Option 3 Sports Medicine
How are sports injuries classified and managed?
Ways to Classify Sports Injuries
Direct Injuries
These are caused by an external force applied to the body, such as a collision, e.g. falling on your hand and hurting it.
Indirect Injuries
Theses are caused by an intrinsic force, i.e. a force within the body, e.g. a sprinter tearing a hamstring. Most of these are due to poor warm up, ballistic movement or a fault in technique. Indirect can also be when the actual injury site is distant from the impact, e.g. a dislocated shoulder from falling on your hand.
Overuse Injuries
A chronic injury caused by repetitive movements, e.g. tennis elbow.
Soft Tissue
Includes damage to skin, muscle, tendons, ligaments, nerves, cartilage, blood vessels, organs, e.g. sprains, strains, contusions, abrasions.
Hard Tissue
Damage to hard tissue, bones, teeth, e.g. fractures, breaks, dislocations.
Soft Tissue Injuries
Tears, Sprains, Contusions
Tears – disruption of fibres of muscle, ligament or tendons. These are caused usually when a muscle contracts too quikly. Ranges from a strain to a complete tear.
Sprains – A tear of ligament fibres. Sprains are graded to their severity, No damage, Little damage (1st degree), Moderate damage (2nd degree), Extensive damage (3rd degree).
Contusions (bruises) – Most are on surface, however some penetrate into bone. They interrupt blood flow to surrounding tissue. Internal bleeding may continue for a period of time.
Inflammatory Response
When soft tissue is injured, it becomes inflames by activating a self-healing process.
Phase 1 Inflammatory stage
- Pain, redness and swelling around injured area
- Loss of function and mobility
- Damage to cells and surrounding tissue
- Increased blood flow to area
Phase 2 Reapair and regenerative stage (3 days to 6 weeks)
- Elimination of debris
- Formation of new fibres
- Production of scar tissue
Phase 3 Remodelling stage
- Increase production of scar tissue
- Reduce swelling
- Ease pain
Skin Abrasion, Laceration, Blisters, Calluses
An abrasion causes pain and shallow bleeding as a result of the skin being scraped.
A laceration is a wound where the flesh has incurred an irregular tear.
Blisters are caused by a collection of fluid below or within the epidermal layer.
Calluses are increased thickness of skin that usually occur over bone protuberances.
Managing Soft Tissue Injuries
RICER
Properly used, RICER will ensure the injury heals in correctly in the shortest time. If not used the injury will take longer to heal and be weaker and have less flexibility.
Rest. To reduce bleeding into the injury and prevent further injury. Place in comfortable position with injury elevated and supported. Until beginning a program of careful mobilisation.
Ice. O reduce pain, blood flow, swelling, spasm, enzyme activity, tissue demand or oxygen. Crush ice, gel packs, water immersion. Be careful from overexposure to cold by wrapping in insulating material. 20 minutes every hour for few days.
Compression. Decreases bleeding, reduces swelling. Wrap an elastic bandage. At the time of injury and repeated for at least 24 hours.
Elevation. Decreases bleeding, reduces swelling, reduces throbbing. Raise injured area above heart by placing under a support. Whenever possible in the day and for the following few nights.
Referral. To understand the nature and extent of injury, and seek guidance in a program of rehab. As soon as possible after injury.
HARM
Heat. Sauna, spa, hot rubs, etc first 72hrs. Increases bleeding.
Alcohol. Increases swelling.
Running. Exercise will make injury worse.
Massage. In first 72hrs, increases swelling and bleeding.
Immediate Treatment of Skin Injuries
The aims of immediate treatment are:
· Prevent further tissue damage (and blood loss)
· To minimise swelling
· To ease pain
· To reduce the formation of scar tissue
· To reduce the time needed for rehabilitation (promotion of healing)
For the majority of skin injures the following management steps should be undertaken:
· Reduce the danger of infection
· Control bleeding with RICER
· Access the severity of the wound
· Clean the wound using clean water
· Apply antiseptic
· Dress the wound with sterile pad
· Refer to medical attention
Hard Tissue Injuries
Fractures
There are two types, simple (closed), the bone breaks but remains underneath the skin. Compound (open), the bone protrudes through the skin. Different types include greenstick, comminuted, depressed, impacted, oblique, longitudinal, spiral, transverse and serrated. Symptoms of fractures include, intense pain, sound of bone cracking, swelling, deformity, bruising, discolouration, loss of function.
Dislocations
The displacement of a bone or joint. Technically a dislocation is not a hard tissue injury because, although the bone is displaced, it is not damaged. The real damage is to ligaments.
Managing Hard Tissue Injuries
Immobilisation
Above and below the injury with a splint or sling.
Medical Treatment
Serious hard tissue injuries need medical attention. Do not move the patient. Immobilise. Check for impaired circulation. RICER may be used.
Assessment of Injuries
In unconscious follow DRABC.
If conscious follow TOTAPS
Talk – Is there any pain? Where does it hurt?
Observe – Look for swelling, redness, deformity. Compare sides of body.
Touch – Gently! Is it tender to touch? What is the extent of pain?
Active movement – The player moves gently until affected by pain. Significant restriction indicates medical attention is required.
Passive movement – Gentle movement by the observer. Stop at point of pain or restriction. Return to play should not be considered unless there is pain free full ROM.
Skills Test – The player performs test, and results of pre injury are compared.
How does sports medicine address the demands of specific athletes?
Children and Young Athletes
Medical Conditions
Asthma – a narrowing of the airways which makes breathing difficult. Swimming improves asthma. It should not hinder participation if care is taken :
- Adequate warm up/cool down
- Use preventative medication if necessary.
- Be aware of techniques of asthma treatment.
- Exercise at steady intensity.
- Extra care in cold weather or sick.
Diabetes – complex heredity or developed disease where the supply of insulin is reduced or completely severed. It can be controlled by diet, medication, exercise. Diabetics need a pre-game meal to boost blood sugar levels and an hourly glucose supplementation, e.g. banana.
Epilepsy – a disruption to brain function, causing a brief alteration to the level of consciousness and resulting in seizures. Can be treated with medication. Coaches need to be aware. Collision sports are not recommended. Treatment: allow seizure to occur unrestrained, ensure safe surroundings, if longer than 10 minutes seek medical attention.
Overuse Injuries
e.g. stress fractures. Small fractures caused by repetitive pounding on hard surfaces. Coaches can prevent overuse injuries by ensuring appropriate conditioning and stretching programs.
Thermoregulation
Refers to the action of the hypothalamus in the brain in responding to changes in the body’s temperature and initiating appropriate mechanisms, e.g. sweating. Children dehydrate easy and are at risk of hypothermia. Coaches should allow adequate fluid intake, provide jumpers when ‘off’, practice in the hade, etc.
Matching of Opponents
Matching for growth and skills should occur in competitive sport. Many children’s sports are modified by rules and equipment suited to the maturity of players. Some sports for safety reason see children matched according to size, not age.
Appropriateness of Resistance Training
Overuse injuries can result. Susceptible due to reduced flexibility and muscle tendon mismatches. Growth plates not affected. Training principles are important, progressive overload, intensity, recovery. Focus on skill and technique since improvements come from neuromuscular development. Work on big muscle groups, free weights, machines are designed for adults so may not be a good option.
Adult and Aged Athletes
Heart Conditions
Prescribed exercise conveys considerable benefits with little risks to people in these groups. Exercise reduces blood pressure. Medical clearance should be obtained (pre-screening) before starting a program. Stress tests may be required. Start slow with a gradual build up. Must be aerobic and personalised.
Fractures/Bone Density
Osteoporosis is a condition where bones become brittle as a result of lack of mineral content. Physical activity increases bone mass and makes bones stronger. Inactivity should be avoided as this encourages calcium discharge from the bone making it weaker. Sporting programs should be safe and painless and should focus on improving balance, strength, coordination, aerobic capacity and flexibility, e.g. deep water running and aerobics.
Flexibility/Joint Mobility
Problems experienced by old people include arthritis, aching joints and tight muscles. These problems respond positively to safe stretching and improving ROM. The programs need to be low impact and specific to a persons limitations.
Female Athletes
Eating Disorders
Are characterised by behaviour such as purging, binge eating and starving. The most common eating disorders are anorexia nervosa and bulimia nervosa. To help prevent:
- expect athletes to do their best and not focus on winning.
- Be better educate to detect signs of disorders, nutrition experts can be used.
- Invite parents/peers to support athletes.
Disorders are often seen in, dancing, boxing, gymnastics.
Iron Deficiency
Without sufficient iron, the number of red blood cells are reduced, limiting the oxygen-carrying capacity of the blood and the degree to which the athlete is able to participate. Iron deficiency contributes to fatigue, loss of energy. The problem is more evident in females because they usually consume less red meat and lose 5-40mg during menstruation. Anaemia is the condition where there is an abnormally low level of haemoglobin, resulting in less oxygen being carried to the tissues. Endurance athletes may require supplementation.
Bone Density
Is directly related to the quantity of calcium in the bones. This causes susceptibility to fractures and structural wearing. Calcium is regulated by parathyroid glands. Bones are strongest when people are in their 20’s. Post menopausal women begin to lose calcium. Women should be aware of safety and risks in sport and choose aerobic sports. Weight bearing exercise or strength training is effective in preventing bone loss. Women should have a well balanced diet and include lots of calcium and dairy. Warm up is important for bone density problems.
Pregnancy
Regular moderate exercise can have benefits including weight control, maintenance of fitness and well being, improved muscle tone. Athletes should avoid thermal stress, and contact sports are not recommended. Before participation women should seek medical advice. Reduce intensity as pregnancy progresses.
Menstruation
Impact on performance differs, some women report difficulties whilst others aren’t affected. Activities should not be avoided unless undue pain or abdominal cramp is experienced. Difficulties should be discussed with a physician.
What role do preventative actions play in enhancing the well being of the athlete?
Physical Preparation
Skill and Technique
The coaches are responsible to teach correct skill and technique to prevent injuries. Especially in contact/collision sports. Boxing, rugby, e.g. correct tackling technique.
Safe Sporting Movement
This means a controlled movement with confidence. Difficult skills should be broken down. Equipment should be used, e.g. gymnastic belts.
Flexibility
Very important in warm up to make muscles more elastic and prevent muscle tearing. Muscles lose elasticity with age.
Endurance
When you are tired, skill level diminishes and injury risk increases. Muscular and CV endurance delays fatigues and loss of technique.
Strength
A well balanced strength program is needed, i.e. agonists and antagonists. Appropriate to the strength needed for a sport, e.g. Rugby, neck strength, Netball. Knee strength.
Sport Specific Requirements
These vary from sport to sport and position to position. Develop specific components as well as total body fitness.
Individual Participants Needs
Specific to injuries, level of fitness, position in team, playing weaknesses. Coaches should cater for all individual needs.
Warm up, Stretching and Warm Down
1 – General body warm up, jogging skipping, increases blood flow, raises muscle temperature.
2 – Stretching, static and PNF, increases elasticity, muscle extensibility.
3 – Calisthenics, push ups, sit ups, strengthens muscles, draws blood from organs to skeletal muscle.
4 – Skill rehearsal, drills and routines, increase agility, game readiness, stay warm.
Cool down - Minimizes muscle stiffness and soreness.
- Helps disperse lactic acid.
- Prevents blood pooling.
Cool down should be low intensity aerobic and some stretching.
Sport Policy and the Sports Environment
Responsibilities of the Club, School, Sports Administrator
Develop policies which reduce the risk of injuries to players, refs, coaches, spectators and other sports staff. Provide safe environment, e.g. fill pot holes. Provide qualified referees and coaches. Provide organized competitions that are challenging, enjoyable and safe. First aid provision.
Rules of Sports and Activities
Rules should be followed to avoid injuries.
Modified Rules for Children
e.g. Auskick, Rooball, T-Ball, Nettaball, Kanga Crciket, Minkey, Mod League. This is for safety, enjoyment and level of fitness. Dieter’s from bad habits. Less players so everyone gets a go. Emphasis is on skills.
Even Competition
Age, weight, size, ability. Prevents injury, promotes participation.
Grounds and Facilities
Even safe playing surface, first aid facilities, clean change rooms, etc.
Protective Equipment
Apparel and Protective Guards
Absorb and deflect a direct blow, e.g. mouth guard.
Deflects a blow and protects, e.g. chest guard.
Limit access and restricts movement, e.g. boot studs, joint guards.
Safe Court and Field Design
e.g. sprung floor in gymnastics, pads on goals in football, fences not being too close.
Safe Playing Equipment
Equipment in good working order. Must be checked, suited for its purpose, fits (children especially.)
Thermoregulation
Temperature Regulation
Thermoregulation is the maintenance of core body temperature within 1` of 37`C
Radiation is the loss of heat in the form of infared rays. The greater the difference between the body’s heat and the environment, the greater the radiated heat loss. (60%)
Conduction is the transfer of heat from a body to an object by contact (3%).
Convection is the transfer of heat by moving fluid. The body will heat up the air around it. (12%)
Evaporation i.e. sweating. It is only effective if the water can evaporate (25%).