injury prevention and rehabilitation

What is an acute injury ?

A sudden injury associated with a traumatic event

Impact

Fall

What is a chronic injury ?

A slowly developed injury associated with over use

What are acute hard tissue injuries ?

Fractures

Dislocation

What is a fracture ?

Partial or complete break in the bone due to an excessive force that overcomes the ability to flex

What are signs of a fracture ?

Pain

Inability to move

Swelling

Discolouration

What is a compound fracture ?

Open fracture, when the bone breaks through the skin

What is a simple fracture ?

Closed fracture, doesn’t Pearce the skin = limits damage to surrounding tissue

What is a transverse fracture ?

Crack perpendicular

What is an oblique fracture ?

Crack diagonal

What is a spiral fracture ?

Twist of the bone

What is a comminuted fracture ?

Crack that fragment

What is an avulsion fracture ?

Bone fragment detaches from point of soft tissue insertion ?

What is an impact fracture ?

Compress at each end

What is a fissure fracture ?

Surface hair line crack

What is a greenstick fracture ?

Splintering of the bone surface from bending

What is a dislocation ?

Bone displaced away from original position

What are the signs of dislocation ?

Pain

Add shape

What is a cause of a dislocation ?

Impact (direct)

Fall (indirect)

What is subluxation ?

Partial or incomplete dislocation

Usually damage to ligament

What are acute soft tissue injures ?

Contusion

Haemotoma

Sprain

Strain

Abrasions

Blisters

Concussion

What is a contusion ?

Also know as a bruise

Rupture of the blood vessel

What is a haematoma ?

Blood clot is the tissue or muscle

What is a sprain ?

Damage to ligament which hold joint together

How does a sprain occur ?

Over stretching

Twisting

Impact fall

What is a strain ?

Damage due to over stretch or tear of muscle fibres or tendon

What causes strain ?

Over stretching

Contacting muscles to fast

What is an abrasion ?

Damage to surface of the skin caused by scraping

What is a blister ?

Pocket of fluid collects between layers of skin

What is a concussion ?

TBI that results in a disturbance of brain function

What causes a concussion ?

Director blow to the head

Whiplash effect

What are clear indication of a concussion ?

Balance issues

Sickness (immediate)

Loss of consciousness

Siezers

Memory loss / confusion

What may indicate indicate a concussion ?

Bleeding

Dizziness

Nausea

Vision blurred

Fatigue

What are chronic hard tissue injuries ?

Stress fracture

Osteoarthritis

What is a stress fracture ?

Tiny crack in the surface of a bone

Caused by indue stress

What is stress fractures most common in ?

Distance runner

Basketball

Gymnast

What is osteoarthritis ?

Joint disease caused by breakdown of articular on bone surface

Causes sharp spikes = bone spurs

What are signs of osteoarthritis ?

Joint swells up

Bone thickens underneath

What are chronic soft tissue injuries ?

Shin splint

Tendonosis

What are shin splits ?

Chronic shin pains

Medial tibial stress syndrome (MTSS)

Common in runners

What causes shin splits ?

Repeated overuse in tibias anterior and posterior

What is tendonsois ?

Chronic tendinitis, deterioration of collagen in tendons

What are symptoms of tendonosis ?

Burning

Stinging

Aching

What are intrinsic injury risk factors ?

Risk or force that comes from with in the body

Individual variables

Training effect

What are individual variables ?

Posture and alignment - different leg length, biomechanics altered

Previous injury - come back form soft tissue injury to soon

Age - older increase injury risk

Nutrition - difficenies increase risk

What are training effects ?

Poor prep - sleep, hydration, warm up correct

Inadequate fitness - early fatigue = poor technique, decisions, over loading

Inappropriate flexability - hypermobility, poor stability, lack ROM

What are extrinsic risk factors ?

Risk / force that comes from outside the body

Poor technique

In correct equipment

Inappropriate overload

What is poor technique ?

Poor biomechanics = over use injury

Competitive level appropriate

What is incorrect equipment ?

Protective equipment = gum shield

Must be age size specific

What is inappropriate overload ?

Repetitive strain

Intensity / duration to high - injury

What is an effective warm up ?

Lasts 20-45 mins

Gradual build in intensity

Stage 1 - pulse raiser

Stage 2 - dynamic stretching

Stage 3 - skill rehearsal

What are the physiological benefit of a warm up ?

Lower injury risk and raise performance

Increase enzyme activity, diffusion gradient and metabolic activity

Improve muscle contraction

Increase elasticity of muscle

What does research suggest about static stretching ?

Has no effect on injury prevention

Reduces peak force production in tendons

Reduces eccentric strength and agility

Reduces muscle oxygen consumption

Reduces antagonist co-ordination, hampers explosive moves

What a a good cool down?

Lasts 20-30 minutes

Gradual decrease intensity

Stage 1 - moderate intensity

Stage 2 - stretching

Cool down effect on DOMs and active recovery ?

Some effect on DOMs but little evidence proves it

Fatigue and ankle injuries in netball ?

80% of netball injuries are ankles (42% sprains)

Fatigue is biggest risk factor when fatigued neuromuscular preparation decreases which limits landing effectiveness

What is the first S in saltaps ?

Stop the game

Prevents further injury

What is the first A in saltaps ?

Ask

Gain information about the injury

What is the L in SALTAPS ?

Look

Is there any visable sign of injury

What is the T in SALTAPS ?

Touch

Feel for swelling or discomfort

What is the A in SALTAPS ?

Active movement

Can the person move the injury

What is the P in SALTAPS ?

Passive movement

Can the aider move the injury through ROM

What is S in SALTAPS ?

Stability / strength

Weight bear / withhold resistance

What is the P in PRICE ?

Protect

Prevent further harm

What is R in PRICE ?

Rest

Remove game, take weight off

What is the I in PRICE ?

Ice

Cold compress

What is C in PRICE ?

Compress

Bandage / sling

What is E in PRICE ?

Elevate

Above heart to reduce swelling encourage venous return

What are the effect of PRICE on ligament sprain ?

Have limited blood supply so ice less effective than pain free movement

What are the 6 R’s in concussion recognision ?

Recognise - signs and symptoms

Remove - take away from game immediately

Refer - get checked by medical professional

Rest - at least 24hrs rest, until symptom free

Recover - follow GRTP : U18 - 2 weeks 018 - 1 weeks

Return - 1 week build up to full return

What is GRTP ?

Gradual return to play

2 days light exercise

2 days sport specific drills

2 days full contact

Full return to play

What is rehabilitation ?

Restoring full physical function after an injury has occurred

It aims to restore, strength, flexability, endurance, speed

What are the 3 stages of rehab ?

Early : gentle exercise to encourage tissue to heal

Mid : progressive loading of connective tissue and bone to develop strength

Late : functional exercise and drills to ensure preparation for proper performance

What’s is the acute phase of stretching ?

With in 3 days, no stretching should occur

Price and complete rest advised

Stretching makes it worse

What is the mid phase of stretching ?

After 3 days, inflammation, swelling bleeding should have subsided

Start gentle active rehab

2 weeks heat therapy and gentle static

4x daily

Wha the later phase of stretching ?

Another 2 weeks focus on ROM strength and coordination

PNF stretching added to passive routine

Desensitise stretch reflex increase ROM and decrease pain

What is the long term stetching ?

Active dynamic stretching through developmental program should be used

What is sport massage ?

Move fluid and nutrients through tissues accelerating healing

Stretches tissue, releasing tension to improve elasticity

Breaks down scar tissue that can limit future flexability

Reduces pain through heat, circulation and relaxation

Not to be used on complete rupture, contusion, open wounds

What is cold therapy ?

Apply ice or cold compress to an injury or after exercise for a therapeutic effect

Used for acute injuries and after exercise to relive symptoms of exercise induced muscle damage

What are the positive of cold therapy ?

Vasoconstriction of blood vessels decreases blood flow

Decrease swelling and pain

What is negative of cold therapy ?

Tissue and nerve damage if in contact for a long time, abrasion if direct contact

What is heat therapy ?

Apply heat to an area before training for a theraputic

After 48hrs 20 mins at a time

Chronic injuries and late stage acute injures before exercise

What are the postives of heat therapy ?

Vasodilation of blood vessels increase blood flow

Decrease muscle tension

Decrease stiffness and pain

What are negative of heat therapy ?

Increased swelling and pain after acute injury

What is contast therapy ?

Alternate cold and heat

3-5 days past injury 1:3 / 1:4 cold : hot 6-5 Minutes

Acute injures after bleeding and infalmtion has stopped to relief symptoms EIMD

What are the postives of contast therapy ?

Larger increase blood flow, nutrient delivery damage

Decrease pain and swelling

What are negative of contrast therapy ?

Limited benefit over or above cold

What are NSAID’s ?

Non steroid anti inflammatory drug

Ibuprofen / relax gels

What are the postives of NSAID’s ?

Reduces the inflammatory response after an injury

They do this by interfering with the chemical response, pain signals and reducing temperature

What are the negatives of NSAID’s ?

Stomach issues - not taken with food , ulcers, gastrointestinal

Headache

Dizziness

Stroke / heart attack

What is physiotherapy ?

Mobilisation / manipulation of joints and tissue

Electrotherapy / ultra sound to repair / simulate tissue

Exercise to strenth muscle

Massage to stretch / relax tissue , relive pain and increase circulation

Sport specific programme and advice

Posture and alignment

What is arthroscopy - key whole surgery ?

Under local / general anaesthetic

Small incision and cameras for guidance

Less damage to surrounding tissue, less pain

Faster recovery

Cartailage / soft tissue

What is open surgery ?

General / locals anaestic

Joint / bone reconstruction and repair

Potential stronger repair

Increase infection risk significant scaring

Bankart procedure = shoulder stabilisation

What is the treatment for simple fracture ?

Medial attention - ambulance may by required

PRICE - reduce swelling, cast sling

Pain relief / anti inflammatory

May require surgery

Physiotherapy

Mimumn 6 weeks

What is the treatment of stress fracture ?

Medical attention required for diagnosis

PRICE recuse swelling

Rest 2 weeks

Imobliation

Gradual build up in strength, posture and alignment

What is the treatment for dislocation ?

Immediate medial attention

Immobilisation - splint, sling

PRICE reduce swelling pain relief

Anti infalmmatory pain relief

Surgery if not in place

Physio / rehab

What is the treatment of sprains ?

Medical attention may be required

PRICE rescue swelling

Immobilisation

Anti inflammatory, pain relief

Light weight bear, gentle pain free movement

May require surgery

What the treatment for torn cartilage ?

Medial attention

PRICE reduce swelling and pain

Anti inflammatory, pain meds

Physiotherapy , rehab

Arthroscopy surgery

Hydro therapy

What is the treatment for exercised induced muscle soreness ?

Cold therapy

Massage and stretching techniques

Anti inflammatory, pain relief