Responding to injuries and medical conditions in sport

Question 1

What is the protocol for recognising concussion?

Answer 1

Worlds Rugbys 6 R’s for concussion

Question 2

What are the 6 R’s?

Answer 2

Recognise, Remove, Refer, Rest, Recover, Return

Question 3

What is meant by recognise in the 6 R’s for recognising concussion?

Answer 3

Parents, players, coaches and officials should all be aware of the signs and symptoms of concussion

Question 4

What is meant by remove in the 6 R’s for recognising concussion?

Answer 4

If the player has a suspected concussion they must be removed from play immediately

Question 5

What is meant by refer in the 6 R’s for recognising concussion?

Answer 5

Player should be immediately referred to a qualified healthcare professional who is trained in treating and evaluating concussion

Question 6

What is meant by rest in the 6 R’s for recognising concussion?

Answer 6

Player must rest from exercise until they are symptom free and not be left alone for the first 24 hours

Question 7

What is meant by recover in the 6 R’s for recognising concussion?

Answer 7

Player must fully recover and be treated before making a return to exercise. Return should be authorised by a healthcare professional

Adults must take a minimum of 1 week, under 18s two weeks

Question 8

What is meant by return in the 6 R’s for recognising concussion?

Answer 8

The player should compete the ‘graduated return to play’ GRTP protocol and have written authorisation

Question 9

What is the ‘graduated return to play’ GRTP protocol?

Answer 9

1. Minimum rest period with complete body and brain rest without symptoms
2. Light aerobic exercise to increase heart rate
3. Sport-specific exercise incorporating running drills without any head impact
4. Non-contact training drills with growing complexity to increase cognitive load
5. Full-contact practice with normal training activities to assess functional skills
6. Return to play

Question 10

What is PRICE?

Answer 10

Protocol for the treatment of acute injuries

Question 11

What does PRICE stand for?

Answer 11

Protection
Rest
Ice
Compression
Elevation

Question 12

What is the aim of the PRICE protocol?

Answer 12

Limit swelling and decrease pain around the injury and therefore speeding up the healing/recovery process

Question 13

What is the protect element of PRICE?

Answer 13

Protect the injury and person from any further damage
eg. stop play, use padding, splints, crutches

Question 14

What is the rest element of PRICE?

Answer 14

Allow the injury time to heal and recover to prevent further damage and reduce recovery time

Question 15

What is the ice element of PRICE?

Answer 15

Apply ice indirectly to the skin to reduce inflammation and pain. 10 minutes every 60 minutes for 48-72 hours post injury

Question 16

What are the effects of ice?

Answer 16

Decreases circulation, metabolic activity, and inflammation. Numbs skin

Question 17

What are the benefits of using ice?

Answer 17

Decreases pain, swelling, inflammation, and muscle spasm/cramping

Question 18

What will ice do?

Answer 18

Reduce bleeding into tissues, prevent or reduce swelling so recovery process can start, reduce muscle pain and spasm, reduce pain by numbing the area and limiting effects of swelling

Question 19

What is the compression element of PRICE?

Answer 19

Compressing the injury with tear tape, crepe or a stretch bandage will help to reduce swelling, inflammation and blood pooling

Question 20

What are the benefits of compression?

Answer 20

-effective way of treating by compressing the limb to increase pressure, this narrows blood vessels and prevents excessive bleeding as well as decreased swelling
-minimal expense
-easy to apply

Question 21

What are the negatives of compression?

Answer 21

If too tight and does not stretch sufficiently then further damage of tissue can occur
eg. necrosis (cell death)

Question 22

What is the elevate element of PRICE?

Answer 22

Raise the injury above heart level to reduce blood flow to the area, thus decreasing swelling

Question 23

What is SALTAPS?

Answer 23

Protocol for the assessment of sporting injury

Question 24

What does SALTAPS stand for?

Answer 24

Stop, Ask, Look, Touch, Active Movement, Passive Movement, Strength Testing

Question 25

Explain the stop element of SALTAPS

Answer 25

Stop the game is a player is injured and observe the injury

Question 26

Explain the ask element of SALTAPS

Answer 26

Ask questions about the injury eg. where is the pain? which way did you fall?

Question 27

Explain the look element of SALTAPS

Answer 27

Look, search for specific signs eg. burning, swelling, broken skin, bleeding, foreign objects

Question 28

Explain the touch element of SALTAPS

Answer 28

Gently touch/palpate the injured area to identify painful regions and inflammation

Question 29

Explain the active movement element of SALTAPS

Answer 29

Ask the player if they can move the injured area without assistance

Question 30

Explain the passive movement element of SALTAPS

Answer 30

If there is active movement, gently move the injured area through its full range of motion

Question 31

Explain the strength testing element of SALTAPS

Answer 31

Ask player to stand, lift or put pressure on the injured area if they can, ask weather they feel able to continue playing, and if so observe their movement and behaviour closely

Question 32

When should you stop using the SALTAPS protocol?

Answer 32

-If at the ‘Look’ stage there is obvious signs of injury, player should be removed from the game or stop training to receive treatment -For the ‘Touch,Active,Passive movement’ stages it is importantly that the most qualified and experienced individual makes the assessment

Question 33

What are the positives of SALTAPS?

Answer 33

-An effective structure to assess for possible injury -Can be done pitch-side -Players can return to play if all aspects of SALTAPS are ‘passed’ -Responder can stop SALTAPS at any time to refer the player to hospital/medical help -Easy for coaches to learn/remember -Prevents further damage occurring

Question 34

What are the negatives of SALTAPS?

Answer 34

-Responder may not ask the right questions/spot deformity etc. so injury may be missed -Player may not answer accurately/truthfully/mask pain if they want to stay on the pitch -Player may be cleared to return to play with an injury -6Rs in rugby may be more appropriate for concussion assessment -Not appropriately qualified professional -Could make the injury worse

Question 35

What are the positives of PRICE?

Answer 35

-Speeds up recovery -Other treatments can be used in addition, such as pain-reliefs medicines/massage -Easily accessible

Question 36

What are the negatives of PRICE?

Answer 36

-Some injuries may need urgent further medical treatment eg. shoulder dislocation so PRICE not sufficient on its own -Risk of ice burns if ice applied directly to skin/ avoid icing chest if performer has angina -Compression may be too tight and limit blood flow -Raising upper body part above heart may cause more pain/worsen injury -Not appropriate for all injuries eg. compound fracture

Question 37

Evaluate the 6Rs to treat concussion

Answer 37

-Signs and symptoms may not be obvious -At lower levels healthcare professionals may not be immediately available -Legal obligation of officials/coaches in their care, but players may deny concussion, want to stay on the field -Intimidation of healthcare professions to enable player to return to field and play on, incentive to leave player on pitch to see if they are okay -Easy to remember, learn, educate, advertise