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2 - The need for clinical guidelines

Injury to the soft tissues of the body is a major cause of pain and disability resulting in loss of function, often with socio-economic consequences due to lost working days. The psychological impact of inability to perform normal functional and recreational activities cannot be ignored.

2.1 - Background

Although soft tissue injury can occur in any aspect of daily activity, the major thrust of investigations and research into the incidence and management of soft tissue injury has tended to concentrate on those injuries incurred as a result of sport and leisure activities. The health benefits of exercise are well documented (Royal College of Physicians, 1991) and this has led to encouragement by central government for increased participation in sport and exercise activities as part of its policy that ‘prevention is everybody’s business’ (DHSS, 1976). Similarly, the medical world has directed more and more attention to the relationship between sport and exercise and health, in terms of both physiology and pathology.

  • ‘The economic costs of ill health which could be attributable to lack of endurance fitness have been studied extensively in the United States and West Germany but not, as yet, in this country, although there is no reason to believe our situation is very different. It is undoubtably true that in some cases, appropriate exercise could avoid hospitalisation and the cost of other services, as well as retaining the services of many individuals as active members of the community’ (Sports Council, 1971, cited Williams and Sperryn, 1981
  • The American College of Sports Medicine has put forward position statements providing advice on the duration and intensity of exercise necessary to provide a protective effect

With the general population increasingly participating in a more active lifestyle and with more demanding and intensive training regimens by sportsmen and women, soft tissue injuries appear to be occurring more frequently and receiving more publicity in the lay press (Kellet, 1985). The danger of injury occurs not only in the top levels of competitive sport but in popular leisure-time activities as well (Sports Council, 1976, cited Williams and Sperryn, 1981.

Little scientific interest has been displayed in the management of such injuries until the last 20-25 years. Even so, although a few soft tissue injury and sports injury clinics are beginning to emerge in some NHS Trusts, the Department of Health has made no firm commitment towards sports medicine in the UK. Indeed, the antisports lobby has in the past regarded injury in sport as ‘essentially self-inflicted’ (Williams, 1976) and, even more strongly, ‘Sports medicine [is] a pseudospeciality which [is] dangerous, meddlesome and wasteful…NHS resources [are] being diverted towards treating and rehabilitating sportsmen, at the expense, indirectly at least, of the remainder of the population’ (Pringle, 1980, cited Davies, 1981).

2.2 - Epidemiology of soft tissue (sports) injury

Since there has been no unifying medical speciality under which soft tissue injury, from whatever cause, has been managed, it is difficult to ascertain the overall incidence of injury. To gain some insight into the extent of the problem, sports medicine literature has in the past provided some figures.

  • Approximately five per cent of all cases seen in A/E departments of hospitals in the UK are due to participation in sport / exercise - an estimated 2,000,000 sports injuries per annum, of which ten per cent involve time off work. (Williams and Sperryn, 1981)
  • Attendances at sports injury/ sports medicine clinics: Cambridge - 281 (1978); 520 (1979); 290 (1980-Jan-April) St James Hospital (Leeds) - over 2,000 (Sept 1972-July 1976) Portsmouth - 14-16 new patients each week
  • A study by Groh and Groh (1975, cited Kuprian, 1981) investigated the socioeconomic aspects of sports injuries in West Germany. They investigated 2,739 injuries, of which: 637 missed one weeks work 702 missed two weeks work 392 missed up to three weeks work 258 missed up to four weeks work 186 missed up to six weeks work 110 missed up to eight weeks work. Time off by the remainder ranged from three to 12 months. Average time off work was three weeks

These figures indicate that in the late 1970s and early 1980s, soft tissue injury due to participation in sport and leisure activities was becoming an increasing problem, both from medical and socio-economic points of view. More recently, the Sports Council recognised that although the health benefits of exercise are well established and documented, the costs in terms of injuries and the resources needed to treat them are not. In order to present a balanced and complete picture of the benefits of exercise, the Sports Council commissioned the Medical Care Research Unit of the University of Sheffield to undertake a study of the risks and costs of sport and exercise related injury in England and Wales during the year 1989-90 (Nichols et al, 1991).

Questionnaires were sent to 28,000 persons, aged 16-45 years, in 16 of the 90 Family Health Service Associations in England and Wales, asking about participation in sport or exercise during the previous four weeks and any injury incidents which occurred during that time. From the results of this study, national estimates were made.

  • 19.3 million incidents resulted in new injuries
  • 9.8 million were ’substantive’, potentially serious, in need of treatment or prevented the injured from participating in their usual activities
  • 1.4 million resulted in participants taking time off work
  • Average duration of each episode of time off work was six days
  • Time off work equated to up to eight million days each year as a result of new injuries, at an estimated cost of £405 million
  • 6.4 million new injury episodes resulted in contact with treatment providers
  • 1.3 million new injury episodes were seen at A/E departments
  • Of the sample studied, 56 per cent of incidents resulted in recurrent injuries
  • Direct and indirect costs of sport- and exercise-related injuries is £500 million per year

The US department of Labour statistics also show that chronic soft-tissue injuries of tendon, ligament and fascia account for the majority of prolonged instability, and time lost from work (US Department of Labour, 1995), reinforcing the importance of optimal early management.

2.3 - Long-term sequelae of soft tissue (sports) injury

All the evidence therefore seems to point to the desirability of ensuring the most effective early (immediate) management of these injuries, which will ensure more complete recovery of function, and reduce the socio-economic costs of lost work-days and prolonged morbidity.

Although it is difficult to assess the potential cost benefits of effective early treatment, there is evidence to suggest that poor management of these injuries may lead to long-term adverse sequelae, such as early onset degenerative joint disease, leading to disability and impairment, and expensive joint replacement surgery.

— Phil @ 9:48 pm, June 27, 2006


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