MANAGEMENT OF SPORT INJURY

UNIVERSITI TEKNOLOGI MARA (UiTM)

FAKULTI SAINS SUKAN & REKREASI DR ANUAR B. SUUN E-mail: anuar987@salam.uitm.edu.my Tel : 0192338646

TERMINOLOGY

..SPORTS INJURY can be broadly defined as any injury occurs due to sporting and vigorous physical activities

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SPORTS MEDICINE TEAM

THE NURSE PHYSICIANS ORTHOPEDIST NEUROLOGIST INTERNIST OPTHALMOLOGIST PEDIATRICIAN PSYCHIATRIST DENTIST PODIATRIST PHYSICIANS ASSISTANT PHYSICAL THERAPIST

STRENGTH&

CONDITIONING SPECIALIST BIOMECHANIST EXERCISE PHYSIOLOGIST NUTRITIONIST SPORT PSYCHOLOGIST SOCIAL WORKER EQUIPMENT PERSONNEL

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ROLES OF SPORTS MEDICINE

Prevent injury Providing initial first aid & injury
management Evaluate injury Treatment, rehabilitation & reconditioning Motivation Ensuring a safe playing environment Explaining the important of nutrition Conducting physical examination ORGANIZATION & ADMINISTRATION record keeping, ordering equipment and supplies, supervising personnel Referral to physician, health services & hospitals
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Age Sex Size Body composition Muscle power Muscle weakness Muscle imbalance Muscle stiffness Lack of flexibility Malalignment

Surfaces Equipment environmental

condition training errors psychological factors inadequate nutrition training method & competition
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3 types of bleeding in blood vessels

Arteries carry OXYGENATED blood from the heart to the body loss of blood from artery is always serious & profuse bright red blood flows freely from the wound in spurts that occur each time the heart beat Venous veins carry DEOXYGENATED blood back to the heart Capillaries Between vein & arteries-exchange between the blood & the tissues takes place Capillaries bleed is the least serious form of bleeding but should be controlled & the step should be taken to reduce contamination

If large vein is injured, bleeding maybe profused; does not display the spurts seen in arterial bleeding The loss is as steady flow, with dark red/maroon in color
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CONTROLLING EXTERNAL BLEEDING

Apply pressure with dressing (sterile dressing)

Function if direct/indirect & elevation pressure have failed to control the bleeding adequately 11 arterial pressure-point sites on each side of the body THIGH femoral artery to the leg When the limb is elevated, the effects of gravity will help lower the blood pressure in the injured part & reduce the flow

UPPER ARM Brachial artery pressure point is use to control profuse bleeding
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CARES FOR BLEEDING

Have someone alert the EMS system dispatcher Provide an open airway & monitor the PULSE Keep the athlete at rest & provide emotional support Treat for shock Loosen restrictive clothing Refrain from giving the athlete anything by mouth & be prepared for vomiting Splint fractures when appropriate Constantly monitor the athlete until the EMS system can respond
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PRINCIPLES OF WOUND CARE

CLINICAL FEATURES
OPEN WOUND

CLOSED WOUND
Happen in our body OR under the skin Internal body

Happen outer layer of the skin External body

E.g. Abrasions, punctures, cuts, avulsions, incised, burning, amputation

E.g. sprain, strain, contusion, fracture/dislocation, bruises, swelling

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CARES FOR OPEN WOUND

EXPOSE WOUND Clean & clear the wound surface Control bleeding

Apply a dressing

Reassure the athlete

Bandage a dressing

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COMPLICATION
Shock e.g. hypovolemic shock Chronic blood loss e.g. anemia, hemoglobin decrease Infection OR contamination : Tetanus, blood-born pathogen

Deformity
Renal failure
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Shock
Shock develops because
the cardiovascular system fails to supply an adequate supply of blood to all the bodys vital tissues This causes a greater loss of blood, then forces the heart to beat even more rapidly

HYPOVOLEMIC

TOXIC OR CHEMICAL

SEPTIC

NEUROGENIC

ANAPHYLACTIC

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CARE FOR SHOCK

Have someone alert the EMS system
dispatcher Keep the athlete at rest, lying down Ensure open airway & breathing Control all serious external bleeding Splint major fractures Elevate uninjured lower extremities Prevent loss of body heat Give nothing by mouth Assess PULSE & respirations at least once every 5 minutes

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Soft tissue or non-bony tissue is categorized as contractile and contractile @NONCONTRACTILE TISSUE Skin, joint capsules, ligaments, fascia, cartilage, dura- meter, and nerve roots @CONTRACTILE TISSUES Muscles, tendons, or its bony insertion

Nerve, ligaments, Tendons, Muscles, Fascia, Cartilage (Meniscus) being categorized as soft tissues except for bone

Many of these injuries create symptoms of

inflammation & degenerative tissue responses

These all injuries may be result of a single

episode of injury OR as a result of repeated overuse where can damage and pain
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swelling

Rupture

Bruises

Hematoma

Sprain

Discoloration
Contusion
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Strain

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CRYOTHERAPY (Cold therapy)

Any used of ice or cold applied for therapeutic purposes. Result in the withdrawal of HEAT from the body
Use of COLD in ACUTE and
SUBACUTE injury Multiple type of cold applied that used the type of electromagnetic energy Immediate skin cooling The depth can reach 5cm Classification as infrared radiation COLD is applied, HEAT is removed 15mins cold application
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TYPE OF CRYOTHERAPY
*Flaked ice in towel *Flaked ice in plastic bag *Ice massage *Cold spray *Ice bath *Cold compression *Ice immersion
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USES OF CRYOTHERAPY

EFFECT

Decrease

metabolism Decrease circulation Decrease pain Decrease muscle spasm Decrease inflammation Stiffness

IMMEDIATE To

limit the body response (swelling, pain, muscle spasm)

REHABILITATION

To restore function

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CPR or Cardiopulmonary Resuscitation is used to prevent biological death when someone is experiencing cardiac arrest

The person will not be RESPONSIVE, BREATH & CIRCULATING BLOOD The techniques applied during CPR provide the athlete with air & circulation

COMPLICATIONS #Athlete injury #Gastric distention #REGURGITATION OR vomiting

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Procedures of CPR for the adult victims

(one rescuer CPR)
Determine unresponsiveness, position athlete, open airway, Look, listen & feel (3 to 5 seconds for breathing) Deliver 2 breaths at 1 to 1 seconds per ventilation Check carotid pulse for 5 to 10 seconds if NO pulse, then begin chest compressions COMPRESSION 80 to 100/min (15/9 to 11 sec) VENTILATIONS 2 ventilations/15 compressions Do 4 cycles, then check PULSE

DO PERIODIC ASSESSMENT OF BREATHING & PULSE

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FRACTURE

DISLOCATION

#A partial or complete

interruption in a bone continuity #It can occur without external exposure or can extend through the skin, creating an external wound (open fracture) #A sudden, violent muscle contraction or repetitive abnormal stress to a bone also cause a fracture

# A dislocation occurs

whenever one end of a bone that makes up a joint is pulled out of place # the mechanism of injury is forceful, i.e. a blow OR a twisting OR pulling action # soft tissues are damaged in all cases of dislocation

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Type of fracture
CLOSED
OPEN

SPIRAL #Torsional force; common in football &

skiing, sports in which the foot is firmly planted when the body is suddenly rotated in an opposing direction TRANSVERSE #Direct blow; occurs in straight line, more or less at right angles to the bone shaft OBLIQUE #Direct blow; occurs when one end of the bone receives sudden torsion or twisting while the other end is fixed or stabilized AVULSION #is the separation of a bone fragment from its cortex at an attachment of a ligament or tendon. This fracture usually occurs as a result of a sudden, powerful twist or stretch of a body part GREENSTICK #Incomplete breaks in bones that have not completely ossified e.g. adolescents. COMMINUTED #consist of three or more fragments at the fracture site
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? due to bone

pierce skin ? External force pierce skin & fracture bone ? Infection

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SOUND OF
BREAKING LOSS OF NERVE FUNCTION

EXPOSED BONE

TENDERNESS

GRATING

SOUND

SWELLING

TINGLING

SENSATION
LOSS OF USE

DISCOLORATION DEFORMITY MUSCLE SPASM

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IMMEDIATE TREATMENT FOR #

TOTAP
Keep the person warm with the blanket to decrease the possibility of shock

Cut away the clothing, if possible, but do not move the injured part to do so

Follow the instruction of RICE Call for ambulance/physi cian/specialist

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 Restoration to a

former capacity or standing or to rank (to return the athlete to the previous function) A restoration of function to the greatest possible time in order to reach this goal and achieve safe

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MUSCLE CONDITIONING

SPORTS SKILL

MAINTENANCE OF CARDIORESPIRATORY FITNESS

FLEXIBILITY

FUNCTIONAL EXERCISE

PSYCHOLOGY CORRECTION OF ABNORMAL BIOMECHANIC

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PROPRIOCEPTION

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Therapeutic Modalities
Cold Modalities Cryotherapy (ice bag, ice pack, ice
massage) High-voltage galvanic stimulation Heat modalities Superficial Heating modalities @ Hydrocollator packs (Hot packs) @ Parrafin @ Hydrotherapy (warm OR hot whirlpool) Deep Heating Modalities @ Ultrasound Transcutaneous Electrical Nerve Stimulation (TENS) Electroacupuncture

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NO PERSISTENT SWELLING, BIOMECHANIC ABNORMALITY PAIN-FREE ROM FUNCTIONAL TESTING GOOD PROPRIOCEPTION

ADEQUATE CV FITNESS

GOOD FLEXIBILITY

ADEQUATE STRENGTH & ENDURANCE PROPHYLACTIC BRACING, STRAPPING FUNCTIONAL TESTING PSYCHOLOGICAL READY

PHYSIOLOGICAL HEALING PROCESS

SKILL REGAINED
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GRADUAL & PROGRESSIVE RETURN TO SPORT

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CAUSES

CLINICAL FEATURES & DIAGNOSIS

Muscle twitching & cramps, usually after midday; spasms in arms, legs, abdomen

TREATMENT

PREVENTION

HEAT CRAMP

Hard work in heat; sweating heavily; imbalance between water & electrolytes

Ingesting large amount of water, mild stretching, & ice massage of affected muscle

Acclimatize athlete properly; provide large quantities of water; increase intake of calcium, sodium, & potassium slightly

HEAT EXHAUSTION

Prolonged sweating; inadequate replacement of body fluid losses; diarrhea; intestinal infection

Excessive thirst, dry tongue & mouth; weight loss; fatigue; weakness; in-coordination; mental dullness; small urine volume; slightly elevated body temperature; high serum protein & sodium; reduced swelling

Bed rest in cool room, increase fluid intake to 6-8L/day; sponge with cool water; keep record of body weight; keep fluid balance record; provide semiliquid food until salination is normal

Supply adequate water and other liquids; provide adequate rest & opportunity for cooling

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Cont_________________________________
CAUSES HEAT STROKE
Thermoregulatory failure of sudden onset

CLINICAL FEATURES & DIAGNOSIS

Abrupt onset, preceded by headache, vertigo, & fatigue; flushed skin; relatively less sweating that seen with heat exhaustion; pulse rate increases rapidly & may reach 160-180; respiration increases; BP seldom rises; temperature rises rapidly to 105 or 106oF (40-41oC); athlete feels as if he or she is burning up; diarrhea, vomiting; circulatory collapse may produce death; could lead to permanent brain damage

TREATMENT
Emergency measures to reduce temperature must be taken immediately (e.g. emersion in ice water bath or sponge cool water & air fan over body, massage limbs); remove to hospital

PREVENTION

Ensure proper

acclimatization, proper hydration Educate those supervising activities conducted in the heat Adapt activities to environment

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ACTIVITIES:

Warming up & preparing specific muscles and the Use all large muscles body for the extra stress of group strenuous activities Be easy effort to BEGIN AIMS: Gradually build up to To achieve better results in moderate effort training or performance Continue (10 min) until following it perspiration To avoid damage to the Be followed immediately muscles, tissues or body due to long period of by muscle physical activity stretching Make it interesting!!
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Gradually lower the physiological function of the body AFTER EXERCISE to avoid negative & physiological effects Slow down the physiological function Breathing Exercise Light STRETCHING AIMS Enhance Recovery Reduce the accumulation of LACTIC ACID

ACTIVITIES

Relaxing exercise 5 to 15 minutes duration Promote blood return to

the heart Decrease HEART RATE

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PRINCIPLES OF STRETCHING
Activities which lengthen the muscle fibers (and mobilize) connective tissue Increase range of movement (ROM) at a joint
WHY STRETCH? To decrease the risk of injury To enable full development of opposing muscle group To increase mobility To improve relaxation Decrease STRESS Improvement in posture Improve blood circulation

Warm up prior to

stretching Stretch before and after exercise Do not over stretch, particularly early stage Gently & slowly stretched Stretch to the point of tension but never pain Hold a stretched in a comfortable position A daily program produce better results Do Not BOUNCE!

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BENEFITS OF WARM-UP & COOL-DOWN

INCREASE range of motion (ROM) Relaxed muscle attachment Improved Coordination More efficient movement DECREASE in common acute
injuries REDUCE risk of overuse injuries Improved psychological preparation Improved performance
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Cont___________________________
TECHNIQUES

PLYOMETRIC* Stretching-

STATIC* When a

muscle or group of muscles are slowly stretched and held for a short period (usually 8 to 12s)

shortening cycle (myotatic stretch reflex); Refers to exercise in which the muscle is loaded in an eccentric (lengthening) contraction, followed immediately by a concentric (shortening) contraction EQUAL MOTION or maintaining the same speed of movement throughout the ROM e.g. gym equipment (specially design equipment allows muscles to encounter the same resistance for concentric & eccentric contraction
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PNF*(Proprioceptive
reciprocal inhibition. When a muscle is contracted, the antagonist or opposing muscle is relaxed

Neuromuscular Facilitation) Based on

ISOKINETIC* means

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DANGER
Control any danger to self, athlete & others

RESPONSE
Shake & Shout

RESPONSE
Make comfortable Observe ABC Check for & manage Bleeding Check for & manage other injuries (STOP)

NO RESPONSE
Turn athlete on side

AIRWAY
Open & clear airway

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Cont___________________________
BREATHING
Look, listen & feel

BREATHING
Keep in side position Observe ABC Check for & manage Bleeding Check for & manage other injuries (STOP)

NO BREATHING
Turn athlete on back

Commence EAR

CIRCULATION

Pulse present Continue EAR Check pulse & breathing after 1 Mins

Not breathing, pulse absent Commence CPR Check pulse & breathing after 1 Mins 37

& then every least 2 mins

& then every least 2 mins

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TALK

Ask the player what happen Where does it hurt? What kind of pain is it? Look at the affected area for REDNESS or SWELLING Is the injured side different from other side?

OBSERVE

TOUCH ACTIVE MOVT. PASSIVE MOVT.

Touch will indicate warmth for inflammation touch also assesses pain Ask the injured player to move the injured part without any help If the player can move the injured part, carefully try to move it yourself through its full range of motion

SKILLS

Did the active and passive movement produce pain? If no, can the player stand & demonstrate some of the skills from the game carefully? If an injury is identified, remove the player from the activity immediately sportsINJURY/anuar2005 38

How?
REST Place the athlete in a comfortable position, preferably lying down. The injured part should be immobilized and supported ICE The conventional methods are: Crushed ice in a wet towel/plastic bag Immersion in icy water Commercial cold pack wrapped in wet towel Cold water from the tap is better than nothing 20mins application every 2hours for the first 48hours

Why?
Further activity will increase bleeding & damage Ice decreases: SWELLING PAIN MUSCLE SPASM SECONDARY DAMAGE TO THE INJURED AREA Compression: Reduces bleeding & swelling Provides support for the injured part Elevation reduces: BLEEDING SWELLING PAIN

COMPRESSION Apply a wide compression bandage over a large area covering the injured part, as well as above & below the injury ELEVATION Raised injured area above the level of the heart at all possible times

REFERRAL Refer to a suitably qualified professional such a Doctor or Physiotherapist for a definitive diagnosis & ongoing care

Early referral for a definitive diagnosis to as certain the exact nature of the injury & to gain expert advice on the rehabilitation program required
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THANK YOU.