Exam 1 - 1 Flashcards
Sports medicine - 2
- broad field of medical practice related to PA and sport
- multidisciplinary including the physiological, biomechanical, psychological, and pathological phenomena associated with exercise and sports
ACSM
american college of sports medicine
4 things that the coach is responsible for?
- prevention of injuries
- provide/direct appropriate health care to the injured athlete
- thorough understanding of the skills, techniques, and environmental factors that may adversely affect the athlete
- work closely with medical staff
umbrella - 2 sides of sports medicine
performance enhancement
injury care and management
8 professions of performance enhancement
exercise physiology biomechanics sports psychology sports nutrition strength and conditioning personal fitness training coaching physical ed
8 professions of injury care and management
practice of med - physicians and assistants AT sports PT sports massage therapy sports dentistry osteopathic med orthotists/prosthetists sports chiropractic
triangle sports med model
coach, treatment, performance, bottom is prevention surrounding the athlete
sports med team 1-9
treatment
- sports med, physician (canadian academy of sports and exercise
- orthopedic surgeon
- AT
- Sports PT
- Massage Therapist
- nutritionist
- dentist
- podiatrist
- chiropractor
Sports sci 1-7
biomechanist exercise physiologist sports psychologist strength and conditioning coach biochemist anatomist bioengineer
When collaborating with other personels on the team, what’s important
know the roles and responsbilities of each medical professonal and stay in your lane
What kind of treatments do we aspire to provide - 4
knowledge, competency, effective and evidence based
what kind of treatments can sports professionals give - 7
- injury prevention and health promotion
- clinical examination and diagnosis
- acute care of injury and illness
- therapeutic interventions
- psychosocial strategies and referral
- health care admin
- PD and responsibility
sports med physician (CASEM) and 4 responsibilities
absolute authority in determining health status of an athlete who wishes to participate in a sports program
- compile medical histories
- diagnosing injury
- deciding on a disqualification and return to play
- attending practices and games - on call
AT and 3 responsibilities
start to finish - most time - prevention, immediate care and management of athletic injuries
- prevention focus on MSK assessment, equipment, prophylactic support
- immediate care includes injury assessment and basic emergency life support
- management - contemporary rehab techniques and modalities to facilitate the healing of an injury
CAT - how to become one (3)
certified athletic therapist - devoted to the health care of the physically active ind
- Bachelors’s, athletic therapy program at 1/7 CATA accredited institutions
- valid first responder certificate and 1200 hrs of onfield and inclinic practical training
- national certification exam - written and practical
5 competencies in AT
prevention assessment intervention practice management professional responsibility
6 things ATs do
onfield urgent emerge care, assessment and management
onfield nonurgent assessment, management and transportation
sideline return to play decision
prophylactic support techniques
orthopedic physical assessment (advanced, course, spinal and peripheral)
rehab (advanced cource)
kinesiologists - 3
independently with client to develop training programs - rehab clinics, primary care networks and with other health care professionals such as chiros, PTs, OTs, ATs, and dieticians
CSEP - CEP
canadian society for exercise physiology - certified exercise physiologist
CSEP - CPT
canadian society for exercise physiology - certified personal trainer
exercise physiologist/therapist -2
- csep- cep - assessments, prescribe conditioning exercise, exercise supervision, counseling and healthy lifestyle ed with healthy or pop. with med conditions, functional limitations or disabilities associated with MSK, cardiopulmonary, metabolic, neuromuscular and aging conditions
- csep - cpt
strength and conditioning specialist - 3
certified strength and conditioning specialist -improve performance - sports specific testing sessions to design and implement safe and effective programs, also nutrition and injury prevention
tactical strength and conditioning facilitator
CPT/CEP
consult with and refer athletes to other professionals when appropriate
To participate in a sport you need - 5
medical clearance - communicable disease
EAP - site specific - emergency action plan - address, call person, access of facility and phone numbers
facility safety
personal equipment and readiness
observation - event, MOI throughout, previously injured athlete, high risk athletes, atheletes with pre-existing medical conditions
when an injury happens - 6
enter field when SAFE to do so - no glass
witness - info from bystander
number of athletes involved - triage
C spine mechanisms and control - stabilize head and neck
posture of athlete - decerabrate vs decordecate - call 911
Enact EAP
decerabrate vs decordacate
yardsale and limp
neurological trauma where everything is moving towards in and seizure
Level of consciousness - 6
posture of athlete
obvious LOC - talking/walking - conscious/unconsious
AVPU - alert/verbal/painful/unresponsive
C-spine control
Position/location of athlete
Unresponsive EMS activation
air way - 4
obvious open airway - talking, heavy breathing
removal of potential obstructions
airway management - practice based on your level of training - head tilt chin lift, manual maneuvers, OPA/MPA, other
EMS?
breathing - 4
obvious breathing - talking breathing heavy
hypo/hyperventilation management - practice based on your training
- talk to, calm
- O2 administration
AR (CPR standard)
EMS activation
circulation - 3
obvious circulation - CCBMP = coughing, colour&skin temp, moving, breathing, pulse - always check for neck
CPR
EMS
deadly bleeding - 3
obvious arterial bleeding
femoral and carotid artery
first aid standard management - direct pressure, elevate, dressing, pressure points
After injury - what do you look for - 6
level of consciousness airway breathing circulation deadly bleeding CNS
CNS check - 3
Rule out spinal injury - spine not involved, no MOI, chief complaint elsewhere - if no, stabilization and through exam required with urgent paradigm
rule out head injury
- in not, thorough exam required, use SCAT or urgent paradigm
directly to peripheral jts/area
urgent vs non-urgent
stop and load - graduated model
non-urgent - staying and playing
focused secondary survey - 3
initial orthopedic scan
- jt/area defined
assessment
management
assessment - 4
what prudent skill sets and or qualifications of professional peers
SAM - skeletal - bony integrity, articular - movement (Active/passive) - luxated, dislocated, motor-control of the)
MSC - muscular- isometric/passive (dont let me move my finger), sensory - temp, 2 pt discrimination, sharp/dull, altered sensation, what am i touching? circulation - color and temp, pulse
clear joint above and below as warranted (MOI, CC)
management of focused secondary survey - 3
transport, immobilize/stabilize
- where - sideline/med facility
- how? - walk with aid, stretcher, 2 man lift, ems
Immob/transport - 5
Where stablize - method - hand above and below immob - method transport - destination and method EMS?
assess/referral - 6
through clinical sideline assessment
referral - whom, when, timely follow up (regarless of RTP status
communication - player, coaches, parents
follow up
documnet
consideration for immediate RTP
graduated return to play/prescription - 4
preparation - stabilize, protect, therapy/rehab
functional test sport specific - load
decision about RTP - clearance - doc/supervisor
monitor and document - half time, post event, next workday
3 actions following focused secondary survey
immob/transport
assess/referral
graduated RTP/RX
liability
legally responsible for the harm one causes another
AT main responsibilities - 2
prevention of injury and reducing further injury or harm
Why do we care about liability - 2
accidents happen and legal lawsuits against authority - know your legal limitations and provide health care responsibilities as dictated by law
what is legal action tried under? - 3
TORT law - civil wrong done to an ind
- act of omission/nonfeasance - ind fails to perform their legal duty
- act of commision/malfeasance - ind commits an act that is not legally theirs to perform
standard of care
measured by what another minimally competent ind educated and practicing in that profession would have done in the same or similar circumstances to protext an ind from harm or further harm - what a resonable and prudent ind would do within your knowledge and training
standard care is dictated by
professionals duty/scope of practice - roles and responsibilities of an ind in that profession and delineates what should be learned in the professional prep of that ind
Why are we behind in treatment
conservative and the principle of not hurting anyone
duty of care
AT to their participants
failure to provide that results in liability or negligence
negligent torts - misfeasance
commiting an act that is ones responsibility to uses the wrong procedure or right procedure in an improper manner
negligent torts - malpractice
commits a negligent act while providing care
negligent tort - gross negligence
total disregard for safety of others
Participants assume what risks?
the ones inherent with PA but not the risk that a professional will breach the duty of care
to find an ind liable you must prove 4 things
there was a duty of care
there was a breach of duty
there was harm
the resulting harm was a direct cause from that breach of duty
good samaritan law
limited protection to someone who choses to provide first aid who voluntarily chooses to do so should sth go wrong but we have a duty of care
you will be judged on your
performance so know the expected competency
statue of limitations
length of time to sue for damages from negligence - 1-3 yr sometimes 3 yrs after they turn 18
AT and coaches can take 5 steps to limit the risk of litigation
- inform the participant about inherent risks of participation - assumption of risk by waivers - minors are your responsibilities
- foreseeing the potential for injury and correcting the situation before harm occurs
- obtaining informed consent from ind/guardian before participation and treatment - duty of care must help
- quality products and equipment
- strict confidentiality of all med records
16 axns that can result in litigation
failing to warn about risks
treating without consent
failing to provide med info concerning alt treatment or risks with needed treatment
failing to provide safe facilities, fields and equipment
aware of potentially danger but didnt do anything about it
failing to provide a adequate injury prevention program
allowing an injured or unfit player to play and resulting in further injury or harm
failing to provide quality training, instruction, supervision
unsafe equipment
moving injured before properly immobilizing
failing to employ qualified med personnel
failing to have a written EAP
failing to properly recognize injury or illness
failing to immediately refer an injured to proper physician
failing to keep adequate records
treating an injury that did not occur within your facility
23 things you can do to manage athletic injuries and decrease risks of litigation
warn of danger
supervise constantly and attentively
properly prepare and condition
properly instruct skills
proper and safe equipment and facilities
good personal relationships
specific policies and guidelines for operation of athletic health care program
develop and follow EAP
familiar with health status and med history of athletes for additional care/caution
records of injuries and rehab
document efforts to create a safe playing environment
detailed job description in writing
written consent when providing health care - esp minors
cofidentiality of records
dont dispense any drugs
certify in CPR/AED and first aid
no use/precense of faulty/hazardous equipment
work with team doc and AT and use protective equipment
no injured player unless cleared esp head
always follow orders of AT and doc
liability insurance to protect against litigation and know the limits
know limits of expertise and applicable state regulations
common sense - health and safety of athlete
4 - why is communication important
personal relationships with athletes parents and coworkers
good record of injuries and rehab
dont give drugs
common sense in decisions of safety and health
assumption of risk - 3
legal liability waiver to express/imply agreement that they assume the risk involved in the B
take a risk when they play but should be made aware of potential risks
AT’s responsibility that they are aware
Sample form for treatment
med authorization/consent for med treatment of
- agree to pay all fees and costs arising
general liability insurance
slip and fall - injury at school/work property
professional liability insurance - 4
registered kins - pro athletes with a contract - their contract is on your insurance when they are under your care
- covers claims of negligence on ind part
- know the limits of your coverage
- may not cover criminal complaint
professionalism and dating
just date and tell people
professionalism - 6
look and act like one appropriate touching dont act in a sexually inappropriate way professional and social context texting and social media code of ethics
mission of CCES - 2
foster ethical sport for all canadians - we will not cheat
you are a educated role model now
CCES
canadian centre for ethics in sports
3 purposes of CCES
Canada’s anti doping program - govt give money to amateur sports but they are subjected to random drug tests
serve public interest and protect the rights of athletes to fair and ethical competition by promoting and striving for fair and doping free sport in canada
meet mandatory requirements of the world anti doping program
russians and doping
no anti doping officers that are wata approved
3 fundamentals of CCES
authority through govt’s canadian policy against doping in sport - when you sign as a member of the sport you promise not to cheat
sport adopt CADP into by laws for govt funding
sign on to SADP through signing as members of their sport
top 6 threats to good sport
doping - most significant violence - no game or sports related bad parental B weak sport governance neg pro sport values lack of access and inclusion
doping
performance enhancing substances or methods
what constitutes as doping - 2/3
sci evidence that substances or methods have the potential to enhave sport performance - fairness
sci ecidence that use of substances/methods rep a potential health risk - harm
use of it violates the spirit of the sport - integrity
doping control officer
official trianed and authorized by CCES with delegated responsibility for onsite management of sample collection session
type of testing - 2
incompetition - game day/event
out of competition - whereabouts program
types of athletes tested - registered testing pool
domestic athletes - random - highly ranked
motto of CCEP
anytime - anywhere
6 ways to be considered as doping
presence, use, refusing, failure, tampering, possesion, traficking - just take it, admin
5 consequences of doping
presense, possesion, use = up to 4 y ban
refusal and tampering - up to 4 yr
trafficking and admin - 4+ yrs
all made public to media by CCES
must establish - how it entered the body - was not performance enhancing, did not mask - evidence
4 ways to decide who to test
random selection
targeted testing
intelligence based testing - good athletes
biological passport program
what % of canadians were tested before socci
100
liability of doping
you - responsible for what you consume and what is found in your urine/blood
top drug seizure in ab, bc, on
marijuana
top drug seized in quebec
steroids and its also the number 2 seized drug in quebec
whats on the prohibited list - 9
- Anabolic Agents
- Hormones and related substances (EPO, Insulin)
- Beta-2 agonists (asthma)
- Agents with anti-estrogenic activity
- Diuretics or other masking agents
- Stimulants
- Narcotics
- Cannabinoids
- Glucocorticosteroids
drug prohibited at all times
Drugs prohibited at ALL times!
- Anabolic Agents
- Hormones
a. EPO, hGH - Beta-2 Agonists
a. Enhance flow of oxygen - Agents with Anti-Oestrogenic Activity
- Diuretics and Other Masking Agents
- Methods enhancing Oxygen transfer
a. Blood doping / packing - Pharmacological, Chemical, and Physical Manipulation
a. Urine tampering - Gene Doping
Prohibited doping during comp only - 6
- Stimulants
- Narcotics
- Cannabinoids
- Glucocorticosteroids
a. Anti-inflammatories - Other Drugs
a. Alcohol, beta blockers etc. - Specified Substances
a. Generally available but may be abused for performance enhancement purposes. i.e. ephedrine, inhaled beta-2 agonists etc.
3 prohibited doping methods
- Enhancement of Oxygen transfer
- Chemical and Physical manipulation (urine and blood samples)
- Gene Doping - hyperplase muscles
- Hypoxic devices are ok.
gene doping
genetic enhancement that cannot be detected nor shut off - hyperplasia doenst stop so you die - allele with myostatin knocked out
how do i know if sth is ok - 3
drug info number - every sport fed has own rules
drug ref online - globaldro and CCES
how many global dro inquiries last yr
108000
suppliments
CCES media release supplement kaizen HMB and pos test
declaration of doping
declare all prescription and /or non meds and or supplements taken in the past 7 days
why does the drug program exist - 2
sport and society cannot exist w/o rules or agreed upon codes of conduct - protect the rights of clean athletes but not to catch dirty or cheating ones
8 reasons why athletes dope
- Money drives the athlete to win?
- Edge over competition
- Peer Pressure
- Physical appearance
- Status, recognition
- Coaches are paid to win
- Parents
- Pharmaceutical companies?
highest use of anti doping lab in QC - 3
MLB
CCES
NBA
anti doping lab in QC
second largest in the world
designer steroid
on the rise
stimulant s6
nightmare
stimulant s6
nightmare
new weight loss stim
methylhexanamine/dimethylhexanamine - bad
where do designer steroid/stim come from?
china
anabolic steroids in 1988 vs 2006
20 vs more than 200
top 3 steroids
testosterone
nandrolone
stanozolol
the clear
- THG or Tetrahydrogestrinone (often referred to as THG or The Clear) is an anabolic steroid.
- THG is a Designer steroids which means it was designed to keep the T:E ratio low.
- Kelli White – modafinil and THG
top 3 sports with AAs
cycling - pedal harder
baseball
hockey - power endurance
HGH - 8
- Somatrem or Somatropin
- Anabolic hormone that affects all body systems and is important in muscle growth
- One of the most highly sought after drugs among athletes. Why?
- Anabolic properties and difficult to detect
- hGH causes hyperplasia vs. hypertrophy with AAS
- Affects of hGH persist after cessation of use vs. AAS
- Beware!
- Acromegaly, stimulation of ALL tissues including internal organs, nonreversible effects, injection administration
EPO
metabolic agent
erythropoietin - increases the oxygen carrying capacity of the blood, decreases exercise heart rate, and lowered post-exercise lactate levels
• Normally taken with AAS such as nandrolone to potentiate the effects of EPO!
• BEWARE – Increased systolic blood pressure, increased blood viscosity, seizures, thrombosis, as you dehydrate, your hematocrit % increases or your blood thickens! 50% to 60%
the way you play
how you live, behave and who you are
etiology
cause of injury/disease - mechanism
pathology
structural or functional changes that result from the injury process
symptom
perceptible change that indicates injury or disease - (what they feel and or describes)
sign
objective, definitive and obvious factor for a specific condition
diagnosis 1 -3
name of a specific condition - physician
legal implications
differential Dx - ATs
index of suspicion
prognosis - 4
prediction of the course and outcome of the condition - spectrum
what is to be suspeccted as it heals (when can i play)
how long will you be experiencing pain/disability - permanent?
time frame/expected outcome
sequela
condition resulting from disease or injury, development of a additional condition as a complication of an existing injury
syndrome
group of S&S that together, indicate a particular injury or disease
anatomical planes - 3
med profes refer to sections of the body in terms of anatomical planes/flat surfaces - imaginary lines drawn through and upright body -used to describe specific body part
axial
transverse anatomical direction
what are anatomical planes in references to?
anatomical position
midline
sagittal plane
ventral
ant
cephalad/cranial
head
caudal/caudad
tail/tail end
What do we do with abdominopelvic quadrants
palpate for tenderness and gas
right upper quadrant - 6
liver, rt, kidney, colon, pancreas, gall bladder
right lower quadrant - 4
appendix, ascending colon, right ureter, major vessels - artery and vein
left upper quadrant - 5
stomach , spleen, left kidney, transverse and descending colon, pancreas
left lower quadrant - 4
descending colon, small intestine, left ureter, major vessels - aetery and vein
eversion
turning outward
inversion
turning inward
pronation to the foot vs hand - 3 -1
combo of eversion, abduction of forefoot and dorsi flexion
hand turned down
supination to the foot vs hand - 3 - 1
inversion, plantarflexion and adduction of the forefoot
hand turned up
valgus
deviation of part of extremity distal to jt towards midline - knocked knees
varus
deviation of part of extremity distal to jt away from midline - bow legged
bones of the foot
26
14 phalangeal
5 metatarsal
7 tarsal
foot anatomy compared to hand anatomy
wider base for balance and propelling the body forward
metatarsals
5 bones articulate with the tarsals and phalanges
tarsals
between lower leg and metatarsal
medial longitudinal arch
medial border of calc to distal head of 1st metatarsal
lat longitudinal arch
lat aspect of calc, cuboid, and 5th metatarsal
ant metatarsal arch
distal heads of metatarsals
transverse arch
transverse tarsal bones - cuboid and middle cuneiform
interphalangeal jt - 1- 2
bw proximal and distal phalanx - flexion and extension
metatarsophalangeal jt 1-4
MT and proximal phalanx - flexion, ext, add, abd
tarsometatarsal jt 1-4
cuboid and all 3 cuneiforms and MT
flex, ext, add, abd
subtalar jt - 4
talus and calc - pronation, sup, in/e
talocrural jt 2-2
ankle mortis
talus and distal tib fib
ankel PF and DF
why are you unstable on your toes?
talus is wide in the front and narrow in the back
2 phases of gait
stance - move from pos lat to big toe
heel strike, midstance and toe off
swing - after toe off and initiate contact for heel strike
greater trochanter bursitis
too much swing in hips
why is pronation important for gait
4 prolonged pronation injuries
shock absorption
stress fracures, tendonopathies, medial tibial stress syndrome, knee pain
why is supination important for gait?
3 prolonged supination injuries
forceful propulsion of body forward
stress fractures, tendonopathies, lower back pain
high arch
supinated - tight musculature on the inside of your calf
ATFL injury from
Supination
Footware for pronation - 4
rigid heel counter, less flexible shoe, board lasted
hypermobility problems
footwear for supination - 4
flexible shoe, increased shock absorption, stitch lasted
hypomobility problems
lower leg
portion of lower extremity that lies between the knee and ankle
tibia, fibula, talus and calcaneous
tibia - 2
2nd longest bone in body
3 surfaces - pos, med, lat
fibula - 2
attachment for muscles
6 wks you can play with plates
talus
link between lower leg and foot
calcaneous - 2
heel and site of attachment for achilles
sup and inf tibiofibular jt
sup - reinforced by stabilizing ligs ant and post
inf - reinforced by ankle ligs
interosseous membrane - 2
cover entire length of both bones - ant and pos tibfib lig is the distal of the interosseous mem
medial lig - 5
ant talofibular, pos talofibular and calc tabolibular
deltoid - triangle
later mal is longer so eversion less than inversion
med surface of talus, calc, and navicular
resistance to eversion - eversion test
3 lateral lig
ant talofib - refrain ant displacement of talus
calcfib - restrain inversion of calc
pos talofib - refrains pos displacement oftalus
3 muscles of the ant compartment and function
tibialis ant, extensor hallicus longus - in front of med mal, extensor digitorum longus - dorsiflex
3 muscles of lat compartment and functions
peroneous longus and brevis - evert foot
peroneous tertius - dorsiflex ankle
2 muscles of sup pos compartment and function
gastroc and soleus - achilles tendon - plantarflex
3 muslces of deep pos compartment and function
tibialis pos, flexor digitorum longus and flexor hallicus longus - behind medial malleous
3 articulations in your foot
proximal and distal interphalangeal jt
metatarsalphalangeal jt
intrinsic muscle in the foot
extensor digitorum brevis
Ant compartment 3 muscles pulse muslce action
Tom's hairy dog - med to lat on ant surface TA - most prominent and medial extensor hallicus longus - DF first toe extensor digitorum longus - extends toe dorsalis pedisis artery pulse peroneous tertius DF ankle and extend toes
lateral compartment - 2
peroneous longus and brevis - evert and DF foot
Deep pos compartment 3 muscles nerve muslce function
Tom dick and harry - ant to pos
tib pos - invert and PF foot
flexor digitorum longus - flx toes
pos tibial artery - main blood supply to foot
tibial nerve - main nerve supply to sole of foot (tarsal tunnel
flexor hallicus longus - cannot be palpated
invert the ankle
claw toes - 2
hyperflexion of MTP and flexion of proximal and distal IP jt
associated with pes cavus and painful calluses
hammer toes
similar to claw
morton’s foot - 2
second toe is longer than first - stress to 2nd toe and hypomobility to 1st toe
difficulty putting on tight shoes
accessory navicular - 2
double ankle jt
prominence on the navicular tubercle
pes cavus - 2
signs and symptoms - 3
management - 3
high arch
excessive supination
general foot pain,
metatarsalgia
abnormal shortening of achilles tendon asymptomatic dont correct
orthotic,
stretching achilles tendon and plantar facsia
pes planus -2
cause - 2
signs and symptoms - 2
management - 3
flat foot
excessive foot pronation
weak musculature invertors or stretched plantar lig
pain and feeling of weakness in the med longitudinal arch
calcaneal eversion, bulging of navicular bone, flattening of the medial longitudinal arch
asymptomatic dont treat
orthotics
strengthening of the foot invertors, toe curls
assessment of the foot - 7
weight bearing walking - stance, swing, push off running talocrural - dorsiflex - active 20, plantarflex - active 50 subtalar supination pronation
mechanical injury - 2
injuries occur when force applied to any part of the body results in a harmful disturbance in function and or to the structure
- external force directly on the body or occur internally within the body
tissue properties - 2
tissues have the ability to resist a particular load - stronger the tissue, greater the magnitude of load it can with stand
stress strain curve
toe - elastic - (ultimate strength) - plastic (necking) -failure range (strain deformation
toe
1.5-4% of total fibre lengthening that is possible
necking
point at which tissue strength noticeably decreases so that less stress is needed to cuase a change in the tissues length - partially rips
plastic range
doesnt completely recover
stretching and tissue properties - 2
toe is where everyone goes
has to go through plastic for permanent deformation - PNF - passive to barrier (passive restraint) then you keep going and get past it - compensation from the body and scream and push back but hold for 10 seconds and repeat till no slack - you have to hurt a little
does static stretching increase flexibility?
no
slow vs fast load
fast much more dangerous and forceful
load
outside forces acting on tissue
stress
internal reaction or resistance to an external load
strain
extent of deformation of tissue under loading
viscoelastic
material whose mechanical properties vary depending on rate of load
yield point
elastic limit of tissue
mechanical failure
elastic limit of tissue exceeded, causing tissue to break
5 primary tissue stresses leading to injuries
tension, stretching, compression, shearing, bending
tension
force that pulls or stretches tissue
stretching
when go beyond yield pt leads to rupturing of soft tissue or fracturing of bone
compression
large force that crushes tissue
shearing
force that moves across in a parallel fashion across tissue - muscle is okay but bone will break
bending
force on a horizontal axis that places enough stress to cause the structure to bend
acute injuries and 6 examples
within 3 days- some sort of healing and it was an event - sudden and traumatic
contusions, sprains, strains, dislocations, subluxations, fractures
contusions - 6
MOI
What happens
bruise
external force causes soft tissues to be compressed against hard bone
capillaries may break and cause bleeding into the tissues which accumulates under the connective tissue
deep contusions can bruise the bone
pain improves within a few days and discoloration decreases with a few weeks
muscle pain with active contraction
myositis ossificans
MOI
What happens
dont take care of the inflammation - you need to pad and let it heal
occurs when a muscle or soft tissue is bruised repetitively
ca begins to deposit in muslce fibre - blood pooling and ph changes
may impact movement
Treatment of myositis ossificans
usually surgical intervention is needed
prevention of myositis ossificans
protect from repeated contusions - use padding
common 2 places of myositis ossificans
quads and biceps
muscle strain
tearing or stretching of the muslce fiber when its forced to contract against increased resistance
degree of strain is related to
number of muscle fibres torn
grade 1 of muscle strain
some fibres stretched or torn - minimal swelling, tenderness and pain with AROM, rest doesnt hurt and full ROM
grade 2 muscle strain
more fibres torn, increased pain and greater loss of muslce function with AROM - divot or depression - may be swelling
grade 3 muscle strain
complete rupture
no pain, palpable defect, loss of muscle function, swelling and bruising
what is the usual MOI for a grade 3 muslce strain
fast eccentric force
3 common grade 3 muscle strains
biceps, achilles, hamstrings
charlie horse RTP rule
if you cant actively get 90 degrees
ligaments
tough inelastic bands connecting bone to bone
lig sprain
when jt is forced to move beyond normal limits, damage to lig or jt capsule that provides support to a jt - crushing and tearing - disrupting the integrity of a joint
can you play on a lig injury?
yes if your muslces are still good
how are lig sprains graded?
severity of damage
grade 1 sprain
minor stretching /tearing of fibers - pain, localized swelling, minimal instability
grade 2 sprain
more tearing, increased pain, swelling, more instability
grade 3 sprain
complete rupture of fibres, little to no pain, groww swelling, joint stiffness, complete instability
dislocation/luxation - 2
one bone in a jt forced completely out of normal alignment - deformity
can result in other soft tissue injuries - rupture of lig and tendons, avulsion fractures, chronic joint stability
how to reduce a dislocation
manually or surgically
common dislocation - 3
shoulders, elber, fingers
subluxation - 3
partial dislocation
bone forced out but goes back into alighment
can cause lig stretching/tearing, capsular distention - increase likeliood of reoccurrence
common subluxation - 3
patella, shoulder jt, fingers
fractures
signs and symptoms
extreme stress/strain on bones
deformity, point tenderness, swelling, pain with AROM/PROM, crepitus
X-ray or other dianostics to rule out
open/closed fracture
protrude/breaks through skin
little or no displacement between bone ends
our tests for fractures - 4
tuning for, vibration, indirect pressure, axial loading
chronic injuries - 2
6 ex
repetitive microtraumas and overuse inflammation is the process for acute injuries - when the source of irritation is not removed, inflammatory process becomes chronic tendinopathy tendinitis tenosynovitis bursitis osteoarthritis stress fractures
tendinitis MOI signs and symptoms treatment ex - 4
inflammation of tendon
repetitive movements - when it moves or slides on other things its irritated and inflamed
pain with movement, swelling, increased temp, crepitus
rest, cross training to allow tendon to rest/decrease inflammation
tennis elbow, bicep tendinitis, achilles, ITB
cross training
2 or more aerobic classes
ankle - 6 bones
tib fib talus calc navicular metatarsals
tibia - 3 parts
ant border
posteromedial border
med mal
fibula - 2
head of fibula in sup ribiofibular jt
lat mal
important part of talus
head
calcaneous - 3
sustentaculum tali - supports talus and attachment site for spring (deltoid lig)
peroneal tubercle - distal to la mal, separate peroneus longus and brevis
medial tubercle
med tubercle
- med plantar surface
- attachment of plantar aponeurosis
- weight bearing
part of navicular
navicular tuberosity
metatarsals - 2 things we need to know
1st and 5th metatarsal
styloid of 5th
medial lig
deltoid
dorsum lig
ant inf tibiofibular lig
lat lig - 3
ant talofibular lig
cfl
pos talofibular lig
4 special tests
eversion
inversion
ant drawer
thompson
eversion test - 2
stabilize tib and evert calc
assess deltoid lig stability
inverstion test - 2
assess ATFL and CFL stability
talus gaps in ankle mortise
Ant drawer test - 2
ATFL is the only structure preventing forward subluxation of the talus
stablize tib, grip calc and draw calc (and talus) forward while pushing the tib pos
thompson test - 3
tests continuity of the achilles tendon
patient lies prone on table, squeeze muslce belly of the gastroc - should have resultant PF of foot
may also present - pain, swelling, TOP, inability to PF foot strongly, able to walk but absense of push off, toe off, and flat foot gait
6 common injuries to the ankle and lower leg
ankle sprains achilles tendonitis, rupture shin splints plantar fasciitis (Arch) mortons neuroma turf toe
ankle sprains
MOI
S&S - 4
management
most common athletic injury esp inversion sprains
inversion of the ankle with PF or DF (inversion or lateral sprains), eversion with generally DF
pain and disability, unable to weight bear, swelling, bruising
PIER, xray to rule out fracture, strenthening and balance exercises
grade one ankle sprain
tearing of some fibres
grade 2 ankle sprain
more tearing of fibres with noticable laxity in the jt
grade 3 ankle sprain
complete rupture of fibres
what might lead to ankle injury
poor balance
after an ankle injury
balance may be affected due to subject’s inability to determine position of ankle therefore gait will be affected as well
achilles tendon rupture
MOI
S&S - 5
management - 2
quick motion from PF to DF sudden snap in achilles area pain may be present swelling over tendon point tenderness inability to raise up onto toes non-operative - PIER, Nonsteroidal anti-inflammatory drugs, casting, gentle stretching and strengthening operative - surgical attachment of ends of achilles, then PIER, ROM, strengthening and balance exercises
achilles tendonitis
MOI - 2
S&S - 3
management - 5
overloaded due to excessive stress - decreased flexibility is also a contributing factor pain and stiffness in area decrease in strength of G/S complex crepitus with movement need to decrease stress on the tendon PIER and correct faulty mechanics Heel lift to put the foot into slight PF Stretching GS complex casting if athlete is non-compliant
shin splints - 4
medial tibial stress syndrome
stress reacion inflammation of the periosteal and musculotendonis fascial junctions
distance runners
rule out stress fracture and ant compartment syndrome
Shin splint MOI - 4
S&S - 3
Management - 6
training errors, improper or poor footwear, tight achilles
repetitive microtrauma
pain in middle or distal 1/3 of lower leg
varies in intensity from with activity only to pain with ADL
4 grades of pain
referral to physician to rule out stress fracture
modify activity
correct abnormal pronation, local treatment, stretch GS, taping
plantar fasciitis - 2
pain under proximal arch and heel
plantar fascia supports the arch of the foot
5 causes of plantar faciitis pain
stretching of facia as in toe extension fascia shortens as a result of improper footwear or gait mechanics leg length discrepancy excessive pronation tightness of GS
Plantar fasciitis S&S - 2
management - 6
pain on anteromedial aspect of heel with weight bearing and toe extension burning pain with weight bearing esp morning orthotics night split PIER arch taping stretching GS proper footwear
Metatarsalgia/morton’s neuroma
5 causes
pain in forefoot
tight GS
increased pressure on forefoot due to gait alterations
causes nerves to be impinged between matatarsals
aggravated with collapse of transverse arch
pronated foot
2 S&S for metatarsalgia/morton’s neuroma
management -3
pain in forefoot
tingling and/or numbness in forefoot
orthotics, stretching GS
strenthening foot intrinsic muslces with toe curls
Turf toe causes - 2
hyperextension results in sprain of MTP jt of 1st toe
occur b/c shoes are very flexible of turf (surface) is very sticky and allows more flexion of the 1st MTP jt
2 S&S of turf toe
4 management
pain and swelling in and around 1st MTP jt
pain with 1st toe flexion when pushing off
stiffer shoes in the forefoot
taping to prevent toe extension
PIER
Retrocalcaneous bursitis cause - 3
inflammation of the bursa that lies bw the achilles and calcaneous
- pressure and rubbing
- exostosis - bony outgrowth - pump bump
2 S&S of retrocalcaneal bursitis
4 management
pain with palpation swelling on both sides of insertion PIER NSAIDS heal lift to decrease irritation on tendon find irritating cause
clonic spasm vs tonic spasm
intermittent contraction and relaxation vs constant muscle contraction
MOI of leg cramps
unknown - thought to occur from lack of fluid
S&S of Leg cramps
considerable pain and cramping
management of leg cramps - 3
stretching with pressure applied over muscle cramp
ice
rehydrate
acute leg fractures MOI
S&S - 2
direct/indirect trauma
pain and disability
immediate swelling over fracture site
splint and refer
stress fracture MOI - 3
repetitive trauma
pronated - fibular stress fractures
supinated - tibial stress fractures
S&S of stress fractures -3
along bone with palpation
positive fracture test at times
bone scan to rule out fracture
management of stress fractures
correct mechanical causes, NWb for rest
stretch tight structures
Type of tape for prophylactic taping principles
white, non-elastic, adhesive 1 1/2 inch width
what to consider while buying tape - 3
grade of backing fibres - thread count/quality
quality of adhesive
winding tension
Tape prep for prophylactic taping - 4
skin surface, nicks and cuts, shaving, allergies
9 things for a tape job
razor soap tape remover - dehesive tuff skin prowrap heel and lace skin lube tape and stretch tape scissors/shark
3 phases of healing process
inflammatory (hemostasis) response - 0-4d
fibroblastic repair 1-inf
maturation - remodeling 2-inf
continuum - overlap and have no set/end pt
goal of you during healing process
create an environment that is conducive to the healing process
When does inflammatory begin
what does it result in?
duration?
once tissue is injured - direct injury to cells of soft tissue
Release of materials needed for the inflammatory response
2-4 d - ice in 72 hrs
purpose of inflammation - 2
protect/splint, localize and rid body of some injurious agent in prep of healing
associated with vascular, cellular and chemical responses
Why is the inflammation phase critical?
if it does not accomplish what is needed/does not subside, normal healing cannot take place
Symptoms of inflammatory response
Swelling Heat Altered function Redness Pain
2 events of inflammatory phase
vascular reaction
formation of a clot
vascular reaction - 2
vascular spasm - vasoconstriction of vascular walls to reduce blood flow (5-10min - ice, tensor, immob), followed by vasodilation
formation of a platelet plug, blood coagulation, and growth of fibrous tissue
chemical mediators released - histamine, leukotaxin, necrosin to limit amt of exudate and swelling, swelling depends on the extent of tissue damage
formation of a clot - 3
damage to BV exposes the endothelium and collagen fibers
platelets and leukocytes adhere to the exposed fibers, eventually forming a plug
localize the injury process
Fibroplasia
Period of scar formation
Fibroblastic phase
time frame
S&S- 2
formation of scar
first few hours and up to 4-6 weeks
inflammatory S&S subside
tender to touch and painful with certain movements - depends on the tissues diff peak points
What is happening in fibroblastic phase - 2
new capillaries bud into wound to deliver oxygen - increase blood flow and nutrients to site - initially a granulation tissue to fill in gaps
as healing continues fibroblast accumulate at the would site and synthesize new extracellular matrix that contains collagen, elastin, ground substance and additional proteins
day 6-7 of fibroblastic - repair phase - 3
collagen fibers deposited in a random fashion, forming a scar
tensile strength increases in proportion to the rate of collagen synthesis
increase in tensile strength decreases fibroblast production to begin next phase
Maturation-remodeling phase - 5
long term - up to several yrs
realignment or redeling of collagen fibers that make up the scar tissue and ongoing breakdown and synthesis of collagen
increased stress and strain causes the collagen fibers to realign along the lines of tension
tissues gradually assume normal appearance and function
by the end of 3 weeks - firm, strong, contracted, non-vascular scar forms
Chronic inflammation - 4
acute inflammatory phase does not eliminate the agents and restore tissue to normal state
can last for m to y
repeated microtraumas and overuse of a particular structure
typically resistant to both physical and pharmacological treatments
Cartilage healing capability
dependent on whether the damage is to the cartilage or subchrondral bone - bone progresses normally
Lig healing capability - 3
normal
fibrin clot helps to bridge the torn ends of the lig
over m scar continues to mature in response to stress and strain - up to 12 m
why is lig healing variable - 2
scar tissue is insufficient
lig not reattached to the proper location on the bone - lig failure
3 stages of healing in muscles
in large and force producing muslces - hemorrage, edema, phagocytosis to clear debris
scar formation, myiblastic activity to regenerate myofibrils
maturation - collagen fibers arrange themselves along lines of tensile force - needed for active muscle contraction
active muscle contraction is needed for
normal tensile strength
Length of rehab in muscles depend on
degree of strain = can be longer than lig sprain
Muscle strain and too soon for return to play
reinjury and start healing process again
Nerve healing
process - 3
cells dont regenerate when they die but nerve fibers do
peripheral nerve regeneration at 3-4mm/d
damaged nerves in CNS regenerate very poorly bc they lack CT sheaths and schwann cells dont proliferate
surgical intervention in severed nerve - increases healing potential
Bone healing - 3
callus formation needs to occur at the fracture site
remoddling process - ongoing where osteoblasts lay down new bone and osteoclasts remove bone according to the forces placed on the healing bone - wolff’s law - bone adapts to the mechanical stress and strain by changing size, shape and structure
osteoblast/clast activity may cont for 2-3 years
3 types of trauma to bone
contusion of periosteum
closed nondisplaced fractures
displaced open fractures that involve soft tissue
factors that impede healing - 7
extent of injury - edema hemorrhage poor vascular supply infection separation of tissue muscle spasm health, age and nutrition
extent of injury and healing -2
greater the damage the more inflammation present - microtears vs macrotears
edema and healing
increased pressure causes tissue separation, inhibits neuromuscular control and impedes nutrition to the injured structure
hemorrage and healing - 3
increased bleeding causes increased pressure, additional tissue damage
if its bleeding its not healing
poor vascular supply and healing
poorly and slow - tendons and ligs
infection and healing - 2
delays healing and increases granulation tissue
separation of tissue and healing - 2
need more scare tissue to fill the gap
smooth edges vs jagged/separated edges
muscle spasm
cause traction of torn tissue, separating the 2 ends, affecting approximation
health, age and nutrition - 2
older age has less elastic properties of tissue vit c(collagen synthesis), vit k(clotting), vit A(immune system)
PIER
pressure - pressure on blood vessels to make it harder for fluid to leak out
ice - vasocontriction therefore reducing swelling
elevation - uses gravity to assist in fluid drainage in area
rest - ceases damage to the area by not placing stress on injured structures
Pain - 2
subjective sensation
unpleasant sensory and emotional experience associated with actual or potential tissue damage
Goal with pain
control acute pain by encouraging the body to heal through exercise designed to progressively increase functional capacity and return the patient to full activity as quick and safe as possible
acute vs chronic pain
less than 6m vs greater than 6m and cont beyond usual normal healing time
referred pain
away from the actual site of irritation
How do you treat pain -2
therapeutic modalities and manual therapy techniques
ex: heat, cold, electrical stim, ultrasound, manipulation, ART, massage etc
medication - Physician - NSAIDs or analgesics
4 ways to treat pain with therapeutic exercises
exercises/stretches to ROM; helps enhance realignment of scar tissue
exercises to help strengthen injured tissues or surrounding areas
include proprioception
advance to functional exercise
infection in inflammatory stage
cant get out of it
what colors are healed scares
white, if its pink small roots of capillaries are still feeding it
what to make sure with scars
mobile and flexible to ensure consistency matches skin
healing by primary intention
stitches
how to figure out when to use stitches
open it to see deepness and if it goes back together its okay steri strip, if not - get stitches
In what environment do cuts heal better in?
moist environment
how do you heal chronic inflammation
reset it to square 1
stability for a jt after a lig injury
generally pretty good, some are within the jt capsule and gets less blood
3 treatments during skeletal inflammatory
milk massage, ice, anti inflammatory
2 treatments of skeletal during fibroblastic phase
gentle ROM, take gravity out and test
2 treatments of skeletal during fibroblastic phase
gentle ROM, take gravity out and test
smoking and healing
worse - 256x for CO to bind to RBC than O2
1-10 scale for pain
5 you are stopping2, for a break, 7 youre crying, 9/10 hospital
