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Human Kinetics 361 Introduction to Athletic Training.

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Presentation on theme: "Human Kinetics 361 Introduction to Athletic Training."— Presentation transcript:

1

2 Human Kinetics 361 Introduction to Athletic Training

3 Objectives: zTo enable students to understand the mechanism and results of injury to the athlete through a 3-dimensional concept of anatomy. zTo enable students to accurately assess the acute athletic injury. zTo appreciate the importance of prevention

4 Approach to each topic: zStabilization of the joint - bony, static or dynamic zMechanisms of injury zTreatment of the acute injury zCommon injuries of the various regions of the body.

5 How to be successful in HKIN 361 zYou need to create a 3-dimensional model of each region in your mind. zYou need the anatomy background to do this. Bone up!! zYou need to be able to make it ‘work’ zYou cannot memorize and regurgitate zYou need to understand and solve

6 A 3-D model

7 zPreliminary Topics

8 Legal Issues: zLiability - negligence A. from Errors of Omission or not doing something a reasonably prudent person would have done e.g.. Not sustaining vital organs not withdrawing an injured athlete B. from Errors of Commission or doing something a reasonably prudent person would not have done

9 Legal Issues Always: 4Err on the side of caution 4If in doubt, don’t 4Attend to every injury!! 4Keep records of everything 4Carry/dispense no medications 4Require MD note after concussion

10 Legal Issues NEVER Diagnose an injury. Only a MD can do this. YOU can only assess, the injury, which means you should … ALWAYS ….refer the injury for diagnosis!

11 Legal Issues zInformed Consent vs waiver yMust explain inherent dangers of sport yMust explain the steps toward proper instruction, including videos, posters etc. yMust require athlete adherence yMust require signature of athlete and BOTH parents. yMust be Dated

12 Ethics zTHE INJURED PLAYER zTHE INHERENT DANGER OF DRILLS zREINFORCEMENT OF ILLEGAL OR UNSAFE ACTS zMUSCULOSKELETAL IMMATURITY zCOACH vs TRAINER

13 Preseason Physical zA.History xPrior injuries/surgery xserious illnesses/conditions xany prescribed R x zB.Strength xhigh school xcollege xclub level

14 Contraindications to Participation in Collision Sports zOne kidney, eye zheart disease, congenital abnormality zrespiratory disorders (unless controlled) zinfectious/contagious skin disorders zhepatomegaly zhaemophilia zsplenomegaly zmusculoskeletal inadequacy

15 Physiology of Trauma The information on capillary pressures that follows is based on mean values, and may differ from reported pressures from specific areas of a capillary. The numbers are less important than the concepts that will be covered.

16 Physiology of Trauma: Maintenance of Circulatory Volume zThe spaces between the epithelial cells of the capillary wall are such that they prevent the blood cells and larger fat and protein molecules from escaping, while allowing the fluids and smaller nutrient molecules to pass into the interstitial space (at the arteriole end) zAs fluid leaves, the conc. Of the plasma increases within the capillary, which increases conc. gradient, (osmotic gradient), and fluids are pulled back into the capillaries (at the venule end)

17 The Pressure Systems zAt the arteriole end, nutrients and oxygen are supplied to the interstitial space via fluids pushed out of the capillaries by Hydrostatic Pressure zAt the venule end, the fluids return to the circulatory system through an Osmotic Gradient Osmotic press. Hydrostatic press.

18 HOMEOSTASIS zTo maintain circulatory volume, the pressures should be equal: – internal press --external press = net press. zHydrostatic:17mm-6.3mm23.3mm zOsmotic :28.5mm5.5mm 23.0mm Net filtration:0.3 mm

19 PHYSIOLOGY OF TRAUMA Types of Injury 1.Acute: caused by macrotrauma, usually a single insult. Presence of exudate 2.Subacute: usually hours after acute trauma. Haematoma stabilized, ecchymosis. 3.Chronic: caused by repetitive microtrauma. Presence of transudate.

20 PHYSIOLOGY OF TRAUMA the inflammatory response zWhen insulted, the body has protective and regenerative mechanisms instigated through the release of chemical mediators. These lead to the INFLAMMATORY RESPONSE zSome insults are great enough to cause disruption of the capillary membrane leading to blood loss into the interstitial space

21 Inflammatory Response #1: Macrotrauma zPhysical damage to the capillary wall will result in loss of plasma solids into the interstitial space ( exudate ), resulting in swelling (edema). and discolouration (ecchymosis)

22 Inflammatory Response #1: Macrotrauma

23 Inflammatory Response #2: Microtrauma zWhen the normal capillary (A) is dilated from the effects of chemical mediators (B) such as histamine and bradykinin, the space between the epithelial cells enlarges and allows the smaller plasma solids to escape into the interstitial space. A B

24 Inflammatory Response #2: Microtrauma zThis upsets the pressure equilibrium by decreasing the osmotic gradient. This leads to fluid being left outside the capillary (transudate)– which leads to swelling (edema) but NO discolouration. A B

25 The Effects of Edema- transudate zSwelling znecrotic debris zpain zspasm zreduced joint motion zsecondary hypoxic tissue necrosis

26 The Effects of Edema Exudate zSwelling znecrotic debris zpain zspasm zreduced joint motion zsecondary hypoxic tissue necrosis

27 Effects of Edema -healing by 2nd intention zSwelling pushes the ligament ends away from each other. zHealing occurs with a block of scar tissue zresults in permanent joint laxity

28 Effects of Edema - healing by 1st intention zIf edema is controlled, the ligament ends will heal with minimal scarring and minimal increase in joint laxity

29 Reducing the Extent of Edema... zInhibits the size of necrotic debris zreduces 2ndary hypoxic tissue necrosis zfacilitates healing by 1st intention zreduces pain zmaintains joint mobility and function

30 Acute Treatment zIce : DECREASES PAIN,SPASTICITY,LOCAL BLOOD FLOW zCompression : reduces edema zElevation : assist lymphatic draining zRestricted Movement collagen formation zReferral

31 Healing

32 SHOCK A potentially fatal situation that can occur relative easily in Sport. It is the loss of circulatory volume from any one of a number of causes

33 SHOCK

34 SHOCK - predisposition zExtreme fatigue zExtreme dehydration zhigh levels of anxiety zillness

35 SHOCK - causes zExtreme blood loss zextreme pain zpsychological trauma

36 SHOCK - Tx

37 Musculo-skeletal Exam zPrimary Survey yA irway yB reathing yC irculation yD eadly bleeding

38 Musculo-skeletal Exam zPrimary Survey zImperative to have current CPR and First Aid to work with athletes.

39 Muscuolo-skeletal Exam zSecondary Survey zH istory zO bservation zP alpation zE valuation of Function / zS elective tissue tensions

40 Muscuolo-skeletal Exam zSecondary Survey yShould be done asap xTo reduce false-negatives xTo reduce false-positives yCalm the athlete. yDon’t be rushed. yPain is better than no pain!!

41 Muscuolo-skeletal Exam zSecondary Survey – REMEMBER… yDO NOT: xdiagnose the injury xadminister any medications (exceptions) xIf in DOUBT,( DON’T !!!) yDO: x follow MD or PT instructions xTreat every injury as serious! xLiaise with MD & PT re: return to activity (RTA)

42 The ANKLE - anatomy zThe Joints zcrural joint 1.tibiofibular jt. 2.Talotibial jt 3.talofibular jt

43 The ANKLE - anatomy zThe Joints ysubtalar joint,

44 The ANKLE - anatomy zThe Joints ymidtarsal joint

45 The ANKLE -stabilization zBone zligament (static) zmusculo- tendinous (dynamic)

46 The ANKLE -stabilization zBone zligament (static) zmusculo- tendinous (dynamic)

47 The ANKLE -static stabilization zBone zligament (lat.) 1.Ant. Tibiofibular lig. 2.Ant. Talofib. Lig. 3.Calcaneofib. Lig. 4.Lat. Talocalcaneal lig. zmusculo- tendinous

48 The ANKLE -static stabilization zBone zligament (medial) 1.Deltoid lig. (3 directional fibres) 2.Spring lig. 3.Short plantar lig. zmusculo- tendinous

49 The ANKLE -static stabilization zBone zligament (ant.) 1.Anterior tibiofibular lig. 2.Called ‘syndesmosis jt’ 3.Distal & proximal 4.Diastasis of…. zmusculo- tendinous (dynamic)

50 The ANKLE - dynamic stabilization zBone zligament (static) zmusculo- tendinous (dynamic)

51

52

53 ANTERIOR STABILITY zBone: wide margin of Talus (very strong) zStatic:joint capsule (weak) zDynamic: Anterior compartment muscles, &peroneus tertius m.(strong)

54 LATERAL STABILITY zBone: lateral maleolus (strong) zStatic:ATFL, calcanealfibular lig (weak), jt capsule (weak). zDynamic: Peroneus brevis m., Peroneus longus m. (very weak)

55 POSTERIOR STABILITY zBone: Nothing zStatic:posterior capsule (weak) zDynamic: Triceps surae (very strong)

56 MEDIAL STABILITY zBone: Medial malleolus (strong) zStatic:Deltoid lig. (very strong) zDynamic: Medial flexor group, Tibialis Anterior m. (very strong)

57 THE FOOT - anatomy zCavus Foot yhigh arched ypermanently supinated

58 THE FOOT - anatomy zPlanus Foot yflat foot yexcessively pronated 1.Functional or 2.Structural pes planus

59 The FOOT - biomechanics zHeel plant ysubtalar jt locked yfoot supinated yshock delivered up calcaneus

60 The FOOT - biomechanics zMidstance ysubtalar/midtarsal jts. unlock yfoot pronates yshock absorbed

61 The FOOT - biomechanics zToe off ysubtalar/midtarsal jts. Locks again yfoot supinates yprovides rigid lever for propulsion

62 The FOOT - biomechanics zExcessive Pronation yCauses the sustentaculum tali to rotate away from the talus. yThe talus, unsupported, drop forward and medially. yThe talus falling out of the crural jt causes internal tibial torsion. yThis causes mal-alignment at knee, or yInternal torsdion of femur …..

63 The ANKLE - mechanism of injury zINVERSION

64

65 the ANKLE - MECHANISMS OF INJURY zEVERSION y15% or less

66 the ANKLE - MECHANISMS OF INJURY zWhat can we say about this injury? zWhere is the initial damage? zWhat causes the purple at the bottom? zNotice edema at toes.

67 the ANKLE - MECHANISMS OF INJURY zHYPERDORSIFLEXION

68 the ANKLE - MECHANISMS OF INJURY zHYPERPLANTARFLEXION

69 The ANKLE SPRAIN - grades zGrade I yno differential laxity ypain +1 yswelling +1 yRTA 1-2 weeks zGrade II ylaxity ypain yswelling (but variable) yRTA weeks zGrade III yno end point ypain -ve yswelling +3 yRTA months

70 Hallux Valgus zMechanism: yvalgus displacement of 1st MTP jt. zCause: ygenetic ymuscle imbalance yshoe fit zTreatment (TX) ytaping ymuscular control

71 Hallux Valgus zMechanism: yvalgus displacement of 1st MTP jt. zCause: ygenetic ymuscle imbalance yshoe fit zTreatment (TX) ytaping ymuscular control

72 Hallux Valgus zMechanism: yvalgus displacement of 1st MTP jt. zCause: ygenetic ymuscle imbalance yshoe fit zTreatment (TX) ytaping ymuscular control

73 Morton’s Neuroma zMechanism: ycompression of nerve body zCause: yshoe fit ( too narrow) zTreatment (TX) ybare feet ywide forefoot shoes ysurgery

74 Morton Toe zMzMx: yeyelongated 2nd metatarsal yCyCan cause sesamoiditis zCzCause: ygygenetic zTzTX: ynynothing except proper fit

75 Claw toes zMechanism: yjt. Contracture of D.I.P. zCause: yshoe too short ycavus foot zTreatment (TX) ystretching ycorrect shoe fit

76 Tennis Toe zMx: yshear across the unguum zCause: yshoes too short or long ypoor toe hygiene zTx: yshoe fit yHygiene

77 Ingrown Toe-nail zMx: ylateral growth of nail zCause: ypoor hygiene zTx: yV-cut in nail yExcise nail

78 Ingrown Toe-nail Tx. 1 2

79 Astro Toe zMx: ysubperiosteal haematoma zCause: ycontusion to the 1st MTP joint zTx: yastro pads ymore forefoot cushion yRelieve pressure

80 Astro Toe zMx: ysubperiosteal haematoma zCause: ycontusion to the 1st MTP joint zTx: yastro pads ymore forefoot cushion yRelieve pressure

81 Heel Bruise zMx: ysubperiosteal haematoma zCause: ycontusion to the calcaneal tuberosity zTx: yheel pads (bilateral)

82 Runner’s Bump zMx: yosteoblastic activity zCause: ypressure to the posterior aspect of the calcaneus zTx: yfelt donut

83 Plantar Fasciitis zMx: yexcessive tension on the plantar fascia zCause: yexcessive pronation zTx: yarch support yintrinsic muscles

84 Achilles Tendonitis zMx: ytraction forces on the tendon zCause: yexcessive pronation yuphill running ycavus foot zTx: ybilateral heel lifts yRx, S & S

85 Achilles Tendon Rupture zMx: yeccentric contraction zCause: ylanding from dismount zTx: ysurgery

86 Achilles Tendon Rupture zMx: yeccentric contraction zCause: ylanding from dismount zTx: ysurgery

87 Achilles Tendon Rupture zMx: yeccentric contraction zCause: ylanding from dismount zTx: ysurgery

88 Fractures - styloid avulsion zMx: yeccentric contraction of peroneals zCause: yplantarflexion + inversion zTx: ysurgery

89 Fractures - metatarsal zMx: yaxial load ytransverse load zCause: ykicking something ygetting stepped on zTx: yO.R.I.F.

90 Fractures - Malleolar zMx: yavulsion ycompression zCause: yextreme inversion yextreme eversion zTx: ysurgery

91 Fractures - Maisonneuve zMx: ytransverse compression of fibula zCause: ysliding tackle ykick yextreme inversion zTx: ysurgery, if displaced

92 Lower Leg Problems zSHIN SPLINTS yCHRONIC Compartment Syndrome yACUTE Compartment Syndrome yTibial Stress Syndrome yinterosseous membrane inflammation

93 Compartment Syndromes zCompartments yAnterior xext. hallucis longus xExt. digitorum longus xTibialis Anterior ydeep post. x Flex hallucis longus xflex digitorum longus xtibialis posterior

94 Compartments ysuperficial posterior. xGasroc xsoleus xplantaris yperoneal xbrevis xlongus

95 Compartment Syndromes Acute zMx. yIntrafascial swelling zCause: yacute trauma ykick to anterolateral aspect of the leg z Sx. yloss of motor function ypain ysymptoms WORSEN with cessation of X’s yTX. yCRISIS !

96 Compartment Syndromes c hronic zMx. yIntrafascial swelling zCause: yrapid hypertrophy yinflammatory response zTX. yRest, Rx, S & S yBiomx z Sx. yloss of motor function ypain ysymptoms relieved with cessation of X’s yabnormally elevated intrafascial pressure after cessation of exercise (5 min.)

97 Tibial Stress Syndrome zMx. yStress fx to the lower 1/3 of tibia yinternal tibial torsion zCause yexcessive pronation ycavus foot-force dispersion z Sx. yPain over lower 1/3 yconstant irritation yexacerbated with exercise ypalpable bump at fx z Tx. yRest until 10 days painfree. ybiomx

98 Tibial Stress Syndrome

99 Other Fractures zCall for paramedic help zsplint and mobilize to emergency

100 Other Fractures zCall for paramedic help zsplint and mobilize to emergency room

101 Other Fractures zCall for paramedic help zsplint and mobilize to emergency room

102 Other Fractures zCall for paramedic help zsplint and mobilize to emergency room

103

104 The Knee

105 KNEE - Anatomy zStabilization: yBoney - none ystatic : xcollaterals xcruciates xjoint capsule

106 KNEE - Anatomy zStabilization: ydynamic xextensors xflexors xpes anserinus xgastrocnemius

107 KNEE - Anatomy zStabilization: ydynamic xextensors xflexors xpes anserinus xgastrocnemius

108 Knee - menisci zCadaveric picture Of menisci zCushions shock zFemoral stability zBlood supply

109 KNEE - Damaged menisci

110 Knee stability zFermoral condyles

111 Knee stability zPatellar surface

112 Knee stability zPatella Alta

113 Knee - Anatomy: Collaterals zM.C.L.

114 Knee - collateral ligs. zL.C.L.

115 KNEE - Anatomy: cruciates

116 Knee -Injuries zACL Rupture yMx: xanterior translation xexcessive valgus stress xexcess internal tibial rotation xexcess external tibial rotation xhyperextension with int.rot. ySx: x+ve drawer/Lachman xno end-point xswelling: 3+ xpain:variable

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118

119 Knee - injuries Posterior cruciate rupture zMx: yPosterior translation of tibiia w.r.t. femur zSx: yExcessive posterior drawer yinstability zTx: yR.I.C.E. yrefer

120 Knee -Injuries zMCL Sprain yMx: xexcessive valgus stress xexcess external tibial rotation ySx: x+ve valgus stress test x+ve Apley distraction test xno end-point xswelling: 3+ xpain:variable

121 Knee -Injuries zLCL Sprain yMx: xexcessive varus stress xexcess internal tibial rotation ySx: x+ve varus stress test x+ve Apley distraction test xno end-point xswelling: 3+ xpain:variable

122 Knee - injuries Subpatellar Pain Syndrome zMx: ylateral tracking of patella zCause: yinsufficient vastus medialis m. yproblematic Q angle zSx: ysubpatellar crepitus ysubpatellar pain ytheatre sign

123 Knee - injuries Subpatellar Pain Syndrome zQ angle measurement

124 Knee - injuries Subpatellar Pain Syndrome zTx: ystrengthen V. Medialis m. ypatellar stabilization xbraces xsurgery

125 Knee - injuries Jumper’s Knee zMx: yeccentric contractile force of quads ymicrotrauma to insertion of quadriceps tendon of infrapatellar ligament. zCause: yrepetitive jumping (V-ball, B-ball) yrepetitive squats with weight (power cleans) yrepetitive push-off (skate-boarding) ymost prevalent with post adolescence

126 Knee Injuries: jumper’s knee

127 Knee - injuries Jumper’s Knee zSx: ypain at inferior or superior pole of the patella. xAggravated with exercise zTx: ydecrease activity to tolerance level yRx ystrength and flexibility program xeccentric drop program

128 Knee - injuries Tibial tubercle traumatic apophysitis, or??? zMx: ydistraction force on tibial tubercle xrepetitive concentric contractions xrepetitive eccentric contraction zCause: yjumping, skateboarding, dismounts

129 Knee - injuries Tibial tubercle traumatic apophysitis zSx: yPain at Tibial tubercle, exacerbated with exercise ypain with any blunt trauma to Tibial tubercle. zTx: regulate exercise to tolerance levels, protect the tibial tubercle

130 Knee - injuries prepatellar bursitis zMx: yrepetitive microtrauma ysingle insult blunt trauma zCause: ykick to knee ykneeling for long periods yrock on a field

131 Knee - injuries prepatellar bursitis zSx: ygolf ball-like swelling on the knee cap yusually little pain or dysfunction zTx: yR.I.C.E. yspontaneously resolves

132 Knee - injuries dislocated patella zMx: yPatella alta, excess Q angle zSx: yDeformity yPain 3+ zTx: y911

133 Knee - injuries subluxed patella zMx: yPatella alta, excess Q angle zSx: yNo obvious malalignment yPain 3+ zTx: yUse patellar apprehension test& Ice massage + elevation.

134 Iliotibial band friction syndrome zGreater risk with genu varus zTight IT band rubs on lateral epicondyle. zPain over lat. Epicond. At 30 deg. Knee flex, weight bearing.

135 Thigh Injuries: hamstring strain zMx : yIpsilateral/contralateral strength imbalance yAgonist/antagonist strength imbalance yPoor joint. proprioception yLack of flexibility yCortical miscue on biceps Femoris m. (short head) zSx: yPain w/ contraction or overstretching ischial tuberosity yLoss of function yPalpable depression (grade III) zTx: yS&S, rehab at high angular velocities.

136 Thigh Injuries: hamstring strain: origin pull zMx : yIpsilateral/contralateral strength imbalance yAgonist/antagonist strength imbalance yPoor joint. proprioception yLack of flexibility zSx: yPain with deceleration ischial tuberosity yLoss of function zTx: yS&S, rehab at high angular velocities.

137 Thigh Injuries: Quad strain zMx: yEccentric contraction (landing) yBlocked concentric movement yIpsi/contralateral strength imbalance zSx: yLoss of function yPain with contraction yPain in flexed position yPalpable depression with grade III zTx: yS & S. progressive rehab w/ high angular velocities

138 Thigh Injuries zThigh Contusion

139 Thigh Injuries: myositis ossificans zMx: ossification of connective tissue(perimysium): ectopic bone formation zSx: yReduce range of motion y+ve X-Ray

140 Thigh Injuries: myositis ossificans zAssessment: zGrade I: athlete can flex knee to 90 o or more. zGrade II: …..flex from 45 o to 90 o zGrade III……flex less than 45 O z Monitor size of haematoma: measure length & width every other day.

141 Thigh Injuries, DOMS zDelayed Onset Muscle Soreness yUsually after eccentric exercising yAfter hard w/o, long layoff yPresents after 48hrs. yLasts for 7 – 14 days yDoesn’t respond to antiinflammatories zTx: ????? rest

142 The Hip & Pelvis zHead of Femur zAnatomical neck zAcetabulum zAcetabular labrum zischial tuberosity zpubic symphysis zpubic tubercles zA.S.I.S. zGreater trochanter

143 The Hip & Pelvis yCoccyx ySacroiliac line(s) yIschial tuberosities (hamstring tears)

144 The Hip & pelvis Anterior view of R. hip. Notice winding of the joint capsule, tightens with extension of the hip joint.

145 The Hip Joint zThe angle of the neck to the shaft - Angle = coxa valgus Angle = coxa varus

146 The Hip Joint zThe orientation of the neck to the shaft - femoral torsion. Angle = anteversion Angle = retroversion

147 The Hip Joint zThe greater Trochanter in abduction will compress the superior lip of the acetabular labrum

148 Doing the Splits Flexion – extension splits Notice pelvic rotation to the extended side.

149 Doing the Splits zAbduction splits zNotice external rotation of femurs, moves greater trochanter out of the way.

150 Muscles of Thigh zAnterior View

151 Hip musculature zKey words: zGluteus maximus zGluteus minimus zGluteus medius zPiriformis zSciatic foramen zhamstrings

152 Hip Injuries zHip Pointer zSx: yecchymosis yPain w/ abdominal use zEtiology: subperiostial haematoma zTx: RICE, modalities, flourimethane???

153 Hip Injuries Osteitis Pubis / pubic apophysitis zOsteitis pubis/pubic apophysitis zStress fx at pubic tubercle zInflammation of the growth plate zNo activity zLong time to heal!!!

154 Pelvic Aches & Pains zSacroiliac spain zCoccyx zPiriformis syndrome zGreater trochanteric bursitis zHip dislocation

155 zMidterm is on everything up to this point. zFinal exam is on everything after this.


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