E-KHEL PATHSHALA

SPORTS PHYSIOTHERAPY

CONTENT LITERATURE: LEVEL- 2

Duration
Number of
Takeawa of
Content Piece Takeaways/ Takeaway Description Mode
y Code Takeaway
Tasks
(minutes)
KSIPV1 Healing Phases of Injury 4 Video
Severity Grades of Sports
KSIPV2 4 Video
Injuries
KSIPV3 Signs & Symptoms of injury 4 Video
Knowing Assessment for sports
severity of KSIPV4 participation by 4 Video
injury and 7 physiotherapist
allowing KSIPV5 Criteria for Return to Sports 4 Video
participation Intervention by
KSIPV6 physiotherapist for safe 4 Video
participation
Plan for maintaining tissue
KSIPV7 4 Video
fitness
Pre-Participatory
PRSIV1 Examination by a 3 Video
Physiotherapist
Injury screening tests and
PRSIV2 4 Video
sports specific concerns
Common and Sports specific
PRSIV3 4 Video
injuries
Prevention
Risk factors associated with
and PRSIV4 4 Video
sports injuries
Rehabilitation 8
Principles of Injury
of sports PRSIV5 3 Video
Prevention Program
injuries
Prevention strategies and
PRSIV6 4 Video
intervention methods
Principles and planning of
PRSIV7 rehabilitation for sports 4 Video
injuries
Rehabilitation methods and
PRSIV8 4 Video
techniques

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 Knowing severity of injury and allowing participation

 Healing Phases of Injury

Soft tissue healing is defined as the replacement of destroyed tissue by living tissue in
the body. This process consists of two parts - regeneration and repair.

 During the regeneration component, specialized tissue is replaced by the

proliferation of surrounding undamaged specialized cells.
 In the repair component, lost tissue is replaced by granulation tissue which
matures into scar tissue.
The cellular reaction after injury depends on the tissue type as well as the extent of the
wound and there are no defined boundaries between stages as the wound healing
response “transitions” into the next stage of healing.

The healing process is tri-phasic:

1. Acute inflammatory phase
2. Repair phase
3. Remodeling phase

Acute inflammatory phase

Phase - 0 to 72 hours:
• Immediately following an injury, there will be inflammation and bleeding in the
injured area that results in pain, redness, swelling and heat.
• This phase starts rapidly within a 6-8 hours after the soft tissue injury, reaches the
maximal reaction between 1-3 days and gradually resolves in a few weeks.
• Achieved by vasoconstriction, retraction of injured blood vessels, fibrin
deposition and clotting.
• Phagocytosis the process by which the phagocytes that serves as an important
bodily defence mechanism against infection by microorganisms and tissue debris
happens during this phase.
• Healing in this phase takes place by fibrotic repair and is not well organized.

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Repair phase
Phase - 48 hours to 6 months:
• In this phase there is the development of collagen by the fibroblasts.
• This collagen is the “plaster” that is used to establish a connective tissue matrix which
will consolidate and contract (“dry”) early on (3-14 weeks), but may continue for up
to 6 months.
• It is essential that the tissues are sufficiently tensioned to promote organized healing
(e.g. ranges of motion, gentle manipulation, etc).

• The properly applied forces of active exercises and passive mobilization assure
optimal tissue repair.
• However, because this repair is a work in process, it is essential that the body is not
pushed beyond its limits resulting in re-injury or suboptimal repair.
Remodeling phase
Phase – 3 Weeks to 12 months:
• This phase is all about the reorganization of the resulting scar from the first 2 phases
so that the tissue is as close to resembling the original tissue as possible.
• Of course, even the best repair process cannot result in tissue integrity equal to the
original tissue.
• With ligaments that have been stretched beyond their limits, there is a permanent
plastic deformation which subjects them to hyper mobility which overtime has been
reported to result in joint degeneration and osteoarthritic changes.

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  Severity Grades of Sports Injury
A. Type of Tissue Injuries-

SITE ACUTE INJURIES OVERUSE INJURIES

Bone Fracture Stress fracture

Periosteal contusion Bone strain
Stress reaction
Osteitis
Periostitis
Apophysitis

Articular cartilage Osteochondral/chondral fracture Chondropathy (e.g. chondromalacia)

Minor osteochondral injury/lesion

Joint Dislocation Synovitis

Subluxation Osteoarthritis

Ligament Sprain/tear (grades I - III) Inflammation

B. Grades of Sports Injury

Grade I (Mild): Tissue is stretched.

 Slight swelling (hardly noticeable)

 Mild loss of range of motion (ability to move in various directions) and strength (0 –
25%)
 No decrease in stability

Grade II (Moderate): Involves stretching and some tearing of tissue.

 Moderate swelling (may look “baseball” size)

 Usually includes some bruising
 Moderate loss of range of motion and strength (25 – 75%)
 Some decrease in stability

Grade III (Severe): Complete tearing of tissue.

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 Significant swelling and bruising
 Near complete loss of range of motion and strength (75 – 100%)
 Marked decrease in stability

 Signs & Symptoms of Injury

Injury signs & symptoms include:
• Skin Injuries- Abrasions (scrapes), Lacerations (cuts), Blisters, burns, white skin in
frostbites, etc
• Internal or External Bleeding or uncontrolled or heavy bleeding, hemorrhage
• Tissue swelling, edema, with or without discoloration
• Bone injuries- Pain, tenderness, spasm, , loss of movement, etc
• Joint / Ligament injuries- Pain, joint swelling, reduced mobility (range of motion of
the joint), weight bearing is painful
• Muscle / tendon injuries- Pain, tenderness, swelling, bruising and hematoma
formation as in case of contusion, pain on contraction of muscle / movement

 Assessment for Sports Participation by Physiotherapist

• Assessment by the physiotherapist for effective participation and prevention of sport
injuries is crucial to maximize the health and performance of athletes.
• So, the physiotherapist follows important strategies including pre-participation
examination (PPE) before beginning of player’s training program and sports
participation.
• Pre-participation examination broadly covers Musculo-skeletal status evaluation,
injury or any pain worries, and player’s functional abilities.
• Follow up assessment and return to sports assessment is done to allow the player for
safe sports participation after any injury that includes majorly pain evaluation, weight
or load bearing capability, range of motion and strength issues, limitations for any
action or performance if any, etc.

 Criteria for Return to Sports

• Returning an athlete to sport following an injury requires physiotherapist to be part of
a decision-making team.
• While the physio must ensure adequate rehabilitation, they must also weigh the
negative consequences of keeping an athlete away from training too long.

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• Guidelines should consider the physical, physiological, and psychological demands of
returning to sport.

• Return-to-sport evaluations consist of a range of tests that measure the quality and
quantity of limb movement.
The tests used include-
1. Range of motion tests
2. Muscle strength tests
3. Balance tests, Hop tests (weight bearing test)
4. Clinical examination to know the state of injury
5. Specific fitness requirement for particular sporting event
6. The patient’s reported feelings of readiness
7. Functional and Performance-based tests.

 Intervention by Physiotherapist for Safe Participation

Intervention strategies include but limited to-
• Proper Warm-up program [i.e. FIFA 11 program for Football game]
• Posture correction if any

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• Strength training
• Stretching / flexibility training
• Balance/ proprioceptive training
• Plyometrics, Eccentric training
• Agility training
• Orthotics and taping
• Correcting biomechanics of movement
• Psychological and/or cognitive skills
• Employing adequate recovery methods
• Any other required physiotherapeutic methods

 Plan for Maintaining Tissue Fitness

• Based on PPE screening key findings, a physiotherapist will design a Prehab program
to improve and maintain tissue fitness.
• This may include exercise programs addressing the flexibility of muscles, joint range,
mobility and stability, strength of muscles, balance and co-ordination, core stability,
game specific movements and fitness, etc.
• This will help prevent any future sports related injuries and hence maintain tissue
fitness as well.

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 Prevention and Rehabilitation of sports injuries

 Pre-Participatory Examination by a Physiotherapist

The purpose of pre-participation screening in sports is to decrease the number of sport-
related injuries and death by identifying individual abnormalities that may predispose an
athlete to injury. It also help identify athletes that may be at risk for further injury or
illness and to refer these athletes for additional medical evaluation prior to allowing them
to participate.
Screening is designed to identify intrinsic or individual factors that may predispose a
player to both acute or overuse injury. 
• Before starting with any training program or active sports participation, the player
must undergo in-detail PPE by a physiotherapist.
• PPE includes the detailed medical or surgical history, injury history- current or past
injuries, joint range of motion and strength tests, mobility and flexibility tests, balance
and coordination tests, gait and posture analysis, etc.
• Based on the findings, the physiotherapist will decide the athlete’s participation in the
training / sports and if any aspect of health and fitness need to be corrected the
physiotherapist employs various intervention methods such as strength and flexibility
training, balance and stability training, proprioceptive and agility training, functional
training, etc.

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 Injury Screening Tests & Sports Specific Concerns
For many years, physiotherapists have screened athletes with the aim of identifying
the athletes at risk for injury, so that they can then implement injury prevention
programmes for these athletes. More recently, the focus has, however, shifted from
using screening to predict injuries to rather using screening to identify possible
predispositions to injury.
Musculo-skeletal screening includes the assessment of range of motion, muscle
asymmetry, muscle strength, altered biomechanics, balance- coordination and joint
stability/ integrity, bad posture or pait pattern, functional impairement and to identify
significant injuries.
Screening also helps to identify any orthopaedic conditions that may require further
evaluation and treatment, including physiotherapy.
Risk factors for injuries in any sport is different for each sporting event. So, injury
predisposition or prediction varies from one sport to another. For example, presence of
flat feet can cause injuries in runners than in shooters or archers. Joint integrity or
stability in knees is very important for a discus or shotput thrower than for a cyclist or a
swimmer. Injuries and their predisposing causes are different in sports such as bicycling,
golf, gymnastics, martial arts, racquet sports, weightlifting, etc as per the movement/
action involved and also on the continuous and intermittent load / impact falls on the
body.

 Common & Sports Specific Injuries

Sports injuries are usually classified as either:
1. Direct or indirect (cause)
2. Soft tissue or hard tissue (location)

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3. Acute and overuse injuries (type)
Direct injuries are caused by an external force or collision, which is produced by a source
outside of the body.
The most common sports injuries are:

 Ligament or joint sprains

 Muscle or tendon strains

 Contusion and swollen muscles

 Bony pain like shin bone pain or fracture of bone

 Dislocation of joints

 Lumber or cervical disc or spinal joint injuries

Some examples are- Shoulder Rotator cuff injuries, Tennis elbow, Tibia bone stress
fracture, Thigh Quadriceps contusion, Hamstrings pull / strain, Low back muscle injury,
Ankle sprain, Knee ligament sprain or ACL tear, etc.

Name of Sport Type of Injuries

Runners Runners’s knee ( Patello-Femoral Joint Syndrome),

shin splints / stress fracture
Jumpers
Jumper’s knee (patellat tendonitis), Ankle sprain,
Low back injury
Throwers
Shoulder Rotator cuff strain / impingement, Knee
injury, Low back injuries

Hockey Shoulder AC joint injury, Low back injury, Knee

MCL or ACL injury, Ankle sprain, Muscle contusion

Football Finger injury, Acheles tendon injury, Ankle sprain,

Knee tendonitis, Sever’s disease

Basketball Ankle sprain, knee injuries, Quadriceps, Hamstrings

and Groin injury, Back injury, Concussion

Swimming Shoulder Impingement, Biceps tendinitis, Knee MCL

sprain, Neck or back injuries

Tennis Tennis elbow, Shoulder injury, low back SI joint

injury, Muscle strain- calf, hamstring
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Badmonton Knee Patello-Femoral Joint Syndrome, Jumper’s
knee, Ankle sprain, Shoulder Impingement Syndrome
 Risk Factors Associated with Sports Injuries
Intrinsic Risk Factors

 Age (maturation, ageing)

 Sex (Male or Female)

 Body composition (e.g. body weight, fat mass, BMI, bone and muscle mass)

 Fitness level (e.g. muscle strength/power, VO2 max, joint ROM)

 Health (previous injury, joint instability)

 Anatomy (alignment, intercondylar notch width)

 Skill level (e.g. sports-specific technique, postural stability)

 Psychological factors (e.g. competitiveness, motivation, perception of risk)

Extrinsic Risk Factors

 Human factors (e.g. teammates, opponents)

 Sports factors (e.g. coaching, training errors, rules, referees)

 Protective equipment (e.g. helmet, mouth guard, shin guards, etc)

 Sports equipment (e.g. shoes, hockey stick, racquets, etc)

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 Environmental factors (e.g. weather, snow and ice conditions, floor and turf type,
maintenance of playing surface)

 Principles of Injury Prevention Program

Warm up:

 Increased blood flow to muscles.

 Increased joint range of motion.

 Improved muscle flexibility.

 Improved circulation

Stretching:

 Make sure you’re warm before stretching

 Hold stretches for 30-60 seconds

 Repeat, stretching further the second time

 Stretch to point of tension not pain

 Stretch before and after exercise

Appropriate Training

 Training methods and individualised program as per periodisation plan and

requirement of the game should be implemented properly.
Appropriate Footwear & Equipment

 Wear protective gear, such asshoes, helmets, protective pads, and other gear.

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Taping and Bracing
 To restrict undesired and harmful movements i.e. Using adhesive tape, bandages,
braces like knee cap/ support, ankle binder, tennis elbow support, etc
Adequate body recovery

 Active cool down.

 Sauna and Steam Bath

 Cold Whirlpool, Ice bath or Contrast bath

 Massage

Proper nutrition

 Adequate Glycogen Repletion

 Adequate Protein Intake

 Adequate Hydration with sodium, potassium (minerals) and Vitamins

 Prevention Strategies and Intervention Methods

To reduce the risk of injury (Sports specific concern):

 Take time off. Plan to have at least 1 day off per week and at least one month off per
year from training for a particular sport to allow the body to recover.

 Wear the right gear.  Players should wear appropriate and properly fit protective
equipment such as pads (neck, shoulder, elbow, chest, knee, shin),
helmets, mouthpieces, face guards, protective cups, and eyewear.

 Strengthen muscles. Conditioning exercises and Gym training used to strengthen

muscles is very useful.

 Increase flexibility. Stretching exercises after games or practice can increase

flexibility. Stretching should also be incorporated into a daily fitness plan.

 Use the proper technique. This should be reinforced during the playing season by
the coach.

 Take breaks. Rest periods during practice and games can reduce injuries and prevent
heat illness.

 Play safe. Strict rules against headfirst sliding (baseball and softball), spearing
(football), and checking (in hockey) should be enforced.

 Do not play through pain.

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  Avoid heat illness by drinking plenty of fluids before, during and after exercise or
play; decrease or stop practices or competitions during high heat/humidity periods;
wear light clothing.

 Principles and Planning of Rehabilitation for Sports injuries

The ultimate goal of the rehabilitation process is to limit the extent of the injury, reduce or
reverse the impairment and functional loss, and prevent, correct or eliminate altogether the
disability.
Principles:
Here are seven principles of rehabilitation, which can be remembered by the
mnemonic: ATC IS IT.
A: Avoid aggravation. It is important not to aggravate the injury during the rehabilitation
process. Therapeutic exercise, if administered incorrectly or without good judgment, has the
potential to exacerbate the injury.
T: Timing. The therapeutic exercise portion of the rehabilitation program should begin as
soon as possible—that is, as soon as it can occur without causing aggravation.
The sooner patients can begin the exercise portion of the rehabilitation program, the
sooner they can return to full activity. Following injury, rest is necessary, but too much rest
can actually be detrimental to recovery. Athletes can however rest the portion of the body that
is actually injured and work the rest of the body - often referred to as “relative rest”.
C: Compliance. Without a compliant patient, the rehabilitation program will not be
successful. To ensure compliance, it is important to inform the patient of the content of the
program and the expected course of rehabilitation.
Setting goals and including athletes in decision making works as a motivation factor to
continue the rehabilitation process. Thus goals working as a motivating factor, increases the
effort to reach the goal, and thereby increases focus, endurance, and direction for the athletes
to continue, which is an important part of rehabilitation after an injury.
I: Individualization. Each person responds differently to an injury and to the subsequent
rehabilitation program. Even though an injury may seem the same in type and severity as
another, undetectable differences can change an individual’s response to it. Individual
physiological and chemical differences profoundly affect a patient’s specific responses to an
injury.
S: Specific sequencing. A therapeutic exercise program should follow a specific
sequence of events. This specific sequence is determined by the body’s physiological
healing response.
I: Intensity. The intensity level of the therapeutic exercise program must challenge the
patient and the injured area but at the same time must not cause aggravation. Knowing when

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to increase intensity without overtaxing the injury requires observation of the patient’s
response and consideration of the healing process.
T: Total patient. Treating the Whole Patient. It is important for the unaffected areas
of the body to stay in normal tone and size. This means keeping the cardiovascular
system at a pre-injury level and maintaining range of motion, strength, coordination, and
muscle endurance of the uninjured limbs and joints. The whole body must be the focus
of the rehabilitation program, not just the injured area.

 Rehabilitation Methods and Techniques

Rehabilitation methods and techniques are implemented to enchance healing of injured
tissues, reduce pain and associated problems, improve musculo-skeletal standard of athlete.
Pain Management: PRICE protocol, Electrotherapy, Exercise therapy, Strapping/ taping,
etc.
Manual Therapy: Different manual therapy techniques such as Soft-tissue release,
traction, joint manipulation, trigger point therapy, etc should be incorporated as indicated.
Flexibility and Joint range of motion: Stretching exercises, mobilization and
manipulation of joints, etc.
Strength and Endurance: Strength training methods specifically for improving strength
and endurance of the muscles [Progressive Resistance Eercises].
Proprioception and Coordination: Weight bearing joints are affected with loss of
proprioception or joint sense, so balance and proprioceptive exercises / training is added.
Functional Rehabilitation: General and specific functional movements- exercises and
activities need to be implemented when there is no pain and requisite strenngth and flexibility
has been achieved.

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 Sports specific exercises and training: Sports specific exercise drills shaould be added
in later stage of rehabilitation after functional movements become strong. For example,
throwing drills for throwers, rackets sports.

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