MODULE 6: Trauma and Risk (KPE162)

definition of trauma

wound

definition of injury

health disorder

• that is caused by violence

types of trauma

1. physical

2. chemical

3. psycho-social

what is physical trauma

refers to injuries that are caused by external forces

• ex. motor vehicle collisions, homicide, temperature, fires

what is chemical trauma 

refers to injuries that are caused by poisons, toxins, drugs / other harmful substances

• ex. exposure to hazardous chemicals, substance abuse, contamination

what is psycho-social trauma

refers to harm that is caused by verbal, visual, emotional, sexual or social actions

• ex. bullying, verbal abuse, exposure to a traumatic event

definition of risk

refers to exposure to the chance of injury/loss

what is reasonable risk management

process where you..

• balance the potential risks w/ the expected benefits

why is reasonable risk management important

as it helps to..

•  minimize unnecessary harm while still allowing beneficial activities 

what is absolute risk (AR)

the frequency of a disorder occurring per specified level of exposure to a risk

• expressed as the # of disorders / amount of exposure to the risk (disorders/exposure to risk)

what is relative risk (RR)

measure that compares the risk of a disorder in one group to the risk in another group

• expressed as absolute risk in group 2 / absolute risk in group 1 (AR₂/AR₁)

how can we interpret relative risk (RR)

if RR = 1, then both groups have the same (“normal”) risk

what is hazard ratio (HR)

an estimate of RR measured over a specific (study) period

goal of preventing disorders

to reduce how often disorders occur

• and/or how severe they are

what is a risk factor

a factor that is positively or negatively correlated with the likelihood of a disorder

what is prevention

to minimize risk by adjusting to certain factors

• ex. avoiding factors with positive risk correlation (or known causation) 

what is morbidity

the state of having a disease, injury or health disorder

what is mortality

death (or the rate of death in a population)

ranking of physical trauma as a cause of death in canada

5th leading COD

what are DALYS

disability-adjusted life years

• it is a measure of lost healthy life due to injury / death 

relationship between young people / mortality & morbidity

young people experience MORE serious injuries + death from trauma

• compared to other age groups 

relationship between young people / DALYS

young people have higher DALYS

• because they lost more potential years of life (because they are more likely to die/get injured from trauma than other people) 

canadian trends in burden of disease (from injuries)

1. overall burden (from trauma) = steady

2. motor vehicle collisions = decreasing burden = less harm to young people

3. slips + falls = increasing burden = more harm to old people 

what does the increasing / decreasing burden mean

1. decreasing burden = fewer injuries / deaths

2. increasing burden = more injuries / death 

what are the “big three” causes of trauma-related morbidity / mortality (in canada)

1. motor vehicle collisions (MVCs) 

2. suicide 

3. slips & falls 

what is suicide associated with

highly associated with mental health disorders (MHDs)

which groups are at higher risk of MVC-related death or injury

1. young > old

2. male > female

3. inc risk w/ alcohol

what are risk factors in PA

facots that are connected with (or linked to) a higher / lower chance of injury

what are extrinsic risk factors

refers to factors that are outside the person that influence their injury risk

• ex. choice of activity, environment, equipment 

what are intrinsic risk factors

refers to personal characteristics that influence their injury risk

• ex. technique / perceptuo-motor control (how well you perform + coordinate movements), motor control, strength, flexibility, fatigue

examples of uncontrollable intrinsic risk factors

factors that cannot be changed (either through training/lifestyle choices) 

• age

• genes (alleles, SNPs) 

• sex

• static alignment (body in non-moving position) 

• prior diseases or injuries 

examples of intrinsic factors that are somewhat affected by choices

factors that can be improved via training, practice + better movement skills

• flexibility / joint laxity 

• technique + perceptuo-motor control (coordination, posture, dynamic alignment) 

how do intrinsic risk factors influence activity choices

it ensures that we avoid activities that pose high risk

• ex. choosing activities based on uncontrollable factors

• ex. choosing activities that develop balance + stability to reduce risk 

how is PA choice an extrinsic risk factor

because the activity you choose exposes you to different injury risks

• ex. soccer has higher risk than walking 

how do venues influence injury risk

refers to where you’re active → which increase/decrease risk of injury

• ex. surfaces, padding, lighting, facility conditions 

how does equipment affect injury risk

safety gear + proper playing equipment prevent injuries

how do rules / enforcement act as extrinsic risk factors

good rules + consistent enforcement = lower injury risk

issues of PA quality for risk analysis

1. type of activity - different activities have different inherent injury risks

2. technique / skill - good technique = lowers injury risk

3. progression of quality - how movement skills improve over time (reduces risk)

issues of PA quantity for risk analysis

1. volume (WL)  - total amount of activity (ex. hours/week)

2. intensity (WL-distribution) - how hard the activity is (ex. vigorous) 

3. progression of quantity - increasing workload gradually to avoid overuse injuries 

what is sutton’s law

a heuristic (rule-of-thumb) meaning “go where the money is”

relationship between sutton’s law / trauma risk analysis

refers to focusing on the biggest sources of injury risk (where most trauma actually occurs) 

definition of acute trauma

single-rep violence 

• injuries caused by sudden, single traumatic event

definition of overuse injuries

repetitive micro-violence

• develop gradually over time from repetitive stress

issues of PA quality that affect risk of acute trauma

in order of most → least impact

1. type of activity 

2. technique 

issues of PA quality that affect risk of overuse injuries

technique

issues of PA quantity that affect acute trauma

in order of most → least impact

1. intensity (WL-distribution)

2. progression of quantity (increasing workload gradually)

issues of PA quantity that affect overuse injuries

progression 

issue of intent in type of physical activity

1. intent to injure (trying to hurt someone on purpose) 

2. intent to collide (sport requires you to run into people) 

3. intent to accept risk (you know the activity is dangerous but choose it anyway)

what makes “extreme sports” high-risk 

they have a high chance of unintended collisions/fatal errors

example of bad technique that raises injury risk

axial-coronal collapse in the lower extremities

• when the leg collapses inward during movement

• leads to ACL ruptures (acute) or heel pain (overuse) 

how can you measure the risk of injury from workload progression

1. WTWR > 1.1 (current week WL / last week WL)

2. ACWR > 1.5 (short-term load/long-term load)

what does WTWR > 1.1 mean

if it’s above 1.1 → WL increases by at least 10% = increased injury risk

• because too fast of a progression = higher injury risk

what is the rule of 10%

idea that you shouldn’t increase training by more than 10% per week

• therefore WTWR < 1.1 

what does ACWR > 1.5 mean

the short-term load > 1.5x the long-term load

• meaning bigger jump in load = higher injury risk 

biomechanical strategies to prevent injury

helps to prevent mechanical overload

1. dissipate energy (absorb + spread impact)

2. distribute energy over space (spread force across a larger area)

3. distribute energy over time (slow down the impact)

4. constrain unsafe joint motion (limit harmful movements - ex. tapes)

what are safety-based rules

refers to rules that are created after injuries / dangerous patterns are identified

what is the spearing rule (1976)

it banned leading with the crown (top) of the helmet

• reduces neck injuries

what is the helmet rule (2018)

it penalized initiating contact with the helmet when the head is lowered

• reduces neck/head injuries

what does “don’t cross the stupid line” mean

a parachute canada message that..

• recognizes risk-taking can be fun + normal 

• encourages youth to make smart + manageable risks

how do social contexts influence trauma risk

social factors (community norms, culture, laws) can increase / decrease the risk of many types of trauma

• ex. unsafe road laws → more MVC injuries

• ex. social pressure online → more bullying → abuse by peers