The LFAC guide to sports injuries and the risks posed by different sporting activities.
The New Year’s resolution enthusiast
Who?
All age groups, sometimes with poor baseline fitness levels. The main risk factor for this group derives from a sudden increase in activity without adequate preparation or technique.
Risks
Stress fractures are the main problem when there is a sudden increase in activity. These ‘hairline’ fractures are caused by a series of loading and unloading cycles that weaken the bone, precipitating a break.
Bear in mind
Indications of a likely stress fracture are pain which persists for more than 72 hours, swelling which persists for more than 24 hours, pain which increases with activity and weight-bearing and also pain which is present at rest.
The weekend warrior
Who?
Commonly aged 30–60, combining professional jobs with intense endurance training at the weekend. Main risk is overuse injuries; they are reluctant to rest and very likely to keep training despite pain.
Risks
This group will commonly run 20 to 40 miles each week, so there is a major risk of tendon over use injury (tendinopathy). Achilles tendinopathy and plantar fasciitis are very common problems for this group.
Bear in mind
Tendinopathy is degenerative, not inflammatory, so is unlikely to respond to anti-inflammatory medication. Specialist extracorporeal shockwave therapy is now established as an effective treatment.
The ball sports player
Who?
Fitness will vary but enthusiasm usually abounds. The main risk comes from the twisting, turning and sometimes jumping involved in ball sports, plus the potential for collisions.
Risks
Two injuries commonly affecting this group are: ‘Jones fracture’ of the fifth metatarsal – the bone that runs along the outer side of the foot; and navicular fracture on the top of the midfoot. Ankle sprains are also extremely common.
Bear in mind
Jones and navicular fractures are often missed because patients can normally still walk. But without proper treatment, both can lead to severe and chronic pain. Sometimes, a patient will have a sprained ankle combined with a Jones fracture. Commonly the focus is on the obvious ankle sprain while the more serious fracture is missed. Repeated ankle sprains suggest underlying ankle instability which must be addressed.
The skiier
It is interesting to note that, thanks to improvements in the ski boot, you are now statistically less likely to pick up a foot or ankle injury on a ski scope than by playing football. Injury rates now stand at an average of two injuries per 1,000 ski days.
Risks
Injuries do, of course, still occur. Studies show the majority of injuries are sprains, followed by fractures, lacerations and dislocations. For the foot and ankle, the two main injuries are: the so-called “snowboarder’s fracture” (lateral process of talus); and tendon injuries when the skier jumps then lands on an uneven surface (dislocation of the peroneus longus).
Bear in mind
Both of these diagnoses are elusive, since people may be able to walk and work. Usually, the injury does not show on normal x-ray. A specialist diagnosis is required. Left untreated, both injuries may become a chronic source of pain and weakness in the ankle joint area.
