Chapter 3

Understand:  Inflammation process in healing  Treatment rationale of ice vs. heat Identify:  Principles of physical rehabilitation and range of motion  More common musculoskeletal disorders  Athlete’s vital signs  Distinguish between acute and chronic injury management

 Injury  Injury (strain, sprain, contusion, open wound): the body immediately begins the process of healing.  Healing:  Healing: the process where the body repairs damage tissue.  Inflammation:  Inflammation: one component of the healing process, where the body begins to repair itself.

 Acute Injury:  Acute Injury: muscle strain or ligament sprain, tissue is torn, capillaries are damaged, and cells die, interference in blood and oxygen supply.  Bodies Reaction:  Bodies Reaction: sending specialized cells to the injured site attempting to limit damage and begin healing (blood clotting, contracting muscles, which splints the area to restrict further movement, and reduce blood flow.)  Bodies Reaction:  Bodies Reaction: pain, swelling, redness, heat, and loss of function. Hey guys

 Pain:  Pain: pressure on nerve endings from internal hemorrhage and cellular response to lack of oxygen.  Swelling:  Swelling: (edema) accumulation of fluids in the damage area. ◦ Hemorrhage, lymph fluid, and synovial fluid contributes to swelling and pressure. ◦ Gravity also increases swelling.  Redness:  Redness: increased blood supply (the body provides the site with nutrients for repair).

Three Phases of the Healing Process: 1. Inflammation- 1. Inflammation- redness and swelling (2-4 days) 2. Initial repair- 2. Initial repair- (tissue repair) scare tissue is the first tissue the body generates. (2-4 weeks) 3. Regeneration- 3. Regeneration-replace all damaged tissue with new and healthy tissue. (1 year)

Vital Signs: Vital Signs: measures that monitor life (heart rate, breathing, pulse) Pulse Pulse: Adult beats/minute; child beats/minute  Rapid, but weak pulse-shock, bleeding, diabetic coma, and/or heat exhaustion.  Rapid, but strong pulse-heat stroke and/or severe fright.  Strong, but slow pulse-skull fracture and/or stroke.  No pulse  No pulse -cardiac arrest and/or death.  Take pulse neck (carotid artery) and wrist (radial artery)

Respiration-adult breaths/minute, child breaths/minute  Shallow breathing-shock  Irregular/gasping-cardiac related  Frothy blood from the mouth-chest fracture (rib fracture) in upper lateral portion of chest (arm pit). Watch, feel, and count (rise and fall of chest)

Temperature-oral 98.6 degrees  Hot, dry skin-disease, infection, and/or over- exposure to environmental heat.  Cool, clammy skin-trauma, shock, and/or heat exhaustion.  Cool and/or dry skin-over-exposure to cold.

Skin Color  Red Skin-heat stroke, diabetic coma, and/or high blood pressure.  White(pale)-insufficient circulation, shock, fright, hemorrhage, heat exhaustion, and/or insulin shock.  Blue-blood is poorly oxygenated.  Non-white athlete-examine inner lip, gum, fingernail beds. (they still exhibit a paling of skin)

Pupils:  Constricted (sunlight)-during traumatic situation: central nervous system and/or intake of depressant drug.  Dilated (dark room) or unequal-during traumatic situation: head injury, shock, heat stroke, hemorrhage, and/or intake of stimulant drug.  Pupils fail-brain injury, intake of alcohol, or drug poisoning. PEARL PEARL-Pupils Equal And Reactive to Light (examination of the eyes)

State of Consciousness: Level of Consciousness (LOC) 1. Mental awareness 2. Memory and ability to recall 3. Response to commands, directions, events, etc. AVPU AVPU-alert, verbal, responds to pain, and unresponsive.

Movement (Four Patterns): 1. Active (athlete provides movement) 2. Passive (trainer moves body part) 3. Assistive (trainer assists the athlete with movement) 4. Resistive (trainer provides resistance to oppose the movement of the body part)

Abnormal Nerve Stimulation: 1. Motor (movement)-athlete contracts affected muscle 2. Sensory (feeling)-athlete touch (i.e. sharp vs. soft) Blood Pressure Adult: 120(systolic)/80(diastolic)  Heart contracts(blood out), systolic pressure can be determined, as heart relaxes(blood in), diastolic pressure is determined.

ICE vs. HEAT  Ice-first hours-Reevaluate and if swelling, pain, redness still present continue with ice. Reduces: swelling, blood flow, pain 1. Ice packs-15 minutes-no directly to skin 2. Ice message-5-10 minutes-move ice continuously 3. Whirlpool-15 minutes-perform rehab movements-downfall, not elevated. 4. Cold spray-no longer then 10 seconds-damage to skin, only cools surface.

Heat- increased blood flow, reduced muscle stiffness, muscular relaxation.  Hot packs-towels to protect skin.  Hot whirlpool-follow-up treatment, rehab movements. Contrast bath-follow-up treatment (hot/cold water immersion) heat pack and ice packs

EXERCISE- movement of the body (muscles)  increases circulation at a deeper level.  Strength  Regain lost range of motion Therapeutic Modalities: decrease pain, swelling, muscle spasm (utilized with exercise)  Electrical -currents  Heat-short wave and microwave  Light-ultraviolet  Cold  Air  Water  Message  Laser

Acute vs. chronic: 1. Acute-quick onset, short duration (PRICES) 2. Chronic-Long duration, repeating. Continued PRICES, but is coupled with exercise, therapeutic modalities, heat, and contrast treatments.

GOAL GOAL- return injured athlete to pre-injury level of strength, power, endurance, flexibility, and confidence as quickly and safely as possible.  Arranged by Athletic Trainer upon physicians protocol.  Pain-should be avoided  Athlete follows the program.

Five Phases designing a Program: 1. Post-surgical/acute injury 2. Early exercise 3. Intermediate exercise 4. Advanced exercise 5. Initial sports re-entry Various rates of recovery should be expected.

Athlete needs to return: 1. Joint range of motion (ROM)-normal movement of a joint 2. Muscle Flexibility 3. Muscular Strength 4. Muscular Power 5. Endurance 6. Balance 7. Proprioception 8. Kinesthetic awareness 9. Cardiovascular Fitness (total body conditioning)

 Arthritis: inflammation of a joint  Atrophy: decreasing in size of organ or tissue due to degeneration of cells  Bursitis: inflammation of bursa sac  Contracture: fibrosis of muscle tissue producing shortening of the muscle (doesn’t generate strength)  Contusion: a bruise, skin is not broken, direct blow  Dislocation: displacement of one or more bones or a joint or organ from original position  Epicondylitis: (pitchers elbow, tennis elbow) inflammation of the epicondyle and the tissues adjoining them to the humerus

 Fasciitis: inflammation of a fascia  Myositis: inflammation of muscle tissue  Myositis Ossificans: inflammation of muscle, with formation of bone  Sprain: ◦ stretching or tearing of joint structure (ligaments and joint capsules) ◦ Strains stretching or tearing of muscle and tendons  Subluxation: partial or incomplete dislocation  Tendinitis: Inflammation of the tendon