1. http://www.youtube.com/watch?v=LA3vB5vvYgg (lower leg fracture)
Basic Injury Care
(lower leg fracture)

2. Basic Injury Care
After an injury to an athlete, what is the primary goal of the athletic trainer (with regard to the athlete)?

3. PRICE Protection Prevent further injury Methods of doing so
Participation Modifications
Transportation
Splinting
Crutches and cane
Bracing

4. PRICE cont Rest Allows for healing to occur Prevents aggravation
First hours are most important
Absolute Rest vs. Active Rest

5. PRICE cont Ice Body exaggerates inflammatory response
Causes vasoconstriciondecreased swelling
Decr cellular metabolism
Decr tissue hypoxia
Decreases pain

6. ICE Types of ice Frequency and duration Ice bags Frozen gel packs
ICE
Types of ice
Ice bags
Frozen gel packs
Modalities (cold whirlpool, game ready, etc.)
Frequency and duration
20 minutes on, 40 minutes off
Hunting response
Observed by Sir Thomas Lewis in 1930

7. PRICE cont Compression Best when combined with ice
Intermittent vs. Constant
Effects on swelling
Counteracts gravitational effects
Aids movement of swelling from joint space

8. PRICE cont. Elevation Helps decrease swelling
Use gradient to help circulate blood flow
Injured area above level of heart
Best when combined with active movements (venous pumping)

9. Let’s Put it all Together
What do most of the items or PRICE, particularly the Ice, Compression, and Elevation, have in common?
Why do you think this is so important?

10. Injury Video
(DeAndre Brown broken leg)

11. In addition to swelling, we need to address PAIN!!
Pain occurs from “Mechanical Failure” of tissue (injury)
Release of chemical mediators (prostaglandins)
Nerve impulses sent to brain
Excess swelling pressing on nerve fibers
Leads to more impulses sent to brain
Pain-spasm-pain cycle perpetuates pain

12. Question of the day
What are the five elements of P.R.I.C.E. and what is the primary goal of the last three elements (I.C.E.)?
ANSWER: Protection, Rest, Ice, Compression, and Elevation; Ice, compression, and elevation all focus on decreasing swelling.

13. Pain-Spasm-Pain Cycle
Pain occurs muscles spasm to protect area more pain occurs (tightness and compression)
Need to interrupt this somehow!!
Pain
Spasm

14. Pain Control Theories Gate Control Theory Central Biasing Theory
Endogenous Opiates Theory

15. Gate Control Theory (spinal cord)
Brain acts as final destination and gives signals to rest of body
Transmission cell (spinal cord) relays signals to brain
Consider it as a “Gate” to the brain
Pain fibers travel to transmission cell
ENTER GATE Pain
Sensory feedback stimulates A-Beta fibers
Travel to transmission cell faster= “CLOSING GATE” Decrease in pain

16. Gate Control Theory Diagram
Trans cell
PAIN
Injury

17. Gate Control Theory Diagram
DECREASED PAIN
Trans cell
Sensory Stimulation
Injury

18. Central Biasing Theory (brainstem)
“Pain Inhibits Pain”
C fibers stimulated through controlled stimulation
Brainstem releases serotonin (linked to happiness)
A-delta fibers inhibited/shut down (at spinal cord)
Pain sensation does not travel to brain
Much more complex, but essentially, creating pain decrease in acute pain

19. Endogenous Opiates Theory (brain)
Enhances production of natural endorphins
Rhythmic stimulation of muscles (and A-delta fibers)
Increased endorphin production
Secretion of ACTH (adrenocorticotropic hormones) which help produce natural cortisone (anti-inflammatory agent)
Also results in central biasing as well