Sport Books Publisher1 Out of Harm’s Way: Sport Injuries Chapter 8.
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Transcript of Sport Books Publisher1 Out of Harm’s Way: Sport Injuries Chapter 8.
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Sport Books Publisher 1
Out of Harm’s Way: Sport Injuries
Chapter 8
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Sport Books Publisher 2
Outline:
Biomechanical principles of injury Injury treatment and rehabilitation Pain: nature’s warning system Soft tissues injuries Dislocations Fractures Concussions Overuse injuries Injury prevention
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3Sport Books Publisher
Biomechanical Principles of Biomechanical Principles of InjuryInjury
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Tissue Types
Each type of tissue possesses unique Each type of tissue possesses unique mechanical characteristicsmechanical characteristics
Epithelial Muscle Connective Nervous
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Loading
To best understand the biomechanical characteristics of tissue we examine its behaviour under physical load
Under load a tissue experiences deformation
Deformation can be visualized through deformation curve
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
dHigh
Low
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
dHigh
Low
Elasticity: capacity of a tissue
to return to its original shape after removal of load
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Sport Books Publisher 8
A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
dHigh
Low
Plastic region begins
Tissue no longer posesses elastic properties
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
dHigh
Low
Permanent tissue deformation(does not return to original shape)
Resulting in micro-failureor injury (e.g. sprains)
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
dHigh
Low
Macro- or completes failure(e.g. torn ligament)
Tissue becomes completelyunresponsive to loads
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
dHigh
Low
Area = strength of the material
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
dHigh
Low
Slope = stiffness (or resistance to deformation) of the material
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Tissues Response to Training Loads
1. Training load =/ elastic limit– Micro-failure making of new tissue– Positive training effect
2. Training load > elastic limit– Permanent failure– Injury
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Forces Acting on Tissue
TENSIONTENSION TORSIONTORSIONBENDINGBENDINGCOMPRESSIONCOMPRESSION SHEARSHEAR
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Injury treatment and Injury treatment and rehabilitationrehabilitation
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Treatment– Received by patient from a health
care professional– Promotes healing– Improves quality of injured tissue– Allows quicker return to activity
Rehabilitation– Therapist’s restoration of injured
tissue +patient's participation– Individualized for each athlete
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Healing PhasesHealing Phases
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InflammatoryResponse
Phase
InflammatoryResponse
Phase2 – 4 days
InflammatoryResponse
Phase
InflammatoryResponse
Phase
hrs – 6 wks
InflammatoryResponse
Phase
InflammatoryResponse
Phase
3 wks - yrs
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Inflammatory Response Phase
Inflammation begins at the time of injury
Signs– Redness– Swelling– Pain– Increased temperature– Loss of function
Protect Rest Cryotherapy
– Decreases swelling, bleeding, pain and spasms
Compression– Decreases swelling
Elevation– Decreases swelling
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Fibroplastic Repair Phase
Repair and scar formation
Granulation tissue fills the gap
Collagen fibres are deposited by fibroblasts
Signs seen in the phase1 subside
Rehab-specific exercises– Restore range of motion
and strength
Manual massage therapy and ultrasound– Help break down scar
Protective taping and bracing
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Maturation-Remodeling Phase
Remodeling or realigning of the scar tissue
More aggressive stretching and strengthening– To organize the scar tissue along the lines of
tensile stress
Include sport-specific skills and activities
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Pain: nature’s warning systemPain: nature’s warning system
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Pain
Nature’s way of telling us something is wrong
One of the best indicator of when it is best to resume play
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Problem with Ignoring Pain
PainPainPainPain
Masking withMasking withmedicationsmedications
Masking withMasking withmedicationsmedications
Continued Continued participationparticipation
Continued Continued participationparticipation
Pushing injured Pushing injured tissue closer to tissue closer to yield-level pointyield-level point
Pushing injured Pushing injured tissue closer to tissue closer to yield-level pointyield-level point
GastrointestinalGastrointestinalcomplicationscomplications
GastrointestinalGastrointestinalcomplicationscomplicationsAddictionAddictionAddictionAddiction
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Soft tissues injuriesSoft tissues injuries
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ContusionsContusions
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Bruise Compressing force crushes
tissue E.g. “charleyhorse” – quadriceps
Discoloration and swelling Myositis ossification –
abnormal bone formation in a severe contusion
Life-threatening if the tissue involved is a vital organ
P-R-I-C-E
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Strains and SprainsStrains and Sprains
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STRAIN
Tendon or muscle tissue is stretched
or torn
SPRAIN
Ligament or the joint capsule is stretched pr
torn
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Grades of sprains and strains
GRADE 1– Slightly stretched or torn; few muscle fibres
GRADE 2– Moderately stretched or torn, more muscle fibres
GRADE3– Complete rupture– Surgery required– E.g. ACL tear
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Common Strains
Quadriceps Adductors Hip flexors Hamstrings Rotator cuffs
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Hamstring Strains
Most frequently strained muscles Mechanism:
– Rapid contraction in a lengthened position– E.g. sprinting and running
Due to strength imbalance– Hamstring strength >>> quadriceps strength
Emphasize hamstrings and quadriceps equally
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Ankle Sprains During running, walking, dancing or stepping off a curb Most common = lateral ankle sprain
– Inversion Common reoccurrence
– Decreased proprioception Symptoms
– Rapid swelling– Point tenderness
Rehabilitation– Decreases reoccurrence– Incorporation of balance exercises
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DislocationsDislocations
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Great enough forces push the joint beyond its normal anatomical limits
Joint surfaces come apart
Subluxation– When supporting structures (e.g. ligaments) are
stretched or torn enough– Bony surfaces partially separate
Most common = fingers Can become chronic
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Dislocation of the ShoulderDislocation of the Shoulder
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Most mobile most unstable joint Categories of dislocation:
– Partial (subluxation)– Complete
Most common– Head of humerus slips anteriorly– Falling backwards on extended arm
Symptoms– Swelling, numbness, pain, weakness,
bruising– Capsule and/or rotator cuff tears– Brachial plexus injury
Require medical treatment to relocate head of humerus back to glenoid fossa
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FracturesFractures
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Simple fracture– Stays within the surrounding
soft tissue Compound fracture
– Protrudes from the skin Stress fracture
– Results from repeated low magnitude loads
Avulsion fracture– Involves tendon or ligament
pulling small chip of bone
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ConcussionsConcussions
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Injury to the brain Mechanism:
– Violent shaking or jarring action of the head
– Brain bounces against the inside of the skull
Symptoms– Confusion– Temporary loss of normal brain
function REST
No such thing as “minor concussion and “shaking off”
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Overuse injuriesOveruse injuries
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Due to – Repeated and accumulated microtrauma– Non-sufficient recovery
Results from– Poor technique– Poor equipment– Too much training– Type of training
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TendonitisTendonitis
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Symptoms– Pain (aggravated by movement)– Tenderness– Stiffness near joint
Inflammation of tendon as a result of a small tear in the tendon
TendonitisTendonitis
Excessive ,repetitive
motion
Excessive ,repetitive
motion
Improper technique
Improper technique
Age (loss in
elasticity)
Age (loss in
elasticity)
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Tennis Elbow
Lateral epicondylitis Affect forearm extensors
– Attach to lateral epicondyle– Extend wrist and fingers
Contributing factors– Excessive forearm pronation and wrist flexion– Gripping racquet too tightly– Improper size3 grip– Excessive string tension– Excessive racquet weight– Topspins– Hitting ball off-centre
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Gofer’s and Little League Elbow
Medial epicondylitis Affects tendons of forearm flexors
– Attach to medial epicondyle– Flex wrist and fingers
May result in collateral ligament and ulnar nerve injury
May affect medial humeral growth plate in young children (little league elbow)
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Jumper’s Knee
Patellar tendonitis Affects infrapatellar ligament Caused by:
– Repetitive eccentric knee actions
– Eccentric load during jump preparation >>> body weight
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BursitisBursitis
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Inflammation of the bursae– Tiny fluid-filled sacs– Lubricate and cushion pressure
points between bone and tendons
Results from overuse and stress– Age is also a factor
Most common– Shoulder, elbow and hip
Inflammation and pain aggravated by movement and direct pressure
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Shoulder ImpingementShoulder Impingement
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Excess movement of the humeral head + lack of space
Inflammation of bursae or rotator cuff tendon
Result of muscle imbalances in shoulder muscles– Weak shoulder depressors– Strong shoulder elevators
Balanced strength training
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Stress FracturesStress Fractures
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Stress fracture Results from repeated
low-magnitude forces
1. Small disruption of the outer bone layer
2. Weakened bone3. Cortical bone fracture
NOT a shin splint
Shin splints Pain along inside tibial
surface Involve pain and
inflammation NO disruption of cortical
bone
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Injury preventionInjury prevention
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Protective EquipmentProtective Equipment
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Warm Up and Cool DownWarm Up and Cool Down
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Keeping Fit and FlexibleKeeping Fit and Flexible
“Use it or lose it”
Especially important during the off-season
Preparing the muscle for placing demands
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Eating and RestingEating and Resting
In order to function effectively body must receive– Proper nutrient – Adequate rest
Avoid over-training and lack of sleeping