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Sports Medicine
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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).
Indirect Injury
Tissue damage resulting from internal forces such as excessive strain or poor technique without external contact (e.g., hamstring tear).
Soft Tissue Injury
Damage to muscles, tendons, ligaments, cartilage, skin, or nerves; includes sprains, strains, contusions, abrasions, and blisters.
Hard Tissue Injury
Damage to bones or teeth such as fractures, dislocations, or lost teeth; usually more serious than soft-tissue injuries.
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.
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.
Strain
Tear of a muscle or tendon caused by internal forces, overtraining or poor technique; pain, swelling, bruising, loss of strength.
Grade 1 Tear
Small (<5%) fibre tear; slight pain and swelling, no strength loss.
Grade 2 Tear
Larger but incomplete tear (>50% fibres); significant pain and power loss.
Grade 3 Tear
Complete muscle or tendon rupture requiring surgery; total loss of function.
Contusion
Bruise caused by ruptured capillaries and internal bleeding after direct impact; pain, swelling, discoloration.
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.
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.
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.
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.
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.
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.
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.
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.
Rest (RICER)
Cease activity 24–72 h to prevent further damage and restart of inflammation.
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.
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.
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.
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.
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.
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)
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.
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
DRSABCD
Primary survey:
Danger
Response
Send for help
Airway
Breathing
CPR
Defibrillation.
STOP Assessment
On-field check:
Stop play
Talk to athlete
Observe injury
Prevent further harm
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
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?
Observe (TOTAPS)
Compare limbs for swelling, redness, deformity, bleeding.
Touch (TOTAPS)
Palpate area to locate pain, heat, swelling, abnormalities.
Active Movement (TOTAPS)
Athlete moves injured part unaided to gauge range of motion.
Passive Movement (TOTAPS)
Assessor moves joint to test ligament and tendon stability.
Pushing or pulling the joint, moving through full range of motion.
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.
Children and Young Adults
medical conditions - asthma, diabetes, epilepsy
overuse injuries (stress fractures)
thermoregulation
appropriateness of resistance training
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.
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.
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.
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.
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.
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.
Adult and Aged Athletes
heart conditions
fractures and bone density
flexibility and joint mobility
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.
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.
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
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.
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.
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.
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
Female Athletes
eating disorders
iron deficiency
bone density
pregnancy
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.
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.
Anorexia Nervosa
Eating disorder marked by self-starvation and extreme weight loss.
Bulimia Nervosa
Eating disorder involving binge eating followed by purging.
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.
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.
Amenorrhoea
Absence of menstruation, often associated with low energy availability and low bone density.
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.