week 1,2 & 3 Flashcards
Anatomy, Risk assessement and concussion
How are veins and arteries commonly named?
using underlying bones and nearby structures
Whats the largest artery
Aorta
What is the largest vein?
Vena cava
What is the thickness of artery walls?
2.5cm
Where does the aorta supply blood to and from?
Out of the heart and to the body
Where is the carotid artery?
Neck
Where does the carotid artery supply blood to?
Brain and iliac
Where is the jugular?
Neck
Where does the jugular supply blood to and from?
From brain to the hepatic, femoral and renal
Whats the rate of recovery with poor blood supply?
Slow, blood cannot reach the site of the injury and so repair is slower
How can nerves be damaged?
Stretched like soft tissue, compression and impingement
What is the nerve that innervates the upper limb?
Brachial plexus
What key nerve is in the forearm?
Medial nerve
What nerve runs past the funny bone (humerious) ?
Ulnar nerve
What connects bone to bone?
Ligaments
What connects bone to muscle?
Tendon
What are ligaments made of?
Collagen and elastin
What are the roles of ligaments?
Stabilization, proprioception, attaching articulating bones, guide joint movement
What is the function of tendons?
To transfer force
What are tendons made of?
Collagen fibers and proteoglycans
Why are tendons made of collagen?
Collagen has high tensile strength, making very strong in the direction of the fibers
What are the orientation of fibres in tendons and ligaments?
Parallel, oblique or spiral
How do the ACL and PCL move when knee flexion occurs?
Unwind from spiral and straighten, stretching the spiral, allowing for internal stabilization
What are the 4 ligaments of the knee?
ACL - anterior cruciate
PCL - posterior cruciate
MCL - medial collateral
LCL - lateral collateral
What are the 3 positions where ligaments can be present?
Intra-articular, capsular and extracapsular
What is an intra-articular ligament (example)?
Ligament found within the joint, ACL/PCL
What is a capsular ligament (example)?
Thickening of the joint capsule, anterior talofibular
What is an extracapsular ligament (example)?
Ligaments found outside of the joint capsule, calcaneofibular
Which ligament types have the greatest blood supply?
Capsular ligaments - fastest healing time
Which ligaments have the worst blood supply?
Intra-articular ligaments - slowest healing
What is a key issue with ligament injuries?
Reduction in proprioceptive function and therefore there is increased mechanical instability, feeling of joint buckling and recurrent injuries
How much does training increase the strength of the ligament?
10-20%
Whats the effect of immobalisation?
Dramatic reduction in the strength of the joint, even if only for a few weeks
What allows the stretch of ligaments?
Elastin
When does initial deformation occur?
104%
When does complete rupture occur?
108%
How is collagen affected at 104% stretch?
Increased load switches the fibers from elastic to plastic, causes a degree of permanent damage
What is the solution to complete rupture?
Surgery
What are the 3 grades of injury?
Minor, partial and complete and relate to sprain, strains and dislocations
Where are the 3 points sprains can occur?
Mid-substance, insertion and avulsion
What are the 2 key ligaments involved in inversion ankle sprain?
Calcaneofibular and anterior talofibular
What are tendons made and their organisation?
80-90% collagen, fibers arranged in the direction of the force
What are the function of sheaths on tendons?
To prevent rubbing on the skeleton, can cause inflammation of the tendons
What is inflammation of the tendon called?
Tendonitis
What is inflammation of the sheath called?
Synovitis
How does strength training effect tendon size?
Strength and the size of the tendon increase proportionally to the size of the muscle unless steroids used
Difference between ligament and tendons?
Strength greater in tendons but less elastin
What strength can the Achilles withstand?
2.5 times body weight and 9 times when landing
How can tendon strength be measured?
Tendon transducers
Whats epidemiology?
Study of determinants, occurrence and disturbance of health and disease in a defined population
What are the 6 stages of TRIPP?
- Survey for injuries
- Establish etiology and mechanism
- Develop the preventative measure
- Evaluate the science in ideal conditions
- Describe implementation context to inform implementation strategy
- Evaluate effectiveness of preventative measure in real world context
What does TRIPP stand for?
Translating Research into Injury Prevention Practice
What did the 1995 postal survey show regarding participation?
Ageing decreases participation especially in females, highest participation in football, swimming/diving, dancing and running
When the postal survey was repeated 10 years later what changed?
Cycling increased following the Olympics, gym activities increased with increase in physical activity but reduction in sport
What sport is considered the riskiest?
Rugby with 95 per 1000
What is the cuases of recurrent injuries?
Biomechanics, internal factors, strength and fatigue
Why are overuse injuries common in football?
Players tend to come back from injuries too quickly with insufficient rehabilitation
Why is standardisation important?
The participation rates of football are greater than the participation is rugby, as a result greater injuries will appear to occur in football than rugby, prevents the discrepency of results
What is the usually standardization value for injury?
1000
What is an extrinsic injury (example)?
Caused by an external object such as a ball or projectile
What is an intrinsic injury (example)?
Sprains and strains that are likely to be recurrent
What is the problem with postal surveys?
Low return rate, small sample size isn’t representative of the population, homogeneous sample of those who have had an injury, retrospective view - difficult to remember, discrepancy in injury definition
How can injury reporting affect epidemiology?
Variable nature of reporting injuries, people report severity differently and the categorization can be unrealistic of the true injury
What are the strengths of injury surveys?
High intra-rater reliability, adjusted for exposure, training injuries included, training and competition time lost documented, prospective studies use set injury coding, definitions of severity, professional vs amateur, improved generalisability
What are the weaknesses with injury surveys?
Retrospective may lead to bias, multiple injury recorders lowere inter-rater reliability, part season analysed, single team analysed, risk hours of training/playing not accounted for, other studies use different methodology
Whats the ideal design for epidemiology study?
Injured and non-injured, several teams, prospective collection, one recorder, uniformity of definitions, definitions of severity, exposure hours and incidence in competition and training accounted for, acknowledge existing filters
How do you prevent injury?
Warm-up, stretch, correct coaching, safe technique, cool down, professional rehab, fitness and stabilization
What is epidemiology used for?
Identify where and when to focus on the prevention particularly for intrinsic and recurrent injuries
What are internal risk factors?
Physical defects, past injury, physical fitness/endurance, strength, speed, skill, co-ordination, flexibility/stability, physical build, psych factors, age and gender
What are external risk factors?
Sport related, venue, equipment, weather and trainer
How does venue affect risk?
Surface and footwear that is appropriate to the surface, lighting can reduce sight (projectiles), Perimeter fences and protective equipment
How does equipment affect risk?
Sticks and rackets cause injury, appropriate protective equipment, correct shoes and clothing
How does weather affect risk?
Temperature, relative humidity, wind (flight change of projectiles), clothing and hydration for the environment
How does the trainer affect risks?
Rules to protects from danger, referee applying the rules in the situation
Why are children at greater risk of injury?
Growth plates have not fully developed, less resistant to torsional and shear stress
Whats the effect of growth with high load on children?
Cause permanent damage of the growth plate and stunt growth, plasticity bends bones irreversibly
Whys supervision of children important?
Ensures proper techniques, prevent musculoskeletal damage, no overloading, training load lower (slower recovery rate)
How can protective equipment change injury profiling (boxing example)?
Use of headgear means that more punches are thrown with than without, making more entertaining and risk of head injury is reduced
How can gender increase injury risk?
Women have smaller anatomical structures, wider Q angle adds greater force to the outside of the knee
What are key training errors?
Persistent high intensity training, sudden increase in mileage/intensity, repetitive hill running, inadequate warm up single high intensity session
How can stretching affect injury risk?
Holding stretch allows for a greater muscle stretch, holding for 30-60s as part of 5 min warm up, trains the nerve loop as well as the muscle
How can rules prevent injury risk?
By enforcing rules effectively, risk is reduced as the individuals physical and mental capacity is not questioned
How are officials responsible for reducing risk?
Need to uphold the rules and therefore safety, overlooking fouls can cause injury
What is the most common body part to get an injury?
Leg
Where do groin injuries usually occur?
Adductor longus near the pubic insertion
What sports are groin injuries common?
Football, sprinting and riding
What is a cause of groin tear?
Explosive movement that causes an overstretch, constant repetitions causing calcification
How is groin strength tested?
HAGOS (hip and groin pain score)
Why are adolescent groins more susceptible injury?
They are more delicate and experience more stretch if the muscle hasn’t grown as much as it needs to
What is trochanteric bursitis?
Overuse injury of one leg, repetitive changes of movement with rotation and abduction
What are some common causes of trochanteric bursitis?
Genetic, unequal leg length, running on a slant repeatedly,
What is used produced to reduce rubbing at the greater trecanta?
Bursae fluid
How much blood does the femur hold?
2 pints of blood (18% of body)
What damage is caused by dislocation?
Blood vessels, nerves and ligament
Where are common tears in the upper leg?
Illiopsoas, sartorius and rectus femoris (rare - from patella injury)
What is the first sign of a hamstring tear?
Pulling up in the first 3 seconds and instant pain
What is patella tendonitis?
Pain below the patella from repeated activities, slow recovery because of poor blood supply`
How can eccentric training be used in patella tendonitis recovery?
12 week programme, 25 degree of 3*15 reps and 90 degree flexion for the other leg to do a concentric rise
What are symptoms of a knee ligament injury?
Pain, unable to weight bear, haematoma, swelling, tenderness and instability (buckling)
What is the cause of an ACL injury?
Twisting motion with a force (by direct blow or indirect contact)
Whats the function of medial meniscus?
Internal rotation and partial knee flexion
Whats the function of lateral meniscus?
External rotation and partial knee flexion
What are some of the risk factors for knee ligament tears?
Neuromuscular dominance, hamstrign weakness (related to quad), previous injury
What are the key mechanisms that cause ACL injury?
Load bearing, partial flexion, internal rotation, medial/lateral imbalance of weight
How can epidemiology aid knee injuries in football?
Identifies that knee loading is not the problem but valgus and valrus and rotation, unanticipated, greater load on testing
How can aetiology aid knee injuries in football?
Does different training influence knee loading, co-contraction ratios, decreasing knee valgus/varus load
How can prevention strategies aid knee injuries in football?
Reduction in the lateral placement of the foot, reduction in trunk flexion
How can evaluation/education aid knee injuries in football?
Assess over a season, assess influence of surface, compare side stepping kinematics, compare lab with field
What is chondromalacia patella?
Runners knee, degeneration of cartilage of the posterior side of the patella
What causes shin splints?
Pronation and eversion with thickening of the tibeal periosteum at the soleus fixation
What percentage of injuries does an ankle inversion sprain account for?
84%
What are the risk factors for ankle injury?
Shoe design, tackles, surface, previous injury
What ligament is the most common in ankle injury?
Anterior talofibular
What is the treatment for a complete rupture of the achillies?
Surgery and plaster/fixed angle boot
How do you prevent an Achilles rupture?
Good warm up, surface and shoe considerations, prompt treatment of pain (prevent overuse), eccentric loading
What is classified as a head injury?
Any injury sustained to the head, brain injures, cuts, bruises and breaks
What do the shades in an MRI?
Lighter areas are where there is a lot of blood, darker less blood blood activity
What is the definition of a concussion?
A complex pathophysiological process affecting the brain induced by bio-mechanical forces
What are some of the effects of traumatic brain injuries?
Skull fractures, altered consciousness, impaired cognitive function, seizures, vegetative state
Which sport has the most common concussion occurrence (values)?
Cyclists absolute, female ice hockey relative (0.91 per 1000), elderly with high slips, trips and falls
What is the cause of a concussion?
Impacts to the head caused by linear or angular acceleration of the brain
How does point of impact affect concussion?
Closer the impact vector to the heads center of gravity, lesser the rotational acceleration (head pivots on the neck)
Whats the effect of linear acceleration on the brain?
Causes pressure waves/gradients in brain cause neuronal disruption
Whats the effect of rotational acceleration on the brain?
Causes large sheering forces at brain center
Why do brain deformation occur?
Shear forces suddenly applied to the base of the skull, bone provinces in the base of the skill put pressure on the brain
What are risk factors of a concussion?
Females (different axons, longer recovery), age (youths, symptom assessment response), genetic
What are the symptoms of a concussion?
Loss of consciousness, headaches, seizure, dizziness, confusion, loss of concentration, drowsiness, blurred vision
What is used in sport to assess concussion?
SCAT - Sports concussion assessment tool, checklist to test memory and orientation
What is post concussion syndrome?
Lingering symptoms after initial impact because of low level structural damage - more common in women
What is second impact syndrome?
Diffusion of cerebral swelling leads to a loss of autoregualtion and increased blood pressure, causes herniation of the brain stem
What are prevention strategies for concussion?
Rule changes (body checking ice hockey, -67%), protective equipment (cycling 70%, mouth guards, jugular)
What is CTE?
Chronic Traumatic Encephalopathy, repeated head impacts, greater exposure hours and impacts
What is dementia pugilistica?
Dementia specifically related to repeated head impacts, common in American football/sub-concussions
What are sub-concussions?
Impacts that don’t result in diagnosabel symptoms of concussion
How are sub-concussions measured?
Neurophysiological, biomechanical and neuroimaging
What fraction of eye injuries lead to blindness?
1/3
What percentage of penetrating eye injuries does sport account for?
13%
What percentage of eye injuries is preventable with eye protection?
90%
What are the 6 key parts of the eye?
Iris, pupil, cornea, lens, retina and optic nerve
What are closed globe injuries?
Most common non-penetration injury, caused by blunt trauma, bruising and abrasions to superficial layers of the eye
What are open globe injuries?
Very rate, full thickness injury to the cornea, from sharp objects or high velocity blunt trauma, uveal tissue prolapsing out of corneal wound
What are ocular injurues?
Burns or radiation injuries from high UVA and UVB and no suncream, snowsports most common
