describes sports injuries. their mechanism of injuries, classification and management.

1. Classification & Management of
sports injuries
MUJEEB UR RAHMAN
ASSISTANT PROFESSOR
IPM&R KMU.

2. Ways to classify sports injuries
• Cause of the injury
• Direct injury, indirect injury and overuse
injury
• The type of body tissue damaged
• Soft-tissue injury and hard-tissue injury.

3. • Direct injury
• External blow or force collision
• Struck with an object
• Examples:
• Hematomas (‘corks’) and
bruises,
• joint and ligament damage,
• dislocations and
• bone fractures.

4. • Indirect injury
• An indirect injury can occur in two ways:
• The actual injury some distance from the impact
site.
• Falling on an outstretched
hand dislocated shoulder.
• The injury does not result from
physical contact with an object or person
over-stretching, poor technique,
fatigue and lack of fitness.
• Ligament sprains and muscle
strains and tears.

5. • Overuse injury
• Overuse injuries occur when excessive and repetitive force is
placed on the bones and other connective tissues of the body.
• Little or no pain might be experienced
• The symptoms of overuse injury  increasing training
frequency or intensity
• Poorly planned training programs
 inc overuse
injuries

6. Other causes of overuse injury are
Poor technique and poor equipment.
• Poor backhand technique
• Use of a heavy racquet in tennis
• Ankle or knee pain from  running style or
footwear.
• Examples:
• Stress fractures and tendonitis .

7. Classification according to tissue type
Soft-tissue injury
• Skin injuries—abrasions, lacerations and blisters
• Muscle injuries—tears or strains of
muscle fibers and contusions
• Tendon injuries—tears or strains of
tendon fibers and inflammation
(tendonitis)
• Ligament injuries—sprains and tears of
ligament fibers.
• Soft-tissue injuries can result in internal
bleeding and swelling.
• Prompt and effective management of this
bleeding aids recovery.

8. Hard tissue injuries
• Damage to the bones of the skeleton.
• Fractures and joint dislocations  bruising of the bone.
• A direct force can bruise a bone and cause bleeding
between the outer layer of the bone and the underlying
compact bone. This is common in a bone such as the tibia
(shin) where there is little muscle tissue over the bone to
absorb the force.
• Bones have a blood supply and internal bleeding can result
from a fracture.
• In major injuries, this internal bleeding in the bone,
together with bleeding from surrounding damaged tissue,
can lead to shock and serious circulatory complications

9. • Secondary injury
• Athletes returning to activity are at risk of a
secondary injury.
• An injury that occurs as a result of a previous
injury being poorly treated or not being fully
healed.
• Athletes risk recurrence of injuries if they
commence playing before regaining full strength
and ROM.

10. Soft-tissue injuries
• Three common soft-tissue injuries are:
• Strains
• Disruption of the fibers of a muscle or tendon.
• Microscopic (few fibers) or severe, involve larger fibers of muscles and
tendons.
• Mechanism Over-stretched or when a muscle contracts too quickly.
• Severity ranges from microscopic level (a strain),to a small number of
fibers through to a complete rupture of all muscle fibers.
• A sprain is a tear of ligament fibers, muscles or tendon supporting the
joint
• Mechanism A joint extended beyond its normal ROM.
• Involve a small number of fibers through to a complete rupture.
• In extreme circumstances, the fibers of the ligament, muscle or tendon can
remain intact and rip from the bone.
• A contusion or bruise is bleeding into the soft tissue.
• It is caused by a direct blow from another person, an implement or an
object. A bruise can occur to any soft tissue of the body.

11. Skin abrasions, lacerations and blisters
• Very common in sport.
• They include:
• Minor wounds  Abrasions (grazes), blisters and small
lacerations.
• They also include bone fractures and more serious lacerations
 suturing (stitches).
• Small skin abrasions, lacerations not requiring sutures and
blisters are manageable conditions, and in most cases do not
require referral to a doctor.

12. • Abrasions  outer layer of skin is removed
(scraping action).
• Dirt or gravel, which should be removed.
• Extensive, deeper abrasions require medical
attention.
• Depth and location of the laceration  Suturing ?
• Medical attention  Expose tissues, such as fat,
tendons or bone.
• Superficial laceration will require
suturing IF???
• Deep lacerations are usually
accompanied by significant bleeding.

13. Hematoma:
• Definition and Mechanism of Hematoma
• A hematoma is a local accumulation of blood in a tissue, space
or organ.
• In muscle it has 2 mechanisms of injury (Klein et al, 1990):
• 1. Direct: following direct impact or contusion
• 2. Indirect: following a tear or rupture of fibers of the muscle
• Contracted vs relaxed muscle trauma?

15. Types of Hematoma
• There are two types:
• Intramuscular Haematoma:
• The muscle sheath and the fascia will remain intact.
• Confining the bleed within the tissues  inc pressure  compression
capillary beds and counteract the bleed) (Bird et al., 1997).
• Signs and symptoms will remain localised.
• Characteristics include:
• Swelling (beyond 48 hours).
• This is because the contained blood causes an osmotic gradient and
interstitial fluid is drawn into the muscle (Peterson and Renstrom, 2001).
• Pain and tenderness
• Decreased muscle function (reduced contraction and extensibility)
• Prognosis…. Bad as compared to inter mysositis ossificans & fibrosis.

16. • Inter-muscular Haematoma:
• Fasica/sheath is torn.
• This allows communication of the fluid between
muscles/compartments.
• Dramatic bruising and swelling  travels distally secondary to
gravity.
• In Inter-muscular hematomas the pain settles considerably
following the first 24 hours (Smith et al., 2006)…???

18. Physical therapy management of
hematoma (smith et al. 2006)
• Acute Phase Management (First 24 – 72 hours)
• REST:
• A period of relative rest is important.
• Whilst the pain should not be ignored but once the athlete can move the limb they
should do so (Renstrom, 2003).
• Early mobilisation is widely advocated (Smith et al., 1996).
• ICE:
• Proposed in the acute stages  vasoconstriction.
• Ice is proposed to reduce:
• Blood Flow
• Edema
• Muscle Spasm
• Metabolism (and therefore secondary hypoxic damage)
• Pain
• Muscle Inhibition

19. • COMPRESSION:
• No conclusive evidence.
• However, the physiological effects are undeniable.
• Thorsson et al. (1987) showed moderate compression was
able to reduce intramuscular blood flow by up to 50% in
healthy athletes.
• ELEVATION:
• No conclusive evidence can be drawn from the studies.
• The decreased arterial pressure and increased venous return.
• The application of which is obvious in haematoma
management.

20. Resolution Phase Management (72
hours +)
• HEAT:
• Giombini et al. (2001) showed that hyperthermia was superior to US for
reduction of VAS and hematoma resolution following lower limb sports
injuries.
• Such an improvement in hematoma resolution was mirrored by animal studies
performed Lehmann et al. (1983).
• ULTRASOUND:
• There are some studies that examined the effects of US following muscle
hematoma and their effects on haematoma absorption  present
conflicting results.
• Some studies have shown increases in cellular activity (of unknown
statistical significance),whilst others do not.
• Additionally, it is also possible that the positive effects reported by some
studies are a result of the thermal effects of ultrasound.
• It is challenging to draw clear conclusions of the role of ultrasound in
muscle haematoma management.

21. • EXERCISE:
• AROM and isometric exercises are widely advocated (Smith et
al., 2006).
• This is generally progressed to include resistance exercise (see
table below).
• COMBINED PROGRAMS:
• “Combined Program” which has included a 3 phase program
(Smith et al., 1996; Ryan et al., 1991).
• However, it is challenging to draw any conclusions on the
effectiveness of the programs as none include a control or
non-intervention arm.
• The table below discusses the overall components of the
combined programs.

23. • No Evidence
• No evidence/studies which examined the role of the
following treatments.
• Additionally, they were not commonly proposed by a
variety of sports medicine textbooks (Smith et al.,
2006):
• Thermal Contrasts
• Massage
• Electrical Stimulation

24. • Myositis Ossificans
• Myositis ossificans is a serious and relatively common
(~10%) complication following muscle haematomas (Smith
et al., 2006).
• Characteristics:
• Radiologically evident after 3 – 6 weeks
• Significant loss of ROM
• Significant tenderness and hardening on palpation
• More common in intramuscular hematomas
• Rehabilitation should include:
• Rest
• Gentle Rehabilitation

25. • Prognosis
• There have been a wide range of recovery periods following
muscle haematoma.
• Intramuscular haematomas have a worse prognosis than
intermuscular haematomas (Smith et al., 2006).
• Other poor diagnostic indicators include reduced distal
pulses and paraesthesias.
• Ryan et al. (1991) evaluated the use of combined program
(see above) following quadriceps contusions and found the
following results. The average time to recovery was
• Mild Injuries (knee ROM at 12 - 24hrs > 90 degrees): 13
days
• Moderate Injuries (knee ROM at 12 - 24hrs 45 – 90
degrees): 19 days
• Severe Injuries (knee ROM at 12 - 24hrs < 45 degrees): 21
days

26. Inflammatory response
• The initial stage of repair of body tissue is the acute inflammatory
phase
• 24 to 72 hours after injury.
• Immediate response of the body  increase the flow of blood and
other fluids to the injured site.
• If blood vessels damaged there  direct bleeding into the
surrounding tissue  an increase in tissue pressure, pain.
• All these changes produce inflammation.
• Redness, heat, swelling, pain and loss of function.
• Unchecked inflammation  severe scar tissue.
• Prevention of scar tissue formation directly proportional to the time
required for rehab and return of function to pre-injury level.

27. • To be continued

28. Managing soft-tissue injuries
• Effective management of soft-tissue injuries  RICER
procedure
• Immediate management of soft-tissue injuries (acute
phase)  Successful rehabilitation
• The aims of immediate treatment are to:
• Prevent further tissue damage
• Minimize swelling
• Ease pain
• Reduce the formation of scar tissue
• Reduce the time needed for rehabilitation.

30. • These aims are achieved through the application
of the RICER procedure.
• R •  first 48–72 hours  severity of the injury.
• I •  20–30 minutes every 2 hours for the first 48–72 hours.
• C •  fluid build-up & protection
• E •  Seated or lying down
• R •  for Referral.
• Actions to be avoided…?

32. Immediate treatment of skin injuries
• The aims of the immediate management :
•  Prevention of infection for both the victim and the first aider,
•  Minimization of blood loss and tissue damage, and
•  Promotion of healing in order to reduce recovery time.
• For most skin injuries the common management steps that should be followed
are:
• 1 Reduce the dangers of infection ?
• 2 Control bleeding with rest, pressure and elevation
• 3 Assess the severity of the wound
• 4 Clean the wound using clean water, saline solution or a diluted antiseptic
• 5 Apply an antiseptic to the wound
• 6 Dress the wound with a sterile pad and bandage.
• 7 If necessary, refer
• Skin injuries that should be referred to medical attention include  ?

33. Hard-tissue injuries
• Types of hard-tissue injuries
• Fractures and dislocations.
• A fracture is a break in a bone.
• Direct force,
• An indirect force or
• Repetitive smaller impacts (stress fracture).
• If the skin over a fractured bone is intact, the fracture is?
• If the skin is broken, the fracture is ?
• The skin might be broken either by the force of the injury that caused the fracture or by a
piece of broken bone protruding through the skin.
• A fracture is described as ‘?’ if nearby tissues and/or organs are damaged.
• In some cases, a simple fracture can be difficult to detect. The signs and symptoms of a
fracture include:
• pain at the site of the injury
• inability to move the injured part
• unnatural movement of the injured part
• deformity of the injured part
• swelling and discoloration
• grating of bones.

34. • Dislocations
• Dislocations are injuries to joints where one bone is
displaced from another.
• Often accompanied by considerable damage to the
surrounding connective tissue.
• Dislocations occur as a result of the joint being pushed past
its normal range of movement.
• Common sites of the body where dislocations occur are the
finger, shoulder and patella.
• Signs and symptoms of dislocation include:
• loss of movement at the joint
• obvious deformity
• swelling and tenderness
• pain at the injured site.

36. Managing hard-tissue injuries
• Medical treatment
• Because hard-tissue injuries can be accompanied by significant
damage to muscle, blood vessels, surrounding organs and nerves,
immediate medical treatment is required.
• For serious hard-tissue injuries, the person should not be moved,
and an ambulance should be called.
• Immediate management:
• Immobilize and support  splint or sling.
• Check for impaired circulation and other possible complications.
• Arrange for transport to hospital and professional medical
assessment.
• Implement the RICER procedure—if it does not cause pain.

38. • Immobilisation
• Management of hard-tissue injuries aims  minimize movement
• This is achieved by immobilizing the joints ? and ? the injury site.
• If the injury site is the shaft of a long bone (for example, the femur
or humerus), the injury can be supported with a sling or splint.
• A supporting splint should be long enough to extend beyond the
nearest joints of the injured site.
• The correct application of the splint is essential. When correctly
applied, a splint is secured at all these six points:
• above the joint above the fracture
• below the joint below the fracture
• at the joint above the fracture
• at the joint below the fracture
• just above the fracture
• just below the fracture

41. • In some cases of fracture, a rigid splint is unnecessary.
In these cases, a sling or bandaging of the injured limb
to the other limb is adequate.
• With dislocation, immobilization is also the immediate
aim. Under no circumstances should the first aider
attempt to relocate the dislocation.
• As a result of the dislocation there can be associated
damage to the bones and to the ligaments of the joint.
• In most cases, an X-ray is needed before relocation.
Any rushed attempt by the first-aider to relocate the
dislocation might result in further damage to the joint.

42. Assessment of injuries
• It is important to follow correct assessment procedures
when assisting an injured athlete.
• TOTAPS
• When attending to an injured athlete  unconscious
 DRABCD
• If the athlete is conscious  TOTAPS method of injury
assessment.
• Provide information about the extent of the injury, and
will indicate whether the person should be permitted
to continue the game/performance or should be given
professional medical help.

43. DRABCD stands for
danger,
response,
airway,
breathing,
compressions and
defibrillation.

44. TOTAPS stands for:
T • Talk
O • Observe
T • Touch
A • Active movement
P • Passive movement
S • Skills Test.
It is important to note that the control of bleeding takes
priority over TOTAPS.

45. • Talk
• cause, nature and site of the injury info. For example:
• How did the injury happen?
• Where does it hurt?
• Did you hear any snaps or cracks?
• Do you have any ‘pins and needles’?
• Is the pain sharp or dull?
• Did you continue to play for any time?
• For suspected concussion athlete’s alertness and level of consciousness.
• If the athlete shows signs of serious injury the person should be immobilized and
professional help should be sought immediately.
• The first aider might also seek information on the injury history of the athlete (for
example, previous injuries to the body part) and might talk to witnesses who saw
the injury occur.
• Observe
• After questioning the athlete, visually examine the site of the injury.
• Look for deformity, swelling and redness. If the injury is to a limb, compare.?
• If there is obvious deformity, there is likely to be a fracture or serious
ligament/tendon damage, and medical assistance is needed  no deformity
‘touch’.

46. • Touch
• If there is no obvious deformity and the athlete is not especially
distressed, feel the site of the injury.
• Using your hands and fingers, gently touch the site without moving
it.
• If possible, feel the corresponding site on the other side of the body
and compare. Note any differences.
• Observe the athlete’s level of distress as you touch the injury.
• If touching the injury causes the athlete intense pain, the injury
might be serious and medical diagnosis is necessary.
• If touching the injury causes only slight pain  ‘active movement’.
• If there is evidence of a fracture or dislocation, the procedure is
stopped at this point. Specific management for a fracture should
begin.

47. Touch

48. • Active movement
• Observe the degree of pain.
• Observe the extent or range of movement that is
achieved by the athlete.
• Compare.
• As the athlete moves, feel the injured site for any
clicking or grating.
• If the athlete cannot move the injured site, or has only
minimal range of movement RICER procedure is
used, and medical assistance.
• If the athlete can move without intense discomfort,
proceed to the passive moment.

49. • Passive movement
• Reached the passive movement stage  not serious.
• A decision needs to be made as to whether or not the
athlete should continue to play.
• The ‘passive movement’ stage requires the first aider
to move the athlete’s injured body part and determine
how much pain-free movement is possible.
• If the athlete cannot have the injured part manipulated
through the normal range of movement without pain,
the first aider should not continue.
• RICER treatment should be administered. If the range
of movement is normal, the athlete should be asked to
stand.

50. • Skills test
• If the athlete can stand  pressure on the injured
site by performing movements
• For example, the athlete could run, hop, jump
and push. If these actions can be completed ?
• For example, in the case of a football player being
assessed for an ankle injury, you would ask the
player to  ?

51. •Thank You