Out of Harm’s Way: Sport Injuries Chapter 8 Sport Books Publisher

Outline: Biomechanical principles of injury Injury treatment and rehabilitation Pain: nature’s warning system Soft tissues injuries Dislocations Fractures Concussions Overuse injuries Injury prevention Sport Books Publisher

Biomechanical Principles of Injury Sport Books Publisher

Each type of tissue possesses unique mechanical characteristics Tissue Types Epithelial Muscle Connective Nervous Each type of tissue possesses unique mechanical characteristics Sport Books Publisher

Loading To best understand the biomechanical characteristics of tissue we examine its behaviour under physical load Under load a tissue experiences deformation Deformation can be visualized through deformation curve Sport Books Publisher

C B A High Load Low Small Large Deformation Ultimate Failure Elastic Limit B Load Plastic Region Elastic Region Low A Small Large Deformation Sport Books Publisher

to return to its original shape High Ultimate Failure C Elastic Limit B Elasticity: capacity of a tissue to return to its original shape after removal of load Load Plastic Region Elastic Region Low A Small Large Deformation Sport Books Publisher

Tissue no longer posesses High Ultimate Failure C Elastic Limit B Plastic region begins Tissue no longer posesses elastic properties Load Plastic Region Elastic Region Low A Small Large Deformation Sport Books Publisher

C B A High Load Low Small Large Deformation Permanent tissue deformation (does not return to original shape) Resulting in micro-failure or injury (e.g. sprains) High Ultimate Failure C Elastic Limit B Load Plastic Region Elastic Region Low A Small Large Deformation Sport Books Publisher

C B A High Load Low Small Large Deformation Ultimate Failure C Elastic Limit Macro- or completes failure (e.g. torn ligament) Tissue becomes completely unresponsive to loads B Load Plastic Region Elastic Region Low A Small Large Deformation Sport Books Publisher

Area = strength of the material High Ultimate Failure C Elastic Limit B Load Plastic Region Elastic Region Low A Small Large Deformation Sport Books Publisher

Slope = stiffness (or resistance to deformation) of the material High Ultimate Failure C Elastic Limit B Load Plastic Region Elastic Region Low A Small Large Deformation Sport Books Publisher

Tissues Response to Training Loads Training load =/ elastic limit Micro-failure  making of new tissue Positive training effect Training load > elastic limit Permanent failure Injury Sport Books Publisher

Forces Acting on Tissue TENSION COMPRESSION BENDING TORSION SHEAR Sport Books Publisher

Injury treatment and rehabilitation Sport Books Publisher

Treatment Rehabilitation Received by patient from a health care professional Promotes healing Improves quality of injured tissue Allows quicker return to activity Rehabilitation Therapist’s restoration of injured tissue +patient's participation Individualized for each athlete Sport Books Publisher

Healing Phases Sport Books Publisher

Inflammatory Response Phase Inflammatory Response Phase Inflammatory 2 – 4 days Inflammatory Response Phase hrs – 6 wks Inflammatory Response Phase 3 wks - yrs Sport Books Publisher

Inflammatory Response Phase Inflammation begins at the time of injury Signs Redness Swelling Pain Increased temperature Loss of function Protect Rest Cryotherapy Decreases swelling, bleeding, pain and spasms Compression Decreases swelling Elevation Sport Books Publisher

Fibroplastic Repair Phase Rehab-specific exercises Restore range of motion and strength Manual massage therapy and ultrasound Help break down scar Protective taping and bracing Repair and scar formation Granulation tissue fills the gap Collagen fibres are deposited by fibroblasts Signs seen in the phase1 subside Sport Books Publisher

Maturation-Remodeling Phase Remodeling or realigning of the scar tissue More aggressive stretching and strengthening To organize the scar tissue along the lines of tensile stress Include sport-specific skills and activities Sport Books Publisher

Pain: nature’s warning system Sport Books Publisher

Pain Nature’s way of telling us something is wrong One of the best indicator of when it is best to resume play Sport Books Publisher

Problem with Ignoring Pain Masking with medications Continued participation Pushing injured tissue closer to yield-level point Gastrointestinal complications Addiction Sport Books Publisher

Soft tissues injuries Sport Books Publisher

Contusions Sport Books Publisher

Compressing force crushes tissue E.g. “charleyhorse” – quadriceps Bruise Compressing force crushes tissue E.g. “charleyhorse” – quadriceps Discoloration and swelling Myositis ossification – abnormal bone formation in a severe contusion Life-threatening if the tissue involved is a vital organ P-R-I-C-E Sport Books Publisher

Strains and Sprains Sport Books Publisher

Tendon or muscle tissue is stretched or torn STRAIN Tendon or muscle tissue is stretched or torn SPRAIN Ligament or the joint capsule is stretched pr torn Sport Books Publisher

Grades of sprains and strains Slightly stretched or torn; few muscle fibres GRADE 2 Moderately stretched or torn, more muscle fibres GRADE3 Complete rupture Surgery required E.g. ACL tear Sport Books Publisher

Common Strains Adductors Hamstrings Quadriceps Hip flexors Rotator cuffs Sport Books Publisher

Emphasize hamstrings and quadriceps equally Hamstring Strains Most frequently strained muscles Mechanism: Rapid contraction in a lengthened position E.g. sprinting and running Due to strength imbalance Hamstring strength >>> quadriceps strength Emphasize hamstrings and quadriceps equally Sport Books Publisher

Ankle Sprains During running, walking, dancing or stepping off a curb Most common = lateral ankle sprain Inversion Common reoccurrence Decreased proprioception Symptoms Rapid swelling Point tenderness Rehabilitation Decreases reoccurrence Incorporation of balance exercises Sport Books Publisher

Dislocations Sport Books Publisher

Great enough forces push the joint beyond its normal anatomical limits Joint surfaces come apart Subluxation When supporting structures (e.g. ligaments) are stretched or torn enough Bony surfaces partially separate Most common = fingers Can become chronic Sport Books Publisher

Dislocation of the Shoulder Sport Books Publisher

Most mobile  most unstable joint Categories of dislocation: Partial (subluxation) Complete Most common Head of humerus slips anteriorly Falling backwards on extended arm Symptoms Swelling, numbness, pain, weakness, bruising Capsule and/or rotator cuff tears Brachial plexus injury Require medical treatment to relocate head of humerus back to glenoid fossa Sport Books Publisher

Fractures Sport Books Publisher

Simple fracture Compound fracture Stress fracture Avulsion fracture Stays within the surrounding soft tissue Compound fracture Protrudes from the skin Stress fracture Results from repeated low magnitude loads Avulsion fracture Involves tendon or ligament pulling small chip of bone Sport Books Publisher

Concussions Sport Books Publisher

No such thing as “minor concussion and “shaking off” Injury to the brain Mechanism: Violent shaking or jarring action of the head Brain bounces against the inside of the skull Symptoms Confusion Temporary loss of normal brain function REST No such thing as “minor concussion and “shaking off” Sport Books Publisher

Overuse injuries Sport Books Publisher

Due to Results from Repeated and accumulated microtrauma Non-sufficient recovery Results from Poor technique Poor equipment Too much training Type of training Sport Books Publisher

Tendonitis Sport Books Publisher

Inflammation of tendon as a result of a small tear in the tendon Tendonitis Excessive , repetitive motion Improper technique Age (loss in elasticity) Symptoms Pain (aggravated by movement) Tenderness Stiffness near joint Sport Books Publisher

Tennis Elbow Lateral epicondylitis Affect forearm extensors Attach to lateral epicondyle Extend wrist and fingers Contributing factors Excessive forearm pronation and wrist flexion Gripping racquet too tightly Improper size3 grip Excessive string tension Excessive racquet weight Topspins Hitting ball off-centre Sport Books Publisher

Gofer’s and Little League Elbow Medial epicondylitis Affects tendons of forearm flexors Attach to medial epicondyle Flex wrist and fingers May result in collateral ligament and ulnar nerve injury May affect medial humeral growth plate in young children (little league elbow) Sport Books Publisher

Jumper’s Knee Patellar tendonitis Affects infrapatellar ligament Caused by: Repetitive eccentric knee actions Eccentric load during jump preparation >>> body weight Sport Books Publisher

Bursitis Sport Books Publisher

Inflammation of the bursae Tiny fluid-filled sacs Lubricate and cushion pressure points between bone and tendons Results from overuse and stress Age is also a factor Most common Shoulder, elbow and hip Inflammation and pain aggravated by movement and direct pressure Sport Books Publisher

Shoulder Impingement Sport Books Publisher

Excess movement of the humeral head + lack of space Inflammation of bursae or rotator cuff tendon Result of muscle imbalances in shoulder muscles Weak shoulder depressors Strong shoulder elevators Balanced strength training Sport Books Publisher

Stress Fractures Sport Books Publisher

Pain along inside tibial surface Involve pain and inflammation Shin splints Pain along inside tibial surface Involve pain and inflammation NO disruption of cortical bone Stress fracture Results from repeated low-magnitude forces Small disruption of the outer bone layer Weakened bone Cortical bone fracture NOT a shin splint Sport Books Publisher

Injury prevention Sport Books Publisher

Protective Equipment Sport Books Publisher

Warm Up and Cool Down Sport Books Publisher

Keeping Fit and Flexible “Use it or lose it” Especially important during the off-season Preparing the muscle for placing demands Sport Books Publisher

In order to function effectively body must receive Eating and Resting In order to function effectively body must receive Proper nutrient Adequate rest Avoid over-training and lack of sleeping Sport Books Publisher