Sports conditions,injuries and prevention Kate Logan & Claire Prenter Final year physio students
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Transcript of Sports conditions,injuries and prevention Kate Logan & Claire Prenter Final year physio students
Sports conditions,injuries and prevention
Kate Logan & Claire PrenterFinal year physio students
Sports Injuries and Conditions:• Commonly encountered sports injuries and conditions
include:• Fractures• Concussion• Bleeding• Joint injuries• Soft tissue injuries
– Muscle injuries– Tendon and ligament injuries
• Skin damage• Dehydration• Hyperthermia (heat stroke) and hypothermia
Who has had a fracture?.....
What is a Fracture?
• A fracture is a break in the continuity of a bone or a loss of continuity in the substance of a bone
Clinical signs of a fracture
• A deformity that can be seen or felt
• Pain on stressing the limb
• Abnormal movt in a limb due to movt at # site
• Crepitus or grating between bone ends
• Impaired function
• Swelling at the fracture site
• Tenderness at # site
Fractures
Causes of fractures• Direct trauma
– caused by external forces which exceed the strength of the bone.
– direct violence e.g. RTA, a blow
or
• Indirect trauma– Fracture results from twisting or rotational
forces being applied to the bone
– e.g football studs planted, rotation force applied to the limb resulting in spiral # of the tibia
or
• Pathological fracture– bone is already weakened or diseased
– fracture because the bone’s internal structure is weakened
• Stress fracture– Caused by repeated excessive loading of a bone, the
cumulative forces result in a break
Types of fracture:
• Classified by skin damage• Or shape of fracture • Or displacement
Classified by skin damage:
• Open: skin’s broken either by external force or internal one
• Closed: simple fracture
Fractures
Fractures
Classified by shape
• Shape of the fracture– Transverse or Horizontal – Oblique / Spiral– Comminuted (many small parts)– Crush– Greenstick -
• children, bend in immature bone with a break in cortices
Eg transverse fracture of tibia and oblique fracture of tibia:
Classification by displacement:
– Undisplaced
– Displaced
– Impacted
– Stable
Comminuted displaced fracture of a femur
Stable undisplaced fracture of a radius:
Stages of fracture healing:
• Stage 1: Haematoma (0–2 wks)
• Stage 2: Cellular proliferation (2-6 wks)
• Stage 3: Callus formation• Stage 4: Consolidation stage (6-12 wks)
Ossification occurs 12 -26 wk callus matures
• Stage 5: Stage of remodelling (1-2 yrs)
Why do physios treat fractures?
• Aim to restore the patient to optimal functional state
• Prevent fracture and soft-tissue complications
• Get the fracture to heal, and in a position which will produce optimal functional recovery
• Rehabilitate the patient as early as possible
Who has had concussion?
Sports Concussion:
• Head injuries in sport are common in all contact sports, the vast majority are minor
• Common sports for these are:– football– Boxing– Gymnastics– Horse riding – Martial arts
...impact from camogie stick
Causes:
• Direct blow to head, face, neck, or elsewhere on the body with force transmitted to the head
• Typically results in rapid onset of short-lived impairment of neurological function that resolves spontaneously
• May or may not involve loss of consciousness
Symptoms:
• Headache• dizziness• Unsteadiness• Feeling stunned or dazed• Seeing stars or flashing lights• Tinnitus• Double vision
• Sleepiness, sleep disturbance, • Poor concentration• Nausea/vomiting• Slurred speech• Personality change• Impaired playing ability
Which 2 sports have the highest incidence of concussion?
1. Professional horse jumping jockeys2. Australian footballers
Physio role?
• Remove player from field of play!• Exclude the presence of serious head injury or
spinal injury• If athlete’s unconscious assume presence of
head injury and spinal injury and manage accordingly – hospital...for assessment and observation...
Bleeding
• Open and closed wounds– Incised: a cut from a sharp edge– Laceration: rough tear or crush to the skin– Abrasion: graze or superficial wound from a
rough surface
– Contusion: bruise or internal bleeding– Puncture: an object entering the body– Velocity injury: a puncture wound at
velocity will cause extensive damage, there may be an entry and exit wound
Physio role:
• From first aid perspective, dress wound to maintain sterile state and remove to hospital for treatment if required
• Sports medic on pitch side can stitch wounds as required
Joint Injuries:
Joint injuries:• High energy impact• Damage to:
– Menisci – Ligaments– Joint capsule– Bony structures
• Knee “big three” – Anterior cruciate ligament (ACL), medial
meniscus, medial collateral ligament (MCL)– Traumatic knee, shoulder, elbow, wrist,
ankle injuries eg dislocations
What are the Soft Tissues?
• Muscles & Tendons• Ligaments, Joint Capsules, Bursa• Cartilage• Nervous Tissue
Types of soft tissue injuries
• TRAUMATIC:
• Specific cause is identified
• Cause of injury easily identified
• OVERUSE:
• Develop slowly not attributed to one incident
• Specific injuries assoc with a particular sport
Injury Classification
• ACUTE: rapid onset, traumatic event with a clearly identifiable cause.
• CHRONIC: slow insidious onset, gradual development of structural damage.
• SUB-ACUTE: period between acute and chronic, usually 4-6 weeks post-injury.
Causes of Soft Tissue Injuries
• Intrinsic causes of injury
–factors within the sports person
• Extrinsic causes of injury
–factors outside the sports person
Muscle Injuries
• Muscle strain= tear in muscle fibres beyond its limit
• Causes: (i) forceful contraction of the muscle (ii) Overstretching the muscle
Muscle Injuries
• Classification of muscle strains
Grade Extent of damage SymptomsGrade 1 5% or less muscle
fibresMinimal pain
Grade 2 5% - 99%Some muscle fibres still present
Moderate / severe pain on contractionLimited ROM
Grade 3 Complete rupture No contractionLess pain / no pain
Muscle InjuriesAssessing a Muscle strain:
1. PAIN on mvt / resistance2. PAIN on contraction3. PAIN on palpation
Muscle most susceptible to injury?Rectus femoris (quad) HamstringsGastrocnemius (calf)
Tendon Injuries
• Tendon properties:– Connects muscle to bone– Low blood supply
• Tendonitis –inflammation???• Tendinopathy – Degeneration of tendon• Healing tendon:
– HEAT (increase blood supply)– DTFM– Strengthen– Stretch
Ligament Injuries
• Ligament Properties:– Connects bone to bone
Grade 1 –minimal swelling, bruising, painGrade 2 – Moderate to severe swelling, bruising,
painGrade 3 – A lot of swelling, agony, may or may not
bruise
Management of soft tissue injuries
• Acute Injury• PRICE:
– Protect– Rest– Ice– Compression– Elevation
Icing• Limits Inflammatory process• First 48-72 hours• Methods: - Crushed ice in a towel, frozen veg, Ice
bath, Chemical ice packs (pitch-side), Freeze spray / cryogel
• Application: - 10 mins every 2 hours
• Dangers of leaving ice on too long - Ice burn - Never damage - Increase in blood flow
The aims of early management
The management of STI in the first 72 hours: • to reduce pain • to reduce local tissue temperature • to limit and reduce inflammatory fluid• to reduce metabolic demands of the tissues • to protect the damaged tissue from further injury • to protect the newly-formed fibrin bonds from
disruption • to promote collagen fibre growth and realignment • to maintain general levels of cardio-respiratory and
musculoskeletal fitness / activity
Management of medical problems• HYPOTHERMIA• ‘Hypo’ = Below / under ‘Thermia’= heat
- Condition in which a person’s body temperature is sufficiently below normal to cause distress and disorder of normal bodily functions.– Mental deterioration– Loss of coordination– Unconsciousness– Failure of breathing and circulation– Death
Hypothermia• Causes:
- Cold- Wind- Wet clothing- Perspiration- Water immersion
• Stages:Peripheral (core 37-36)Moderate (core 34)Severe (core 32 or lower)
Hypothermia• Signs / Symptoms:
-Tiredness / exhaustion - Shivering - White / purplish appearance (bluish tinge to lips / fingers) - Clumsiness / falling/ tumbling - Weak grip and slowness in muscle contraction - Cold rigid arms and legs - Poor concentration, loss of interest, lethargy - Slurred speech
Hypothermia• Treatment:• Removal from cold, wet, windy conditions
(shelter)• Insulation to prevent further heat loss• Passive or active re-warming• Gentle and minimal handling• Provision of nutritional and fluid support• Transport to medical facility
Hypothermia
• Hypothermia hits stumbling Lebanese
Gloucester30th Oct 2000New Zealand Vs Lebanon Rugby LeagueGroup2
Hyperthermia
• Hypertherma = overheating of body• Hyper = ‘ high’, therma = ‘heat’• Body can not effectively regulate excess heat /
elevated temperatures• Temperature > 37.5–39.9 °C• Causes:
– Exposure to excessive heat– Exposure to high humidity– High physical exertion– Dehydration
Hyperthermia• Signs and Symptoms
- Hot, dry skin - Dizziness / Fainting - Nausea / Vomiting - Headaches - Gastrointestinal problems e.g. Diarrhoea - Multi-organ dysfunction
Treatment: - Cool / tepid water immersion - Rehydration - Sponging head, neck, trunk with cold water - Sit in shade
Dehydration
• Fluid Loss exceeds Fluid Intake• Causes:
- Excessive Sweating - insufficient fluid intake - Hot & humid conditions - High intensity exercise
Dehydration
• Consequences:– Increase in perceived effort– Reduced performance– Impaired reaction times, judgement,
concentration and decision-making
• Electrolyte Drinks - Sodium (speeds fluid absorption)- Carbohydrate (provides fuel) - Small amounts frequently (500-800ml/Hr)
Quick overview of........• Fractures• Concussion• Bleeding• Joint injuries• Soft tissue injuries
– Muscle injuries– Tendon and ligament injuries
• Skin damage• Dehydration• Hyperthermia (heat stroke) and hypothermia
Questions: