4. Off Field

Off Field Injury Assessment

Introduction to Athletic Therapy

  • Course: KNSS 220

1. History

A. Personal Information

  • Who: Collect appropriate demographics of the patient including:

    • Name

    • Age

    • Birthday

    • Alberta Health Card number

    • Gender

    • Job

    • Emergency contact

    • Address

  • Note: This information is usually gathered by the receptionist prior to the assessment.

B. Mechanism of Injury

  • What happened?

  • How did it happen?

  • When did it happen?

  • Importance of understanding descriptive words that provide clues regarding the type of injury (e.g., knee hyperextension may indicate a tensile force through the PCL of the knee).

C. Pain Assessment

  • Five related questions concerning pain:

    1. Location: Where is the pain located?

    2. Onset: Was the onset gradual or acute?

    3. Type of pain: Is the pain sharp, dull, aching, or shooting?

    4. Severity: Rate the pain on a scale from 1 to 10.

    5. Aggravating/relieving factors: What makes the pain feel worse or better?

D. Sounds/Sensations

  • Ask the patient:

    • Did you experience any abnormal sensations or hear any unusual sounds during the injury?

    • Examples:

    • Pop: May indicate a ligament tear

    • Crack: May indicate a fracture

    • Snap: May indicate a tendon popping over a bony prominence

  • Example statement: "Every time I bring my leg forward, I feel a snapping sensation on the side of my hip."

E. Signs and Symptoms

  • Question: "Are there any other symptoms you are experiencing that we haven’t yet covered?"

  • This allows the patient to disclose additional signs and symptoms, crucial for a clinical diagnosis (e.g., low back pain radiating to the groin).

F. Previous Health/Injury History

  • Health history: Include categories such as:

    • Diabetes

    • High blood pressure

    • Cardiovascular disease

    • Hypertension

    • Rheumatoid arthritis

    • Asthma

  • Previous injury history:

    • Document any significant injuries, especially those related to the site of the current injury.

    • Note that specific health and injury history questions pertain to different body parts as explained in the lab manual.

G. Medications/Allergies

  • It’s critical to know any medications the patient takes as their side effects may influence the complaint.

  • Common medication-related side effects:

    • Skin rash (e.g., turf burn)

    • Dizziness (e.g., concussion)

    • Headache (e.g., upper neck tension)

    • Darkened urine (e.g., kidney contusion)

  • Also, inquire about allergies, particularly to latex and cold urticaria, as these are common in athletic therapy settings.

2. Observation

A. Bilateral Comparison

  • Always compare bilaterally during inspections.

B. Visual Indicators

  • Check for:

    • Swelling: Indicative of injury

    • Discoloration: May suggest bruising or other issues

    • Deformity: Look for abnormal shapes or misalignments

C. Formations and Abnormalities

  • Identify formations or abnormalities that are not caused by the current injury.

  • Inspect from all views:

    • Posterior/anterior

    • Medial/lateral

    • Dorsal/plantar

    • Dorsal/palmar

3. Palpation

A. Techniques and Checks

  • Evaluate:

    • Skin Temperature: Use the back of the hand for heat detection.

    • Pulses: Use two fingers to check pulse strength.

    • Bones and Bony Prominences: Assess for irregularities and injuries.

    • Soft Tissue: Inspect muscles, tendons, and ligaments.

4. Functional Testing

A. Range of Motion (ROM)

  • Assess using:

    1. Active Range of Motion (AROM)

    2. Passive Range of Motion (PROM)

    3. Resisted Range of Motion (RROM)

  • Orthopedic Positions: Evaluate movements like:

    • Abduction/Adduction

    • Eversion/ Inversion

    • Flexion/Extension

    • Horizontal abduction/adduction

    • Pronation/Supination

    • Radial/Ulnar Deviation

B. Manual Muscle Testing (MMT)

  • Evaluates the patient’s ability to withstand different levels of resistance, indicating the extent of the injury.

  • Rating scale:

    • From 0 to 5 (0 being no contraction, 5 being the ability to resist full pressure).

C. Goniometry

  • Measures joint range of motion.

  • Used during initial assessment and subsequent measurements throughout treatment until full return to activity.

  • Criteria for patient’s return to activities also relies on goniometric data.

D. Neurological Testing

  • Assess:

    • Cerebral function

    • Cranial nerve function

    • Cerebellar function

    • Sensory testing

    • Reflex testing

    • Projected or referred pain

    • Motor testing

E. Joint Play/Joint Mobilizations

  • Utilized by clinicians to assess normal and abnormal endpoints while evaluating a patient’s joints through ranges of motion.

5. Special Tests

  • Conduct special tests to reproduce specific pain through targeted movements and positions.

  • Note: These tests should not be used independently to diagnose but rather aid in forming an educated diagnosis.

6. What Now?

A. Post-Evaluation Actions

  • After evaluation and clinical diagnosis:

    • Construct a treatment plan collaboratively with the patient to rehabilitate the injury and restore pre-injury status.

B. Possible Referrals

  • Consider referrals for:

    • Diagnostic Imaging: X-ray, ultrasound, etc.

    • Other Health Care Professionals: e.g., massage therapists, psychologists, nutritionists, physical therapists, physicians.

C. Treatment Modalities

  • Possible treatment strategies include:

    • Modalities (e.g., heat, cold, electrical stimulation)

    • Exercise therapy

    • At-home care/instructions (e.g., exercises, icing)

    • Follow-up appointments (determine when and how often to see the patient).

7. Class Activity: Role Playing a History Intake

  • Activity Steps:

    1. Pair up, assigning one as the clinician and one as the patient.

    2. The patient should create an injury story without disclosing the injury type.

    3. The clinician follows through with the history intake process.

    4. At the end of the session, the clinician attempts to guess the injury.

    5. Switch roles after completing both parts of the activity.