sports medicine

Question 1

Ways to classify sports injuries

direct:

Answer 1

Direct- injury at point of contact (external)- hit by a bat
This could be two players colliding with each other in a soccer tackle, or an external object coming in contact with a person, such as a hockey stick hitting a person in the shins.

Question 2

indirect:

Answer 2

Indirect- through the body (internal-referred)-pull a hamstring kicking a ball.
An indirect injury is a result of internal forces within the body, and can be the result of poor technique, lack of fitness or poor equipment.

Question 3

soft tissue injury:

Answer 3

A soft tissue injury- is related to body tissue and generally results in internal bleeding. Body tissue
consists of; muscles, which are made up of cells and allow the body the move; tendons, which are fibrous tissue that connects muscle to bones; ligaments, which are fibrous tissue that connects bones to bones.

Sprains, strains, tears, lacerations, skin abrasions and contusions, as well as tendinitis, inflammatory response and blisters, are common soft-tissue injuries.

A tear is a disruption of the fibres of a muscle or tendon. The severity of a tear can range from a microscopic to full rupture of all the connecting soft tissue to a bone or muscle.

A sprain is a tear of the ligament fibres, muscles or tendons that support a joint. Sprains usually occur when a joint is extended beyond its normal range of motion.

A contusion or bruise is a bleeding into any soft tissue structure. It is usually caused by the direct impact of an object or person.

Question 4

hard tissue injury:

Answer 4

A hard tissue injury is one that relates to the bones or teeth. Bones are the core component of the skeletal system. If they are injured, this will impact on the support and protection of the body.

Hard tissue injuries include fractures, dislocations and loss of teeth.

Question 5

Overuse

Answer 5

-injury occurs as a direct result of a repeated force on body parts, including bones, tendons and muscle. Common overuse injuries include shin splints, stress fractures, tendonitis and tennis elbow. The constant pressure can be due to poor technique which, overtime, leads to an overuse injury (for example, a shoulder injury due to poor pitching technique in softball). Overuse injuries are also a result of repetitive forces continually impacting on a body part, such as a stress fracture from continually running on concrete.

Question 6

how to manage soft tissue injury: RICER

R- REST

I- ICE

C- COMPRESSION

E- ELEVATION

R- REFERRAL

Answer 6

Soft tissue injuries such as a hamstring muscle strain are immediately managed by using the RICER method. This is a treatment regime that will ensure that a soft tissue injury is correctly managed, and reduces the impact that the inflammatory response may have on the injury if it is left untreated.

Rest is the first consideration in RICER, and refers to the immediate termination of activity for the athlete. This will prevent further injury by minimising further movement and hence reducing bleeding in the area. The athlete would be initially treated on the track and placed in a comfortable position. Their leg would be elevated and supported while the trainer determines further action.

Ice is then administered to the injury site. The purpose of this is to reduce pain and swelling by cooling the area, and hence discouraging blood flow to the area. This will be carried out by placing a bag of crushed ice in a wet towel on the hamstring. This is administered for 20 minutes at a time on the injury. This treatment should be repeated every hour for the next 24–48 hours, to ensure that swelling is kept to a minimum.

Compression is another consideration to ensure that bleeding is reduced and therefore swelling is kept at a minimum. This can be achieved initially at the track by securing the ice to the injured hamstring with a clear plastic wrap wound around the ice. Additionally, an elastic bandage covering both above and below the injured hamstring will also alleviate swelling. This also can be administered over the next 24–48 hours to supplement the icing of the injury.

Elevation of the injury is a vital part of the process, and should be administered immediately when the athlete is rested once the injury has been sustained. This can be achieved by using a sports bag, or a pillow placed under the athlete’s foot and hamstring to support and raise the leg. The purpose of elevation is to raise the injured hamstring above the level of the heart. This will assist in reducing the throbbing that may occur if swelling and blood flow to the area are not minimised. This is again an action that the athlete can continue over several days to provide comfort and assist with an efficient recovery process.

Referral is the last phase of RICER, and is vital in the case of an indirect type tissue injury. As the injury has resulted from an intrinsic force within the body, an athlete will not be able to determine the extent or nature of the cause of the injury without seeking expert advice. Seeing a doctor or physiotherapist will assist the athlete in determining how badly the hamstring muscle is strained. Once the grade of the strain is established, the physio will the recommend the appropriate rehabilitation needed for the injury. In the case of grade one hamstring strain, this may involve further rest, while a more severe hamstring strain may need surgical repair.

Question 7

Assessment of injuries: Hard tissue injury

Answer 7

After an injury it is important to assess before taking action. it is important that DRSABCD procedures, which may involve resuscitation, are followed before the injury is assessed.
• If the injury is not life-threatening and athlete is conscious, a sports medicine practitioner can go through DRSABCD as they enter the sporting arena and then go in to assess injury.

TOTAPS
• Totaps is the accepted assessment process for an injury to see if medical attention is needed, or activity can resumer.

• T- talk to the injured athlete
• Observe- look for signs of swelling, deformity, change of colour
• Touch- real around the site for deformity, swelling, heat and to identify source of pain
• Active movement- to determine function an mobility. Ask athlete to move injured site and assess
range of motion. If full range ask for isometric contraction - pushing against you
• Passive Movement- If full range not present- generally more the area for athlete; may give a clearer picture of actual range of motion- watch for signs of discomfort.
• Skills- athlete should perform a graduated skills test, to determine their ability to return to play.
Standing, walking, jumping, changing direct ext, performing the required skill - throwing a ball.

Question 8

Children and young athletes

• medical conditions (asthma, diabetes, epilepsy)

Answer 8

Asthma
• People with asthma have extra-sensitive airways
• triggers like dust, pollens, animals, smoke and exercise may cause the airways to swell and narrow
• This leads to wheezing, coughing and difficulty breathing

Management:
• Steps to following the case of asthma attack:
- sit person comfortably upright. Stay calm and reassuring
- give 4 puffs of a blue puffer/inhaler. These are best given through a spacer. Give one puff every 4 breaths, holding the breath for 2-4 seconds after a puff.
- wait 4 minutes. If there is no improvement, give another 4 puffs
- If little or no improvement, call ambulance (000)

Some activities provoke an asthma attack more than others- there is significant risk with running,
some risk with cycling and little risk swimming in warm water.

Question 9

Diabetes

Answer 9

• It is a complex hereditary or developmental disease where the supply of insulin is reduced or eliminated
• Type 1 diabetes is usually hereditary an the pancreas does not produce insulin at all. It is treated with injected insulin.
• Type 2 diabetes is usually developmental and is usually the result of a sedentary lifestyle and poor nutrition. Obesity is a significant determinant for type 2. It is treated with a managed diet and lifestyle adjustments.
• Hypo-glycemia- low glucose levels (blood sugar level below 3.0)
• mild cases- dizziness, weakness and disorientation
• Severe cases- convulsions, unconsciousness, brain damage
• Hyper-glycemia - high glucose levels (blood sugar level over 10.0)
• causes: lethargic, thirsty and strong thirst
• damage toL Eyes, Kidney, Nerves
• can cause coma or death if untreated

Exercise:
• Regular exercise is an important part of diabetes management
• helps insulin to work more efficiently
• Assists with blood glucose control
• Reduces stress
• If diabetes is poor;y treated then it is best to avoid exercise until blood glucose has settled
• regular exercise prevents diabetes
• Controls weight
• lower blood pressure levels
• reduce the risk of heart disease
• suitable types of exercise: walking, swimming, dancing, cycling ect.
• 30 mins exercise per day
• Because exercise utilises sugar, diabetics need a pre-game meal to raise blood sugar levels and hourly glucose supplements if exercise is prolonged

Question 10

Epilepsy

Answer 10

• Epilepsy is a brain disorder characterised by recurring seizures and fits. Seizures are caused by sudden flurries of electrochemical activity in the brain, which disrupts the
conversation between neurons.

Exercise-related risk factors include: Extreme fatigue, lack of sleep, electrolyte loss, hyperthermia, hypo-glycaemia
• Physical exercise reduces the risk of epileptic seizures
• moderate exercises are encouraged eg yoga
• Extra care should be taken
• Risk is greater for seizures involving impaired awareness or loss of consciousness
• risk of further damage in high contact sports
• head gear is recommended
• people falsely believe that exercise will trigger a seizure, but this is not the case
• Some anti-epileptic drugs (AED’s) cause fatigue, or problems with concentration, vision or coordination

Question 11

Overuse injuries (stress fractures)

Answer 11

• Children and young athletes are at risk of developing overuse injuries for a number of reasons:
- Prolonged periods of practice without rest- training camp
- Poor biomechanics technique- fast bowling in cricket)
- Inadequate equipment- poor running shoes
- Physiological abnormalities- unbalanced muscle and bone due to growth rate
• Training should be monitored and should have rest days
• variety in sport is important- different strokes in swimming
• Signs and symptoms
- tenderness, swelling and a limited range of motion- RICER
- May lead to more serious conditions eg- stress fractures and tendonitis

Question 12

Thermoregulation

Answer 12

• Children are less able to effectively control their body temperature at 35.7
• greater risk of hypothermia (cold), hyperthermia (hot)
• Main contributing factors:
- Underdevelopment of sweat glands for cooling. Body will continue to heat up and use less effective methods of cooling such as radiation and convection
- Higher surface are to volume ratio- increases the heat that is absorbed
- Slower rates of acclimatisation- the physiological changes required to manage hot and cold days take longer to occur, such as vasodilation and vasoconstriction and also sweating.
• Cold and Hot days, winds on cold days increase convection of body heat and humidity on hot days hinders evaporation.
• For Safety children should avoid extreme conditions, have regular rest and water breaks on hot days, wear loose and light coloured clothing and warm cloths that keeps heat in on cool days.

Question 13

Appropriateness of resistance training

Answer 13

• can benefit health and performance of children and young people but certain precautions are necessary to ensure their health and wellbeing.
• Doing competitive strength and power training with heavy weights before the age of 16 can damage growth plates leading to stunted growth or injury
• up until 12, weight training should be light and focus on endurance
• As weights are gradually introduced, the resistance should be low allowing for 15-20 repetitions
• After 15, heavier weights can be slowly introduced, but only maximum 70%
• it is essential that programs are balanced, focused on muscle groups, and close supervision to ensure safety and good form

Question 14

Hard tissue injury: Describe the management of fractures and dislocations.

Answer 14

Fractures and dislocations are classified as a hard tissue injury and will both require medical intervention. To manage a fracture, it is essential to immobilise the injured limb or area, eg using a sling for a fractured forearm, or clavicle. If the fracture has pierced the skin, it is essential to reduce and control any external bleeding, using pressure, provided it does not cause further pain or injury. The athlete should be monitored for shock. The athlete should then be taken to a medical facility for treatment by a doctor, eg X-ray and plaster cast or splint if required. A dislocation is an injury to a joint where a bone has been displaced from the joint structure. To manage this, do not move the joint. The injured joint should be supported in a comfortable position and if possible a sling should be applied. The athlete or first aider should not attempt to relocate the joint, this must be done by a medical professional after an X-ray has been taken. Applying ice may help to reduce the swelling and pain for a dislocation.

Question 15

adult and aged athletes:

heart condition

Answer 15

Cardiovascular systems become less efficient and this
leads to decreased ability to carry oxygen

become fatigued quicker

• Aged people with heart
conditions need to be aware of suitable options for exercising that are available to what extent they can participate.

Older people should exercise at 65-75% of their max heart rate
• Lifelong physical activity is essential in maintaining and improving cardiovascular health

• anyone with history of CVD or risk factors should see their doctor before commencing new exercise program
- 2-3 alternate days. 4-5 days a week recommended. Low to medium intensity explore sports of low intensity such as bowls, cycling or golf

Question 16

Fractures/ bone density

Answer 16

Bones will fracture easily in cases of falls

low calcium levels contribute to brittle bones.

Osteoperosis is the thinning of bone tissue and loss of
bone density.

Resistance training should be considered as it assists with bone density and the development of stronger, thicker bones.

Not high impact could lead to fractures

Gentle, light weight bearing exercises walking, dancing, low impact aerobics

Question 17

Flexibility /

Joint movement

Answer 17

Tendon elasticity declines as well as being loss mile inligaments and muscles.

Flexibility and joint mobility decrease with age

Yoga and tai chi have proven physical benefits
- improve their symptoms through regular exercise.
aqua sport allows exercise to be carried out in a non-weight bearing environment.

Question 18

female athletes

Answer 18

Eating disorders
• Eating disorders can impair performance.
• Restrictive eating can reduce the energy available for muscular contractions.
• Dehydration can impact greatly on thermoregulation and the body’s capacity to work at the level of intensity required for optimal performance.

Iron deficiency
• During menstruation females lose more iron than normal and therefore need to ensure that adequate iron is consumed at all times.
• Iron is necessary for the production of haemoglobin, which transports oxygen in the blood. This oxygen is used for a number of processes in the human body including muscular and energy
producing reactions.
• Iron deficiency can lead to anaemia resulting in fatigue, reduced lactate clearance and reduced energy production. These factors have the potential to hinder sporting performances for female athletes.

Bone Density
• Low bone density can impact on a female’s activity patterns by reducing the strength levels of bones and increasing the risk of fractures.
• It is recommended that females consume a diet containing the recommended amounts of calcium combined with participation in weight bearing exercise as this.

Question 19

What role do preventative actions play in enhancing the wellbeing of the athlete?

Physical Preparation

Answer 19

Warm up, stretching and cool down

Warm up :
• prepares the body for physical training or competition
• most important injury prevention technique
• cause redistribution in blood flow
• aids in digestion and circulation
• causes blood to be drawn to the skeletal muscles where oxygen and nutrients are needed by the cells to enable muscle contractions
• higher muscle temperatures increases the ability of the muscle to stretch without tearing

Stretching:
• as we age our muscles lose their elasticity. Stretching increases flexibility and the length of the muscles around the joints and reduces the likelihood in injury.
• Muscles need to be stretched prior to activity using static (10-12 second hold), or PNF (staticisometric-static) stretches.
• Static is safest for children while PNF is used by advanced athletes. Stretching must be specific to the needs of the sport.

Cool down:
• undertaking a cool down allows the body to return to its pre-exercise state. A cool down in needed to:
• Disperse lactic acid
• Maintain the stretch in muscle groups
• Prevent blood pooling
• A cool down includes stretching for 10 mins; calisthenics and a gross motor activity e.g. jog or swim.

Question 20

Sports Policy and the Sports Environment

Rules of sports and activities

Answer 20

Sports policy and the sports environment promote safe participation in many ways through the use of rules in sport, modified rules for children, matching of opponents, use of protective equipment and safe grounds equipment and safety. This is evident during the game of Rugby League/Union, Netball and Karate within the community and in large-scale professional versions of the game.

-rules are put into place to assist the flow of a game but also to ensure the safety of its participants.
• Sports associations have well-defined rules stating what constitutes dangerous activity and the penalties to punish the offence.
• E.g. a head high tackle is common, but illegal, and those that engage in it are dealt with. Another example: marathon runners are obliged to consume fluid to prevent heatstroke. And hockey
goalkeepers must have protective clothing before allowed to take the field of play.

Question 21

modified rules for children

Answer 21

• Many sports associations have modified the rules of their sport to safeguard the risk of injury to young and developing players. These modified rules promote enjoyment, involvement and
continuity in their sport.

Modifications include:

• Decrease in the size of field/court. Using a smaller field space and distances in Little Athletics.
• Smaller and safer equipment. E.g. lowering the backboard in basketball or using a lighter ball and bat in cricket and enhance the chance of successful shooting.(increases participation)
• Rule changes: e.g. no tackling allowed, but tagging is allowed (Oz tag), so children only need a basic understanding to participate.
• Games shortened to prevent fatigue
• Increased use of protective equipment
• Awarding trophies and certificates for achievement other than winning e.g. for participation and effort

Question 22

matching of opponents, eg growth and development, skill level

Answer 22

• Difference in skill level, growth and development creates uneven competition. This is because of differences of physical maturity between younger players.
• To promote safety it is desirable to match children with others of comparable size. While the risk is higher in contact sports, larger children may be able to hit or bowl faster. This uneven
competition can lead to disinterest, disempowerment for smaller athletes and injuries.
• There is debate about whether we should grade contact sports due to size or age in an effort to try and reduce injuries to smaller players. To truly make junior competition fair and even,
consideration would need to be given to their size, age, gender, strength, psychological development and skill level of competitors.

Question 23

use of protective equipment

Answer 23

• Protective equipment is designed to reduce the chance of injury while not hindering performance.
• It should allow for airflow, comfort and not threatening to others. E.g. Footwear is the most essential piece of protective equipment and should be specific to the sport.
• It helps reduce sprains, strains, blisters, and structural deformities e.g. a cross trainer which helps reduce injury due to its flexibility in the toes, a high heel to support the Achilles tendon, soft but sturdy midsole to absorb impact, support for the arch of the foot and a quality non-slip sole.

Question 24

safe grounds, equipment and facilities

Answer 24

Safe Grounds: It is essential for the safety and of participants that the playing area is suitable for play. The following issues must be addressed before the start of play.

• Playing surface should be in good condition and no holes or exposed sprinkler heads
• All rubbish including grass is removed
• Permanent fixtures such as corner posts or field posts should be should be padded and secured to the ground
• Perimeter fences, spectators, media and any unnecessary equipment are kept well back from the sideline
• Lines should be clearly marked
• Adequate lighting
• Adequate matting where necessary e.g. gymnastics, high jump

Safety Equipment: equipment must:

• Be regularly checked (maintenance)
• Be well-constructed
• Be stable and properly secured
• Suited to the size and ability of a child (e.g. ball shouldn’t be so heavy, if hit, can cause potential injury)
• Sufficient in number (e.g. there should be enough long socks and enough shin pads for the whole soccer team)
• Padded appropriately

Safe Facilities: When designing facilities, officials need to consider the area around the field/court. E.g. if goals are in or close to the field of play, they must be padded. Players who go beyond this field of play through movements such as tackles must have enough room to be able to stop safely. Sponsor signs, timing devices, false start equipment and lane markers should not interfere with player movements on or off the field.

Question 25

Taping and Bandaging

Answer 25

-preventative taping
refers to the application of adhesive or non-adhesive strapping or bandages to a joint area to protect, support or strengthen the joint during movement. Sports such as basketball can place
stress on an athlete’s joints and cause injury. Taping in these situations is a preventative measure.
Taping principles:
- Non-elastic tape should be used
- Joint needs to be in a position which is stabilized
- To ensure tension, pull the tape, then apply
- To ensure strength, overlap applications
- Reapply if circulation is cut
- Avoid creasing the tape
- Avoid continuous taping
- Completely cover the skin

-taping for isolation of injury after an injury, taping is often used especially during the rehabilitative process. Support should be
given as the injured area becomes accustomed to the demands of full activity. Taping can also assist the athlete in body conditioning exercises to maintain fitness as much as possible during recuperation, and allows the athlete to be able to participate.

-bandaging for immediate treatment of injury.
Immediately after an injury, some bandaging is essential. Using the RICER regime, compression bandages are applied to restrict bleeding and swelling in the injured area. The type of bandaging
necessary varies according to the type of injury and the location of the injury. Bandaging at this point, serves to limit the motion of the body part, usually by securing it to another body part. E.g. a
sprained thumb may need to be strapped and supported by the wrist.

Question 26

How is injury rehabilitation managed?

Answer 26

Progressive mobilisation
• After treatment it is essential for movement to be restored ASAP
• It involves gradually extending the range of movement
• May initially be passive until active movement can be restored

Graduated exercise Stretching
• to reduce scarring, stretching is important
• most appropriate are proprioceptive(push and go further) neuromuscular facilitation (PNF)
• Initially, movement should be within pain barriers and gradually increased as strength increases.

Conditioning
• It involves adapting the body to a range of strength, agility and power skills to ensure full function
• this is followed by exposure to non-competitive situations where full movement is required.

Total Body Fitness
• it is regaining pre-injury fitness
• must involve all principles of training, particularly progressive overload
• Programs should involve all muscle groups and energy systems.
• Adaptions should include:
-Hypertrophy of muscles (increased size)
- increased capillarisation and blood flow
- Strengthening of ligaments and tendons
- Increased elasticity of fibres
- Increased joint mobility
- Absence of pain
- Full confidence in the injury
- Fully restored balance and coordination

Training
• With total body fitness restored, full training can commence
• The athlete will be expected to train fully with no pain
• This involves warm up, conditioning, drills, skills, development exercises, tactics and cool down.

Use of heat and cold
• The application of heat and cold to an injured site is important in the healing process
• Cold is used for the immediate treatment of injury as it prevents swelling due to internal bleeding.
It can be applied by using ice packs, ice contained in plastic and wrapped in a towel or cool water/ice baths and immersion for short periods.
• Cold will also be useful after exercise and training when the injured area has been through a workout
• Heat should not be used in the early stages of injury while bleeding at the injured site is still occurring
• It may help in promoting movement and blood flow and relaxing the muscles through rehabilitation.

Question 27

Why do iron deficiency and lower bone density affect female athletes? (8 marks)

Answer 27

Iron deficiency and bone density can have significant impact on a female’s participation in physical activity. These health issues have a substantial affect on a female’s body function and therefore must be managed in order to minimise the negative impact on sports performance.

Iron is a mineral crucial in the role of transporting oxygen. Without sufficient iron, the number of red blood cells is reduced, limiting the oxygen-carrying capacity of blood thus affecting the degree to which the female athlete is able to participate in sport. A lack of iron commonly occurs amongst women as they consume less red meat and lose iron through menstruation. Iron deficiency can lead to anaemia whereby the level of haemoglobin is less available to the tissue. Iron deficiency can lead to fatigue, loss of energy, decreased aerobic capacity, poor performance, poor recovery and poor concentration levels.
Exercise-induced anaemia is common amongst female athletes as result of training where iron reserves are heavily drained. For example; in the case of a netball player, a lack of iron would result in the athlete feeling tired, drained and fatigued making her unable to pay attention to what is occurring on the court.
This may lead to mis-catching, stepping and overall poor performance. Additionally, the athlete may not be receiving adequate oxygen to resynthesis ATP when working aerobically, which prevents optimum performance. It is clear that a lack of iron can negatively impact an athlete’s sport participation, which
means that it is important that female athletes must be aware of this important mineral. Supplementation is often a measure that is taken.

Bone density refers to the thickness and strength of bones. It is directly related to the quantity of calcium of the bones. For females, this is a major concern that can impact on sporting participation. In some cases overactive parathyroid glands result in calcium discharge from bone tissue to bloodstream, causing brittle bones and osteoporosis. Female athletes with bones low in calcium are more prone to fractures and injuries, have to avoid high contact sport, must be wary of weight baring exercises, and have reduced levels of strength in their bones. They are more susceptible to structural weakening and fractures. For example; a female gymnast may want to have a thinner figure so they cut out red meat or dairy (due to fat content), which leads to a lack of energy and weaker bones. If she was too fall on the bar she would most likely fracture a bone.

In this way, iron deficiency and low bone density are both issues that interrelate and negatively impact a female’s participation in sport. Females should manage these issues by having special diets that have more iron and calcium to ensure that they are receiving these important minerals.