SPORTS MEDICINE

Outline the management techniques for skin injuries.

1. Reduce danger of infection by wearing gloves 2. Prevent bleeding by compression 3. clean wound with water 4. Use an antiseptic 5. Cover with compression bandage

What are the ways to classify sports injuries? (dashes)

- Direct and Indirect - Soft and hard tissue - Overuse

What are the return to play policies? (dashes)

- Monitoring progress - psychological readiness - specific warm up procedures - return to play policies - ethical considerations

Describe the ethical considerations in response to an athlete returning to play from an injury.

- Pressure from media, team-mates and coaches to participate (financial reasons) as players are seem as commodities - use of painkillers to mask pain and can hide further damage to organs and tissue.

What are PHYSICAL PREPARATION METHODS to enhance the well-being of the athlete? (dashes)

- conductive pre screening - physical fitness - skill and technique - warm up and cool down

What are the return to play policies? (dashes)

- ethical issues - indicators of readiness - return to play policies - psychological readiness - specific warm up procedures - monitoring progress

Outline hard tissue injuries (dashes)

- fractures - dislocations

What are the rehabilitation procedures? (dashes)

- graduated exercise - progressive mobilisation - training - use of heat and cold

Identify the aspects of sports policy and the sports environment (dashes)

- rules of sports and activities - modified rules for children - matching of opponents - use of protective equipment - safe grounds, equipment and facilities

List the types of taping and bandaging (dashes)

- taping for isolation - preventative taping - bandaging fro immediate treatment of injury

List soft tissue injuries and their management (dashes)

- tears, sprains, contusions - skin abrasions, lacerations, blisters - inflammatory response

List the ENVIRONMENTAL CONSIDERATIONS to ensure the well being of the athlete and to further prevent injury

- temperature regulation - climatic conditions - hydration guidelines - acclimatisation

What are the rehabilitation procedures? (dashes)

- use of heat and cold - training - progressive mobilisation - graduated exercise (stretching, total body fitness and conditioning)

What are the three phases of graduated exercise and how do these contribute to rehab?

1. Stretching (PNF most effective)- important to ensure that it heals without scar tissue which shortens the muscle and makes it prone to further injury. 2. Conditioning (strengthening muscles)- implies a build-up in fitness as a result of adaptations to gradual increases in physical stress and should incorporate the concept of PROGRESSIVE OVERLOAD for the best results. The principle of SPECIFICITY is also important. The conditioning regime needs to target general cardiorespiratory fitness together with increasing the need for strength, power and local muscular endurance around the injured area. 3. Total body fitness- regaining the level of mental and physical fitness reached by the athlete before the injury occurred as REVERSIBILITY causes a loss of total body fitness. The athlete should do some form of exercise whilst injured (upper body strength if an injured ankle). The required adaptations before returning to competition include: hypertrophy, increased joint mobility and blood flow to injured area, strengthened tendons and ligaments and pain free.

Explain the guidelines for fluid intake

57% of total body weight is water and is loss through sweat. Recommended fluid intake is 200-300 millimetres every 20-30 minutes. Athletes can weigh themselves before and after an event to determine how much water they have lost and how much they need to drink- 1 kilo= 1 litre loss of fluid (times this by 1.5 to become hydrated again.) Lower water-> lower blood plasma-> less blood available to muscles-> reduced circulatory function

How can you monitor psychological readiness

A balance between motivation, self-assurance and common sense is fundamental to a safe return to play. Taping can provide support and can act as a psychological form of treatment.

Provide relevant examples for both a direct and indirect injury.

A direct injury can be a COLLISION, for example in rugby league, two players may collide heads during a tackle, causing damage to the skull and possibly triggering concussion. Another example is being hit with a hockey stick in hockey which can cause contusion and also hard tissue injuries such as bone fractures. An indirect injury is not caused by any external force so may result from INCORRECT TECHNIQUE or an OVERUSE injury. For example, over stretching in gymnastics can cause damage to soft tissues such as hamstrings, even causing them to tear.

Describe direct and indirect injuries.

A direct injury is caused by an external blow or force, generally causing hard tissue injuries. An indirect injury is caused by an intrinsic force that doesn't result from a physical object and these are usually soft tissue injuries.

Explain the signs and symptoms of both fractures and dislocations and describe their management strategies.

A fracture is a break in a bone resulting from a direct or indirect force (a collision in soccer can cause a fractured tibia or incorrect technique in volleyball can cause wrist fracture if the ball is volleyed incorrectly. SIMPLE (closed)- skin is intact OPEN (compound)- skin is broken COMPLICATED- fracture damages organs such as lungs S/S: pain, immobility, deformity, swelling Management: immobilise, DRABCD, control bleeding, treat shock, MA Dislocations are injuries to joints where one bone has been displaced by another causing significant damage to soft tissue. It can be caused by over stretching or being pushed past normal ROM (can dislocate shoulder whilst swinging in baseball, hockey. Common dislocation sites include finger (netball), Knee (skiing) and shoulder. S/S: loss of movement, swelling, deformity, pain Management strategies: splint for immobilisation, ice, elevation, support, MA

What are the differences between a SPRAIN and a STRAIN?

A sprain is a tearing or over-stretching of a ligament resulting in pain and inflammation whereas a strain is a microscopic tear of a muscle or tendon causing bruising and bleeding.

Describe tears, sprains and contusions.

A tear is a disruption of the fibres of a MUSCLE OR TENDON (connects bone to muscle) and occurs when a muscle QUICKLY CONTRACTS. A strain is a microscopic tear causing bleeding and bruising. A sprain arises from the stretching or tearing of a LIGAMENT (connecting bone to bone) and causes swelling and pain. RICER should be applied for this injury. Contusions are bruises and bleeding into the soft tissue usually caused by direct impact (knee into thigh in soccer).

Describe the need of training in rehabilitation.

After total body fitness is achieved, training can resume, assuming that the athlete is completely pain free and feels stability in the injured area. They should complete the full training program.

Explain the need for the matching of opponents in sport situations.

Age and/ or size groups in sport are implemented to promote safety, matching children with others of comparable ability and size. Most sports (soccer, netball and basketball) group children according to their age or ear group at school, however, this is not always effective due to the variations in maturity in children. Strength and motor skills should be taken into consideration which promotes enjoyment not competitiveness.

Explain the method of taping for isolation.

Aims to reduce pain and preventing further injury (e.g. sprained ankles and knees in netball, fingers in volleyball/ basketball, Injured shoulder in rugby). Taping for isolation limits range of motion, increases stability of joint and reduces inflammation.

Explain the importance of physical fitness as a preventative action for injury.

By being fit and developing the physical components necessary for sport involvement, injury can be prevented. For example, netball players should work on improvements in agility, speed, hand-eye coordination and specific technique relating to shooting (if required), passing, catching and landing.

Describe the use of heat and cold in rehabilitation procedures.

COLD: - reduces the inflammatory response and hence, pain and swelling - Should be used as initial management (first 48- 72 hours after injury) - Should not be used if the player wishes to return to play as ice will stiffen the soft tissues and increase the chance of re-injury - cryotherpay is the use of ice/ cold gel packs/ ice massage/ ice immersion/ contrast bath - use of ice correctly in RICER can reduce recovery time - should be used in 20 minute intervals HEAT: - increases circulation to the site - decreases pain - enhances inflammatory response - increases elasticity to new ligaments - thermotherapy includes heat packs, deep heat, contrast baths - should not be applied to acute injuries

What are the return to play policies and procedures?

Coaches, sports administrators and sports medicine professionals play an important role in establishing guidelines for athletes who are managing injury and deciding whether to play with injury and when to return to the arena. At professional levels of sport, policies exist to prevent the recurrence of injury including compulsory consultation with doctor/ physio, x rays, discussion of strapping, fitness assessment.

How does a warm up in a rehab procedure differ from a normal warm up (specific warm up)?

Injured athletes may need a longer warm up and stretching period than a normal athlete as the soft tissue around the injured site may not be as stable as before the injury so proper dynamic stretching and physical activity before games is essential.

How does correct skill and technique improve well-being.

Injuries can occur due to poor technique with either one large direct blow or smaller, repetitive, minor impacts. Correct skill and technique contribute to injury prevention as the necessary muscles are 'worked' and strengthened. For example, in dance, you need to correct technique for a pirouette as this skill is the base movement for other skill (turning leaps, pump turns), so mastering this skill will ensure the correct development of multiple other skills. Also, in cricket, for maximum power when hitting the ball, the bat must be handled and swung with the correct technique. Skill and technique may need to be modified in certain climatic conditions such as wind, rain and humidity.

Explain safe grounds, equipment and facilities in relation to sports policy and environment.

It is the responsibility of the organising group to ensure that the sports ground and equipment is free of any dangerous obstacles etc. Safety Guidelines for Children in Sport and Recreation recommends: - playing surface is in reasonable condition (e.g. flat oval with no ditches) - clean environment (e.g. with no or limited pollution) - permanent fixtures (e.g. goal posts, basketball back-boards) have padding - lighting (e.g. night tennis/ soccer/ netball games) is adequate - equipment is suited to size of child - equipment is free of rust and has no sharp edges (e.g. top of hurdles is smooth)

What is an overuse injury?

Overuse injuries occur when excessive and repetitive force is placed on the bones and soft tissue. There will be little or no pain in the early stages which causes the athlete to continue placing strain on the injured site. This can include the inflammation of tendons surrounding the knee, where a soccer player will continue to participate despite their injury. Overuse injuries commonly occur from POORLY PLANNED training PROGRAMS (limited rest), POOR TECHNIQUE (wrong backhand technique in tennis can cause an athlete to develop and overuse injuries in their triceps), POOR EQUIPMENT (cricket bat is too heavy or long for the athlete which causes incorrect technique).

How does one bandage for immediate treatment of injury?

Part of RICER (compression) for soft tissue injuries (usually ankles/ knees in high impact sports. It reduces bleeding and inflammation, providing support for injury. Bandage also reduces movement (rest part of RICER)

Assess the importance of pre screening measures to ensure the well-being of an athlete.

Pre screening is a preventative measure performed prior to the commencement of exercise so the coach can determine current fitness levels and become familiar with medical history. It is usually in the form of a questionnaire (have you ever had a heart attack/ stroke, do you have asthma/ diabetes, do you regularly exercise). With the completion of this stage, coaches will have a deeper, more thorough understanding of the athlete's needs and the methods and actions that need to be taken in order to maintain well-being and physical fitness. Complications include: - OVER 35 years for MALE and 45 for FEMALE as high blood pressure, heart conditions and obesity begin to become prevalent issues. - PREGNANCY as exercise can cause distress to foetus, lower birth rates and decrease blood flow to uterus - OVERWEIGHT as injuries are more common and there are more issues regarding increased blood pressure and circulation. - DIABETES which decreases sporting abilities - SMOKING means that an athlete has less endurance and cardio-respiratory problems

Outline progressive Mobilisation and its contribution to the rehabilitation process

Progressive mobilisation refers to the gradual increase in the joint range of motion/movement. Joints after an injury tighten due to the lack of movement due to RICER. PM stretches the muscle around the injured site, this should take place as soon as possible to help reduce scar tissue. Progressive mobilisation utilises dynamic, static and PNF stretching, but NOT ballistic stretching as this can cause further damage.

Discuss preventative taping

Prophylactic taping refers to the application of bandages to a joint area to protect, support or strengthen the joint during movement. Netball, basketball and football players place incredible strain on knees and ankles so they often strap these joints to promote stability, prevent injury, provide support. However, taping will never provide the joint with the same stability of body's natural connective tissues and hence resistance training should be utilised to strengthen these soft tissues. Sometimes, taping can be too restrictive and actually decrease performance. Thus, tape for prevention of injury needs to be non-elastic, firm in place, always begin with anchors, then stirrups on inside of leg, completely cover skin, finish with locks

Analyse the use of protective equipment in sport.

Protective equipment promotes safety and ensures correct technique, preventing direct impacts to the player. For example, mouth guards in softball protect the teeth and jaw by absorbing the kinetic energy of the ball, usually travelling at high speeds. Also, shin pads are compulsory equipment in soccer (both outdoor and indoor) to prevent contusions on the shin area. Also, hats in cricket assist in preventing sun burn in the short term and skin cancer in the long term. Good quality equipment is essential but usually costs more money. In sports such as ice hockey and cricket where injury is of a high risk, protective equipment must be reliable, properly fitted and rigid. In most cases, the wearing of protective equipment is voluntary and the athlete takes personal responsibility for their own safety, however, in children games, the parents have a duty of care to provide and ensure that their child is wearing appropriate protective gear. Foot wear has to be supportive (cushioning) with the athlete wearing orthotics if necessary (especially for marathon or cross-country running).

How does an athlete monitor progress as part of returning to play?

Results from a pre-test taken before injury could be compared to those of a post- test after injury rehabilitation procedures are complete. This will establish if the athlete has returned to total body fitness. Psychological condition should be monitored through visual observation, interview, ongoing physical tests, evaluation sheets.

Explain why RULES of sports and activities are necessary.

Rules assist the flow of play and protect participants from injury (spear tackes are banned in collision sports such as rugby league, softball catchers must wear protective gear, non-contact sport in netball) Many clubs loose a lot of money from player injuries (NRL judiciary takes legal action against players through violence), hence the rules are there to protect players and ensure fair play

Explain each of the following: skin abrasions, lacerations, blisters

Skin abrasions occur when the OUTER LAYER OF SKIN has been removed. Any gravel in abrasions should be removed using water, this will clean the wound. Lacerations are when the SKIN IS CUT and these need to be cleansed with antiseptic soap, dried with a gauze applied. If bone or soft tissues are exposes, medical attention is required and stitches may be necessary. Blisters result from FRICTION, where one layer of rubs and separates from another, meaning that small pockets of fluid form. These can be caused from FAULTY EQUIPMENT (shoes with limited/ worn padding and/ or thin socks in marathon run). Blisters should be rested for 24 hours to allow the natural bodily functions to repair the blister.

Outline soft and hard tissue injuries.

Soft tissue injuries involve the skin (blisters, abrasions), muscles (tears or strains), tendons (inflammation, tears or strains) and ligaments (sprains, tears). The initial stage of repair of body tissue is the acute inflammatory phase occurring in the first 24 to 72 hours after injury. 'RICER' should be used for soft tissue injuries. Hard tissue injuries involve significant damage to the bone. Most common are fractures and dislocations and often a direct force can bruise a bone.

Describe the climatic conditions.

TEMPERATURE- aim is to maintain homoeostasis. Sustained performance in heat can lead to heat stroke/ hyperthermia, increasing blood volume and blood transports heat instead of oxygen and nutrients- body sweats more. Athlete should implement strategies such as pouring water over themselves, exercising in cool parts of day, wear light clothing. Performance in cold conditions can lead to hypothermia and if the body loses more than one degree Celsius- vaso-constriction, shivering, hypothermia. Athletes should not overdress in water, but rather wear insulating clothing. Need long, dynamic warm ups before competing in cold events (e.g. skiing) HUMIDITY- refers to water concentration in atmosphere limit's body's ability to dissipate heat. Ice vest would be useful. WIND- convection and conduction leads to heat loss. Wind proof jackets in windy conditions (marathon runs, cycling and wetsuits in surfing) should be worn. RAIN- can increases heat loss through convection and makes conditions dangerous. AThletes should play according to conditions, (not turn a sharp, downhill corner in cycling whilst raining) ALTITUDE- after 1500m above sea level, an athletes performance will be negatively affected in the short term but positively in the long term. Air is less dense meaning each litre of air contains less oxygen molecules- less nutrients to transport to body's working cells (low air pressure). Greater radiation from sun at higher altitudes -hat and sunscreen should be worn POLLUTION- lung function is affected by carbon monoxide (found in car exhaust fumes), reduces delivery of oxygen to muscles and increases air resistance. Beijing Olympics 2012- had to clear city.

Explain the method used to assess injuries.

TOTAPS used to determine EXTENT of injury! If the patient is unconscious, you MUST use DRSABCD, however, if the patient is conscious, with a significant injury you should use TOTAPS. TALK: how did it happen, where does it hurt the most, how does it feel? If severe pain, go to RICER OBSERVE: observe the site for deformity, swelling, compare to other limb. If serious deformity/ swelling, go to RICER. TOUCH: gently feel to pinpoint area of pain. If pain is severe. go to RICER. ACTIVE MOVEMENT: allow them to move to site themselves, flexion, extension etc. RICER is major pain PASSIVE MOVEMENT: you move the site SKILLS TEST: perform a required skill in game (side step in netball, kick of ball in soccer)

Describe temperature regulation (convection, radiation, conduction, evaporation)

The body aims to maintain homoeostasis of 37 degrees Celsius- lower is hypO, higher is hypER. RADIATION causes heat gain if temperature outside is warmer than body's surface, causes heat loss if surrounding atmosphere is cooler. Radiation is the transfer of internal energy in the form of electromagnetic waves - usually infra-red. CONVECTION is the process of air moving across the skin or a transfer of heat away from the skin through wind. It is defined as heat transferred by mass motion of a fluid, such as air or water, when the heated fluid moves away from the source of heat, taking heat energy with it. CONDUCTION is the transfer of heat from a body to an object by direct contact (playing on a hot tennis court increases body's temperature, sitting on a cool, seat is the loss of heat) EVAPORATION is heat loss through sweating and vaso-constriction and is the main form of heat loss in endurance events (marathon, tri-athalon).

What are the indicators for readiness and how do they impact on injury rehab?

The indicators of readiness are: - elasticity (new tissue has been stretched) - strength (the new tissue is strong/ stable) - mobility (full range of movement) - pain free - balance (can effectively balance on injured limb) These factors can be checked through physical tests (beep/ agility test) or skills tests (netballer tested on his ability to sprint and dodge players)

Explain the inflammatory response.

The inflammatory response is the body's initial response to a soft tissue injury. This includes 3 stages: 1. ACUTE INFLAMMATORY PHASE (24 to 72 hours after injury): increased blood flow to the areas resulting in swelling, pain, redness around the site and loss of mobility. 2. REPAIR AND REGENERATIVE STAGE (3 days to 6 weeks): production of scar tissue, removal of debris and formation of new fibres. 3. REMODELLING STAGE (six weeks to multiple months): Increased production of scar tissue and replacement tissue needed to strengthen and develop in direction that force in applied. RICER should be used immediately after soft tissue injury occurs. REST: inactivity for first 48- 72 hours ICE: Do not apply ice to open wounds! Ice (crushed ice in a wet towel or frozen gel packs) cause blood vessels to constrict, decreasing circulation, blood flow and tissue demand for oxygen and hence inflammation. 20 mins every hour COMPRESSION: elastic bandage for at least 24 hours to decrease swelling ELEVATION: above heart for follwing three days to reduce bleeding, swelling and throbbing. REFERRAL: see doctor/ physiotherapist asap to understand nature of injury and obtain exercises to assist with rehab

Why are there modified rules for children?

To minimise the risk of injury as children are not little adults (their bones are weaker, they have a lower aerobic and anaerobic capacity, less coordination and their brain has still not fully developed. This will lower child obesity rates (significantly high in Australia). For example, tee ball is a sport implemented for children as they cannot effectively pitch a ball, the backboard in basketball is also lowered as children as significantly shorter and weaker than the average adult and lastly, the field size is decreased in soccer due to their lower lung and hence aerobic capacity. There are also trophies and certificates for participation which encourages the child to play for another season- increasing revenue for the club.

What does warm up, stretching and cool down do in assisting with the well being of the athlete.

Warm up prepares the body for game situations by increasing the blood flow throughout the body, increasing body and muscle temperature, stretching ligaments and mentally preparing the athlete. 1. EASY EXERCISE- short, light exercise e.g. jogging 5-10 mins light sweat 2. STRETCHING- 10 - 15 mins of PNF and dynamic stretching to increase the length of muscle, increase blood circulation and improve ROM. 3. CALLISTHENICS- push-ups, crunches, star jumps 4. SKILL REHEARSAL- drills, routines Cool down should start with intense activity to flush out lactic acid gradually becoming lighter and ending with static stretching.

What is acclimatisation?

When an athlete adjusts to a change in environment, allowing them to maintain performance in the new environmental conditions. HYPOXIA (lack of oxygen at altitude) stimulates physiological adaptations: * Short term- hyperventilation, increased cardiac output/ blood pressure * Long term- increased red blood cells, increased haemoglobin

How is injury rehabilitation managed? (dot points)

o Rehabilitation procedure o return to play

How are Sports Injuries Classified? (dot points)

o Ways to CLASSIFY sports injuries o SOFT tissue o HARD tissue o ASSESSMENT of injuries

What role do preventative actions play in enhancing the well-being of the athlete? (dot points)

o physical preparation o sports policy and the sports environment o environmental considerations o taping and bandaging

How is injury rehabilitation managed (dot points)

o rehabilitation procedures o return to play