KNES 315 Care and Prevention for athletic Injuries (Section 1, 2) (Chapters 1, 2, 3, 4, and 6)

Sports Medicine

- refers to a broad field of medical practices related to physical activity and sport. -Focus on areas of performance enhancement, injury care and prevention. -Defined by American college of sports Medicine (ACSH) as multidisciplinary.

Muscular Strength

-Ability of a muscle or group of muscles to produce force in one maximal effort against resistance. Affected By: -Size of weight -Number of muscle fibers -Neuromuscular efficiency -Biomechanical factors -Fast twitch or slow twitch fibers -Level of physical activity -Injury Assessments: -One repetition max -HS male- 150 Ib back squat -College female: 65 lb back squat -Multiple repetition max -Handgrip -HS male: 40 kg -HS female: 28kg -50 y/o male- 46kg -50 y/o female: 30kg

Muscular Endurance

-Ability of muscle tissue to exert repetitive tension against resistance, over an extended period. -Fatigue is related to endurance -Relationship between strength and endurance. -Lifting low weights/faster velocity/more reps -Relevant to activities of daily living Assessments: Prone Plant -Athletic male: 120 seconds -Athletic female: 90 seconds Push ups -HS male: 30 -HS female: 12 -50 y/o male: 15 -50 y/o female: 14

Muscular Power

-Ability of muscle to produce force in a given time for a specific height or distance -Started when at least 80% of strength -Weight training at higher contractile velocities. -Use of plyometric exercises -Explosive exercise that maximizes the myotatic on-stretch reflex. -Caution: injury potential. Assessments: Vertical Jump -HS male:2" -Collegiate female: 1.5" -Long Jump -Triple hop.

Agility

-Ability to change directions rapidly when moving at a high rate of speed.

Speed

-Ability to move body mass over time -Can be assessed by timed sprints.

Strength

-Ability to produce force in a given time. -Measures can involve isometric, isotonic, or isokinetic testy.

Power

-Ability to produce force in a given time. -Measures include: Throwing a medicine ball, vertical jump and reach, single-or two-legged hop for distance, and stair climbing.

Reaction Time

-Ability to respond to stimulus.

Cardiovascular Endurance

-Ability to sustain, submaximal exercise over an extended period. -"Ran Test", sport specific assessment of athletics CV fitness.

General Medical Problems

-Acute/Chronic disease or conditions.

Steps to reduce (Risk of Litigation)

-All personal licensed and certified -Have qualified individuals -Have a thorough pre-participation clearance plan -Have a well established primary health care team -Have an Emergency Action Plan (EAP) -Thorough record keeping -Equipment-inspect, provide information and warnings -Know your scope of practice and standard of care -Educate administration, coaches patients, clients.

Cardiovascular Exam

-Auscultation of heart sounds. -Check for cardiac abnormalities -History of LOC, Syncope, Dizziness, SOB, Heart palpitutional, Chest pain during/after activity.

Pulmonary Exam

-Auscultative for breath sounds. -Hx of coughing or breathing difficulty, asthma. -Ear, Nose, and Health exam.

Cardiovascular

-Body's ability to sustain submaximal exercise over an extended period. -Detraining occurs within 1-2 weeks -Cardiovascular level impacts fatigue. -Aerobic vs. anaerobic Assessments: -Distance-based walk and run test -Time-based walk or run test -Shuttle run or PACER or beep test -Submaximal step test.

Balance

-Body's coordinated neuromuscular response to maintain a deferred position of equilibrium in response to changing visual, tactile, or kinesthetic stimuli.

Tort

-Civil Wrong done to an individual whereby the injured party seeks a remedy for damages suffered. -Not acritical act

Good Samaritan Laws

-Conditions very from state to state, but immunity generally applies only when emergency first aider: -Acts during an emergency -Acts in good faith -Acts without expected compensation -Is not guilty of misconduct or gross negligence -Laws are easy to get around and should not be relied upon by rescuers who seriously believe the laws will protect them from litigation regardless of their actions.

Personal Liability Insurance

-Covers negligence in a civil case -Know the limitations of the coverage

General Medical

-Current issues -Past Surgery or hospitalizations - Medications (including OTC) -Use of Alcohol, Tobacco, ergogenic aid.

Dental Examination

-Determine number of teeth and last visit to dentist. -Exam: Gum Condition and presence of cavities, dental appliances.

Anthropometry

-Determines individuals body type. -Ectomorphic, Mesomorphic, Endomorphic.

Gastrointestinal Exam

-Digestive system, eating habits, nutrition -History of heartburn, indigestion, diarrhea or constipation

Responsibilities of Team Physicians

-Direct supervisor of AT -Advise supervise, and discuss -Physician and AT must be able to work together -Important to have similar philosophical opinions regarding injury management. -Helps to minimize discrepancies and inconsistences -Compiling medical hx and conducting physical exams -Pre-participation screening -Diagnosing injury -Deciding on disqualification -Decisions regarding athletics' ability to participate based on medical knowledge and psychophysiological demands of sport. -Attending practice and games.

Frequency

-Entry level exam followed by a limited annual re-evaluation -Entry level exam at each level of participation.

Exam for Heat disorders

-Environment related - history of cramping, syncope, exhaustion, or heat stroke -Use of medications

Goals for PPE

-Establish baseline, parameters for injury -Immunization status -Detect medical conditions -Still healing? -Predispose athlete? -Additional testing needed? -Identify mental health issues -Assess and evaluate physical maturity and fitness. -Determine if patient can play and at what level if medical contraindications exist. -Meet legal and insurance requirements.

Virtual Signs

-Established baseline physiologic parameters and vital statistic. -Pulse, Blood Pressure, Temperature, Respiration Rate, Pulse, Ox

Body Composition

-Fat/nonfat Lean tissue -More reliable for a determining appropriate weight. -Measures: hydrostatic weighting, skinfold measurements, DEXAS... -Athletes: 12-17% body fat.

Clearance for Participation

-Final authority is Supervising physician -Team Physician -Primary Care Physician

Closed Kinetic chain

-Footer hand IS in contact with the ground or some surface; weight bearing. -Functional exercises -All contractions and different muscle groups.

Open Kinetic chain

-Footer hand NOT in contact with the ground or some surface -Target specific muscle.

Athletic Training

-Healthcare trainers are healthcare professionals who collaborate with physicians to optimize activity and participation of patients and clients. - Encompasses the prevention, emergency care, clinical diagnosis, therapeutics intervention and rehabilitation of inquiries and medical conditions. -Recognized by the American Medical Association (AMA) as a healthcare profession.

Physical Fitness Profile

-Hinder athletic performance -Predispose the athletic to injury -Establishes a baseline of data in the event an injury does occur. -Body Composition, Maturation and growth, Flexibility, Strength, Power, Speed, Agility, Balance, Reaction Time, (V endurance)

Neurologic Exam

-History of past head injury, loss of consciousness, amnesia, or seizures -Exam: pupillary examination and reaction to light, cranial nerve assessment, motor-sensory exam, deep tendon reflex testing

Crisis Communication

-How to respond quickly and efficiently to protect and ensure the health, safety, and well-being of others -Weather, public health, act of terror.

Emergency Action Plan (EAP)

-How well access to EMS and transportation of a patient to the hospital occur. -Meet with key stakeholders and practice the plan -Posted to public

Product LIABILITY

-Implied warranty -Expressed warranty -Strict Liability -NOCSAE (National Operating Committee on standards for Athletic Equipment)

State Regulation of the AT

-In form of LISENSE -Limits practice of athletic training to those who have met minimal requirements established by a state licensing board. -Limits the number of individuals who can perform functions related to athletic training as dictated by the practice act. -Most restrictive of all forms of regulation. -Certification -Does not restrict using the title of athletic trainer to those certified by the state. -Can restrict performance of athletic training functions to only those individuals who are certified. -Registration -Before an individual can practice athletic training he or she must register in that state. -Individuals has paid a fee for being placed on an existing list of practitioners but says nothing about competency.

Assumption of Risk

-Individual acknowledges understanding of the risks of their participation in the activity and voluntarily chooses to participate, assuming all risks of injury or even death due to their participation.

Refusing Help

-Individuals have the right to refuse treatment -Exception: Increased risk for further injury.

Informed Consent

-Injured party has been reasonably informed of needed treatment, possible alternative treatment, and advantages and disadvantages of each course of action. Exclusionary clause- Outlines the specific injuries and/or conditions that the health care provider may refuse to treat. -Obtain pair to any treatment -Potential for battery.

How is an Athlete Trainer different from a physical Therapists

-It is not unusual to find a physical therapist interested in sports, athletics, and the physically active working toward certification as an athletics trainer. -A certified athletic trainer interested in working with patients outside of the physically active population may work toward licensure as a physical therapist.

Genitonriary Exam

-Kidney and genitourinary origins. -Females: Menstrua history, gynecologic symptoms

Eccentric Contraction

-Lengthening increases joint angle. -Work to decelerate a limb and provide shock absorption.

Soft Materials

-Light due to incorporation of air into material -Examples: gauze padding, neoprene, Sorbothan, felt, moleskin, and foam Open-cell vs. closed-cell foam

Maturity Assessment

-Means to protect young physically active athletes -Growth sports may play a role in certain injuries.

Standard of Care

-Measured by what another minimally competent individual educated and practicing in that profession would have done in the same/similar circumstances to protect an individual from harm. -Dictated by the profession's duty or scope of care. -ex) An individual acting as an athletic trainer will be held to the standard of care expected of any individual holding the ATC credentials.

Static (stretching)

-Movement is slow and deliberate -GTO override impulses from the muscle spindles. -Safer, more effective muscle stretches.

Provide Communication

-Must have the ability to contact or communicate with EMS, health care providers -Cell phone, walkie talkie

Rule for Protective Pads

-NFSHSA (National Federation of state high school Associations) -NCAA (National Collegiate Athletic Association) -Specific rules established -Written authorization from physician can be required. -AT/couch must be aware of specific rules.

Musculoskeletal Exam

-Nature of injury and when it occurred -Who Evaluated it -Duration of tx, rehab, use of protective equipment.

Scope of Care

-Outlines the role and responsibilities of an individuals in that profession. -Delineates what should be learned in the professional preparation of that individual.

Failure to Warn

-Participants must be informed that risk for injury exists and understand the nature of that risk.

Orthopedic Screening

-Patient completes an injury evaluation form. -Clinical (AT or Physician) performs the screening -A collection of movements at each joint. -Assessing for range of motion, pain. -Find any area of hyper/hypomobility, test the integrity of the joint-laxity.

What organization(s) govern the legal matters as it pertains to:

-Physical Educators -Athletic Trainers -Physical Therapists -Coaches -Strength and Conditioning coaches -Personal Trainers

Other key members in Health care involved in care and Prevention

-Physical Therapist -Physician Assistant -Strength and Conditioning specialist -Chiropractor -Massage Therapist -Occupational Therapist -Exercise Physiologist -Personal Trainer -Sports psychologist or Athletic coaster -Nutritionist

Tanner Scale

-Physical maturation measurements -Based on external palmary and secondary sex characteristic's.

Players on the Sports Medicine Team

-Physicians -Nurse -Physicians Assistances -Physical Therapist -Athletic Trainer -Massage Therapist -Exercise Physiologists -Nutritienalist -Sport Psychologist -Coaches -Strength and conditioning specialist

Overload Principle

-Physiologic improvements occur only when an individual physically demands more of the muscles than is normally required. -Stress cannot be great enough to produce injury before the body can adjust. -Strength gains depend primarily on intensity of overload, not the specific weight.

Protective Equipment

-Prevent injury or protection an existing injury. -Protection from forces -High velocity-low mass: focal injury -Low velocity-high mass: diffuse injury -Design factors that can reduce potential injury. -Increase impact area -Disperse impact area to another body part. -Limit the relative motion -Add mass to the body part -Reduce friction -Absorb energy -Resist the absorption of bacteria, fungus, and viruses.

Physicians Commonly Hired Physicians

-Primary care _____ with rotatory in sports medicine. -Orthopedic _______ and/or surgeons -Doctor of osteopathic medicine

Policies and Procedures

-Provide qualified health care -Keep health care facilities for that purpose and clean. -Establish healthy habits -Medically cleared, showering after practice, adequate sleep and nutrition -Document -Pre-participation exams -HIPAA -FERPA -Injury (accident forms) -Equipment inventory -Annual reports -Budget

Comparative Negligence

-Relative degree of negligence -Damages awarded on a proportionate basis

Ballistic (stretching)

-Repetitive bouncing motions at the end of the available range of motion. -Muscle spindle is stretched but GTO does not fire: muscle resists relaxation. -Momentum can lead to overstretching, tear.

Laboratory Tests

-Required by some states -Exception-Sickle cell test (NCAA mandate).

Confidentiality

-Right to privacy -What can and cannot be shared.

Concentric Contraction

-Shortening: decreases Joint angle -Work to accelerate a limb

Flexibility Assessments

-Sit and reach to measure tannic and hip flexion. -Norms: 3-8" past vertical -Over under shoulder flexibility Test. -Less than 2" is fair. -More than 2" is poor.

Statute of Limitations (State Rules)

-Specific length of time an individual can sue for injury resulting from negligence -Varies by state, generally ranges from one to three years). -Clock begins at the time the negligent act results in suit or from the time injury is discovered following negligent act. -Maryland Malpractice 3 years from injury discovering or 5 years from when injury was committed by the practitioner. -Minors generally have an extension until they turn 18 years old.

Dynamic (stretching)

-Sport specific: controlled functional movements. -Activities and stimulates tissues and increase blood flow.

Quality Control

-Standards of quality agentic -NOCASE (National operating committee on standards for Athletic Equipment) -Football, baseball, softball, and lacrosse helmets and facemasks. -Other equipment (protective eye wear, ice hockey helmets, and facemasks) -ASTM (American Society for testing and Materials) -HECC (Hockey equipment certification council) -CSA (Canadian standards committee) -When an athlete provides their own protective equipment, the responsibilities of the athletic trainer do not change! -The athletic trainer assumes legal responsibilities for use of any custom-made devices.

SAID Principle

-The body responds to a given demand with a specific and predictable adaptation. -Will adapt and overcome demands and therefore minimize injury. -Achieved by manipulating intensity, duration, frequency, specifically, speed and progression.

Flexibility

-The total ROM that occurs pain-free in each of the planes of motion. -Measured with a goniometer, flex meter, or tape measure. -Functional measurements of flexibility. -Combination of normal joint mechanics, mobility, of soft tissues, and muscle extensibility. -May be limited by: Bone structure, adipose tissue, skin, scar tissue, tendons, injury. -Mechanoreceptors influence flexibility. -Muscle spindle -Golgi: Tendon Organ

Hard Materials

-Thermomoldable plastics—able to be heated and shaped before rehardening -Examples: orthoplast, thermoplast, casting materials

Preventing Litigation

-Understanding your complete duty of care -Understand what your governing bodies expect

Supplemental form for female

-Update yearly and closely review by medical personal. -Collect medical release and insurance info at the same time.

Eye Examination

-Visual Acuity -Peripheral vision and depth perception -Nystagmus -Pupil size

All Athletes sign (Assumption of Risk) which acknowledges:

-Voluntarily participation in the activity -Assumes all risks of injury or even death due to their participation -Assumption of risk from does not assume the risk that the professional will breach their duty of care.

Roles and Responsibilities of athletic Trainer

-Work with patients from time of injury to resolution -Directly responsible for all phases of health care in a physical environment -Injury prevention -Recognition, evaluation, assessment of injuries -Immediate care of injuries and illness -Treatment, Rehabilitation, and reconditioning. -Health care administration -Professional development and responsibility

Participation Categories

1. Cleared for all activities without restriction. 2. Cleared with recommendation to treater evaluate further. 3. Not cleared until further evaluation, treatment, rehab. 4. Not cleared for certain sports or for any sports.

How do you become an athletic Trainer?

1. Earn a degree from a (AATE) Accredited program-MS 2. Meet BOC established requirements (pass the test) which gives you the certification-ATC 3. Meet state licensing guidelines-LAT

Athletic Training: Role Delineation (9th edition)

1. Injury and illness Prevention and Wellness Promotion 2. Examination, Assessment and Diagnosis 3. Immediate and Emergency care 4. Therapeutic intervention 5. Health care administration and professional Responsibility.

*Components of a PPE*

1. Medical History 2. Physical Exam 3. Orthopedic Screening (part of physical exam or separate) 4. Physical fitness profile.

Criteria required to prove Negligence

1. There was a duty of care 2. There was a breach of that duty 3. There was harm (pain and suffering, permanent disabilities or loss of wages). 4. The resulting harm was a direct cause from that breach of duty.

Timing of the Exam

4-6 weeks prior to athletic sensory-permits time to: -Correct minor problems -Refer medical problems to a specialist

Primary care Physician

Advantages: Familiarity, relationship, Privacy Disadvantages: $$, Commitment of M.D.

Group or Station Format

Advantages: Number of professionals involved, less $$, Time efficient. Disadvantages: Organization demands, decreased privacy, follow-up difficulty, communication problems.

Malpractice

An individual commits a negligent act while providing care.

Malfeasance

An individual commits an act that is not their responsibility to perform.

Commission

An individual commits an act that is not theirs to perform or commits an act that is their duty to perform but carries out the wrong procedure, leading to injury or harm. -ex) Disturbing prescription medication: failing to follow a physicians orders.

Misfeasance (Mistake)

An individual commits an act that is their responsibility to perform but assess the wrong procedure or does the right procedure in an improper manner.

Omission

An individual fails to perform a legal duty. -ex) Failure to warm athletes of the potential risks associated with participation: failure to assess a reported injury.

Nonfeasance (Failure to Perform)

An individual fails to perform their legal duty of care.

Gross Negligence (Lying)

An individual has total disregard for the safety of others.

Physical Examination

Assessment of: -Height, Weight, Body Composition, Blood Pressure, Pulse, Vision, Skin, Dental, ENT, Heart, Lungs, abdominal, Lymphatic, Geuitalia, Maturation index, Urinalysis, and blood work.

Older than 65 years of age

Begin/increase activity to prevent a major medical illness: need an extensive exam based on individual and physical needs and medications.

Health Insurance

Contract between company and policy holder in which they will reimburse a portion or total medical bill. -Primary and secondary insurance -Accident insurance (injury occurs on playground) -Catastrophic insurance -Anybody involved in patients that are physically active should have an appropriate insurance plan to maximize benefits if an injury occurs.

Coaches

Definition and Role? -Determine who plays and what positions/Helping people participating in sports to work towards achieving their full potential. And Team goal. How do you become? -Experience and Potential -Qualifications: Coaching, Sports Science, Sports studies, movement studies, Physical educator, Instructing exercise and fitness. Employment Settings/Population work with? -Professional Sports, College Sports, Secondary school sports, Irregular hours, evenings, weekends, holidays. State Regulation? 1. None (Bachelors only in Canada) 2. Knowledge of the Sport -Recommended to have NFHS Certified (National Federation of High School Associations)

Proprioceptive neuromuscular facilitation (PNF)

Exercises that stimulate proprioceptors in muscles, tendons, and joints to improve flexibility and strength. -Increase flexibility in one muscle group (agonist) and simultaneously increase strength in another group (antagonist). Advantages: -Early use can aid in elongation of scar tissue-careful! -Single plane or diagonal patterns. Techniques: -Contract-relax, hold relax and slow-reversal-hold-relax.

Negligence

Failure to provide a DUTY OF CARE -(If sued falls under Tort law)

Adult population (30-65y)

High incidence of overuse injuries: nature of the activity?

Prepubescents Child (6-10y)

ID previously undiagnosed congenital abnormalities.

Dermatologic Exam

Identify contagious lesions, skin infections Other lesions (e.g., warts, acne)

Legal Considerations

Injury problem has grown to such proportions that it is firmly untracked in most American court rooms: -'05 LaSalle FB, 23 yr, second impact, 7.5 million -'08 Max Gilpen, 15 yr heat stroke, 1.5 million -'13 UCF FB player, 19 yr sickle cell attack, 200k -'14 Retired NFL Players vs. the NFL, 765 million -People involved in the delivery of health care are accountable for their actions.

Types of Materials

Low-density material -Light and comfortable to wear -Only effective at low levels of impact intensity. High-density material -Less comfortable, Less cushioned -Can absorb more energy by deformation, less stress to arch. Resilience -High -Regain their shape after impact -Used over areas subject to reported impact -Non resilient or slow-recovery resilient. -Best protection -Used over areas subject to one-time or occasional impact.

Pubescent Child (11-15y)

Maturation, established good health practices for safe participation.

Standard of care

Measured by what another minimally competent individual educated and practicing in that profession would have done in the same/similar circumstances to protect an individual from harm -Dictated by the profession's duty or scope of care -ex) An individual acting as an athletic trainer will be held to the standard of care expected of any individual holding the ATC credentials.

Hypermobility

More susceptible to ligament sprains dislocations, chronic back pain, disc prolapse, spongy lotistesis, pes planes, Joint effusion, tendonitis.

Hypomobility

More susceptive to muscle strains, nerve pinch syndromes, and overstress tendonitis.

Preparticipation Exam (PPE)

Objective: To ensure health and safety of a physically active individual.

Primary Players of sports Medicine Team

Physician, Coach, and Athletic Trainer do their best to improve the ATHLETE!

Clearance for Participation

Physicians determines level of participation. -Rehabilitation Act and Americans with disabilities Act. -Most Physicians base their recommendations on the American readying of Pediatric committee on sports medicine guidelines.

Foreseeability of Harm

Recognizing a potential danger and removing the danger before an injury occurs.

Employment settings for AT's

Secondary schools -30,000 public high schools in U.S. -18% of NATH members work in this setting Colleges and Universities -Number of AT's varies considerably: around 19% -Extent of care varies. School Districts -AT floats between several schools in same district Professional Teams -800 NATA members work in this setting -22% of employed AT's Hospitals and sports Medicine Clinics -17% AT's found in this setting Non-traditional settings -2% AT's oversee fitness, injury rehabilitation, and work-hardening programs -Occupational Health, Performing Arts, Military, and Public Safety.

Liability Considerations

The proper use of protection equipment is usually a shared responsibility among the athletic staff. AT duty -Select appropriate equipment -Properly fit equipment -Instruct individual in proper care of equipment -Warn individual of any danger in using the equipment in approximately. -Supervise and monitor proper use of equipment. Duties of others -Head Coach: recommendations of specific equipment. -AD: Purchase equipment, budget -Equipment Manager: Proper fitting, maintenance, recertification.

Post pubescent or young adult group (16-30y)

hx or previous injuries and sport-specific examinations are critical: the more strenuous activities, contact or collision sports require a more extensive examination.