Treating sports injuries

In a perfect world, medications would never produce side effects,

operations would always be successful, and the best movie would win the
Oscar. In that world, Harvard Men's Health Watch would be in every
mailbox, and exercise would continue to prevent disease and prolong life
without causing any aches and pains. For better or worse, perfection can
never be achieved in the real world. It's a wonderful world, and exercise is
wonderful for health, but people who exercise do run a risk of injury.
Although exercise rarely triggers serious heart problems, they must be the
first concern for everyone who works out. To protect yourself, get a checkup before you start a serious exercise program. Listen to your body for
warning symptoms such as chest pain, a racing or erratic pulse, undue
shortness of breath, and light-headedness, and get help if you experience
any of these symptoms.
Although cardiac problems are infrequent, musculoskeletal woes are
relatively common. A study of 6,313 adults who exercised regularly found
that 21 percent developed an exercise-related injury during the course of a
year. Two-thirds involved the legs; the knee was the most frequently injured
joint.
It sounds grim, but it's not. For one thing, injuries are much more common
with intense exercise and competitive sports than with moderate exercise
done for health. For another, people who exercise actually have a lower
long-term risk of disability than sedentary people. A 13-year study of 370
exercisers age 50 to 72, for example, found that exercise was linked to a
reduced risk of disability and a lower death rate, even among elderly folks
who engaged in running, a high-impact activity.
Injuries do occur, but many are preventable, most are mild, and the majority
will respond nicely to simple treatment at home. An old runner's adage
boasts, "I have two fine doctors, my right leg and my left." It's true for
disease prevention, but for injury treatment you'll also need your head and

your hands. And you should know when to consult a health care
professional.
General principles
Prevention. It's always the best treatment. Here are a few key tips:

Work yourself into shape slowly. It's the most important element of
prevention, particularly for "weekend warriors" who may be tempted to go
all out without preparing themselves properly. It's a growing problem,
particularly for the baby boom generation; in fact, doctors have coined a
new diagnosis, "boomeritis," for the phenomenon. Use a graded exercise
program to get into shape gradually, and then stay in shape the year round.
Warm up before each exercise session and cool down afterwards.

Stretch regularly; exercise makes muscles strong, but they also get
tight and short stretching preserves flexibility and reduces the risk of
injury.

Use good equipment; it's particularly important to have supportive,

well-fitting shoes for weight-bearing activities.

Use good technique; a few lessons or a little coaching can improve

your mechanics as well as your performance.

Don't overdo it. Fatigue and dehydration impair concentration, often

leading to a misstep or fall. Overuse is the major cause of injuries; give
your body a chance to rest and recover after workouts, particularly when
you're first getting into shape. Alternate hard sessions with easier ones.
Vary your routine so that you use different parts of your body; some people,
for example, might walk one day, play tennis the next, and garden the third.
A day off now and then doesn't hurt, either.
Recognition. If prevention fails, early detection is the next line of defense.
Be alert for symptoms. A bit of soreness and stiffness is normal, but pain,

swelling, diminished strength or mobility, and discoloration of the skin is

not. Spot small problems before they become big ones. If your problem
seems small, treat it yourself. But if you don't improve or if you have a
major injury get expert help.
Common injuries: An exerciser's guide
Many sports injuries feel the same, but there are important differences
among them. Here is a glossary of some common problems:
Sprains. Injuries to ligaments, the fibrous connective tissues that connect
one bone to another. In first-degree sprains, the ligament is stretched; in
second-degree sprains, some fibers are torn; in third-degree sprains, most
or all of the fibers are torn. In general, first-degree sprains produce only
pain and swelling, second-degree injuries are often accompanied by
weakness and bluish discoloration due to bleeding, and third-degree
sprains produce severe weakness and decreased mobility.
Strains. Injuries to muscles or tendons, the fibrous tissues that connect
muscles to bones. Commonly known as muscle pulls, strains also come in
first-, second-, and third-degree varieties. Like sprains, strains are usually
caused by a misstep or fall that places excessive force on a tendon or
muscle, so that fibers are stretched or torn.
Tendinitis. Inflammation of a tendon, often caused by overuse or poor
body mechanics. Pain is the major symptom, but warmth, swelling, and
redness may occur. The pain is typically most severe at the start of
exercise; it eases up during exercise, only to return with a vengeance
afterward.
Fasciitis. Inflammation of the layer of fibrous tissue that covers many
muscles and tendons. Overuse is often to blame. A common example is
plantar fasciitis, inflammation of the sole of the foot, which plagues many
walkers and runners.

Bursitis. Inflammation of the small, fluid-like sacs that cushion joints,

muscles, or bones like miniature shock absorbers.
Arthritis and synovitis. Inflammation of a joint (arthritis) or the membrane
that surrounds it (synovitis). Like bursitis, joint inflammation often occurs
without being triggered by exercise, but both problems can also result from
overuse or trauma. Pain and swelling ("water on the knee," for example)
are common symptoms.
Dislocations. Often very painful and disabling, dislocations occur when
bones slip out of their proper alignment in a joint. A deformity is often
visible, and the joint is unable to move properly. Although some athletes
attempt to realign (reduce) a dislocation themselves, it should be done by a
physician or highly experienced trainer or therapist.
Fractures. A disruption in the continuity and integrity of a bone. Except for
broken toes and stress (hairline) fractures, nearly all fractures require
skilled medical management.
Contusions. Bleeding into tissues caused by direct trauma the "black
and blue."
Muscle cramps and spasms. Unduly strong and sustained muscle
contractions that can be very painful (the "charley horse"). Gentle
stretching will help relieve cramps; hydration and good conditioning help
prevent them.
Lacerations and abrasions. Cuts and scrapes; small ones can be
managed with soap and water and Band-Aids, but larger ones may require
special dressings or sutures. Tetanus shots are not necessary if
immunizations have been kept up to date with boosters every 10 years.
Self-treatment: The price is right
Use a five-point program to handle your injuries; the key is PRICE:
Protection, Rest, Ice, Compression, and Elevation.

Protection. Injured tissues must be protected against further injury. Protect

your small injuries by applying bandages, elastic wraps, or simple splints.
Something as easy as taping an injured toe to its healthy neighbor can do
the job. See your doctor for problems that require precision splints or casts.
Rest. Injured tissues need time to heal. It's an obvious principle, but once
you're hooked on exercise you may be tempted to ignore it. Don't give in to
temptation you'll shortchange yourself with shortcuts. But you can rest
selectively; you may have to give up tennis while your serving shoulder
recovers from tendinitis, but you can still walk, jog, or hike. In a curious
way, an injury is often a blessing in disguise, forcing you to diversify your
workouts and acquire new skills.
Ice. It's the cheapest, simplest, yet most effective way to manage many
injuries. Ice is an excellent anti-inflammatory, reducing swelling and pain.
For best results, apply an ice pack for 10 to 15 minutes as soon as possible
after an injury. Repeat the ice treatment each hour for the first four hours,
then four times a day for the next two to three days. Protect your skin with a
thin cloth, and don't allow your skin to become red, blistered, or numb. After
48 to 72 hours, switch to heat treatments, using the same schedule and
principles.
Compression. Pressure will help reduce swelling and inflammation. In
most cases, a simple elastic bandage will suffice; it should be snug but not
too tight. Remember that swelling may develop slowly hours after your
injury, so you may have to loosen your wrap. Another trick is to place a
small piece of foam rubber directly on the injured area before you wrap it;
this will allow you to put gentle pressure where it's needed without
constricting an entire joint or limb.
Elevation. It's a simple strategy that enlists the force of gravity to drain fluid
away from injured tissues, reducing swelling, inflammation, and pain. Keep
your sore foot or other limb up on a hassock or put a pillow under it in bed;
elevating an injured area will help you get back to Earth faster.
Medication

PRICE is the key to the early management of most kinds of injuries, but
you may also need medication for pain or inflammation. Acetaminophen
(Tylenol, other brands) may be the best choice for the first day, since it will
reduce pain without increasing bleeding. After the first day or two, consider
aspirin or another nonsteroidal anti-inflammatory (NSAID) such as
ibuprofen (Advil, other brands) or naproxen (Aleve) to fight inflammation as
well as pain. NSAIDs can irritate the stomach and cause bleeding; for
safety's sake, take them with milk or food. Prolonged NSAID use can lead
to other complications, so use the lowest dose that works and always follow
directions.
The PRICE program relies on applications of cold and then heat, often
supplemented by anti-inflammatory medications or pain relievers. Instead
of an ice pack or warm pack, you can rub in an ointment that will make your
tissues feel cool or warm. And you can also buy liniments, gels, and
ointments that contain anti-inflammatory medications. Topical antiinflammatories are available without a prescription, and they are much
safer than oral anti-inflammatory medications. Anti-inflammatory ointments
are very popular with patients, but doctors have been skeptical. However, a
British meta-analysis of 86 trials involving 10,160 patients concluded that
these ointments can reduce pain in acute injuries (such as sprains and
strains) and chronic conditions (such as arthritis) about a third of
patients improved, but their relief was only modest to moderate.
Liniments can be messy or irritating. Some have an unpleasant odor and
many are expensive. If you want to use a liniment, start with one that
contains an NSAID. But no matter what brand you select, be prepared for
one side effect not measured by the British scientists: disappointment.
Liniments are not cure-alls. Even if they reduce pain, they won't help heal
injured tissues. For that, you'll need time, rest, and conventional medical
therapy. So if a liniment helps, use it, but only as part of a complete
program of protection, rest, and physical therapy.
The next step: Rehabilitation

Your pain is gone and your swelling is down but your treatment is not yet
over. Instead, plan your rehabilitation and return to exercise with the same
care that you used to treat your injury. As a rule of thumb, give yourself two
days of rehab for each day of inactivity due to injury. Start with gentle
range-of-motion exercises, and then gradually increase your weightbearing activities. When you are comfortable, consider building up your
tissues with graded resistance training using calisthenics, light weights, or
resistance equipment such as Cybex or Nautilus. If all goes well, you can
be stronger than before your injury, thus reducing your risk of reinjury.
Don't neglect stretching exercises to improve your flexibility. Use heat or
massage to warm up your injured tissues before you start your rehab
exercises; afterward, apply ice to the area to reduce inflammation. The
judicious use of aspirin or other NSAIDs may also facilitate your
rehabilitation program.

Treating sports injuries

Treatment for a sports injury will depend on factors such as how
severe the injury is and the part of your body affected.
Some general treatments that may be helpful for your injury are described
below. You can also find out about treating specific injuries by clicking on
the links at the end of the page.
PRICE therapy
Minor injuries, such as mild sprains and strains, can often be initially
treated at home using PRICE therapy for two or three days.

PRICE stands for protection, rest, ice, compression and elevation.

Protection protect the affected area from further injury; for
example, by using a support.
Rest avoid exercise and reduce your daily physical activity. Using
crutches or a walking stick may help if you cannot put weight on your
ankle or knee, and a sling may help if youve injured your shoulder.
Ice apply an ice pack to the affected area for 15-20 minutes every
two to three hours. A bag of frozen peas, or similar, will work well.
Wrap the ice pack in a towel to avoid it directly touching your skin and
causing an ice burn.
Compression use elastic compression bandages during the day to
limit swelling.
Elevation keep the injured body part raised above the level of the
heart whenever possible. This may also help to reduce swelling.
Pain relief
Painkillers, such as paracetamol, can be used to help ease the pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) tablets or creams, such
as ibuprofen, can also be used to help ease any pain and help to reduce
any swelling.
Aspirin should not be given to children under 16 years of age.
Immobilisation
Immobilisation can sometimes help to prevent further damage by reducing
movement. It can also reduce pain, muscle swelling and muscle spasm.
For example, slings, splints and casts may be used to immobilise
injured arms, shoulders, wrists and legs while you heal.
If you only have a sprain, prolonged immobilisation is not usually
necessary, and you should try gently moving the affected joint as soon as
you are able to do so without experiencing significant pain.
Physiotherapy
Some people recovering from a long-term injury may benefit
from physiotherapy.
This is a specialist treatment that can involve techniques such as massage,
manipulation and exercises to improve the range of motion, strengthen the
surrounding muscles, and return the normal function of injured area.

A physiotherapist can also develop an exercise programme to help

strengthen the affected body part and reduce the risk of the injury recurring.
Corticosteroid injections
If you have severe or persistent inflammation, a corticosteroid injection may
be recommended.
These can help to relieve pain caused by your injury, although for some
people the pain relief is minimal or only lasts for a short period of time. If
necessary, the injections can be repeated every few months, but care must
be taken to avoid side effects, such as thinning of the skin.
Surgery and procedures
Most sports injuries don't require surgery, but very severe injuries such as
badly broken bones may require corrective surgery to fix the bones with
wires, plates, screws or rods.
In some cases, however, it may be possible realign displaced bones
without needing an operation.
Certain other injuries may also occasionally require surgery. For example,
an operation may be needed to repair a torn knee ligament.
Read more about knee ligament surgery.
Recovery
Depending on the type of injury you have, it can take a few weeks to a few
months or more to make a full recovery.
You shouldn't return to your previous level of activity until you have fully
recovered, but you should aim to gently start moving the injured body part
as soon as possible.
Gentle exercises should help to improve the areas range of movement. As
movement becomes easier and the pain decreases, stretching and
strengthening exercises can be introduced.
Make sure you don't try to do too much too quickly, as this can prolong your
recovery time. Start by doing frequent repetitions of a few simple exercises,
before gradually increasing the amount you do.
In some cases, you may benefit from the help of a professional, such as
a physiotherapist or sports injury specialist, who can design a suitable
recovery programme and advise you about which exercises you should do
and the number of repetitions.
Treating specific injuries

Click on the links below for more information on treatment for specific
injuries:
back pain
broken arm or wrist
broken ankle
broken leg
bursitis
cartilage damage
concussion
dislocated shoulder
hamstring injuries
heel pain
minor head injuries
severe head injuries
shoulder pain
sprains and strains
tendonitis
tennis elbow

reating back pain

Treatments for back pain vary depending on how long you've had the
pain, how severe it is, and your individual needs and preferences.
The various treatments for back pain are outlined below. You can also read
a summary of the pros and cons of the treatments for back pain, allowing
you to compare your treatment options.
Short-term back pain
Initially, back pain is usually treated with over-the-counter painkillers and
home treatments. Most people will experience a significant improvement in
their symptoms within six weeks.
Keep moving
It used to be thought that bed rest would help you recover from a bad back,
but it's now recognised that people who remain active are likely to recover
more quickly.
This may be difficult at first if the pain is severe, but try to move around as
soon as you can and aim to do a little more each day.
Activity can range from walking around the house to walking to the shops.
You will have to accept some discomfort, but avoid anything that causes a
lot of pain.

There is no need to wait until you are completely pain-free before returning
to work. Going back to work will help you return to a normal pattern of
activity, and it can distract you from the pain.
Painkillers
Paracetamol is often one of the first medications recommended for back
pain, although some people find non-steroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen, more effective.
A stronger painkiller, such as codeine, is also an option and is sometimes
taken in addition to paracetamol.
Painkillers can have side effects. Some can be addictive, while others may
not be suitable, depending on your health and medical history for
example, the long-term use of NSAIDs can affect how well your kidneys
work.
Your pharmacist or GP will be able to give you advice about the most
appropriate type of medication for you.
If over-the-counter medications are not controlling your pain, your GP may
be able to prescribe something stronger. They may also recommend a
short course of a muscle relaxant, such as diazepam, if you experience
muscle spasms in your back.
Hot and cold treatments
Some people find that heat for example, a hot bath or a hot water bottle
placed on the affected area helps ease the pain.
Cold, such as an ice pack or a bag of frozen vegetables, placed on the
painful area can also be effective.
Don't put the ice directly on to your skin though, as it might cause a cold
burn. Wrap an ice pack or bag of frozen vegetables in a cloth before putting
it on your skin.

Another option is to alternate between hot and cold using ice packs and a
hot water bottle. Hot and cold compression packs can be bought at most
pharmacies.
Relax and stay positive
Trying to relax is a crucial part of easing the pain as muscle tension caused
by worrying about your condition may make things worse.
Read about relaxation tips to relieve stress.
Although it can be difficult, it's also important to stay optimistic and
recognise that your pain should get better, as people who manage to stay
positive despite their pain tend to recover quicker.
Change your sleeping position
Changing your sleeping position can take some of the strain off your back
and ease the pain.
If you sleep on your side, draw your legs up slightly towards your chest and
put a pillow between your legs. If you sleep on your back, placing pillows
under your knees will help maintain the normal curve of your lower back.
Exercise and lifestyle
Try to address the causes of your back pain to prevent further episodes.
Common causes include being overweight, poor posture and stress.
Regular exercise and being active on a daily basis will help keep your back
strong and healthy. Activities such as walking, swimming and yoga are
popular choices.
The important thing is to choose an enjoyable activity that you can benefit
from without feeling pain.
Read more about preventing back pain.
Long-term back pain

If you have had back pain for more than six weeks (known as chronic back
pain), your GP will advise you about which painkillers to take and may
recommend:
exercise classes group classes supervised by a qualified
instructor, where you are taught exercises to strengthen your muscles
and improve your posture, as well as aerobic and stretching
exercises
manual therapy therapies including manipulation, mobilisation and
massage, usually carried out
by chiropractors, osteopaths or physiotherapists, although
chiropractic and osteopathy aren't widely available on the NHS
acupuncture a treatment where fine needles are inserted at
different points in the body; it's been shown to help reduce lower back
pain, although it's not always available on the NHS
These treatments are often effective for people whose back pain is
seriously affecting their ability to carry out daily activities and who feel
distressed and need help coping.
There is also some evidence that a therapy called the Alexander
technique may help people with long-term back pain, although the National
Institute for Health and Care Excellence (NICE) does not currently
recommend this treatment specifically.
Some of the other treatments that may be recommended are described
below.
Antidepressants
If painkillers do not help, you may be prescribed tricyclic antidepressants
(TCAs), such as amitriptyline. TCAs were originally intended to
treat depression, but they are also effective at treating some cases of
persistent pain.
If you are prescribed a TCA to treat persistent back pain, the dose is likely
to be very small.

Counselling
If the treatments described above are not effective, you may be offered
psychological therapy to help you deal with your condition.
While the pain in your back is very real, how you think and feel about your
condition can make it worse.
Therapies such as cognitive behavioural therapy (CBT) can help you
manage your back pain better by changing how you think about your
condition.
Pain clinics
If you have long-term pain, you may be able to attend a specialist pain
clinic.
Pain clinics help people manage their pain and provide advice about things
such as increasing your activity level and how to have a better quality of life
despite being in pain.
Your programme may involve using a combination of group therapy,
exercises, relaxation and education about pain and the psychology of pain.
Surgery
Surgery for back pain is usually only recommended when all other
treatment options have failed or if your back pain is so severe you are
unable to sleep or carry out your daily activities.
The type of surgery suitable for you will depend on the type of back pain
you have and its cause.
Two procedures sometimes carried out include:
a discectomy where part of one of the discs between the bones of
the spine (the vertebrae) is removed to stop it pressing on nearby
nerves (known as a slipped or prolapsed disc)
spinal fusion where two or more vertebrae are joined together with
a section of bone to stabilise the spine and reduce pain

These procedures can help reduce pain caused by compressed nerves in

your spine, but they are not always successful and you may still have some
back pain afterwards.
As with all types of surgical procedures, these operations also carry a risk
of potentially serious complications.
In some cases, nerves near the spine can be damaged, resulting
in problems such as numbness or weakness in a part of one or both legs
or, in rare cases, some degree of paralysis.
Before you agree to have surgery, you should fully discuss the risks and
benefits with your surgeon.
Read more about spinal surgery.
Treatments not recommended
A number of other treatments have sometimes been used to treat long-term
back pain, but are not recommended by the National Institute for Health
and Care Excellence (NICE) because of a lack of evidence about their
effectiveness in treating non-specific back pain (back pain with no identified
cause).
These include:
low level laser therapy where low energy lasers are focused on
your back to try to reduce inflammation and encourage tissue repair
interferential therapy (IFT) where a device is used to pass an
electrical current through your back to try to accelerate healing while
stimulating the production of endorphins (the bodys natural
painkillers)
therapeutic ultrasound where sound waves are directed at your
back to accelerate healing and encourage tissue repair
transcutaneous electrical nerve stimulation (TENS) where a
machine is used to deliver small electrical pulses to your back
through electrodes (small sticky patches) that are attached to your
skin; the pulses stimulate endorphin production and prevent pain
signals travelling from your spine to your brain

 lumbar supports cushions, pillows and braces used to support

your spine
traction where a pulling force is applied to your spine
injections where painkilling medication is injected directly into your
back

Introduction
A broken arm or wrist is usually caused by a fall onto an outstretched
arm. It typically takes about six to eight weeks to heal in adults, and
less time in children.
Doctors refer to all breaks or cracks in bones as fractures.
Go to your nearest accident and emergency (A&E) department if you think
you or your child has broken a bone. If the injury is severe, dial 999 for an
ambulance.
If it feels like only a minor fracture and it is not an emergency, it may be
more appropriate to go to a minor injuries unit.
How can I tell if the arm or wrist is broken?
A broken arm or wrist bone will be extremely painful and there may also be:
swelling or tenderness around the injured area
bleeding, if the bone has damaged the tissue and skin

These symptoms may also occur if your arm or wrist is sprained rather than
broken (read about sprains and strains). An X-ray in hospital is the only
way to confirm whether or not the bone is broken.
If it's a clean break, you may have heard a snap or a grinding noise during
the accident. The bone can break straight across, diagonally, or in a spiral
pattern.
In severe cases, the bone may break into many pieces (comminuted), stick
out at an angle or poke through the skin (open or compound fracture).
What you can do
It's important not to eat or drink anything if you think you've broken your
arm because you may need a general anaesthetic so that the bone can be
realigned.
Before reaching hospital, a sling may help stabilise the arm (this
goes under the arm and around the neck). Avoid trying to straighten the
arm.
Applying an ice pack, such as a bag of frozen peas wrapped in a tea
towel, to the injured area can help reduce pain and swelling.
If your child has injured their arm or wrist, try to get someone else to drive
so you can support and comfort them.
How a broken arm or wrist is treated
A broken arm or wrist is usually treated in a hospital accident and
emergency department. The treatment differs depending on the severity of
the injury.
A doctor will give you or your child painkillers and fix a splint to the arm to
secure it in position and prevent further damage. An X-ray of the arm will
then be taken to see what kind of fracture it is. Even hairline fractures
show faintly on X-ray.
A simple fracture, where the bone remains aligned, can be treated
by applying a plaster cast. This holds the broken ends together so they
can heal. You'll be given painkillers to take home and be told how to look
after your cast. An appointment will be made to attend a fracture clinic so
specialist orthopaedic doctors can take over the care of your fracture.
With more severe arm or wrist fractures, the bones can become misaligned
(displaced). If the bone isn't realigned (reduced), the bones won't heal well.
Doctors use a technique called "closed reduction" to pull the bones back
into position.

Local or regional anaesthetic will be used to numb the arm (this is rarely
used in children), or you'll be put to sleep using a general anaesthetic. If
doctors are happy with the bones' new position, a plaster cast will be
applied and you'll have regular follow-up appointments and X-rays.
Certain fractures are best treated with surgery to realign and fix the broken
bones. This includes displaced fractures, fractures involving a joint, and
open fractures. Surgeons can fix bones with wires, plates, screws or rods.
This is called open reduction and internal fixation (ORIF). Any metalwork
isn't usually removed unless it becomes a problem.
In rare cases, an external frame, known as an external fixator, is used to
hold the broken bones in place.
After most types of surgery, a plaster cast is applied to protect the repair. A
sling may also be provided for comfort. You'll usually be able to go home
within a day or two of having surgery.
Recovering from a broken arm or wrist
The plaster cast will need to stay on until the bone has healed. The length
of time it will take to heal will depend on the type of fracture, whether it's
damaged the surrounding tissues, and the person's age.
For example, a young child who's cracked their wrist will need to wear a
cast or removable splint for just two to three weeks. However, in older
people, a wrist injury can take much longer to heal and stiffness is very
common.
A useful rule of thumb is that the time taken for the bone to regain full
strength is usually the same as the time it takes for the fracture to heal.
That is, if youve been in plaster for six weeks, it will take six weeks to
regain full strength.
It's important not to get a plaster cast wet. Read more about how should I
care for my plaster cast? for further information and advice.
The orthopaedic doctors will decide when you can take the cast off and
when you can return to work and normal activities.
Your arm may be stiff and weak after being in a cast. Physiotherapy can
help build strength in the arm muscles and restore full movement. However,
it's rarely needed for children.
The risk of re-breaking or cracking the bone after the plaster cast is
removed is increased, particularly in children. Children should avoid using
trampolines, bouncy castles, soft play areas and playing contact sports for
a further two to three weeks to minimise this risk.

Adults shouldn't drive while their arm is in a cast. Ask your doctor for advice
about when you can drive again.

Useful terms
humerus thebone between the shoulder and elbow
radius thebone between the elbow and wrist (thumb side of the
arm)
ulna the bone between the elbow and wrist (little-finger side of the
arm)
simple or closed fracture an easily treated break with little
damage to the surrounding tissue
compound or open fracture a complicated break with damage to
the surrounding skin
comminuted fracture where the bone has broken into several
pieces
hairline fracture a minor crack to the bone which only shows up
faintly on X-ray

Introduction
A broken or fractured ankle is a relatively common injury, often
caused by twisting the ankle, a fall, or a sporting accident.
It may be treated with a cast or surgery and usually takes between six and
12 weeks to heal.
How do I know if my ankle is broken?
If you injure your ankle, the following can be signs of a fracture:
pain and tenderness particularly in the bones around the ankle

 being unable to walk or put any weight on the ankle

swelling and significant bruising
a 'crack' sound during the injury
the ankle being a funny shape (dislocated)
bone poking out of the skin (open or compound fracture)
Because of the shock and pain of breaking your ankle, you may also feel
faint, dizzy or sick.
If the injury is not severe it can be difficult to tell if your ankle is broken or
just sprained. An X-ray is needed to confirm whether the ankle is broken
and help determine the most appropriate treatment.
What you should do
If you think you may have broken your ankle, go to your nearest accident &
emergency (A&E) department as soon as possible.
If it feels like only a minor fracture and it is not an emergency, it may be
more appropriate to go to a minor injuries unit.
Try to avoid putting any weight on the ankle. Ask a friend or relative to drive
you to hospital and support your weight as you walk on your other foot.
Raising the leg and applying an ice pack (try a bag of frozen peas wrapped
in a tea towel) can help reduce pain and swelling while you make your way
to hospital. You can also take over-the-counter painkillers, such
as ibuprofen or paracetamol, to help relieve the pain.
Call 999 for an ambulance if the ankle looks like it might be dislocated, or
you can see bones poking through the skin.
How a broken ankle is treated
If your ankle is dislocated or the bones are badly misaligned (displaced) the
doctor or paramedic may decide to manipulate them back into place
(reduction). This is to avoid potential problems with the blood and nerve
supply to the foot.

A splint will then usually be applied to protect your ankle and keep the
bones in the correct position while you are transferred to an accident and
emergency department. You will be given strong painkillers or sedation to
ensure your comfort during this procedure.
At the hospital, your doctor will then decide whether you need surgery or if
you just need a cast to support your ankle as it heals naturally.
An X-ray is needed to confirm the fracture and to help decide on the
appropriate treatment.
Cast
Most ankle fractures will need to be put in a plaster cast or splint for around
six weeks.
You'll usually be advised not to put any weight on the broken ankle for at
least the first few weeks so you will need to use crutches to support
yourself. This will depend on your fracture and in some cases you will be
advised to walk on the ankle.
Over the next few weeks, you'll normally be asked to attend follow-up
appointments with an orthopaedic surgeon (a specialist in problems
affecting the bones and joints) at a fracture clinic.
Your doctor can advise you about things you can do to help your ankle heal
and further X-rays may be carried out to make sure it's healing correctly.
They may also replace your original plaster cast with a lighter one or a
special removable boot as you recover.
Surgery
More severe fractures often require surgery to realign the bones and fix
them in position. This is usually carried out under a general
anaesthetic (where you are put to sleep).
The surgeon makes cuts in the skin near the ankle and the bones are put
back into position. A combination of plates, screws and wires may be used
to hold the bones together, and the wound is closed using stitches. The
metalwork is not normally removed later on unless it becomes a problem.

Most people will stay in hospital for one or two days after surgery. A plaster
cast will be placed over the ankle to protect it before you go home.
Recovering
It takes about six to 12 weeks for a broken ankle to heal, but it may take
longer to regain full movement and return to all of your normal activities.
Swelling can sometimes take a few years to improve.
Ask friends or family to go shopping for you, as you won't be able to do this
yourself. You will, however, be able to move around your home on crutches
and manage stairs.
How soon you can return to work depends on how badly you fractured your
ankle and the type of work you do, but you will probably be off for at least
four to six weeks.
Follow your doctor or surgeon's advice on elevating, moving and resting the
ankle, and make sure you attend all follow-up appointments after you have
been discharged from hospital. If necessary, you may be referred to a
physiotherapist who can show you exercises that may help speed up your
recovery.
Read more about caring for a plaster cast.
When to see your GP
Check the ankle regularly and see your GP if:
the pain gets worse or is not relieved by ordinary painkillers your
GP may be able to prescribe a stronger painkiller
you develop any other medical problems or want advice about
returning to work
you are planning on flying after ankle surgery having recent
surgery can increase your risk of developing deep vein thrombosis
(DVT) and your GP can advise you whether it's safe to fly
When to go back to hospital

Go back to your nearest A&E department if:

you have pins and needles or numbness in your toes
the skin around your ankle or foot has turned blue
the ankle becomes very swollen
youre having problems with your plaster cast
there is a foul-smelling discharge from a surgical wound on your
ankle
These signs may indicate an infection or a problem with the nerves or
blood supply to the ankle.

Introduction
A broken leg (leg fracture) will be severely painful and may be swollen
or bruised. You usually won't be able to walk on it.
If it's a severe fracture, the leg may be an odd shape and the bone may
even be poking out of the skin.
There may have been a "crack" sound when the leg was broken and the
shock and pain of breaking your leg may cause you to feel faint, dizzy or
sick.
What to do
If you think you or someone else has broken their leg, go immediately
to your nearest accident and emergency (A&E) department. Call 999 for an
ambulance if the injury seems severe or you're not able to get to A&E
quickly.

While you make your way to A&E or wait for an ambulance:

avoid moving the injured leg as much as possible keep it straight
and put a cushion or clothing underneath to support it
don't try to realign any bones that are out of place
cover any open wounds with a sterile dressing, a clean cloth or a
clean item of clothing maintain direct pressure on the wound if
it keeps bleeding
If the person is pale, cold and sweaty (in shock), lie them down and
carefully rest their legs above the level of their heart to improve their blood
flow. When raising the broken leg, ensure it's kept straight and supported
by a cushion. Keep them warm and calm until you can get medical help.
How a broken leg is treated
Immobilisation
First, a doctor will give you painkillers and may fix a splint to your leg to
secure it in position and prevent further damage. For severe pain, you may
be given painkilling gas through a face maskor medication through a drip
into a vein. An X-ray is often necessary to assess the fracture.
If the broken bone is still in position, you'll usually just need a plaster cast.
This holds the bone in place so it can heal. If there's a lot of swelling, you
may just have a splint or cast around the back half of your leg until the
swelling goes down. A full cast can be fitted a few days later.
You may be provided with painkillers to take home and information on how
to look after your cast. Read more about how to look after your plaster cast.
Reduction
If the bones are misaligned, a doctor or surgeon may need to put them
back into place. This is known as "reduction".
Sedatives are sometimes provided before the procedure and local or
regional anaesthetic is used to numb the site of the break. In some cases

a general anaesthetic is needed (which means youll be asleep during the

procedure).
Once the bones are in the correct position, a plaster cast can be applied
(see above).
Surgery
Severe fractures are often treated with surgery to realign and fix the broken
bones. Surgeons can fix bones with metal wires, plates, screws or rods.
Plates, screws and rods will usually be left in place permanently unless
they become a problem, whereas wires will be removed 4-6 weeks after the
operation.
Sometimes an external frame (external fixator) is attached to the broken
bones with metal pins to help keep them in place. This is removed once the
fracture has healed.
After surgery, a plaster cast may be applied to protect the leg (see above).
Follow-up appointments
An appointment will be made for you to attend a fracture clinic so specialist
orthopaedic doctors can monitor your fracture. The first appointment is
usually booked for a week or two after you're discharged from hospital.
Severe fractures will usually heal within three to six months, but may
require follow-up appointments every few months for a year or more
afterwards. Further X-rays are often necessary to check how well your leg
is healing.
Recovering from a broken leg
You'll be given advice by your doctor about how much you should move
your leg and when you can put weight on it.
It takes around six to eight weeks for a minor fracture to heal. You'll
probably need to use crutches or a wheelchair during this time, until it's
possible to put weight on the leg again. You'll be shown how to safely use
any mobility equipment you're provided with.

More severe fractures can take between three and six months to fully heal.
Some can take even longer.
The hospital may recommend regular physiotherapy appointments to help
you maintain or regain muscle strength, movement and flexibility. This will
include specific exercises to do before and after the cast is removed.
Don't try to rush your recovery by returning to your normal activities too
quickly, as the broken bone may not be fully healed even when the pain
has gone. Follow the advice of your doctor, who'll probably recommend
gradually increasing how much you use your leg over time.
You shouldn't drive while in a cast. Seek advice from your doctor about
when you can drive again.
Possible complications
For most people, a broken bone will heal within a few months and there
won't be any further problems.
However, complications can sometimes occur. These include:
Damaged muscle, nerves or blood vessels around the fracture
this can occur during the initial injury or during surgery. It may lead to
loss of movement or feeling, or may affect the blood supply to the
limb.
Bone infection this is more likely if surgery is performed or the
broken bone stuck out of the skin. It can significantly delay healing
and will often require treatment with antibiotics and/or surgery.
Compartment syndrome a painful and potentially serious
condition caused by bleeding or swelling within a bundle of muscles.
This can occur soon after a fracture, after the plaster cast has been
applied or after surgery. Emergency surgery will usually be needed to
relieve the build-up of pressure in your leg.
Occasionally, a further operation may be needed if the bone doesn't heal
properly. This can happen if the bone doesn't align properly during surgery,
you put too much weight on the bone before it heals, the fracture is severe,
if you have diabetes or you smoke during your recovery.

Types of fracture
Some broken bones are more serious than others it depends on the
location of the fracture, how the bone has broken and whether there is any
damage to the surrounding tissue. The most common types of fracture are:
Stress fractures tiny cracks in the bone caused by overuse;
common in athletes.
Undisplaced or hairline fracture a fracture through the bone with
little damage to the surrounding tissue.
Displaced fracture the two parts of the broken bone have moved
apart (misaligned).
Comminuted fracture the bone has broken (shattered) into several
pieces.
Open or compound fracture a complicated break where the bone
has broken through the skin, or the initial injury has exposed the
broken bone.

Treating bursitis
Most cases of bursitis can be treated at home with self-care
techniques and over-the-counter painkillers.
The pain usually improves within a few weeks, but the swelling may take
longer to completely disappear.
Exactly how long it takes to recover may depend on where the bursitis is
and whether it is caused by an infection (septic bursitis).
Self-care

There are a number of things you can do yourself to reduce the swelling in
the affected joint. Rest the joint until your symptoms improve and avoid
strenuous activities that are likely to cause additional pain, such as running.
Wearing padding may help protect the joint from further injury. For example,
knee pads may help if you have bursitis in your knee joints.
Ice packs are also a good way of reducing inflammation and pain. Wrap an
ice pack (or a bag of frozen vegetables) in a towel and apply it to the
affected area for 10-20 minutes. Repeat this every few hours.
While sleeping, avoid lying on the side that has bursitis. If possible, raising
the body part above the level of your heart may help reduce the
inflammation. For example, you can prop your foot up on a pillow to raise
your ankle.
If your knees, ankles or hips are affected, try to avoid long periods of
standing up. Standing on a soft surface can help, as can placing a pillow
between your knees when lying on your side. Being overweight can also
cause bursitis, so losing weight may help.
Painkillers such as aspirin, paracetamol or ibuprofen can help to relieve the
pain. Ibuprofen, or other non-steroidal anti-inflammatory drugs
(NSAIDs) such as naproxen or diclofenac, can also be used to help reduce
swelling.
Always read the patient information leaflet that comes with the medicine to
check that it is suitable for you and that you are taking the correct dose.
Aspiration
If the swelling caused by bursitis is particularly severe, you may want to
consider having the fluid drained out. This procedure, known as
aspiration, can relieve the pain and improve the range of movement in your
joint.
During aspiration, a needle is used to draw out the fluid before the area is
covered with a dressing. You'll need to avoid strenuous activity for about
two days afterwards.

Corticosteroids
If your bursitis symptoms are severe or they do not respond to
treatment, corticosteroid injections are another possible treatment option.
Corticosteroids contain steroids, a type of hormone, and can be used to
reduce inflammation.
Your GP can inject corticosteroids directly into the affected area. Possible
side effects include the surrounding tissue wasting away and discolouration
of the skin around the injection site.
You will not be able to have a corticosteroid injection if you have septic
bursitis, and cannot have more than three corticosteroid injections a year in
the same area.
Antibiotics
Your GP will prescribe antibiotics if tests confirm that you have
septic bursitis. These may include:
flucloxacillin
erythromycin
clarithromycin
These will usually be taken as tablets or capsules two or four times a day
for seven days. After seven days, your GP should check how well you're
responding to the antibiotics. If you still have signs of infection, you may
need to take antibiotics for another seven days.
If you're prescribed antibiotics, it's important that you finish the entire
course, even if your symptoms improve. This will help to prevent the
infection returning.
Referral
If your symptoms do not improve with treatment after a couple of months,
your GP may refer you to a specialist. This may be:

 a rheumatologist a specialist in conditions that affect the bones,

muscles and joints
an orthopaedic surgeon a specialist in the surgical treatment of
conditions that affect the bones, muscles and joints
You may also be referred if you have infected bursitis that does not get
better or reoccurs.
Surgery
In some cases, surgery may be recommended to remove the affected
bursa, particularly where septic bursitis does not respond to antibiotics.
Surgery either involves removing the bursa completely, or making an
incision in your skin and draining the fluid out of the bursa (incision and
drainage).

reating concussion
There are a number of self care techniques you can use to relieve
mild concussion symptoms. If more serious symptoms start to
develop, seek immediate medical treatment.
Some self care techniques for mild symptoms of concussion are outlined
below.
apply a cold compress to the injury to reduce swelling a bag of
frozen vegetables wrapped in a towel could be used, but never place
ice directly on the skin as it's too cold; apply the compress every two
to four hours and leave it in place for 20 to 30 minutes
take paracetamol to control pain do not use non-steroidal antiinflammatory drug (NSAID) painkillers such as ibuprofen or aspirin as
these can sometimes cause bleeding at the site of the injury
get plenty of rest and avoid stressful situations where possible

 avoid drinking any alcohol or taking recreational drugs

only return to work, college or school when you feel you have
completely recovered
only drive a car or ride a bike when you feel you have completely
recovered
do not play any contact sports for at least three weeks without
seeing your GP first this includes sports such as football and
rugby
make sure you have someone to stay with you for the first 48
hours after the injury this is in case you experience more serious
follow-up symptoms
When to seek follow-up advice
Sometimes the symptoms of a more serious brain injury do not occur for
several hours, or possibly days, after the initial injury has taken place. This
means it's important that you remain alert for signs and symptoms that
could suggest a more serious injury has occurred.
If you or someone in your care has any of the signs or symptoms listed
below, go to your nearest accident and emergency (A&E) department as
soon as possible:
unconsciousness or lack of consciousness, such as problems
keeping your eyes open
mental confusion, such as forgetting who or where you are
any drowsiness that goes on for longer than one hour when you
would normally be wide awake
any problems understanding or speaking
any loss of balance or problems walking
any weakness in one or both arms or legs
any problems with eyesight
a very painful headache that will not go away
any vomiting
any fits or seizures
clear fluid coming out of the ear or nose
bleeding from one or both ears

 sudden deafness in one or both ears

Returning to sports
Despite being one of the most common sport-related injuries, there is no
internationally agreed consensus on advice about when it is safe to return
to playing a contact sport, such as rugby, after a concussion.
Most national sporting federations and organisations recommend a "stepwise" approach, where you wait until you are free from symptoms and then
resume a low level of physical activity.
If the symptoms do not return, you can step up to a more intense level of
activity. If symptoms are still under control, continue to step up through the
levels, eventually returning to playing the sport.
A 2013 conference of experts in sports medicine recommended these
steps:
1. complete rest until symptoms have passed for at least 24 hours
2. light aerobic exercise, such as walking and cycling
3. sport-specific exercises, such as running drills for football or rugby
(but no activity that involves impact to the head)
4. non-contact training, such as passing drills for football
5. full training, including physical contact such as tackling
6. return to play
If you are symptom-free, you should be able to return to play within a week.
If you experience a return of symptoms, rest for 24 hours, drop down to a
previous step, and then attempt to move up again.

Minor cartilage damage may improve on its own within a few weeks,
but more severe damage will often require surgery.
This page covers:
Initial treatment and self-care
Physiotherapy
Surgery
Less common surgical procedures
Initial treatment and self-care

If you've injured your joint and your symptoms aren't too severe for
example, you're still able to put weight on and move the joint you can
often look after yourself using "PRICE therapy".
PRICE stands for:
Protection protect the affected area from further injury by using a
support, such as a knee brace.
Rest rest the affected joint as much as possible during the first two
or three days (crutches may help if you've injured your knee or
ankle). Then try gradually returning to light activity over the next few
days and weeks.
Ice apply an ice pack or bag of frozen vegetables wrapped in a
towel to the injured area for 15 to 20 minutes every two to three hours
during the first two or three days.
Compression compress or bandage the injured area to limit any
swelling and movement that could damage it further. You can use a
simple elastic bandage or an elasticated tubular bandage available
from a pharmacy.
Elevation keep the injured area raised and supported on a pillow
whenever you can to help reduce swelling.
If your joint is painful, take ordinary painkillers such as paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs).
Visit your GP if your symptoms haven't started to improve after a few days
of PRICE therapy.
Physiotherapy
Physiotherapy can be helpful if you have difficulty moving the affected joint.
Your GP may be able to refer you to a physiotherapist, or you may choose
to pay for private treatment.
A physiotherapist can teach you exercises to help strengthen the muscles
surrounding or supporting your joint. This may help to reduce pain
and pressure on the joint.
Physiotherapy can also be useful when you're recovering from the surgical
procedures described below.
Surgery
Severe cartilage damage doesn't tend to heal very well on its own, so
surgery is often necessary in these cases.
Surgery is usually performed using arthroscopy a type of "keyhole"
surgery where special instruments are inserted into the joint through small
cuts (incisions) although sometimes larger incisions need to be made.

It's normally carried out under general anaesthetic (where you're asleep).
Some of the main procedures are:
Lavage and debridement the joint is cleaned out to remove any
loose tissue and the edges of the damaged area are trimmed to make
them smooth. It may sometimes be possible to repair the damage at
the same time.
Marrow stimulation (microfracture) tiny holes are made in the
bone beneath the damaged cartilage, which releases bone marrow
into it. The marrow cells then begin to stimulate the production of new
cartilage.
Mosaicplasty small plugs of healthy cartilage from nonweightbearing areas of a joint, such as the side of the knee, are
removed and used to replace small areas of damaged cartilage.
Osteotomy the alignment of the leg is altered slightly to reduce
pressure on the damaged area and improve pain. This usually
involves adding or removing a wedge of bone from the shin or thigh
bone. The bone is fixed with a plate until it heals.
Joint replacement replacing the whole joint with an artificial one,
such as a knee replacement or hip replacement, is occasionally
necessary if the damage is particularly severe.
Talk to your surgeon about which type of surgery they think is best for you,
what the possible risks are, and how long they expect it will take you to
recover.
You'll usually need to take things easy for at least a few weeks after
surgery, and you may not be able to return to strenuous activities and
sports for several months.
Less common surgical procedures
There are also a number of alternative surgical techniques that are
sometimes used to treat cartilage damage, including:
Allograft osteochondral transplantation (AOT) similar to
mosaicplasty, but the replacement cartilage is obtained from a
recently deceased donor and is used to repair larger damaged areas.
Autologous chondrocyte implantation (ACI) the surgeon first
takes a small sample of cartilage cells from the joint. These are then
used to grow more cells in a laboratory and the new cells are used to
replace the damaged cartilage.

 Artificial scaffolds a special patch or gel is used to repair the

damaged cartilage. It may be used in combination with marrow
stimulation or on its own.
However, these procedures are only carried out in a few hospitals in the
UK and aren't routinely provided on the NHS. You may be able to pay for
them privately, but they can be very expensive.
The National Institute for Health and Care Excellence (NICE) says there's
too much uncertainty about ACI for it to be used on the NHS, unless it's
being done as part of a clinical trial. But this will be reviewed again soon, so
this recommendation may change.
For more information, see the NICE guidance on the use of autologous
chondrocyte implantation for the treatment of cartilage defects in the knee
joints.

Treating concussion
There are a number of self care techniques you can use to relieve
mild concussion symptoms. If more serious symptoms start to
develop, seek immediate medical treatment.
Some self care techniques for mild symptoms of concussion are outlined
below.
apply a cold compress to the injury to reduce swelling a bag of
frozen vegetables wrapped in a towel could be used, but never place
ice directly on the skin as it's too cold; apply the compress every two
to four hours and leave it in place for 20 to 30 minutes
take paracetamol to control pain do not use non-steroidal antiinflammatory drug (NSAID) painkillers such as ibuprofen or aspirin as
these can sometimes cause bleeding at the site of the injury
get plenty of rest and avoid stressful situations where possible
avoid drinking any alcohol or taking recreational drugs
only return to work, college or school when you feel you have
completely recovered
only drive a car or ride a bike when you feel you have completely
recovered

 do not play any contact sports for at least three weeks without
seeing your GP first this includes sports such as football and
rugby
make sure you have someone to stay with you for the first 48
hours after the injury this is in case you experience more serious
follow-up symptoms
When to seek follow-up advice
Sometimes the symptoms of a more serious brain injury do not occur for
several hours, or possibly days, after the initial injury has taken place. This
means it's important that you remain alert for signs and symptoms that
could suggest a more serious injury has occurred.
If you or someone in your care has any of the signs or symptoms listed
below, go to your nearest accident and emergency (A&E) department as
soon as possible:
unconsciousness or lack of consciousness, such as problems
keeping your eyes open
mental confusion, such as forgetting who or where you are
any drowsiness that goes on for longer than one hour when you
would normally be wide awake
any problems understanding or speaking
any loss of balance or problems walking
any weakness in one or both arms or legs
any problems with eyesight
a very painful headache that will not go away
any vomiting
any fits or seizures
clear fluid coming out of the ear or nose
bleeding from one or both ears
sudden deafness in one or both ears
Returning to sports

Despite being one of the most common sport-related injuries, there is no

internationally agreed consensus on advice about when it is safe to return
to playing a contact sport, such as rugby, after a concussion.
Most national sporting federations and organisations recommend a "stepwise" approach, where you wait until you are free from symptoms and then
resume a low level of physical activity.
If the symptoms do not return, you can step up to a more intense level of
activity. If symptoms are still under control, continue to step up through the
levels, eventually returning to playing the sport.
A 2013 conference of experts in sports medicine recommended these
steps:
1. complete rest until symptoms have passed for at least 24 hours
2. light aerobic exercise, such as walking and cycling
3. sport-specific exercises, such as running drills for football or rugby
(but no activity that involves impact to the head)
4. non-contact training, such as passing drills for football
5. full training, including physical contact such as tackling
6. return to play
If you are symptom-free, you should be able to return to play within a week.
If you experience a return of symptoms, rest for 24 hours, drop down to a
previous step, and then attempt to move up again.

Dislocated shoulder
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Introduction
A dislocated shoulder usually happens after a heavy fall onto the arm.
It takes between 12 and 16 weeks to heal after the shoulder has been
put back into place.
Dislocating your shoulder means the ball joint of your upper arm has
popped out of the shoulder socket. The surrounding tissues may also have
become overstretched or torn.
The shoulder is one of the easiest joints to dislocate because the ball joint
sits in a very shallow socket. This makes the arm extremely mobile and
able to move in many directions, but also means it's not very stable.
Most people dislocate their shoulder during a contact sport such as rugby,
or in a sports-related accident. In older people the cause is often falling
onto outstretched hands, for example after slipping on ice.
Shoulder dislocations can occur more easily in people who are highy
flexible, such as those with joint hypermobility (loose joints).
How do I know if I've dislocated my shoulder?
In most cases of dislocated shoulder, the ball part of the joint pops out in
front of the shoulder socket. This is usually obvious because:
you won't be able to move the arm and it will be extremely painful
the shoulder will suddenly look square rather than round
you may be able to see a lump or bulge (the top of the arm bone)
under the skin in front of your shoulder

It's much more unusual for the bone to pop out of the back of the shoulder
joint. This usually happens after an epileptic fit or electrocution injury and is
less easy to spot.
What you should do
If you think you have dislocated your shoulder, go to your nearest accident
and emergency (A&E) department immediately.
Don't try to pop your arm back in yourself, as this could damage the
tissues, nerves and blood vessels around the shoulder joint.
While waiting for medical help, avoid moving your upper arm as much as
possible. Place something soft, such as a folded blanket or pillow, in the
gap between the arm and side of the chest to support it. If you can, make a
simple sling to hold the lower arm across the chest, with the elbow bent at
a right angle.
How a dislocated shoulder is treated
When you get to A&E, you will be assessed and examined. You will usually
be X-rayed to make sure you haven't broken any bones, as it's fairly
common for someone who has dislocated their shoulder to also break the
bone of their upper arm or the joint.
If you do have a fracture, further scans may also be carried out to
investigate it in more detail. Fractures with a shoulder dislocation will
require specialist orthopaedic care and may involve surgery.
If you dont have any fractures, your arm will be gently manipulated back
into its shoulder joint using a procedure known as reduction.
Surgery is sometimes necessary if the tissues surrounding the joint are
badly torn and the joint is not stable. If the tissues are overstretched but not
torn, surgery can sometimes be avoided by doing appropriate exercises to
strengthen the shoulder.

Reduction
You will be given some medication to sedate you and ensure you are as
relaxed and pain-free as possible.
Reduction is usually carried out in the A&E department, but sometimes it is
done in the operating theatre under general anaesthetic (where you are
asleep) under the care of an orthopaedic team.
You will usually sit on the bed while the doctor rotates your arm around the
shoulder joint until it goes back in its socket. This may take a few minutes.
Once the shoulder joint is back in place, you will often have another X-ray
to check the shoulder is in the correct position.
Repairing tears in the shoulder tissues
Some people tear a rotator cuff tendon (bands of tissue that stretch over
the top of the shoulder) as well as the labrum (the cuff of tough tissue
surrounding and supporting the shoulder joint) when they dislocate
their shoulder.
If these tissues have been damaged, you may need surgery to repair them.
For some people, this can significantly reduce the risk of dislocating the
same shoulder again in the future (see below).
These operations are carried out under general anaesthetic and are
increasingly being done with keyhole surgery, using only small incisions
and an arthroscope (a thin tube fitted with a light source and a camera).
Recovering from a dislocated shoulder
You can usually go home soon after reduction, but you'll need to rest your
arm in a sling for a few weeks.
You will usually be referred to the orhopaedic department for follow-up care
and you may also be referred to a physiotherapist for rehabilitation to
strengthen your shoulder.

Arm and shoulder exercises

You may be asked to rest your arm in the sling for two to three weeks while
the soft tissues around the shoulder repair themselves.
After this, a physiotherapist can show you some gentle arm and shoulder
exercises to do at home with your arm out of its sling. These will help
reduce stiffness, relieve some of the pain and build up strength in your
shoulder muscles.
Before you begin your exercises, hold an ice pack (or a bag of frozen peas
wrapped in a tea towel) on the shoulder for 10 to 15 minutes and take
some painkillers.
For some useful exercises to get you started, see the NHS
leaflet: rehabilitation after shoulder dislocation (PDF, 482kb).
It's normal to experience aching, discomfort or stretching when doing these
exercises. However, if you have intense pain for more than 30 minutes, do
the exercise less forcefully and less often.
It's better to do short, frequent sessions of five to 10 minutes four times a
day rather than one long session, and to gradually increase the number of
repetitions you do.
Pain relief
The shoulder may be very painful during the first two to three weeks at
home and you may need to take painkillers, such
as paracetamol or ibuprofen. Always follow the dosage instructions on the
packet.
If this doesn't control the pain, see your GP for a prescription for a stronger
painkiller, such as codeine.
Recovery time
You can stop wearing the sling after a few weeks, but it takes about 12 to
16 weeks to completely recover from a dislocated shoulder.

You can usually resume most activities within two weeks, but avoid heavy
lifting and playing sports involving shoulder movements for six weeks to
three months. Your orthopaedic surgeon and physiotherapist will advise
you.
You'll probably be off work for two to four weeks, or longer if you have a
physical job. Discuss this with your GP, physiotherapist or consultant.
If you've also broken your arm or shoulder joint, you may need to wear your
sling for up to six weeks and recovery will take longer.
Dislocating the shoulder a second time
If you've dislocated your shoulder once, you're more likely to dislocate it
again in the future particularly if you're less than 20 years old.
Your chances of another dislocation depend partly on how well the tissues
surrounding the joint healed the first time. It can help if the torn tissues
were surgically repaired after the dislocated shoulder was fixed.
Regularly doing the exercises your physiotherapist recommends and
avoiding awkward arm positions can also reduce the risk of dislocating your
shoulder again.

Introduction
A hamstring injury is a strain or tear to the tendons or large muscles
at the back of the thigh.
It's a common injury in athletes and can occur in different severities. The
three grades of hamstring injury are:

 grade 1 a mild muscle pull or strain

grade 2 a partial muscle tear
grade 3 a complete muscle tear
The length of time it takes to recover from a hamstring strain or tear will
depend on how severe the injury is.
A minor muscle pull or strain (grade 1) may take a few days to heal,
whereas it could take weeks or months to recover from a muscle tear
(grade 2 or 3).
The hamstrings
The hamstrings are tendons (strong bands of tissue) at the back of the
thighs that attach the large thigh muscle to the bone.
The term 'hamstring' also refers to the group of three muscles that run
along the back of your thigh, from your hip to just below your knee.
The hamstring muscles aren't used much while standing or walking, but
they're very active during activities that involve bending the knee, such as
running, jumping and climbing.
What causes hamstring injuries?
A hamstring injury can occur if any of the tendons or muscles are stretched
beyond their limit.
They often occur during sudden, explosive movements, such as sprinting,
lunging or jumping. But they can also occur more gradually, or during
slower movements that overstretch your hamstring.
Recurring injury is common in athletes and sportsmen, as you're more
likely to injure your hamstring if you've injured it before.
Regularly doing stretching and strengthening exercises, and warming up
before exercise, may help reduce the risk of injuring your hamstring.
How do I know if I've injured my hamstring?

Mild hamstring strains (grade 1) will usually cause sudden pain and
tenderness the back of your thigh. It may be painful to move your leg, but
the strength of the muscle shouldn't be affected.
Partial hamstring tears (grade 2) are usually more painful and tender. There
may also be some swelling and bruising at the back of your thigh and you
may have lost some strength in your leg.
Severe hamstring tears (grade 3) will usually be very painful, tender,
swollen and bruised. There may have been a "popping" sensation at the
time of the injury and you'll be unable to use the affected leg.
When to see your GP
Most hamstring injuries can be cared for at home using the techniques
outlined below.
Consider seeing your GP if you have any concerns about your injury,
particularly if you think it's a severe injury, it's not healing, or your
symptoms are getting worse.
Your GP can also advise you about when you can return to your normal
activities and what exercises you should do to aid your recovery in the
meantime. They may be able to refer you to a physiotherapist for specialist
treatment in some cases.
Rest and recovery
Recovering from a hamstring injury may take days, weeks or months,
depending on how severe the strain or tear is.
A completely torn hamstring (grade 3) may take several months to heal and
you'll be unable to resume training or play sport during this time.
Initial treatment
During the first two or three days, you should care for your injury by
following the steps below.

 Rest keep your leg as still as you possibly can and avoid physical
activity. Your GP may recommend using crutches in more severe
cases.
Ice apply cold packs (a bag of frozen peas wrapped in a tea towel
will also work) to your hamstring for 15 to 20 minutes every two to
three hours during the day. Don't apply ice directly to your skin.
Compression compress or bandage the thigh to limit any swelling
and movement that could cause further damage. You can use a
simple elastic bandage or elasticated tubular bandage available from
a pharmacy.
Elevation keep your leg raised and supported on a pillow as much
as possible, to help reduce any swelling.
Regular painkillers, such as paracetamol or a non-steroidal antiinflammatory drug (NSAID) cream or gel, may also help relieve the pain.
Short-term use of oral NSAIDs, such as ibuprofen tablets, can also help
reduce swelling and inflammation. However, these aren't suitable for
everyone. Check the leaflet that comes with your medication to see if you
can take it.
Gentle exercises and stretches
Returning to strenuous exercise too quickly could make your injury worse,
but avoiding exercise for too long can cause your hamstring muscles to
shrink and scar tissue to form around the tear.
To avoid this, you should start doing gentle hamstring stretches after a few
days, when the pain has started to subside.
This should be followed by a programme of gentle exercise, such
as walking and cycling, and hamstring strengthening exercises.
Your GP can give you further advice and, if necessary, refer you to
a physiotherapist for a suitable exercise programme.
To avoid injuring yourself again, you should only return to a full level of
activity when your hamstring muscles are strong enough. Your
physiotherapist or GP will be able to advise you about this.

Many people need to avoid sports for at least a few weeks, but the length
of time you need off will depend on the severity of your injury.

Treatment for heel pain usually involves using a combination of

techniques, such as stretches and painkillers, to relieve pain and
speed up recovery.
See your GP or another suitably qualified healthcare professional, such as
a podiatrist, if youve had persistent heel pain for a number of weeks and it
hasn't cleared up. They'll be able to diagnose the problem and give you
specific advice about a suitable exercise programme.
Most cases of heel pain get better within 12 months. Surgery may be
recommended as a last resort if your symptoms don't improve after this
time. Only one in 20 people with heel pain will need surgery.
Rest
Rest the affected foot whenever possible. Avoid walking long distances and
standing for long periods. However, you should regularly stretch your feet
and calves using exercises such as those described below.
Pain relief
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be
used to help relieve pain.
Some people also find applying an ice pack to the affected heel for five to
10 minutes can help relieve pain and inflammation.
However, don't apply the ice pack directly to your skin. Instead, wrap it in a
towel. If you don't have an ice pack, you can use a packet of frozen
vegetables.
Exercise
Exercises designed to stretch both your calf muscles and your plantar
fascia (the band of tissue that runs under the sole of your foot) should help
relieve pain and improve flexibility in the affected foot.
A number of stretching exercises are described below. It's usually
recommended that you do the exercises on both legs, even if only one of

your heels is affected by pain. This will improve your balance and stability
as well as relieving your heel pain.
Towel stretches
Keep a long towel beside your bed. Before you get out of bed in the
morning, loop the towel around your foot and use it to pull your toes
towards your body, while keeping your knee straight. Repeat three times
on each foot.
Wall stretches
Place both hands on a wall at shoulder height, with one of your feet in front
of the other. The front foot should be about 30cm (12 inches) away from the
wall.
With your front knee bent and your back leg straight, lean towards the wall
until you feel a tightening in the calf muscles of your back leg. Then relax.
Repeat this exercise 10 times before switching legs and repeating the
cycle. You should practise wall stretches twice a day.
Stair stretches
Stand on a step of your stairs facing upstairs, using the banister for
support. Your feet should be slightly apart, with your heels hanging off the
back of the step.
Lower your heels until you feel a tightening in your calves. Hold this
position for about 40 seconds, before raising your heels back to the starting
position. Repeat this procedure six times, at least twice a day.
Chair stretches
Sit on a chair, with your knees bent at right angles. Turn your feet sideways
so your heels are touching and your toes are pointing in opposite
directions. Lift the toes of the affected foot upwards, while keeping your
heel firmly on the floor.
You should feel your calf muscles and Achilles tendon (the band of tissue
that connects your heel bone to your calf muscle) tighten. Hold this position
for several seconds and then relax. Repeat this procedure 10 times, five or
six times a day.
Dynamic stretches
While seated, roll the arch of your foot (the curved bottom part of the foot
between your toes and heel) over a round object, such as a rolling pin,

tennis ball or drinks can. Some people find that using a chilled can from
their fridge has the added benefit of helping to relieve pain.
Move your foot and ankle in all directions over the object for several
minutes. Repeat the exercise twice a day.
Footwear
Your GP or podiatrist may advise you to change your footwear.
You should avoid wearing flat-soled shoes because they won't provide your
heel with support and could make your heel pain worse.
Ideally, you should wear shoes that cushion your heels and provide a good
level of support to the arches of your feet.
For women, wearing high heels, and for men wearing heeled boots or
brogues, can provide short- to medium-term pain relief. This is
because they help reduce pressure on the heels.
However, these types of shoes may not be suitable in the long-term
because they can lead to further episodes of heel pain. Your GP or
podiatrist will be able to advise you about suitable footwear.
Orthoses
Orthoses are insoles that fit inside your shoe to support your foot and help
your heel recover. You can buy orthoses off-the-shelf from sports shops
and larger pharmacies. Alternatively, your podiatrist should be able to
recommend a supplier.
If your pain doesn't respond to treatment and keeps recurring, or if you
have an abnormal foot shape or structure, custom-made orthoses are
available. These are specifically made to fit the shape of your feet.
However, there's currently no evidence to suggest that custom-made
orthoses are more effective than those bought off-the-shelf.
Strapping and splinting
An alternative to using orthoses is to have your heel strapped with sports
strapping (zinc oxide) tape, which helps relieve pressure on your heel. Your
GP or podiatrist can teach you how to apply the tape yourself.
In some cases, night splints can also be useful. Most people sleep with
their toes pointing down, which means tissue inside the heel is squeezed
together.
Night splints, which look like boots, are designed to keep your toes and feet
pointing up while you're asleep. This will stretch both your Achilles tendon
and your plantar fascia, which should help speed up your recovery time.

Night splints are usually only available from specialist shops and online
retailers. Again, your podiatrist should be able to recommend a supplier.
Corticosteroid injections
If treatment hasn't helped relieve your painful symptoms, your GP may
recommend corticosteroid injections.
Corticosteroids are a type of medication that has a powerful antiinflammatory effect. They have to be used sparingly because overuse can
cause serious side effects, such as weight gain and high blood pressure
(hypertension).
As a result, it's usually recommended that no more than three corticosteroid
injections are given within a year in any part of the body.
Before having a corticosteroid injection, a local anaesthetic may be used to
numb your foot so you don't feel any pain.
Surgery
If treatment hasn't worked and you still have painful symptoms after a year,
your GP may refer you to either:
an orthopaedic surgeon a surgeon who specialises in surgery that
involves bones, muscles and joints
a podiatric surgeon a podiatrist who specialises in foot surgery
Surgery is sometimes recommended for professional athletes and other
sportspeople who have heel pain that's adversely affecting their career.
Plantar release surgery
Plantar release surgery is the most widely used type of surgery for heel
pain. The surgeon will cut the fascia to release it from your heel bone and
reduce the tension in your plantar fascia. This should reduce any
inflammation and relieve your painful symptoms.
Surgery can be carried out either as:
open surgery where the section of the plantar fascia is released by
making a cut into your heel
endoscopic or minimal incision surgery where a smaller incision
is made and special instruments are inserted through it to gain
access to the plantar fascia
Endoscopic or minimal incision surgery has a quicker recovery time, so
you'll be able to walk normally much sooner (almost immediately),
compared with two to three weeks for open surgery.

A disadvantage of endoscopic surgery is that it requires a specially trained

surgical team and specialised equipment, so you may have to wait longer
for treatment than if you were to choose open surgery.
Endoscopic surgery also carries a higher risk of damaging nearby nerves,
which could result in symptoms such as numbness, tingling, or some loss
of movement in your foot.
As with all surgery, plantar release carries the risk of causing complications
such as infection, nerve damage and a worsening of your symptoms after
surgery (although this is rare).
You should discuss the advantages and disadvantages of both techniques
with your surgical team.
Extracorporeal shockwave therapy (EST)
Extracorporeal shockwave therapy (EST) is a fairly new type of noninvasive treatment. Non-invasive means it doesn't involve making cuts into
the body.
EST involves using a device to deliver high-energy soundwaves into your
heel. The soundwaves can sometimes cause pain, so a local anaesthetic
may be used to numb your heel.
It's claimed that EST works in two ways. It's thought to:
have a "numbing" effect on the nerves that transmit pain signals to
your brain
help stimulate and speed up the healing process
However, these claims haven't been definitively proven.
The National Institute for Health and Care Excellence (NICE) has issued
guidance about the use of EST for treating plantar fasciitis.
NICE states that there are no concerns over the safety of EST, but there
are uncertainties about the effectiveness of the procedure for treating heel
pain.
Some studies have reported that EST is more effective than surgery and
other non-surgical treatments, while other studies found the procedure to
be no better than a placebo (sham treatment).
For more information, you can read the NICE guidance about using EST for
treating plantar fasciitis (PDF, 96.4kb).

Treating a minor head injury

You can usually recover from a minor head injury at home but keep
an eye out for any new symptoms that might develop.
If your child experiences a knock, bump or blow to the head, sit them down,
comfort them, and make sure they rest. You can hold a cold compress to
their head try a bag of ice or frozen peas wrapped in a tea towel.
Seek immediate medical advice if symptoms such as mild dizziness and a
headache get worse.
Read more about when you need to seek urgent medical attention.
Advice for adults
If you have a minor head injury:
ask someone to stay with you and keep within easy reach of a
telephone and medical help for the first 48 hours after the injury
have plenty of rest and avoid stressful situations
don't drink alcohol or take recreational drugs
don't take sleeping pills, sedatives or tranquillisers (unless they're
prescribed by your doctor)
take paracetamol if you have a mild headache, but avoid nonsteroidal anti-inflammatory drug (NSAIDs), such as ibuprofen and
aspirin, unless advised or prescribed by a doctor
don't play contact sport, such as football or rugby, for at least three
weeks without talking to your doctor
don't return to work, college or school until you've completely
recovered and feel ready
don't drive a car, motorbike or bicycle or operate machinery until
you've completely recovered

When to seek medical attention

Go to your nearest accident and emergency (A&E) department if you
develop any of the symptoms listed above.
See your GP for advice if you still have symptoms two weeks after the head
injury or you're unsure about driving or returning to work.
Advice for children
If your child has a minor head injury:
give them paracetamol if they have a mild headache, but avoid
NSAIDs such as ibuprofen and aspirin (aspirin should never be given
to children under the age of 16)
avoid getting them too excited
don't have too many visitors
don't let them play contact sports, such as football or rugby, for at
least three weeks without talking to your doctor
make sure they avoid rough play for a few days
When to seek medical attention
Take your child to A&E if their symptoms worsen or they develop any new
symptoms.
See your GP for advice if your child still has symptoms two weeks after the
head injury, or you're unsure about them returning to school or sport.

Treating a severe head injury

A severe head injury must always be treated in hospital to minimise
the risk of complications.
Initial treatment

The healthcare professionals treating you will prioritise any potentially lifethreatening injuries.
For example, they may:
check your airway is clear
check your breathing and start cardiopulmonary resuscitation (CPR
or mouth-to-mouth)
stabilise your neck and spine for example, by using a neck brace
stop any severe bleeding
provide pain relief if you're in a lot of pain
splint any fractured or broken bones (strapping them into the correct
position)
Once your condition is stable, you'll have a computerised tomography scan
(CT) scan to help determine the severity of your injury.
Read more about diagnosing a severe head injury.
Observation
If you need to stay in hospital for observation, the healthcare professionals
treating you will regularly check:
your level of consciousness and how alert you are
the size of your pupils and how well they react to light
how well you can move your arms and legs
your breathing, heart rate, blood pressure, temperature and the level
of oxygen in your blood
These checks will be made every half an hour until it's clear you know who
and where you are, you can speak and move as requested, and your eyes
are open. After this, checks will be less frequent.
If your CT scan results show bleeding or swelling inside your skull, a small
device called an intracranial pressure (ICP) monitor may be fitted. A thin
wire will be inserted into the space between your skull and the brain,

through a small hole drilled into the skull. The wire is attached to an
electronic device that will alert hospital staff to any changes in the pressure
inside your skull.
Cuts and grazes
Any external cuts or grazes to your head will be cleaned and treated to
prevent further bleeding or infection. If there are foreign bodies in the
wound, such as broken glass, they'll need to be removed.
Deep or large cuts may need to be closed with stitches until they
heal. Local anaesthetic may be used to numb the area around the cut so
you don't feel any pain.
Neurosurgery
Neurosurgery is any type of surgery used to treat nervous system problems
(problems with the brain, spinal cord and nerves). In cases of severe head
injury, neurosurgery is usually carried out on the brain.
Possible reasons for neurosurgery include:
a haemorrhage severe bleeding inside your head, such as
a subarachnoid haemorrhage, which puts pressure on the brain and
may result in brain injury and, in severe cases, death
a haematoma a blood clot inside your head, such as a subdural
haematoma, which can also put pressure on the brain
cerebral contusions bruises on the brain, which can develop into
blood clots
skull fracture (see below)
These problems will be identified during tests and a CT scan. If surgery is
needed, a neurosurgeon (an expert in brain and nervous system surgery)
may come and speak to you or your family about it.
However, as the problems listed above can be serious and may require
urgent treatment, there may not be time to discuss surgery before it's
carried out. In such cases, your surgeon will take the time to discuss the
details of the surgery with both you and your family after the operation.

Craniotomy
A craniotomy is one of the main types of surgery used to treat severe head
injuries.
During a craniotomy, a hole is made in the skull so that the surgeon can
access your brain. The procedure will be carried out under general
anaesthetic, so you'll be unconscious and unable to feel any pain or
discomfort.
The surgeon will remove any blood clots that may have formed in your
brain and repair any damaged blood vessels. Once any bleeding inside
your brain has stopped, the removed piece of skull bone will be replaced
and reattached using small metal screws.
Skull fractures
Your skull may be fractured during a head injury. The CT scan will help
determine the extent of the injury.
There are different types of skull fractures, including:
simple (closed) fracture where the skin hasn't broken and the
surrounding tissue isn't damaged
compound (open) fracture where the skin and tissue is broken and
the brain is exposed
linear fracture where the break in the bone looks like a straight line
depressed fracture where part of the skull is crushed inwards
basal fracture a fracture to the base of the skull
Open fractures are often serious because there's a higher risk of bacterial
infection if the skin is broken. Depressed fractures can also be very serious
because small pieces of bone can press inwards against the brain.
Treating skull fractures
Most skull fractures will heal by themselves, particularly if they're simple,
linear fractures. The healing process can take many months, although any
pain will usually disappear in around 5 to 10 days.

If you have an open fracture, antibiotics may be prescribed to prevent an

infection developing.
If you have a severe or depressed fracture, surgery may be needed to help
prevent brain damage. This will usually be carried out under general
anaesthetic.
During surgery, any pieces of bone that have been pressed inwards can be
removed and returned to their correct position. If necessary, metal wire or
mesh may be used to reconnect the pieces of your skull.
Once the bone is back in place, it should heal naturally. Your surgeon will
be able to explain the procedure you're having in more detail.
After surgery
Depending on the seriousness of your operation, you may need to recover
in an intensive care unit (ICU). This is a small, specialised ward where
you'll be constantly monitored.
In an ICU, you may be placed on a ventilator, which is an artificial breathing
machine that moves oxygen-enriched air in and out of your lungs.
Once you're well enough, you'll be moved to a high-dependency unit (HDU)
or another ward and your condition will continue to be monitored until
you're well enough to leave hospital.
Read more about recovering from a severe head injury.

Treating shoulder pain

There are several types of treatment for shoulder pain, depending on
the cause of your shoulder pain and your symptoms.
Some treatment options, such as heat or ice packs and painkillers, may
help to reduce pain and treat minor injuries at home.

You should see you GP if your pain is either the result of an injury, it's
particularly bad, or there is no sign of improvement after a couple of weeks.
Your GP may refer you for specialist treatment with an orthopaedic surgeon
(a specialist in conditions that affect the bones and muscles) or a
rheumatologist (a specialist in conditions that affect the muscles and joints)
if you have:
a frozen shoulder
a rotator cuff disorder
an acromioclavicular joint disorder
a rotator cuff tear
shoulder instability and you are under 30 years old
Treatment options
The main treatment options for shoulder pain include:
avoiding activities that make your symptoms worse
using ice packs
painkillers
anti-inflammatories
physiotherapy
arthrographic distension (hydrodilatation)
surgery (in some cases)
The various treatments for shoulder pain are outlined below. You can also
read a summary of the pros and cons of the treatments for shoulder pain,
allowing you to compare your treatment options.
As well as pain, you may also have reduced strength or movement in your
shoulder. In this case, a combination of different treatments may be used.
Read more about treating frozen shoulder.
Avoiding activities

Depending on what is causing your shoulder pain, your GP may

recommend that you avoid certain activities or movements that could make
your symptoms worse.
For example, in the early, painful stage of frozen shoulder, you may be
advised to avoid activities that involve lifting your arms above your head
and stretching vigorously. However, you should continue using your
shoulder for other activities, because keeping it still could make your
symptoms worse.
If you have shoulder instability, you may be advised to avoid any
movements that are likely to make the instability worse, such as overarm
throwing or bench pressing.
If you have sprained your acromioclavicular joint (the joint at the top of your
shoulder), you may be advised to avoid activities that involve moving your
arm across your body (such as a golf swing or weightlifting). You should
keep the shoulder mobile with light tasks if possible, but avoid heavy lifting
and contact sports for 8 to 12 weeks. You may also be given a sling (a
supportive bandage) to wear to support your arm for up to a week after
your injury. Osteoarthritis is the most common cause of acromioclavicular
joint disorders.
Ice packs
If you injure your shoulder for example, while playing sport you can
apply an ice pack to the affected area to reduce pain and inflammation.
You should apply the ice pack for 10-30 minutes. A bag of frozen peas, or
similar, will also work well. Wrap the ice pack in a damp towel to avoid it
directly touching your skin and causing ice burn.
Painkillers
If your pain is mild, taking painkillers such as paracetamol or codeine may
be enough to control it. Always follow the dosage instructions on the packet
to ensure the medicine is suitable and that you do not take too much.

If your shoulder pain is more severe, your GP may recommend or prescribe

a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen,
diclofenac or naproxen.
As well as easing the pain, NSAIDs can also help reduce swelling in your
shoulder capsule. They are most effective when taken regularly, rather than
when your symptoms are most painful.
Corticosteroid tablets
Corticosteroids are medicines that contain steroids, which are a type of
hormone. Hormones are powerful chemicals that have a wide range of
effects on the body, including reducing pain and swelling.
You may be prescribed corticosteroid tablets for frozen shoulder. Some
evidence suggests that these may provide short-term pain relief for a few
weeks. However, it is not clear whether corticosteroid tablets are any better
than other treatment options, such as corticosteroid injections.
Corticosteroid tablets can also cause a number of side effects.
Read more about the side effects of corticosteroids.
Corticosteroid injections
If your shoulder pain is very severe, oral painkillers may not be enough to
control the pain.
Corticosteroid injections in and around your shoulder joint may help to
relieve the pain and increase your range of movement for several weeks at
a time. However, the injections cannot cure your condition completely, and
your symptoms may gradually return.
Some experts believe that the use of corticosteroid injections should be
delayed for as long as possible, and there is little evidence to suggest that
this is an effective treatment. However, they may help to reduce pain,
thereby allowing you to do your physiotherapy and rehabilitation more
effectively.

Cautions
After having a corticosteroid injection, you may experience side effects at
the site of the injection, including:
temporary pain
lightening of your skin
thinning of your skin
Having too many corticosteroid injections can damage your shoulder.
Therefore, you may only be able to have this treatment up to three times in
the same shoulder in one year.
Read about corticosteroids for more information.
Hyaluronate injections
Hyaluronate is another medicine that can be injected into your shoulder to
treat shoulder pain. One review of a number of studies found that
hyaluronate was effective at reducing pain.
However, the National Institute for Health and Care Excellence (NICE)
does not recommend hyaluronate to treat osteoarthritis (a condition that
affects the joints). It found that hyaluronate only helped a little and that
corticosteroid injections were a better treatment choice. Therefore,
hyaluronate may not be used for this condition.
Physiotherapy
Physiotherapy uses a number of different physical methods to promote
healing. If you are referred to a physiotherapist, they should explain to you
what treatment they will use and how it will work.
Possible treatments include:
specific shoulder exercises for example, if you have shoulder
instability, you may be given exercises to strengthen your shoulder
massage where the physiotherapist uses their hands to manipulate
your shoulder

Read more about some of the different techniques used in physiotherapy.

Shoulder exercises
If you have shoulder pain, it's important to keep your shoulder joint mobile
with light and gentle movement. Not using your shoulder can cause your
muscles to waste away and may make any stiffness worse. Therefore, if
possible, you should continue using your shoulder as normal.
If your shoulder is very stiff, exercise may be painful. Your GP or
physiotherapist can give you exercises to do without further damaging your
shoulder.
You may be given exercises to do on your own, or you may complete the
exercises with supervision from your GP or physiotherapist. You may also
have manual therapy, where the healthcare professional moves your arm
for you. Manual therapy uses special techniques to move the joints and soft
tissues in your shoulder.
One review of a number of studies found that long-term physiotherapy
was as effective as surgery for impingement syndrome (any type of
damage to the tendons in the rotator cuff).
Arthrographic distension (hydrodilatation)
Arthrographic distension or hydrodilatation may sometimes be
recommended to treat frozen shoulder. A special fluid, which shows up
clearly on X-rays, is injected into your shoulder joint at the beginning of the
procedure. Under continuous X-ray guidance, a mixture of saline,
corticosteroid and local anaesthetic is then injected into the shoulder joint.
This procedure usually only takes about 15 minutes, is done under local
anaesthetic, and you can go home the same day. Physiotherapy may be
recommended afterwards to help you regain a good range of movement in
your shoulder.
Surgery for frozen shoulder

If other treatments for frozen shoulder have not worked, you may be
referred for surgery. There are two possible surgical procedures explained
in more detail below.
Manipulation
Manipulation involves having your shoulder moved while you are
under general anaesthetic. During the procedure, your shoulder will be
gently moved and stretched while you are asleep.
Afterwards, you will usually need to have physiotherapy to help maintain
mobility in your shoulder. Manipulation may be used if you are finding the
pain and disability from your shoulder difficult to cope with.
Arthroscopic capsular release
An alternative procedure to manipulation is arthroscopic capsular release,
which is a type of keyhole surgery. The surgeon will carry out the procedure
after making an incision that is less than 1cm (0.4in) long. A special probe
opens up your contracted shoulder capsule and any bands of scar tissue
are removed. This should greatly improve your symptoms.
As with manipulation, you will need physiotherapy after the surgery to help
you regain a full range of movement in your shoulder joint.
Surgery for a rotator cuff tear
Surgery may be used to treat rotator cuff tears if the tear is large or if other
treatment options have not worked after three to six months. It's possible
that having surgery earlier will lead to a quicker recovery, although there is
currently not enough research into whether early surgery is beneficial.
During the procedure, a small amount may be shaved off the bones in your
shoulder. Damaged tendons and bursae (fluid-filled sacs found over joints
and between tendons and bones) may also be removed. This creates more
space within the joint to allow your rotator cuff to move freely.
The operation can be performed as:
open surgery a large incision is made in your shoulder

 mini-open surgery a small incision is made in your shoulder

arthroscopic surgery a type of keyhole surgery that uses a camera
to look inside your shoulder joint
Evidence suggests that people return to work about a month earlier if they
have mini-open surgery rather than open surgery.
As with frozen shoulder surgery, you will need physiotherapy after your
operation to help you regain a full range of movement in your shoulder
joint.
Surgery for shoulder instability
If your shoulder dislocates (the ball comes out of the socket) regularly or
severely, you may need surgery to prevent it happening again and to
prevent surrounding tissues and nerves from becoming damaged.
Depending on the type of instability you have, surgery may involve:
tightening stretched ligaments or reattaching them if they have torn
(ligaments are tough bands of connective tissue that link two bones
together at a joint)
tightening the shoulder capsule by tightening it with stitches
Surgery for shoulder instability can either be done using keyhole or open
surgery. After the operation, your shoulder will need to be immobilised
(prevented from moving) using a special sling for several weeks. You will
also need physiotherapy to improve your strength. Full recovery may take
several months.
Joint replacement (arthroplasty) for osteoarthritis of the shoulder
Joint replacement therapy, also known as an arthroplasty, is the most
common treatment for osteoarthritis of the shoulder. During an arthroplasty,
your surgeon will remove your affected joint and replace it with an artificial
joint (prosthesis) made of special plastics and metal. An artificial joint can
last for up to 20 years. However, it may eventually need to be replaced.
Dislocated shoulder

If your shoulder is dislocated (the ball has come out of the socket), go
to the nearest accident and emergency (A&E)
department immediately.
The healthcare professionals at the hospital will put the ball of your upper
arm bone (humerus) back into the joint socket. This procedure is called a
reduction.
After a reduction, you will need to rest your arm by wearing a sling
(supportive bandage) for a few weeks. You may also be prescribed pain
relief medication.
Recovery generally requires a course of physiotherapy involving exercises
to help regain the strength in your shoulder muscles.
Read more information about a dislocated shoulder.
Treating sprains and strains
Most sprains and strains can be managed at home using over-thecounter painkillers to ease any pain.

If the injury is minor, you can look after yourself by using "PRICE therapy"
and "avoiding HARM". These are described below.
PRICE therapy
PRICE stands for:
Protection protect the affected area from further injury by using a
support or, in the case of an ankle injury, wearing shoes that enclose
and support your feet, such as lace-ups.

 Rest stop the activity that caused the injury and rest the affected
joint or muscle. Avoid activity for the first 48 to 72 hours after injuring
yourself. Your GP may recommend you use crutches.
Ice for the first 48 to 72 hours after the injury; apply ice wrapped in
a damp towel to the injured area for 15 to 20 minutes every two to
three hours during the day. Don't leave the ice on while you're asleep,
and don't allow the ice to touch your skin directly because it could
cause a cold burn.
Compression compress or bandage the injured area to limit any
swelling and movement that could damage it further. You can use a
simple elastic bandage or an elasticated tubular bandage available
from a pharmacy. It should be wrapped snuggly around the affected
area, but not so tightly that it restricts blood flow. Remove the
bandage before you go to sleep.
Elevation keep the injured area raised and supported on a pillow to
help reduce swelling. If your leg is injured, avoid long periods of time
where your leg isn't raised.
Avoiding HARM
For the first 72 hours after a sprain or muscle strain, you should avoid
HARM. This means you should avoid:
Heat such as hot baths, saunas or heat packs.
Alcohol drinking alcohol will increase bleeding and swelling,
and slow healing.
Running or any other form of exercise that could cause more
damage.
Massage which may increase bleeding and swelling.
Moving sprained joints
Most healthcare professionals recommend you don't stop using a sprained
joint. The injury will heal quicker if you begin to move the joint as soon as
you're able to do so without experiencing significant pain.
Your doctor may be able to teach you a number of exercises that will help
you improve the joint's functionality.
If you have a severe ankle sprain, you may be advised not to use it for a
while, or even have it put into a cast for a week or so.
Immobilising strained muscles

Depending on your injury, the advice for muscle strains can vary. You may
be advised to keep your injured muscle still for the first few days. Your
doctor may recommend using a brace, cast or splint to help keep it as still
as possible.
The aim of immobilising the muscle is to allow it to start healing, so you can
move it without tearing or pulling it again in the same place. After a few
days, you'll probably be advised to start using the muscle again.
Treating pain
Paracetamol is usually recommended for painful sprains or strains. If it
doesn't help, you may need an additional stronger painkiller such
as codeine that's only available on prescription.
Your GP may also prescribe a non-steroidal anti-inflammatory drug
(NSAID) cream or gel, such as ibuprofen or ketoprofen, to help treat pain.
Gently apply the cream or gel to the injured area and wash your hands
immediately afterwards.
Ketoprofen can make your skin sensitive to light (photophobia). You should
avoid exposing treated areas of skin to direct sunlight or artificial sources of
light, such as sunlamps or sun beds, during treatment and for two weeks
afterwards.
Oral NSAIDs, such as ibuprofen tablets, can also help reduce swelling and
inflammation. However, they shouldn't be used in the first 48 hours after the
injury because they may delay healing.
Physiotherapy
For more severe injuries, particularly muscle strains, your doctor may
consider referring you for physiotherapy.
Physiotherapy aims to restore movement and function to an injured area of
the body. The physiotherapist may show you exercises to help improve the
range of motion and return normal function to the injured area.
This may reduce your risk of experiencing long-term problems or injuring
the area again.
Recovery
The length of time it takes to recover from a sprain or strain depends on
how severe it is.
Generally, after an ankle sprain you'll probably be able to walk a week or
two after the injury. You may be able to use your ankle fully after six to

eight weeks, and you'll probably be able to return to sporting activities after
eight to 12 weeks.
For muscle strains, the time it can take to recover can vary considerably.
Some people recover within a few weeks, whereas others may not be able
to return to their normal activities for several months.
Some people may experience continued problems, such as pain,
intermittent swelling or instability, for months, or even years, after the
original sprain or strain.
Contact your GP if your injury doesn't improve as expected or your
symptoms get worse. They may consider referring you to an orthopaedic
specialist for further assessment and treatment.
Surgery
It's rare to need surgery to repair sprains or strains. It's usually only
required for severe muscle strains, particularly those in professional sports
people.
In these cases, without surgery, it's likely the affected muscle won't fully
regain its former strength, and the person's performance may be affected.
For people who aren't sports professionals and those with more minor
strains, the loss of muscle strength is usually too mild, or the risk of
repeated injuries too low, to justify the risks of surgery.
Surgery is rarely carried out for sprains because it's unclear whether it's
any more effective than less invasive treatments.

Treating a tendon injury

Tendon injuries sometimes get better within a few weeks, but more
persistent cases can last for several months.

There hasn't been much research into the best treatments for tendonitis
and other tendon injuries, so it's not clear exactly which are the most
effective.
Some of the treatments that may be recommended are described below,
although your doctor may suggest different options depending on the
specific injury you have.
The various treatments for tendon injuries are outlined below. You can also
read a summary of the pros and cons of the treatments for tendon injuries,
allowing you to compare your treatment options.
Self-care
Some tendon injuries can be cared for at home using the measures
outlined below.
Rest
When you first injure your tendon, stop doing the activity that caused the
injury and try to avoid any activities that cause your pain to get worse. This
can help prevent any further damage and allow the tendon to heal.
Some form of support, such as a bandage, splint or brace, may help
prevent the affected body part moving.
How long you need to rest for depends on which tendon is affected and
how severely it's damaged. Prolonged rest is generally considered
unhelpful as this can lead to long-term stiffness, so you should aim to
gradually restart exercise when your pain allows.
Ice packs
Regularly applying an ice pack to the affected area during the first few days
after the injury may help ease the pain and swelling.
Don't put ice directly on your skin though, as it may cause a cold burn.
Instead, wrap it in a towel or put a towel over the injured area before
applying the ice pack. A bag of ice cubes or frozen vegetables wrapped in a
towel works just as well.

Hold the ice pack on the affected area for around 15-20 minutes several
times a day.
Painkillers
Mild pain can sometimes be treated with over-the-counter painkillers such
as paracetamol or ibuprofen. These are available as tablets or capsules,
although ibuprofen also comes as a gel you apply directly to the affected
area.
Before using these medications, check the leaflet that comes with them to
see if they are suitable. Generally, ibuprofen shouldn't be used for long
periods and isn't recommended for people with asthma, kidney
disease or stomach ulcers.
Therapies and injections
See your GP if your symptoms are severe or are not getting better within a
few weeks. They may be able to refer you for one of the more specialist
treatments described below.
Physiotherapy
Physiotherapy for tendon injuries often involves a special exercise
programme to help stretch and strengthen the injured tendon and
surrounding muscles.
A physiotherapist may also be able to arrange an assessment of how you
perform certain activities, such as running. You can then be advised of
ways to improve any problems with your technique and posture that may
have contributed to your injury.
Corticosteroid injections
Corticosteroids can be injected around injured tendons to reduce pain and
inflammation. They can also be combined with local anaesthetic to further
relieve pain.
However, while these injections can help reduce pain, they aren't effective
for everyone and the effect sometimes only lasts a few weeks.

The injections can be repeated if they help, but a gap of at least six weeks
between treatments, and a maximum of three injections into one area, is
usually recommended because frequent injections can cause side effects.
Possible side effects include the weakening of the tendon (which can
increase the risk of rupturing or tearing), and thinning and lightening of the
skin.
Extracorporeal shock wave therapy
Extracorporeal shock wave therapy (ESWT) may be a treatment option for
some tendon injuries that haven't responded to other treatments.
It involves passing shock waves through your skin to the affected area. This
may be carried out over one or more sessions, and local anaesthetic may
be used to numb the area first.
It's not clear exactly how ESWT works, but in some cases it helps break up
deposits that have built up on an injured tendon and it may help promote
healing.
Possible risks of ESWT include:
the tendon rupturing
temporary redness or swelling
pain during the treatment
feeling sick
The National Institute for Health and Care Excellence (NICE) has produced
guidelines on ESWT for calcific tendonitis, ESWT for tennis
elbow and ESWT for Achilles tendinopathy.
Surgery
Surgery may be an option for some tendon injuries, but this is often only
considered as a last resort because it's not always effective and carries a
risk of complications such as wound infections, scarring and rupturing of
the affected tendon.

Surgery can be used to:

remove the damaged section of tendon
remove lumps or deposits that have formed on the tendon
encourage the tendon to heal
repair ruptured tendons
Increasingly, tendon operations in the shoulder and knee are carried out
using a technique called arthroscopy. This is a type of keyhole surgery
where special surgical instruments and a long, thin tube containing a
camera are inserted through small cuts in your skin.
Arthroscopy can reduce scarring and allow you to recover more quickly, but
it will often still be several weeks or months before you can return to your
normal activities.

Treating tennis elbow

Tennis elbow is a self-limiting condition, which means it will
eventually get better without treatment.
However, it can often last for several weeks or months, because tendons
heal slowly. In some cases, tennis elbow can persist for more than a year.
A number of simple treatments can help alleviate the pain of tennis elbow.
The most important thing you can do is rest your injured arm and stop
doing the activity that caused the problem (see below).
Holding a cold compress, such as a bag of frozen peas wrapped in a towel,
against your elbow for a few minutes several times a day can help ease the
pain.

Invasive treatments, such as surgery, will usually only be considered in

severe and persistent cases of tennis elbow, where non-surgical
approaches have not been effective.
The various treatments for tennis elbow are outlined below. You can also
read a summary of the pros and cons of the treatments for tennis elbow,
allowing you to compare your treatment options.
Avoiding or modifying activities
If you have tennis elbow, you should stop doing activities
that strain affected muscles and tendons.
If you use your arms at work to carry out manual tasks, such as lifting, you
may need to avoid these activities until the pain in your arm improves.
Alternatively, you may be able to modify the way you perform these types
of movements so they do not place strain on your arm.
Talk to your employer about avoiding or modifying activities that
could aggravate your arm and make the pain worse.
Painkillers and NSAIDs
Taking painkillers, such as paracetamol, and non-steroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, may help ease mild pain
and inflammation caused by tennis elbow.
As well as tablets, NSAIDs are also available as creams and gels (topical
NSAIDs). They are applied directly to a specific area of your body, such as
your elbow and forearm.
Topical NSAIDs are often recommended for musculoskeletal conditions,
such as tennis elbow, rather than anti-inflammatory tablets. This is because
they can reduce inflammation and pain without causing side effects, such
as nausea and diarrhoea.
Some NSAIDs are available over the counter without a prescription,
while others are only available on prescription. Your GP or pharmacist will
be able to recommend a suitable NSAID.

Read more about non-prescription and prescription-only medicines.

Physiotherapy
Your GP may refer you to a physiotherapist if your tennis elbow is causing
more severe or persistent pain. Physiotherapists are healthcare
professionals who use a variety of methods to restore movement to injured
areas of the body.
Your physiotherapist may use manual therapy techniques, such as
massage and manipulation, to relieve pain and stiffness, and encourage
blood flow to your arm. They can also show you exercises you can do to
keep your arm mobile and strengthen your forearm muscles.
The use of an orthoses such as a brace, strapping, support bandage or
splint may also be recommended in the short term.
Read more about physiotherapy.
Corticosteroid injections
Corticosteroid injections are sometimes used to treat particularly painful
musculoskeletal problems. However, there is limited clinical evidence to
support their use as an effective treatment for tennis elbow.
Corticosteroids are a type of medication that contain man-made versions of
the hormone cortisol.
Corticosteroid injections may help reduce the pain of tennis elbow in the
short term, but their long-term effectiveness has been shown to be poor.
The injection will be made directly into the painful area around your
elbow. Before you have the injection, you may be given a local
anaesthetic to numb the area to reduce the pain.
Shock wave therapy
Shock wave therapy is a non-invasive treatment, where high-energy shock
waves are passed through the skin to help relieve pain and promote
movement in the affected area.

How many sessions you will need depends on the severity of your pain.
You may have a local anaesthetic to reduce any pain or discomfort during
the procedure.

The National Institute for Health and Care Excellence (NICE) states
that shock wave therapy is safe, although it can cause minor side effects,
including bruising and reddening of skin in the area being treated.
Research shows that shock wave therapy can help improve the pain of
tennis elbow in some cases. However, it may not work in all cases,
and further research is needed.
Surgery
Surgery may be recommended as a last resort treatment in cases
where tennis elbow is causing severe and persistent pain. The damaged
part of the tendon will be removed to relieve the painful symptoms.

The Seven Most Common Sports Injuries

What weekend warriors need to know about preventing and
treating the seven most common sports injuries
By Matthew Hoffman, MD
Listen
FROM THE WEBMD ARCHIVES
After a sedentary work week, end-zone catches and 36-hole
weekends can take their toll in common sports injuries. The seven
most common sports injuries are:
1. Ankle sprain

2. Groin pull
3. Hamstring strain
4. Shin splints
5. Knee injury: ACL tear
6. Knee injury: Patellofemoral syndrome injury resulting from
the repetitive movement of your kneecap against your thigh
bone
7. Tennis elbow (epicondylitis)
To see how to prevent and treat these common sports injuries
and to learn when it's time to look further than your medicine
cabinet to treat sports injuries read on.
The most common sports injuries are strains and sprains
Sprains are injuries to ligaments, the tough bands connecting
bones in a joint. Suddenly stretching ligaments past their limits
deforms or tears them. Strains are injuries to muscle fibers or
tendons, which anchor muscles to bones. Strains are called pulled
muscles for a reason: Over-stretching or overusing a muscle
causes tears in the muscle fibers or tendons.
Think of ligaments and muscle-tendon units like springs, says
William Roberts, MD, sports medicine physician at the University of
Minnesota and spokesman for the American College of Sports
Medicine. The tissue lengthens with stress and returns to its
normal length unless it is pulled too far out of its normal range.

SLIDESHOW

A Visual Guide to Knee Replacement

Start
Preventing the most common sports injuries
Sometimes preventing common sports injuries is beyond our
control, but many times sports injuries are preventable. Some
injuries, Roberts says, we bring on ourselves because we're not
conditioned for the activity. His advice: Work out daily and get
double benefit enjoy your weekend activities and garner the
health benefits.
Every workout should start with a gentle warm-up to prevent
common sports injuries, says Margot Putukian, MD, director of
athletic medicine at Princeton University. Getting warmed up
increases blood flow to the muscles, gets you more flexible, and
could decrease injuries, she adds.

Overuse injuries are common and preventable, according to

Putukian. Don't come out and hit the ball for an hour after not
playing for a while, she says. Whether it's hiking, running, or team
sports, do some pre-participation training first by lightly working
the relevant muscle groups in the weeks before the activity.
And learn to recognize when you've already left it all on the field.
Stop when you are fatigued, says Roberts. Muscle fatigue takes
away all your protective mechanisms and really increases your risk
of all injuries. You can always come out to play again next
weekend if you don't get injured today.
Treating the most common sports injuries
Usually, common sports injuries are mild or moderate there's
some damage, but everything is still in place. You can treat them at
home using the PRICE therapy method described later in this
article. But you should expect that some common sports injuries
may take months to heal, even with good treatment. If a sprain or
strain is severe, however, the entire muscle, tendon, or ligament is
torn away, and surgery may be needed.
Here are some specific tips for treating each of the most common
sports injuries:
1. Ankle sprain
What it is: Most athletes have experienced a sprained ankle, which
typically occurs when the foot turns inward. This turning stretches
or tears the ligaments on the outside of the ankle, which are
relatively weak.
What you can do: With an ankle sprain, its important to exercise to
prevent loss of flexibility and strength and re-injury. You can ask

your doctor or physical therapist to help you know what kinds of

exercise you should do.
When to see a doctor: Its important to note where the sprain has
occurred. A 'high ankle sprain' is slower to heal and should
probably be seen by a doctor to make sure the bones in the lower
leg did not separate, says R. Marvin Royster, MD. Royster is
assistant team physician for the Atlanta Braves and an orthopedic
surgeon with Peachtree Orthopedic Clinic in Atlanta. One way to
recognize a high ankle sprain is that this sprain usually causes
tenderness above the ankle.
2. Groin pull
What it is: Pushing off in a side-to-side motion causes strain of the
inner thigh muscles, or groin. Hockey, soccer, football, and
baseball are common sports with groin injuries, says Royster.
What you can do: Compression, ice, and rest will heal most groin
injuries. Returning to full activity too quickly can aggravate a groin
pull or turn it into a long-term problem.
When to see a doctor: Any groin pull that has significant swelling
should be seen early by a physician, Royster says.
3. Hamstring strain
What it is: Three muscles in the back of the thigh form the
hamstring. The hamstring can be over-stretched by movements
such as hurdling kicking the leg out sharply when running.
Falling forward while waterskiing is another common cause of
hamstring strains.
What you can do: Hamstring injuries are slow to heal because of
the constant stress applied to the injured tissue from walking, says

Royster. Complete healing can take six to 12 months. Re-injuries

are common because it's hard for many guys to stay inactive for
that long.
4. Shin splints
What they are: Pains down the front of the lower legs are
commonly called shin splints. They are most often brought on by
running especially when starting a more strenuous training
program like long runs on paved roads.
What you can do: Rest, ice, and over-the-counter pain medicine are
the mainstays of treatment.

SLIDESHOW

A Visual Guide to Knee Replacement

Start
When to see a doctor: The pain of shin splints is rarely an actual
stress fracture a small break in the shin bone. But you should
see your doctor if the pain persists, even with rest.
Stress fractures require prolonged rest, commonly a month or
more to heal.
5. Knee injury: ACL tear
What it is: The anterior cruciate ligament (ACL) holds the leg bone
to the knee. Sudden cuts or stops or getting hit from the side can
strain or tear the ACL. A complete tear can make the dreaded pop
sound.
When to see a doctor: Always, if you suspect an ACL injury. ACL
tears are potentially the most severe of the common sports
injuries. A completely torn ACL will usually require surgery in
individuals who wish to remain physically active, says Royster.
6: Knee injury: Patellofemoral syndrome
What it is: Patellofemoral syndrome can result from the repetitive
movement of your kneecap (patella) against your thigh bone
(femur), which can damage the tissue under the kneecap. Running,
volleyball, and basketball commonly set it off. One knee or both
can be affected.
What you can do: Patience is key. Patellofemoral pain can take up
to six weeks to clear up. It's important to continue low-impact
exercise during this time. Working out the quadriceps can also
relieve pain.
7. Tennis elbow (epicondylitis)

What it is: Repetitive use of the elbow for example, during golf
or tennis swings can irritate or make tiny tears in the elbow's
tendons. Epicondylitis is most common in 30- to 60-year-olds and
usually involves the outside of the elbow.
What you can do: Epicondylitis can usually be cleared up by staying
off the tennis court or golf course until the pain improves.
The PRICE principle for treating common sports injuries
The U.S. Marines say that pain is weakness leaving your body.
Most of the rest of us would add, OK, but can't we hurry it up a
little? The answer is yes. Using the PRICE method to treat any
common sports injury will help get you back in the game sooner.
First, its important to know that swelling is a normal response to
these injuries. Excessive swelling, though, can reduce range of
motion and interfere with healing. You can limit swelling and start
healing faster after common sports injuries by using the PRICE
principle:
P protect from further injury
For more severe injuries, protect the injured area with a
splint, pad, or crutch.
R restrict activity
Restricting activity will prevent worsening of the injury.
I apply ice
Apply ice immediately after a common sports injury. Ice is
the miracle drug for sports injuries, says Putukian. It's an
anti-inflammatory, without many side effects. Use ice for 20
minutes every one to two hours for the first 48 hours after the

injury. Don't use heat during this time it encourages

swelling and inflammation.
C apply compression
Compression with an elastic bandage will help reduce swelling.
E elevate the injured area
Elevating the injured area above the heart will also reduce
swelling.
Over-the-counter pain relievers usually relieve the pain of common
sports injuries to a tolerable level. If they don't, it's probably time
to see a doctor.
When to get medical attention for common sports injuries
We know you're tough but you also need to be smart. If you
suspect a serious injury or if you have any of these signs, see a
doctor:
Deformities in the joint or bone it looks crooked, or moves
abnormally
You cannot bear weight or can't use the limb without it giving
way
Excessive swelling
Changes in skin color beyond mild bruising
It's not getting any better after a few days of PRICE therapy