AthT 267 Exam 2

national operating committee on standards for athletic equipment

NOSCAE; Organization which establishes minimum safety requirements

Safety equipment institute(SEI)

oversees certification of athletic equipment
Statement on helmets which states that the helmet met the requirements of the manufacturer

If an athlete is injured and it is determined that defective or inadequate equipment was responsible

manufacturer is responsible

If an athletic trainer, coach, or athlete modifies the equipment and injury results

manufacturer has no liability

HECC:

hockey equipment certification council

NAERA

national athletic equipment reconditioning association

CSA

canadain safety administration

Head protection

helmets(FB, BSB/SB, ice hockey, lacrosse, skiing)

Helmets

To absorb/distribute force:
Fluid (or air) filled bladders inside composite material shell

Revolutionary changes

Computer designed helmet that extends further past the jaw for additional protection and stability
The distance between the helmet and head has been increased
Padding inflates to fit the players head shape
The face guard system has isolated attachment points from the shell, reducing jarring from low-level impacts to the face guard

Face protection

FB: no less than 2 bars of the facemask

Mouth guard:

Should not alter mouth guards a the negates the warranty
Stock, boil, and bite and custom molded
NCAA sports that require mouthguards?
Football - mandates a color
Hockey
Lacrosse

Shoulder:

shoulder pads
Flat vs cantilevered
Epaulet

Breast support

sports bra
Coopers ligament

thorax/rib

flax jacket

hip/butt

pad, girdle

Groin:

cup

Socks

Prevent blisters, athletes foot

Shoes

a shoe should bend where the foot bends
Toe box, arch support, sole, heel counter, upper
Replace after 300-500 miles
Lasts

Ankle braces

Lace up
Semirigid stirrup
Rigid support

Knee braces

3 types: Protective, Functional, Rehabilitative

protective knee brace

prevent knee injuries

functional knee brace

during the rehab process or for use during an injury to continue to play
Neoprene sleeves with and without hinges

rehabilitative knee brace

used following surgical repair or LT injury, used to restrict ROM

Upper extremity- elbow, wrist, hand

Protective gloves
Neoprene sleeves
Hinged braces
Elbow pads

Soft materials:

felt, foam, moleskin, viscoelastic/gel pads

Nonyielding materials:

thermomoldable (orthoplast), casting

Primary concern

maintain cardiovascular function, respiratory function and central nervous system function (consciousness)

Initial evaluation/primary survey- ABCs

Performed quickly and accurately
May determine the degree and extent of permanent disability- assess for life-threatening concerns

Secondary evaluation/secondary survey

Closer look at the injury after life threatening issues are ruled out
Assess vital signs
True injury evaluation

Primary survey

responsiveness-AVPU(alert(with you), verbal (are you okay-response), painful(sternal rub or pinch of trap response), unresponsive)
ABCs
Bleeding
Shock

Unconscious athletes

Primary survey
Always suspect neck or c-spine injury
facemask/equipment removal?
Transportation?
Need to move patient?
Once stabilized-begin secondary assessment

Always suspect neck or c-spine injury

Stabilize c-spine(grab underneath them and grab traps)
How are you going ot access their airway?
supine/breathing(the best case scenario) vs prone/breathing(dont have access to their airway) vs prone/not breathing

facemask/equipment removal

If transport- need to take off ALL equipment bc some places dont have the equipment or knowledge of how to remove it

Need to move patient?

Hazards (fire, explosion, scene safety)
Cannot provide medical care at current position

Secondary survey

Vital signs
Medical history questions
Musculoskeletal evaluation
Systematic screening from head to toe
Look for signs and symptoms throughout the body comparing one side to the other
Continue to monitor patients condition. It may worsen.

Vital signs

LOC(level/loss of consciousness)
Pulse
Respiration
Blood pressure
Body temperature
Skin color
Normal, grey, red(heat stroke), pale, cyanosis(cant breath)
Pupils
Dilated, constricted?
Neurological response

Systematic screening from head to toe

Ask for consent and describe what you are going to do

Look for signs and symptoms throughout the body comparing one side to the other

Pain in a particular area
Bleeding or other wounds
An area that is swollen or deformed from its usual appearance

Decision making

Seriousness of injury
First aid techniques
transportation : sidelines, athletic training clinic, hospital
How are you going to get them off the field/court?
Spine boarding?
Ambulation?
Immobilized?

Ambulation

If laying down, prone to supine to sitting, wait, then standing(dont let athletes stand up right away)

ambulation techniques

Manual conveyance: move injured athlete to another area
2 set carry, walking assist
rickshaw/sports chair
Crutches
Gator

Crutch fitting:

Standing with feet close together
Place tip 6" away from outer margin of shoe(up) and 2" in front of the shoe(out)
The underarm is 1" below the axilla and elbow angle should be at 30 degrees

Cane fitting:

Measure superior aspect of greater trochanter of the femur

Walking with the crutches/cane

NWB(non weight bearing), PWB(partial weight bearing), FWB(full weight bearing)
Place crutches 12-15" ahead of the feet, lean forward, pull top of crutch to the body and swing with the uninjured leg between the crutches
Stairs: "up with the good, down with the bad"
Cane: which hand should you hold the cane in?- the uninjured side
Crutch palsy- DONT lead forward on crutches- can cut off nerve supply

Spine boarding

Anytime you suspect a spinal injury, you immediately want to activate EMS
for a spinal injury or an unconscious victim
Usually helpful to have about 4-5 people(8 for larger athletes)
One person is in charge of the head/neck, ensuring for proper alignment (the one with most experience)

Retrieve spine board

Place spine board close to patient
Extremities close to the patient in axial alignment
Each person is responsible for 1 area(shoulders, hips, lower leg)
"Captain" gives command to log roll/lift as 1 unit onto the board
The athlete's head must be stabilized the entire time
Perform specific type of spine boarding technique
Attach athlete to spineboard using straps
Attach cervical collar or for those wearing a helmet or towel

Supine boarding

If supine
Lift and slide technique
Scoop stretcher

Lift and slide:

Studies show to be more effective in restricting motion
Helpful larger athletes or those wearing equipment
Need 3 individuals on each side- 8 total

Other spine boarding techniques:

Scoop stretcher
Vacuum air mattress

Shoulder pad removal

Only remove if the helmet is also being removed- for correct spinal alignment
Cut through the jersey/shirt
Cut through the laces and straps for the shoulder pad
Lift the athlete
Remove the helmet and shoulder pads at the same time
Lower the athlete

Facemask removal
Why?

Access the mouth to perform CPR
NATA recommends that anytime an athlete suffers a spinal/serious head injury, the facemask should be removed if the decision is made to transport them to a hospital

facemark removal equipmentFM extractor

FM extractor
Trainers angels
gardening/pruning shears
Screwdriver

4 types

Pre-participation evaluation
initial/on the field evaluation
Off the field evaluation
Progress evaluation

Off field evaluation

After the patient has been transported off the field
Away from crowd noise, people staring, etc
May be in the athletic training clinic, sideline, physician office, ER
Evaluation to assess/diagnose the current injury illness
Evaluation needs to be organized, reproducible, and comprehensible

HOPS

History
Observation(inspection)
Palpation
Special tests

History

Most important part of the evaluation
If you listen, the athlete will likely tell you what is wrong based on their history answers
MAPPS

MAPPS

Mechanism of injury (MOI)
Acute or chronic
Pain- level, type, location, variation, duration, radiation
Previous injury?
Sounds and sensations- what did they hear, feel?

Other questions?

Medical health history
Are you on any medications?
What have you done to treat this injury/illness?

History cont

Be sure to ask open ended questions- not questions that ask for a yes or no response
Be calm and maintain eye contact
Listen to the patient

Observation

Look at the athlete/patient to visually see if there are any abnormalities
Obvious deformity
Gait- are they limping
Are they willing to move the body part?
Swelling
Ecchymosis
Posture
Muscle atrophy
Redness
Always check bilaterally

Palpation

Always be sure to ask for consent
Assess for:
Point tenderness
Difference in tissue texture
Abnormalities - crepitus, muscle spasm, scar tissue
Start away from the injury- proximal to distal
BLT- bones, ligaments, tendons
Compare bilaterally

Special tests

Used to detect specific pathologies
Rule out ligament sprains
Assess flexibility/range of motion(ROM)
Evaluate strength levels
Assess neurological issues
Circulation
Always compare bilaterally
ROM assessment
muscle strength tests

ROM test

Active, passive, resistive (AROM< PROM, RROM)

muscle strength test

manual muscle test
Objective grade given to muscle strength
0-5
Break test (isometric) vs MMT (isotonic)

Special tests/ stress tests

Determine the extent of the injury
Used to rule out injuries or correctly identify injured structures

Functional testing

Can they return to play?
Running
jumping/hopping
Functional hop test
Throwing
Agility drills

Neurology assessment

Dermatomes
Myotomes
Reflexes

So you have come to a conclusion on the injury, what do you do next?

Document the injury
SOAP note- written documentation of the injury
Subjective(everything patient is telling you, opinion based- history)
Objective(something fact based, observed, O, P, S)
Assessment(diagnosis)
Plan(next steps)
Long term goals
Short term goals
Referrals
Daily treatment
Rehabilitation
Protection- taping/bracing

Progress notes

Daily check in
Reassess ROM, strength
Changes from the last treatment session
Pain better? Worse?
Swelling better? Worse?
Changes in activity?
Did the treatment/exercise help? Worsen the injury?

Acute (traumatic injuries)

One time events
Fractures
Dislocations
Sprains
Contusions
Strains

Chronic (overuse) injuries

Repetitive motions
Tendinitis
Tenosynovitis
Bursitis
Osteoarthritis

Tissue stresses

tension, compression, shearing, torsion, bending

Tension

force that pulls or stretches tissue

Compression:

produced by external loads applied toward one another from opposite directions

shearing

occurs when equal but not directly opposite loads are applied to opposing surfaces, causing these surfaces to move in parallel direction

torsion

twisting in opposite directions from the opposite ends of a structure

bending

occurs when 2 force pairs act at opposite ends of a structure or when 3 forces causes bending

Muscle strains/tears

Damage from a muscle/tendon being overstretched by tension or forced to contract against too much resistance, separation or tearing
grade 1,2,3
are often more debilitating than ligament sprains, especially in large force producing muscles

grade 1 muscle strain/tears

some muscle fibers are stretched, tenderness/pain with AROM, full ROM possible

grade 2 muscle strain/tears

# of muscle fibers have been torn, active contraction of the muscle is painful, depression/divot can be felt at site of tearing, swelling occurs from capillary bleeding, discoloration, decrease ROM due to pain

grade 3 muscle strain/tears

complete rupture of the muscle/tendon, significant impairment/total loss of motion; pain is initially intense, but diminishes due to nerve fiber separation

Muscle cramps

Extremely painful involuntary contractions that occurs in calf, abdomen, hamstrings
Caused by loss of water/electrolytes

Muscle spasm

Reflex reaction caused by trauma
Clonic: alternating involuntary contractions and relaxation in succession
Tonic: rigid contractions that last a period of time

Muscle soreness:

Acute onset: occurs during and immediately after exercise
DOMS: occurs 24-48 hours later

Myofascial trigger point

Hypersensitive nodule found within a taut band of skeletal muscle or fascia
Referred pain seen at a different site

Contusion

Its just a bruise!
Ecchymosis:

Ecchymosis:

discoloration from torn capillaries
Its just the purple color

Myositis ossificans

Calcium deposits grow in the area following repeated blows to the same area
Can build spurs

Tendons:

attach muscle to bone

tendinitis/tendinosis

Inflammation of a tendon
S&S: pain with movement, swelling, warmth, crepitus

Tendinosis:

degeneration of the tendon if the tendon fails to heal/without inflammation

Tenosynovitis

Inflammation of a tendon and its synovial sheath

Ligaments:

connect bone to bone
have a poor blood supply, heal slowly

Ligament sprain

Damage applied to a joint that forces motion beyond its normal limits of movement
grade 1,2,3

grade 1 ligament sprain

stretching a separation of the ligament fibers with mild instability of the joint;mild-moderate pain; localized and swelling and joint stiffness

grade 2 ligament sprain

tearing and separation of the ligament fibers with moderate instability of the joint; moderate-severe pain; swelling

grade 3 ligament sprain

total tearing of the ligament, leading to instability of the joint; severe pain following by little pain; large amount of swelling, very stiff joint

Dislocation

When at least 1 bone in a joint is forced completely out of its normal and proper alignment
Must be put into place/reduced
Often injuries surrounding structures- fracture, ligament ruptures

Subluxation

Similar to dislocation, bone comes partially out of its normal articulation, but goes back into place
Very likely to sublux/dislocate again as the surrounding ligaments/tendon can stretch