Management of Injuries during Outdoor Sports


T. Naga Ravi Kiran*, E. Sagar Reddy, D. Venkat Nagendra Babu, J. N. Sureshkumar

Department of Pharmaceutical Chemistry, Narasaraopeta Institute of Pharmaceutical Sciences, Yellamanda, Narasaraopeta. Guntur (Dt), Andhra Pradesh.

*Corresponding Author E-mail:



Outdoor sport recreation during all ages i.e., childhood, adolescence, adulthood etc., is of paramount importance in physical endurance and building stamina. The physical, mental, and emotional amassment associated with athletic endeavors can play an unparallel great appropriation in adulthood. Whether it is a group sport demanding the solidary effort of various traits and skills or the mental abilities required of one-to-one competition, character development often prospers. Unfortunately, on the rearside of many athletic endeavors lies the peril of injury, which can lead to long-term consequences. Therefore, equating the pros and cons is often an ideal course to making reasonable decisions about athletic involvement. The aim of this review is to identify the available research in regard to the risk factors and frequently occurring injuries in several sports and their curbing and management.


KEYWORDS: Rehabilitation, Resusciation, Sprain, Athlete.




Sport means an activity involving physical activity and skill. Here, two or more parties engage against each other. Sports are an integral part of human life and there is great importance of sports in all spheres of life. Furthermore, Sports help build the character and personality of a person. It certainly is an excellent tool to keep the body physically fit. Most noteworthy, the benefits of Sports are numerous that books can be written. Sports have a humongous positive effect on both the mind and body.


Sport has played an important role in our lives for many centuries since mankind’s evolution. Millions of people round the globe are fond of sports and games.


Sport keeps us fit, makes us healthy, more organized, better disciplined and an active team member. It offers us a lot of delight, makes us mighty, and prolongs our life. It unites people of different classes and nationalities irrespective of social, economical, race and creed status.


It's no secret that training and competing can take a toll on an athlete’s body. Movements like running, swimming, jumping, tackling, kicking and pivoting, done on a regular basis, can lead to wear and tear on one’s muscles, joints and bones. This holds especially true if proper technique is not adhered to while training. Each of our Sports Rehabilitation Center staff members is highly-qualified to treat a wide range of sports injuries in our patients. However, we feel it just as important for athletes to have their own basic understanding of injury prevention as well as the types of conditions they should be on the lookout for.


Sports offer many benefits to mankind which include Physical, Psycological and Social benefits which are stated below.


Fig.1 Benefits with sports



Different sports produce different injuries and complications. The most common types of sports injuries include:

·       Sprains. Ligaments are pieces of tissue that connect two bones to one another in a joint.

·       Abnormal stretching or tearing the ligaments results in a sprain

·       Strains. Tendons are thick, fibrous cords of tissue that connect bone to muscle.

·       Over working or tearing muscles or tendons results in a strain. Strains are commonly mistaken for sprains. Here’s how tell them apart.

·       Knee injuries. Any injury that interferes with how the knee joint moves could be a sports injury. It could range from an overstretch to a tear in the muscles or tissues in the knee.

·       Swollen muscles. Swelling is a natural reaction to an injury. Swollen muscles may also be painful, weakening and long lasting.

·       Achilles tendon ruptures. The Achilles tendon is a thin, powerful tendon at the back of your ankle. During sports, this tendon can break or rupture. When it does, you may experience sudden, severe pain and difficulty walking.

·       Fractures. Bone fractures are also known as broken bones. A fracture is a condition that changes the contour (shape) of the bone. Fractures often occur when there is a high force or impact put on a bone.

·       Dislocations. Sports injuries may dislocate a bone in your body. When that happens, a bone is forced out of its socket. This can be painful and lead to swelling and weakness.

·       Rotator cuff injury. Four pieces of muscle work together to form the rotator cuff. The rotator cuff keeps your shoulder moving in all directions. A tear in any of these muscles can weaken the rotator cuff.



In the U.S, about 30 million children and teens participate in some form of organized sports, and more than 3.5 million injuries occur each year, which cause some loss of time of participation. Almost one-third of all injuries incurred in childhood are sports-related injuries. By far, the most common injuries are sprains and strains.


Obviously, some sports are more dangerous than others. For example, contact sports such as football can be expected to result in a higher number of injuries than a non-contact sport such as swimming. However, all types of sports have a potential for injury, whether from the trauma of contact with other players or from overuse or misuse of a body part.


The following statistics are from the National SAFE KIDS Campaign and the American Academy of Pediatrics:


Injury rates:

·       More than 3.5 million children aged 14 and younger get hurt annually playing sports or participating in recreational activities.

·       Although death from a sports injury is rare, the leading cause of death from a sports-related injury is brain injury.

·       Sports and recreational activities contribute to approximately 21 percent of all traumatic brain injuries among American children.

·       Almost 50 percent of head injuries sustained in sports or recreational activities occur during bicycling, skateboarding, or skating incidents.

·       More than 7, 75,000 children, aged 14 and younger, are treated in hospital emergency rooms for sports-related injuries each year. Most of the injuries occurred as a result of falls, being struck by an object, collisions, and overexertion during unorganized,unsupervised or informal sports activities.



·       Playground sports, and bicycle-related injuries occur most often among children between ages 5 and 14 years old.

·       The highest rates of injury occur in sports that involve contact and collisions.

·       More severe injuries occur during individual sports and recreational activities.

·       Most organized sports-related injuries (62 percent) occur during practice.



According to the Consumer Product Safety Commission, the injury statistics for 2019 provided by the consumer product safety commission state that injuries are resulted from various outdoor sports as mentioned below-


·       Basketball - More than 1,70,000 children aged 5 to 14 were treated in hospital emergency rooms for basketball-related injuries.

·       Baseball and softball - Nearly 110,000 children aged 5 to 14 were treated in hospital emergency rooms for baseball-related injuries. Baseball also has the highest fatality rate among sports for children aged 5 to 14, with three to four children dying from baseball injuries each year.

·       Bicycling - More than 2,00,000 children aged 5 to 14 were treated in hospital emergency rooms for bicycle-related injuries.

·       Football - Almost 2,15,000 children aged 5 to 14 were treated in hospital emergency rooms for football-related injuries.

·       Ice hockey - Nearly 20,000 children aged 5 to 14 were treated in hospital emergency rooms for ice hockey-related injuries.

·       In-line and roller skating - More than 47,000 children aged 5 to 14 were treated in hospital emergency rooms for in-line skating-related injuries.

·       Skateboarding - More than 66,000 children aged 5 to 14 were treated in hospital emergency rooms for skateboarding-related injuries.

·       Sledding or toboggan - More than 16,000 children aged 5 to 14 were treated in hospital emergency rooms for sledding-related injuries.

·       Snow skiing or snowboarding - More than 25,000 children aged 5 to 14 were treated in hospital emergency rooms for snowboarding and snow skiing-related injuries.

·       Soccer - About 88,000 children aged 5 to 14 were treated in hospital emergency rooms for soccer-related injuries.

·       Trampolines - About 65,000 children aged 14 and under were treated in hospital emergency rooms for trampoline-related injuries.



1.     Hip Flexor Strain:

The hip flexors are muscles found on the upper-front side of the thigh. The main functions of the hip flexor muscles are to lift the knee toward your trunk, as well as assist moving your leg toward and away from the other leg. Hip flexors can be weak in individuals who sit a great deal at work or can become weak and stiff in individuals who have poor sitting posture. Sports injuries to this muscle group can be caused by sprinting, running inclines and activities with quick turns and sudden starts.


2.     ACL Tear or Strain:

The ACL, anterior curiae ligament, is one of the major stabilizing ligaments of the knee. The most common cause of sports injuries for an ACL strain is slowing down and trying to cut, pivot or change directions. Complaints of instability when walking or turning corners, as well as increased swelling in the knee would be common as ACL tear symptoms.


3.     Concussion:

A concussion can be defined as injury to the brain, due to a blow to the head where the brain is jarred or shaken. Concussions are serious injuries that should not be taken lightly. An athlete who experiences a concussion should seek out a certified athletic trainer or a physician with experience treating concussions.


4.     Groin Pull:

A groin pull is also called a groin strain. The groin muscles run from the upper-inner thigh to the inner thigh right above the knee. Groin muscles pull the legs together and are often injured with quick side-to-side movements and/or a lack of flexibility.


5.     Shin Splints:

Athletes with shin splints complain of pain in the lower leg bone, or the tibia. Shin splints are most often found in athletes who are runners or participate in activities with a great deal of running, such as soccer. Athletes typically get shin splints diagnosed early in their season, as they increase activities or mileage too quickly.


6.     Sciatica:

Sciatica is back pain that also travels down the back of the leg or even to the feet. This radiating pain can additionally be associated with numbness, burning and tingling down the leg. Sciatica can be seen in athletes who are in a flexed forward posture, such as cyclists, or athletes.


7.     Hamstring Strain:

The hamstring muscle is located on the back of the thigh. Unfortunately, the hamstring muscles can be tight and are susceptible to a strain, which is also called a pulled muscle. Poor stretching techniques or lack of stretching can be the cause of a hamstring tear/strain. Often, an athlete with a hamstring tear will experience bruising in the back of the thigh or the knee.


8.     Tennis or Golf Elbow:

Tennis and golfer’s elbow is usually seen with athletes performing a great deal of gripping activities. It can be labeled as an overuse sports injury, also known as medial or lateral epicondylitis. Due to the repetitive action, the tendons of the forearm can become inflamed and make any wrist or hand motions extremely painful. Often, athletes will complain of a lack of grip strength.


9.     Shoulder Injury:

Shoulder injuries cover a large number of sports injuries from dislocations, misalignment, strains on muscles and sprains of ligaments.


·       Not warming up properly,

·       Poor technique,

·       Not using equipment correctly, or

·       Not taking the proper safety precautions for your sport.



Competitive athletes, such as sprinters, long-distance runners, gymnasts and rugby players, hold a high risk of injury due to the intense nature of their training and the overuse of specific muscle groups.


Children are also at risk of sports injuries because they are undeveloped and still developing physically. For example, the female shape changes significantly during puberty (usually between ages 10 and 16). As the hips widen, exercise can put pressure on different parts of the legs and feet, which can sometimes lead to injury.



A first-aid kit is a necessity to help you respond effectively to common injuries and emergencies while coaching and playing. In general, they contain CPR mask, bandages, Disposable instant cold packs, roll gauze, sterile gauze pads, anti septic solutions, antibiotic ointments, cotton tipped applicators, saline water, several pain killers, and sprays.



The primary goal of first aid is to stop the damage activity and prevent further injury or damage.


If you get injured while playing sports, here’s what to do right away. These injury treatment tips will keep prevent your pain and injury from getting worse and may help you heal more quickly.


These are the few tips which will help you get out of unanticipated situations

1.     If You Have Pain, Stop Exercise Immediately.

2.     Reduce Swelling with Ice and Compression.

3.     Place the Ice in the Right Way.

4.     Medicate When Appropriate under supervision.



In modern days, all major sports have their own set of medical staff and emergency medical assistance to minimize the risk and to ensure the care of any scenario after a fatal accident. But still, accidents and deaths can come in any form at any time, so here is the list of sportsmen Who Died on The Field.


1.     Philliphughes:

The cricket world received a terrible jolt in 2014 when Phillip Hughes died at the age of 25, after being struck by a bouncer on the side of his head, below the helmet.


2.     Antonio Puerto:

Spain international Puerto, 22, collapsed while playing for Seville in a La Liga match against Getafe and passed away three days later in 2007 from multiple organ failure stemming from prolonged cardiac arrest.


3.     Ray Chapman:

American baseball player Ray Chapman played as a shortstop for Cleveland Indians throughout his entire career. He is the only Major League Baseball player to face death from an injury during game play in 1920.


4.     Steve McElvene:

The university of Dayton red shirt freshman Steve McElvene died on may 12,2016 at age 20 after he collapsed at his family’s home. An enlarged heart was believed to be the cause of death.


5.     Donnavan Hill:

Hill, a California teenager whose paralyzing pop Warner football injury alarmed to increase safety for young players, died on May 11, 2016 of complications from surgery related to management of his injury.


6.     Antonio Puerta:

Spanish footballer Antonio Puerto played in Spain International Football team, Spain U21 and Spain U23. Puerto collapsed in the penalty area due to a cardiac arrest at home ground Sanchez Pizjuán against Getafe CF after only 35 minutes of the game. As a tribute, all 22 participants wore jerseys printed the name ‘PUERTA’ on the back and black armbands in a match against A.C. Milan on 31 August 2007.


7.     Duk Koo Kim:

South Korean boxer, Duk Koo Kim won 17 fights out of 20 fights in his entire career, out of which 8 wins came by knock-outs with his traditional Southpaw stance. He died during a world championship boxing match against Ray Mancini on November 13, 1982. Referee Richard Green stopped the fight after Kim went flying into the ropes because of simultaneous hard right-hand punches by Mancini and declared Mancini the winner.


He was rushed to the hospital where he was found to have “a subdural hematoma consisting of 100cc of blood in his skull.” Koo Kim died four days after the fight with Mancini on November 18,11982. This death surely serves its mention among the tragic deaths.


8.     Chuck Hughes:

American football wide receiver Chuck Hughes played for Philadelphia Eagles from 1967 to 1969. He then played for Detroit Lions from 1970 to 1971 in the National Football League (NFL). Hughes is the only NFL player to die on the field during a game to date. He died of a fatal heart attack with just over a minute to play in a game. He was drafted in the fourth round in the 1967 NFL Draft by the Philadelphia Eagles.


9.     Reggie Lewis:

American professional basketball player, Reggie Lewis played as a Small forward for the Boston Celtics in the NBA from 1987 to 1993. He suffered sudden cardiac death on the basketball court on 27th July, 1993 at an off-season practice at Brandeis University in Waltham, Massachusetts.


After the tragic death of Lewis, his Number 35 jersey was retired by the Boston Celtics and also by the Northeastern.


10. Bill Master ton:

Canadian–American professional ice hockey center Athlete Bill Master ton is the only player to die as a direct result of injuries during a game in NHL history. He played for the Minnesota North Stars in the National Hockey League (NHL) in 1967–68 season. He faced a severe internal brain injury on the game against the Oakland Seals at the Met Center. Bill died during the first period of Minnesota on January 13, 1968. The impact of the collision with Larry Chan and Ron Harris caused Master ton to bleed from his nose, ears, and mouth. He received emergency medical treatment in the dressing room. And then, rushed to Fairview-South dale Hospital but died without ever attaining consciousness. He died on January 15, some 30 hours after his tragic sports accident.


From all the above instances, irrespective of the cause of death and sport, prior athletic event, physical and mental examination, taking the necessary measures for cardiopulmonary resuscitation, prompt defibrillation, and, finally, the preparation of national registries in which all deaths are recorded will help the upcoming athletes.



Injuries during Sports are a Dime a Dozen. Injuries may range from a simple sprain to life threatening. A timely response towards the rescue of injured avoids a serious, irreversible and even a fatal damage.


After an injury is noticed or happened, the effects like swelling, pain can be happening. RICE (Rest, Ice, Compression and Elevation)



1.     Rest:

Rest the area to allow the tissues time to heal.


2.     Ice:

Applying cold therapy (ice or an ice pack wrapped in a thin towel) to an acute injury reduces swelling and pain. Ice is a vaso-constrictor. It causes the blood vessels to narrow and limits internal bleeding at the injury site. Apply cold Ice to the affected area every two hours for no more than 20 minutes at a time. Allow the skin temperature to return to normal before icing it again. You can ice an acute injury several times a day for the next three days.


3.     Compression:

Compression of an acute injury is perchance the next most important immediate treatment tip. By quickly wrapping the injured body part with an elastic bandage or wrap, you help control swelling to a minimum. If possible, it's helpful to apply ice to the injured area over the compression wrap to limit the swelling effect.


4. Elevation:

Elevating the injured area is another way to reduce the blood flow and swelling at the area.


·       Medicines should only be a small part of an overall treatment plan. Sports injuries need to be properly diagnosed and treated in a way that looks at both the causes and effects of the injury.


 Fig. 2 RICE Technique



As mentioned above, RICE technique may provide an effective means of minimizing the immediate damage, a further follow-up is needed through pharmacological means for exhaustive treatment. The most commonly used drugs are mentioned below.

·       Non steroidal anti-inflammatory drugs (NSAIDs): are helpful for chronic conditions in which the inflammation does not help the injury heal. For acute injuries, they may actually delay healing.

·       Sports medicine doctors may recommend rest, heat or cold to the affected area, pain-relieving medications, electrical stimulation of the muscles and nerves, a cortisone injection, or in extreme cases, surgery.

·       Analgesics: Two sub-categories exist, namely narcotic and non-narcotic preparations. Narcotics exist in both Injectables and oral forms. Injectables include Morphine, Meperdine, and Dihydromorphinone. Non-narcotic preparations include Aspirin, Paracetamol and Ibuprofen.

·       Anti-inflammatory Medications: The other class of drugs commonly used in the Injury treatment of athletes is the anti-inflammatory medications. These exist as steroid and non-steroidal anti-inflammatory agents (NSAIDS). They include the commonly prescribed oral form, prednisone, and the various preparations that are the main ingredient of “cortisone shots’’ (pain and inflammation relieving injection)

·       Antibiotics: Antibiotics may be required in the treatment of sports-sustained lacerations (cuts) and abrasions which become secondarily infected. Recently there has been concern raised over the growing incidence of infections caused by an antibiotic resistant strain of the very common bacteria, Staphylococcus aureus (a gram positive bacteria responsible for skin infections, food infections and bacteremia).

·       Miscellaneous OTC Medications: These include the highly publicized glucosamine and chondroitin sulfate, MSM(Methyl sulfonyl methane), a large variety of herbal based medications, as well as nutritional and mineral supplements indicated to help the body maintain fluid and flexibility in the joints.



The role of sports is unparallel and it helps improve physical fitness and mental balance. As injuries are inevitable during sporting, the following strategies may be followed to avoid them.


1.     Take time off:

Plan to have atleast 1 day off per week and at least one month off per year from training for a particular sport to allow the body to recover.


2.     Wear the right gear:

Players should wear appropriate and properly fit protective equipment such as pads (neck, shoulder, elbow, chest, knee and shin bone), helmets, mouth pieces, face guards, protective cups, and eyewear. Young athletes should not assume that protective gear will prevent all injuries while performing more dangerous or risky activities.


3.     Strengthen muscles:

Conditioning exercises like warm-up stretching during practice strengthens limb muscles involved in play and during practice sessions.


4.     Increase flexibility:

Stretching exercises after games or practice can increase flexibility. Stretching should also be incorporated into a daily fitness plan.


5.     Use the proper technique:

Most suitable technique should be chosen based on age, physical stamina and experience in the particular sport.


6.     Take breaks:

Rest periods during practice and games can reduce injuries, prevent heat illness and collapse by having periodical breaks and stay resilient.


7.     Play safe:

Strict rules against head first sliding (baseball and softball), spearing (football), no bodyline (cricket) and checking (in hockey) should be enforced.


8.     Do not play through pain:

Player should not withstand and tolerate pain and continue the game. Any sort of inconvenience as to be reported immediately to the coach or physiotherapist nearby.


9.     Avoid heat illness:

Be avoided from heat wave by drinking plenty of fluids before, during and after exercise or play. Decrease or stop practices or competitions during high heat/humidity periods. Wear light clothing to avert excessive perspiration.


10. If children are jumping on a trampoline:

They should be supervised by a responsible adult, and only one child should be on the trampoline at a time. 75% of trampoline injuries occur when more than one person is jumping at a time. A skilled coach presence will prevent any unwanted injuries.


11. Sports-Related Emotional Stress:

The pressure to win can cause significant emotional stress for a child. Sadly, many coaches and parents consider winning the most important aspect of sports. Young athletes should be judged on effort, participation, sportsmanship and hard work. They should be rewarded for trying hard and for improving their skills rather than punished or criticized for losing a game or competition. The main goal should be to have fun, recreation and learn lifelong physical activity skills.



All work and no play make jack a dull boy.


In this technology driven modern era, man find less and even no time for physical activity. Consequently, it leads to several disorders like obesity, Diabetes mellitus, cardiac disorders etc., Outdoor sports provide a good deal of physical exercise, promotes team work, social behavior and agility. Sports and injuries are inseparable. Preventive care, proper supervision and right choice of sport and technique will avoid, minimize the injury. Any unanticipated injuries could also be handled with expertise, timeliness and well equipped first-aid box ensures an in time management of any critical situation. Any injury happened should be documented well furnishing all details in injury record/register. The role of well experienced coach and trainer is to create the right conditions for learning to happen and to find ways of motivating the players and most importantly managing the injuries quite commonly happening in outfield.



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Received on 18.02.2020         Modified on 15.03.2020

Accepted on 20.04.2020       ©A&V Publications All right reserved

Res.  J. Pharmacology and Pharmacodynamics.2020; 12(2): 57-63.

DOI: 10.5958/2321-5836.2020.00012.9