The Book: Understanding Sports Injury: What Coaches and Athletes Need to Know

Are athletic injuries out of control?

It seems that injury is a fact of life for athletes and coaches. What can be done about this? What can you do? There is no shortage of advice regarding injury prevention—some measures are effective, but others are difficult, unproven and useless.

Discouraging maybe, but not hopeless.

Often it is possible to prevent making an injury worse. This requires recognition of the injury, an understanding of the potential consequences, and seeking appropriate care. In order to do this, an athlete or coach must have some practical knowledge the musculoskeletal system and the predictable patterns of injury.

My coauthor, an orthopedic surgeon, and I designed this book to make information accessible to athletes and coaches in a form that was understandable and useful:  principles of injury are explained;  medical terms are modified for ease of use;  text navigation is made easy by in-text cross references, an extensive glossary with pronunciation, a comprehensive index, and grouping of chapters by body region;  there are over 65 large, color, narrative drawings illustrating normal anatomy and injury.

A PREVIEW

Take a look at this is section dealing with one type of stress fracture excerpted from Chapter 6: Ankle and Foot.

STRESS  FRACTURE 

Stress fractures may occur in various bones of the foot: the long, thin metatarsal bones, the navicular (see Fig. 6-11), the fibula, the talus, the calcaneus, and the sesamoids (see Fig. 6-10).

These bones are subjected to the pounding forces generated by running and jumping; impact forces to the foot and leg can be several times an athlete’s own bodyweight. Track and field athletes, especially distance runners, and basketball players, most often develop these injuries.

Some fracture locations are considered more serious because their risk of poor healing is higher than at other locations.  Among foot and ankle stress fractures, these are (1)  the fifth metatarsal, (2)  the sesamoid bones, (3)  the talus, (4)  the tibia at the medial malleolus (see page 188) and (5)  the navicular bone. Surgery is more often required for these fractures.

Why does this happen?

A stress fracture is an overuse injury (see Chap. 1: Stress Fractures, page 9).  The stress of athletic training causes microscopic bone breakdown which will normally heal if given adequate recovery time. If there is not enough recovery time and the stress forces continue at frequent intervals, the damage accumulates and the micro-fracture enlarges. The eventual outcome can be a complete fracture.

There are several specific risk factors: arch extremes (too high or extremely flat), excessive eversion (pronation, see Fig. 6-4), previous foot fracture or ankle injury, intense training without adequate recovery  time, and the female triad (see Female Triad, page 182).

Navicular Bone

Track athletes and basketball players are especially prone to this injury. The navicular bone is a critical part of the foot arch and the transverse tarsal joint (see Fig. 6-11). It is subjected to large stress loads during push off and landing activities such as jumping and sprinting.  A portion of the bone normally has poor blood flow and this may contribute to the poor healing sometimes associated with a fracture in this location.

How do stress fractures feel?

1.  The typical pain pattern is a slowly developing pain at the site of the injury, which is worsened by activity and improved by rest.

2.  With a navicular stress fracture, pain is felt in the arch along the inner aspect of the foot; direct pressure to the bone on the top of the foot (dorsum of foot) is also painful.

3.  As the fracture enlarges, even normal walking produces pain.

4.  Ultimately, the area of the fracture swells and is tender to touch and pressure.

Treatment

Generally, these stress fractures heal if given enough rest. This typically requires a period of limited weight bearing on the affected extremity.

Navicular fractures usually heal with proper rest but may require two or three months of modified activity. Wearing a cast and avoiding weight bearing is often necessary. A fracture that doesn’t heal with rest and/or a cast may require surgical repair. Medical evaluation is recommended.

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