Lecture 3 And 4 Flashcards
Why is sport injury prevention important
17 655 Canadians were hospitalized from sport injuries
1 in every 3 youth ages (- to -) in Canada seek ——-
11-18 in Canada seek medical attention for a sport related injury every year
Lower extremity (knee and ankle) injuries are —% of youth injuries
60%
Concussions are —% of injuries in youth
20%
Within hockey and rugby what % of injuries are concussions
Over 50%
Team sport has an increased risk of injury True or False
True
Injuries in youth sport burden 10% in —, 10% in —— and 10% in ——-
Hockey, basketball and soccer
What are the consequences of sport injuries
- reduced participation in sport
- reduced physical activity
- missed school/work time
- weight gain and obesity
- early post traumatic osteoarthritis; increase risk of subsequent injuries
- psychosocial consequences
- health care and indirect costs are high
What is the van mechelen model MIDTERM
- Establish the extent of the injury problem “what’s the problem? Common injuries? Severity?
- Find the mechanisms and risk factors (cause) “understand how these injuries occur” “understand patterns”
- Introduce a preventive measure “how to change this pattern” “design injury prevention and implement”
- Evaluate the effectiveness of intervention “was it effective”
What is key in preventing injuries in sport
Understanding injury mechanism
How to understand injury mechanism
- Understand what happens before injury Events leading to injury situation
- Injury situation; was it a direct contact injury or was it non contact
- Whole body biomechanics
- Joint biomechanics what is going on around joint of injury
What are examples of intrinsic risk factors (relating to athlete) non modifiable
- Age
- Sex
3.Body size - Previous injury
- Malalignment of lower extremities
What are examples of modifiable intrinsic risk factors
- Physical fitness
- Joint mobility
- Muscle tightness
- Ligamentous laxity
- Dynamic strength
- Static strength
- Skill level
What are extrinsic risk factors
-exposure
-types of sport
-playing time
-position in the team
-training
-coaching
-foul play
-envionrmnrt
-time of day
Anything not pertaining to the athlete
What are the levels of prevention
- Primary prevention (reduce occurrence)
Prevention of first time injury in healthy population - Secondary prevention
Early diagnosis (early detection and diagnosis of injury)
3.tertiary prevention
Minimize consequences, (rehab, reduce consequences of injuries)
Injury prevention strategies
- training strategies
- rule modification
- equipment
Strategies used in sport injury prevention studies
-training programs to improve fitness/movement quality
-new or modified sport equipment
-new or modified rules
-education
-training programs to improve psychosocial and or cognitive skills
-policy change
-multi-component /multiple interventions
What are the most researched sports and their associated percentages
Soccer (25%) Rugby (8%) American Football (8%) Basketball (7%) Hockey (7%)
What is neuromuscular trainings focus
- focuses on performing exercises that train the nerves and muscles to react and communicate
What is NMT
-specialized form of physical training that focuses on improving the coordination and function of the nervous and muscular system
What is NMT designed to do
Designed to enhance movement control, stability of movements, movement technique and skills, strength, power and speed, particularly those involved in sport and daily activities
What are the key components of NMT
- Balance training
- Proprioceptive training
- Coordination
- Agility drills
- Plyometrics
- Strength training
Regular NMT can reduce injury rates up to —-%
70%
What are the aims of neuromuscular training
- to improve neuromuscular control and joint stability
- to improve movement skills and technique
- to enhance performance
- to reduce the risk of injuries
Why is good technique, movement control and coordination important
Helps individuals
- enhance, learn, relearn fundamental and sport specific movement patterns and skills
- execute movements with greater precision and efficiency
- generate a fast and optimal muscle firing patten
- increase joint stability
- decrease joint forces
Improper technique case 1 in floor ball
- improper knee alignment (abduction) results in valgus injury due to improper running technique/ changing direction, sudden dynamic movements cause partial/complete ACL tear
Changing direction in floor ball and associated injuries
-180 degree pivot turn (should be performed keeping body weight inside toward direction heading to
Will result in injury if body weight places stress on acl causing knee to cave in
Common in soccer, bbal, floor ball, foot ball and other direction change sport
What are critical teaching points associated with prevention of injury
1.alignment
2. Balance
3.proper mechanism
Neuromuscular training in rehabilitation aims
-to restore normal movement patterns
-improve joint stability
-to reduce side differences; coordination, strength and power
-to reduce the risk of subsequent injuries
- to enhance performance
What exercise are done for strengthening included ins some NMT programs
-squats
-lunges
How many NMT hours and repetitions a year example in men U18
10-20 mins NMT warmup before every practice and game
10-20mins cool down after each practice and game
Association between injuries and training load
-rapid increases in training loads
-insufficient practice vs competition
-too little variation in training load (monotony)
-spikes in training load
What is associated with a training load
-intensity,duration and frequency of exercise
-specific exercise type
-external training load (external resistance,weights, equipment;weightlifting) vs internal training load (body weight, Pilates, yoga)
What is structure specific training load
-sum of movement and structure specific loads
Like how running is high impact bone affecting
Are structure specific training loads different between individuals
YES
Structure specific training load with a overweight player
-greater patellar tendon specific training load
Player with poor knee control will—— (relate it to structure specific training load)
Have greater knee joint structure specific training load than a person with proper knees
What are the 3 questions associated with sport specialization
- Have you quit another sport to focus on your primary sport
- Do you consider your primary sport more important than your other sport
- Do you train more than than 8 months a year in your primary sport
Within the shred basketball NMT warm up what 4 categories were involved
1.aerobic
2. Agility
3. Strength
4.balance
What is involved within the aerobic component of the NMT basketball video
1.forward run
2.forward run and backward zigzag
3.skiping
4. Forward run increase speed
What is involved in the agility portion of warm up
- Single leg jumps over a line
- Jumps in place
What is involved in the strength portion of the NMT video
1.plank
2. Side plank
3. Hamstrung
4. Walking lunges
5. Side lunges
What is associated in the balance portion of the video
- Single leg balance
- Single leg balance toss
Important things to remember about NMT warm up
-backward zigzag (focus on pushing off with knee over the ankle and not allowing knee to fall inward especially when changing direction)
-forward backward skipping (knee over ankle, light landing)
-In all of them proper body alignment especially at knee and hip is critical
-done carefully and mindfully, prioritizing activating proper muscles and proper technique
Define sport injury
-tissue damage/derangement of normal physical function due to participation in sports
-generally due to external forces (transfer of kinetic energy)
When force applied to tissue is greater than to what the maximal force the tissue can take it results in
Tissue damage
Sport injury can affect all tissues True or False
True
Sport injury may result from a ———-
Clear acute mechanism,clear repetitive mechanism or form a combination of both
What are the different modes of onset
- Acute sudden onset injury (traumatic injury, single definable event
2.repetitive gradual onset injury (overuse injury)
3.repetitive, sudden onset injury (micro damages accumulate and a single event makes it feel like its a sudden onset)
Classification of contact
- Direct contact injury, force applied directly to injured area at the time of injury, through contact with another athlete or contact with an object
- Indirect contact injury, contact to any other body region example force hits shoulder causing athlete to sprain ankle also through contact with another athlete or object
- Non contact injury, injury related to athletes poor technique, misalignment, without any contact form another external source at the time of injury
Soft tissue injury is affecting what structure
-cartilage injuries , muscle injuries, tendon injuries and ligament injuries
Skeletal injuries affect what structure
-bone; involved bone fractures, other bone injuries
Acute traumatic injuries involve
-bleeding (hematoma)
Articulate cartiliage
-flexible cartiliage that provides a smooth surface for joint movement (end of bones)
Fibrocartilage
-a tough cartilage able to absorb loads of, shock absorbers
Found in the discs of the spine and the meniscus
What is tendon
-connects a muscle to a bone
What is enthesis
The junction between tendon and bone
What does a ligament do
Joins two bones together
What structures does a tear affect
Muscle, ligament or tendon breakage
What structures are affected in a sprain injury
- ligament over stretch
What structures are affected by strain injury
-muscle and tendon overstretch
What structured associated in a fracture injury
Bone (crack or break)
What is associated with a rupture injury
-internal organs, tendons and ligaments
Stiffness
-ability of a tissue to resist a load (resist deformation, changing shape)
Yield point
-indicated the limit of elastic behaviour and the beginning of plastic behaviour , tissue stops behaving normally and starts to get damaged
Creep
- deformation in the shape/ properties of a tissue that occurs under the influence of persistent mechanical stresses
Elastic region
The stress applied where the tissue stretched but returns to its original shape
Plastic region
-passes yield point, resulting in micro-damages to tissue, cannot return to its original shape, start of permanent changes
Tissue failure
-tissue can no longer withstand stress, breaks or fails (causing an injury)
If you only stay in the elastic region it may be hard to gain flexibility True or False explain
True; the tissue doesn’t stretch stretch enough to adapt or become more flexible
What are the 4 stages of wound healing
- Hemostasis
- Inflammation
- Proliferation
4.remodelling
Hemostasis
-process to prevent and stop bleeding, when injury occurs resulting in formation of a clot
Wound healing results in the
Restoration of tissue integrity
Hemostasis also known as stop the
Leak
Hemostasis is the process to ——-
Prevent and stop bleeding when injury occurs—> results in formation of a clot
Steps in Hemostasis
- Vascular spasm
- Formation of platelet plug
- Blood clotting (coagulation cascade)
- Formulation of the final clot
Platelets release growth factors
Inflammation
Purpose
Key Cells
Mechanisms
Purpose: Prevent infection and clear debris.
Key Cells: Neutrophils (first responders), macrophages, lymphocytes.
Mechanisms: Chemotaxis, phagocytosis, degranulation, and production of reactive oxygen species.
Proliferation; processes and key factors
Processes: Angiogenesis, granulation tissue formation, collagen deposition, epithelialization, and wound contraction.
Key Factors: Growth factors like TGF-β, PDGF, VEGF, and cytokines.
Tissue Remodeling
Duration: and processes
Duration: Can take up to 2 years.
Processes: Collagen remodeling, scar maturation, and regaining tissue strength (up to 80% of original strength).
Factors Affecting Wound Healing
Nutrition: Essential nutrients like vitamin A, carbohydrates, and omega-3 fatty acids.
Hypoxia: Necessary for re-epithelialization but excessive hypoxia impairs healing.
Infection: Prophylactic antibiotics reduce infection risk.
Immunosuppression: Conditions like HIV, cancer, and use of steroids delay healing.
Chronic Diseases: Diabetes, cardiovascular diseases impair healing.
Age: Elderly patients have slower healing due to thinner epidermal layers and chronic diseases.
Genetics: Conditions like keloid scars and incisional herniae have genetic components.
Surgical Technique: Proper tissue handling, aseptic techniques, and avoiding tension across wounds.
Why is understanding wound healing crucial
for reducing morbidity and mortality from wound complications.
Inflammation
• Defensive response of tissues to a physical or
chemical injury, or bacterial infection
• Recruitment of cells to destroy debris and
bacteria:
• Neutrophils – for the first 48 hours
• Macrophages – peak around 48–72 hours
• Lymphocytes – appear after 72 hours
• Indicated by redness, warmth, swelling, pain,
and dysfunction
What are the steps involved in proliferation
- Angiogenesis
- Fibroblast migration
- Epithelialization
4.wound retraction
angiogenesis
Formation of
new blood
vessels
• Restore blood
flow
Fibroblast migration
Fibroblasts produce collagen fibers and elastin
• Results in granulation tissue which replaces the clot
epithelialization
Epithelial cells
cover
denuded
epithelial
surface
Wound retraction
Contraction of the wound
what is the aim in tissue remodelling
Increase tissue strength
What are the key components of the remodeling stage
-granulation tissue matures into scar
-form and function of the scar tissue depend on loading during this stage
-the stage may last several months-years has important implications for return to sport
-you can never achieve the same level of tissue strength than before the injury
During rehabilitation when bone and soft tissue respond to loading
Remodel accordingly
During rehabilitation healing structures need …
To be exposed to progressive loads
How long the stages of wound healing take
Hemostasis-minutes to hours
Inflammation-days
Proliferation- weeks
Remodelling-months/years
Too much bleeding slows healing true or false
True
Early treatment goals
-limit bleeding
-limit swelling
-relieve pain
-improve conditions for subsequent treatment and healing
Peace
Protect, elevate, avoid, compress, educate
What is involved in the protect phase in peace
Unload or restrict movement for 1-3 days
Elevation
Elevate the injured limb higher than the heart
Avoid
NSAIDs and ice
Compress
Helps limit edema and hematoma
Educate
Educate patients in the benefits of an active approach to recovery
Peace is used for —-
Immediate care after injury
Love is used for
Starting rehab
Love stands for
Load
Optimism
Vascularization
Exercise
Load in love stands for
Active approach with movement and exercise benefits most patients
Optimism
Optimistic patient expectations are associated with better outcomes
Vascularization
-cardiovascular activity is a cornerstone in the management of injuries
Exercise
They help to restore, mobility, strength and proprioception early after injury
Price
-protect
-rest
-ice
-compress
-elevate
Police
-protect
-optimal loading
-ice
-compress
-elevate
Stages of tissue healing
- Acute stage days, peace, price and police
- Subacute stage (rehabilitation stage), weeks, love
3.chronic stage; training, months, love
Acute stage and what to avoid
-do no harm
-essential that treatment begins as soon as possible
In the 3 days following acute injury avoid
-heat- hot bathes, hot showers
-moderate-vigorous-strenuous activity;walking and briskly running
-massage
