which the tendon crosses
your heel. Your physician will diagnose both conditions
heel spuris found over the calcaneus (heelbone). through physical examination, and may use an X-ray to
confirm the diagnosis.
CAUSES
Plantar fasciitis occurs in sports with a lot of running and RISKS AND COMPLICATIONS
jumping, and those that are played on hard surfaces, such as Untreated plantar fasciitis will usually worsen, making
basketball. These sports involve repeated stress to the underside walking painful. You may also experience knee, hip, and
of the foot, causing the toe joints to bend and putting pressure lower-back problems. An untreated heel spur may make
on the heel end of the plantar fascia, leading to inflammation. your surrounding tendons inflamed, encouraging calcium
Shoes that do not cushion the foot sufficiently, or support the deposits and worsening your heel spur.
arch, are also a factor, as is being overweight. Heel spurs occur
when the heel bone is irritated by the tendon that attaches the WHEN WILL I BE FULLY FIT?
plantar fascia to the heel bone, causing the bone to deposit Without surgery, plantar fasciitis should heal within a few
calcium in the area of the irritation. They sometimes occur months; if you have had surgery, you should wait 36 months
with plantar fasciitis, but not always. before returning to sport.
A N K L E , F O O T, A N D T O E I N J U R I E S 161
TREATMENT
Ifyou think you may have Ifplantar fasciitis is If your plantar fasciitis fails If your plantar fasciitis
plantar fasciitis, you should: diagnosed, your physician to respond to early treatment, symptoms persist for 612
stop activity. may: your physician may: months, your physician may:
rest until the pain subsides. prescribe analgesic give you an injection recommend surgery to
apply ice to reduce swelling, medication. of corticosteroid to help relieve tension and
then heat to promote blood recommend an orthotic alleviate your symptoms. inammation from the
MEDICAL
Once your physician has You should now be able to: You should now be able to: You should now be able to:
referred you, your physical stretch your injured calf perform lower-limb strength liftleg weights that are at
therapist may: to the same extent as your training without pain and with least 80% of your one-rep max.
suggest various treatments, uninjured one. no increase in swelling; start complete foot plyometrics,
such as electrotherapy, to feel no morning pain or at 50% of your one-rep max such as jumps and hops
reduce local inammation.
use soft-tissue massage
stiffness in your plantar fascia.
You may begin:
and aim for 4 sets x 812 reps
of barbell squats ( p.192) and
( pp.25659), and speed drills
( pp.25253), without pain.
to relieve your symptoms. single-leg calf raises Romanian deadlifts ( p.196). perform high-intensity
suggest using a night splint
( p.204) over the edge running, at distances relevant
PHYSICAL THERAPY
to stretch your plantar fascia. of a step; aim for 5 sets x to your sport, without pain.
perform a full biomechanical 810 reps. You should complete sport-specic
assessment of your foot and not feel any pain. drills without difculty.
ankle to see if wearing insoles functional warm-up drills participate in full training.
or orthotics to support the such as walking kick-outs
medial arch will speed
up recovery.
( p.185), full-body exercises
such as walking lunges
suggest you perform
self-massage with a golf ball
( p.180), and low-level foot
plyometrics such as walking
( p.245) under the arch of
your foot.
pop-ups ( p.254). Stop if you
have any pain or swelling.
You may begin:
deep-water pool running
to maintain tness.
TREATMENT &
REHABILITATION
From the point of injury to your return to play, appropriate treatment
and therapy are key to your recovery. This chapter provides essential
information on immediate treatment of various injuries, and guides you
step-by-step through a wide range of exercises that may be recommended
as part of your rehabilitation program. Make sure you consult your doctor
and physical therapist before beginning any exercise program, and follow
the general guidelines set out in the introduction of this book.
164 T R E AT M E N T A N D R E H A B I L I TAT I O N
MINOR INJURIES
Any injury that breaks the skin carries an BLISTERS AND BRUISING
infection risk. Infection can come from the A blister is a fluid-filled bubble under the skin caused by
air, dirt,or clothing embedded in the wound. repeated rubbing or friction. A bruise is bleeding into the
Keeping injuries clean is an important part skin and surrounding tissue from a blow that does not
break the skin. Both frequently affect athletes.
of sports-related first aid.
HOW TO TREAT BLISTERS
MINOR CUTS OR ABRASIONS The ideal treatment is to rest and wait until it has healed, but
Any break in the skin must be cleaned and protected from this may not be possible if you are in mid-game. Cover with
infection. Rinse it with clean cold water and pat it dry. Cover a gel blister adhesive bandage if you have one. Never pierce
the injury with a dressing pad larger than the wound. For small or burst a blister; this increases the risk of infection.
wounds, use an adhesive bandage; for larger ones, use a sterile
pad and a bandage, or a combined sterile dressing.
JOGGERS NIPPLE
1 Wash the area with clean
water and rinse. Pat the
area and surrounding skin dry
Long-distance runners can suffer from joggers nipple, a gently and thoroughly with a
result of clothing rubbing against the nipples over time. sterile gauze pad. If it is not
Men can prevent this by wearing a well-fitting sports vest. possible to wash the area,
A properly fitting sports bra protects female runners. To keep it as clean as possible.
treat joggers nipple, clean the nipple with warm water and
air dry. Lubricate with moisturizer or antiseptic ointment. Keep your
foot at
A small adhesive bandage on each nipple acts as a barrier.
NOSE BLEEDS
2 Cover the blister with an
adhesive dressing; make
sure the pad of the adhesive
A severe blow to the nose may cause bleeding, swelling, bandage is larger than the
and bruising around the nose and eyes (a fractured bone blister. A gel blister adhesive
will require hospital treatment). A cut to the nose or septum bandage has a cushioned
(the partition dividing the nostrils) will also cause nasal pad that provides extra
bleeding. Before treating a nose bleed, ensure that there protection and comfort.
are no other head injuries that need urgent medical
attention. Severe bleeding may require a hospital visit. HOW TO TREAT BRUISING
To reduce the swelling and pain of a bruise, raise and support
SCALP WOUNDS
A scalp wound can bleed profusely, making it appear worse
than it actually is. However, it may mask a more serious head
1 Dont try to remove the object,
which may be plugging bleeding.
Control bleeding by pressing firmly
injury. If the victim becomes drowsy, has a headache, or on either side of the wound.
double vision (this can develop hours later), seek emergency Push the edges of the cut together
medical help. A large scalp wound may require stitches. but take care not to press directly
on the object.
Use a pad
Raise the wound above the level
thats larger
than the wound of the victims heart. Keep the injured body
part raised to slow
Secure the pad blood ow to the area
with a roller
bandage
2 Place a piece of gauze lightly
over the object to protect it, then
build up padding on either side (rolled
bandages are ideal). Bandage over the
pads and the object in the wound.
Check the circulation beyond the
EYE INJURIES
The eye can be seriously injured by a blow from a racquet, If you can see an object on the surface of the eye, try lifting it
hockey stick, or hard ball, risking a ruptured eyeball, facial off with the corner of a handkerchief, or washing it out with
fractures, or even loss of vision. Always wear the eye sterile water, rinsing away from the good eye. Dont remove
protection recommended as appropriate for your sport. anything that is sticking to the eye, or embedded in it.
2 Secure the
dressing with a
bandage. If blood
3 While waiting for help,
every 10 minutes,
check that the bandage is
soaks through, apply not too tight. Gently press
a second dressing a fingernail beyond the
on top of the first. dressing. If the skin color
does not return quickly,
rebandage more loosely.
TREATING SHOCK
Shock is a life-threatening condition that occurs if the circulatory clammy skin. As the condition progresses, his breathing will
system fails. In sports, the most common cause of shock is severe become rapid and shallow, his pulse weaker, and his skin a pale
bleeding. Initially, the victim will have a rapid pulse and pale grayblue. Untreated, shock will lead to unconsciousness.
DEALING WITH SHOCK
Do not give the victim anything to eat or drink because an anesthetic Raise the victims legs Loosen tight
may be needed; moisten his lips with water if hes thirsty. Call for help; as high as possible. Use clothing around
the victim must be transported in the treatment position. sport bags, or anything his neck, chest,
else you have at hand and waist
Help the victim lie down; insulate him from the ground with blankets.
Raise and support his legs as high as you can above heart level.
Treat the cause of shock, for example bleeding (see above). Suspect
shock, too, if you notice any symptoms, yet cant see any obvious
injuryit could be caused by internal bleeding.
Loosen tight clothing, for example at the neck, chest, and waist. Keep
his head low: this may prevent him from losing consciousness. Keep the
victim warm: cover him with a coat, spare clothing, or a blanket.
Dont move the victim unnecessarily. Monitor his level of response,
breathing, and pulse while waiting for help. Begin cardiopulmonary
resuscitation if he loses consciousness ( p.173).
168 T R E AT M E N T A N D R E H A B I L I TAT I O N
ENVIRONMENTAL INJURIES
Some sports expose players to extremes of HYPOTHERMIA
heat and cold, which can overwhelm the bodys This life-threatening condition develops if the bodys core
temperature falls below 95F (35C). This is a common
ability to regulate temperature. This can be
condition in marathon runners, who rapidly lose heat when
fatal. Wearing the correct sports clothing offers they stop running. Treatment aims to prevent further heat
protection, but if there is an emergency, act fast. loss. Its vital that a victim is warmed up gradually. If he is
Dont leave a victim. Call for help or send warmed up too quickly, blood is diverted away from vital
someone to seek help while you treat the victim. organs, such as the heart and brain, to the skin, which can
actually speed up cooling of the body. A victim with
hypothermia must be moved on a stretcher.
COLD INJURIES
Exposure to cold, for example during skiing or rock climbing,
can cause body parts to freeze (frostnip and frostbite), or the
bodys core temperature to drop (hypothermia).
1 If possible, and if there is no risk of further cold, remove
any wet clothing and replace with warm, dry clothes.
Put
gloved
hands
in the
1 If there is no risk of refreezing,
warm the area gradually with
body heatplace the victims hands
The foil coating of a
rst aid blanket traps
heat and reects it
armpits in his own armpits, or his feet in back toward the body
your armpits. He can take
acetaminophen if the process is
painful. Do not attempt rewarming
if there is any risk of refreezing.
SUNBURN
Protect yourself by avoiding training or playing in the middle
of the day. Always wear a hat and suitable ultraviolet-proof
clothing recommended for your sport. Before exposure, apply In cases of heat Raise the victims feet
exhaustion, give so that they are higher
SPF 50 suncream. If you are sunburned, stay out of the sun; the victim plenty than his head
use cold compresses, followed by moisturizers on your skin. to drink
Take acetaminophen to ease pain. Leave blisters intact.
DEHYDRATION
Vigorous exercise in hot temperatures will require a greater
fluid intake than mild exercise in mild climates. Help the
victim sit down and give fluids; water or sports drinks are
usually sufficient, but rehydration salts mixed with water is
best. If the victim complains of cramps, help him stretch
the affected muscles, then massage them firmly.
WARNING!
If a victim suffering from heatstroke falls unconscious, be
ready to give cardiopulmonary resuscitation ( p.173).
CALF
Sit the victim down and support his affected THIGH
leg. Help him straighten his leg, and ex his If the cramp is in the back of his thigh, straighten his
toes to reverse the spasm. Then massage the leg to stretch the muscle; if its in the front of his
painful muscle. thigh, bend the leg. Once the pain eases, massage
the affected area.
Massage his calf
muscles rmly
FOOT
Help the victim stand on his good foot and
stretch the muscles to reverse the spasm. Once
the cramp has eased, massage the affected area
of his foot.
LEG INJURY Put rst bandage Secure third and fourth Tie second
around the knees bandages above and bandage in a
Injuries to the leg can be seriousan unstable fracture could below injury gure eight
pierce a large blood vessel, causing severe bleeding. Dont around the
ankles and feet
move the victim unless necessary, making sure his legs have
been immobilized first. If you see any signs of shock ( p.167)
ensure his head is low, but do not raise his legs.
SPINAL INJURY
If the victim has fallen on his back, or from a height, SUPPORT THE HEAD AND NECK
it is best to assume that he has a spinal, as well as Kneel behind his head. With your elbows on your
a head, injury. Dont move himsupport his thighs, put your hands on either side of his head
head and neck in line with the rest of his to keep it in line with his body. Wait for help.
back. Moving him could damage his spinal
cord, which may result in permanent Make sure you are comfortable Ensure that the victim can
because you may have to wait hear you by keeping your
paralysis below the injured area. Call for for help to arrive ngers clear of his ears
emergency help, or send someone to
get help while you stay with him. In the
eventuality that you have to leave the
victim to get help, and he is unable
to maintain an open airway, put him
in the recovery position ( p.173).
172 T R E AT M E N T A N D R E H A B I L I TAT I O N
UNCONSCIOUSNESS
If someone falls unconscious during a match
or in training, your priority is to make sure his
airway is open so that he can breathe. Ask Talk to the victim
someone to call for emergency help while you and ask him to
open his eyes
treat him. Make sure that you dont move the
victim, and dont leave him alone unless you
have to go and get help yourself.
MOBILITY EXERCISES
Mobility exercises are crucial to the prevention are involved in your chosen activity. In
and rehabilitation of injuries. To help prevent rehabilitation you must always regain mobility
injury it is essential that you have sufficient before you can work on your stability, strength,
mobility to perform whatever movements and power to get you back to full fitness.
1 NECK ROTATION
This simple movement helps ease neck ache, maintain neck should be able to rotate your neck through
flexibility, and delay or prevent age-related stiffness. You 7090 degrees on either side without straining.
Gaze straight
ahead
Keep your
chin level
Keep your
Keep your shoulders relaxed
chin raised as you ex
your neck
Look straight
ahead Raise your chin without
forcing it upward
Keep your
shoulders and
upper body
relaxed
Tense your
core muscles
for support
4 SHOULDER ROTATION
The stability of your shoulder joints stems from the joints, and also warms up your trapezius muscles (the
muscles and ligaments around them, rather than from large muscles on each side of the upper part of your back)
your skeletal system. This exercise frees up your shoulder before beginning a resistance-training session.
Keep your
chest high
7 TORSO ROTATION
This exercise helps you
mobilize your core Keep your
muscles, moving forearms in
your upper body line with
your chest
while keeping
Turn with your
your hips shoulders
stationary.
Keep your
core engaged
1 Stand upright,
with your feet
shoulder-width
2 Using a
smooth
motion, rotate
3 Rotate back
through the
start position,
apart, your elbows your upper to your left,
raised to the sides, body to your and repeat,
and your hands right, keeping alternating
palms downward. your elbows the direction.
and forearms
in line.
MOBILITY EXERCISES 177
8 FRANKENSTEIN WALK 9 PIKE WALK
This exercise mobilizes your This challenging, functional mobility exercise works your
hips and hamstrings. You calves, hamstrings, the core muscles of your lower back, and
should carry it out walking. your shoulders. With practice, some people can bend almost
Ensure you keep a steady in half, but persevere if your movement is limited. Control of
tempo and extend your your shoulders, pelvis, and spinal position is crucial.
front leg under tight
control rather than Keep your spine in
letting it swing. 1 Position yourself as if you were
about to perform a push-up a neutral position
Extend your
hand, palm
( pp.22829), with your hands
shoulder-width apart and
downward your arms straight.
2 Bring your
right leg up
to touch your
Keep your
Maintain a straight
back throughout
legs straight
left hand (or as
near as your
flexibility will
allow). Return to
an upright stance
Keep your right
leg as straight
as possible
3 When you reach
the point at which
you cannot continue
and repeat with walking forwards,
your other leg. hold the position for
a few moments,
then walk your
feet back to the
Keep your left leg start position. Keep your
straight and solid arms straight
and your foot at and your hands
on the oor at on the oor
178 T R E AT M E N T A N D R E H A B I L I TAT I O N
10 LEG ABDUCTION
In this hip mobility exercise you move your leg in a This movement works to free up your gluteals and the
different plane to that in the leg flexion (see below). muscles in your groin area.
Support yourself
with your hands Keep your
against a wall spine in
a neutral Keep your
position hips facing
forward Point your
foot outward
1 Place both
palms against
a wall with your
2 In a slow and
controlled way,
swing your right leg
Move your
leg across
your body
body leaning across your body,
slightly forward.
Shift your weight
onto your left leg.
pointing your toes
out at the end of
the swing.
3 Swing your leg back across
your body to full extension.
Return to the start position,
then repeat with your left leg.
11 LEG FLEXION
This movement works your hips and hamstrings. Like the moving one leg at a time, but here both your moving
harder Frankenstein walk ( p177), this exercise involves leg and your stabilizing limb are worked at once.
1 Stand on your
left leg with
your right leg
2 Keep your left foot
firm and flat on the
floor, and bring your
3 Bring your right
leg up as high
as you can, keeping
slightly behind the right leg forward in it straight. Hold for
line of your body. front of you. Keep a few seconds, lower
Rest your right your right knee as it, then repeat with
Keep your foot on tiptoes. straight as possible. your left leg.
right leg Lightly place your Tense and hold your core
as straight left palm against a muscles for support
as possible
wall or piece of
apparatus to help
maintain your
balance.
Keep the
movement
Bend your knee very smooth and
slightly for balance controlled
13 ANKLE MOVEMENTS
These movements are essential to the effective functioning you regain flexibility in your ankle joint, if you have had
of your ankle, and are ideal rehabilitation exercises to help
an ankle injury ( pp.14447) or ankle surgery.
Keep your
shoulders
up and your
Keep your heel on back straight
the oor
Maintain a
straight back Keep your
hips straight
and aligned
1 Sit with your right leg straight out in front of you and
your left leg bent at a right angle, your left foot flat on
the floor. Keeping your right leg straight, pull your right foot
2 Sit with your right leg straight out in front of you and
your left leg bent at a right angle, your left foot flat on
the floor. Keeping your legs straight, turn your right foot
up toward you as far as you can, then push your foot back and ankle inward as far as you can and then outward as
down so your toes are pointing away from you. Do this for far as possible. Do this for at least 2030 repetitions, then
at least 2030 repetitions, then repeat with your left foot. repeat with your left foot.
180 T R E AT M E N T A N D R E H A B I L I TAT I O N
14 SQUAT VARIATION
This is one of the key
If you cannot do a full squat while keeping
movement patterns Hold your arms out your heels at, try putting a small in
for your lower body straight with your
(12 cm) block under your heels.
palms facing down
and core. Good form
is key: go as low as Hold your
possible to improve chest up Hold your torso upright
throughout the exercise
your range of
motion and do
Keep your Keep your
not bounce. head level
spine neutral
Ensure that the bend
Ease your in your knees follows
hips back the line of your feet
15 WALKING LUNGE
This is an excellent way to mobilize your hips and thighs. making it an excellent mobility exercise for all types
The walking lunge tests both your balance and coordination, of sports. You can also perform it from a fixed position.
Maintain a
strong posture Lift your left leg
throughout through in one
Your upper Make sure
uid movement
leg should that your
be parallel knee is over
to the oor your foot
Feel the stretch
in your hips Rest your
back leg on
the ball of
your foot
MOBILITY EXERCISES 181
16 OVERHEAD LUNGE 17 ROTATIONAL LUNGE
This demanding lunge mobilizes This is another good mobility exercise leg. In addition, the movement
your hips and thighs along with your for your hips and thighs. You should engages your torso, which rotates as
thoracic spine and shoulders. Adding feel it stretching the hip flexor of your you turn your head, first to one side
a light weight overhead also works back leg and the gluteals of your front and then to the other.
the stabilizers in your shoulders and
puts emphasis on the mobility of
your hips and lower back. Keep your
head level
and gaze
forward
Keep your
Hold the bar front foot at
with your arms on the oor
straight above
your shoulders
18 PUNCH LUNGE
This exercise is designed to help your hips, torso, upper your lower and upper body to work together, which is very
back, and shoulders to work in unison. It encourages important for correct shoulder function following an injury.
Support your
Stand with your weight on
feet shoulder- your left leg
width apart
19 SHOULDER DUMP
This exercise helps you coordinate the movement of your encourages your lower and upper body to function
hips and shoulders to ensure that they work together. Like as a unit, which is very important after any form of
the punch lunge (see above), the shoulder dump also shoulder injury.
Squeeze your
shoulder blades
together
Keep your
back straight
Allow your
arms to hang Engage your
down vertically core muscles
Relax your
Keep your shoulders
back straight
Keep your
pelvis neutral
Keep your
shoulders relaxed
but squeeze
your shoulder
blades together
Push your
PROGRESSION
Once you are used to the exercise,
you can make it harder by holding
a dumbbell in each hand. Ensure
that you start with light weights
and maintain good form. 3 As you reach the top of the movement, push up
between your shoulder blades as high as you can.
Pause, then return to the start position.
184 T R E AT M E N T A N D R E H A B I L I TAT I O N
22 PRESS-UP 23 WINDOW-WIPER
This simple exercise is great for This dynamic exercise works your hip joints, upper
rehabilitation of shoulder injuries legs, and shoulders. It helps get your rotator cuff
( pp.7075), working the muscles
of your upper body and building
functioning as part of a full-body movement, and
makes the lower and upper body work together.
your core strength. It can be It is another useful exercise for the rehabilitation
performed on a chair or a bench.
of shoulder injuries ( pp.7075).
Keep your back
Rotate your straight and
hand so your shoulder
it points blades together
Look straight
ahead upward
Grip the
edges of
the chair
1 Stand next to a wall with your feet
slightly more than shoulder-width
apart. Holding a small cloth in your
2 Bend your knees and drop down
into a squat position, keeping the
cloth pressed against the wall. Try to
right hand, press it gently against the squat as low as possible.
wall, with your arm bent.
Push up
through
Engage your hips
your core
muscles
Straighten
your knees
Push down
with your
heels
Bend your
knee slightly
Transfer
your weight
Try to get Feel the forward Maintain your Feel the
your leg stretch position against stretch in
horizontal in your the wall your lats
inner
thighs
26 STATIONARY SUPERMAN
This exercise is excellent for improving your balance and essential exercise for the rehabilitation of lower-body
coordination, as well as your hamstring flexibility. It is an injuries. Practice in front of a mirror to perfect your form.
Keep your
spine straight
Keep your
pelvis neutral
Bend your
left knee to a
maximum of
Start to straighten 2030 degrees
your right leg
behind you
27 HIP HITCHER
This exercise works your abductor muscles. To begin with, weight, but as you progress, you will be able to increase
you may need to use a swinging bar to support your the flexion of your hip.
1 Stand upright
with your left
foot on a step and
2 Push your left
hip inward,
raising your
3 Allow your right
foot to drop
down past the edge
your right foot right hip of the step, keeping
unsupported in slightly your left leg as
the air. Place your at the straight as you
hands on your same time. can. Pause,
hips for balance. return to the
Raise your start position,
right hip and repeat. Let your
left hip
drop
outward
Squeeze your
left buttock Keep your
knees
straight
Keep your
hips forward
and aligned
Make sure that
your feet stay
in contact
2 Slowly lower your right leg toward the step, keeping it
straight throughout. Touch your heel onto the block, then
raise your right leg back to the start position. Complete the
desired number of repetitions, then repeat with your left leg.
PROGRESSIONLEVELS 2 AND 3
Once you have full control over the
movement, you can progress to Levels
2 and 3. For Level 2, use the doorframe
support but remove the step and
lower your leg to the oor. For
3 Lift your left knee as far as it will go, while keeping your
hips aligned. Slowly lower your knee back to the start
position and repeat for the required number of repetitions
Level 3 (see right), perform
the exercise without the
doorframe or the block.
before swapping sides.
188 T R E AT M E N T A N D R E H A B I L I TAT I O N
30 NEURAL GLIDE
Also known as flossing, this is a great exercise for helping starting off, be gentle and dont push it too hardyou will
with neural tension in your spine and legs. When you are develop the range of movement eventually.
Sit up
straight Look straight
Flex your ahead
neck
Extend your
knee Feel the
stretch in
your leg
and spine
31 CARIOCA SIDESTEP
This is a simple coordination drill that can be used for any
lower-limb injury and also as part of your rehabilitation
following a hamstring injury ( pp.10809). It is also often
used as part of a warm-up for numerous sports.
Shift your
Shift your weight on
weight on to your
to your right leg
right leg
1 Stand with
your legs 2 Moving to your
left, swing your
roughly shoulder- right leg across and
3 Keeping your weight on
your right leg, swing
your left leg around from
4 Continue to move
sideways, this time
swinging your right leg
5 With your weight on
your right leg, swing
your left leg in front of
width apart. in front of your body, the back, so that your feet behind your left, shifting your body. Repeat Steps
and shift your weight are roughly shoulder-width your weight onto your 15 over the desired
onto your right foot. apart again. right foot. distance, then reverse.
MOBILITY EXERCISES 189
32 SIDEWAYS WALK PROGRESSION
This drill helps improve your lateral movement, which
Begin the exercise at a walking pace, gradually build to a skip and
is important in most sports, and also helps rehabilitation then try to do the drill as fast as you can. Alternatively, you can try
following a leg injury. the exercise on your toes or heels.
1 Attach a
band or
strap to both
2 Step to your
left, keeping
your right foot
3 Bring your
right leg
toward your left
of your ankles, on the floor, leg. Repeat
and stand placing your Steps 13 over
with your weight on the desired
legs shoulder- both legs. distance, then
width apart. reverse the
direction.
Follow the
movement
with your
Keep your head
elbow high
2 Round your back upward and pull
in your stomach, letting your head
drop forward.
Keep your
core engaged Stretch your
head upward
and backward
Twist at
your hips
Straighten
your legs
Feel the
stretch here Feel the stretch
in your side
1 Sit on the roller with your right buttock and cross your
right leg over your left leg. Rolling backward and
forward, work on the outside of your buttock before
1 Lie on your right side over the roller, which should fit
under your armpit, and place your hands behind your
head for stability. Use your back muscles to roll down
shifting your weight to the middle of your buttock. from your armpit to the base of your shoulder blade. Roll
Repeat for at least 30 seconds before switching sides. back up and repeat for at least 30 seconds. Switch sides.
STRENGTH-TRAINING EXERCISES
Strength training is often a crucial part of physician, and must guide your form.
your rehabilitation program. Your physical Achieving perfect form in these exercises is
therapist will design your exercise regimen key to helping you return to your sport with
under the direction and prescription of your the necessary control, strength, and power.
40 BARBELL SQUAT
This multi-joint exercise is extremely effective at developing but must be performed with good form. To improve your
the muscles of your legs, pelvis, and spine. It is a great form, increase the depth of your squat by placing a small
foundation exercise for building overall power and strength, (1 in/12 cm) block under your heels.
Gaze straight
ahead
1 Take a balanced
grip on the bar
on the rack. Duck
2 Breathe deeply
and, tensing your
abs and gluteals, start
beneath it and stand the descent. Keep
up with your feet your feet pointing Hold your
directly under the slightly outward, chest high
bar. Step back and and ensure that your
stand upright with knees follow the
the bar resting angle of your feet
on the upper part as you bend your
of your back. knees and ease
your hips back.
Place your
feet just wider
than shoulder
width apart
3 Maintain a neutral
spine and lower
your body slowly and
4 Continue bending
at the knees until
your thighs are
under tight control, parallel to the floor.
easing your hips farther Your torso should be
back. Bend your knees, at a 45-degree angle.
making sure you keep Return to the start
them over your toes. position and repeat
as required.
ST R E N G T H -T R A I N I N G E X E R C I S E S 193
41 SINGLE-LEG SQUAT
This exercise works in a similar way to the squat ( p.180),
but is a much more challenging movement to perform
correctly because it requires much greater leg strength,
balance, and core stability.
1 Stand up
straight with
your arms by your
2 Breathing in and
engaging your core,
raise your arms out in
3 Continue dropping your
buttocks until you reach
a half-squat position, or as far
sides and your front of you and lift your as you can go. Pause at the
feet roughly right leg off the floor, bottom of the movement and
shoulder-width dropping your return to the start position.
apart and pointing buttocks Repeat with
straight ahead. downwards your left leg.
Engage your
and keeping core and Keep your
your knees keep your pelvis in
over your feet. hips level a neutral
position
Ensure your knee
stays in line with
Start with your your foot
legs shoulder-
width apart and
your knees soft
Support your
weight on
your left leg
42 STRAIGHT-LEG RAISE
The ability to straighten your knee fully is crucial to knee tighten your quadriceps and hold them while performing
rehabilitation, whatever your injury may be. Learning to a straight-leg raise is one of the basics you need to master.
Position your
right foot
just ahead of
your torso
44 BARBELL LUNGE
This exercise strengthens the large muscles of your legs in training for racket sports because it improves your ability
and your glutes. It is a dynamic movement that is useful to reach those difficult shots.
Look straight
1 Stand
with your
feet hip-
ahead
3 Let your left
knee almost
touch the floor,
width apart and
your knees soft.
Rest the barbell
2 Engage your
core muscles
and take one long
then straighten
your right leg
and step
across your upper step forwards with back to the
back, holding it your right foot. At the start position.
with a wide grip, same time, lower your Complete your
your knuckles left knee toward the set and repeat
facing backward. floor, breathing freely. with your left leg.
Keep
your knees
slightly bent
Bring your
left foot up
on your toes
Ensure that
your left thigh
is vertical
ST R E N G T H -T R A I N I N G E X E R C I S E S 195
45 45-DEGREE LEG PRESS
This simple machine exercise is suitable for those who
do not have good core strength and are not familiar
( p.192). Performing the movement with only one leg
is also a great way to do extra work on an injury as part
with more functional exercises, such as the barbell squat of your rehabilitation program.
1 Select a weight on
the stack and sit
on the machine. Place
2 Push with your
legs until they
are almost fully
your feet hip-width extended. Pause Keep your
apart on the platform, at the top of the heels and toes
take the weight on movement, then pressed against
Bend your the platform
your legs, release the knees to return to the start
safety lock, and hold at least position slowly
the handle supports. 90 degrees and under control. Extend your legs
almost fully
Keep your
head and
back well
supported
on the pad
Rest your
back against
the pad Align your
knee joint
1 Select a weight
from the stack
and sit on the
2 Keeping your
back stable
against the seat,
with the
machines machine. Adjust push the moving
pivot the moving arm so arm back in a
that it is under your smooth motion
ankles and does not by contracting your
slide up your calves. hamstrings. Return
Position the lap pad it under control to
above your knees. the start position.
Place your
ankles on the
pad of the Press your ankles
moving arm against the pad
196 T R E AT M E N T A N D R E H A B I L I TAT I O N
47 ROMANIAN DEADLIFT
This exercise balances work on your quads with makes an excellent addition to a general training program
development of your hamstrings and glutealsthe for most sports, especially for those that require leg
muscles that extend your hips. The Romanian deadlift strength and power.
Drive off
Hold the bar with Ensure that your feet your feet
an alternate hook remain rmly planted
gripone hand at on the oor
over, and one under
WARNING!
Correct lifting technique is essential in
this movement. Never lift with your spine
exed forward: not only will the exercise be
ineffective, but you also risk spinal injury.
Grip tightly so that Always raise and lower your shoulders and
the bar does not hips together. Keep the bar close to your
rotate in your hands body and do not drop it at the end of the
movement; always lower it under control.
ST R E N G T H -T R A I N I N G E X E R C I S E S 197
48 STRAIGHT-LEG DEADLIFT
This is a useful exercise for strengthening your lower back excellent movement for anyone who runs or is involved in
and developing your hamstrings and gluteals. It is an high-speed and contact sports.
Keep your
back straight Engage your
throughout core muscles
Keep your
arms straight
1 Stand upright
with your feet
hip-width apart
2 With your
head facing
forward and
3 Keeping
your core
muscles tight,
and the barbell your knees slowly pivot
resting across almost locked, Feel it at your hips
your upper bend from here to raise your Bend your
knees to a
thighs. Hold the your waist upper body maximum
bar with straight to lower to the start of 30 degrees
arms and an the barbell. position,
overhand grip. Inhale as exhaling as
you do so. you do so.
49 SINGLE-LEG DEADLIFT
As with the straight-leg deadlift (see above), this exercise Because you have to balance on one leg at a time, this
strengthens your lower back, gluteals, and hamstrings. exercise also works your core muscles.
1 Stand with a
dumbbell in
each hand in an
2 Keeping your abs contracted,
your back straight, and your
chest lifted, slowly lower the
3 Lower the dumbbells down
your shin as far as you can
reach. Hold, then flex your left
overhand grip, dumbbells toward your left foot. hamstring and push your hips
with your feet Keep your left leg bent slightly forward to bring your body back
slightly less than throughout the movement, and to the start position. Repeat with
shoulder-width lift your right leg for balance. your right leg.
apart. Place your
left foot about
half a step in Push your buttocks Keep your back
backward straight throughout
front of your
right foot.
Keep your
arms straight
1 Stand with
your feet
facing forward
2 Bending
your right
leg slightly,
3 Standing
on your right
leg, engage your
4 Lower your left
foot to the board
and lift your right
on a decline lift your left core and bend foot off. Push up
board set foot off the your right knee through your
to an angle ground until slowly for as left foot and
of about your left deep a squat stand to the
25 degrees. knee is as possible, start position.
almost at and hold Switch feet.
a right angle. briefly.
Engage
your core
Support your
Point your feet weight on your
forward right foot
Maintain a strong
back and engage
your core
1 Put on a pair of
socks or some
shoe covers over your
2 Pull your legs
together gently
and under control
sneakers. Stand on a until you are standing
slide board with your upright with your
feet as far apart as is ankles together.
comfortable, and your Slowly return to
hands held behind the start position. Feel the
your lower back. stretch on
the inside
of your
thighs
Keep your
knees straight
55 SKATING SLIDE-BOARD
This exercise works your abductor and adductor muscles, movement slowly at first and build up speed, distance, and
which support your pelvis and groin. Perform the the number of repetitions as you progress.
Slightly bend
your knees
Keep your
pelvis neutral
57 ADDUCTOR PULLEY
This exercise builds strength and endurance in the adductor
rehabilitation of groin injuries ( p.104) and pain in your
muscles of your leg, and is another useful movement in the
sacroiliac joint ( p.62).
Put your
weight
on your
right leg
202 T R E AT M E N T A N D R E H A B I L I TAT I O N
Maintain a
strong posture
Keep your throughout
back straight
1 Stand facing a
step or bench
and place your
Hold your
body upright
2 Push down
with your left
heel and use your
Put your
weight
3 Drive your body
up onto the step,
exhaling as you do
on this
left foot on top, left thigh and gluteal knee and so. Step down
making sure that muscles to lift contract backward, reversing
your heel is not your right foot up your quads the movement to
hanging over onto the bench. the start position.
the edge. Your left knee Repeat for the
should be at required number
an angle of of repetitions, then
about 90 swap feet.
degrees.
61 BOX STEP-DOWN
This movement also works the main muscles of your leg falling forward or twisting. This is a more advanced exercise
your quads, hamstrings, and gluteals. The muscles of your than the step-up (see above), requiring more control from
calves also help you, while your core stops your body from your quadriceps and gluteals.
62 ECCENTRIC INVERSION
Eccentric exercises are used to help treat tendon disorders. quite uncomfortable to begin with, but you will gradually
This exercise works the tendon on the inside of your ankle, be able to increase your range of motion and can use ankle
which is called your tibialis posterior ( p.152). It may be weights as you progress.
Maintain a stable
position by holding
onto a bar or the wall
63 CALF RAISE
This exercise develops the muscles of your lower leg. To heavier free weights, testing your balance further. You can
begin with, work on a Smith machine to help stabilize your also perform the exercise using one leg at a time, which is
body. When you are confident, perform the exercise with useful for the rehabilitation of various lower-limb injuries.
Engage
your core
muscles
Balance
with
your arm
1 Stand on your
left leg on a
low step, your leg
2 Slowly lower
your left heel,
feeling the stretch
3 Place your
right foot on
the step and use
straight, your toes through your your right leg to
on the step, and Achilles tendon raise your body
your heel off the and your calf back up to the
edge. If necessary, muscle, until your start position.
use your arm to heel is lower than Complete your
support yourself. the level of the step. set and switch legs.
( pp.14043) and in late-stage calf injury rehabilitation affected leg to lower your body during the movement.
Use your
arm for
support
1 Stand on your
left leg on a
low step, your
2 Lower your
left heel slowly
until it is lower than
3 Place your
right foot on
the step and use
knee bent, your Bend your the level of the step, your right leg to
knee to
toes on the step, about 45 feeling the stretch raise your body
and your heel degrees through your Achilles back up to the
off the edge. tendon and your start position.
Use your arm calf muscle. Complete your
for support set and switch legs
if necessary. Keep your
knee bent
Position your Drop your heel
heel off the below the edge
edge of the step of the step
206 T R E AT M E N T A N D R E H A B I L I TAT I O N
66 ONE-ARM ROW
This is a great exercise for your back and shoulders and body posture with a low risk of injury. To get the best
one that offers great results in terms of strength and upper- results, it is important not to rotate your torso or hips.
Support part of
Hold the dumbbell your body weight
with your arm straight on your arm
Draw your
elbows down
Keep your thighs in a controlled
anchored under movement
the pad
Engage
your core
muscles A narrow
grip works
your smaller
muscles
Kneel on Hold your
the pad feet together
69 CHIN-UP
This challenging exercise is great for advanced back, sports that involve gripping and grappling. Begin with
shoulder, and arm rehabilitation and ideal for training for the assisted version (see above) to build your strength.
Lift your
chin above
Take a neutral your hands
grip with
medium hand
spacing to place
Hang the least stress
on fully on your wrists Pull your body
extended and elbows upward
arms
70 GOOD MORNING
This exercise works your glutes and hamstrings, while It is an ideal movement for medium to advanced hamstring
your large spinal erector muscles hold your back flat. rehabilitation after injury or surgery.
Plant your
heels on
the oor
Maintain your
knee angle
Begin with your throughout
arms straight the exercise
Hold the
weights with
straight arms
73 LOW ROW
This important upper-back exercise works the stabilizers of this with a single arm is an excellent exercise for people
your core and your posterior shoulder muscles. Practicing with shoulder injuries or dysfunction.
Maintain an upright
position, ensuring
1 Set the pulley
high and
select the desired
Keep your head
level and your
eyes forward
2 Bring the bar
in an arc all
the way down
that your weight does
not shift forward
Keep your
buttocks, head,
and shoulders Keep your feet
well supported at on the oor
throughout
Move your
shoulders in
front of the bar
Keep your
Keep an
Ease your arms straight Maintain
overhand
hips back grip on a straight
the bar back
Keep your
wrists
straight
Use an
overhand grip
Keep your
back straight
Engage
78 SHOULDER ISOMETRICS
The muscles of your rotator cuff are vital in stabilizing the involve throwing. This series of exercises works your rotator
movement of your shoulder joints, especially in sports that
cuff and is used early on after a shoulder injury ( pp.7075).
Use your
right hand
to resist the
outward
rotation
Take an
overhand
1 Stand
facing a
low pulley
grip on the
handle 2 Keeping
your
left arm
3 Lower
your left
arm to the
and grip the still, slowly start position.
handle in pivot your Complete
your left forearm up your set
hand. Raise to a vertical and repeat
your elbow position, with your
to the side breathing right arm.
in line freely as
with your you do so.
shoulder.
Keep your
knees soft
80 INTERNAL ROTATION
This exercise develops the internal rotator cuff muscles
of your shoulder. A simple pulley rehabilitation exercise,
it is ideal for a rotator cuff injury ( p.70), especially as you
can easily adjust the weight as you progress.
Place one
foot out
in front
Stabilize your Keep your Keep your
body with hips vertical right arm
your right foot xed
Feel it at
Rotate your forearm the back of
to the vertical position
but no further
your shoulder
3 Now push a
little farther and
feel your shoulder
blades stretch across
your upper back to
achieve the extra
range. Hold for 23
seconds then slowly Bring your
return to the start hands toward
84 STANDING Y VARIATION
This exercise strengthens the muscles of your shoulders
Lifting the weights with your knuckles turned
and upper back, and helps improve the stability of your in and your thumbs pointing downward puts
shoulder joints. In particular, it works your supraspinatus more emphasis on the front of your shoulders.
and front deltoid muscles.
Relax your
shoulders
Keep your
core engaged
Keep
Ensure your your elbows
back is slightly bent
straight
Keep your
knees soft
Follow through
with your arms
Hold the
ball at face Keep your
height arm straight
Keep your
body still
1 Stand upright
with your feet
shoulder-width
2 Let go of
the ball and
allow it to drop
3 Catch the
ball at about
waist height, and
apart. Hold a before following then return to the
small, weighted its movement starting position.
ball at face height, with your hand.
with your arm
raised in front
of you.
88 TRICEPS PUSH-DOWN
This is a basic strengthening exercise for your triceps Reversing the grip on the bar turns this in to a pull-down
muscles, which form the back of your upper arms. that also works the muscles of your forearms.
Hold your
body upright
and do not
tilt forward
Keep your Apply equal
elbows tight pressure to
to the sides both sides
of your body of the bar
Push down
Keep your hard with
back at your feet Lower the bar until your
knuckles touch your chest
1 Stand holding
the dumbbells
with straight arms
2 Curl the
dumbbell
in an upward
3 Pause for
a second at
the top of the
at your sides, your arc toward movement before
thumbs pointing your shoulder, returning the
forward. Pull your keeping your weight to the
shoulders back core engaged starting position
and keep your and your chest under control.
spine neutral high throughout Work your arms
throughout. the movement. alternately.
ST R E N G T H -T R A I N I N G E X E R C I S E S 219
91 WRIST EXTENSION
You need a strong grip to work effectively with heavy you to hold greater loads for longer periods, which
weights. This exercise strengthens your forearms, allowing will help you work your large muscle groups.
Maintain a
Slowly move neutral spine
the dumbbell
Hold your wrist as high as Keep your
level with the front you can forearm still
of your knee
Keep your
feet at on
the oor
Keep your
spine neutral Slowly move
the dumbbell
Keep your wrist as low as Keep your
level with the you can forearm still
front of your knee
Keep your
feet at on
the oor
Rest your
knees on the mat
3 Lie on a mat with your knees raised and your feet flat on
the floor. Raise your body into a bridge position, lifting
your shoulders off the floor, so that your weight is resting
on your feet and the back of your head. Controlling your
breathing, initially try to hold the position for 10 seconds,
3 Press your right hand to your temple and your left hand
to the back of your head. Turn your head to the right,
resisting with both arms, stopping your head from moving.
building toward 30 seconds as you progress. Hold, then relax, then switch hands and direction.
ST R E N G T H -T R A I N I N G E X E R C I S E S 221
95 CURL-UP
A key part of most exercise programs, this movement your rehabilitation, you can increase the difficulty of the
strengthens your rectus abdominis muscle, which helps exercise through five levels as your strength and endurance
stabilize your pelvis. If it is recommended as part of gradually improve.
Keep your left Lift only your
foot in line with chest, shoulders, Keep your
your right knee and head right leg
straight
1 Lie on your back with one leg straight and the other
bent at a 90-degree angle with your foot flat on the
floor. Bend your elbows and place your hands palm-down
2 Keeping your elbows on the floor, engage your core
to lift your shoulders up, exhaling as you do so, ensuring
that you lift only your shoulders off the floor, rather than
under your lower back. Rest your elbows against the floor. lifting your upper body and doing a sit-up. Hold for
8 seconds, then return to the start position for 2 seconds.
Complete your set then switch leg positions.
PROGRESSIONLEVEL 2 PROGRESSIONLEVEL 3
Perform the curl-up as in Level 1, with your hands under the small Place your hands across your chest instead of behind your back,
of your back, this time with your elbows off the oor. As for Level 1, straightening one leg along the oor, bending the other at 90
keep one leg straight along the oor and the other bent at a right degrees with your foot at on the oor, and only lifting your chest,
angle with your foot at on the oor. Hold for 8 seconds at the top shoulders, and head off the oor. Hold for 8 seconds at the top,
of the movement, then return to the start position for 2 seconds. then return to the start position for 2 seconds. Complete your
Complete your set then switch leg positions. set, then switch leg positions.
PROGRESSIONLEVEL 4 PROGRESSIONLEVEL 5
Position yourself with a wobble-board under your lower back Perform the exercise with your lower back positioned on a Swiss
and your hands across your chest, with one leg straight along ball and your hands across your chest. Plant your feet rmly on
the oor and the other bent at a right angle with your foot at the oor and bend your knees at 90 degrees. Hold for 8 seconds,
on the oor. Lift your chest, shoulders, and head, hold at the top then return to the start position for 2 seconds. Complete your set
for 8 seconds, then return to the start position for 2 seconds. before switching leg positions.
Complete your set before switching leg positions.
222 T R E AT M E N T A N D R E H A B I L I TAT I O N
3 Pause at the
top of the
movement, then
Contract lower and untwist
your abs your upper torso
to return to the Keep your
elbows straight
start position.
Repeat for your
other side.
Ensure that
your back is at
1
Start with your body in a push-up position ( p.228),
but with your toes resting on the ball. Engage your
core to stop your lower back arching.
1 Kneel down, resting your hands and lower arms on
the top of the ball, and ensure that your back is flat.
Keep your
back straight
throughout Extend your
Keep your arms forward
pelvis neutral
100 SWISS BALL ARM PUSH 101 SINGLE ARM AND LEG RAISE
This exercise requires you to stabilize your pelvis, lower This exercise engages the transversus abdominis muscle of
back, shoulders, and neck while working your abdominals your core, using it to stabilize your pelvis against the motion
and shoulder-blade stabilizers. It is a full-body exercise that of your arms and legs. This muscle acts as a natural girdle,
can be used to rehabilitate almost any injury. flattening your abdomen and supporting your lower back.
Relax your
shoulders
Keep your
head and neck
muscles relaxed
Keep your
feet together
Rest your
forearms against
the oor
1 Lie on your back on a mat with your hips and knees bent
at 90 degrees, and your feet roughly hip-width apart in
the air. Point your arms up directly over your shoulders,
1 Lie face down on an exercise mat with your elbows to
your sides and your hands alongside your head, palms
facing the ground.
palms facing forward, and contract your abs.
Keep your back
at and tight
Pull your
bent leg
back toward
your chest
2 Lower your left arm behind you and extend your right
leg, bringing it as close to the floor as possible without
arching your back. Draw your left knee in to your chest.
2 Engaging your core and leg muscles, raise your body
from the floor, supporting your weight on your forearms
and toes while breathing freely.
Keep your
back straight
throughout
Align your
elbow with
your hips
1 Lying on your right side, prop
yourself up on your right forearm.
Extend your legs and keep your feet
2 Engage your abdominals and
push downward through your right
elbow to raise your hips off the ground,
and feet together. Make sure that your right making sure that you keep your ribcage
elbow is directly under your shoulder elevated and your shoulder lowered.
and in line with your hips. Rest your Hold for 8 seconds, then return to the
left arm along your side. start position for 2 seconds. Repeat 10
times, then switch sides.
ST R E N G T H -T R A I N I N G E X E R C I S E S 227
104c SIDE PLANK (LEVEL 3) 104d SIDE PLANK (LEVEL 4)
This further progression makes it even harder for you to This is the most complex version of the exercise. It requires
balance. As a result, it works the muscles at the sides of excellent strength and stability in your core stabilizers to
your torso harder and helps improve your posture. keep your body balanced.
Balance on the
side of your foot
Keep your
shoulder
and elbow
aligned
Keep your
ribcage raised
Engage your
core muscles
Keep your
hips straight
105 PUSH-UP
This is one of the simplest and most effective exercises WARNING!
for your core, chest, shoulders, back, and arms. Its Do not let your torso sag as you push yourself up. This will cut
added benefit is that it requires no apparatusjust down the range of your movement, diminishing the benet to
your chest, shoulders, and arms. Failure to straighten your arms
your own body weight. There are many variations that after each rep will also make the exercise less effective.
can be used and this is a great middle- to final-stage
exercise for those suffering from lower back pain ( p.60).
Tense your
spinal erectors
Support your
Maintain
weight on Keep your a neutral
your toes legs straight spine
Tense
your abs
Keep your trunk
Point your level and do not
ngers forward allow it to sag
Keep your back in Align your head Keep your core Extend your arm
a neutral postion with your spine muscles tight straight out in front
VARIATION 3 VARIATION 4
As in the push-up on one leg, having one hand out in front of you Raising one leg during the push-up means that your core stabilizers
makes your core muscles work harder and in a slightly different way, have to work much harder to keep you balanced. Stretch through
while providing extra benet to the muscles of your chest, shoulders, your hip to lift your foot off the oor, making sure that you keep
and arms. Ensure that you keep your core engaged throughout the your knee extended. Avoid twisting your hips, and hold the lift
movement, and repeat with your other arm. before returning to the start position. Repeat with your other leg.
Keep your
pelvis neutral Keep your hips
and torso in line Maintain
straight legs
Position one
hand out in
front of you
PROGRESSIONLEVEL 2 PROGRESSIONLEVEL 3
Raising a leg rather than an arm will demand more balance and Combining an arm lift and a leg lift requires good strength and
control. Engage your abdominal muscles and lift your right leg stability. Contracting your abs, lift your right leg behind you to hip
behind you to hip height. Balance and hold, then return to the start height and your left arm forward to shoulder height. Hold, then
position. Being careful to keep your back straight and not to arch lower your leg and arm, under control, to the start position. Keeping
your spine, repeat with your other leg. your body straight, repeat with your other leg and arm.
1 Position yourself
in a split kneeling
position on your knees
2 Engaging your core,
pull the cable down
and across your body,
Maintain the
angle of
3 Keeping the cable
close to your body,
push down with your
with a pulley cable bending your elbows the cable arms to finish the
machine to your right. as you reach the movement. Hold
Extend your right leg midpoint of your chest. briefly and return
in front of you so that to the start position.
your knee is bent at Swap sides.
90 degrees and your Keep your
shoulders straight
foot is flat on the floor.
Keeping your back
Keep your
straight, align your core engaged
back, shoulders, hips, throughout
and knees. Grab the Bend your
right leg at a
rope or stick with 90-degree angle
straight arms.
your right leg. Lift your engage your core to down with your
left heel off the ground. pull the cable down arms to finish
Keep your hips and and across your the movement.
shoulders aligned and body, bending your Hold briefly, then
your back straight. elbows as you reach return to the start
Hold the cable with the midpoint of position and
your arms extended your chest. switch sides.
above you.
Keep your back and
shoulders straight
Fully extend
Bend your knee your arms
at a right angle
Begin with
your arms Bend your
straight left leg at Keep the cable
and fully a right angle taut and at the
extended same angle
Keep your
core engaged
and your
hips aligned
Push downward
through your feet
Keep your
shoulders Fully extend
straight your arms
Keep the cable
Bend your taut and at the
Engage
left knee at a same angle
your core
90-degree angle
1 Lie face down, with your hands flat on the floor and level
with your shoulders, as though you are about to perform
a push-up ( p.228).
2 Pressing your hips against the floor, push your upper torso
upward with your arms, lifting your head and shoulders
up as high as you can, relaxing your lower back, and breathing
PROGRESSIONLEVELS 2 AND 3
out. Pause and use your arms to lower your torso back to the
Like most exercises, there are higher levels of difculty to work start position.
through as you progress. For level 2, perform the exercise as above,
but without a partner holding your stationary leg. For level 3, keep
both your feet together and rotate them to alternate sides. For each
movement, make sure that you control your pelvis and keep your VARIATION
shoulders and arms at on the oor throughout the exercise.
If your injury means that one side of your back is more painful
Keep your than the other, there is a useful variation of this exercise you can
legs straight perform to help your condition. While you are lying face down
and in line Keep your
shoulders on your stomach, as in Step 1, shift your legs towards your
Keep your and arms at painful side and extend your upper torso upwards. Doing this
feet together will encourage your disc bulge to reverse and the disc to move
back to its correct position.
ST R E N G T H -T R A I N I N G E X E R C I S E S 235
111a EXTENSION HOLD (LEVEL 1)
This exercise helps balance your trunk by conditioning and will be a mainstay in the rehabilitation of any back
your lower-back muscles, which work opposite your abs. or pelvic injury. You will need a partner to assist you with
A strong trunk provides protection against back injury this exercise.
Come to a straight
back position but
dont overextend
Keep your
legs straight
throughout
Raise the
dumbbell off
the ground
1 Lie on your back with your knees bent at right angles and
your feet flat on the floor, hip-width apart. Keep your
arms at your sides, with your palms facing down.
2 Engaging your core, slowly lift your buttocks off the floor
until your body is in a straight line from your knees to
your shoulders. Pause at the top, then reverse the movement
to return to the starting position.
1 Secure a barbell in a
rack or Smith machine,
over a bench, at a height
2 Keeping your body
rigid, pull yourself
up until your chest
that allows you to hang almost touches the
from the bar without your bar. Hold, then lower
back touching the floor. yourself slowly,
Lie face-up under the straightening your
bar, and hold it with your arms back to the
hands shoulder-width start position.
apart, engaging your
core and keeping Raise your chest until it
your body straight. almost touches the bar
VARIATION
Engage
your core Sit upright on the reformer with your feet held in place and your
knees bent at a 45-degree angle. Keeping your spine and shoulders
stable, grasp the handles with your arms bent at a right angle and
hold. Perform the movement for the desired number of repetitions,
then rest.
Drive
up with
your legs Let the bar
touch the
tops of
your thighs
Push off with the
balls of your feet
1 Load up your
barbell. Place your
feet hip-width apart,
then explosively
extend your legs and
hips, pressing the bar 3 Bend your knees
and lower the
bend your knees, and up until you stand bar under control.
use an overhand grip tall. Hold the bar Rest the bar on your
to lift the bar onto overhead, keeping shoulders, and repeat
your shoulders. Dip your arms locked- the move until you
into a shallow squat. out and body strong. finish the set.
ST R E N G T H -T R A I N I N G E X E R C I S E S 239
Control
the descent
of the bar
Rotate your arms
around the bar
Push up
with your
quads Keep your
Spread your feet at on
feet slightly the oor
to the sides
Explode
vertically
from the
squat
STATIC-STRETCHING EXERCISES
Static stretches are an important aspect them before may reduce your capacity
of injury prevention and are also useful in to release power, and does little to reduce
recovery from injury. Static stretches should your chances of injury. You should always
be performed after you have exercised; using aim to balance both sides of your body.
prevent inflammation of
the areailiotibial band 1 Sit on the floor with your legs
extended. Bend one leg and
syndrome ( p.132)
which is a common
cross it over your extended leg so
that your foot is flat on the floor.
cause of pain. Supporting yourself with one arm,
reach over with your free hand
and gently press on the outside
Feel the stretch in of your knee until you can
the outside of your Bring your feel the stretch in your ITB.
rear leg front leg
across
1 Stand facing
away from a
bench or other
2 Bend your
supporting leg
slowly, lowering
3 Push up
with your
supporting leg
suitable support. your body until to return to the
Bend one knee and you can feel the start position.
place your foot on stretch in your Be sure to repeat
the support. Keep opposite thigh. the stretch on Push up
your body upright your other leg. to return,
and your head up. working
Keep your hips your calf
Rest the top in line with your Feel the muscles
of your foot shoulders stretch in strongly
on the bench your quads
Flex at
Bend your your ankle
knee to an
angle of about
90 degrees
242 T R E AT M E N T A N D R E H A B I L I TAT I O N
Keep your
body upright Feel the stretch in
your adductors
Feel the
stretch in your
adductors
Straighten
your back
Keep your
Lean forward Keep your
Keep your knee bent
at your pelvis feet at
hips aligned
Squeeze
your gluteals
STAT I C - ST R E TC H I N G E X E R C I S E S 245
136 SLEEPER STRETCH
Many people neglect the stretching of their posterior
capsule (the back of the shoulder). It is very important to
problems, especially shoulder impingement ( p.72). This
simple yet effective stretch targets your posterior capsule,
maintain adequate flexibility in this area to prevent shoulder and you should aim for equal mobility on both sides.
Rotate your
forearm
Keep your Keep your toward
pelvis neutral knees bent the oor
Lie on your
shoulder
PROPRIOCEPTION EXERCISES
Proprioception is the name for the signals joints, and the direction and pressure of your
that your joints, tendons, ligaments, and movements. These exercises work to improve
muscles send to your brain to provide it your balance, coordination, and agility, and
with information about the position of your often involve full-body movement.
Use your
arms to
help you Land rmly,
drive taking your weight
forward on your right leg
PROPRIOCEPTION EXERCISES 247
141 FOUR-POINT KNEEL PROGRESSIONSWISS BALL LEVELS 13
This exercise is good for improving your balance, and
Level 1: Kneel with your toes tucked under and the Swiss ball at
also works your hips, upper back, shoulders, and core. It arms length in front of you. Lean forward at your hip, extending
is particularly useful in shoulder, groin, and lower-back your right hand to rest on the ball. Supporting your weight on your
pain rehabilitation. Begin with a wobble board and, as knees and your right hand, hold, and relax, before switching hands.
your strength and balance improves, progress through to
Level 2 of the movement. Once you have mastered that, Keep your right
work through Levels 13 using a Swiss ball (see right). shoulder relaxed
Keep your
chest high
Level 2: Kneel with your feet slightly apart and the Swiss ball in
front of you. Lean forward to rest both your hands on the ball,
then raise your whole body up into a plank, supporting your
weight on your arms and toes. Hold, then relax.
Keep your spine
neutral and in line
with your head
1 Stand on your
left leg, using it
to support your
2 Stretch your
right foot out
in front to 12
3 Point your foot toward
3 oclock, between 4 and
5 oclock, and straight behind
body weight. oclock, pointing you to 6 oclock, returning to
Imagine there your toes and center between each move.
is a large clock bending your left Angle your leg behind you
on the ground knee to lengthen between 7 and 8 oclock,
and that your left your reach. Return then in front to the left to
foot is positioned to center and between 10 and 11 oclock.
in its center. stand tall. Now Switch legs and start again.
stretch your leg
Keep your hips between 1 oclock Feel the stretch in
aligned and Bend your your inner thigh
and 2 oclock. left knee
maintain a
stable position Stretch your leg
out straight
Keep your
head erect and
Maintain facing forward
an upright
posture
throughout
Keep your
weight on
the toes
of your
left foot
Bend your leg
at a right angle
PROGRESSION
Keep your
chest upright Once you have completed the drill on one
and arms leg, switch legs and work your way around
relaxed at the clock face as described here. Note that
your sides you will not be reaching toward 9 oclock
during the multidirectional lunge. As your
proprioception improves, you can move
on to performing the exercise standing on
Engage
a wobble board, and a BOSU.
your core
12 12
Stand
Take a deep breath tall
before starting
the exercise
Swing your
left arm back VARIATION
and right arm
forward When you have mastered this exercise, use
a step or bench with a greater height. You
Minimize any will need even more power to drive your
side-to-side body upward, so remember to push down
movement
with your right heel
and to use your
Your left right thigh and
knee makes
a 90-degree gluteal muscles to
angle at the lift your left leg
Contract your top of the up and through.
right gluteal, movement Another option
hamstrings, and is to step onto
quadriceps an unstable
surface, such
as a BOSU
or wobbleboard.
Keep your
scapula
at against
Keep your your back
shoulders level
Maintain a xed
position to ensure
Keep scapula at that your shoulder
against your back does all the work Keep your
scapula at
against
your back
Move the Swiss
ball vertically
1 Stand facing a wall with your left hand on your hip and
your right arm straight out in front of you. Gently hold a
Swiss ball against the wall with the palm of your right hand.
2 Keeping your right arm straight, now use your shoulder
to move the ball from side to side as though drawing
a cross. Repeat both movements with your left arm.
Keeping your arm straight, raise and lower your shoulder to
move the ball up and down in a straight line.
252 T R E AT M E N T A N D R E H A B I L I TAT I O N
Quickly
accelerate
PROPRIOCEPTION EXERCISES 253
149c FIGURE-EIGHT DRILL
This drill requires speed, spatial awareness, and quick turns suitable for sports that involve sudden changes of direction,
gaining confidence in cutting and turning is crucial to safe such as rugby, soccer, and tennis. You will need to adapt the
return to play after any leg injury. This drill is particularly distances to your chosen sport.
sprint 16 ft (5 m) to touch
cone C. Turn at cone C,
sprint forward 33 ft (10 m) C
to touch cone D, then turn
and sprint the final 16 ft
(5 m) to touch cone A. Rest D 33ft
and repeat as required. (10m)
16
(5m f t
)
E
)
0m
t (2
C 6 6f
PLYOMETRIC EXERCISES
Plyometric exercises are based on a range often involve stretching and contracting
of movements that work to increase your your muscles to build a combination of
speed, power, and flexibility, and are ideal strength, responsiveness, and explosive
for the vast majority of sports. The exercises power in your body.
Keep your
knees rm but
not locked
Stay on tiptoes
throughout
1 Engaging your
core, raise
your left knee
2 Step forward
with your left
leg under control
as high as you and bring your right
can and swing arm down. Raise
your right arm your right knee
up, hand balled and left arm and
in a loose fist. move forward.
Repeat as required.
Keep your
Keep your feet at supporting
on the ground leg straight
P LY O M E T R I C E X E R C I S E S 255
152 STRAIGHT-LEG CIRCLES-IN
This plyometric drill works your calf muscles and Achilles your hips. Again, as you improve you can increase
tendons, while also beginning to engage the rotation of the speed at which you perform the drill.
1 Imagine a straight
line. Stand with both
feet on the line, your
2 Walk forward by swinging
your right foot out and
then inward in a circular
3 Step off with the toes of
your left foot, swinging
your left leg outward at your
4 Bring your left leg inward,
returning your foot to the
central line. Continue.
right leg behind you. motion, and back to the line. hip joint.
1 Imagine two
parallel lines
in front of you.
2 Move forward by
swinging your left
leg inward and then
3 Flex your
right leg,
swinging it in
4 Bring your
right leg
outward and
outward, landing your toward you. onto the
left foot on the left right parallel
parallel line. line to finish
Keep your the move.
arms loose Repeat.
at your sides Maintain an
upright posture
Keep your
knees rm
but soft
1 Keeping your
legs straight
throughout,
2 Landing on
your toes,
immediately
3 Swing your
left leg forward
in a long stride,
swing your right push off with using your right
leg up and take your left foot. arm for balance
a long stride if necessary.
forward. Repeat the
sequence for
the required
Keep your distance.
hips aligned
Take the
impact
evenly in
both legs
Bend your
knees to
prepare
Tuck your
feet together Land rmly
on both feet
Disperse the
impact through
Press your your hips
feet together
Land rmly
on both feet
Land on stiff,
Press bent knees
your feet
Bend your together
knees in
preparation
Stand with
your feet
shoulder-
width apart
P LY O M E T R I C E X E R C I S E S 259
160 BOX JUMP-DOWN
This drill requires good strength in your quadriceps and exercise that you should only attempt once you can
hamstrings in order to control your knees. It is an advanced perform box jump-ups (see opposite) without pain.
1 Stand on a high
box with your
feet shoulder-width
2 Push up off the
box, bending
through your hips,
3 Land on the floor,
keeping your knees
soft and using your
apart and your arms knees, and ankles. arms to balance
hanging loose by yourself. Return to
your sides. the start position.
Swing your
arms forward
to aid your
momentum
Bend your
knees before
the jump
Land on stiff,
bent knees
161 BOUNDING
This advanced exercise helps improve your explosive power sudden bursts of speed or activity. It requires high levels
and acceleration, making it good for sports that require of control and whole-body coordination.
TESTING EXERCISES
Testing exercises are a useful means of proprioception during the rehabilitation
monitoring the rate of your recovery and process. They enable your physical therapist
the development of your power, speed, to assess your progress and identify areas
reach, range of motion, balance, and for improvement.
Swing your
Plant your legs through
feet rmly on to drive your
the ground body forward
Bend your
knee at a
right angle
Stick to
the ground
Land
with your Land
Push off your knees rmly
foot as soon rm but on your
as you land bent nal hop
Side-step to
A cone B, still
facing forward
Keep high
on your toes Run backward,
when running counting the
backward cones, to cone A
GLOSSARY
Abductor A muscle that functions to pull a limb Bone density The amount of bone tissue in a Explosive power The maximum power you have,
away from your body. given volume of bone. applied in a short burst.
Achilles tendon A long tendon in your body that Bursa A sac of uid found around most joints Extensor A muscle that works to increase the angle
attaches your calf muscles to your heel bone. of the body. It reduces friction, allowing joints at a jointfor example straightening your elbow.
to move freely. The plural of bursa is bursae. It usually works in tandem with a exor.
Active range of motion During rehabilitation,
the movements you are able to make yourself Bursitis Inammation of the bursa, making Fracture A break in a bone, ranging
using muscle strength, as opposed to your movement of the joint to which it is attached from minor cracks to serious breaks into
passive range of motion. difcult and painful. separate fragments.
Acute Happening quickly or lasting for a short time. Cable pulley machine A resistance training Flexor A muscle that works to decrease the
machine in which various attachments, such as a angle at a jointfor example bending your elbow.
Adductor A muscle that functions to pull a limb
bar, handle, or rope, can be linked to weights by a It usually works in tandem with an extensor.
toward your body.
cable. Force is transferred via a pulley or system of
Form The posture or stance used when performing
Aerobic A process that requires oxygen. Aerobic pulleys. These machines are designed to provide
exercises. Good or proper form makes the exercise
metabolism occurs during long-duration, low- continual resistance throughout the full range of
more effective and helps prevent injury.
intensity exercises, such as long-distance running motion of the exercise.
and swimming. Free weight A weightusually a barbell or
Cardiac muscle A type of involuntary muscle
dumbbellnot tethered to a cable or machine.
Alternating grip A grip on a bar in which one found in the walls of your heart.
palm faces toward your body, the other away. Head (of a muscle) The point of origin of
Chronic Persists for a long time.
This grip prevents a loaded bar from rolling in a muscle.
your hands and is recommended when working Clean In weight lifting, a single explosive movement
Hernia Occurs when an organ protrudes through
with very heavy weights. used to lift the weight to shoulder height.
the wall of, for example, the muscle that holds it.
Anaerobic A process that takes place without Cool-down A period after completion of your
Hook grip A method of holding a barbell
oxygen. Anaerobic metabolism occurs during main training session that includes activities such
where the ngers cover the thumb, which helps
short-duration, high-intensity exercises, such as slow jogging, walking, and stretching of your
maintain control of the weight.
as weight lifting and sprinting. major muscle groups. It is designed to help return
your body to its preexercise state. Impingement Pain resulting from rubbing
Analgesic medication Used to relieve or reduce
between the tendons of the rotator cuff in the
pain, this can be applied topically or administered Core The central part of the body, mainly the
shoulder, often caused by inammation forcing
by tablet or injection. Different medications have stomach and lower back muscles, but also
them against each other.
different functions, for example reducing pain by including the pelvis, chest, and upper back.
reducing inammation, but all produce the result of Isometric A form of training in which your muscles
Corticosteroids Hormones applied via
limiting your experience of pain in the body. work but do not contract signicantly, such as when
injection, cream, or tablets, for example to
pushing against an immovable object.
Antagonistic muscles Muscles that are arranged in reduce inammation.
pairs to carry out exion and extension of a joint; Isotonic A form of training in which your
CT scan Stands for X-ray Computed Tomography.
for example, one muscle of the pair contracts to muscles work against a constant resistance, so
This type of scan builds a 3D picture of the
move a limb in one direction, and the other that the muscles contract while the resistance
body by taking two images and putting them
contracts to move it in the opposite direction. remains the same.
together digitally.
Anterior The front part or surface, as opposed ITB (Iliotibial Band) A tough group of bers
Dislocation Usually caused by a blow to a joint,
to posterior. running along the outside of your thigh that
which then becomes detached from its setting.
primarily works as a stabilizer during running.
Barbell A type of free weight made up of a bar
Displaced fracture An injury where the two
with weights at both ends, which is long enough Lactic acid A waste product of anaerobic respiration.
parts of a broken bone have pulled away from
for you to hold with at least a shoulder-width It accumulates in your muscles during intense
each other.
grip. The weights may be permanently xed exercise and is involved in the chemical processes
or removable. Drill Practice version of a skill required in sport, that cause muscular cramp.
usually repeated.
Baseline scores Measurements taken at the Lateral Positioned toward the outside of your
beginning of a process of training or physical Dumbbell A type of free weight made up of a body or a part of your body. Movement in the
therapy; these provide a control against which to short bar with a weight at each end. It can be lateral plane refers to a side-to-side movement.
judge levels of improvement. lifted with one hand.
Ligament A tough and brous connective tissue
Biceps Any muscle that has two heads or origins, Dynamic exercise Any activity in which your that connects your bones together at your joints.
but commonly used as shorthand for the biceps joints and muscles are moving.
Medicine ball A weighted ball for use in plyometric
brachii, which is located on your upper arm.
Erector A muscle that raises a body part. weight training. It can help to build explosive power.
GLOSSARY 265
Metabolism The sum of all your bodys Quadriceps Any muscle with four heads, but Spotter A training partner who assists you with a
chemical processes; it comprises anabolism commonly used to describe the large muscle at lift, providing encouragement and physical support
(building up compounds) and catabolism the front of your thigh. if necessary, for example intervening if you are
(breaking down compounds). about to fail the lift.
Range of motion (ROM) A term used in physical
Mineral Any one of many inorganic (noncarbon- therapy, this is the movements a particular joint is Sprain An injury sustained by a ligament that is
based) elements that are essential for normal capable of in every direction. Limited ROM means overstretched or torn.
body function and that must be included in that you are unable to use your joint as normal.
Stabilizers The muscles that help you to keep
your diet.
Regimen A regulated course of exercise and diet your balance while you are working a particular
Mobility exercise An exercise that helps designed to produce a predetermined result. muscle. Sit-ups, for example, primarily work the
you maximize the ease of use of your joints, stomach muscles but other muscles are also
Rehabilitation The process of recovering fully from
or helps a physical therapist assess your level working to stabilize you.
an injury, often with the assistance of professionals.
of rehabilitation.
Static exercise An exercise in which you hold one
Repetition (rep) One complete movement of a
MRI (Magnetic Resonance Imaging) A type of positionfor example, pushing against an
particular exercise, from start to nish and back.
scan that reads the molecular structure of the immovable object.
body to form an image to aid diagnoses. Resistance training Any type of training in which
Strain An injury to muscle bers caused by
your muscles work against resistance; the resistance
Neutral spine The position of the spine that is overstretching.
may be provided by a weight, an elastic or rubber
considered to be good posture. In this posture,
band, or your own body weight. Strength training A form of resistance training
the spine is not completely straight, but has
in which your aim is to build the strength of
slight curves in its upper and lower regions. Rest interval The pause between sets of an
your skeletal muscle.
It is the strongest and most balanced position exercise that allows muscle recovery.
for the spine and needs to be maintained in Subluxation Partial dislocation of a joint.
Rotator cuff The four musclesthe supraspinatus,
many exercises.
infraspinatus, teres minor, and subscapularisand Swiss ball A large, inatable rubber ball used
One-rep max The maximum amount of weight that their associated tendons that hold your humerus (the to promote stability during exercise. Also known
you can lift in a single repetition for a specic long bone of your upper arm) in place in your as an exercise ball.
weight-based exercise. shoulder joint and enable your arm to rotate.
Tear A rip in, for example, a muscle.
Rotator cuff injuries are common in sports that
Osteoarthritis A degenerative disease in which the
involve throwing motions. Tendinopathy Painful tendons, often resulting
body suffers a loss of cartilage, leading to stiff,
from overuse while doing repetitive actions.
painful joints. Rupture A major tear in a muscle, tendon, or
ligament. Organs can protrude through muscle Tendon A type of connective tissue that joins your
Passive range of motion The movements a
ruptures, producing hernias. muscles to your bones, thereby transmitting the
physical therapist or helper is able to make with
force of muscle contraction to your bones.
parts of your body while fully supporting the Set A specic number of repetitions.
weight of the body parts. Thoracic Relating to the chest area.
Shoulder girdle The ring of bones (actually an
Plyometrics Exercises that aim to improve the incomplete ring) at your shoulder that provides Triceps Any muscle with three heads, but
speed and power of movements by training an attachment point for the many muscles commonly used as shorthand for the triceps
muscles to contract more quickly and powerfully. that allow your shoulder and elbow joints brachii, which extends your elbow.
to move.
Posterior The back part or surface, as opposed Undisplaced fracture An injury in which cracks
to anterior. Skeletal muscle Also called striated muscle, may form in the bone but the parts of the bone
this type of muscle is attached to your skeleton do not separate.
Power The amount of force produced by a body
and is under voluntary control. Contracting your
movement in a given timea combination of VISA-P (Victorian Institute of Sport Assessment
skeletal muscle allows you to move your body
strength and speed. patellar score) A measure of patellar tness based
under control.
on a questionnaire.
Preexhaustion A form of training in which you
Slide-board A smooth board with adjustable
carry out a single joint exercise before a heavy Warm-up A series of low-intensity exercises that
bumpers at either end.
compound movement for that body part, thereby prepares your body for a workout by moderately
stressing the target muscle before you start to Smith machine A common piece of gym stimulating your heart, lungs, and muscles. These
work it properly. equipment made up of a barbell constrained within normally involve a combination of dynamic
sets of parallel steel rails that allow the motion of exercises and low-intensity cardiovascular work.
Proprioception The term used to describe the
the bar only in a limited vertical direction.
signals originating from joints, tendons, ligaments, Wobble board Circular in shape with a at
and muscles that is sent to the brain to provide Smooth muscle A type of muscle found in the top and hemispherical underside, this piece of
information about joint position, direction, walls of all the hollow organs of your body which equipment is used to promote good balance,
and pressure. is not under voluntary control. and to improve the stability of your core.
266 INDEX
INDEX
A sinus tarsi syndrome 153 B forearm fractures 8283
Awalk 254 sprain 14647, 153 back golfers elbow 7879
abs see also Achilles tendon; foot; cervical spine fracture 30 hip labral tears 100101
side plank 22627 heel; leg disks see disks (back) mallet nger 9293
single arm and leg raise 224 ankle, exercises lower back pain 18, 22, 24 rotator cuff injuries 22, 28,
Swiss ball arm push 224 A-walk 145, 147, 151, 254 sacroiliac joint dysfunction 26 7071
Swiss ball donkey 222 barbell squat 145, 147, 152, sacroiliac joint inammation shoulder bursitis 7273
Swiss ball jack-knife 39, 153, 192 6263 simple rib fracture 76
223 box jump 17, 258, 259 see also spine bat- and club-based sports,
Swiss ball twist 222 box stepup 21, 203 back, exercises exercises
see also chest; torso calf raise 147, 151, 153, 204 bridge 236 pec stretch 240
Achilles tendon dead bug 147, 225 chin-up 39, 47, 207 standing Y 215
damage 42 eccentric inversion 152, 204 dead bug 225 Swiss ball twist 222
Haglunds syndrome hops 33, 35, 145, 147, 257, extension hold 235 bench press, close-grip 218
15051 26162 four-point kneel 41, 247 bicycling 4243
retrocalcaneal bursitis jumps 147, 25660 hip wiper 234 collarbone fracture 6667
15051 knee-to-wall stretch 145, 243 hops 61, 63, 26162 collarbone joint injuries 6869
rupture 14041 kneeling superman 145, 147, jumps 61, 63, 25660 concussion 50
tear 17, 19, 20 22829 kneeling superman 19, 43, forearm fractures 8283
tendinopathy 140, 14243 lawnmower 145, 190 61, 63, 65, 22829 iliotibial band (ITB) syndrome
see also ankle; heel; leg movements 147, 179 lat foam roller 191 13233
Achilles tendon, exercises pilates reformer 147, 237 lat pull-down 63, 206 jaw fracture and dislocation 54
Awalk 141, 143, 254 push press 153, 238 lawnmower 190 piriformis syndrome 6465
barbell squat 143, 192 shuttle-run drill 147, 253 low row 209 wrist fracture 8485
calf raise 141, 204 single-leg squat 145, 193 McKenzie extension 61, 234 bicycling, exercises
dead bug 141, 225 single-leg stand 147, 246 one-arm row barbell good morning
eccentric calf drop 141, 143, step-up and hold 147, 250 overhead lunge 181 208
205 walking pop-up 145, 254 pike walk 47, 177 foam roller exercises 191
Frankenstein walk 141, arm prone plank 45, 225 kneeling superman 22829
177 fractures 30, 36, 40, 44, 8083 prone row 209 biodex machine test 125, 263
hops 141, 143, 151, 26162 humerus fracture 30, 8081 pull, horizontal 237 blisters, rst aid 165
lawnmower 143, 190 injury, rst aid 170 punch lunge 182 blood injuries 16, 18, 164, 16667,
lunge walk 143, 151, 180 lower arm fractures 32 push-up 22829 170
pilates reformer 141, 237 radius fracture 30, 36 rear lateral raise 215 BMX biking see bicycling
punch lunge 141, 182 sling, use of 170 seated pulley row 208 board-based sports 323
single-leg stand 141, 246 tendon inammation 20, 22, side plank 63, 22627 calf stretch 243
speed drill 143, 25253 40, 42 side-lying L 31, 41, 214 hand clock drill 248
straight-leg circle-in 255 ulna fracture 30, 36 single arm and leg raise 224 hops 26162
T-drill 141, 263 wrenching 16 single-leg deadlift 197 Lancelot stretch 244
T-test 141, 263 see also elbow; hand; shoulder; standing Y 23, 215 Swiss ball twist 222
adductor muscles wrist straight-leg deadlift 19, 197 bones, joints, and muscles, rst aid
strain 18, 24, 36 arm, exercises stride stretches 19, 244 17071
tendinopathy 104105 chin-up 39, 207 Swiss ball arm push 224 bounding 121, 259
adductor muscles, exercises close-grip bench press 218 Swiss ball curl-up 63, 221 box jump 25859
adductor lift 201 deadlift, single-leg 81, 197 Swiss ball jack-knife 39, 223 box step 203
adductor squeezes 103, 105, dumbbell bench press 81, 83, upper back stretch 240 and hold 250
199 210 badminton see racket-based sports boxing see combat sports
hip hitcher 186 hammer dumbbell curl 218 barbell breathing difculties 164, 167, 171
long-lever adductor drop 37, lawnmower 83, 190 good morning 208 bridge
103, 105, 199 medicine ball chest throw 81, jump squat 239 double- and single-leg 109
manual, short-lever 83, 216 lunge 194 isometric 220
103, 105, 198 pull, horizontal 237 pull, horizontal 237 single-leg 236
pulley exercises 103, 105, push-up 22829 push press 238 bruises (contusions)
201, 230233 scapular clock 81, 83, 251 squat 192 rst aid 165
skating slide-board 200 shoulder dump 81, 182 baseball see bat- and club-based and hamstring injuries 10809
stretch 242 standing Y 81, 83, 215 sports
altitude sickness 168 triceps push-down 217 basketball see net-based sports
ankle athletics see running bat- and club-based sports 223
fracture 17, 35, 36, 46, Aussie rules football see collision cheekbone fracture 53 C
14445 team sports elbow bursitis 77 calf
ligament sprain 17, 20, 30, AVPU scale and consciousness nger fracture and dislocation cramp 171
35, 36, 46 levels 17273 9495 injuries 13637
INDEX 267
strain 17, 42 9495 12021 E
see also leg hamstring injuries 108109 patellar dislocation 11415 elbow
calf, exercises hip fracture 9697 posterior cruciate ligament bursitis 77
box step 137, 203 hip labral tears 100101 (PCL) injury 12829 dislocation 82
calf drop, eccentric 137, 205 metacarpal fracture 91 quadriceps injuries 11011 humerus fracture 30, 8081
carioca sidestep 137, 188 metatarsal fracture 158 sciatica 18 tendon injuries 7879
dead bug 137, 139, neck strain and whiplash 5657 toe fracture 159 tennis elbow 22, 24, 28, 38,
225 neck stretch syndrome 58 trochanteric bursitis 9899 7879
pike walk 47, 177 osteochondritis dissecans upper arm fracture 8081 throwers elbow 7879
raises 137, 204 12021 contact team sports, exercises see also arm
stretch 243 posterior cruciate ligament deadlift, straight-leg 197 elbow, exercises
walking pop-up 135, 145, 254 (PCL) injury 12829 gure-eight drill 253 dead bug 79, 225
canoeing see water sports quadriceps injuries 11011 kneeling superman 22829 dumbbell bench press 79, 210
carioca sidesteps 188 sacroiliac joint inammation stride stretch 244 eccentric wrist extension 79,
carpal tunnel syndrome 24, 38, 90 6263 T-drill 263 219
wrist rotation 176 shoulder joint injuries 7475 T-test 263 four-point kneel 77, 79, 247
cat and camel 190 simple rib fracture 76 contusions see bruises (contusions) medicine ball chest throw 77,
chest toe fracture 159 CPR (resuscitation) 164, 173 79, 216
punctured lung 44 tongue, bitten or swallowed cramp 171 side-lying L 79, 214
ribs see ribs 55 cricket see bat- and club-based single-leg squat 79, 193
chest, exercises upper arm fracture 8081 sports Swiss ball donkey 77, 222
dumbbell bench press 210 wrist fracture 8485 curl-up 221 environmental injuries 16869
medicine ball chest throw 216 collision team sports, exercises cuts and grazes, minor, rst aid 165 equestrian sports 4445
pec stretch 23, 240 box jump 25859 collarbone fracture 6667
push-up 22829 gure-eight drill 253 collarbone joint injuries 6869
wall sit press 185 power clean 23839 hip fracture 9697
chin-up 207 shuttle-run drill 253 D sacroiliac joint inammation
clam 187 wall sit press 185 de Quervains syndrome 8889 6263
climbing see extreme sports combat sports 3031 dead bug 225 equestrian sports, exercises
cold injuries 168 cheekbone fracture 53 deadlift Lancelot stretch 244
collarbone collarbone joint injuries 6869 Romanian 196 prone plank 45, 225
acromioclavicular joint injuries hip labral tears 100101 single- and straight-leg 197 side plank 22627
32, 44, 46 jaw fracture and dislocation 54 dehydration 169, 171 extreme sports 4647
dislocation 34 metacarpal fracture 91 dinghy sailing see water sports altitude sickness 168
fractures 16, 34, 42, 44, 46, 6667 neck strain and whiplash 5657 disks (back) bowstring injury 9293
joint injuries 16, 18, 32, 44, push press 238 degeneration 22, 28, 40, 42, 44 cold injuries 168
46, 6869 side-lying L 214 herniated 26, 40, 46 jaw fracture and dislocation 54
see also shoulder tongue, bitten or swallowed 55 injury 16, 38, 44 pike walk 177
collarbone, exercises walking kick-out 185 nerve irritation 38 eye injuries 40, 166
dumbbell bench press 67, 69, concussion 16, 18, 22, 30, 32, 36, prolapsed 28
210 40, 42, 44, 46, 50 slipped 18, 6061
four-point kneel 67, 247 contact team sports 1819 see also back; spine
lawnmower 69, 190 Achilles tendinopathy 14243 disks (back), exercises F
low row 69, 209 Achilles tendon rupture 14041 A-walk 61, 254 face see head and face
medicine ball chest throw 67, ankle fracture 14445 Bulgarian dumbbell split squat fencing see combat sports
69, 216 anterior cruciate ligament 61, 194 eld hockey see contact team
punch lunge 69, 182 (ACL) injury 33, 12425 dumbbell bench press 61, 210 sports
scapular clock 67, 251 calf injuries 13637 hip hitcher 61, 186 gure-eight drill 253
shoulder dump 69, 182 carpal tunnel syndrome 24, lunge walk 61, 180 ngers
shoulder isometrics 67, 212 38, 90 McKenzie extension 61, 234 dislocations 16, 18, 20, 30, 36,
side-lying L 67, 214 collarbone fracture 6667 neural glide 61, 188 40, 42, 9495
sleeper stretch 69, 245 collateral ligament injuries side plank 61, 22627 fractures 16, 18, 20, 32, 36, 42,
standing Y 69, 215 12627 Swiss ball curlup 61, 221 46, 9495
collision team sports 1617 elbow bursitis 77 dislocations, rst aid 170 mallet nger 9293
ankle fracture 14445 nger fracture and dislocation diving see swimming-based sports mallet nger and fracture
anterior cruciate ligament (ACL) 9495 dodgeball see contact team sports 9293
injury 33, 12425 forearm fractures 8283 dressage see equestrian sports numbness in 58
calf injuries 13637 groin strain 104105 drowning 168 tendon injuries 9293
carpal tunnel syndrome 24, hamstring injuries 108109 dumbbell see also hand; thumb
38, 90 hernia 106107 bench press 210 ngers, exercises
cheekbone fracture 53 hip fracture 9697 Bulgarian dumbbell split squat dumbbell bench press 95, 210
collarbone fracture 6667 hip labral tears 100101 194 four-point kneel 93, 95, 247
collarbone joint injuries 6869 leg fracture 45, 13435 eccentric wrist extension 219 mini trampoline throw 95, 216
collateral ligament injuries meniscus tear 13031 hammer dumbbell curl 218 push press 93, 238
12627 metatarsal fracture 158 incline dumbbell bench press shoulder isometrics 95, 212
concussion 50 osteitis pubis 102103 210 rst aid 16473
nger fracture and dislocation osteochondritis dissecans shoulder press 211 ossing 188
268 INDEX
four-point kneel 59, 247 push-ups 103, 22829 disorders 8889 osteitis pubis 102103
manual isometrics 57, 59, 220 side plank 103, 22627 racket-based sports, exercises piriformis syndrome 6465
rotation 57, 174 single arm and leg raise 224 barbell lunge 194 retrocalcaneal bursa 150
scapular circle 57, 59, 251 single- and double-leg squats gure-eight drill 253 shin splints 138
shoulder rotation 57, 175 103, 193 lawnmower 190 sinus tarsi syndrome 153
side exion 57, 59, 174 skating slide-board 103, 200 sleeper stretch 245 tibialis posterior tendinopathy
Swiss ball arm push 224 slide-board 103, 200 T-drill 263 152
torso rotation 57, 176 standing gluteal 37, 243 raises, arm and leg 193, 224 trochanteric bursitis 9899
net-based sports 2021 Swiss ball arm push 224 real tennis see racket-based sports running, exercises
Achilles tendinopathy 14243 T-drill 103, 263 recovery position 17273 barbell squat 192
nger fracture and dislocation T-test 103, 263 resuscitation (CPR) 173 gure-eight 123, 127, 137,
9495 pike walk 47, 97, 101, 129, 177 ribs, 253
hamstring injuries 108109 pilates, dead bug 225 bruising and fractures 30, 44 foam roller exercises 191
hip fracture 9697 pilates reformer 237 standing Y 77, 215 single-leg squat 193
meniscus tear 13031 plank see also chest
patellar tendinopathy 12223 prone 225 RICE procedure 170
rotator cuff injuries 7071 side 22627 road racing see cycling
net-based sports, exercises polo see equestrian sports robbery 183 S
lunge walk 21, 180 power cleans 23839 rockclimbing see extreme sports scapular circle, clock and cross
medicine ball chest throw press-up 184 roller-blading and skating see 251
216 pulley skate-style sports scarecrow rotation 213
rotational lunge 181 chops 23031 Romanian deadlifts 196 scarf stretch 240
netball see net-based sports dynamic hug 214 rotator cuff sciatica 18, 26, 6061, 6465
neural glide 188 hip extension 202 impingement syndrome 7273 Bulgarian dumbbell split squat
nose bleeds 165 internal rotation 213 inammation 20, 7273 194
lifts 23233 injuries 22, 28, 7071 dumbbell bench press 210
scarecrow rotation 213 tears 16, 23, 24, 36, 40, 42 and hamstring syndrome 108
seated pulley row 208 tendinopathy 7071 hip-hitchers 186
O punctured lung 44 see also shoulder lunge walks 180
OsgoodSchlatter syndrome 12223 push rotator cuff, exercises McKenzie extension 234
press 238 dumbbell bench press 71, 210 neural glide 188
push-up 22829 eccentric drop-catch 217 side plank 22627
push-up plus 183 internal rotation 213 Swiss ball curl-up 221
P triceps push-down 217 kneeling superman 71, 22829 sculling see water sports
parkour see extreme sports lawnmower 190 shock treatment 167
pec stretch 240 medicine ball chest throw 71, shoes, badly-tting see trainers,
pelvis 216 badly-tting
dislocation 30 Q mini trampoline throw 216 shoulder
inammation 36 quadriceps push-up 71, 22829 acromioclavicular joint fracture
osteitis pubis 18, 36, 102103 injuries 42, 11011 scapular clock 71, 251 44
pain 26 strain 17, 18, 26, 42 scarecrow rotation 213 acromioclavicular joint
see also groin; hip tear 20, 26 shoulder dumps 71, 182 separation 32, 46
pelvis, exercises see also thigh shoulder isometrics 71, 212 bursitis 20, 22, 24, 28, 7273
A-walk 103, 254 quadriceps, exercises side-lying L 71, 214 dislocation 18, 31, 32, 36, 40,
adductor manual, short-lever box jump-down 259 sleeper stretch 71, 245 42, 46, 7475
103, 198 box steps 203 standing Y 71, 215 frozen 7273
adductor pulley exercise 103, stretch 35, 243 rounders see bat- and club-based impingement 20, 24, 28, 40,
201 3-point quad stretch 241 sports 7273
barbell squat 103, 192 row joint inammation 7273
carioca sidestep 103, 188 one-arm 206 joint injuries 7475
clam 187 prone 209 posterior/anterior dislocations
curl-up 61, 63, 103, R seated pulley 208 30
221 racket-based sports 2425 rowing see water sports rotator cuff see rotator cuff
dead bug 103, 225 ankle fracture 14445 rugby league and union see sternoclavicular joint injuries
deadlift, Romanian 103, 196 carpal tunnel syndrome 90 collision team sports 30
deadlift, straight-leg 103, 197 elbow bursitis 77 running 2627 subluxation 22, 7475
dumbbell bench press 103, nger fracture and dislocation calf injuries 13637 tendon inammation 38
210 9495 collateral ligament injuries see also collarbone
extension hold 103, 235 forearm fractures 8283 12627 shoulder, exercises
hamstring lower, Nordic 103, groin strain 104105 compartment syndrome 139 box step-up 73, 203
202 hernia 106107 foot tendon injuries 15455 chin-up 207
hip wiper 234 hip labral tears 100101 heel bone fracture 14647 dead bug 225
hip hitcher 63, 186 impingement syndrome 7273 hypothermia and marathon dumbbell bench press 73, 75,
isometric adductor squeezes rotator cuff, injuries 7071 runners 168 210
103, 199 shoulder bursitis 7273 iliotibial band (ITB) syndrome dumbbell shoulder press 211
kneeling superman 103, tennis elbow 7879 13233 dynamic hug 214
22829 wrist and hand tendon metatarsal fracture 158 eccentric drop-catch 217
INDEX 271
lat pull-down 206 and foot tendon injuries extension hold 235 W
lawnmower 73, 75, 190 15455 four-point kneel 247 walking
low row 209 patellar dislocation 11415 jack-knife 223 kick-out 185
medicine ball chest throw plantar fasciitis 160 roll-out 223 lunge 180
21, 75, 216 and retrocalcaneal bursa scapular clock/circle/cross pop-up 254
onearm row 206 150 251 resisted lateral 189
overhead lunge 181 snowboarding see board-based twist 222 retrocalcaneal bursa 150
pec stretch 73, 240 sports sideways 189
pike walk 47, 177 soccer see collision T wall sit press 185
press-up 184 team sports T-drill 263 warm-up and cool-down see
pulley chop 23031 softball see bat- and club-based T-test 263 individual sports
pulley lift 23233 sports table tennis see racket-based water polo see swimming-based
punch lunge 182 speed drills 25253 sports sports
push-up 22829 speed-skating see skate-style taekwando see combat sports water sports 389
push-up plus 183 sports tennis see racket-based sports carpal tunnel syndrome 90
rear lateral raise 215 spine tennis elbow 22, 24, 28, 38, 7879 drowning 168
robbery 183 cervical spine fracture 30 thigh hip labral tears 100101
rotation 175 disks see disks (back) cramp 171 iliotibial band (ITB) syndrome
scapular clock 73, 75, 251 fractures 24, 36 femur fracture 46 13233
seated pulley row 208 injury, rst aid 171 iliotibial band (ITB) syndrome piriformis syndrome 6465
shoulder dump 75, 182 sacroiliac joint inammation 13233 simple rib fracture 76
shoulder isometrics 75, 212 26, 6263 iliotibial band tightness 26, Swiss ball jack-knife 223
shrug from hang 211 spinal cord damage 44 43, 99 wrist and hand tendon
side-lying L 31, 41, 214 see also back see also leg, upper disorders 8889
sleeper stretch 73, 245 spine, exercises thigh, exercises waterskiing see ski-based sports
standing Y 73, 75, 215 adductor lift and pulley 201 barbell squat 111, 192 weightlifting and powerlifting
Swiss ball arm push 224 barbell, good morning 208 box step-up 111, 203 2829
Swiss ball roll-out 223 bridge 236 Bulgarian dumbbell split squat Achilles tendon rupture 14041
wall sit press 185 ossing 188 194 calf injuries 13637
window-wiper 184 kneeling superman 22829 multi-directional lunge 99, 249 neck nerve injuries 5859
show-jumping see equestrian neural glide 188 overhead lunge 181 slipped disk and sciatica 6061
sports overhead lunge 181 rotational lunge 181 wrist and hand tendon
shuttle-run drill 253 pulley chops 23031 walking lunge 180 disorders 8889
side pulley lifts 23233 throwers elbow 7879 weightlifting and powerlifting,
plank 22627 wall sit press 185 thumb exercises
side-lying L 214 sprains and strains, rst aid 170 de Quervains syndrome hamstring lower 187
stretch 244 sprinting see running 8889 Romanian deadlift 196
sinus tarsi syndrome 153 squash see racket-based sports fractures 22 whiplash 32, 36, 42, 44, 46
skate-style sports 36 7 squat 180 intersection syndrome 8889 whitewater rafting see water sports
forearm fractures 8283 barbell 192 see also ngers; hand window-wiper 184
sacroiliac joint inammation Bulgarian dumbbell split squat toes windsurng see board-based sports
6263 194 fracture 159 wounds see blood injuries
wrist fracture 8485 single- and double-leg 193 strain 17 wrestling see combat sports
skate-style sports, exercises single-leg decline 198 see also foot wrist
long-lever adductor drop stand, single-leg 12531, 147, 246 tongue, bitten or swallowed 55, avascular necrosis 84
199 standing Y 215 172 carpal tunnel syndrome 24,
multi-directional lunge 249 stationary superman 186 torso 38, 90
standing gluteal 243 steeplechase see equestrian sports abdominals see abs dislocation 16, 18, 20, 30, 36,
skateboarding see board-based step-ups see box steps pulley chop 23031 40, 42, 82
sports straight-leg circles, in and out pulley lift 23233 fractures 16, 18, 20, 32, 36, 42,
ski-based sports 3435 255 punch lunge 182 46, 8485
cold injuries 168 straight-leg scratch 256 rotation 176 inammation 46
joint injuries 6869 stride stretch 244 side plank 45, 22627 ligament strain 38
sacroiliac joint inammation sunburn 169 Swiss ball twist 222 muscle strain 44
6263 surng see board-based sports see also chest scaphoid fracture 84
wrist and hand tendon swimming-based sports 4041 track cycling see cycling strain 20, 32, 46
disorders 8889 elbow bursitis 77 tendon disorders 8889
ski-based sports, exercises impingement syndrome tendon strain 38
hops 26162 7273 wrist, exercises
Lancelot stretch 244 neck strain and whiplash U dumbbell bench press 85, 89,
Nordic hamstring lower 202 5657 unconsciousness 17273 210
skull fracture 22, 32, 34, 36, 46 rotator cuff, injuries 7071 eccentric wrist extension 219
see also head and face side-lying L 214 mini trampoline throw 85,
sky-diving see extreme sports Swiss ball 89, 216
sleeper stretch 245 arm push 224 V rotation 176
slide-board 200 curl-up 221 volleyball see net-based scapular circle 85, 89, 251
sneakers, badly tting donkey 222 sports shoulder isometrics 89, 212
272 ACKNOWLEDGMENTS
ACKNOWLEDGMENTS
ABOUT THE Dr. Ritan Mehta is a Registrar on the PUBLISHERS
SAFETY INFORMATION
CONTRIBUTORS Specialist Training program in Sports and ACKNOWLEDGMENTS
Exercise Medicine in London, England,
All physical activity involves
Dr. Ian Beasley is Head of Medical and Club Doctor for Barnet Football Many thanks to the following people
some risk of injury. Participants
Services for the English Football Club. He is also a general practitioner and organizations for their generous
must therefore take all
Association, and the senior England with a special interest in Musculoskeletal help in producing this book. reasonable care during their
soccer team. He has worked for a Medicine and Rheumatology. training, and on the eld of play.
number of soccer clubs in all the For modelling: Scott Tindal; Any individual who is intending
senior English divisions, and at major Dr. James Noake is a Specialist Mary Paternoster; Gareth Jones; to start a new sporting activity
tournaments, such as the Olympic Registrar trainee in Sports and Exercise Sam Bias Ferrar; Chris Chea; Michelle or exercise program should
and Commonwealth Games. He is Medicine (London Deanery), and Grey; Anouska Hipperson; Sean always seek professional
based in London, England. gained an MSc SEM in 2006/07. Newton; Caroline Pearce; Rufus medical advice before they
begin. Any treatment or
Shosman; and William Smith.
rehabilitation program should
Dr. Colin Crosby is Medical Director Dr. Gary ODriscoll is Club Doctor
always be carried out under the
of the Department of Sports and for Arsenal Football Club. He was For use of facilities: Fit Club,
guidance of the appropriate
Exercise Medicine at The Garden also Doctor to the Ireland rugby union Wymondham, Norfolk, England; professionals. Users of this
Hospital, London, England, and team and the last two British Lions Jackie Waite and the staff at Woking book should not consider the
Treasurer and Past President of rugby union tour. Leisure Center & Pool in the Park, information it contains as a
the Sports and Exercise Section England; and Karen Pearce and the substitute for the advice of
of The Royal Society of Medicine. Filippo Spiezia is a fourth-year staff at Fenners Fitness Suite at the medical professionals and
resident in Trauma and Orthopedic University of Cambridge, England. accredited physical therapists.
Dr. Geoff Davies is a Wales-based Surgery at Universit Campus
The publishers of this book,
Sports Physician who provides Bio-Medico, Rome, Italy. He has a For additional material and assistance:
and its contributors, are
clinical services to both the NHS special interest in Sports Trauma. Derek Groves; Glen Thurgood; Len
condent that the exercises
and the UK Ministry of Defence. Williams; the British Weightlifting described herein, when
He is also Sports Physician to the Dr. Richard Weiler is a Specialist Association (BWLA); Hannah Bowen; performed correctly, with
Cardiff Blues and Wales Under-18 Registrar in Sports and Exercise Cressida Tuson; Ruth ORourke-Jones; gradual increases in resistance
rugby union teams. Medicine at Imperial College Constance Novis; Heather Jones; and proper supervision, are
Healthcare NHS Trust, Charing Jemima Dunne; and Mary Allen. safe. However, readers of this
Prof. Lennard Funk is an Cross Hospital, London, England. book must ensure that the
Orthopedic Surgeon at He also works with the England Many thanks to all the illustrators equipment and facilities they
use are t for purpose, and
Wrightington Hospital, Lancashire, soccer and British Paralympic teams. who worked so hard throughout
they should adhere to safety
England, and Professor at Salford the project: Philip Wilson; Debbie
guidelines at all times. They
University, England. He lectures Chris Lendrum is a practicing physical Maizels; Mark Walker; Mike Garland;
should also ensure that
widely on shoulder surgery, sports therapist at Kensington Physiotherapy, Darren R. Awuah; Debajyoti Dutta; supervisors have adequate
injuries, and medical informatics. London, England, with interests in Richard Tibbitts (Antbits Illustration); insurance and relevant, up-
shoulder and spinal rehabilitation. A Jon Rogers, Phil Gamble; and to-date accreditations and
Dr. Peter Gerbino is a Fellow of the Member of the UK Chartered Society of Joanna Cameron. Thank you also to qualications, including
American Academy of Orthopedic Physiotherapists, he also holds a diploma Margaret McCormack for indexing. emergency rst aid.
Surgeons. He is a team physician in Personal Training and Sports Massage.
for the US gure-skating team and PICTURE CREDITS The publishers, medical
consultants, consultant editors,
has provided medical care for many The publisher and consultant editors
and contributing authors
other top US athletes. He is based would also like to thank the following Thank you to the following
of this publication take no
in Monterey, California. individuals for their contributions: agencies and individuals for their responsibility for injury to
Dr. Jane Dunbar; Dr. Eric N. Dubrow; kind permission to use their persons or property consequent
Dr. Joanne Larkin is a Specialist Dr. Graham Jackson; Dr. David photographs as reference: on embarking upon the
Registrar trainee in Sports and Lloyd; Dr. Kalpesh Parmar; Mr. Ron Getty: 002-003c; 048-049c exercises and treatments
Exercise Medicine (London McCulloch; Dr. Richard Smith; Biodex Medical Systems, Inc.: 263b described herein.
Deanery), undertaking an MSc Mr. Andy Williams; Graham (photo courtesy of Biodex Medical
in SEM at Bath University, England. Anderson; and Paula Coates. Systems, Inc.)