Treatment of Sports Medicine Injuries

1. Treatment of Sports Medicine Injuries

2. Introduction • Immediate care of an injury athlete or person engaging in physical activities • Rehabilitation of the injured part of body using conservative methods • The applications of new technologies • Treatment and prevention of environmental injuries

3. Immediate Care • Athletic injuries may life-threatening • Asphyxia • Water inhalation • Strangulation by external means • External bleeding • Cutting a blood vessel on a sharp object • Initial management of theses involves • ABC (airway, breathing, circulation) • CPR (Life-saving technique) • If bleeding is a problem, it needs to be controlled

4. Cardiopulmonary Resuscitation (CPR)

5. Most musculoskeletal injuries are not life-threatening, but immediate care should initiated quickly • Control bleeding and edema • Management early inflammation, pain, and muscle spasm • Acronym of these procedures is • P= protection • R= rest • I = ice • C= compression • E= elevation • S= stable

6. Cryotherapy for immediate and long-term treatment • Cold causes a vasoconstriction of blood vessel and reduces limb temperature and help reduces swelling • Slowing the tissue metabolic rate and pain and in control of muscle spasm • Application about 20 min per hour for 1.5 to 1.5 hours or cold may lead to tissue damage

7. Applying pressure to an injury helps reduce hemorrhaging and the creation of a hematoma • Reduction of fluid seepage into surrounding area and facilitation of the absorption rate • Decreasing the possibility of secondary injury • Elevation of a body part is another strategy to reduce swelling • Extremity above the level of the heart facilitates the return of fluid through the vein back to the heart and reduces edema • Immobilizing the limb may be accomplished through taping, casting, splinting or aids (crutch, cane) • Certain amount of rest is vital for the healing process • Too much rest of immobilizing can lead to loss of motion in a joint and muscular atrophy

8. Rehabilitation Treatment for Sports Medicine Injuries • Exercise • Various types of exercise in conjunction with therapeutic procedure are used to rehab. patient

9. Isometric Exercise • A type of strength training in which the joint angle and muscle length do not change during contraction • Use during early stage of rehab. process • When extremity is immobilized it helps to reduce muscle atrophy

10. Dynamic Exercise • Is used to strengthen a group of muscles through a range of motion • Can be perform either concentric or eccentric exercise • More muscle force can be developed during eccentric exercise than isometrics or concentric exercise • Eccentric contractions, although important, it may produce post exercise muscle soreness (DOMS) • There are may be a compromise between rehab. and training and the amount that would produce soreness

11. Isokinetic Exercise • Produces more force at some joint angles than others and therefore can present more stress on a joint t that might be appropriate for rehabilitation • A type of dynamic exercise • Use dynamometer that provide an accommodation in resistance at each set velocity • Use in assess muscle strength and to increase muscular strength

12. Treatment Modalities • Cryotherapy • Clod has been used in immediate care and first aids • Is appropriate for sprains, strains, hematoma, contusions, and problems such as fasciitis, tenosynovitis, tendonitis • Cold therapy • Increases pain threshold • Decreases velocity of impulses (desensitized nerve endings) • Decreases muscle spindle firing • Decreases muscle’s reaction to stretch; helps relax • Reduces spam • Shunting reaction by cryotherapy

13. Cryokinetics • Combination of cold and exercise (passive or active movement) • An approach results in less disuse atrophy and reduces the possibility of developing adhesions

14. Thermotherapy • is the application of heat to the body for pain relief and health • It can be beneficial to those with arthritis and stiff muscles and injuries to the deep tissue of the skin • The therapeutic effects of heat include • increasing the extensibility of collagen tissues; • decreasing joint stiffness; • reducing pain; • relieving muscle spasms; • reducing inflammation, edema, and aids in the post acute phase of healing; • increasing blood flow-the increased blood flow to the affected area provides proteins, nutrients, and oxygen for better healing

15. Four methods of thermotherapy • Conduction: direct contact with a heat source (whirlpool, paraffin baths, analgesic balms) • Convection: indirect heat such as heated water or air (whirlpool: heat and hydro-massage) • Radiation: transfer of heat or energy through space by electromagnetic waves (infrared lamp) • Conversion: heat by other forms of energy (diatherapy, ultrasound, phonophoresis) • Ultrasound is one of the most frequently used modalities of penetrating heat in sports medicines (to rehab. bursitis, tendinitis, fasciitis, and soft tissue injury)

16. Electrical Stimulation • Is used to control swelling, reduce atrophy, increase blood flow, reeducate muscles, and control of pain • By regulating the characteristics of electric current (type of current, current pulse width, frequency, and intensity) the desired outcomes in the rehab. process may be obtained • Iontophoresis (Electromotive Drug Administration (EMDA)) • is a technique using a small electric charge to deliver a medicine or other chemical through the skin • To anesthesia, fight infection, and plantar warts • Transcutaneous electrical stimulation (TENS) • Become a treatment to diminish acute and chronic pain • This type of direct , low-intensity current produces “gating” mechanism in dorsal horn of the spinal cord that turns off the pain signal

18. Surgery • More invasive measures are sometime required • Orthopedic surgeon • Graft from neighboring tissue of torn muscle or tendons • Realignment of patella

19. Surgical Materials • Various plastic materials have been used in artificial joints, and these need to be designed to be biocompatible with neighboring tissues • Gore-Tex polyester • Teflon • Dacron

20. Arthroscopy • is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision.

21. Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage. • The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. Instead, for knee arthroscopy for example, only two small incisions are made — one for the arthroscope and one for the surgical instruments to be used in the knee cavity. • This reduces recovery time and may increase the rate of surgical success due to less trauma to the connective tissue.

22. Micro-fracture is used to put small holes in bone and promote healing by blood clotting and production of fibrocartilage • Autologous chondrocyte transplantation (ACT)- damaged knee cartilage can be repaired by patient’s own healthy tissue is used to grow new cells

23. New Technology • The computer in rehabilitation • Physical therapists used to conduct range of motion exercise for a brief of time • Continue passive motion (CPM) is a postoperative treatment method that is designed to aid recovery after joint surgery • Computer control a machine that provides extended periods of continual flexion and extension at a joint

24. Radiography • Injury Detection • Osgood-Schlatter’s condition

25. Bone Imaging • Radioisotope (technetium) bone imaging is often used when a stress fracture is suspected • As certain types of fractures, hot spots are sometimes evident a day earlier than when the fracture shows up on a radiograph • Cold spots may indicate a decrease radionuclide uptake found in the early stage of a disorder called vascular necrosis

26. Arthrography • Radiology technique that permits inspection of joint surface and surrounding structure • Air introduced into the articular cavity as a thin layer of radiological contrast medium coats articular surface • This detection technique is often used for suspected knee, shoulder, and ankle injuries • Examination of the radiographs helps determine whether a ligament teat exists

27. Computerized Tomography • Tomography in which computer analysis of a series of cross-sectional scans made along a single axis of a bodily structure or tissue is used to construct a three-dimensional (horizontal, sagittal, and frontal) image of that structure. • Some advanced systems provide a greater acuity to detect various types of lesions, plus the patient is subjected to less radiation than conventional CAT scan

28. Ultrasound Is a safe and noninvasive technique used to assess numerous physical activity problems Sound wave are bounced off different structures and reflected back to the transducer and these reflected sound wave are received and integrate into an electron system that constructs a two-dimensional picture (real time image)

29. Cystoscopy • Urologists have inspected the urinary bladder • Orthopedic surgeons use a similar device to inspect joints of the body • Both arthroscopy and arthroscopic surgery may be conducted under local or general anesthesia and are done as an outpatient procedure

30. Magnetic Resonance Imaging (MRI) • The technique is based on the effect of a magnetic field has upon proton excitation • Tissue protons in a magnetic field absorb energy, causing the to wobble • Radio-wave are used to create this magnetic field • After the waves are turned off, the protons return to their original state and emit energy, which is magnetic resonance signal • This bears no known side effects or risks

31. Sport Diving Injuries • Barotrauma • Frequent occur during descent, when a diver is unable to equalize pressure in the internal anatomic air spaces as the ambient pressure increases • Nitrogen Narcosis • As partial pressure increases, more nitrogen is forced into solution with the body • This condition affects the central nervous system with sequential symptoms of dizziness, impairment of mental processing etc…

32. Air Embolism • Is a condition associated with the ascent of the diver • Air or other gas bubbles enter the blood stream and cause obstruction in small arterial vessels and cause hypoxia, and tissue ischemia • Decompression Sickness • Condition arising from dissolved gases coming out of solution into bubbles inside the body on depressurization • Two types of decompression illnesses • Type I is called musculoskeletal bends • Type II is called central nervous system bends

33. Treatment of Environmental Injuries

34. Heat-related Disorders • Heat Cramps • are muscle spasms that result from loss of large amount of salt and water through exercise. • Heat cramps are associated with cramping in the abdomen, arms and calves. • This can be caused by inadequate consumption of fluids or electrolytes • Heat Exhaustion • Can be a precursor of heatstroke; the symptoms include heavy sweating, rapid breathing and a fast, weak pulse • Heat Stroke • Defined by a body temperature of greater than 40.6 °C (105.1 °F) due to environmental heat exposure with lack of thermoregulation. Symptoms include dry skin, rapid, strong pulse and dizziness

35. Preventing Heat Disorders • Ample fluid replacement must be done • Heat acclimatization (cardiovascular and hormonal adjustment) to environment • Appropriate uniforms, equipment and length of activity sessions

36. Cold Injuries • Exposure to cold can produce a variety of injuries that occur as a result of man's inability to adapt to cold. • These injuries can be divided into localized injury to a body part, systemic hypothermia, or a combination of both • Hypothermia or systemic cold injury occurs when the core body temperature has decreased to 35 degrees C (95 degrees F) or less. • The general principals of pre-hospital management are to (1) prevent further heat loss, (2) rewarm the body core temperature in advance of the shell, and (3) avoid precipitating ventricular fibrillation • There are two general techniques of rewarming--passive and active • The freezing of the corneas has been reported to occur in individuals who keep their eyes open in high wind-chill situations without protective goggles (e.g., snowmobilers, cross-country skiers).

37. Frostbite • is the medical condition where localized damage is caused to skin and other tissues due to extreme cold. • Frostbite is most likely to happen in body parts farthest from the heart and those with large exposed areas. • The initial stages of frostbite are sometimes called "frostnip".

38. Chilblains • are acral ulcers (that is, ulcers affecting the extremities) that occur when a predisposed individual is exposed to cold and humidity. • The cold exposure damages capillary beds in the skin, which in turn can cause redness, itching, blisters, and inflammation

39. Discussion • Do you know other measures which runners suffering chronic bone injury are therapeutically beneficial. • In case of extreme cold environment, should you still implement cryotherapy to relieve an acute injury? • Could you design a various types of exercise in conjunction with therapeutic procedure are used to rehab a young adult whose locomotion impairment has brought his life a great inconvenient.