ATR2010-Ch2- Concepts of Sports Injury

intrinsic causative factors in injury

- age - gender (sex) -genetics - body size/morphology (fitness level, weak muscles, lax (loose) or unstable joints, skill level ,etc) - injury history -psychological Psyche/cognitive Soul, mind or spirit Persona (personality)

chronic (on acute) injuries

- an acute injury that becomes a chronic condition - ankle sprain that leads to instability which leads to frequent episodes of giving out chronic on acute- ankle sprain that is acutely sprained (acute injury), because of its location, more likely to become chronic on acute because of how much you use the ankle

Catostrophic injury

- serious, life threatening injury (rarely results in fatality) (has the potential to be fatal) - disability, usually neurological; cognitive impairment; peripheral nerve damage and weakness - can result in permanent damage (for rest of life) examples: Traumatic brain injury (not a concussion), concussion is mild, motorcycle accident would be this Spinal cord injury- usually don't recover 100 percent, usually not fatal, paraplegia, quadriplegia , cervical spine usually Heat stroke- 100 percent preventable Anaphylactic shock/severe allergic reactions- could be environmental, food Sudden cardiac arrest/respiratory arrest- undetectable condition Massive blood loss (internal or external hemorrhage)

extrinsic causative factors in injury

1. Environment -Type of activity or sport -High risk exposures (Practices, games, etc.) Playing and practicing surfaces Weather 2. Equipment (e.g.; restrictive clothing) 3. Conditioning & training errors, etc. (Overtraining or under training)

Classification of Sports

American Academy of Pediatrics (AAP) has developed classifications for sports. Contact/collision (football, wrestling) Limited contact/impact (basketball, baseball) Non-contact (swimming, golf) determines priority for coverage (medical supervision) sport specific recommendations for coverage ATC may have to cover more sports more than others based on the classification of sports (covering wrestling and football more than swimming) people may specialize in contact or collision sports; some ppl don't want to work in sports that have contact; you can hone in to exact risk factors

acute (on chronic) injuries

Chronic injury with lingering symptoms (microtrauma) Episode of macrotrauma e.g.: Achilles tendon acute on chronic- wear and tear and then you get a macro trauma force- achilles and patellar- not designed to rupture unless there is a history of wear and tear

not on slide but hard vs soft tissue

Hard tissue is usually referring to bones, while soft tissue refers to muscle, ligaments, tendons, or connective tissue.

chronic injuries

Injury characterized by a slow, insidious onset, resulting from a series of micro-traumatic events (wear and tear) (overuse) Gradual development of structural damage. Chronic injuries develop over time and are often associated with repetitive, cyclic activities, such as running. (cycling, swimming, throwing) These injuries are commonly called "overuse injuries." Common sites include the Achilles (ankle), patellar (knee), and the rotator cuff tendon (shoulder)

acute injuries

Injury characterized by rapid onset, resulting from a macro-traumatic event Acute injuries typically involve significant trauma followed by pain, swelling, and loss of function

definition of sports injury

No universally acceptable definition of sports injury (only characterize) Characterized by: Sport participation- game, practice, or sanctioned event (conditioning or weightlifting) Body area involved- head, knee, shoulder, ankle Tissue damaged- muscle, ligament, cartilage, bone, neural Severity- mild (grade 1 or 1st degree), moderate (grade 2 or 2nd degree), or severe (grade 3 or 3rd degree)- gauge this from assessment Mechanism (how did it occur or cause) Time lost or how long away from competition Was the athlete evaluated by medical personnel, and did they receive treatment?

Concept of Critical Force slides (2 slides, a lot of info, just try to familiarize with it)

Soft tissue injuries (ligament, tendon and muscle) and bone In most injury cases: Tendons, ligaments and bone are progressively weakened by micro-damage (chronic attenuation) accumulated during each sub-maximal loading cycle before it can be repaired (insufficient recovery) -James Ashton-Miller, PhD (University of Michigan) Leads to acute macrotrauma- when you look at the full timeline of an injury, you can see the events leading up to the injury likely causing this to occur( Tear, fracture or rupture) Key: prevention body is subjected to microforces, which weaken the body over time (wear and tear), accumulates, insufficient recovery, body isn't given time to repair itself slide 2: Injuries occur in response to mechanical forces that exceed the critical force level of a particular tissue. Threshold for damage or injury -Macro-trauma - single force -Micro-trauma - multiple, repetitive forces (fatigue)- tissue fatigues, doesn't have time to recover, vulnerable and susceptible to a force that causes injury (macro trauma) Question of how much stress a structure can withstand without failing. critical force may vary within the same tissue depending upon, genetics (familial predisposition), age, temperature, skeletal maturity, and previous injury each person's threshold is different; varies within the individual based on whether you warmed up and temperature sprain your ankle, have chronic issues, have a lower threshold for now on, the critical force drops every time, this causes reoccurrence scar tissue is never as strong as original tissue, lowering the critical force genetics- injury prone age- very young and very old

strain

Structural damage to tendon, muscle, or musculotendinousjunction First-degree strain: mild with no swelling, pain noticeable with use Second-degree strain: more extensive soft-tissue damage, pain, and moderate loss of function Third-degree strain: complete rupture, significant swelling & loss of function muscle, tendon- both woven together same scale as sprain

Mechanical forces of injury (what are the three types of forces, what are CT most resistant to, and other info)

Three types of force Compressive - direct blow, blunt forces Tension (tensile) - pulling apart Shear (friction) - rubbing or twisting (ACL tear, land awkwardly, tibia displaced from femur, tensile force is placed on ACL, and then ACL rotates (shear) Connective tissues are most resistant to tensile forces, and less resistant to compressive/shear forces Therefore, injuries usually occur as a result of a combination of forces critical forces?- yield point where you enter the injury zone, trying to stay under this threshold compressive- something hits you, you run into something tension- stretching or pulling apart shear force- frictional, rubbing, twist a tissue, when a tissue twists, there is increased friction body was designed to resist tensile load

Acute injuries and chronic overuse in terms of critical force also- which graphs do COA and AOC go with

acute injuries- may have a critical force of 1000 N; staying under that usually, but may have a moment where you jump up, lack in an awkward position, and then exceed that threshold and tear your ACL chronic overuse- because of the wear and tear you have put on the body part, the critical force threshold is lowered exceedingly as more microtraumas are obtained, making you more suscpetible to a macrotrauma event; chronic- microtraumas drop critical force (threshold), so forces that may not usually be critical cause a macrotraumatic event due to susceptibility COA goes with the graph where cirtical force may be high but an macro trauma event still occurs due to the exceeding of that threshold AOC- goes with the graph which has a lower threshold than before due to the chronic overuse and microtraumas placed on the body part

three injury categories

catastrophic acute (on chronic) chronic (on acute)

contusion

commonly referred to as "bruises"; may involve skin, muscle, and/or bone pain, stiffness, swelling, ecchymosis (discoloration of skin due to underneath bleeding), hematoma (blood pools under the skin (bruise)) May result in myositis ossificans; generation of bone, calcium deposits in muscle, protect it from the repeated exposures of the repeated stress blunt force, direct blows soft tissue is most involved bone bruise can occur- Travis Kelce has deep bone bruise most frequent injury in sports

Each structure or tissue (e.g.; muscle or tendon) has a ________ or threshold level of resistance before they yield to failure. critical force may vary within the same tissue, depending upon

different critical force Genetics - familial predisposition Age Temperature Skeletal maturity Previous injury

dislocation

displacement of bone surfaces comprising a joint subluxation- partial displacement, moves out of place but can go back luxation- total displacement, can't go back into place usually involves structural damage to ligaments; joints are very complex and have diff types of CT and other tissues; joints have tendons, muscles, nerves, and blood vessels, which can all be impacted by a dislocation all dislocations should be diagnosed and treated by a physician

concussion

mild trauamtic brain injury (mTBI) microscopic damage to axon bundles temporary disruption in brain function can't see it on an imaging test; there's no imaging that can be used to diagnose a concussion well uses the function and symptoms of the individual microscopic- temporary disruption to axon bundles and neural function mechanical forces to the brain transient- proper function comes back within minutes, hours, and days

what type of material resists deformation when stressed?

plastic or viscous

main types of injuries (injury type and what tissue/organ it involves)

sprains- ligaments strains- tendon and muscle contusions- usually soft tissue (skin, muscle); can also be hard tissue (bone) fractures- bone tissue dislocations- (joints - soft & hard tissue) Concussions (brain - neural tissue)

Rules of thumb slide (didn't do but pretty helpful in understand the other concepts)

strain- affects muscle and tendon - muscle- joint mvmt and joint stability - tendon connects muscle to bone sprain- affects ligament - ligament- connects bone to bone, stabilizes joints and guides joint mvmt contusion- affects soft tissue and bone

fracture (definition and 4 types)

structural damage (breaks or cracks) to bone tissue closed- most of them, bones are broken, not enough displacement to penetrate the skin open- displacement penetrates the skin, more complicated, infections are a big risk stress- fatigue fractures, microtrauama to the bone, can become full fractures if not identified; reactions within the bone that it starts to break down; fatigue of the bone, bone is breaking down but not recovering, often overlooked by athletes salter-harris- fractures that affect growth plate regions, preadolescent and adolescent kids, not musculoskeletally mature

sprain

structural damage to ligaments First-degree: mild with no swelling, can still use extremity, not much pain Second-degree: ligament damage, pain, and dysfunction Third-degree: complete tear of ligament(s), doesn't have to be fully ruptured; enough of the tissue is torn to disable the individual and supply a lot of pain grade them based on severity can be in between

ropes are more susceptible to ____ while shoe laces are more susceptible to ___ and ___

tensile loading, compression and shear bundling of the fibers and densely packing and organization makes connective tissue very resistant to tensile loading, shoe laces- break at the end (compression and shear)