Injury Prevention

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

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

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

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

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

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

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

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

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

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

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

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”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

Elbow Hyperextension Taping Have athlete stand with the elbow flexed at least 30-45 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

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

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

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

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.

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

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

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

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

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

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

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)

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

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

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

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

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

The End Any Questions???