HOPS

1. HOPS Evaluation Procedures for Athletic Injuries

2. H – History The most essential part of the process. • Helps the athletic trainer determine what they will do during the remainder of the evaluation process. • Most times a person is able to determine what is wrong by getting a good history. • Almost like being a detective.

3. H – History During the History it is important for the sports medicine professional to: • Be calm and reassuring. • Ask open ended questions. • Listen carefully to the athlete/patient’s response for possible clues. • Maintain eye contact when possible. • Obtain the history as soon after the injury as possible.

4. H – History • Start with understanding the mechanism of injury. • What is the problem? • How did it occur? • When did it occur? • Did you fall? How did you land? • Which direction did your joint or body part move? • Did the athlete hear any abnormal sounds or feel any abnormal sensations? Key sounds. Sounds occurring at the time of injury can provide valuable information about the type and severity of the injury. Cracks, pops, snaps or tears.

5. H – History • Next determine pain characteristics. • What type of pain is it? • Nerve pain is sharp, bright or burning. • Bone pain tends to be localized and piercing. • Vascular system pain tends to be poorly localized, aching and referred from another area. • Muscular pain is often dull, aching and referred to another area.

6. H – History • Next determine pain characteristics. • Where is the pain? The deeper the injury site, the more difficult to match the pain with the site of trauma. • Does the pain move? Does pain increase at night? • Pain the subsides during activity usually indicates chronic inflammation • Pain that increases throughout the day indicates progressive increase in edema.

7. H – History • Next determine pain characteristics. • Does the patient feel sensations other than pain? • Pressure on nerve roots can produce a sensation of “pins and needles” (paresthesia) • Ask the athlete to quantify the amount of pain present using a pain scale of 1 to 10.

8. H – History • Determine joint responses. • If the injury is related to the joint, is there instability? • Does the joint feel as though it is giving out? • Does the joint lock and unlock?

9. H – History • Evaluate level of function. • Were they able to keep playing after the injury or did they come out of the game? • Are they able to use the injured body part normally? • Determine if injury is acute or chronic? • Acute – happened in one action/event • Chronic – progressed over time

10. H – History • Find out if there have been any previous injuries to the area. • Has this ever happened before? When? There may be an underlying weakness that caused the injury.

11. O-Observation This is often modified by the complaint of the athlete/patient. Here we are looking at the athlete and the injury and visually inspecting them. Often comparing the injured body part to the non-injured side.

12. O-Observation Suggestions: • Is there obvious deformity? • How does the patient move? • Is there a limp? • Are movements abnormally slow, jerky, and asynchronous? • Is the patient unable to move a body part? • Is the patient holding his or her body stiffly to protect against pain? • Does the patient’s facial expression indicate pain or lack of sleep? • Are there any obvious body asymmetries?

13. O-Observation Suggestions: • Does soft tissue appear swollen or wasted as a result of atrophy? • Are there unnatural protrusions or lumps such as occur with a dislocation or fracture? • Is there a postural malalignment? • Are there abnormal sounds such as Crepitus when the athlete moves? • Does the body area appear inflamed? • Is there swelling, heat or redness? • Are there any obvious wounds?

14. P - Palpation Both the injured and non-injured sites should be palpated (touched) and compared. The athletic trainer is looking for an abnormality in structures that may not be observed but may be felt

15. P - Palpation • Evaluate away from the injured area first. This helps to gain the athletes confidence and you will be less likely to miss secondary areas of pain and injury. • Bony palpation allows the athletic trainer to feel an abnormal gap in the joint, a swelling along a structure, a misalignment, or a protuberance.

16. P - Palpation • Soft tissue palpation allows the athletic trainer to detect many things. • Swelling, lumps, gaps, and abnormal muscle tension • Skin temperature variation. • Torn ligaments and tendons. • Muscle twitching and tremors. • Excessive skin dryness or wetness. • Abnormal skin sensations • Variations in structure shapes, tissue tightness and textures

17. S – Special Tests Special Tests should be performed by trained professionals only.

18. S – Special Tests Movement assessment – Range of Motion • Active Range of Motion (AROM) – Done by the athlete • Depending on where the athlete has pain when moving the body part may determine what is wrong with them. • Passive Range of Motion (PROM) – Done by the health care professional • Depending on where the athlete has pain when someone else is moving the body part may determine what is wrong with them

19. S – Special Tests Movement assessment – Range of Motion • Muscle strain – pain with active contraction and passive stretch. • Ligament – pain with movement and stretching. • End Points Normal • Cartilage Tear • Muscle Spasm • Ligament Sprain (ACL)

20. S – Special Tests Manual Muscle Testing – Strength • Done to Test the weakness of specific muscles

21. S – Special Tests Neurologic Examination • Typically done when there was a head injury. Deals with Cerebral function, cranial nerve function, and cerebellar function. • Sensory Testing - Sometimes done when there is a sensory loss in the musculoskeletal system and test by dermatome (area of skin innervated by a single nerve) or myotome (muscle or groups of muscles innervated by a specific motor nerve). • Referred pain testing • Motor testing – like manual muscle testing.

22. S – Special Tests • Joint Stability Testing • Specific tests to determine the integrity (strength and stability) of a joint. • Determine the severity of an injury or sometimes what specifically is wrong.

23. S – Special Tests • Testing Functional Performance • Sometimes done to determine if an athlete can immediately return to play. • Determines the functional ability of the athlete at that immediate time. • Can they…run, cut, plant, back pedal, block, hit…in short, can they play their sport

24. Medical Referral When immediate diagnosis by a physician is not available, the athletic trainer or coach must assume responsibility for evaluating the injury. Determine if the injury is of a serious or non-serious nature. If the injury appears to be more serious, referral to a physician is indicated.