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SPORT INJURY &

MANAGEMENT
Onarisa Ayu, MD

Learning objectives
How to classify injuries as chronic or acute
How to classify injuries as soft tissue or hard tissue
Different types of skin damage cuts, grazes, blisters
and chafing
The causes and treatment of strains, sprains,
dislocations and torn cartilage
How to identify and treat fractures
The treatment of injuries R.I.C.E.
The causes and treatment of unconsciousness
D.R.A.B.C., resuscitation and the recovery position
The causes and treatment of concussion, dehydration
and hypothermia.

Any idea???
Bruise

bone is pulled or twisted out of place at a


joint.

Sprain

A cracked or broken bone

Fracture

Bleeding under the skin

Concussion

Torn of the ligament

dislocation

common cause of unconsciousness

CLASSIFYINGSPORTSINJURIES

direct
indirect
overuse

type of tissue injured;


soft
hard

DIRECT INJURIES

Caused by forces
generated from
outside the body.
Direct injuries
result in

fractures,
dislocations,
sprains and
bruises.

INDIRECT INJURIES

Caused by a force
within the body.
Occur as a result of;
- inadequate warmup
- ballistic movements
- excessive strain on
muscles and tendons

OVERUSE INJURIES

Result from intense


or unreasonable use
of joints or body
areas.
Provoked by
repetitive, lowimpact exercise such
as jogging or
stepping.
Cause pain and
inflammation around
the site of the injury.

OVERUSE INJURIES

Anterior shin splints;

irritation to the front


portion of the
shinbone.

Tendonitis;

irritation of tendons
e.g.in the Achilles
tendon in the heel.

SOFT TISSUE
This includes:
Muscles
Tendons
Ligaments
Joint tissue
Fatty tissue
Types of soft tissue injuries
include:
Bruises (haematoma)
Sprains (ligaments)
Strains (tendons)
Lacerations (skin)
Dislocations (joints)
Tendonitis (tendons)

HARD TISSUE
Hard tissue includes:
Teeth
Bones

SOFT TISSUE INJURIES

SOFT TISSUE INJURIES

Acute;
occurring
suddenly
Chronic;
prolonged
Chronic soft tissue
injuries
necessitates a long
rehabilitation due
to their severity.

TEARS, SPRAINS, CONTUSIONS


Tears (Strains): a disruption of the fibres of muscle or
tendon. Occurs when the muscle/tendon is overstretched or
the muscle contracted too quickly
Sprains: a stretching or tearing of the ligament fibres,
muscles or tendons supporting a joint. Occurs when a joint
is extended beyond its range of movement.
Strains and Sprains can be classified according to severity
Grade 1 being the least serious up to Grade 3 being the
most serious
Contusions: a bruise (bleeding) into the soft tissue.
Generally caused by contact with a solid (usually blunt)
object.

SKIN ABRASION, LACERATION,


BLISTERS, CALLUSES
Skin abrasions: occur when the
outer layer of the skin is
removed, usually a scraping
action.
Lacerations: a cut, which will
usually require stitches,
depending on the depth of the
cut. This is usually caused by a
sharp object.
Blisters: occur because of friction,
which causes a pocket of fluid to
form under the skin
Calluses: when a build-up of dead
skin forms at a site where
constant friction has occurred.

Chronic injuries
Injuries can be classed as chronic or acute. First, we will
consider chronic injuries.
Chronic injuries are caused by continuous stress on a
body part over a long time.
Here are some common chronic injuries:
tennis elbow
golfers elbow
shin splints.

Chronic injuries can be caused by training too


hard, not allowing time for recovery, poor footwear
and bad technique.

Chronic injuries
Golf and tennis put a lot of strain on the
elbow.
In golf and tennis elbow, the tendons that
attach muscles to the elbow joint become
inflamed, sore and painful.

These injuries should be treated by


applying an icepack and resting for several
weeks.
Physiotherapy treatment may be needed
and possibly cortisone (steroid) injections to
relieve the pain.

Chronic injuries
Shin splints are pains in the lower leg,
caused by continuous stress over a
long period of time.
Either the tendons around the tibia
become inflamed, or stress fractures
develop these are cracks along the
length of the bone.
Shin splints should be treated with ice
and plenty of rest. Cushioned
footwear and special insoles can help
to prevent the injury returning.

INFLAMMATORY RESPONSE
This is the initial stage of repair involving the
first 48-72 hrs after the injury as the body
increases blood flow to the injured site.

Phase 1
Inflammatory
stage:

Redness
Heat
Swelling
Pain
Loss of
function

Phase 2 Repair
stage (3 days to
six weeks)

Eliminate debris
Form new fibres
Produce scar
tissue

Phase 3
Remodelling stage
(6 weeks to months)

development of
scar tissue tissue
needs to
strengthen in the
direction force is
applied
dependant on
amount of
exercise and
rehab routine
aim to regain full
function

MANAGING SOFT TISSUE INJURIES

SOFT TISSUE INJURIES


MUSCLES/TENDONS/LIGAMENTS
ALWAYS THINK
RECOGNITION OF INJURY AND APPROPRIATE
MANAGEMENT- ACUTE CHRONIC?
USE:
R - REST
I ICE
C COMPRESSION
E ELEVATION
R REFERRAL
STRAINS/SPRAINS

RICER (Rest, Ice, Compression, Elevation, Referral)


Rest: minimal movement for the first 48-72 hrs
Ice: causes blood vessels to constrict to decrease blood
flow. Apply for 20-30 mins every 2 hrs for 48-72 hrs.
Compression: ice should be firmly applied in a wide elastic
bandage. This reduces swelling and provides support.
Elevation: ensure the injury site is elevated above the
heart. This reduces the volume and pressure of blood flow
to the injury and reduces swelling.

Referral: a medical assessment should be sought ASAP to


as ascertain the full extent of the injury.

SOFT TISSUE INJURIES


DEFINITELY NO:
H HEAT
A ALCOHOL / ASPIRIN
R RUNNING (exercise)
M MASSAGE
IN THE FIRST 24 72 HOURS OR LONGER

KNOW SOME BASIC


ANATOMY
The knee.
A minefield
to diagnose.
Leave it to
the experts!

LATERAL/MEDIAL ANKLE

IMMEDIATE TREATMENT OF SKIN


INJURIES
The immediate response aims to:

Prevent further damage and reduce the risk of infection


Reduce swelling
Erase or minimise pain
Restore flexibility
Regain full function
Prevent reoccurrence.

For abrasions/lacerations:

Stop bleeding if necessary and clean the wound where possible


Apply non stick sterile dressing
Seek stitches if necessary

For burns:

Immediately apply cold running water


Keep clean and sterile
Seek medical advice

HARD TISSUE INJURIES

FRACTURES
It is a break in a bone, which can be
as simple as a small crack with no
visible deformity, or complex, in that
it may affect vital organs close to the
fracture site.

Common causes include:

Direct contact with:


Others
Objects
The ground
Indirect force on another body part (falling and
landing on arm; fractured clavicle)
Inappropriate muscular action (jumping from a
height, landing on feet; fractured patella)
Overuse, repeated trauma (running; stress
fracture in foot)

Types of fractures include


Simple/Closed: the bone is fractured
but there is no wound at the site.
Open/compound: the jagged end of a
fractured bone protrudes through the
skin.

Signs and symptoms


include:
Pain
Reduced/no movement
Local tenderness
Deformity
Irregular alignment
Swelling

DISLOCATIONS
It is where one bone is displaced from another
Signs and symptoms may include:
Loss of movement at the joint
Obvious deformity
Swelling and tenderness
Pain at the injury site

Subluxation: a partial dislocation where the joint


dislocates and then relocates.

FRACTURE DISLOCATION
ALWAYS THINK
DAMAGE
DAMAGE TO
SOFT TISSUES
NERVES
BLOOD VESSELS
MINIMAL MOVEMENT - IMMOBILISE.
TRANSPORT - AMBULANCE IN ALL CASES
OF MAJOR FRACTURE OR DISLOCATION.

A DISLOCATION IS A FRACTURE
UNTIL PROVEN OTHERWISE

FRACTURE DISLOCATION
GREAT CARE!

FRACTURE DISLOCATION
IMMOBILISATION?

DO NOT REDUCE!
ICE - SUPPORT - TRANSPORT

MANAGING HARD TISSUE


INJURIES
IMMOBILISATION
To another limb
To another part of the body
To a firm, smooth, straight object
Splint above the joint above the
fracture and below the joint below
the fracture

MEDICAL TREATMENT
Support the site with a sling or splint
Check for impaired circulation
Arrange for transport
Implement RICER if it does not cause pain.
NEVER ATTEMPT TO REDUCE/RELOCATE A
DISLOCATION!
DO NOT ATTEMPT TO RE-ALIGN FRACTURED
LIMBS!
SEEK MEDICAL ATTENTION!

Unconsciousness

Unconsciousness can be caused by a number of things.


1.
2.
3.
4.
5.

Fainting common fainting is a temporary abnormality in blood flow


to the brain. It can be caused by stress, heat or physical exertion.
Head injury any blow to the head can cause unconsciousness,
whether it damages the skull or not.
Heart attack or stroke this can interrupt blood flow to the brain.
Asphyxia breathing is obstructed, for example if the person has
inhaled water.
Shock caused by blood loss, infection or heart problems.

Unconsciousness can also be a sign of a wide range of


illnesses, for example, diabetes.

D.R.A.B.C.

Resuscitation

If an unconscious casualty is not breathing, rescue breaths (or mouthto-mouth resuscitation) can be used.
This involves the rescuer repeatedly blowing air
into the mouth of the casualty to inflate and
deflate their lungs. This allows some oxygen
into the body.

If a casualty has no pulse, chest compressions can be used.


The rescuer pushes down firmly and repeatedly
on the casualtys chest, mimicking the action of
the heart and circulating some blood around the
body.

Used together, these two techniques are known as


cardiopulmonary resuscitation, or CPR.

The recovery position

An unconscious casualty who is breathing and has no lifethreatening conditions should be placed in the recovery
position.
This keeps the airway open and prevents them
swallowing their own tongue or choking on vomit.

Concussion

Concussion is a common cause of


unconsciousness while playing
sport.
Concussion occurs when an
individual has received a blow to
the head, causing an injury to the
brain. This could be caused by
falling or being hit by something or
someone.

EMPICS Ltd

A person may be concussed without losing consciousness. The signs


can include disorientation, loss of vision, vomiting, paleness, a
racing pulse and shallow breathing.
Concussion should be treated at hospital.

Dehydration
When we exercise, especially in
hot conditions, the body loses water as a
result of sweating.
If the performer does not re-hydrate by
drinking lots of water, they may suffer
from dehydration.
The body also loses important
electrolytes salts which conduct nerve
impulses and maintain cell metabolism.
This results in the performer feeling very
tired, nauseous and faint.

The performer should stop exercising and rehydrate somewhere cool.

Hypothermia
Normal body temperature is 37C.
If a performers body temperature falls
below 35C, they begin to suffer from
hypothermia.
People who take part in activities in
mountainous areas or on water are
particularly at risk.
Common symptoms of hypothermia are
shivering, paleness, loss of dexterity
and erratic behaviour.

A hypothermic person should be warmed-up gradually.


They need warm, dry clothing, warm drinks
and high energy foods.

Causes and treatments

ASSESSMENT OF INJURIES

PROTOCOL WHEN INJURY/ILLNESS


OCCURS VITAL!

D.R.A.B.C.D.
T.O.T.A.P.S.

TOTAPS (Talk, Observe, Touch, Active


movement, Passive movement, Skills)
Talk: talk and find out exactly what happened. This will provide
valuable info about the nature of the injury.
Observe: look at the injury site and see if there are any signs of
obvious deformity. Compare opposite sides of the body.
Touch: gently feel the areas for any sign of deformity or swelling and
try to pinpoint the area of pain.
Active movement: ask the player to perform a range of movements
such as flexion, extension and rotation. If these can be done without
pain, proceed.
Passive movement: physically mobilize the joint as far or further than
the patient did actively, aiming to identify painful areas and any
instability
Skills test: ask the player to perform a range of skills necessary for
participation in the game, i.e. sidestep.

REMOVAL FROM THE


FIELD OF PLAY
ALWAYS THINK
DO NOT ATTEMPT TO REMOVE A
PLAYER FROM THE FIELD WHO:
IS UNCONSCIOUS.
HAS A SUSPECTED SPINAL INJURY.
HAS A MAJOR DISLOCATION/FRACTURE.
HAS A SUSPECTED INTERNAL INJURY.
HAS AN INJURY OR CONDITION THAT
COULD BE SERIOUSLY WORSENED BY
MOVEMENT.

REMOVAL FROM THE


FIELD OF PLAY
ALWAYS ENSURE AN AMBULANCE IS CALLED IN
THE ABOVE SITUATIONS OR IF IN DOUBT
PROTOCOL?
CONSIDER: ALL CONDITIONS MUST BE MANAGED
BY THE FIRST AID OFFICER UNTIL THE
AMBULANCE RESPONDS.
THIS WILL DEPEND UPON LOCATION.
ISOLATED AREAS DISTANCE.
AVAILABILITY OF AN AMBULANCE.
TIME IS AN IMPORTANT FACTOR!
YOU WILL BE OF GREAT ASSISTANCE TO THE FAO!!

Assessment can be stopped at any


stage if the player cannot proceed or
if danger is apparent.
If the player can perform to the
satisfaction of the assessor, the
player can return to the game.
If there is risk of further damage
through continued play, remove the
player from the game

HOW WOULD YOU MANAGE


THIS?

THANK YOU