E-KHEL PATHSHALA

SPORTS PHYSIOTHERAPY

CONTENT LITERATURE: LEVEL- 1

Duration
Number of
Takeaway of
Content Piece Takeaways/ Takeaway Description Mode
Code Takeaway
Tasks
(minutes)
BMPSV1 Introduction 4 Video
Structure of
BMPSV2 4 Video
Musculoskeletal System
Function of Skeletal
BMPSV3 4 Video
Basics of System
Musculoskeletal Function of Muscular
BMPSV4 4 Video
system and system
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Physiotherapy Functional joints and
BMPSV5 4 Video
for Soft tissue Mechanism of Movement
injuries BMPSV6 Type of Soft Tissue Injuries 4 Video
On-field care of Soft Tissue
BMPSV7 4 Video
Injuries
Physiotherapy treatment for
BMPSV8 4 Video
Soft tissue injuries
PIAV1 Active movements 3 Video
PIAV2 Passive movements 3 Video
Musculoskeletal Injuries in
PIAV3 4 Video
Sports
Post-injury importance of
Post-injury PIAV4 Active and Passive 4 Video
importance of Movements
active and 8 Early vs. Delayed
PIAV5 4 Video
passive mobilization of joints
movement Contraindications of Active
PIAV6 4 Video
and Passive Movements
Regaining Functionality of
PIAV7 4 Video
Joints
Post-injury Training for
PIAV8 4 Video
Mobility and Strength

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Basics of Musculoskeletal system and Physiotherapy for Soft tissue injuries

 Introduction
The human musculoskeletal system, also known as the human locomotor system is an organ
system that gives humans the ability to move using their muscles and bones. The
musculoskeletal system provides form, support, stability, and movement to the body.
It is made up of the bones, muscles, tendons, cartilage, ligaments, joints and other connective
tissues that supports and binds tissues and organs together. The musculoskeletal system's
primary functions include supporting the body, allowing motion, and protecting vital organs. 

 Structure of Musculoskeletal System

The bones provide stability to the body. Muscles keep bones in place and also play a role in
the movement of bones.
Musculoskeletal system is subdivided into two broad systems: 
• Skeletal system
• Muscular system

Human skeleton, the internal skeleton serves as a framework for the body. This framework
consists of many individual bones and cartilages. The human skeleton consists of two
principal subdivisions, (1) axial- vertebral column and the skull and (2) the appendicular to
which the pelvic (hip) and pectoral (shoulder) girdles and the bones and cartilages of the
limbs belong.

There are 206 bones in an adult human skeleton. Each bone has three main layers:

 Periosteum: The periosteum is a tough membrane that covers and protects the outside
of the bone.
 Compact bone: Below the periosteum, compact bone is white, hard, and smooth. It
provides structural support and protection.
 Spongy bone: The core, inner layer of the bone is softer than compact bone. It has
small holes called pores to store bone marrow.

The other components of the skeletal system include:

 Cartilage: This smooth and flexible substance covers the tips of your bones where
they meet. It enables bones to move without friction (rubbing against each other).
 Joints: A joint is where two or more bones in the body come together.
 Ligaments: Bands of strong connective tissue called ligaments that hold bones
together.

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Human muscle system, the muscles of the human body that work on the skeletal system and
that are concerned with movement, posture, and balance. The muscle’s structure is broadly
divided into striated (or skeletal muscle), smooth muscles and cardiac muscles. Skeletal
muscles function under voluntary control, smooth muscles are under involuntary control and
are found in the walls of blood vessels and of structures such as the intestines, stomach and
urinary bladder. Cardiac muscles are also under involuntary control and it makes up the mass
of the heart and is responsible for the rhythmic contractions of heart, the vital pumping organ.

Based on their histological appearance, these types are classified into striated and non-striated
muscles; with the skeletal and cardiac muscles being grouped as striated while the smooth
muscle are non-striated. The skeletal muscles are the only ones that we can control by the
power of our will, as they are innervated by the somatic part of the nervous system. In
contrast to this, the cardiac and smooth muscles are innervated by the autonomic nervous
system, thus being controlled involuntarily by the autonomic centres of the brain.

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  Tendons: Tendons are bands of tissue that connect the ends of a muscle to the bone.

 Skeletal system and function

The skeletal system provides support and protection for the body’s internal organs and gives
the muscles a point of attachment. Bones articulate with each other and form the joints,
providing our bodies with a hard-core, yet mobile, skeleton. The integrity and function of the
bones and joints is supported by the accessory structures of the skeletal system;
articular cartilage, ligaments, and bursae.

Function of the Skeletal System

• The main function of the skeletal system is that it provides a framework to the body
and provides shape.
• Along with the muscular system, the skeletal system helps in the movement of the
body parts of the body and locomotion of the body.
• The skeletal system is hard and so forms a protective layer for the softer, more
delicate organs from any form of injury. The rib cage protects the heart, lungs and
visceral organs, the brain is protected by the skull, etc.
• It is the growth and development of bones that provides the height and width of an
individual.
• The center of the bone consists of the bone marrow which produces blood cells.

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Function of Muscular System
1. Maintain Posture: Muscular system create and keep the human frame in the correct
position. They help a person to balance their physique and accurately perform all
movements.
2. Movement: The primary muscular system function is the motion of body parts. When
they contract, it results in various activities such as walking, eating, running, etc. Tiny
skeletal muscles are accountable for the finest movements, such as writing, speaking,
etc.
3. Blood Circulation: The muscles present in the heart ensure proper flow of blood to
various portions of the body.
4. Respiration: For breathing purposes, there is a necessity of the diaphragm muscle. It
relaxes pushing air from the lungs.
5. Regulation of Temperature: The muscular system is also accountable for
maintaining stable body temperature.

 Smooth Muscles:
The smooth muscles present in visceral organs such as intestines, stomach and blood vessels
help in digestion, excretion, blood flow in arteries and veins, etc.
 Cardiac Muscles:
The cardiac muscles present in heart performs pumping action of the heart and thereby flow
of blood throughout the body.

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 Functional joints and mechanism of movements
Joints: This classification is based on the degree of movement allowed by the joint. These
are further divided into three types:

• Immovable joint/ synarthrosis: This is an immobile joint so it offers a strong bonding

between the articulating bones.

• Slightly movable joint/ amphiarthrosis: These joints allow little mobility and are
mostly cartilaginous joints. These are found in joints between vertebrae.
• Freely movable joint/ diarthrosis: These are freely movable joints and are synovial
joints. They provide maximum mobility to body parts and are mostly found in the
limbs. 

Ligaments: Bands of strong connective tissue called ligaments hold bones together.

Joints are important because they facilitate the movement of the body parts. The joint acts as
a pivot and the muscles create the necessary force needed for movement. The ligament holds
the bones at the joint when there is any movement of the body part.

 Type of soft tissue injuries

• A soft tissue injury is the damage to the muscles, ligaments and tendons in any part of
the human body.

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• These types of injuries can occur during sports, exercise, or even everyday activities.
• There are generally two basic types of soft tissue injuries – acute soft tissue injuries
and overuse soft tissue injuries. 

1. Acute soft tissue injuries – Any soft tissue injury that occurs due to sudden trauma
such as a fall, twist or blow is called acute soft tissue injury. They are called so
because they occur almost in an instance. Few acute types of soft tissue injuries are
sprains, strains, contusions etc. 
2. Overuse soft tissue injuries – These types of soft tissue injuries occur when we exert
our body more than it’s breaking point. Here, the soft tissue injuries are due to
constantly repeated impact on the tissues with less recovery time. Some of the overuse
types of soft tissue injuries are bursitis, tendinitis, etc.

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 On-field care of soft tissue injuries
Soft tissue injuries are commonly categorized depending on the time frame since injury
and the healing processes that are occurring at that time.
Acute (protection phase) - Pain, tenderness, bleeding and swelling is at its worst in this
phase.
Sub-Acute (repair phase) - A soft tissue injury is termed as sub-acute when the initial
acute phase makes a transition to repairing the injured tissues. Pain and swelling started to
reduce in this phase.
Chronic Stage (remodeling phase) - After around a week to six weeks of soft tissue
injury, the healing tissue becomes reasonably mature and strong. The new scar tissue
inside is often found to be less strong enough to cope with increasing physical load. Pain
and swelling at this phase is substantially reduced but on forceful and weight bearing
action it may hurt.
On-field care-
The primary goal of sports injury first aid is to stop the activity and prevent further injury
or damage. There is a need to manage certain symptoms until medical help arrives. On
basic first aid, PRICE protocol is followed in most non-emergency type of injuries.
P- Protection
R- Rest
I- Icing
C- Compression
E- Elevation
Protection is done to support the injured body part, preventing further damage. This is
done in the form of- Taping, bracing and strapping; use of orthotics (immobiliser), etc.

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Rest from activity and specifically to the body part injured is very important.
Icing in the form of ice bag / pouch application to the injured site is very important to
help reduce pain and swelling.
Compression in the form of crepe bandaging should be done from distal part to proximal
part in circular or criss-cross fashion with even pressure to the swollen part is essential to
reduce swelling.

Elevation of the part injured above the level of heart is important to assist reduction of
swelling from the periphery.

 Physiotherapy treatment for soft tissue injuries

• Treatment depends on the grade and severity of the injury. In the early stages the
injured person must avoid to put a lot of weight on the affected area in order to
prevent further damage. Absolute or relative rest to the injured part is necessary.
• PRICE Protocol is followed in the beginning. Cold therapy is used to decrease the
inflammation and swelling in the acute stage.
• Pain free movement in the injured part / segment is initiated. In the beginning passive
movement followed by active movement should be started. With respect to muscle
actions, static / isometric muscle contractions followed by isotonic muscle contraction
is started.
• In physiotherapy treatment, electrotherapy in the form of different type of current
(Trans Electrical Nerve Stimulation- TENS, Interferential Therapy- IFT, etc.) and
Ultrasonic, Laser therapy may be employed to help repair damaged tissues and reduce
pain-inflammation.

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• Joint stiffness is common post joint and soft tissue injuries, joint mobilization exercise
and free exercises facilitating/ forcing joint movement may be started within the limit
of pain.
• PNF (Proprioceptive Neuromuscular Facilitation) exercises and static type of
stretching exercises is initiated to get back the muscle length and contractility.
Proprioceptive and balance training is incorporated as per the requirement of the
player.
• Resistance training, weight bearing and functional exercises are added in later stage of
injury management in rehabilitation phase that produces changes enabling the player
to return to sports participation.

Post-injury importance of active and passive movement

 Active Movements
Range of motion (ROM) in a joint refers to how far the person is able to move or stretch
a part of the body. It’s different for each of us. Possibility of proper movement in a joint
and its measurement is useful in sports participation.

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The range of motion possible actively by a person in any particular joint, in any particular
direction is call Active movement.
Active movement is made by internal forces:
– muscles, tendons & fascia;
– the potential of gravitational force.
Types: 1. Localized and 2. General
We do active movements in our day today activities.

 Passive Movements
The joint range of motion possible by passive force by the same person or by outside
force is called Passive movement. A passive movement can be anything from a gentle
rocking motion to a deep stretch. 
Passive movement is made by an external force:
– the forces of another person;
– gravitational force;
– force on transport etc.

We use Passive Movements in specific requirements:

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• In acute, inflamed tissues / conditions.
• In comatose, paralytic, or complete bedridden patients
• In muscle-reeducation as a first step

 Musculoskeletal Injuries in Sports

Anyone can suffer a sports injury, but there are certain predisposing factor that can
increase the chance of injury in sports.
Types of sports injuries
Sports injuries are broadly categorized into two kinds:
• Acute injuries, which happen suddenly.
• Chronic injuries, which are usually related to overuse and develop gradually over
time.
In some cases, wear and tear from overuse injuries can set the stage for acute injuries.
Site and tissue specific injuries in sports-

Site Acute Injuries Overuse Injuries

Bone Fracture Stress Fracture

Shin Splints/ Pain
Joint Dislocation Synovitis
Subluxation Osteoarthritis
Ligament Sprain or Tear Chronic Sprain

Muscle Strain or Tear Chronic Compartment

Syndrome
Contusion
DOMS
Cramp
Fibrosis
Acute Compartment Syndrome
Tendon Tear (Partial/ Complete) Tendinitis
Tendinosis
Skin Abrasion Blister
Laceration
Puncture Wound

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Injuries to the musculoskeletal system that are common in athletes include fractures,
dislocations, sprains, strains, tendinitis, or bursitis. 

 Post-injury Importance of Active & Passive Movements

PASSIVE MOVEMENT-
• When it comes to the initial phase of injury recovery, passive movement can help to
mobilize the joints and muscles, especially during an acute phase of swelling and
inflammation when this might be uncomfortable to do actively.
• Passive movement can also prevent stiffness and further limitation of movement in
those unable to move the joint. It will also be used throughout the treatment to check
the progression of the injury recovery process. 
ACTIVE MOVEMENT-
• During the early phase of recovery, active movements of uninjured joints and limb
can help maintain range of motion and strength of those joints.
• Active movements are extremely helpful because it allows to build strength and
increase flexibility in the joints.
 Early Vs. Delayed Mobilization of Joints
Early Mobilization: Helps in reducing swelling, maintain range of motion and prevent
muscle atrophy and stiffness. However, it may cause joint laxity.
Delayed mobilization: It helps in proper healing process and joint stability. However, it
may lead to stiffness, contracture formation, loss of range of motion, muscle atrophy, etc.
A physiotherapist will assess the injury type and decide the type of mobilization required,
but the aim should be early movement or mobilization to the affected areas to decrease
adhesion formation and stiffness to develop.

 Contraindications of Active and Passive Movements

Contraindications of Active Movements:
1. Any condition that disrupts the healing process
2. Acute tear, fracture or surgery
3. Some cardiac conditions
4. Unstable condition
Contraindications of Passive Movements:
1. Acute injury stage

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2. Early stage of fracture healing
3. Unbearable pain
4. Incomplete tear of muscles or ligaments

 Post-injury training for mobility and strength

• Post-injury there is usually restriction in range of motion of joints, reduced strength in
surrounding muscles secondary to tissue damage and lack of use and also there may
be remnant pain in the area.
• A physiotherapist assesses and addresses the remaining problem associated with the
injured athlete. Resistance training and mobility exercises should be started after the
pain and joint stiffness is reduced to maximum extent.
• In the rehab process, the physiotherapist design the individualised rehab plan in order
to include mobility and strength training.
• Injuries to the musculoskeletal system could result in skeletal muscle hypotrophy
and weakness, loss of aerobic capacity and fatigability. During rehabilitation after
a sports injury, it is important to try to maintain cardiovascular endurance. Thus
regular bicycling or arm cycling, swimming, walking-jogging and other muscle
exercise programmes with relatively high intensity and short rest periods like
circuit training can be incorporated as deemed necessary.
• Flexibility training is an important component of rehabilitation in order to
minimise the decrease in joint ROM. Also, a variety of stretching techniques can
be used in improving range of motion, including PNF, ballistic stretching and
static stretching. Foam rolling is frequently used to stretch the fascia, a layer of
connective tissue beneath the skin that envelops the entire body and the tight muscles
as well. Foam rollers and Swiss ball can also be used in exercises specifically aimed
at improving balance and strengthening athlete’s core.
• Strengthening should transition from general exercises to sport-specific exercises
designed to replicate movements common in given sports. Cross-training is
encouraged, especially with activities that do not produce any symptoms from the
injury. Weight training and various conditioning exercises may be added to regain
maximum strength and stability.

• All rehabilitation programs must take into account, and reproduce, the activities
and movements required when the athlete returns to the field post-injury. The
goal of function-based rehabilitation programmes is the return of the athlete to
optimum athletic function. Examples of functional training include joint angle-
specific strengthening, velocity-specific muscle activity, closed kinetic chain
exercises, and exercises designed to further enhance neuromuscular control and
sporting activities.

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