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Injuries and the Healing Process

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1 Injuries and the Healing Process
Olympic High School Sports Medicine Chapter 12,13

2 Vocabulary Chapter 13 Osteoblasts Osteoclasts Wolff’s law Callus
RICE Muscle Tendon DOMS Myositis Fasciitis Ectopic calcification Creptitation Synovia Articulation Osteochondrosis Apophysis Osteoblasts Osteoclasts Wolff’s law Callus Mechanoreceptors Muscle guarding Trigger point Open fracture Closed Fracture

3 Types of Injuries Strains/Sprains Contusion
Grade 1- slight stretch but no deformity, mild to mod. Pain, localized swelling Grade 2- some tearing of fibers, mod. Instability, mod. Severe pain, swelling Grade 3- total rupture, major instability, severe pain at first then little or no pain, swelling is great Contusion Bruise, hematoma, ecchymosis Tendinitis: inflammation of tendon Overuse injury, pain, swelling, crepitus Bursitis: inflam. Of bursa Swelling, pain, increased pressure Wound Injuries:blister, abrasion, laceration, skin avulsion, incision, puncture Tenosynovitis:same as tendonitis but inflamed tendon/synovial sheath.

4 Types of Injuries continued: fractures

5 Types of Injuries continued
Muscle Cramps/spasm: muscle contraction/tightness due to fatigue or injury Myositis Ossificans: calcification of muscle due to excessive bleeding. Dislocation: complete displacement of bone with the joint Subluxation: partial displacement of bone with the joint Epiphyseal Injuries: growth plate injuries. Salter fractures for epiphyseal fractures Nerve Injuries: Hypoesthesia: a diminished sense of feeling Hyperesthesia: an increased sense of feeling such as pain or touch Paraesthesia: numbness, prickling, or tingling, which may occur from a direct blow or stretch to an area Kyphosis: round back, forward-thrust head, winged scapulae, flat chest. Tight pectoral muscles Lordosis: sway back or hollow back. Tight lower back muscles with weak abdominal muscles. Lineman or gymnasts most susceptible. Scoliosis: lateral curvature of the spine Genu Valgum: knock knee Genu Varum: bowleg

6 How do injuries happen? What are the possible injuries that can happen in this slide?

7 Mechanical Forces and Strengths
Compression Force: A force that with enough energy crushes tissue. A contusion occurs if too much force is applied Tension Force: a force that pulls and stretches tissue. Sprains/strains, avulsions, ruptures Shearing Force: a force that is transverse to fibers. sprains

8 Example of injuries

9 Pain Two types of soreness
Acute-onset muscle soreness - accompanies fatigue, and is transient muscle pain experienced immediately after exercise Delayed-onset muscle soreness (DOMS) - pain that occurs hours following activity that gradually subsides (pain free 3-4 days later) Potentially caused by slight microtrauma to muscle or connective tissue structures Prevent soreness through gradual build-up of intensity Treat with static or PNF stretching and ice application within hours of insult

10 Muscle Stiffness Does not produce pain
Result of extended period of work Fluid accumulation in muscles, with slow reabsorbtion back into bloodstream, resulting in swollen, shorter, thicker muscles --resistant to stretching. Light activity, motion, massage and passive mobilization assists in reducing stiffness

11 Vocabulary Vasoconstriction Vasodilation Regeneration Phagocytosis
Serum Synthesis/lysis Cryokinetics Modality Conduction Convection Conversion

12 Inflammatory Response
Inflammatory Phase Occurs first for 3-4 days Swelling, redness, pain, heat, loss of function. This occurs to protect the body Acute Inflammation- Before inflammation begins intact blood vessels vasoconstriction up to 10 minutes Then blood coagulation begins to seal broken vessels Then vasodilatation- blood viscosity increases slowing blood flow and swelling then serum seepage min. Phagocytosis starts to clean out debris Internal swelling: 1. Throboplastin is sent 2. Thromboplastin and calcium is sent Thrombin to fibrinogen into final fibrin clot

13 Inflammatory Response
Repair Phase- Fibroplastic(scar formation) Regeneration Regrowth of lost cells Last up to 3 weeks following injury Primary healing- heal around edges Secondary healing – gaps heal toward each other Remodeling Increase scar tissue first 3 weeks Last 3 months to a year Factors that impede healing 1. Extent of the injury 2. Edema/hemorrhage 3. Poor vascular supply 4. Separation of tissue 5. Muscle spasm 6. Atrophy 7. Infection 8. age

14 Pain Perception Pain- Psychological aspects of Pain Referred Pain-
Is described by: burning, sharp, dull, aching, tingling Deep pain is different than superficial pain How Psychological aspects of Pain Must treat the whole athlete Personality differences plays a role in pain perception Referred Pain- Visceral pain has a tendency to radiate and give rise to pain that becomes referred to skin’s surface

15 COLD AND HEAT Types of cold: Physiological effects of cold
Ice bag, ice massage, ice boot, cold whirlpool, ice bucket, chemical spray Physiological effects of cold Decrease in local temperature up to 4” Vasoconstriction of capillaries w/in first min., vasodilation 5 min., vasoconstriction 20 min. (Hunting effect) Decrease local cell metabolism Decrease blood flow Decrease nerve velocity Decrease excitability of muscle Analgesic effect (numb) which will decrease spasm

16 Cold and Heat cont. Types of heat Physiological effects of heat
Conduction-transmission of heat between two objects Convection-heat produced by a moving mass(gas or liquid) Conversion-heat by electrical current Radiation- ultraviolet light Physiological effects of heat Increase elasticity of muscles & tendons Increase blood flow- vasodilation Decrease spasm Increase local cell metabolism Increase excitability of muscle Increase temp. to 3mm depth

17 Indications of heat Indications of cold Contraindications
Post acute phase Decrease spasm Decrease pain Help wound healing Prior to exercise Contraindications Acute injuries Hyper/hypo sensitive to heat Circulatory problems Indications of cold Acute trauma Anti-inflammatory Decrease pain Decrease spasm Post exercise Prior to therapy Contraindications Before or during activities Hyper/hypo sensitive to cold Circulatory inefficiency

18 Different Modalities Heat Therapies Short-wave diathermy: Ultrasound:
High frequency electrical current. Used for: bursitis, capsulitis, osteoarthritis, spasm, strains Heat depth= up to 2 inches Ultrasound: High frequency sound waves causes molecules to vibrate and warm Used for: joint contractures, scar tissue, tendonitis, bursitis, skeletal muscle spasm, and pain Paraffin bath: Hot wax used for extremities especially the hand. Massage Techniques: Effleurage- stroking, Petrissage- kneading, friction-heat, tapotement- percussion, vibration-rapid shaking

19 Contrast Baths and other Modalities
Hot and cold modality Physiological effects: Same as heat/cold Flushing affect. Brings in new material for repair and flushes out edema When should you use contrast bath? When swelling has subsided (48-72 hours) Time interval for treatments 4 min. cold then 1 min hot 4 times end in cold= 24 min. 3 min. cold then 2 min hot 4 times end in cold= 23 min 2 min. cold then 3 min hot 4 times end in hot= 20 min 1 min. cold then 4 min hot 4 times end in hot= 20 min Or 5 min. cold/ 5 min. hot

20 Treatment times and Temperatures
Ice bag, ice boot, ice whirlpool (55-65 degrees) - 20 min. Ice massage 5-10 min. Warm whirlpool ( degrees), moist heat pack –10 min. Ultrasound- 5-7 min. Muscle stim min.

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