Rec and Care: Final Exam Review

Sports medicine model

Athlete centered model, where the coach, performance, treatment and prevention are surrounding the athlete. Model highlights importance of injury prevention, enhances athletic performance and increases injury prevention during play.

Sports medicine model : coach

responsible for;
- injury prevention
- provide/direct appropriate health care to the injured athlete
- thorough understanding of the skills, techniques, and environmental factors they may adversely affect the athlete
- work closely with medical staff

Sports medicine model : treatment

know the roles and responsibilities of each medical professional - stay in your lane
- knowledge, competency, effective and evidence-based treatments
- clinical examination and diagnosis
-acute injury and illness
- therapeutic interventions ; what should we do, where and when
- psychosocial strategies and referral
- healthcare administration
- professional development and responsibility

Sports medicine model : sports med team

Sports Med Physician : CASM
orthopedic surgeon
athletic therapist
sports physiotherapist
massage therapist
nutritionist
dentist
podiatrist
chiropractor

Sports medicine model :Sports science

biomechanist
exercise physiologist
sports psychologist
strength and conditioning coach
biochemist
anatomist
bioengineer

Legal Liability: Legal action is tried under

tort law

Legal Liability: tort law

civil wrong done to an individual

Legal Liability: act of omission

an individual fails to perform their legal duty

Legal Liability: act of comission

an individual commits an act that is not legally theirs to perform

Legal Liability: standard of care

measured by what another minimally competent individual educated and practicing in that profession would have done in the same or similar circumstance to protect an individual from harm or further harm

Legal Liability: negligence

failure to provide a duty of care can result in liability or negligence

Legal Liability: negligent torts may occur as a result of

malfeasance
misfeasance
nonfeasance
malpractice
gross negligence

Legal Liability: malfeasance

committing an act that is not one's responsibility to perform

Legal Liability: misfeasance

committing an act that is one's responsibility to perform but used the wrong procedure , or does the correct procedure in an improper manner

Legal Liability: nonfeasance

fails to perform the legal duty of care

Legal Liability: malpractice

occurs when an individual commits a negligent act while providing care

Legal Liability: gross negligence

occurs when an individual has total disregard for the safety of others

Legal Liability: to find an individual liable , you must prove ALL 4

1. there was a duty of care
2. there was a breach of duty
3. there was harm
4. the resulting harm was a direct cause from that breach of duty

Legal Liability: doping

international term that refers to the use of performance-enhancing substances or methods

Legal Liability: what constitutes doping ?

2/3 have to apply
1. scientific evidence that the substances or methods have potential to enhance sport performance
2. scientific evidence that the use of the substances or methods represents a potential health risk to the athlete
3. use of the substance or method violates the spirit of the sport

Legal Liability: doping violations, strict liability

you are responsible for what you consume and what is found in your blood and urine

Legal Liability: anabolic steroids

Top 3
1. testosterone
2. nandrolone
3. stanozolol

Legal Liability: anabolic steroids : THG

"The clear"
- designer steroids, designed to keep the T:E ratio low

Legal Liability: purpose of anabolic steroid for performance enhancement

Legal Liability: HGH

anabolic hormone that affects all body systems and is important in muscle growth
- one of the most highly sought after drugs among athletes

Legal Liability: hGH performance enhancement

anabolic properties and difficult to detect
cases hyperplasia and hypertrophy with AAS
affects last after cessation of use vs AAS

Legal Liability: ergogenic aids

stimulants
- used to increase alertness, reduce fatigue or increase competitiveness and hostility
sympathomimetic drugs
- work on adrenergic receptors
- cause mental stimulation and increased blood flow, but can cause elevated blood pressure, headache, increased and irregular heartbeat, anxiety, and tremors

Legal Liability: legal concerns

administering drugs vs dispensing
record keeping

Legal Liability: legal concerns - administering drugs

defined as a single dose of medication to be used by a patient

Legal Liability: legal concerns - dispensing drugs

constitutes providing a sufficient quantity to be used for multiple doses

Legal Liability:

Medical terminology : ?

Mechanisms of sport injury: mechanical injury

occur when a force is applied to any part of the body resulting in a harmful disturbance in function and or to the structure in

Mechanisms of sport injury: cause of injuries

external forces directed on the body or can occur internally

Mechanisms of sport injury: stress strain curve

toe - accounts for 1.5%-4% of total fiber lengthening that is possible
elastic range
necking - point at which tissue strength noticeably decreases so that less strain is needed to cause a change in the tissues length - prior to rupture
permanent deformation - plastic range
failure - rupture

Mechanisms of sport injury: stress

internal reaction or resistance to an external load

Mechanisms of sport injury: strain

extent of deformation of tissue under loading

Mechanisms of sport injury: tissue stresses leading to sports injuries

tension
stretching
compression
shearing
bending

Mechanisms of sport injury: acute injuries

contusions
myositis ossificans
muscle strains
ligament sprains
dislocation
subluxation

Mechanisms of sport injury: ligament sprains - grade 1

minor stretching/tearing of fibers, pain, localized swelling and minimal instability

Mechanisms of sport injury: ligament sprains - grade 2

more tearing of the fibers, increased pain, swelling, more instability

Mechanisms of sport injury: ligament sprains - grade 3

complete rupture of the fibers, little/no pain, gross swelling, joint stiffness, and complete instability

Mechanisms of sport injury: chronic injuries

tendinitis
tenosynovitis
bursitis
osteoathritis
stress fractures

tissue repair: three phases of healing

1. Inflammatory phase
2. Fibroblastic repair
3.Maturation - remodeling phase

tissue repair: goal

to create an environment that is conducive to the healing process

tissue repair: inflammatory phase

begins immediately after a tissue is injured
results in the release of materials needed
typically lasts 2-4 days

tissue repair: purpose of inflammation

protect, localize, and rid body of some injurious agent in preparation of healing
- associated with vascular, cellular and chemical responses

tissue repair: symptoms

SHARP
S- swelling
H- heat
A- altered function
R- redness
P- pain

tissue repair: what two events occur in the inflammatory response phase

vascular reaction
formation of a clot

tissue repair: vascular reaction

vascular spasm, formation of a platelet plug, blood coagulation and growth of fibrous tissue
- causes vasoconstriction of the vascular walls to reduce blood flow, followed by vasodilation
- chemical mediators are released

tissue repair: formation of a clot

damage to the blood vessels exposes the endothelium and collagen fibers
- platelets and leukocytes adhere to the exposed fibers , eventually forming a plug
- helps to localize the injury process

tissue repair: fibroblastic repair phase

period of scar formation is referred to as fibroplasia
begins within first few hours and can last as long as 4-6 weeks
new capillaries bud into the wound, delivering oxygen, increasing blood flow and nutrients to the site
-= granulation tissue produced - fills the gaps

tissue repair: signs and symptoms of phase 2

associated with phase one may decreased, but may be tender to touch and painful with certain movements

tissue repair: phase 2 , continued healing

fibroblasts accumulate at the wound site and synthesize new "extracellular matrix" which contains collagen, elastin, ground substance and additional proteins

tissue repair: phase 2: week 6-7

fibroblasts begin producing collagen fibers which are deposited in a random fashion, forming a scar
tensile strength increases in proportion to the rate of collagen synthesis
increase in tensile strength = decreased fibroblast production

tissue repair: maturation remodeling phase

long term; may take up to several years to complete
realignment and remodeling of collagen fibers that make up the scar tissue
- ongoing breakdown and synthesis of collagen
increases stress and strain causes the collagen fibers to realign along the lines of tension
tissue gradually assumes normal appearance and function
by the end of three weeks, a firm, strong, contracted, non-vascular scar forms

tissue repair: healing capabilities - cartilage

dependent on whether the damage is to the cartilage or subchondral bone. if damage to bone-healing will progress normally

tissue repair: healing capabilities - ligament

variable
- scar tissue is insufficient
- ligament is not reattached to the proper location
may take up to 12 months to complete

tissue repair: healing capabilities - skeletal

initially - hemorrhage, edema, phagocytosis to clear debris
phase 2 - scar formation, myoblastic activity occurs to regenerate myofibrils
phase 3 - collagen fibers arrange themselves
ACTIVE MUSCLE CONTRACTION IS NECESSARY TO REGAIN NORMAL TENSILE STRENGTH
- lengthy rehab time regardless of degree

tissue repair: healing capabilites -

do not regenerate after they have died
- regeneration can take place in the fiber ; if the cell is NOT affected
slow process
- 3-4mm per day

tissue repair: healing capabilites - bone

callus formation needs to occur at the fracture site
- remodelling
osteoblasts lay down new bone and osteoclasts remove bone according to the forces placed on the healing bone

tissue repair: management

PIER
P- pressure
I-ice
E- elevation
R- rest

cryotherapy :

The Knee: type of joint

synovial, modified hinge joint

The Knee: movements

flexion, extension, internal rotation, external rotation

The Knee: formed by the

femur
tibia-plateau
patella

The Knee: fibula

not involved and is not weight bearing
provides site for muscle/ligament attachment
forms the superior tibiofibular joint

The Knee: what structures attach to the head of the fibula

The Knee: type of injury involvement

posterolateral knee injuries

The Knee: articulations : tibiofemoral

tibia and femur
allows for flexion, extension, internal and external rotation

The Knee: articulations : patellofemoral

patella and femur
patella; largest sesamoid bone in the body, lined by hyaline cartilage
- allows stronger muscle pull of the quadriceps due to changing the angle of the patellar tendon

The Knee: menisci

fibrocartilaginous discs in knee
function : improve joint congruency, aid in joint nutrition, transmit force, decrease contact load

The Knee: meniscus - medial

c shaped fibrocartilage
less mobile
higher incidence rate

The Knee: meniscus - lateral

o-shaped
a larger degree of movement

The Knee: meniscus - blood supply

blood supply on to the outer 1/3 of the meniscus
no blood or nerves to inner 2/3 therefore poor healing capacity