KIN3KO3 Sports Injuries

Assessment process

1. history

2. observation

3. palpation & rom tests

4. muscle group strength test

5. special tests

why take history

gather info about injury, find athlete context and initial treatment plan, possible suspects

observation

skin integrity, posture, position of comfort, muscle atrophy (bilateral),d

edema

soft tissue swelling

inflammatory or infection

fluid interference (pregnancy, medication)

indentation - pitting edema

echymosis - bruising appearance of an edema, shows interruption of blood vessels

hematoma

type of swelling

blood in tissues

clustered in a lump

joint effusion

swelling contained in synovial joint

types of swelling

joint effusion, hematoma, edema

palpation and joint rom testing

evaluate bilaterally

passive rom -> available movement? where pain?

active rom → how much the athlete can produce

helps see pain and symptoms & arc of pain

muscle strength testing

manual testing (MMT)

bilateral, uninvolved first

4→ can apply resistance but not equal to uninvolved side, 5 is equal or uninjured

3→ can resist gravity

2→ cannot resist gravity, some range of motion, 1 no ROM

progressive build and release of isometric contractions

mid range for best strength -> not 100% at risk of further injury

1-5 rough grading of strength scale

special tests

use suspects

tests to reproduce symptoms and MOI

can pick up other problems

specific

mechanism of injury of lateral ankle sprain

awkward landing

unevenground

forced inversion, often in plantarflex position

happens in a sudden moment

anatomical structures of lateral ankle sprain

lateral ankle ligaments, ATFL in PF, potential fibularis injury

1st lat degree ankle sprain

mostly localized, less restriction in ROM, centralized swelling, pain when changing direction general lat body weight shifts

2nd-3rd degree lat ankle sprain

swelling in toes, echymosis (bloodflow interrupted), blood pooling near calcaneus, if longterm can cause chronic ankle instability

grading sprains

first deg: <70 ligs torn

second deg: 70-80% ligaments torn

third deg: 90-100%, pop/snapping sensation

elastic → plastic → fail zone

mobility increases, stability decreases

more severe=more structures involved (i.e. syngerist injury, capsule sprain, etc)

rtp factors

return to play

mobility aids, timeline, pain, ROM, strength, context

syndesmosis sprain MOI

weight bearing position, dorsiflexion and directional change, often in cleat sports, external rotation in relation to tibia

syndesmosis sprain anatomical structure/ characteristics

tib fib joint injury

talus dome injury

medial deltoid ligament

AITFL

longerhealtime as easier to stress

failure point

energy > ability of tissue to absorb energy

landing

foot in pronated dorsiflexion

energy absorbed by musculotendinous units eccentrically (plantarflexors eccentrically contract, abdorbing landing)

passive structures (everters, pronators, ligaments and fascia) lengthen to absorb energy

bones bend, compress and twist

medial tibial stress syndrome MOI & characteristics

no single event repeated stress and slowly growing more persistent pain

>5 cm in length along posteromedial border of tibia

low grade, localised swelling possible

MTSS etiological factors (causes)

1. traction from mtu pulls on periosteum causing periostitis (irritation to low vascular, highly sensitive periosteum)

often caused by tibpost muscle as a pronator and plantarflexor

2. axial compression, tibial bowing/bending stress on distal 2/3rds of tibia

3. insufficient bone remodelling (osteoclasts > osteoblasts)

4. nutrition (vit d/calcium deficiency) or hormones (estrogen)

BSI

bone stress injury spectrum

1-2, healthy adaptation

3, pereosteal inflammation

4, microfractures of cancellous bone

5, complete fracture through cortical bone

achilles tendinopathy characteristics

proximal pain, 2-6 cm above calcaneus in the center

feeling of stiffness in morning, particularly in plantarflexion

tendon appears thicker

difficulty on pushoff, lunge into plantarflexion or toe landings

achilles tendon characteristics

highly tensile, twisted structure

hypovascular

tendinopathy spectrum

1. reactive, preteoglycans and non-inflammatory fluid increase

2. tendon dysrepair: collagen synthesis increase with challenges

   1. degeneration: structural integrity decrease, stiffness and peak strength decrease, partial or full thickness tears possible

most painful test for atfl sprain

plantarflexion, inversion

most painful test for high ankle sprain

dorsiflexion

most painful for achilles tendinopathy

dorsiflexion stretch pain, anterior pain in plantarflexion

peroneus longus sprain most painful test

anterior pain in eversion

stretch pain in inversion

most painful test of MTSS

anterior pain in inversion

stretch pain in eversion

non pain results from special testing

decreased ROM, weakness on inversion

causes of pain/weakness in tests

ligament pulled apart, injured muscle contracts, stretch pain if muscle is being pulled apart, joint surface or cartilage being compressed

knee ligament sprain clinical presentation

strange sounds & sensations (snap, bang, pop, etc)

deep and difficult to localise pain, inflammation specific unless mcl (more superficial)

subtle to extreme swelling

more bleeding → cruciate ligament

variable weight-bearing status

wipe/swipe test for more modest joint effusion

mechanism of injury for meniscal tear

rapid pivot over loaded foot

deceleration, landing on cutting manuvoer

characreristics of meniscal tear & ligament sprains

less joint stability, bone bruises, lowered neuromuscular function from compromise of sensimotor system

moi for knee ligament sprain

falling on flexed knee

hit on lat side (MCL sprain)

hyperextension and varus (LCL, PFL, PCL)

patellar dislocation prsentation

obvious deformity, spontaneous reduction (shift back to normal) common

ligament, cartilage and bone injury

patellar disloaction moi

0-30 degrees of knee flexion, tibia external rotation, or valgus

how to lessen patella dislocation

neuromuscular training

hamstring muscle strain moi

large eccentric load at high speed

common in sprint, gymnastics, waterskiing

hamstring muscle strain characteristics

musculotendinous unit highly vascular, significant bruising

snaps/pops near posterior thigh

pain distal to ischial tuberosity

potentialal for edema & echymyosis

likely to influence weightbearing status

shortened stride, some completley unable to bear weight

injury risk up with history of other injuries

avulsion fracture

possible if fully pulling hamstring off bone, pulls off a bit of bone alone with it off ischial tuberosity

prevention of hamstring strain

nordic hamstring curl

patellofemoral pain syndrome causes

many factors (syndrome)

biomechanically: forces between patella + femur, alignment of patella in femoral strochlea

biological: bony maladaptation to overload (more fluid volume, bone remodelling), stressed patella = bone problem, can break down cartilage, increase of interosseus pressure from fluid release in bone

PFPS characteristics

anterior knee pain, deep to patella and around it

pain when flexion + extenison (shearing motion), especially loaded

mid-joint swelling may present

weakness in knee extensors

stressed more with greater pressure (walking→stairs→running→one leg squat)

pfps associated factors

can develop track issues

associate w internal hip rotation, adduction and valgus

destabilized by offloading medial side → more pressure on condyle

can develope kinesiophobia

patellar tendinopathy characteristics

pain at apex (bottom)

very localized

most common in jumping athletes

aggravated on impact

heals very slowly, breaks slowly over time

pain over time leading to potential tear

patellar tendinopathy treatment/training

loaded eccentric training

single leg decline squat

heavy slow resistance protocol

isometric trianing of knee extensors (i.e wall sit)

infrapatella strap → pushed pressure onto patella tendon, equally distributing load and offloading pain

ITB syndrome characteristics

fat pad inpingement (pinching) syndrome

compression of sensitive fat pad under distal end into lat knee due to itb tension

itb syndrom pain

repretitive felxion or exnteion of 20-30 degrees -> itb most tense

early-midstance of walking cycle, downstroke of cycling,

presention of itb syndrome

2-3 cm above lat joint line pain

painful in 20-30 degree position

endurance sport pain

can be influenced by differing bike seat position, running surface angles, etc

PFPS treatment

glut med (abductors) and extensor training decreases pain and increases function