Background: Ligament injuries, especially those linked to sports and recreational activities, are becoming increasingly common among young and active populations. However, public understanding of their causes, symptoms and treatment remains limited, particularly in semi-urban and rural regions like Kangra. This study assesses awareness levels, misconceptions and early management behaviors regarding ligament and sports-related orthopedic trauma in Kangra district, Himachal Pradesh. Materials and Methods: A community-based descriptive cross-sectional study was conducted between January and March 2025 with 420 participants aged 16–35 years. A structured bilingual questionnaire was used to collect data on socio-demographic characteristics, knowledge of ligament injuries and first-aid or treatment-seeking behavior. Responses were scored and awareness was categorized as Very Good (≥80%), Good (60–79%), Fair (41–59%) and Poor (<40%). Associations between knowledge levels and demographics were analyzed using chi-square tests. Results: Of the 420 respondents, 62.6% had good or very good awareness regarding ligament injuries and sports-related trauma. While 73.5% identified twisting motions as a cause of ligament tears, only 39.8% understood the importance of R.I.C.E (Rest, Ice, Compression, Elevation) as an immediate response. Misunderstandings around complete rest vs. graded rehabilitation were also common. Rural participants and those without formal sports education showed significantly lower awareness. Conclusion: Despite moderate awareness levels about ligament injuries in Kangra, significant gaps persist particularly regarding first-aid, rehabilitation and prevention. Enhanced outreach through sports clubs, schools and local media is vital to improve orthopedic injury literacy and reduce complications from delayed or inappropriate treatment.
Ligament injuries are one of the most frequent orthopedic traumas encountered in sports and physically active individuals. Whether it’s a twisted knee during football, a sprained ankle from running or shoulder strain during weightlifting, these injuries can have lasting effects on joint stability and mobility if not managed appropriately. Globally, anterior cruciate ligament (ACL), medial collateral ligament (MCL) and ankle ligament sprains represent a major share of sports-related consultations [1-3].
In India, where competitive sports and recreational physical activity are gaining popularity, awareness around ligament injuries has not kept pace. This knowledge gap is especially visible in semi-urban and rural areas where access to sports medicine, physiotherapy and orthopedic rehabilitation services is limited. Injuries are often misdiagnosed, self-treated or ignored, leading to chronic pain, re-injury and long-term disability [4-6].
Kangra district, with its youth participating in community-level sports, school games and gym-based workouts, represents a population at high risk of such injuries. However, little data exists on how well these individuals understand ligament injury mechanisms, early warning signs or appropriate treatment protocols like the R.I.C.E method and rehabilitation.
This study aims to evaluate the level of public awareness in Kangra regarding ligament injuries and sports-related orthopedic trauma, identify critical gaps, and offer insight into educational strategies that can reduce injury-related morbidity and improve outcomes in active populations.
Study Design
A descriptive cross-sectional study was conducted.
Study Area and Population
Individuals aged 16–35 years from urban and rural areas of Kangra district were included. Participants comprised students, amateur athletes, gym-goers and active community members.
Study Duration
January 2025 to March 2025
Sample Size and Sampling Technique
420 participants were selected using purposive sampling from educational institutions, sports grounds, fitness centers and community events.
Inclusion Criteria
Aged 16–35 years
Regular involvement in physical activity or sports
Resident of Kangra district
Provided informed consent
Exclusion Criteria:
Diagnosed chronic orthopedic conditions
Incomplete questionnaire responses
Data Collection Tool
A structured, bilingual questionnaire validated by orthopedic and physiotherapy professionals. It included:
Socio-demographics
20 multiple-choice knowledge questions about ligament injuries, symptoms, first-aid, treatment and prevention
Self-reported injury management behavior
Scoring and Analysis
One point was awarded per correct response. Scores were categorized into:
Very Good: ≥80%
Good: 60–79%
Fair: 41–59%
Poor: <40%
Data were analyzed using SPSS v26, applying descriptive statistics and chi-square tests to examine associations (p<0.05 considered significant).
Ethical Considerations
Ethics approval was granted by the Ethics Committee. Written consent was obtained from all participants.
This demographic data reflects a predominantly young, active population with a fair distribution between urban and rural settings. This demographic data reflects a predominantly young, active population with a fair distribution between urban and rural settings. The educational breakdown supports comparative analysis between varying awareness levels linked to formal sports education and exposure to injury prevention knowledge.
Table 1: Socio-Demographic Profile of Participants (N=420)
| Variable | Category | Frequency (n) | Percentage (%) |
| Age Group | 16–20 | 139 | 33.1 |
| 21–27 | 188 | 44.8 | |
| 28–35 | 93 | 22.1 | |
| Gender | Male | 235 | 56.0 |
| Female | 185 | 44.0 | |
| Education | School level | 101 | 24.0 |
| Undergraduate | 205 | 48.8 | |
| Postgraduate | 114 | 27.2 | |
| Residence | Urban | 186 | 44.3 |
| Rural | 234 | 55.7 |
Table 2: Ligament Injury Awareness – 20 Knowledge Questions and Correct Responses
| No. | Question | Options | Correct Ans | Percentage |
| 1 | What is a ligament? | a) Bone, b) Muscle, c) Connective tissue, d) Nerve | c | 72.4% |
| 2 | Common cause of ligament injury? | a) Fever, b) Running, c) Twisting motion, d) Heat | c | 73.5% |
| 3 | Best immediate response to ligament injury? | a) R.I.C.E, b) Ignore, c) Full immobilization, d) Massage only | a | 39.8% |
| 4 | Symptom of ligament tear? | a) Itching, b) Redness, c) Swelling & instability, d) Blisters | c | 65.7% |
| 5 | Should ligament injuries always be operated? | a) Yes, b) Never, c) Depends on severity, d) Only elderly | c | 56.4% |
| 6 | Can ligament sprains heal without surgery? | a) No, b) Yes with rehab, c) Only with painkillers, d) Don’t heal | b | 58.9% |
| 7 | What is R.I.C.E? | a) Food, b) Rest Ice Compress Elevate, c) Relax In Cold Evening, d) None | b | 42.0% |
| 8 | Importance of physiotherapy post-injury? | a) Not needed, b) Only for athletes, c) Very important, d) Makes worse | c | 61.2% |
| 9 | How long should rest be taken after injury? | a) 1 day, b) Until swelling subsides, c) 1 month, d) Never | b | 54.5% |
| 10 | Can untreated sprain cause chronic instability? | a) No, b) Yes, c) Rarely, d) Only in elderly | b | 59.1% |
| 11 | Which joint is most prone to sprain? | a) Elbow, b) Ankle, c) Wrist, d) Hip | b | 68.3% |
| 12 | Ligament tears are confirmed using? | a) X-ray, b) MRI, c) Blood test, d) CT scan | b | 64.1% |
| 13 | Common sports for ligament injuries? | a) Chess, b) Swimming, c) Football, d) Yoga | c | 71.0% |
| 14 | Can warming up prevent injuries? | a) No, b) Yes, c) Not sure, d) Depends on sport | b | 60.7% |
| 15 | Are all ligament injuries painful? | a) No, b) Yes always, c) Only torn ligaments, d) Depends on temperature | a | 47.2% |
| 16 | Is self-massage recommended? | a) Always, b) Rarely, c) Never, d) Only under guidance | d | 49.8% |
| 17 | Can you walk with a torn ligament? | a) Yes easily, b) With difficulty, c) No, d) Only when sitting | b | 51.6% |
| 18 | Proper footwear can help in? | a) Fashion, b) Injury prevention, c) Speed, d) Jump height | b | 65.4% |
| 19 | Ignoring a sprain can lead to? | a) Recovery, b) Re-injury, c) Faster healing, d) No effect | b | 58.2% |
| 20 | Are ligament injuries preventable? | a) No, b) Not sure, c) Yes with precautions, d) Only in women | c | 62.7% |
The expanded set of 20 questions paints a more comprehensive picture of public understanding. While general awareness about symptoms and vulnerable joints was high, responses on diagnostic tools and injury management revealed uncertainty. Only a small majority knew about MRI diagnosis and proper footwear benefits, indicating a need for deeper community-based sports health literacy.
Table 3: Knowledge Score Classification
| Knowledge Level | Score Range | Frequency (n) | Percentage (%) |
| Very Good | ≥80% | 124 | 29.5% |
| Good | 60–79% | 139 | 33.1% |
| Fair | 41–59% | 103 | 24.5% |
| Poor | <40% | 54 | 12.9% |
Despite encouraging numbers in the top two awareness brackets, almost 37.4% fell into fair or poor categories. These individuals are at higher risk of injury mismanagement and complications. Tailored interventions through local coaches, trainers and peer groups could improve this baseline and promote safe sports practices.
The findings from this study reveal a mixed yet informative picture of the public’s understanding of ligament injuries in a semi-urban district like Kangra. The relatively strong awareness of basic anatomy and common causes of ligament injuries demonstrates that general health literacy is present among young and active individuals. However, a more nuanced understanding such as recognizing early intervention techniques and appropriate rehabilitation strategies was noticeably lacking.
One of the most concerning insights was that fewer than half of the participants could correctly identify R.I.C.E. as the immediate management protocol for acute ligament injuries. This lack of knowledge could lead to incorrect first aid, delayed recovery and an increased risk of chronic joint instability. Likewise, knowledge about diagnostic tools like MRI and the importance of physiotherapy in recovery phases was inconsistent across educational backgrounds.
The urban-rural divide in awareness is particularly significant. Urban participants had greater access to fitness centers, professional trainers and online health resources, which likely contributed to higher knowledge scores. In contrast, rural participants were more likely to rely on informal advice, traditional remedies or avoid treatment altogether due to lack of access or awareness.
Additionally, there was confusion surrounding whether ligament injuries require surgery or can be conservatively managed. This confusion, if not clarified, may lead to overtreatment or fear of seeking medical care. Furthermore, many participants underestimated the role of injury prevention strategies such as proper footwear, warm-ups and strength training all of which are essential for reducing the incidence of ligament trauma.
The results strongly advocate for community education programs tailored to sports-related injury prevention. These can include workshops in schools, colleges, gyms and local sports events. Coaches and physical education instructors should be empowered to deliver basic injury awareness content and first-aid protocols like R.I.C.E. must be popularized through local media and campaigns. Reinforcing practical behavior, not just anatomical knowledge, will be key to reducing the treatment burden and long-term disability associated with ligament injuries [7-9].
This study underscores the urgent need to improve public understanding of ligament injuries, particularly in settings where youth are actively engaged in sports but lack structured exposure to injury prevention and rehabilitation knowledge. While foundational awareness exists in Kangra, critical gaps remain especially in first-aid responses and long-term management. To bridge these gaps, multi-level interventions must target rural communities, educational institutions and sports organizations. Strengthening orthopedic health literacy will not only promote faster recovery but also foster a safer, more informed athletic culture in the region.
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