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Warm-up

Warm-up. What are some things that happen to the body when it is injured? Is swelling a good thing? Is scar tissue a good thing? Do you have any scars? Is pain physiological or psychological?. TISSUE RESPONSE TO INJURY. SPORTS MEDICINE PRINCIPLES OF ATHLETIC TRAINING.

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Warm-up

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  1. Warm-up • What are some things that happen to the body when it is injured? • Is swelling a good thing? • Is scar tissue a good thing? • Do you have any scars? • Is pain physiological or psychological?

  2. TISSUE RESPONSE TO INJURY SPORTS MEDICINE PRINCIPLES OF ATHLETIC TRAINING

  3. THE INFLAMMATORY RESPONSE • ACUTE OR CHRONIC • ACUTE HAS A SHORT ONSET • CHRONIC HAS A LONG ONSET AND LONG DURATION

  4. ACUTE INFLAMMATION • THREE PHASES • ACUTE, REPAIR, AND REMODELING • PHASE 1: ACUTE • INITIAL BODY RESPONSE • 3 TO 4 DAYS • REACTION DESIGNED TO: a. Protect b. Localize c. Rid the body of some injurious agent in preparation for healing and repair

  5. ACUTE INFLAMMATION • MAIN CAUSES OF INFLAMMATION ARE : • TRAUMA • CHEMICAL AGENTS • THERMAL EXTREMES • PATHOGENIC ORGANISMS • CELLULAR DEATH OCCURS FROM THE TRAUMA • DEATH OF TISSUE MAY BE CAUSED BY LACK OF OXYGEN

  6. ACUTE INFLAMMATION • R.I.C.E PRINCIPLE SHOULD BE USED TO DETER TISSUE DEATH R.est- stay of injured area I.ce- apply ice immediately for 15-20 minutes C. ompression- depending on the area injured a compression wrap should be applied (never on the lower leg) E.levation- elevate the injured area above the heart

  7. ACUTE INFLAMMATIONVASCULAR RESPONSE • VASOCONSTRICTION: IN THE FIRST HOUR BEFORE INFLAMMATION OCCURS • DECREASE IN THE DIAMETER OF THE BLOOD VESSEL • COAGULATION BEGINS TO SEAL BROKEN VESSELS AND IS FOLLOWED BY ACTIVATION OF CHEMICAL INFLUENCES • VASODILATION: INCREASE THE DIAMETER OF THE BLOOD VESSEL • LEADS TO SWELLING (EDEMA) • EXUDATES OF PLASMA AND CONCENTRATION OF RED BLOOD CELLS • THE CELL WALL BECOMES MERE PERMEABLE

  8. ACUTE INFLAMMATIONBLEEDING AND EXUDATES • THE EXTENT OF FLUID IN THE INJURED AREA IS HIGHLY DEPENDENT ON THE EXTENT OF DAMAGED VESSELS AND THE PERMEABILITY OF THE INTACT VESSEL

  9. WARM-UP • AN INJURY THAT JUST HAPPENED IS CONSIDERED AN __________ INJURY? • WHAT IS EDEMA? • WHAT IS ECCYMOSIS? • WHAT DOES R.I.C.E. STAND FOR? • THE INITIAL BODIES RESPONSE TO INJURY IS DESIGNED TO DO WHAT? • WHAT IS VASODIALATION? • IT HAS BEEN DETERMINED THAT THE IMMEDIATE APPLICATION OF ICE REDUCES THE HEALING TIME BY?

  10. PHASE II: REPAIR PHASE(HEALING) • FOLLOWS INFLAMMATORY PHASE • 48-72 HOURS TO APPROXIMATELY 6 WEEKS • THIS PHASE OCCURS WHEN THE AREA HAS BECOME CLEAN THROUGH THE REMOVAL OF CELLULAR DEBRIS, ERYTHROCYTES AND THE CLOT • THIS PHASE DEPENDS ON HOW WELL WE TREAT THE PATIENT DURING THE ACUTE PHASE!

  11. TYPES OF HEALING • TISSUE REPAIR IS ACCOMPLISHED THROUGH THREE PROCESSES • RESOLUTION: THERE IS LITTLE TISSUE DAMAGE AND NORMAL RESTORATION • GRANULAR TISSUE: OCCURS IF RESOLUTION IS DELAYED • REGENERATION: REPLACEMENT OF TISSUE BY THE SAME TISSUE

  12. HEALING cont. • GRANULATION TISSUE IS SCAR TISSUE • THE PROXIMITY OF THE INJURY DETERMINES THE AMOUNT OF SCAR TISSUE • GRANULATION HEALING HAS 2 TYPES: • PRIMARY HEALING: LOW SCAR TISSUE • SECONDARY HEALING: GAP IN INJURY

  13. PHASE III: REMODELING(REHABILITATION) • OVERLAPS THAT OF REPAIR • FIRST 3 TO 6 WEEKS ARE CHARACTERIZED BY INCREASE PRODUCTION OF SCAR TISSUE AND INCREASED STRENGTH OF THEIR FIBERS • STRENGTH OF SCAR TISSUE CONTINUES TO INCREASE FROM THREE MONTHS TO YEARS • THE SCAR TISSUE IS ONLY AS STRONG AS THE DEMANDS THAT YOU PLACE ON IT

  14. CHRONIC INFLAMMATION • SWELLING THAT LAST FOR MONTHS TO YEARS • RESULT OF REPEATED MICRO TRAUMA AND OVERUSE

  15. SOFT TISSUE HEALING • ALL TISSUES OF THE BODY EXCEPT FOR BONE • THE BODY AS 4 TYPES OF SOFT TISSUE: • EPITHELIAL TISSUE: SKIN • CONNECTIVE TISSUE: TENDONS, LIGAMENTS, CARTILAGE, FAT, BLOOD VESSELS • MUSCLES • NERVOUS TISSUE: BRAIN, SPINAL CORD, & NERVES

  16. CARTILAGE HEALING • ARTICULAR CARTILAGE HAS LIMITED CAPACITY TO HEAL • CARTILAGE HAS LITTLE TO NO DIRECT BLOOD SUPPLY • THE CLOSER THE CARTILAGE IS TO A BLOOD SUPPLY THE MORE LIKELY IT WILL HEAL (BUT IT WILL TAKE TIME)

  17. LIGAMENT & MUSCLE HEALING • UNDERGOES THE THREE PHASES OF ACUTE, REPAIR AND REMODELING • FULL LIGAMENT HEALING WITH SCAR MATURATION MAY TAKE AS LONG AS TWELVE MONTHS • MUSCLE MUST HAVE REHABILITATION STRENGTHENING EXERCISES IN A PROGRESSIVE MANNER TO HEAL COMPLETELY

  18. NERVE HEALING • NERVE CELLS DO NOT REGENERATE • REGENERATION CAN TAKE PLACE WITHIN A NERVE FIBER • THE CLOSER THE INJURY IS TO THE NERVE CELL THE MORE DIFFICULT REGENERATION BECOMES

  19. MODIFYING SOFT-TISSUE HEALING • HEALING PROCESS IS UNIQUE IN EACH ATHLETE. • DIFFERENT TISSUE VARY IN THEIR ABILITY TO HEAL (CARTILAGE) • AGE AND NUTRITION MAY ALSO AFFECT HEALING • MANAGEMENT CONCEPTS: • ANTI-INFLAMMATORY DRUGS- DECREASE VASODILATION • THERAPEUTIC MODALITIES: COLD, HEAT, ULTRASOUND, ELECTRIC STIM • THERAPEUTIC EXERCISE: STRENGTH AND RANGE OF MOTION ARE THE KEY a. IMMOBILIZATION IS NOT ALWAYS GOOD FOR INJURIES

  20. FX HEALING TAKES TIME, COACHES, TRAINER, & ATHLETES MUST BE PATIENT FX HEALING FOLLOWS THE SAME THREE PHASES OF HEALING BUT IS MORE COMPLEX ACUTE PHASE: TRAUMA HEMORRHAGE BONE DEATH REPAIR PHASE: GRANULATION WOVEN BONE CALLUS FORMATION REMODELING PHASE: RESORPTION OF CALLUS TRABECULAR BONE BONE FRACTURE HEALING

  21. IN GENERAL ACUTE FX HEALING HAS 5 STAGES HEMATOMA FORMATION CELLULAR PROLIFERATION CALLUS FORMATION OSSIFICATION REMODELING HEMATOMA FORMATION: ACUTE INFLAMMATION USUALLY LAST ABOUT 4 DAYS HEMATOMA FORMS AROUND THE ENDS OF THE BONE AND A CLOT FORMS ACUTE FX HEALING

  22. FX HEALING • CELLULAR FORMATION • HEMATOMA BEGINS ORGANIZATION OF GRANULAR TISSUE AND GRADUALLY BUILDS A FIBROUS JUNCTION BETWEEN THE FRACTURED ENDS • THESE CELLS INITIALLY PRODUCE A FIBROUS CALLUS, THEN CARTILAGE, AND FINALLY WOVEN BONE

  23. FX HEALING • CALLUS FORMATION • SOFT CALLUS: FORMED WITHIN 1-2 WEEKS • UNORGANIZED NETWORK OF WOVEN BONE AT THE ENDS OF THE FRACTURE • LATER ABSORBED AND REPLACED BY BONE • SOFT CALLUS STAGE THE INTERNAL AND EXTERNAL CALLUS ARE PRODUCED • THESE CALLUS START TO IMMOBILIZE THE FX

  24. FX HEALING • HARD CALLUS • IN 3-4 WEEKS THE HARD CALLUS STARTS TO FORM INTERNALLY FIRST FOLLOWED BY THE EXTERNAL CALLUS • THE HARD CALLUS CONTINUES TO GROW UP TO 3-4 MONTHS • THE HARD CALLUS IS A GRADUAL CONNECTION OF BONE FILAMENT TO THE WOVEN BONE AT THE FRACTURE ENDS

  25. FX HEALING • OSSIFICATION: • OCCURS WHEN THE BONE HAS BEEN PROPERLY IMMOBILIZED AND THE BONE ENDS BECOME CROSSED WITH THE LAYING DOWN OF PRIMARY BONE • THE CALLUSES ARE ABSORBED BY THE OSTEOCYTES (BONE CELLS) • THE FRACTURE HAS BEEN BRIDGED AND FIRMLY UNITED

  26. FX HEALING • REMODELING • OCCURS AFTER THE CALLUS HAS BEEN ABSORBED AND THE NEW BONE HAS BEEN LAID DOWN • THIS CAN LAST UP TO YEARS • THE REMODELING PHASE IS CONSIDERED COMPLETE WHEN THE FX HAS BEEN RESTORED TO ITS FORMER SHAPE OR HAS DEVELOPED A SHAPED THAT CAN WITHSTAND IMPOSED STRESSES

  27. MANAGEMENT OF ACUTE FX • BONES MUST BE IMMOBILIZED UNTIL X-RAYS REVEAL THE HARD CALLUS HAS FORMED • SOME DOCTORS ALLOW THE ATHLETE TO RETURN TO ACTIVITY AT THIS STAGE AS LONG AS THE FX IS NON-WEIGHT BEARING AND IMMOBILIZED • ITEMS THAT MAY AFFECT THE HEALING PROCESS • POOR BLOOD SUPPLY • POOR IMMOBILIZATION • INFECTION

  28. PAIN

  29. PAIN • MAJOR INDICATOR OF INJURY! • PAIN RECEPTORS (NOCICEPTION) • TYPE C FIBERS (SLOW) • TYPE A FIBERS (FAST) • TYPE C RATE OF .5 TO 2 METERS PER SECOND • TYPE A RATE OF 5 TO 30 METERS PER SECOND

  30. PAIN • TYPE C ARE THE SLOW TRAINS TO THE BRAIN AND CARRY THE DULL ACHING TYPE PAIN • TYPE A ARE THE FAST TRAINS TO THE BRAIN AND CARRY THE SHARP STABBING TYPE PAIN • BOTH THESE TRAINS TELL THE BODY TO RELEASE ITS OWN PAIN KILLERS

  31. PAIN CATEGORIES • ACUTE VERSUS CHRONIC: • ACUTE PAIN IS PAIN THAT IS LESS THAN SIX MONTHS IN DURATION • ACUTE PAIN IS WHEN TISSUE DAMAGE OCCURS AND SERVES AS A WARNING! • CHRONIC PAIN HAS A DURATION LONGER THAN SIX MONTHS

  32. PAIN CATEGORIES • REFERRED PAIN: OCCURS AWAY FROM THE INJURY SITE • 3 TYPES OF REFERRED PAIN • MYOFASCIAL PAIN: TRIGGER POINTS • SLCEROTOMIC & 3. DERMATOMIC: BONE, MUSCLE, FASCIA, OR SKIN AREAS SUPPLIED BY A SINGLE NERVE ROOT • THESE TYPES OF PAIN CAN CAUSE DEPRESSION, ANXIETY, FEAR & ANGER

  33. VARIATIONS IN PAIN SENSITIVITY • PAIN MODULATION: PAIN IS A MIXTURE OF BOTH PHYSIOLOGICAL AND PSYCHOLOGICAL • MANAGEMENT CAN BE A MAJOR CHALLENGE • PAIN ASSESSMENT: VERY DIFFICULT • USE A SCALE OF 1 TO 10 • USE WORDS LIKE: NONE, SLIGHT, MILD, MODERATE, SEVERE

  34. TX OF PAIN • KEY IS TO STOP PAIN-SPASM-PAIN CYCLE! • HEAT AND COLD • ANALGESIA • PAIN GATE THEORY (HEAT, ICE, TENS, ACUPUNCTURE, COUNTERIRRITANT, ELECTRIC STIM) INJURED ATHLETE

  35. PSYCHOLOGICAL ASPECT OF PAIN • TOUGHEST PART OF MY JOB • PLAY WITH PAIN AND NOT INJURY??? • CRY WOLF SYNDROME • EASIER TO DETERMINE WITH THE “TOUGH” ATHLETES?

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