PDH sports med
How are sports injuries classified and managed?
Ways to classify sports injuries
Direct: A force generated from outside the body.
i.e. Dislocated shoulder, bruised knee
Indirect: A force generated from inside the body.
i.e. Hamstring tear, stress to ligaments in the knee.
Soft tissue: Damage to muscles, tendons, ligaments, cartilage, skill, blood vessels, organs and nerves. Can be acute(pain straight away) or chronic( pain over time).
i.e. bicep tear, bruised shoulder, sprained wrist, strains, dislocated hip.
Hard tissue: Any injury to bones or teeth. Can be acute(pain straight away) or chronic( pain over time).
i.e. broken arm, dislodged tooth.
Overuse: Intense or unreasonable, use of joint or body area.
i.e. Stress fracture, shin splints
Soft tissue injuries
Strain/tear:
Tear in the muscle
Classified into 3 grades:
small tear
50% or more of the muscle is torn
complete tear, surgery needed
e.g Pulled hamstring
Sprain:
Tear or a ligament
Classified into 3 grades:
small tear
50% or more of the muscle is torn
complete tear, surgery needed
e.g. Rolled ankle, ACL rupture
Contusion:
A bruise, can be internal or external
Capillaries ruptured causing internal bleeding
Normally an external force, can be internal.
e.g. Bruised elbow, knee bones rubbing creating a bruise.
Skin abrasion(Graze):
Scraping or wearing of skin, usually not deep
Treatment: Clean wound, disinfect and cover with non-stick dressing
e.g. Grazed knee from soccer tackle
Laceration:
Deep cut or tear of skin
Contact from something sharp
Treatment: Apply pressure, medical attention, stitching may be necessary, ice if bleeding continues
e.g. Cut from kitchen knife
Blister:
Caused by friction or burning
Build up of serum in skin
Treatment: Cover with padding, don’t pop
e.g. Blister on hand from tennis racquet
inflammatory response
Phase 1 Acute inflammation
Fast and painful swelling
Vasodilation of blood vessels to allow more fluid into tissue
Inflammation can cause secondary damage, causing loss of function if inflammation is large
Lasts 48-72 hours RICER method should be used now
Phase 2 repair inflammation
Body begins to repair injured site
White blood cells clean up debris and new body tissue begins to be formed.
Often scarring occurs in this phase
Lasts 3 days to 6 weeks
Phase 3 remodelling inflammation
More scared tissue is produced
Body tissue is developed and strengthened
Scared tissue can be replaced
Light exercise is important
Hard tissue injuries
Hard tissue injuries are injuries to the bones or teeth.
Fractures:
A fracture is a type of broken bone and can be classified 3 ways.
Closed/simple: are fractures which stay in the body.
Open/compound: are fractures which protrude through the skin
Complicated fracture: A fracture that causes more damage to other nerves, organs or blood vessel
Types of fractures:
Complete: Completely broken through the bone
Incomplete: Also known as a green-stick fracture, a partial break where the bone is only partially broken
Comminuted: More than 2 parts of the bone are fractured. Can be smashing the bone or the same bone in a few areas.
Other types of fractures include:
Depressed: dent in skull
Impacted: broken but jammed together
Oblique: broken on an angle
Longitudinal: along the axis of the bone
Spiral: torque on the bone
Transverse: perpendicular
Dislocations:
A dislocation is an abnormal separation in the joint between two or more bones.
Doing this damages the surrounding soft tissue including sprains and strains to muscles.
Can be direct or indirec
DO NOT try to relocate the dislocation.
Assessment of injury
TOTAPS:
Talk:
talk to the patient
find out what happened
"Where does it hurt"
"Has this happened before"
Observe:
Any obvious signs of swelling or deformity
Compare both sides of the body
Touch:
Gently feel the injury for any signs of swelling or deformity
Pinpoint area of pain by gentle touching
Active movement:
Get the patient to perform a variety of movements with the injured area.
Complete slowly
Passive movement:
First aider slowly moves the patients injured area.
Skills test:
Perform a skill in the game.
How does sports medicine address the demands of specific athletes?
Children and young athletes:
Medical conditions
Asthma
Definition: A chronic respiratory condition that affects the airways, causing inflammation and narrowing of airways.
Symptoms: Common symptoms include wheezing, coughing, shortness of breath, chest and tightness.
Triggers: Common triggers include allergens, respiratory infections, exercise, cold air, smoke and strong odours
Types: There are different types, including allergic asthma and non-allergic asthma.
Management strategies
Medication management:
Use of inhalers
Developing an asthma plan in consultation with medical professional.
Education and awareness
Educate young athletes fosters a supportive environment and reduce stigma.
Train to recognise asthma symptoms.
Choosing appropriate sports
Swimming
Jogging
Cycling
Monitoring and regular check-ups
Regular follow ups with healthcare professionals.
Keep track of symptoms.
Diabetes
What is diabetes
A chronic, metabolic disease characterised by elevated levels of blood gluecose which leads to serious damage to the heart, blood vessel, eyes , kidneys and nerves.
Implications of diabetes on the way young people engage in sports
Hypoglycaemia: Low blood sugar
Hyperglycaemia: High blood sugar
Dehydration
How is diabetes managed
Often through insulin injections and access to sugary foods.
Should participate in regular physical activity can help manage both types of diabetes.
Can prevent hyperglycaemia
Access to food and sugary drinks during physical activity
Supervisors should know the first aid procedures used to manage episodes.
Epilepsy
What is it
A medical condition resulting in disruption of normal brain activities, resulting in a seizure.
A seizure is a sudden altercation of behaviour due to a temporary change in the electrical function of the brain
Symptoms/signs
Temporary confusion
Uncontrolled jerking movements in the arms and legs
Staring spells
Stiff muscles
Factors that can predispose a seizure
Overexertion
Over-heating
Dehydration
Low blood sugar(hypoglycaemia)
High fever
Implications
Epilepsy varies between people in severity
Anti epileptic drugs can reduce the chance of seizures.
Collision related sports should be avoided if seizures are regular.
Overuse injuries
Def: Overuse injuries result from repetitive movements causing repetitive stress on involved body parts.
Major cause of overuse injuries:
Poor recovery
High stress loads
Poor technique
Poor muscle imbalance
Common types of overuse injuries:
Shin splints
Stress fractures
Tendonitis
Young athletes are more likely to be at risk for overuse injuries as their bones are still growing. This means they need longer periods for recovery and greater amounts of nutrients.
They can also occur from small injuries which were not properly addressed and catered for.
Implications for engagement in sports
Young athletes should participate in a wide range of sports
This ensures growth is holistic and balanced
Should prioritise receiving enough recovery
Management
This should be supervised by a professional
Should stop movement which causes injury.
Thermoregulation
Def: a homeostasis process that maintains a steady internal body temperature despite changes in the external environment.
Anything outside of 36.5 and 37.5 is considered irregular
Implications
The bodies ability to thermoregulate is not developed fully for children .
Low exercise economy. Children require more to do exercise than adults
High ration of body surface area to mass.
Diminished sweat capacity due to underdeveloped sweat glands.
A child's body will overheat 3-5 times faster than an adults.
Management
Breaking sport matches into smaller sections
Playing early morning to avoid heat of day
Applying sunscreen and wearing airy clothes.
Children should wear warm clothing
Have an adequate extended warm up.
Resistance training effectiveness
Def: The act of weight training for muscular gain.
Resistance training is no more dangerous to older people than it is to younger people
However exercise needs to be done under supervision and appropriate weight.
Implications
Increases muscular size
Muscular strength
Muscular power
Muscular speed
Bone strength
Helps prevent injury
Management
Always be supervised and managed
First aid must be used immediately if it is serious
Adult and aged athlete
Heart conditions
Def: A range of conditions which affect the structure and function of the heart.
Risk factors:
High blood pressure
Cardiovascular disease
Angina
Survivors of heart attacks
Heart valve disease
Implications:
Limits the intensity of exercise available
Management:
Should participate in. activities with low intensity such as golf, cycling, tennis or walking.
Medication
Lifestyle changes such as diet exercise or smoking.
Medical procedures such as pacemakers
Heart transplant
Early detection is key.
Fractures/Bone Density
Definition of fracture: Any break of a bone in the body
Fractures are more likely to occur in people who have poor bone density. Additionally, poor bone density can lead to osteoporosis.
Poor bone density
Reasons for having poor bone density can be from:
Genetics
Female
Early menopause
Small size
Inadequate diet
Poor physical activity.
Diet
Fractures and bone density are greatly affected by our diets.
As we get older, we need more nutrients to keep our bones healthy, making our chances of fractures lower. Key nutrients for good bone health include:
Calcium (Milk, cheese, Tofu, sardines, seeds, leafy greens)
Vitamin D (The sun and oily fish like salmon, mackerel or sardines
Phosphorus (Dairy, seafood, sunflower seeds, lentils, eggs)
Sodium (yummy food)
Protein (Chicken, red meat, fish,)
Sport
As bone density decreases, the level of impact the bones can comfortably receive also decreases. Examples of smart choices for sports participation include:
Cycling
Walking
Golf
Tennis
Swimming
In addition to these activities, older people can be encouraged to complete other forms of exercise to increase bone density. For example, Weight bearing exercises such as walking and running can encourage the bone to adapt to the physiological challenges which increases bone strength, resulting in bone density.
Similar to muscles, bones can adapt to the strain put on them. However, it is important the stress inflicted is only enough to causes adaptations and not fractures. So, resistance training can be encouraged as long as proper technique is used and preferably under supervision. Doing this can increase bone density without significant risk.
Note: If an adult or aged athlete has a fracture, it is important to not engage in sports that use the injured bone until it is completely healed.
Flexibility/Joint mobility
Def: joint mobility is the ability of a joint to move through its full range of motion. Flexibility is most commonly used in reference to multiple joints range of motion or to the whole body.
Age does not limit a joints ability to move but the lack of use does.
Sports participation
By gradually increasing movement in the joints through regular exercise, you can increase flexibility and joint mobility.
Examples are Yoga, Tai Chi, Pilates
Female athletes
Eating Disorders
Def: A behavioural condition described by severe and persistent disturbance in eating behaviours and distress through emotions
What is it:
Something that is detrimental to all athletes but especially common in female athletes
Female athletes are often under the pressure to fit the social pressures of the female physique, while still being a great athlete.
Most eating disorders focus too much on weight, body shape and food.
How they occur:
Social pressures result from the demands of training for some sports
What happens to an athlete with an eating disorder:
Decreased energy
Poor bone health
Disturbances to menstrual cycle
Long term consequences like chronic health and complex recovery processes
How they affect the individual:
Decreased performance
Increase risk for injury and hormonal imbalances
How it affects participation in sport:
Physical and psychological well-being
Hinders in motivation and focus
Hard to fully engage in training
Iron Deficiency
What causes it:
Lack of iron in diet
Menstruation
Symptoms:
Unexplained fatigue
Headaches
Dizziness/lightheaded
Heart issues and chest pain
15-35% of women in endurance sports are effected by iron deficiency compared to 3-11% for male athletes
What can female athletes do to combat negative effects of iron deficiencies:
Iron supplements
Blood transfusions
High iron diet
Degree of effect on sports participation:
Athlete cannot deliver enough oxygen to muscles to sustain performance
Have to rely heavily on anaerobic energy systems
Athlete will feel tired quicker (fatigue)
Causes with iron deficiencies to be less likely to participate in sport
Bone density
Reasons for having poor bone density can be from:
Genetics
Female
Early menopause
Small size
Inadequate diet
Poor physical activity.
Diet
Fractures and bone density are greatly affected by our diets.
As we get older, we need more nutrients to keep our bones healthy, making our chances of fractures lower. Key nutrients for good bone health include:
Calcium (Milk, cheese, Tofu, sardines, seeds, leafy greens)
Vitamin D (The sun and oily fish like salmon, mackerel or sardines
Phosphorus (Dairy, seafood, sunflower seeds, lentils, eggs)
Sodium (yummy food)
Protein (Chicken, red meat, fish,)
Sport
As bone density decreases, the level of impact the bones can comfortably receive also decreases. Examples of smart choices for sports participation include:
Cycling
Walking
Golf
Tennis
Swimming
In addition to these activities, older people can be encouraged to complete other forms of exercise to increase bone density. For example, Weight bearing exercises such as walking and running can encourage the bone to adapt to the physiological challenges which increases bone strength, resulting in bone density.
Note: If an adult or aged athlete has a fracture, it is important to not engage in sports that use the injured bone until it is completely healed.
Pregnancy
Def: Pregnancy is the term describing the period which a fetus develops inside the womb
Pregnancy lasts around 40 weeks or 9 months
Female athletes during pregnancy:
Can continue sports while being pregnant
Shouldn’t exercise during the heat of day
Can cause overheating
Activities involving lying on your back after your first trimester is not advised
How pregnancy affects the female body:
Increase in relaxin - increases flexibility of body but can reduce bladder control
Greater range of motion in joints - can be a problem if joint stretches beyond its normal limit
Centre of gravity will shift forward
Blood volume and haemoglobin levels will increase
How is injury Rehabilitation managed
Rehabilitation procedures
Progressive mobilisation
Use RICER as bringing movement back to the injured area is extremely important
Progressive mobilisation should be used
Continue progressive mobilisation until full range of motion is restored.
Avoid aggravating injury as it will increase healing time
Active and passive movement
Graduated exercise
Stretching:
Increase flexibility of scar tissue
PNF stretching
Strengthens and stretches area
Conditioning:
Strengthens muscle around injury
Prevents muscle atrophy
Should follow principle of specificity and progressive overload
Total body fitness:
Maintenance of overall body fitness, flexibility, endurance and strength
Should be sport specific
Not overstress injured area.
Training
Gradually increase involvement until full program is resumed
E.g. Avoid contact drills early on
Re-establish skills, co-ordination and confidence in competitive environment
Must be pain-free
Use of heat and cold
Heat:
Increase flexibility
Decrease joint stiffness
Used before stretching
Decrease muscle spasm
Not used in first 2-3 days post-injury (inflammation stage 1)
Cold:
Decrease swelling and inflammation
Decrease pain
Should be used in first 2-3 days post injury
Used after doing rehab exercises on injured part
Return to Play
Indicators of readiness for return to play
Athletes must be:
Pain free
Mobility (e.g. writing the alphabet with their ankle to show full mobility)
flexibility
strength
Have a positive mental state/confidence
Elasticity
Balance
Monitor Progress
Tests indicate readiness to play
Compare pre and post injury results(must be within 10% of pre-injury results)
Tests must be specific to injury
E.g. agility test for knee
Psychological readiness
May take longer to return than the physical aspect
Confidence/self-assurance around the injured area is needed
Taping = boosts confidence
Specific warm up procedures
More focus on injured area
E.g. PEP(Prevent injury and enhance performance) program for ACL - includes stretching, strengthening, plyometrics and agility
Policies and procedures
Amateur level: mainly the player with guidance from doctors(physio)
Pro level:
Policies/procedures e.g. fitness/skills test
Coaches and trainers also have an input
Policies are extremely different between sports
E.g. higher risk in contact sports or high intensity sports
Ethical considerations
Pressure to participate can be due to:
Significance of event
Teammates
Coaches
Sponsors
Financial opportunities
Use of painkillers:
Masks pain
Increase risk of further injury as an athlete can be unaware they are doing further damage
Prolonged healing process
What role do Preventative actions play in enhancing the wellbeing of the athlete
Physical preparation
Pre-screening assesses:
Current fitness level
Medical history and conditions
Previous injuries
Allows for safe and affective exercises
Skill and technique:
Makes movements more efficient and reduces chance of injury.
Correct skill and execution must be taught then practised - slowly move into competitive situations
E.g. How to fall properly in a rugby tackle, Heel striking in running causes excess stress on the bones, muscles and joints
Physical fitness:
Helps athletes cope with demands of sport/activities
Components of physical fitness:
Flexibility, cardio respiratory fitness, muscular endurance, power, strength agility
Training should target appropriate fitness components:
E.g. strength --> rugby player
E.g. Agility --> Tennis
Warm up, stretching, cooldown:
Warm-up:
Preps body for activity
Ensures gam readiness by practising skills
Increase in muscle temp (reduces risk of tears)
Stretching:
Increase muscle extension
Need to stretch beyond required range BEFORE performance
More attention to muscles working hardest in sport
Cool down:
Prevents blood pooling
Removes lactic acid
Sports policy and the sports environment
Rules of sports and activities
Protect from injury/ promote safety
E.g. penalty for dangerous tackle(e.g. head high tackle in rugby)
Heat rules (over 3 degrees = longer breaks in tennis)
Rugby union scrum rules
Scrum engagement procedures (crouch, touch, pause, engage)
Each player in front row must have a replacement
Modified rules for children
Children have specific needs due to being smaller and having less skill
Rules are modified to accommodate for these needs. This promotes enjoyment and safety, encouraging them to continue the sport.
E.g. Kanga cricket - soft balls, smaller boundaries, no 'no balls'
E.g. Junior netball - ring lowered to improve shooting success.
E.g. Beaton park Friday night tennis comp has green and red balls for the below 10 league which are softer and more bouncy.
Matching of opponents
Normally matched according to age
Can lead to uneven competition due to varying size and skill levels
Matching opponents on:
Growth and development = safer, extra important in contact sports. E.g. Rugby league has an 85kg max weight for younger age groups
Skill levels = even competition, challenges all players, helps maintain interest, increase motivation
MRS CHRISTIAN EXAMPLE. AFL is more popular in VIC so there are more specific categories, resulting in more even competition compared to NSW where the sport is less popular, resulting in a wider range of classifications.
Protective equipment
Helps prevent injury by absorbing impact from direct blow.
E.g. mouthguards, helmets, shinpads
Specific equipment for each sport.
Safe grounds, equipment and facilities
Equipment
Must be regularly checked and maintained
E.g. padding on trees on mountain biking
Facilities
Promotes safety
E.g. first aid kit, Ambulance access point, lighting for at night games
Grounds
Even(no holes)
Free of rubbish(e.g. broken glass)
Environmental considerations
Temperature regulation
Normal body temp = 37 degrees
During exercise, body temp is >37 degrees
4 ways to loose heat:
Convection
Heat loss from flow of air across skin
E.g. a fan
Looses clothing helps combat this
Radiation
Heat loss to environment through rays
Loose clothing helps combat this
Conduction
Heat transfer from body to cooler objects by contact
E.g. wet towel
Evaporation
Heat loss through sweating
Main strategy from body during exercise
Drink adequate water, expose skin to allow evaporation
Climate conditions
Heat + humidity = hyperthermia. Because evaporation is restricted
Cold + wind = Hypothermia. Because convection from wind causes 'wind chill' e.g. a fan
Impact of climate conditions on safe participation
Hot/humid:
Wear light, loose clothes
Drink more water than you sweat
Avoid exercise all together if it is too hot
Cold/Wind:
Wear clothing that covers skin to prevent wind chill
E.g. wetsuit in surfing/ spearfishing.
Dress in layers to trap heat. Don’t overdress as this can cause excess sweating
Stay active (e.g. goal keeper needs to stay moving)
Rain, altitude, Pollution
Rain:
Decrease body temp(hypothermia)
Slippery playing surface
Decrease visibility
You should wear:
Waterproof clothes
Appropriate footwear
E.g. metal studs
Altitude:
Decrease aerobic capacity
Decrease air resistance
Increase performance in high jump, long jump, kicking a ball, etc
You should:
Train at higher altitudes PRIOR to the event
Use sunscreen(increase UV)
Pollution:
Irritates airways
Increases air resistance
decrease oxygen
Hazard for asthma or cardiorespiratory problems
Train in large cities to combat this
You should:
Avoid outdoor aerobic exercise in peak hour traffic as there is extra pollution.
Guidelines for fluid intake
Environment has a direct impact on athletes fluid requirements
E.g. hot day = sweat more = drink more
Exercise increases fluid loss
Dehydration can cause: loss of coordination, impaired performance in endurance events, heat illnesses
Guidelines:
<1 hour = water
>1 hour = sports drink
Pre: 500ml, 30 mins before
During: 200ml, every 15 mins
After: 1.5L per kg of body weight lost.
Acclimatisation
Technique where athletes train in expected conditions BEFORE competition.
E.g. heat, cold, altitude
Allows body to adapt - improving performance
Promotes safety. E.g. reduce risk of illness.
E.g. heat tents improve sweating response = more effective evaporation = enhanced cooling.
Taping and bandaging
Preventative taping
When:
Sports with explosive movements
Contact sports
Why:
Stress on joints
High potential for injury
How:
Protects joints by providing limits to unwanted movements
E.g. preventative taping an ankle to stop rolling of ankle
Taping for isolation of injury
Used post - injury to support/strengthen joint during rehab.
Benefits:
Decrease risk of re-injury
Helps athletes maintain fitness (e.g. weight training)
Allows athletes to return to play sooner (e.g. needed for finals)
Increase player confidence
Bandaging for treatment
Immediate post injury (RICER)
Bandaging provides compression
Reduces bleeding/swelling
Helps immobilise injured parts
Prevents further injury
Elastic tape used - more flexible = allows for swelling