PDHPE Notes - Sports Medicine

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Sports Medicine

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61 Terms

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Direct Injury

Tissue damage caused by an external force making contact with the body at the injury site (e.g., bruise from a tackle).

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Indirect Injury

Tissue damage resulting from internal forces such as excessive strain or poor technique without external contact (e.g., hamstring tear).

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Soft Tissue Injury

Damage to muscles, tendons, ligaments, cartilage, skin, or nerves; includes sprains, strains, contusions, abrasions, and blisters.

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Hard Tissue Injury

Damage to bones or teeth such as fractures, dislocations, or lost teeth; usually more serious than soft-tissue injuries.

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Overuse Injury

Chronic injury from repetitive stress with inadequate recovery, producing scar tissue and weakness (e.g., tennis elbow, stress fractures).

  • cause by low impact, repetitive exercise.

  • develop over time - small injuries produce scar tissue and the body doesn’t have enough time to form actual body tissue.

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Sprain

Tear of a ligament (bone-to-bone) usually from an external force being transferred through the body and to the other side of a joint; pain, swelling, bruising, loss of stability.

  • Ligament is stretched beyond its normal movement.

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Strain

Tear of a muscle or tendon caused by internal forces, overtraining or poor technique; pain, swelling, bruising, loss of strength.

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Grade 1 Tear

Small (<5%) fibre tear; slight pain and swelling, no strength loss.

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Grade 2 Tear

Larger but incomplete tear (>50% fibres); significant pain and power loss.

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Grade 3 Tear

Complete muscle or tendon rupture requiring surgery; total loss of function.

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Contusion

Bruise caused by ruptured capillaries and internal bleeding after direct impact; pain, swelling, discoloration.

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Abrasion

Superficial scraping of of wearing away of skin on a rough/hard surface; shallow bleeding and infection risk.

  • Clean wound, wash with disinfectant, cover with non-stick dressing.

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Laceration

Irregular skin tear from sharp impact or contact with a sharp device; high infection risk, may need stitches.

  • Apply pressure, clean wound, apply non-stick dressing.

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Blister

Fluid-filled lesion within epidermis from continuous friction or burning, risk of infection if blister pops.

  • Cover with padding to remove the object causing friction.

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Inflammatory Response

Body’s three-stage reaction (inflammation, proliferation, maturation) to injury for repair and defense.

  • Involves vasodilation, allowing more blood to the area and more fluid to exit the vessels into surrounding tissue.

  • Causes redness, swelling, pain, heat, and loss of function.

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Inflammation Phase

First 24–72 h; vasodilation of blood vessels → swelling, pain, heat, loss of function; fluid removal begins.

  • RICER is important during this time.

  • Often fast and painful.

  • Crucial for removing damaged cells and beginning tissue repair.

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Proliferation Phase

48 h–6 wk; collagen is laid down, granulation tissue forms, swelling and colouring subsides, scar tissue begins to form, greater mobility and function return.

  • Body begins to fix the injured site → white blood cells (leukocytes) clean up debris.

  • Repair tissue fibres are shorter, inelastic, and different in texture - increases risk of recurrence of rupture at this stage.

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Maturation / Remodelling Phase

6 wk–months; scar tissue reorganises, strength and function restored with rehab.

  • Continues to build the injured area - new collagen is synthesised, resulting in the formation of organised and functional scar tissue.

  • Requires rehabilitation programs to fully restore mobility.

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RICER

Immediate soft-tissue management protocol:

  • Rest, Ice, Compression, Elevation, Referral

  • Focused on controlling the inflammatory response and minimising pain → if not managed, the inflammatory response can cause further damage to the area due to increased pressure.

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Rest (RICER)

Cease activity 24–72 h to prevent further damage and restart of inflammation.

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Ice (RICER)

Apply cold 20 min on/off for 48 h to reduce pain, inflammation and speed up recovery.

  • Ice pack, bag of ice, other forms of cryotherapy.

  • Ice causes vasoconstriction of arteries to reduce inflammation - when ice is taken away, vasodilation occurs, allowing new blood to flow through and waste to be removed.

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Compression (RICER)

Firm bandaging 24–72 h to limit swelling and provide support to the injured area.

  • Helps force fluid away from the injured area, reducing inflammation - also reduces movement to limit reinjury.

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Elevation (RICER)

Raise injury above heart to aid fluid drainage and decrease swelling.

  • Complete as much as possible within the first 72 hours.

  • Gravity assists with the removal of fluid and helps move blood back to the heart, reducing the inflammatory response.

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Referral (RICER)

Seek medical assessment and rehab plan to optimise recovery and prevent recurrence.

  • GPs can provide anti-inflammatory drugs to reduce pain and improve recovery.

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Immediate Treatment of Skin Injuries

Primary concern is to prevent infection:

  • Clean wound with soap and water/an antiseptic cream.

  • Cover wound with a non-stick dressing.

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Fracture

Break in the bone; hearing or feeling a break, grating of bone, pain, redness, loss of function, deformity, bone protruding.

  • closed/simple - remains inside the body and does not pierce skin.

  • open/compound - pierces the skin so the bone can be seen.

  • complicated - complete (bone breaks into 2), comminuted (bone breaks in more than 2 parts), incomplete/greenstick (does not break the whole way through)

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Dislocation (Luxation)

Abnormal displacement of a bone at a joint, damaging surrounding soft tissues including sprains and strains; pain at joint, swelling, burising, deformity, tenderness, loss of movement.

  • Caused by excessive force, either direct or indirect.

  • Can technically be considered both hard and soft.

  • Subluxation is when the bone goes back into itself.

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Management of Hard Tissue Injuries

DRSABCD followed by TOTAPS.

  • control bleeding and shock

  • cover wounds

  • check for other injuries

  • keep casualty still

  • reduce pain

  • check for circulation

  • immobilise

  • seek medical attention

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DRSABCD

Primary survey:

  • Danger

  • Response

  • Send for help

  • Airway

  • Breathing

  • CPR

  • Defibrillation.

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STOP Assessment

On-field check:

  • Stop play

  • Talk to athlete

  • Observe injury

  • Prevent further harm

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TOTAPS

Secondary assessment - should be stopped as soon as there is an indication the player should not continue to play.

  • Talk

  • Observe

  • Touch

  • Active movement

  • Passive movement

  • Skills test

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Talk (TOTAPS)

Question athlete about pain, sounds, and mechanism of injury.

  • Where does it hurt?

  • Did you hear a snap or crack?

  • How did it happen?

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Observe (TOTAPS)

Compare limbs for swelling, redness, deformity, bleeding.

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Touch (TOTAPS)

Palpate area to locate pain, heat, swelling, abnormalities.

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Active Movement (TOTAPS)

Athlete moves injured part unaided to gauge range of motion.

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Passive Movement (TOTAPS)

Assessor moves joint to test ligament and tendon stability.

  • Pushing or pulling the joint, moving through full range of motion.

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Skills Test (TOTAPS)

Sport-specific drills to decide if athlete can safely return to play.

  • Specific to sport, progressing from low intensity to more powerful movements.

  • Begin with no equipment then gradually increase.

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Children and Young Adults

  • medical conditions - asthma, diabetes, epilepsy

  • overuse injuries (stress fractures)

  • thermoregulation

  • appropriateness of resistance training

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Asthma

Airway inflammation causing bronchial constriction, limiting airflow into and out of the lungs.

  • Can be exercise induced (EIA) - more likely to be triggered in longer duration activities.

  • Swimming is the preferred form of exercise - moist air.

  • Children should have an Asthma Management Plan developed with a GP, carry a Ventolin puffer, complete a warm-up and cool-down, and use lots of subs or interchanges.

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Diabetes

Type I: Autoimmune absence of insulin production leading to high blood glucose; managed with injections.

Type 2: Insulin inefficiency often from inactivity/poor diet; causes elevated blood glucose and insulin.

  • Glucose is an important source for ATP production - if levels are too low or too high, the child may experience a hypo or hyperglycemic episode.

  • Managed through insulin injections and access to sugary foods.

  • Regular breaks or interchanges may be needed.

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Epilepsy

A group of medical conditions relating to disruption of normal brain activity, resulting in seizures (sudden, uncontrolled bursts of electrical activity in the brain).

  • Collision sports should be avoided if seizures are common.

  • Avoid abseiling, rock climbing, skydiving and surfing.

  • Managed through medication.

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Overuse Injuries (Stress Fracture)

Tiny crack in bone from repetitive loading - results from repetitive movements placing stress upon a part of the body.

  • Often starts small and goes unnoticed, leaving the area weak and vulnerable to further injury.

  • Children are particularly susceptible as their bodies are still developing - need longer recovery periods and have greater nutritional requirements.

  • Children should engage in a wide variety of sports and NOT specialise in a sport at a young age - ensures development is holistic and balanced.

E.g., stress fracture in the shins → athlete should stop running for 4-8 weeks → ice the area to reduce inflammation → use an anti-inflammatory medication.

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Thermoregulation

Body’s maintenance of stable core temperature via heat gain/loss mechanisms - prevents hyper and hypothermia.

  • Children overheat 3-5 times faster than adults → they have underdeveloped sweat glands, meaning they sweat less and release fluid more slowly than adults - rely more on radiation and convection to lose heat.

  • Children have a smaller body mass to surface area ratio - large area of skin for heat or cold to enter the body, but a smaller mass to be affected by this temperature.

  • Less muscle mass decreases heat generation.

  • Wear appropriate clothing, play early in the morning to avoid extreme heat, consume fluids regularly, reduce long bouts of activity.

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Appropriateness of Resistance Training

Appropriate for young athletes when proper supervision is provided and guidelines are followed - increases muscular size, strength, power and speed.

  • Age-specific instruction, safe training environment.

  • Should be mature enough to follow direction and understand the benefits and risks.

  • 1RM should be avoided - intensity should be fairly low with higher reps.

  • Technique should be mastered before adding resitance.

  • 2-3 times per week.

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Adult and Aged Athletes

  • heart conditions

  • fractures and bone density

  • flexibility and joint mobility

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Physical Activity Guidelines for Adult and Aged Athletes

Under 65: 150-300 min moderate or 75-150 min vigorous activity weekly.

Over 65: at least 30 min of physical activity on most days.

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Heart Conditions

Collective term for cardiovascular issues such as angina, hypertension, heart attacks, and heart valve disease.

  • Aging process makes the cardiovascular system less efficient, and an older person has a decreased ability to carry oxygen.

  • Heart conditions can increase osnet of fatigue.

  • Can still adapt to exercise, but should get medical clearance first - may need to complete a stress test to check it is safe to participate in a certain sport.

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Management of Heart Conditions

  • GP approval

  • 5-7 minute warm-up and cool-down

  • Never exercise to the point of chest pain or angina - includes dizziness, nausea, shortness of breath, irregular heartbeats during or after exercise

  • Exercise with a friend in case of emergency

  • Do not exercise when it is too hot, cold or humid

  • 30 min per day, 5 times a week

  • Aerobic training is best

  • Light weight resistance training - no isometric movements or less than 10RM

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Bone Density

Measure of mineral content in bone; indicator of bone strength.

  • Osteoporosis is the severe reduction in bone mineral density and load bearing capabilities - can be heightened by gender, genetics, early menopause, small size, inadequate diet, poor physical activity levels.

  • Inactivity can encourage calcium discharge from the bone, making it weaker.

  • Can increase the risk of fractures.

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Management of Fractures and Bone Density

  • Eat a diet rich in fruits and vegetables - calcium, Vitamin D, phosphorus, protein

  • Avoid contact sports and those that involve powerful changes in directions

  • Sports should be safe, beneficial, and not cause pain - may focus on balance, strength, coordination and flexibility

  • Weight bearing activities can increase bone strength - slow bone loss in legs, hips and spine.

  • Resistance training can be beneficial with correct technique

  • Stability and balance exercises can prevent falls - high-impact jerky exercises, and bending/twisted should be avoided.

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Flexibility and Joint Mobility

Ability of a joint to move through its full range of motion.

  • As adults decrease movement, flexibility decreases which can increase the risk of strains and sprains - loss of elasticity in muscles and tendons.

  • Can affect posture.

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Management of Flexibility and Joint Mobility

  • Slowly increase range of motion at each joint through regular exercise - increase intensity as mobility increases

  • Focus on exercises that increase balance and stability - can prevent fractures caused by falls

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Female Athletes

  • eating disorders

  • iron deficiency

  • bone density

  • pregnancy

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Female Triad

Link between low energy availability (eating disorders), menstrual dysfunction (iron deficiency), and low bone density.

  • Menstruation affects haemoglobin and iron levels, resulting in decreased oxygen carrying capacity, intensity levels and motivation.

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Eating Disorders

Abnormal behaviours (starvation, purging, bingeing) to control weight/food intake, impairing health and performance.

  • Incidence is INCREASING - female athletes are under pressure to fit societal expectations of the ‘desired’ weight.

  • Leads to starvation and dehydration - decreases energy and nutrient intake.

  • Can cause iron deficiency and low bone density - increase fatigue and lethargy.

  • Must be recognised and attended to immediately.

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Anorexia Nervosa

Eating disorder marked by self-starvation and extreme weight loss.

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Bulimia Nervosa

Eating disorder involving binge eating followed by purging.

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Iron Deficiency

Insufficient iron leading to low haemoglobin and reduced oxygen transport - females need extra iron intake due to blood loss at menstruation and typically a lack of iron in their diet.

  • Can result in anemia (low haemoglobin count) - not enough oxygen is delivered, decreasing rate of lactate clearance.

  • Recommended daily intake is 12-16mg - females should eat iron-rich foods such as meat and seafood, increase Vitamin C intake to improve iron absorption, and potentially take a supplement.

  • Exercise-induced anaemia is common - the result of intense training where iron reserves are drained through sweat and a destruction of red blood cells.

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Bone Density - Female

Measure of the amount of minerals per square centimetre of bone.

  • Calcium deficiency is associated with osteoporosis and bone fractures in older women - increased risk due to hormonal changes at menopause, inadequate calcium intake.

  • Recommended daily intake is 800mg - post menopause is 1100mg.

  • Weight bearing exercise can decrease risk of osteoporosis.

  • High impact activities should be avoided by older women.

  • Include a warm-up, progress to stretching, use ice of inflamed or arthritic joints to prevent swelling/soreness.

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Amenorrhoea

Absence of menstruation, often associated with low energy availability and low bone density.

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Pregnancy

Generally a female can continue doing any activities that they already do when pregnant.

  • Increase in the hormone relaxin allows for greater flexibility - looser ligaments and increase range of motion.

  • Centre of gravity will shift forwards - may impact stability.

  • Blood volume and haemoglobin levels increase.

  • Activities that lead to overheating can lead to a lack of hydration - vigorous exercise, contact activities, scuba diving and exercising during the heat of the day are risks.

  • Mild to moderate exercise is safe - better weight control, improved mood, maintenance of fitness, prevention of gestational diabetes.

  • Complete a warm-up and cool-down.

  • Decrease intensity throughout stages of pregnancy.