Empi Q6: Sports Emergencies in PT
OUTLINE
I. Sports Emergency Framework
II. Sports Injuries
III. Emergency Action Plan
IV. Innovation in Sports Emergency Care
LECTURE | RECORDING | BOOK | IMPORTANT | MNEMONICS
Speaker: Maria Angela L. Borras, PTRP
Affiliated with the UP Fighting Maroons
SPORTS EMERGENCY RESPONSE FRAMEWORK
● Mitigate → Prepare → Respond → Recover
○ Mitigation – minimizing all possible emergencies
that might happen
○ Prepare – mitigating is not always possible (e.g.
traveling abroad for games means emergencies
can occur) so being prepared is important
■ More than just preparing the medical kit
■ Knowing what time the game/training will
happen and the possible concerns (e.g. too
hot, too cold, time zone differences)
○ Respond – as the first aid responder it is important
that you are the most calm; when you encounter
emergency itself
○ Recover – upon response, we must also be able to
determine if a player is fit to return to play or
requires more professional help (e.g. emergency
care or hospital for ancillary procedures)
■ It is common for substitutions to occur in sports
but some sports limit the number of possible
substitutions (e.g. football)
● As a sports PT chances are you will be the medical
practitioner in field
○ In europe they have a medical or sports doctor with
them in field
○ In PH, usually team PT assumes role of primary
medical practitioner
○ Whenever we join trainings or games → always the
first person to ensure that if anything happens to
the team or coaches, we are prepared
SPORTS INJURIES
● Common injuries that occur in athletes
● Better to be prepared than shocked when these injuries
happen
Exercise Associated Muscle Cramps
● Exercise-associated muscle cramps (EAMC) are among
the most common problems in almost all sporting events
○ Typically involves multi jointed muscles
○ Lower extremity > upper extremity
■ Common for LE because muscles used for
running, jumping and pivoting are double
jointed
■ Performing a movement involves pulling a
muscle group from different ends
○ Calf, hamstrings, quadriceps
● Presentation
○ Feeling of sudden “snapping back” and localized
“cramp prone state” to be followed with sense of
tightness and muscle pain stopping the player from
doing further movement
■ There are times where a player will need to be
pulled out of the game but most of the time first
aid is enough
● Management
○ Facilitate muscle relaxation through (1) hot
spray/hot modality (2) activation of GTO/muscle
spindle reflex relaxation
■ Pts should have control over their muscle
again
■ Cold sprays are not used all the time
■ Hot cream/hot spray is used if you suspect
EAMC
○ Facilitate lengthening to normal state through
stretching (stretch should not provoke the same
type of pain reported by the patient upon onset of
EAMC)
■ E.g. for calf, press on achilles tendon before
doing the stretch to activate the GTO
■ In games this condition usually occurs and
majority of people start to stretch the player
even when the muscle is not prepared → very
painful and can cause damage
■ We must promote relaxation more than just
stretching the patient
PREVENTION IS BETTER THAN CURE
1. Assure that players are well rested prior to game
2. Ask about sleep time night before the game
3. Proper warm-up
○ Should not exceed percentage of effort needed
during a game
4. Strap or tape as needed
5. Hydrate, ensure carbohydrate intake
○ Especially true for players cutting on carbs and
trying to lose weight → body eats up most of the
protein → Increased chances of experiencing
cramps
 Sprains and Strains
● Sprains – ligamentous affectation; commonly on ankles
and knees
● Strains – muscle involvement; commonly on back and
shoulders
● Optimal loading is done immediately in order for us to
identify whether or not there is a serious injury
○ If a player cannot maintain a certain position
without feeling instability or that the knee or ankle
will give away → we know that it is a serious
condition that may warrant medical help
○ Not really talking about making the players do what
they need to do → more on perceiving what is
comfortable to them
● Compression is not just limited to bandaging anymore
○ There are kinesiotape techniques that can mimic
bandaging
Bleeding
● The Laws of the Game: Regulations for bleeding wounds
○ Any player bleeding from a wound must leave the
field of play
○ They may not return until the referee is satisfied
that the bleeding has stopped
○ A player is not permitted to wear any clothing with
blood on it
○ Important because if you have a light jersey with no
extra jersey → player might have to sit out just
because of bleeding
○ Always keep hydrogen peroxide in the first aid kit
because it dissolves blood
■ Like in HS when girls get skirt stains →
hydrogen peroxide is used
● Control bleeding by applying direct pressure, by elevating
the affected limb, by wound closure, or by arterial
tourniquet
○ For sports PT familiarize yourself with different
types of wound coverage
■ Blood will just penetrate a gauze
■ There are specific coverings that are safe for
the skin and will stick regardless of when the
players are sweating
Eye Injuries
● High velocity trauma (such as a punch or elbow to the
eye for contact sports or equipment like balls or racquet)
● Has the potential to cause a penetrating eye injury or
orbit fracture (and should be taken very seriously)
Assessment
● Remember that normal acuity does not equate to
absence of injury
● Make sure that the specific nerves and blood supply are
not injured
1. Check for the following changes:
a. Pupil shape
b. Evidence of bleeding (including conjunctival
hemorrhage or hyphaemia)
c. Reactivity to light (pen light)
d. Eye movements should be checked and visual
fields should also be assessed
e. Reduce upwards gaze (due to an entrapped inferior
rectus following an orbital floor blowout fracture)
■ Might want to send the player to the nearest
hospital for x-ray
2. Palpate for tenderness
3. Assess facial sensation (a blowout fracture can also
cause infra-orbital paraesthesia)
*When there is an injury of the eye, we also suspect a problem
with the nose
Nasal Fracture
● Most common facial bone to be fractured
○ Parts damaged usually are the nasal septum and
inferior part of the nose (hence injury at the
cartilage)
○ Check for evidence of bleeding more than just the
crack
● Lateral blow is more likely to injure superior 1/3 of the
nose
● Epistaxis (nose bleeding)
○ Apply direct compression
○ Apply vaseline/petroleum jelly to stop blood flow
temporarily
○ Use topical decongestants (Otrivin) if restricted
airways are reported
○ Sometimes it is not evident
■ If a player got hit and there is a ridge upon
palpation → check for internal bleeding as well
■ Even if epistaxis is stopped, there is still a
chance for internal bleeding
■ Go to an emergency care facility or have your
pt consult a MD
● Assessment
○ Ocular inspection of nose, assessment of
sensation, visual field and eye movements, probing
for septal hematoma (cotton buds)
 ● Ancillary Procedure ● Other mechanisms include a direct blow from an
○ Facial x-rays, facial CT (more reliable) opponent’s elbow, a hard landing onto the field of play or
● Treatment collisions of man-to-man and to objects such as the post
○ Control swelling by cold compress (soccer, basketball, volleyball)
○ Regular decongestants in two days ● Whatever the mechanism of chest wall injury, most
injuries cause severe pain, and removal from the field of
play is usually warranted, either temporarily or for the
Anaphylaxis
duration of the match, unless the chest wall can be
adequately strapped to alleviate the pain and allow
● A severe, potentially life-threatening allergic reaction functionality once again
● Known trigger factors include food, medications, ○ To alleviate the pain we usually allow prescription or
hymenoptera stings, fever and infections (such as upper intake of specific NSAIDS or strapping just to put
respiratory tract infections). compression on the area and momentarily hinder
○ We need to be very particular because sometimes any inflammation on the area so the player can
anaphylaxis occurs after and not immediately after continue
the allergic factor was consumed
○ The response of the body to specific substances Rib Fracture
can also change over time
● Most common injury sustained ff blunt chest trauma
■ Maam had a pt who experienced an allergic
● 50% of all thoracic injuries
reaction to a medication p 6 hours despite
● 10% of who received blunt trauma had one or more rib fx
having taken it already before
● Most significant symptom: pain c breathing (inspiration)
● The risk of anaphylaxis may also be increased by
○ When player tells you they find it difficult to breathe
“cofactors” that include NSAIDS, exercise, and alcohol
(pain upon chest expansion) → player must be
● Anaphylaxis is fatal! Treat as a medical emergency!
cleared of any fracture
● Mainstay treatment of severe anaphylaxis is the
○ Treat this as a life threatening emergency
administration of epinephrine (adrenaline) by
intramuscular administration into the antero-lateral thigh
Assessment
(vastus lateralis)
● OI for visible distress, pain on manual compression of the
○ For FIFA (not sure about NBA), the PT or primary
rib(s) over the affected site and presence of bruising or
medical practitioner on the field has authority to
swelling over the fx site
administer intramuscular epinephrine via injection
● Check the player post injury for alertness, adequacy of
on anterolateral thigh/vastus lateralis
the airway, breathing and circulation status (ABC)
● If no medical personnel can administer the intervention,
● Auscultate lung breath sounds bilaterally to ascertain if
rush to the medical facility.
a clinical pneumothorax is present
● Anti-histamine intake has little to no effect once signs of
○ A fractured rib may tear the visceral pleura and
anaphylaxis is present
underlying lung and cause a pneumothorax
● Anaphylaxis is a very serious condition and can cause
breathing problems
Fractures and Dislocations
Cervical Spine Injuries
● Always make sure that when you suspect for a possible
fracture
● Stabilization, rather than immobilization, is needed to
○ The player is fully conscious with no concussion or
protect the cervical spine
injury to the head
● Immobilization can compress structures that can affect
○ The player does not have a possible injury to the
the patient’s ability to breathe and can cause pressure
neck or spine
sores
○ There is no threat to the player’s airway from other
● Stabilization allows some gentle spontaneous movement
injuries to the head or neck
and is less likely to cause these complications
○ The player is breathing adequately without pain or
● A patient should not be immobilized for more than 20
discomfort
mins
○ There is no obvious (internal) bleeding that needs
control
*Based on sports emergency protocol being implemented by
■ If we see contusion on body parts that have not
FIFA
been directly hit → sign of internal bleeding →
considered as a medical emergency requiring
Chest Injuries a visit to the right medical facility

● The mechanism of injury for chest concerns are usually

from hitting against a hard object
Fractures
● Basic principles of fracture management include:
○ Controlling any external bleeding from the fracture
site
○ An assessment and recording of neurovascular
functional to the fracture site
■ E.g. common peroneal nerve runs on fibula so
it is common to have decreased sensation if
affectation of tibia/fibula is suspected
○ Pain control
○ Traction, realignment or reduction where necessary
■ Usually done by emergency doctors especially
if the case is suspected to be fx
○ Immobilization of the fracture site post reduction
■ Immobilization > stabilization
○ Elevation of the immobilized fractured limb
Dislocation
● Spontaneous reduction
○ If a shoulder is dislocated and we put our patient in
a relaxed position by virtue of the recoil of the joint
or ligaments holding the joint in its place → it might
go back
● Basic principles of dislocation management include
○ Control pain
○ Attempt to relocate if there is no substantial muscle
spasm, if there is, splint and transfer to hospital
■ No extreme distress from the pt or overfiring of
muscles (too much contraction)
■ If in case the pt can relax or he was already
given pain meds and was calmed down → can
do spontaneous reduction
○ Knee dislocations are limb-threatening injury →
treat as medical emergency!
■ D/t blood supply crossing the area
Management
*Shoulder dislocation is very common in sports so better if you
familiarize yourself with the biomechanics of the shoulder
General Convulsive Seizures
● < 5 mins duration (less than 5 mins of active continuous
convulsing
○ Basic life support care is all that will be required
(CPR)
○ The pt may be escorted or transported to one of the
Primary Dysmenorrhea
medical posts in the stadium for the continued
observation and care which may include blood
glucose evaluation
● > 5 mins
○ The pt may deteriorate into status epilepticus with
its known high morbidity and mortality
complications, if not terminated rapidly
○ Deliver patient to nearest emergency facility
● Players having seizures are regarded as hypoglycemic
until blood glucose is taken
○ Not just sugar levels that cause seizure
(1) Secure the patient for transfer and position in
recovery position
(2) Loosen any restraining garments
(a) For breathing and easier recovery
(3) Do not attempt to restrain the patient in any way,
unless absolutely necessary
(a) Unless for transfer and you need to make
sure the pt does not roll over the spine board
(4) Do not attempt to force any object into the mouth or
between the teeth
(a) There is a belief that if a pt has a seizure he
might swallow the tongue → might fall into a
relaxed state because the pt is unable to
control it
(b) Experts have already debunked this but just
in case, do not put your hand or anything
inside the pts mouth → instead put them in
recovery position so if anything gets inside
the esophagus, you are actually helping the
pt dislodge it
Gynecological Injuries
● Most common injuries/complaint
○ Lower abdominal pain
○ Genital bleeding
○ Genital trauma
○ For men when they get hit on the balls
■ Maam says in her experience whenever males
get hit in the balls they always complain of
throat obstruction (as if the balls went up their
throat and they couldn’t breathe)
○ Management also applies for female athletes with
trauma insensitive areas such as the genitals or
chest
● Always consider the player’s airway, breathing, and
circulation
● Check whether the player is hypotensive
● Administer appropriate analgesia
● Assure pain control
● Control bleeding via ice pack application or use vaginal
gauze tampons
○ Or apply ice on the hip area
● Transfer to hospital immediately!
● Chronic, cyclic, pelvic, spasmodic pain associated with
menstruation in the absence of identifiable pathology and
is typically known as menstrual cramps or period pain
(Daley, 2008)
● Common for younger players, sx controlled by NSAIDs or
hot compress
○ We are expecting this to happen especially when
there is stress d/t big game, player tries to lose
weight, disruption of sleep cycle
○ Similar to what is happening to female students
here (feel dysmenorrhea during hell week)
○ Muscle relaxants can also help
 ○ Warm modalities help our muscles relax and
increases blood flow especially in the adbominal
area
● Studies on using contraceptive pills have emerged but
use of this intervention is still on case to case basis
● Consultation with an OB-GYN is warranted

Secondary Dysmenorrhea
● Suggestive of underlying pathology such as uterine
fibroids, adenomyosis, or endometriosis
● Common for older players, intervention is as prescribed
by OB-GYN or other MD specialists
● Happens to older players who are already towards
menopausal stage EMERGENCY ACTION PLAN in SPORTS
○ Reports pain even when it is not the time for their
period
● Like an emergency action plan in other cases like in our
house when there is a typhoon, fire, etc.
Sports-Related Concussion ● Almost the same in sports but here, we have more
individuals involved in planning
● A big issue in sports injury ● Emergency personnel hi:)
○ There are lots of considerations in this topic ● Roles of first responder
● Caused by a strong impact to the head that leads to ○ Of all the first responders, who will take care of
problems with thinking or other neurological sx those who are wounded seriously, those who need
● Concussions can occur in any sport when there is a blow transfers, those who need to be given first aid →
to the head, neck, or body that sends a strong force to “triaging”
the head ● Emergency communication hi! :)
● Sx of concussion include: ○ What will happen if a stampede occurs
○ Headache ○ How will the people in the field call out the people in
○ Cognitive problems such as mental fogginess or the stadium
changes in memory ○ That’s why we have radios
○ Problems with balance and coordination ○ How will the players be protected
○ Behavioral changes such as irritability, and slowed ● Emergency equipment
reaction time ● Emergency transportation
● Behavioral changes is something we look for players that ○ Transporting victims as well as survivors
we suspect to have a concussion ● Venue directions with map
● They are suddenly very aggressive and disrespectful ○ Venues or arenas always have illustrations of
where you are and where the nearest exit is
Maddock’s Questionnaire ● On-field emergency protocol
○ If competing abroad, PTs usually get an orientation
1. At what venue are we today?
for this
2. Which half is it now?
● Emergency action plan checklist for non-medical
3. Who scored last in this match?
emergency
4. What did you play last week?
5. Did your team win the last game?
SPORTS INNOVATION
● Helps us decide after if we should field in the athlete
again
● We don’t ask for our name because sometimes players
are not that familiar with our full name
● Consists of memories of current events and of the past
week
● If player gets 3/5 questions wrong, we sideline the player
and perform a thorough assessment (SCAT-5) prior to
waiting for transfer to an emergency facility

SCAT 5
● Concussion recognition tool that is used as a
standardized tool for different sporting events
● There are versions for adults, adolescents, and children
● Representation on how AI has been used to predict the
occurence of sports related concussion in NFL or
american football
● KNN model (left graph)
○ Identifies which of the ff factors will predispose the
player more to the injury or concussion
○ We saw that if the player gets injured during
pre-season, there is a big chance that this player
might have an injury/concussion during game
season. Having an injury pre-season will mean that
the player is still in the rehabilitation phase and
there could be a chance that the player’s
kinesthesia, proprioception are not as good
● Might be different for other sports
● Other tests (right graph)
○ Different types of machine learning language
○ Such as linear regression, Gradient Boosting
Method, Random Forest
○ Based on the data we inputted, we ask the
machine:
■ “Based on this computation, what will
predispose the athlete into concussion?”
■ “Based on this specific criteria or history, how
will we know that we will prevent injury in the
future?”
● Use of AI in sports
○ If we are able to link or maximize the use of data
science in our medical know-hows, we can mitigate
or prevent more injuries