BOC athletic training

Policies

are clear and accurate written statements that identify basic rules and principles used to control and expedite decision making.

Procedures

describe the process by which something is done (the how)

SOAP Notes

Subjective: what the patient tells the athletic trainer about the injury. Objective: information gathered during the evaluation such as ROM, Pain, strength levels. ASSESMENT: professional opinion about the injury based on information obtained during previous steps. PLAN: how the injury will be managed with short term and long-term goals.

Principles of conditioning

safety, warm up/cool down, motivation, overload, consistency, progression, intensity, specificity, individuality, minimal stress

SAID Principle (specific adaptations to imposed demands)

When the body is subjected to stresses and overloads of varying intensities it will gradually adapt overtime to overcome whatever demands are placed on it.

Dynamic Warm-up

involves continuous movement using hopping, skipping, and bounding activities with several different footwork drills and patterns

Dynamin Stretching

controlled stretches recommended prior to beginning activity

static stretching

Passively stretching an antagonist muscle by placing it in maximal stretch and holding it for 30 seconds.

Proprioceptive Neuromuscular Facilitation (PNF)

Stretch muscle statically, contract and stretch muscle statically beyond initial static stretch

PNF streches

Slow reversal hold, relax, Contract and relax , hold-relax

nutrition

the science of the substances in food that are essential to life. Three major functions are growth, repair and maintenance of all tissues, regulate body processes, production of energy.

Nutrients

Carbohydrates, fats, proteins, water, vitamins and minerals.

Carbohydrates, proteins and fats are MAcronutrients. Vitamins, minerals and water are MIcronutrients.

Dietary Recommendations

Carbohydrates 55-60%

Fat 25-30%

Protein 15-20%

Carbohydrates( Energy Sources)

Sugars, Starches and fiber

Glycolysis

process that breaks down glucose to produce energy

Fat soluble vitamins

A, D, E, K

water soluble vitamins

Vitamin C, thiamin, riboflavin, niacin, B6, B12, biotin and pantothenic acid.

Antioxidants

Vitamin C, Vitamin E and beta-carotene.

Electrolytes

sodium, potassium, chloride, magnesium and calcium

Pre-game meal

Meal should be eaten 3-4 hours before and be higher in carbohydrates and liquids consumed should be easily absorbed and low in fat

skinfold measurements

A method to estimate body fat by measuring with calipers the thickness of a fold of skin and subcutaneous fat.

bulimia nervosa

An eating disorder when a person gorges themselves with thousands of calories after a starvation period and then purges themselves with induced vomiting/ diurtetics.

anorexia nervosa

AN eating disorder with a distorted body image and major concern about weight gain and deny hunger and are hyperactive, engage in abnormal amount of exercises

female athlete triad(REDS)

combination of an eating disorder, amenorrhea and osteoporosis.

Conductive Heat Exchange

Physical contact with other objects can result in either heat loss or heat gain

Convective Heat Exchange

Body heat can be lost or gained depending on circulation of medium

Radiant Heat Exchange

Comes from sunshine and will cause increase in temperature

Evaporative Heat Loss

Sweat glands in the skin allow water to be transported to the surface where it then evaporates, taking large quantities of heat with it

Preventing Heat Illness

Appropriate hydration, gradual acclimatization, weight records, monitoring of heat index, appropriate uniforms, unrestricted fluid and electrolyte replacement.

Hydration recommendations

17-20 Fluid ounces of water/ sports drink 2-3 hours before exercise and drink 7-10 fluid ounces of water/ sport drink 10-20 mintues before exercise.

The Wet Globe Temperature

Less than 78.0 degrees is normal activity.

78.0-82.0 Green- Use discretion in planning intense exercises and normal activity

82.1-86.0 Yellow- limit intense exercise to 1 hour and limit total outdoor exercise to 2.5 hours.

86.1-89.9 Red- Stop outdoor practice session and outdoor physical conditioning.

Greater than 90 degrees Black- Cancel all outdoor exercise requiring physical exertion.

Heat Illnesses

Heat cramps, heat stroke, heat syncope, heat exhaustion

Heat Syncope

rapid physical fatigue during overexposure to heat

TX. lying down in cool environment and replenishing fluids.

Heat Cramps

muscle spasms that result from a loss of large amounts of salt and water through perspiration

Tx. Ingesting large amounts of fluids, stretching, ice massage.

heat exhaustion

Prolonged sweating lading to dehydration and inability to sustain adequate cardiac output

TX. activate EAP and cool body temperature with bed rest in cool environment, IV fluids

Heat stroke

a condition marked by fever and often by unconsciousness, caused by failure of the body's temperature-regulating mechanism when exposed to excessively high temperatures.

TX. Activate EAP, immerse in cool tub and get body temperature below 105 degrees.

Exertional Rhabdomyolysis

sudden catabolic destruction and degeneration of skeletal muscle accompanied by leakage of myoglobin and muscle enzymes into the blood.

Lighting

8 miles out

Equipment regulatory agencies

NOCASE (national operating committee on standards for athletic equipment.

Tissue Loading

compression, tension, shearing, bending, torsion

Compression

external loads applied toward one another on opposite surfaces in opposite direction

Tension

force that pulls stretches tissue generated in response to equal/opposite external loads that pull a structure apart.

Shearing

equal but not directly opposite loads are applied to opposing surfaces forcing those surfaces to move parallel directions

Torsion

twisting in opposite directions from opposite ends of a structure cause shear stress over the entire cross section of that structure

Three types of muscles

skeletal, smooth, cardiac

TENDON ATTACH MUSCLE TO BONE

Muscle strain

muscle is overstretched by tension or forced to contract against to much resistance, separation or tearing into the muscle fibers.

Grade 1 Strain

muscle fibers have been stretched/torn some tenderness and pain in AROM

Grade 2 Strain

A number of muscle fibers are torn and AROM is extremely painful, and a divot can be felt in muscle belly and some discoloration.

Grade 3 Strain

Complete rupture of the muscle belly at the point of tendont attachment.

Muscle Cramps

are extremely painful involuntary muscle contraction that occur most commonly in the calf, abdomen, or hamstrings. Related to excessive loss of water and to some extent several electrolytes or ions.

Muscle Guarding

Muscles that surround the injured area contraction in response to pain

Muscle spasms

is a reflex reaction caused by trauma to the musculoskeletal system

Clonic Muscle Spasm

involuntary muscle contraction characterized by alternate contraction and relaxation in rapid succession.

Tonic muscle spasm

type of muscle contraction characterized by constant contraction lasts for a period of time. Rigid muscle contraction

Muscle soreness

pain caused by overexortion in exercise

DOMS (delayed onset muscle soreness)

Intense muscle soreness after 24-48 hours

DOMS (delayed onset muscle soreness) Causes

Small tears in the muscle tissue

Disruption of the connective tissues that holds muscle and tendon fibers together.

Tendinosis

breakdown of a tendon without inflammation. ( Tendon Degeneration)

Synovial Joints

Composed of two or more bones that articulate with one another to allow motion in one or more places. Articulating bones are lined with a very thin, smooth cartilaginous cover called hyaline or articular cartilage. All joints are surrounded by a thick ligamentous joint capsule. Inner surface of the joint capsule is lined with a synovial membrane, that produces synovial fluid which provides lubrication, shock absorption and nutrition to the joint.

Diastasis

Seperation of articulating bone

Dislocation

when one bone in a joint is forced completely out of its normal and proper alignment and muscle be manually or surgically put back into place or reduced

Subluxation

Bones come partially out of the joint but then goes right back into place

Epiphyseal

growth plate is a cartilaginous disk located near the end of each long bone

Osteoblasts

bone-producing cells

osteoclasts

bone-remodeling cells

general fractures classification

Greenstick Fracture- incomplete breaks in the bone that have not completely ossified.

Communited Fracture- Consist Of three of more fragments at the fracture site. Caused by a hard blow or fall in awkward position.

Linear Fracture- The bones splits along its length. Result of jumping from a height and landing in such a way to impact force or stress to the long axis.

Transverse Fracture- Occur in a straight line more or less at right angles to the bone shaft.

Oblique Fracture- When one end of the bone receives sudden torsion or twisting while the other end is fixed.

Stress Fractures Reason

Overtraining

going back into competition to soon after injury/illness

Moving from one event to another event without proper training

Starting initial training to quickly

Changing habits/environment

Postural and foot conditions

Salter-Harris Fracture

An epiphyseal plate fracture; a common injury seen in children

Salter-Harris Classification

Type 1. complete separation of the physis in relation to the metaphysis without a fracture to the bone.

Type 2. Separation of the growth plate and a small portion of the metaphysis.

Type 3. Fracture of the Physis

Type 4. Fracture of a portion of the physis and metaphysis

Type 5. No displacement if the physis but the crushing force can cause a growth deformity.

The Inflammation Process

8 Steps

Primary Injury

Any damage that impairs a tissue structure or function. mAcrotrauma is acute injury (sprain, strain or fracture)

MIcrotrauma- chronic injury (overuse, cyclic loading and friction)

Physical agents, chemical agents, biological agents

Ultrastructural Changes

Cells respond and adapt to the stress applied to the body part and stress exceeds cell's ability to adapt it is altered but recovered quickly become damaged and die. Cell membrane is disrupted and break down and spills into the extracellular space. Content spill out and kills the damage cell.

Ultrastructural Changes response cycle

1. Chemical from damaged cells released into extracellular space

2. Hemorrhage ( swelling occur as a result of tissue damage

3. Vasoconstriction cease of blood flow occurs temporarily

4. Blood clotting occurs with blood vessel in tissue damage area

5. Edema formation

6. Pain and muscle spasm

7. Arthrogenic neural inhibition occurs

Chemical Mediation

Lysosomes, Histamine, bradykinin, prostaglandins, cytokines and other chemicals are released in response to tissue trauma to modify and regulate the inflammatory response. Bind to pain receptors and when primary injury occurs most cells are released. Chemicals released from mast cells are histamine, serotonin, heparin.

Chemicals

Histamine- increase capillary permeability (vasodilation) cause free protein and water/ plasma to move into the tissue space between adding to the swelling

Neutrophil chemotactic factor

attracts neutrophils to the site of inflammation to eat dead tissue

Serotonin

increase capillaries membrane permeability is (responsible for swelling.)

Heparin

Prevents occlusion of capillary blood flow

Prostaglandin E1&E2

Increase capillary membrane permeability, PGE2 responsible for attracting leukocytes to ana area

Bradykinin

Found in plasma an activated following cell trauma and increase capillary permeability. Bind to pain receptors initiating pain response

Cytokines

family of hormones responsible for intracellular communication released from macrophages. (Immune System)

TNF-a- responsible for cellular death that occurs.

IL-1- responsible for moving leukocytes from blood stream.

IL-6- Produced by macrophage and T-Cells

Hemodynamic Changes

Goes through minor constriction (Vasoconstriction) Followed by vasodilation. Increased dilatation blood flow to area and increase swelling and place pressure on pain fibers. Blood slow increase and slow the blood flow and allow leukocytes to move to margins of blood vessels.

Leukocytes

1. Tumble along the vessel wall

2. Move along the vessel wall

3. Adhere to the vessel wall near an opening

4. Fall out of the bloodstream and move to the injured area

Number or leukocytes present are dependent on the amount of tissue damage.

Metabolic Changes

Energy decreases and oxygen decreases. The cells switch from anaerobic metabolism and the cell membrane functions slow down. Decrease sodium/potassium pumps concentrations of intracellular sodium at a low level. Increase sodium concentration cell increase water in cells.

Cells swells and burst and increase intracellular acidosis- lysosome digest cell membrane attacked.

permeability changes

Histamine and bradykinin increase the permeability of small blood vessels.

The endothelial cells contract, pulling away from each other.

Gaps are left, through which the WBCs can move out of the vessel and to the injury

site.

Leukocyte migration

Leukocytes oass through and adhere to the endothelium and to other WBC's. The WBC's move out of the vessel by squeezing through the endothelial gaps.

Neutrophils and Macrophages

Neutrophils- stimulated by neutrophil chemotactic factor and is the most abundant leukocyte in the human body. 50-70% if leukocytes

First line of defense and are smaller, faster and have a higher count.

Temporarily of defense is 7 hours and cannot reproduce and is responsible for collateral tissue damage.

Macrophages- Second line of defense can reproduce, and main function is phagocytosis and can live for months. Release potent enzymes that may destroy connective tissue and release chemical medication and prolong inflammation and release factors that aid in healing.

Phagocytosis

Neutrophils and macrophages digest cellular debris and other foreign material into pieces small enough to be removed from injury site.

Phagosome

Neutrophils and macrophages that engulf debris into sacs.

Once enclosed, lysomes that are located in leukocyte unite with the phagosome become a phagolysome.

Afferent Nerves

Transmits impulses from the site of irritation to the spinal cord

Efferent Nerves

From the spinal cord to the sites of the irritation

A-Delta Pain Fibers

Large fibers and are slightly myelinated and fast. Instant pain and withdrawal for acute sensations temperature.

A-Beta Pain fibers

Large Fibers myelinated and fast. Pressure/Touch and sensory receptors in skin and joints.

C-fibers pain fibers.

Most abundant nerve fiber in the body. Small fibers, nonmyelinated and slow/ Throbbing, pressure, chronic pain and nagging, extreme temperature.

Gate Control Theory

Built on the idea that only one type of sensory input can travel through the spinal cord. Operates at spinal cord level and located in the dorsal horn. Lamina II, substantia gelatinosa.

Cranial Nerves

12

1. Olfactory

Smell

2. Optic

Vision

3. Oculomotor

Eye movement and opening of eyelid, constriction of the pupil and focusing