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SPSC 3276 Injuries > Midterm Cards > Flashcards

Midterm Cards Flashcards

1
Q

What is sports medicine?

A
  • 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
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2
Q

professions in sport medicine

A

coach, nurse, athletic director, physical educator, dentist, kinesiologist, physiotherapist, psychologist, chiropractor

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3
Q

what is athletic training?

A

subspecialty of sports medicine that provides an array of health care support services for athletes provided by athletic trainer

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4
Q

where can you find athletic training?

A

schools, professional sports, hospitals, clinics, offices, military and law enforcement, industrial, commercial, performing arts

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5
Q

injury vs accident

A

injury:
- prepared for: preventable
- controllable
- part of sporting experience
- predictable
accident:
- tried to be preventable
- not inherent to activity
- unpredictable

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6
Q

sports aid vs first aid

A

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

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7
Q

injury vs accident vs sports aid vs first aid

A

sports aid treats injuries
first aid treats accidents

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8
Q

roles of athletic trainer

A

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)

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9
Q

3 guiding statements of AT

A

1) prevention > cure
2) never allow minor injuries become major ones
3) when in doubt, refer

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10
Q

acute

A
  • pain @ rest
  • pain in diffuse area - pain during passive ROM
  • first 24-72 hours
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11
Q

sub-acute

A
  • no pain at rest
  • pain at extreme ROM
  • referred to after 72 hours
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12
Q

chronic

A
  • resistant to rehab
  • localized pain with specific activities
  • after 3-7 days to long term
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13
Q

etiology

A

cause of injury

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14
Q

symptom

A

subjective comments from athlete; any sensation experiences as a departure from normal

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15
Q

sign

A

objective indications seen by AT

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16
Q

diagnosis

A

name of specific injury/ condition

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17
Q

prognosis

A

projected outcome of injury

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18
Q

bilateral symmetry

A

R/L sides are mirror images

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19
Q

surface anatomy

A

form and marking of the body surface
-> important for injury assessment (observation/palpitation)

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20
Q

contralateral

A

opposite side

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21
Q

ipsilateral

A

same side

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22
Q

mechanism of injury

A

manner and location by which excess forces or stresses are applies to the body, resulting in athletic injury

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23
Q

cephalic

A

towards crown

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24
Q

caudal

A

towards tail

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25
Q

name all 4 planes

A

orange: sagittal
green: median
blue: frontal
red: transverse

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26
Q

observation

A
  • looking for body form deformity
  • symmetry
  • shape and bone placement
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27
Q

palpitation

A

to assess:
- ROM and joint function
- internal structures

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28
Q

label the prominent landmarks

A
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29
Q

emergency action plan

A
  • blueprint on how to respond to emergency situations
  • written document that is comprehensive yet flexible to adapt to any emergency situation
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30
Q

when to refer

A

1) evaluate extent of injury
2) determine minor, moderate, or severe
3) walk in clinic?
4) MD’s office

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31
Q

referencing in minor injury

A
  • rest at home/sidelines
  • see physician now or later
  • see physio, chiro, etc
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32
Q

referencing in major injury

A
  • initiate EAP
  • hospital emergency room: transportation by ambulance, self, or another person
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33
Q

what is the importance of a predetermines EAP

A

for proper assessment and care of athletes who have suffered injury or sudden illness

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34
Q

EAPs should be prepared in conjunction with who?

A
  • local paramedics
  • hospital emergency departments
  • sport physicians
  • school/team nurse
  • other allied health care professionals associated with team/event
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35
Q

what is considered a LIFE THREATENING situation when initiating EAP?

A
  • obstructed airway
  • respiratory failure
  • cardiac arrest
  • severe heat problems
  • head/brain damage
  • cervical spine injury
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36
Q

what is considered a SERIOUS situation when initiating EAP?

A
  • severe bleeding
  • joint dislocation
  • fractures
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37
Q

unconsciousness

A

the inability to respond to any sensory stimuli (exception of deep pain)

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38
Q

3 levels of consciousness

A

1) lethargic
2) stupor
3) coma

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39
Q

causes of unconsciousness

A
  • direct blow to head
  • diabetes
  • epilepsy
  • anaphylactic shock
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40
Q

what is included in a primary survey?

A

ABCs turned into CAB

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41
Q

C-A-B

A

compression, airway, breathing

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42
Q

what is included in a secondary survey?

A
  • 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
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43
Q

normal respiration rates for:
- newborn
- infants
- toddler
- child
- adolescent
- adults

A

newborn -> 30-40
infants -> 30-60
toddler -> 26-32
child -> 20-30
adolescent -> 16-20
adults -> 16-22

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44
Q

what to do in a suspected spinal injury?

A
  • don’t move athlete (unless essential)
  • manage as though a spine injury exists (ABC’s, neurological, status of LOC, activate EAP)
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45
Q

what to do with face masks in an injury

A
  • should be removed in most cases
  • remove as quickly as possible (even if conscious)
  • need appropriate tools for removal
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46
Q

what to do with helmets in an injury

A

do not remove helmets

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47
Q

what increases potential for injury with a helmet removal

A

the presence of shoulder pads elevates trunk

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48
Q

how to remove hockey helmets

A

1) splay helmet with fingers
2) have someone slide helmet up and off

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49
Q

how to remove football helmets

A

1) remove cheek pads
2) tilt helmet off occupant and remove without spreading helmet apart

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50
Q

what to do in the event of thunder and lightning

A
  • 30 sec flash-bang ratio -> 30 min wait before resuming activity
  • can also stop at first sight of lightning
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51
Q

safe shelter for thunder and lightning

A
  • grounded building
  • vehicle with metal roof
  • cell phone use OK to call 911
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52
Q

risks for extreme temperature

A

hyper/hypo- thermia

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53
Q

how/when to modify training for extreme temperatures

A
  • avoid peak hrs in heat
  • access to dry and/or shaded areas
  • increase rest and hydration breaks
  • rain and cold temperatures
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54
Q

who is at risk during extreme temperatures

A
  • dehydrated
  • excessive/improper clothing
  • low fitness level
  • fatigued
  • age (<15/>40)
  • obese
  • people in sidelines/stands
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55
Q

who are the personnel in EAP

A
  • certifications/roles for team ERT (emergency response team) members
  • call person and backup call person
  • charge person and backup charge person
  • mode of communication
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56
Q

what are some facility policies in EAP

A
  • 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
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57
Q

what to do after the emergency

A
  • someone informs emergency contact
  • all documentation filled out correctly
  • incident report
  • debriefing session
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58
Q

athletic injury

A
  • 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
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59
Q

what are the 2 sources of force?

A

created inside or outside the body

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60
Q

example of force created inside the body

A

muscle contraction (eccentric especially) too powerful for connective tissue

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61
Q

examples of forces created outside the body

A

running into object, another person, repeated landing

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62
Q

mechanism of injury

sports injury module

A

application location, magnitude, and direction of which excess forces/stresses are applied to the body

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63
Q

the 2 types of injuries

A

exposed and unexposed

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64
Q

what is an exposed injury?

A

disrupts skin continuity

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65
Q

what is an unexposed injury?

A

internal, skin is not broken

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66
Q

2 types of mechanisms

A

indirect and direct

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67
Q

what is an indirect mechanism and example

A

from force away from point of injury
ex. FOOSH (skiers thumb)

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68
Q

what is a direct mechanism and examples

A

injury at site of excessive force
ex. plant and twist, direct contact

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69
Q

what are the results of direct mechanisms

A

contusion and hematoma

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70
Q

contusion

A
  • 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
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71
Q

hematoma

A
  • 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
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72
Q

what causes indirect injuries?

A

chronic and repetitive overuse

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73
Q

types of indirect injuries

7 examples

A

,muscle strain, ligament sprain, ligament, dislocation, subluxation, fractures and stress fractures

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74
Q

muscle strain

A

injury to a muscle or tendon from over-exertion

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75
Q

minor muscle strain

A

overstretch a muscle or tendon

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76
Q

severe muscle strain

A

partial/complete tears in muscle or tendon

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77
Q

grades of muscle strains

A

I: stretching, small tears (pull)
II: larger, but incomplete tear (partial tear)
III: complete tear (avulsion)

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78
Q

ligament sprain

A

stretching/ tearing of ligaments, most common in ankles

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79
Q

grades of ligament sprains

A

I: small tears, stable
II: larger tear, some laxity, endpoint
III: complete tear, laxity, endpoint

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80
Q

ligament

A

fibrous tissue that connect two bones together in your joints

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81
Q

dislocation

A

injury where the bone is forced from it’s normal position and out of the joint

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82
Q

causes of dislocation

A

trauma, fall, collision

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83
Q

examples of dislocation

A

acromioclavicular, knee, hip dislocation

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84
Q

subluxation

A
  • incomplete/partial dislocation of a joint
  • not moving how it should or it’s misaligned
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85
Q

luxation

A

a complete separation of the joints

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86
Q

fractures

A

a disruption of the continuity of a bone

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87
Q

stess fracture

A

fracture resulting from repeated loading with relatively low magnitude forces

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88
Q

myositis

A

inflammation of connective tissue within a muscle

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89
Q

myositis ossifications

A
  • bone tissue forms within a muscle
  • can be from repetitive trauma to a muscle - body will reabsorb it
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90
Q

tendinitis

A

inflammation of a tendon
ACUTE

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91
Q

tendinosis

A

tendon condition associated with degeneration rather than with inflammation
CHRONIC

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92
Q

tendinopathy

A

increased cellularity and matrix protein, with collagen fibrils in disarray in tendon

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93
Q

tenosynovitis and example

A

inflammation of a tendon sheath
ex. De Quervain’s tenosynovitis (wrist)

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94
Q

bursitis

A

inflammation of bursa

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95
Q

bursa

A

a fibrous sac membrane containing synovial fluid typically found between tendons and bones, acts to decrease friction during movement

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96
Q

recovery

A

the physiological processes taking place after exercise when the body is restored to its pre-exercise condition

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97
Q

what is included in the recovery process?

A
  • replenishment of muscle glycogen, phosphagen
  • removal or metabolites
  • re-oxygenation of myoglobin
  • protein replacement
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98
Q

acute fatigue

A
  • muscle fatigue that occurs after strenuous training, which is normal after hard training
  • recovery occurs in 24-48 hrs
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99
Q

chronic fatigue

A
  • 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
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100
Q

types of fatigue

A
  • metabolic: energy stores
  • neurological: PNS (muscle) or CNS
  • psychological: competition pressure, personality conflicts, school exams
  • environmental: climate, time zones, biological clock (sleep disturbances)
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101
Q

role of sleep in recovery

A

sleep is for recovering from previous wakefulness and/or prepare for functioning int he subsequent wake period

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102
Q

what happens when sleep is restricted

A

restricted to <6 hrs for 4 or more nights:
- impair cognitive performance and mood
- disturb glucose metabolism
- impair appetite regulation
- impair immune function

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103
Q

regular amount of sleep for adults and elite athletes

A

adults: 6.8-7.4 hrs
athletes: 8:36 +/- 0:53

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104
Q

what happens to elite athletes sleep?

A

increase sleep latency (time to fall asleep) and decreased sleep efficiency which affects growth hormones

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105
Q

overtraining

A
  • 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
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106
Q

burnout

A

a state of physical, mental, and emotional exhaustion

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107
Q

staleness

A

state of performance due to burnout; distinguished by still motivated to train

108
Q

signs and symptoms of overtraining

A

increaser resting HR, increased injury risk, decreased motivation, decreased appetite, change in mood, and decrease in performance

109
Q

most important signs of overtraining

A

change in mood and decreased performance

110
Q

3 goals of prevention action plan (PAP)

A

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

111
Q

when should medical screening be conducted? what is its purpose? requirement? test type?

A
  • 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+
112
Q

general medical history: when and who?

A
  • athletes fill out medical history card prior to team/sport involvement
  • athletes GP fills out medical card
113
Q

what is included in PPE (pre-participation exam)?

A
  • medical history
  • cardiovascular exam
  • musculoskeletal exa
  • neurological exam
  • eye exam
  • dental exam
  • lab test/blood work
114
Q

what is included in physical fitness profile?

A
  • anthropometry
  • body composition
  • maturation/growth
  • flexibility
  • strength/power/speed
  • agility/balance/reaction
  • cardiovascular endurance
115
Q

who conducts the PPE?

A
  • primary care physician
  • paediatrician
  • orthopaedic surgen
  • dentist
  • dietitian
116
Q

when to perform PPE?

A

days prior to training or centralization camp (up to 6 weeks before start)

117
Q

frequency of PPE

A

annually

118
Q

who conducts physical fitness profile?

A
  • lab testing by exercise physiologist
  • kinesiology students
  • strength and conditioning coach
119
Q

timeline of PFP

A

days prior to training/centralization camp following PPE

120
Q

frequency of PFP

A

bi-annually; before and after training camp

121
Q

what are the contraindications to participation? name 5.

A
  • 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)
122
Q

functional biomechanics

A
  • 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
123
Q

2 contradictory constraints to purposeful motor movements

A

1) to move one/several body segments towards a goal
2) to stabilize other segments in order to maintain posture and equilibrium

124
Q

what are the basic systems of function and how do they interact?

A
  • nervous, muscular, skeletal, cardiovascular system
  • all structures react together and form a functional chain of human biomechanics
125
Q

injury risk factors

A
  • previous injury
  • high/low BMI
  • asymmetry (strength/flexibility/ROM)
  • poor dynamic neuromuscular control or balance
  • excessive muscle activation
    -dynamic lower extremity alignment
126
Q

neuromuscular control: how does it happen?

A
  • 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
127
Q

where are joint mechanoreceptors found?

A

in joint capsule, ligaments, menisci, muscles, tendons

128
Q

where are muscle mechanoreceptor found?

A

in muscle spindles and golgi tendon organs

129
Q

how does balance happen?

A

involves positioning body’s COG over a base of support and integrating info from various proprioceptors in body

130
Q

injury disrupts __________ ________ mechanism

A

neuromuscular feedback

131
Q

what must be restored in injury rehab?

A

must restore proprioception feedback in injury rehab

132
Q

posture

A

body position that minimizes stress on the joints

133
Q

what does posture asses?

A

gauge of:
- mechanical efficiency
- kinesthetics sense
- muscle balance
- neuromuscular control

134
Q

what are the types of performance postures?

A

active, static, or dynamic

135
Q

ideal standing posture

A

the line of gravity bears a definite relation to certain anatomical landmarks when viewed from the side

136
Q

plum line

A

the line of gravity

137
Q

plum line

A

the line of gravity

138
Q

landmarks in ideal standing posture

A

ear -> shoulder (acromion) -> hip (greater trochanter) -> knee (condyle) -> ankle (malleolus)

139
Q

spine deviations and poor posture

A

deviations in the line of gravity away from these land marks represent “poor” posture

140
Q

kyphosis

A

upper back curvature (thoracic)

141
Q

lordosis

A

lower back curvature

142
Q

scoliosis

A

”s” shape of spine in the frontal plane

143
Q

how do joints get injured

A

prolonged postural strain and increased rotary forces injures the joint structures

144
Q

what to all joints need

A

mobility and stability

145
Q

name the joint structures and label what their function is

A

green: cervical spine (stability)
red: thoracic spine (mobility)
blue: lumbar spine (stability)
orange: hip (mobility)
yellow: knee (stability)
purple: ankle (mobility)

146
Q

mobility

A

the ability to produce a desired movement

147
Q

stability

A

the ability to resist an undesired movement

148
Q

controlled mobility

A

optimal positioning to carry out activity requires a harmonious relationship between mobility and stability

149
Q

what does it mean when joint structures are “stacked”

A

a joint that need more mobility is surrounded, above and below, by a joint that needs more stability

150
Q

what do lever systems consist of ?

A

rigid bar, pivot/fulcrum, load, force

151
Q

rigid bar

A

rod

152
Q

pivot/fulcrum

A

joint centre

153
Q

load

A

weight to move

154
Q

force

A

supplies energy for movement (muscle)

155
Q

increased distance from effort to fulcrum = ?

A

decreased effort

156
Q

increased distance from load to fulcrum = ?

A

increased load (feels like increased effort)

157
Q

proper lifting technique

A
  • weight held close to centre of body
  • back straight
  • knees bend to meet load
  • weight lifted with leg strength not back strength
158
Q

flexibility

A

a range of motion and joint

159
Q

what is flexibility dependent on?

A
  • normal joint mechanics
  • mobility of soft tissue
  • muscle extensibility
160
Q

why is strength and flexibility balance important?

A

for maintaining posture

161
Q

strength structures and matching flexibility structures needed for balance

A

strength: abdominal, scapular adductor, thoracic spinal extensor
flexibility: pectoral, hamstring, hip flexor

162
Q

what causes postural deviations?

A

deviating lower limb mechanics also contributes to redistribution of weight and the joints

163
Q

genu valgum

A

knocked knees: weight on lateral side, gap on medial

164
Q

genu varum

A

bowlegs: weight on medial side, gap on lateral

165
Q

tibial recurvatum

A

hyper extension of the knee

166
Q

what happens in patellar tract deviations?

A

may redistribute weight at the knee joint altering the pulley system between patella and quad muscles

167
Q

iliotibial band (function laterally, function proximally, function distally)

A
  • 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
168
Q

Q angle

A

qualifies the degree of deviation in lower limb

169
Q

Q angle norms

A

males <13 degrees
female <18 degrees (more at risk for injury)

170
Q

meniscus

A
  • 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%)
171
Q

mechanical functions of meniscus

A
  • control joint motion
  • provide structure for joint stability (cup-shaped)
  • provide function for load transmission
172
Q

subtalar deviation

A

implicated in changes in normal arch formation

173
Q

subtalar valgus

A
  • pes planus/flat foot
  • loose/flexible
  • pronation
174
Q

subtalar varus

A
  • pes cavus/ high arch foot
  • rigid
  • supination
175
Q

determining arch type

A

arch will collapse with weight so be sure to check foot while person is both weight-bearing and non-weight bearing

176
Q

how to select a shoe

A
  • proper shoe can help re-align foot
  • shoe selection should incorporate properties for foot management based on foot architecture and athletic needs
177
Q

orthotics

A

soft, semi-rigid, or rigid inserts are made from specific cast molding of athletes foot

178
Q

cycle of asymmetries

A

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

179
Q

mechanism of fatigue and musculoskeletal injury

A

leads that are high in magnitude and repetitive in nature leade to musculoskeletal injury

180
Q

performance factors of fatigue

A
  • impact velocity
  • landing technique
  • floor surface stiffness
  • footware characteristics
  • neuromuscular fatigue
181
Q

label the graph

A

A: load
B: frequency of load
C: likelihood of injury

182
Q

what are the mechanics of running?

A
  • 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
183
Q

management options

A
  • assess
  • stretch (balance muscle pains)
  • strength
  • stabilize
  • mobilize
  • control (change posture, workloads, activities, frequency, intensity, foot ware, terrain, etc.)
183
Q

management options

A
  • assess
  • stretch (balance muscle pains)
  • strength
  • stabilize
  • mobilize
  • control (change posture, workloads, activities, frequency, intensity, foot ware, terrain, etc.)
184
Q

management options for injuries

A
  • assess
  • stretch (balance muscle pains)
  • strength
  • stabilize
  • mobilize
  • control (change posture, workloads, activities, frequency, intensity, foot ware, terrain, etc.)
185
Q

bodys response after serious trama

A

systematic and predictable manner

186
Q

process to evaluate extent of injury

A

1) understand the mechanism of the traumatic sequence
2) understand how to methodically inspect an injury (HOPS)

187
Q

non-bony tissue

A
  • anything but bones; skin, muscle, tendon, ligament, fascia, nerve, cartilage
188
Q

non-bony tissue common injuries

A

sprains, strains, contusions, tendonitis/tendinosis
- each tissue will have a yield point (or elastic limit)

189
Q

label the tissue

A

left: muscle-tendon (parallel, vascular)
right: ligament (wavy, avascular)

190
Q

directions with tissues and joints

A
  • 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
191
Q

types of forces on body

A

compression, tension, shearing

192
Q

compression

A

axial loading along an axis

193
Q

tension

A

stretching, pulling along an axis

194
Q

shearing

A

oppositely directly loads that are parallel

195
Q

label the types of forces

A

A: compression
B: tension
C: shearing
D: shearing

196
Q

types of injury to the skin

A

abrasions, incisions, laceration, avulsion, puncture, blisters

197
Q

abrasions

A

dermis exposed

198
Q

incisions

A

sharp cut (clean)

199
Q

laceration

A

irregular tear (jagged)

200
Q

avulsion

A

tearing off of skin (or another part of body)

201
Q

puncture

A

may be deep

202
Q

open wound management

A
  • 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
203
Q

predictive reparative process

A

physical responses to physical trauma

204
Q

what are the physical responses to physical trauma

A
  • inflammation and healing
  • damaged cells lose nutrition and ability to function normally
205
Q

necrosis

A

when deprived of O2 results in cell death

206
Q

hematoma

A

pool of blood with disrupted tissue

207
Q

2 results of trauma

A

1) primary injury: bleeding, damaged tissue
2) secondary injury: damage occurring secondary to primary injury

208
Q

blood components

A

liquid fraction:
- plasma (water)
- approx. 50%
formed elements:
- blood cells
- approx. 45%
- RBC (erythrocytes), WBCs (leukocytes), platelets (thrombocytes)

209
Q

inflammation

A
  • complex biological response of vascular tissues to harmful stimuli
  • series of interrelated physical and chemical activities
210
Q

what does inflammation do?

A
  • localize the extent of injury
  • remove foreign material and dying tissues so that healing can begin
211
Q

3 phases of the inflammation response

A

I: acute vascular response
II: repair and regeneration (proliferative phase)
III: remodelling and maturation
*these overlap within tissue

212
Q

phase I: acute vascular response

A

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

213
Q

inflammation signs and symptoms

A

redness, swelling, heat, pain, loss of function

214
Q

phase II: repair and regeneration (proliferative phase)

A

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)

215
Q

phase III: remodelling and maturation

A

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

216
Q

the therapist role in 3 phases

A
  • 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
217
Q

principles of rehabilitation theory

A
  • use modalities to aid in the healing (restore ROM, strength of tissues)
  • lengthly immobilization leads to atrophy
  • timing of therapy is crucial
218
Q

rehabilitation therapy for muscle and tendon

A
  • 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
219
Q

rehabilitation therapy for ligaments

A
  • approx. 6-12 months
  • stress during remodelling increases collagen strength
  • too early could increase length of fibres and increase joint laxity
220
Q

shock

A
  • 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
221
Q

hypovolemic shock

A

caused by decreased blood volume

222
Q

cardiogenic shock

A

due to heart problems

223
Q

anaphylactic shock

A

caused by severe allergic reaction

224
Q

septic shock

A

due to infection

225
Q

neurogenic shock

A

caused by damage to the nervous system

226
Q

obstructive shock

A

caused by embolism, pneumothorax

227
Q

signs and symptoms of shock

A
  • pulse: rapid & weak
  • skin: cool, clammy, pale
  • breathing: rapid, shallow
  • sweating: profusely
  • pupils: dilated (dull eyes)
  • BP: steadily falling
  • Unconsciousness
  • nausea
228
Q

treatment for shock

A
  • comfort athlete
  • maintain body heat (blankets)
  • elevate feet and legs (help gravity)
  • continue to monitor vitals
229
Q

goals of immediate care of injuries

A
  • decrease effect of injury a its onset
  • control swelling, decrease hematoma
230
Q

RICES

A

rest, ice, compress, elevate, support

231
Q

POLICE

A

protect, optimal loading, ice, compression, elevation

232
Q

MOVE

A
  • movement
  • options for cross training
  • vary rehab with strength, balance, and agility
  • easing back into activity
233
Q

rest (optimal load)

A
  • 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
234
Q

ice

A
  • decrease secondary tissue damage and results in smaller hematoma to be resoled
  • practical: 12-20 mins on with protection
235
Q

ice: attributes of cryotherapy

A
  • 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)
236
Q

theory of using ice for recovery

A

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

237
Q

practical use of cryotherapy

A

ice bath <5-20 mins (if low fat area <10 mins), varying with volume and intensity of training

238
Q

compression

A
  • 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)
239
Q

elevation

A
  • 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
240
Q

support (protect/optimal load)

A
  • stabilization and immobilization will prevent further injury
  • practical: (braces, splints, casts, tape, pads or crutches)
241
Q

phase I rehab

A
  • control swelling
  • decrease pain
  • immobilize for the first 24-48 hrs
  • early mobility: >48 hrs
242
Q

phase II rehab

A
  • maintain cardiovascular fitness and ROM
    -restore, increase muscular strength (isometrics-holds, then isotonics- dynamic, then isokintetics- speed machine)
  • re-establish neuromuscular control
243
Q

phase III rehab

A
  • return to activity
  • regain sport specific skills
  • continue to strengthen injured area
  • use of the following are beneficial (healing, ultrasound, massage)
244
Q

return to play

A

the point in recovery from an injury when a person is able to return to playing sport at pre-injury level

245
Q

when can athlete return to activity?

A
  • 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
246
Q

concussion

A
  • a functional injury; acceleration and deceleration injury of the brain
  • don’t have to be hit in the head to have a concussion
247
Q

concussion features

A
  • no abnormality seen on standard imaging
  • brain is like jello and neurons get stretched
  • depolarization of neurons (number of symptoms)
  • energy crisis
248
Q

mechanisms of concussion

A

1) direct blow
2) indirect blow
3) chronic repetitive blow

249
Q

diagnosis of concussion

A

1) mechanism of injury
2) one symptom

250
Q

signs and symptoms of concussion

A

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

251
Q

observable signs of concussion

A
  • lying motionless
  • balance/gait difficulties/motor incoordination (stumbling, slow/laboured movements)
  • blank/vacant look
  • facial injury after head trauma
252
Q

management of suspected concussion on field

A

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)

253
Q

management of suspected concussion in sidelines

A

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

254
Q

concussion diagnosis

A
  • rule out cervical fracture or more serious injury
  • don’t leave athlete alone (watching for deterioration)
  • when in doubt, sit them out
255
Q

monitoring after concussion

A
  • 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)
256
Q

red flags for concussion

A
  • 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
257
Q

assessment of concussion after diagnosis

A
  • vital signs: to establish baseline
  • physical signs (ex. pupil abnormalities)
  • cognitive assessment
  • balance assessment
  • coordination assessment
  • SCATS
258
Q

SCATS

A

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

259
Q

symptom assessments for comcussions

A

1) number of symptoms /22
2) symptom severity score /132

260
Q

management after concussion diagnosis

A
  • education and reassurance
  • prognostic variables
261
Q

education and reassurance after concussion diagnosis

A
  • 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
262
Q

prognostic variables after concussion diagnosis

A
  • 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
263
Q

rest

A
  • 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
264
Q

recovery stages of concussion

A

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

265
Q

post-concussion syndrom (PCS)

A

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

266
Q

pathophysiology of PCS

A

unknown
main theories:
1) blood flow abnormalities (physiological)
2) metabolic, inflammation/hormonal
3) visual and/or vestibular dysfunction
4) cervical spine dysfunction
5) psychological

SPSC 3276 Injuries (2 decks)

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