CE course: Sport Injuries

{mosimage}By Ramaz Mitaishvili
1.    Introduction
1.1.    Common Sport Injuries:

2.    Anatomy of Skeletal System
Skeletal System

• Is the vast and complex system.
• Made up more than 206 bone as well as cartilage.
• This bone and cartilage combo makes up 20% of total mass of the human body. 6 –12% of an adult's total skeleton is replaced each year (bone remodeling). Skeletal mass peaks usually in the late 20s.
• Protects vital organs and supports fleshy structures.
• Provides calcium (bone contains 99% of the body's calcium) and phosphorus reserve.

Note
1. The term "paired" usually means that a bone paired of the copy of itself. For example: the temporal bones that help make up of sides of skull are paired bones.
   The opposite of paired bones are unpaired- that the bone doesn't have a match.
2. "Articulates with" means connects with.
So, for example radius and ulna are two bones of forearm. Both of these bones connect to the humerus- bone of an arm.
Therefore ulna and radius articulate with a humerus.
So, if one bone articulates with another bone- it connected to.

2.1.    Bones

• Are calcified connective tissue consisting of cells (osteocytes) in a matrix of ground substance and collagen fibers.
• Contain internal soft tissue, the Marrow, where blood cells are formed.
• Are classified, according to shape, into: long, short,   flat, irregular, and sesamoid bones.

2.1.1.    Long bones

• Are longer than they are wide.
• Have a shaft (diaphysis) and two ends (epiphysis)
• Include: Clavicle, Humerus, Radius, Ulna, Femur, Tibia, Fibula, Metacarpals, and Phalanges.

2.1.2.    Short bones

• Are found only in the wrist and ankle and are approximately cuboid shaped.

2.1.3.    Flat bones

• Include the Ribs, Sternum, Scapulae, and bones in the vault of the Skull.

2.1.4.    Irregular bones

• Include bones of mixed shapes.
• Include bones of the Skull, Vertebrae, and Coxa.

2.1.5.    Sesamoid bones

• Develop in certain tendons.
• Are found in the knee and the wrist.

2.2    The axial and appendicular divisions
The Skeletal System can be broken down by 2 major divisions: axial and appendicular                                                  
2.2.1.    The Axial division

• Composed of 80 bones and forms longest axis of the body, which includes 3 major regions: Skull, Vertebral Column, Bony Thorax
• Supports head, neck, and torso.
• Protects brain, spinal cord, heart and lungs.

2.2.2.    The Appendicular division

• Helps to move
• Allows to manipulate in environment.
• Made up of upper (arms) and the lower limbs (legs), and girdles of these limbs, which attach the limbs to the Axial Skeleton.
• Bones of the legs, arms, and girdles all have duplicates (bilateral symmetry).

2.3    Joints

• Are the sites of junction or union between two or more bones.
• Are classified on the basis of their structural features into fibrous, cartilaginous, and synovial types.

2.3.1. Synovial joints

• Permit a great degree of free movement.
• Are characterized by joint cavity, articular cartilage, synovial membrane (which produces synovial fluid), and articular capsule.
• Are classified according to axes of movement into:  plane, hinge, pivot, ellipsoidal, saddle, and ball-and-socket joints.

2.3.2. Plane joints

• Have flat articular surfaces and are limited in movement by the articular capsule.
• Allow simple gliding or sliding movement.
• Occur in the proximal tibiofibular, intercarpal, intermetacarpal, carpometacarpal, sternoclavicular, and acromioclavicular joints.

2.3.3. Hinge Joints

• Resemble door hinges and allow movement around one axis at right angles to the bones (uniaxial).
• Allow movements of flexion and extension only.
• Occur in the elbow, knee, ankle, and interphalangeal joints.

2.3.4. Pivot joints

• Allow rotation only (uniaxial).
• Occur in the superior and inferior radioulnar joints, and in the atlanto-axial joint.

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2.3.5. Ellipsoidal joints

• Allow movement in two directions (biaxial) at right angles to each other.
• Allow flexion, extension, abduction, and adduction.
• Occur in the wrist (radiocarpal), atlanto-occipital, and metacarpophalangeal joints.

2.3.6. Saddle joints

• Resemble a saddle on a horse's back.
• Allow flexion, extension, abduction, adduction, circumduction.
• Occur in the carpometacarpal joint of the thumb.

2.3.7. Ball-and-socket joints

• Allow flexion, extension, abduction, adduction, circumduction, medial and lateral rotation.
• Occur in the shoulder and hip joints.

2.4.    Body movements (joint movement)

2.4.1.    Flexion
Movement, generally in the sagittal plane, that decreases the angle of the joint and lessens the distance between the two bones (or part of the body).    
2.4.2.    Extension (the reverse of flexion)
Movement generally in the sagittal plane that increases the angle of a joint and the distance between two bones (or part of the body). If extension is greater than 180 degrees, it is termed as hyperextension.
2.4.3.    Abduction
Movement of a limb away from the midline or median plane of the body generally on the frontal plane, or the fanning movement of fingers or toes when they are spread apart (the digits move away from the longitudinal axis of the hand or foot).
2.4.4.    Adduction (the reverse of abduction)
Movement of a limb toward the midline of the body. The digits move toward the longitudinal axis of the hand or foot.
2.4.5.    Rotation
Movement of a bone around its longitudinal axis without lateral or medial displacement.
2.4.6.    Circumduction
 A combination of flexion, abduction, extension and adduction performed one after the other. The proximal end of the limb remains stationary and the distal end moves in a circle. The limb as a whole outlines a cone.
2.4.7.    Protraction
Movement that results in a portion of the body being moved forward on a plane parallel to the ground.
2.4.8.    Retraction (the reverse of protraction)
Movement that results in the protracted portion of the body being moved on a parallel plane, back to its original position.

2.4.9.    Elevation
 Movement that results in a portion of the body being moved or lifted upward along a frontal plane.
2.4.10.    Depression(the reverse of elevation)
Movement that results in a portion of the body being moved downward along a frontal plane.
2.4.11.    Pronation
Movement of the palm of the hand from an anterior or upward-facing position to a posterior or downward-facing position. This action moves the distal end of the radius across the ulna. (There is NO rotation of the arm: the arm is immobile during pronation)
2.4.12.    Supination (the reverse of pronation)
Movement of the palm from a posterior position to an anterior position. During supination, the radius and ulna are parallel.
2.4.13.    Inversion
 Movement that results in the medial turning of the sole of the foot.
2.4.14.    Eversion (the reverse of inversion)
Movement that results in the lateral turning of the sole of the foot.
2.4.15.    Dorsiflexion
Movement of the ankle joint in which the foot is flexed upward (standing on one's heels).
2.4.16.    Plantarflexion (the reverse of dorsiflexion)
Movement of the ankle joint in which the foot is flexed downward (standing on one's toes or pointing the toes).
2.4.17.    Opposition
Mmovement in which the thumb is brought to touch the pad of another finger of the same hand. This movement allows us to grasp and manipulate object.
2.4.18.    Reposition (the reverse of opposition)
Movement that returns the thumb to its anatomical position.

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3.    Anatomy of Muscular System
3.1. Muscles

• Consist predominantly of contractile cells containing actin and myosin.
• Are classified into three types: skeletal, smooth, and cardiac
• Produce the movements of various parts of the body by contraction which may be voluntary (skeletal muscles) or involuntary (cardiac and smooth muscles).

3.1.1. Skeletal muscles

• Make up about 40% of the total body mass.
• Are over 600.
• Attached to the Skeletal System and have an “origin” and an “insertion”. Origin describes usually  proximal attachment to unmovable bone; Insertion describes usually distal attachment to movable bone.
• Are responsible for moving the structure below it (the muscles of the Thigh move the Leg; the muscles of the Arm move the Forearm.
• Are responsible for body movements and facial expressions.
• Help us stand, maintain posture by resisting the pull of gravity.
• Can adjust themselves to stabilize joints.
• Generate heat.
• It cells are Elongated, Striated and under Voluntary Control.
• Surrounded by epimysium (thin layer of connective tissue). Each small bundles of muscle cells (fascicles) surrounded by perimysium. Each muscle cell surrounded by endomysium.
• Are named using 7 criteria (within each muscle's name are certain descriptions characterize the muscle (Location, Action, Direction of fibers, Shape, Number of origins, Origins and insertions, Relative size).

*first letters of those words make up the phrase: LAD SNOR
Location
By name of bones directly associated with muscle (Frontalis, Temporalis named for cranial bones beneath).
Action
Indicates type of movement that muscle creates (Flexor muscles decrease angle between bones – Flexes; Extensor muscles increase angle between bones – Extends).
Direction of fibers
Describes orientation of muscle fibers relative to the longest axis of the body (from head to toe). Can be: Rectus (Straight), transversus (across or perpendicular to the Longest axis of the body), oblique (oriented an in angle to the axis).
Shape
Descrribes muscle shape (Deltoid muscle is triangular. Delta – greek symbol like triangle; Trapezius – shaped like trapezoid.
Number of origins
Refers to the number of attachments muscle to bone (Biceps has two attachments; Triceps- three; Quadriceps- four).
    
Origin and insertion
Describes attachment to bones (Sternocleidomastoid muscle originate to the Clavicle(Collarbone) and Sternum(Breastbone) and Inserts itself on the part of Temporal bone called Mastoid Process.
Relative size
Maximus and Major refer largest group of muscles. Minimus and Minor refer smallest group of muscles. Longus refers the longest muscle in a muscle section. Brevis refers the shortest muscle in a muscle section.
3.1.2. Structures associated with muscles

• Aponeuroses are flat fibrous sheets or expanded broad Tendons that attach to muscles and serve as the means of Origin or Insertion of flat muscle.
• Bursa lined by a smooth inner surface and  is a pocket of connective tissue found adjacent to a joint. Bursa facilitates the gliding movements of muscles and tendons over bony prominences.
• Fascia is a Fibrous sheet that envelops the body under the Skin and invests the muscles. May limit the spread of pus and extravasated fluids such as urine and blood. Superficial fascia is a loose Connective tissue between the dermis and the deep fascia. Deep Fascia is a fibrous sheet which invests the muscles. Forms potential pathways for infection. Has no sharp distinction from epimysium.

  3.1.3. Terminology associated with muscles             

• Hamstring muscles flex knees and bend legs; the hamstrings are involved in virtually every move.  Each hamstring is actually a belt of three muscles that run along the back of the thigh from buttock to knee, where they connect to the bones of the lower leg. They are counterparts to the powerful quadriceps muscles at the front of the thighs and can be subject to great stress.
• Thenar – the fleshy part of the hand at the base of the thumb
• Plantar- Pertaining to the sole of the foot
• Meniscus is crescent-shaped cartilage in the knee joint
• Rotator cuff is a group of four flat tendons that fuse together and surround the front, back and top of the shoulder joint like a cuff on a shirt sleeve.
• Tendon attaches muscle to bone
• Ligament attaches bone to bone

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4.    Sport Injuries
4.1. Fracture (broken bone)

• Is a break in the continuity of a bone.
• Occur when the physical force exerted on the bone is stronger than the bone itself.
• Is common; most people have at least one during their life.  An estimated 10 percent to 15 percent of all childhood injuries are broken bones, though children’s fractures are generally less complicated than fractures in adults.
• The ankle, hand, wrist and collarbone are common sites of fracture.
• Can be complete, incomplete, compound and simple.

Complete fracture when the bone snaps into two or more parts.
Incomplete fracture when the bone cracks but does not break all the way through.
Compound fracture (open fracture) when the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin.
Simple fracture (closed fracture) when the bone breaks but there is no open wound in the skin.
Greenstick fracture: an incomplete fracture in which the bone is bent. This type occurs most often in children.
Transverse fracture: a fracture at a right angle to the bone’s axis.
Oblique fracture: a fracture in which the break slopes.
Comminuted fracture: a fracture in which the bone fragments into several pieces.
Impacted fracture is one whose ends are driven into each other. This is commonly seen in arm fractures in children and is sometimes known as a buckle fracture. Other types of fracture are pathologic fracture, caused by a disease that weakens the bones, and stress fracture, a hairline crack.
4.1.1. Symptoms

• Swelling or bruising over a bone.
• Deformity of an arm or leg.
• Pain in the injured area that gets worse when the area is moved or pressure is applied.
• Loss of function in the injured area.
• In compound fractures, bone protruding from the skin

4.1.2. Causes

• Usually caused by a fall, blow or other traumatic event.
• Pathologic fractures are those caused by disease that weakens the bones.

4.1.3. Diagnosis
 Used X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) or a bone scan.

4.1.4. Treatment
 Always requires emergency treatment at a hospital!
If not treated promptly; possible complications include damage to blood vessels or nerves and infection of the bone (Osteomyelitis) or surrounding tissue. Recuperation time varies depending on the age and health of the patient and the type of fracture. A minor fracture in a child may heal within a few weeks; a serious fracture in an older person may take months to heal.
If bones may be broken in the back, neck or hip, do not move the person; instead, call for emergency medical assistance.
Person can be  in shock(faint, pale or breathing shallowly), call for emergency help, lay the person down, and raise his or her legs about 10 – 12 inches unless you think leg bones may be broken.
Before transporting the person, protect the injured area to avoid further damage.
For broken arm or leg bones, put a splint (made of wood, plastic, metal or another rigid material padded with gauze) against the area to prevent movement; wrap the splint to the area using gauze. If there is bleeding, apply pressure to stop bleeding before splinting, then elevate the fracture.
Fractured bones must be set (reduction) in their proper place and held there in order to heal properly. Repositioning bone without surgery called closed reduction. Most fractures in children are treated with closed reduction. Serious fractures may require open reduction — repositioning using surgery. In some cases, devices such as pins, plates, screws or glue are used to hold the fracture in place. Open fractures must also be cleaned thoroughly to avoid infection.
After setting, most fractures are immobilized with a cast, splint or, occasionally, traction to reduce pain and help healing. In most cases, medication is limited to analgesics to reduce pain. In open fractures, antibiotics are administered to prevent infection. Rehabilitation begins as soon as possible, even if the bone is in a cast. This promotes blood flow, healing, maintenance of muscle tone, and helps prevent blood clots and stiffness.
After the cast or splint is removed, the area around the fracture usually is stiff for several weeks, with swelling, bumps and, in children, increased hair on the arms and legs. With fractured legs, there may be a limp. Symptoms generally disappear within a few weeks.
If you have broken a bone, once the cast or splint is removed you should gradually begin using the area again. It may take another four to six weeks for the bone to regain past strength. Exercising in a swimming pool is generally a good way to rehabilitate bones.
4.1.5. Prevention
Always:

• Wear the proper safety equipment (helmets and other protective pads) for recreational activities, such as bike riding or contact sports.
• Keep walkways and stairs free of objects that could cause to trip.
• Regular exercise improves strength and balance, which help reduce falls.

         4.2. Sprains and Strains
Sprains and strains are among the most common injuries, ranging from twisted ankles to aching backs. A sprain injures ligaments, the tough, fibrous bands of tissue that connect bones to one another at a joint. A strain damages muscle tissue, leaving muscles or the tendons that attach muscle to bone, stretched or torn.
In the ankle joint, a sudden, quick movement has forced the joint beyond its normal range of motion, causing a sprain. The ligaments are stretched and torn, and tissue around the injury has become swollen and the skin discolored. In most cases, a sprained joint will still function but can be painful to use.
Given adequate time and rest, most sprained joints or strained muscles will heal themselves. But severe tearing or complete rupture of the affected tissues usually requires surgical repair. And damage caused by a sprain can leave the bones in the affected joint improperly aligned, or the ligaments so stretched and weakened that the joint is particularly vulnerable to future injury.
4.2.1. Symptoms
Sprains, which affect joints, and strains, also called muscle pulls, usually occur after a fall or sudden movement that pulls or twists a part of the body violently.
For a sprain:

• Pain in the affected joint.
• Rapid swelling of a joint, often accompanied by bruising.
• Stiffness and difficulty moving a joint.

For a strain:

• Sharp pain at the site of an injury, followed by stiffness, tenderness, and in some cases, swelling.

4.2.2. Causes
Anything that places sudden or unaccustomed stress on joints or muscles may cause a sprain or strain. Falls, lifting heavy objects, and the exertion of an unfamiliar sport are common culprits. Being overweight, inactive or in poor physical condition boosts the likelihood of injury.
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4.2.3. Diagnostic and Test Procedures

• Detailed history.
• Physical exam of the affected area.
• X-rays to rule out, or an MRI scans to check for ruptured tissues.

4.2.4. Treatment
Treatment of both sprains and strains focuses on control of the initial pain and swelling, followed by adequate rest to allow healing.
4.2.5. Conventional Medicine
Most sprains and strains heal in two to three weeks. Rest, ice, compression and elevation immediately following the injury, along with aspirin or ibuprofen to reduce inflammation and pain. Elastic bandages may then be used to support or immobilize the injured area while it heals, and a sprained ankle or knee often calls for crutches to keep weight off the joint. To speed healing, may also recommend heat or infrared treatments from a physical therapist after the initial swelling is controlled.
4.2.6. Prevention
The best way to prevent sprains or strains is to keep yourself in good physical shape, so that your muscles, ligaments, and tendons are strong and flexible enough to resist trauma. To prevent recurring injury, ask your doctor for exercises designed to rehabilitate the muscles in the injured area. If you are overweight, ask about an appropriate diet and a general conditioning program

4.3. Dislocation, epicondylitis, lower back injuries, groin strain, Patellar tendonitis (jumper's knee), Charley horse
4. 3.1. Dislocation

• Occurs when two bones are jolted apart at a joint and is often accompanied by a ligament tear in the joint. The pain is caused by the severe stretching of soft tissues.
• Is most common in the thumb and shoulder joint. Acromioclavicular joint (AC) separation occurs when the ligaments that support the collarbone are torn.

4.3.2. Epicondylitis

• Affects the elbow and typically occurs in sports requiring frequent wrist manipulation and forearm rotation.
• The lateral (affecting the outer elbow) form is tennis elbow.
• The medial (affecting the inner elbow) form is golfer's elbow.

4.3. 3. Lower-back injuries

• Such as muscle tears, are common in sports that involve a lot of bending.
• The high velocity and full contact nature of hockey and football frequently cause neck and spine injuries, such as a herniated disk, in which an intervertebral disk protrudes from the spinal column.

4.3.4. Groin strain

• May result from intense leg movement, including twisting and spreading that tears the adductor muscle which connects the leg with the pubic bone.

4.3.5. Patellar tendonitis (jumper's knee)

• Is  most common lower-body injuries.

• Continual jumping may result in tearing of the tendon just below the kneecap, or patella. The knees may also suffer from other injuries, such as tears of the meniscus.

4.3.6. Charley horse

• Sudden tearing of muscle fibers that may occur after excessive athletic activity and the consequent accumulation of fluid in the muscle that causes pain, tenderness and local swelling.  
• Increased interest in jogging and cross training has resulted in a parallel rise in leg injuries, including shin splints, tendonitis and stress fractures, especially in the tibia or fibula bones. If continually exposed to stress from prolonged standing, running or walking, a stress fracture may result in a larger fracture. 
• The foot often falls victim to injury because it must support the weight of the entire body. Plantar fascitis often affects inexperienced runners, causing pain along the inner heel and along the arch of the foot, sometimes accompanied by stiffness and numbness in the heel. A similar problem, march fracture, develops in the bones of the foot when extreme stress (running, walking) is continually placed on the ball of the foot.

4.3.7.   Symptoms

• Pain, discomfort, restricted movement, tenderness and swelling may be indicative of some form of muscle or ligament injury, such as a sprain or strain.
• Pain, swelling, tenderness and deformity may indicate a fracture.
• Pain, restricted movement, misshapen appearance and swelling in a joint are symptoms of a dislocation.
• Localized pain just below the kneecap may be a sign of patellar tendonitis. In adolescents, the condition may indicate Osgood-Schlatter disease if accompanied by swelling.
• Pain in the elbow, often accompanied by tenderness in the inner or outer portion of the elbow and forearm, and possibly a weak and painful grasp, may indicate epicondylitis.

4.3.8.    Causes
An AC separation results from sudden impact on the side of the shoulder or on an outstretched arm. Wear on the rotator cuff, causing rotator cuff tendonitis, may occur if you continually engage in sports that require overhead motion like that in a tennis serve. Medial epicondylitis is caused by traumatic, repetitive arm motion, as when pitching in baseball. Sudden, violent twisting of the elbow or continual pulling and strain on the forearm muscles can cause the condition.
A charley horse is usually caused by a sudden, acute strain in the leg, but mineral deficiency, hormone imbalance, calcium deposits in the muscles or dehydration can also be causes. Muscle imbalance, a poorly aligned leg, or running on a hard road with improper footwear may cause a stress fracture. Tight hamstrings may contribute to lower-back problems, and tight Achilles tendons may precede cases of tendonitis of the foot and ankle.
4.3.9.    Diagnosis
Basic assessment begins with medical history and a physical exam.

• X-rays.
• Bone scan.
• Arthroscopy, tiny camera inside a very small tube, called an arthroscope, to examine the interior of your joints; it is useful in both diagnosing and repairing some joint injuries (for example, cartilage fragments can be removed through the tube).

• Ultrasound
• Magnetic resonance imaging(MRI) produces excellent images of soft tissue, enabling diagnosis of damage to muscles, ligaments and tendons.

4.3.10.    Treatment
Treatment for sports injuries aims to relieve pain, repair or realign bones and restore body to its full athletic ability.
Most minor soft-tissue injuries are best treated with RICE: rest, ice, compression, elevation.
Injuries such as tendonitis and plantar fasciitis usually require rest and a rehabilitation program to maintain flexibility and strength. Aspirin or ibuprofen may help reduce the pain and inflammation that accompany these conditions.
Depending on the severity of the pain, your physician may treat your epicondylitis with an injection of a corticosteroid, with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or with aspirin. An elbow cuff and physical therapy may also be indicated. For acute pain as a result of an AC separation, codeine may be prescribed for the first couple of days. Thereafter, aspirin and a nonsteroidal anti-inflammatory drug may be taken for chronic pain. immobilize the injured area with a sling.
If possible, the displaced bones of a dislocation are manipulated back into place. If this is not feasible, you may need surgery, after which the joint is immobilized until it is stable.
4.3.11.    At-Home Remedies
Use the RICE method.
Replacing fluids lost through perspiration with a carbohydrate-electrolyte sports drink helps prevent cramping.
Ice packs reduce swelling; a bag of frozen vegetables can be a makeshift ice pack. Do not use chemical cold packs; they are much colder than water packs. Place a damp towel around your pack so that it is not directly on your skin. Use ice for up to 48 hours after an injury to reduce swelling and pain. However, be aware that temporary stiffness may also result.
A warm compress may relieve muscle pain, especially before massage and stretching.
To relieve cramping, elevate the affected area to direct blood flow toward the heart. Gently stretching the muscle will usually stop a cramp.
If muscles are sore the day after a tough workout, soak in a hot tub and rest the affected area.
4.3.12.    Prevention
Sports injuries usually result when the muscles are poorly conditioned. You should have a 10-minute warm-up session – running in place or doing jumping jacks – before an athletic activity to increase your body temperature and diminish chances of muscle injury. Stretching before and especially after your workout will prevent soreness the next day.
Always warm up with 5 to 10 minutes of light to moderate activity before you stretch!
Engage in your sport or exercise at least three times a week to maintain proper conditioning.
The highlighted areas show some of the sites of common injuries sustained from sports or other physical activity. The best way to prevent an athletic injury is to be in good physical condition and to stretch for several minutes before and after exercising. Never attempt to "play through" pain — doing so may cause more extensive injury and lengthen the time needed for complete healing.
4.4.    Muscle Cramps
From a stitch that grabs your side while you're running to a charley horse in your calf awakening you in the dead of night, muscle cramps can be an all-too-common source of discomfort. Normally, a muscle at work contracts — tightening to exert a pulling force — then stretches out when the movement is finished or when another muscle exerts force in the opposite direction. But sometimes a muscle contracts with great intensity and stays contracted, refusing to stretch out again; this is a muscle cramp.
4.4.1. Symptoms

• A sharp, sudden, painful spasm — or tightening — of a muscle, especially in the legs.
• The affected muscle's hardness to the touch.
• In some cases, visible distortion or twitching of the muscle beneath the skin.
• In other cases, extremely severe cramps in the arms and legs, beginning without warning, and sometimes affecting the abdominal muscles as well. These symptoms are typical of heat cramps.
• Persistent cramping pains in lower abdominal muscles, which may occur with back problems or during menstruation

4.4.2. Causes
Muscles contract or lengthen in response to electrical signals from nerves; electrolytes such as sodium, calcium and magnesium, which surround and permeate muscle cells, play a key role in the transmission of these signals. Imbalances in those electrolytes — as well as in certain hormones, body fluids and chemicals — or malfunctions in the nervous system itself can foul up the flow of electrical signals and cause a muscle to cramp.
Physical overexertion depletes fluids and electrolytes and can lead to cramping, particularly in people who work or exercise in conditions that overheat their bodies. Activities like working in the garden on a hot summer day, if you are not careful to drink plenty of fluids, may cause heat cramps. And if you do not take steps to alleviate them, heat cramps can progress to much more serious heatstroke and heat exhaustion.
Hormone imbalances caused by diabetes and thyroid problems can also cause cramps, as can a reduced supply of blood-borne oxygen to muscles. Blood oxygen levels often fall in smokers, for instance, causing muscles to cramp — especially when smokers engage in hard physical labor. If you move in your sleep, you may pinch a nerve, signaling a muscle to contract and perhaps leading to a cramp. If you're prone to night cramps, do stretching exercises before you go to bed.
4.4.3. Treatment
Severe cramps in the chest, shoulders or arms can be symptoms of a heart attack.
No medicinal treatment of common muscle cramps is required. Massaging a cramping muscle, stretching, or drinking water to relieve heat cramps is usually sufficient remedy.    
4.4.4. Prevention
Drink six to eight cups of water every day. Be sure to acclimate yourself to exercise routines and sports, especially in early summer. Do stretching exercises regularly, particularly before bed. If you smoke, enroll in a program to help you quit
4.5.    Rotator Cuff Problems
When the muscles contract, they pull on the rotator-cuff tendon, moving the shoulder in the direction you want. The trouble is, these tendons may not be strong enough to withstand excessive use, particularly in a sport like tennis, which involves repetitive shoulder motion. The rotator-cuff tendons simply begin to wear down and become swollen and inflamed, a condition called Impingement.
The serve is the major source of tennis-related rotator-cuff injuries, but badly hit overheads also can aggravate the tendons. In the early stages, you feel aching in the top and front of the shoulder or on the outer side of the upper arm. The pain increases when you do any activity that requires lifting your arm above shoulder level.
4.6. Shin Splint
One of the most common ailments of active people, is a general term referring to pain in the lower leg.
Experts differ when explaining what the exact condition is, although most agree that it involves the two muscles that run from the knee to the ankle and the side of the foot, swathing the tibia, or shinbone. These muscles point the foot up and down, and support the arch and the front of the foot to keep it from slapping while walking and running. Injuries that result in small tears in the fibers of these muscles bring on shin splints.
Shin splints may also be related to a condition known as compartment syndrome, in which a muscle grows too large for its outer sheath. Stress fractures of the tibia and irritation to the nerves in the shin are also associated with shin splints.
4.6.1. Symptoms
Pain, aching, and occasionally, swelling anywhere in the lower leg. Most often on the front of the leg, toward the inside or on the inner side of the leg, toward the back.
4.6.2. Causes

• Any unusual or repetitive stress to the lower leg.
• Seasoned athletes and novices alike suffer from the ailment, with runners, cyclists, skiers and aerobic dancers being especially vulnerable.
• People who have flat feet, knock-knees or bowlegs place abnormal stress on their legs and are likely to suffer from shin splints.
• Poorly cushioned shoes, exercising on unyielding surfaces such as concrete, and poor posture can contribute to the condition.

4.6.3. Treatment

• Adequate rest to allow for healing, followed by a program of strengthening exercises designed to ward off recurrences.

4.6.4. Conventional Medicine
Doctors usually recommend the sports medicine therapy RICE (rest, ice, compression and elevation) as initial treatment for shin splints. Ice is especially important in the first few days after symptoms begin. Ice for 10-15 minutes several times a day. Doctors may prescribe crutches to keep weight off the injured leg, and aspirin or ibuprofen to reduce inflammation and pain. Your doctor may recommend that you see a physical therapist for an exercise program and may suggest ultrasound treatment to relax the muscles, improve circulation, and promote healing.
4.6.5. Prevention
The key to preventing shin splints is finding as many ways as possible to cut down on the stresses that tend to cause the injury. Wear supportive shoes, and check with a podiatrist about inserts to help correct postural difficulties that may contribute to shin splints. Stretching exercises for the muscles in the toes, heel, knee and lower leg can help condition the muscles and make them more resistant to injury. Be sure to exercise on resilient surfaces such as wood or earth, not on unyielding concrete.
Overuse of muscles or the tendons that secure them to the bone can result in discomfort and inflammation. One common type of overuse injury is known as shin splints, which can cause disabling pain along the shinbone at the inside front of the lower leg or on the inner back of the calf.
4.7. Carpal Tunnel Syndrome  (CTS)

• Can cause pain, tingling, numbness, and weakness in the fingers and thumb.
• Begin suddenly or gradually.
• Often affects both hands. If not treated, it can lead to permanent nerve and muscle damage. With early diagnosis and treatment, however, there is an excellent chance of complete recovery.

The numbness, tingling, and weakness from CTS are due to pressure on the median nerve. This nerve carries signals between the hand and brain. In the wrist, the median nerve and several tendons that allow the fingers and thumb to bend pass through the carpal tunnel, a tunnel created by the carpal (wrist) bone and other tissue. The most common cause of CTS is swelling or inflammation around the tendons and nerve, which increases the pressure within the carpal tunnel. This increased pressure affects median nerve function, causing the symptoms of CTS.
Carpal tunnel syndrome may improve with rest and splinting or may require surgery. It is important that it be treated before permanent nerve and muscle loss take place.
4.8. Hamstring Injury
Professional athletes and dancers are particularly prone to hamstring pulls, but anyone is susceptible, especially people who push themselves a little too far in weekend sports. The danger in a hamstring pull is giving in to the temptation to "play through the pain," which will aggravate and possibly complicate the injury. Recognizing pain as a warning to stop and let the body heal is the most important step in recovery.
4.8.1. Symptoms

• Sharp pain in the back of the thigh, during or immediately after sports or other strenuous activity.
• Swelling and loss of strength in the back of the upper leg.
• Difficulty walking or sitting, and inability to bend the leg.

4.8.2. Causes
A pulled hamstring is invariably the result of overstressing or tearing the muscle fibers, typically by suddenly twisting, straightening or overextending the thigh . A minor hamstring pull is simply a case of stretching the muscle too far, but in some cases a crippling muscle spasm can result. Tearing the muscle belt itself, or separating the muscle from the connective tendons, is a much more serious injury.
4.8.3. Diagnosis
Aching muscles and joints can sometimes mask more serious ailments such as viral, which can be accurately diagnosed only by experts.
4.8.4. Treatment
Like other strains, a hamstring pull generally heals itself. You can expect to regain full use of the leg in a few days or weeks, depending on your physical condition and the degree of the injury.
4.8.5. Conventional Medicine
The established recovery procedure for muscle strain is RICE: rest, ice, compression and elevation. Your doctor may also recommend a painkiller such as ibuprofen, which are also anti-inflammatory agent, or acetaminophen. Like all painkilling drugs, they should be used to relieve discomfort, not to mask pain in order to continue the activity.
Warm compresses, 10 minutes on and 10 off, will help relax the muscle after the initial pain subsides. Binding your thigh with an elastic bandage will support the injured muscle; you may want to use a crutch to keep weight off the leg.
4.8.6. Prevention

• Keep your body in good condition and avoid pushing yourself beyond your level of fitness.
• Take a few minutes to warm up. Major muscles like your hamstrings work best if you stretch them gradually and let them relax. Once into the activity, don't overstress your muscles. They'll begin to tell you when they have had enough, and it's foolish — even dangerous — to push them past their limits. When the activity is over, stretch the muscles gradually so they don't tighten up and go into a muscle contraction, or cramp, which can be just as painful as a muscle pull — although shorter lived.

4.9. Bursitis and Tendonitis
Bursitis: Acute or chronic inflammation of a bursa. Tendinitis: Inflammation of the lining of the tendon sheath (tenosynovitis) and of the enclosed tendon (tendinitis).
 Bursitis is inflammation of a bursa which results in pain, tenderness, stiffness and in some cases, swelling and redness. Any bursa can be affected by the inflammatory process, but bursitis involving the shoulder, elbow, hip and knee are most common.
Although the cause of this condition is unknown, repetitive direct pressure over a bursa can be a predisposing factor. In particular, certain activities or occupations are associated with specific example because of the nature of the physical stress placed on the bursa: e.g. housemaid's knee (kneeling), student's elbow (leaning). Shoulder bursitis, the commonest type, is characterized by an aching pain localized on the outside of the top of the shoulder. Pain is intensified by lifting and backwardly rotating the arm. Typically, there is stiffness in the morning which diminishes with heat and routine activities.
Both tendonitis and tenosynovitis occur spontaneously or in association with injury, work and sports activities, certain types of arthritis or infection. As with bursitis, the shoulder is most commonly affected. The attachment of the biceps tendon at the shoulder is especially vulnerable to this condition. Bicipital tendonitis is manifested by aching along the biceps muscle that radiates up to the shoulder and down to the forearm. The pain is worse with movement. Among the other common locations for tendonitis are the elbow, wrist, hand, knee, and ankle.
4.9.1. Achilles Tendonitis (tendonitis of the heel)

• Achilles tendon is the large thick tendon that connects the Gastrocnemius and Soleus muscles of the calf to the heel.
• The inflammation may be associated with overuse syndrome, trauma, infectious process or an arthritic process. 

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 Did you know that?
 

•      The smallest bones in the body are found in the ear.
•      The longest bone in the body is the femur.
•      The bones are filled with a fatty substance called bone marrow. In this marrow, red and white blood cells are manufactured and then released into the bloodstream.
•      Mandible is one of the famous Hollywood star. Every day Mr. Mandible receives thousands of punches and kicks.
•      Over half the body's bones are in the hands and feet.
•      The only jointless bone in your body is the hyoid bone in your throat.
•      Your growth in height is likely to stop by the time you are 16 if you're a girl and 18 if you're a boy.
•      Osteoporosis causes 1.3 million fractures each year in the United States.
•      In elderly people hip fractures can be particularly dangerous, because the prolonged immobility required during the healing process often leads to blood clots or pneumonia. About a third of elderly women with hip fractures die within six months.
•      Of the estimated 24 million Americans afflicted with osteoporosis, at least 80 percent are women. Experts believe women are more susceptible because their bones tend to be lighter and thinner, and because their bodies experience hormonal changes after menopause that appear to accelerate the loss of bone mass. In men osteoporosis is uncommon until after the age of 70.
•      As many tennis players know, the Rotator Cuff is a land mine. Studies indicate that one in five advanced players have rotator-cuff problems at some point in their careers. Monica Seles, Richard Krajicek, Patrick McEnroe and Pam Shriver are a few of the pros who have injured their rotator cuffs.
•      The stapedius muscle is the smallest of the skeletal muscles in the human body.
•      Myasthenia Gravis most often affects women between the ages of 20 and 30, but it can strike anyone after adolescence; after 40, it actually afflicts more men than women.