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 morbidity 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 that may 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, athletes 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 known 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 shinbone 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-inflammatory 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 pelvic bones) comes to a dramatic edge. When this area receives a blow, there is a knifelike effect that is largely responsible for the injury. Not only is the soft tissue compressed between the offending object and the iliac spine, but also the pelvis is bruised itself. As with other contusion, 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 difficulty 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, 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 specialist is recommended.