http://www.youtube.com/watch?v=LA3vB5vvYgg (lower leg fracture) Basic Injury Care http://www.youtube.com/watch?v=LA3vB5vvYgg (lower leg fracture)

Basic Injury Care After an injury to an athlete, what is the primary goal of the athletic trainer (with regard to the athlete)?

PRICE Protection Prevent further injury Methods of doing so Participation Modifications Transportation Splinting Crutches and cane Bracing http://www.canesgalore.com/images/Crutches%20(5).jpg

PRICE cont Rest Allows for healing to occur Prevents aggravation First 48-72 hours are most important Absolute Rest vs. Active Rest

PRICE cont Ice Body exaggerates inflammatory response Causes vasoconstriciondecreased swelling Decr cellular metabolism Decr tissue hypoxia Decreases pain http://1.bp.blogspot.com/_CICPc_7jGD4/S4P__n4t_1I/AAAAAAAAAJo/KgmZX3GO9Eg/s200/Injury+ice.jpg

ICE Types of ice Frequency and duration Ice bags Frozen gel packs http://www.isokineticsinc.com/mm5/graphics/00000001/icebag1500fs.jpg http://fitasaphysio.com.au/Images/FlexIce1.jpg ICE Types of ice Ice bags Frozen gel packs Modalities (cold whirlpool, game ready, etc.) Frequency and duration 20 minutes on, 40 minutes off Hunting response Observed by Sir Thomas Lewis in 1930

PRICE cont Compression Best when combined with ice Intermittent vs. Constant Effects on swelling Counteracts gravitational effects Aids movement of swelling from joint space https://www.cvs.com/CVSApp/images/articles/192497.jpg

PRICE cont. Elevation Helps decrease swelling Use gradient to help circulate blood flow Injured area above level of heart Best when combined with active movements (venous pumping)

Let’s Put it all Together What do most of the items or PRICE, particularly the Ice, Compression, and Elevation, have in common? Why do you think this is so important?

Injury Video http://www.youtube.com/watch?v=BGmT2jeVzFs (DeAndre Brown broken leg)

In addition to swelling, we need to address PAIN!! Pain occurs from “Mechanical Failure” of tissue (injury) Release of chemical mediators (prostaglandins) Nerve impulses sent to brain Excess swelling pressing on nerve fibers Leads to more impulses sent to brain Pain-spasm-pain cycle perpetuates pain

Question of the day What are the five elements of P.R.I.C.E. and what is the primary goal of the last three elements (I.C.E.)? ANSWER: Protection, Rest, Ice, Compression, and Elevation; Ice, compression, and elevation all focus on decreasing swelling.

Pain-Spasm-Pain Cycle Pain occurs muscles spasm to protect area more pain occurs (tightness and compression) Need to interrupt this somehow!! Pain Spasm

Pain Control Theories Gate Control Theory Central Biasing Theory Endogenous Opiates Theory

Gate Control Theory (spinal cord) Brain acts as final destination and gives signals to rest of body Transmission cell (spinal cord) relays signals to brain Consider it as a “Gate” to the brain Pain fibers travel to transmission cell ENTER GATE Pain Sensory feedback stimulates A-Beta fibers Travel to transmission cell faster= “CLOSING GATE” Decrease in pain

Gate Control Theory Diagram http://sciblogs.co.nz/guestwork/files/2010/03/brain1.jpg Trans cell PAIN http://www.jyi.org/articleimages/1397/originals/img0.jpg Injury

Gate Control Theory Diagram http://sciblogs.co.nz/guestwork/files/2010/03/brain1.jpg DECREASED PAIN Trans cell http://www.jyi.org/articleimages/1397/originals/img0.jpg Sensory Stimulation Injury

Central Biasing Theory (brainstem) “Pain Inhibits Pain” C fibers stimulated through controlled stimulation Brainstem releases serotonin (linked to happiness) A-delta fibers inhibited/shut down (at spinal cord) Pain sensation does not travel to brain Much more complex, but essentially, creating pain decrease in acute pain

Endogenous Opiates Theory (brain) Enhances production of natural endorphins Rhythmic stimulation of muscles (and A-delta fibers) Increased endorphin production Secretion of ACTH (adrenocorticotropic hormones) which help produce natural cortisone (anti-inflammatory agent) Also results in central biasing as well