CHAPTER 7:

Safety Practices in Sports and Exercise

My Fitness Story

Like most Filipinos, I love playing basketball. I play whenever I can. One time, I played a game against a
very tough opponent; they were competitive and played rough. During the game, one of the players
pulled my arm as I rebounded the ball. I lost my balance and twisted my knee when I landed. I heard a
“pop” and knew it was bad. Few hours later, the doctor told me I tore my ACL. My life changed at that
moment.

- Mike
What are injuries? Why is my risk injured higher now that I am more active?
Individuals who engage in various types of physical activities such as sports and exercise have a higher risk of
getting injured compared to those who practice a sedentary lifestyle. However, the potential benefits of an active
lifestyle outweigh the risks of suffering injury.

Most of the injuries are preventable and awareness of the risk factors will help in reducing the risk.
Furthermore, vigilance and safety measures can dramatically reduce the occurrence of injuries.

Injuries are damaged tissues or organs that occur when it encounters trauma or physical force that is greater
than what it can resist or absorb. The tissues can withstand varying degrees of stress and strain, but it will break down it
is experiences an impact that is stronger than what it can tolerate.

Factors influencing the ability of our tissues or organs to effectively resist or absorb forces include inherent
abnormality, age, technique, fitness level, equipment, and environmental aspects.

Tissues and organs react to the impact and direction of the force. Tensile forces are those that act away from
the center of the structure, causing a pull or stretch. Compressive force impacts the center causing it to bend or fold.
Shear forces are opposing forces toward the different ends of the structure causing it to twist. The mechanism of how
the force was applied is just as important as it impact. The bone is strong in resisting compressive strength while muscle-
tendon units are strong at resisting tensile forces. An individual who engages in various types of strenuous activities will
expose his/her body to these forces which could result to an injury.

Aside from the knowledge of the forces that cause the injury, it is important to understand the ability of the
structures to resist or absorb forces. Injuries in sports and fitness commonly affect the musculoskeletal structures. The
ligaments, tendons, muscles, and bones have inherent strength that helps withstand strong forces. The strength
properties of each musculoskeletal structure vary according to the density of collagen and elastin fibers present. Its
ability to withstand sudden or acute forces also depends on the tissues that soften the impact on the structure. In
general, sports injuries can be classified into two: acute and chronic/ overuse. Acute injuries have signs and symptoms
that manifest immediately after force application. On the other hand, the signs and symptoms of chronic or overuse
injuries occur after a long period of exposure to the force.
 Structure Function Acute injury
Ligaments Stabilize joints Sprain
Tendons Attaches muscles to bones Strain
Muscles Creates movements Strain
Bones Anchor for muscles Fracture
Joints Fulcrum for movement Dislocation
Table 7.1. Functions of Various Musculoskeletal Structures

Sprains, strains, fractures, dislocation, and wounds are examples of acute injuries. An excessive stretching
force can cause the fibers of the ligament, muscle, or tendon to break. An overstretched ligament is called a sprain.
Sprains can be classified as mild, moderate, or severe, depending on the loss of function and the number of torn fibers.
A similar classification is used for a strained muscle. A strain is also caused by excessive stretching that causes tears in
the muscle-tendon unit. Fractures are breaks in the continuity of the bone. It usually occurs as the result of high impact
forces that cause the bone to bend or twist. Dislocations are bones that are pushed out from their joint capsule.

How do overuse injuries occur? How are they classified?

Overuse injuries are common among individuals who have been training for a long period of time with
minimal rest and recovery between sessions. During training, the musculoskeletal structures receive higher loads that
what it is used to. However, the body has the ability to heal and recover from this, given enough recovery time and
nutrition. Some individuals that train too hard and too soon are not able to cope with the increased demand resulting to
microscopic injuries. These microscopic injuries will accumulate over time, resulting to overuse or chronic injury.
Overuse injuries include stress fractures (bone), tendinopathy (muscle-tendon unit), osteoarthritis (joint), bursitis (fluid
filled sac).

There are three types of overuse injuries according to severity: Stage I, Stage II, and Stage III. Athletes with
Stage I injury complain of pain only after the activity, game, or training session, while athletes with Stage II injury
complain during and after an activity but do not feel it during rest. However, in Stage III, the athlete feels pain whether
at rest or play.

Category Fibers Damaged Loss of Function

Mild Minimal tear Pain when moved
(first degree)
Moderate Partial tear Pain at rest and when moved
(second degree)
Severe Complete tear Complete loss of function
(third degree)
7.2. Classification of Sprains and Strains according to severity

Are certain individuals at more risk of getting injured? What factors increase the risk of injury?
 It is widely accepted that people engaging in sports or fitness training have a higher risk of getting injured.
Children and older are also at a higher risk because of poor motor control and weak musculoskeletal structures. There
are certain characteristics or factors that increase the likelihood of injury. These risk factors increase the susceptibility of
the individual to injury, but it does not cause the injury. Risk factors are classified as non-modifiable (i.e., age, gender)
and modifiable (tournament rules, apparel). Some experts classify risk factors as intrinsic or extrinsic factors. The most
common intrinsic risk factor is muscle imbalance between muscle pairs where the muscle becomes a little too tight.
Since women in general have wider hips, a high Q angle in the quadriceps is a common risk factor among them. A high Q
angle has been associated with acute injuries to the knee joint.

According to several studies, obese individuals and those with poor fitness level have a higher risk of getting
injured. Studies also show that injuries are associated with age. Fractures and other acute injuries are common among
the youth while overuse injuries are common among older individuals.

Aside from intrinsic factors or characteristics inherent to the individual, there are other factors related to the
environment or extrinsic factors. These include the use of protective equipment and footwear, coaching experience and
qualification, rule modification, and use of a structured warm- up before the game. The evidence of these factors is not
consistent and there is a need for more high-quality research to validate the impact on injury prevention.

Why does a body part swell after getting injured? Falling or breaking a fall

During acute injuries, the body will initiate the healing process through the inflammatory response. The
inflammatory response removes the damage tissues by increasing blood flow and activating the lymphatic system to the
injured site. Swelling occurs due to fluid accumulation because of increased blood flow and blood vessel permeability.
Aside from swelling, inflammation is also characterized by pain, redness, and warmth. The muscles surrounding the area
contract to guard the injured site and prevent aggravation. During inflammation, special cells remove the damaged
tissues to provide a foundation where new tissue can grow.

The laying down of new cells and blood vessels in the injured site is the actual repair phase. The repair phase
can last for several days or months, depending on the type of injury. The new tissue does not have the strength of the
original tissue and is still prone to re-injury. It is during the last phase or the maturation phase that the tissue will
become stronger as it aligns itself to provide maximal resistance to tensile forces.

The entire healing process takes several months to a year to complete. There are factors that may prolong
the healing period such as too much swelling, limited blood supply, old age, and weak muscle strength. It is important
that proper care is given to the injury to minimize delay and maximize strength of new tissue. Chronic injuries undergo a
similar healing process, but special attention should be given to determine its cause. Individuals should refrain from
training until the cause of the injury is identified, to avoid recurrence.

Injury Type of injury Common cause of injury

Sprain Acute Twisting or pulling force

Strain Acute Pulling force during rapid acceleration
Fracture Acute Falling or breaking a fall
Dislocation Acute Falling or breaking a fall
Stress fracture Overuse Repetitive high impact stress
Tendinopathy Overuse Repetitive movement using poor technique
Osteoarthritis Overuse Repetitive high impact stress
Bursitis Overuse Repetitive movement using poor technique
Table 7.3. Common causes of acute and overuse injuries
 COMMON SPORTS INJURIES

What are the most common acute injuries?

Sprain

Sprains are overstretched ligaments. The ligaments stabilize and limit joint mobility. When the joint is
forced into a position that is beyond its normal range, it will overstretch the ligament. The most common sprains are
located at the lower limbs such as the ankle and knee because they are subjected to stress daily. Moreover, sports
participation increases the likelihood twisting the knee and ankle. An individual usually feels a popping sound when a
knee ligament is completely torn. A completely torn ligament may need a surgical reconstruction before the athlete can
play again. A sprain joint will take several day or months to heal, depending on the severity.

A common sprained ligament is the anterior cruciate ligament (ACL). The ACL is a connective tissue that
stabilize the knee every time the muscles contract. The sprained ligament can have minimal tears, or it can be
completely ruptured. The injury commonly occurs when the knee twists while weight is placed on it due to improper
landing after jump, running too fast or without proper warm- up. It is common in soccer, basketball and volleyball. It is
also more common in females than in males. The injury usually takes several weeks or months to recover depending on
its severity. Surgery is recommended for individuals who suffer a complete ACL rupture especially if they still want to
pursue the same level of physical activity.

Strain

Strain is a twist, or tear of muscle or tendon (a cord of tissue that connects the muscle to bone). It is also
an acute, non-contact injury that results from overstretching or over contraction.

Sometimes, a muscle would contact and generate a force that is significantly higher that what is usually
does. The forceful contraction rapidly pulls the muscle-tendon unit, which can result to a muscle strain. The most
common strains are located at the lower limbs such as the hamstring and calf muscle. An individual who suffers a strain
will feel a sudden sharp pain at the muscle belly. The muscle will be painful to touch ad movement will be weak. Some
types of strains involve the complete rupture of the muscle -tendon unit and this requires surgery before the athlete can
play. The healing process usually takes six to eight weeks.

Fracture

The most common fractures are located at the upper limbs such as the hand and forearm. Fractures are
more common in growing bones because it is less dense. There are also a higher number of fractures in the upper
extremities because it is not a strong and compact as the bones on the lower extremities. Fractures in the upper limb
occur when individuals support their weight using their hands when they fall or slip. There are different types of
fractures and the healing period is between three weeks to several months, depending on the severity of the injury. It is
normally treated with immobilization by attaching a fixator or a cast.

Dislocation
 Dislocations commonly occur in joints that allow greater range of motion. The most common
dislocations are located at the upper limbs such as the shoulder and elbow. These joints are commonly affected when an
individual uses his/her hand to support his/her weight when he/she falls. When the bone is pushed out of the proper
alignment, the injury will cause a deformity and constant pain. Furthermore, the individual will not be able to move the
affected limb. The pain will be relieved once the bone is repositioned.

Concussion

Concussion are life-threatening injuries because they disrupt the normal function of the brain. A severe
blow to the head could cause the blood vessels in the brain to rupture. As the blood leaks out the rupture blood vessels,
it will accumulate inside the skull. As the volume of blood increases the pressure inside the skull starts to build up. The
accumulated blood will put pressure on the brain, blocking the blood supply to different areas of the brain. If the
condition is not resolved immediately, the brain starts to die. It is important to go to a medical facility as soon as
possible so the injury will not worsen.

What are the most common acute injuries?

Stress Fracture

Stress fractures commonly occur among runners who train for long periods without adequate rest
periods. According to a study, running athletes who average more than 65 kilometers a week have a higher risk to stress
fracture. The repetitive workload creates microtrauma- as thick as a strand of hair- in the bone and gets bigger over
time. The usual area affected is the shinbone. The individual feels a dull aching pain that worsens over time. This type of
fracture does not require immobilization, but the individual must stop exercise for around four weeks to give it time to
heal.

Tendinopathy/ tendinitis

The most common overuse injury in sports involve the muscle-tendon unit called tendinopathy/
tendinitis. It is usually due to muscle imbalance between muscle pairs. The most common site of tendinitis in the upper
limb involves the muscle-tendon units around the elbow (tennis elbow). The most common site of tendinitis in the lower
limb involves the muscle-tendon units around the elbow (jumper’s knee). The pain usually eases during activity but will
worsen after playing. The individual should maintain fitness but avoid activities that utilize the injured muscle-tendon
unit. The recovery period usually takes three weeks to several months.

Osteoarthritis

Osteoarthritis is the wear and tear of a joint that results to its deterioration. The friction deteriorates the
cartilage that protects the bones from rubbing against each other. The knee joint is the common site for the
degenerative changes that occur in the cartilage. An individual feels pain and a grinding sensation as it worsens. The
condition further aggravates when the individual is overweight or obese. The recovery period takes several months
because of poor blood supply to the area. In severe cases, doctors recommend surgery to replace the joint.

Bursitis

The bursa is a sac-like musculoskeletal structure that provides support and cushioning to the joint. It
protects commonly used joints such as the shoulders and the knee from repetitive mechanical stress (friction). This
injury is commonly in swimmers and runners. The inflammation of the bursa interrupts the surrounding structures,
causing pain during movement. The recovery period usually takes two weeks or month.
 Can heat illnesses lead to a life-threatening condition?

Heat illnesses (e.g., cramps, stroke) are due to exercise dehydration and high blood temperature commonly
attributed to training in poor weather conditions. Adverse or poor weather conditions like too much heat prevent the
body to cool down through perspiration. If the body cannot dissipate the heat, the core body temperature increases
beyond the tolerable limit. The risk of suffering seizures and other medical conditions increase when the bod
temperature reaches 40 degrees Celsius.

The most life-threatening case of heat illness is heat stroke. This condition is likely to occur if an athlete trains
outdoors for several hours and the air temperature is above 35 degrees Celsius and the relative humidity is above 80%.
In this weather condition, the body would try to cool itself by increasing the blood flow to areas close to the skin. The
heat is passed to the sweat formed on the skin as it evaporates, the body passes the heat to the environment. However,
when the air temperature is high, the body is not able to effectively pass the heat into the environment. In addition, the
sweat will not evaporate when the relative humidity is high. These weather conditions trap the heat inside the body that
can lead to a drastic drop in blood pressure which can result to death.

Signs of Dehydration
- Dizziness, fatigue, weakness, dry mouth, flushed skin, headache, blurred vision, difficulty swallowing, dry skin,
hot skin, rapid pulse, frequent need to urinate

SPORTS INJURY PREVENTION

Most sports injuries can be prevented with adequate preparation and proper knowledge. The following
strategies can minimize the occurrence of these injuries:

1. Adopt a Comprehensive Training Program. A comprehensive training program goes beyond addressing the
fitness parameters such as aerobic capacity and strength. It is a holistic program that suits an individual’s need
and demands. The individual must first assess the weakness and abnormality of his/her movements and fitness
to be able to customize his/her training program. The program contains the correct exercise and proper
execution as well as posture, corrective exercises, core exercises, stability exercises and other exercises that will
improve neuromuscular efficiency.
2. Use protective equipment and practice correct technique. Individuals derive fun from playing sports and other
physical activities (dance) that they sometimes forget to wear proper protective gears. Injuries while playing a
sport or game can be prevented by sing some protective equipment. An individual should also learn to correct
technique to avoid injury. An incorrect technique may put the musculoskeletal structure into an awkward
position which leads to injury. Practice the correct technique when lifting barbells and dumbbells off the floor.
3. Incorporate recovery in the training program. Training and exercise is a controlled form of stress that stimulates
the body to become stronger. While it is important to train and exercise, it is also necessary to incorporate
recovery in the routine. Recovery provide the body time to rebuild broken musculoskeletal structures. Hence, an
individual should also eat properly to help the body restore lost nutrients. It is common to lose water,
electrolytes, and energy sources during an exercise session. Eating properly and drinking adequate amount of
water can help delay fatigue and decrease risk of dehydration. It is recommended to drink water before, during,
and after an exercise session to prevent dehydration.
4. Follow rules and decorum during competition. Tournament directors and sports officials draw up rules and
regulations for any competition to maintain fairness and safety for everyone involved. These rules should be
 strictly enforced to prevent excessive physical contact that might lead to injuries. It is important to practice
sportsmanship and to resolve conflict without resulting to violence. It is understandable that officials will make
judgment errors regarding the game, but this should not spark violent outburst from the players.

How can the possibility of getting injured while training be minimized?

Fitness and training can be prevented if an individual takes the necessary preparations and precautions on the
following variables:

1. Proper attire. The attire should be appropriate for the chosen activity. It is important to consider comfort and
protection when choosing an appropriate attire. A special attention should be given when choosing footwear
because may chromic injuries are caused by inappropriate shoes. A good pair of shoes will provide stability,
support, cushion, and comfort.
2. Proper technique. An individual need to consult a trainer and ask for proper instruction in performing the
chosen activity or exercise. The knowledge on how to execute the movement is just as important as the
movement. The benefit of the exercise will be compromised if it is not performed with the correct technique.
For example, poor running mechanics can lead to patellofemoral pain and plantar fasciitis.
3. Gym etiquette. Individuals that subscribe to gym facilities should be aware of the rules and etiquette. Each
facility has its own list of rules, but these are the most common:
 Ask for a spotter when lifting loads close to 1RM.
 Do not drop the barbell at the end of the set.
 Put weights and dumbbells on designated racks.
 Be aware of the exercise area for each equipment.
 Do not use mobile phone inside the gym.
 On a track, inner lane is for walking while outer lane is for running.
 Do not engage in horseplay nor talk in a loud voice.
 Do not wear loose jewelry while working out.
4. proper environmental conditions. It is advisable to check the environmental conditions before the exercise
session. It is possible that the area or the weather is not conductive for the activity. The risk of getting sprained
is higher when the ground is uneven compared to a running track. The weather conditions should also be
considered before training because it can lead to heat exhaustion and stroke or frostbite and hypothermia.
There is a greater risk for heat stroke when the humidity is above 80% and the temperature is above 35 degrees
Celsius.
5. Adequate recovery. The recovery period is just as important as the workout session. It is important to provide
the body with an adequate and proper nutrition to recover. Many chronic injuries occur because the workload
was too hard, or it was performed too soon. If pain is recurring during the exercise, it is best to stop the activity
and consult a doctor or ask a fitness trainer to modify the exercise.