KIN 240 Midterm 1

what are some stakeholders from the medical rtp?

• sports physician

• physical therapist

• soft tissue specialist

• athletic trainier

what are some stakeholders from the perfomance rtp?

• s&c coach

• nutrition

• psychologist

• sport scientist and coach

what is a certified exercise physiologist

• involved in exercise testing and screening

• works with gen pop, high perfomance athletes, chronic health conditions, functional limitrations or disabilities

what is a certified personal trainer

• does pre-participation health screening

• sub-maximal fitness assessments

• works with health individuals between 15-69

what are sport medicine physicians

• under the canadian academy of sport exercise medicine

• not the same as a family med doc

  • they specialize in skills related to medical conditions

  • completeted further personal training in sport med fellowship or additional unit degree

what is a sport physiotherapist

• A physiotherapist with additional certification focused on sport-related care

• has written and practical certificates (or diploma)

• similar scope of practice to athletic therapist

what is a certified athletic therapist

• narrow scope

• specalizes in msk injury, recognition, management, treatment and rtp

what are a sports therapist area of expertise

1. prevention

2. immediate care

3. clinical assessment

4. treatment, rehab, reconditioning

what is prevention in injury care and management?

• ensuring the protective gear works

• conditioning

• screening and assessment to recognize and observe abnormal movement patterns

what is immediate caare in injury care and management?

• acute injury recognition and management

• emergency interventions and EAP

• on and off field evaluation skills

what is clinical assesment in injury care and management?

• understanding pathology of injuries and illnesses

• coordination with other medical practitioners

what is treatment, rehab and reconditioning in injury care and management

• developing theraping skills via education and workshops

• exercised based treatment and rehab

• knowing exercise physiology

• identifying key performance indicators to guide an athletes rtp

what are the steps to build an IST from scratch?

• identify needs and limitations

• identify who you want to work with

• build relationships with other professionals

what are the components of a sport-related concussion (SRC)?

• traumatic brain injury

• caused by a blow to the head, neck or body

• force is transmitted to the brain and may trigger neurological and metabolic changes

• symptoms either immediate or delayed

What is contrecoup?

• athlete colliding with an opponent/object/surface that imparts a forc eon their body

• creates an impulsive force upon the brain

• forces can also lead to tension and compression tissue injury

  • common in sport collisions

what are the “R”’s of SRC?

• recgonize

• reduce

• remove

• refer

• retern to learning/sport

what are the 4 domains of SRC symptoms?

• migraine (physical)

• neuropsychiatric

• sleep

• cognitive

how do you reduce potential of SRC in hockey?

• mouthguard reduces by 28% across all ages

what are some key steps in field evaluation of a concussion?

• evaluate onsite (emergency principles)

• rule out cervical spine injury

• stay with the athlete

• monitor for deterioration

what types of sideline assessment tools exist?

• SCAT6

• app-based tools

• subjective assessment (like where the athlete reports symptoms)

when you do a neurophysical assesment?

• done after the symptoms resolve

• most sensitive when compared to baseline

• aids in RTP decisions

whats the best first step in concussion management?

• recognize symptoms and remove activity

• refer to a healthcare practitioner

what are the 3 steps to return to learning

1. do daily activities that do not result in more than mild exacerbation of symptoms

2. do school activities; homework, reading

3. return to school part time - half day at school, breaks during school

4. return to school full time

athlete shouldnt go back to sports until they are back to school w/o symptoms getting worse

what is step 1 in returning to sport?

• symptom limited activity

• daily activities that don’t provoke symptoms and not specific

• want to have a gradual integration of cognitively stimulating activity

what is step 2 in returning to sport?

• aerobic activity

• controlled activities that don’t put the athlete at risk and they are not sport specific

  • 2A: light, lower than 55% maxHR

  • 2B: mod, 70% maxHR

• activities such as stationary cycling (preferred), treadmill walking

what is step 3 in returning to sport?

• sport specific exercise

• no activity where risk of head impact or contact exists and removed from team enviornment

• do sport specific skills that are isolated and cognitively challenging

  • ex: juggling, passing, throwing, catching

what needs to be done before transitioning into stage 4-6 when managing return to sport

• symptom free with no aggravation of symptoms

• presence of symptoms with 4-6 tasks means athlete should return to stage 3 until symptoms resolve

what is stage 4 in returning to sport?

• non-contact training drills

• high intensity drills and activities and return to usual resistance training

• technical and tactical drills that involve interacting with teammates and requires rt/decision making

what is stage 5 of returning to sport?

• full contact practice in controlled situations (should be cleared by a HCP)

• introduce sport specific contact and restore confidence through exposure

what is stage 6 of returning to sport?

• return to sport

• completed stage 5 with no hesitancy and has full confident in abilities and health

• can return due to enough conditioning

  • the first game may bring on symptoms again but to pass this stage, no symptoms should arise post game

why is baseline testing for SRC not as affective in children compared to adults

they are constantly growing their neurocognitive abilities

what are some symptoms athletes may experience when theres an injury to the skull or brain?

• loss of consciousness

• disorientation or amnesia

• motor deficits

• cognitive deficits

what is a cerebral contusion/hematoma?

• small hemorrhages or intracerebral bleeding within the cortex, brain stem or cerebellum

• may occur when the head strikes a stationary object at high velocity or force

what are some signs and symptoms of a cerebral contusion/hematoma?

• may experience immediate loss of consciousness or severely altered consciousness

• dilation of one pupil, depression of pulse and respiration

how do you manage a cerebral contusion/hematoma?

• recognize severity of symptoms

• activate EAP

• requires ongoing medical management, extended rehab and RTP process

what is a scalp/upper face laceration? whats a key symptom?

• blunt trauma or penetrating trauma tends to be the cause

• may occur with a serious head trauma

• bleeding is often extensive

how do you manage a scalp/upper face laceration?

• first aid

• wound bigger than 1/8 in depth - referral to a physican

• smaller wounds, covered with a protective covering and gauze

whats a mandible fracture and some of its signs and symptoms?

• direct blow to the jaw (fractures near the front angle)

• s&s nclude deformity, loss of occlusion of teeth, bleeding around the teeth and lower lip anesthesia

how do u manage a mandible fracture?

immobilize and refer to urgent care

what is a mandibular subluxation or dislocation?

• involves injury to the temporomandibular joint (TMJ)

• MOI is a blow to the open mouth from the side

what are the signs and symptoms of a mandibular subluxation/dislocation?

• subluxed: a decrease in ROM, pain at end ranges, isolated pain to TMJ and surrounding musculature

• dislocated: locked-open position, easily noted by misaligned teeth

how do u manage a mandibular subluxation/dislocation

• manage acute symptoms and stabilize if needed

• Refer for medical management

• May be physician, could also be trained MSK therapist

what is a nasl fracture? and is its signs and symptoms?

• a direct blow to the nose

• there is hemmorrhaging and possible deformity

• also check for a src

how do u manage a nasal fractute?

• check for src

• control bleeding and if needed refer for an x-ray

• heel smash method

what is a tooth fracture and its s&s?

• impact to the jaw or direct truama

• s&s include fractures with framents, bleeding if complicated, possible x-ay needed

how do u manage a tooth fracture?

• uncomplicated crown fractures do not require immediate attention

• root fractures: refer to a dentist asap

what are some things to consider when assesing the eye?

• use extreme caution

• eyes should be covered together

• movement of unaffected eye will cause movement in affected eye

what are signs and symptoms of foregin bodies in the eye?

• foreign objects causing lots of pain and disability

• do not rub eye to try and remove or recover with fingers

how do u manage foreign bodies in the eye?

• close eye and determine location; either upper or lower lid

• wash eye with saline and rinse with affected eye at bottom

• if object is embedded, close and patch both eyes and refer to a physician

whats a corneal abrasion or laceration and its s&s?

• direct contact to eye with a sharp object (ex; fingernail)

• there may be severe pain and watering of the eye

how do u manage a corenal abrasion or laceration?

patch both eyes and refer to a physician

what is a hyphema and its s&s?

• blunt blow to the eye

• causes collection of blood in anterior chamber of eye

• vision is partially or completely blocked

how do u manage hyphema?

patch both eyes and refer to a physician

what is acute conjunctivits?

• pink eye

• cause by bacteria or allergens

• conjuctival irritation causd by wind, dust, smoke, air pollution

• aso caused by a cold or upper resp conds

what ate s&s of acute conjunctivitis and how do u manage it?

• eyelid is swelling with discharge and itching

• highly infectious; stay home and contain

how do u strengthen the cervical spine?

• muscle strengthening to resit hyperflexion, extension and rotational forces

• athlete should brace neck (double chin) prior to impact

• isometric exercise to strengthen or sport specific exercise

how do prevent injury at the thoracic spine?

• correct posture and avail rom (flexion and extension)

• functional strength and biomechanics

how do u prevent injury at the lumbar spine?

• avoid unnecessary stresses and strains of daily living and positions/posturs that causes injury

• correct asymmetries or deficiences

• conditioning to emphasize trunk flexibility

• strengthen spinal extensor and abdnominal musculature

what is the mcgill big three

• core exercise that strengthen and support the lumbar spine

• creating an unstable base to build strength around the lumbar spine

what is lordosis?

• anterior tilt of the pelvis

what is kyphosis

• rounded thoracic

• head tilt forward significantly and can cause pain

how should u asses the cervical spine?

• assess position of the head and neck

• symmetry of shoulders

• assess rom

What symptoms indicate facet joint involvement in the thoracic spine?

• Unwilling to rotate or side flex

• Pinpoint pain with movement

What symptom suggests costal-vertebral involvement in the thoracic spine?

Pinpoint pain with deep inhalation

what are some things to remember when observing the lumbar spine and sacroiliac joint?

• coordinated movement of the lower back involves the pelvis, lumbar spine and sacrum

• equal levels in the shoulders and hips (illiums)

what are some things to remember when palpating the lumbar spine and sacroiliac joint?

• palpate over spinous processes; any sharp pain is a red flag

• palpate over transverse process; rib articulations

what is a cervical fracture?

• axial load through top of the head with a flexed spine

• other neck positions can result in varying forms of structural damage

how do you manage a cervical fracture?

• stablize the patients neck/spine regardless of level of consciousness

• use extreme care and caution

• know scope

what are acute strains of the neck/upper back? what are the signs and symptoms?

• results in an unexpected movement of the head

• may involve traps, scm, scalenes, levator scapulae

• s&s involves localized pain, point tenderness and restricted ROM

  • must rule our csp invovement when on field

how do u manage an acute strains of the neck/upper back?

• immobilization

• refer to sports med phys with x-rays, pain management, nerve involvement

what is a brachial plexus neurapraxia? (burner)

• stretching/compression of brachial plexus

• disrupts peripheral nerve function

• common in contact sports

what are the signs and symptoms of a burner?

• burning sensation, numbness and tingling

• may include pain extending from shoulder into hand

• severity injury will influence duration of return

how do u manage a burner?

• return to activity once s&s resolve

• also once able to achieve pre-injury strength and sensation

what is acute torticollis? (wryneck)? what is its signs and symptoms

• pain on one side of the neck upon wakening

• result of a synovial capsule impingement within a facet

• s&s include palpable point tenderness and muscle spasm, restricted rom and muscle guarding

how do you manage wryneck

• traction (pulling, seperation b/w vertabrae)

• superficial heat

• soft tissue treatments

what is low back pain?

• poor mechanics during loaded/unloaded tasks

• back trauma

• muscle imbalances

• repetitive patterns

what are the signs and symptoms of low back pain?

• pain

• general weakness, antalgic gait

what is spondylosis

• generation of the vertebrae due to congenital weakness

  • aka stress fraacture

• happens on on side of vertebrae

what is spondylolistheis?

• development of sppondylosis to both sides of the verebrae

• slipping of one verebrae above or below anohe

what are the signs and symptoms of spondylolysis and listhesis

• spondylolysis begins unilaterally

• pain and persistent aching

• low back stiffness with increased pain after activity

• frequent need to change position

• segmental hypermobility

how do u manage spondylolysis and listhesis?

• acute symptom management

• exerises directed at controlling/stabalizing hypermobile segements

  • trunk strengthening

  • dynamic core strengthening

  • abdominal work

what is SI joint dysfunction

• truamatic causing an upshift of one illium

• irrirtation and stretching of sacrotuberous or sacrospinous ligaments

what are some of the signs and symptoms with SI joint dysfunction?

• palpable pain and tenderness over the joint medial to PSIS (w/ muscle guarding)

• pelivc asymmetries

• pain may radiate posteriorly, laterally or anterioly down the thigh

• sitting is comfy but you experience pain when first getting up/extending through SI joint

what ate the 3 forces causing injury to tissue?

• compression

• tension

• shearing

what are the forces causing injury to long bones?

• bending

• torsion

what is a compression force?

• a force with enough energy to crush tissues

• can be from 1 blow or repeated submaximal blows = damage in tissue (or even a fracture in bone)

what is a tension force?

• pulling force which stresses tissue beyond yield point

• results in sprain, strain or avulsion type injury

what is a shearing force?

• a force moving paralell across the tissue

what is a bending force?

• bone bending occurring under axial load (2 point contact)

• external force going opposite of other 2 points of load

what is a torsion force?

• loads caused by twisting of the bone in oppsite directions from opposite ends

  • rotation force

• could cause spiral fracture

what is a life-threatneing injury?

• places athlete at immediate risk of their health, wellbeing, life

what is a serious injury?

• a debilitating injury that has significant implications on the ability of an athlete to continue participating in sport

• may impact adl

• may require surgery or rehab

whats a non-life threatning or non-seriosu injury

• majoirty of sports injuries fall in this category

• wide variety of debilittation, time loss and rehab needed

what is an acute injury?

• immediate onset, injury occuring after MOI

• athlete may not report pain right away

• accompanied with signs of SHARP (swelling, heat, altered function, redness, pain)

• requires immediate intervention

what is a chronic injury?

• a number of small acute events or micro-traumas

• may not be able to identify source and could be caused by a numerous factors

what are the 3 key roles in an EAP?

• charge person

• call person

• control person