1. Athletic Training

2.  Injury History  Inspection and Observation  Pain and Palpation  Range of Motion  Manual Muscle Testing  Special Test  Functional Testing  Physical Referral / Diagnostic Tests

3.  Who? What? When? How?  Asking questions to find out what injury occurred.  A good thorough Injury History will often tell you what the injury is without physically touching the individual  What are some questions you should ask during injury history?  Questions that would help you figure out what is wrong

4.  What happened or How did it happen?  Injury mechanism  When did it happen?  Did this injury ever happen before?  Are you taking any medications?  Any relevant surgeries?  Is this your dominant side?  What sport do you play or even what position do you play?  Do you have any pain anywhere else on your body?  Do you have any allergies?  Did you hear or feel a anything (“pop”)

5.  Signs and symptoms  Signs  Swelling  Echymosis  Deformity  Carrying Angle  Bleeding  Discoloration  Symptoms  Dizziness  Headache  Nausea  Memory loss  Retrograde  Post-traumatic  ***Bilateral Comparison – to know what is normal for that person you compare the injured part of the body to the uninjured part

6.  Palpate specific anatomical structures  distal / proximal to the injury  Pain on bone = contusion, fracture or maybe dislocation / subluxation  Pain on ligament = contusion or sprain  Pain on muscle or tendon = contusion, strain, tendonitis or perhaps bursitis  Pain  Type of pain: burning, stinging, tingling, etc…  Grade your pain on a scale of 1 to 10  Remember pain is relative to each individual  Does the pain change with: movement, weight bearing, exertion, etc…

8.  Active AROM  Passive PROM  Goniometer – quantify the ROM (put an exact measurement or number to it)  Bilateral Comparison  Joint Clearing – check the joint immediately distal and immediately proximal to the “injured” joint

9.  Manual assessment of strength  You apply steady resistance throughout the ROM to assess muscular strength.  Scale  5/5 full ROM against a full resistance  4/5 full ROM against a partial resistance  3/5 full ROM against gravity  2/5 full ROM with gravity eliminated  1/5 no ROM but signs of muscle contraction  0/5 no ROM and no signs of contraction  ***Bilateral Comparison

10.  Very specific test that assess certain injuries  Example: Thompson Test – assess Achilles tendon rupture  http://www.youtube.com/watch?v=AmDi08rlR3I http://www.youtube.com/watch?v=AmDi08rlR3I  http://www.youtube.com/watch?v=gkHgY-Y45VY http://www.youtube.com/watch?v=gkHgY-Y45VY  http://www.youtube.com/watch?v=uzzV5BRWlIc &feature=related http://www.youtube.com/watch?v=uzzV5BRWlIc &feature=related

11.  Special tests for fracture  Tap test http://www.youtube.com/watch?v=0kPjh1nTf-U&feature=BFa&list=PLA8677004E806402F&lf=results_video http://www.youtube.com/watch?v=0kPjh1nTf-U&feature=BFa&list=PLA8677004E806402F&lf=results_video  Longitudinal compression test

12.  Progression of activities that get more challenging  Lower body –  Walk straight ahead, jog straight ahead, jumping or hopping, sprint straight ahead, running figure eights (big and small), cutting, side shuffles, cross-over running, sport specific activities  Sport Specific activities are specific to the sport and even to the position within that sport  Basketball – lay-up drills, rebounding drills, “suicides”, defensive shuffles, pivoting  Football Lineman – 5 yard bursts, footwork drills, monkey rolls, blocking drills

13.  By law, only a physician can diagnose an injury  Physician can give “standing orders”  Only a physician can refer for diagnostic testing  X-ray  MRI  CT scan  Blood Work  Bone Scan

14.  Lateral Ankle Sprain  http://www.youtube.com/watch?v=_KBYLBuAym http://www.youtube.com/watch?v=_KBYLBuAym  Ankle Dislocation  http://www.youtube.com/watch?v=RP42cEbqUD0 http://www.youtube.com/watch?v=RP42cEbqUD0

15.  Injury mechanism: excessive inversion or excessive plantarflexion with inversion  History of ankle sprains would make the person more likely to sprain the ankle again  Type of sport, footwear, playing surface could predispose someone to sprain their ankle  They will sometimes hear or feel a “pop”  Person usually says “they landed on something or landed in a hole or an uneven surface”

19.  Swelling and possibly echymosis in either over or just below the lateral malleolus  Possible even distal to the ankle joint  Possible deformity (indicating fracture)  Point tender to the touch: specifically over the three ligaments on the medial side of the ankle  Carrying angle for ankle injuries: Limping on your heel or unable to bear weight at all  **Bilateral Comparison will tell you what is normal for that person

23.  Pain will depend on the severity of the injury and the person’s tolerance for pain  The pain will increase will weight-bearing  Especially going up and down stairs and changing directions

25.  Limited AROM and PROM in all motions. Especially Plantarflexion, Dorsiflexion and Inversion  Goniometric measurements  Joint clearing- check the toes and foot as well as the knee  A simple squat would clear all joints

26.  Acutely – 0/5 -1/5  Within a few hours to a few days – 2/5 – 4/5

27.  Take the patient through the functional test noting at what level they are immediately following the injury  Throughout the rehabilitation process and at the end of the rehab process you will retake them through the progression to make sure that they are improving and can ultimately return to activity