PE Sports Med

Question 1

Ways to classify injuries

Answer 1

direct (force outside body) vs indirect (force within body)
soft tissue vs hard tissue
overuse

Question 2

strain vs sprain

Answer 2

strain: muscles and tendons
sprain: the fibres of ligaments are torn

Question 3

grading

Answer 3

first - least serious, 1-3 wks
second - moderate, 4-8 wks
third - extensive damage, full rupture, surgery, 10-12 wks

Question 4

soft tissue injuries

Answer 4

sprain
strain

contusion (internal)
- internal bleed caused by direct impact that has compressed the fibres of the normal muscle

abrasion (external)
- essentially a grazing of the layers of skin, easily infected due to exposed blood vessels

lacerations (external)
- cut or slicing of skin layers

blisters (external)
- friction burn to layers of skin

Question 5

inflammatory response

Answer 5

1. inflammation
   bleeding occurs and swelling of the injured site
   aim is to get scar tissue forming over tissue damage
   - RICER
2. regeneration
   newly created tissue pushes out the scar tissue
   - light rehab
3. remodelling
   exercise the new tissue to be flexible
   - full rehab, light game work

Question 6

RICER

Answer 6

rest (still, until beginning a program of careful mobilisation)

ice (avoid freeze burn, timing will depend on size of area)
- reduces pain, blood flow, swelling, spasm

compression (bandage)
- reduces bleeding, swelling

elevation (whenever possible for next few days)
- reduces bleeding/swelling/throbbing

referral (as soon as possible)
- to understand nature and extent of injury
- to seek guidance for rehab

Question 7

soft tissue injuries management

Answer 7

muscle strain
- stretching or tearing of muscle or tendon (muscle to bone)
- signs are swelling, bruising, athlete holding quickly
- symptoms are pain on stretch
- DRSABCD, TOTAPS, RICER, no HARM (heat, alc, run, massage)

skin abrasion
- grazing of surface of skin
- signs are bleeding, redness, road rash
- symptoms are stinging pain
- DRSABCD, TOTAPS, clean in sterile conditions, dress if necessary, cover

contusion
- internal bleeding due to direct contact
- signs are immediate swelling, followed by yellow brown colour
- symptoms are area is very tender to touch
- DRSABCD, TOTAPS, RICER, no HARM, gentle stretch

Question 8

types of fractures

Answer 8

simple - cracked bone breaks into 2 seperate pieces, does not break the skin
compound - cracked bone breaks into 2 seperate pieces, sticks through the skin
greenstick - stress crack
oblique - clean
comminuted - multiple
depressed - compression fractures

Question 9

types of immobilisation

Answer 9

splint for fracture, sling for dislocation

Question 10

dislocation/subluxation

Answer 10

dislocation - bones of a joint capsule come out partially or in full
subluxation - bone has popped out and then popped back in (becomes soft tissue because of damage to surrounding)

Question 11

hard tissue injuries management

Answer 11

tooth dislodgement
- occurs when tooth has exited the gums
- signs are miss/have tooth, bleeding gums, pain, discomfort
- DRSACBD, TOTAPS, safe transportation, gum is clean and cover, tooth is wrapped

fractured wrist
- break on the edge of forearm bones
- signs are abnormal range, protruding bone, pain, discomfort, grinding sensation
- DRSABCD, TOTAPS, safe transportation, apply splint to immobilise

hip subluxation
- occurs when the ball and socket joint has popped out and back in
- signs are lock up of joint, loss of mobility, popping sound
- DRSABCD, TOTAPS, safe transportation, immobilise, refer for scans

Question 12

TOTAPS

Answer 12

T: Talk
O: Observe
T: Touch
A: Active movement (themselves)
P: Passive movement (you move it for them)
S: Skills test (mimic the game)

Question 13

children in sport conditions

Answer 13

epilepsy
- seizure disorder (nerve cell activity to brain is disturbed)
- extreme fatigue, lack of sleep, dehydration (cause)
- signs are confusion, staring, jerking movements, loss of consciousness
- most likely in collision sports, summer sports, indoor lighting sports
- focus on technique when colliding, reduce time training in hot conditions, coach and one other adult educated on 000 and recovery position

asthma
- airways narrow and swell, making it difficult to breathe
- cold/dry air, air pollution, chlorine, extended deep breathing (cause)
- signs are coughing, wheezing, shortness of breath, tightness in chest
- most likely in snow sports (cold, high alt), high-polluted areas
- coach and one other adult educated on 4x4x4 ventolin, allow more breaks to get breath back

growth plate damage
- injury to new bone tissue which can affect growth
- over-exertion in mechanical load (cause)
- signs are inability to move area, inability to put pressure on area, swelling, redness
- most likely in anything with lifting/loading
- good stretching routines, correct form, variety, resistance bands instead of load, prioritise technique over load

diabetes
- hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar)
- imbalance between training and nutrition, rapidly increased exercise, lots of adrenalin
- signs are weakness, shaking, thirst, confusion, nausea
- most likely in prolonged time and intensity, team sports
- coach and one other adult educated (calm, stop, hydrate, food if low), reduce time doing intense activity, more breaks to hydrate, complete pre/post BGL test

Question 14

adult and aged athlete conditions

Answer 14

heart conditions
- e.g., heart attack, high blood pressure, stroke
- this is because the cardiovascular system becomes less efficient, decreased ability to carry oxygen
- should do aerobic 60-75% intensity, avoid strenuous exercise, exercise with friend, lower volumes, pre-screening a must
e.g., walking, golf

fractures/bone density
- e.g., osteoporosis, stress fractures
- bones that are more brittle will fracture more easily
- lower intensity, not too much pressure on joints via low load, avoid collisions/high impact
- e.g., swimming, cycling

flexibility/joint mobility
- e.g., rheumatoid arthritis (chronic inflammation - autoimmune disease) and osteo arthritis (flexible tissue at ends of bones wears down from rubbing)
- flexibility decreases with age due to a loss of elasticity
- encourage muscle mass, improve flexibility, improve core strength, improve balance
- e.g., yoga, tai chi

Question 15

female athlete conditions

Answer 15

iron deficiency
- low iron causes haemoglobin levels to drop, meaning there is less oxygen in our blood stream. therefore, our working muscles don’t receive enough oxygen, and a lack of fuel means our aerobic performance is limited
- “sports anaemia”
- caused by malnutrition/overtraining
- increased fatigue during race
- managed by sports eating strategies, regular screening of iron levels, maintain safe training volumes

eating disorders
- anorexia/bulimia and causes malnutrition
- affects level of micro and macro nutrients
- decrease energy supply, decrease power and aerobic capacity, increase injury and illness
- managed by regular blood screenings, work with sports nutritionist, work with sports psychologist on body image issues

bone density
- density of bones is thin, makes skeleton more vulnerable
- can be caused by age, hormone levels, menstruation issues
- more vulnerable to injuries, more vulnerable to strength/power depletion, affects anaerobic output
- managed by regular screening of blood and bone density, biomechanical analysis to pick up alignment issues with skeleton

pregnancy
- hormonal changes as well as physical side affects
- 1st trimester no change, maybe even increased power and vo2 max
- 2/3 trimester negative effects e.g., carrying weight
- managed by adjustment in training levels when finishing 1st trimester

Question 16

physical preparation

Answer 16

pre-screening
- end result is an exercise prescription (FITT)
- gathering info to determine what to do
- identify risks through surveys

skill and technique
- biomechanical support of the body
- vulnerable athletes e.g., contact, load, repetitive
- avoidance of injury
- e.g., rugby union muscular development and technique for scrum

physical fitness
- build a body that is capable of performing the fitness demands
- some sports may require a positional body
- developing correct fitness components
- e.g., netball needs agility, reaction time, speed, balance

warm up, stretching and cool down
- huge emphasis on specific routines to prepare players for the upcoming session and for the recovery for the next session
- vital components of a training session to avoid injury

Question 17

pre-screening and the prevention examples

Answer 17

dancing
- feet strains/sprains (there-band strength work and rolling out of feet with small ball)
- lower back injuries (increase strength of surrounding glutes and core to take load off)
- knee dislocations (strength exercises of quads, single leg hops)
- achilles/calf issues (calf strength exercises, elasticity exercises)

soccer
- lower limb soft tissue strains
- ankle and knee strains
- lower back alignment issues
- glute activation issues
(core stability, glute activation exercises, lower limb strength training, foam rolling in warm up, lower back ROM exercises)

Question 18

sports policy and the sports environment

Answer 18

• rules of sports and activities
• modified rules for children
• matching of opponents
• use of protective equipment
• safe grounds, equipment and facilities

ALL ABOUT HOW TO KEEP THE PLAYERS SAFE DURING THE GAME

Question 19

examples of sports policies and the sports environment

Answer 19

soccer

rules of sports and activities
- no slide tackling from behind, boots can’t have metal studs, no swinging on goal posts, can’t use elbows when competing for headed ball

modified rules for children
- down size field, reduce player numbers, graded/age based comps

matching of opponents
- skill level, age, gender, experience/intellect

use of protective equipment
- shin guards, mouth guards, gloves, correct footwear (e.g., no twisting, firm, shock absorption)

safe grounds/equipment/facilities
- grounds must be free of foreign material, must be a playable smooth surface, line markings must be clear with no toxic material
- equipment must meet approved standards, consistently checked and repaired

support good coaching - WWC and coach license
player safety policies - heat rule 38 degrees
suggested improvement - limited concussion policy, limited resources for multi-gender change rooms

Question 20

environmental considerations

Answer 20

• temperature regulation
• climatic conditions
• guidelines for fluid intake
• acclimisation

Question 21

environmental considerations examples

Answer 21

temperature regulation for hot
- convection (fans - 12%)
- radiation (sun - 60%)
- conduction (touching - 3%)
- evaporation (sweat - 25%)

temperature regulation for cold
- metabolism (breaks down energy to produce heat, eat more in colder months)
- movement (heat is a by-product)
- can also use radiation (seek sun)

climatic conditions
- humidity may dehydrate more, difficult to breath, heat exhaustion (fix by hydration, more breathable clothes, get used to conditions)
- rain may cool body quicker, affect playing surface, more collisions, vulnerable to slipping (fix by adequate footwear, rain protective clothes, train indoors)
- altitude may cause breathing difficulties, less oxygen, work harder, colder/drier conditions (fix by acclimatisation, protective clothing, hydration)

fluid
- during 50:50 ration, 200mL every hour
- after 125% body weight lost, 50:50 ratio
- prevention for heat is to hydroload (supports sweating)
- if dehydrated, heart rate increases quicker, core body temp rises, decrease in muscular power, muscle memory effected, decline in aerobic

acclimatisation
- altitude training (increase red blood cells, increase haemoglobin, increase oxygen, increase V02 max, takes 3-4 weeks)
- psychological training (allows mind to adjust to environment and sensory overload)
- climatic training (allows body to adapt to expected performance environment like humidity

Question 22

taping and bandaging

Answer 22

• preventative taping
  restrict some movement, athlete can still perform movement of skill, e.g., ankle strapping to prevent
• taping for isolation of injury
  allows for healing to continue, provides support for injured area
• bandaging for immediate treatment of injury
  way to immobilise, and prevent further damaged, may support RICER for soft tissue or lock in place a hard tissue injury

EXAMPLE: kinesio
- mimics elasticity of muscles
- different levels of resistance
- leave it on for days
- supports normal movement
- range of function
BUT takes a very long time and is complicated, expensive

Question 23

rehab procedures

Answer 23

progression mobilisation
- modified movements to progressively return to full ROM
e.g., hamstring leg swings, leg curls, bridging
e.g., shoulder shrugs, circumduction, add/abduct

graduated exercise
- stretching (taking surrounding tissue through its stretch-flex and recoil mechanism)
e.g., hamstring PNFs, static and light dynamics glute focus
e.g., shoulder PNFs, static, dynamics of neck/upper arm
- conditioning (muscular strength and endurance)
e.g., hamstring dead lifts, leg extensions, bridging
e.g., shoulder raises, presses, shrugs
- total body fitness (exercising within limits of injury but trying to maintain fitness components)
e.g., hamstring swimming and cycling
e.g., shoulder cycling and running

training
- training back in actual sports and starting with modified training to match injury, gradually increasing demands
e.g., hamstring some pressure/no direction opp/increase intensity TO skills under pressure, competition with opp, preventative taping
e.g., shoulder full skills training/some pressure/no direct opp TO skills under pressure/comp with opp/preventative taping

use of heat and cold
cold - use after session
reduces blood flow and inflammation at injured site, prevent DOMS, cryotherapy (ricer)

heat - prior to session
increase blood flow to generate heat in muscles, heat packs and gels

Question 24

return to play

Answer 24

• indicators of readiness for return to play (pain free, degree of mobility)
• monitoring progress (pre-test and post-test)
• psychological readiness
• specific warm up and cool down
• return to play policies and procedures (e.g., NRL concussion, boxing KO)
• ethical considerations (e.g., who’s decision, use of painkillers)

Question 25

nrl and boxing policies

Answer 25

RETURN TO PLAY

nrl
- sports trainer OF assessment
- fail (15 min head injury assessment)
- independent doctor makes assessment if HIA passed
- fail HIA, off rest of game and for 11 days

boxing
- any knockout stop match
- after first KO, must have 1-2 months off
- medical clearance to return
- 2 KO in 3 months, automatic 6 months off