The arrival of summer evokes the promise of sun-filled days, allowing us to enjoy the outdoors. Furthermore, with several big sporting events on the calendar, such as Wimbledon and the Open Golf, many are inspired to dust off their trainers.
Written by Denis O’Driscoll, Superintendent Pharmacist, LloydsPharmacy
With this upsurge in activity, comes an increased risk of sports-related injuries, presenting community pharmacists and their teams with an opportunity to treat and help with minor sports injuries.
Knowing how to identify common sporting injuries and provide specific advice to patients on their effective management, including the role of over-the-counter treatments, as well as when to refer for specialist assessment and treatment, can help many steer clear of long-term muscular pain and joint damage.
A worryingly high percentage of people simply ignore niggling sports injuries or treat them incorrectly, according to research. Research also show that men are three times more likely to injure themselves playing sport than women.
Not only is physical inactivity linked to poor cardiovascular fitness and obesity, the World Health Organisation (WHO) estimates it to be the main cause for approximately 21–25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischaemic heart disease burden.
Acute and Chronic Injuries
Sport injuries can be acute or chronic. Acute sports injuries occur as a result of a sudden impact or awkward movement. Examples include a cut to the skin or a sprained ankle. Chronic sports injuries develop over time, often due to continual use of the same joints or muscle groups.
Chronic sports injuries can occur due to bad technique or occasionally structural abnormalities, such as an inherited bone or muscle problem. These injuries should be further investigated by a medical professional to determine the cause and to prevent the injury getting worse.
Some of the most common sports injuries include:
• Sprains,
• Strains,
• Cuts and bruises,
• Bone fractures and breaks,
• Tendonitis (inflammation of a tendon),
• Blisters, and
• Head injuries.
Whilst the figures regarding sports injury presentation to A&E are of note, community pharmacies will collectively see many more minor sports injuries.
Common risk factors for sports injury include inadequate warm up, fatigue, over intensive training, unsuitable equipment and a changed environment (e.g. very hot weather, poor lighting, or physical contact with another person or equipment).
Injury prevention can be achieved through dynamic stretching before activity.
A sprain or a twisted joint can happen in most limbs but most commonly in the ankle. One or more ligaments of the ankle experience excessive stress and become abnormally stretched when the foot is moved past its normal range of motion. The sudden excess stress puts a strain on the ligaments. Once the strain goes beyond the yield point, the ligament becomes damaged, or sprained.
Blood vessels leak fluid into the joint, starting from the site of the injury. Increased blood flow and inflammatory exudates including white blood cells, macrophages and leukocytes migrate to the area, causing both inflammation and swelling.
This results in pain, sensitivity and throbbing as the nerves are further sensitised. As further blood flow increases to the site, the area looks a lot redder, feels a lot warmer, becomes more sensitive and there is a decrease in mobility.
Use non-steroidal antiinflammatory drugs (NSAIDs) to treat pain, reduce any localised heat, decrease swelling and improve mobility. Oral pain relief normally starts soon after the first dose and the full analgesic effect occurs within a week.
Topical NSAIDs can be applied directly to the site of the injury. Topically applied NSAIDs penetrate the skin and result in therapeutically significant concentrations in underlying inflamed soft tissues, joints and synovial fluid, probably entering the synovial joint mainly via systemic circulation.
In tendinopathies (painful tendons), inflammation plays a lesser role and so NSAIDs have little influence on healing but they can help with short-term analgesia. If used in the first seven days inn sprains, strains or ligament tears NSAIDs can also be used to limit pain and swelling thus increasing the chances of the patient regaining function and returning to activity sooner.
Patients should be advised to take NSAIDs with food. Following that advice, short-term use of NSAIDs is safe but patients should be advised that long-term use increases the risks of systemic side effects (such as gastrointestinal and cardiovascular effects).
Tennis elbow (epicondylitis) is a painful condition that affects the outside of the elbow. It is caused by strenuous overuse of the muscles and tendons of the forearm and around the elbow joint.
The symptoms of tennis elbow include:
• tenderness around the elbow, and
• pain when moving the elbow.
Tennis elbow is caused by repetitive movement of the muscles in the lower arm. It can be treated with anti-inflammatory medication, an elbow splint to support the arm or a cortisone injection. Sufferers should be advised to avoid activities that cause pain and, in a sporting setting, obtain advice to correct faulty technique.
Tendonitis is inflammation (swelling) of a tendon. Symptoms of tendonitis include:
• swelling, redness and pain at the injured area,
• restricted movement of the affected area, and sometimes
• a change in appearance of the affected area, such as a lump or a visible change in position of a limb.
Tendonitis is a fairly common injury that can result from a strain or tear in a tendon. Tendonitis can occur in the tendons around the shoulder, elbow, wrist, finger, thigh, knee or the back of the heel (Achilles tendonitis).
Blisters are a common minor injury caused by friction on soft skin. Endurance athletes, such as long-distance runners, sometimes develop blisters on their feet. Rowers are at risk of developing blisters on the palms of their hands.
Although painful, most blisters will heal on their own unless they become infected, but they can be easily prevented in the first place by covering tender spots with a friction-resistant dressing or plaster. If they do occur, then specialist blister plasters, which claim to aid rapid healing by absorbing the fluid, protecting skin from bacteria and helping relieve the pain of friction and pressure, can be used.
Remind customers who have diabetes to be particularly vigilant when checking for blisters, as their foot injuries take longer to heal due to poorer blood circulation.
Athlete’s foot (tinea pedis) is a fungal infection that usually begins between the toes.
Symptoms include itching or burning and flaking skin, particularly between the toes, although the whole foot can be affected. The condition can be treated with products containing fungicidal or fungistatic ingredients. Making sure the feet are completely dry after washing; regularly changing footwear and wearing cotton socks can help ensure feet are less fungus-friendly.
Role of the Pharmacist
Two approaches exist for the immediate treatment of acute injuries, the main one being a simple five-step protocol, PRICE (P rotection, R est, I ce, C ompression, E levation). Rest after injury is usually considered appropriate for the first 48–72 hours. During this time, non-weight bearing is usually recommended and crutches or slings can provide support. After 48 hours, MICE (M ovement, I ce, C ompression, E levation) can be introduced, with gentle movement replacing rest. If pain is experienced on repetition of gentle movement, or if there is constant pain, then rest should continue for another 24 hours before the introduction of movement is tried again. If this is unsuccessful, referral to a GP should be considered. Earlier referral may be advised if pain is particularly severe.
Points to consider when taking a history from the patient include:
• Was the patient treated immediately or later after the injury?
• What treatment was received?
• Was the patient able to continue with their activity?
• What was the intensity of the activity leading up to sustaining the injury?
• Has this or any other injury occurred before?
• Is this an acute or chronic injury? Injuries to the head, cervical spine, or the thoracic or abdominal organs should be treated as potentially life-threatening and referred to secondary care urgently. A patient with suspected concussion following a blow to the head, face, neck or where an ‘impulsive’ force may be transmitted to the head, who presents subsequently with changes in behaviour, vomiting, dizziness, headache, doublevision or excessive drowsiness requires urgent medical assessment.
Treating Cuts and Scrapes
Minor scrapes and cuts are easily treated at home with basic wound-care or first-aid supplies. Because cuts can happen at any time, every home should have tweezers, gauze pads, bandages, and antibiotic ointment.
Here are some steps that pharmacists should tell patients to follow in treating cuts at home:
• Rinse a cut with cool water
• Wash around the cut with soap; avoidgettingsoapinto the wound
• Remove dirt and debris from the wound with tweezers; clean the tweezers with rubbing alcohol before using them
• Apply direct pressure with a clean gauze pad to a bleeding cut
• Treat the cut with antibiotic ointment
• Cover the cut with a bandage (deeper cuts may require a butterfly bandage)
• Do not pick at a scab while a cut is healing
Treating Bruises
Although bruises can be painful, treatment is limited. The best care for bruises involves rest and ice. Ice stops blood flow to the injury site, thus limiting the size of the bruise. Rest allows the site to heal.
Here are some further guidelines for patients for treating bruises at home:
• Apply ice packs or cold compresses as soon as possible
• Reapply ice packs every hour for 10-15 minutes during the first day, if needed
• With bruised legs or feet, elevate the legs as much as possible during the first day
• Take acetaminophen, if needed, for pain; do not take aspirin
• With large bruises, limit activity during the first day
• Use heat packs after 48 hours to promote healing
Here are some signs that bruises need medical attention:
• The bruise swells
• The bruise does not start to fade within a week
• The bruise occurs easily or for no obvious reason
Sports Injuries are one of the most common presenting to the pharmacy with pain. The are are three OTC oral analgesics available.
Aspirin
• Analgesic
• Antipyretic (reduces a fever)
• Anti-inflammatory
• Contra-indicated in under 16s
• Refer to pharmacist for patients on anticoagulants (blood thinners)
• Refer to pharmacist for patients with a history of gastrointestinal symptoms
Paracetamol
• Analgesic
• Antipyretic
• First line agent for pain and fever in children over 2 months
• Not an anti-inflammatory
• Caution not to take other products that contain paracetamol. Always read the label!
• Licensed for use in pregnancy when required
Ibuprofen
• Analgesic
• Antipyretic
• Anti-inflammatory. Ibuprofen is a Non Steroidal Anti-Inflammatory Drug (NSAID).
• Anti-inflammatory effect may take more than one dose but analgesic effect is immediate
• For children from 3 months
Diclofenac
• Analgesic
• Antipyretic
• Anti-inflammatory (NSAID) –Diclofenac is more potent than Ibuprofen
• Typically administered in topical form
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