1. Injury Prevention

2. Injury Prevention
The best method of managing and caring for athletic injuries is to PREVENT them from occurring
Many factors are important in the prevention process
Equipment
Bracing
Taping
Coaching Techniques
Body Mechanics
Universal Precautions

3. Protective Equipment
Proper selection and fit are essential in prevention of injuries
Should be designed to prevent injury and protect injured parts against further injury
Minimal functional interference
Cause no harm to other participants
Simple to fit and maintain
Durable and reliable
Not expensive

4. Protective Equipment
The hazard demonstrated in each individual sport dictate the need for specific types of protection
Contact Sports
Padding must protect primary contact points
Vital areas such as head, neck, kidneys, genitalia have priority for protection
High velocity hazards (ball/puck sports)
Helmets, face masks, eye protection needed
Dental protection

5. Protective Equipment
Modifications and improvements in sport equipment are continually being made
Protective equipment can be abused
By using equipment as a weapon against their opponent
Players who take dangerous risks and rely on equipment to protect them

6. Legal Concerns
Manufacturers and purchasers of sports equipment must foresee all possible uses and misuses of equipment
Must warn the user of any potential risks in the use or misuse of the equipment

7. Legal Concerns To decrease possibilities of injuries and litigation:
Buy protective equipment from reputable manufactures
Buy the safest equipment resources permit
Ensure equipment is assembled correctly-follow all instructions to the letter
Maintain all equipment properly
Use equipment only for purpose designed
Warn athletes who use equipment of all risks
Use great caution when customizing any equipment or don’t do it at all
Use no defective equipment

8. Selection and Fitting of Equipment
Correctly fitting equipment is very important for injury prevention
To fit athlete these factors should be considered:
Size
Sport Position
Strength
Age and Physical Development
Skill Level

9. Design of Protective Equipment
Channeling
Forces are channeled away from anatomical structures
Dispersion
Forces are dispersed over a large area
Mechanical Structuring
Forces are reduced through the use of a mechanical structure
Restriction
Anatomical ranges of motion are reduced to prevent forces that cause injury

10. Head Protection Nothing can eliminate the possibility of head injury
Helmets do help to significantly lessen head injury severity
Head protection is advised/mandated in football, ice hockey, lacrosse, boxing etc..
Helmets must fit correctly to function properly

11. Helmets
Helmets should be able to absorb force levels high enough to fracture the skull
Helmets should be monitored often because fit can be altered by:
Temperature, hair length, internal padding
Loss of air from cells, spread of facemask
National Operating Committee on Standards for Athletic Equipment has had a major influence

12. NOCSAE All helmets must have NOCSAE certification
To be NOCSAE approved:
Helmet must be able to tolerate forces to many different areas
Withstand repeated blows
Withstand high mass low velocity impacts
Even though helmet is certified does not mean it is fail-safe

13. NOCSAE Warning Warning placed on all football helmets
“Do not use this helmet to butt, ram or spear an opposing player. This is a violation of football rules, and can result in severe head, brain, neck injury, paralysis, or death to you and possible injury to your opponent. There is a risk these injuries may also occur as a result of accidental contact without intention to butt, ram or spear. No helmet can prevent all such injuries”

14. Face Protection Four categories Full face guards Mouth guards
Protect against flying or carried objects
Mouth guards
Majority of dental injuries can be prevented
Absorbs shock of chin blows, helps prevent concussions
Ear guards
Wrestling and boxing
Eye protection devices
Corrective lenses, glasses, headgear

15. Trunk and Thorax Protection
Shoulder, ribs, spine and genitalia have insufficient soft tissue protection
Shoulder Pads and Restraints
Flat-quarterback or receiver
Cantilevered-blocking and tackling athletes
Flak jackets protect ribs and thoracic area
Breast Support- Sports Bra
Groin and Genitalia-Cup

16. Other Padding and Braces
Shoulder Braces
Restraining devices for chronic dislocated shoulder
Restricts upper arm from being abducted and externally rotated
Hip pads
Collision and high velocity sports to protect vulnerable areas such as iliac crest
Abdominal and low back supports
Designed to give relief and permits movement

17. Limb Protection Footwear Shin and Lower Leg Thigh and Upper Leg
Socks and Shoes
Shin and Lower Leg
Hard shelled, molded shin guards
Thigh and Upper Leg
Pads slip into ready-made pockets in the uniform
Knee Supports
Knee pads, Elastic sleeve, Bracing
Ankle Supports
Commercial bracing and ankle taping
Hand, Wrist, Arm and Elbow Protection
Padded gloves, mitts and boxing gloves

18. Footwear Can mean the difference between success, failure and injury
Socks
Poor fitted socks can cause abnormal stresses and cause irritations
Socks should be clean, dry and without holes
Shoes
Chronic abnormal pressure to foot can cause permanent structural deformities, calluses, blisters
Can cause mechanical disturbances that affect total postural balances, effecting joints and muscles The bare human foot was designed to function on uneven surfaces

19. Shoes cont... Shoes were created to protect against harmful surfaces
Left foot generally varies in size and shape from the right foot
It is important to measure both feet and simulate the conditions under which they will perform with shoes on
Fit shoes at the end of the day
Toes can be fully extended without being cramped
When dealing with cleats- cleats should be positioned under two weight bearing joints

20. Foot pads
Can be helpful in treating a variety of foot problems as well as hip and knee
Commercial or Custom-made orthotics
Corns, bunions, fallen arches, pronated feet
Foam, Felt, Plaster or aluminum and heel cups

21. Prophylactic Knee Braces
To prevent or avoid
Effectiveness is controversial
Players at greatest risk- Offensive and Defensive Lineman, Linebackers, Tight Ends
Designed to provide protection against lateral and medial, but not rotary forces

22. Knee Braces cont… Studies are divided
Decrease, No difference and Increase in knee injuries
More studies need to be conducted concerning:
Relative strength of braces
Weather they pre-stress the knee joint and produce injuries

23. Functional Knee Braces
Customized orthopedic knee brace prescribed for the athlete
Following serious knee joint injury that produces chronic instability/surgery
Designed to prevent re-injury to the cruciate ligaments
Effectiveness better documented

24. Taping Used for the care and protection of the athlete
Adhesive tape offers a number of possibilities
Retention of wound dressings
Stabilization of compression-type bandages that are used to control bleeding
Support of recent injuries to prevent additional injuries
Protect against acute injuries- by limiting ROM

25. Taping Guidelines Be sure the area is dry, clean and free of body hair
Use some form of tape adherent to ensure bonding of the tape to the skin
Apply one layer of prewrap over adherent
Apply lubricated pad
Prevents cuts, blisters and rashes
Overlap each strip of tape to the previous strip by half

26. Taping Guidelines Cont.…
Avoid spaces between tape segments
Spaces may result in blistering
Smooth and mold the tape to the natural contour of the area
Try to make athlete comfortable, but maintain dorsiflexion
After wrapping/taping is complete check for comfort and impaired circulation

27. Taping Usage
Tape is available in variety of widths, strength and elasticity
Tape should adhere readily when applied
Stretch and elastic should be used for smaller, more angular body parts
Tape should be stored in a cool place
Temperatures greater than 75 degrees may alter the adhesive ability

28. Taping Usage Cont...
To tear tape, hold firmly on each side of the proposed tear line, and pull the free end away at an angle so that the forces crosses the lines of the fabric at a sharp angle
Edges should be straight, no loose threads
Special cutters are made for tape removal
Avoid cutting over bony prominences
Look for blisters and skin irritations as the tape is removed

29. Effectiveness of Taping
Controversy
Taping only should be used in conjunction with proper exercise
Improperly applied wrap/tape can compound an injury and create postural imbalances

30. Arguments for and against Taping
Most studies agree that taping does contribute to a lower incidence of injury/re-injury
Prophylactic taping is superior to lace on braces for the first 20 minutes, after that they are equal
Against
Tape usually becomes loose with wear
The skin is mobile, thus taping can not be effective
Taping weakens the leg muscles
Moisture develops between skin/tape, thus affecting tape adherence
Tape tears under stress

31. Complications of Taping
Skin allergies
Skin irritations
Blisters
Lacerations
Reactions to tape adherent

32. Common Taping Procedure
Routine Non-Injury Ankle Taping
Have athlete sit on table with leg extended, the lower part of the calf past the edge of the table
Have athlete hold foot at a 90 degree angle in dorsiflexion
Apply a coat of tape adherent to protect the skin

33. Ankle Taping Apply a foam pad over the instep and back of the heel
Apply a layer of prewrap to the ankle
Using 11/2 inch tape, apply an anchor around the ankle about 5-6 inches above the malleolus
Apply another anchor at the distal third of the longitudinal arch, making sure not to constrict the base of the fifth metatarsal

34. Ankle Taping Apply 2-3 stirrups in consecutive order
Begin on the medial part of the calf
Pull up on the lateral aspect of the leg with moderate tension
This places the foot into slight eversion
Apply circular strips form the point of the proximal anchor, moving downward until the malleolus is completely covered

35. Ankle Taping Apply arch strips down to the distal anchor
Apply a heel lock
Start high on the instep, bring the tape along the ankle at a slight ankle
Hook the heel
Lead the tape under the arch
Finish by coming up on the opposite side by the starting point
Cover the ankle again with a second layer of tape (optional)

55. Prophylactic Thumb Taping
Protects the joints and surrounding muscles
Have athlete fully extend and adduct the fingers, by keeping the thumb in a relaxed, neutral position
Stand in front in the athlete
Apply rewrap to the forearm, wrist and thumb

56. Thumb Taping
Using 1 inch tape place an anchor strip around the wrist and another around the distal end of the thumb
From the anchor at the tip of the thumb to the anchor around the wrist, apply 4 strips in a series on the dorsal side of the thumb
Hold these strips in place by applying one locking strip around the wrist and one encircling the tip of the thumb

57. Thumb Taping Add a series of three “spica” strips
The first spica is started on the radial side at the base of the thumb and carried under the thumb, completely encircling it and then crossing the starting point
The strip should continue around the wrist and finish at the starting point
The following 2 spica strips should overlap the preceding strip by at least 2/3 inch and move downward on the thumb
Place a final locking strip around the wrist

72. Elbow Hyperextension Taping
Have athlete stand with the elbow flexed at least degrees, and the forearm in neutral position
Taper should stand facing the arm
Apply adhesive spray to the area
Apply prewrap from mid-humerus to the mid-forearm
Apply two anchor strips loosely around the arm, approximately 2-3 inches above and below the elbow joint

73. Elbow Hyperextension Taping
Construct a checkrein
Place a 4 inch strip of tape against the center of a 10 inch strip of tape, thereby “blanking out’ the center portion of the longer strip
Place the checkrein so that is spans the two anchor strips with the blanked out side facing down

74. Elbow Hyperextension Taping
Place 5 additional 10 inch strip of tape over the first checkrein (tape fan)
Finish by securing the checkrein with three locking strips both above and below the elbow joint
A figure-8 elastic wrap can be added over the taping to prevent the tape from slipping because of perspiration

84. Sports Medicine Professional Obligations
Ethical and Legal responsibility to each athlete they work with
Athletes welfare should be placed above all other considerations-coaches, parents etc...
Do not allow non-medical considerations influence judgement
If pressure is exerted an question of judgement arises a Physician’s opinion should be called for- Physician has final call

85. Sports Medicine Obligations
If find unsafe coaching practices of facilities:
Notify appropriate person
If advice is ignored report the findings and recommendations should be made to the highest authority
Use careful judgement to ensure frivolous remarks are not made
Same situation applies for use of illegal or banned drugs
Treat every athlete equally
Be loyal to the coaches, team, physicians, etc.

86. Coaching Techniques Coach is responsible for teaching playing skills
Coaches should impart a proper game philosophy and an overall safety awareness
“Win at all costs” syndrome is dangerous and shows little regard for the safety of the athletes
Coaches can show concern by meeting with team members and parents to inform about potential injuries and means of prevention

87. Coaching Obligations
Warn athletes of potential for head and neck injuries
Insist on blocking and tackling techniques that reduce the chance of injury
Must provide or delegate appropriate person to give emergency care and first aid in absence of a sports med professional
At least one member of any coaching staff should have training in CPR and first aid
Safety and well being of athlete must always have highest priority

88. Body Mechanics Center of Gravity
More than half the total body weight is located in the upper part of the body, which is supported by thin bones
Center of gravity increases stability as it is lowered- for example widening the stance
Musculature serves as a shock absorber by absorbing impact and distributing it over a larger area

89. Body Mechanics Posture Spine has 3 curves that help maintain balance
The head weighs close to 14 pounds and is balanced on top of 7small cervical vertebrae
Particular vulnerable to injury
Strengthening the neck muscles is an important protective measure

90. Body Mechanics Musculoskeletal System Factors
Heredity, congenital or acquired defects may predispose athlete to a specific type of injury
Postural deviations are often major underlying cause of sport injuries
For example a consistent pattern of knee injury may be related to asymmetries within the pelvis and the legs

91. Knee Disorders Genu Valgum Knock Kneed
Weight bearing line passes to the lateral side of the center of the knee joint
Results of the inward angling of the thigh and lower leg
Causes the body weight to be borne on medial aspect
More prone to medial knee injuries

92. Knee Disorder Genu Varum Bow Legged Opposite of Genu Valgum
The extra stress is placed on the lateral aspects
Athlete more prone to lateral knee injuries
If severe should be directed into non-contact activity (same for Genu Valgum)

93. Spinal Abnormalities Kyphosis Round Back
Abnormal curvature of thoracic spine
Forward Head and Flat chest
Basketball players, gymnasts, weight lifters common to have this deviation
Susceptible to anterior dislocations of arm

94. Spinal Abnormalities Lordosis Scoliosis
Abnormal curvature of lumbar spine
Sway back
Football linemen and gymnasts are prone
Scoliosis
Lateral curvature of the spine
Can be attributed to unequal leg length

95. Universal Safety Precautions
Universal body substance precautions with all body fluids, blood being most common
When a wound is oozing or bleeding, sporting activity should be stopped ASAP
Wear gloves for all routine procedures
Wash hands with germicide soap before and after using latex gloves
Change gloves after each treatment
Discard gloves that are torn, cut or punctured into a biohazard container

96. Universal Safety Precautions
Wear a protective face mask/eyewear if a procedure may drop or spry into eyes, nose or mouth
Dispose used needles, scalpel blades and other sharp items into a biohazard container
Any needle pricks should be reported to a physician
Clean all tables and counters regularly with a bleach solution
Use an approved pocket mask shield when giving artificial respiration

97. Universal Safety Precautions
Educate staff, coaches, athletes, etc. about the risks for contacting and spreading contagious diseases
If athlete has blood on their uniform
They must be brought out of play until blood can be cleaned up
A solution of bleach and water is used to remove the blood from the uniform
Precautions serve to protect not only the sports medicine professional, but also the athlete

98. The End
Any Questions???