Common Exercise Injuries: Prevention and Treatment

Injury Classification

Type	Description	Examples
Acute	Sudden onset (traumatic)	Sprain, fracture, dislocation
Chronic	Gradual onset (overuse)	Tendinopathy, stress fracture
Primary	Direct result of activity	Muscle strain
Secondary	Compensatory	Opposite side injury

RICE Protocol (Acute Phase)

Component	Description	Duration
Rest	Protect injured area, avoid aggravating activities	24-72 hours
Ice	20 minutes on, 20 minutes off	Every 2-3 hours for 48-72 hours
Compression	Elastic bandage (distal to proximal)	Throughout acute phase
Elevation	Above heart level	As much as possible for 48 hours

Modified RICE (POLICE): Protection, Optimal Loading, Ice, Compression, Elevation — emphasizes early controlled movement.

Sprains (Ligament Injury)

Grade	Description	Clinical Findings	Recovery
I (Mild)	Microscopic tearing	Mild pain, no laxity	1-3 weeks
II (Moderate)	Partial tear	Moderate pain, some laxity	3-6 weeks
III (Severe)	Complete tear	Severe pain, significant laxity	3-6 months (may require surgery)

Common Sprains

Joint	Mechanism	Most Common Ligament
Ankle (lateral)	Inversion	Anterior talofibular (ATFL)
Knee	Valgus stress	Medial collateral (MCL)
Thumb (skier’s)	Hyperabduction	Ulnar collateral (UCL)
Wrist	FOOSH	Scapholunate interosseous

Strains (Muscle/Tendon Injury)

Grade	Description	Clinical Findings	Recovery
I	< 5% fibers torn	Mild pain, full strength	1-2 weeks
II	Moderate tear	Pain, weakness, defect may be palpable	3-6 weeks
III	Complete rupture	Severe pain/loss of function	3-6 months (often surgical)

Common Strains

Muscle	Activity	Mechanism
Hamstrings	Sprinting, kicking	Eccentric overload
Quadriceps	Kicking, jumping	Eccentric overload
Groin (adductors)	Lateral movement, kicking	Abduction overload
Calf (gastrocnemius)	Push-off (“tennis leg”)	Plantarflexion with knee extension
Rotator cuff	Throwing, overhead	Impingement, tendinopathy

Tendinopathy

Type	Histology	Pain Pattern	Best Approach
Tendinitis	Acute inflammation	Localized, warm	Relative rest, ice, NSAIDs
Tendinosis	Chronic degeneration (no inflammation)	Diffuse, stiff	Eccentric loading, shockwave
Paratenonitis	Inflammation of sheath	Crepitus, diffuse	Ice, modalities, relative rest

Common Tendinopathies

Condition	Tendon	Treatment
Tennis elbow (lateral epicondylitis)	Extensor carpi radialis brevis	Eccentric wrist extension, brace, shockwave therapy
Golfer’s elbow (medial epicondylitis)	Flexor-pronator group	Eccentric wrist flexion, stretching
Achilles tendinopathy	Achilles	Eccentric heel drops (Alfredson protocol)
Patellar tendinopathy (jumper’s knee)	Patellar tendon	Eccentric squats on decline board
De Quervain tenosynovitis	Abductor pollicis longus, extensor pollicis brevis	Splinting, corticosteroid injection

Common Overuse Injuries

Injury	Location	Cause	Treatment
Shin splints (medial tibial stress syndrome)	Posteromedial tibia	Running, jumping, overpronation	Rest, ice, gait retraining, strengthening
Runner’s knee (patellofemoral pain)	Around/below patella	Patellar tracking, quadriceps weakness	VMO strengthening, hip external rotation strengthening
Plantar fasciitis	Plantar heel	Tight calves, high arches, overpronation	Stretching (calf, plantar fascia), night splints, orthotics
IT band syndrome	Lateral knee	Running, cycling, ITB tightness	ITB foam rolling, hip strengthening, lateral glute strengthening
Stress fracture	Tibia (most common), metatarsals, navicular	Repetitive loading, ↑↑ training	Complete rest 6-8 weeks, cross-training
Bursitis (shoulder, hip, knee)	Subacromial, trochanteric, prepatellar	Repetitive friction	Rest, NSAIDs, steroid injection
Carpal tunnel syndrome	Wrist (median nerve)	Repetitive flexion/extension	Wrist splint (night), steroid injection, release surgery

Return to Play Criteria

Criterion	Description
Pain-free	No pain with full range of motion and activity
Full strength	≥ 90% strength compared to uninjured side
Full range of motion	Symmetrical to uninjured side
Sport-specific testing	Can perform sport movements without pain
Gradual progression	50% → 75% → 90% → 100% intensity over 1-2 weeks

Injury Prevention Strategies

Strategy	Evidence	Application
Dynamic warm-up	Strong	10-15 minutes (jogging, dynamic stretches, sport-specific movements)
Strength training	Strong	2-3×/week, focus on eccentric control
Neuromuscular training	Strong	FIFA 11+, landing mechanics (jumping sports)
Flexibility	Moderate	Regular static stretching after exercise
Proper equipment	Strong	Appropriate footwear, protective gear
Gradual progression	Strong	10% rule (increase distance, weight, or time by ≤ 10%/week)
Load management	Strong	Periodization, rest days, taper before competition
Cross-training	Moderate	Variety of activities reduces repetitive load

When to Seek Medical Attention

Red Flag	Potential Issue
Inability to bear weight	Fracture, grade III sprain
Joint instability	Ligament tear, dislocation
Visible deformity	Fracture, dislocation
Numbness/tingling	Nerve involvement
Locking/buckling (knee)	Meniscal tear, ACL tear
Pain at night (waking from sleep)	Tumor (rare), severe inflammation
No improvement after 2 weeks of RICE	May require imaging
Fever with joint pain	Septic arthritis (emergency)

Rehabilitation Phases

Phase	Goal	Timeline	Activities
Acute	Control pain, inflammation, protect tissue	Days 1-7	RICE, gentle PROM
Subacute	Regain ROM, begin strengthening	1-4 weeks	AROM, isometrics, light resistance
Remodeling	Strength, endurance, proprioception	2-8 weeks	Progressive resistance, balance training
Return to sport	Sport-specific training	4-12 weeks	Plyometrics, agility, sport simulation
Maintenance	Prevent reinjury	Ongoing	Continue strengthening, warm-up