HERS 570 Exam 1

History of AT

AT profession has evolved over the course of 100+ years of assisting physically active individuals

Important Dates:
-1917: Dr. S.E. Bilik
-1950: NATA
-1990: American Medical Association

BOC

Following completion of the clinical education and academic requirements of the major, a student will be eligible for the BOC National Certification Exam.

who are athletic trainers?

-Credentialed Healthcare Providers
-Practice under the direction of physicians
-Required to complete continuing education
-\>70% have Master's degrees
-Graduates of nationally accredited athletic training education programs
-As of 2022, all athletic training education programs must be at the master's or doctorate level

what do athletic trainers do?

-Prevention
-Emergency Care
-Clinical Diagnosis
-Therapeutic Intervention
-Rehabilitation of injuries and illnesses

patient care settings for athletic trainers

-Public and private secondary schools
-Colleges/universities
-Professional and Olympic sports
-ED, Urgent care
-Clinics: Sports medicine, Orthopedics, Physical therapy
-Occupational health
-Police/fire departments, military
Performing arts

If my patient has a suspected concussion/traumatic brain injury:
1....and loses consciousness at the time of the event, does this mean that it was more severe than if he/she had no LOC?
2.Does he/she need a CT scan right away?
3.Should I recommend the caregiver wake him/her up throughout the night?
4.Should I recommend the caregiver take away all electronics, video games, and tv?
5.Should I recommend the patient take ibuprofen or acetaminophen for a headache?

1. not more severe
2. no
3. no
4. no
5. no unless they absolutely have too (Tylenol is good to take)

2.When should my patients use ice for an injury?

Acute injuries

3.Should my patients put a towel or washcloth between the ice bag and the skin to prevent frostbite?

no

1.What is the difference between a sprain and strain?

Sprain: ligament
Strain: muscle/tendon

4.When should my patients use heat for an injury?

Chronic injuries

No heat on an acute injury (will increase blood flow making it bigger)

5.If my patient has a muscle strain, should I recommend stretching?

Moderately, but needs to be completely warmed up (muscle fibers tear when muscle is stretched)

6.Does taping prevent ankle sprains?

Depends --\> never had sprains: start taping, will not be effective in spraining. If you tape someone's ankle who's sprained in the past, it can prevent.

7.What skills can I teach my patients to provide external support for their injuries?

Taping, wrapping, equipment fitting

tissue properties (mechanical injury)

load
stiffness
stress
strain
deformation

load

external force acting on tissues, which causes internal reactions

stiffness

ability to resist a particular load

stress

internal resistance of the tissues to an external load

strain

extent of deformation of tissue under loading (1st degree: small tear, 3rd: full tear)

deformation

change in shape of a tissue

tissue loading

compression, tension, shearing, bending, torsion

compression

external loads applied towards one another on opposite surfaces in opposite directions

Examples: Contusions, fractures, arthritic conditions, axial load (on head)

tension

Pulls or stretches tissue

Examples: Muscle or ligament sprains, nerve tension

shearing

opposite forces to opposing surfaces

Examples: blisters, disc injuries, fracture

bending

different ways; when the ends exert a force one direction causing a bow in the middle

Ex. MCL injury (hits form outside of knee), fracture

torsion

twisting in opposite directions

Example: landing with foot ext. rotated and rest of lower extremity internally rotated - spiral fx, or foot getting stuck and turning

acute injuries

sudden onset

ex. sprained ankle, straining muscle

chronic injuries

injury that lasts 2-3 weeks that isn't getting better (lingers for a while)

Ex. Stress fracture, inflammation (tendinitis/tendinosis)

muscle strains (1st degree)

-minimal tearing
-Movement: can still move and okay strength
-some stretch/tear, tender, p! on AROM, full ROM

muscle strains (2nd degree)

-partial tear
-Harder to move
-tearing, p! w/active contraction, depression/divot, swelling, discol

muscle strains (3rd degree)

-complete tear or rupture
-Movement: not able to function
-rupture, sig. impairment & p!

what can you not determine a muscle strain degree off of?

swelling and pain

•Can't determine degree based on swelling (everyone swells differently)
•Visual Analogue Scale (VAS) 0-10
•Can't figure out degree based on pain because people have different pain tolerance

muscle soreness: acute

just worked out and it hurts

muscle soreness: DOMS

Delayed Onset Muscle Soreness: typically, more when working out and the next day or so you are sore

Peaks 24-48 hours

chronic/inflammatory conditions

-apophyitis
-bursitis
-capsulitis
-myositis
-neuritis
-periostitis
-tendinitis
-tendinosis
-tenosynovitis

apophysitis

Inflamm of bony projection/ outgrowth @ muscle attachment

apophysitis S/S

P!, tender, swelling, bony prominence

bursitis

Inflamm/swelling of a bursa

bursitis S/S

P!, red, hot, fluid, crepitus

capsulitis

Inflammation of joint capsule

capsulitis S/S

P!, local inflamm/swelling, ↓ ROM

myositis

Inflamm response in muscle or surrounding tissue, ossification

myositis S/S

P!, inflamm, tender, ↓ ROM, calcium deposit

neuritis

Inflamm/irritated nerve/nerve sheath

neuritis S/S

Local & referred P!, P! w/ percussion (tapping), ↓ sensation & motor FN

periostitis

Inflamm of membranous lining of bone

periostitis S/S

P!, swelling, "bumpiness," tender along bone, P! w/ muscle action

tendinitis

inflamm of tendon

tendinitis S/S

P!, swelling, tender, crepitus, P! w/ AROM & RROM

tendinosis

Microscopic tearing & degeneration of tendon from repetitive trauma

tensinosis S/S

Chronic P!, tender, ↓ ROM, P! w/ passive stretch, P! & weakness w/ AROM & RROM

tenosynovitis

Inflamm of synovial sheath around the tendon

tenosynovitis S/S

P! w/ palpation & movement of tendon, swelling/thickening, crepitus ("crunchy"), ↓ROM

ligament sprains: 1st degree

minimal disability, tender, little/no p!, full ROM, should be able to walk, little/no swelling

ligament sprains: 2nd degree

some FN loss, can bear wt. but difficult to walk, p! on ROM in 1+ direction, swelling & tenderness

ligement sprains: 3rd degree

complete FN loss, can't bear wt, limited ROM, swelling, discoloration, refer to R/O Fx

subluxation

partial dislocation and goes back in or completely goes out and comes back in

dislocation

"once a dislocation, always a dislocation"

bone injuries MOI

extreme stress & strain on bone

bone characteristics

diaphysis
epiphysis
periosteum

diaphysis

shaft, compact bone

epiphysis

ends, cancellous bone

periosteum

dense fibrous covering, contains osteoblasts and blood vessels

fractures

greenstick
comminuted
linear (length wise)
transverse (across)
oblique
spiral

greenstick

splinters

In kids/ adolescents (bones aren't completely hardened)

like trying to break a young twig in half - usually just bends &/or splinters - but with enough force it will break

comminuted

-Compression fracture and multiple piece
-Surgery

linear (length wise)

straight down shaft

transverse (across)

straight across bone

oblique

fracture is angles

spiral

twisting force (goes in opposite directions)

open vs. closed

open: bone goes through skin
closed: stays under skin

stress fractures

Won't show up on x-ray right away (will show a few weeks later)

epiphyseal/growth plate injuries

If growth plate is fractured, limb may be shorter or longer for life

fracture healing

-Usually requires immobilization ~6-8 weeks
-Requires osteoblast (builds bone) activity to lay down bone & form callus
-After cast removal, normal stresses & strains will aid in healing & remodeling
•Osteoclasts (breaks down bone) assist in re-shaping of bone in response to normal stress

nerve injuries

dermatomes
myotomes
reflexes

dermatomes

nerve goes out to the skin (sensation on skin)

myotomes

nerve activates or causes muscle to fire

reflexes

hitting tendon to make sure nerve is function properly

grading for nerve injuries

•Hypoesthesia - little (low) sensation
•Hyperesthesia - high sensation
•Paresthesia - abnormal (tingling)
•Anastasia - no sensation

tendon/compression injuries (nerve injuries)

•Nerve injured because pulled or compressed

healing process

-Interference with healing process will delay healing/return to activity
-Create optimal healing environment
•Little can be done to speed the process, much can be done to create the optimal environment it!

*cannot speed up someone's healing time

healing process phase 1

Inflammatory Response
•Immediately following injury - critical!
•Symptomatically presents with the following
-Redness, swelling, warmth, tenderness, fn loss
•Stage lasts ~4 days following injury
•Tx: ice application only - heat application will delay the process

healing process phase 2

Fibroblastic Repair
•May last up to 6 weeks
•Tissue regeneration
•Tenderness & pain disappear

healing process phase 3

Maturation - Remodeling
•Long-term process
•Re-alignment or remodeling of collagen fibers
•Scar tissue development

factors that impede healing

-Extent of injury
-Edema (swelling)
-Hemorrhage (bleeding)
-Poor vascular supply
-Tissue separation
-Muscle spasm
-Atrophy (loss/decrease of muscle size)
-Corticosteroids
-Keloids
-Infection
-Health (smoker, nutrition, sedentary, etc.)
-Age
-Nutrition

keloids

•African American population
•Genetic
•Scar is bigger and bumpier (can impede healing)

SOAP

Subjective: subjective questions - what happened, what do you feel, what's your pain on a scale of 0-10, has it happened before

Objective: measured (ROM degree)

Assessment: Dx

Plan: what are you going to do with them

EAP

Emergency Action Plan
-Separate plan for each facility
-Rehearse at least 1x/year
-Communicate with stakeholders!

components of EAP

-Venue address @ top of plan
-Personnel & role of each person
-Communication (location of telephone line & phone number)
-Available emergency equipment
-How to activate EMS & what information to relay
-Venue directions
-Access to gates/locks
-Sports medicine staff & phone numbers

WSU EAP collaboration with:

-Winona Ambulance
-WSU Security
-Winona Health

primary survey

check, call, care

check

-Primary Survey (are they going to live - conscious, breathing, etc.)
-Helmet & facemask removal AND shoulder pads
-Secondary Survey

call

-keys
-security

care

-What about patients under 18?Assumed consent

check for life threatening injuries

-If unconscious:
-Activate EMS
-Leave helmet on
-If helmet comes off, then shoulder pads must come off
-Remove facemask

Prone vs. supine patient

when you call 911 what information do you give them?

-Location
-Current state of patient (conscious/unconscious)
-Equipment they need to bring
-What treatment you've been giving
-Give them vitals (bp, HR, respirations) - if taken
-Medications that have been taken
-How many people are involved (1 or more people injured)
-Where to enter facility

hemorrhage

-direct pressure
-elevation
-pressure points

direct pressure

-Firm pressure (hand and sterile gauze) on site of injury against the bone

elevation

-Reduces hydrostatic pressure and facilitates venous and lymphatic drainage - slows bleeding

pressure points

-Points on either side of body where direct pressure is applied to slow bleeding

shock S/S

Skin (pale)
-May be losing blood
-Brain may be responding that way

Pulse
-Fast but weak

BP
-High but goes low fairly quickly