Injury Prevention Flashcards
Objectives of Pre-Participation Screening
Primary:
1. Screen for conditions that may be life-threatening or disabling
2. Screen for conditions that may predispose to injury or illness
* This is not about diagnosing genu valgum or decreased thoracic ext (examples)
Secondary:
1. Determine general health and fitness
2. Serve as an entry point to health care for adolescents
3. Provide an opportunity to initiate discussion on health-related topics
4. Get a baseline for comparison later
5. Fulfills legal requirement
When should pre-participation screens occur?
At least six weeks prior to the start of the preseason practices so injuries can be adequately treated.
Essential Elements of PPE
- Medical history
- General medical exam
- MSK exam
- Athletic fitness
Medical examination: Tests
- Blood pressure
- Pulse
- Respiratory rate
- Body weight
- Height
- Visual acuity
Cardiac factors to make referral on?
- HR over 120
- Arrhythmias
- Systolic/diastolic murmurs
Red Flag: Strength Ratios
> 15% difference right to left
These carry significant risk for injury
Core tests
- Modified double straight leg lowering test
- Flexor endurance test
Flexibility assessment
It is important to note that general flexibility alone is not the key but rather specific flexibility as dictated by the individual sport.
Conditions that could limit participation
- Drug use
- Acute illness
- Blood borne pathogens
- Heart diseases
- Skin lesions
- Recurrent heat illnesses
- Some eye conditions
- Eating disorders
- Hepatomegaly
- Spleenomegaly
- Kidney abnormalities
- Seizures
- Uncontrolled asthma
Decision to participate
The final decision lies with the athlete or with the parents and not the health care provider.
Outcome measures for ankle and ACL?
FAM for ankle; IKDC for ACL. Kinesiophobia as well.
Y Balance Test
- Anterior
- Posteromedial
- Posterolateral
Have to push the front of the box and do it in a controlled manner, need to come back upright controlled.
3-6 practice trials and then best of next 3.
Check leg length as well.
Want to be within 4 cm of uninvolved side anteriorly and within 6-7 cm posterolateraly/medially
CKC DF
<9-10 cm from toe to wall is abnormal
<35-38 degrees abnormal
Landing Error Scoring System
30 cm box -> horizontal distance of 50% body height (heels land at this point). 17 points on there to score.
Hop Testing
They have to stick the landing for 2 seconds. 2 practice tries and then measure the third.
Triple crossover test (15 cm gutter they have to jump over): they have to go lateral first.
Timed hop test: say go and time how long it takes them to get 6 meters (average the 3 attempts).
We would like a limb symmetry index of less than 3%.
How to ease them into sport specific testing?
Start at 50% for 1st test
Can move up to 75 and then 100% after you make sure they’re safe
Pro-Agility Test
-10 yard space (5 yards off to each side)
- Start in 3 point stance with hand on center line and feet straddling line
- Go to the right, then left, then through center
Cutting Tests
- Run to backpedal
- Figure of 8
- Y cut bilaterally
- T cut bilaterally
- Backwards V cut bilaterally
- Z pattern
- “Simon Says”
Simon Says Example
- Run in place
- Cut left
- Backpedal
- Run in place
- Vertical jump
- Hop on one leg
- Etc.
Software Program For Athletes
Move2Perform
Neurofibromatosis
Genetic disorder that causes tumors to form on nerve tissue. Can develop anywhere in the nervous system (brain, spinal cord, nerves).
Want to look for cafe au lait spots (these are common in many people), freckling in groin or armpits, tiny bumps on iris, pea sized bumps on skin.
What might you see for spina bifida occulta?
Dimple, patch of hair, or red patch.
Hop Tests For Ankle
- Figure of 8 Hop test: 5 meters and time them 2 cycles
- Side hop test: 30 cm jump back/forth 10 times
- 6-m crossover hop test: time them once
- Squat hop test: 40x40 cm square. Hop forward then medial (keep going and do 5 times around.
Assess psychological readiness to get back to sports
Tampa scale of kinesiophobia
Sudden cardiac death (prodromal symptoms)
Potential Symptoms:
- Chest pain (occurs anywhere from 4 weeks to hours before the event)
- Dyspnea, syncope, fatigue, even general exercise intolerance.
How often does death occur with sudden cardiac death
Usually within 1 hour
Categories of Cardiac Issues leading to death
Congenital or acquired and each can be either structurally normal or abnormal heart
Four main heart conditions leading to sudden cardiac death in those under 40
- Hypertrophic cardiomyopathy (33%)
- Coronary artery anomalies (16%)
- Commotion cordis (9%)
- Myocarditis (5%)
Hypertrophic Cardiomyopathy
Heart muscle is over-hypertrophied (thickened) and can make it harder to pump blood. Usually inherited (60% have 1st degree relative with it). Marfan’s syndrome big cause of this (ocular, cardiovascular, skeletal). Fibrillin gene defect that alters connective tissue throughout body. Could lead to ruptured aortic aneurysm. Usually tall, thin, wide wingspan (more than height), joint hyper mobility. May have scoliosis, pectus excavatum.
Coronary artery anomalies
The abnormal artery is compressed as the ascending aorta dilates with exercise. Reduced blood flow to heart. Prodromal symptoms may be fatigue, exercise induced syncope, or chest pain.
Commotio Cordis
Normal heart. 80% blow from projectile, 20% hit from another player. All about timing, not force. Causes ventricular arrhythmia. Occurs during ventricular repolarization (peak of the T-wave, the small bump after QRS wave).
Myocarditis
Inflammation of the heart muscle. Due to viral infection. Dyspnea (SOB), orthopnea (SOB when lying flat), exercise intolerance, tachycardia. May have diarrhea or malaise.
Hours/week recommendation physical activity by pediatric athletes?
No more than 16-20 hours / week of vigorous physical activity
Overhead sport recommendations and pediatric burnout (non-pitch count related)
- Play only one overhead throwing sport at a time
- Avoid playing that sport year round
- Don’t combine throwing demanding positions in back to back days (pitching one day then catching the other)
- If a pitcher can do breaking related pitches without symptoms this is okay but if they do them and sx’s develop then need to terminate this
Recommended pitch count limits
9-14 years old (full effort pitches in competition)
75/game, 600/season, 2-3K/year
15-18 years old
90/game and no more than 2 games/week
Training and conditioning program recommendations for young athletes?
- All categories of training for LE’s to reduce overuse for UE
- Should be doing general fitness program at least 2 months before season starts
- At least 1-2 days off / week from practice, games, and sport specific training
- Only participate on 1 team of the same sport if 2 sporting team leads to practice and/or games >5 days/week
- Take 2-3 nonconsecutive months away from a specific sport in they do it year round.
Long bone parts in adults vs children
A fully-developed adult bone is made up of two regions—the diaphysis and metaphysis—while a developing child’s bone has four regions—the diaphysis, metaphysis, epiphysis, and physis.
Where should PPE ideally be performed?
The athletes PCP office (they can receive ongoing immunizations and screening for psychosocial issues)
