SPORTS PHYSICAL THERAPY

SHS.512
M Ammar Akbar
 CONTENT
 Introduction to Sports Injuries.

 Classification of Sports Injuries.

 Principles of management of different tissue injuries.

 Principles of treatment of all open wounds.

 ASSESSMENT DETAIL
 QUIZ 10%

 MID TERM 20%

 CLASS PARTICIPATION 05%

 ASSIGNMENT 05%

 VIVA 20%

 FINAL 40%
 Introduction to Sports Injuries
 Regular physical activity is probably the most important
overall determinant of a population’s health.

 Unfortunately, physical activity may extract a cost in the

form of an activity-related injury.

 Such an injury may be categorized as either being an acute

injury or an overuse injury depending on the mechanism
of injury and the onset of symptoms
 Classification of Sports Injuries
SITE ACUTE INJURY OVERUSE INJURY

Bone •Fracture •Stress fracture

•Periosteal contusion
Articular •Osteochondral/ chondral
Cartilage fractures
•Minor Osteochondral injury
•Bone strain
•Stress reaction
•Osteitis/Periostitis
•Apophysitis
•Chondropathy
(e.g. softening, fibrillation,
fissuring, chondromalacia)

Joint •Dislocation •Synovitis

•Subluxation •Osteoarthritis
Ligament •Sprain/tear (grades I–III) •Focal tissue thickening/fibrosis
 Classification of Sports Injuries
SITE ACUTE INJURY OVERUSE INJURY

Tendon •Tear (complete or partial) •Tendinopathy (includes paratenonitis,

tenosynovitis, tendinosis, tendinitis)

Bursa •Traumatic bursitis •Bursitis

Nerve •Neuropraxia •Entrapment

•Minor nerve injury/irritation
•Adverse neural tension

Skin •Laceration •Blister

•Abrasion •Callus
•Puncture wound
 Articular Cartilage
 Class 1:
“Disruption of the articular cartilage at its deeper layers
with or without subchondral bone damage, while the
articular surface itself remains intact”

 Class 2:
“Disruption of the articular surface only”

 Class 3:
“Disruption of both articular cartilage and subchondral
bone”
Articular Cartilage
 Ligament Injury
 A Grade I sprain represents some stretched fibers but
clinical testing reveals normal range of motion on
stressing the ligament.

 A Grade II sprain involves a considerable proportion of

the fibers and therefore, stretching of the joint and
stressing the ligament show increased laxity but a definite
end point.
 Ligament Injury
 A Grade III sprain is a complete tear of the ligament with
excessive joint laxity and no firm end point.

 Grade III sprains can also be pain-free as sensory fibers

are completely divided in the injury.
Ligament Injury
Ligament Injury Management
 Muscular Injury
 Muscles are strained or torn when some or all of the fibers
fail to cope with the demands placed upon them.

 Muscles that are commonly affected are the hamstrings,

quadriceps and gastrocnemius; these muscles are all
biarthrodial (cross two joints) and thus more vulnerable to
injury.

 A muscle is most likely to tear during sudden acceleration

or deceleration.
 Muscular Injury
 Muscle strains are classified in three grades:

 A Grade I strain involves a small number of muscle fibers

and causes localized pain but no loss of strength.

 A Grade II strain is a tear of a significant number of

muscle fibers with associated pain and swelling.

 Pain is reproduced on muscle contraction.

 Muscular Injury
 Strength is reduced and movement is limited by pain.

 A Grade III strain is a complete tear of the muscle.

 This is seen most frequently at the musculotendinous

junction.
 Muscular Injury
 A number of factors predispose to muscle strains:

 Inadequate warm-up
 Insufficient joint range of motion
 Excessive muscle tightness
 Fatigue/overuse/inadequate recovery
 Muscle imbalance
 Previous injury
 Faulty technique/biomechanics
 Spinal dysfunction.
 Muscular Injury
 Management of muscle strains requires first aid to
minimize bleeding, swelling and inflammation.

 Subsequent treatment promotes efficient scar formation

through the use of:

 Strengthening exercises
 Electrotherapeutic modalities
 Soft tissue therapy
 Stretching.
Muscular Injury
 Muscle Contusions
 A muscle contusion usually results from a direct blow
from an opposition player or firm contact with equipment
in collision sports, such as football, basketball and hockey.

 The blow causes local muscle damage with bleeding.

 The most common site of muscle contusions is the front of

the thigh in the quadriceps muscle.

 This injury is known as a ‘cork thigh’ or ‘charley horse’.

 Muscle Contusions
Management of contusion includes:
 Minimization of bleeding and swelling

 Encouragement of resorption of the blood clot with

electrotherapeutic modalities

 Carefully controlled soft tissue therapy

 Stretching

 Strengthening
 Muscle Contusions
 Heat, alcohol and vigorous massage increase bleeding
after a contusion and must be avoided.

 Athletes playing sports with a high risk of contusion in a

specific area should consider the use of protective
equipment such as padding.

 An occasional complication of a muscle hematoma is

myositis ossificans.

 This occurs when the hematoma calcifies.

 Muscle Contusions
 Although this is most common following more severe
muscle contusions, it may also occur in relatively minor
cases.

 Myositis ossificans should be suspected in any muscle

contusion that does not resolve in the normal time frame.

 An X-ray performed 10 to 14 days after the injury may show

an area of calcification.

 Management of myositis ossificans is conservative and

recovery is usually slow.
 Muscle Cramps
 Muscle cramps are painful, involuntary muscle
contractions that occur suddenly and can be temporarily
debilitating.

 The most common site of muscle cramps is the calf

muscle but they may occur in any muscle.

 Disturbances at various levels of the central and peripheral

nervous system and skeletal muscle are involved in the
mechanism of cramp and may explain the diverse range of
conditions in which cramp occurs.
 Muscle Cramps
 The cause of cramps include:

 Dehydration

 Low potassium or low sodium levels

 Inadequate carbohydrate intake

 Excessively tight muscles

 Muscle Cramps
 The treatment of cramps is aimed at reducing muscle spindle and
motor neuron activity by reflex inhibition and afferent stimulation.

 Regular muscle stretching

 Correction of muscle balance and posture

 Adequate conditioning for the activity

 Mental preparation for competition

 Avoidance of provocative drugs may all be beneficial.

 Muscle Cramps
 Other strategies such as

 Incorporating plyometrics

 Eccentric muscle strengthening into training programs

 Maintaining adequate carbohydrate reserves during

competition.
 Tendinopathy
 Normal tendons consist of tight parallel bundles of collagen
fibers.

 Injuries to tendons generally occur at the point of least blood

supply,

 For example, with the Achilles tendon usually 2 cm (0.75 in.)

above the insertion of the tendon, or at the musculotendinous
junction.

 A tendon rupture occurs without warning, usually in an older

athlete without a history of injury in that particular tendon.
 Tendinopathy
 The two most commonly ruptured tendons are the Achilles
tendon and the supraspinatus tendon of the shoulder.

 The main objective of the treatment of tendon injuries is

to restore full motion and function.

 Partial tears are characterized by the sudden onset of pain

and by localized tenderness but they may be difficult to
distinguish from tendinopathy
Tendinopathy
 Tendinopathy
 When investigation is indicated, ultrasound and MRI can
be useful.

 Both modalities can distinguish between a partial or

complete tendon rupture and overuse tendinopathy.

 Generally, acute tendon rupture requires surgical treatment

followed by progressive rehabilitation.
 Principles of treatment of all open
wounds

Stop any Apply a pressure bandage directly to the injured part and elevate it.
associated
bleeding If the wound is open and clean, bring the wound edges together using
adhesive strips or sutures.

A contaminated wound should not be closed.

Prevent Remove all dirt and contamination by simple irrigation.

infection
Extensively wash and scrub with antiseptic solution as required as soon as
possible.

If the wound is severely contaminated, prophylactic antibiotic therapy

should be commenced (e.g. flucloxacillin, 500 mg orally four times a day).

If anaerobic organisms are suspected (e.g. wound inflicted by a bite), add

an antibiotic such as metronidazole (400 mg orally three times a day).
 Principles of treatment of all open
wounds

Immobiliz This applies when the wound is over a constantly moving part, for example,
ation the anterior aspect of the knee.
(where
needed) Certain lacerations, such as pretibial lacerations, require particular care and
strict immobilization to encourage healing.

Check All contaminated wounds, especially penetrating wounds, have the

tetanus potential to become infected with Clostridium tetani.
status
Tetanus immunization consists of a course of three injections over 6 months
given during childhood.

Further tetanus toxoid boosters should be given at 5 to 10 year intervals.

In the case of a possible contaminated wound, a booster should be given if
none has been administered within the previous 5 years.