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Sports Medicine
Prevention, assessment, treatment and rehabilitation of injuries sustained in athletic events
SIQ: How are sports injuries classified and managed?
Ways to classify Sports Injuries
Soft Tissue Injuries
Hard Tissue Injuries
Assessment of Injuries
SDP: Ways to classify Sports Injuries
Direct and Indirect
Soft and Hard Tissue
Overuse
Direct Injuries
External force is applied to the body causing injury. Example, cricket batsman developing a contusion on the shoulder by being struck on the arm by the ball
Indirect Injuries
Caused by an internal force in the body. Example, soccer player straining ankle
Soft Tissue Injuries
Occur in muscles, tendons, ligaments as well as the skin. Example, Sprinter strains their hamstring in push-off
Hard Tissue Injuries
Injuries to bones and teeth. Example, boxer breaks teeth in match
Overuse Injuries
Caused by repetitive stress or strain on the body. Occur over time. Example, Tennis player develops tendinitis in elbow from too many backhands
SDP: Soft Tissue Injuries
Tears, sprains contusions
Skin abraisions, lacerations, blisters
Inflammatory response
(SLT: Management)
Tear
Damage to a muscle or tendon caused by over-stretching of the muscle fibres, causing some or all of these fibres to tear
Strain
Aka tear, when muscle fibres/tendons fail to cope with demands placed on them
Sprain
Damage to ligament (holds muscle to bone)
Contusion
Caused by a collision with another person or object; causes local muscle damage and bleeding
Abrasion
Occurs when surface layers of skin have been broken
Laceration
Causes damage to skin and underlying tissue
Blister
Outer layers of skin are separated due to excessive friction- causes pocket of fluid
Inflammatory Response
A natural response immediately following tissue damage. Blood rushes to the site, causing redness and swelling (Oedema), heat and reduced function. Often excessive and slows the healing process, without RICER, collagen replaces the damaged tissue, and scar tissue produced which is bulky and limits future movement and strength.
Management of Soft Tissue Injuries
RICER - Rest, Ice, Compression, Elevation, Referral - Used in the first 48-72 hours after an injury
SDP: Hard Tissue Injuries
Fractures and Dislocations (SLT: Management)
Fracture
Crack, chip or break in the bone. Common in young children as their bones are still growing and can bend easier. All fractures require DRSABCD and RICER if soft tissue is injured
Simple fracture
Bone is broken but does not pierce skin.
Compound fracture
Bone is broken and breaks surface of skin.
Complicated fracture
Bone is broken and causes internal damage.
Management of fracture
- Control bleeding
-Identify type of fracture
-Immobilise with broad bandages
-Ensure bandages do not cut of circulation
-Call medical assistance
Tooth Injury management
-Locate tooth
-Rinse in person's saliva/milk
-Reinsert tooth holding the crown of the tooth, or --Store in milk until reaching a dentist
Dislocation
-Bone has been removed from its joint structure.
-Symptoms include pain, swelling, limited movement, deformity, bruising
Subluxation
A dislocation that immediately realigns itself, 'popping in and out' a joint
Management of dislocation
-Support in comfortable position
-Do not attempt to relocate
-Sling dislocation
-Apply RICER to reduce swelling if possible
-Seek medical advice
Management of Hard Tissue Injuries
Immobilise the joint using a bandage and splint/sling to prevent further movement that could cause injury.
Medical attention
SDP: Assessment of Injuries
TOTAPS - Talk, Observe, Touch, Active Movement, Passive Movement, Skills Test
SIQ: How does sports medicine address the demands of specific athletes?
Children and young athletes
Adult and aged athletes
Female Athletes
SDP: Children and Young Athletes (MORT)
Medical Conditions (Asthma, Diabetes, Epilepsy)
Overuse Injuries
Thermoregulation
Resistance Training
Medical conditions (children/young athletes)
- Asthma
- Diabetes
- Epilepsy
Asthma (children/young athletes)
- chronic inflammatory condition of the airways in which the bronchioles contract and restrict oxygen intake
- shouldn't be an excuse for participation
- coughing and wheezing (signs)
- exercise is beneficial (swimming is best)
- measures: first aid action plan warm up/cool down, steady intensity, medication, adequate water
4x4x4
Diabetes (children/young athletes)
- Body does not produce or properly use insulin
- Don't stop playing sport
- Exercises assists in managing condition
- Diet = well balanced (complex carbs significant amount)
- Ensure their are plenty of breaks for eating and monitoring blood levels
-Hypoglycaemia- worse than hyperglycaemia
Epilepsy (children/young athletes)
- Disruption to brain function, causing a brief alteration to the level of consciousness and resulting in seizures or fits
- Shouldn't stop participation in sport/ activity
- Get assessed by doctor before enrolling
- Seizures occur on a daily or weekly basis, collision and water sports should be avoided
- Players, parents or supervisors should be present and know what to do if a seizure occurs
Overuse injuries (children/young athletes)
- Repeated use of body e.g. stress fractures (skin splints)
- Common causes - high training volume, intensity and frequency, inadequate warm ups, poor technique
- Have days of non-training and monitor volume and intensity (to avoid)
-Allow recovery time
-Use different muscles
-Cross training
-Warm up and cool down
Thermoregulation (children/young athletes)
- Balancing of heat loss with heat gain is managed through this
- Children are at risk from environmental stress (less ability to loose heat through evaporation)
- Children's acclimatisation to heat is slower (increase possibility for dehydration)
- Higher chance of developing hyperthermia from exposure to cold
-No exercise in 34 degrees+
-Provide adequate rest breaks
Appropriateness of resistance training (children/young athletes)
- Strength training is an integral part of overall program to improve skill and fitness
- Low resistance, high reps though full range of movement
- Strength specialisation is avoided - may lead to imbalance between muscle groups and contribute to injury
-Must be supervised
Must not start until after puberty- can stunt growth
tailored to individual
SDP: Adults and Aged Athletes (HFF)
-Heart Conditions
-Fractures/bone density
-Flexibility/joint mobility
Heart Conditions (Adults and Aged Athletes)
CV system becomes less efficient and its ability to pump blood is reduced
Recommendations:
Lower intensity exercise
Always warm up and cool down
Allow plenty of rest/recovery time
Discourage holding breath in activities
Alternate workout days
Low-medium intensity
Fractures/Bone Density (Adults and Aged Athletes)
Bones become brittle with age and changes in Oestrogen in women.
Avoid high impact/contact sports.
Weight bearing activities should be encouraged.
Osteoporosis: extreme bone frailty- people with this should seek medical advice before starting exercise regime
Flexibility/Joint Mobility (Adults and Aged Athletes)
Ligaments, Tendons and Muscles lose elasticity as people get older.
Sedentary lifestyle causes cartilage to shrink and stiffen
Exercise increases fast twitch muscle fibres, which improves reaction time so falls are less likely
They should focus on flexibility.
Activities (Pilates, Yoga) are recommended.
SDP: Female athletes (PEIB)
Eating disorders
Iron deficiency
Bone density
Pregnancy
Eating disorders (female athletes)
- Low body fat and idealised body shape and size are expected. E.g. gymnastics, dance.
- Twice the risk of developing eating disorders, which may result from, Peer influence, Social expectation
- Implications: Trainers and coaches can - Be better educated to detect signs of eating disorders, monitor diet, Engage parents in training schedule and diets
Health risks of eating disorders
Loss of energy, weak bones, abnormal heart beat, dehydration, starvarvation
Iron deficiency (female athletes)
- Causes anaemia (low haemoglobin) which reduces number of red blood cells limiting oxygen
- Reasons:
Females consume less red meat
Menstruation
Intense training (endurance events)
- Implications:
Supplementation not necessary for all athletes however iron levels need to be monitored
High iron levels can cause liver disease, diabetes and heart problems
Bone density (female athletes)
- Quality of calcium in bones
- Low calcium in bones = fractures and structural weakening
- Regulated by parathyroid gland - controls the level of calcium stored and what is released
- Following menopause women loose calcium faster
- Well balance diet with adequate calcium (milk, cheese)
Pregnancy (female athletes)
- Exercise in the cool of the day
- Consume adequate water - avoid thermal stress which can affect foetal development
- Sustained moderate exercise has considerable benefits;
Maintain fitness and general wellbeing
Weight control
Improve muscle tone
SIQ: What role do preventative actions play in enhancing the well-being of the athlete?
Physical preparation
Sports policy and the sports environment
Environmental considerations
Taping and Bandaging
SDP: Physical preparation (PSPW)
Pre-screening
Skill and technique
Physical fitness
Warm up, stretching, cool down
Pre-screening
-Preventative measure to perform prior determining athletes fitness and medical history
-Provides starting point for exercise
-Consider age, gender, health, previous experience
-Risk factors for those: overweight, diabetes, pregnancy, high blood pressure
Skill and technique
-Lack skill/poor technique restrict opportunities
-Lead to increase risk of injury
-Responsibility on coaches to ensure competent basic skill and self protection
Physical fitness
- Enhances wellbeing which ensures level of physical fitness is attained
- Has a range of elements and quantity required depends on the sport e.g. more cardio than strength
- Major contributing factor to injury
- Ensures energy supplies are adequate and body systems are able to meet the demands
Warm up
- Prevent injury
- Geared to the demands of the sport
- Time taken varies - endurance sports have a longer warm up
- Causes redistribution in blood flow
- Increase the ability of the muscle to stretch without tearing
- Reflexes improve
Stretching (static, PNF)
- 4 to 5 times a week
- Stretched passed the range required
- Static - gradually stretched beyond normal range (Hold 30 secs)
- PNF - performed with a partner. Isometric contraction (push against) then relax
- Must be specific to the sport
- Greater demand = more stretching
Cool down
- Recovery
- Body temp, circulation and respiratory rates return to pre-exercise state
- Maintain the stretch in muscle groups
- Disperse lactic acid
- Prevent blood pooling
- Involves; stretching, performing callisthenics and gross motor activities (light jog, swim)
- Not intense and short
SDP: Sports policy and the sports environment
- Rules of sports environment
- Modified rules for children
- Matching of opponents (growth and development, skills level)
- Use of protective equipment
- Safe grounds, equipment and facilities
Rules of sports environment
Set guidelines for safe conduct of sport. Sticking to rules is essential to prevent injury
Modified rules for children
Many sports have been modified to meet specific needs of children. Modification applies to equipment, field size, time, rules
Matching of opponents (growth and development, skills level)
Most junior competition run on ages decision however maturity level can differ and size and strength. Considerations should be given to size, age, gender, strength, psychological development and skill level
Use of protective equipment
Equipment must protect desired areas, allow movement, be comfortable EG mouth guards, helmets, gloves and padding
Safe grounds, equipment and facilities
Clubs must provide safe fields, equipment and facilities that suit players, crowds. Fencing of area to keep unwanted visitors out etc
SDP: Environmental considerations
- Temperature regulation (convection, radiation, conduction, evaporation)
- Climatic conditions (temp, humidity. wind, rain, altitude, pollution)
- Guidelines for fluid intake
- Acclimatisation
SDP: Temperature Regulation (CRCE)
Convection, radiation, conduction, evaporation
Convection
The process of air moving across the skin's surface
Radiation
The transfer of heat to and from the atmosphere (e.g. the skin surface will warm the air surrounding the body, causing the net effect of heat loss from the body)
Evaporation
The loss of heat from the body via sweating. The airflow over the fluid on the surface of the skin causes accelerated heat loss from the body into the surrounding air.
Conduction
The transfer of heat to and from the skin via direct contact with an object (eg ice pack)
SDP: Climatic conditions
Temperature
Humidity
Wind
Rain
Altitude
Pollution
SLT: Analyse effect of temp on sport participation
Low ambient temp increase the risk of lowering athletes core temp --> hypothermia
Need effective warm up, clothing, acclimatise appropriately.
SLT: Analyse effect of Humidity on sport participation
Put athlete at risk of dehydration, and hyperthermia. Cause fatigue, dizziness and lack of coordination. Inhibits ability to cool down using evaporation.
Increase fluid intake, clothing, regular rest breaks, shade.
SLT: Analyse effect of altitude on sport participation
Air is thinner higher up you go, less O2 for the lungs to extract and use for muscle performance.
Spend a number of weeks training at high altitude prior to competition to acclimatise adequately.
SLT: Analyse effect of rain on sport participation
In warm weather, may help the body to disperse heat and lower temperature. In cold weather, increase heat loss from body increasing the risk of hypothermia. Slippery playing surface --> injury, collisions, falls, loss of control on equipment.
SLT: Analyse effect of pollution on sport participation
Decrease efficiency (ability to) breathe, reducing the body's ability to oxygenate blood. Symptoms: wheezing, coughing, watery eyes and feeling of restriction.
Guidelines for fluid intake
During sport: 200-300mL every 15-20mins of exercise in warm weather. An adult male athletes exercising in warm weather should drink approx 3 L of water per day to maintain hydration.
Weigh yourself before and after, weight loss = amount of water you should drink.
Be careful not to over hydrate (hyponatraemia: low blood sodium levels)
Acclimatisation
The process of preparing the athlete's body for optimal performance in the climatic conditions that will be experienced during the event. Achieve this by training in these conditions in the months/weeks leading up to the event, allowing the body to adapt to function at its peak.
SDP: Taping and Bandaging
Preventative Taping
Taping for Isolation of injury
Bandaging for immediate treatment of injury
Taping
Supports joint structure or muscles and gives player confidence in mobility
Preventative taping
Usually used in proffessional sports that put a lot of strain on joints, eg AFL
Taping occurs to prevent injury- gives confidence
can cause reliance on tape and restrict motion
Isolation of Injury
Gives support during condition whist in rehabilitation, and return to play
Prevents further injury, eg taping fingers, but does not prevent injury as a whole
Bandaging for immediate injury
Compression bandages used in Ricer and Immobilisation bandaging used in HT Injuries
Reduces severity
minimises inflammatory response and provides support
SIQ: How is injury rehabilitation managed?
Rehabilitation procedures
Return to Play
SDP: Rehabilitation procedures
To regain physical fitness to a pre-injury level. Includes
Progressive mobilisation
Graduated exercise
Training
Use of heat and cold
Progressive Mobilisation
As soon as the acute swelling phase is over and pain is reduced, athlete should attempt to slowly move injury
This can be done actively or passively
TO reduce build up of scar tissue, which will restrict future movement
Stretching (Graduated Exercise)
Start with static stretch to begin to improve flexibiity around the joint, before progressing to PNFwhich will help speed up the recovery process
Conditioning (Graduated Exercise)
Start with calisthenics and isometric contractions
progressively overload
Strengthens joint to initiate a return to maximum strength
Total Body FItness (Graduated Exercise)
Important to maintain other ares of fitness both skill and health related
Involves cross-traing that does not compromise rehabilitation
Training
Should progressively increase demands onon injured tissue
AIm is to achieve pre-injury fitness levels and skill
Athletes sould be pain free before returning to play
Use of heat and cold
RICER should be used immediately, with ice to reduce inflammatory response. After first 72 hours, heat should be used to alleviate pain and increase blood flow, which will get rid of any damaged cells and decrease scar tissue
SDP: Return to play
Involves specific physical, psychological and ethical considerations. Should prioritise player's welfare
- Indicators of readiness for return to play
- Monitoring progress
- Psychological readiness
- Specific warm-up procedures
- return to play policies and procedures
- Ethical considerations
Indicators of readiness
If rehabilitated correctly, injury should have normal function
This means pain free and having full range of motion
Monitor progress
Progress should be monitored through tests, which should be compared to pre-season fitness.
These tests should be sport specific and place demand on injured joint similar to the demand placed on it by the sport
Psychologocal Readiness
Athletes can lose confidence due to being away from competition
Supporting damaged tissue can improve confidence via taping
Athlete should play lower-grade games or be on reserve until confidence is restored or they could be a danger to themselves and others
Specific Warm Up
Developed to achieve full recovery and minimise further re-injury
Should target injured muscles and joints
should develop from static to PNF and dynamic
promotes flexibility at joint
Return to play policy and procedures
Should prioritise player welfare
Dictate when player can return to play
E.g Concussion guidelines say player can return under any circumstances, even if they pass the SCAT test
All medical examinations should be done by a doctor independent of the game's bias
Ethical Considerations
Athletes have lots of pressure to participate, and often want to return before recovered
This can cause further injury, which may be life-threatening
Therefore athlete must be pain free and have full motion
Painkillers are unethical, and should not be used to cheat the pain-free rule, as it subdues the nerves
Coaches and organisations should not pressure their athlete to return when injured.