Chapter 14

1. Chapter 14 Lindsey Mashburn / Nick Grubb Athletic training

2. History AT- began between 1900-1925 assisting predominantly male sport teams. As AT evolved trainers moved to a variety of settings - individual, team sport medicine settings, corporate, industrial, and clinical AT- have a limited scope of practice falling under (MD) (OD)

3. Athletic training is a well recognized allied health profession dealing with the prevention, care, and rehabilitation of active people. Athletic training encompass in area’s of • Medicine • Anatomy • Physiology • Biomechanics • E. Physiology • Nutrition • Psychology • Physics • Management • Pharmacology

4. Athletic Medicine The sports medicine team is headed by the physician. The AT is the on-site representative of the physician. The AT evaluates injuries to provide the physician information for diagnosis.

5. Athletic Medicine Athletic trainers work side by side with Physicians. -While a doctor may not be present the AT is the eye’s and ears of the Doctor. AT’s are usually the first to respond to an emergency and evaluate injuries on behalf of the physician. AT’s also help prevent injuries from becoming more severe. -(RICE) -Immobilization

6. Team work Medical teams may include:

7. Job opportunities The job of a trainer can be various. Ex: • Gym trainer • Boxing coach • Soccer coach • Athletic or celebrity personal trainer World class swimmer Dara Torres employ’s up to 12 different specialists for her training program • Olympic coach • University sport team member

8. Job Opportunity • Currently the largest job market area for AT’s are in sports medicine clinics working with multiple Allied health professions. AT’s may also work with local community programs, individuals, school education programs, marketing, or owning their own business • The second largest job market is in a secondary schools as teachers and trainers. • The third largest setting is in colleges and universities, employing ≤ 10% most of those jobs are in teaching and program directors-(AT’s w/doctoral degrees)

9. Job Opportunity • Professional sport job opportunities are limited, hiring only about 1% of all AT’s. • Industrial/Corporate: rising opportunity dealing with physically active employee’s. (wellness programs) It is more cost effective to treat individuals on sight. Resulting in a decrease of lost profit, by decreasing lost time/productivity.

10. Body of Knowledge(NATA) 6 core areas of expertise • Prevention of athletic injury • Recognition, Evaluation, Assessment • Immediate care of injury • Treatment, rehabilitation, reconditioning • Organization and administration • Professional Development & Responsibilities

11. Prevention A trainers job is to assess and maintain the safety of the athletic environment. There are several ways this is achieved • Pre-activity examination (history, par-Q, Risk stratification) • Informed consent- it’s important to clearly educate the client/athlete about possible risks inherent to physical activity • Prevention is everyone’s job-important to know the signs and symptoms of injury and of the healing process for assessment of progress

12. Prevention Minimization of risk • clean work area • Maintain equipment: • Utilize safety equipment • Use safe training procedures • Preventative/ wellness programs

13. Prevention cont: • Use caution when dealing with adverse environmental conditions heat stroke, cold injury, air pollution circadian dysrhythmia Every year 5-10 high school football players die from heat stroke, usually overweight males subjected to heat and humidity

14. Recognition, Evaluation, and Assessment Again AT’s are the eye’s and ears of physicians and usually the first to intervene in the event of injury. Thus evaluation is very important since the information is used by a physician and sport medical team members for proper diagnosis and treatment. AT’s are also the “go between” for the physician. They update and communicate with the athletes (or worker) coaches and family members on the athlete’s condition of injury. Video: NBA

15. Recognition, Evaluation, and Assessment • AT’s must possess current certification in (CPR) from either the: -American Red Cross -American Heart Association -National Safety Council • AT’s must also take care to prevent exposure to blood born pathogens. (OSHA) requires -The use of latex gloves. -Must be immunized for HEP-B and HIV -Or must sign consent waiver First aid certification is not required but encouraged

16. Recognition, Evaluation, and Assessment

17. Primary Survey • Primary survey – can be formal/informal can be as simple as noting speech or signs of breathing, voluntary movement. Even if the athlete’s injury is miner monitoring levels of consciousness is very important situations can change without warning

18. Secondary survey • Secondary survey- evaluates the specific complaints of the athlete. • Begins with an injury history. It’s important to be accurate for a physicians diagnosis later. Note any previous injury at the same location and if so the previous outcome • Observation/ Palpation • The AT should notice location of injury, deformation, skin discoloration, inflammation. • palpation of the injury starts away from injury and working toward the most painful area. • It’s important to understand the Athlete’s body language, don’t be to firm you want the athlete to feel safe under your supervision

19. Secondary survey cont: Testing may be need to properly assess injury. Response to touch, circulation, the ability to move muscle groups, finally (ROM). (ROM) can be active, passive, or resistive. • Active: Athlete move the body part • Passive: Trainer move the body part (ex: stretching) • Resistive: Athlete move the body part against an opposing force

20. Secondary survey cont: If all other previous evaluations are good special testing my be used. Functional testing is based off previous information gathered and evaluation. Based on the results, an AT may determine if restrictions are need or if the athlete may return to activity. • Mild injury- return to activity • Moderate/severe- remove and refer to physician • Highly severe- EMS

21. Recognition, Evaluation, and Assessment • Constructing a written record (SOAP) • Subjective: what the athlete tells you • Objective: Quantifiable what the AT notes (signs, observations, palpation, special tests) • Assessment: The AT or physicians professional opinion of nature and severity of injury • Plan: Treatment of injury, referral to rehabilitation

22. Immediate Care of Athletic Injury • Acute care • Most often seen • (RICE) Rest, ice, compression, elevation • Rest maybe removal from activity or complete restriction of bodily movement i.e.: crutches, sling, splint, cast. • Ice helps alleviate swelling and further inflammation but not initial • Compression used in conjunction with ice for swelling • Elevation helps in lymphatic drainage

23. Immediate Care of Athletic Injury Along with emergency care education such as CPR, any athletic training program should have an Emergency care plan • A written documented plan that outlines personnel duties, equipment and execution of triage in the event of a first aid emergency • Lead by senior ranking AT or designated physician • Also incorporates EMS personnel • Frequently practiced • Personnel may assume multiple roles

24. Treatment, Rehabilitation, Reconditioning Without AT assistance • “Use or lose it” athletes can suffer from down time, function and mobility loss • cardiovascular functions can diminish decreased stroke volume, HR, cardiac output, and respiratory functions With AT assistance • Results indicate that athletes have less down time when AT’s assist in the treatment of injury. • Athlete’s are more likely to retain their strength, endurance, and mobility. • Athlete’s experience less loss of cardiac output, stroke volume, and respiratory function

25. Treatment, Rehabilitation, Reconditioning To prevent these problems AT’s utilize various active, passive, and resistive exercises To minimize stress and provide a good workout, training may incorporate cycling or swimming which is low impact on joints but good for cardiovascular endurance.

26. Treatment, Rehabilitation, Reconditioning (ROM) • AT’s not only focus of the physiological movements of the body, but the accessory movements as well • Physiological movements are the normal movements of a joint (flex/extend knee) • Accessory movements are small movements that reposition bones to maximize physiological movements (ant. tibial translation/ rotation) • Both are closely related to one another and needed for normal functioning of joints

27. Treatment, Rehabilitation, Reconditioning Forms of exercise • Isometric exercise: focus on tightening a muscle but not moving the joint through the full range of motion. • To get a full work out you may need several incremental movements. • Example: shoulder flexion exercise (normal range 0-1800) is split into 12 separate exercises in a 150 arch While this may be good enough for some joints and activities it may not be sufficient for others.

28. Treatment, Rehabilitation, Reconditioning • Some treatment may warrant Isotonic exercise movements • Two key components Isotonic are concentric/ eccentric movements • Concentric: shortening muscles against the force of gravity (bench press, arm curls) on the up stroke • Eccentric: shorten muscles in a controlled rate (bench press, arm curls) on the down stroke Basically you control the rate, at which you allow gravity to force the movement. This can help improve specific muscle groups and help tone muscles. • Isokinetic exercises offer the advantage of the capability of full range of motion

29. Treatment, Rehabilitation, Reconditioning Closed kinetic chain exercises: • Deal with terminal segments (hand, foot) in contact with a surface • Widely incorporated into training programs of highly skilled athletes and rehabilitation programs. • Example: a slide board used to simulate skating motions for an athlete recovering from ACL injury.

30. Treatment, Rehabilitation, Reconditioning Open kinetic chain exercise • Incorporate terminal segments that don’t touch external surfaces (your limbs but not hands & feet) • Example: a knee extension bench exercise were the bar is fixed to the tibia above the ankle

31. Treatment, Rehabilitation, Reconditioning The general goal of all these different types of exercise is • the recovery of proprioception, ROM, and neuromuscular coordination rehabilitation. • Functional progression phase: moving from inflammation phase to repair phase to remodeling phase. (may take days, weeks, months) • Use of therapeutic modality: short and long term goals achieved through a mixture of exercises aimed at returning ROM • Trainers may release healthy athletes but they still need to continue exercise to fully recover

33. Athletic training part II

34. Organization and Administration • This area encompasses personal management, facility management and design, budgeting, pre-participation physical examinations, medical record keeping, insurance, and public relations. • hours of operation • patient load before deciding how to equip and staff the facility • who is treated • budgeting to purchase expendable supplies and permanent equipment.

35. All of these elements must be present for a negligence claim to be successful. Negligence • Four Elements: • Duty • Breach of duty • Causation • Damage

36. Common Athletic Injuries • Usually occur from trauma or overuse • Signs, symptoms, and functional significance must be evaluated to classify injury. • Signs – Information gathered through objective assessment. Heart rate, blood pressure, body temperature. • Symptoms – Subjective information described by the athlete. Pain, nausea, lightheadedness, and dizziness.

37. Common Athletic Injuries Cont. • Sprains • Strains • Contusions • Overuse injuries • Dislocations • Subluxations • Fractures • Neurologic Injuries

38. Common Athletic Injuries Cont. • Sprains – stretch beyond normal physiologic limits of a ligament. Inhibits range of motion (ROM). • Graded by severity • First-degree sprain – stretches a ligament without tearing fibers and without deformity. • Second-degree sprain – partial tearing of ligament, moderate to strong pain, moderate swelling, inflammation, and loss of function. • Third-degree sprain – severe loss of joint function, often with complete tearing of ligament. Severe pain, swelling, joint instability, and inflammation. This often requires surgical intervention or extensive rehabilitation. Also requires, time away from sports activity. End feel of joint is usually soft/mushy (test that measures joint laxity and ligament stability).

39. Common Athletic Injuries Cont. • Strains – stretch a muscle, a tendon, or muscle-tendon unit beyond normal physiologic limits. • Cause – sometimes caused from absorbing outside forces generated by a collision or inappropriate placement of body parts, but mostly caused by abnormal muscle contraction. • Graded by severity • First-degree – minimal stretching or microtrauma, minimal pain, and loss of function • Second degree – partial tearing of some tissue, moderate pain, loss of function, hematoma formation, muscle spasm, and inflammation. • Third-degree- complete tearing of muscle, tendon, or combined unit, sever loss of function, significant pain, severe loss of strength, hematoma formation, possible calcium formation during healing process, and a possible palpable defect in the muscle

40. Common Athletic Injuries Cont. • Contusions (bruises) – compression injuries that range from superficial damage to deep muscle or bone bruising with significant hematoma. • Caused by direct blow to a body part and result in pain and swelling. • Skin discoloration (ecchymosis) • Dark purple at first, greenish yellow as healing progresses.

41. Common Athletic Injuries Cont. • Overuse Injuries –very common. • Caused by repetitive micotrauma – before an original injury has been allowed to heal, the mechanism is repeated again and again. • Without visible or palpable defects, there is pain on movement and passive stretch, some swelling, loss of function, and inflammation. • Example – Tendinitis –an inflamed tendon

42. Common Athletic Injuries Cont. • Dislocation – A complete disruption of articulating joint surfaces with tearing of most , if not all, ligaments surrounding a joint. • Common sites include finger joints, wrist, elbow, shoulder, and patella. • They should always be referred to a physician or emergency room.

43. Anterior Dislocation of knee Shoulder Dislocation Common Athletic Injuries Cont.

44. Common Athletic Injuries Cont. • Subluxation – A partial dislocation. • The joint surfaces have become disassociated, but spontaneous reduction (moving back into the normal position) of the deformity has taken place.

45. Common Athletic Injuries Cont. • Fractures – a disruption in the continuity of a bone caused by stress • Different Types: • Spiral – caused by twisting forces • Oblique – caused by compression, bending, and twisting. • Transverse – caused by bending forces • Open – penetrate the skin • Closed – under the skin • Any facture should be splinted in the position that is found and athlete should be taken to a physician or emergency room

46. Common Athletic Injuries Cont.

47. Common Athletic Injuries Cont. • Neurologic Injuries: • Closed-head Injuries- concussions and vascular damage. • Cervical Vertebra fractures can penetrate spinal cord • Bulging lumbar disk – pressure on spinal nerve roots leading to atrophy of musculature, abnormal pain sensations, and gait problems.

48. Inflammatory Response • A process whereby the body seeks to control harmful effects of trauma, bacterial and viral invasions, and decreased blood supply. • Signs include: • Pain • Redness • Temperature • Swelling • Loss of function

49. Inflammatory Response Cont. • Early Phase – begins immediately after injury and lasts as long as 3 days. • Late Phase – overlaps the early phase and continues for about a week longer. • A process that involves arteries constricting and in response allows WBC in the capillaries to line the walls. Following there is more dilation of blood vessels with increased blood flow. The capillaries then begin to leak. WBC and protein move outside into the tissue. This attracts water from plasma and swelling occurs

50. Tissue Repair • Begins on the 3rd day after injury and continues for about 3 weeks. • The first week involves scar formation • Synthesis of collagen, developing capillaries bud from intact capillaries on outer edge of wound and a scar takes on a reddish granular appearance. Scar begins to contract. • Remodeling begins on 9th day and can last a year or more. • Collagen molecules are reordered along stress lines through injury site. As collagen is replaced, capillaries will be removed. The final scar has few blood vessels and a white appearance.