In an age where many Americans have a sedentary lifestyle, taking the time to exercise is important to overall health and well-being.1 Exercise helps control weight, reduces risk of heart disease and some cancers, helps the body manage blood sugar and insulin levels, makes smoking cessation easier, improves mental health and mood, helps maintain thinking and learning skills while aging, strengthens bones and muscles, reduces risk of falls, improves sleep, improves sexual health and increases longevity.1 Participation in sports can have benefits beyond exercise, in that it boosts self-esteem and create friendships.2 However, exercise and sports can also cause physical injuries.3 Sometimes, the diagnosis and/or treatment of a sports injury can be invasive, involving surgery or another inpatient procedure.4,5 Given that many sports injuries can be painful and require aggressive treatments, anesthesia providers should be familiar with the most common types of sports injuries and their role in diagnosis or treatment.
Sports injuries can develop from accidents; poor training practices, such as overtraining or increasing training too quickly; use of improper gear; and lack of warming up or stretching.3 The most common sports injuries are sprains and strains, knee injuries, swollen muscles, Achilles tendon injuries, shin pain, rotator cuff injuries, fractures and dislocations.3 Initial treatment often entails the RICE (rest, ice, compression and elevation) method to reduce pain and swelling and speed healing.3 Other pain relief and treatment options include taking pain medication such as acetaminophen, ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs); immobilizing the injured area; getting physical therapy or massage; using corticosteroid injections; and surgery.6 Injury types may vary by age, sport and gender, but common injuries include head injuries, fractures, anterior cruciate ligament (ACL) and injuries and ankle sprains.7-10 Female athletes present with more bone stress injuries (BSIs) and male athletes may be less likely to report concussions.8 Older patients may be more likely than young patients to show knee injuries or inflammatory conditions.7 Injuries can also vary widely in extent, cause and necessary treatment.8 For athletes whose identities are tied to physical ability, long-term sports injuries can have extensive psychological effects.11 Given the range of injuries across sports, genders, ages and causes, clinicians must be prepared for an array of patient experiences.
Given their expertise in pain management and anesthetic drugs, anesthesiology practitioners are often crucial to the diagnosis and treatment of sports injuries. In a study by Kulacoglu et al., clinicians used anterior inguinal exploration with local anesthesia to assess chronic groin pain in soccer players.12 Through this slightly invasive procedure, clinicians were able to distinguish between posterior inguinal floor weakness (“sports hernia”), osteitis pubis (inflammatory disease of the pubic area), rectus abdominis injury, adductor tendon injury or pelvic stress fracture.12 Dahlstedt and Dalén examined patients’ knee stability under general or epidural anesthesia to help diagnose ACL injuries.13 Meanwhile, Dezawa et al. performed minimally invasive surgery to release the piriformis muscle under local anesthesia, which ultimately led to the patient’s recovery from painful piriformis syndrome.4 Foster et al.’s study of overall United States hospital practices found that the use of general anesthesia alone was most common for ACL reconstruction surgery.5 However, between 2004 and 2009, there was a slight increase in the use of general anesthesia in combination with regional anesthesia or single femoral nerve injection.5 Regional anesthesia alone was only used in one percent of 53,968 arthroscopic ACL reconstructive procedures.5 According to a paper by Üzümcügil et al., anesthesia may be necessary in the emergency department or prehospital setting for procedural preparation and pain management.14 This includes administration of peripheral nerve blocks, sedation and other forms of analgesia.14 The authors state that if the injury necessitates surgery, combinations of anesthetic techniques and postoperative pain management should aim to hasten recovery, facilitate rehabilitation and accelerate the return to the sport.14 Athletes’ determination and sometimes financial need to return to a sport encourages the use of local anesthetics for injury pain.15 A study by Kannus et al. from 30 years ago found that long-acting bupivacaine was a useful anesthetic in combination with local steroid injections for musculoskeletal overuse injuries.16 More recent papers show some concern about local anesthetic injections depending on length of use and location. Nepple and Matava’s review shows that the primary concern associated with local anesthetic injections is an increased risk of tendon rupture.17 Additionally, injection of ketorolac tromethamine, an analgesic NSAID, can increase risk of bleeding.17 Orchard et al.’s survey of rugby players found that local anesthetic injections to acromioclavicular joint sprains, finger and rib injuries and iliac crest contusions appeared to be safe, while ankle, wrist and sternum injections led to worsened injuries after playing.18 Some clinicians wonder if local anesthetic injection for quick return to play is in the long-term best interest of the patient.15 Evidently, anesthesia has various applications to diagnosis and treatment of sports injuries, with some uses being more controversial than others.
Sports can be beneficial to one’s mental and physical health, but they can also lead to painful and chronic injuries such as stress fracture, ACL tears and joint issues. Anesthesia providers can help in the diagnosis and treatment of sports injuries through administering anesthesia during surgical procedures and for pain relief. More research is needed to determine the long-term effects of using local anesthetics to return quickly to a sport.
1.Benefits of Exercise. MedlinePlus. Bethesda, MD: U.S. National Library of Medicine; August 30, 2017.
2.University of Missouri. Benefits of Sports for Adolescents. MU Health Care 2020; https://www.muhealth.org/conditions-treatments/pediatrics/adolescent-medicine/benefits-of-sports.
3.Sports Injuries. MedlinePlus. Bethesda, MD: U.S. National Library of Medicine; January 2, 2017.
4.Dezawa A, Kusano S, Miki H. Arthroscopic release of the piriformis muscle under local anesthesia for piriformis syndrome. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2003;19(5):554–557.
5.Foster BD, Terrell R, Montgomery SR, Wang JC, Petrigliano FA, McAllister DR. Hospital Charges and Practice Patterns for General and Regional Anesthesia in Arthroscopic Anterior Cruciate Ligament Repair. Orthopaedic Journal of Sports Medicine. October 2013;1(5):1–5.
6.National Health Service. Treatment. Sports injuries March 21, 2017; https://www.nhs.uk/conditions/sports-injuries/treatment/.
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11.Heil J. Psychology of Sport Injury. Champaign, IL: Human Kinetics Publishers; 1993.
12.Kulacoglu H, Ozyaylali I, Kunduracioglu B, Yazicioglu D, Ersoy E, Ugurlu C. The Value of Anterior Inguinal Exploration With Local Anesthesia for Better Diagnosis of Chronic Groin Pain in Soccer Players. Clinical Journal of Sport Medicine. 2011;21(5):456–459.
13.Dahlstedt LJ, Dalén N. Knee laxity in cruciate ligament injury: Value of examination under anesthesia. Acta Orthopaedica Scandinavica. 1989;60(2):181–184.
14.Üzümcügil F, Saricaoglu F, Aypar Ü. Anesthesia Managements for Sports-Related Musculoskeletal Injuries. In: Doral MN, Karlsson J, eds. Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015:2159–2169.
15.Hughes C. Local anesthetic use in sport for early return to play – should we be offering these jabs? Clinical Journal of Sport Medicine Blog January 13, 2012; https://cjsmblog.com/2012/01/13/local-anesthetic-use-in-sport-for-early-return-to-play-should-we-be-offering-these-jabs/.
16.Kannus P, Jarvinen M, Niittymaki S. Long- or short-acting anesthetic with corticosteroid in local injections of overuse injuries? A prospective, randomized, double-blind study. International Journal of Sports Medicine. 1990;11(5):397–400.
17.Nepple JJ, Matava MJ. Soft tissue injections in the athlete. Sports Health. 2009;1(5):396–404.
18.Orchard JW, Steet E, Massey A, Dan S, Gardiner B, Ibrahim A. Long-term safety of using local anesthetic injections in professional rugby league. American Journal of Sports Medicine. 2010;38(11):2259–2266.