Week 2 Flashcards
Mechanism of injury (MOI)
How an injury happened
Sources of MOI
Trauma
Overuse
Trauma
From an external force on the body
Overuse
Repetitive strain on a tissue
Onset of MOI
Acute/traumatic
Insidious
Acute/traumatic
Sudden onset
Insidious
Gradual and often of unknown origin
Signs
Something you see
Symptoms
Something the athlete feels/describes
Examples of signs
- bruising
- swelling
- heat/cold
- spasm/guarding
- sweating
- shivering
- vomiting
Examples of symptoms
- pain
- tingling
- numbness
- burning
- tight
- pressure
- nausea
Pain
- not every experience is the same
- comes with fear and shock
- imp to reassure
Psychological affects of injuries
- anger
- fear
- denial
- sadness
- catastrophizing
- regret
Things to consider for psychology of injuries and performance
- coping strategies
- support at home
- access to care
- professional support
- team/coach support
How can we help with the psychology of injuries?
- listen
- reassure
- know when to refer
- educate
- coach/player/family/friend support
- mindful and sequential return to play
- keep them part of the team
Types of skin wounds
- lacerations
- abrasions
- punctures
- contusions
- blisters
Laceration
Slice in tissues
Management of lacerations
- Control bleeding
- Clean the wound
- Steri-strips
Step 1: Control the bleeding
- PPE (gloves)
- Pressure
- Elevation
Pressure to control bleeding
- “all gauze sponges” ie. non-sterile loose gauze
- add extra layer of gauze as needed (don’t remove previous layer)
- conforming stretch gauze bandage
Step 2: Clean the wound
- soap and water
- cinder suds (lifts dirt and debris)
Step 3: Steri-strips field coverage considerations
- dry the area around the laceration
- adhesive spray via Q-tip
- rub Q-tip on either side of laceration where steri-strips will be applied
When do we send for stitches?
- only done effectively within 24hrs of injury
- deep wounds affecting more then just skin
- unable to stop the bleeding
- wound is to the face
- wound is across the joint
Minor cuts and abrasions
- superficial layers of skin
- for return to play: non-stick gauze and cover roll
Punctures
- if object is still in, leave it in
- pad around it with gauze rolls
- send for medical attention
Contusions
- bleeding under skin from blunt trauma
Deep contusions
- need proper management to avoid myositis ossificans
- no deep tissue massage
- effleurage or lymph drainage
- ice
- protective padding (donut pad)
How can contusions be supervised in clinic?
- ultrasound (pulsed setting)
- interferential current (IFC)
Blister prevention
- skin lube over areas of friction
Blister treatment
- if broken, clean well
- second-skin
- coverroll/hypafix
When do we seek medical attention?
- unable to control bleeding
- wound is dirty and unable to be cleaned
- deep wound or puncture
- object is still impaled
- changes in sensation
- wound is from human/animal bite
- wound is from rusty object
Cartilage and meniscus healing
- limited capacity to heal
- little or no direct blood supply
Ligament healing
- during repair phase, collagen or connective tissue fibres lay down randomly
- gradually scar is formed
- over following months collagen fibres align in response to joint stress/strain
Skeletal muscle healing
- regeneration of new myofibers is minimal
- healing and repair follows the same process of random collagen alignment and develops tensile strength in response to stress/strain
Healing of nerves
- regeneration can take place very slowly (3-4mm/day)
- peripheral nerves regenerate better than central nervous system
Phases of wound healing
- Hemostasis
- Inflammation
- Repair and regeneration
- Remodelling
Hemostasis
Process leading to cessation of bleeding
What is inflammation?
Essential vascular and cellular response for proper tissue healing
Repair and regeneration- what is formed?
Formulation of granulation tissues
Timeline of stages of wound healing
- Inflammation: 4-6 days
- Proliferation: 4-24 days
- Remodelling: 21 days -2 years
Tissue response to injury (acute)
Acute musculoskeletal injuries fall into 3 phases:
1.Inflammation
2. Repair and regeneration
3. Remodelling
Phase 1: Inflammatory response (acute)
- vasodilation of blood vessels
- white blood cells (neutrophils and macrophages) fight infection, break down and clean up damaged tissue
Signs and symptoms of inflammation
- redness
- swelling
- heat
- pain
- loss of function
Phase 2: Repair and regeneration (acute)
- collagen laid down in disorganized mix
- revascularization bring oxygen and nutrients
- edges of wounds draw closer
Phase 3: Remodelling (acute)
- collagen reorganizes along lines of stress (Wolff’s law)
- tissues increase in tensile strength
Tissue healing phases (table)
- Inflammatory response phase
- Fibroblastic repair phase
- Maturation-remodelling phase
Inflammatory response phase (table)
- pain, swelling, redness
- decreased collagen synthesis
- increased inflammatory cells
Fibroblastic repair phase (table)
- collagen fiber production
- decreased collagen fiber organization
- decreased inflammatory cells
Maturation-remodelling phase (table)
- proper collagen fiber alignment
- increased tissue strength
Bone healing 5 stages
- Hematoma formation
- Cellular proliferation (cells grow and divide)
- Callus formation (soft callus)
- Ossification (hard callus)
- Remodelling
How long does bone healing take?
6-8 weeks
Inflammatory phase aims of treatment
- decrease inflammation
- decrease pain
- decrease swelling
- decrease activity
- protect
- educate
Inflammatory phase time
days 1-5
Demolition phase aims of treatment
- decrease residual swelling
- decrease residual pain
- increase ROM
- increase flexibility
- increase strength
- increase proprioception
- prevent second degree complications
- increase CV fitness
- educate
Demolition phase time
days 3-15
Healing phase aims of treatment
- increase circulation
- decrease pain or muscle spasm
- increase ROM
- increase flexibility
- increase strength
- increase CV (sports specific)
- increase proprioception
Healing phase time
10 days to 8 weeks
Long term goals aims of treatment
- maintain/restore skin and connective tissue
- ensure full ROM, strength of lesion side, restore flexibility, psychological readiness
- optimal biomechanics
- correct training habits/equipment
- maintain/increase proprioception
- protect injury site
- educate
Guidelines for return to play
- full ROM, 80% strength
- able to perform the demands of the sport
- psychological readiness
What tools do student trainers have?
- heat and cold
- massage
- educate
- exercise
- taping and wrapping
- wound care
Heat indications- when do we use it?
- healing phase and beyond
- relaxation
- promote flexibility
Tissue response to heat
- increased circulation
- increased inflammation
- increased metabolism
- increased edema/swelling
- decreased pain
- decreased spasm
Types of heat
- most heat application (hydrocollator packs)
- electric heating pads
- hot tub
- microwaveable bean bag
- infrared sauna
- ultrasound (continuous setting)
Infrared vs traditional saunas
- infrared: heat skin/body
- traditional: heat air around you
Temp of infrared sauna
- 37 degrees C
Temp of traditional sauna
- 60-80 degrees C
Which conditions do saunas benefit?
- high BP
- heart failure
- dementia and alzheimer’s
- headaches
- T2D
- arthritis
- relaxation
- improved circulation
- detox
Contraindications to heat
- inflamed tissues
- bleeding disorders
- blood clots
- impaired sensation
- metal implants
- infection
- open wounds
- additional contras for whole body ie. sauns, hot tub
Additional contraindications for whole body
- pregnancy or trying to conceive
- multiple sclerosis due to heat intolerance
- illness
Tissue response to cold (cryotherapy)
- decreased inflammatory response
- decreased edema/swelling
- decreased pain
- decreased circulation
- decreased hematoma formation
- decreased muscle spasm
- decreased tissue metabolism
- decreased enzymatic activity
- decreased extensibility
Cryotherapy types
- crushed ice or ice cubes
- gel packs or frozen peas
- frozen beanbag
- ice cup massage
- cold immersion
- hyperbaric gaseous cryotherapy (neurocryostimulation)
- cryochamber
Cryotherapy consideration: Ice bag
- flatten ice and remove air pockets by sucking air out of bag
- apply a barrier btwn ice and skin
- time: 15-20 min
Cryotherapy consideration: frozen beanbag
- already has soft covering
- time: 10-15 min
Cryotherapy consideration: ice cup massage
- fill styrofoam cup 1/2 way and freeze it
- apply to skin in circular continuous motion
- time: 5-10 min
Cryotherapy consideration: cold immersion
- 10 degrees for CBAN (cold, burning, achy, numb)
Cryotherapy consideration: Neurocryostimulation
- sprays micro crystals of liquid CO2 at -78 degrees C
Cryotherapy consideration: cryochamber types
- Electric (cools the air)
- Liquid nitrogen
Cryotherapy consideration: electric cryochamber
- temps as low as -160 degrees C for at least 3 min and until skin gets to desired temp
- settings: 7, 9, 11 degrees
Cryotherapy consideration: liquid nitrogen cryochamber
- temp as low as -130 degrees
- timing 2-4 min
Contraindications of electric cryochamber
- pregnancy
- high BP
- blood clots
- heart conditions
- infection
Contraindications to cold
- raynaud’s phenomenon
- urticaria (hives/rash)
- clotting disorders
- over superficial nerves
- altered skin sensation
- complex regional pain syndrome
Raynaud’s phenomenon
- caused by decreased blood flow to fingers/toes due to vasospasm
Indications for massage- when to use it
- tight muscles
- injured muscles
How does massage help tight muscles?
- increase extensibility
- decrease pain
What type of massage should be used for an injured muscle in the inflammatory phase?
- effleurage/lymph drainage only
- decrease pain and swelling
What type of massage should be used for an injured muscle in the healing phase?
- deeper forms
- increase circulation
Massage protocols
- educate on why you’re massaging
- clear contraindications
- always obtain consent
- expose the are to be treated
- be professional
Contraindications to massage therapy
- acute inflammation (except for lymph drainage)
- contusions (lymph drainage only)
- acute spasm around another injury
- over open wounds or skin reactions
- altered sensation
- possible blood clot
- bleeding disorders
- over varicose veins
- deep vein thrombosis
- some medical conditions
Medical conditions that are contraindications to massage therapy
- cancer
- diabetes
Four main principles of massage therapy
- General - specific - general
- Superficial - deep - superficial
- Proximal - distal - proximal
- Peripheral - central - peripheral
What should you always do when applying any modality or form of treatment?
- clear contraindications
- expose the area to be treated
- ask permission
Open terminus lymphatic drainage massage
- in hollow above clavicles
- gentle pumping C motions
Pre-event massage
- indications: general tissue warm up
- short duration, energetic (not relaxation)
- local & general (not whole body)
Pre-event massage techniques
- petrissage
- shaking/rocking
- vibration
Petrissage
- spreading the muscle belly perpendicular to muscle fibres
- avoid stripping the muscle mass and ends of tendons
Shaking/Rocking
- pre event: faster, shorter
- post event: slower, longer
Vibration
- engage tissue, hand-over-hand, vibrate
Sterile gauze
Used once wound has been cleaned or to help clean the wound
Non-stick gauze
Used to dress the wound for long term application (doesnt stick to wound as it dries)
Hypafix/coverroll
Used to secure the non-stick gauze
When to ice vs heat
- ice: inflammatory phase
- heat: healing phase
