Midterm Cards Flashcards
What is sports medicine?
- a multi-disciplinary term encompassing all phases of medical concerns related to sport, exercise or recreational activity
- apply medical and scientific knowledge to prevent, recognize, manage, and rehab injuries related to sport, exercise, or recreational activity
professions in sport medicine
coach, nurse, athletic director, physical educator, dentist, kinesiologist, physiotherapist, psychologist, chiropractor
what is athletic training?
subspecialty of sports medicine that provides an array of health care support services for athletes provided by athletic trainer
where can you find athletic training?
schools, professional sports, hospitals, clinics, offices, military and law enforcement, industrial, commercial, performing arts
injury vs accident
injury:
- prepared for: preventable
- controllable
- part of sporting experience
- predictable
accident:
- tried to be preventable
- not inherent to activity
- unpredictable
sports aid vs first aid
sports aid:
- deals with injuries
- chronic injuries
- confusing area with respect to trainer, involves treatment and healing
first aid:
- deals with accidents
- acute accidents
- protocol for treatment
injury vs accident vs sports aid vs first aid
sports aid treats injuries
first aid treats accidents
roles of athletic trainer
1) injury and illness prevention, and wellness promotion
2) initial examination and assessment
3) immediate and emergency care
4) therapeutic intervention (taping, rehab, return to sport)
5) health care administration and professional responsibility (procedures, policies, credentials)
3 guiding statements of AT
1) prevention > cure
2) never allow minor injuries become major ones
3) when in doubt, refer
acute
- pain @ rest
- pain in diffuse area - pain during passive ROM
- first 24-72 hours
sub-acute
- no pain at rest
- pain at extreme ROM
- referred to after 72 hours
chronic
- resistant to rehab
- localized pain with specific activities
- after 3-7 days to long term
etiology
cause of injury
symptom
subjective comments from athlete; any sensation experiences as a departure from normal
sign
objective indications seen by AT
diagnosis
name of specific injury/ condition
prognosis
projected outcome of injury
bilateral symmetry
R/L sides are mirror images
surface anatomy
form and marking of the body surface
-> important for injury assessment (observation/palpitation)
contralateral
opposite side
ipsilateral
same side
mechanism of injury
manner and location by which excess forces or stresses are applies to the body, resulting in athletic injury
cephalic
towards crown
caudal
towards tail
name all 4 planes
orange: sagittal
green: median
blue: frontal
red: transverse
observation
- looking for body form deformity
- symmetry
- shape and bone placement
palpitation
to assess:
- ROM and joint function
- internal structures
label the prominent landmarks
emergency action plan
- blueprint on how to respond to emergency situations
- written document that is comprehensive yet flexible to adapt to any emergency situation
when to refer
1) evaluate extent of injury
2) determine minor, moderate, or severe
3) walk in clinic?
4) MD’s office
referencing in minor injury
- rest at home/sidelines
- see physician now or later
- see physio, chiro, etc
referencing in major injury
- initiate EAP
- hospital emergency room: transportation by ambulance, self, or another person
what is the importance of a predetermines EAP
for proper assessment and care of athletes who have suffered injury or sudden illness
EAPs should be prepared in conjunction with who?
- local paramedics
- hospital emergency departments
- sport physicians
- school/team nurse
- other allied health care professionals associated with team/event
what is considered a LIFE THREATENING situation when initiating EAP?
- obstructed airway
- respiratory failure
- cardiac arrest
- severe heat problems
- head/brain damage
- cervical spine injury
what is considered a SERIOUS situation when initiating EAP?
- severe bleeding
- joint dislocation
- fractures
unconsciousness
the inability to respond to any sensory stimuli (exception of deep pain)
3 levels of consciousness
1) lethargic
2) stupor
3) coma
causes of unconsciousness
- direct blow to head
- diabetes
- epilepsy
- anaphylactic shock
what is included in a primary survey?
ABCs turned into CAB
C-A-B
compression, airway, breathing
what is included in a secondary survey?
- continue to monitor ABC’s
- collect thorough history of injury
- document level of consciousness
- measure respiration
- check the eyes/ pupils
- monitor skin colour and temperature
- look for signs of trauma (bleeding/posture)
- SCAT card
normal respiration rates for:
- newborn
- infants
- toddler
- child
- adolescent
- adults
newborn -> 30-40
infants -> 30-60
toddler -> 26-32
child -> 20-30
adolescent -> 16-20
adults -> 16-22
what to do in a suspected spinal injury?
- don’t move athlete (unless essential)
- manage as though a spine injury exists (ABC’s, neurological, status of LOC, activate EAP)
what to do with face masks in an injury
- should be removed in most cases
- remove as quickly as possible (even if conscious)
- need appropriate tools for removal
what to do with helmets in an injury
do not remove helmets
what increases potential for injury with a helmet removal
the presence of shoulder pads elevates trunk
how to remove hockey helmets
1) splay helmet with fingers
2) have someone slide helmet up and off
how to remove football helmets
1) remove cheek pads
2) tilt helmet off occupant and remove without spreading helmet apart
what to do in the event of thunder and lightning
- 30 sec flash-bang ratio -> 30 min wait before resuming activity
- can also stop at first sight of lightning
safe shelter for thunder and lightning
- grounded building
- vehicle with metal roof
- cell phone use OK to call 911
risks for extreme temperature
hyper/hypo- thermia
how/when to modify training for extreme temperatures
- avoid peak hrs in heat
- access to dry and/or shaded areas
- increase rest and hydration breaks
- rain and cold temperatures
who is at risk during extreme temperatures
- dehydrated
- excessive/improper clothing
- low fitness level
- fatigued
- age (<15/>40)
- obese
- people in sidelines/stands
who are the personnel in EAP
- certifications/roles for team ERT (emergency response team) members
- call person and backup call person
- charge person and backup charge person
- mode of communication
what are some facility policies in EAP
- areas are checked regularly for safety hazards
- phones and emergency supplies in working order and are accessible
- EMS info and access routes updated and posted next to phones
- ERT members familiar to access routes
- visiting teams receive info about EAP and emergency equipment
what to do after the emergency
- someone informs emergency contact
- all documentation filled out correctly
- incident report
- debriefing session
athletic injury
- disruption in tissue continuity resulting from athletic or sports related activity causing cessation of participation or restriction of usual activity
- occurs when the forces applies to the body exceeds the body’s ability to absorb those forces (overuse) which leads to structures tearing
what are the 2 sources of force?
created inside or outside the body
example of force created inside the body
muscle contraction (eccentric especially) too powerful for connective tissue
examples of forces created outside the body
running into object, another person, repeated landing
mechanism of injury
sports injury module
application location, magnitude, and direction of which excess forces/stresses are applied to the body
the 2 types of injuries
exposed and unexposed
what is an exposed injury?
disrupts skin continuity
what is an unexposed injury?
internal, skin is not broken
2 types of mechanisms
indirect and direct
what is an indirect mechanism and example
from force away from point of injury
ex. FOOSH (skiers thumb)
what is a direct mechanism and examples
injury at site of excessive force
ex. plant and twist, direct contact
what are the results of direct mechanisms
contusion and hematoma
contusion
- compression injury involving accumulation of blood and lymph within a muscle
- caused by a direct blow to the body
- can cause damage to the skin and deeper tissue
hematoma
- a localized mass of blood and lymph confined within a space or tissue
- blood collects and pools under the skin outside the blood vessel
- symptoms are usually more severe than a bruise and may need surgical draining
- caused by greater trauma
what causes indirect injuries?
chronic and repetitive overuse
types of indirect injuries
7 examples
,muscle strain, ligament sprain, ligament, dislocation, subluxation, fractures and stress fractures
muscle strain
injury to a muscle or tendon from over-exertion
minor muscle strain
overstretch a muscle or tendon
severe muscle strain
partial/complete tears in muscle or tendon
grades of muscle strains
I: stretching, small tears (pull)
II: larger, but incomplete tear (partial tear)
III: complete tear (avulsion)
ligament sprain
stretching/ tearing of ligaments, most common in ankles
grades of ligament sprains
I: small tears, stable
II: larger tear, some laxity, endpoint
III: complete tear, laxity, endpoint
ligament
fibrous tissue that connect two bones together in your joints
dislocation
injury where the bone is forced from it’s normal position and out of the joint
causes of dislocation
trauma, fall, collision
examples of dislocation
acromioclavicular, knee, hip dislocation
subluxation
- incomplete/partial dislocation of a joint
- not moving how it should or it’s misaligned
luxation
a complete separation of the joints
fractures
a disruption of the continuity of a bone
stess fracture
fracture resulting from repeated loading with relatively low magnitude forces
myositis
inflammation of connective tissue within a muscle
myositis ossifications
- bone tissue forms within a muscle
- can be from repetitive trauma to a muscle - body will reabsorb it
tendinitis
inflammation of a tendon
ACUTE
tendinosis
tendon condition associated with degeneration rather than with inflammation
CHRONIC
tendinopathy
increased cellularity and matrix protein, with collagen fibrils in disarray in tendon
tenosynovitis and example
inflammation of a tendon sheath
ex. De Quervain’s tenosynovitis (wrist)
bursitis
inflammation of bursa
bursa
a fibrous sac membrane containing synovial fluid typically found between tendons and bones, acts to decrease friction during movement
recovery
the physiological processes taking place after exercise when the body is restored to its pre-exercise condition
what is included in the recovery process?
- replenishment of muscle glycogen, phosphagen
- removal or metabolites
- re-oxygenation of myoglobin
- protein replacement
acute fatigue
- muscle fatigue that occurs after strenuous training, which is normal after hard training
- recovery occurs in 24-48 hrs
chronic fatigue
- muscle fatigue that accumulates over time when there isn’t enough recovery
- may occur after several days of hard training
- takes 3-7 days to recover from resulting fatigue
types of fatigue
- metabolic: energy stores
- neurological: PNS (muscle) or CNS
- psychological: competition pressure, personality conflicts, school exams
- environmental: climate, time zones, biological clock (sleep disturbances)
role of sleep in recovery
sleep is for recovering from previous wakefulness and/or prepare for functioning int he subsequent wake period
what happens when sleep is restricted
restricted to <6 hrs for 4 or more nights:
- impair cognitive performance and mood
- disturb glucose metabolism
- impair appetite regulation
- impair immune function
regular amount of sleep for adults and elite athletes
adults: 6.8-7.4 hrs
athletes: 8:36 +/- 0:53
what happens to elite athletes sleep?
increase sleep latency (time to fall asleep) and decreased sleep efficiency which affects growth hormones
overtraining
- athlete trains intensely but does not recover from acute/chronic fatigue
- leads to decrease performance even after extended period of rest
- can lead to burnout or stress
burnout
a state of physical, mental, and emotional exhaustion
staleness
state of performance due to burnout; distinguished by still motivated to train
signs and symptoms of overtraining
increaser resting HR, increased injury risk, decreased motivation, decreased appetite, change in mood, and decrease in performance
most important signs of overtraining
change in mood and decreased performance
3 goals of prevention action plan (PAP)
1) good coaches carefully plan practices so that athlete compete and play in an environment that is safe
2) good coaches emphasize basic skills and techniques that are designed to prevent injury
3) an athlete will be confident if they are trying their best in an environment that affords then an all- out effort
when should medical screening be conducted? what is its purpose? requirement? test type?
- necessary at start of any training
- educate individuals regarding risk of participation
- identify factors that place them at risk of injury/illness
- exam requirements are risk and age dependent
- PAR-Q+
general medical history: when and who?
- athletes fill out medical history card prior to team/sport involvement
- athletes GP fills out medical card
what is included in PPE (pre-participation exam)?
- medical history
- cardiovascular exam
- musculoskeletal exa
- neurological exam
- eye exam
- dental exam
- lab test/blood work
what is included in physical fitness profile?
- anthropometry
- body composition
- maturation/growth
- flexibility
- strength/power/speed
- agility/balance/reaction
- cardiovascular endurance
who conducts the PPE?
- primary care physician
- paediatrician
- orthopaedic surgen
- dentist
- dietitian
when to perform PPE?
days prior to training or centralization camp (up to 6 weeks before start)
frequency of PPE
annually
who conducts physical fitness profile?
- lab testing by exercise physiologist
- kinesiology students
- strength and conditioning coach
timeline of PFP
days prior to training/centralization camp following PPE
frequency of PFP
bi-annually; before and after training camp
what are the contraindications to participation? name 5.
- neurological (concussion)
- single organ (eye, kidney, testicle)
- pulmonary (lung infection)
- cardiovascular (abnormal enlarged heart, infection, murmurs, conditions, pacemaker, previous MI, on anticoagulants)
- genital/urinary systems (missing one kidney, infection6 weeks following appendectomy)
- musculoskeletal (incomplete healing, inflammatory arthritis, hip disease, back/neck pain)
- skin (bacterial/ viral infection)
- ear, nose, throat (recent middle ear operation)
- heme (hemophilia, HIV/AIDS, amenorrhea)
functional biomechanics
- applying the principles of mechanics to living organisms to understand the relationships and interactions that the various body parts, segments, and systems have with each other that contribute to the ability/inability to function
- carry out purposeful activity and dynamics of motion
- combines physics/engineering with anatomy/physiology
2 contradictory constraints to purposeful motor movements
1) to move one/several body segments towards a goal
2) to stabilize other segments in order to maintain posture and equilibrium
what are the basic systems of function and how do they interact?
- nervous, muscular, skeletal, cardiovascular system
- all structures react together and form a functional chain of human biomechanics
injury risk factors
- previous injury
- high/low BMI
- asymmetry (strength/flexibility/ROM)
- poor dynamic neuromuscular control or balance
- excessive muscle activation
-dynamic lower extremity alignment
neuromuscular control: how does it happen?
- sensory receptors located in muscles, tendons, ligaments, and joints provide input to CNS relative to tissue deformation
- visual and vestibular centres provide information about body position and balance
- the ability to sense body position is controlled by mechanoreceptors
where are joint mechanoreceptors found?
in joint capsule, ligaments, menisci, muscles, tendons
where are muscle mechanoreceptor found?
in muscle spindles and golgi tendon organs
how does balance happen?
involves positioning body’s COG over a base of support and integrating info from various proprioceptors in body
injury disrupts __________ ________ mechanism
neuromuscular feedback
what must be restored in injury rehab?
must restore proprioception feedback in injury rehab
posture
body position that minimizes stress on the joints
what does posture asses?
gauge of:
- mechanical efficiency
- kinesthetics sense
- muscle balance
- neuromuscular control
what are the types of performance postures?
active, static, or dynamic
ideal standing posture
the line of gravity bears a definite relation to certain anatomical landmarks when viewed from the side
plum line
the line of gravity
plum line
the line of gravity
landmarks in ideal standing posture
ear -> shoulder (acromion) -> hip (greater trochanter) -> knee (condyle) -> ankle (malleolus)
spine deviations and poor posture
deviations in the line of gravity away from these land marks represent “poor” posture
kyphosis
upper back curvature (thoracic)
lordosis
lower back curvature
scoliosis
”s” shape of spine in the frontal plane
how do joints get injured
prolonged postural strain and increased rotary forces injures the joint structures
what to all joints need
mobility and stability
name the joint structures and label what their function is
green: cervical spine (stability)
red: thoracic spine (mobility)
blue: lumbar spine (stability)
orange: hip (mobility)
yellow: knee (stability)
purple: ankle (mobility)
mobility
the ability to produce a desired movement
stability
the ability to resist an undesired movement
controlled mobility
optimal positioning to carry out activity requires a harmonious relationship between mobility and stability
what does it mean when joint structures are “stacked”
a joint that need more mobility is surrounded, above and below, by a joint that needs more stability
what do lever systems consist of ?
rigid bar, pivot/fulcrum, load, force
rigid bar
rod
pivot/fulcrum
joint centre
load
weight to move
force
supplies energy for movement (muscle)
increased distance from effort to fulcrum = ?
decreased effort
increased distance from load to fulcrum = ?
increased load (feels like increased effort)
proper lifting technique
- weight held close to centre of body
- back straight
- knees bend to meet load
- weight lifted with leg strength not back strength
flexibility
a range of motion and joint
what is flexibility dependent on?
- normal joint mechanics
- mobility of soft tissue
- muscle extensibility
why is strength and flexibility balance important?
for maintaining posture
strength structures and matching flexibility structures needed for balance
strength: abdominal, scapular adductor, thoracic spinal extensor
flexibility: pectoral, hamstring, hip flexor
what causes postural deviations?
deviating lower limb mechanics also contributes to redistribution of weight and the joints
genu valgum
knocked knees: weight on lateral side, gap on medial
genu varum
bowlegs: weight on medial side, gap on lateral
tibial recurvatum
hyper extension of the knee
what happens in patellar tract deviations?
may redistribute weight at the knee joint altering the pulley system between patella and quad muscles
iliotibial band (function laterally, function proximally, function distally)
- laterally, the IT band supports the extensor mechanism and is an important lateral stabilizer of the patello-femoral joint
- proximally, the IT band originates from the tensor fascia lata muscle
- distally, inserts on tibia
Q angle
qualifies the degree of deviation in lower limb
Q angle norms
males <13 degrees
female <18 degrees (more at risk for injury)
meniscus
- the structure of the medial and lateral meniscus in the knee assists the pulley system but is stressed with any mechanical deviation
- lateral meniscus naturally bears most of the load with weight bearing (approx. 70%)
mechanical functions of meniscus
- control joint motion
- provide structure for joint stability (cup-shaped)
- provide function for load transmission
subtalar deviation
implicated in changes in normal arch formation
subtalar valgus
- pes planus/flat foot
- loose/flexible
- pronation
subtalar varus
- pes cavus/ high arch foot
- rigid
- supination
determining arch type
arch will collapse with weight so be sure to check foot while person is both weight-bearing and non-weight bearing
how to select a shoe
- proper shoe can help re-align foot
- shoe selection should incorporate properties for foot management based on foot architecture and athletic needs
orthotics
soft, semi-rigid, or rigid inserts are made from specific cast molding of athletes foot
cycle of asymmetries
asymmetries in movement case compensation
-> compensation causes poor efficiency
-> poor efficiency increases fatigue
-> fatigue destroys body awareness (distorts proprioception)
-> loss of body awareness increases the risk of injury
mechanism of fatigue and musculoskeletal injury
leads that are high in magnitude and repetitive in nature leade to musculoskeletal injury
performance factors of fatigue
- impact velocity
- landing technique
- floor surface stiffness
- footware characteristics
- neuromuscular fatigue
label the graph
A: load
B: frequency of load
C: likelihood of injury
what are the mechanics of running?
- technique: using arms? up on toes?
- surfaces: grass? cement? ice?
- shoes: right fit? too worn?
- training increased: too much too soon?
- terrain: uphill? downhill?
- foot and leg anomalies: valgus? varus?
- muscle imbalances: strength/flexibility
- fatigue: acute and/or accumulative
management options
- assess
- stretch (balance muscle pains)
- strength
- stabilize
- mobilize
- control (change posture, workloads, activities, frequency, intensity, foot ware, terrain, etc.)
management options
- assess
- stretch (balance muscle pains)
- strength
- stabilize
- mobilize
- control (change posture, workloads, activities, frequency, intensity, foot ware, terrain, etc.)
management options for injuries
- assess
- stretch (balance muscle pains)
- strength
- stabilize
- mobilize
- control (change posture, workloads, activities, frequency, intensity, foot ware, terrain, etc.)
bodys response after serious trama
systematic and predictable manner
process to evaluate extent of injury
1) understand the mechanism of the traumatic sequence
2) understand how to methodically inspect an injury (HOPS)
non-bony tissue
- anything but bones; skin, muscle, tendon, ligament, fascia, nerve, cartilage
non-bony tissue common injuries
sprains, strains, contusions, tendonitis/tendinosis
- each tissue will have a yield point (or elastic limit)
label the tissue
left: muscle-tendon (parallel, vascular)
right: ligament (wavy, avascular)
directions with tissues and joints
- tissue structures are stronger in resisting forces from certain directions compared to others
-the anatomical design of many many joints means they are more susceptible to injury from a given direction
types of forces on body
compression, tension, shearing
compression
axial loading along an axis
tension
stretching, pulling along an axis
shearing
oppositely directly loads that are parallel
label the types of forces
A: compression
B: tension
C: shearing
D: shearing
types of injury to the skin
abrasions, incisions, laceration, avulsion, puncture, blisters
abrasions
dermis exposed
incisions
sharp cut (clean)
laceration
irregular tear (jagged)
avulsion
tearing off of skin (or another part of body)
puncture
may be deep
open wound management
- control bleeding (clot initiates healing)
- gauze to apply pressure
- clean the wound (soap and water or saline; remove debris)
- dress the wound (sterile bandage)
- make sure ends approximated: use butterfly/steri-strips/stitches
predictive reparative process
physical responses to physical trauma
what are the physical responses to physical trauma
- inflammation and healing
- damaged cells lose nutrition and ability to function normally
necrosis
when deprived of O2 results in cell death
hematoma
pool of blood with disrupted tissue
2 results of trauma
1) primary injury: bleeding, damaged tissue
2) secondary injury: damage occurring secondary to primary injury
blood components
liquid fraction:
- plasma (water)
- approx. 50%
formed elements:
- blood cells
- approx. 45%
- RBC (erythrocytes), WBCs (leukocytes), platelets (thrombocytes)
inflammation
- complex biological response of vascular tissues to harmful stimuli
- series of interrelated physical and chemical activities
what does inflammation do?
- localize the extent of injury
- remove foreign material and dying tissues so that healing can begin
3 phases of the inflammation response
I: acute vascular response
II: repair and regeneration (proliferative phase)
III: remodelling and maturation
*these overlap within tissue
phase I: acute vascular response
1) initiate immediate vasoconstriction (first 5-10 mins)
2) histamine causes vasodilation and increased vascular permeability (“phagocytosis”-white blood cells and macrophages ingest and dispose of unwanted substances. blood clotting-platelets help to seal off area)
3) fluids leak out of blood vessels and collect at injury site and result in edema (swelling) (24-48 hrs)
4) excessive swelling leads to secondary injury (fluid will drain though blood and lymph system)
5) phase I last 0-6 days, up to 2 weeks
inflammation signs and symptoms
redness, swelling, heat, pain, loss of function
phase II: repair and regeneration (proliferative phase)
1) begins once all necrotic debris is cleared from injury sight
2) dense capillary network will form
3) fibroblast proliferate damaged area and makes collagen
4) collagen forms a loose mesh network of connective tissue at the injury site (vascular and fragile)
5) scar tissue begins to form (disorganized structure of tissue)
6) phase II normally lasts 3-21 days (begins within 12 hrs and may continue up to 6 weeks)
phase III: remodelling and maturation
1) begins once fibroblasts disappear
2) scar tissue collagen begins to align with direction of stress and the cross-link formation becomes more organized
3) scar tissue is avascular and inelastic and may be present up to 1 year
the therapist role in 3 phases
- minimize initial damage and promote the healing process
-> address the inflammatory response - ensure undue stress is avoided until tissues are ready
-> even on healthy tissues
principles of rehabilitation theory
- use modalities to aid in the healing (restore ROM, strength of tissues)
- lengthly immobilization leads to atrophy
- timing of therapy is crucial
rehabilitation therapy for muscle and tendon
- approx. 3 weeks for muscle
- approx. 4-6 weeks for tendon
- early activity promotes full strength and ROM return
- too early could cause increased bleeding and edema and decreased ROM
rehabilitation therapy for ligaments
- approx. 6-12 months
- stress during remodelling increases collagen strength
- too early could increase length of fibres and increase joint laxity
shock
- diminished amount of blood available in circulatory system, and as a result, not enough oxygen carrying blood cells are available to tissues
- a collapse of the cardiovascular system when insufficient blood cannot provide circulation for the entire body
- vascular system loses capacity to hold fluid portion of blood within the system because of dilation of blood vessel (decrease BP) and disruption of osmotic fluid balance
hypovolemic shock
caused by decreased blood volume
cardiogenic shock
due to heart problems
anaphylactic shock
caused by severe allergic reaction
septic shock
due to infection
neurogenic shock
caused by damage to the nervous system
obstructive shock
caused by embolism, pneumothorax
signs and symptoms of shock
- pulse: rapid & weak
- skin: cool, clammy, pale
- breathing: rapid, shallow
- sweating: profusely
- pupils: dilated (dull eyes)
- BP: steadily falling
- Unconsciousness
- nausea
treatment for shock
- comfort athlete
- maintain body heat (blankets)
- elevate feet and legs (help gravity)
- continue to monitor vitals
goals of immediate care of injuries
- decrease effect of injury a its onset
- control swelling, decrease hematoma
RICES
rest, ice, compress, elevate, support
POLICE
protect, optimal loading, ice, compression, elevation
MOVE
- movement
- options for cross training
- vary rehab with strength, balance, and agility
- easing back into activity
rest (optimal load)
- continuing after injury may cause injured site to continue to haemorrhage and increase initial amount of tissue damage
- injured area is weaker and more susceptible to further (more serious) damage
- practical: depends on nature of injury- 10 mins to months
ice
- decrease secondary tissue damage and results in smaller hematoma to be resoled
- practical: 12-20 mins on with protection
ice: attributes of cryotherapy
- constrict capillaries and decrease blood flow
- increase blood clotting to decrease hemorrhaging
- decrease pain and muscle spasm
- increase tissue stiffness
- decrease biochemical activity (decreasing overall inflammation)
theory of using ice for recovery
icing damaged muscle causes blood vessels to contract, which greatly reduces blood circulation, then with re-warming, blood begins flowing back into limbs very quickly. increased circulation helps flush out lactic acid while refreshing your muscles with a new supply of oxygen
practical use of cryotherapy
ice bath <5-20 mins (if low fat area <10 mins), varying with volume and intensity of training
compression
- decrease and controls swelling
- feels more comfortable for athlete (mild support and some pain relief)
- practical: wrap elastic band distal to proximal, never at night, use pads in anatomical “pockets” and some specific taping techniques)
elevation
- decrease and controls welling (limits blood flow/fluid pooling, encourages venous return, decrease pressure so less fluids leak out of blood vessels into injury site)
- practical: place injury above level of heart
support (protect/optimal load)
- stabilization and immobilization will prevent further injury
- practical: (braces, splints, casts, tape, pads or crutches)
phase I rehab
- control swelling
- decrease pain
- immobilize for the first 24-48 hrs
- early mobility: >48 hrs
phase II rehab
- maintain cardiovascular fitness and ROM
-restore, increase muscular strength (isometrics-holds, then isotonics- dynamic, then isokintetics- speed machine) - re-establish neuromuscular control
phase III rehab
- return to activity
- regain sport specific skills
- continue to strengthen injured area
- use of the following are beneficial (healing, ultrasound, massage)
return to play
the point in recovery from an injury when a person is able to return to playing sport at pre-injury level
when can athlete return to activity?
- seen by physician and received medical clearance
- pain free normal ROM
- no swelling (bilateral comparison)
- no tenderness
- 80-100% strength (bilateral comparison)
- 80-100% return of balance and coordination
concussion
- a functional injury; acceleration and deceleration injury of the brain
- don’t have to be hit in the head to have a concussion
concussion features
- no abnormality seen on standard imaging
- brain is like jello and neurons get stretched
- depolarization of neurons (number of symptoms)
- energy crisis
mechanisms of concussion
1) direct blow
2) indirect blow
3) chronic repetitive blow
diagnosis of concussion
1) mechanism of injury
2) one symptom
signs and symptoms of concussion
symptoms:
-headache, feeling like in a fog, emotional symptoms
physical signs:
- LOC, amnesia, neurological deficit
balance impairment:
- irritability
cognitive impairment:
- slowed reaction times
sleep/wake disturbances:
- drowsiness
observable signs of concussion
- lying motionless
- balance/gait difficulties/motor incoordination (stumbling, slow/laboured movements)
- blank/vacant look
- facial injury after head trauma
management of suspected concussion on field
1) stabilize the neck and instruct not to move
2) “what is your name?” (first question always)
3) if responsive ask: where are you? what day is it? what is the score? tell me what happened? (check for amnesia of the event)
4) what are you feeling? (symptoms) headache, dizziness, nausea, ringing in ears, blurry vision
5) do you have any pain in your neck?
6) do you have any pain in your arms/legs?
7) assess sensory of extremities while stabilizing neck
8) assess active movement of extremities
9) have athlete rotate neck side to side (must be able to turn head >45 degrees each direction without pain)
management of suspected concussion in sidelines
if the athlete comes off field under own will, but you are suspecting a concussion
1) sit them down immediately
2) Maddock’s Questions:
- where are we today?
- what period/half is now?
- who scored last in this match?
- what team did we play last?
- did your team win the last game?
3) ask about symptoms:
- no symptoms, ok to continue
- any symptoms, pull from the game
4) no medications
5) SCATS
6) remove gear and sit in shade
concussion diagnosis
- rule out cervical fracture or more serious injury
- don’t leave athlete alone (watching for deterioration)
- when in doubt, sit them out
monitoring after concussion
- 2-3 hrs
- don’t allow athlete to sleep for at least 3 hr after concussion
- want to monitor for decreasing condition (intracranial hemorrhage/edema)
- likely be very fatigued (ATP decline)
red flags for concussion
- severe/worsening headache
- very drowsy or can’t be awakened
- seizures
- decrease level of consciousness >2 hours after injury (can’t recognize people/places)
- unusual behaviour, very confused, very irritable
- weakness/numbness in arms/legs
- unsteady on feet/slurring speech
- fluid leaking form ears, bruising behind ears, 2 black eyes
- vomiting
- inability to remember more than 30 mins before injury
assessment of concussion after diagnosis
- vital signs: to establish baseline
- physical signs (ex. pupil abnormalities)
- cognitive assessment
- balance assessment
- coordination assessment
- SCATS
SCATS
sport concussion assessment tool
- assesses vital sign, cognitives, balance, and coordination
- standardize tool for evaluating concussions
- used for athletes 13 yrs <
- 12 yrs>/ use child SCATS
symptom assessments for comcussions
1) number of symptoms /22
2) symptom severity score /132
management after concussion diagnosis
- education and reassurance
- prognostic variables
education and reassurance after concussion diagnosis
- one of the best ways to reduce the incidence of persistent symptoms
- what us a concussion? your brain is not damaged - this is temporary
- what are you likely to experience
- what things you can do to improve your outcomes? sense of control
prognostic variables after concussion diagnosis
- high symptoms severity score (also related to anxiety and poor coping skills - increase education and reassurance needed)
- pre-existing mental health status (anxiety and depression)
-early removal from play - male/female
- time from injury to assessment
rest
- insufficient evidence for complete rest
- after a brief period of rest during the acute phase (24-48) hrs) after injury patients can be encouraged to become gradually and progressively more active
- stay below their cognitive and physical symptoms worsening
recovery stages of concussion
1) symptom limited activity
2) light cognitive activity
3) half day at school/work
4) full day at school/work
5) return to physical activity
6) sport specific activity
7) non-contact training
8) medical clearance
9) full practice
10) game play
post-concussion syndrom (PCS)
aka “persistent concussion symptoms”
3 of the following, 4 weeks after injury:
- headache, dizziness, fatigue, irritability, sleep problems, concentration problems, memory problems, problems tolerating stress/emotion/alcohol
pathophysiology of PCS
unknown
main theories:
1) blood flow abnormalities (physiological)
2) metabolic, inflammation/hormonal
3) visual and/or vestibular dysfunction
4) cervical spine dysfunction
5) psychological
