Telling Them Apart: Chronic and Acute Sports Injuries

The term 'sports injury' refers to the kinds of injuries that may be sustained during sports or exercise. Sports injuries can be broadly categorised into 2 types – chronic and acute injuries. It is important to be able to distinguish these 2 kinds of injuries, as it would give you a better idea of how to manage them.

Defining chronic and acute injuries

Chronic injury

A chronic injury is the result of prolonged, repetitive motion that is particularly common in endurance sports such as swimming, running and cycling. As such, chronic injuries are often referred to as overuse injuries – injuries resulting from overusing one body area while playing a sport or exercising over a long period.

Common types of chronic sports injuries:

• Stress fractures
• Tennis elbow
• Shin splints
• Runner's knee
• Heel inflammation
• Ankle sprain
• Groin pull
• Hamstring strain

These injuries are commonly related to one of the following – improper technique, trying to progress too fast, or overdoing certain motions while playing a sport. They are commonly associated with sports such as long distance running, cycling and swimming.

Acute injury

An acute injury, on the other hand, is an injury that occurs suddenly and is usually associated with trauma such as cracking a bone, tearing a muscle or bruising. It could be a result of falling or crashing into another player during sports.

Chronic/overuse sports injuries outnumber sudden acute injuries in almost every athletic activity, but because these injuries are not instantly disabling, they attract less medical attention than those that cause a sudden and obvious loss of function.

Telling the difference between chronic and acute injuries

The difference between chronic and acute sports injuries lies in the signs and symptoms of the injury. Acute injuries occur suddenly and are usually associated with severe pain. Examples of acute injuries are a broken bone, muscle tear or bruising. Chronic injuries result from overusing one body area over a long period. Examples of chronic injuries are stress fractures and heel inflammation.

Signs of a chronic injury include:

• Pain when performing an activity
• A dull ache when at rest
• Swelling

As opposed to chronic injuries, the symptoms of an acute injury typically occurs within 2 weeks of the injury. In the acute phase, the body uses inflammation to repair the damaged tissues.

Signs of an acute injury include:

• Sudden severe pain
• Swelling
• Inability to place weight on a lower limb
• Extreme tenderness in an upper limb
• Inability to move a joint through its range of motion
• Extreme limb weakness
• Visible dislocation or break of a bone

How to manage acute sports injuries

R.I.C.E is an acronym many sports trainers and athletes use to treat a minor acute injury. It stands for Rest, Ice, Compress and Elevate.

Resting is one of the most effective ways to start your healing process. Your injured body part will be weak and vulnerable to further injury, especially in the first few hours, so take a break to help it heal.

Apply a bag of crushed ice. The benefits of applying ice are the greatest in the first 2 days after sustaining an injury. It will help relieve pain and prevent swelling. Wrap ice in a cloth or towel before placing it on the injured area. Leave it on the injured area for about 15 – 20 minutes each time, and allow your skin to return to normal temperature in between icing.

Compress the injured area with an elastic bandage to minimise swelling by preventing the build-up of fluid. The bandage should be firm, but not too tight such that it causes discomfort or interferes with blood flow.

Finally, elevate the injury above the level of your heart. This will minimise swelling by allowing fluid to drain away from the area. If you can't raise it above your heart, try to keep the injured area at the same level as your heart or close to it. If you have a swollen knee or ankle and you are seated, prop your leg on another chair.

Continue applying the R.I.C.E method for the first 2 – 3 days. Thereafter, you may begin to alternate heat packs with ice. Applying heat may promote the circulation of blood to the injured area, helping to deliver oxygen and nutrients to support the healing process.

When your swelling has gone down, you can remove your compression bandage and begin to gently exercise the injured area. Start slowly with light stretching, taking care to not push it to the point of pain. Keep stretching and moving for the first few weeks until you are comfortable with normal use and exercise.

How to manage chronic sports injuries

When it comes to chronic injuries, you may still apply the first 2 treatment methods (Rest and Ice). But most chronic injuries can only be resolved with the use of medication and physical therapy.

In the short term, anti-inflammatory medication may help to cope with pain and inflammation associated with the injury. In the longer term, however, your healthcare provider may send you to a physical therapist to do some gentle stretching and strengthening exercises.

The prevention of injury recurrence is the most important aspect of managing overuse injuries during sports. The majority of overuse injuries involve muscle fatigue due to a lack of strength or endurance. As a result, the muscle tightens and may undergo structural damage followed by muscle spasms and shortening.

This indirectly leads to muscle weakness so that a recurrence of the injury occurs easily. Recurrence of overuse injuries will continue until broken by active treatment interventions.

Some simple ways you may avoid chronic sports injuries include ensuring you always use proper gear, warming up and cooling down before and after exercising, and making sure never to overexert yourself.

When to see the doctor

For an acute injury
If you suspect your injury is severe, head straight for the emergency department. The following symptoms may be a good guide to follow in deciding if your injury requires professional care:

• Severe swelling and pain
• Visible deformities, such as large lumps or limbs bent at strange angles
• Popping or crunching sounds when you move the injured area
• Inability to support any weight with the injured area
• Instability in a joint
• Trouble breathing
• Dizziness
• Fever

For a chronic injury
Many overuse injuries happen over time and often have subtle symptoms. This can result in a delay in diagnosis and treatment, and delays can lead to more serious or disabling injuries.

You should contact your doctor if the injury seems minor but doesn't improve with home treatment. Any condition that affects training or performance but has not been diagnosed or treated should also be the green light to consult your doctor.

If there is swelling, discolouration, visible bruising or severe pain after the first few weeks of injury, you should seek medical attention.