Sport Injury Classification

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Wanda van Niekerk, Vidya Acharya, Kim Jackson, Claire Knott, Jess Bell, Aminat Abolade, 127.0.0.1, Tony Lowe, WikiSysop, Samuel Adedigba and Khloud Shreif  

Introduction

Sport injuries are diverse in terms of the mechanism of injury, how they present in individuals, and how the injury should be managed. Defining exactly what a sports injury is can be problematic and definitions are not consistent. Verhagen et al (2010) highlight that definitions of sport injury can be discussed in both theoretical and operational terms . According to Engebretsen et al (2012) a sports injury may be defined as "damage to the tissues of the body that occurs as a result of sport or exercise" .  The International Classification of Functioning, Disability and Health (ICF) is one of the most well know mechanisms and considered the gold standard for classification of medical conditions but is currently rarely used in the field of sports medicine. For researchers in sport defining simple, pragmatic, consistent, operational criteria which describe an injury that can be applied across a range of sports is vital, particulalry when developing injury surveillance systems. Many comprehensive systems have been developed to classify injury in order to assist with development of injury surveillance which can be used across sports . 

There are many ways to classify sports injuries basd on the time taken for the tissues to become injured, tissue type affected, severity of the injury, and which injury the individual presents with. 

Injury Classification 

Mechanism

According to Brukner & Kahn (2012) this is one of the most common methods of classifying sports injuries, and relies on the sports physiotherapist knowing and understanding both the the mechanism of injury and the onset of the symptoms. 

Acute

Injury occurs suddenly to previously normal tissue. Acute injuries occur due to sudden trauma to the tissue, with the symptoms of acute injuries presenting themselves almost immediately. The principle in this instance is that the force exerted at the time of injury on the tissue (ie. muscle, tendon, ligament, and bone) exceeds the strength of that tissue.Forces commonly involved in acute injury are either a direct or indirect.

Direct / Contact Injury

A direct injury is caused by an external blow or force.

• A collision with another person e.g.during a tackle in rugby or football
• Being struck with an object e.g. a basketball or hockey stick

Indirect / Non-Contact Injury

An indirect injury can occur in two ways:

• The actual injury can occur some distance from the impact site e.g. falling on an outstretched hand can result in a dislocated shoulder
• The injury does not result from physical contact with an object or person, but from internal forces built up by the actions of the performer, such as may be caused by over-stretching, poor technique, fatigue and lack of fitness. 
  

Common Acute Injuries include:

• Sprains
• Strains
• Fractures
• Dislocations

Overuse

Any repetitive activity can lead to an overuse injury. Overuse injuries occur over a period of time, usually due to excessive and repetitive loading of the tissue, with symptoms presenting gradually. Little or no pain might be experienced in the early stages of these injuries and the athlete might continue to place pressure on the injured site.This prevents the site being given the necessary time to heal. In contrast to acute injuries, the cause of overuse injuries is often much less obvious. The principle in overuse injury is that repetitive microtrauma overloads the capacity of the tissue to repair itself .

To better understand overuse injury it helps to think in terms of what is happening at the microscopic level to the tissue that has been “stressed” during the repetitive workouts. During exercise the tissues (muscles, tendons, bones, ligaments, etc) experience excessive physiological stress. When the activity is over the tissues undergo adaptation so as to be stronger to be able to withstand a similar stress in the future if required. Overuse injury occurs when the adaptive capability of the tissue is exceeded and tissue injury then develops . That is, in the over-zealous athlete there is not enough time for adaptation to occur before the next work out and the cumulative tissue damage eventually exceeds a threshold for that tissue causing pain and tissue dysfunction. The adaptive capability of the tissue may be exceeded secondary to excessive repetitive forces attributable to one or more commonly a combination of risk factors including ;

Intrinsic	Extrinsic
Age Child Adolescent Adult Masters Physiology Lack of Flexibility Muscle Imbalance  Muscle Weakness Fatigue Anatomical Size Body Composition Poor Biomechanics	Training Errors Increased / Excessive Volume Increased / Excessive Frequency Increased / Excessive Intensity Equipment Damaged Inappropriate Worn Out Temperature Hot Cold Playing Surfaces Uneven v Even Grass v Concrete

According to Clarensen (2014)  overuse injuries are a problem in many sports with athletes exposed to high training loads, tight competition schedules and insufficient recovery thought to be particularly at risk; especially when participating in sports involving repetitive movements or impacts. For example, approximately two-thirds of athletes, who traiedn between 20 and 35 hours per week, sustained a performance-limiting overuse injury in athletics over a one year period . Similarly between 29% and 44% of elite volleyball players, who often perform over 500 jumps per week , report symptoms of jumper’s knee  . While it is recognised that overuse injuries are common in elite sport they also occur among recreational athletes , young athletes , and even among sedentary individuals after transient increases in activity .

Common Overuse Injuries include: 

• Achilles Tendinopathy
• Tennis Elbow  
• Iliotibial Band Syndrome

Tissue Type

Soft Tissue

Ligament

Tendon

Muscle

Skin

Hard Tissue

Cartilage

Bone

Fractures
A fracture is a break in a bone. This can result from a direct force, an indirect force or repetitive smaller impacts (as occurs in a stress fracture).
If the skin over a fractured bone is intact, the fracture is described as ‘simple’ or ‘closed’. If the skin over a fracture is broken, the fracture is described as ‘open’ or ‘compound’. The skin might be broken either by the force of the injury that caused the fracture or by a piece of broken bone protruding through the skin. A fracture is described as ‘complicated’ if nearby tissues and/or organs are damaged.
In some cases, a simple fracture can be difficult to detect.

The signs and symptoms of a fracture include:

• Pain at the site of the injury
• Inability to Move the injured part
• Unnatural Movement 
• Deformity
• Swelling and Discolouration

Dislocations
Dislocations are injuries to joints where one bone is displaced from another. A dislocation is often accompanied by considerable damage to the surrounding connective tissue. Dislocations occur as a result of the joint being pushed past its normal range of movement. Common sites of the body where dislocations occur are the finger, shoulder and patella.
Signs and symptoms of dislocation include:

• Loss of Movement at the Joint
• Obvious Deformity
• Swelling and Tenderness
• Pain 

Resources

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Recent Related Research (from Pubmed) 

References 

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