Chronic and acute sports injuries: no pain, no gain?

Acute and chronic injuries are terms that are frequently thrown about when talking about sports injuries. Patients often get quite confused. Highly-esteemed London-based consultant orthopaedic surgeon; Mr Pramod Achan explains the difference between the two types of injuries, how they’re distinguished, what the most common types of acute and chronic sports injuries are, and when to see a specialist.

What are acute and chronic injuries?

Chronic injuries are those that have been there for a long-time causing pain. It's a small injury that's been niggling at you over some time, perhaps in the hip, the ankle, or the knee. You've known it's there, and yet you're still able to perform. You’re probably not achieving your optimal performances, but are still able to contribute to, for example, team sports.

An acute injury is a much more sudden event. It’s an injury that forces you to stop, like a sprain of an ankle. You’ll know the time, date, and exact nature of the injury. Whereas with chronic injuries, you're more likely to talk about something that's been niggling without an exact start date or an exact event that triggered it.

One term that you may come across is acute-on-chronic. This is where somebody has had a long-standing chronic injury with an acute event that has then pushed it over the edge to make it much more problematic for the patient.

Are there ways to tell them apart from the signs and symptoms?

Whether an injury is chronic or not is determined by the timeline. Patients may say that they can't remember when it first started, how it started, or more commonly, how long it's been going on; this is a chronic problem. If patients know exactly when and how the injury occurred, then that's an acute problem.

In terms of the symptoms, an acute injury is likely to have swelling and severe, often sharp pain. Patients often require a splint or a bandage. There may even be abrasions to the skin and associated other injuries affecting other parts of the body.

In a chronic injury, it's much more likely that they're wearing some sort of strapping, which they take on and off. Often a doctor or surgeon can tell by the appearance of the strapping how long they've been using it. This helps to distinguish between the two types of injuries.

What are the most common acute sports injuries?

One of the most common acute injuries is something called a meniscal tear, which is when the soft tissue shock absorber inside the knee (meniscus) tears because of innocuous twisting. Cruciate ligaments, the ligaments within the knee that stabilise the joint, can also be torn as a result of twisting.  These are drastic injuries, but they can be treated effectively. Patients can return to the sport they love if the injury is managed well early.

Hip impingement is another common sports injury. Often it presents with groin pain that is exacerbated by either kicking or twisting. Patients feel it in the centre of the groin and then radiating out towards the side, but it severely affects their ability to play sports or to run.

What are the most common chronic sport injuries?

When talking about chronic injuries to the knee and the hip, the actual pathology is the same as the acute injuries. Chronic sporting injuries differ from acute ones, in that patients have often rehabilitated and got back to a certain level of sport where they're able to compete.

In a chronic knee injury, the patient has been injured but worked hard with a physiotherapist and has built up strong muscles around the cruciate ligament or meniscus, to compensate for their weakness. Over time, these muscles may become weaker and suddenly the knee starts to give way in situations that it didn’t previously. In the beginning, patients can tolerate it, the pain plays up for one or two weeks in the year, but the rest of the time they're able to play competitive sports. There there’s a point where suddenly the pain is there all the time.

If left untreated, secondary problems from acute injury can occur. Pains will try to manage the pain by putting less pressure on the injured joint, by adjusting their kick, for example. I commonly tell my patients that the old adage of no pain, no gain is not true of sports injuries. The pain this refers to is that muscle burn in the gym that you have to get through to get the muscle to grow stronger. This isn’t the case for muscle-tendon injuries or particularly joint injuries. Trying to run through them or overcome the pain barrier is potentially going to do more harm.

What are the best ways to manage both acute and chronic injuries?

With an acute injury, you're going to do more damage by trying to run through either an injured joint or muscle. The first thing to do is to stop and prevent the inflammation with ice, elevation, rest, anti-inflammatory medication, and then a splint or brace can often help.

As soon as the inflammation is under control contact, you should visit a specialist. People often worry they are bothering a specialist for a minor injury, but you're never wasting their time. They will be able to provide the best advice to help rehabilitation. Instead of ignoring an injury, and hoping that it will go away, it’s best to work actively to rehabilitate yourself much as professional sportspeople do.

When is the best time to see a doctor?

It depends on the severity of the injury and how much it's troubling you. In the very early stages of an injury that is still very swollen and painful, it may be difficult for the specialist to assess the injury and can even cause more discomfort. If necessary, the specialist will organise an appropriate scan to get more information on the injury. Once the acute phase has settled down, a formal evaluation of the joint can be made. Often the joints both above and below are assessed, to make sure it isn’t a secondary problem.

The simple answer to the question is to see them early if you’re worried about it. If managed well, you will get back to the levels of activity that you were enjoying before the injury. That's what we, as specialists, want for all our patients, irrespective of age.

If you’re interested in booking a consultation with Mr Pramod Achan to seek advice on a sporting injury, or any other pain affecting your hip or knee, you can do so by visiting his Top Doctors profile today.