Chapter overview Classifying and managing injuries Classifying sports injuries page 259Classifying sports injuries Soft-tissue injuries page 263Soft-tissue injuries Hard-tissue injuries page 267Hard-tissue injuries First aid page 270First aid Injury rehabilitation Rehabilitation page 276Rehabilitation Returning to play page 282Returning to play Now that you’ve finished … answers
If injuries are classified according to their cause, the three categories are: direct injury indirect injury overuse injury. If injuries are classified according to the type of body tissue damaged, the two categories are: soft-tissue injury hard-tissue injury.
Direct injury Caused by an external blow or force. Examples of injuries that result from external forces include haematomas (corks) and bruises, joint and ligament damage, dislocations and bone fractures.
Indirect injury Can occur due to a collision, but differs from direct injuries because the actual injury is some distance from the impact site. E.g. falling on outstretched hand and dislocating shoulder Can occur from the actions of the athlete. Often the result of overstretching, poor technique, fatigue or lack of fitness; e.g., muscle strains and tears, and ligament sprains
Overuse injury Occur when excessive and repetitive force is placed on the bones and connective tissues of the body. Often occur when there is a change in training practices Examples of injuries that result from repetitive forces are stress fractures (small cracks in the bone) and tendonitis (inflammation of a tendon). Personal reflection Have you ever had an overuse injury? What caused it?
Table 7.1Overuse injuries InjurySymptoms and signs Possible causesManagement Shin sorenessTenderness Pain in shins Pain increases by running and jumping Swelling Increased activity Poor footwear Posture imbalance Muscle imbalance Decrease painful activity RICER Physiotherapy Correct footwear Orthotic control Knee painPain around knee Pain increased by sport, stairs, sitting, hills Swelling Discolouration Increased activity Posture imbalance Poor footwear Muscle imbalance Growth spurt Decrease activity RICER Physiotherapy Tape Correct footwear Orthotic control Heel painTenderness over heel Pain increased by running, jumping Tight calf muscles Growth spurt Poor footwear Decrease activity RICER Physiotherapy Stretching program Correct footwear Orthotic control
Table 7.1Overuse injuries (cont.) InjurySymptoms and signs Possible causesManagement Shoulder painPain on certain movements Reduced movement Local tenderness Increased activity, e.g. swimming Poor technique, e.g. swimming, pitching, serving Decrease activity RICER Physiotherapy Stretching program Exercises Modify activity Elbow painPain in and around elbow Pain increased by certain activities, e.g. shaking, lifting, gripping Jarring Increased activity e.g. golf, tennis Muscle imbalance Poor technique Change of grip Lack of control Decrease activity RICER Physiotherapy Stretching program Elbow brace Modify technique Source: Australian Coaching Council Inc.
Soft-tissue injury Soft-tissue injuries are the most common sports injuries. They include: skin injuries—abrasions, lacerations and blisters muscle injuries—bruises (contusions), and tears or strains of muscle fibres tendon injuries—tears or strains of tendon fibres and inflammation (tendonitis) ligament injuries—sprains and tears of ligament fibres.
Hard-tissue injury Those involving damage to the bones. Range from severe fractures and joint dislocations to bruising of the bone
Secondary injury Occurs as a result of a previous injury being poorly treated or not being fully healed.
Table 7.2Injury incidence in AFL (2009 season) Body areaInjury type New injuries per club per season Head/neckConcussion0.5 Facial fractures0.5 Neck sprains0.1 Other head/neck injuries0.1 Shoulder/arm/elbowShoulder sprains and dislocations1.3 Acromio-clavicular joint injuries0.5 Fractured clavicles0.2 Elbow sprains or joint injuries0.2 Other shoulder/arm/elbow injuries0.1 Forearm/wrist/handForearm/wrist/hand fractures1.1 Other forearm/wrist/hand injuries0.4 Trunk/backRib and chest wall injuries0.3 Lumbar and thoracic spine injuries1.4 Other buttock/back/trunk injuries0.5 Hip/groin/thighGroin strains/osteitis pubis3.2 Hamstring strains7.1 Quadriceps strains2.2 Thigh and hip haematomas1.0 Other hip/groin/thigh injuries, including hip joint1.0
Table 7.2Injury incidence in AFL (cont.) Body areaInjury type New injuries per club per season KneeKnee anterior cruciate ligament0.6 Knee medial cruciate ligament0.7 Knee posterior cruciate ligament0.3 Knee cartilage1.9 Patella injuries0.2 Knee tendon injuries0.5 Other knee injuries1.0 Shin/ankle/footAnkle joint sprains2.6 Calf strains1.3 Achilles tendon injuries0.6 Leg and foot fractures1.0 Leg and foot stress fractures0.9 Other leg/foot/ankle injuries1.5 OtherMedical illnesses2.9 Non-football injuries0.1 New injuries/club/season 37.6 Source: J Orchard and H Seward 2010, 2009 Injury Report, Australian Football League, Melbourne
Types of soft-tissue injuries Tears, sprains and contusions Skin abrasions, lacerations and blisters
Managing soft-tissue injuries 1. RICER: rest, ice, compression, elevation and referral Personal reflection Have you used RICER to successfully manage a soft-tissue injury?
2. Treating skin injuries For most skin injuries, such as abrasions, lacerations and blisters, seven management steps should be followed: 1. Reduce the dangers of infection (for example, by wearing gloves). 2. Control bleeding with rest, pressure and elevation. 3. Assess the severity of the wound. 4. Clean the wound using clean water, saline solution or a diluted antiseptic. 5. Apply an antiseptic to the wound (for example, Savlon or Betadine) after ensuring that the person is not allergic to the antiseptic to be used. 6. Dress the wound with a sterile pad and bandage. 7. If necessary, refer the person to medical attention.
Types of hard-tissue injuries 1. Fracture: a break in a bone 2. Dislocations: injuries to joints where one bone is displaced from another. Fractures are classified into three types: simple (left), compound (centre) and complicated (right).
Managing hard-tissue injuries 1. Medical treatment: hard-tissue injuries can be accompanied by significant damage to muscle, blood vessels, surrounding organs and nerves. 2. Immobilisation: minimising the movement of the joints above and below the site of the injury
Table 7.3Approaching injured athletes—a summary StepAction 1.DangerControl dangers, then assess injured athlete 2.Life threatUse DRABCD 3.Initial injury assessmentUse STOP 4.Detailed injury assessment Use TOTAPS 5.Initial managementManage appropriately Refer to health professional Source: J Orchard and H Seward 2010, 2009 Injury Report, Australian Football League, Melbourne
DRABCD The six letters of the abbreviation stand for: danger response airway breathing compressions defibrillation (if available). A critical step in assessing injury is determining consciousness.
STOP A fast method for assessing injuries on a field. STOP stands for: Stop Talk Observe Prevent
TOTAPS Used to provide information about the extent of the injury. TOTAPS stands for: Touch the injured site to help determine the seriousness of the injury. talk observe touch active movement passive movement skills test
Progressive mobilisation The freeing of hindered joints to allow improved motion. Can be achieved by the athlete carefully exercising the injured joint or by another person manipulating the injured part. The range of movement is gradually increased over time until the full range of movement is restored. Should begin soon after the injury because inactivity can increase the formation of scar tissue.
Graduated exercise 1.Stretching improves rehabilitation by: reducing muscle tension increasing circulation increasing muscle and tendon length increasing the range of motion. 2.Muscle conditioning: Even if the injured area is immobilised (for example, in a cast or brace) a program should be designed to prevent muscle atrophy (wasting of muscle tissue). 3.Total body fitness: The choice of exercises to maintain total body fitness will depend on the type and severity of injury and the athlete’s sport.
Retraining for skills Timing, speed and coordination are affected by rest. Returning to competition too early would risk re-injury because their movement skills, game skills and confidence have not been re-established. Retraining must be aimed at re-establishing all skills in an environment that is as close as possible to competition conditions.
Heat treatment Heat is applied to increase circulation, either in the body generally or in a particular area. The body’s general physiological responses to heat are: decreased pain increased ability to stretch relaxation increased blood flow reduced joint stiffness decreased muscle spasm increased inflammatory response (more blood and fluid flows to the area) increased tissue healing. Heat should not be applied to acute injuries.
Cold treatment Cold is commonly applied to an injury: during the initial phase of injury treatment after therapeutic exercise of injured sites. Cold applied to an injury has the physiological effects of decreasing: swelling circulation to the injured site acute inflammation pain and discomfort muscle spasm tissue metabolism.
Assessing readiness to return to play Must avoid pressure to participate and first assess: 1. Physical readiness: being pain free and having mobility restored to the injured area. 2. Psychological readiness: monitoring anxiety levels and assessing behaviour of athlete
Monitoring progress Athletes’ physical and psychological condition should be monitored when they return to play. This might involve: observing the athlete’s performance discussing progress with the athlete conducting ongoing testing (comparing test results pre-injury with current results) using performance-evaluation techniques.
Warm-ups after injury Athletes returning to play may require: Longer, harder or more specific warm-up and stretching routine than other athletes. Extra care the injury site and surrounding tissues to ensure adequate flexibility, blood flow and readiness to perform.
Return-to-play policies Return-to-play policies, procedures and guidelines vary depending on the sport. Decisions about readiness to play may be determined by a particular sport’s governing organisation or be left to the discretion of individual sporting clubs.
1. Describe practices that should be avoided after a soft-tissue injury. During the first two to three days after a soft-tissue injury, certain actions must be avoided. These include applying heat (for example, hot liniments, spas, saunas and hot baths), drinking alcohol, physical activity and massage. These actions all increase blood flow and therefore swelling.
2. Outline the procedure for the immediate management of skin injuries. For most skin injuries, such as abrasions, lacerations and blisters, seven management steps should be followed: 1.Reduce the dangers of infection (for example, by wearing gloves). 2.Control bleeding with rest, pressure and elevation. 3.Assess the severity of the wound. 4.Clean the wound using clean water, saline solution or a diluted antiseptic. 5.Apply an antiseptic to the wound (for example, Savlon or Betadine) after ensuring that the person is not allergic to the antiseptic to be used. 6.Dress the wound with a sterile pad and bandage. 7.If necessary, refer the person to medical attention.
3. Explain the difference between the first aid assessment of sporting injuries and their long-term management. First aid aims to: treat unconscious casualties provide information about the extent of an injury. provide initial pain relief and treatment helps to indicate whether the person should be permitted to continue a game Finally, first aid determines if the person should be given professional medical help. It is a professional medical practitioner who determines what long-term management is required. The initial stages of assessment and first aid can play a large part in the long-term successful recovery of an injury.
4. Do some research to discover the most common injuries that occur in your chosen sport. Create an informative brochure for athletes and coaches. In your brochure, you should summarise the: a latest injury statistics b classification of injuries sustained c primary causes of injury d preventative methods. Your brochure should include diagrams and graphs to represent the statistics you find. Answers will vary.
5. Compile a media file of articles about injuries sustained by elite athletes. For each injury: a classify it by cause and tissue type b outline relevant management procedures. Answers will vary.
6. Create a short film of the management procedure for soft-tissue injuries and hard-issue injuries. Answers will vary.
7. Contrast the management methods used to treat soft-tissue injuries and hard-tissue injuries. Soft-tissue injuries are managed using the RICER procedure, which recommends rest, ice, compression, elevation and referral (also see answer to question 2). Hard-tissue injuries are managed by immobilising the injured site.
8. Describe the inflammatory response and the role it plays in injury rehabilitation. The acute inflammatory phase, during the first 24 to 72 hours after injury, is the initial stage of repair of body tissue. The body’s immediate response to injury is to increase the flow of blood and other fluids to the injured site. If blood vessels at the site are damaged, there will also be direct bleeding into the surrounding tissue. The accumulation of fluid in the area causes an increase in pressure, which produces pain.
9. Discuss each step of the TOTAPS procedure and the role it plays in assessing a sporting injury. 1.Talk—ask questions to gather information about the cause, nature and site of injury 2.Observe—examine the site of the injury to look for deformity, swelling and redness 3.Touch—feel the site of the injury (if there is no obvious deformity or the athlete is not especially distressed) and compare with the corresponding site on the other side of the body. Note any differences in bone shape and skin temperature. 4.Active movement—If there is no evidence of a fracture or dislocation, ask the athlete to try to move the injured part and observe the degree of pain. 5.Passive movement—First aider moves the athlete’s injured body part to determine how much pain-free movement is possible 6.Skills test—decide if the athlete can return to play by having them perform movements similar to those required in the activity to be resumed.
10. Justify the four rehabilitation procedures commonly used after sporting injuries. Progressive mobilisation—necessary because the range of movement is gradually increased over time until the full range of movement is restored. Mobilisation of the injured part should begin soon after the injury because inactivity can increase the formation of scar tissue. Graduated exercise—necessary to reduce muscle tension, increase circulation, increase muscle and tendon length and increase the range of motion. Retraining for skills—even though they might have a full range of movement and flexibility, strength and fitness, if athletes were to return to competition at this stage they would risk re-injury because their movement skills, game skills and confidence have not been re-established. Timing, speed and coordination are affected by rest. To prepare for the physical and psychological demands of competition, the athlete must \ undertake active retraining. Heat and cold are used to break down the body’s responses to an injury and increase the body’s healing responses.
11. Outline what may determine whether a player is psychologically ready to return to play. There is no formal model in place to determine an athlete’s psychological readiness. However, coaches, teachers and medical professionals should discuss with athletes their readiness and observe their behaviour in order to make a decision.
12. Discuss the possible consequences for an athlete who returns to play prematurely. If an athlete returns prematurely after injury it might cause the injury to become worse. This will extend the recovery time, and the athlete ends up spending more time out of action.