Football Sport

Dealing with localised pain due to bone bruise

DOCTOR’S CORNER with JOSEPH KABUNGO
PARTICIPATING in contact sport such as soccer can be so stressful at times. Stress can arise from the pressure associated with the game itself and also from the injuries resulting from the game.
Two days ago I was having a discussion with my brother and colleague, Dr Clarence Chiluba, who complained of a problem affecting his groin and I did not hesitate to tell him that am also nursing a hamstring muscle strain.
One common understanding between the two of us was just how frustrating it is to suffer from injuries, which limit your participation in sport. It is one of the reasons why young soccer players return to play prematurely after suffering from various injuries .The frustration from injury is actually worsened when there is a recurrence of such an injury.
Many times, I come across soccer players with a bruised bone, and they are always concerned with their return to active playing.It is not uncommon to find the coach of a football player under pressure and in the process they end up using a player who has not completely recovered from a bone bruise.
The question I always face is just how these injuries come about and how to decide when a player is ready for competitive matches. Before I answer to some of the questions relating to this, I always ask the players just how often they wear shin guards and other sports protective attire.
Soccer being a contact sport demands that shin guards have to be worn by a player in training or during competitive matches. Soccer players do not take this issue of shin guards seriously and sooner than later, they end up with a bruised bone.
I do not intend to discuss the protective wear in soccer today, but just want to appreciate that these are extremely important in offering protection from injuries during participation in soccer.
Different types of injuries, always characterize soccer being a contact sport. Some of the injuries can be classified as minor and others are said to be severe. The classification of these injuries is based on the number of days the player is expected to be out of action. The severity of an injury will determine just how long a football player or any one engaged in contact sport is going to be out of competition or training.
Am always faced with questions from my media colleagues, who are always eager to know just how long a player who is injured is going to be out. My response has always been consistent, that no two injuries are the same, though there might be a lot of similarities, but the outcome might not necessarily be the same.
This goes for the time one similar injury will take to heal between two players. The basic treatment of most of the common injuries occurring in football follows the same principles with modifications as may be found necessary.
Any football player is worried by any injury they face either it being minor or severe. The only relief they get is when they are told about the nature of the injury and also the expected time to resume football activities. One such injury is that which involves the bone.
It is not surprising that the bone does not only fracture but can also be affected in contact sport by bruising.
A bone bruise is said to occur when there is an impact to the bone during sport, accidents or any other direct trauma to the bone without causing any obvious breakage in the bone continuity. A break in bone continuity is what is referred to as a fracture, but this is quite different from a bone bruise. A bone bruise only affects the top part of the bone.
What must be appreciated is that bone is a living tissue, which has a blood supply and nerve supply. The top part of the bone has what is called a cortex, which is made up of fibers, and this is where calcium deposits are found.
It is the partial damage to theses fibers, which constitutes a bone bruise. In another dimension, a complete damage to the fibers results into a fracture and this is the reason why each time there is localized area of pain in a player, a fracture must not be forgotten as a possible cause.
Bone bruises are a very common feature in contact sport such soccer and rugby. The parts, which are prone to bruising, are the bones of the thigh, the foot, the ankle, the heel and also the hip bone. Bruising of the ribs is also a common feature of contact sport.
I normally encounter bone bruises in many of the football players I see. Bone bruises are so painful and the player is always worried on the outcome of such an injury.
Bone bruises usually differ from one individual to the other, and there absence from training and competition will actually differ. The bone bruises should not worry football players because their outcome is generally good.
It must be appreciated that though different football players can suffer from bone bruises, the way they react to such is quite different, and this in some way has a bearing on the time they will miss training and competitive matches.
In short the outcome of bone bruises is different in terms of the time the player will have to stay out. Minor bone bruises will see players returning to training and competitive matches in at least seventy-two hours (3 days).
Many players do suffer from bone bruises and to them, it is just localized pain, which affects their participation in football. It is important to suspect a bruised bone, if there is localized pain after an impact to the affected part.
There is also swelling, and if it is the foot or thigh which is affected, the individual might also have difficulties in walking. Whenever these signs and symptoms occur in football, it is important to think of a bone bruise and also not forgetting the possibility of a fracture.
The important thing to do whenever such a thing occurs is the usual PRICE (Pressure, Rest, Ice, Compression and Elevation) therapy. This is a basic principle, which if followed, always produces amazing results in the first forty-eight hours. Many players do have prolonged signs and symptoms of bone bruises because of the delay in starting the PRICE therapy.
This form of treatment must be started in the immediate and repeated every two to three hours. There is also need to use anti inflammatory drugs to reduce the pain and a qualified medical doctor must always prescribe these.
Having talked about the PRICE therapy it is not enough to end at that, but to go a step further and do other investigations. One such basic investigation, which can be done, is a plain X-ray.
The X-ray is important in this case so that the possibility of a fracture is excluded. Whenever a bone bruise is considered the possibility of a fracture must not be forgotten and this is the reason why an X-ray is a must.
However, a plain X-ray will not show any abnormality or no breakage in bone continuity will be seen in bone bruises. In many cases this can now be treated as a bone bruise, but the X-ray has to be well looked at so that a minor crack in the bone is not missed which will have a different method of treatment.
In advanced medical facilities a magnetic resonance imaging (MRI) is an appropriate investigation to identify a bone bruise. An MRI will exactly show the damaged area and give an indication on the extent of damage. However in our Zambian setting it is important that at least an X-ray is done to make sure that a fracture is not missed.
It is important to always consider the possibility of a bone bruise in contact sport whenever there is direct impact, which results in, intense localized bone pain.
Bone bruises are a common feature in contact sport like football and have to be treated early. Return to play can only be advised after the affected player is no longer feeling pain. If a player is suspected to have a bone bruise appropriate medical attention must be sort within the shortest possible time.
For Questions and Comments Write To: Dr Kabungo Joseph Email address: zengajk@yahoo.com or kateulejk@gmail.com


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