ON-FIELD PHYSIOTHERAPY

1. ON-FIELD PHYSIOTHERAPY

2. CONTENTS • Roles of on-field physiotherapist • Basic assessment procedures • Prevention and assessment of heat & cold injuries • Management of acute soft tissue injuries

3. Why we need on field physiotherapy?

4. ON FIELD PHYSIOTHERAPIST • Roles • On-field services in Hong Kong • Team Physiotherapist • Domestic, National and International Level

5. ON-FIELD PHYSIOTHERAPY SERVICES • 1996 International Masters Hockey Tournament • 1996 Seoul International Women’s Road relay • Hong Kong Cricket team - Bangladesh Cricket Tournament • Standard Chartered Shenzen - Hong Kong Marathon

6. Swire Group Tsing Ma Bridge 10 km and Marathon • Hong Kong - Beijing Relay • Standard Chartered International Marathon (1997-2002)

8. Sports Physiotherapy in Elite level • SDB, 5 full time physiotherapists • Hong Kong Team physiotherapists • 1987 Asian Athletic Championship • 1992 Barcelona Olympics, 1994 Commonwealth and Asian Games, 1996 Altanta Olympics (3) • 2002 Busan Asian Games: 8 physiotherapists

12. KNOW THE SPORT ON FIELD SERVICES KNOW THE VENUE

13. PREPARATION • Deployment of manpower • Equipment

15. Types of injury Cases Muscle soreness/strain 175 Ligamentous sprain 112 Tendonitis 44 Joint problems 41 Contusion 42 Laceration 7 Haematoma 3 Concussion 1 Others 6

16. Types of services Number IFT 44 US 158 TENS 34 HVG 7 ICE 98 Manual technique 210 Massage 211 Strapping and taping 70 Dressing 13 Education and advice 85

17. ON-FIELD MANAGEMENT • ASSESSMENT PROCEDURES • VENUE • PERSON

18. SYSTEMATIC APPROACH • Scene Survey • Is the scene safe?

20. It is frequently better to remain uncertain about a diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool.

21. PRIMARY SURVEY OF THE PATIENT LOC Talk to the patient and assess his level of consciousness A Alert V Response to vocal stimuli P Response to pain U Unresponsive

22. AIRWAY + C-SPINE CONTROL Is the victim able to maintain his airway If he can talk, the airway is OK Open airway by jaw thrust if necessary Do not use head tilt as this may affect the C-spine

23. BREATHING Assess if victim is breathing adequately. Is it too fast? too slow? too shallow? Oxygen, if available, should be given if breathing is laboured. Feel for any tenderness

24. BREATHING • Auscultate the chest for unequal air entry • Check if the trachea is central

25. CIRCULATION Arrest any visible haemorrhage using direct pressureCheck both carotid and radial pulseIf radial pulse is weak or not palpable, the patient is probably in shockCapillary refill is less than 2 secondnormally

26. CIRCULATION If the patient is unresponsive and with no carotid pulse==> this is cardiac arrest. you should start cardiopulmonary resuscitation immediately

27. DECISION POINT : SEND FOR THE AMBULANCE IMMEDIATELY Impaired conscious state Airway obstruction Breathing difficulties Significant external bleeding especially when control by external pressure is ineffective

28. DECISION POINT : SEND FOR THE AMBULANCE IMMEDIATELY • feature of shock: thready pulse, cold clammy hands, delayed capillary refill • unstable pelvis • major fracture of limb bones

29. CARDIOPULMONARY ARREST • PROBABLE CAUSES: • HEAD TRAUMA • Cx INJURY • MAXILOFACIAL OR THORACIC TRAUMA • CVA • MYOCARDIAL INFARCTION

30. HAEMORRHAGE • INTERNAL:- • COLD • RAPID PULSE AND RESPIRATION • PALPABLE PAIN AND TENDERNESS • RESTLESSNESS • EXCESSIVE THIRST • BLOOD IN THE URINE OR STOOL • OBSERVE FOR SHOCK OR ARREST

31. HAEMORRHAGE External • Direct Pressure • Arterial Pressure Pt. Compression • Area should be elevated

32. SECONDARY ASSESSMENT • Chief Complaints • Behaviour of symptoms • Location & radiation of the symptoms • Mode of onset • Mechanism of injury • Functional alterations • Related symptoms • Past injuries

33. LOOK AND PALPATION • Location of Pain • Degree & type of swelling • Temperature & texture of the area • Muscle spasm • Tissue continuity & deformity • Neuromuscular function • Abnormal Motion or sensation

34. MOVEMENT • Active & Functional Motions • Resistive Motion • Specific Stress Test • Sport Specific Function • Return to activity

35. HEAT INJURY

36. Exercise 20-25x Metabolic Heat Stress 25% efficiency Metabolic heat production Exercise Shivering Thryoxine Sympathetic stimulation Heat Production Heat Balance Radiation Conduction Convection Evaporation Climatic Heat Stress Temp. rad. Eng. Wind vel. Humdity Heat loss WBGT 0.1: 0.7: 0.2

37. CONVECTION • Responsible for transferring heat from working muscles and the skin surface • Temp differential between skin and environment • Heat transfer coefficient, body surface area and wind velocity • Minimal body fat and loose-fitting clothing

38. CONDUCTION • Minimal effect on body heat transfer • Direct contact between skin and an object

39. RADIATION • Solar radiation and radiation from tracks, roads, and surrounding structures • Can be a major contributor to heat load

40. EVAPORATION • Most important heat dissipation mechanism in warm environments • Sweating – a fit athlete can produce up to 30 ml of sweat per min • Evaporation depends evaporative heat transfer coefficient – air velocity and water vapor pressure gradient (relative humidity)

41. WBGT • Wet Bulb Globe Temperature • Three monitors: • Dry bulb (Tdb)  air temperature • Wet bulb (Twb)  relative humidity • Black globe (Tg)  solar radiation • WBGT = 0.1Tdb + 0.7Twb + 0.2Tg

43. Without adaptive mechanisms, moderate exercise could elevate temp by 1C every 5-6’

44. HEAT INJURY Warm, humid conditions, inadequate fluid replacement Fluid/electrolyte solutions Prevention: added salt to food, high K+ diet Loss of Sodium and Potassium Cool fluids pre-hydrate Heat Cramp Dehydration Profuse Sweating Clammy & Cool Skin Headache & Weakness Nausea & Weakness Rapid Pulse & Disorientation Red, Hot and Dry skin Strong & Rapid pulse Lack of sweating, CNS symptoms unsteady gait confusion, combative behaviour, coma Heat exhaustion Shading remove excess cloth cooling with ice, sponges hydration monitor vital sign hospital Medical Emergency !! Heat Stroke

45. PREVENTION • Conditioning • Acclimatization • Fluid replacement • Venue and schedule  sweat rate  core temperature  plasma volume  heat storage 3-4 hrs/day, 60-70% load 5-10 days • Thirst: poor indicator • 2-3%; intense exercise 3L/hr • Every L loss,  0.3 C • Q  1L/min • HR  8 Intake: 400-600 ml 15-20’ 200-300 ml every 15-20’

46. CHILDREN AND HEAT INJURY • Sweat less effectively; • produce  metabolic heat for given workload; • acclimatize more slowly than adults; • larger M/A; •  renal tubular filtration rate; • self perceive;

47. BUT HOW ABOUT COLD INJURY? • Heat loss also depends on air movement, humidity, evaporation (sweating) and ambient temperature • Wind velocity exacerbates heat losses

48. Shivering, cold, hunger Confusion muscle spasm Slow pace Adequate clothing High energy bar Avoid wind exposure Mild Hypothermina Semi-conscious confused actions Extremely tired Poor coordination Muscle stiffness Slurred speech Disorientation Loss of consciousness Faint heartbeat Moderate Hypothermia Medical Emergency !! Severe Hypothermia

49. Acute Sports Injuries Treatment that comes with PRICE!