Injury Flashcards
What is an acute injury?
Injuries resulting from a sudden there and then, stress to the body
What is an example of a cause of an acute injury?
A big hit in rugby
What is a chronic injury?
Injuries resulting from continuous stress over time to the body and normally linked to over training.
What are soft tissue injuries?
Stress/damage to soft tissues eg ligaments, tendons, muscles, skin and internal organs.
What are hard tissue injuries?
Stress/damage to a hard tissue eg bone/joint/cartilage
What is normally more serious, hard or soft tissue injuries?
Hard
What are examples of acute soft tissue injuries?
Sprain Strain Exercise induced muscle damage (DOMS) Haematoma Cramp Abrasion Concussion
What are examples of acute hard tissue injuries?
Fracture
Dislocations
Torn cartilage
What are examples of chronic soft tissue injuries?
Tendinosis
Tennis elbow
Achillis tendinosis
Medial tibial stress syndrome (MTSS/shin splints)
What are examples of chronic hard tissue injuries?
Stress fracture
Osteoarthritis
What is a sprain?
Damage (stretch/tear/rupture) to a ligament
What causes a sprain?
Sudden twist/impact or fall moving the joint beyond it’s normal/extreme ROM. eg common at the ankle when turning
What is a strain?
Damage to a muscle/tendon
What causes a strain?
Overstretching a muscle/tendon.
eg common in adductors in lunging sports such as badminton
What are the symptoms of a sprain/strain?
Pain, inflammation, bleeding/bruising and less ability for weight bearing.
Symptoms are dependent on severity, categorised using a 3 grade system (grade 3 is most severe)
What is a haematoma?
A localised pocket of congealed/thickened blood
What causes a haematoma?
Impact/blow to the body causing the rupture of blood vessel leading to bleeding which congeals to form bruising (contusion)
What is a cramp?
An involuntary muscle contraction
What causes a cramp?
Low oxygen and increased dehydration lead to less sodium/salt leading to muscle fatigue and insufficient ATP for the muscle to release the muscle contraction.
What is an abrasion/friction injury?
Superficial damage to the skin
What causes an abrasion/friction injury?
Contact/friction with a playing surface or clothing/equipment rubbing on the body causing mainly minor friction burns eg friction from a slide tackle on astro-turf.
What is a concussion?
A brain injury causing a temporary/complete loss of consciousness and brain functioning.
What causes a concussion?
Direct impact to the head or whip lash movement of the head which shakes the brain inside the cranium eg in contact sports such as rugby and boxing.
What are the symptoms of concussion?
Nausea, headaches, shallow breathing, dizziness, loss of balance/memory.
One major impact to the head (rugby) or repeated smaller impacts (boxing)
What is a fracture?
Partial/complete break in a bones continuity
What causes a fracture?
Mostly due to direct impact from a blow/fall to a simple twist, sudden muscle contraction or repetitive abnormal stress
What are the symptoms of a fracture?
Pain, swelling, loss of movement, deformity/discolouration. Most common in contact sports eg rugby
What is a dislocation/subluxation?
Partial/complete displacement of one bone from another.
What causes a dislocation/subluxation?
Primarily due to a force causing the joint to go beyond its normal ROM eg impact from from opponent/fall
What are the symptoms of a dislocation/subluxation?
Deformity, tenderness, loss of limb function/movement, swelling, pop/pain, can cause a rupture of ligament/tendon.
Most common in fingers/shoulders
What is tendinosis?
Degeneration of a tendon.
What causes tendinosis?
Repetitive overuse, common at tendons of the ankle/heel, knee, shoulder, elbow and wrist.
Increase in intensity/duration of training, lack of recovery time, tight muscles.
What are the symptoms of tendinosis?
Swelling, ache pain when moving/touching, stiffness/weakness, decrease ROM.
What is medial tibial stress syndrome (MTSS/shin splints)?
Inflammation of the tibialis anterior/posterior muscle/tendon (myositis)
What causes medial tibial stress syndrome (MTSS/shin splints)?
Overuse of the muscle/tendon/bone, often by a sudden increase in training/training on hard surfaces. Postural alignment, poor footwear.
What are the symptoms of medial tibial stress syndrome (MTSS/shin splints)?
Shin pain/irritation/tenderness before and during but increase after rest.
What is a stress fracture?
Small cracks in a bone surface
What causes a stress fracture?
Overuse of skeletal bones often by a sudden increase/change in training/surfaces, rhythmic repetitive stress, muscle fatigue.
Increased chance in weight bearing bones eg tibia/fibula. eg cross country runners
What are the symptoms of a stress fracture?
Pain/swelling/touch sensitive, more acute during the event than after.
What is osteoarthritis?
A degenerative joint disease.
The breakdown and eventual loss of articular/hyaline cartilage at ends of bones. This cartilage lubricates, cushions, absorbs and protects the ends of the bones from wear and tear.
What causes osteoarthritis?
Abnormal/repetitive compression over time, causes microtrauma and bone thickens and forms bone spurs/projections.
Repeated sprains weaken ligaments and increase micro tears
What are the symptoms of osteoarthritis?
Joint pain, swelling and bone spurs. Limits ROM.
What are the risk factors to osteoarthritis?
Trauma Overuse Major injury in earlier life Ageing Obesity/overweight
What are the 2 types of risk factors for injury?
Extrinsic
Intrinsic
What is the definition of extrinsic risk factors?
Risk/force from outside the body eg other objects/individuals/environment
What is the definition of intrinsic risk factors?
Risk/force from within the body eg internal forces/stresses from within
What are the 4 types of extrinsic risk factors?
Inappropriate technique
Inappropriate training
Environment
Equipment/clothing
What are the 4 types of intrinsic risk factors?
Individual variables - previous injury
Individual variables - mental/psychological aspects
Training effects - physical fitness components
Training effects - motor fitness components
What are examples of Inappropriate technique as an extrinsic risk factor?
Coach Poor technique Playing time Position played Level of performance Risks unique to the sport
What are examples of inappropriate training as an extrinsic risk factor?
Too much/too soon Plyometric training before ready Inappropriate training programme (not specific) Too much overload Variance Not specific No warm up/cool down Moderation (testing)
What are examples of environment as an extrinsic risk factor?
Heat Altitude Cold Time of day Time of season Laxity of officials Crowd control
What are examples of equipment/clothing as an extrinsic risk factor?
Shin pads
Gum shield
Scrum cap
Footwear
What are examples of individual variables - previous injuries as an intrinsic risk factor?
Gender Age Physical maturation Posture/alignment Less nutrition Less joint stability
What are examples of individual variables - mental/psychological aspects as an intrinsic risk factor?
Confidence Past experience Innate intelligence Innate motivation Innate skill level
What are examples of training effects - physical fitness components as an intrinsic risk factor?
Strength How early fatigue occurs Posture/alignment Lower aerobic capacity Body composition Warm up/cool down Less flexibility
What are examples of training effects - motor fitness components as an intrinsic risk factor??
Reaction time Lower agility Slower speed Decrease coordination Less balance
What are the aims of a warm up?
Prepare athlete physio/psychologically - increase performance.
Decrease risk of injury
How does a warm up prepare an athlete to perform?
Increases core body/muscle temp, increase HR/VE/Q and vascular shunt to increase oxygen to muscles, increase motor coordination, increase synovial fluid/lubrication of joints, increase elasticity (speed/force) of connective tissues.
Why use dynamic stretching in the warm up and not static?
Prepares the muscles for dynamic movement (static stretching doesn’t).
Increases subsequent speed and force of muscle contraction (static stretching doesn’t)
Increase motor antagonistic motor coordination (static stretching doesn’t)
Decrease risk of injury during dynamic activity (static stretching doesn’t)
What is the aim of a cool down?
Maintain the metabolic activity of the CV/respiratory systems to help remove the by-products of exercise and start the acute injury healing stage
How does a cool down help start the acute injury healing stage?
Active cool down maintains muscle & respiratory pumps which prevents blood pooling in active muscles and maintains SV,HR,VE,Bp and vascular shunt of Q to muscles flushing muscle capillaries with oxygen which increases removal of CO2 and lactic acid. Increases alactacid recovery phase of EPOC.
Stretching - returns muscle/connective tissues back to pre exercise length, decrease muscle tension/tightness/relaxation, maintains joint ROM.
What is SALTAPS?
An assessment protocol for assessing whether an athlete should continue or be removed from the activity after a sporting injury.
What does the first S mean in SALTAPS?
Stop play and see what’s happened eg ankle twisted
What does the first A mean in SALTAPS?
Ask questions about the injury/others who observed it. What/how did it happen? Where is the pain? Did you hear a noise? Any other pain?
What does the L mean in SALTAPS?
Look and evaluate signs/symptoms eg breaks/deformity, bleeding, bruising, swelling, stress/anxiety level
What does the T mean in SALTAPS?
Touch area carefully to see which area is hurt. Feel for inflammation and observe for signs of pain.
What does the second A mean in SALTAPS?
Active movement by patient. Ask if they can move and check joint ROM. Feel area to feel for clicks/grinding. Compare opposite side if they can’t.
What does the P mean in SALTAPS?
Passive movement by therapist. Gently move/assess joint ROM evaluate pain/ROM and compare to opposite side.
What does the last S mean in SALTAPS?
Strength test. Can person stand/put pressure on injury sufficient to play on? Do they think they can play on?
What is PRICE?
A 5 step protocol for the treating of acute soft tissue injuries
What are the 5 steps of PRICE?
Protect Rest Ice Compression Elevation
What is the protect part of PRICE?
Protect the injury/person and also protect yourself eg stop the game.
Protect the area being treated with a support/splint/crutches if possible.
If patient can move then move to a safer area but if there is any doubt then don’t move.
What is the rest part of PRICE?
Rest for the first 2/3 days to allow an injury time to heal, as playing through pain causes increased damage and decreases recovery.
Gradual increase in movement to reduce muscle strength lost/reduce atrophy.
What is the ice part of PRICE?
Apply ice to reduce the pain and inflammation (10-15 minutes every 1-3 hours).
Optimum 10-15 degrees to decrease inflammation without cell damage.
Melted ice water preferable to ice packs/spray.
Don’t apply directly to skin to prevent cold burns.
Repeated rather than continuous ice applications most effective.
What is the compression part of PRICE?
Compression of the injured area helps reduce swelling using stretch bandage/tape
Monitor tightness as the injury can continue to swell during sleep
What is the elevation part of PRICE?
Elevate injured area above the heart to decrease blood flow and therefore swelling.
Do not elevate injured area if it causes excessive pain.
When should PRICE be used?
Immediately after an injury has been sustained, while further attention is sought.
Earlier it is administered, the more reduced the acute symptoms are and increase speed of healing.
If too much pain during PRICE then stop immediately and seek further medical treatment.
Follow PRICE for 2/3 days post injury.
What is the definition of World Rugby IRB 6 R’s?
It is a protocol for the treatment of concussion
What are the World Rugby IRB 6 R’s?
Recognise Remove Refer Rest Recover Return
What is the recognise part of the World Rugby IRB 6 R’s?
Parents, players, coaches and officials should all learn the signs and symptoms of a concussion so they can understand when an athlete might have a suspected concussion.
What is the remove part of the World Rugby IRB 6 R’s?
Any suspected/concussed performer must be removed from play immediately
What is the refer part of the World Rugby IRB 6 R’s?
Once removed from play, performers should be referred immediately to a qualified healthcare professional who is trained in evaluating and treating concussions.
What is the rest part of the World Rugby IRB 6 R’s?
Players must rest from exercise until symptom-free (accompanied for 1st 24 hours) and then start a graduated return to play.
What is the recover part of the World Rugby IRB 6 R’s?
Full recovery from concussion is required before return to play is authorised - including being symptom-free.
Rest and specific treatment options are critical for the health of the injured participant.
What is the return part of the World Rugby IRB 6 R’s?
In order for safe return to play, the player must be symptom free and cleared in writing by a qualified healthcare professional. Athlete must complete a GRTP protocol (Graduated return to play)
What is the definition of rehabilitation?
A programme aimed at enabling the athlete to return to sport with full physical functioning (flexibility/strength/power/endurance) post injury in the shortest time.
What are the stages of rehabilitation?
Injury SALTAPS Remove and treat in 3 stages: 1 - Acute stage 2 - Sub-acute stage 3 - Rehabilitation stage
What is the acute stage of rehabilitation?
Immediate/48 hours
Price treatment to decrease inflammation/pain and promoting healing
What is the Sub-acute stage of rehabilitation?
3-14 days - 6 weeks / early stage
Light exercise still allowing healing.
Decrease inflammation/bruising/pain increase NSAIDs/cold/heat/contrast/physiotherapy/stretching/ massage.
What is the rehabilitation stage of rehabilitation?
Progressive overload gradually increase strength/RoM to prepare for full functioning exercises.
Gradual increase in intensity and strength development to full activity functioning.
What are the 6 types of treatment methods?
Stretching Massage Heat/cold/contrast therapies Anti-inflammation Physiotherapy Surgery
What are the common treatments of hard tissue injuries?
Immobilise and ice.
Surgery, physiotherapy, pain relief/NSAIDs.
Immediate medical assistance.
More often serious than soft tissue.
Often include injury to soft tissue injuries and require soft tissue treatments.
What are the common treatments of soft tissue injuries?
Acute stage - PRICE/massage/NSAIDS.
Sub-acute stage - NSAIDs/ cold/ heat/ contrast/ physiotherapy/ stretching/ massage.
Rehabilitation stage - NSAIDs/ cold/ heat/ contrast/ physiotherapy/ stretching/ massage. Full functioning: strength/power/endurance work
When should stretching be used in rehabilitation?
Sub-acute phase
Early-mid rehabilitation phase
Rehabilitation phase
What stretching should be used in the sub-acute rehabilitation stage?
Light/gradual static stretching and heat therapy.
3 days - 2 weeks gradual increase in number of sessions, increase stretch and RoM.
What stretching should be used in the early-mid rehabilitation?
Continued static stretching + PNF stretching, week 3-4.
RoM, strength and coordination exercises are focused on.
What stretching should be used in the rehabilitation stage?
More developmental stretching, increased functional focus via active/dynamic stretching of injured area/joint. Week 4-5.
Increase RoM and strength exercises,
What are the weaknesses of stretching?
No weaknesses unless they use the wrong type of stretch.
What are the benefits of stretching in the sub-acute rehabilitation stage??
Inflammation/pain decreases.
Reinstates/lengthens elastic properties of muscle / connective tissues and joint RoM which increases recovery.
No ballistic, PNF, isometric or dynamic stretching,
What are the benefits of stretching in the early-mid rehabilitation stage??
Gradual increase RoM Decrease tissue scarring Decrease pain sensation Gradual increase strength of muscle/connective tissues No full activity functioning exercises
What are the benefits of stretching in the rehabilitation stage??
Developmental stretching increases RoM and strength of muscle/connective tissues than previously existed before the injury.
Decrease risk of injury reoccurring.
Fully functioning activity/exercise prior to inclusion back into full competitive activity/training.
What is the definition of massage therapy?
The systematic manipulation of soft tissue
What are the benefits of massage therapy?
Useful during enforced rest.
Restore mobility to soft tissues in the same way as joint mobilisation and aims to increase joints RoM.
Increase circulation/blood flow so more oxygen and nutrients are delivered to fatigued muscles/damaged tissues.
Increase healing and removal of waste products/toxins.
Warms/mildly stretches soft tissues, decreases tensions/pressure which decreases pain and increases elasticity/joint mobility and increase RoM.
Increase breakdown/removal knots/adhesions/micro trauma.
less rigidity of scar tissue from previous injury sites that can lead to inflexible tissue, future injuries and pain.
Increase mood state/relaxation and less fatigue feeling.
More body awareness.
What are the negatives of massage therapy?
Can’t use in acute stage.
Not used on ruptures, contusions or open wounds as it can increase bleeding and increase complications.
What is the definition of cold therapy?
Use of ice/cold water therapies - also known as cryotherapy to treat injuries
What are the uses of cold therapy?
PRICE - acute injuries
Post exercise to decrease the symptoms of DOMS
What are the benefits of cold therapy?
Decrease temperature/inflammation and pain to injured area.
Vasoconstriction of blood vessels supplying injured area.
Decrease blood flow/Q to tissues
What are the negatives of cold therapy?
Tissue and nerve damage if in contact for too long.
Skin abrasions if ice is in direct contact with skin.
Shock response if temperature is too cold (black out/Bp/HR)
Increase time if more fat tissue
What are 4 examples of cold therapies?
PRICE - Acute injuries, immediately up to 24 hours, ice packs to target injury areas.
Water immersions - post exercise ice/water bath, 10 minutes at 10 degrees, decrease pain/swelling/DOMS, maintain subsequent performance.
Cryo-kinetics - Cold therapy followed by dynamic rehabilitation exercises (best for sprains).
Cryo-stretching - Cold therapy followed by stretching, decrease muscle pain/DOMS, increase RoM.
What is the definition of heat therapy?
Use of heat to help increase injury repair/rehabilitation and decrease muscle tension
What are the uses of heat therapy?
Primarily for chronic injuries eg during late, functional and rehabilitation stages of injury.
Combined with stretching to increase tissue temperature.
Prior to exercise to support warm up and increase muscle/connective tissue temperature
What are the benefits of heat therapy?
Vasodilation of injured tissue blood vessels to increase blood flow/Q to injury site which increase healing nutrients, increases speed of healing and removal of damaged tissues, decreased muscle tension and stiffness, improved pain relief.
What are the negatives of heat therapy?
Not to be used during acute stage (0-48 hours) as it increases blood flow/Q to injured area which increases swelling and pain/burns
What is the definition of contrast therapy?
The alternating of heat and cold to help increase injury repair and decrease muscle tension. can be whole body or a specific injury site.
What are the uses of contrast therapy?
Acute injuries - mid-late stage after swelling has stopped (2-5 days)
After exercise to decrease symptoms of DOMS/exercise induced muscle damage and increase relaxation,
What are the benefits of contrast therapy?
Cold increases vasoconstriction which decreases blood flow/Q to injury site to decrease swelling and pain and muscle spasm.
Heat increase vasodilation which increases blood flow/Q to injury site to increase delivery of nutrients to repair injury/remove scar tissues and increase repair and decrease swelling/pain.
What are the negatives of contrast therapy?
Increased swelling if used too early/during acute stage.
Cold therapy may be more effective on its own.
Never use on inflamed/red area (increase swelling/pain).
Not practical for all areas.
What are examples of heat therapy?
Heat wraps/packs - 15/20 minutes depending upon depth of tissue.
Heat rubs/creams/gels - eg deep heat
Water immersions - 10-20 minutes, hot water temperatures between 33-106 degrees
What is the cycle of contrast therapy?
Cold immersion 10 degrees 1 minute (can be 4 minutes)
Heat immersion 4 minutes 35-100 degrees
Cold immersion 1 minute 10 degrees (can be 4 minutes)
Heat immersion 4 minutes 35-100 degrees
Repeat cycle for 15/20 minutes
What is the definition of NSAIDs?
Non steroid anti inflammatory drugs.
Medicines taken to decrease inflammation, temperature and pain.
What are the uses of NSAIDs?
All acute injuries - short term injuries to soft tissue
All chronic injuries - long term injuries
What are the benefits of NSAIDs?
Inhibits chemicals released after an injury which helps to decrease inflammation, pain receptors, temperature which can increase healing process and speed recovery.
What are the negatives of NSAIDs?
Pain is a normal response which acts to prevent a performer restart training.
Less pain may leaf athlete to think injury repair is greater and make them start training too early.
Short term can cause nausea, headaches, diarrhoea, dizziness and skin irritation.
Long term can cause strokes, heart attacks, anaemia, liver/kidney damage.
Some can be addictive, overdose if pain is excessive and advice isn’t followed.
What are examples of NSAIDS?
Aspirin - Inhibits nerve impulses to brain which decreases pain. Acts as antipyretic which decreases temperature and inflammation.
Ibuprofen
Phenylbutazone - Potent anti-inflammatory agent used for chronic musculoskeletal injuries eg arthritis
What is the definition of physiotherapy?
Treatment of musculoskeletal injuries/diseases using physical treatments.
Treatments are administered by a qualified physiotherapist. Excludes administration of drugs/surgery but physiotherapist may refer to GP or surgeon.
What are the 6 physiotherapy treatment?
Mobilisation/manipulation Soft tissue techniques Electrotherapy Exercise therapy Posture/alignment Sport specific rehabilitation
What are the benefits of the mobilisation/manipulation physiotherapy treatment?
Decreases muscle/connective tissue atrophy and maintains motor neurone coordination/efficiency.
Decrease joint compression and degeneration of articular cartilage.
What are the benefits of the soft tissue techniques physiotherapy treatment?
Relax and restore mobility, ease pain and increase circulation to soft tissues eg massage/myofascial.
What are the benefits of the electrotherapy physiotherapy treatment?
Pass electrical current/sound waves to heat, micro massage and increase enzyme metabolism and therapeutic affect.
Stimulate repair of tissues by increasing circulation to an injured area.
Used on scar tissue, tendonitis, bursitis, muscle spasm, pain, calcification.
eg interferential/TENS ot ultrasound
What are the benefits of the exercise therapy physiotherapy treatment?
Stretching - regain soft tissue elasticity/RoM
Exercises - regain and strengthen muscles / connective tissues and increase joint stability. Increase circulation and decrease inflammation.
Maintain RoM/strength across injury free/rest of body
What are the benefits of the posture and alignment physiotherapy treatment?
Training to eradicate any incorrect working (sitting) and exercise (poor technique) postures causing the sports injury (decrease soft tissue tension and increase power/speed)
What are the benefits of the sport specific rehabilitation physiotherapy treatment?
Specific advice on how to prevent further injuries in a specific sport eg hurdler have specific exercises/stretches to increase strength/RoM around hip joint and biomechanical/technique to decrease injury.
What is the negative of the mobilisation/manipulation physiotherapy treatment?
Decrease joint stability as decrease ligament/muscle and bone strength.
What is an example of what a physio would do in the first session?
Acute stage Initial assessment Pain relief (NSAIDs) PRICE advice to decrease swelling. Taping to increase support/circulation
What is an example of what a physio would do in the second session?
Sub-acute stage Re-assess Soft tissue - massage Electrotherapy Taping and RoM exercises to follow
What is an example of what a physio would do in the third session?
Late sub-acute stage/early rehabilitation phase
Re-assess
Repeat soft tissue/electrotherapy
Progressive RoM/weight bearing/strengthening/stretching exercises
Proprio-reception/gait/balance exercises
What is an example of what a physio would do in the fourth session?
Rehabilitation stage
Re-assess
Outline a specific exercise programme specific to their sport to include:
Stretching/strength/balance exercises to be followed post treatment leading to semi-full competition
What is the definition of surgery?
A manual technique used on a patient to investigate/treat a pathological injury/tissue.
Treatment administered by a qualified surgeon)
What are the 2 types of surgery used?
Keyhole/arthroscopy surgery - More appropriate for soft tissue injuries. Less invasive, less pain/trauma/risk of infection and decrease recovery time.
Open surgery - More appropriate for major joint replacements/fractures. Only used when keyhole surgery not possible
What are common injuries that require surgery?
Meniscal tears (knee joint) Joint replacements (full/partial) Ligament surgery (cruciate knee ligament) Articular cartilage surgery
