common injuries midterm

strength and conditioning coach role in sports medicine team

oversee fitness of an athlete; often employed at collegiate and professional levels to conduct team and individual training sessions; certified by National Strength and Conditioning Association (NSCA); certified in CPR, AED, and first aid; must work with athletic trainers when modifying conditioning programs relative to injuries; not available in majority of secondary schools- the athletic trainer or team coach typically assumes the role

personal fitness trainer

responsible for designing comprehensive exercise programs to meet an individual’s needs and goals- considers the individual’s health history, capabilities, and objectives for fitness; qualifications- American College of Sports Medicine (ACSM), the National Academy of Sports Medicine (NASM), the National Strength and Conditioning Association (NSCA), and the American Council on Exercise (ACE); all certified in CPR and AED; strongest growth segment of the fitness industry; provides prehab, conditioning, special medical needs, and weight management

recreational specialists

plan, organize, and oversee leisure activities and athletic programs in local recreation, camp, and park areas, playgrounds, health clubs, and fitness centers; ensure that the environment for activity is as safe as possible; certified in CPR, AED, first aid

athletic administrators role in sports medicine team

responsible for hiring personnel who comprise the sports medicine team like coaches, athletic trainers, sports nutritionists, team physicians, sport psychologists; must be sure that hired individuals possess the necessary credentials and are willing to work as a team; oversee and develop policies and procedures, risk management plans, and emergency action plans

coaches role in sports medicine team

be aware of the responsibilities of each individual associated with the sports medicine team; ensure that athletes have undergone a preventative injury conditioning program; ensure that sports equipment is of the highest quality, is properly fitted, and is properly maintained; certified in CRP, AED, first aid; appropriate coaching licenses and certifications- American Sports Education Program (ASEP), National Council of Accreditation of Coaching Education (NCACE)

athletic trainers role in sports medicine team

work with athletes from the time of injury to their return to competition; directly responsible for all phases of health care in an athletic environment; work in schools, colleges, pro teams, sports med clinics; knowledge and competent in a variety of sports medicine specialties; should be Certified Athletic Trainers (ATC); injury/illness prevention and wellness promotion- educate athletes, parents, and coaches about the risks inherent to sports participation, make the competitive environment as safe as possible to reduce the risk of injury, organize physical exams and preparticipation screenings; examination, assessment, and diagnosis with injuries; immediate and emergency care; certified in CPR, AED, first aid; therapeutic interventions, including recognizing the role of mental health in injury and recovery

team physician role in sports medicine team

compiling medical histories and conducting physical exams- preparticipation screening; diagnosing injury, deciding on disqualification- determining when the athlete should return to activity; attending practice sessions and game; working closely with the athletic trainer

relationship between the sports medicine team and the athlete

primary concern should be the athlete- all individuals must work cooperatively in the best interest of the athlete, coach should defer to the medical staff and support decisions regarding the health care of the athlete; close communication between all parties involved is critical; athlete should be well informed- coach and athletic training must make a point of educating the student athlete about injury prevention and management

components of the preparticipation screening

medical history, cardiovascular, nervous system, general medical conditions, respiratory system, gastrointestinal and urogenital, dermatological, musculoskeletal, mental health

emergency action plan

everyone involved should know their role; should be developed for accessing the emergency medical system and subsequent transportation of an injured athlete to the emergency care facility; meetings should be scheduled periodically with EMS; should be reviewed by administrators and revised on a regular bases; primary concern is to maintain the functioning of the cardiovascular and central nervous system

record keeping

critical responsibility of a health care program; necessary for accurate and timely assessment and evaluation of practices; documentation of all practices to ensure that responsibilities and expectations are being met

purpose of preparticipation screening

identify athletes that may be at risk, establish a baseline to which comparisons may be made following injury ImPACT; medical history should be completed prior; physical exam, maturity assessment, orthopedic screening, sports disqualification; cannot release record without written consent

liability

being legally responsible for the harm one causes another person

negligence

failure to use ordinary or reasonable care; tort based on the establishment of these 4 elements- 1. duty to provide care, 2. breach of duty, 3. harm occurred, 4. breach caused the harm; athletic trainers employed by public schools or state funded colleges may be protected by the legal doctrine of sovereign immunity- neither the government nor any employees can be held liable for negligence

torts

legal wrongs committed against a person or property of another; may emanate from nonfeasance- failing to perform a legal duty, malfeasance- individual committing an act that is not theirs to perform, misfeasance- individual improperly does something that they have the legal right to do or administrating treatment incorrectly

assuming care of injured athletes- legal obligations

once athletic trainers assume the duty of caring for an athlete, they are obligated to provide appropriate care; good samaritan law- provides limited protection against legal liability to any individual who voluntarily chose to provide care

statutes of limitations

sets a specific length of time an individual can sue for damages resulting from negligence

assumption of risk

athlete is aware of inherent risks involved in participating in an activity and voluntarily chooses to be exposed to those risks, expressed in the form of a waiver by the athlete or their parent; does not excuse those in charge of activities from exhibiting reasonable care and prudence in regard to conduct of activities or foreseeing potential hazards

waiver

document that expresses the assumption of risk athlete has while playing a sport; can be implied from the athlete’s conduct, can be used as defense against the athlete’s negligence suit, subject to various interpretations, courts will determine whether assumptions by minors are reasonable

product liability

manufacturers of all types of athletic and fitness equipment are obligated to design and produce equipment that will not cause injury; manufacturers will not be held liable if products were inappropriately used by consumers; equipment warning labels inform athletes of possible dangers inherent with product use, athletes are to sign a form indicating they have understood the warning; National Operating Committee on Standards for Athletic Equipment (NOCSAE)

health insurance

contract between an insurance company and a policyholder; insurance company agrees to reimburse a portion of the total medical bill after some deductible has been paid by the policyholder

managed care

costs of health care are monitored closely by insurance carriers

affordable care act

mandated the availability of affordable health care insurance for every american, 2010

tax act

individuals or families in america are no longer obligated to purchase health insurance under federal law

secondary insurance

covers an athlete’s remaining medical bills once their personal insurance company has made its payment; includes a deductible that will not be covered by the plan; some institutions offer insurance coverage in which all medical expenses are paid for by the athletic department

SAID principle

specific adaptations to imposed demands; indicates that the body will gradually adapt to overcome the specific demands imposed on it; principles of conditioning are warm up/cool down, motivation, overload, consistency, progression, intensity, specificity and individuality, stress, safety

warm up

precaution against unnecessary musculoskeletal injuries and muscle soreness; may enhance certain aspects of performance; prepares the body psychologically for some upcoming physical work; stimulates the cardiorespiratory system to a moderate degree, enhancing blood circulation and blood flow to working skeletal muscles and increasing muscle temperature; increases metabolic processes, core temperature, and muscle elasticity; should begin with 2-3 min of slow walking, light jogging, or cycling to increase metabolism and warm up the muscles; dynamic warm up- continuous movement using hopping, skipping, and bounding activities with several different footwork drills and patterns

muscular contractions

muscle doing the contraction- agonist, muscle going against the contraction- antagonist

isometric contraction

no length change of the muscle occurs during contraction

concentric contraction

shortening of the muscle with contraction in an effort to overcome or move some resistance

eccentric contractions

lengthening of the muscle with contraction because the resistance is greater than the muscular force being produced

functionality- functional strength training

technique used to improve muscular strength and neuromuscular control; involves tri-planar activities designed to challenge the whole body- requires the central nervous system to integrate proprioceptive information from multiple muscles to produce a specific movement pattern; uses integrated exercises designed to improve functional movement patterns in terms of both increased strength and improved neuromuscular control

NOCSAE protective sports equipment

national operating committee on standard for athletic equipment has standards for equipment to reduce head injuries; this label does not warranty helmets- only indicates that the helmet met the requirements when manufactured or reconditioned

liability of manufacturer of protective sports equipment

if an injury occurs as the result of an athlete using apiece of equipment and if that piece of equipment is determined to be defective or inadequate for its intended purpose, the manufacturer is considered liable; if an equipment is modified and the athlete who was wearing it is injured, the modifier and the employing institution become liable

head protection

NOCSAE has developed standards for football helmet certification, must protect athletes against concussive forces that may injure the brain, all helmets must have a NOCSAE certification, while helmets must be certified they may not always be fall safe; each helmet must have a visible exterior warning label

football helmet

have air-filled pockets to absorb the forces of impact; test helmet technology attempts to minimize the impact forces transmitted to an athlete’s head by having a shell that flexes at specific points; riddell speedflex incorporates five accelerometers (measure force of hits)

hemlet fitting

athletes must routinely check for proper fit, especially in the first few days that it is worn; with change in altitude, fit of air bladder helmets must be rechecked; chin straps- ensure proper head and helmet relationship (2 snap and 4 snap straps); jaw pads are essential to prevent lateral rocking

ice hockey helmets

have undergone extensive testing in an effort to upgrade and standardize; must withstand high-velocity impacts (being hit with a stick or puck) and the high mass-low velocity impacts produced by running into the boards or falling on the ice; helmets must be able to disperse force over a large area and decelerate forces that would act on the head through an energy-absorbing liner; all helmets that athletes wear must be approved by the Canadian Standards Association (CSA)

baseball/softball batting helmets

must withstand high velocity impacts; research has indicated that these helmets do little to dissipate the energy of the ball during impact- possible solution would be to add external padding or to improve the helmet’s suspension; each on deck batter and runner is required to wear a baseball/softball head protector that carries a NOCSAE stamp similar to football helmets

cycling helmets

designed to protect the head during one single impact

lacrosse helmet

required for male lacrosse players, females must wear protective eyeguard; made of hard plastic with wire mesh cage or face mask to protect the front of the face; face mask must have a center bar running from top to bottom to absorb repeated impact from a hard high velocity projectile; use a four point buckling system to keep helmet in place and ensure better fit

face protection

for high school hockey players, helmets should be equipped with commercial plastic coated wire mesh guards that meet the Hockey Equipment Certification Council and the American Society for Testing Materials; openings in the guard must be small enough to prevent a hockey stick from penetrating; throat protection- laryngotracheal injuries can be fatal- baseball catchers, lacrosse goalies, and ice hockey goalies at highest risk- throat protection should be mandatory

mouth guards

most dental injuries can be minimized with appropriate customized intraoral mouth guards; should fit tightly and comfortably and not impede speech or breathing; ready made stock varieties, commercial (formed after being put in boiling water), custom-fabricated (form over a mold made from an impression of the athlete’s maxillary arch)

ear guards

wrestling, water polo, and boxing can cause deformity to the ears

eye protection

glasses- properly fitted and designed for protection and withstanding rigors of the sport, polycarbonate lenses; contact lenses; eye guards necessary in sports that use fast moving projectiles and implements

socks- footwear protective equipment

poorly fitted socks can cause excessive pressure to the toes; socks that are too long can cause skin irritations and blisters because of wrinkles; should be clean, dry, and without holes, consider the material

footwear protective equipment

should be plenty of room for the toes in the fitness shoe; sole of the shoes should possess a shock-absorptive function and it must be durable, must provide good traction, be made of a tough material, and be resistant to wear

shoe fitting- footwear protective equipment

measuring both feet is imperative as there will be slight differences in the shape and size of the feet; athlete should approximate the conditions under which they will perform in order to fit the sports shoe to wear; should be snug but allow ample movement of the foot and toes during performance conditions; consider stiffness of the sole and the width of the shank or narrowest part of sole

orthotics- footwear protective equipment

device for correcting biomechanical problems that exist in the foot that can potentially cause an injury; some athletes need orthotics that are custom made by a physician, podiatrist, athletic trainer, or physical therapist

heel cups- footwear protective equipment

used for a variety of conditions including plantar fasciitis, heel spur, achilles tendonitis, heel bursitis; used to help compress fat pad under the heel providing more cushioning during weight bearing activities

considering the sport or activity- footwear protective equipment

outdoor distance running, strength training, agility training, sport specific footwear, unique sports needs like ultra endurance, obstacle course

primary survey

life threatening injuries take precedence over other injuries sustained; includes cardiopulmonary resuscitation, profuse bleeding, shock; rescue squad should always be contacted

secondary survey

surveys the entire body for injury; conducted if the athlete has no life-threatening injuries; vital signs- important to identify if one or more are not normal

sudden cardiac arrest- emergency CPR- primary survey

individuals associated with competitive or recreational sports program should be certified in CPR, AED, and first aid by the American Heart Association, American Red Cross, or National Safety Council; good samaritan laws; duty to act for coaches, fitness professionals, and others responsible for the athlete

unconscious- primary survey

state of insensibility characterized by lack of conscious awareness; always to be considered to have a life threatening injury that requires immediate primary survey; note body position and level of consciousness; circulation, airway, breathing; injuries to neck and spine; protective equipment removed to expose airway; in absense of breathing put in supine position and CPR; secondary survey begins when stabilized

controlling bleeding- primary survey

hemorrhage- abnormal discharge of blood; arterial flow is bright red; direct pressure, elevation, pressure points; internal hemorrhage- danger lies in difficulty of diagnosis, bleeding within skull, thorax, or abdomen may be life threatening; hospitalizations and observation by medical staff is highly recommended; severe cases may lead to shock

shock- primary survey

occurs when a diminished amount of blood is available to the circulatory system; results in a lack of oxygen carrying blood cells, which causes widespread tissue death- may lead to death of person if left untreated

signs and symptoms of shock- primary survey

moist, pale, clammy skin; weak and rapid pulse; increased and shallow respiratory rate; decreased blood pressure; urinary retention and fecal incontinence in severe cases; disintrest in surroundings, irritability, restlessness, excitement; extreme thirts

shock management- primary survey

dial 911, maintain core body temp, elevate feet and legs 8-12 inches above heart; positioning may need to be modified based on injury

first part of rehab process- isometric exercises

performed in the early phase of rehab when a joint is immobilized for a period of time; an alternative for cases in which use of resistance training through full ROM could make the injury worse; increase static strength, assist in decreasing the amount of atrophy, and reduce swelling

second part of rehab process- progressive resistance exercises

can be performed using a variety of equipment; utilizes isotonic contractions to generate force against resistance while the muscle changes length; concentric and eccentric strengthening exercises should be used

third part of rehab process- isokinetic exercises

incorporated in the later phase of the rehab program; use fixed speed with accommodating resistance to provide maximal resistance through ROM; speed of movement can be altered; isokinetic measures are used as criteria in making decisions for athlete’s return to functional activity following injury

fourth part of rehab process- plyometric exercises

incorporated into the later stages of rehab program; use a quick stretch of muscle to facilitate a subsequent concentric contraction; useful in restoring or developing an athlete’s ability to produce dynamic movements associated with muscular power; rapid generation of force is key to successful performance in many sports activities

recovery length factors on the psychology of an injured athlete

longer and more difficult period of rehab leads to negative psychological response to injury; physical factors- injury severity, healing rate, overall health; psychological factors- motivation, fear of reinjury, confidence level; social factors- family support, teammate support, coach support

personality and injury risk

psychological traits may predispose an athlete to repeated injury- athletes could be risk takers, reserved, detached, tender-minded players, apprehensive, over protective, easily detached; some may become more aggressive to reduce anxiety leaving them at a higher injury risk; some may be continuing to be injured because of fear of failure

predictors of injury

injury prediction is psychological and physical- athletes under stress emotionally are more prone to injury than those who are adjusted emotionally; ex- angry athlete may take their frustrations out on other players and then lose perspective on desirable and approved conduct

goal setting

effective motivators for compliance to rehab of an athletic injury as well as for reaching goals in general sports setting; athletes set goals since their first competition, usually starting at an early age; athletes should be aware of the goal and have a sense that it can be met; goals should be a joint venture between athlete and coach to be successful; feeling of social support and self efficacy important

fractures

result of extreme stresses placed on bones; open fracture, closed fracture; long bones can be stressed by tension, compression, bending, torsion, and shear

stress fractures

result from overuse; occur in weight bearing bones of leg and foot; treat with stopping activity for 14 days

sprains

damage to a ligament or joint capsule that provides support to a joint; grade 1 is stretching and some separation, grade 2 is some tearing and separating; grade 3 is total tear; long term healing process for grade 3

strains

a stretch, tear, or sip in the muscle or its tendon; grade 1 is some fibers were stretched or torn, grade 2 is a number of fibers have been torn and muscle contraction is painful, grade 3 is complete rupture of a muscle has occurred in the area of the muscle belly at the tendinous attachment to bone with significant impairment or total loss of movement and intense pain initially thaat quickly diminishes due to nerve damage

fracture healing

involves osteoblasts that lay down extra bone formation (callus) over the fracture site during the immobilization period and osteoclasts that reshape the bone in response to normally applied stresses and strains once the cast is removed; normal stresses and strains aid the bone in the process of healing and regaining tensile strength

treatment of stress fractures

stress fractures do not show up on xrays until osteoblasts begin laying down bone; if suspected, the athlete should suspend the activity for 14 days and return to activity should be gradual, stress fractures usually do not require casting

treatment of sprains

rehab- long term process for grade 3 sprains if surgery is involved; restoration of joint stability is difficult with grade 1 and 2 sprains- stretched or partially torn ligament results in formation of inelastic scar tissue, preventing the ligament from regaining its original tension, structures around the joint should be strengthened, increased muscle tension provided by strength training can improve joint stability

treatment of strains

grade 3 strains involving large tendons that produce great amounts of force must be surgically repaired; regardless of severity, rehab is a lengthy process; returning to activity too soon may result in reinjury

inflammatory response phase of healing process- first step

begins immediately following injury; most critical phase of the healing process; phagocytic cells clean up the mess created by injury- release chemicals to facilitate healing; characterized symptomatically by redness, swelling, tenderness, increased temp, and loss of function; lasts 2-4 days after

fibroblastic repair phase of healing process- second step

proliferative and regenerative activity leading to a scar formation and repair of the injured tissue occurs; begins within the first few hours following injury and lasts 4-6 weeks; many of the signs and symptoms associated with inflammatory response subside

maturation-remodeling phase of healing process- third step

long term process- involves the realignment of scar tissue according to tensile forces acting on the tissue; collagen fibers that make up the scar realign to the position of maximum efficiency parallel to lines of tension; tissue gradually resumes normal appearance and function; after about 3 weeks a firm strong contracted nonvascular scar tissue exists; maturation may take several years to be totally complete

risk factors for complications with injury recovery

growth plate injuries- growth plates are weak in children, damage can change bone growth; overtraining- chronic fatigue, performance decline, increased injury rate; early specialization- year round participation in one sport causes burn out and overuse injuries

components of injury prevention

proper physical and psychological coordination, conditioning, using appropriate safety equipment, creating a safe playing environment, providing adequate adult supervision, enforcing safety rules in any sports program, preparticipation physical exam