Care and Prevention Test
Routinely used various reasons
Provide compression to minimize swelling
Should never be used as a substitute for rehab
Elastic Wrap application
Pressure and tension should be standardized
Should be wrapped in position for maximum contraction
More turns with moderate tension would cause more loss of circulation compared to less turns with maximum tension
60-70% of force should be used on tension of wrap
Need to overlap the tape by half to reduce blistering and pressure points
Needs to be smooth when taping
Make sure the pressure itself is consistent
Mechanical forces of injury
~Types of forces
Tensile (Pulling, force is parallel to the fibers)
Shear (Stretching,force is perpendicular to the fibers)
Compression (Smashing, crushing of the fibers)
3-point bending (combination of all 3 forces)
Each type of tissues has a limit for how much force it can withstand (critical force)
Age, temperature, skeletal maturity, gender, and body weight can affect the mechanical properties
~ Load (critical force) Deformation Curve
The curve describing how much force our muscles, ligaments, tendons, etc can take before failure (injury)
~Healing process following an injury
Starts with Inflammatory response, response to encase the injury or damage
~usually one to four days
Then the Fibroblastic repair occurs, when the discoloration occurs, the damaged cells are dying and are being repaired, once the swelling has left the next stage begins
Finally there is the Maturation Remodeling stage which is the rebuilding of the affected area to get back to 100%
~The inflammatory process
Normal signs and symptoms
Swelling or edema
Pain
Reddening of the skin
Increased temperature in the affected area
Loss of function
Initial trauma causes destruction of cells and damages blood vessels
In response to injury, chemicals are released that affect vascular system and nearby cells
The effects of these chemicals are:
- Degradative (cellular breakdown)
- Vasoactive (vasodilators)
- Chemotactic (attract scavenger cells)
Vasoactive and Chemotactic response
- Release of histamines, bradykinins, and prostaglandins into the bloodstream
Pain/ Vasodilation/ Permeability
~Inflammatory phase
Due to vasodilation and vessel permeability allow for plasma proteins, platelets, macrophages, neutrophils, and leukocytes move out of the capillaries to injured tissue
Neutrophils and leukocytes engage in phagocytosis which eat dead or dying cells
~Inflammation also occurs from secondary metabolic injury: or Hypoxia
No oxygen available and cellular death from the lack of oxygen
This is called SECONDARY INJURY
Platelet: what clots the blood to stop bleeding
Neutrophils: WBC that helps fight infection by ingesting microorganisms
Pain and Injury
Tells the body where there is tissue damage currently
Fibroblastic Repair phase
Polymorphs, monocytes, and histiocytes migrate into the area of injury
These cells break down cellular debris and set the stage for regeneration and repair
You have the formation of new capillaries
Connective tissues heal by forming scar tissue
Fibroblasts migrate into the damaged area and mature
Maturation Phase
Acute traumatic injuries
Fractures
dislocations/subluxations
Strains
Contusions
Strains
Nerve injuries
Fractures
Diaphysis - Shaft-hollow and cylindrical
Epiphysis - Found at the ends of bones and hyaline cartilage growth
Growth plate- a thin layer of cartilage
Stress fracture
Occur from repetitive force
Overload due to muscle contraction altered stress distribution due to muscle fatigue changes in surface
They get worse overtime due to repetitive motions
Management
Hard to catch with x ray
If suspected stop activity for 14 days
Usually doesn't require casting
COntusions
Superficial will produce bruising but a bone contusion will not have this because it is too deep for the blood to pool
Muscle strains and injuries
Strain is on a 1, 2 ,3 scale
Strain is for muscles sprain is fro ligaments
Chronic overuse injuries (tendonitis)
Often get stuck in the inflammatory phase
~Myofascial trigger point
Occurs at the motor unit, where the nerves intervate on the muscle to send signals to the muscle
Intervention procedure
~No clear set of criteria for treatment of acute soft-tissue injury.
Several options
Cryotherapy includes bags of crushed ice, ice cups, ice water immersion, and commercial cold packs
~used to stop swelling
After the acute phase, thermotherapy is appropriate (ex: hydrocollator packs, moist warm towels, and ultrasound diathermy)
When an injury occurs, cryotherapy is needed after the injury. If it is not right after then the body will still have the swelling which we are trying to avoid.
~Icomosis: discoloration starts at the injury site
Shows us that the swelling phase has stopped
When we ice we slow down the process in the injury area but after the swelling phase we move into the heat phase which speeds up the recovery in injury
RICE
~Best for soft tissue injuries and paired with rehabilitative exercise
R- REST (should be for 48 hours)
I - ICE (20 min at a time, 4-8 times a day)
C - Compression (Reduce swelling)
E - Elevate (6-10 in above the heart)
Police
~
P - Protect
O - Optimal Loading (Doing as much as you can without excessive pain)
L
I - Ice
C - Compression
E- Elevate
Peace and Love
~
P - protection
E - Elevate
A - Avoid anti-inflammatories (bad because we still want swelling in the area)
C - Compression
E - Education (Know your body, let things take their time)
&
L - Load (Let pain guide you to gradually return)
O - Optimism
V - Vascularisation (choose pain-free cardiovascular activities to increase blood flow)
E - Exercise
Anatomy of the Ankle and Foot
Ligaments
Deltoid ligament is the primary stabilizer of the MEDIAL SIDE of the ankle joint
Lateral side : 3 lateral ligaments and 2 Anterior/posterior side
~Lateral
Anterior talofibular
Posterior talofibular
Calcaneofibular
~Anterior/posterior
Anterior tibiofibular
Posterior Tibiofibular
Four arches of the foot
Medial longitudinal arch
LAteral longitudinal arch
Metatarsal arch
Transverse arch
Plantar Fascia
Ligaments that connect the heel all the way to the metatarsals
Functions
Shape of the arch
Shock absorption
Stabilizes the arch
Muscle of the lower leg
3 sections of the lateral calf
Peroneus long
Peroneus brevis
Peroneus tertius
Common injuries of the foot and toes
Fractures
Bursitis
Tendonitis
Etc
Bursitis
~Achielies bursitis
Fluid filled sac to reduce swelling
When the bursa sac is struck it will swell
Plantar fasciitis
When the tissue is inflamed or too tight it will be tender and affect walking
Bottom of the foot and it usually closer to the heel
Heel bruises and heel spurs
- Heel bruise
Irritation of fat pad
Cannot withstand weight
Can become chronic inflammation of the bone covering
~Heel spurs
Can be related to chronic heel bruise and plantar fasciitis
Chronic inflammation can result in ossification on bottom of the heel
Treatment
Applying a donut shaped gel pad to reduce weight bearing
Morton's foot
When the 1st metatarsal is shortened
Or
An elongated 2nd metatarsal
Results in weight shift to the 2nd metatarsal which can cause pain and shipping of the front of the 2nd metatarsal
Can result in
Metatarsalgia
Flattening of the metatarsal arch
Mortons Neuroma
An abnormal growth of fluid that fills in between the metatarsals which puts pressure on a nerve
Arch Problems
Pes planus
Flat foot, over pronation
Causes stress on the plantar fascia
Corrective arch orthosis or shoe selection is most beneficial
Pes Cavus
High arch amd associated with plantar fasciitis
Athlete may benefit from orthotic device
Turf toe
~Cause of injury
Hyperextension injury resulting in spain of 1st metatarsophalangeal joint
Tendonitis of Flexor hallicus Longus Tendon
Happens on the plantar side of the foot
Bunions
~ May result from inflamed bursa or joint deformities
Typical at 1st metatarsophalangeal joint, but 5th metatarsophalangeal can also be affected
Often caused by improper shoes
Toe Bruise
Common injuries are torn-off hails or Subungual hematoma formation under the nail (blood blister under the nail bed
Hematomas under nail needs to be released
Use commercially available nail bore to drill small hole in the nail to release blood
Ingrown Nail
~ Ingrown toenails may result from improperly fitting shoes
Soak infected toe in warm antibacterial solution
Elevate toenail by placing a small cotton roll under it and leave in place as nail grows
Have athlete wear shoes that fit more comfortably
INFECTION IS THE BIGGEST CONCERN
Blisters and Calluses
~ common formations resulting from friction between layers of skin as a result of improper fit or broken in shoes
Blister
When a blister forms, fluid collects between skin layers, occasionally the fluid will contain blood
Large blisters should be drained and the area padded to prevent further friction
Calluses
Form around bony areas
File/buff to prevent growth
Done because with calluses it can change your gait since the callus will raise your foot
Hard and Soft Corns
~Cause of condition
Results in pressure from improperly fitting shoes
Wearing narrow shoes and excessive foot perspiration
Poor foot hygiene
Heavily infected areas, can cause death of the tissue
Ankle and Lower leg
Bones of ankle and foot
Tarsals
- talus
- calcaneus
Tibia
Fibula
Ligaments
The deltoid ligaments is the primary stabilizer of the medial side of the ankle joint
Lateral ligaments have 3 primary ligaments:
ANterior talofibular
Posterior Talofibular
Calcaneofibular
Lower leg compartments
~Compartment syndrome
Pressure in the compartments of the leg which causes cell death from either no blood in or from no blood coming out
High systolic blood pressure (first number) no blood in
High diastolic bp (Second number) no blood out
Ankle injuries
~ Ankle sprains can occur in virtually any sport
Inversion sprains are more common, 80-85% of all ankle sprains are to the lateral ligaments
Eversion sprains, while less frequent, are to the medial ligaments and are often very severe
Syndesmotic Ankle Sprain
~The syndesmotic ligament (in between the tib fib)
High ankle sprains affect the posterior and anterior tib-fib ligament
~Tibiofibular sprains or high ankle sprains
Tib-fib sprains involve dorsiflexion followed by external rotation of the foot
Athlete is unable to dorsiflex foot, walks on toes
Chronic ankle instability
~Chronic ankle instability is when an athlete experiences repeated ankle sprains
~Functional causes
Rehabilitate weakened structures
Restore ankle proprioception and neuromuscular control
~Prevention
Taping or bracing
Bracing is better than taping
Bracing with high toe shoes is best
ANkle Fracture/dislocations
in some cases the ankle can be fractured or dislocated
~Cause of injury
Often similar to those seen in ankle sprains
~Signs of injury
Swelling and pain may be extreme with possible deformity
Tibial and Fibular fractures
~Cause
Impact injuries
~Need to make sure there is vascularity through the leg
Stress fractures of the Tib-Fib
~Cause of injury
Common overuse of the leg
Result of repetitive loading during training and conditioning
~Signs of Injury
Point tenderness, difficult to discern bone and soft tissue pain
Pain
Pain within activity
Tendon injuries
Athletes who dramatically increase workout times or running distances, or who run on hard, uneven, or uphill surfaces are prone to achilles tendonitis
The injury can be either acute or chronic. Acute injuries often associated with explosive jumping
Tendonitis
~ Signs and Symptoms
Increased temp in the immediate area
Tendon is painful on touch and movement and appears thickened
Achilles tendon rupture
~ SIgns and Symptoms
Swelling and deformity at site of injury
Athlete reports a pop or snap associated with the injury
Pain in lower leg that ranges from mild to extreme
Loss of function, mainly in plantar flexion
Medial Tibial Stress syndrome (Shin SPlints)
~ Shin Splints is a very common disorder of lower leg
The membrane covering the bone (periosteum) becomes inflamed
Pulling away from the bone (periostitis)
~The pathology of this disorder are unclear
May relate to biomechanics and neuromuscular characteristics or to training errors
Shin Contusion
~Cause of injury
Direct blow to lower leg (impact periosteum)
~Signs of injury
Intense pain and rapid forming hematoma
Compartment syndrome
~Compartment syndrome involves a swelling of the muscles inside lower leg compartments
Swelling puts pressure on vessels and nerves, can cause permanent damage
FOur components:
Anterior (most common)
Lateral
Superficial posterior
Deep posterior
~Acute trauma, such as being kicked in the leg, can result in swelling within the compartment
Routinely used various reasons
Provide compression to minimize swelling
Should never be used as a substitute for rehab
Elastic Wrap application
Pressure and tension should be standardized
Should be wrapped in position for maximum contraction
More turns with moderate tension would cause more loss of circulation compared to less turns with maximum tension
60-70% of force should be used on tension of wrap
Need to overlap the tape by half to reduce blistering and pressure points
Needs to be smooth when taping
Make sure the pressure itself is consistent
Mechanical forces of injury
~Types of forces
Tensile (Pulling, force is parallel to the fibers)
Shear (Stretching,force is perpendicular to the fibers)
Compression (Smashing, crushing of the fibers)
3-point bending (combination of all 3 forces)
Each type of tissues has a limit for how much force it can withstand (critical force)
Age, temperature, skeletal maturity, gender, and body weight can affect the mechanical properties
~ Load (critical force) Deformation Curve
The curve describing how much force our muscles, ligaments, tendons, etc can take before failure (injury)
~Healing process following an injury
Starts with Inflammatory response, response to encase the injury or damage
~usually one to four days
Then the Fibroblastic repair occurs, when the discoloration occurs, the damaged cells are dying and are being repaired, once the swelling has left the next stage begins
Finally there is the Maturation Remodeling stage which is the rebuilding of the affected area to get back to 100%
~The inflammatory process
Normal signs and symptoms
Swelling or edema
Pain
Reddening of the skin
Increased temperature in the affected area
Loss of function
Initial trauma causes destruction of cells and damages blood vessels
In response to injury, chemicals are released that affect vascular system and nearby cells
The effects of these chemicals are:
- Degradative (cellular breakdown)
- Vasoactive (vasodilators)
- Chemotactic (attract scavenger cells)
Vasoactive and Chemotactic response
- Release of histamines, bradykinins, and prostaglandins into the bloodstream
Pain/ Vasodilation/ Permeability
~Inflammatory phase
Due to vasodilation and vessel permeability allow for plasma proteins, platelets, macrophages, neutrophils, and leukocytes move out of the capillaries to injured tissue
Neutrophils and leukocytes engage in phagocytosis which eat dead or dying cells
~Inflammation also occurs from secondary metabolic injury: or Hypoxia
No oxygen available and cellular death from the lack of oxygen
This is called SECONDARY INJURY
Platelet: what clots the blood to stop bleeding
Neutrophils: WBC that helps fight infection by ingesting microorganisms
Pain and Injury
Tells the body where there is tissue damage currently
Fibroblastic Repair phase
Polymorphs, monocytes, and histiocytes migrate into the area of injury
These cells break down cellular debris and set the stage for regeneration and repair
You have the formation of new capillaries
Connective tissues heal by forming scar tissue
Fibroblasts migrate into the damaged area and mature
Maturation Phase
Acute traumatic injuries
Fractures
dislocations/subluxations
Strains
Contusions
Strains
Nerve injuries
Fractures
Diaphysis - Shaft-hollow and cylindrical
Epiphysis - Found at the ends of bones and hyaline cartilage growth
Growth plate- a thin layer of cartilage
Stress fracture
Occur from repetitive force
Overload due to muscle contraction altered stress distribution due to muscle fatigue changes in surface
They get worse overtime due to repetitive motions
Management
Hard to catch with x ray
If suspected stop activity for 14 days
Usually doesn't require casting
COntusions
Superficial will produce bruising but a bone contusion will not have this because it is too deep for the blood to pool
Muscle strains and injuries
Strain is on a 1, 2 ,3 scale
Strain is for muscles sprain is fro ligaments
Chronic overuse injuries (tendonitis)
Often get stuck in the inflammatory phase
~Myofascial trigger point
Occurs at the motor unit, where the nerves intervate on the muscle to send signals to the muscle
Intervention procedure
~No clear set of criteria for treatment of acute soft-tissue injury.
Several options
Cryotherapy includes bags of crushed ice, ice cups, ice water immersion, and commercial cold packs
~used to stop swelling
After the acute phase, thermotherapy is appropriate (ex: hydrocollator packs, moist warm towels, and ultrasound diathermy)
When an injury occurs, cryotherapy is needed after the injury. If it is not right after then the body will still have the swelling which we are trying to avoid.
~Icomosis: discoloration starts at the injury site
Shows us that the swelling phase has stopped
When we ice we slow down the process in the injury area but after the swelling phase we move into the heat phase which speeds up the recovery in injury
RICE
~Best for soft tissue injuries and paired with rehabilitative exercise
R- REST (should be for 48 hours)
I - ICE (20 min at a time, 4-8 times a day)
C - Compression (Reduce swelling)
E - Elevate (6-10 in above the heart)
Police
~
P - Protect
O - Optimal Loading (Doing as much as you can without excessive pain)
L
I - Ice
C - Compression
E- Elevate
Peace and Love
~
P - protection
E - Elevate
A - Avoid anti-inflammatories (bad because we still want swelling in the area)
C - Compression
E - Education (Know your body, let things take their time)
&
L - Load (Let pain guide you to gradually return)
O - Optimism
V - Vascularisation (choose pain-free cardiovascular activities to increase blood flow)
E - Exercise
Anatomy of the Ankle and Foot
Ligaments
Deltoid ligament is the primary stabilizer of the MEDIAL SIDE of the ankle joint
Lateral side : 3 lateral ligaments and 2 Anterior/posterior side
~Lateral
Anterior talofibular
Posterior talofibular
Calcaneofibular
~Anterior/posterior
Anterior tibiofibular
Posterior Tibiofibular
Four arches of the foot
Medial longitudinal arch
LAteral longitudinal arch
Metatarsal arch
Transverse arch
Plantar Fascia
Ligaments that connect the heel all the way to the metatarsals
Functions
Shape of the arch
Shock absorption
Stabilizes the arch
Muscle of the lower leg
3 sections of the lateral calf
Peroneus long
Peroneus brevis
Peroneus tertius
Common injuries of the foot and toes
Fractures
Bursitis
Tendonitis
Etc
Bursitis
~Achielies bursitis
Fluid filled sac to reduce swelling
When the bursa sac is struck it will swell
Plantar fasciitis
When the tissue is inflamed or too tight it will be tender and affect walking
Bottom of the foot and it usually closer to the heel
Heel bruises and heel spurs
- Heel bruise
Irritation of fat pad
Cannot withstand weight
Can become chronic inflammation of the bone covering
~Heel spurs
Can be related to chronic heel bruise and plantar fasciitis
Chronic inflammation can result in ossification on bottom of the heel
Treatment
Applying a donut shaped gel pad to reduce weight bearing
Morton's foot
When the 1st metatarsal is shortened
Or
An elongated 2nd metatarsal
Results in weight shift to the 2nd metatarsal which can cause pain and shipping of the front of the 2nd metatarsal
Can result in
Metatarsalgia
Flattening of the metatarsal arch
Mortons Neuroma
An abnormal growth of fluid that fills in between the metatarsals which puts pressure on a nerve
Arch Problems
Pes planus
Flat foot, over pronation
Causes stress on the plantar fascia
Corrective arch orthosis or shoe selection is most beneficial
Pes Cavus
High arch amd associated with plantar fasciitis
Athlete may benefit from orthotic device
Turf toe
~Cause of injury
Hyperextension injury resulting in spain of 1st metatarsophalangeal joint
Tendonitis of Flexor hallicus Longus Tendon
Happens on the plantar side of the foot
Bunions
~ May result from inflamed bursa or joint deformities
Typical at 1st metatarsophalangeal joint, but 5th metatarsophalangeal can also be affected
Often caused by improper shoes
Toe Bruise
Common injuries are torn-off hails or Subungual hematoma formation under the nail (blood blister under the nail bed
Hematomas under nail needs to be released
Use commercially available nail bore to drill small hole in the nail to release blood
Ingrown Nail
~ Ingrown toenails may result from improperly fitting shoes
Soak infected toe in warm antibacterial solution
Elevate toenail by placing a small cotton roll under it and leave in place as nail grows
Have athlete wear shoes that fit more comfortably
INFECTION IS THE BIGGEST CONCERN
Blisters and Calluses
~ common formations resulting from friction between layers of skin as a result of improper fit or broken in shoes
Blister
When a blister forms, fluid collects between skin layers, occasionally the fluid will contain blood
Large blisters should be drained and the area padded to prevent further friction
Calluses
Form around bony areas
File/buff to prevent growth
Done because with calluses it can change your gait since the callus will raise your foot
Hard and Soft Corns
~Cause of condition
Results in pressure from improperly fitting shoes
Wearing narrow shoes and excessive foot perspiration
Poor foot hygiene
Heavily infected areas, can cause death of the tissue
Ankle and Lower leg
Bones of ankle and foot
Tarsals
- talus
- calcaneus
Tibia
Fibula
Ligaments
The deltoid ligaments is the primary stabilizer of the medial side of the ankle joint
Lateral ligaments have 3 primary ligaments:
ANterior talofibular
Posterior Talofibular
Calcaneofibular
Lower leg compartments
~Compartment syndrome
Pressure in the compartments of the leg which causes cell death from either no blood in or from no blood coming out
High systolic blood pressure (first number) no blood in
High diastolic bp (Second number) no blood out
Ankle injuries
~ Ankle sprains can occur in virtually any sport
Inversion sprains are more common, 80-85% of all ankle sprains are to the lateral ligaments
Eversion sprains, while less frequent, are to the medial ligaments and are often very severe
Syndesmotic Ankle Sprain
~The syndesmotic ligament (in between the tib fib)
High ankle sprains affect the posterior and anterior tib-fib ligament
~Tibiofibular sprains or high ankle sprains
Tib-fib sprains involve dorsiflexion followed by external rotation of the foot
Athlete is unable to dorsiflex foot, walks on toes
Chronic ankle instability
~Chronic ankle instability is when an athlete experiences repeated ankle sprains
~Functional causes
Rehabilitate weakened structures
Restore ankle proprioception and neuromuscular control
~Prevention
Taping or bracing
Bracing is better than taping
Bracing with high toe shoes is best
ANkle Fracture/dislocations
in some cases the ankle can be fractured or dislocated
~Cause of injury
Often similar to those seen in ankle sprains
~Signs of injury
Swelling and pain may be extreme with possible deformity
Tibial and Fibular fractures
~Cause
Impact injuries
~Need to make sure there is vascularity through the leg
Stress fractures of the Tib-Fib
~Cause of injury
Common overuse of the leg
Result of repetitive loading during training and conditioning
~Signs of Injury
Point tenderness, difficult to discern bone and soft tissue pain
Pain
Pain within activity
Tendon injuries
Athletes who dramatically increase workout times or running distances, or who run on hard, uneven, or uphill surfaces are prone to achilles tendonitis
The injury can be either acute or chronic. Acute injuries often associated with explosive jumping
Tendonitis
~ Signs and Symptoms
Increased temp in the immediate area
Tendon is painful on touch and movement and appears thickened
Achilles tendon rupture
~ SIgns and Symptoms
Swelling and deformity at site of injury
Athlete reports a pop or snap associated with the injury
Pain in lower leg that ranges from mild to extreme
Loss of function, mainly in plantar flexion
Medial Tibial Stress syndrome (Shin SPlints)
~ Shin Splints is a very common disorder of lower leg
The membrane covering the bone (periosteum) becomes inflamed
Pulling away from the bone (periostitis)
~The pathology of this disorder are unclear
May relate to biomechanics and neuromuscular characteristics or to training errors
Shin Contusion
~Cause of injury
Direct blow to lower leg (impact periosteum)
~Signs of injury
Intense pain and rapid forming hematoma
Compartment syndrome
~Compartment syndrome involves a swelling of the muscles inside lower leg compartments
Swelling puts pressure on vessels and nerves, can cause permanent damage
FOur components:
Anterior (most common)
Lateral
Superficial posterior
Deep posterior
~Acute trauma, such as being kicked in the leg, can result in swelling within the compartment