Sports Medicine: Just the Facts

b.Head, upper leg, and knee are most prevalent in

game situations (47%).

1. Sprains, strains, and contusions were top
   three injuries.
   c. Player–player contact accounted for 40% of
   injuries in game situations.
   3.Catastrophic injuries (U.S. Consumer Product Safety
   Commission’s National Injury Information, 2001)
   a. Data collected from 1982 to 2001.
   b.In both high school and college, there have been
   only four fatalities, four nonfatal (permanent
   severe functional disability) injuries, and three
   serious injuries (significant injury without per-
   manent disability) reported as a result of direct
   competition or practice.
   c. Four fatalities have occurred as a result of indi-
   rect contact while playing lacrosse (exertional
   injury or complication of a nonfatal injury).

INJURIES IN LACROSSE

• Noncontact (Matthews, Hinton, and Burke, 2001;
  Casazza and Rossner, 1999; Bartlett, Cress, and Bull,
  1991)
  
  
  1. Lower extremity
     a. Groin, hamstring, and low back strains
     i. Associated with twisting motion of the torso.
     ii. Common motion during passing, shooting,
     checking, and scooping ground balls.
     iii. Performed at high speeds and with rapid
     changes in direction.
     iv. Cryotherapy and strengthening of affected
     regional musculature key in return to play
     and reducing repeat injuries.
     b.Knee
     i. Similar to other field sports, anterior cruciate
     ligament(ACL) and medial collateral liga-
     ment(MCL) injuries are not uncommon.
     
     
     1. Account for fewer than 20% of injuries.
     
     
     2. MCL more commonly affected than LCL.
     
     
     3. Because of the MCL’s deep attachment to
        the medial meniscal periphery, meniscal
        tears should be suspected with higher
        grade MCL injuries.
     
     
     4. Typically the result of force on the lateral
        aspect of knee at full extension, with foot
        planted.
     
     
     5. May be the result of a lateral blow, but
        more often the result of planting and
        directional change resulting in intolerable
        stresses on ligaments.
        6.Grade I and II may be treated nonsurgically.
        7. Cryotherapy, hinged braces, hamstring,
        and quad strengthening are mainstay of
        rehabilitation.
        8. Recovery may take up to 6 weeks, with
        hinged brace used in competition for
        1–2 months for protection.
        ii. Patellofemoral syndrome (PFS)
     
     
     
     
  
  
  
  

1. Often seen in female players aged 12 to
   15, owing to anatomic stresses.


2. Typically presents as anterior knee pain
   without any physical findings (i.e., insta-
   bility or effusion).


3. Risk factors include foot pronation, genu
   valgus, rotated or tilted patellae, or an
   increased Q-angle.
   4.Strengthening of medial quadriceps
   (VMO) and hamstrings are mainstay of
   prevention and treatment.


4. Some significant anatomic abnormalities
   may require surgical intervention to alle-
   viate symptoms.
   c. Ankle
   i. Accounts for 16.2% of total injuries in
   NCAA lacrosse (1994–1996 ISS).
   ii. Majority are inversion injuries.
   iii. Slight inversion and plantar flexion is the
   state of least stability, and the point when
   injury most often occurs.
   iv.Ligamentous injuries are most common.
   1.Anterior talofibular ligament(ATFL), fol-
   lowed by Calcaneofibular ligament(CFL),
   and then Posterior talofibular ligament
   (PTFL).


5. Deltoid ligament injuries are associated
   with eversion mechanism.


6. Avulsion fractures should be suspected
   with higher grade ligamentous injuries
   (grade 2 or higher).
   v.Early mobilization for nonfractures is the
   key to rapid return to healthy play.
   1.Consider nonweight bearing exercises
   (i.e., aqua jogging).


7. Strengthening of evertors, invertors, plan-
   tar and dorsiflexors, as well as hip ab- and
   adductors, and extensors.
   3.Final rehabilitation should include dynamic
   strengthening focusing on proprioception
   (i.e., slide board, figure 8 running drills).


8. Most sprains will recover in 1 to 3 weeks.


9. Upper extremity
   a. Much less common
   b.Blocker’s exostosis
   i.Most often with repetitive stick-to-body
   contact at deltoid insertion.

550 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS