Sports Medicine Primer for the Soccer Coach

1. Sports Medicine Primer for the Soccer Coach Scott Hamill, ATC, PTA Dominican Hospital Sports Medicine Center

2. The risk of injury is inherent in sports • Coaches are first responders and may need to deal with injuries from abrasions to concussions • Three million kids play high school and youth soccer in the U.S. • Approx. 450,000 injuries occur yearly

3. Injury Prevention • Proper conditioning • Proper warm up/stretching • Equipment: well fitting cleats, shin guards, synthetic balls, fixed goals, field conditions • Hydrate • Avoid overtraining: stress followed by REST and the body grows stronger • Encourage athletes to talk about injuries. Injuries addressed early resolve more quickly

4. Sports Injury Treatment

5. Soft Tissue Injury • PRICE: Protection, Rest, Ice, Compression, Elevation • Contusion • Ice, compression, protection • Deep thigh contusion: flex knee and ice to prevent hematoma • Abrasion • Clean, disinfect, dress • Laceration • Clean,disinfect, dress. • Suture if too wide or deep to close. Location • Blister • Puncture with sterilized needle and drain • Apply antibiotic and cover with gauze or bandaid • Callus

6. Sprain • Ligaments connect bone to bone • Severity: mild moderate severe • Ice, support, compression, crutches • Send for xray if unable to walk on the ankle, significant swelling, symptoms don’t improve after a few days, pain in foot or above ankle

7. Strain • Muscle/tendon • Ice, compression, crutches • No massage or stretching first 48 hours • No heat for 72 hours • Gentle stretching after light warm up • Strength exercises if no localized pain • Progress to full go gradually

8. Finger Splint, ice, send to ER Ankle Do not move athlete if obvious fracture/dislocation call 911 Fracture/Dislocation Management

9. Patella Usually dislocates laterally Do not move athlete Call 911 Shoulder Usually dislocates anteriorly Sling, ice, transport immediately If parent or coach can’t transport call 911

10. Teeth Assess for concussion Put tooth in container with saline, milk, saliva Get to Dentist or ER Can be saved if treated in 2-3 hours Eye Foreign body Wash out with athlete side lying If object cannot be removed or eye is punctured cover eye with gauze and send to ER. Do not remove impaled object Head and Face Injuries

11. Nose • Bleeding • Assess for concussion • Pinch nostrils and hold one minute • Rolled gauze under bottom lip • Rolled gauze in nostrils for return to play

12. Nose fracture • Suspect concussion/neck injury • Crepitus/cracking at bridge of nose • Obvious deformity • Rolled gauze on each side of nose taped down on cheeks • Ice and send to doctor

13. Abdominal Injuries • Organ injuries • Wind knocked out. Calm athlete and hands on head to open rib cage • Testicular spasm. If athlete is on back bring both knees to the chest and hold 20 seconds. • Internal bleeding. Rebound tenderness: pain when pressing on abdomen is released. Watch athlete for dizziness, lethargy, fainting, vomiting. Call 911 and put into shock position on back with legs elevated and cover for warmth.

14. Concussion Mangement • No return to play same day. • When in doubt sit them out • Progressive exertional return to contact • Any return of symptoms and process begins again at day one • Impact baseline test • Cumulative traumatic encephalopathy

15. Cervical Injuries • Do not move athlete! Other athletes should be told to never try to help injured athlete to their feet! • Symptoms: • Numbness, tingling, burning in extremities • Loss of motor control. Can’t move arms, legs, hands, feet. • Neck pain

16. Treatment • Stabilize head/spine • Calm athlete • Activate EMS • Assess and maintain ABCs

17. Heat Injuries • Signs and Symptoms • Chills • Dark colored urine • Dizziness • Dry mouth • Headaches • Thirst • Weakness

18. Prevention • Proper training for the heat • Fluid replacement before, during and after exertion. 16 oz one hour before exercise, 4-8 oz during. • Appropriate clothing—light colored, loose fitting and limited to one layer • Early recognition via direct monitoring of athletes by other players, coaches and medical staff • Monitoring the intensity of physical activity appropriate for fitness and the athlete's acclimatization status

19. Treatment • Get athlete to shaded area • Cool rapidly with ice packs cold water from hose or water bottles • Water soaked towels over body • Provide cold beverages if able to drink • Activate EMS

20. When can the Athlete Return to Play? • Lower body • Full ROM, Full strength • Two legged hop X 10 • Injured leg hop X 10 • Jog in place • Jog straight ahead • Run straight ahead • Back pedal • Carioka both directions • Stop progression if pain or limp develops

21. Upper body • Full ROM, Full strength • Push up x 10 • Sport specific movements

22. Emergency Plan • Make sure someone has cell phone coverage • Know where EMS will access field • Appoint coach or parent to direct EMS to injured athlete

23. Internet Resources • stopsportsinjuries.org • Nata.org • childrensmemorial.org • Smsmf.org (ACL Injury Prevention) • www.cdc.gov/concussion (concussion info) • www.soccerinteractive.com (dynamic ex) • http://www.youtube.com/watch?v=snPo9omB4wA&feature=related (Ankle taping video)