Chapter 8 The Injury Process

The Physics of Sports Injury Connective Tissue Connective tissues are the most common type of tissue in the body. Connective tissues include ____________ __________________________________ __________________________________ In some sports, nearly 50% of acute injuries involve either tendon or muscle.

The Physics of Sports Injury (cont.) Muscle/fascia are thought to be injured by excessive tension during contractions. Tendons are extremely strong structures; strains occur most often at the distal ____________________________(MTJ). These strains are the ____ _________soft tissue injuries related to sports.

Mechanical Forces of Injury Types of Force

Mechanical Forces of Injury (cont.) Tendons resist ________ forces. Bones resist ___________ forces. Ligaments resist _________ forces. Each type of tissue has a limit for how much force it can withstand (critical force).

The Physiology of Sports Injury Is a predictable sequence of physiologic actions that occur when the body reacts in a manner to repair damaged tissues. Begins during the first few minutes following an injury. The body’s initial response to trauma is commonly called _________________.

The Inflammatory Process (cont.) Normal signs and symptoms of inflammation include: .

Acute Inflammatory Phase Initial trauma destroys millions of cells. _________________ is followed by vasodilation. Damage to blood vessels results in blood flow into ___________ ______causing a hematoma. A _________ is the “localized collection of extravasted blood.” ___________ _________injury results in additional cellular destruction.

Acute Inflammatory Phase (cont.) In response to injury, chemicals are released that affect nearby cells. The effects of these chemicals are: _______________ (cellular breakdown). ________________ (vasodilators). ________________ (attract scavenger cells).

Acute Inflammatory Phase (cont.) _____________ __________is responsible for the manufacture of bradykinin. ____________ increases vascular permeability and triggers the release of prostaglandins resulting in: Vasodilation. Increased vascular permeability. Pain. Blood clotting.

Acute Inflammatory Phase (cont.) Plasma proteins, platelets, and leukocytes move out of capillaries and into damaged tissue. Macrophages migrate into the damaged area. Arachidonic acid is formed by a combination of leukocyte enzymes and phospholipids derived from cell membranes.

Acute Inflammatory Phase (cont.) The acute inflammatory process results in a walling off of the damaged area from the rest of the body. The acute phase lasts up to 3 or 4 days, unless aggravated by additional trauma.

Resolution (Healing) Phase During this phase, special leukocytes (polymorphs and monocytes) and a type of macrophage (histocytes) migrate into the area of injury.

Regeneration and Repair Except for bone, connective tissues heal by forming scar tissue that begins to develop 3–4 days after the injury. Fibroblasts are immature connective tissue fibers that can mature into several different types of cells.

Regeneration and Repair (cont.) ______________is the formation of new capillaries. ________ _______may take up to four months. Scar tissue can be 95% as strong as the original tissue. Stress on the tissue is helpful for rehabilitation; exercises are critical to this process. Bone tissue heals by way of specialized cells (__________________________).

Pain and Acute Injury Everyone copes with pain differently. . Pain results from sensory input received through the nervous system and indicates location of tissue damage. Messages concerning sensory information that travel quickly through the nervous system are given higher priority than pain messages that travel more slowly.

Intervention Procedures Sports medicine community has no clear set of criteria for first aid treatment of acute soft- tissue injury. _____________ includes bags of crushed ice, aerosol coolants, ice cups, ice water immersion, and commercial cold packs. After the acute phase,___________is appropriate (i.e., hydrocollator packs, moist warm towels, and ultrasound diathermy).

Intervention Procedures (cont.) Modalities such as ultrasound should ONLY be used under the supervision of trained allied health personnel. . If they must be prescribed by a physician, these agents represent treatments that are beyond the scope of the coach. OTC drugs should also be used with caution. (Consult parents when athlete is under 18 years of age.)

Cryotherapy Direct application of cold may reduce vasodilation in the first few minutes after injury. . Courtesy of Ron Pfeiffer

Cryotherapy (cont.) In extremities, elevation and compression are also helpful in treatment. Elastic wrap secures the ice bag to the body. Cold application has analgesic effect and reduces muscle spasm. Risk of frostbite is minimal with crushed ice.

Thermotherapy Thermotherapeutic agents: Increase vasodilation. Are useful in the final phases of injury repair.

Pharmacologic Agents Steroidal and NSAIDs Both affect aspects of the inflammatory process. Steroidal drugs resemble gluococorticoids, but the exact mechanism of their action is unknown. Steroids may:

Pharmacologic Agents (cont.) Steroids must be used with care. . Steroids may be injected or taken orally and include drugs such as: Cortisone, hydrocortisone, prednisone, prednisolone, triamcinolone, and dexamethasone.

NSAIDs NSAIDs do not have the negative effects of steroids. NSAIDs are very popular drugs. .

NSAIDs (cont.) NSAIDs block the conversion of arachidonic acid to prostaglandin. Research is inconclusive regarding NSAIDs’ effect on tissue healing and strength.

RICE Best approach to the care of soft tissue injury is _______ along with prescribed pharmacologic agents and supervised rehabilitative exercise. R = I = C = E =

The Role of Exercise Rehabilitation Properly supervised physical activity is very effective for many injuries. . © AbleStock

Exercise Rehabilitation Rehabilitation must be supervised by professionals with appropriate training, such as a BOC-certified Athletic Trainer or a Physical Therapist with sports medicine training.

Exercise Rehabilitation (cont.) Rehabilitative exercise is a four-phase process.

Injury Rehabilitation Injury rehab should be considered an ongoing process. Without this approach, the likelihood of reinjury is high.