Sports Injuries
From overuse tendinopathy to ligament ruptures: evidence-based treatment with the goal of returning you to your sport – safely and at the right time.
Sports injuries: acute and overuse
Sports injuries fall into two broad categories: acute traumatic injuries (ligament ruptures, fractures, dislocations, muscle tears) and overuse injuries (tendinopathies, stress fractures, impingement syndromes). Both require accurate diagnosis and evidence-based treatment – not reflexive surgery or unproven interventions.
As an athlete myself, I understand the importance of returning to sport quickly – but above all, correctly. Premature return increases re-injury risk significantly. Return to sport is based on measurable criteria (strength symmetry, functional tests, psychological readiness), not on the calendar alone.
- Lateral epicondylalgia (tennis elbow)
- Patellar tendinopathy (jumper's knee)
- Achilles tendon rupture and tendinopathy
- Ankle ligament injuries and instability
- ACL and other knee ligament injuries
- Muscle tears and contusions
- Stress fractures
- Shoulder injuries in overhead athletes
Tendinopathy: the evidence has changed
Tendinopathy (previously called tendinitis) is not an inflammatory condition – it is a degenerative process with failed healing response. This distinction has fundamental therapeutic implications. Corticosteroid injections, once widely used for tendinopathy, are now contraindicated based on high-quality evidence: a landmark RCT by Coombes et al. (JAMA 2013) showed that cortisone injections led to significantly worse outcomes at 6 and 12 months compared to physiotherapy or watchful waiting, despite short-term pain relief. The same applies to tennis elbow, patellar tendinopathy and Achilles tendinopathy.
The evidence-based treatment for tendinopathy is progressive loading: eccentric training and heavy slow resistance (HSR) protocols stimulate collagen synthesis and structural remodelling of the tendon. A 12-week structured loading programme is the first-line treatment for most tendinopathies.
Achilles tendon rupture
Achilles tendon rupture is the most common large tendon rupture, affecting recreational athletes aged 30–50. The Thompson test (calf squeeze) has 96% sensitivity. Treatment decision: operative versus conservative with functional orthosis. A meta-analysis (Soroceanu et al., JBJS 2012) showed equivalent outcomes between operative and non-operative treatment with functional rehabilitation. The key is early functional loading – not immobilisation in a cast. Surgery is preferred in young, active patients and athletes; conservative management with a functional orthosis is appropriate for older or less active patients.
Return to sport: criteria-based, not calendar-based
Returning to sport too early after injury significantly increases re-injury risk. After ACL reconstruction, re-rupture risk is 15 times higher if return occurs before 9 months. Criteria for return to sport include: strength symmetry ≥90% (isokinetic testing), successful completion of sport-specific functional tests, and psychological readiness (ACL-RSI questionnaire). These criteria apply across injuries – not just ACL.
Frequently asked questions
Are cortisone injections helpful for sports injuries?
For acute bursitis and joint inflammation, cortisone can provide short-term relief. For tendinopathy (tennis elbow, patellar tendinopathy, Achilles tendinopathy), cortisone injections are contraindicated based on high-quality evidence – they provide short-term relief but lead to worse long-term outcomes and weaken tendon tissue.
How long does recovery from an ACL rupture take?
Return to pivoting sport typically takes 9 months with a criteria-based protocol. Returning earlier significantly increases re-rupture risk. The rehabilitation plan is discussed in detail before surgery.
Do I need surgery for a sports injury?
Not necessarily. Many sports injuries – including meniscus tears, rotator cuff tears, and tendinopathies – respond well to structured conservative treatment. Surgery is indicated when conservative management has failed, when there is a structural problem that requires repair, or when the injury pattern clearly benefits from surgical treatment.
References & Evidence
- Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA 2013;309:461–469. PMID: 23385272
- Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am 2012;94:2136–2143. PMID: 23224384
- Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 2016;50:804–808. PMID: 27162233
- Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med 2015;49:1277–1283. PMID: 25979840
- Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998;26:360–366. PMID: 9617396
- Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006;333:939. PMID: 17012266
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