Lecture 2 Flashcards
What is MOI
-mechanism of injury
-how did the injury happen
Sources of MOI
-trauma
-overuse
Types of onset of an injury
-acute/traumatic
-insidious
What is an insidious injury
-gradual and often of unknown origin
What is a sign
-something you see
What is a symptom
-something the athlete feels/describes
What are examples of signs
-bruising
-swelling
-heat/cold
-spasm/guarding
-sweating
-shivering
-vomiting
What are examples of symptoms
-pain
-tingling
-numbness
-burning
-tight
-pressure
-nausea
How do we often measure pain
-on a subjective scale
What comes with pain
-shock
-fear/catastrophizing
What psychological symptoms may come with injuries
-anger
-fear
-denial
-sadness
-catastrophizing
-regret
How can we help manage injuries from a psychological standpoint
-listen
-reassure with a plan
-know when to refer
-educate on injury
-coach/friend/player support
-mindful and sequential return to play
Types of skin wounds
-lacerations
-abrasions
-punctures
-contusions
-blisters
Management of lacerations
-control bleeding
-clean the wound
-steri strips
Step 1 control bleeding components
-personal protective equipment
-pressure
-elevation
Step 2 clean the wound components
-soap and water
-cinder suds
Step 3 steri strips considerations
-dry area around laceration
-adhesive spray via Q tip
-rub Q tip on either side of laceration
When do we send for stitches
-stitches can only be done effectively within 24 hours of injury
-deep wounds affecting more than just the skin
-unable to stop bleeding
-on the face
-across a joint
What is a minor cut/abrasion
-superficial layers of skin
How to prep player to return to play with minor cut or abrasion
-non-stick gauze and cover roll
What is a puncture
-common in feet and hands
-can penetrate multiple levels
What to do if object is still in puncture wound
-leave it in
-pad around it with gauze rolls
-send for medical attention
What to keep in mind with deep contusions
-do not massage
What is a contusion
-bleeding under the skin from blunt trauma
How can you protect a contusion
-use a donut pad
Clinical control of a contusion
-ultrasound
-interferential current (IFC)
What is a blister
-fluid filled bubble caused by friction
Prevention of blisters
-skin lube over areas of friction
Treatment of blisters
-clean
-second skin
-hypafix
When do we seek medical attention
-unable to control the bleeding
-wound is dirty and unable to be cleaned
-deep wound or puncture
-object is still impaled
-changes in sensation
-wound is from a human/animal bite
-wound is from a rusty object
Cartilage and meniscus healing
-limited capacity to heal
-little or no direct blood supply
Ligament healing
-during repair phase, collagen or connective tissue fibres lay down randomly
-gradually a scar is formed
-over following months, collagen fibres align in response to joint stress/strain
Skeletal muscle healing
-regeneration of new myofibers is minimal
-healing and repair follows the same process of random collagen alignment and develops tensile strength in response to stress/strain
Nerves healing
-slowest to regenerate
-3-4 mm/day
-peripheral nerves regenerate better than central nervous system
4 molecular steps of wound healing
-hemostasis
-inflammation
-repair and regeneration
-remodeling
Hemostasis
-process leading to cessation of bleeding
Inflammation
-essential vascular and cellular response for proper tissue healing
Repair and regeneration
-formation of granulation tissues
Remodeling
-strengthening of tissues along lines of tension
Stages of wound healing
-inflammation
-proliferation
-remodeling
How long does inflammation typically last
-4-6 days
How long does proliferation typically last
-4-24 days
How long does remodeling typically last
-21 days-2 years
Acute musculoskeletal injury healing steps
-inflammatory
-repair and regeneration
-remodeling
What happens in the inflammatory state
-vasodilation of blood vessels
-white blood cells fight infection, break down and clean up damaged tissue to start healing process
Signs and symptoms of inflammation
-redness
-swelling
-heat
-pain
-loss of function
What happens during repair and regeneration (proliferation)
-collagen laid down in disorganized matrix
-revascularization brings oxygen and nutrients
-edges of wound draw closer
What happens during remodeling
-collagen reorganizes along lines of stress
-tissues increase in tensile stress
Bone healing stages
-hematoma formation
-cellular proliferation
-callus formation
-ossification
-remodeling
How long on average does a bone take to heal
-6-8 weeks
Aims of treatment stages
-inflammatory phase
-demolition phase
-healing phase
-long term goals
Inflammatory phase goals
-decrease inflammation
-decrease pain
-decrease swelling
-decrease activity
-protect
-educate
Inflammatory phase days
-1-5
Demolition phase goals
-decrease residual swelling
-decrease residual pain
-increase ROM
-increase flexibility
-increase strength
-increase proprioception
-prevent secondary complications
-increase cardiovascular fitness
-educate
Demolition phase days
-3-15
Healing phase goals
-increase circulation
-decrease pain or muscle spasm
-increase ROM
-increase flexibility
-increase strength
-increase CV
-increase proprioception
Healing phase days
-10 days - 8 weeks
Long term goals
-maintain/restore skin and connective tissue
-ensure full RM, strength, flexibility, and psychological readiness
-optimal biomechanics
-correct training habits
-increase proprioception
-protect injury site
-educate
Guidelines for return to play (RTP)
-full ROM, 80% strength
-able to perform the demands of sport
-psychological readiness
When do we use heat
-healing phase and beyond
-for relaxation
-promote flexibility
Tissue response to heat
-increase circulation
-increase inflammation
-increase metabolism
-increase edema and swelling
-decrease pain
-decrease spasm
Types of heat
-moist heat application (hydrocollator packs, hot wet towel)
-electric heating pads
-hot shower/bath
-microwaveable bean bag
-infared sauna
-ultrasound
Traditional sauna
-heats air around you
-heats to 60-80 degrees
Infrared sauna
-heats skin/body
-heats to around 37 degrees
Benefits of infrared sauna for conditions
-high blood pressure
-heart failure
-demetia/alzheimers
-headaches
-type 2 diabetes
-arthritis and chronic pain
-relaxation
-improved circulation
-sweating therefore detox
Contraindications to heat
-inflamed tissues
-bleeding disorders
-blood clots
-impaired sensation
-metal implants
-infection
-open wounds
-pregnancy or trying to conceive (whole body)
-multiple sclerosis (whole body)
-illness (whole body)
Tissue response to cold
-decrease inflammatory response
-decrease edema/swelling
-decrease pain
-decrease circulation
-decrease hematoma formation
-decrease muscle spasm
-decrease tissue metabolism
-decrease enzymatic activity
-decrease extensibility
Types of cryotherapy
-crushed ice or ice cubes
-gel packs or frozen peas
-frozen beanbag
-ice cup massage
-cold immersion tub
-hyperbaric gaseous cryotherapy
-cryochamber
Hyperbaric gaseous cryotherapy
-sprays microcrystals of liquid CO2 at -78 degrees celcius
Cryochamber types
-electric
-liquid nitrogen
Electric cryochamber
-temps as low as -160 degrees for 3 min
-timing: as long as it takes to get skin to desired temp
Liquid nitrogen cryotherapy
-temps as low as -130 degrees
-timing: 2-4 min
Electric cryochamber contraindications
-pregnancy
-high BP
-blood clots
-heart conditions
-infection
Contraindications to cold
-reynauds phenomenon
-urticaria
-clotting disorders
-over superficial nerves
-altered skin sensation
-complex regional pain syndrome
When to use massage
-tight muscles
-injured muscles
How can massage help tight muscles
-increase extensibility
-decrease pain
How can massage help injured muscles in inflammatory phase
-decrease pain
-decrease swelling
What type of massage to use in inflammatory phase
-effleurage/lymph drainage only
How can massage help injured muscles in healing phase
-increase circulation to promote healing
What type of massage should be used in healing phase
-deeper forms
Massage protocols
-educate on why you use it
-clear contraindications
-always obtain consent
-expose the area to be treated
-be professional
Contraindications to massage therapy
-acute inflammation
-contusions
-acute spasm around another injury
-over open wounds or skin reactions
-altered sensation
-possible blood clot
-bleeding disorders
-over varicose veins
-deep vein thrombosis
-cancer
-open wounds
-bleeding disorders
-diabetes
4 main principles of massage
-general-specific-general
-superificial-deep-superficial
-proximal-distal-proximal
-peripheral-central-peripheral
How to open terminus massage technique
-make āVā with hands and make gentle C motions towards ground
What techniques to use for massage
-petrissage
-shaking/rocking
-vibration
Petrissage
-spreading the mm belly across the fibres
-avoid stripping the mm and ends of tendons
Shaking/rocking
-use fast motion for pre event
-use slow motion for post event
Vibration
-engage tissue, hand over hand, vibrate
-cane be useful over particularly tight areas or knots
