Sports med powerpoint 2011


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Sports med powerpoint 2011

  1. 1. Ways To Classify Sports Injuries
  2. 2. <ul><li>Injuries occur more frequently in contact sports such as football. </li></ul><ul><li>May be the result of overuse. </li></ul><ul><li>Usually classified according to their cause; </li></ul><ul><li>direct, indirect, overuse </li></ul><ul><li>or type of tissue injured; </li></ul><ul><li>soft, hard </li></ul>CLASSIFYING AND MANAGING SPORTS INJURIES
  3. 3. <ul><li>Caused by forces generated from outside the body. </li></ul><ul><li>Direct injuries result in </li></ul><ul><ul><li>fractures, </li></ul></ul><ul><ul><li>dislocations, </li></ul></ul><ul><ul><li>sprains and </li></ul></ul><ul><ul><li>bruises. </li></ul></ul>
  4. 4. <ul><li>Caused by a force within the body. </li></ul><ul><li>Occur as a result of; </li></ul><ul><li>- inadequate warm-up </li></ul><ul><li>- ballistic movements </li></ul><ul><li>- excessive strain on muscles and tendons </li></ul>
  5. 5. <ul><li>Result from intense or unreasonable use of joints or body areas. </li></ul><ul><li>Provoked by repetitive, low-impact exercise such as jogging or stepping. </li></ul><ul><li>Cause pain and inflammation around the site of the injury. </li></ul>
  6. 6. <ul><li>Anterior shin splints; </li></ul><ul><li>irritation to the front portion of the shinbone. </li></ul><ul><li>Tendonitis; </li></ul><ul><li>irritation of tendons the Achilles tendon in the heel. </li></ul>
  7. 7. <ul><li>Include damage to; muscle </li></ul><ul><li>tendons </li></ul><ul><li>ligaments </li></ul><ul><ul><ul><ul><ul><li>cartilage </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>skin </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>blood vessels </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>organs </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>nerves . </li></ul></ul></ul></ul></ul>
  8. 8. <ul><li>Acute; </li></ul><ul><li>occurring suddenly </li></ul><ul><li>C hronic; </li></ul><ul><li>prolonged </li></ul><ul><li>Chronic soft tissue injuries necessitates a long rehabilitation due to their severity. </li></ul>Two of the most common soft tissue injuries are tears and contusions.
  9. 9. <ul><li>Hard tissue injuries cause damage to bones and teeth. </li></ul><ul><li>Frequently more serious than soft tissue injuries. </li></ul>Examples; dislodging a tooth fracturing a bone Most common is a fracture.
  10. 10. <ul><li>Due to it’s structural support role, </li></ul><ul><li>hard tissue that has </li></ul><ul><li>been injured must be carefully examined </li></ul><ul><li>and cared for. </li></ul>
  11. 11. - tears, sprains, contusions - inflammatory responses - skin abrasion, lacerations, blisters, calluses
  12. 12. <ul><li>Soft tissue injuries include damage to muscle, tendons, ligaments, cartilage, skin, blood vessels, organs and nerves. There are many types of soft tissue injury. They may be acute (occurring suddenly, such as a fracture or sprain) or chronic (prolonged). Acute soft tissue injuries include sprains, strains, dislocation, torn cartilage, contusions and abrasions. Prolonged soft tissue injuries may include many of the same types of injury, but their severity necessitates a long rehabilitation. Two of the most common soft tissue injuries are tears and contusions. </li></ul>
  13. 13. <ul><li>A tear occurs when tissue is excessively stretched or severed. Two types of tear are </li></ul><ul><ul><li>sprains and </li></ul></ul><ul><ul><li>strains. </li></ul></ul>
  14. 14. <ul><li>Ligaments are strong, rigid and relatively inelastic tissue. Their role is to connect bone to bone, thereby providing joint stability. Sprains occur when these ligaments are stretched or torn, resulting in pain, swelling and the inability to perform normal joint movements. Proper rehabilitation management techniques are recommended, as healing in the stretched position will cause permanent instability in the joint. Healing is a slow process because ligaments have a relatively poor blood supply. Sprains can be classified according to the severity of ligament damage. </li></ul>
  15. 15. <ul><li>Strains are different to tears in that they happen only to muscles and tendons. They cause considerable pain and bleeding may cause discolouration around the injury. Any movement in the form of stretching and any pressure on or around the injury will result in sharp pain. There are three levels of strains; these are </li></ul><ul><ul><li>First degree (relatively little damage), </li></ul></ul><ul><ul><li>Second degree (moderate damage), </li></ul></ul><ul><ul><li>Third degree (extensive damage). </li></ul></ul>
  16. 16. <ul><li>Impact with a player or object sometimes causes a contusion . Contusions vary in intensity. Some are superficial, remaining close to the skin. However, others penetrate deeply, causing bone to bruise. Contusions interrupt blood flow to surrounding tissue. When this occurs, a haematoma (blood tumour) forms as the blood clots in the connective tissue membrane. Internal bleeding into the area may continue for a period of time. </li></ul>
  17. 17. <ul><li>Abrasions, lacerations, blisters and calluses are forms of skin trauma. They are caused by the application of force, such as scraping or friction to the outer layer of skin. They can cause concern and considerable discomfort. </li></ul>
  18. 18. <ul><li>Abrasions occur in games like rugby, where a player may execute a tackle on a dry, hard surface. </li></ul><ul><li>The injury causes pain and shallow bleeding as a result of the skin being scraped. </li></ul><ul><li>The skinned area may be embedded with dirt and foreign materials. </li></ul><ul><li>Treatment : gentle cleansing and sterilisation of the wound to prevent infection. </li></ul>
  19. 19. <ul><li>A laceration is a wound where the flesh has incurred an irregular tear. </li></ul><ul><li>Lacerations can occur to to the scalp and mouth, particularly the lips and tongue if the soft tissue has been forced against the teeth. </li></ul><ul><li>Pressure may need to be applied to prevent bleeding. </li></ul><ul><li>Lacerations longer than one centimetre need to be referred to a doctor. </li></ul>
  20. 20. <ul><li>Blisters are caused by a collection of fluid below or within the surface layer of the skin giving rise to intense pain. </li></ul><ul><li>Blisters can contain clear liquid or even blood if a blood vessel has been ruptured. </li></ul><ul><li>Blisters occur when new equipment is used, equipment is used for a long time repetitively, or the activity requires sudden changes in direction, causing friction (in a shoe). </li></ul><ul><li>Treatment: 24 hours rest. If fluid in blister is still present and causing concern, it may need to be surgically released and dressing applied. Torn blisters should be washed in soap and water and liquid antiseptic applied. </li></ul>
  21. 21. <ul><li>Calluses are increased thickness of skin that usually occur over bone protuberances. </li></ul><ul><li>Caused by constant pressure from external sources eg: a shoe that is too small </li></ul><ul><li>Commonly found on hands because of gripping bat etc. </li></ul><ul><li>Calluses cause pain because the area underneath loses blood supply and elasticity, resulting in cracks and tears. </li></ul><ul><li>Prevention: ensure clothing and equipment fit, using materials to reduce friction (eg: Socks) and applying donut pads and jellies to reduce resistance between body and object. </li></ul>
  22. 22. <ul><li>Hard Tissue Injuries </li></ul>
  23. 23. CAUSE DEFINITION EXAMPLE <ul><li>Direct contact with </li></ul><ul><li>Others </li></ul><ul><li>Implements </li></ul><ul><li>The ground </li></ul>The bone is struck directly, breaking at the point of impact Forearm is hit by a hockey stick, resulted in a fractured ulna Indirect force on a body part Force is indirectly applied to the bone causing a fracture away from the point of impact. Landing on an out stretched arm, resulting in a fracture of the clavicle. Inappropriate muscular action, for example forceful contraction Muscles contract forcefully and strongly pull on bones causing a fracture An athlete jumping from a height, landing on their feet and fracturing their patella. Overuse, repeated trauma The repeated use (overuse) of a joint causes small fractures in the bone called stress fractures A runner who trains long distances may develop a stress fracture of a bone in the foot.
  24. 24. <ul><li>Cause damage to bones and teeth e.g.dislodging a tooth or fracturing a bone. </li></ul><ul><li>Frequently more serious than soft tissue injuries. </li></ul><ul><li>Must be carefully examined because of their structural role. </li></ul>
  25. 25. <ul><li>A fracture is a break in a bone. </li></ul><ul><li>Stress fractures develop slowly and caused by overuse. </li></ul><ul><li>Classified as simple or compound fractures. </li></ul>
  26. 26. <ul><li>Signs and Symptoms; </li></ul><ul><li>intense pain </li></ul><ul><li>sound of a bone cracking </li></ul><ul><li>swelling and deformity </li></ul><ul><li>bruising and discoloration </li></ul><ul><li>loss of function </li></ul><ul><li>grating sound if moved </li></ul>
  27. 27. <ul><li>Simple or Closed </li></ul><ul><li>The bone is fractured </li></ul><ul><li>but there is no cut or wound at the </li></ul><ul><li>fracture site. </li></ul>
  28. 28. <ul><li>Compound or Open </li></ul><ul><li>A jagged end of the fractured bone protrudes through the skin or there is a cut near the fracture site but the bone does not penetrate the skin. </li></ul>
  29. 29. <ul><li>There are many different types of simple fractures they include; </li></ul><ul><li>greenstick (zig zag) </li></ul><ul><li>communited (broken into small pieces) </li></ul><ul><li>depressed (sunken) </li></ul><ul><li>oblique (diagonal) </li></ul><ul><li>spiral (corkscrew) </li></ul><ul><li>transverse (horizontal) </li></ul>Types of Fractures
  30. 30. <ul><li>Occurs when the fractured bone damages the local tissues, ie. the organ(s) which it protects. </li></ul><ul><li>For example, a lung punctured by a fractured rib. </li></ul>
  31. 31. <ul><li>Dislocation is the displacement of a bone at a joint. </li></ul><ul><li>Cause pain and deformity </li></ul><ul><li>Not a hard tissue injury technically as the bone is not damaged. </li></ul><ul><li>Damage occurs to ligaments which have been stretched or ruptured. </li></ul><ul><li>Bone actually comes out of the joint and remains out until it is physically reinserted. </li></ul>
  32. 32. <ul><li>Signs and symptoms of dislocation are; </li></ul><ul><li>deformity and swelling </li></ul><ul><li>pain and tenderness </li></ul><ul><li>loss of function </li></ul>
  33. 42. potentially between 30 – 50% of sports injuries are preventable
  34. 43. <ul><li>Human (54%) </li></ul><ul><ul><li>Muscle weakness and imbalance </li></ul></ul><ul><ul><li>Inadequate warm up and cool down </li></ul></ul><ul><ul><li>Spectators </li></ul></ul><ul><ul><li>Collision </li></ul></ul><ul><ul><li>Improper technique </li></ul></ul><ul><li>Terrain (31%) </li></ul><ul><ul><li>Uneven ground </li></ul></ul><ul><ul><li>Obstructions on grounds </li></ul></ul><ul><ul><li>Wet and/or slippery grounds </li></ul></ul><ul><li>Equipment (15%) </li></ul><ul><ul><li>Unsafe protective equipment </li></ul></ul><ul><ul><li>Inadequate, ill fitting protective equipment </li></ul></ul><ul><ul><li>Unpadded fixtures </li></ul></ul>
  35. 44. <ul><li>Warm Up </li></ul><ul><li>Athletes should warm up before all trainings and competitions as close to the commencement as possible. They should warm up with 5 – 10 minutes of light activity, stretching and specific skills of the sport – until they have a light sweat. </li></ul><ul><li>Warm up: </li></ul><ul><ul><li>Helps prepare the mind and body for exercise </li></ul></ul><ul><ul><li>Increases body and muscle temperature </li></ul></ul><ul><ul><li>Increases the blood and oxygen to the working muscles </li></ul></ul><ul><ul><li>Increases flexibility </li></ul></ul><ul><li>Stretching </li></ul><ul><li>Stretching should be performed during warm up and cool down and should follow ‘Guidelines for safe stretching’. </li></ul><ul><li>Stretching: </li></ul><ul><ul><li>Lengthens muscles so there is minimal strain during exercise </li></ul></ul><ul><ul><li>Reduces the risk of injury </li></ul></ul><ul><ul><li>Maintains flexibility so muscles can respond effectively during sporting activity </li></ul></ul>
  36. 45. <ul><li>Cool Down </li></ul><ul><li>Athletes should gradually reduce activity for 5 – 10 minutes following training or competition, followed by static stretching. </li></ul><ul><li>Cool down: </li></ul><ul><ul><li>Prevents pooling of the blood in the limbs, which can lead to dizziness and fainting </li></ul></ul><ul><ul><li>Aids the removal of waste products from the muscles eg lactic acid </li></ul></ul><ul><ul><li>Helps maintain flexibility </li></ul></ul><ul><ul><li>Enhances recovery </li></ul></ul><ul><ul><li>Reduces muscle soreness and stiffness </li></ul></ul><ul><li>Skill Development </li></ul><ul><li>The higher the skill level the lower the rate of injury, therefore skill development and technique is crucial. </li></ul>
  37. 46. <ul><li>Fitness </li></ul><ul><li>Fitness is important because it allows the athlete to perform at their best and assists in injury prevention. While injuries can occur at any time they are more likely to occur at the end of the sporting activity because the athlete is tire, less able to cope with physical demand and less capable of performing skills to an adequate level due to fatigue. </li></ul><ul><li>Components of fitness include: </li></ul><ul><ul><li>Cardiovascular endurance (heart and lungs delivering oxygen to the muscles over time) </li></ul></ul><ul><ul><li>Muscular endurance (muscles continuing work over an extended period of time) </li></ul></ul><ul><ul><li>Strength (muscles producing force against resistance) </li></ul></ul><ul><ul><li>Speed (to move as fast as possible) </li></ul></ul><ul><ul><li>Power (producing maximum force in the shortest time) </li></ul></ul><ul><ul><li>Flexibility (range of movement around a joint) </li></ul></ul>
  38. 47. Improving fitness: Involves the principle of overload, the body must work harder than it is used to, adapt to this higher level and then improve. This must be done gradually; therefore only one FITT factor should be increased at a time. F Frequency (number of session per day/week) I Intensity (how hard the exercise is performed) T Time (length of time at the intensity required) T Type (exercise must be specific to fitness component)
  39. 48. <ul><li>Rules of the game </li></ul><ul><li>Many rules are written for the safety of the game, therefore athletes should learn both the written and unwritten rules of the game. Coaches should emphasise good sportsmanship and fair play and discourage violence or dangerous techniques. </li></ul><ul><li>Sporting grounds/areas </li></ul><ul><li>Environments should be safe, be sure of the following: </li></ul><ul><ul><li>Level and firm </li></ul></ul><ul><ul><li>Free from obstructions eg sprinkler heads </li></ul></ul><ul><ul><li>Permanent fixtures should be padded, flexible and highly visible </li></ul></ul><ul><ul><li>Spectators should be well away from the playing areas </li></ul></ul><ul><ul><li>Adequate matting is provided where necessary </li></ul></ul><ul><ul><li>Have safe ground markings </li></ul></ul>
  40. 49. <ul><li>Equipment </li></ul><ul><li>Check equipment for: </li></ul><ul><ul><li>Properly erected/constructed </li></ul></ul><ul><ul><li>Stable or movable if necessary </li></ul></ul><ul><ul><li>Properly anchored </li></ul></ul><ul><ul><li>Padded as appropriate </li></ul></ul><ul><ul><li>Checked before being used, especially if supporting body weight </li></ul></ul><ul><li>Change rooms </li></ul><ul><li>Should be: </li></ul><ul><ul><li>Clean and tidy </li></ul></ul><ul><ul><li>Adequate size for the number of athletes using them </li></ul></ul><ul><ul><li>Have adequate soap, paper towel, rubbish bins, brooms, disinfectant available at all times. </li></ul></ul>
  41. 50. <ul><li>Protective equipment </li></ul><ul><li>Should be: </li></ul><ul><ul><li>Designed to protect against injury </li></ul></ul><ul><ul><li>Light and comfortable to wear </li></ul></ul><ul><ul><li>In good condition </li></ul></ul><ul><ul><li>Correctly assembled </li></ul></ul><ul><ul><li>Correctly worn by the athlete </li></ul></ul><ul><ul><li>An appropriate size and fit and not interfere with function </li></ul></ul><ul><ul><li>Appropriate for the sport and conditions encountered </li></ul></ul><ul><li>Taping and Bracing </li></ul><ul><li>Taping and bracing can help to reduce injury or the chance of injury by restricting the movement of the joint. It is effective in prevention and reducing the severity of injuries. </li></ul>
  42. 51. <ul><li>Fluid replacement </li></ul><ul><li>When exercising it is important to replace lost fluids, especially in the heat, otherwise it can lead to dehydration, fatigue, reduced performance, heat illness and even death. </li></ul><ul><li>When exercising in heat or humid conditions: take it easy, wear loose, light coloured clothing that permits air flow and drink before, during and after activity. </li></ul><ul><ul><li>Note: It is possible to become dehydrated in cooler conditions </li></ul></ul><ul><ul><li>Children and elderly are more susceptible to heat illness so must be closely monitored in hot and humid conditions. </li></ul></ul>
  43. 52. <ul><li>Sunshine </li></ul><ul><li>Australia’s harsh conditions, especially between 11 am and 3 pm can be harmful. The Australian Cancer Society recommends: </li></ul><ul><li>Slip on a shirt </li></ul><ul><li>Slop on some sunscreen </li></ul><ul><li>Slap on a hat </li></ul><ul><li>Wrap on a pair on sunglasses </li></ul><ul><li>Cold </li></ul><ul><li>When exercising in the cold consider the following: </li></ul><ul><ul><li>Plan properly and avoid long breaks </li></ul></ul><ul><ul><li>If long breaks occur re warm up </li></ul></ul><ul><ul><li>Wear warm clothing </li></ul></ul><ul><ul><li>Dress in layers to trap heat </li></ul></ul><ul><ul><li>The layer closest to the body should be a natural fibre (wool or cotton) </li></ul></ul><ul><ul><li>Cover heads, face and hands to reduce heat loss </li></ul></ul><ul><ul><li>Wear wind and waterproof outer clothing </li></ul></ul>
  44. 53. <ul><li>Appropriate management of existing illness/injury </li></ul><ul><li>When ill or injured an athlete should not train as it can cause tissue and organ damage and further damage to the injury. </li></ul><ul><li>Before returning to sports, athletes should ensure: </li></ul><ul><ul><li>The doctor or physio has given them clearance </li></ul></ul><ul><ul><li>The injured part has full range of movement </li></ul></ul><ul><ul><li>Injured area has full strength </li></ul></ul><ul><ul><li>The injured area is pain free </li></ul></ul><ul><ul><li>There is no inflammation of the injured area </li></ul></ul><ul><li>Personal Hygiene </li></ul><ul><li>Bathing reduces body odour, keeps skin healthy, is soothing to the skin, prevents chafing and prevents blocked pores. Hand washing reduces the risk of spreading infection or illness. This is important for the health of the athlete. </li></ul>
  45. 54. <ul><li>Group hygiene </li></ul><ul><li>Golden Rule </li></ul><ul><li>DO NOT </li></ul><ul><li>SHARE </li></ul><ul><li>DO NOT share towels, razors, sponges, face washers, water bottles or any other equipment that may contain body fluids </li></ul><ul><li>Discourage communal bathing areas such as spas </li></ul><ul><li>Ban spitting or urinating in team areas </li></ul><ul><li>Do not put hands in water buckets </li></ul><ul><li>Proper use of water bottles, nozzle should not touch the lips </li></ul><ul><li>All clothes, equipment and surface areas contaminated by blood must be treated as potentially infectious and treated accordingly </li></ul><ul><li>All athletes should be vaccinated against Hep B </li></ul><ul><li>All group areas should be dry and clean with adequate supplies of cleaning products. </li></ul>
  46. 55. <ul><li>Balanced competition </li></ul><ul><li>Competitions should not simply by age groups, try to balance through: </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Size </li></ul></ul><ul><ul><li>Strength </li></ul></ul><ul><ul><li>Skill </li></ul></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Disability </li></ul></ul><ul><ul><li>Height </li></ul></ul><ul><ul><li>Weight </li></ul></ul><ul><li>Common Sense </li></ul><ul><li>Tells you it is far better to prevent than manage!!!! </li></ul>
  47. 56. <ul><li>S STOP T TALK O OBSERVE P PREVENT FURTHER INJURY Severe injury – get help Less severe – RICER regime Minor injury – play on </li></ul>
  48. 57. <ul><li>T TALK </li></ul><ul><li>O OBSERVE </li></ul><ul><li>T TOUCH </li></ul><ul><li>A ACTIVE MOVEMENT </li></ul><ul><li>P PASSIVE MOVEMENT </li></ul><ul><li>S SKILL TEST </li></ul>
  49. 58. TYPE CAUSE INJURY ACUTE INJURIES Injuries that occur from a known, or sometimes unknown incident. Symptoms and signs develop rapidly. (i) Bruise (haematoma) Direct force applied to the body, such as being hit or kicked, or making contact with player, implement etc. Compression of soft tissue, resulting in damage to soft tissue and bleeding into the tissue eg bruise (haematoma) May bruise any soft tissue (muscle, skin & fat, periosteum) (ii) Sprain Joint is forced beyond its normal range of motion <ul><li>Ligament fibres are torn </li></ul><ul><li>Categorised according to severity </li></ul><ul><li>First degree (mild) – very few fibres are torn </li></ul><ul><li>Second degree (moderate) large number of fibres are torn </li></ul><ul><li>Third degree (severe) –a complete rupture of the ligament </li></ul>(iii) Strain Muscle is overstretched or contracts too quickly <ul><li>The muscle and/or tendon fibres </li></ul><ul><li>are torn. </li></ul><ul><li>Categorised according to severity </li></ul><ul><li>First degree </li></ul><ul><li>Second degree </li></ul><ul><li>Third degree </li></ul>OVERUSE INJURIES Injuries that develop over a period of time. Symptoms and signs develop slowly i. continual, repetitive movements Inflammation and pain eg bursitis ii. Repeating the movement following a minor acute injury which was not noted and which is then aggravated by the repeated action. Repeated stress and microtrauma to soft tissue eg shin splints, tennis elbow
  50. 59. <ul><li>Minimise tissue damage </li></ul><ul><li>Minimise inflammation </li></ul><ul><li>Prevent further tissue damage </li></ul><ul><li>Early and efficient removal of blood clot and tissue swelling </li></ul><ul><li>Minimise scarring of damaged tissue </li></ul><ul><li>Regain full function before returning to play </li></ul><ul><li>Enable the doctor or physiotherapist to make an early diagnosis because the swelling will be less </li></ul><ul><li>Reduce rehabilitation time </li></ul><ul><li>Minimise the seriousness of the injury </li></ul><ul><li>Allow rehabilitation to begin sooner </li></ul><ul><li>Allow early and complete return to sport </li></ul>
  51. 60. <ul><li>R REST </li></ul><ul><li>I ICE </li></ul><ul><li>C COMPRESSION </li></ul><ul><li>E ELEVATION </li></ul><ul><li>R REFER AND RECORD </li></ul>
  52. 61. <ul><li>R – Rest the athlete </li></ul><ul><li>How – remove athlete from the field without further damaging and rest from the activity causing the injury </li></ul><ul><li>Why – movement will increase blood flow to the injured site, may cause blood clots to dislodge & begin bleeding again and may cause further damage </li></ul>
  53. 62. I – Ice applied to the injury Apply ice directly over the injured site and surrounding tissue for 20 – 30 minutes every 2 hours, How – in a wet towel or plastic bag, in a frozen cup of water continuously moving over the site (ice massage) or a freezer gel bag with a wet towel between the pack and the skin Why – Ice decreases swelling and pain Remember – check the athlete and move the ice around to avoid; cooling too fast, superficial tissues cooling and not deeper areas and oversensitivity to ice. Reassure that the initial cold pain will subside and do not apply ice direct to the skin to avoid ice burns. Do not apply ice to – diabetics, persons with cardiovascular or circulation problems, persons with Raynaud’s phenomenon and other diseases, special body area eg eyes.
  54. 63. <ul><li>A procedure employing the application of ice or cold in the management of an injury </li></ul><ul><li>Effects </li></ul><ul><li>Vasoconstriction </li></ul><ul><ul><li>Reduced Blood Flow </li></ul></ul><ul><ul><li>Reduced Swelling and Haemotoma </li></ul></ul><ul><ul><li>Reduced Inflammatory response </li></ul></ul><ul><ul><li>Speeds up Recovery </li></ul></ul><ul><ul><li>Improves Healing </li></ul></ul><ul><li>Reduced Nerve Conduction </li></ul><ul><ul><li>Reduced muscle spasm </li></ul></ul><ul><ul><li>Reduced pain </li></ul></ul><ul><li>Stages of Sensation </li></ul><ul><ul><li>Initial coldness of ice </li></ul></ul><ul><ul><li>Warming sensation </li></ul></ul><ul><ul><li>Aching in the injured area </li></ul></ul><ul><ul><li>Numbness </li></ul></ul><ul><li>Methods of Application </li></ul><ul><ul><li>Ice packs </li></ul></ul><ul><ul><li>Gel packs </li></ul></ul><ul><ul><li>‘ Cryo-Cuff’ </li></ul></ul><ul><ul><li>Ice bucket </li></ul></ul><ul><ul><li>Ice massage </li></ul></ul><ul><ul><li>Vapo-coolant spray </li></ul></ul>
  55. 64. <ul><li>C – Compression applied to the injury </li></ul><ul><li>How – apply a firm, elastic, non-adhesive bandage over the ice pack to hold it in place and provide compression </li></ul><ul><li>Why – reduces swelling and bleeding at the injury site </li></ul><ul><li>Remember – look for numbness, tingling, coldness and pale blue skin when compressing as these are signs that the bandaging is too tight. Reapply not as tight and once ice is completed reapply a dry bandage. </li></ul>
  56. 65. <ul><li>E – Elevate the injured area </li></ul><ul><li>How – raise the injured area above the level of the heart wherever possible (when applying ice, when at home, between rehabilitation exercises) </li></ul><ul><li>Why – elevation decreases bleeding, swelling and pain </li></ul><ul><li>R – Refer and record </li></ul><ul><li>How – refer to a health care professional for diagnosis and management, record observations, assessment and initial management </li></ul><ul><li>Why – to obtain an accurate and definitive diagnosis and for continuing management and rehabilitation. </li></ul>
  57. 66. <ul><ul><li>NO </li></ul></ul><ul><ul><li>H HEAT </li></ul></ul><ul><ul><li>A ALCOHOL </li></ul></ul><ul><ul><li>R RUNNING OR EXERCISING </li></ul></ul><ul><ul><li>M MASSAGE </li></ul></ul>
  58. 67. <ul><li>H – Heat </li></ul><ul><li>Such as sauna spa, hot water bottle, hot shower and baths, hot liniment rubs as it increases the bleeding to the area. </li></ul><ul><li>A – Alcohol </li></ul><ul><li>As it increases swelling </li></ul><ul><li>R – Running </li></ul><ul><li>Any exercise too soon can make the injury worse </li></ul><ul><li>M – Massage </li></ul><ul><li>Any use of massage and heat rubs in the first 48 – 72 hours increases swelling and bleeding and disrupts the healing process. </li></ul>
  59. 68. When soft tissue is injured, it becomes inflamed but responds by activating a self-healing process. This is referred to as the inflammatory response and may last up to three or four days after the injury occurs, depending on the extent of the damage. The injury will progress through the following phases as part of the healing process.
  60. 69. <ul><ul><ul><li>pain, redness and swelling around the injured area </li></ul></ul></ul><ul><ul><ul><li>loss of function and mobility </li></ul></ul></ul><ul><ul><ul><li>damage to cells and surrounding tissues </li></ul></ul></ul><ul><ul><ul><li>increased blood flow to the area </li></ul></ul></ul><ul><ul><ul><li>leakage of fluid causing swelling (oedema) </li></ul></ul></ul><ul><ul><ul><li>the formation of many blood vessels to promote healing. </li></ul></ul></ul>
  61. 70. <ul><ul><ul><li>the elimination of debris </li></ul></ul></ul><ul><ul><ul><li>the formation of new fibres </li></ul></ul></ul><ul><ul><ul><li>production of scar tissue </li></ul></ul></ul>
  62. 71. <ul><ul><ul><li>increased production of scar tissue </li></ul></ul></ul><ul><ul><ul><li>replacement tissue that needs to strengthen and develop in the direction that the force is applied. The type of remodelling varies according to the timing and degree of mobilisation of the injury. Excessive exercise too early will cause further damage. Too little exercise will allow large quantities of scar tissue to form, which lacks strength and flexibility. </li></ul></ul></ul>
  63. 72. <ul><ul><ul><li>reduce swelling </li></ul></ul></ul><ul><ul><ul><li>prevent further damage </li></ul></ul></ul><ul><ul><ul><li>ease pain. in the long term, treatment aims to: </li></ul></ul></ul><ul><ul><ul><li>restore flexibility </li></ul></ul></ul><ul><ul><ul><li>regain full function </li></ul></ul></ul><ul><ul><ul><li>prevent recurrence </li></ul></ul></ul><ul><ul><ul><li>return the player to the field as soon as possible. </li></ul></ul></ul>
  64. 73. The Three Phases of Healing
  65. 74. <ul><li>This diagram shows the three phases of the repair response, which can be applied to the healing of tissue in general. It also shows the cells involved in the healing process. </li></ul>Intensity of Response Injury Repair Phase Remodelling Phase 0 3d 4d 11days 6 weeks 6 months
  66. 75. <ul><li>0 days – Erythrocytes and Megakaryocytes – Platelets PDGF, MDGF etc. </li></ul><ul><li>0 – 1 days – Polymorphonuclear leucocytes, monocytes, lymphocytes, mast cells and macrophages </li></ul><ul><li>2 days – Fibroblasts </li></ul><ul><li>4 days – Endothelial cells (EDGF) </li></ul><ul><li>11 days – Microfibroblasts </li></ul>
  67. 76. <ul><li>Cell necrosis occurs immediately following injury </li></ul><ul><li>Blood capillary rupture leads to haemorrhage and leakage of plasma </li></ul><ul><li>Vasoconstriction occurs within 5 – 10 minutes followed by vasodilation </li></ul><ul><li>Lymphatic capillaries are also ruptured leading to fluid leakage into the area </li></ul><ul><li>Clotting agents block both the blood and lymphatic capillaries, which prevents any drainage from the area </li></ul><ul><li>Combination of vasodilation, fluid leakage and cessation of fluid drainage leads to redness, swelling and heat </li></ul><ul><li>Pain is due to tissue pressures as well as release of chemicals </li></ul><ul><li>These chemicals also attract a rapid accumulation of certain leukocytes, lymphocytes and macrophages into the injured area </li></ul><ul><li>Macrophages are essential for the progression of the repair process due to their phagocytic properties and the releasing of further fibroblast growth factors, which are essential to the next phase </li></ul>
  68. 77. <ul><li>Proliferation of Capillaries and Connective tissue </li></ul><ul><li>Formulation of granulation tissue containing budding capillaries and fibroblasts. This can be seen in open wounds and is destined to become scar tissue. </li></ul><ul><li>Collagen (Type III) causes wound contraction </li></ul><ul><li>Scar tissue changes the material properties of the tissue, especially in ligaments and tendons where target collagen fibrils determine the tensile strength </li></ul><ul><li>Collagen (I) is orientated in parallel bundles – this forms the classic collagen ‘crimp’ </li></ul>
  69. 78. <ul><li>Myofibroblasts (contains actin proteins), interact with the newly laid down collagen fibrils and continue contraction of the collagen fibril framework </li></ul><ul><li>They also reorientate the collagen fibrils in the direction of loading, especially during ligament repair </li></ul><ul><li>Collagen maturation continues and cell numbers decrease within the tissue </li></ul><ul><li>Early motion of ligament as opposed to immobilisation appears to send mechanical signals to the fibroblasts at this stage to assist in the remodelling process </li></ul><ul><li>This process is the removal of early poorly orientated collagen fibrils and the deposition of new collagen fibres in the direction of loading </li></ul>
  70. 79. <ul><li>The major objective is – </li></ul><ul><li>Minimise movement of the injured body part by: </li></ul><ul><ul><li>Immobilising the joint above the fracture </li></ul></ul><ul><ul><li>Immobilising the joint below the fracture </li></ul></ul><ul><ul><li>Support the injured area using a splint or sling </li></ul></ul><ul><li>Immobilise and support the injured area using a splint or sling </li></ul><ul><li>Where an ambulance is close at hand (less than 45 minutes), it is recommended that fractures be managed in the position found to prevent further damage. This can be achieved with padding rather than splinting. </li></ul><ul><li>Check for signs of impaired circulation </li></ul><ul><li>Seek qualified help </li></ul><ul><li>Arrange transport to the hospital </li></ul><ul><li>‘ RICER’ regime and NO ‘HARM’ if appropriate for the injury and if it does not aggravate the pain. </li></ul>
  71. 80. <ul><li>Splinting: </li></ul><ul><li>Choose an appropriate splint – the body, the other limb, a smooth, firm object long enough to extend beyond the joint above and below the fracture </li></ul><ul><li>Pad the splint at the sites of contact and any hollows </li></ul><ul><li>Tie the splint to the injured limb above and below the fracture </li></ul><ul><li>Immobilise the joints above and below the fracture by tying the splint at those joints </li></ul><ul><li>Immobilise the fracture site and provide further support by bandaging above and below the fracture </li></ul><ul><li>Check for signs of impaired circulation </li></ul><ul><li>Air splint: </li></ul><ul><li>An air splint is easy to apply, provides support and is comfortable. However, they can leak, are often not returned to medical clinics, are difficult to re-clean and sterilise, can impair circulation if inflated too much and do not support upper arm or upper leg injuries. </li></ul><ul><li>If they are used carefully place the injured limb in the splint, do up the zipper, inflate until firm (ensuring you can touch the limb through the splint) and check circulation and sensation. </li></ul><ul><li>Slings: </li></ul><ul><li>Low arm sling – provides support for the forearm and maintains it in a horizontal position </li></ul><ul><li>High arm sling – provides support for the arm and elevates the forearm </li></ul><ul><li>Improvisation – proper slings are best but improvising is an alternative </li></ul><ul><li>Knots – when bandages and slings are being used, use reef knots as they do not tighten and can be quickly released. </li></ul>
  72. 81. <ul><li>The management of a dislocation is the same as that of a fracture. </li></ul><ul><li>The management of a dislocation involves the following steps: </li></ul><ul><ul><ul><li>Immobilise and support the injured area using a splint or sling </li></ul></ul></ul><ul><ul><ul><li>Check for signs of impaired circulation </li></ul></ul></ul><ul><ul><ul><li>Seek qualified help </li></ul></ul></ul><ul><ul><ul><li>Arrange transport to the hospital </li></ul></ul></ul><ul><ul><ul><li>‘ RICER’ regime and NO ‘HARM’ if appropriate for the injury and if it does not aggravate the pain. </li></ul></ul></ul><ul><li>Due to the deformity associated with dislocations: </li></ul><ul><ul><li>pad the injury to the body, other limb or splint before being tied for immobilisation </li></ul></ul><ul><ul><li>It may not be possible to effectively immobilise some dislocations, therefore allow the athlete or support person to keep the injured area in the position of most comfort, and then pad appropriately. </li></ul></ul>
  73. 82. <ul><li>Common dislocations: </li></ul><ul><ul><li>Shoulder – are common because of the structure of the joint, first time dislocations may have fractures and nerve damage. Refer to a doctor for relocation – DO NOT ATTEMPT THE RELOCATION. </li></ul></ul><ul><ul><li>Fingers – may be associated with fractures, refer to a doctor for relocation. </li></ul></ul><ul><ul><li>Patella – are not overly common but occur more often in teenage athletes, some relocate spontaneously as the muscle spasm relaxes, however they still require medical attention. </li></ul></ul><ul><li>Why not to relocate a dislocation: </li></ul><ul><ul><li>The potential for fractures to exist </li></ul></ul><ul><ul><li>The muscles that cross the joint usually go into very forceful spasm, thus anaesthetic is often needed for relocation </li></ul></ul><ul><ul><li>The damage to ligaments or impingement of nerves </li></ul></ul>
  74. 83. <ul><li>Common complications associated with dislocations: </li></ul><ul><li>The potential complications are the same as a fracture and also include: </li></ul><ul><ul><li>Bleeding – there may be bleeding in the joint </li></ul></ul><ul><ul><li>Possible fractures – sometimes the inability to move the joint is due to a fracture not the dislocation. Hence all dislocations should be immobilised, supported and not moved/relocated without x-ray. </li></ul></ul><ul><ul><li>Ligament damage – dislocation usually results in torn or ruptured ligaments around the joint and/or reduced stability at the joint, which may cause the joint to be more prone to further dislocations. </li></ul></ul><ul><li>ALL DISLOCATIONS MUST BE REFERRED FOR PROPER ASSESSMENT AND FOLLOW UP. </li></ul>
  75. 84. Diagnostic Tests
  76. 85. <ul><li>Most useful in assessing bony injuries and joint dislocations </li></ul><ul><li>Provide a general view of an injury </li></ul><ul><li>Painless, patient remains still for a few seconds </li></ul>
  77. 88. <ul><li>Assesses joint injuries </li></ul><ul><li>Involves injection of a dye into a joint followed by an X-ray </li></ul>
  78. 89. Radiography equipment
  79. 91. <ul><li>Allows cross-sectional and ‘up close’ assessment of bone, soft tissue and calcified areas </li></ul><ul><li>Assists in identifying small fractures and bone fragments within joints </li></ul><ul><li>Best suited to anatomically complex regions such as the spine, shoulder, hip and ankle joint </li></ul><ul><li>CT Arthrogram (as per arthrogram) </li></ul><ul><li>Uses CT scanning to closely assess a joint </li></ul>
  80. 93. Figure 1 shows a computed tomography (CT) scan of two normal kidneys, looking from the top of the head down. Figure 2 shows a CT scan of two kidneys that are much smaller and misshapen because of chronic kidney disease.
  81. 94. <ul><li>Allows cross-sectional assessment of soft tissue and hard tissue </li></ul><ul><li>A magnetic field around the injured site causes all joint structures to be displayed in varying shades </li></ul><ul><li>Provides most complete view of the internal structure of the body. (disease detection, joints, soft tissues, and bones of the body </li></ul>
  82. 96. Side views of the knee show the normal location of the outside, or lateral, meniscus (see fig.1) and a meniscus that has been torn and moved (see fig. 2).
  83. 97. <ul><li>Use a dye that seeks out and attached to new bone forming cells (osteoblasts) </li></ul><ul><li>Useful for assessing bony or joint injuries </li></ul><ul><li>Dye is injected into arm 3-4hrs before scan </li></ul>
  84. 100. <ul><li>Use sound waves to assess soft tissues, especially muscles and tendons </li></ul><ul><li>Most commonly used to assess large tendons (e.g. Achilles, Patella, Rotator Cuff) </li></ul>
  85. 103. <ul><li>Assess the pressure in muscle compartments at rest and during exercise </li></ul><ul><li>Involves placing a catheter in the compartment while area is under anaesthetic. Catheter is attached to a manometer which measures the pressure </li></ul><ul><li>Most common in the lower legs </li></ul>
  86. 104. <ul><li>Rehabilitation of an athlete is to ‘return the athlete to the previous level of fitness, skill and competition’. </li></ul><ul><li>Rehabilitation: </li></ul><ul><ul><li>Begins during the definitive care of an injury </li></ul></ul><ul><ul><li>Continues through to prevention of further injuries </li></ul></ul><ul><ul><li>Is based on the ‘SAID’ principle </li></ul></ul><ul><li>S Specific </li></ul><ul><li>A Adaptation to </li></ul><ul><li>I Imposed </li></ul><ul><li>D Demands </li></ul><ul><ul><li>The more you do something the easier it becomes, provided there is no pain </li></ul></ul><ul><ul><li>Practice must be perfect and specific to the requirements of the athlete to achieve progress </li></ul></ul><ul><ul><li>As the skills become easier, progress to a more difficult task, until it becomes easy, and then progress again. </li></ul></ul><ul><li>Rehabilitation programs are generally set by a doctor or physiotherapist. </li></ul>
  87. 105. <ul><li>END OF POWERPOINT </li></ul>