Presentation on theme: "What two schools played the first game of football?"— Presentation transcript:
What two schools played the first game of football?
First Game of Football In 1869, the first game played in the United States occurred, between Princeton and Rutgers. This is also often considered to be the first U.S. game of college footballfirst game playedPrinceton Rutgerscollege footbal
Charley Horse (where did the name come from?) Quad Contusion
he term may date back to American slang of the 1880s, possibly from the pitcher Charlie "Old Hoss" Radbourn who is said to have suffered from cramps. [slangpitcherCharlie "Old Hoss" Radbourn [
What is a quadriceps contusion? A quadriceps contusion is one of the more common injuries seen in athletes competing in contact sports and results from a direct blow to the front of the thigh. This type of injury often goes undertreated and may result in serious complications for the athlete.
Two types of Contusions Intramuscular which is a tearing of the muscle within the sheath that surrounds it. This means that the initial bleeding may stop early (within hours) because of increased pressure within the muscle however the fluid is unable to escape as the muscle sheath prevents it. The result is considerable loss of function and pain which can take days or weeks to recover. You are not likely to see any bruising come out with this type - especially in the early stages. Intermuscular which is a tearing of the muscle and part of the sheath surrounding it. This means that the initial bleeding will take longer to stop especially if you do not ice it. However recovery is often faster than intramuscular as the blood and fluids can flow away from the site of injury. You are more likely to see bruising come out with this one.
Deep Quad Contusion Because of the location of the quadriceps, they can be subject to direct blows during sports competition. A deep quadriceps contusion can be one of the most disabling injuries for an athlete because injury to these muscles can severely impact an athlete’s ability to effectively use his/her leg.
Physiological Responses Broken blood vessels resulting in bleeding (hematoma) into the injured area Crushed muscle tissue resulting in hip and knee dysfunction
Myositis Ossificans If there is major untreated and/or unresolved bleeding deep in the muscle tissue, a serious condition known as myositis ossificans can occur. Myositis ossificans is the result of a hematoma within a muscle that calcifies rather than heals. Rather than the body healing the hematoma with fibroblasts (baby collagen fibers), the body lays down baby bone cells resulting in a bony growth deep in the muscle tissue.
Imaging Indications for imaging imaging not necessary if mild contusion and extensor mechanism intact Radiographs plain radiograph to evaluate for myositis ossificans in chronic injuries MRI has the highest sensitivity and specificity for disorders of the quadriceps MRI helpful in moderate to severe contusions or if quadriceps tendon competency in doubt
MO A myositis ossificans located deep within a quadriceps muscle can cause significant pain and disability for the athlete. The specific cause of this occurrence is not known, but there seems to be a correlation between the severity of the quadriceps contusion and the incidence of myositis ossificans.
What are the classifications of quadriceps contusions? Quadriceps contusions can be classified as mild, moderate, and severe. Mild injuries result in mild pain and swelling, but the athlete is able to walk without a limp. Contusions are referred to as mild, moderate or severe determined by the amount of motion of the knee after injury; (mild > 90˚, moderate 45-90˚ and severe < 45˚).
Quad Classifications A moderate muscle contusion results in an increase in bleeding into the muscle tissue and more damage to the actual muscle fibers. The signs and symptoms will be more pronounced including a noticeable limp, more bruising and swelling, and an inability to flex the knee past 90 degrees without significant pain.
Quad Classifcations With a severe contusion, the bleeding may actually track down into the knee area and down in to the lower leg creating extensive discoloration (bruising). Swelling may continue to increase over a 24 hour period resulting in stiffening of the thigh and knee as the effusion increases. Athletes with severe contusions may not be able to bend their knee past 45 degrees and may have significant difficulty walking. These athletes may need to be placed on crutches.
Last, a palpable hematoma may be felt in an athlete with a severe contusion. When the muscle is palpated, a firm mass may be felt (hematoma) with defined borders. This area will be very tender for the athlete so care should be taken when palpating a deep contusion.
Presentation Symptoms pain at anterior thigh Physical examination tenderness at anterior thigh limited active knee flexion due to pain possible knee effusion perform straight leg raise to ensure extensor mechanism is intact test sensory branches of femoral nerve (lateral, intermediate, and medial cutaneous nerves) during evaluation for compartment syndrome
What can I do to prevent a quadriceps contusion? In sports that require protective thigh equipment (football, hockey), athletes should take care in ensuring that protective pads are correctly sized to fit the front of the thigh and that they are correctly positioned prior to competition. However, in most sports, preventing a quadriceps contusion is not possible.
Prevention of Myositis Ossificans The athlete returns to participation too soon The thigh is re-injured before healing occurs Massage or heat are applied during the treatment phase The hematoma is improperly treated
Initial Treatment Immediately after the injury apply ice to the injured area and place the muscle on a light stretch (90˚) for 20 minutes Repeat the “ice-on-stretch” 1–2 times every 2 hours for the first 48–72 hours
Treatment Unlike most injuries, a quadriceps contusion needs to be treated with unique positioning of the athlete. The athlete needs to be positioned with the knee bent in maximal flexion while the ice pack is applied.ice pack
Treatment The athlete should be immediately pulled from participation. Continued activity will result in increased bleeding into the thigh because the heart is pumping harder and faster during physical exertion. This may result in prolonged rehabilitation to remove the resulting hematoma and return function to the leg.
Treatment After the ice treatment is completed, a six inch compression wrap should be applied to the thigh using slightly overlapping circles beginning at the knee and working up the thigh. The compression wrap should be snug, but not too tight. The wrap will provide a mechanical barrier to help keep the swelling out of the muscle tissue.
Treatment If the athlete has pain while walking and is limping, the athlete should be placed on crutches and be non-weight bearing for the first 24 – 48 hours. Pushing through pain is not an option with this type of injury because of the seriousness of the complications. Athletes should be encouraged to continue the use of crutches moving from non-weight bearing to partial-weight bearing as pain diminishes.
Regaining Range of Motion and Strength As the pain begins to diminish and the muscle begins to heal (usually after 48 hours), gentle range of motion exercises and muscle setting exercises can be started. The athlete should be careful not to overstretch the muscle (move through pain) or push too hard to regain the range of motion of the knee.
Treatment Quadriceps muscle setting exercises are isometric contractions (no movement of the knee or hip). The athlete is asked to tighten his/her quadriceps with the knee in an extended position. The athlete should hold the contraction for five to ten seconds and repeat ten times every hour.
Treatment It is important that the athlete understand that he/she not contract the quadriceps past the point of pain. Early in the rehabilitation, the athlete might only be able to contract the quadriceps at 50% intensity. As the muscle heals, the athlete can increase his/her contraction intensity as able.
Treatment the athlete can complete a quadriceps muscle set at full intensity without pain, the athlete can then progress to straight leg raises. These are performed with the athlete lying on a table, unaffected knee bent, upper body resting on elbows, and injured leg straight. The athlete then contracts the injured quadriceps, lifts the leg equal to the height of the uninjured knee, and then slowly returns the injured leg to its resting position.
Treatment The athlete can initially perform 3 sets of 5 repetitions of these exercises and gradually work up to 3 sets of 10 repetitions. When the athlete can perform 30 pain free repetitions, the athlete can add increasing increments of ankle weights for added resistance.
Functional Sport-Specific Training The final component in any rehabilitation program is the addition of sport specific exercises. These are exercises specifically designed to put the athlete through the skills and demands of his/her sport in a progressive fashion so as to ensure that the muscle has completed healed and that the athlete has the confidence necessary to return to sport.
Fundamental Sports Specific Training The athlete’s sport is analyzed for a breakdown of fundamental skills. The athlete is then asked to perform these skills beginning at 50% intensity. As the athlete continues through the list of basic skills, the intensity is gradually increased incrementally over time until the athlete performs the skills full out. Depending on the classification of the injury, this phase may take anywhere from several days to several weeks.
When can I return to play? Pain free full range of motion of the hip and knee Pain free full strength equal to the uninjured quadriceps Completion of sport-specific functional training Protective padding of the quadriceps if appropriate
Treatment Once the athlete has full pain-free range of motion of the leg and strength equal to the uninjured quadriceps, the athlete may begin functional sport specific exercises in order to prepare the athlete to return to sports participation.
Operative thigh fasciotomies if indicated for compartment syndrome