3Types of Injuries Strains/Sprains Contusion Grade 1- slight stretch but no deformity, mild to mod. Pain, localized swellingGrade 2- some tearing of fibers, mod. Instability, mod. Severe pain, swellingGrade 3- total rupture, major instability, severe pain at first then little or no pain, swelling is greatContusionBruise, hematoma, ecchymosisTendinitis: inflammation of tendonOveruse injury, pain, swelling, crepitusBursitis: inflam. Of bursaSwelling, pain, increased pressureWound Injuries:blister, abrasion, laceration, skin avulsion, incision, punctureTenosynovitis:same as tendonitis but inflamed tendon/synovial sheath.
5Types of Injuries continued Muscle Cramps/spasm: muscle contraction/tightness due to fatigue or injuryMyositis Ossificans: calcification of muscle due to excessive bleeding.Dislocation: complete displacement of bone with the jointSubluxation: partial displacement of bone with the jointEpiphyseal Injuries: growth plate injuries. Salter fractures for epiphyseal fracturesNerve Injuries:Hypoesthesia: a diminished sense of feelingHyperesthesia: an increased sense of feeling such as pain or touchParaesthesia: numbness, prickling, or tingling, which may occur from a direct blow or stretch to an areaKyphosis: round back, forward-thrust head, winged scapulae, flat chest. Tight pectoral musclesLordosis: sway back or hollow back. Tight lower back muscles with weak abdominal muscles. Lineman or gymnasts most susceptible.Scoliosis: lateral curvature of the spineGenu Valgum: knock kneeGenu Varum: bowleg
6How do injuries happen?What are the possible injuries that can happen in this slide?
7Mechanical Forces and Strengths Compression Force: A force that with enough energy crushes tissue. A contusion occurs if too much force is appliedTension Force: a force that pulls and stretches tissue. Sprains/strains, avulsions, rupturesShearing Force: a force that is transverse to fibers. sprains
9Pain Two types of soreness Acute-onset muscle soreness - accompanies fatigue, and is transient muscle pain experienced immediately after exerciseDelayed-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 structuresPrevent soreness through gradual build-up of intensityTreat with static or PNF stretching and ice application within hours of insult
10Muscle Stiffness Does not produce pain Result of extended period of workFluid 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
12Inflammatory Response Inflammatory PhaseOccurs first for 3-4 daysSwelling, redness, pain, heat, loss of function.This occurs to protect the bodyAcute Inflammation-Before inflammation begins intact blood vessels vasoconstriction up to 10 minutesThen blood coagulation begins to seal broken vesselsThen vasodilatation- blood viscosity increases slowing blood flow and swelling then serum seepage min.Phagocytosis starts to clean out debrisInternal swelling: 1. Throboplastin is sent 2. Thromboplastin and calcium is sent Thrombin to fibrinogen into final fibrin clot
13Inflammatory Response Repair Phase- Fibroplastic(scar formation)RegenerationRegrowth of lost cellsLast up to 3 weeks following injuryPrimary healing- heal around edgesSecondary healing – gaps heal toward each otherRemodelingIncrease scar tissue first 3 weeksLast 3 months to a yearFactors that impede healing1. Extent of the injury2. Edema/hemorrhage3. Poor vascular supply4. Separation of tissue5. Muscle spasm6. Atrophy7. Infection8. age
14Pain Perception Pain- Psychological aspects of Pain Referred Pain- Is described by: burning, sharp, dull, aching, tinglingDeep pain is different than superficial painHowPsychological aspects of PainMust treat the whole athletePersonality differences plays a role in pain perceptionReferred Pain-Visceral pain has a tendency to radiate and give rise to pain that becomes referred to skin’s surface
15COLD AND HEAT Types of cold: Physiological effects of cold Ice bag, ice massage, ice boot, cold whirlpool, ice bucket, chemical sprayPhysiological effects of coldDecrease in local temperature up to 4”Vasoconstriction of capillaries w/in first min., vasodilation 5 min., vasoconstriction 20 min. (Hunting effect)Decrease local cell metabolismDecrease blood flowDecrease nerve velocityDecrease excitability of muscleAnalgesic effect (numb) which will decrease spasm
16Cold and Heat cont. Types of heat Physiological effects of heat Conduction-transmission of heat between two objectsConvection-heat produced by a moving mass(gas or liquid)Conversion-heat by electrical currentRadiation- ultraviolet lightPhysiological effects of heatIncrease elasticity of muscles & tendonsIncrease blood flow- vasodilationDecrease spasmIncrease local cell metabolismIncrease excitability of muscleIncrease temp. to 3mm depth
17Indications of heat Indications of cold Contraindications Post acute phaseDecrease spasmDecrease painHelp wound healingPrior to exerciseContraindicationsAcute injuriesHyper/hypo sensitive to heatCirculatory problemsIndications of coldAcute traumaAnti-inflammatoryDecrease painDecrease spasmPost exercisePrior to therapyContraindicationsBefore or during activitiesHyper/hypo sensitive to coldCirculatory inefficiency
18Different Modalities Heat Therapies Short-wave diathermy: Ultrasound: High frequency electrical current.Used for: bursitis, capsulitis, osteoarthritis, spasm, strainsHeat depth= up to 2 inchesUltrasound:High frequency sound waves causes molecules to vibrate and warmUsed for: joint contractures, scar tissue, tendonitis, bursitis, skeletal muscle spasm, and painParaffin bath:Hot wax used for extremities especially the hand.Massage Techniques:Effleurage- stroking, Petrissage- kneading, friction-heat, tapotement- percussion, vibration-rapid shaking
19Contrast Baths and other Modalities Hot and cold modalityPhysiological effects:Same as heat/coldFlushing affect. Brings in new material for repair and flushes out edemaWhen should you use contrast bath?When swelling has subsided (48-72 hours)Time interval for treatments4 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 min2 min. cold then 3 min hot 4 times end in hot= 20 min1 min. cold then 4 min hot 4 times end in hot= 20 minOr 5 min. cold/ 5 min. hot
20Treatment 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.