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In sports medicine, we often focus on the more severe
and “down time” injuries and neglect the smaller yet still
important injuries. Many
of these injuries are evaluated and managed not by sports
doctors but by coaches and trainers in the training rooms,
locker rooms, and field houses.
Although this is often appropriate, more complicated or
refractory cases demand the attention of a physician.
Milder collision injuries are often neglected and not
adequately treated in various sports.
Although there is rarely any long term morbitity from
this neglect, the effectiveness of the athlete can be severely
diminished. One of
the more common of these injuries is a contusion.
When people hear that they have a contusion, it is
frequently dismissed as “just a bruise”.
Although there are many such injuries that do not require
therapy or protection there exists the possibility with these
complaints to hamper the player’s season.
The first such injury is a soft tissue contusion.
These frequently occur in the larger muscle groups of the
arms and legs. The
triceps and quadriceps are probably the most commonly involved.
Obviously, the mechanism for this injury is a direct
blow. In the sports
medicine clinic a helmet to the extremity is many times to
blame.
In the absence of a confounding factor a soft tissue
contusion will always heal.
However, athetes who are susceptible to receiving this
sort of injury once are likely to re-injure themselves.
Blows to a previously injured muscle only add injury to
injury in a cycle that does not allow the muscle group to heal.
With only one common exception, when the insult to
the muscle stops the injury will heal.
However, if there is constant and recurrent injury, the
blood that accumulates can cause the development of calcium
deposits within the substance of the muscle.
This is know as myositis ossificans.
This can be a very difficult condition to treat.
The best way to deal with this complication is to
prevent it. After
receiving a significant soft tissue injury, that area must be
protected and allowed to heal.
Also, anti-inflammatory measures such as oral medications
and physical modalities may be used to help control swelling,
bleeding, and inflammation.
Another problem that can be mistaken for a small
injury is a bone bruise. These
occur where there is little soft tissue padding between the skin
and the bone. The
shin bone is a key site for this sort of injury.
After receiving a blow directly to a bone, there can
develop a collection of blood between the bone covering and the
bone itself. Although
not a fracture nor nearly that serious, a sub-periosteal
hematoma can be a very painful condition that can effectively
reduce an athlete’s competitiveness.
These must be treated aggressively if the goal is to
return the patient to competition soon.
The treatment for the bone bruise is essentially the
same as for the soft tissue injury.
Protection of the injured area and avoidance of further
collision is key. But,
as mentioned, this may be very difficult in athletics.
Also, the anti-inflamatory measures are often helpful
here as well.
One case involves significant damage to both the soft
tissue and the bone and is very common in football and other
sports. The common
name for this problem is known as a hip pointer.
A hip pointer results from a direct blow to the bony
pelvis. The spine
of the ileum (one of the pelvic bones) comes to a dramatic edge.
When this area receives a blow, there is a knife-life
effect that is largely responsible for the injury.
Not only is the soft tissue compressed between the
offending object and the iliac spine, but the pelvis is bruised
itself.
As with other contusions, this would heal if the
athlete were able to kick back, relax and baby his or her
injury. However,
this is rarely the case. Protection
and control of pain and inflammation play an important role
here. Protection of
this area is exceptionally difficult and sometimes requires a
healthy dose of ingenuity from the coach or trainer.
Although it is totally appropriate for athletes,
coaches, trainers and therapists to treat the minor bumps and
bruises encountered in sports medicine.
However, if the problem is more intense than usual, takes
too long to get better or if time is of the essence,
consultation with a sports medicine specialists is recommended.
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