American Chiropractic Association
Participation in sports or exercise is an important step
in maintaining your health. Exercise strengthens your
heart, bones, and joints and reduces stress, among
many other benefits. Unfortunately, however, injuries
during participation in sports are all too common. Often,
these injuries occur in someone who is just taking up
sports as a form of activity, doesn’t use proper safety
equipment, or becomes overzealous about the exercise
The more commonly injured areas of the body are the
ankles, knees, shoulders, elbows, and spine.
Remember that you should discuss any exercise program
with your doctor of chiropractic before undertaking
Strains and Sprains
Although bones can sometimes be fractured with acute
sports injuries, the most commonly injured structures
are the muscles, tendons, and ligaments. Tendons
attach muscles to bones, and ligaments attach one
bone to another.
An acute twisting or overextension of a joint can lead to
tears of muscles and tendons, called “strains,” and
tears of ligaments result in “sprains.” These tears range
from mild to severe. In mild injuries, just a few fibers are
torn or stretched. Severe injuries, where there is a tear
through the full thickness of the structure, are most
often considered unstable injuries and frequently require
surgical intervention. The intervertebral disc, a ligament
between the vertebrae of the spine that works as a
shock absorber, can also be torn, resulting in a disc
bulge and/or herniation.
Ankle sprains most often involve tears of one or more of
the ligaments along the outside of the ankle. Knee ligaments,
including the larger external supportive ligaments
and the smaller internal stabilizing ligaments, can
also be torn. The cartilage on the back of the patella
(knee-cap) can also become eroded from overuse, leading
to a condition termed chondromalacia patella.
In those who are training too much, overuse of a particular
These injuries are called “overuse syndromes.”
A common overuse injury is tendinosis, also called tendinitis.
In this condition, the tendon becomes inflamed
from repetitive use. In the shoulder, the rotator cuff (a
complex of muscles that stabilizes and moves the
shoulder) becomes inflamed, resulting in rotator cuff
tendinitis. Tennis elbow is another form of tendinitis that
occurs along the outside of the elbow, most commonly
in tennis players. In golfer’s elbow, the tendons on the
inside of the elbow are affected.
Some athletes may experience a stress fracture, also
called a fatigue fracture. This type of fracture occurs
when an abnormal amount of stress is placed on a normal
bone. This might occur in a runner who rapidly
increases the amount of mileage while training for a
running as a form of exercise but overdo it from the
start, rather than gradually progress to longer distances.
One final common injury is worth mentioning, and that
is shin splints. This overuse injury is caused by
microfractures on the front surface of the tibia (shin
bone). This is most often seen in runners, although other
athletes can also be affected.
Diagnosis and Treatment
Sports injuries are most often diagnosed from the history
of the activity that brought on the pain, along with a
physical examination. In some cases, x-rays are necessary
to rule out a fracture. Magnetic resonance imaging
(MRI) and diagnostic ultrasound are also used in finding
soft-tissue injuries, like tendinitis and sprains.
Fractures require the application of some stabilizing
position. Rarely, surgical intervention is required. There
is a relatively standard treatment protocol for most of
the other overuse types of injuries. This protocol
involves the following:
Generally no more than 48 hours of rest and/or immobilization
is needed, depending on the severity of the
injury. In most cases, the sooner the person becomes
active after an injury, the more rapid is the recovery. In
fact, long-term immobilization can sometimes be harmful
to recovery. Your doctor of chiropractic will guide this
process, as too early a return to activity, choosing the
wrong type of activity, or excessive activity can be detrimental.
Ice or heat
Ice or heat can be helpful with pain reduction and tissue
Compression of the area may reduce the amount of
swelling from the injury. Your doctor of chiropractic will
determine if this will be beneficial in your case.
Elevation of the injured arm or leg above the level of the
heart is thought to be helpful in reducing swelling.
Recent research has demonstrated that some nonsteroidal
anti-inflammatory drugs may actually slow the
healing process by restricting the body’s natural healing
mechanisms, so they should be used sparingly.
Recent research has shown us that, in some cases, joint
manipulation can be helpful with pain reduction and
more rapid recovery. Your doctor of chiropractic will
determine if this procedure will be helpful in your case.
A Word AboutPrevention
In many cases, sports injuries can be prevented. Proper
conditioning and warm-up and cool-down procedures,
as well as appropriate safety equipment, can substantially
reduce injuries. Understanding proper techniques
can also go a long way toward preventing injuries.
Sufficient water intake is also an important preventive
Common Signs and Symptoms
of Sports Injuries
Fractures can be recognized by acute pain and tenderness,
along with swelling and possible bruising
over the fracture site, often with visible deformity of
the affected bone. It is a myth that if someone can
move the joint near the pain, there is no fracture.
Stress fractures generally result in a slower onset of
pain that is made worse with activity.
Strains most commonly cause pain at the site of the
injured tendon, particularly where it inserts into the
muscle or bone. The muscle itself may also be painful.
There may be some weakness and even muscle
spasm. Pain is most severe with movement of the
affected muscle or tendon. The area is also tender to
In sprains, pain and tenderness are felt over the
affected ligament. Swelling of the joint, along with
bruising, is also common, as is a reduced range of
joint motion. If there is excessive motion and/or a visible
deformity in the joint, this most often signifies a
more serious, full-thickness ligament tear.
Tendinitis causes pain, tenderness, and swelling over
the tendon, which is made worse by the motions that
stress the tendon. There is also generally restricted
range of motion, particularly in the direction of the
Chondromalacia patella results in knee pain, particularly
behind the patella, along with a grinding or grating
sensation. The pain is most often felt when running
on an incline.
For more information on prevention
and wellness, or to find a doctor of chiropractic
near you, go to the Patient
Information section on ACA’s Web site at
www.acatoday.org/Patients or call
703 276 8800.
Lawrence H. Wyatt, DC, DACBR, FICC, Writer
Nataliya Schetchikova, P hD,Editor