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

1. Sports conditions,injuries and preventionKate Logan & Claire PrenterFinal 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

15. 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? • Professional horse jumping jockeys • 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

45. Muscle Injuries Assessing a Muscle strain: • PAIN on mvt / resistance • PAIN on contraction • 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