Sports are the major form of exercise also played for recreation purpose. it accumulates major risk of sports related injuries, this slide show suggests, how to prevent it and management of the same from physiotherapy point of view.

1. Sports Injury
By: Radhika Chintamani
Prevention of Sports Injury
[Ref: Anderson. M. Fundamentals of sports injury and management.]
In particular, three areas that should be addressed include physical conditioning, proper skill
techniques, and use of protective equipments.
Conditioning and Injury Prevention:
An effective, physiologically appropriate physical conditioning program can not only improve
performance, but it can also minimize the risk of injury and illness.
Basic Principles of Conditioning:
In efforts to develop a specific component of fitness (e.g., flexibility; strength; endurance;
particular skill), the Specific Adaptation to Imposed Demands (SAID) principle or specificity
must be followed.
The SAID principle: states that the body responds to a given demand with a specific and
predictable adaptation. An exercise program must address the specific needs of the individual
with regard to their fitness and skill goals as well as to the various body parts.
Principle of specificity: States that a goal of improved muscular endurance requires different
criteria from that of a program focused on the development of muscular strength. Specificity also
applies to the development of particular skills. For example, exercises that mimic the throwing
action will benefit a baseball pitcher, but are not applicable to a football lineman.
The principle of overload: states that physiologic improvements occur only when an individual
physically demands more of the body than is normally required. If the demands are within
appropriate physiological limits, the body will adapt and improve its function. As such, if the
demands are insufficient (e.g., too little exercise), improvement will not take place. If the
demands are too strenuous, there is a risk for injury. A common error in carrying out a
conditioning program is doing “too much too soon.” The body must be stressed at tolerable
physiological limits. Exceeding those parameters by performing at an inappropriate intensity, for
too long a duration, or for too many consecutive days, can lead to injury and setbacks, rather than
improvement. As such, a program based on progression is essential to ensure that the individual
does not overuse any structure(s) (e.g., joints; muscles; tendons). Overload is achieved by
manipulating frequency, intensity, and duration in the exercise program. Frequency
 Frequency refers to the number of exercise sessions per day or week. The number of days
in which an individual should engage in a conditioning program will vary depending on
various factors (e.g., goals; current fitness level). In determining the number of days of a
specific exercise/activity, progression must be considered. Specifically, the overload
principle should be implemented on a gradual and systematic basis over a period of time.
In doing so, the individual will have time to adapt physiologically to the demands. It is
also important to ensure that an individual maintains an appropriate frequency. For
example, if a training program is based on participation in an activity 3 days a week
without participation in back-to-back days, a lack of adherence on the part of the

2. participant will require adjustments to the program. Both the participant and the coach
must understand that failure to adhere to a defined schedule can result in lack of
improvement and increased susceptibility to injury.
 Intensity Intensity reflects both the caloric cost of the work and the specific energy
systems activated. It refers to the amount of work being done during an exercise. The
level of intensity for any given activity should be based on the component being
developed, the current performance level, and desired goals.
 Duration Duration refers to the length of a single exercise session. The recommended
duration may be stated in terms of minutes (e.g., walking 45 minutes) or the number of
repetitions and sets (e.g., muscular endurance training three sets of 12 to 15 repetitions).
Principle of Individuality: From various perspectives, it is important to recognize that each
participant is potentially different. As such, individual participants will have different responses
to a conditioning program. Several factors can influence differences, including age, gender, body
type, heredity, lifestyle, fitness level, illness/chronic conditions, and previous experience.
Accordingly, an effective conditioning program is designed based on the individual. Developing
and implementing a conditioning program for a group of participants (e.g., physical education
class; members of a high school athletic team) is not an easy task, but it is a manageable and
necessary one.
Flexibility:
Flexibility is the total range of motion (ROM) at a joint that occurs pain-free in each of the
planes of motion. Joint flexibility is a combination of normal joint mechanics, mobility of soft
tissues, and muscle extensibility. Flexibility can influence performance in physical activity. An
absence of flexibility or excessive flexibility can potentially reduce the ability to effectively
perform an action or skill and, in doing so, improve or hinder performance of a particular action
or skill. Muscles contain two primary proprioceptors that can be stimulated during stretching,
namely the muscle spindles and Golgi tendon organs. Because muscle spindles lie parallel to
muscle fibers, they stretch with the muscle. When stimulated, the spindle sensory fibers
discharge and through reflex action in the spinal cord initiate impulses to cause the muscle to
contract reflexively and, in doing so, inhibit the stretch. Muscles that perform the desired
movement are called agonists. Muscles that oppose or reverse a particular movement are referred
to as antagonists. Unlike muscle spindles, Golgi tendon organs are connected in a series of fibers
located in tendons and joint ligaments, and respond to muscle tension rather than length. If the
stretch continues for an extended time (i.e., over 6 to 8 seconds), the Golgi tendons are
stimulated. This stimulus, unlike the stimulus from muscle spindles, causes a reflex inhibition in
the antagonist muscles. This sensory mechanism protects the musculotendinous unit from
excessive tensile forces that could damage muscle fibers.
Stretching techniques: Flexibility can be increased through various stretching techniques like
Static stretching (10-30sec hold), dynamic stretching (to fire the muscle spindle, usually quick
stretch, and slow stretch=to activate the golgi tendon , minimum hold of 6-8sec.), ballistic
stretching (quick, fast stretch, chances of tear), PNF stretching (stimulation of proprioceptors),
etc.
Active Inhibition technique: the muscle group reflexively relaxes prior to the stretching
maneuver. Common methods include contract–relax, hold–relax, and slow reversal–hold–relax.

3. Alternating contractions and passive stretching of a group of muscles are then performed.
Contractions may be held for 3, 6, or 10 seconds, with similar results obtained.
Reciprocal Inhibition: uses active agonist contractions to relax a tight antagonist muscle. In this
technique, the individual contracts the muscle opposite the tight muscle, against resistance. This
causes a reciprocal inhibition of the tight muscle, leading to muscle lengthening. (One of the
principle of MET).
Application of principles of flexibility:
Frequency: stretching exercises be performed a minimum of 2 to 3 days per week, but more
optimally, 5 to 7 days a week.
Intensity: Movement to the desired stretch position should be initialed slowly and continue until
to a feeling of slight tension or burn is felt.
Duration: The final position should be held for 15 to 30 seconds, and repeated—two to four
times with a 30 to 60 second rest period between repetitions.
Muscular strength and endurance:
Muscular strength Muscular Endurance
Strength is the ability of a muscle or group of
muscles to produce force in one maximal
effort. Muscular strength influences the ability
to execute normal activities of daily living and
aids in reducing or preventing postural
deformities
Muscular endurance is the ability of muscle
tissue to exert repetitive tension over an
extended period. The rate of muscle fatigue is
related to the endurance level of the muscle
(i.e., the more rapid the muscle fatigues, the
less muscle endurance).
In the role of providing stability for any given
joint, the basic principle is that the stronger the
muscle, the better the protection for the joint.
Imbalances in muscle strength can lead to
musculoskeletal dysfunction and pain.
As muscle endurance is developed, density in
the capillary beds increases, providing a
greater blood supply, and thus a greater oxygen
supply, to the working muscle.
Increases in muscle endurance may influence
strength gains.
Physiological Principles:
Factors affecting the muscle strength and endurance are: the number and size of muscle fibers,
the type of muscle fiber, neuromuscular coordination, and gender.
- The strength of a skeletal muscle is determined by the cross-sectional diameter of the
muscle fibers. The size of the muscle fiber will increase in response to progressive
resistance exercise (i.e., overload). An exercise program cannot increase the numbers of
fibers. Rather, it increases the size of the fibers present. But resistance training increases
both hypertrophy, and split hyperplasia.
- Gender differences exist with regard to the absolute strength of males and females.
Because testosterone present within males, are the growth factor of muscle, hence during
recovery period of the trainingsecretion of the testosterone growth of muscle. For
both males and females, the initial 3 to 4 weeks of a strength training program are
characterized by a rapid increase in strength. This phenomenon is attributed to an
improvement in neuromuscular coordination. During the initial stage of a strength
training program, the nervous system begins to innervate an increased number of motor
units and there is an increased rate in the firing of motor units. As a result, the muscle is

4. capable of generating increased force. The training effect results in improved
coordination of the motor unit that allows for more efficient and effective functioning.
- Skeletal muscles are composed of two primary types of fibers, namely slow twitch (Type
I) and fast twitch (Type II). Slow-twitch fibers have a slow contraction time and they
yield relatively low levels of force production. Slow-twitch muscles are more resistant to
fatigue and are best suited for aerobic activities that require relatively low levels of force
production (e.g., walking; distance running; posture maintenance). Fast twitch fibers have
a faster contraction rate than slow twitch fibers. They are able to generate higher levels of
force production in a short period of time, but they are more prone to fatigue. Fast-twitch
fibers are further categorized as Type IIa and Type IIb. The Type IIa fiber has a relatively
high force production and moderate resistance to fatigue. The Type IIb fibers have the
fastest rate of contraction, but they are the most sensitive to fatigue.
Strength:
1. Static strength: also known as isometric strength. Here the muscle is trained for
maintenance of strength in such a way that there is no movement instead the static
postural hold is seen. That is 00
movement is seen at that particular joint. This technique
increases the control capacity of the limb, and also, postural control.
2. Dynamic strength: the strength of the muscle is increased by improving the stergth
through various range of motion. The speed here is variable.
3. Isotonic strength: same as dynamic but, the speed is m aintained constant, i.e. between
600
to 1000
per sec.
4. Isokinetic strength: the velocity of the moving limb is kept constant.
Application principle:
Frequency: requires a minimum of 2 days per week. The 2 days should not be back to back, as
the muscles must be given time to rest between exercise sessions. The absence of a rest period
can lead to injury as well as an inability of the muscle to sustain sufficient intensity to create the
necessary overload.
Intensity: The intensity of the overload should be a weight that is at least 80% of the individual’s
maximum capacity (1 RM). The maximum capacity is the amount of weight that can be lifted as
a single repetition.
Duration: high intensity is combined with low repetitions (i.e., one to five). The number of sets
can vary from one to three with a period of rest from 3 to 5 minutes between sets.
Application principle of endurance:
Frequency: minimum of 2 to 3 days per week. Similar to strength training, training days should
not be back to back as the muscles must be given time to rest between exercise sessions.
Intensity: 40-60% individual’s 1RM.
Duration: 12 to 20 repetitions per set. The number of sets can vary from one to three with a
period of rest from 3 to 5 minutes between sets.
Cardiorespiratory Endurance:
Cardiorespiratory exercise can be aerobic or anaerobic depending upon the energy system being
utilized. An aerobic exercise requires oxygen to produce energy. The aerobic energy system is
utilized for activities that last longer than several minutes. In comparison, anaerobic exercise
does not require oxygen for energy, but rather it uses lactic acid to convert nutrients to energy.
Anaerobic exercises are short, intense bursts of activity that last for less than several minutes.
Physiological Benefits of Cardiorespiratory exercise:

5.  Increase in the size (i.e., volume and weight) of the heart that improves the strength and
pumping efficiency of the heart.
 Increase in cardiac output.
 Decrease in heart rate results in less stress on the heart during exercise and at rest.
 Increase in stroke volume results in the heart being able to pump more blood per beat.
 Increase in the number of red blood cells in the body enabling a more efficient transport
of oxygen throughout the body.
 Improved circulatory efficiency that results in the working muscles requiring less blood
due to an improvement in the delivery, extraction, and utilization of oxygen.
 Reduced blood pressure resulting in a more efficient cardiovascular system as well as
decreased susceptibility to hypertension.
 Decrease in total cholesterol with an increase in the level of high-density lipoprotein
cholesterol (i.e., “good cholesterol”).
 Increase in the strength of the muscles involved in respiration that results in more
efficient pulmonary function (i.e., flow of air in and out of the lungs).
Application Principles:
Aerobic training includes activity 3 to 5 days per week lasting for 20 to 60 minutes more than
twice weekly at an intensity of 55 to 60 to 90% of maximal heart rate. Target HR can be
calculated by;
An estimated HRmax for both men and women is about 220 beats/minute. Heart rate is related to
age, with maximal heart rate decreasing as an individual ages. A relatively simple calculation is
HRmax =220 – Age.
(With a 20-year-old individual working at 80% maximum, the calculation is 0.8 (220 – 20) or
160 beats per minute.)
Another commonly used formula (Karvonen formula): assumes that the targeted heart rate range
is between 60 and 90%. The calculation is;
Target HR range= [(HRmax - HRrest) x 0.60 and 0.90] + HRrest.
(If an individual’s HRmax is 180 beats/minute and the HRrest is 60 beats/minute, this method
yields a target HR range of between 132 and 168 beats/minute.)
Protective Equipments and Injury Prevention:
Potential means by which equipments can protect an area from accidental or routine injuries
associated with a particular activity are listed;
i. Increase the impact area.
ii. Transfer or disperse the impact area to another body part.
iii. Limit the relative motion of a body part.
iv. Add mass to the body part to limit deformation and displacement.
v. Reduce friction between contacting surfaces.
vi. Absorb energy.
vii. Resist the absorption of bacteria, fungus, and viruses
It is essential that the coach is informed of, and understands, their role in ensuring the proper use
of protective equipments. For example, in some settings, it may be determined that the coach is
legally responsible for:
● Selecting the most appropriate equipment.
● Properly fitting the equipment to the individual.

6. ● Instructing the individual in proper care for the equipment.
● Warning the individual of any danger in using the equipment inappropriately.
● Supervising and monitoring the proper use of all protective equipments.
Protective equipments Head and Face:
Football Helmets:
Footballs helmets consist of an outer shell constructed of plastic or a polycarbonate alloy, a
material that is lightweight and impact-resistant. The inside of the helmet contains a single or
double air bladder, closed-cell pads, or a combination of the two. The football helmet is designed
to reduce the incidence and severity of head trauma. The helmet also features increased side and
facial protection to lessen the impact in these areas. The NOCSAE mark should be on every
football helmet. It indicates that the helmet meets minimum impact standards and can tolerate
forces applied to several different areas of the helmet.
Ice-Hockey Helmet:
reduce head injuries; however, they do not prevent neck injuries caused by axial loading. The use
of head protection with a face mask seems to have given many players a sense of invulnerability
to injury. Studies have shown that the risk of spinal cord injury, and in particular, quadriplegia,
may be three times greater in hockey than in American football.9 The major mechanism for this
injury is head-first contact with the boards secondary to a push, or a check from behind.
Batting Helmet:
compulsory in baseball and softball and require the NOCSAE mark.1 Most batting helmets are
open-faced with a double ear-flap design and can protect the majority of the superolateral
cranium, but not the jaw or facial area.
Other Helmets:
Lacrosse helmets are mandatory in the men’s game, optional in the women’s game, and are also
worn by field hockey goalies. The helmet is made of a high-resistant plastic or fiberglass shell,
and must meet NOCSAE standards. The helmet, wire face guard, and chin pad are secured with a
four-point chin strap.
An effective bicycle helmet has a plastic or fiberglass rigid shell with a chin strap and an energy-
absorbing foam liner. Regardless of the type, the helmet can provide substantial protection
against head injuries and injuries to the upper and midface region. Improved designs have
produced helmets that are lightweight and aerodynamic with an increase in the number of
ventilation ports. Wearing a cycling helmet does not increase thermal discomfort to the head or
body and has no additional impact on the core temperature, head skin temperature, thermal
sensation, heart rate, sweat rate, and overall perceived exertion.
Face Guards:
Face guards, which vary in size and style, protect and shield the facial region from flying
projectiles.
Football face guards are made of heavy-gauge, plastic coated steel rod, designed to withstand
impacts from blunt surfaces, such as the turf or another player’s knee or elbow.
Ice hockey face guards are made of clear plastic (polycarbonate), steel wire, or a combination of
the two, and must meet the HECC and ASTM standards. Hockey face guards primarily prevent
penetration of the hockey stick, but are also effective against flying pucks and collisions with
helmets, elbows, side boards, and the ice. The use of full-coverage face masks in amateur ice
hockey has greatly reduced facial trauma. The use of a single chin strap, however, still allows the

7. helmet to ride back on the head when a force is directed to the frontal region, and, in doing so,
exposes the chin to lacerations.
Lacrosse face guards must meet NOCSAE standards. The wire mesh guard stands away from the
face, but the four-point chin strap has a padded chin region in case the guard is driven back
during a collision with another player.
Eye Wear:
Eye injuries are relatively common and almost always preventable, if proper protective wear is
worn. There are three types of protective eyewear: goggles, face shields, and spectacles. The type
of eyewear will vary depending upon the sport or physical activity.
Mouthguards:
An intraoral readily visible mouthguard is required in all interscholastic and intercollegiate
football, ice hockey, field hockey, and men’s and women’s lacrosse.
Properly fitted across the upper teeth, a mouthguard can absorb energy, disperse impact, cushion
contact between the upper and lower teeth, and keep the upper lip away from the incisal edges of
the teeth. This action significantly reduces dental and oral soft-tissue injuries, and to a lesser
extent jaw fractures, cerebral concussions, and temporomandibular joint injuries.
Throat and Neck Protectors:
Blows to the anterior throat can cause serious airway compromise as a result of a crushed larynx
and/or upper trachea, edema of the glottic structures, vocal cord disarticulation, hemorrhage, or
laryngospasm.
Helmets used in field hockey, lacrosse, and ice hockey also provide anterior neck protectors to
protect this vulnerable area. Cervical neck rolls and collars are designed to limit excessive
motion of the cervical spine and can be effective in protecting players with a history of repetitive
burners or stingers.
Protective equipments in Upper body and their functions:
Region Equipment Function
Shoulder Shoulder pads protect the soft- and bony-tissue structures in the shoulder, upper
back, and chest. The external shell is generally made of a
lightweight, yet hard plastic. The inner lining may be composed
of closed- or open-cell padding to absorb and disperse the shock;
however, use of open-cell padding reduces peak impact forces
when compared with closed-cell pads
Elbow The entire arm is subjected to compressive and shearing forces in
a variety of sports, such as those seen in blocking and tackling an
opponent, deflecting projectiles, pushing opponents away to
prevent collisions, or breaking a fall. Goalies and field players in
many sports are required to have arm, elbow, wrist, and hand
protection. However, in high school and collegiate play, no rigid
material can be worn at the elbow or below, unless covered on
all sides by closed cell foam padding.
Forearm Counterforce
Forearm brace
relief for individuals with lateral and medial epicondylitis. These
braces are designed to reduce tensile forces in the wrist flexors
and extensors, particularly the extensor carpi radialis brevis.
Wrist and Gloves

8. Hand
Thoracic, Ribcage and Abdomen:
Catchers in baseball and softball wear full thoracic and abdominal protectors to prevent high-
speed blows from a bat or ball. Individuals in fencing, and goalies in many sports, also wear full
thoracic protectors. Quarterbacks and wide receivers in football often wear rib protectors
composed of air-inflated, interconnected cylinders to absorb impact forces caused during
tackling. These protectors should be fitted according to the manufacturer’s instructions.
Lumbo-sacral Protection:
Includes weight-training belts used during heavy weight lifting, abdominal binders, and other
similar supportive devices. Each should support the abdominal contents, stabilize the trunk, and
prevent spinal deformity or injury during heavy lifting. Use of belts or binders can significantly
increase proprioception and intra-abdominal pressure to reduce compressive forces in the
vertebral bodies and, in doing so, potentially lessens the risk of low back trauma.
Sports Injury Assessment
[Ref: France. C.R. Introduction to sports medicine and Athletic training.]
The assessment and evaluation of athletic injuries are important proficiencies that everyone on
the athletic health care team must possess. The certified athletic trainer is often the first person
on the scene of an athletic injury. It is important to note that certified athletic trainers can assess
and evaluate an injury, but they cannot diagnose. Diagnosis of injuries is the domain of the
licensed health care provider, typically the physician.
Assessment: The orderly collection of objective and subjective data on an athlete’s health status.
Diagnosis: Using information from assessment and physical evaluation findings to establish the
cause and nature of the athlete’s injury or disease; made only by a physician or other licensed
health care provider.
Assessment and evaluation consist of the orderly collection of objective and subjective data on
an athlete’s health status. based on professional knowledge and knowledge of the events that
occurred. A diagnosis is what the physician or licensed provider states to be the problem, based
on his or her skills, expertise, and medical school training. The physician uses all the information
obtained in an evaluation to arrive at a diagnosis of the injury.
Assessment and evaluation is the compilation of subjective and objective data related to the
presenting signs and symptoms of a particular injury or disease state. Diagnosis is the ability to
take that data and make a scientifically based statement specifying the injury or disease process.
Factors influencing Athletic Injuries:
i. Anthropomorphic status: include the athlete’s size, weight, and structure. It also
includes gender, strength, and maturity level. These data describe the
anthropomorphic status of an individual or situation.
ii. Mechanism of force: comprises all forces involved at the time of an impact: the
direction of the force, its intensity and duration, the activity being undertaken, and the
position of the body or body part at the time of injury. Biomechanical factors must be
taken into account as well. An example is a basketball player who falls to the court
after trying to rebound the ball. The basic mechanism of force for this occurrence is

9. falling from a height of several feet onto a hardwood floor without any cushioning
effect.
iii. Speed: influences the type and severity of athletic injuries. The greater the speed of
the collision, the greater the chance of injury. As athletes continue to get larger and
faster, the types and severity of collision injuries increase. This is why it is not
advisable to have athletes of different maturity levels practice or compete against one
another.
iv. Protective equipment used: can greatly reduce the risk of injury by absorbing and
distributing force. Dissipation of force reduces the amount and type of forces
absorbed by the body. New materials and better equipment design have helped keep
injury levels moderate even as athletes get bigger, faster, and stronger. An example of
this is the pole vault (in track and field).
v. Skill level: Beginners are often at greater risk for both minor and major injuries
because of their unfamiliarity with or inability to master the basic techniques of the
activity or sport. Judgment may also be underdeveloped. Playing within one’s ability,
and being in control, are important factors in minimizing the risk of injury.
Recognition and Evaluation:
Recognition of injuries is the process whereby the certified athletic trainer determines the
probable cause and mechanism of injury. This determination may be based on direct observation
or second-hand accounts. When evaluating emergencies, it is important to control life threatening
conditions first, and to activate emergency medical services (EMS) when needed. If in doubt,
activate EMS. This is called Primary Injury Survey.
Primary Injury Survey: Assessment of life-threatening emergencies and management of airway,
breathing, and circulation. EMS should be activated when threats to life are suspected.
a. Airway: Open the victim’s airway by tilting the head back and lifting the chin, if no
spinal or neck injury is suspected. If spinal injury is a possibility, use the jaw-thrust
technique.
b. Breathing—Listen, look, and feel for signs of breathing. If the victim is not breathing,
give two breaths and check for signs of circulation.
c. Circulation—Check for signs of circulation, such as breathing, coughing, or movement in
response to the breaths. If the victim has no signs of circulation, start chest compressions.
Adults require 15 chest compressions for every 2 rescue breaths.
CPR is given whenever necessary: The three basic steps in performing CPR on adults are:
1. CALL. Check the victim for unresponsiveness. Shake and shout to see if the victim is
unconscious. If there is no response, call 911 and return to the victim. In most locations, the
emergency dispatcher can assist by giving instructions for CPR.
2. BLOW. Tilt the victim’s head back and look, listen, and feel for breathing. If breaths cannot
be heard, felt, or observed by watching for movement of the chest, begin rescue breathing. If the
victim is not breathing normally, pinch the nose and cover the mouth with your own. Blow until
chest rise is observed. Give two breaths. Each breath should take about one second.
3. PUMP. Check for signs of circulation such as breathing, coughing, and movement. If the
victim is still not breathing, coughing, or moving, begin chest compressions. Push the chest
down about 2 inches, right between the nipples, 30 times. Push hard and push fast. Pump at the
rate of about 100 compressions per minute.
Automated Electronic Defibrillator. Device used to shock heart back into normal rhythm.

10. Secondary Injury survey: A thorough, methodical evaluation of an athlete’s overall health to
reveal additional injuries beyond the initial injury.
H.O.P.S. An acronym for the approach to the secondary-injury survey: history, observation,
palpation, and special tests.
History:
1. What happened? Body part injured; description of injury.
2. When did the injury occur?
3. What factors influenced the injury?
- Position of body and injured area at time of injury.
- Weightbearing or non-weight-bearing?
- Activity at time of injury
- Collision or contact?
- Speed at time of injury—velocity or acceleration?
- Direction of force?
- Intensity and duration of force?
- Results of force—twisting, hyperextension, hyperflexion?
4. Was a sound heard? By the individual or anyone else? Quality of sound: pop, snap, rip?
5. Where is pain located now? Where was it located at the time of injury? Ask the athlete to
point to where the pain is located.
6. Pain characteristics: sharp or dull/achy? Stabbing, throbbing? Constant, cramping,
intermittent? Painful at rest or only with use of injured body part?
7. Pain intensity: VAS scale.
8. Is neurological function intact? Numbness, pins-and-needles prickling, muscle weakness,
paralysis, burning sensation?
9. Is there any instability? A sense that something isn’t working right? “If I let you, would
you be able to use the injured body part now?” [Do not have the person use it—merely
ask the question.]
10. Prior history of injury to this body part?
OBSERVATION. Compare the injured to the uninjured side. Specifically look for deformity
(indicating dislocation or fracture), swelling (especially in the hollow spaces around joints),
bleeding, and color changes in the skin (vascular problems or bruising/ecchymoses)
ON PALPATION: Examine the uninjured side first. Be sure to palpate (touch) firmly enough to
produce pain if it is present; palpating too lightly may result in missing a significant injury. On
the uninjured side, the pressure should feel firm and slightly unpleasant, but not painful. During
palpation, observe the athlete’s face for signs of wincing. Palpate one joint above the injured
area and continue to one joint below. During palpation, be sure to feel the bones, ligaments, and
muscles/tendons.
ACTIVE MOTION. Active motion is movement done by the athlete. Ask the athlete to move the
injured body part through the full range of motion: up and down, in and out, rotating. Permit the
individual to tolerate some discomfort in attempting this. Refusal or inability to move through
the full range of motion suggests a significant injury.

11. PASSIVE MOTION. Passive motion is movement through a range of motion performed by the
examiner while the athlete relaxes all muscles, done by the examiner, with the athlete relaxing all
muscles. The examiner supports the individual’s injured body part, and move.
STRENGTH. To test for strength, begin isometrically without resistance, and then through the
range of motion against resistance. Compare to the uninjured side for size and firmness of
muscle mass. Note any visible defects in the injured muscle. Palpate for knots or lumps in the
injured muscle.
STABILITY. Stability tests investigate ligamentous laxity. The athlete must relax all muscles
around the injured joint to obtain a satisfactory evaluation. This is a stress test for ligaments.
Support the injured body part at the distal (far) end of the distal bones of the joint (e.g., for the
knee, support the leg just above the ankle, at the distal part of tibia). Use the other hand to stress
the ligament at the affected joint line.
SPECIAL EXAMINATIONS. Special tests and examinations may be necessary to establish the
degree of injury. For example, the Lachman Anterior Drawer Test for the knee can establish the
integrity of the anterior cruciate ligament.
FUNCTIONAL ACTIVITY TESTS: determine the level of activity the athlete may resume. If
the injured athlete has passed the various tests, demonstrating a normal inspection, minimal pain
upon palpation, full range of motion, full muscle strength against resistance, and joint stability
(no pain or marked laxity to stress compared to the uninjured side), the certified athletic trainer
must determine what level of activity to permit during treatment. Instruct the injured athlete to
stand, walk, hop, jog, sprint, cut, and twist, one after another, to demonstrate the ability to
perform normally and pain-free compared to the uninjured side.
SPORTS ACTIVITY TESTS: Particular types of movement and actions that are needed in or
related to a particular sport. These tests determines if it is safe to resume the activities of a
particular sport. Ask the athlete to demonstrate the specific maneuvers and actions of that sport,
to determine if he or she can do them normally and painlessly. An example is to ask a basketball
player who is coming back from an ankle injury to sprint, cut, jump, and back-pedal. These are
skills required of the sport, and the athlete must be able to complete these types of activities at
full speed and intensity before returning to it.
Return to play criteria: Before the team physician or certified athletic trainer clears an athlete to
return to his or her sport, several criteria must be met: full strength, freedom from pain, ability to
perform the skills of the sport, and emotional readiness to return to competition.
Full strength Pain free Ability to perform skill of
sport
Emotional
readiness
After an injury occurs,
there will be damage to the
soft tissues surrounding the
injury site. This soft-tissue
damage can affect
muscles, ligaments,
An athlete in pain is
at risk for a
significant injury. A
mild amount of
soreness is not the
same as pain.
To be certain the athlete is
ready to return to his or her
sport, a series of
performance tests will be
necessary These tests are
designed to simulate the

12. tendons. Before an athlete
can return to practice or
competition, these tissues
must be healed.
Muscle atrophy (reduced
muscle mass) is common
with athletic injuries.
Proper rehabilitation is
needed because all muscles
supporting the injury must
be at 100%of pre-injury
strength prior to return to
play.
Athletes may
experience mild
soreness after
returning to their
sport from an injury.
True pain is an
indication that an
injury has not
completely healed.
actual skills required for the
sport. Performance tests
should begin at a low level
of intensity and gradually
increase until the athlete is
performing at game speed.
If at any time the athlete is
not able to perform one of
the tests, she is not ready to
return to the sport. Tests
may include sprinting,
jumping, cutting,
backpedaling, pushing
(football), and so on.
DOCUMENTATION OF INJURY: Having injuries well documented, with follow-up care
clearly written and followed, is essential for the total health of the athlete. This also helps to
keep athletes from “falling through the cracks” and going without the care they require.
There are many different types of formats for reporting injuries. Many training facilities use
the following:
SOAP notes: refers to a particular format of recording information regarding treatment
procedures. This method combines information provided by the athlete and the examiner’s
observations. Consists of the following:
 Subjective: This component incorporates the subjective statements made by the
injured athlete. Chronicling the event is designed to elicit the athlete’s subjective
impressions relating to the time, mechanism, and site of injury. The type and course
of the pain and the degree of disability experienced by the athlete are also
noteworthy.
 Objective: include the certified athletic trainer’s visual inspection, palpation, and
assessment of active, passive, and resistive motion. Results of any special testing
should also be noted here. The objective report also includes assessment of posture,
presence of deformity or swelling, and location of point tenderness. Limitations on
active motion and pain arising or disappearing during passive or resistive motion
should be noted. Finally, the results of tests for joint stability or apprehension are also
included.
 Assessment: nature and extent of injury. Although the exact nature of the injury is not
always known initially, information pertaining to suspected site and anatomical
structures involved is appropriate. A judgment of severity may be included, but is not
essential at the time of acute injury evaluation.
 Plan: include the first-aid treatment rendered to the athlete and the sports therapist’s
intentions as to disposition. Disposition (what is done next) may include referral for
more definitive evaluation or simply application of a splint, wrap, or crutches and a
request to report for revaluation the next day. If the injury is of a more chronic nature,
it would be appropriate for the examiner to include treatment and therapeutic exercise
in the plan.
{Write down an example).

13. Daily sideline injury reports: The daily sideline injury report is a way to track every athlete
who participates in a sport. It allows the training and coaching staff to follow every athlete
every day throughout the season. Coaches can clearly see if an athlete has been injured and
missed practice or if the athlete can practice on a limited basis. The data can later be analyzed
by computer to reveal injury patterns.
Training-room treatment logs: log is filled out by certified athletic trainers as they treat
athletes. The requisite information is the athlete’s name, the date, injury/complaint, treatment
given, and a column to check for follow-up care, if needed. Everyone who has been taped,
wrapped, iced, and so on should be documented. This information is also helpful in creating
budgets, tracking inventory, and showing the need for athletic health care services.
Daily red-cross lists: A daily red-cross list can be used to inform coaches of the status of
their athletes from one practice to another. This form tells the coaching staff that the athlete
is either to have no practice (Ø), limited participation (L), or return to full practice and
competition (R)
Athlete medical referral forms: A medical referral form, which the athlete takes to the
doctor from the certified athletic trainer, allows accurate communication between the training
staff and the physician’s office.
Conservative Management of Sports
Injury:
Goals of rehabilitation:
1. Preserve structural integrity
2. Provide an environment conductive to tissue healing.
3. Restore joint range of motion.
4. Increase muscular strength.
5. Restore proprioception.
6. Maintain and increase cardiovascular aerobic capacity.
7. Enhance coordinated movement and agility in sports specific tasks.
Initial treatment Phase:
POLICE;
Pr: Protected Rest: If continued unrestricted activity is permitted, it could result in increased
bleeding, increased pain, and delayed healing. If the injury is to a lower extremity and the
individual is unable to walk pain-free without a limp, the individual should be placed on crutches
and an appropriate protective device applied to limit unnecessary movement of the injured joint.
If the injury is to an upper extremity and the individual is unable to move the limb without pain,
then the individual should be fitted with an appropriate splint or brace. The length of the time for
the protected rest will vary relative to the severity of the injury. Mild injuries may only require
24-hour rest, while a major injury could require at least 72 hours of rest. Protected rest does not
imply cessation of activity, but simply means “relative rest,” decreasing activity to a level below
that required in participation in sport or physical activity, but tolerated by the recently injured

14. tissue or joint. Supportive taping and bracing are important components of this phase. Bracing
will enable the athlete to begin exercises earlier and allow for regaining lost function, while still
allowing the injury to subside and heal with as little additional damage as possible
OL: Over-loading: after the completion of acute phase. Because acute phase loading leads to
further injury to the injured part.
I: Ice
Stages of cold sensation:
Initial cold sensation 0-3min
Burning and aching sensation 2-7min
Numbness (anaesthesia) 5-12min
The length of application time can range from 15 to 30 minutes. The time for a larger muscle
mass, such as the quadriceps, would be 30 minutes and for a smaller site, such as a finger, 15
minutes should be sufficient. Cold applications should be repeated every 1 to 2 hours while the
patient is awake and continue for at least 72 hours postinjury.
C: Compression: Compression decreases hemorrhage, reduces the space available for fluid
seepage, and encourages fluid absorption. The most common method of compression application
requires an elastic wrap or bandage. The wrap should be applied in a distal-to-proximal direction
to avoid forcing extracellular fluid into the distal aspect of an extremity. The wrap should be
applied with sufficient tension to ensure compression without impairing blood supply. Distal
pulsation must be palpable even after application of wrap.
E: Elevation: Elevation of an injured body part at least 6 to 10 inches above the heart can reduce
bleeding in the area, encourage venous return, and prevent pooling of blood in the extremities.
Elevation should be performed as often as possible during the 72 hours postinjury.
Phases of Rehabilitation:
Phase I II III IV
Begins soon as injury
occurs.
On filed: PT Rx:
POLICE.
After game PT Rx:
isometric
strengthening
exercises and static
muscle stretches. The
goal of these exercises
is to create a flexible
and strong scar tissue
that is oriented in the
connective tissue lines
of stress. There should
never be pain during
this phase
Initiation of phase II
activity IS sIgnaled by
the athlete's ability to
perform isotonic
strengthening
exercises.
Isometric Exercise
Open-Chain Activities
Therapeutic Muscle
Stretching Aerobic
Activity
Proprioceptive Drills
Prepare the athlete for
return to play in the
next phase.
Eccentric Exercise
Closed-Chain
Activities Aerobic
Activity Running or
Throwing Drills
Return of the athlete
to play and the
maintenance of
strength and
flexibility gains.
Dynamic Flexibility
Exercise Sport-
Specific
Strengthening
Exercise Agility Drills
Plyometric Training
Figure