Week 1 [not including lab] Flashcards
Three components of evidence-based medicine
Best evidence, clinical expertise, patient values and preferences
3 components of injury prevention
- Protection that reduces forces: protective equipment, technique development, balanced opponents (ex: weight classes), preventative taping, facilities, rules and enforcement
- Strength of body parts: when, what - strength vs endurance, how
- Screening of participants: Why? - determine if fit, establish athlete’s health; Team medicals? Who, what, when
What are forms of sport preparation?
- general conditioning
- specific training
- protective measures
Why is sport preparation important?
- to decrease incidence of injuries and decrease severity of injuries
describe 4 subcategories of general conditioning
- endurance
- strength
- power
- flexibility
describe the equation for cardiac output
cardiac output = heart rate x stroke volume
fill in the blank: your fitness is proportional to your __________
resting heart rate over 1 min
How should you build your endurance?
20-60min exercise, HR > 150 bpm at least 3 times per week
Define: PRE
progressive resistance exercises
What are 2 examples of protective measures for sport preparation?
- equipment: absorbs energy, disperses energy, deflects a blow, limits excess movement
- nutrition: role of nutrients: growth repair and maintenance of all tissues, regulate body processes, provide energy
Describe the % of caloric intake that the following should make up:
- proteins
- carbohydrates
- fats
- Proteins (20-25% of caloric intake)
- Carbohydrates (55-60% of caloric intake)
- Fats (15-20% of caloric intake)
What happens to extra proteins that are consumed?
- burned as energy or stored as fat
what is the most efficiently broken down and metabolized form of energy for the body?
- carbohydrates
Where are carbohydrates stored and in what form?
- liver and muscles
- glycogen
Fill in the blank: the average 150lb athletes carries _______ calories in the form of carbs
1500 - 2000
What is the primary fuel for light to moderate intensity exercise?
fats
Why are more efficient athletes more likely to burn fats than carbohydrates?
they can maintain the same effort level but at a lower intensity
Fill in the blank: the average 150lb athlete carries up to _____ in fat
80 000 calories
Fill in the blank: Fat to carb utilization switch typically occurs at ____ VO2 max but in athletes can happen at _____ VO2 max (marathon runners, endurance athletes)
- 65%
- 70-80%
What is the role of vitamins for sport training?
- Not metabolized for energy but play key role in metabolism of carbs and fats for energy during exercise
- Involved in the repair and building of muscle protein in response to training
fat soluble vitamins vs water soluble vitamins
- fat soluble vitamins (ADEK): can be stored in body fat and have an increased risk of toxicity
- Water soluble vitamins (BC): excess is excreted in urine, needs to be replenished
What is the role of minerals for sport training?
- electrolytes for proper hydration
- calcium for strong bones
Define: major minerals
100mg+/day (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfur)
Define: trace minerals
<20mg/day (iron, zinc, iodine, copper, manganese, fluoride, selenium, chromium, molybdenum)
Define: anemia
iron deficiency
4 roles of water for exercise
digestion, temperature control, eliminating waste products, prevents dehydration
Sodium ingestion during exercise helps with what?
maintaining or restoring plasma volume during exercise and recovery
- example: Sports drinks help retain water in the body and aid in hydration by increasing the absorption of fluid from intestines → muscles
Why should you be careful in your choice with sports drinks?
Too much sugar slows the absorption of water (careful of sports drinks with sugar)
How is fluid lost?
through skin (sweat), lungs, urination
Dehydration can lead to decreased blood volume. Why can this be problematic?
- Stroke volume decreases
- Exercising muscles receive not enough oxygen
- By-products of exercise are not flushed out as regularly as they should be
- Exhaustion sets in and performance suffers
- Losing as little as 2% of total body weight in water can negatively affect athletic performance
Define: hyponatremia
too much water
Dehydration
- early signs
- late symptoms
- fill in the blank: waterloss of _____ of body weight may = death
- early: thirst, tiredness/weakness, headache, loss of appetite, dry mouth. dark urine, muscle cramps
- late: nausea, hot to touch, dizziness, lack of coordination, confusion, fainting
- > 10-20%
Define: cramping
excessive sweating with sodium/mineral loss, muscle twitching and cramps
Define: heat exhaustion
prolonged period of fluid loss via activity in high temperatures
Define: heat stroke
failure of thermoregulatory system
- Sudden collapse, loss of consciousness, flushed hot skin, shallow breathing, rapid pulse, core temp of 106 degc or higher
Heat disorder prevention
- Fluid and electrolyte replacement
- Gradual acclimatization (1 week: 80% acclimatization, 2 weeks = 100%)
- Monitor temperature humidity
- Identify susceptible individuals
- Weight records
- Uniforms
What is the guiding principle of medicine?
Primum non nocere
- first do no harm
emergency care: ABCD
Airway, breathing, circulation, disability
What are some general points on emergency care? (5)
- Keep head and neck stable
- Keep warm
- NPO: nil per os (nothing by mouth)
- Get help
- Serial repetition of ABCD’s record status
What is the most common cause of asphyxiation of an unconscious patient?
obstruction of the oropharynx by the tongue
Define: shock
state of insufficient blood flow to the tissues of the body as a result of problems with the circulatory system. Common problems are low blood volume, reduced bp, excessive dilation of blood vessels, low heart rate
Signs and symptoms of shock
- Decreased B.P.; weak pulse
- Hypoxia
- Reflexive H.R. increase (tachycardia)
- Cool and clammy skin (warm and dry if its septic shock)
- Anxiety, thirst, impaired consciousness
Treatment of shock
- N.P.O
- ABCD
- Maintain body temp, elevate the legs
- Transport to medical centre ASAP
Describe these common medical abbreviations:
- SSx
- Hx
- PHx
- Ax
- Dx
- DDx
- Tx
- signs and symptoms
- history of current injury
- past history
- assessment
- diagnosis
- differential diagnosis
- treatment
Types of joints (6)
Hinge: ankle Saddle: carpometacarpal joint Facet: spine Pivot: vertebrae of the neck Gliding: tarsal bones of the foot Ball and socket: shoulder
Explain the difference between a open vs closed fracture
open: compound
closed: simple
Explain the difference between acute vs stress fractures
- traumatic fractures (also called acute fractures) are caused by a direct blow or impact
- Stress fractures are tiny cracks in a bone. They’re caused by repetitive force, often from overuse
Response of bone and joints to stress depends on what? (4)
- Structure (strength and stiffness)
- Load (magnitude, duration, direction, repetition)
- Support (muscle activation, equipment)
- Past history
Stress response of tissue depends on what? (4)
- Load: external and internal forces acting on body
- Mechanical stress: tissue response to forces
- Viscoelastic properties: amount of resistance to stress
- Yield point: elasticity of tissue can no longer hold back stress = mechanical failure (strain or sprain)
Define: collagen
strong structural protein with little elasticity
- Stress is linear in relation to elongation
Define: elastin
elastic structural protein
- Stress takes longer than collagen to increase in relation to elongation
Define: strain
stretching and tearing of contractile tissue
Define: sprain
stretching and tearing of non-contractile tissue
Phases of soft tissue injury repair
- Acute inflammatory phase (0-72 hours)
- Proliferation/repair phase (2 days - 6 weeks)
- Remodeling/ maturation phase (4 weeks - 6 months, longer?)
Define: inflammation
protective tissue reaction
When is an inflammation considered clinical?
if it causes pain or disability
Define: rubour inflammation
redness caused by increased blood flow
Define: calor inflammation
heat caused by increased blood flow
Define: tumour inflammation
swelling caused by fluid accumulation
Define: dolor inflammation
pain caused by local tissue pressure
Define: functio laesa inflammation
loss of function due to swelling and tenderness
How long does acute inflammation last for?
0-72 hours
What are the 2 components of acute inflammation?
- vascular events and cellular events
Fill in the blank: acute inflammation events are mediated by _______ derived from plasma proteins or cells (_______) and are produced in response to or activated by stimuli
- chemical mediators
- cytokines
Describe the vascular events that occur during inflammation (5)
- VSCVI
- Vasoconstriction: blood vessels constrict for a brief period
- Stasis: increased blood viscosity
- Coagulation cascade
(Thromboplastin → prothrombin → thrombin → fibrinogen → insulin fibrin clot) - Vasodilation quickly follows (increased blood flow and increased vascular permeability)
- Increased vascular permeability; hallmark of acute inflammation (protein and fluid leakage from artery)
Describe the cellular events that occur during inflammation (4; MRAM)
- Margination: blood vessel dilation; slows blood where vessel has dilated; allows white blood cells to migrate closer to edge of blood vessel
- Rolling: blood cells start to roll as they get closer to edge of blood vessel and pick up endothelial receptors with their own receptors
- Adhesion: blood cells stick to endothelial cell wall
- Migration (diapedesis/extravasation) → chemotaxis: endothelial cell walls expand which allows leukocytes to squeeze through; Chemotaxis: Leukocytes follow chemical signals being released by foreign agents or damaged cells (injury) to site of injury
What are the benefits to inflammation?
supplies things to injury site:
- clotting factors
- anti-infection material and processes (leukocytes, phagocytes (macrophages), antibodies, stick microorganisms to phagocytes, attack foreign cells (put holes in their membranes)
- nutrients (O2, amino acids, glucose, etc.)
Stimulates proliferation of endothelial cells (neovascularization) and fibroblasts (cells that synthesize collagen and extracellular matrix)
cons of inflammation
Excessive or chronic inflammation may lead to tissue destruction, fibrosis, and necrosis (death)
edema: swelling caused by extra fluid trapped in body’s tissue
- Restricts blood flow if no room for swelling
- Produce pain, which can limit movement
Describe the difference between onset, duration, and outcomes for acute and chronic inflammation
acute:
- onset: immediate
- duration: few days
- outcomes: resolution, abscess formation (pus), chronic inflammation
chronic:
- onset: delayed
- duration: up to many months/ years
- outcomes: tissue destruction, fibrosis, necrosis
Explain 3 methods of treatment to inflammation
- Remove underlying cause
- Treat local effects
- Treat systemic effects
What are some ways to remove the underlying causes of inflammation
- incise and drain abscess
- Antibiotics
- Remove foregin body
- Remove mechanical stress
What are some ways to treat local effects of inflammation
- P.O.L.I.C. E. then heat
(Protect, optimal loading, ice, compression, elevation) - N.S.A.I.D. (nonsteroidal anti-inflammatory medications)
- Physiotherapy, chiropractic, RMT, acupuncture, naturopath
What are some ways to treat systemic effects of inflammation
- Antipyretics: medication to fight fever (ASA, acetaminophen)
- Analgesics: pain medication (NSAID, narcotics)
- Antibiotics: fights bacterial infection
Itis? Myositis Arthritis Tendonitis Bursitis Vasculitis Dermatitis
itis = inflammation
Myositis: inflammation of the muscles that you use to move your body
Arthritis: joint inflammation
Tendonitis (proper term: tendinopathy, in most cases it is tendinosis): inflammation of a tendon
Bursitis: bursa inflammation
Vasculitis: blood vessel inflammation
Dermatitis: skin inflammation causing redness and itchyness
Describe the proliferation/ repair phase
- Characterized by proliferation of capillaries (neovascularization) and fibroblasts which synthesize granulation tissue aka scar tissue (a collagen and extracellular matrix with cross-linking)
- As the quantity of collagen at the injury site increases, the number of fibroblasts decrease
- Mobilization or stress applied to the healing tissue decreases the number of cross-links and increases the strength of the tissue
- However, early mobilization may negatively impact the healing process by prematurely reducing the number of cross links
- several months to years
Describe early scar tissue structure
- More type 3, less type 1
- Weak (H-bonds, rather than covalent bonds, between collagen fibres) and susceptible to re-injury
- Poorly vascularized
- Disorganized
Describe the maturation phase after a sprain
- aka remodelling phase
- occurs 1-2 weeks post injury up to a year+
- Long term process that involves realignment and maturation of collagen fibres that make up scar tissue
- Myofibroblasts re-orient collagen fibrils in the direction of loading; increased stress and strain causes collagen fibres to realign to position of maximum efficiency. Parallel to lines of tension; Gradually assumes more normal appearance and function
- Lasts 10-12 months, total maturation phase may take years to be fully complete
How does movement help the maturation phase? (3)
- increases synthesis
- increases lysis
- reorganizes (decreases in weaker type 3 collagen and an increase in stronger type 1 collagen)
What are the benefits of icing after exercise
- Vasoconstriction (hunting response)
- Decreased bleeding into injured tissue
- Decrease in inflammatory response
- Decreased swelling
- Decreased pain - decreases excitability of free nerve endings (nociceptors)
- Decreased muscle spasms
- Decreased cellular damage - decreased secondary tissue hypoxia
- Decrease or delay of cell death
Implications of cold on performance
- Decreased pain sensation
- Golgi tendon organ less sensitive (numb pain)
- Muscle spindles less sensitive
- Increase stiffness at myotendinous junction
- Muscle more susceptible to fatigue if cooled below 25degC
What are the benefits of heat after exercise
- Vasodilation: increased blood flow
- Increase in inflammatory response
- Increased swelling
- Decreased pain
- Decreased muscle spasm
- Decreased stiffness of soft tissues
- Increase metabolism within cells that are warmed
Fill in the blank: Critical temperature threshold for beneficial effects of heat is ____; Can be achieved through 15 minutes of ________
- 39degC
- general exercise (dynamic warm up)
Describe gross vs fine motor skills
Gross motor skills pertain to skills involving large muscle movements, such as walking, or running. Fine motor skills involve use of smaller muscles, such as grasping, object manipulation, or writing
Describe open vs closed motor skills
Closed: static environment (running on a treadmill in your home gym)
open: dynamic environment (running a race outdoors alongside many other runners)
