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PDHPE SPORTS MEDICINE HSC

NOTES
How are sports injuries classified and managed?
Ways to classify sports injuries
Direct and Indirect
Direct
Caused by forces generated from outside the body
Fractures, dislocations, sprains, bruises
Example Shoulder dislocation caused by a tackle in rugby
Indirect
Caused by intrinsic forces (force within the body)
Result of inadequate warm up, ballistic movements, excessive
movements, fault in execution
Result in sprains (ligaments), strains (muscles and tendons),
damage to body structure (tearing muscles)
Example sprinter tearing a hamstring during a race
Soft and Hard tissue
Soft tissue
Injury to tissue, other than bones and teeth, can be caused by
external or internal forces
Acute occur suddenly (sprains, strains, dislocation
subluxation, torn cartilage, contusions and abrasions)
Chronic - prolonged
Examples spraining ankle during soccer due to poor surface,
bruising due to direct force of hockey stick
Hard tissue
Cause damage to bones and teeth
Bruising of the bone or periostitis (bleeding between outer
lining of bone and underlying compact bone, impact to the
shin), dislocation, fractures
Specific example dislocated shoulder due to direct impact of
another in football, fracture due to landing heavily on hand in
netball
Overuse
Over use
Caused by overuse of specific body regions over long periods
of time

Result from repetitive, low impact exercises such as jogging


Cause pain and inflammation
Typical overuse injuries anterior shin splints and tendonitis
(irritation of tendons such as the Achilles tendon in the heel)

Overuse can contribute to stress fractures


Stress fractures = small incomplete bone fractures caused by
repeated pounding, usually on hard surfaces
Swelling and tenderness may indicate a stress fracture
Stress fractures should initially be treated using RICER, but
prolonged rest is needed for full recovery

Soft tissue Injuries


Tears, Sprains, Contusions
Tears
Occur when tissue is stretched or severed
Two types strains, sprains
Sprains
Arise from the stretching or tearing of a ligament
When ligaments are stretched or torn results in pain,
swelling, inability to perform normal joint movements
Healing is slow ligaments have poor blood supply
Classified according to severity

Strains
Occur when a muscle or tendon is stretched or torn
Pain, bleeding, discolouration
Impact with player or object may can cause a contusion
(bruise)

Skin abrasions, lacerations, blisters

Abrasion - cause pain and shallow bleeding


Skinned area may have dirt or other material treatment
involves cleaning sterilization of the wound prevent infection

Laceration (deeper than abrasions) wound where the flesh


has incurred an irregular tear
Deeper than 1cm referred to a doctor
Treatment pressure and cleaning

Blisters caused by a collection of fluid below or within the


epidermal layer of the skin
Contain clear fluid or blood
Occur when
o New equipment is been used or worn
o Equipment is used for a long time e.g. rackets, bats
o The activity requires sudden changes of direction,
causing fricition in shoe
Management rest. Fluid may have to be surgically released.
If blister is torn clean with antiseptic and application of
second skin dressing

Inflammatory response

When soft tissue is injured, it becomes inflamed self-healing


process (inflammatory response)
Lasts up to 3-4 days
Phase 1 (inflammatory stage)
Pain, redness, swelling
Loss of mobility
Damage to cells and tissue
Increased blood flow
Leakage of fluid causing swelling (oedema)
Formation of blood vessels
Phase 2(repair and regenerative stage)
Lasts from 3 days to 6 weeks
Elimination of debris
Formation of new fibres
Production of scar tissue

Phase 3 (remodeling stage)


Lasts from 6 weeks to months
Increased production of scar tissue
Replacement tissue needs to strengthen and develop
Immediate treatment of Soft tissue aims to:
Reduce swelling
Prevent further damage
Ease pain
Long

term, it aims to:


Restore flexibility
Regain full function
Prevent recurrence
Return the player to the field ASAP

Managing soft tissue injury (RICER)


Rest
Ice
Compression
Elevation
Referral
Hard tissue injuries
Fractures
Two broad classifications simple (closed) and compound (open
protrudes through the skin)
Other classifications include:
Greenstick simple, not fully broken
Oblique - not compound, bone breaks and slides
Comminuted breaks in more than one place
Depressed concave, on the skill
Signs and symptoms of fractures
Intense pain
Sound of bone cracking
Swelling, bruising, discolouration
Loss of function
Management
DRABCD

Control of bleeding
Treating shock
Use of splint of bandage to immobolise the area
Medical assistance

Dislocations

Is the displacement of a bone at a joint


Cause pain and are apparent because of deformity
Not a hard tissue injury only damage to the ligaments which
are dtretched or ruptured
More damage can occur if placement is incorrect

Signs and symptoms


Deformity and swelling
Pain and tenderness
Loss of function
Treatment
Do not relocate displaced bone may increase damage
Seek medical attention
Subluxation the bone may momentarily pop out and quickly
return to place

Joint becomes vulnerable and require rehabilitation or surgery

Assessment of injuries
TOTAPS (Talk, observe, touch, active movement, passive movement,
skills test)

Used to assess the state and nature of injury, determine if


they can return to the game
If the player can complete all tasks = return to play
TALK what happened provides information about the nature of
the injury
OBSERVE Any signs of selling or deformity. Compare both sides of
body
TOUCH Touch gently, feel for any signs of deformity
ACTIVE MOVEMENT (player moving area themselves) performs a
range of joint movements e.g. flexion, extension, rotation

PASSIVE MOVEMENTS (the assessor mobilises the joint)


SKILLS TEST The player performs a skill that is required during the
game e.g. a sidestep for rugby league
How does sports medicine address the demands of specific
athletes?
Children and young athletes
Medical conditions (asthma, diabetes, epilepsy)
Asthma
Reduces the width of the airways leading to the lungs
More than 2 million Australians suffer from asthma
Exercise induced asthma (EIA) The airways are dilated
during physical activity and constrict immediately after
exercise ceases
Some activities provoke asthma more than others e.g. greater
risk of an asthma attack occurring while running than
swimming
Management
Activity should be proceeded by controlled breathing and
relaxation exercises
Gradual warm up and leisure warm down
Exercise intensity should be steady
Medication should be used before exercise, if needed
Adequate water
If attacks are triggered by environmental factors, remove the
athlete from that environment
Diabetes
Type 1 Diabetes body cannot produce insulin
Type 2 Diabetes body cannot produce sufficient insulin or
use it efficiently
Management
Balance insulin
Well balanced diet carbohydrates forming a significant
portion
Have a pre-game meal to raise blood sugar levels if exercise
is extended hourly glucose supplementation is needed
Epilepsy

Is a disruption to brain function, causing a brief alteration to


the level of consciousness and resulting in seizures or fits

Management
If seizures occur daily, avoid collision sports
Other players, parents or supervisors should be present and
know what to do if a seizure occurs
Swimming alone, scuba diving and rock climbing should be
completely avoided if they lose control and go unnoticed, it
may lead to serious injury or death
Overuse injuries (stress fractures)

Occur from repetitive actions which place too much stress on


bone and muscle
Children are susceptible to overuse injuries du to different
growth rates in bone and soft tissue
More the sport is played increased chance for overuse
injuries
Examples shin splints, tennis elbow, Achilles tendonitis

Can be caused by:


Playing the same sport all year round or multiple sports
Inadequate warm ups
Lack of a good general level of fitness
Improper technique e.g. overextending on a baseball pitch
Unsuitable equipment e.g. sport shoes that do not provide
proper support
Strength and flexibility imbalances leading to poor body
alignment
Stress fractures most common overuse injury
Management
Immediate rest (lasting from 4-8 weeks)
Ice frequently to reduce inflammation
Possible inflammatory medication
Maintain fitness e.g. swimming
Use of corrective devices and exercises to improve body
mechanics if stress fractures were caused by biomechanical
factors
Thermoregulation

Refers to the maintenance of a stable internal temperature


independent of the temperature of the environment

Children are at increased risk of environment stress because


they:
o Do not lose heat by evaporation at the same rate as
adults sweat glands are not fully developed
o Are slower to acclimatise to heat
o Have lower tolerance to heat increases the possibility
of dehydration
o Have lower tolerance to extreme cold
Management
o Shade to minimise heat exposure
o Regular drink breaks to ensure hydration
o Appropriate clothing
o Avoid vigorous activities in extreme heat

Appropriateness of resistance training

Can be used by children providing that it:


o Incorporates low resistance
o Is not competitive
o Is designed to improve skill and fitness
o Is well planned and balanced exercise a variety of
muscle groups, rest days
Adult and aged athletes
Heart conditions

People with heart conditions include those who:


o Have experienced a heart attack or heart problem
o Suffer high blood pressure
o Have had bypass surgery
Key principles for sports participation with heart conditions
are:
o Obtain medical clearance before beginning an exercise
program
o Exercise must be aerobic e.g. walking, jogging,
swimming, water aerobics
o Progress must be gradual e.g. begin exercise 2-3
alternative days a week
o Activity needs to be of moderate intensity
o The program should be tailored to the individuals taste
o The program must be sustainable
o Have warm and cool down periods reduce placing
heart under sudden change
o Modified strength programs light loads, use major
muscle groups heavy loads can raise blood pressure to
dangerous levels

Fractures/Bone density

Exercise increases bone mass and makes bone stronger, and


is important in delaying osteoporosis; physical activity by
older women is important in delaying post-menopausal bone
density loss
Exercise needs to be safe and beneficial and not cause pain
Osteoporosis bones become thin and weak, increasing the
risk of bone fracture
Most common disease in ageing adults

Options available:
Endurance activities such as walking, cycling, swimming
Cycling and swimming = good because bicycle and swimming
provide support
Low impact and balance activities, such as aerobics
Low range strengthening exercises focusing on the limbs,
trunk and back
Programs are to be avoided if they include:
Activity of high intensity
Exercises with high resistance
Flexibility/Joint mobility

To be

Exercise can have positive effects on flexibility and joint


mobility in older people
Arthritis, aching joints and tight muscles are common
problems
effective, programs need to:
Be low impact
Be specific to a persons limitations
Consider existing medical conditions that may limit movement

Options available:
Walking, cycling swimming, flexibility classes and aqua
aerobics
Water exercises not weight bearing increase in bone +
muscle mass
Prevent falls by increasing balance and stability
Female athletes

Eating disorders

May

Characterized by behaviors such as purging, binge eating and


starving
Most common = anorexia nervosa and bulimia nervosa
Affect more than half of the athletes who compete in events
where low body fat and idealized body shape is expected e.g.
dance, gymnastics, synchronized swimming
result from:
Peer influence, magazines, television
Social expectation
Pressure within athletic sub culture
Need to conform

Cause the following health implications


Malnutrition deficiencies of energy, protein, vitamins and
minerals
Dehydration
Electrolyte imbalance need for homeostatic balance affect
teeth, joints, bones, nerves, muscles blood sugar levels,
delivery of oxygen to cells
Muscular atrophy wasting away of muscles and decline in
muscle mass
Prevention
Expect athletes to do their bests
Be better educated to detect signs
Observe training routines and social practices such as eating
Iron deficiency

Iron deficiency causes anemia


Anaemia when hemoglobin levels drop below 11g per 100ml
of blood
When iron levels are low, the amount of red blood cells is
reduced this limits the oxygen-carrying capacity of the blood
and degree to which the athlete can participate in sport
Contributes to fatigue and loss of energy
Is more common in females as they usually eat less red meat
and lose iron during menstruation
Exercise induced anaemia result of intense training where
iron reserves are heavily drained
Iron levels should be monitored and increased when required
Excessive iron lead to liver disease, diabetes, heart problems
and joint damage
Bone density

Bone density refers to the thickness and strength of bones


Calcium deficiency is associated with osteoporosis and bone
fractures in older females
Calcium is necessary for bone strength and is also required in
the blood to allow muscles and nerves to function correctly
Causes of calcium deficiency in bones include hormonal
changes associated with menopause (cessation of menstrual
period), decreased exercise and inadequate amounts of
calcium in the diet
Athletes with amenorrhea (cessation of menstruation when of
reproductive age) are also prone to calcium deficiency
because of decreased calcium intake or lower oestrogen
levels, or both.
Good sources of calcium include
o Milk
o Cheese
o Yoghurt
o Fruit and vegetables (leafy greens)
o Fish with bones
Adequate calcium intake is essential for maintain bone density
Athletes need to be mindful of maintaining adequate calcium
levels so as not to affect bone density, which may lead to
increased risk of injury
Regular exercise of a light to moderate intensity, is
recommended in younger females as a means of decreasing
the risk of osteoporosis in later life
Oestrogen is also very effective in maintaining bone density,
more affective than increased dietary calcium in this regardLow bone density is associated with amenorrhea

Pregnancy

Mild to moderate exercise is safe and beneficial for pregnant


women
Research shows physically fit women during pregnancy had
fewer medical interventions during labour

Considerations/Implications:
Exercise in the cool of the day
Consume adequate water to avoid thermal stress, which can
affect the development of the foetus
Exercise at comfortable pace
Avoid jumping and jarring movements
Resistance training assist women to tolerate heavier body
and altered centre of gravity
Resistance training carefully supervised to ensure proper
breathing (avoid holding breath increases blood pressure)

Regular moderate exercise is beneficial for:


Maintenance of fitness and general wellbeing
Weight control during later stages of pregnancy
Improved muscle tone
Decrease post natal depression
What role doo preventative actions play in enhancing the
well being of the athlete?
Physical preparation
Prescreening

Assess the health status of a person before they become


involved in a training program
Age, gender, health status and previous experience
important criteria
Important for males over 40 females over 50, asthmatics,
smokers, who are obese or high blood pressure, people with
family history for heart conditions
Tool for encouraging people to begin and maintain exercise
using an exercise prescription
Cxd

Skill and technique


Relates to the efficiency with which we perform required
activities
Skill players demonstrate a high degree of:
Temporal patterning (smaller parts of movements are
executed in sequence, e.g. top spin in table tennis)
Pacing (movements are precisely timed)
Control
Correct skill essential to prevent injury. E.g. footballer who is
unsure how to tackle at risk every time they make a tackle
Physical fitness

Physical components of fitness apply. E.g. flexibility,


endurance, strength etc.
Athletes can prevent injuries by placing special emphasis on
developing the physical components specific to their
activities.
Specific needs for athletes regarding fitness vary from sport to
sport, and then within a sport varying from position to position

Emphasis on special requirements in sport can reduce injuries,


improve specific physical fitness and core strength. E.g. in
rugby union, forwards would need to undertake a specific
neck-strengthening program as they are prone to injury from
scrums.Individuals need specific physical preparation for various
reasons including:
o Previous injury
o A medical condition
o A disability
o An identified personal playing weakness

Warm up

Important injury prevention feature of any training program


The warm up needs to be geared to the demands of the sport
e.g. sports that require explosive movements such as
sprinting, require longer warm ups and adequate stretching
Warm ups cause redistribution in blood flow from internal
organs to skeletal muscles
Muscle temp. Increases hence Increase ability of the muscle
to stretch without tearing and improves reaction reflex time
Positive psychological feelings knowledge that muscles will
respond at the time it has already done so

Stretching

Muscles need to be stretched beyond range required in the


sport
Achieved by a safe stretching program using the following
stretches:
o Static stretches muscle gradually stretched beyond
normal range, held for 30 seconds
o Proprioceptive neuromuscular stretching (PNS) may be
performed with a partner
Stretching programs need to be specific to the needs of the
sport
E.g. A high jumper will stretch all major muscle groups in
preparation for competition, but will give additional attention
to the calf and thigh muscle groups as the demands on these
is the greatest

Cool Down

The period following sport, where body temp, circulation,


respiratory rates return to pre exercise state
Essential to:
Maintained the stretch in muscle groups which may have
shortened e.g. leg muscles of a cyclist may shorten if the legs
do not reach full extension
Disperse lactic acid which has built up
Prevents the blood pooling gradual reduction in heart rate
reduces vasodilation (supply of blood to working muscles) and
the tendency of blood to pool in muscles that have been
heavily worked
Sports policy and the sports environment
Rules of sports and activities

Rules of sport assist the flow of play and protect players from
injury
Rules are enforced by the referee or umpire promote safety
within the game
Injury has the potential to cause permanent damage rule
infringements must be dealt with, such as rugby in head high
tackles
Essential that the athletes safety is the highest priority

Examples of rules in sport, which enhance safety:

Marathon runners obliged to consume fluid during the race


to prevent heat stroke
Rugby League no head high tackles avoid head and neck
injuries such as contusions, or depression fractures and
concussions
Cricket must wear protective gear when batting e.g. helmet,
knee pads prevents fractures, dislodging a tooth, contusions,
brain damage etc
Hockey goal keepers must wear protective gear

Modified Rules for children

By decreasing the size of equipment, making the rules


simpler, equipment softer and games shorter, children can
gain a lot more satisfaction from sport
Example: t-ball, minkey hockey, kanga cricket, netta

Lowers the risk of injury


In relation to some sports, game modification has involved the
design of a complete new game to develop the basic skills of
the original game
E.g. Walla Rugby no pushing in scrums and no lifting in lines
outs etc.

Matching of opponents
Refers to growth and development as well as skill level
Grading of competition leads to safer participation
Grading is done by both age and skill level
Use of protective equipment

All protective equipment must:


o Adequately protect the wearer and other players
o Allow freedom of movement
o Air flow
o Be comfortable
Good quality equipment important for the athletes safety
Higher risk of injury from impact more important for
equipment to be safe and reliable E.g. Cricket ball bowled fast
speed helmet designed to protect batsman. If the equipment
is faulty big gap between mask and metal grid athlete at
risk for injury
Inappropriate footwear lead to blisters, calluses and even
structural deformities
Shoes unique to every athlete different sports, different
stresses on foot
E.g. football sidestepping on grass surfaces (support in form
of springs, assist change in direction. However basket baller
requires shoes that grip on polished floor and provide
cushioned support when the player lands after a rebound
Examples: mouth guards, helmets, facemasks, padding (shin,
shoulder, chest and thigh), wetsuits, hats, gloves, sunglasses

Specific protective equipment

Safe grounds, equipment and facilities

Environmental considerations
Temperature regulation

Normal body temp is


Taping and bandaging
How is injury rehabilitation managed?
Rehabilitation procedures

Objective of rehabilitation athlete to return to play as soon


as possible
Returning too soon may lead to permanent damage
Returning to play is determined by how quickly injury recovers
also on how serious the injury is

Progressive mobilization

After RICER aims to get injured area moving as soon as


possible, without pain, and prevent joint from stiffening up
Important to commence with gentle motion such as walking
then progress to stretching and strengthening
Pain should be an indicator to limits of movement

Graduated exercises (stretching, conditioning, total body fitness)


Stretching
Important so injury heals without scarring
Scarring shortens the muscle and makes it prone to further
injury
Proprioceptive neuromuscular facilitation (PNF) stretching
muscle is stretched and shortened in safe movements
Conditioning
The restoration of muscular strength is essential in injury
rehabilitation
Muscles that are active will increase in size and endurance
whereas those that remain passive will decrease in size
Even if the area is immobilised, a program should be designed
to prevent muscleatrophy (wasting muscle tissue)
Isometric exercises should be used to develop strength in the
position exercised andinvolves no movement of the joint
As swelling and pain lessen, exercises involving pain-free

movement can be introduced


As strength is slowly regained, further resistance can be
applied
The introduction of weight-bearing exercises can be
considered if the injured area isthought to be capable of
support
Isokinetic exercises are considered beneficial at this stage
because they will develop strength through the full range of
movement using uniform resistance
It is important to monitor both the agonist and antagonist
muscles, this will ensure that an appropriate ratio of strength
is being developed

Total body fitness


A program of rehab must involve both restoration of the
injured part to full function and the maintenance of overall
body fitness
Maintenance of flexibility, strength and endurance should be
promoted with activities that are specific to the sport or
activity and that do not endanger recovery from injury
The choice of exercises to maintain total body fitness will
depend on the type and severity of the injury
Activities to promote total body fitness during rehabilitation
include:
- Treadmills
- Rowing or cycling ergometers
- Swimming and water resistance activities
- Weight training
- Walking or light jogging
Training
Full training can resume once total body fitness is achieved
The athlete is expected to participate in full training sessions
This includes the warm up, drills, conditioning, skills, tactics
and cool down
The use of heat or cold is dependent on the stage of rehabilitation
Cold

Treatment
Is used for the immediate treatment of injuries
Reduces pain, swelling and blood flow
Ice should be applied for 20 minutes every hour for up to 4
days

Heat treatment
Heat should not be applied till after bleeding and swelling at
the site halts
Heat treatment promotes blood flow, movement and mobility

Increased blood flow means there is more oxygen and


nutrients being transported to the damaged tissue
Also decreases pain and stiffness

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