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ITP 201:Basic Injury Care<br />Brandi Smith-Young, PT<br />Perfect 10.0 Physical Therapy<br />Perfect10PT@gmail.com<br />
Brandi Smith-Young<br />Competitive gymnast<br />2 time USAG Collegiate National Champions at TWU<br />Bachelors in Kinesi...
Injury prevention<br />
Risk management<br />Make sure the gym is a safe environment<br />Account for injuries before they happen<br />Make sure e...
Safety is #1<br />
Proper biomechanics- upper<br />Push up position<br />Push up<br />When taking off or landing on the wrist it is imperativ...
Improper mechanics lead to repetitive abnormal stress<br />Leads to inefficient performance<br />Leads to injury<br />
Proper Loading mechanics<br />Fingers facing fwd<br />Maintain palmar arches<br />Antecubitalfossa (“Smiley face”) points ...
Proper biomechanics-Lower<br />Single leg standing<br />Single leg ¼ squat<br />When taking off or landing it is imperativ...
Improper mechanics lead to repetitive abnormal stress<br />Leads to inefficient performance<br />Leads to injury<br />
Proper jump/landing mechanics<br />Straight back<br />Hips square<br />Hip inline with the knee<br />Knee inline with the ...
Proper jump/squat mechanics<br />
Proper skill progression<br />Drills<br />Drills<br />Drills<br />More…..drills<br />Make sure an athlete is strong enough...
NO more…one mores<br />Give a specific number of trials for a skill<br />Especially at the end of practice<br />Do NOT let...
First Aid kit<br />Adhesive Bandages-large<br />Standard Band-Aides<br />Knuckle Bandages<br />Fingertip Bandages<br />Iod...
Ace Wrap- 6 in, 4 in, & 2 in
Scissors
Tape
Tweezers
Tylenol-*DO NOT administer medication with acetaminophen
First Aid Guide
*Hepacleanse- 4-10 drops in </li></ul>    about 1/2 cup of water till the water is tinted a light pink.<br />
Other emergency supplies<br />Ice Pack<br />Splinting Supplies-air splint, SAM splint, Vacuum Immobilizers<br />Arm Sling<...
CARDIAC	<br />   RESCUE	 <br />SYSTEMS, INC. 	<br />Please contact: Bert Cattoni<br />Phone: (630) 541-5469 <br />Cell: (6...
Hands-on Only CPRFor adult who collapses only<br />
Conventional CPR for children is still recommended<br />CAB- Chest compression, Airway, Breathing<br />30 chest compressio...
Medical resources<br />Orthopedic Surgeon<br />Doctors who specializes or fellowship trained  (ie fellowship trained ankle...
Develop relationship with PT<br />Have PT come every week or every other week to the gym<br />Triage<br />Screen for injur...
Emergency action plan<br />Have an emergency action plan<br />Train your staff annually on the action plan<br />Who goes t...
EAP cont’d<br />Have plans for various incidences which may arise<br />What to do if an athlete is unconscious after landi...
Traumatic injuries & care<br />
Sprain/Strains<br />Minor injury no obvious deformity or serious injury<br />Rest<br />Ice<br />Elevation (above the heart...
Possible Broken bone-no obvious deformity<br />Apply splint to immobilize<br />Apply ice<br />Elevate above heart<br />Con...
Dislocation or severe fracture-obvious deformity<br />DO NOT move the gymnast from the area<br />Call 911<br />If profuse ...
Possible concussion<br />Use the SCAT 2 for assessment<br />
Concussion grading<br />-Grade I- Dazed look; patient completely lucid (no amnesia, confusion) in 0-5 minutes<br />-Grade ...
*Any gymnast with a head injury needs to be seen by a doctor as soon as possible.  If Grade IV or V concussion occurs call...
Deep laceration<br />-Apply direct pressure with gauze to control bleeding.<br />-Send gymnast to Urgent Care or ER for su...
Non-traumatic injuries &care<br />
Causes of non-traumatic injuries<br />-Improper technique<br />-Improper warm-up<br />-Lack of flexibility (typically true...
prevention<br />-Emphasize technique from the beginning<br />-Focus on all muscle groups<br />-Build core strength early o...
treatment<br />*A therapist can help with all the below and closely guide modified workouts along with progressive return ...
Treatment cont’d<br />-Strengthen weak muscles, stretch tight muscles, and retrain muscle firing patterns when a muscle is...
Ankle Sprains<br />-First 24-48 hours R.I.C.E.<br />-Normalize joint mechanics (See manual physical therapist)<br />-Norma...
spondylolesthesis<br />-Normalize joint mechanics (See manual physical therapist)<br />-Assess possible hypermobility L5-S...
Back pain<br />-Normalize joint mechanics (See manual physical therapist)<br />-Assess possible hypermobility L5-S1, if po...
Shoulder pain<br />-Normalize joint mechanics (See manual physical therapist)<br />-Assess resting position of the shoulde...
Wrist pain<br />-Technique<br />-Normalize joint mechanics (See manual physical therapist)<br />-Scapular and deep cervica...
Tendonitis/tendonopathy<br />*There is no such thing as tendonitis in most cases.  They have found there is no inflammator...
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ITP 201 basic injury care

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ITP 201: Basic Injury Care for gymnast
This lecture was given at the Gymnastics Association of Texas conference 2011. Importance of Emergency Action Plan and triage in the gym.

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Transcript of "ITP 201 basic injury care"

  1. 1. ITP 201:Basic Injury Care<br />Brandi Smith-Young, PT<br />Perfect 10.0 Physical Therapy<br />Perfect10PT@gmail.com<br />
  2. 2. Brandi Smith-Young<br />Competitive gymnast<br />2 time USAG Collegiate National Champions at TWU<br />Bachelors in Kinesiology at TWU<br />Masters in Physical Therapy at Tx St<br />Fellowship trained in Orthopedic manual physical therapy<br />Board certified orthopedic specialist in PT<br />Specialize in treating gymnast<br />
  3. 3. Injury prevention<br />
  4. 4. Risk management<br />Make sure the gym is a safe environment<br />Account for injuries before they happen<br />Make sure every area is covered with mats (no gaps in mats)<br />Move all unused equipment close to the walls or in designated areas<br />Have designated walking areas<br />Update old unsafe equipment<br />Keep the younger kids separate from the team when possible<br />Keep coaches always conscious of safety<br />All coaches CPR & first aide certified annually or biannually <br />
  5. 5. Safety is #1<br />
  6. 6. Proper biomechanics- upper<br />Push up position<br />Push up<br />When taking off or landing on the wrist it is imperative to have good mechanics.<br />
  7. 7. Improper mechanics lead to repetitive abnormal stress<br />Leads to inefficient performance<br />Leads to injury<br />
  8. 8. Proper Loading mechanics<br />Fingers facing fwd<br />Maintain palmar arches<br />Antecubitalfossa (“Smiley face”) points inward (“kiss each other)<br />Elbows straight but not locked out<br />Shoulder blades cinched up to the rib cage (no winging)<br />
  9. 9. Proper biomechanics-Lower<br />Single leg standing<br />Single leg ¼ squat<br />When taking off or landing it is imperative to have good mechanics.<br />
  10. 10. Improper mechanics lead to repetitive abnormal stress<br />Leads to inefficient performance<br />Leads to injury<br />
  11. 11. Proper jump/landing mechanics<br />Straight back<br />Hips square<br />Hip inline with the knee<br />Knee inline with the 2nd toe<br />Hips slightly flexed<br />Knees bent with the knee falling over the midfoot<br />
  12. 12. Proper jump/squat mechanics<br />
  13. 13. Proper skill progression<br />Drills<br />Drills<br />Drills<br />More…..drills<br />Make sure an athlete is strong enough, flexible enough, done the proper progressions and done the skill safely in a safe place before progressing<br />Do NOT let an overzealous athlete convince you to let them chunk things<br />
  14. 14. NO more…one mores<br />Give a specific number of trials for a skill<br />Especially at the end of practice<br />Do NOT let an athlete say….I just want to do one more at the end of practice or after they have done a ton of bad or unsuccessful attempts<br />When an athlete is physically and mentally tired…one more turns into a nightmare real quick!<br />
  15. 15. First Aid kit<br />Adhesive Bandages-large<br />Standard Band-Aides<br />Knuckle Bandages<br />Fingertip Bandages<br />Iodine Swabs<br />Alcohol Pads<br />Burn Ointment<br />Antibiotic Ointments<br />Eye Patches<br />Eye Wash<br />Gauze Pads-4x4 and 2x2<br /><ul><li>Latex gloves
  16. 16. Ace Wrap- 6 in, 4 in, & 2 in
  17. 17. Scissors
  18. 18. Tape
  19. 19. Tweezers
  20. 20. Tylenol-*DO NOT administer medication with acetaminophen
  21. 21. First Aid Guide
  22. 22. *Hepacleanse- 4-10 drops in </li></ul> about 1/2 cup of water till the water is tinted a light pink.<br />
  23. 23. Other emergency supplies<br />Ice Pack<br />Splinting Supplies-air splint, SAM splint, Vacuum Immobilizers<br />Arm Sling<br />Crutches<br />CPR Mask<br />CPR guide<br />AED machine <br /> (Cardiac Rescue Systems www.cardiacrescue.com)<br />www.henryschein.com <br />
  24. 24. CARDIAC <br /> RESCUE <br />SYSTEMS, INC. <br />Please contact: Bert Cattoni<br />Phone: (630) 541-5469 <br />Cell: (630) 854-5150<br />bcattfway@aol.com www.cardiacrescue.com<br />PO Box 5522 Woodridge IL, 60517<br />
  25. 25. Hands-on Only CPRFor adult who collapses only<br />
  26. 26. Conventional CPR for children is still recommended<br />CAB- Chest compression, Airway, Breathing<br />30 chest compressions<br />Clear air way<br />2 breaths<br />30:2 until help arrives<br />www.heart.org<br />
  27. 27. Medical resources<br />Orthopedic Surgeon<br />Doctors who specializes or fellowship trained (ie fellowship trained ankle, knee or board certified spine specialist)<br />Specialize in sport injuries<br />Specialize in pediatric sport injuries<br />Physical Therapist<br />Board certified orthopedic specialist <br />Fellowship trained manual physical therapy, sports PT, movement dysfunction <br />www.apta.org or www.aaompt.org<br />911<br />Do not hesitate to call if uncomfortable with broken bone, concussion, seizure, or any other emergency<br />
  28. 28. Develop relationship with PT<br />Have PT come every week or every other week to the gym<br />Triage<br />Screen for injury prevention/wellness once every quarter lower levels or more frequent for elites (once every 4-6 wks)<br />Assess conditioning program for areas of weakness or overtraining<br />Implement injury prevention program<br />Help come up with Active Recovery program for injured athletes<br />Provide educational talks for staff or parents<br />Get to the doctor more rapidly<br />
  29. 29. Emergency action plan<br />Have an emergency action plan<br />Train your staff annually on the action plan<br />Who goes to the aide of the injured athlete<br />When to call 911<br />Who calls 911<br />What the other coaches do to assist the primary provider or with other athletes or parents<br />Who waits for the ambulance if needed<br />What first aid is administered<br />
  30. 30. EAP cont’d<br />Have plans for various incidences which may arise<br />What to do if an athlete is unconscious after landing on their head<br />What to do in the event of a fracture or dislocation<br />Practice Pit extractions with local fire department<br />
  31. 31. Traumatic injuries & care<br />
  32. 32. Sprain/Strains<br />Minor injury no obvious deformity or serious injury<br />Rest<br />Ice<br />Elevation (above the heart)<br />Compression<br />Call the therapist or team medical provider have gymnast assessed to decide need for further medical care.<br />Small sprains & strains untreated can lead to more serious injuries or troubles<br />Care within 24-48 hrs dec recovery time & inc success full recovery<br />
  33. 33. Possible Broken bone-no obvious deformity<br />Apply splint to immobilize<br />Apply ice<br />Elevate above heart<br />Contact doctor to get an appointment or have parent take the gymnast to Urgent care or ER if the gymnast excessive pain an unable to wait until the next<br />
  34. 34. Dislocation or severe fracture-obvious deformity<br />DO NOT move the gymnast from the area<br />Call 911<br />If profuse bleeding occurs apply direct compression with gauze over wound<br />DO NOT try to relocate a dislocated joint or set a bone. You can do MORE harm and permanent damage to the athlete<br />
  35. 35. Possible concussion<br />Use the SCAT 2 for assessment<br />
  36. 36.
  37. 37. Concussion grading<br />-Grade I- Dazed look; patient completely lucid (no amnesia, confusion) in 0-5 minutes<br />-Grade II-Slight Confusion: mild posttraumatic amnesia that last less than 60 min; possible ringing in the ears: headache; may develop post concussion syndrome that can last several weeks to several years<br />-Grade III- Symptoms listed above in addition to retrograde amnesia in which events prior to the concussion are forgotten<br />-Grade IV- Loss of consciousness for less than 5 minutes followed by stupor, confusion, automatism and finally full alertness<br />-Grade V- Unconsciousness for greater than 5 min; symptoms listed above but more severe, nausea, and vomiting; possible permanent neurological deficits<br />
  38. 38. *Any gymnast with a head injury needs to be seen by a doctor as soon as possible. If Grade IV or V concussion occurs call 911.<br />
  39. 39. Deep laceration<br />-Apply direct pressure with gauze to control bleeding.<br />-Send gymnast to Urgent Care or ER for sutures<br />
  40. 40. Non-traumatic injuries &care<br />
  41. 41. Causes of non-traumatic injuries<br />-Improper technique<br />-Improper warm-up<br />-Lack of flexibility (typically true shoulder, hip flexibility) or range of motion<br />-Improper conditioning<br />-Overuse<br />*Muscle imbalances <br />
  42. 42. prevention<br />-Emphasize technique from the beginning<br />-Focus on all muscle groups<br />-Build core strength early on (true internal/external abdominals, transverse abdominus…not just the “6 pack muscles” rectus) <br />-Do not forget to train the shoulder blade stabilizer and the hip stabilizers<br />-Be specific and meticulous with conditioning, a stickler for form<br />-Cross train/selectively train<br />-Prevent overtraining by taking advantage of soft landings<br />-Wrist guards (Tiger paw) for gymnast doing yerchenko vaults<br />-Regular medical screenings with a therapist or doctor<br />-Treat aches and pains before they become full blown injuries<br />-Deal with the minor injuries to prevent recurring injury, domino affect, or worsening of injuries<br />
  43. 43. treatment<br />*A therapist can help with all the below and closely guide modified workouts along with progressive return to full workouts based on tissue healing.<br />-Identify the cause<br />-Eliminate the cause<br />-Allow inflammation or acuteness of the injury to subside<br />
  44. 44. Treatment cont’d<br />-Strengthen weak muscles, stretch tight muscles, and retrain muscle firing patterns when a muscle is dominant<br />-Maintain strength and endurance while treating an injury<br />-Progressive loading to return to gymnastics without further injury (i.e. start with less numbers, low impact and progress slowly to full numbers and high impact)<br />
  45. 45. Ankle Sprains<br />-First 24-48 hours R.I.C.E.<br />-Normalize joint mechanics (See manual physical therapist)<br />-Normalize ROM and strength<br />-Normalize proprioception<br />-Ankle taping/bracing during the protective phase where ankle is subject to re-injury.<br />
  46. 46. spondylolesthesis<br />-Normalize joint mechanics (See manual physical therapist)<br />-Assess possible hypermobility L5-S1, if positive; brace with simple back brace/wrap during painful activities for up to 300 days (collagen fibers replenish; tissue healing)<br />-Proper lumbar stabilization (using blood pressure cuff; 40-50 with flexion bias)<br />-Avoid hyperextension (no backbends, bridges, back walkovers)<br />-Insure shoulder and hip ranges of motion are normal<br />
  47. 47. Back pain<br />-Normalize joint mechanics (See manual physical therapist)<br />-Assess possible hypermobility L5-S1, if positive; brace with simple back brace/wrap during painful activities for up to 300 days (collagen fibers replenish; tissue healing)<br />-Proper lumbar stabilization (using blood pressure cuff; 40-50 with flexion bias)<br />-Avoid hyperextension (no backbends, bridges, back walkovers)<br />-Insure shoulder and hip ranges of motion are normal<br />- Stretch hip flexors (iliopsoas and quads)<br />-Strengthen hip abductors, extensors, flexors, and external rotators (glut med, glut max, iliopsoas, superior/inferior gemelli)<br />
  48. 48. Shoulder pain<br />-Normalize joint mechanics (See manual physical therapist)<br />-Assess resting position of the shoulder (Anterior medial glide syndrome)<br />-Assess cervical and scapular strength<br />-Stretch pecs and lats<br />-Neck (deep cervical flexors) and shoulder blade (Upper trap, middle trap, lower trap, serratus anterior) strengthening<br />-Rotator cuff strengthening <br />-Make sure rhomboid not doing all the work with shoulder external rotation (re-train if it is)<br />
  49. 49. Wrist pain<br />-Technique<br />-Normalize joint mechanics (See manual physical therapist)<br />-Scapular and deep cervical strengthening<br />-Make treat shoulder and elbow issues to<br />-Wrist extension strengthening (make sure move wrist straight back, not inward) (ECRB tends to dominate)<br />-Finger flexor strength/grip strength<br />-Proper loading of the wrist in plank, pushup, handstand, etc)<br />-Wrist guards (Lion Paws, tiger paws)<br />
  50. 50. Tendonitis/tendonopathy<br />*There is no such thing as tendonitis in most cases. They have found there is no inflammatory response. It is tendonopathy which translates to micro-tearing of the tendon, which if goes untreated can truly rupture the tendon.<br />-Technique<br />-Normalize joint mechanics (See manual physical therapist)<br />-Normalize muscle imbalances affecting the tendon and loading response<br />
  51. 51. Tendon training:<br />• Low loading, lots (1,000s) of repetitions (biking, elliptical, total gym. minimal numbers in the gym, low impact [tumble track, air track, sting mats, pits, etc]) A therapist can give specific tendon training exercises for the involved tendon.<br />• Tendon healing truly takes 10-12 weeks in a good environment with no re-injury to heal.<br />• Careful not to over train, Signs of overtraining: Tightness, stiffness, aching, swelling or pain directly over the tendon<br />
  52. 52. Grading Tendon Injury<br />• Early signs of tendonopathy; Pain at the beginning of workout, decreased once warmed up, and worse within a few hours after workout or towards the end of practice.<br />• Signs tendonopathy progressing: Begin to have pain during activity, no change with warm-up, and increasing after<br />completion of activity, increased intensity of pain.<br />• Signs of tendon partial rupture: Increasing pain intensity, pain during activity, and inability to relieve the pain or swelling <br />(SEE AN ORTHO DOCTOR OR THERAPIST IMMEDIATELY)<br />• Signs of tendon full rupture: Visible defect, possibly hear/feel a pop, inability to activate muscle attaches to the tendon, pain with contraction, pain during activity, inability to relieve pain or swelling. Increased intensity of pain and increased swelling.<br />
  53. 53. Osgood slaughter’s disease<br />Technique<br />-Normalize joint mechanics (See manual physical therapist)<br />-Normalize muscle imbalances affecting the tendon insertion and loading response<br />• Indentify the cause; improper loading on the knee<br />• Address core, hip, and foot weakness<br />• Address proper squatting, jumping, landing mechanics on the knee<br />• Decrease numbers and decrease impact; all guide by pain.<br />• Tendon training, along with proper strengthening and stretching.<br />• Chopat Strap<br />
  54. 54. Sever’s disease<br />-Technique<br />-Normalize joint mechanics (See manual physical therapist)<br />-Normalize muscle imbalances affecting the tendon insertion and loading response<br />• Indentify the cause; improper loading on the ankle/foot<br />• Address core, hip, and foot weakness<br />• Address proper squatting, jumping, landing mechanics on the ankle/foot<br />• Decrease numbers and decrease impact; all guide by pain.<br />• Proper foot wear out side of the gym to decrease the stress.<br />• Tendon training, along with proper strengthening and stretching.<br />
  55. 55. Most injuries can be prevented with:<br />Injury prevention (balance the muscle imbalances)<br />Training proper biomechanics or loading techniques<br />Proper skill progression<br />Facility and equipment safety<br />A working relationship with a PT and doctor<br />Wellness screens (including ROM, flexibility, strength, & balance)<br />
  56. 56. When injuries do occur:<br />Be prepared<br />Have a plan<br />Train your staff<br />Learn from the experience for further injury prevention<br />If it doesn’t look right…don’t touch it<br />Contact a medical provider<br />
  57. 57. Contact Information<br />Perfect 10.0 Physical Therapy <br /> & Performance Training<br />www.perfect10physicaltherapy.com<br />perfect10pt@gmail.com<br />512-426-6593<br />Follow Perfect10PT on gymnastike, facebook, & twitter <br />
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