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Chapter 3


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Chapter 3

  1. 1. Chapter 3 Injuries and the Healing Process The Inflammation Process
  2. 2. The Inflammation Process
  3. 3. The Inflammation Process <ul><li>When an athletic Injury occurs, whether it is a strain, sprain, contusion, or open wound, the body immediately begins a process that eventually results in healing </li></ul>
  4. 4. The Inflammation Process <ul><li>Healing: The process where the body repairs </li></ul><ul><li>damaged tissue. </li></ul><ul><li>Inflammation: One component of the healing </li></ul><ul><li>process, where the body </li></ul><ul><li>begins to repair itself. </li></ul>
  5. 5. Inflammation <ul><li>In an acute injury (Acute = 1 st 24 Hours) </li></ul><ul><li>Examples – muscle strain or ligament sprain </li></ul><ul><li>tissue is torn, capillaries are damaged, and cells die because of the interference in the blood and oxygen supply. </li></ul>
  6. 6. Inflammation <ul><li>In response to the injury, the body reacts by sending specialized cells into the injured area in an attempt to limit damage and to begin healing. </li></ul><ul><ul><li>One function of these cells is the initiation of blood clotting. </li></ul></ul><ul><ul><li>To limit the size of the damage area, the body reacts by contracting muscles in the injured area. Natural splint </li></ul></ul>
  7. 7. Body’s Response <ul><li>Pain – Caused by increase pressure on </li></ul><ul><li>nerve endings (internal hemorrhage) </li></ul><ul><li>Swelling – (edema) the accumulation of </li></ul><ul><li>fluids in the damaged area. </li></ul><ul><ul><li>Hemorrhage (bleeding), lymph fluid, and synovial fluid contribute to swelling. </li></ul></ul><ul><ul><li>Gravity an issue as well. </li></ul></ul>
  8. 8. Body’s Response <ul><li>Redness/Heat due to the increase in blood flow to the area. </li></ul><ul><ul><li>Body’s attempts to provide the injury site with nutrients for repair. </li></ul></ul><ul><li>Loss of Function – the inability to utilize the </li></ul><ul><li>injured anatomical </li></ul><ul><li>structure. </li></ul>
  9. 9. Body’s Response <ul><li>Before healing can occur the removal of unwanted items from the injured area recedes rebuilding. </li></ul><ul><ul><li>Dead Cells </li></ul></ul><ul><ul><li>Removed by the circulatory and lymphatic system. </li></ul></ul><ul><li>Then oxygen rich blood with nutrients can enter the area. </li></ul><ul><ul><li>Now we have an ideal area for the formation of replacement tissue. </li></ul></ul><ul><ul><li>Result is a scar. </li></ul></ul>
  10. 10. 3 Phases of Healing <ul><li>Inflammation (2 to 4 Days) </li></ul><ul><li>Signs: Redness & swelling </li></ul><ul><li>2. Initial repair phase (about 2 weeks) </li></ul><ul><ul><li>Laying down scar tissue; need to break down ASAP, b/c it is tough and once it sets up it will not process the characteristics of muscle, ligament or tendon. </li></ul></ul>
  11. 11. 3 Phases of Healing <ul><li>Regeneration Phase (up to one year) </li></ul><ul><ul><li>The goal would be to replace all damaged tissue with new and healthy tissue. </li></ul></ul>
  12. 12. Vital Signs <ul><li>Those measures that monitor life. </li></ul><ul><ul><li>Examples are heart rate, breathing, pulse </li></ul></ul><ul><li>Vital signs are evaluated during the primary survey and monitored throughout the entire evaluation and initial treatment. </li></ul>
  13. 13. Vital Signs PULSE <ul><li>Adult 60 – 80 beats per minute </li></ul><ul><li>Child 80 – 100 beats per minute </li></ul><ul><li>A rapid but weak pulse could indicate sgock, bleeding, diabetic coma, and/or heat exhaustion. </li></ul><ul><li>A rapid or strong pulse could indicate heat stroke and/or severe fright </li></ul>
  14. 14. Vital Signs PULSE <ul><li>A strong but slow pulse; suspect a skull fracture and/or stroke. </li></ul><ul><li>No pulse = cardiac arrest and/or death. </li></ul>
  15. 15. Vital Signs PULSE <ul><li>Radial Pulse </li></ul><ul><li>(radial artery) </li></ul><ul><li>Carotid artery </li></ul>
  16. 16. Vital Signs RESPIRATION <ul><li>Adult 12 – 20 Breaths per minute </li></ul><ul><li>Child 20 – 25 Breaths per minute </li></ul><ul><li>Breathing that is shallow usually indicates shock. </li></ul><ul><li>Irregular or gasping breath could be cardiac related. </li></ul><ul><li>Frothy blood from the mouth can indicate a chest fracture usually upper chest. </li></ul><ul><li>Measure by watching, feeling, and counting the rise and fall of the chest. </li></ul>
  17. 17. Vital Signs Temperature <ul><li>Oral 98.6 Degrees </li></ul><ul><li>Rectal 99.6 (ok get it out of Your system) </li></ul><ul><li>Axillary 97.6 </li></ul>
  18. 18. Vital Signs Temperature <ul><li>Hot, dry skin usually indicates disease, infection, and/or over exposure to environmental heat. </li></ul><ul><li>Cool, clammy skin is an indicator of shock, and/or heat exhaustion. </li></ul><ul><ul><li>Also over exposure to cold is displayed as cool, dry skin. </li></ul></ul>
  19. 19. Vital Signs Skin Color <ul><li>Red skin indicates heat stroke, diabetic coma, and/or high blood pressure. </li></ul><ul><li>White (pale) skin means insufficient circulation, shock, fright, hemorrhage, heat exhaustion. </li></ul><ul><li>Blue (cyanotic) skin indicates blood is poorly oxygenated. </li></ul>
  20. 20. Vital Signs Skin Color <ul><li>A non-white athlete will show pale skin on inner lip, gum area, and/or finger beds. </li></ul>
  21. 21. Vital Signs Pupils <ul><li>Constricted – Sunlight </li></ul><ul><li>Dilated – Dark Room or Unequal </li></ul>
  22. 22. Vital Signs Pupils <ul><li>In Trauma: </li></ul><ul><li>Constricted Pupils usually indicate injury to the central nervous system and/or intake of a depressant drug. </li></ul><ul><li>Dilated Pupils (1 or both) could indicate head injury, shock, heat stroke, hemorrhage, and/or intake of a stimulant drug. </li></ul>
  23. 23. Vital Signs Pupils <ul><li>When pupils fail to accommodate to light or are unequal this could indicate brain injury, intake of alcohol, or drug poisoning. </li></ul><ul><li>PEARL </li></ul><ul><li>Pupils Equal And Reactive to Light </li></ul>
  24. 24. Vital Signs LOC <ul><li>Level of Consciousness </li></ul><ul><li>3 Items to Review </li></ul><ul><li>Mental awareness </li></ul><ul><li>Memory or the ability to recall </li></ul><ul><li>Respond to Commands </li></ul><ul><li>Also Known As – AVPU - Alert, Verbal, Responds to Pain, and Unresponsive. </li></ul>
  25. 25. Vital Signs Movement <ul><li>Classified into 4 Patterns: </li></ul><ul><li>Active – Athlete provides movement </li></ul><ul><li>Passive – ATC moves the body part </li></ul><ul><li>Assistive ATC helps the athlete with movement </li></ul><ul><li>Resistive ATC provides resistance/force to oppose movement of the body part. </li></ul>
  26. 26. Vital Signs Abnormal Nerve Stimulation <ul><li>Always check for: </li></ul><ul><li>Motor – movement / contract area </li></ul><ul><li>Sensory – feeling / distinguish the quality of </li></ul><ul><li>sensation. </li></ul><ul><li>Help determine if an area has nerve damage. </li></ul>
  27. 27. Vital Signs Blood Pressure <ul><li>120 / 80 Normal BP in a Health Adult </li></ul><ul><li>Systolic Pressure – Heart contracts (High #) </li></ul><ul><li>Diastolic Pressure – Heart relaxes (Low #) </li></ul>
  28. 28. Ice vs. Heat <ul><li>When treating an injury the selection of ice or heat as a modality is critical. </li></ul><ul><li>Normal protocol is the first 24 to 72 hours. </li></ul><ul><li>Always re-evaluate to determine staus of injury </li></ul>
  29. 29. Ice: Physiological Changes <ul><li>Reduce Swelling and Inflammation </li></ul><ul><li>Reduce Blood Flow to the Injury site </li></ul><ul><ul><li>Vasoconstrictor </li></ul></ul><ul><li>Reduce pain @ the injury site </li></ul>
  30. 30. Cryotherapy <ul><li>Cold Therapy </li></ul><ul><li>Types: </li></ul><ul><ul><li>Cold Packs: Initial first aid or follow-up treatments. </li></ul></ul><ul><ul><ul><li>Treatment time 10 to 15 min. </li></ul></ul></ul><ul><ul><ul><li>Especially when using commercial ice packs use a barrier, like a towel, flexi-wrap, etc. </li></ul></ul></ul><ul><ul><ul><li>Prevents frostbite/chemical burns </li></ul></ul></ul>
  31. 31. Cryotherapy <ul><li>Ice Massage </li></ul><ul><ul><li>A Technique of rubbing ice over an injured area. </li></ul></ul><ul><ul><li>Treatment time 5 – 10 minutes depending on the depth & severity of the injury. </li></ul></ul><ul><ul><li>Move cup continuously </li></ul></ul><ul><ul><li>Eric suggest using biofreeze to assist in comfort. Helps ice slide on the skin. </li></ul></ul>
  32. 32. Cryotherapy <ul><li>Cold Whirlpool/Cold Water Immersion (Ice Bucket) Combines Conduction & Convection </li></ul><ul><ul><li>Water Temp should be 50 – 60 degrees F. </li></ul></ul><ul><ul><li>Treatment time 5 to 15 min. </li></ul></ul><ul><ul><li>Supervise! </li></ul></ul><ul><ul><li>Place a barrier around the extremity (toe guard) </li></ul></ul><ul><ul><li>One disadvantage is that extremity is not elevated. </li></ul></ul>
  33. 33. Cryotherapy <ul><li>Cold Spray (ethyl chloride) </li></ul><ul><ul><li>Spray for no more than 10 seconds </li></ul></ul><ul><ul><li>Immediate reduction to pain </li></ul></ul><ul><ul><li>Effective for superficial injuries. </li></ul></ul><ul><ul><li>Cools only the surface. </li></ul></ul><ul><ul><li>Treat: </li></ul></ul><ul><ul><ul><li>contusions, muscle spasms??? </li></ul></ul></ul><ul><ul><ul><li>Spray & Stretch </li></ul></ul></ul>
  34. 34. Heat Physiological Changes <ul><li>Increase Blood Flow to the Injured Area </li></ul><ul><li>Reduced Muscle Stiffness </li></ul><ul><li>Muscular Relaxation </li></ul>
  35. 35. Heat <ul><li>Hot Packs </li></ul><ul><ul><li>Pre-Heated Commercial packs (hydroculator) </li></ul></ul><ul><ul><ul><li>Cover with Towel / Teri Cloth </li></ul></ul></ul><ul><ul><li>Wet Towel with Hot Water </li></ul></ul><ul><ul><ul><li>Wet Towel with water & Microwave (Be Careful!) </li></ul></ul></ul><ul><li>Used in addition to proper warm-up & stretching </li></ul>
  36. 36. Heat <ul><li>Hot Whirlpool </li></ul><ul><ul><li>Similar to Cold Whirlpool </li></ul></ul><ul><ul><ul><li>Conduction + Convection </li></ul></ul></ul><ul><ul><li>Used in conjunction with ROM exercise </li></ul></ul><ul><ul><ul><li>Alphabet with toe for lower extremity injuries. </li></ul></ul></ul>
  37. 37. <ul><li>Contrast Bath </li></ul><ul><li>A follow-up treatment that combines hot & cold water immersion. </li></ul><ul><li>Some injuries with significant swelling respond to alternation of cold and heat. </li></ul>Contrast
  38. 38. Exercise <ul><li>Often overlooked as a treatment. </li></ul><ul><li>My philosophy as well “active healing” </li></ul><ul><li>Increases circulation more efficiently than any modality. </li></ul><ul><li>Maintain strength & flexibility / ROM </li></ul>
  39. 39. Therapeutic Modalities <ul><li>Various electrical modalities are used to decrease pain, swelling, and muscle spasms. </li></ul><ul><li>May be utilized with therapeutic exercise by decreasing pain swelling and enhancing ROM, strength, & flexibility </li></ul>
  40. 40. Therapeutic Modalities <ul><li>Consist of heat, cold, light, air, water, massage, & electricity. </li></ul><ul><li>Considerations: </li></ul><ul><li>Tissue targeted </li></ul><ul><li>Desired treatment (reduce swelling/pain) </li></ul><ul><li>Indications vs. Contraindications </li></ul>
  41. 41. Therapeutic Modalities <ul><li>Examples: </li></ul><ul><li>Ultrasound </li></ul><ul><li>Electrical Stimulation </li></ul><ul><li>Shortwave & Microwave </li></ul><ul><li>Diathermy </li></ul><ul><ul><li>Electrodes and other instruments are used to transmit electric current to surface structures, thereby increasing the local blood circulation and facilitating and accelerating the process of absorption and repair </li></ul></ul>
  42. 42. Therapeutic Modalities <ul><li>Ultraviolet Therapy </li></ul><ul><li>Laser </li></ul>
  43. 43. Therapeutic Modalities <ul><li>Massage </li></ul><ul><li>Friction causes increases in temps of tissue. </li></ul><ul><li>Causes increase circulation </li></ul><ul><li>Considered a heat treatment </li></ul><ul><ul><li>Used to break down adhesions & scar tissue </li></ul></ul><ul><ul><li>Relax muscle spasm </li></ul></ul><ul><ul><li>Can assist the body in removal of toxins </li></ul></ul><ul><ul><li>Also used together with stretching & exercise </li></ul></ul>
  44. 44. Therapeutic Modalities <ul><li>Counterirritants </li></ul><ul><li>Substances when applied to the skin, cause a reaction </li></ul><ul><li>Provides a perception of warmth that is stronger than minor pain. </li></ul><ul><ul><li>Flex-all, Ben Gay, BioFreeze, etc. </li></ul></ul><ul><ul><li>Does not do anything to heal an injury </li></ul></ul>
  45. 45. Therapeutic Modalities <ul><li>Joint Mobilization </li></ul><ul><li>Improves joint mobility by restoring accessory movement. </li></ul>
  46. 46. Acute vs. Chronic <ul><li>Acute – Quick onset, short duration </li></ul><ul><ul><li>Use PRICES protocol </li></ul></ul><ul><li>Chronic – Longer duration, repeating </li></ul><ul><ul><li>Use PRICES in conjunction with exercise and other modalities. </li></ul></ul>
  47. 47. Physical Rehabilitation <ul><li>Goal – to return the injured athlete to </li></ul><ul><li>pre-injury levels. </li></ul>
  48. 48. Physical Rehabilitation <ul><li>Improve Safely: </li></ul><ul><li>Strength </li></ul><ul><li>Power </li></ul><ul><li>Endurance </li></ul><ul><li>Flexibility </li></ul><ul><li>Confidence </li></ul>
  49. 49. Physical Rehabilitation <ul><li>Focus: </li></ul><ul><li>Injured body part </li></ul><ul><li>Prevent deconditioning </li></ul><ul><li>Communication </li></ul><ul><ul><li>Athlete / Parents </li></ul></ul><ul><ul><li>Coach </li></ul></ul><ul><ul><li>Physician </li></ul></ul>
  50. 50. Physical Rehabilitation <ul><li>Concerns: </li></ul><ul><li>Maintain Motivation </li></ul><ul><li>While restrain athlete from trying to rush recovery. </li></ul><ul><li>Rehab should follow physician protocol. </li></ul>
  51. 51. Physical Rehabilitation <ul><li>2 Principles that must be observed: </li></ul><ul><li>Pain </li></ul><ul><ul><li>Avoid </li></ul></ul><ul><ul><li>Stay just below pain threshold (not easy) </li></ul></ul><ul><li>Daily adherence </li></ul>
  52. 52. Physical Rehabilitation <ul><li>5 Phases of Physical rehabilitation: </li></ul><ul><li>Post-surgical/Acute injury </li></ul><ul><li>Early Exercise </li></ul><ul><li>Intermediate Exercise </li></ul><ul><li>Advanced Exercise </li></ul><ul><li>Initial Sports Re-entry </li></ul>
  53. 53. Physical Rehabilitation <ul><li>An Athlete must go through all phases of the program to complete recovery </li></ul><ul><li>ATC must keep in mind that all athletes are different. </li></ul><ul><li>Various rates of recovery should be expected. </li></ul>
  54. 54. Physical Rehabilitation <ul><li>BEFORE AN ATHLETE RETURNS TO ACTIVITY FUNCTIONAL AND SPORT SPECIFIC ACTIVITIES ARE REQUIRED TO ENSURE A SAFE RETURN TO SPORT. </li></ul><ul><li>Safe return to sport does not mean full go, ease into activity. Communicate with coaches & athlete! </li></ul>
  55. 55. Range of Motion <ul><li>Ankle </li></ul><ul><ul><li>Dorsiflexion - 20 ° </li></ul></ul><ul><ul><li>Plantar Flexion – 45° </li></ul></ul><ul><ul><li>Inversion - 40° </li></ul></ul><ul><ul><li>Eversion - 20° </li></ul></ul><ul><li>Knee </li></ul><ul><ul><li>Flexion - 140° - Extension - 0° </li></ul></ul>
  56. 56. Range of Motion <ul><li>Hip </li></ul><ul><ul><li>Flexion - 125 ° </li></ul></ul><ul><ul><li>Extension - 10° </li></ul></ul><ul><ul><li>Adduction - 40° </li></ul></ul><ul><ul><li>Abduction - 45° </li></ul></ul><ul><li>Elbow </li></ul><ul><ul><li>Flexion - 140° - Extension - 0° </li></ul></ul>
  57. 57. ROM <ul><li>Shoulder </li></ul><ul><ul><li>Flexion - 180 ° </li></ul></ul><ul><ul><li>Extension - 45° </li></ul></ul><ul><ul><li>Adduction - 40° </li></ul></ul><ul><ul><li>Abduction - 180° </li></ul></ul><ul><ul><li>Internal Rotation - 90° </li></ul></ul><ul><ul><li>External Rotation - 90° </li></ul></ul>
  58. 58. ROM <ul><li>Forearm </li></ul><ul><ul><li>Pronation - 80 ° </li></ul></ul><ul><ul><li>Supination - 85° </li></ul></ul><ul><li>Wrist </li></ul><ul><ul><li>Flexion - 80° - Extension - 70° </li></ul></ul><ul><ul><li>Adduction - 45° - Abduction - 20° </li></ul></ul>