Athletic Injuries Exam #1

non-consumable capital equipment

(crutches, coolers, athletic training kits)

capital equipment

(remain in the athletic training facility including ice machine, tables)

Medial Tibial Stress Syndrome (Shin Splints)

**fracture on lower tibia Pain in anterior portion of shin • Catch all for stress fractures, muscle strains, chronic anterior compartment syndrome • Accounts for 10-15% of all running injuries, 60% of leg pain in athletes

Developing a Risk Management Plan • Security Issues

- Accessibility to athletic training clinic (staff, physicians, athletic training students) - Athletic training students must be supervised when in the clinical setting - Coaches may have access in secondary school settings

Emergency Action Plan

- Accessing emergency personnel outside setting in the event of emergency - Include transportation of athletes to emergency facilities - Meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care

Facility Personnel Coverage

- Appropriate coverage of facility and sports - Setup of treatments, rehabilitation, game and practice coverage vary

recreational activity

- Can be competitive but often times is done more for leisure and is much less formal - City and community-based recreational leagues and teams - Often include fitness-oriented events - Sometimes recreational athlete will hire a personal fitness trainer - If injury occurs they are more likely to consult with a family physician, athletic trainer, sports chiropractor or a sports physical therapist • Typically, care provided on a fee for care basis

Areas of specialization that focus primarily on performance enhancement*

- Exercise physiology - Biomechanics - Sports psychology - Sports nutrition - Strength & conditioning - Personal fitness training - Coaching - Physical education

• Gymnasium (general issues concerning facility and equipment cleanliness)

- Facility • Cleaning of gymnasium floors • Drinking fountain and shower/locker facility disinfecting • Mats cleaned daily (wrestling) - Equipment and clothing • Proper fitting equipment • Frequent clothing and equipment laundering • Appropriate equipment for weather conditions • Use of clean dry towels and equipment daily

Delivery of healthcare is dependent on whether the event is organized or recreational -- organized:

- Generally competitive - Involves teams, leagues (secondary schools, collegiate and professional teams) - Players of the sports medicine team (coach, athletic trainer, physician) are employed on full- or part-time - College setting may also have nutritionist, sports psychologist, strength & conditioning coach, massage therapist

electrical and equipment safety

- Major concern - Be aware of power distribution system to avoid accidents

strength and conditioning coaches

- Oversee fitness of an athlete - Often employed at the collegiate level for both team and individual training sessions - Typically certified by the NSCA - All strength & conditioning coaches should be certified in CPR/AED1,2,3 and in basic First Aid1,2 (Red Cross1, National Safety Council2 or American Heart Association3) - Must work with the athletic trainer when it comes to modifying a strength training program relative to injury- The athletic trainer should dictate what the athlete can and cannot do when engaging in a strength & conditioning program - Strength & conditioning coaches are becoming available at the high school level

Fire Safety

- Post evacuation plan in case of fire - Smoke detectors/alarm system and fire extinguisher should be tested and in place

Areas of specialization that focus on healthcare and injury/illness management

- Practice of medicine (physicians & physician assistants) - Athletic training - Sports physical therapy - Massage therapy - Dentistry - Osteopathic medicine - Sport podiatry - Orthotist/prosthetists

• Athlete

- Promotion of good health and hygiene is critical • Prompt injury and illness reporting • Follow good living habits • Showering after practice • Avoid sharing clothes and towels • Exhibit good hygiene practices • Avoid common drinking sources • Avoid contact with athletes with contagious disease or infection • Understand the role exercise can play in maintaining a healthy lifestyle

Hygiene and Sanitation • Athletic Training Clinic

- Rules concerning room cleanliness and sanitation must be set and made known to population using facility - Operation should abide by policies set forth by OSHA - Examples • No equipment/cleats in the athletic training room • Shoes off treatment tables • Shower prior to treatment • No roughhousing or profanity • No food or smokeless tobacco Cleaning responsibilities should be addressed appropriately by athletic training staff and custodial staff - 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

Sports medicine organizations tend to have many goals

- Upgrade field by devising and maintaining a set of professional standards (code of ethics) - Bring professionals together for exchange of ideas and research for advancement of profession - Provide opportunities for individuals to work collaboratively toward single purpose

Taping, Bandaging & Orthotics Area:

3-4 taping tables and storage cabinets to treat athletes with proximity to a sink

Catastrophic injuries

98% of injuries requiring hospital emergencies are treat and release relative to sport Sports deaths (struck with object, heat stroke) Catastrophic injuries also include spinal cord trauma, cardiorespiratory injuries/problemsMost injuries are related to appendages Strains, sprains, contusions, fractures, abrasions

Active range of motion

= dynamic flexibility - Ability to move a joint with little resistance

Passive range of motion

= static flexibility - Motion of joint to end points without muscle contraction

Flexibility

Ability to move a joint(s) smoothly through a full range of motion (ROM)

Periodization

Achieve peak performance Decrease injuries and overtraining Program that spans various seasons Modify program relative to athlete's needs

Preventing Injury in the Lower Leg and Ankle

Achilles Tendon Stretching, Strength training, Neuromuscular Control Training, Footwear, Preventive Taping and Orthoses

Achilles tendinitis

Achilles tendinitis is an inflammatory condition involving tendon, sheath or paratenon - Referred to as tenosynovitis - Causes fibrosis and scaring that can restrict tendon motion in sheath - May lead to tendinosis • Achilles tendinosis typically does not present with inflammation, area has lost normal appearance, with cell disorganization/scarring and degeneration • Tendon is overloaded due to extensive stress • Presents with gradual onset and worsens with continued use • Decreased flexibility exacerbates condition

Anaerobic exercise (up to 2 min.)

Activity where intensity is so high that demand for oxygen is greater than body's ability to deliver

Epidemiologic studies may assess various areas

Age or gender Body part Occurrence in different sports Contact, non-contact, limited contact, collision sports50% chance of injury 90% of injuries are muscle strains, contusions, ligament sprains 10% result in microtrauma complications severe chronic conditions

Hypertropy/endurance phase (Low intensity with high volume)

Allows for development of endurance base • Lasts several weeks to 2 months

Open Basket Weave

Allows more dorsiflexion and plantar flexion, provides medial and lateral stability and room for swelling - Used in acute sprain situations in conjunction with elastic wrap and cold application - U-shaped felt pad can be used to provide focal compression • Aids in controlling swelling

Incidence of injury

Analyzes the risk of sustaining an injury during some specified time period

Injury prevalence

Analyzes the total number of injuries in a specific population

Open vs. Closed Kinetic Chain Exercises

Anatomical functional relationship for upper and lower extremities

Elastic wraps can be used to provide support for a variety scenarios:

Ankle and foot spica • Spiral wrap (spica) • Groin support • Shoulder spica • Elbow figure-eight • Gauze hand and wrist figure-eight • Cloth ankle wrap

Functional anatomy

Ankle is a stable hinge joint • Medial and lateral displacement is prevented by the malleoli • Ligament arrangement limits inversion and eversion at the subtalar joint (right below talus) • Square shape of talus adds to stability of the ankle • Most stable during dorsiflexion (10 degrees), least stable in plantar flexion (50 degrees)

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

Drug Testing Programs

Athletic trainers may be asked to oversee drug testing programs - Program may act as a deterrent to employees coming in unfit for duty - May be necessitated by federal guidelines or pre-employment screenings - Legal defensibility is the most important aspect of any drug-testing program - The corporation should use federally certified testing laboratories with all positive tests results confirmed via a medical review department

Wellness Center

Athletic trainers may be involved in organizing wellness screenings and workshops for: • Asthma & diabetes • Hypertension & stroke • Cholesterol • Osteoporosis • Prostate/skin cancer - Designed for early detection, awareness and prevention - Programs designed to educate individuals on nutrition, health and safety may be offered - Health fairs are often an effective means of providing screenings and education

Storage Facility

Athletic training facilities often lack ample storage space - Storage in athletic training room that holds general supplies and special equipment - Large walk-in storage cabinet for bulk supplies - Refrigerator for equipment, ice cups, medicine and additional supplies - Space should be designated for storage of patient belongings

Ergonomic Assessment

Based on anthropometry and biomechanics • Applied to industrial engineering • Used to design, adapt and alter workplace environments to accommodate to a person's strengths, limitations, sizes and shapes - Primary goal often involves injury and accident prevention in workplace by minimizing risk factors • Postures, vibration, repetition & force

biomechanical factors

Bones and muscles = Levers and pulley

ballistic

Bouncing movement in which repetitive contractions of agonist work to stretch antagonist muscle

Proving Negligence

Care giver does something a reasonably prudent individual would not. • Care giver fails to do something a reasonably prudent individual would not.

Catastrophic Insurance

Catastrophic injuries in athletics are relatively rare, but are staggering to all involved • Organizations (NCAA, NAIA, NFSHSA) provide additional coverage to deal with lifetime extensive care

sports coverage

Certified athletic trainer should attend all practices and games - Different institutions have different levels of coverage based on personnel and risks involved with sports

Hours of Operation

Clinic will need to be opened at times that do not conflict with normal working hours • Early morning and evening hours • Weekend hours may also be useful

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

Circuit Training

Combination of exercise stations • 8 - 12 stations, 3 times through • Design for different training goals - Flexibility - Calisthenics - Aerobic exercise

Sling and swathe

Combination utilized to stabilize arm • Used in instances of shoulder dislocations and fractures

acute achilles strain

Common in sports and often occurs with sprains or excessive dorsiflexion

Stress Fracture of Tibia or Fibula

Common overuse condition, particularly in those with structural and biomechanical insufficiencies • Runners tends to develop in lower third of lower leg (dancers middle third) • Often occur in unconditioned, non-experienced individuals • Often training errors are involved • Component of female athlete triad - Signs and Symptoms • Pain more intense after exercise than before • Point tenderness; difficult to discern bone and soft tissue pain • Bone scan results (stress fracture vs. periostitis

Medical History

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

Isometric Exercise

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

muscle contusion

Contusion of leg, particularly in the region of the gastrocnemius **feels like a dead leg in lower leg

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 Postural control and muscular balance - Allow for expression of dynamic functional strength and dynamic stabilization of kinetic chain - Improve neuromuscular efficiency throughout the body

Insurance considerations - cost of care

Costs of care (providers) scrutinized by health insurance companies

triangular bandages

Cotton cloth that can be substituted if roller bandages not available Primarily used for arm slings

Development of Policy & Procedures Manual

Creation of policies and procedures for all involved in health care

Injury

Damage to the body restricting activity

HIPAA Authorization

Description of information to be disclosed - Identification of parties authorized to provide and make use of PHI - Description of each purpose of the use or disclosure - Expiration date or event - Individual's signature - Description of his/her authority to act for the individual if signed by personal representative

cervical arm sling

Designed to support forearm, wrist and hand injuries • Bandage placed around neck and under bent arm to be supported

Chronic Ankle Instability (over and over again)

Develops following 1/3 of all acute ankle sprains.

shin contusion

Direct blow to lower leg (impacting periosteum anteriorly)

Scope of practice

Diverse patient population - In hospital settings time may be spent with in-patient, out-patient and/or ambulatory care - Owner of out-patient facility will dictate patient population seen at clinic - The AT may be involved with patient care, onsite employee fitness, ergonomics, work hardening programs, outreach programs, athletic event coverage - Limitations and restrictions will be dictated by state regulatory statutes

Establishing Negligence

Duty of care exists injured individual and person responsible for injury •Conduct of defendant fell short of that duty of care •Defendant caused injury to occur •Personal property or punitive damages resulted

Ergonomics

Ergonomics is the science of designing products, machines and systems to maximize comfort, efficiency and safety

Sports medicine umbrella - human performance

Exercise Physiology Biomechanics Sport Psychology Sports Nutrition Strength & Conditioning

Nonfeasance

Fail to perform legal duty (i.e. fail to refer)

Medicare

Federal health insurance program for the aged and disabled

Acute leg fractures

Fibula has highest incidence of fracture, occurring primarily in the middle third • Tibial fractures occur predominantly in the lower third • Result of direct blow or indirect trauma

Transition Period

Follows last competition (early off-season) - Unstructured (escape rigors of training)

CKC

Foot or hand are weight bearing - Widely used = more functional

Shoulder arm sling

Forearm support when a shoulder girdle injury exists • Also used when cervical sling is irritating • A commercial arm sling can also be used to provide the same support

Capitation

Form of reimbursement where members make standard payment monthly regardless of services rendered

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

size of muscle

Function of diameter and of muscle fibers - Hypertrophy vs. Atrophy

Slow Twitch (type 2)

Generally major constituent of postural muscles Endurance athletes

Assessment of Flexibility

Goniometer most widely used device • Can also utilize the following tests: - Trunk hip flexion test - Trunk extension test - Shoulder extension test

Tape grade

Graded according to longitudinal and vertical fibers per inch - More costly (heavier) contains 85 horizontal and 65 vertical fibers

The Role of the Athletic Administrator in the Sports Medicine Team

Has a significant impact on the sports medicine team • Responsible for hiring personnel (i.e. coaches, ATC's, strength coaches, nutritionists, team physician) - Must be sure that all individuals have the necessary credentials and are willing to work as a team1-19 • Must also oversee and develop policies & procedures, risk management plan, and emergency action plans • Responsible for the budget and for funding all aspects of an athletic healthcare program - Salaries, supplies, equipment, insurance • Commitment of the administrator can have a tremendous impact on the success of the athletic program

Fiscal Management

Having a basic understanding of business practices may be necessary in for-profit clinical settings - Knowledge of billing practices is critically important - Maintaining positive accounts payable vs. accounts receivable ratio is the goal of all successful businesses - Other responsibilities may include • Financial planning • Establishing contractual obligations • Efficient billing and collection systems • Budget formulation

Medicaid

Health insurance program for people with low incomes and limited resources • Funded via federal government and individual states • Individual states administer Medicaid - Benefits will vary by state

System's 4 components

Heart - Lungs - Blood vessels - Blood • Improvements in endurance are the results of improvements in these 4 components

Fast Twitch (type 1)

High force in short amount of time - Produce powerful movements Sprint faster, jump higher

Assessing the Lower Leg and Ankle

History - Past history - Mechanism of injury - When does it hurt? - Type of, quality of, duration of pain? - Sounds or feelings? - How long were you disabled? - Swelling? - Previous treatments?

Assessing the lower leg and ankle

History. Next 3 steps will confirm or deny observations.

mechanism by which K-tape works

Improves circulation and lymph flow by eliminating tissue fluid or bleeding beneath skin - Correcting muscle function by strengthening weakened muscles - Decreasing pain through neurological suppression - Repositioning subluxed joints by relieving abnormal muscle tension - Stimulates cutaneous mechanoreceptors through pressure and tension on skin, enhancing proprioception through cutaneous feedback

Injury exposure rates

Incidence of injuries per the number of individual athlete exposures during a specific time period

Primary explanation of muscle hypertrophy:

Increase in protein myofilament number and size

Assumption of Risk

Individual 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 individual's negligence suit

neuromuscular efficiency

Initial gains are due to increased efficiency • More effectively engage specific motor units

Administering Pre-participation Examinations

Initial pre-participation exam prior to start of practice is critical • Purpose is to identify athlete that may be at risk • Should include - Medical history, physical exam, orthopedic screening, wellness screening • Establishes a baseline • Satisfies insurance and liability issue

Injury reports and Injury disposition

Injury reports serve as future references • Reports can shed light on events that may be hazy following an incident • Necessary in case of litigation • All reports should be filed in the athletic training room

Syndesmotic Sprain - high ankle sprain

Injury to the distal tibiofemoral joint (anterior/posterior tibiofibular ligament) • Torn w/ increased external rotation or dorsiflexion • Injured in conjunction w/ medial and lateral ligaments *extreme dorsil -- talus = wedge & pulls bones apart

Strength Phase

Intensity and volume increase to moderate levels

Work Hardening/Conditioning Programs

Intensive outpatient therapy for individuals injured on the job Goal is to restore functionality and return to full duty capacity - Both an evaluation and report are assembled and are used to develop a rehabilitation plan

expendable supplies

Involves supplies that cannot be reused- first aid and injury prevention supplies **Yearly inventory and records must be maintained in both areas

Torts

Legal wrongs committed against a person (liability results)

Product Liability

Liability of any or all parties involved in manufactured product for damages caused by product - Includes manufacturer of components, assemblers, wholesaler, and retail store owner • Products with inherent defects are subject to liability suits • May be based on negligence, strict liability or breach of warranty fitness

Accident Insurance

Low cost plan to cover accident on school grounds or in workplace • Protects 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

Aerobic exercise (after 2 min.)

Low intensity exercise that can be sustained for a long period of time

Record Keeping

Major responsibility • The rule not the exception - accurate and up-to-date • Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports

Lower Leg Alignment Tests

Mal-alignment can reveal causes of abnormal stresses applied to foot, ankle, lower leg, knees and hips • Anteriorly, a straight line can be drawn from ASIS, through patella and between 1st and 2nd toes • Laterally, a straight line can go from greater trochanter through center of patella and just behind the lateral malleolus • Posteriorly, a line can be drawn through the center of the lower leg, midline to the Achilles and calcaneus • Internal or external tibial torsion is also a common mal-alignment

LowDye support

Management of fallen arch, pronation, arch strains and plantar fascitis)

Supplies and Equipment inventory

Managing budget and equipment/supplies is critically important • Inventory must be taken yearly in order to effectively replenish supplies

Express Warranty

Manufacturer's written guarantee - product safety

Competition Period

May last 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

Maturity Assessment

Means to protect young, physically active athletes - Methods • Circumpubertal (sexual maturity) • Skeletal • Dental - Tanner's five stage assessment is most expedient

mechanical vs functional instability

Mechanical instability is laxity that physically allows for movement beyond the physiologic limit of the ankle's range of motion • Functional instability is a subjective feeling that the ankle is unstable

Grade 2 Ligament Sprain

Moderate inversion force causing great deal of disability with many days of lost time *half of the fibers torn (out 4 weeks)

Inversion sprains

Most common and result in injury to the lateral ligaments - Anterior talofibular ligament is injured with inversion, plantar flexion and internal rotation Rupture of the anterior talofibular ligament can create rotary ankle instability • Talus rotates about longitudinal axis in the transverse plain - Posterior talofibular and calcaneofibular ligaments can be injured with increased force - Occasionally the force is great enough for an avulsion fracture to occur w/ the lateral malleolus

Professional liability insurance

Most employees have insurance to protect against damages that may arise from injuries occurring on their property • Liability insurance covers against claims of negligence on part of individuals

Indemnity plan

Most traditional form of billing for health care • Fee-for-service plan that allows insured party to seek care without restrictions • Provider charges patient or third-party payer • Charges are set on fee schedule

Fast-Twitch vs. Slow-Twitch Muscle Fibers

Motor units with distinct metabolic and contractile capability

Isokinetic Training

Muscle contraction at a constant velocity • Maximal and constant resistance throughout the full range of motion • Maximal effort = Maximal strength gains • Rehab

antagonist

Muscle undergoing stretch referred to as antagonist (muscle that allows the movement)

The evaluation involves

Musculoskeletal examination (strength, posture, flexibility, gait, neurologic screening) - Functional capacity evaluation • Prolonged sitting, standing • Hand grip strength and lifting abilities • Ability to perform repetitive tasks • Carrying capabilities • Balance - These elements are continually monitored and allow for program adjustment in order to facilitate the patient's return to appropriate levels of performance

Accessing Community Based Health Services

Must have knowledge of local and community health services and agencies in the event of referrals • Referrals should be made with assistance from a physician • Parental involvement is necessary when dealing with psychological and sociological events

For a negligence suit to be successful

Must prove the athletic trainer had a duty to exercise reasonable care - The athletic trainer breached that duty - Establish a connection between the failure to use reasonable care and the injury suffered by the individual

Sickle Cell Trait Screening

NCAA mandated testing for sickle cell trait for Div. I athletes - Blood test to screen for the sickle cell trait prior to the first season - Can avoid the testing • By proving they have previously been tested • Signing a waiver releasing the NCAA and university from liability - NATA consensus statement • Guidelines and precautions for modifying workouts in athletes with sickle cell trait.

Sovereign Immunity

Neither the government nor individuals employed by the government can be held liable for negligence - May vary state to state

Functional training

Newer technique used to improve strength and neuromuscular control • Involves tri-planar activities designed to challenge the whole body *Squat: eccentric --> Glutes & hamsrings + isometric

isometric contraction

No length change occurs during contraction

Incidence rate

Number of new injuries that occur in a particular population during a specified time period.

Osteochondritis Dissecans

Occur in superior medial articular surface of the talar dome • One or several fragments of articular cartilage, w/ underlying subchondral bone partially or completely detached and moving within the joint space • Mechanism may be single trauma or repeated traumas

Achilles Tendon Rupture

Occurs w/ sudden stop and go; forceful plantar flexion w/ knee moving into full extension • Commonly seen in athletes > 30 years old - Can be observed at any age • Generally has history of chronic inflammation - Signs and Symptoms • Sudden snap (kick in the leg) w/ immediate pain which rapidly subsides • Point tenderness, swelling, discoloration; decreased ROM • Obvious indentation and positive Thompson test

Grade 1 Ligament Sprain

Occurs with inversion plantar flexion and adduction • Causes stretching of the anterior talofibular ligament *10% of fibers torn (out 7 days)

Preparatory Period

Off-season

4 grades of pain

Pain after activity - Pain before and after activity and not affecting performance - Pain before, during and after activity, affecting performance - Pain so severe, performance is impossible

Family and the Sports Medicine Team

Parents will also be involved at the high school and middle school level - Parent's decision must be of a primary consideration • Athletic trainer must be prepared to deal with multiple healthcare providers at parent's request - May be dictated via parent's insurance plan • Must also be sure that athlete and family are familiar with Health Insurance Portability and Accountability Act (HIPAA)

Orthopedic Screening

Part of physical exam or separate - Various degrees of detail concerning exam

Percussion and compression tests for fractur

Percussion test is a blow to the tibia, fibula or heel to create vibratory force that resonates w/in fracture • Compression test involves compression of tibia and fibula either above or below site of concern • Tuning forks can also be used to create vibration at point of injury

Cardiorespiratory endurance

Perform whole body activities for extended period of time • Performance vs. fatigue vs. injury

Talar tilt test

Performed to determine extent of inversion or eversion injuries • With foot at 90 degrees calcaneus is inverted and excessive motion indicates injury to calcaneofibular ligament and possibly the anterior and posterior talofibular ligaments • If the calcaneus is everted, the deltoid ligament is tested

Medial Subtalar Glide Test

Performed to determine presence of excessive medial translation of the calcaneus on the talus • Talus is stabilized in subtalar neutral, while other hand glides the calcaneus, medially • A positive test presents with excessive movement, indicating injury to the lateral ligaments

Malfeasance

Performs action that is not his/hers to legally perform (i.e. perform advanced treatment leading to complications)

Misfeasance

Performs an action incorrectly that the he/she has the legal right to do

Proprioceptive Neuromuscular Facilitation

Physical therapy for neuromuscular paralysis - Slow-reversal-hold-relax - Contract-relax - Hold-relax • Ten second push, ten second relax - Best technique to improve flexibility - Technique that involves combination of alternating contractions and relaxation of both agonist and antagonists

General Health Insurance

Policy that covers illnesses, hospitalization and emergency care

Relationship Between the Sports Medicine Team and Athlete

Primary concern should be that of the athlete - All individuals must work cooperatively in the best interest of the athlete - Coach should differ to the medical staff and support decisions regarding athlete health care • Close communication between all parties involved is criticalMust work to develop solid working relationships • Each member will have to gain trust and confidence in the skills and abilities of each other • Imperative that the athlete is kept well-informed - Coach and athletic trainer must make a point of educating the student-athlete

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)

Good samaritan law

Provides limited protection against legal liability to one that provides care should something go wrong

Wellness Screening

Purpose is to determine if athlete is engaged in a healthy lifestyle - Should include questions about: • Diet • Rest • Exercise and weight control • Lifestyle habits that pose a threat to wellness (alcohol, drug, tobacco use, stress).

agonist

Quads (muscle producing movement) referred to as agonist

plyometric exercise

Rapid stretch, eccentric contraction followed by a rapid concentric contraction to create a forceful explosive movement (athlete needs to decelerate their body properly

non-expendable supplies

Re-useable supplies - ace wraps, scissors...etc) **Yearly inventory and records must be maintained in both areas

Health Insurance Portability and Accountability Act (HIPAA)

Regulates dissemination of personal history information (PHI) by coaches, AT's, physicians or other members of sports medicine team - Guarantees athlete access to information and control over disclosure - Athlete may provide written authorization for release of information

Grade 3 Ligament Sprain

Relatively uncommon but is extremely disabling • Caused by significant force (inversion) resulting in spontaneous subluxation and reduction • Causes damage to the anterior/posterior talofibular and calcaneofibular ligaments as well as the capsule *ruptures

Maintaining confidentiality in record keeping

Release of Medical Records - Written consent is required - Waiver must be signed for any release (include specifics of information to be released and to whom) • Only exception - disclosure of information among professionals involved in providing care to the injured individual.

Eversion ankle sprains

Represent 5-10% of all ankle sprains Bony protection and ligament strength decrease injury likelihood - Eversion force results in damage to deltoid ligament and possibly fx of the fibula - Deltoid can be impinged and contused with inversion sprains - Foot that is pronated, hypermobile or has a depressed medial longitudinal arch is more predisposed to eversion sprains

SOAP note format

S: Subjective (history of injury/illness) - O: Objective (information gathered during evaluation) - A: Assessment (opinion of injury based on information gained during evaluation) - P: Plan (short and long term goals of rehab)

Progressive Resistance Exercises (Isotonic training)

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

Restrooms

Should be at least one available within the facility

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

Health Maintenance and Personal Hygiene Screening

Should include questions about: - Skin care - Dental hygiene and dental care - Sanitation - Immunizations - Avoiding infectious and contagious diseases - Sleep habits.

Warm-up

Should last 10-15 minutes resulting in effects that will last 45 minutes

Treatment Log

Sign-in to keep track of services • Daily treatments can be recorded • Treatment of daily therapies can be monitored along with compliance • Can be used as legal documentation in instances of litigation

Ankle Injuries: Sprains

Single most common injury in the physically active caused by sudden inversion or eversion moments

Budgetary Concerns

Size of budget • Different settings = different size budgets and space allocations • Equipment needs and supplies vary depending on the setting (college vs. secondary school) • Continuous planning and prioritizing is necessary to effectively manage monetary allocations to meet programmatic goals

Athletic trainer's office

Space at least 10x12 feet is ample - All areas of athletic training facility should be able to be supervised without leaving office space (glass partitions) - Equipment should include, desk, chair, tack board, telephone, computer and independent locking system

Statutes of Limitation **Nevada = 3 years

Specific length of time an individual can sue 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

What is sports medicine?

Sports medicine refers to a broad field of healthcare related to physical activity and sport - Defined by American College of Sports Medicine (ACSM) as multidisciplinary approach to health management or achievement of full potential

Thompson test

Squeeze calf muscle, while foot is extended off table to test the integrity of the Achilles tendon - Positive tests results in no movement in the foot

Strength training pyramid

Stability - Strength - Power Get athletes stable and then you can generate strength (need solid base) Convert strength to power

Removing tape - Aid of tape scissors and cutters may be required

Start superior to joint and move inferiorly **cut from top down

Liability

State of being legally responsible for the harm one causes to another person

Gastrocnemius Strain

Susceptible to strain near musculotendinous attachment • Caused by quick start or stop, jumping

Epidemiology

Takes an evidence-based approach for identifying risk factors for injury and determining optimal treatment methods in clinical practice Serves as foundation for intervention in interest of public health and preventive medicine

Rules for tape application

Tape in the position in which joint must be stabilized • Overlap the tape by half Start taping with an anchor piece and finish by applying a locking strip

Homan's test

Test for deep vein thrombophlebitis • With knee extended and foot off table, ankle is moved into dorsiflexion • Pain in calf is a positive sign and should be referred

Kinesio taping

Therapeutic in that its effect occurs through activation of neurological and circulatory systems with movement - Provides constant tension (shear) to the skin - Can be used immediately post and during rehab of injury - Used for edema reduction, pain management, and inhibition/facilitation of motor activity

Accident

Unplanned event resulting in loss of time, property damage, injury or death

Closed Basket Weave (Gibney) Technique

Used for newly sprained or chronically weak ankles

elastic adhesive tape

Used in combination with non-elastic tape • Good for small, angular parts due to elasticity as well as soft tissues that expand.

Kleiger's test

Used primarily to determine extent of damage to the deltoid ligament and may be used to evaluate distal ankle syndesmosis, anterior/posterior tibiofibular ligaments and the interosseus membrane • With lower leg stabilized, foot is rotated laterally to stress the deltoid

wrapping

Used to cover open wound, secure compressive/protective pad, provide support

Ankle Stability Tests - Anterior drawer test

Used to determine damage to anterior talofibular ligament primarily and other lateral ligament secondarily • A positive test occurs when foot slides forward and/or makes a clunking sound as it reaches the end point

Power Phase (High intensity/ pre-season)

Volume is decreased to allow adequate recovery

OKC

When foot or hand are not in contact with the ground or supporting surface

Functional tests

While weight bearing the following should be performed • Walk on toes (plantar flexion) • Walk on heels (dorsiflexion) • Walk on lateral borders of feet (inversion) • Walk on medial borders of feet (eversion) • Hops on injured ankle • Passive, active and resistive movements should be manually applied to determine joint integrity and muscle function

Scope of Program

Who will be served by program? - Athlete: to what extent and what services will be rendered (systemic illness, musculoskeletal injuries) - Institution: who else can be served medically and educationally and what are the legalities - Community: outside group and community organizations with legalities again being an issue

work conditioning

Work conditioning = treatment 3 hours/day, 3 days/week

Reducing the Risk of Litigation

Work to establish good working relationships with athletes, parents, patients, and coworkers • Establish policies regarding athletic training facility and coverage • Develop emergency action plan • Become familiar with medical history of individuals under your care • Maintain adequate recordsDetailed job description • Obtain written consent relative to providing health care • Maintain confidentiality • Exercise caution with regards to medication distribution and modality use • Ensure safe equipment and facilities • Develop an understanding with coaches on how and when injured participants will be cleared for return to play • Allow injured players to return following physician clearance Follow physician's orders, particularly when dealing with participation of athlete • Purchase liability insurance • Know scope of practice • Use common sense

Arch Technique 3

X teardrop arch and forefoot support

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

Medical insurance

a contract between the company and policyholder

strength

ability to generate force against resistance

Dynamic activities

activities that require jumping, bounding - High intensity stretch-shortening cycles (where muscle tendon unit requires storage of more elastic energy - Without necessary flexibility the tendon may exceed capacity - Stretching can influence viscosity of tendons making it more compliant = injury reduction

risk factors

also on data analysis

cotton cloth

ankle wraps, triangular and cravat bandages

treatment area

area that accommodates 4-6 adjustable treatment tables, 3-4 stools, and hydrocollator and ice machine accessibility

electrotherapy area

area that houses ultrasound, diathermy, electrical stim units, storage units, grounded outlets, treatment tables and wooden chairs, under constant supervision

exercise rehabilitation area

area that provides adequate space and equipment to perform reconditioning of injuries

hydrotherapy area

area with centrally located sloping floor to drain, equipped with 2-3 whirlpools, shelving and storage space and outlets 5 feet above the floor

Sports medicine generally focuses on....

areas of performance enhancement, injury care, prevention and management

policies

clear written out statements of basic rules • Critical element for operation of athletic training clinic

• Purchasing Systems - Direct buy vs. competitive bidding

competitive bidding = give your supply list to multiple companies and use best --> cheapest/quickest

isotonic contraction

concentric and eccentric Both are considered dynamic movements

procedures

describe the process

muscular endurance

epetitive muscular contractions (increase strength = increase endurance

cohesive elastic wrap

exerts constant even pressure; 2 layer wrap that is self adhering

elastic wrap

extensible and very useful with sports; active wrap allowing for movement; can provide support and compression for wound healing

Negligence

failure to use ordinary or reasonable care

Arch Technique 4

fan arch support

Arch Technique 2

for longitudinal arches

Rehabilitation pool

if space permits, must be accessible to individuals with various injuries, with graduated depth and non-slip surface

power

is the relationship between strength and time

FERPA

law protecting privacy of student education records - Provides parents with certain rights with respect to child's educational records - When child turns 18 rights are transferred to student - School must have written permission prior to releasing information

eccentric

lengthening of muscle with contraction because load is greater than force being produced

hypertrophy

muscle gets bigger (4-6 weeks)

atrophy

muscle gets smaller (7 days)

Strategic plan development

must include administrators, other allied healthcare providers, student-athletes, coaches, physicians, athletic trainers, parents and community health leaders - SWOT Analysis • Ongoing process that reviews strengths, weaknesses, opportunities and threats - Must routinely examine a cost-effectiveness of operating health care program to determine the value of the return on their investment.

Sports medicine umbrella - injury care & management

practice of medicine physical therapy athletic training orthotist/prosthetists strength and conditioning

Turf toe

prevents excessive hyperextension of metatarsophalangeal joint)

hammer or clawed toes

reduces pressure of bent toes against shoes)

Pharmacy area

separate room that can be secured for storing and administrating medications (records must be maintained concerning administration)

concentric

shortening of muscle with contraction in an effort to overcome more resistance

Record's area

space devoted to record keeping which may include filing system or computer based database, that allows access only to medical personnel

Physician's Exam Room:

space for physician to work which may hold exam table, lockable storage, sink, telephone

fractured toes

splints injured to non-injured toe)

gauze

sterile pads for wounds, hold dressings in place (roller bandage) or padding for prevention of blisters

Arch Technique 1

to support weak arches

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

Human Resources and Personnel Issues

• Assembling appropriate personnel to achieve program goals and objectives is critical to success. • Recruitment, hiring and retaining qualified personnel is necessary to be effective • Specific policies are established relative to hiring, firing, performance evaluations and promotions - Must adhere to these principles• Roles and responsibilities must be established - Job descriptions - job specifications, accountability, code of conduct, and scope • Head athletic trainer must serve as a supervisor and work to enhance professional development of staff • Performance evaluations should take place routinely

Responsibilities of the Team Physician

• Athletic trainer works under direct supervision of physician • Physician assumes a number of roles - Serves to advise and supervise athletic trainer • Physician and athletic trainer must be able to work together• Compiling medical histories and conducting physical exams - Pre-participation screening • Diagnosing injury • Deciding on disqualifications - Physician is responsible for determining when the athlete should return to activity • Attending practice and games • It is imperative that the team physician promote and maintain consistently high quality care

Role of the Coach in the Sports Medicine Team

• Coach must be aware of the responsibilities of each individual associated with the team - If there is no athletic trainer, this becomes even more critical • Coach must understand limits of their ability to function as a health care provider in the state in which they are employed • All coaches should be certified in CPR/AED and in basic First Aid • Construct injury prevention conditioning programs • Must provide high quality and properly fit protective equipment • Apply proper first aid if necessaryPossess appropriate coaching licenses and certifications • Have understanding of skill techniques and environmental factors associated with sport • Continuing education through ASEP or NCACE • Function as a coach

Other Members of the Sports Medicine Team

• Exercise Physiologist • Biomechanist • Nutritionist • Sport Psychologist • Emergency Medical Specialists • Strength & Conditioning Coach • Referees Physicians • Dentist • Podiatrist • Nurse/Nurse practitioner • Physicians Assistant • Sports Chiropractors • Physical Therapist • Massage Therapist • Orthotist/prosthetist • Equipment Personnel

How does the Fitness Professional Relate to the Sports Medicine Team?

• Focus of the group is on improving performance • Argument can be made that by an athlete achieving a higher level of fitness, injuries are less likely to occur • The relationship between performance enhancement and injury prevention is critical

Roles & Responsibilities of Athletic Trainers

• Injury prevention & health promotion - Ensure appropriate training, monitor environment, nutrition, maintain & fitting equipment, appropriate use of medication • Clinical examination & diagnosis - Recognize nature and extent of injury • Acute care of injury & illness - Provide first aid and management of acute injuries • Psychosocial strategies & referrals - Recognize abnormal behaviors; recognize the role of mental health in injury/recovery and use of intervention strategies; refer the patient to the appropriate medical personnel for intervention • Therapeutic intervention - Knowledge of equipment, manual therapy, therapeutic modalities • Healthcare administration - Budgeting, inventory, injury records, supervision of assistants, insurance, EAP development • Professional development & responsibility - Educating the public through seminars, research & providing good care

work hardening

• Work hardening = 8 hours of treatment daily, 5 days/week

Roles and Responsibilities of the Athletic Trainer

• Work with athletes from time of injury to resolution • Directly responsible for all phases of health care in an athletic environment • May be employed in a variety of settings - Colleges/Universities/Secondary schools - Sports medicine clinics / Corporate settings - Amateur/professional athletics - Military/NASA/NASCAR/performing arts - Equipment sales/marketing• Must have extensive formal academic preparation and supervised practical experience • The Board of Certification sets academic coursework and clinical experience requirements • Upon meeting the educational guidelines applicants are eligible to sit for the BOC examination • Passing the certification examination = BOC certification as an athletic trainer - Credential of ATC