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Ready for action – a quick guide to managing sporting injuries

As the warm weather encourages more people to participate in sport and exercise, it is likely that pharmacies will see increasing requests for advice on minor injuries. Sarah Purcell considers best practice recommendations and treatment options.

More than a fifth of adults have experienced a sports injury at some time, according to the Podium Analytics ‘Safety in sport perception’ survey 2024.

Injury is especially common among those who play sport with a club or team, with 30 per cent injured in the last year compared with 15 per cent who participate in personal fitness activities.

Chartered physiotherapist Sammy Margo says certain people are more at risk of sports injury. “For example, those new to exercise or returning after a long break who do too much, too soon. Or ‘weekend warriors’, who are sedentary during the week but intensely active on weekends,” she explains.

Then there are older adults, due to age-related changes in tissue elasticity and muscle mass; anyone with a previous injury; those using poor technique; and anyone using inappropriate equipment or footwear; as well as people who skip proper warm-ups.

Lucy Macdonald from the Chartered Society of Physiotherapists says people with chronic conditions such as diabetes are also more at risk of injury, as are perimenopausal women. This is because falling oestrogen levels makes tissues more prone to injury.

Rheumatologist Dr Rod Hughes adds that risk of injury may also rise when people are under stress. “Exercising can then lead to a number of problems, including injury from excessively high intensity exercise and over-exercising,” he says. “Stress may be magnified if someone has set unrealistic exercise goals that they cannot fulfil.

“Emotional stress can trigger a physiological response of increased or abnormal muscle tension, which may impact the body’s flexibility and agility. Interference with bodily movement and coordination may increase the risk of injury, as we are unable to exercise as efficiently as normal, setting up patterns of soft tissue and joint strain that can lead to injury.

“Physical and mental stress lead the adrenal glands to produce more cortisol, which can inhibit muscle and joint tissue healing after injury. In these situations, being less able to effectively recover from exercise, muscles become weakened and more susceptible to further damage.”

That said, let’s consider some of the common injuries that might present in pharmacy.

“Exercising when under stress can lead to a number of problems”

Sprains and strains

A sprain is a stretch or tear of a ligament and occurs when excessive force is applied to a joint. Sprains are graded 1-3, from mild stretching to a complete rupture of a ligament. They most commonly affect ankles, knees, wrists and thumbs.

A strain is a stretch or tear of muscle fibres or tendons. It happens when a muscle has been over stretched or forced to contract too strongly. They are graded 1-3, from a mild strain to a torn muscle. The most commonly affected areas are the feet, hamstrings and back.

Assessment questions

Sammy Margo says it is important to ask the following questions when assessing patients:

  • How did the injury happen?
  • Can you show me where it hurts?
  • When did it happen? 
  • Is it getting better or worse?
  • How would you describe the pain?
  • How is it affecting your daily activities?
  • Have you had any similar injuries before? If so, what helped?
  • What have you tried so far to help you?
  • Do you have any medical conditions or are you taking any medication?

Key signs of a sprain, says Margo, are joint instability and limited movement, with bruising, swelling and pain during movement. A strain causes muscle weakness and spasms, with pain, inflammation and limited flexibility.

Red flags

“Be aware that a calf strain could be a DVT,” says Lucy Macdonald. “Look for swelling or redness. If there is no clear cause of the injury, refer the patient. Screen for possible fractures. Bear in mind that not all fractures are painful, so if in doubt, always refer. For back pain, refer patients to A&E if there is reduced sensation in the saddle area and problems with emptying the bowels or bladder.”

Other red flags include:

  • Numbness or tingling below the injury site
  • Inability to bear weight or use the affected limb
  • An audible pop or snap at the time of injury
  • Any signs of nerve or circulation damage
  • Severe or worsening pain
  • Large intramuscular haematoma.

Treatment advice

Pain relief can be recommended as first-line treatment – topical ibuprofen or paracetamol, or an oral NSAID if required. Advise on PRICE management for the first 48-72 hours following injury:

Protection: protect from further injury by using a support and avoiding activities that cause pain

Rest: limit movement of the affected area

Ice: use a cold pack, cold therapy or ice every two to three hours during the day for 48-72 hours

Compression: use an elastic bandage to reduce swelling (snug, not tight, and removed before bed)

Elevation: keep the injured area elevated and supported on a pillow until the swelling reduces.

“Most sprains and strains improve within two to six weeks,” says Margo. “There should be a gradual return to normal activities.” She advises referring patients to a physiotherapist if:

  • The pain or swelling persists beyond seven to 10 days, despite PRICE
  • Function does not improve in one to two weeks
  • The patient has a recurrent injury
  • The injury affects major joints or weight-bearing ability
  • The patient needs specific rehabilitation in order to return to sporting activity.

Prevention advice

Customers should be reminded of the importance of warming up and cooling down before and after exercising or sport. It is also important to wear the correct footwear and clothing and to use the right equipment for the chosen activity. Plenty of fluids should be drunk before, during and after exercise, with sufficient rest between sessions. Using a supportive device for vulnerable joints can help to prevent re-injury.

Tendinopathy

Tendinopathy happens when a tendon becomes inflamed after an injury or overuse. It most commonly affects the Achilles tendon and is more common among runners, dancers and gymnasts.

The main symptoms are pain in the tendon that worsens with movement; difficulty moving the joint; feeling a grating or cracking sensation on moving the tendon; inflammation of the area, sometimes with heat or redness, and stiffness in the tendon, especially in the morning. If pain is sudden or severe and happens during an activity or accident, it may indicate a tendon rupture.

Assessment questions

Margo suggests these questions when assessing patients for tendinopathy:

  • Where is the pain located?
  • What activities make it worse?
  • Did the pain start gradually or suddenly?
  • Have you changed your activity level or routine?
  • Is the pain worse in the morning or after activity?
  • What have you tried so far?

Red flags

  • Sudden pain in the back of the leg, with an audible snap
  • Difficulty bearing weight
  • Severe pain.

Treatment and advice

Cold therapy can be used for acute symptoms. For pain relief, paracetamol is recommended. NSAIDs can be used in the acute phase, but not long-term. Patients should be advised to reduce or stop the activity that caused the injury and restart once pain allows. Refer for physiotherapy if there is no improvement after seven to 10 days. Giving up smoking has been shown to reduce risk of tendinopathy.

Plantar fasciitis

This is a biomechanical overuse condition caused by repetitive stress on the plantar fascia, a thick band of tissue that runs from the heel to the base of the toes. The main symptom is medial plantar heel pain that is worse on standing up first thing in the morning or after sitting.

“Pain improves initially with activity but worsens with prolonged standing or walking,” says Sammy Margo. “It is made worse by walking barefoot on hard surfaces. Onset is gradual rather than after an injury.”

Assessment questions

It is important to ask about symptoms of heel pain, including onset, location, intensity and impact on daily life. Enquiring as to whether pain is worst first thing in the morning or after sitting down and whether there has there been any recent increase in weight-bearing activity will help with diagnosis.

Treatment and advice

“Recommend a heel pad for shoes to raise the heels slightly and keep the foot stable,” says Macdonald. Wearing supportive shoes (e.g. running shoes) and avoiding slippers, flip flops and sandals is also good advice.

Analgesics can be recommended, and cold therapy can also give relief. Stretching exercises for plantar fascia and calf muscles may be recommended by a physiotherapist or podiatrist.

To prevent recurrence, Margo has this advice: “Advise a gradual increase in activity levels. Continue with stretching exercises for calf muscles and plantar fascia. Replace worn shoes and use appropriate footwear for different activities. Avoid prolonged standing.”

Shin splints

Most common in runners, shin splints cause pain along the shin bones, especially on the medial part of the shin.

Risk factors include a sudden increase in training frequency or intensity; running on hard surfaces; running up an incline; previous leg injury; poorly fitting or unsupportive running shoes, and over-pronation of the feet.

Treatment and advice

Analgesics and cold therapy can be recommended for pain relief. Patients should reduce or stop activities that may have caused the problem – they can switch to other forms of exercise, such as swimming or cycling. Keeping legs elevated when sitting down or using a pillow to elevate them in bed will help to reduce inflammation.

Patients should expect improvement in two to four weeks. To prevent recurrence, placing shock-absorbent insoles inside trainers can help. Running shoes should be replaced regularly.

DOMS

Delayed onset muscle soreness (DOMS) after exercise is common and affects people of all fitness levels. It starts several hours after exercising and is more likely after trying a new activity or exercising for longer or more intensively than usual. It should resolve in two to five days.

Pharmacists can recommend cold therapy or topical ibuprofen to relieve pain, and heat therapy after 48 hours. Gentle stretching can also help.

How should you follow up?

Pharmacy teams can support patients by arranging a follow-up call or appointment to assess their response to treatments,” says Elizabeth Hughes-Gapper, senior brand manager for GOPO Joint Health.

“It is important to check for improvements, ongoing pain or any side-effects. If a referral to a specialist has been made, confirmation and follow-up on any recommendations is essential. Finally, patients should be encouraged to seek further evaluation if new symptoms develop or if the injury 
is not improving, ensuring timely intervention.”

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