1. Sports conditions,injuries and prevention Kate Logan & Claire Prenter Final year physio students

2. Sports Injuries and Conditions: Commonly encountered sports injuries and conditions include: Fractures Concussion Bleeding Joint injuries Soft tissue injuries – Muscle injuries – Tendon and ligament injuries Skin damage Dehydration Hyperthermia (heat stroke) and hypothermia

3. Who has had a fracture?.....

4. What is a Fracture? A fracture is a break in the continuity of a bone or a loss of continuity in the substance of a bone

5. Clinical signs of a fracture A deformity that can be seen or felt Pain on stressing the limb Abnormal movt in a limb due to movt at # site Crepitus or grating between bone ends Impaired function Swelling at the fracture site Tenderness at # site

6. Fractures

7. Causes of fractures Direct trauma – caused by external forces which exceed the strength of the bone. – direct violence e.g. RTA, a blow

10. or Indirect trauma – Fracture results from twisting or rotational forces being applied to the bone – e.g football studs planted, rotation force applied to the limb resulting in spiral # of the tibia

11. or Pathological fracture – bone is already weakened or diseased – fracture because the bone’s internal structure is weakened Stress fracture – Caused by repeated excessive loading of a bone, the cumulative forces result in a break

12. Types of fracture: Classified by skin damage Or shape of fracture Or displacement

13. Classified by skin damage: Open: skin’s broken either by external force or internal one Closed: simple fracture

14. Fractures

16. Classified by shape Shape of the fracture – Transverse or Horizontal – Oblique / Spiral – Comminuted (many small parts) – Crush – Greenstick - children, bend in immature bone with a break in cortices

17. Eg transverse fracture of tibia and oblique fracture of tibia:

18. Classification by displacement: – Undisplaced – Displaced – Impacted – Stable

19. Comminuted displaced fracture of a femur

20. Stable undisplaced fracture of a radius:

21. Stages of fracture healing: Stage 1: Haematoma (0–2 wks) Stage 2: Cellular proliferation (2-6 wks) Stage 3: Callus formation Stage 4: Consolidation stage ( 6-12 wks) Ossification occurs 12 -26 wk callus matures Stage 5: Stage of remodelling ( 1-2 yrs)

22. Why do physios treat fractures? Aim to restore the patient to optimal functional state Prevent fracture and soft-tissue complications Get the fracture to heal, and in a position which will produce optimal functional recovery Rehabilitate the patient as early as possible

23. Who has had concussion?

24. Sports Concussion:

25. Head injuries in sport are common in all contact sports, the vast majority are minor Common sports for these are: – football – Boxing – Gymnastics – Horse riding – Martial arts

26. ...impact from camogie stick

28. Causes: Direct blow to head, face, neck, or elsewhere on the body with force transmitted to the head Typically results in rapid onset of short-lived impairment of neurological function that resolves spontaneously May or may not involve loss of consciousness

29. Symptoms: Headache dizziness Unsteadiness Feeling stunned or dazed Seeing stars or flashing lights Tinnitus Double vision

30. Sleepiness, sleep disturbance, Poor concentration Nausea/vomiting Slurred speech Personality change Impaired playing ability

31. Which 2 sports have the highest incidence of concussion? 1.Professional horse jumping jockeys 2.Australian footballers

32. Physio role? Remove player from field of play! Exclude the presence of serious head injury or spinal injury If athlete’s unconscious assume presence of head injury and spinal injury and manage accordingly – hospital...for assessment and observation...

33. Bleeding Open and closed wounds – Incised: a cut from a sharp edge – Laceration: rough tear or crush to the skin – Abrasion: graze or superficial wound from a rough surface

34. – Contusion: bruise or internal bleeding – Puncture: an object entering the body – Velocity injury: a puncture wound at velocity will cause extensive damage, there may be an entry and exit wound

35. Physio role: From first aid perspective, dress wound to maintain sterile state and remove to hospital for treatment if required Sports medic on pitch side can stitch wounds as required

36. Joint Injuries:

37. Joint injuries: High energy impact Damage to: – Menisci – Ligaments – Joint capsule – Bony structures

38. Knee “big three” – Anterior cruciate ligament (ACL), medial meniscus, medial collateral ligament (MCL) – Traumatic knee, shoulder, elbow, wrist, ankle injuries eg dislocations

39. What are the Soft Tissues? Muscles & Tendons Ligaments, Joint Capsules, Bursa Cartilage Nervous Tissue

40. Types of soft tissue injuries TRAUMATIC: Specific cause is identified Cause of injury easily identified OVERUSE: Develop slowly not attributed to one incident Specific injuries assoc with a particular sport

41. Injury Classification ACUTE : rapid onset, traumatic event with a clearly identifiable cause. CHRONIC: slow insidious onset, gradual development of structural damage. SUB-ACUTE: period between acute and chronic, usually 4-6 weeks post-injury.

42. Causes of Soft Tissue Injuries Intrinsic causes of injury – factors within the sports person Extrinsic causes of injury – factors outside the sports person

43. Muscle Injuries Muscle strain= tear in muscle fibres beyond its limit Causes: (i) forceful contraction of the muscle (ii) Overstretching the muscle

44. Muscle Injuries Classification of muscle strains Grade Extent of damageSymptoms Grade 1 5% or less muscle fibres Minimal pain Grade 2 5% - 99% Some muscle fibres still present Moderate / severe pain on contraction Limited ROM Grade 3 Complete ruptureNo contraction Less pain / no pain

45. Muscle Injuries Assessing a Muscle strain: 1.PAIN on mvt / resistance 2.PAIN on contraction 3.PAIN on palpation Muscle most susceptible to injury? Rectus femoris (quad) Hamstrings Gastrocnemius (calf)

46. Tendon Injuries Tendon properties: – Connects muscle to bone – Low blood supply Tendonitis –inflammation??? Tendinopathy – Degeneration of tendon Healing tendon: – HEAT (increase blood supply) – DTFM – Strengthen – Stretch

47. Ligament Injuries Ligament Properties: – Connects bone to bone Grade 1 –minimal swelling, bruising, pain Grade 2 – Moderate to severe swelling, bruising, pain Grade 3 – A lot of swelling, agony, may or may not bruise

48. Management of soft tissue injuries Acute Injury PRICE: – Protect – Rest – Ice – Compression – Elevation

49. Icing Limits Inflammatory process First 48-72 hours Methods: - Crushed ice in a towel, frozen veg, Ice bath, Chemical ice packs (pitch-side), Freeze spray / cryogel Application: -10 mins every 2 hours Dangers of leaving ice on too long - Ice burn - Never damage - Increase in blood flow

50. The aims of early management The management of STI in the first 72 hours: to reduce pain to reduce local tissue temperature to limit and reduce inflammatory fluid to reduce metabolic demands of the tissues to protect the damaged tissue from further injury to protect the newly-formed fibrin bonds from disruption to promote collagen fibre growth and realignment to maintain general levels of cardio-respiratory and musculoskeletal fitness / activity

51. Management of medical problems HYPOTHERMIA ‘Hypo’ = Below / under ‘Thermia’= heat - Condition in which a person’s body temperature is sufficiently below normal to cause distress and disorder of normal bodily functions. – Mental deterioration – Loss of coordination – Unconsciousness – Failure of breathing and circulation – Death

52. Hypothermia Causes: -Cold -Wind -Wet clothing -Perspiration -Water immersion Stages: Peripheral (core 37-36) Moderate (core 34) Severe (core 32 or lower)

53. Hypothermia Signs / Symptoms: - Tiredness / exhaustion - Shivering - White / purplish appearance (bluish tinge to lips / fingers) - Clumsiness / falling/ tumbling - Weak grip and slowness in muscle contraction - Cold rigid arms and legs - Poor concentration, loss of interest, lethargy - Slurred speech

54. Hypothermia Treatment: Removal from cold, wet, windy conditions (shelter) Insulation to prevent further heat loss Passive or active re-warming Gentle and minimal handling Provision of nutritional and fluid support Transport to medical facility

55. Hypothermia Hypothermia hits stumbling Lebanese Gloucester 30 th Oct 2000 New Zealand Vs Lebanon Rugby League Group2

56. Hyperthermia Hypertherma = overheating of body Hyper = ‘ high’, therma = ‘heat’ Body can not effectively regulate excess heat / elevated temperatures Temperature > 37.5–39.9 °C Causes: – Exposure to excessive heat – Exposure to high humidity – High physical exertion – Dehydration

57. Hyperthermia Signs and Symptoms - Hot, dry skin - Dizziness / Fainting - Nausea / Vomiting - Headaches - Gastrointestinal problems e.g. Diarrhoea - Multi-organ dysfunction Treatment: - Cool / tepid water immersion - Rehydration - Sponging head, neck, trunk with cold water - Sit in shade

58. Dehydration Fluid Loss exceeds Fluid Intake Causes: - Excessive Sweating - insufficient fluid intake - Hot & humid conditions - High intensity exercise

59. Dehydration Consequences: – Increase in perceived effort – Reduced performance – Impaired reaction times, judgement, concentration and decision-making Electrolyte Drinks - Sodium (speeds fluid absorption) -Carbohydrate (provides fuel) - Small amounts frequently (500-800ml/Hr)

60. Quick overview of........ Fractures Concussion Bleeding Joint injuries Soft tissue injuries – Muscle injuries – Tendon and ligament injuries Skin damage Dehydration Hyperthermia (heat stroke) and hypothermia

61. Questions: