Kinesiology 135- Exam 1

Post-exposure Procedures

- AT should have confidential medical evaluation that documents exposure route, identification of source/individual, blood test, counseling and evaluation of reported illness - laws that pertain to reporting and notification of results relative to confidentiality vary from state to state

Visual Observation

- compare injured and non-injured areas - look for gross deformity, swelling, skin discoloration

Cool-down

- essential component of workout - bring body back to resting state - 5-10 minutes in duration - often ignored - decreased muscle soreness following training if time used to stretch after workout

HOPS

- history - observation - physical examination - special tests

Throat Protection

- laryngotracheal injuries, while uncommon can be fatal - baseball catchers, lacrosse goalies and ice hockey goalies are most at risk (should be mandatory in these sports)

Maturity Assessment

- means to protect young physically active athletes - method: circumpubertal (sexual maturity), skeletal, dental - Tanner's five stage assessment is most expedient

Eye and Glasses Guards

- necessary in sports with fast moving projectiles - athletes not wearing glasses should wear closed eye guards to protect orbital cavity - eye guards afford great protection, they can limit vision - polycarbonate eye shield have been developed for numerous pieces of head gear

PRICE

- protection - rest - ice - compression - elevation

Rib Protection

- thorax protectors and rib belts - protect against external forces - air-inflated interconnected cylinders (jacket design)

Manual Conveyance

- used to move mildly injured athlete a greater distance than could be walked with ease - carrying the athlete can be used following a complete examination - convenient carry is performed by two assistants

Examination by Personal Physician

- yields an in-depth history and ideal physician-patient relationship - may not result in detection of factors that predispose the athlete to injury

Providing Coverage

Facility Personnel Coverage - budgetary concerns may be a limiting factor - what personnel are available? Sports Coverage - different institutions (including high schools) have different levels of coverage based on personnel and risks involved with sports

FOOSH

Fall On Out Stretched Hand

NOCSAE

National Operating Committee on Standards of Athletic Equipment

SAIDs

Specific Adaptations to Impose Demands

CMS

center for medicare and medicaid services

Stair climbing with crutches

should be introduced when athlete is able to move effectively on level surface ("up with the good, down with the bad") * crutches always stay with bad foot

Tripod method

swing crutches through without injured limb making contact with ground (two crutches, 1 foot)

Knee Braces

used prophylactically to prevent (re)injury AOSSM has expressed concern about their efficacy in reducing injuries

Incision

wounds with smooth edges

Safety in Lightning and Thunderstorms

- #2 cause of death by weather phenomena - NATA has established position statement due to number of athletes and coaches potentially exposed to lightning scenarios - EAP must be set for this type of event * involving chain of command, monitoring of weather service, decision making regarding removal and return to field - in the even of a storm, shelter indoors should be obtained - other guidelines * avoid large trees, flag/light poles, standing water, telephones, pools, showers, and metal objects * last resorts find car, ravine, ditch, or valley for safety * if hair stands up on hand you are in imminent danger and should get down on the ground but not flat as that increases surface area

Hyperthermia

- ATs require knowledge and information concerning temperature, humidity and weather to adequately make decisions regarding environmental dangers - has caused a number of deaths over the years - must manage heat stress appropriately - hyperthermia = increase in body temperature - anyone that supervises athletes practicing and competing must realize that heat and humidity impact every geographic region of the United States - imperative to be able to recognize signs and symptoms associated with heat-related illnesses and to be able to manage them appropriately

Placing Athlete on Spine Board

- EMS should be contacted if this will be required - must maintain head and neck in alignment of long axis of the body - one person must be responsible for head and neck at all times - primary emergency care must be provided to maintain breathing, treating for shock and maintaining position of athlete - permission should be given to transport by physician

Why is it important to have good flexibility?

- Flexibility (as flexibility increases, strength decreases) * ability to move a joint(s) smoothly through a full range of motion (ROM) - originally believed that decreased ROM results in: * decreased performance capabilities * uncoordinated/awkward movements * predisposes athlete to injury - evidence indicates that flexibility may be more important for participation in more dynamic activities * high intensity stretch-shortening cycles (muscle/tendon unit requires storage of elastic energy) * without necessary flexibility the tendon may exceed capacity * stretching can influence viscosity of tendons making it more complaint= injury reduction - static stretching vs. injury rates and injury reductions

Equipment Reconditioning and Recertification

- NOCSAE has established test standards in order to reduce head injuries * set minimum safety requirements for helmets and masks for football, baseball/softball and lacrosse * accepted standards for various regulatory bodies in sports - type of helmet, amount of use/intensity will determine condition of help over a period of time - NOCSAE label does not warranty helmets (indicates helmet met requirement when manufactured or reconditioned) - NOCSAE reccommends reconditioning and recertification of equipment (consumer should use discretion based on use) - helmets undergoing reconditioning can meet performance for many seasons depending on model and usage (will help equipment last longer, if not kept clean various skin conditions and infections can be unnecessarily transferred

Protecting the Caregiver

- OSHA guidelines are designed to protect coaches, athletic trainers, and other employees - responsibility of institution to protect AT and other staff (provide necessary supplies and eduction) - all staff have personal responsibility to follow guidelines and to enforce them

Universal Precautions

- Occupational Safety and Health Administration (OSHA) established standards for employer to follow that govern occupational exposure to blood-borne pathogens - developed to protect healthcare provider and patient - all sports programs should have exposure control plan (include counseling, education, volunteer testing, and management of bodily fluids)

Types of Braces

- Rehabilitative * widely used following surgery * allows controlled progressive immobilization * adjustable - Functional (off the shelf) * used during and following rehab to provide functional support * ready-made and customized - Neoprene (with medial and lateral support) * used by those that have sustained collateral ligament injuries * some are also used to provide support in those that have patellofemoral conditions

Establishing Negligence

- a duty of care existed between the person injured and the person responsible for that injury - conduct of the defendant fell short of that duty of care - the defendant caused the injury to occur - resultant damages either personal, property, or punitive

Medicare

- a federal health insurance program - designed for the aged and disabled - many third-party payers base decisions on what will be covered under their policies on what medicare and medicaid will cover

Emergency Action Plans

- a plan must exist for accessing emergency personnel (must include transportation of athletes to emergency facilities) - meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care - must have knowledge of local and community health services and agencies in the event of referrals

Human Immunodeficiency Virus (HIV)

- a retrovirus that combines with host cell - virus has potential to destroy immune system - according to World Health Organization 42 million people were living with HIV/AIDS in 2004 - symptoms and signs * transmitted by infected blood or other fluids * fatigue, weight loss, muscle or join pain, painful or swollen glands, night sweats, and fever * antibodies can be detected in blood tests within 1 year of exposure * may go for 8-10 years before signs and symptoms develop * most that acquire HIV will develop acquired immunodeficiency syndrome (AIDS)

Suspected Spinal Injury

- access EMS immediately and wait for rescue squad before attempting to move athlete - transportation and movement should be left to trained experts - maintain head and neck in alignment with long axis of body

Emergency Telephones

- accessibility to phones in all major areas of activity is a must - should be able to contact outside emergency help and be able to call for additional athletic training assistance - radios, cell and digital phones provide a great deal of flexibility

Range of Motion (ROM)

- active range of motion = dynamic flexibility (ability to move a joint without assistance) - passive range of motion = static flexibility (motion of joint when another person moves the joint- no muscle contraction) - must be able to move through unrestricted range - must have elasticity for additional stretch encountered during activity

Hepatitis C (HCV)

- acute and chronic form of liver disease caused by HCV - most common chronic bloodborne infection in U.S. - leading indication for liver transplant - signs and symptoms * 80% of those infected have no signs and symptoms * may be jaundice, have mild abdominal pain, loss of appetite, nausea, fatigue, muscle/joint pain, and/or dark urine - prevention * occasionally spread through sexual contact * spread via contact with blood of infected person, sharing needles, or sharing items that may carry blood (razors, toothbrush) * consider the risks of getting a tattoo or body piercing * ATC should always follow routine barrier precautions

What determines how efficiently the body is using oxygen?

- aerobic capacity = VO2 max - more active = higher capacity - average value = 38-46 ml O2/min/kg - increases in intensity require higher levels of oxygen consumption - inherit certain range of maximum aerobic capacity (genetics)- (dependent on activity levels, also impacted by muscle fiber types)

Preparing the Athlete

- all open wounds and lesions should be covered with dressing that will not allow for transmission - occlusive dressing lessens chance of cross-contamination (hydrocolloid dressing reduces chance that wound will reopen, maintains moist and pliable wound) - when bleeding occurs * athletes must be removed from participation and returned when deemed safe * bloody uniform must be removed or cleaned

Commercial Ankle Braces

- alone or with tape- they are increasingly popular - significant debate over efficacy - little or no impact on performance - compared to tape, the device will not loosen significantly with use

Open vs. Closed Kinetic Chain Exercises

- anatomical functional relationship for upper and lower extremities - OKC (good for early on in rehab process) * when foot and hand are not in contact with the ground or supporting surface - CKC * foot or hand are weight bearing, widely used = more functional (squats for knee extension, leg press)

Prevention of cold stresses

- apparel geared for weather to provide semitropical microclimate for body and prevent chilling - waterproof and windproof fabrics wick moisture away from skin, allowing passage of heat and sweat - layers and adjusting them are key to maintaining body temperature (during period of (in)activity) - inadequate clothing, improper warm-up and chill factor can lead to injury, frostbite, and/or minor respiratory problems

Palpation

- assess bony and soft tissue structures - systemic evaluation beginning with light pressure and progressing to deeper palpation- begin away from injured area

Heat Syncope (heat collapse)

- associated with rapid fatigue and overexposure standing in heat for long periods of time - caused by peripheral vasodilation, or pooling of blood in extremities resulting in dizziness and fainting - treatment: lay athlete down in cool environment, elevate lower extremities, consume fluids

Assumption of Risk

- athlete is made aware of inherent risks involved in sport and voluntarily decides to continue participating - expressed in written waiver or implied from conduct of athlete once participation begins - can be used as defense against an athlete's negligence suit - does not excuse overseers from exhibiting reasonable care and prudence in regards to conduct of activities or foreseeing potential hazards (don't be stupid) - many and varied interpretations (particularly with minors) - often a waiver will stand in court except in incidents of fraud, misrepresentation or duress

Crutch/cane fitting

- athlete should stand with good posture, in flat soled shoes - crutches should be placed 6 inches from outer margin of shoe and 2 inches in front - crutch base should fall 1 inch below anterior fold of axilla (armpit) - hand brace should be positioned to place elbow at 30 degrees of flexion - cane measurement should be taken from height of greater trochanter (top of femur)

Policy Regulation

- athletes are subject to procedures and policies relative to transmission of bloodborne pathogen - a number or sport professional organizations have established policies to prevent transmission - organizations have also developed educational programs concerning prevention, and medical assistance - institutions should educated student athletes (greatest risk is involved in off-field activities) - athletic trainer should take responsibility of educating and informing student athletic trainers of exposure and control policies - institutions should follow universal precautions and implement policies concerning bloodborne pathogens

Identifying Susceptible Individuals

- athletes with large muscle mass - overweight athletes are at an increased risk (related to proportionality of metabolic heat production to surface area) - athlete with increased fluid loss - precautionary measures apply to both males and females - medications or supplements may impair sweating and may predispose them to injury - poor fitness levels, a history of heat-related illnesses or anyone with febrile conditions are at increased risk - uniform selection * based on temperature and humidity * dress for the weather and temperature * avoid rubberized suits - weight records * keep track of before and after measures for first two weeks * if increase in temperature and humidity occurs during the season, weights should again be recorded * a loss of 3-5% = reduced blood volume and could be a health threat

Tetanus

- bacterial infection that may cause fever and convulsions and possibly tonic skeletal muscle spasm for non-immunized athletes - tetanus bacillus enters wound as spore and acts on motor end plate of CNS - following childhood vaccination, boosters should be supplied once every 10 years - if not immunized, athlete should receive tetanus immune globulin (Hyper-Tet) immediately following skin wound

Contact Lenses

- become part of the eye and move with it - comeal and sclera (white part of eye) lenses - peripheral vision, astigamtism and comeal waviness is limited - will not fog and can be tinted - disadvantages include cost, comeal irritation, possibility of coming dislodged - soft hydrophilic lenses and disposable lenses are very popular

Conducting a Secondary Survey

- begin once athlete is stable - vital signs (are they changing?) * heart rate and breathing rate * blood pressure * temperature * skin color * pupils * movement * presence of pain * level of consciousness

Liability

- being legally responsible for the harm one causes another person - must be certain you are aware of all rules and regulations relative to healthcare in a given state

Stretcher Carrying

- best and safest mode of transport - with all segments supported/splinted athlete is lifted and placed gently on stretcher - careful examination is required if stretcher is needed - various injuries will require different positioning on stretcher

Laceration

- blunt force delivered over a sharp bone or a bone that is poorly padded results in would with jagged edges - may also result in tissue avulsion

HIV and Athletic Participation

- bodily fluid contact should be avoided - avoid exhaustive exercise that may lead to susceptibility to infection - according to American with Disabilities Act infected athletes cannot be discriminated against and may only be excluded with medically sound basis

Factors that limit flexibility

- bony structures - tissue approximation - excessive fat - muscle and tendon lengths - connective tissue - scarring and contractures - skin

Stretching Techniques- Ballistic

- can be dangerous - bouncing movement in which repetitive contractions of agonist work to stretch antagonist muscle - while effective in improving flexibility, caution should be exercised (increased motion is achieved through a serious of jerks on resistant tissue) - possible soreness may result if jerks are greater than tissue extensibility - ex: butterfly stretch and moving legs up and down

Puncture wounds

- can easily occur during activity and can be fatal - penetration of tissue can result in introduction of tetanus bacillus to bloodstream - all severe lacerations and puncture wounds should be referred to a physician

Sunscreen

- can help prevent effects of UV radiation - Sun Protection Factor (SPF) * sunscreen effectiveness * indicates how many times longer an individual can be exposed to the sun with vs. without sunscreen before skin turns red - Use * when outside considerable amount * individuals with fair complexion, light hair, blue eyes, or skin the burns easily * throughout the year * apply 15-30 minutes prior to exposure * re-apply after exposure to water, excess sweating, rubbing skin with clothing or a towel

Negligence

- care giver does something a reasonably prudent individual would not - care giver fails to do something a reasonably prudent individual would - athletic trainer has a duty to provide coverage to athletes (obligation) - individual possessing higher level of training will possess higher level of competence - once the individual assumes duty of caring for athlete that person has an obligation to provide appropriate care - obligation to provide services vs. Scope of employment - good samaritan law (provides limited protection against legal liability to one that provides care should something go wrong)

Catastrophic Insurance

- catastrophic injuries in athletics are relatively rare, but are staggering to all involved - organizations provide additional coverage to deal with lifetime extensive care - ensuring that all athletes and faculty/staff coverage is in place is critically important - filing of claims, at times, is the responsibility of the AT - can be very time consuming taking the athletic trainer away from other responsibilities - additional staff may be necessary to deal with added responsibilities

Sport Disqualification

- certain injuries and illnesses warrant special concern when dealing with injury - recommendations can be made

Bloodborne Pathogens in Athletics

- chance of transmitting HIV among athletes is low - minimal risk of on-field transmission - some sports have potentially higher risk for transmission because of close contact and exposure to bodily fluids (martial arts, wrestling, boxing)

Availability of Supplies and Equipment

- chlorine bleach, antiseptics, proper receptacles for soiled equipment and uniforms - wound care equipment and sharps container - biohazard warning labels should be affixed to refrigerators containing blood and shipping containers for infectious material - gloves and bandages should be placed in sealed white bags prior to disposal in regular trash receptacles - disinfectant * contaminated surfaces should be cleaned with solution of 1:10 ratio approved disinfectant to water * contaminated towels should be bagged, labeled, and separated from other soiled laundry, then transported in biohazard container - sharps * needles, razorblades, and scalpels * do not recap, bend needles or remove from syringe * scissors and tweezers should be sterilized and disinfected regularly

Is there a relationship between strength and flexibility?

- co-exist - muscle bound = zero flexibility - strength training will provide individual with ability to develop dynamic flexibility through full range of motion - develop more powerful and coordinated movements

Hypothermia

- cold weather vs. nature of particular sport - most activity allows for adequate heat production and dissipation, allowing for sufficient functioning - temperature in conjuction with wind chill and dampness or wetness can increase chances of hypothermia - with muscular fatigue, in cold weather, rate of exercise begins to drop and rate of heat loss relative to heat production may shift (results in impaired neuromuscular responses and exhaustion) - drop in core stimulates shivering but stops after temperature drops below 85-90 F - death is imminent when temperature falls below 77-85 F

Acquired Immunodeficiency Syndrome (AIDS)

- collection of signs and symptoms that are recognized as the effects of an infection - no protection against the simplest infection - positive test for HIV cannot predict when the individual will show symptoms of AIDS - after contracting AIDS, people generally die within 2 years of symptoms developing - Management * no vaccine or cure for HIV * research looking for preventative vaccine and effective treatment * some antiviral drug combinations help to slow replication of virus - Prevention * education is critical * greatest risk is through intimate sexual contact with infected partner * emphasis safe sexual practices (choose non-promiscuous partners, use latex condoms to provide HBV and HIV barrier, vaginal spermicides)

Points of Service

- combination of HMO and PPO - based on HMO model but allows for care outside of the plan - flexibility is allowed for certain conditions and circumstances

Circuit Training

- combination of exercise stations - 8-12 stations, 3 times through - design for different training goals (flexibility, calisthenics, aerobic exercise)

Medical History (questionnaire)

- complete prior to exam to identify past and existing medical conditions - update yearly and closely review by medical personnel - collect medical release and insurance info at the same time

Year Round Training Cycle

- complete training cycle - seasonal approach based on preseason, in-season, and off-season - changes in intensity, volume, specificity of training occur in order to achieve peak levels of fitness for competition - broken into periods or phases (lasting weeks or months)

Safety Standards for Equipment and Facilities

- concerns relative to materials, durability, establishment of standards, manufacturing, testing methods, and requirements for use (concern should be protective ability not appearance of equipment) - standards must be in place relative to maintenance - a number of groups and agencies are involved in standardizing sports equipment and facilities

Types of Training for Cardiorespiratory Endurance

- continuous * mode (type of exercise)- must be aerobic in nature * frequency (at least 3 times/week) * duration (at least 20 minutes) * intensity (monitor intensity as % of heart rate or perceived exertion) - training heart rate- target heart rate (max HR- 220-age) - karvonen formula- target HR= resting HR+(.6(Max HR - resting HR)) - interval training * intermittent activities involving periods of intense workload and active recovery * must occur at 60-80% of maximal heart rate * allows for higher intensity training at short intervals over an extended period of time * most anaerobic sports require short burst which can be mimicked through interval training - fartlek training (indian runs) * cross-country running that originated in Sweden * speed play * similar to interval training in the fact activity occurs over a specific period of time but pace and speed are not specified * consists of varied terrain which incorporates varying degrees of hills * dynamic form of training * must elevate heart rate to minimal levels to be effective * popular form of training in off-season

Isometric Exercise

- contraction where muscle length remains unchanged - muscle contraction that lasts 10 seconds and should be performed 5-10 times/day - pro: quick, effective, cheap, good for rehab - con: only works at one point in ROM, produces spiking of blood pressure due to Valsalva maneuver

Core Stabilization Training

- core refers to the lumbo-pelvic-hip complex (29 muscles in the lumbar spine, hip, abdomen and around the hip and pelvis) - will help to improve: * postural control and muscular balance * facilitate dynamic functional strength and dynamic stabilization of kinetic chain * improve neuromuscular efficiency throughout the body - often a focus on functional strength, neuromuscular control and power relative to activity (core training and spinal stabilization is often neglected) - optimal stabilization of the spine allows for effective utilization of strength, power and control of the prime movers (if core is weak, movement efficiency declines, could lead to injury)

Training for the Female Athlete

- critical for female athlete - significant hypertrophy is related to testosterone present within body - remarkable gains are experienced initially (due to enhanced nervous system and muscle interaction (efficiency- not muscle bulk)) - following initial gains, plateau occurs, with females - males tend to continue to increase strength with training - critical difference is the ratio of strength to body fat * females have reduced strength to body weight ratio due to higher percentage of body fat * ratio can be enhanced through weight training (results in a decrease in body fat percentage or an increase in lean weight)

Record Keeping

- critical responsibility of healthcare program - necessary for accurate, timely assessment and evaluation of practices - documents all practices to assure that responsibilities and expectations are being met - paper vs. electronic records (medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports)

Compression

- decreases space allowed for swelling to accumulate - important to adjunct to elevation and cryotherapy and may be most important component - a number of means of compression can be utilized (Ace wraps, foam cut to fit specific areas for focal compression) - compression should be maintained daily and throughout the night for at least 72 hours (may be uncomfortable initially due to pressure build-up)

Are sutures necessary?

- deep lacerations, incisions, and occasionally punctures will require some form of manual closure - decision should be made by a physician - sutures should be used within 12 hours - area of injury and limitations of blood supply for healing will determine materials used for closure - physician may decide would does not require sutures and utilize steri-strips or butterfly bandages

Special Test

- designed for every body region for detecting specific pathologies - used to substantiate findings from other testing

Cycling Helmets

- designed to protect the head during one single impact - football, baseball and hockey helmets are more durable and can survive repeated blows - many states require use of cycling helmets, especially in adolescents

Rules of Operation for an Athletic Healthcare Program

- determine who will take care of athletic heath care facility - must develop policies and procedures (delineate daily routine of program) - define scope of program (who will be served by the program, athlete: to which extent and what services will be rendered, institution: who else can be served medically and educationally and what are the legalities)

Foot Orthotics

- device for correcting biomechanical problems that exist in foot that can cause injury - plastic, thermoplastic, rubber, sorbothane, leather support or ready-made products - can also be customized by physician, podiatrist, athletic trainer or physical therapist-- more expensive

Management

- dial 911 to access emergency care - maintain core body temperature - elevate feet and legs 8-12 inches above heart - positioning may need to be modified due to injury - keep athlete calm as psychological factors could lead to or compound reaction to life threatening condition - limit onlookers and spectators - reassure the athlete - do not give anything by mouth until instructed by physician

Head Protection

- direct collision sports require head protection due to impacts, forces, velocities and implements - football helmets * NOCSAE develop standards for football helmet certification * while helmets must be certified, they may not always be fail-safe * athletes and parents must be aware of risks - football helmets generally have air or fluid-filled pockets to absorb force * helmet extends further past the jaw for additional protection and stability * the distance between the helmet and head has been increased * padding inflates to fit the player's head shape * the face guard system has isolated attachment points from the shell, reducing jarring from low-level impacts to the face guard - there are a number of helmet manufacturers (many have closed due to lawsuits and liability cases) - athlete must be aware of risks and what label indicates (athlete reads and signs statement regarding warning label) - each helmet must have visible exterior warning label * label indicates that helmet should not be used to strike and opponent due to risk of injury * indicates risk of injury accidentally and that athlete plays at own risk while using helmet

Understanding the Potential Dangers of Adverse Environmental Conditions

- environmental stress can adversely impact an athlete's performance and pose serious health threats - areas of concern: hyperthermia, hypothermia, lightning storms, over exposure to sun

Trunk and Thorax Protection

- essential in many sports - must protect regions that are exposed to the impact of forces - external genitalia, bony protuberances, shoulders, ribs and spine

Progressive Core Training

- exercises must elicit maximal training response - should be safe, challenging, stress multiple planes, and incorporate a variety of resistance equipment - begin with activities where you are able to maintain stability and optimal neuromuscular control

Heat Stress

- extreme caution should be used when training in the heat (overexposure could result in heat stress) - it is preventable - athletes that train under these extreme conditions are at risk - physiologically the body will continue to function if body temperature is maintained - body must dissipate heat to maintain homeostasis - heat can be dissipated from the body through 4 mechanisms * conduction (direct conduct) * convection (contact with cool air or water mass) * radiation (heat generated from metabolism) * evaporation (sweat evaporating from the skin)

Athletic Health Care Facility Policies

- facility should be used only for prevention and care of sports injuries - rules must be established in the interest of sanitation - policies regarding environmental conditions and emergency protocols should also be set (to minimize disease transmission)

Proprioceptive Neuromuscular Facilitation (PNF)

- first used for neuromuscular paralysis - slow-reversal-hold-relax - contact-relax - hold-relax (ten second push, ten second relax) - best technique to improve flexibility - techniques that involves combination of alternating contractions and relaxation of both agonist and antagonists

Preventing Injuries Through Fitness Training

- fitness is critical for performance and injury prevention - improper conditioning is a major cause in sports related injuries - areas of concern: * flexibility * muscular strength, endurance, power * cardiorespiratory endurance - exercise related injuries can be reduced * improved fitness = more resistant to fatigue and stress

Cold Disorders

- fluid replacement is critical (dehydration = decreased blood volume = less fluid available for tissue warming) - may be useful to monitor weight of athletes training in cold temperatures - injury/illness due to the cold can occur (endurance type activities, winter sports, swimming in cold water)

Exertional Hyponatremia

- fluid/electrolyte disorder resulting in abnormally low concentration of sodium in blood - caused by ingesting too much fluid before, during, and after exercise - may be result of too little sodium in diet or in ingested fluids over a period of prolonged exercise - athletes that ingest large quantities of water and sweat over several hours are at risk (marathon, triathlon) - preventable-- must maintain balance

Helmet Fitting

- follow manufacturer's directions - must routinely check fit - snug fit (credit card test) - with change in altitude bladder helmets must be rechecked - chin straps (2, 4, or 6 strap system) - jaw pads are essential (prevent lateral rocking) - loop straps for race mask - certification is of no avail if helmet is not fit and maintained

Capitation

- form of reimbursement where members make standard payment monthly regardless of services rendered - managed care plans utilize this practice

Calisthenic Strengthening Exercises

- free exercise - isotonic training - gravity's involvement determines level of intensity - full range of motion, may incorporate holding phase - pull-ups, push-ups, back extensions, leg extensions

Lightning Detectors

- hand-held instrument with electronic system to detect presence and distance of lightning/thunderstorm activity (within 40 miles) - can determine level of activity and direction of movement - provides audible and visual warning signals - inexpensive alternative to contracting weather services

Face Guard

- has reduced the number of facial injuries - number of concussions has increased because head is most often used in initial contact - there are a variety of protective options depending on sport and position - proper mounting of the mask must occur with no additional attachments that would invalidate the manufacturer's warranty - all mountings must be flush to the helmet - in high school hockey, face masks are required (with white plastic coating) that meet Hockey Equipment Certifications Council and American Society for Testing Materials - opening can not allow passage of sticks or pucks - additional polycarbonate face shields are also available - the use of throat protectors is also mandated at some levels

Medicaid

- health insurance program for people with low incomes and limited resources - funded by both the federal government and individual - states are responsible for administration of the program

Bloodborne Pathogens, Universal Precautions, and Wound Care

- healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection - must take precautions to minimize risk and prevent contaminations - must be aware of potential dangers associated with exposure to blood or other infectious materials

Monitoring Heat Index

- heat, sunshine and humidity must be monitored closely * takes into account ambient air temperature and relative humidity * attempts to determine how hot it feels to the body - wet bulb globe temperature index (WBGT) provides objective measure for determining precautions concerning participation in hot - WBGT incorporates different thermometer readings * dry bulb (standard mercury temperature) * west bulb (thermometer with wet gauze that is swung around in air) * black bulb (black casing that measures radiant heat) * formula yields WBGT index - DBT and WBT can be measured with psychrometer (combines both thermometers) * wet bulb will be lower due to evaporation of water - drier air = greater depression of wet bulb temperature due to evaporation - ventilation is provided by whirling thermometer (sling psychrometer) or suction fan (aspiration psychrometer) - newer models utilize digital sensors

Eye Protection Devices

- highest percentage of eye injuries are sports related - generally blunt trauma - glasses * may slip on sweat, become bent, fog, detract from peripheral vision or be difficult to wear with headgear * properly fitting glasses can provide adequate protection * lens should be case hardened to cause crumbling and not splintering on contact (disadvantage = increased weight) * polycarbonate lens are virtually unbreakable * may have polarizing/tinting ability * plastic lenses while lightweight are easy to scratch

Legal Concerns for Sport Equipment

- increasing amount of litigation regarding equipment (must foresee all uses and misuses and warn user against potential risks inherent in equipment misuse) - if equipment results in injury due to defect or inadequacy for intended use manufacturer is liable - if equipment is modified, modifier becomes liable

On-Field Injury Assessment

- initial on-field inspection (determine injury severity and transportation from field) - must use logical process to adequately evaluate extent of trauma - knowledge of mechanisms of injury and major signs and symptoms are critical - once the mechanism has been determined, specific information can be gathered concerning the affected area (brief history, visual observations) - gently palpate to aid in determining nature of injury (determine extent of point tenderness, irritation, and deformity) - decisions can be made with regard to seriousness of injury, type of first aid and immobilization, whether condition requires immediate referral to physician for further assessment, manner of transportation from injury site to sidelines, AT room, or hospital) - individual performing initial assessments should document findings of exam and actions taken

Ice (Cold Application)

- initial treatment of acute injuries - used for strains, sprains, contusions, and inflammatory conditions - used to decrease pain, promote vasoconstriction - lowers metabolism, tissue demand for oxygen and hypoxia - applied initially for 20 minutes and then repeated every 1-1/2 hours and should continue for at least the first 72 hours of new injury - treatment must last at least 20 minutes to provide adequate tissue cooling and can be continued for several weeks

Internal Hemorrhage

- invisible unless manifested through body opening, X-ray or other diagnostic techniques - can occur beneath skin (bruise) or contusion, intramuscularly or in join with little danger - bleeding within body cavity could result in life and death situation - difficult to detect and must be hospitalized for treatment - could lead to shock if not treated accordingly ** puncture

Frost nip

- involves ears, nose, chin, fingers, and toes - occurs with high wind and/or severe cold - skin appears firm with cold painless areas that may peel and blister (24-72 hours) - treat with firm pressure, blowing warm air or hands in armpits (if fingers involved) - do not rub

Types of Skeletal Muscle Contractions

- isometric contraction (contraction without movement) * no length change occurs during contraction - isotonic contraction (contraction and movement- agonist and antagonist works together) * concentric: shortening of muscle with contraction in an effort to overcome more resistance * eccentric: lengthening of muscle with contraction because load is greater than force being produced * both are considered dynamic movements

Agonist vs. Antagonist Muscles

- joints are capable of multiple movements - examples: * quadriceps will extend knee with contraction * hamstrings will stretch during extension * quads (muscle producing movement) referred to as agonist * muscle undergoing stretch referred to as antagonist * agonist and antagonist work together to produce smooth coordinated movements

Torts

- legal wrongs committed against a person (liability results) - may emanate from... * nonfeasance (fail to perform legal duty- fail to refer) * malfeasance (performs action that is not his/hers to legally perform) * misfeasance (improperly perform something the person has a legal right to do)

Product Liability

- liability of any or all parties involved in manufactured product for damages caused by product - products with inherent defects are subject to liability suits - may be based on negligence, strict liability or breach of warranty fitness - equipment must not be modified and should be used for intended use to avoid liability issues - manufacturer of equipment has duty to design and produce equipment that will not cause injury - express warranty (manufacturer's written guarantee- product safety) - equipment warning labels (informs athlete of possible dangers inherent with product use - National Operating Committee on Standards for Athletic Equipment (NOCSAE)- minimum standards for equipment to ensure safety

Additional Guidelines (Lightning)

- lightning is generally accompanied by thunder (except 20-40% of the time due to atmospheric disturbances) - flash-to-bang methods estimates distance away from the storm * from time lightning is sighted to the clap of thunder count, divide by 5 to calculate the number of miles away * count of 30 indicates inherent danger and everyone should leave the field - NATA, NCAA, and National Weather Service recommend returning to the field 30 minutes following the last clap of thunder or lightning strike - major misconception is that lightning that is seen striking is coming down * in actuality, it is the return stroke of the lightning going back up after is has already hit the ground

Accident Insurance

- low cost plan to cover accident on school grounds to student - protects student against financial loss from medical and hospital bills - provides for additional protection for institution above regular policy - will cover costs associated with hospital care, surgery, and catastrophic injuries

Exercise vs. Heart Function

- main pumping mechanism - increase exercise = increased oxygen requirement = increase heart pumping - heart able to adapt through increases in heart rate and stroke volume (enhances overall cardiac output) - heart responsible for pumping oxygenated blood throughout the body

Hepatitis B (HBV)

- major cause of viral infection, resulting in swelling, soreness, loss of normal liver function - signs and symptoms * flu-like symptoms like fatigue, weakness, nausea, abdominal pain, headache, fever, and possibly jaundice * possible that individual will not exhibit signs and symptoms-- antigen always present * can be unknowingly transferred * may test positive for antigen within 2-6 weeks of symptom development * 85% recover within 6-8 weeks - Prevention * good personal hygiene and avoiding high risk activities * be cautious as HBV can survive in blood and fluids, in dried blood and on contaminated surfaces for at least 1 week

Insurance

- major changes in insurance have occurred in light of managed care - major increases in the number of lawsuits and cost of insurance - medical insurance is a contract between the company and policyholder - company agrees to pay portion of medical bills following payment of a deductible

Shoe Fitting

- measure both feet, as there will be slight differences - approximate conditions of use - fit at the end of day due to gradual increase in volume due to weight bearing - should be snug but allow ample movement of foot and toes - should break at widest part, coinciding with ball of foot - must also consider width of shank, non-yielding nature of sole and function of arch support - cleated and specialty shoes may present problems with fitting (type and materials will vary, length variations, playing surfaces and activities must be considered)

Sports Drinks

- more effective than just replacing fluids with water - flavoring results in increased desire to consume - replaces fluids and electrolytes - water alone can prematurely stop thirst response and initiate fluid removal by kidneys - small amounts of sodium help in retention of water - optimal CHO level is 14g per 8oz of water - more CHO results in slower absorption - effective for both short and long term activities

How is maximum aerobic capacity assessed?

- most accurate techniques must be performed in a laboratory setting (treadmill, bicycle ergometer, monitor heart rate and gas exchange at a particular workload) - generally utilize heart rate to estimate percentage of maximum aerobic capacity (indirect method, heart rate and aerobic capacity have linear relationship)

Mouth Guards

- most dental injuries can be prevented with appropriate customized intraoral mouth guards - protect teeth, minimize lip lacerations, absorb shock of chin blows - should fit comfortably, not impede speech or breathing - should extend back as far as last molar - constructed of flexible resilient material formed to fit teeth and upper jaw - do not cut down mouth guard as it voids warranty for dental protection and could become dislodged and disrupt breathing - three types: stock, commercial (formed following submersion in water), and custom (fabricated from dental mold) - mandated use in high school and collegiate levels - mouth guards wear down over the course of a season (coaches should routinely inspect mouth guards to determine if replacement is necessary)

Gradual Acclimatization

- most effective method of avoiding heat stress - involves becoming accustomed to heat and exercising in heat - early pre-season training and graded intensity changes are recommended with progressive exposure over 7-10 day period - 80% of acclimatization can be achieved during first 5-6 days with 2 hour morning and afternoon sessions

Ear Guards

- most sports do not use - wrestling, water polo and boxing utilize to prevent ear irritation and ultimately deformity of ears

Indemnity Plan

- most traditional form of billing for health care - fee-for-service plan that allows insured party to seek care without restrictions (pay money every month) - provider charges patient or third-party payer - charges are set on fee schedule

What physiological changes occur to cause increased strength?

- multiple theories of muscle hypertrophy - primary explanation of muscle hypertrophy: increase in protein myofilament number and size - continued need for additional research

Isokinetic Training

- muscle contraction at a constant velocity - maximal and constant resistance throughout the full range of motion - maximal effort = maximal strength gains - rehab - never widely used in strength training - losing popularity in rehabilitation settings

Moving/Transporting Injured Athletes

- must be executed with techniques that will not result in additional injury - no excuse for poor handling - planning is necessary and practice is essential - additional equipment may be required

Preventing Heat Illness

- must exercise common sense and precaution (consume fluids and stay cool) - fluid and electrolyte replacement * single most important step taken by a coach to minimize the chance of heat illnesses * continual re-hydration is critically important * generally only 50% of fluid is ever replaced and should therefore be replaced before, during, and after exercise - fluid replacement should match sweat loss - time of stomach emptying is critical * water is absorbed rapidly from intestine * drink with 6% CHO is eliminated at the same rate if the individual is hydrated * cold drinks tend to empty rapidly and will not induce cramping or put heart at risk * drinks with caffeine and alcohol will promote dehydration - hydration levels can be monitored via urine color and volume

Insurance Billing

- must file claims immediately and correctly - to facilitate, collect insurance information at the start of the academic year - letters should be sent home to fully explain the coverage available and necessary procedures - most schools or colleges will file a claim with their insurance company that will pay for services provided by individual health care professionals

Baseball/Softball Batting Helmets

- must withstand high velocity impacts - research has indicated that helmet does little to dissipate energy of ball - possible solution would be to add additional external padding - helmet must still carry NOCSAE stamp (similar to football label)

Thigh and Upper Leg

- necessary in collision sports - pads slip into ready made uniform pockets - customized pads may need to be held in place with tape and/or wraps - neoprene sleeves can also be used for support of injuries

Legal Concerns

- negligence suits involving coaches, athletic trainers, school officials and physicians have increased in frequency and amount of damages awarded - anyone providing any level of health care to an injured athlete must know limitations * avoid overstepping boundaries * must be aware of practice acts of various healthcare groups

Standard of Reasonable Care

- negligence: the failure to use ordinary or reasonable care - standards of reasonable care: * assumes that a person is of ordinary and reasonable prudence * bring commonsense approach to the situation * must operate within the appropriate limitations of ones educational background

Functional Training

- newer technique used to improve strength and neuromuscular control - involves tri-planar activities designed to challenge the whole body * requires central nervous system to integrate proprioceptive information from multiple muscles to produce a specific movement pattern - involves concentric, eccentric, and isometric muscle contractions - allows not only for development of strength and control but also high levels of core strength and flexibility

Management of HCV

- no vaccine for preventing HCV - multiple tests available to check for HCV (single positive- infection, single negative- does not necessarily mean no infection) - interferon and ribavirin are 2 drugs used in comvination and appear to be the most effective for treatment - drinking alcohol can make liver disease worse

Shoe Selection

- number of options for multiple activities - guidelines for selection - toe box- space for toes (1/2 to 3/4 inch of space from toes to front of shoe) - sole- provide shock absorption and durable * spongy layer to absorb force * midsole that cushions midfoot and toes * hard rubber which contacts the ground - last- form on which shoe is built * may be straight, semi-curved, curved * straight = flat arch or run on inside of foot (pronator) * semi-curved = foot to fit normal arch * curved = more forefoot stability, high arch (supinator) - heel counter- prevents medial and lateral roll of foot - shoe uppers- top of shoe made with combination of materials, designed for appropriate ventilation, drying and support - arch support- durable but soft and supportive to foot - price- due to impact on performance and injury prevention, may be worth the extra investment

History

- obtain information about injury - listen to athlete and how questions are answered

Off the Shelf vs. Custom Protective Equipment

- off the shelf equipment * pre-made and packaged * can be used immediately (neoprene sleeves, inserts, ankle braces) * may pose problem relative to sizing - customized equipment * constructed according to the individual * specifically sized and designed for protective and supportive needs

Shin and Lower Leg

- often overlooked - commercially marketed, hard molded shin guards are used in field hockey and soccer

Exertional Heat Cramps

- painful muscle spasms (calf, abdominal) due to excessive water loss and electrolyte imbalance - occurs in individual in good shape that overexert themselves - treatment: * prevent by consuming extra fluids and maintaining electrolyte balance * treat with fluid ingestion, light stretching with ice massage * return to play unlikely due to continued cramping

Orthopedic Screening

- part of physical exam or separate - various degrees of detail concerning exam

Stretching Techniques- Static

- passively stretching - go to point of maximal stretch (end point resistance), back off slightly and hold for extended period (20-30 seconds, 3-4 times) - controlled, less chance of injury - not dynamic - should precede ballistic stretching

Bloodborne Pathogens

- pathogenic organisms, present in human blood and other fluids (cerebrospinal fluid, semen, vaginal secretion and synovial fluid that can potentially cause disease) - most significant pathogens are Hepatitis B, C, and HIV - others that exist are hepatitis A, D, E and syphilis

Cardiorespiratory Endurance

- perform whole body activities for extended period of time - performance vs. fatigue vs. injury - aerobic exercise (low intensity exercise that can be sustained for a long period of time) - anaerobic exercise (activity where intensity is so high that demand for oxygen is greater than body's ability to deliver) - four components of cardiorespiratory system (heart, lungs, blood vessels, blood) - improvements in endurance are the results of improvements in these four components

Off-field Assessment

- performed by athletic trainer or physician once athlete has been removed from site of injury - divided into 4 segments (history, observation, physical examination, special tests)

General Health Insurance

- policy that covers illnesses, hospitalization and emergency care - sometimes offered through academic institutions for students (athletics) - secondary insurance provided through institutions to cover costs above primary insurance coverage - schools and universities must ensure that athletes have primary insurance coverage (in place or arranged for)

Administering Pre-participation Examinations

- pre-participation exam prior to start of practice is critical - purpose: identify athlete that may be at risk, establish a baseline, reveal condition that may warrant disqualifications (cardiac), satisfy insurance and liability issues

Warm-up

- precaution against unnecessary musculoskeletal injury and soreness (structured warm-ups may reduce injury risk) - may enhance certain aspects of performance - prepares body physiologically for physical work - stimulates cardiorespiratory system, enhancing circulation and blood flow to muscles - increases metabolic processes, core temperature, and muscle elasticity - general (activities which bring a general warming to the body- break a sweat, not related to sport) - specific (specific to sport, stretching, jogging, running, throwing, catching) - should last 10-15 minutes resulting in effects that will last 45 minutes

Overexposure to Sun

- precautions must be taken to protect athletes, coaches, athletic trainers, and support staff - long term effects on the skin * premature aging and skin cancer due to UV exposure * premature aging is characterized by dryness, cracking and inelasticity of the skin * skin cancer is the most common malignant tumor found in humans

Protection

- prevents further injury - immobilization and appropriate forms of transportation will help in protecting an injury from further damage

Treatment for Acute Injury

- primary goal is to limit swelling and extent of hemorrhaging - if controlled initially, rehabilitation time will be greatly reduced - control via PRICE (protection, rest, ice, compression, elevation)

Reimbursement

- primary mechanism of payment for medical services in the U.S. - policyholder insurance company reimburses health care providers for services rendered - number of different options (pre-arranged systems, payment for preventive care, other systems developed to contain costs)

Hiring a Certified Athletic Trainer in Secondary Schools

- problems occurring later from improperly managed injuries could be avoided with proper management from an athletic trainer - according to the NATA, all secondary schools should provide the services of a full-time, on-site, certified athletic trainer to student athletes - American Academy of Pediatrics (1998) adopted a policy recommending employment of athletic trainers in the high school setting

Techniques of Resistance Training

- progressive resistance exercise - overload principle must be applied - must work muscle at increasingly higher intensities to enhance strength over time - if intensity training does not increase, but training continues, muscle strength will be sustained

Establishing Health Habits for the Athlete

- promotion of good health and hygiene is critical - are the athletes cleared to participate? - is each athlete insured? - does the athlete promptly report injury and illnesses? - does the athlete follow good living habits? - do they avoid sharing clothes and towels? - does the athlete exhibit good hygiene practices? - does the athlete avoid common drinking sources?

Insurance to Protect the Professional

- protect against damages that may arise from injuries occurring on school property - covers against claims of negligence on part of individuals - because of rise in lawsuits, professionals must be fully protected, particularly in regards to negligence - will cover negligence in civil case- not criminal complaint - errors and omissions liability insurance have evolved to protect individuals against suits claiming malpractice, negligence, errors and omissions (each person should still have personal liability insurance)

Preferred Providers Organization

- provide discount health care and also limit where treatment can be obtained - must be aware of what facilities are approved for the program in order have cost completely covered - may include additional types of coverage (physical therapy) - PPO pay on a fee-for-service basis

Health Maintenance Organization

- provide preventative measures and dictate where individual can receive care - permission must be gained to see someone outside of the plan (except in emergencies) - HMO will pay 100% of costs if care rendered within the HMO plan providers - coaches, administrators, and ATs must have working knowledge of HMO limits and restrictions

Station Examination

- provides athlete with detailed exam in little time - team of nine is ideal (2 physicians, 2 non-physicians and 5 managers/student athletic trainers)

Plyometric Exercise

- rapid stretch, eccentric contraction followed by a rapid concentric contraction to create a forceful explosive movement - rate of stretch vs. magnitude - jumps, bounds, medicine ball throws - very technical training- skills must be learned with appropriate technique - often develop muscle soreness as a result of extensive eccentric loading

Elevation

- reduces internal bleeding due to forces of gravity (use gravity to push things down to bigger things) - prevents pooling of blood and aids in drainage - greater elevation = more effective reduction in swelling

Lacrosse Helmets

- required for male lacrosse players; females must wear protective eye-guard - hard plastic with wire mess cage - must have center bar running from top to bottom to absorb repeated, high velocity blows - four point buckling system to keep helmet in place and ensure better fit

Hips and Buttocks

- required in collision and high-velocity sports - boxing, snow skiers, equestrians, jockeys and water skiers - girdle and belt types

Exertional Heat Exhaustion

- result of inadequate fluid replacement - signs and symptoms * profuse sweating, pale skin, mildly elevated temperature, dizziness, hyperventilation, and rapid pulse * may develop heat cramp or become faint/dizzy * core temperature will be around 102 F (critical to obtain accurate core temperature) * performance may decrease - treatment * immediate treatment includes fluid ingestion (IV replacement, ultimately), place in cool environment

Keeping Facilities Clean

- rules concerning room cleanliness and sanitation must be set and made known to population using facility - examples: no equipment/cleats in the athletic training room, shower prior to treatment, no roughhousing or profanity, no food or smokeless tobacco - preventing spread of infectious disease is everyone's responsibility - must adhere to OSHA standards and guidelines - cleaning responsibilities are divided between athletic training staff and maintenance personnel - division of responsibilities - maintenance crew: sweep floors daily, clean and disinfect sinks and tubs, mop hydrotherapy room, empty waste baskets - athletic training staff: clean treatment tables, disinfect hydrotherapy modalities daily, clean equipment regularly

Signs of Wound Infection

- same as those for inflammation (pain, heat, redness, swelling, disordered function) - pus may form to accumulation of WBC's - fever may develop as immune system fights bacterial infection - most wound infections can be treated with antibiotics - staphylococcus aureus has become resistant to some antibiotics * methicillin-resistant staphylococcus aureus (MRSA) is more difficult to treat * infection could spread significantly if cause is not discovered and improper antibiotics are used initially

Selecting and Using Protective Sports Equipment

- selection, fitting, and maintenance of protective equipment are critical in injury prevention - ATs and coaches must have knowledge of protective equipment available for different sports and proper fitting procedures - protection is critical in contact and collision sports

Exertional Heatstroke

- serious life-threatening condition, with unknown specific cause - need emergency action plan in place to manage this life threatening condition - signs and symptoms * sudden onset- sudden collapse, LOC, flushed hot skin, minimal sweating, shallow breathing, strong rapid pulse, and core temperature more than 104 F - drastic measures must be taken to treat and cool the athlete (strip clothing, sponge with cool water, immerse in water, transport to hospital immediately)

Progressive Resistance Exercise (PRE- isotonic) Techniques

- shortening/lengthening contractions against fixed resistance - concentric vs. eccentric - various types of equipment can be utilized (free weights, machine weight) - spotter is necessary for free weight training to prevent injury, motivate partner and instruct on technique - when training should be able to perform 3 sets of 6-8 repetitions - increases should occur in increments of 10% - 1 RM (repetition max) can be utilized to measure maximum amount of weight that can be lifted- must be very careful - training of a particular muscle group should occur 3-4 times per week (not on successive days)

Emergency Splinting

- should always splint a suspected fracture before moving ** without proper immobilization increased damage and hemorrhage can occur (potentially death if handled improperly)

Immediate Care

- should be cared for immediately - all wounds should be treated as though they have been contaminated with microorganisms - to minimize infection clean wound with copious amounts of soap, water and sterile solution (avoid hydrogen peroxide and bacterial solutions initially)

Physical Examination

- should include assessment of height, weight, body composition, blood pressure, pulse, vision, skin, dental, ear, nose, throat, heart, lungs, abdomen, lymphatic, genitalia, maturation index, urinalysis, and blood work

Testing Athletes for HIV

- should not be used as screening tool - mandatory testing may not be allowed due to legal reasons - testing should be secondary to education - athletes engaged in risky behavior should undergo voluntary anonymous testing for HIV - multiple tests are available to test for antibodies for HIV proteins - detectable antibodies may appear from 3 months to 1 year following exposure (testing should occur at 6 weeks, 3 months, and 1 year) - many states have enacted laws that protect confidentiality of HIV infected person (AT should be familiar with state laws and maintain confidentiality and anonymity of testing)

Sports Bras

- significant effort has been made to develop athletic support for women - most designed to minimize excessive vertical and horizontal movements that occur with running and jumping - to be effective, should hold breasts to chest, preventing stretching of Cooper's ligament - Types available * compressive (bind breasts to chest wall- recommended for medium size breasts) * support (heavy duty with additional upward support for larger breasts) * lightweight elastic (compression and support not as critical for smaller breasts)

Factors that Determine Levels of Muscular Strength

- size of muscle (function of diameter and of muscle fibers, hypertrophy vs. atrophy) - number of muscle fibers - neuromuscular efficiency (initial gains are due to increased efficiency- more effectively engage specific motor units) - biomechanical factors (bones and muscles = levers and pulleys) - fast-twitch vs. slow-twitch muscle fibers (motor units with distinct metabolic and contractile capability) - individual make-up (muscles contain both types of fibers, muscle functioning impacts ratios (postural vs. powerful movement), genetically determined) - slow twitch- type 1 (generally major constituent of postural muscles) - fast twitch- type 2 (high force in short amount of time, produce powerful movements) - levels of physical activity (will influence increase/decrease) in muscle strength, also impacts cardiorespiratory fitness, flexibility, and increases in body fat) - overtraining (psychological and physiological breakdown) *signs- atrophy, loss of appetite, staleness, declines in performance, weight loss, inability to sleep * prevent through appropriate training protocol, proper diet and rest

Avulsion wounds

- skin is torn from body = major bleeding - place avulsed tissue in moist gauze (saline) plastic bag and immerse in cold water - take to hospital for reattachment

Abrasions

- skin scraped against rough surface - top layer of skin wears away exposing numerous capillaries - often involves exposure to dirt and foreign materials = increased risk for infections

Caring for Skin Wounds

- skin wounds are extremely common in sports - soft pliable nature of skin makes it susceptible to injury - numerous mechanical forces can result in trauma (friction, scrapping, pressure, tearing, cutting and penetration)

Lower Extremity Protective Equipment

- socks * poorly fit socks can cause abnormal stress on foot * should be clean, dry and without holes * different types for different activities * composition (cotton can be bulky, cotton/poly blend are lighter and dry faster)

Statutes of Limitation

- specific length of time an individual can use for injury resulting from negligence - varies by state but 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 - minors generally have an extension - need to keep info for 7 years

Two Primary Rules of Emergency Splinting

- splint one joint above and below fracture - splint injury in position found

Groin and Genitalia

- sports involving high velocity projectiles - require cup protection for male participants - stock item that fits into jockstrap or athletic supporter

Dressing

- sterile dressing should be applied to keep wound clean - occlusive dressing are extremely effective in minimizing scarring - antibacterial ointments are effective in limiting bacterial growth and preventing wound from sticking to dressing - saline solution is recommended for repeated cleaning

Muscle Strength, Power, and Endurance (Definitions)

- strength: ability to generate force against resistance - muscular endurance: repetitive muscular contractions (increase strength = increase endurance) - power: is the relationship between strength and time

Rest

- stresses and strains must be removed following injury as healing begins immediately - days of rest differ according to extent of injury - rest should occur 72 hours before rehab begins

Stretching Techniques- Dynamic

- stretching technique of choice in athletic populations - related to types of activity an athlete will engage in - tend to be more functional in nature - recommended prior to beginning an activity - stretches that mimic components of athletic activity

Frostbite

- superficial frostbite involves only skin and subcutaneous tissue * appears pale, hard, cold and waxy * when re-warming the area will feel numb, then sting and burn * it may blister and be painful for several weeks - deep frostbite indicates frozen skin requiring hospitalization * gradual re-warming is necessary (100-110 F) * tissue will become blotchy red, swollen, painful and may become gangrenous

Ambulatory Carrying

- support or assistance provided to injured individual to walk - serious injury should be ruled out along with further injury with walking - complete and even support should be provided on both sides by individuals - arms of athlete are draped over shoulders of assistants, with their arms encircling his/her back

Evaporative Heat Loss

- sweat glands allow water transport to surface - evaporation of water takes heat with it - when radiant heat and environment temperature are higher than body temperature, loss of heat through evaporation is key - lose 1 quart of water per hour for up to 2 hours - air must be relatively water free for evaporation to occur * relative humidity of 65% impairs evaporation * relative humidity of 75% stops evaporation - heat illness can still occur in cold environment if body is unable to dissipate heat (caused by dehydration and inability to sweat)

Protecting the Athlete from Exposure

- the USOC suggests use of mouthpieces in high-risk sports - shower immediately after practice or competition - athetes exposed to HIV or HBV should be evaluated and immunized against HBV

Conditioning Seasons and Periodization

- traditional seasons no longer exist for serious athletes - periodization * achieve peak performance * decrease injuries and overtraining * program that spans various seasons * modify program relative to athlete's needs

Cross Training

- training for a sport with substitutions of alternative activities (carryover value) - useful in transition and preparatory periods - variety to training regimen - should be discontinued prior to preseason as it is not sport-specific

Muscular Endurance vs. Strength

- training for endurance enhances strength and vice versa - training for strength should involve lower repetitions at heavier weight - training for endurance requires lower weight at 12-15 repetitions - lower weight = higher repetitions

Periods or Phases

- transition period (do something else that won't irritate overuse) * follows last competition (early off-season) * unstructured (escape rigors of training) - preparatory period * off-season * hypertrophy/endurance phase (low intensity with high volume) - allows for development of endurance base - lasts several weeks to 2 months * strength phase - intensity and volume increase to moderate levels * power phase (high intensity/ pre-season) - volume is decreased to allow adequate recovery - competition period * may last less than a week or several months for seasonal sports * high intensity, low volume, skill training sessions * may incorporate weekly training cycles (1-7 days, designed to ensure peak on days of competition)

Assessment of Flexibility

- trunk hip flexion test - trunk extension test - shoulder extension test

Football Shoulder Pads

- two types * cantilevered- bulkier and used by those engaged in blocking and tackling * non-cantilevered- do not restrict motion (quarterback and receivers)

Ice Hockey Helmets

- undergone extensive testing in an effort to upgrade and standardize - must withstand high velocity impacts (stick or puck) and high mass low velocity impacts - helmet will disperse force over large area and decelerate forces that would act on head (energy absorption liner) - helmets must be approved by Canadian Standards Association (CSA)

Personal Precautions

- use appropriate equipment * latex gloves, gowns, aprons, masks and shields, eye protection, disposable mouthpieces for resuscitation * emergency kits should contain gloves, resuscitation masks, and towelettes for cleaning skin surfaces * non-latex gloves can be used when long term exposure to blood and bodily fluids is not likely - doubling gloves is suggested with severe bleeding and use of sharp instruments - extreme care must be used with glove removal - hands and skin surfaces coming into contact with blood and fluids should be washed immediately with soap and water (anti-germicidal agent) - hands should be washed between patients

Heel Cups

- used for a variety of conditions including plantar fascitis, heel spurs, Achilles tendonitis and heel bursitis - used to help compress fat pad, providing more cushion during weight bearing

Management of HBV

- vaccination against HBV should be provided by employer to those who may be exposed - athletic trainers and allied health professionals should be vaccinated - three does vaccination over 6 months - post-exposure vaccination is also available after coming into contact with blood or fluids

Foundations of Conditioning and Training

- warm-up/cool-down - motivation - overload and SAID principle - consistency/routine - progression - intensity - specificity - individuality - relaxation/minimize stress - safety

Proper use of crutch or cane

- when lower extremity ambulation is contraindicated a crutch or cane may be required - faulty mechanics or improper fitting can result in additional injury or potentially falls

Elbow, Wrist, and Hand Protection

- while the elbow is less commonly injured it is susceptible to instability, contusions, and muscle strain - a variety of products are available to protect the elbow - wrist, hand and finger injuries can be functionally disabling - susceptible to fracture, dislocation, ligament sprains and muscle strains - gloves and splints are available for protection and immobilization

Football Shoulder Pads- Fitting

- width of shoulders must be measured - inside of pad should cover tip of shoulder in line with lateral aspect of shoulder - epaulets and cups must cover deltoid and allow motion - neck opening must allow athlete to raise arms over head without pads sliding forward and back - with split clavicle pads, channel for top of shoulder must be in proper position - straps underneath arms should hold pads firmly in-place, without soft tissue restriction - combinations of padding (football and hockey) may be used to supplement padding and protection

Four-point crutch gait

foot and crutch on same side move forward simultaneously with weight bearing