lec 4 - sport injury and healing

Question 1

what is the definition of a sport injury

Answer 1

tissue damage / change in normal function generally due to external forces

Question 2

definition of acute injury

Answer 2

sudden onset injury from a single event

Question 3

definition of sudden onset repetitive injury

Answer 3

single event causes pre existing condition symptomatic (ex: tibial stress fracture on landing that showed pre exisitng morphological changes on imaging)

Question 4

definition of gradual onset repetitive injury

Answer 4

gradual increase in symptoms (ex: increase in shoulder pain, diagnosed with tendinopathy)

Question 5

definition of direct contact injury mechanism

Answer 5

direct contact with another athlete or object on the area of injury

Question 6

definition of an indirect contact injury mechanism

Answer 6

force not applied directly to the area of injury (ex: contact to upper body causing an ACL injury)

Question 7

definition of a non contact injury mechanism

Answer 7

without any contact from another external source (only athletes own mvmts) (ex: overuse injuries)

Question 8

what is articular cartilage and where is it found

Answer 8

flexible cartilage providing a smooth surface for joint mvmts
- found on the ends of bones

Question 9

what is fibrocartilage and where is it found

Answer 9

tough cartilage able to absorb loads
- found in discs of spine, meniscus

Question 10

what is an enthesis

Answer 10

junction between a tendon and a bone

Question 11

what is the stiffness of a tissue

Answer 11

ability of a tissue to resist a load

Question 12

what is the yield point of a tissue

Answer 12

indicates the limit of elastic behaviour and beginning of plastic behaviour
- load after this point causes damage to the tissue (won’t return to normal)

Question 13

what is creep of a tissue

Answer 13

deformation in the shape / properties of a tissue that occrus under the influence of persistent mechanical stress

Question 14

what is the elastic property of a tissue

Answer 14

will return to normal state after the load is removed
- normal for tissues to have

Question 15

what are the 4 stages of wound healing

Answer 15

1. hemostasis
2. inflammation
3. proliferation
4. remodelling

Question 16

what is the function of hemostasis

Answer 16

stop the leak!
- process to prevent and stop bleeding
- results in the formation of a clot

Question 17

what are the 4 steps of hemostasis

Answer 17

1. vascular spasm
2. formation of a temporary platelet plug
3. blood clotting (coagulation cascade)
4. formation of the final clot

Question 18

what is the function of inflammation

Answer 18

clean up!
- defensive response of tissues
- indicated by redness, warmth, swelling, pain, and dysfunction
- can’t heal without inflammation!

Question 19

what is the order of recruitment of cells to destroy debris and bacteria during inflammation

Answer 19

neutrophils - first 48 hours
macrophages - 48-72 hours
lymphocytes - after 72 hours

Question 20

what is the main function of the proliferation phase

Answer 20

rebuild new tissue!

Question 21

what are the 4 steps of proliferation

Answer 21

1. angiogenesis - formation of new blood vessels and restore blood flow
2. fibroblast migration - fibroblasts produce collage fibres and elastin (results in granulation tissue to replace the clot)
3. epithelialisation - epitheilial cells cover stripped surface
4. wound retraction - new tissue built around the wound

Question 22

what is the main function of remodelling

Answer 22

to increase tissue strength

Question 23

what is involved in the remodelling process

Answer 23

granulation tissue matures into a scar
form and function of scar depend on loading during this stage

Question 24

does tissue return to original strength after an injury

Answer 24

no - only about 80% of original strength is acheived

Question 25

should bones and tissues be loaded during rehab

Answer 25

yes - they respond to loading and remodel accordingly
- the healing structures need to be exposed to progressive loads throughout rehab

Question 26

how long does each stage of wound healing take

Answer 26

hemostasis - minutes to hours
inflammation - days
proliferation - weeks
remodelling - months/years

Question 27

what are the goals of early treatment of acute soft tissue injuries

Answer 27

limit bleeding, limit swelling, relieve pain and improve conditions for subsequent treatment and healing
- DO NO HARM

Question 28

what do you avoid in the first 3 days of soft tissue injury

Answer 28

heat, massage, moderate-vigorous PA

Question 29

what main acronym does an acute soft tissue injury need

Answer 29

PEACE

Question 30

what does PEACE stand for

Answer 30

Protect - unload/restrict mvmt for 1-3 days
Elevate - higher than the heart
Avoid - NSAIDs and ice
Compress - helps limit edema and hematoma
Educate - benefits of active approach to recovery

Question 31

which types of injuries need PEACE, and which need LOVE

Answer 31

acute (days) = PEACE
subacute (weeks) = LOVE
chronic (months) = LOVE

Question 32

what does LOVE stand for

Answer 32

Load - active approach to recovery
Optimism - associated with better patient outcomes
Vascularisation - CV activity
Exercise - helps restore mobility, strength, and proprioception

Question 33

where does reinjury often occur

Answer 33

at the biomechanical weak point - interface between the scar and normal tissue