Lecture 4 sports injury and healing process Flashcards
Sport injury
- Tissue damage/derangemetn of normal physical function
- Generally due to external forces (transfer of kinetic energy)
- sport injury can to all tissues: vessels, muscle, ligament, cartilage, nerve, etc.
Mode of onset
- Injury may result from a clear acute mechanism (acute injury), clear repetitive mechanism (overuse injury), or from a combination of both mechanism.
- Acute injury → Sudden onset (single event)
- Overuse injury → Gradual onset (repetitive)
- Overuse injury → Sudden onset (single event / repetitive)
Direct contact injury
Contact with another player/object
Indirect contact injury
Through another athlete/ an object
Noncontact injury
Without any contact from another external source
Soft-tissue injuries
cartilage injuries, muscle injuries, tendon injuries, and ligament injuries
Skeletal injuries
bone fractures, other bone injuries
Acute injuries
bleeding(hematoma)
Articular cartilage
flexible cartilage, provides smooth surface for joint movement (end of bones)
fibrocartilage
a tough cartilage, able to absorb loads (e.g., discs of the spine, meniscus)
tendon
muscle -> bone
enthesis
Junction between a tendon/ligament and a bone
Ligament
Bone -> Bone
Sprain
ligament and joint injuries
strain
Muscle injury
fracture
Bone injury
Rupture
organ, muscle, tendon injuries
Stiffness
Ability of a tissue to resist a load
Yield point
indicates the limit of elastic behaviour and the beginning of plastic behaviour
Creep
Deformation in the shape/properties of a tissue that occurs under the influence of persistent mechanical stresses
Four stages of wound healing
Hemostasis, inflammation, proliferation, remodelling
Hemostasis
-Stop the leak!
* Process to prevent and stop bleeding
when injury occurs → Results in formation of a clot
- Steps:
- Vascular spasm
- Formation of platelet plug
- Blood clotting (coagulation cascade)
- Formation of the final clot
- Platelet release growth factors
Inflammation
- Clean up!
- 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
Proliferation
- Rebuild!
- Healing over, rebuilding new tissue
- angiogenesis, fibroblast migration, epithelialization, wound retraction
Angiogenesis
Formation of new blood vessels, restore blood flow
Fibroblast migration
- Fibroblasts produce collagen fibres and elastin
- Results= granulation tissue which replaces the clot
Epithelialization
Epithelial cells cover denuded epithelial surface
Wound retraction
Contraction of the wound
Remodelling
- Increase tissue strength!
- Granulation tissue matures into scar
- This stage may last several months-years – important implication for return to sport
- Form and functions of the scar tissue depend on loading during this stage
- Never achieve the same level of tissue strength than before injury!
Rehabilitation
- Bone and soft tissue respond to loading -> remodel accordingly
- healing structures need to be exposed to progressive loads.
Wound healing
- Hemostasis: minutes/hours
- Inflammation: days
- Proliferation: weeks
- Remodelling: months/years
Important factors in wound healing
- Nutrition
- Hypoxia
- Infection
- Immunosuppression
- Chronic disease
- Wound management
- Age
- Genetics
- Surgical technique
Early treatment of acute soft tissue injuries
Too much bleeding slows healing
* Goals:
* Limit bleeding
* Limit swelling
* Relieve pain
* Improve conditions for
subsequent treatment and
healing
Acute injury management
PEACE/LOVE
PEACE
- Protect: unload or restrict movement for 1-3 days
- Elevate: elevate the limb higher than the heart
- Avoid: NSAID’s and ice
- Compress: helps limit deem and hematoma
- Educate: educate patients on the benefits of active approach to recovery
LOVE
- Load: 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: exercises help to restore mobility, strength and proprioception early after injury
Old acronyms
PRICE and POLICE
(Protect,rest,ice,compression,elevation)
- also used for acute management
Stages of tissue healing
acute stage, subacute stage, chronic stage
Acute stage
Days
- PEACE
- (POLICE, PRICE)
Subacute stage
(rehabilitation stage)
weeks
- LOVE
Chronic stage
(training stage)
Months
- LOVE
Acute stage- 2
- DO NO HARM!
- ESSENTIAL that treatment begins as soon as possible!
- In the 3 days following acute injury, avoid:
- Heat – hot baths, hot showers, saunas, heat packs
- Moderate-Vigorous-strenuous activity – e.g., walking briskly, running
- Massage
