Let’s get physical

Pharmacists play an increasingly important role in managing sports injuries in the community, writes Damien O’Brien MPSI

Introduction

Participation in sport and physical activity has well- established benefits for both physical and mental health. Regular exercise is associated with reduced cardiovascular risk, improved musculoskeletal strength, better metabolic health, improved respiratory function, and enhanced psychological wellbeing. However, with participation in sport comes an increased risk of injury. While exercise is protective against many chronic conditions, it also exposes individuals to physical stress that may result in tissue damage.

Sports injuries refer to damage to body tissues that occurs as a result of sport or exercise, and can vary widely in severity. Injuries may arise from a single traumatic event, but several factors can increase the risk of injury. Overtraining, involving either training too often or for too long, is one of the most common causes of injury. Other contributory factors include incorrect exercise technique, increasing training intensity too quickly, and not wearing appropriate protective equipment. Sports injuries are a common reason for presentation to community pharmacy, particularly for advice on pain relief, anti- inflammatory medication and recovery supports. This article will explore the role that community pharmacists play in the management of sports injuries, including pharmacological and non- pharmacological treatment strategies, warning symptoms and injury prevention advice.

Classification

Sports injuries can be broadly classified into acute and chronic injuries. Acute injuries occur suddenly and are usually the result of a specific traumatic event. Typical examples include sprains, strains, tears, fractures and dislocations. Patients often experience a defined moment of injury, sometimes accompanied by immediate pain, swelling or loss of function. Chronic injuries develop gradually over time due to repetitive loading of tissues without adequate recovery, with common examples including tendinopathy and stress fractures.

These injuries often begin as mild discomfort during or after exercise and progressively worsen if activity continues without modification. Recognising whether an injury is acute or chronic is important, as it influences appropriate counselling, treatment choice and the need for referral. Acute injuries may benefit from short-term analgesia, while overuse injuries often require activity modification, longer recovery periods and referral.

Diagnosis

Accurate diagnosis of sports injuries is critical for effective management and may be complex, requiring a combination of approaches. Assessment should begin with a patient history, including symptom characteristics, the mechanism of injury, timing of onset and progression of pain or inflammation. Physical examination can help assess bruising, asymmetry, swelling and functional limitation. Imaging techniques, including magnetic resonance imaging (MRI), x-rays, ultrasound and computed tomography (CT) scans, may be required to evaluate soft-tissue or bone injuries in some cases; however, imaging is not always necessary and should be guided by clinical presentation.

Treatment

The management of sports injuries focuses on relieving pain, reducing inflammation, restoring function and preventing recurrence. The approach to treatment depends on several factors including the type of injury, its severity, the patient’s health status and the expected healing time. Some injuries may resolve within days, while others may take several weeks or months to heal. Treatment strategies can be broadly divided into pharmacological and non- pharmacological approaches, which are often used together. In community pharmacy, effective management involves balancing symptom relief with medicine safety and recognising when referral is required.

Pharmacological treatment

Paracetamol

Paracetamol is a first-line option for treating mild-to-moderate pain associated with sports injuries. It
may be used alone or alongside other pharmacological or non- pharmacological strategies. It is generally well tolerated, suitable for a wide range of patients and safe when used correctly. For adults, the maximum recommended dose is 1 g every four-to- six hours, up to a maximum of 4g per day. In children, a weight-based dosing approach is more appropriate, with a maximum dose of 15mg/kg per dose up to four times daily.

Care is required to avoid unintentional overdose, particularly where patients may also be taking combination products containing paracetamol. Caution is advised in patients with hepatic impairment, chronic alcohol use and malnutrition due to the risk of hepatotoxicity.

Non-steroidal anti- inflammatory drugs (NSAIDs) NSAIDs effectively treat sports injuries by reducing pain, decreasing inflammation and improving mobility. They work by inhibiting cyclo- oxygenase (COX) enzymes, reducing the synthesis of prostaglandins involved in pain and inflammation. NSAIDs
are effective in reducing pain and inflammation in sports injuries and may be used alone or in combination with another analgesic.

Commonly used NSAIDs include ibuprofen, aspirin, diclofenac, naproxen, ketoprofen, etoricoxib and mefenamic acid. The choice of agent depends on individual patient factors, comorbidities, bleeding risk, cost, availability, dosing schedule and adverse effect profile.

Although effective, NSAIDs carry significant risks. Adverse effects include gastrointestinal irritation and bleeding, renal impairment, hepatotoxicity, hypertension and thromboembolic events. They are contraindicated in patients with active peptic ulcer disease, a history of gastrointestinal bleeding, severe renal impairment and heart failure. Caution is advised in older adults and those with cardiovascular disease, hypertension or chronic kidney disease. NSAIDs should generally be used at the lowest effective dose for the shortest possible duration, and gastroprotection with a proton pump inhibitor may be appropriate for higher- risk patients.

For many localised soft-tissue injuries, topical NSAIDs are an appropriate first-line option. They provide effective local analgesia and anti-inflammatory action with significantly lower systemic absorption, thereby reducing gastrointestinal, renal and cardiovascular risk. Diclofenac, ibuprofen and ketoprofen are
commonly available as gels, sprays or transdermal patches. Possible adverse effects include local skin irritation and photosensitivity. Oral NSAIDs may be considered where pain is more severe or not adequately controlled with topical treatment, but the benefits must always be weighed against potential risks.

Opioids

Opioids are generally not recommended in the routine management of soft- tissue sports injuries. They may occasionally have a role in short-term analgesia following surgery or severe trauma, or where other analgesic options are contraindicated or not tolerated. Opioids should only be considered if the expected benefit for pain relief and function outweighs the risk of harm. Where they are used, it should be at the lowest effective dose for the shortest possible duration. Adverse effects include sedation, constipation, nausea, respiratory depression, tolerance and dependence.

Non-pharmacological treatment

Non-pharmacological care is central to the management of sports injuries and may be used alone or alongside pharmacological treatment. Traditionally, acute soft-tissue injuries were managed using the RICE approach (Rest, Ice, Compression, Elevation). However, modern sports medicine increasingly emphasises protection, education and progressive rehabilitation, commonly using the POLICE framework:

• Protect the injured area with relative rest for the first 72 hours.

• Optimal Loading by gradually and progressively reintroducing movement and weight-bearing as pain allows.

• Ice, Compression and Elevation to help reduce inflammation and discomfort.

Gentle, graded exercise under the guidance of a physiotherapist plays an important role in recovery. For lower limb injuries, early weight-bearing exercise may support faster functional recovery. Supports such as braces or taping can assist with stability. General health measures, including adequate sleep, hydration and good nutrition, should be encouraged to support healing. Smoking and excessive alcohol consumption impair tissue repair and should be avoided.

Warning symptoms

Although most sports injuries are mild, some symptoms indicate a risk of more serious injury and require medical assessment. Red-flag symptoms include severe or persistent pain, significant inflammation, deformity or visible joint misalignment, and an inability to bear weight. Neurological symptoms such

as numbness, tingling or weakness require urgent evaluation. Signs of infection, including redness, warmth, fever or worsening pain after initial improvement, also warrant referral. Community pharmacists play an important role in recognising these warning signs and directing patients to appropriate care, helping to prevent complications and long-term disability.

Injury prevention strategies

Practical prevention strategies form an important element of sports injury management. Gradual training progression, avoiding sudden increases in intensity, duration or frequency, is

essential. Adequate warm-up before exercise and cool-down afterwards can reduce stiffness and injury risk. Correct technique and appropriate, sport-specific footwear and equipment also reduce risk. Ensuring sufficient rest and recovery time helps prevent chronic overuse injuries. Maintaining overall health, including good hydration, balanced nutrition and quality sleep, supports tissue repair.

Individuals with a history of previous injury should complete full rehabilitation, including physiotherapy where indicated, before returning to full activity. Pharmacists can help to reinforce these practical prevention strategies, which allows individuals to experience the health benefits of physical activity while minimising injury risk.

Role of the pharmacist

Community pharmacists play a key role in the management of sports injuries as highly accessible healthcare professionals. They frequently encounter sports-related presentations and provide initial assessment and advice, helping patients distinguish injuries suitable for self-care from those requiring medical review. They may provide first aid in the pharmacy to patients who have minor cuts, abrasions, bruises or other injuries. They play a key role in recommending appropriate analgesic and anti- inflammatory treatment, ensuring safe and evidence-based medicine use while considering comorbidities, drug interactions and patient preferences.

Pharmacists are well placed to identify red-flag symptoms, prevent inappropriate medication use and
refer patients when necessary. They also provide guidance on non- pharmacological management, rehabilitation and prevention strategies. Through accessible and evidence-based guidance, pharmacists support safe participation in sport and help reduce the burden of injury on patients and the wider healthcare system.

References available upon request