Injuries

Lesson Goals; Become familiar with specific injuries to the shoulder, knee, elbow and ankle Be able to identify different types of injuries Discuss causality of specific injuries i.e; motion, mechanics and overuse Explore taping techniques to immobilize and protect an injured limb or joint

Shoulder Injuries Tendonitis Impingement Syndrome (very common) Multi-Axial Joint ↑ ROM  ↑ Risk of Injury ↑ Mobility  ↓ Stability Overhead movement  ↑ Stress to Shoulder Joint Many Types of Shoulder Injuries: Tendonitis Impingement Syndrome (very common) Tears, Fractures, Separations & Dislocations

Impingement Syndrome Implications; Most common in the AC Joint Acute or Chronic? Why? Lack of space and many structures passing through the AC joint Caused by excessive abduction of the Humerus (why abd?) Implications; Bone Spurs Inflammation of structures and joint capsule Loss of ROM, function and eventually strength Preventative measures?

Impingement syndrome

AC Separations & Sprains Function: - allows to raise arm above head Mechanism of Injury: - direct force (body check) - falling on outstretched hands Severity: - grade 1,2,3, sprains - grade 3 = completely torn - step or piano key deformity - surgery required Recovery & Prognosis: - RICE!!! & Sling (different types) - Restore full ROM - Restored Strength - Return to play at athletes discretion Sling used to take away downward force acting on the shoulder and to lift it back to its natural position. Different types of slings allow you to not only lift the arm but also press down on the clavicle bone to bring the joint back to its normal position (only if athlete can tolerate pressure on clavicle Allows you to raise your arm above your head

Dislocations and Separations A dislocation occurs when a bone is displaced from its original location. Depending on the severity, tendons and ligament may be sprained or torn. The joint looks deformed/awkward Painful when touched The joint is not useable Medical attention is required! Do not try to put it back in place yourself!, you may cause more damage!

SHOULDER DISLOCATIONS Account for 50% of all dislocations in the body - ROM - relies on supporting muscles for stability - surgery usually not necessary, unless tissues are torn, - RICE & Sling Anterior Dislocation most common (95% of all shoulder dislocations) - Head of the Humerus is forced out anteriorly & Inferiorly - direct impact or forced abduction & external rotation Recovery: RICE, Restore ROM & strength rotator cuff muscles Release tension in dominant muscles (pecs, lats, trapezius) Post Surgery  joint immobilized for up to 6 weeks (sling) several months for full recovery more susceptible to for more dislocations in the future…..why?

Rotator cuff muscles

Elbow Injuries Medial Epicondylitis: (golfer’s elbow) Inflammation on the medial aspect of the elbow Involves muscles that originate at the medial aspect of the elbow Cause: (chronic overuse) - repeated flexion & or pronation (wrist) - golf, pitching, javelin, bicycling, weightlifting Recovery: - can be lengthy (months/years) - RICE - deep tissue manipulation (ART) - practice proper technique (deadlift example) - massage wrist flexors - stretch wrist extensors - strengthen wrist flexors - condition wrist extensors

Elbow Injuries Lateral Epicondylitis (tennis elbow) - inflammation of the lateral aspect of the elbow - involves muscles that originate at the lateral aspect of the elbow Cause: (chronic overuse) - repeated extension & or supination of the wrist - novice player, poor technique, poor equipment (heavy racquet) - inadequate strength, power, flexibility & endurance Recovery for both: - can be lengthy (months) - RICE - deep tissue manipulation (ART) - practice proper technique - massage wrist extensors - stretch wrist flexors - strengthen wrist extensors - condition wrist flexors

Knee Injuries Most traumatized joint…why? Many sports place stress on the knee Complexity of joint increases its chance for injury Most common injuries: Patello-Femoral pain syndrome (Chronic) Improper tracking of the patella due to muscle length & tension issues (pulley system) Ligament Injuries (ACL & PCL) - Factors contributing to Knee Injuries: Position of knee ( joint angles ) Foot fixed to the ground (cleats?) Angle & Force of Trauma Previous injury (degree, proper rehabilitation) Strength of muscles crossing the joint Improper execution of movement Muscle imbalances

ACL & PCL Injuries Recovery: ACL  prevents anterior translation of tibia Injury most commonly occurs from planting & twisting motion PCL  prevents posterior translation of the tibia Injury most commonly occurs from hyperextension falling on the tibia with the knee flexed at 90° Not as common due to strength of PCL compared to ACL Recovery: RICE, Strengthen & improve flexibility of muscles around Knee & Hip (Post Reconstructive Surgery) Biking within first 2 months Light jogging within 4 months Return to sport within 6-9 months minimum

The Knee http://wvir.images.worldnow.com/images/181327_G.jpg

Jumpers Knee

“Jumpers Knee” Treatment? Inflammation of the inferior aspect of the Patellar Tendon Similar to Patellar Tendinitis or Patellar-Femoral Syndrome Caused by excessive jumping (incorrectly) Pain is right below the knee cap Treatment? Correct jumping technique Similarly to Patellar Tendinitis, correct muscle length and tension discrepancies RICE! Tape Jumpers Knee to aid in healing and recovery!

Ankle & Foot Injuries High risk for injury Foot in contact with the ground Supports entire body First joint to absorb forces from the ground Composed of 26 bones 15 Phalanges, 5 Metatarsals, 7 Tarsals, Tibia & Fibula (most complex joint) http://www.hawaii.edu/medicine/pediatrics/pemxray/v3c03.html

Lateral & Medial aspects of the Ankle

Ankle & Foot Injuries Inversion Sprains (turning over on your ankle) Involve 1 or all 3 of the lateral ankle ligaments Anterior & Posterior Talofibular Ligaments Calcaneo Fibular Ligament Most Common ankle injury……why? Lateral supporting ligaments  WEAK Medial supporting ligament(s)  STRONG it is more difficult to Evert the foot because the Talus butts up against the distal head of the Fibula Eversion sprains are often mistaken for distal Fibular head fractures Mechanism of Injury: Explosive side-by-side motion, such as in tennis or basketball Ankle sprain can occur during any weight-bearing activity (walking) Inversion sprains are very common for individuals who wear high heeled shoes

Ankle & Foot Other Potential Mechanisms of Injury? Landing from a jump Stepping or landing on opponent’s foot Changing directions Decelerating Uneven surfaces Improper footwear for sport in question Diagnosis: Pain, swelling, tenderness, unable to walk, bear weight, visual deformity Recovery: RICE, ROM & Strength of supporting structures “PROPRIOCEPTION!!” (Neural & Muscular Balance) VERY IMPORTANT! Moderate ankle sprain (grade 1 & 2)  1 to 6 weeks of rehabilitation Severe Ankle sprain (grade 3)  8 to 12 months of rehabilitation

Where do many injuries originate from and why do they occur in the first place? Although the injury & symptom may be in one of the joints studied in this unit, the fact is that a good majority of all injuries stem from an improper position of the hip. More particularly, the muscles that attach to the hip are struggling to keep the hip in a neutral position during bracing and movement. Your exercise and control and stability program should begin with reestablishing proper muscle balance within the hip joint. The second most common reason for most injuries is improper execution of movement. The third most common reason is poor nutrition, mental/emotional stress and poor sleeping patterns or not enough sleep (recovery)

Test your knowledge part 1 1) what are the 3 most common injuries to the shoulder joint? 2) what are the 2 most common chronic injuries to the elbow joint? 3) what are the 4 most common injuries to the knee joint? 4) what are the 2 most common injuries to the ankle joint? dislocations, separations and impingement Medial and lateral epicondylitis ACL and PCL tears, patellar-femoral syndrome and meniscus tears Eversion and Inversion Sprains

Test your knowledge part 2 1) This injury causes a piano key deformity in the shoulder 2) This injury causes pain inside the shoulder joint, especially during abduction of the humerus. 3) This injury causes pain on the medial aspect of the elbow joint 4) This injury causes pain on the tibial tuberosity or inferior aspect of the patella 5) This injury causes inflammation and swelling on the lateral maleolus of the ankle AC separation Impingement Syndrome Medial epicondylitis or inflammation of the tendon junction on the medial aspect of the humerus Patellar-Femoral Syndrome Inversion Sprains

Test your knowledge part 3 1)To treat this injury, rehabilitation of the rotator cuff muscles is crucial 2) This injury requires massaging the extensors of the forearm as a first step to recovery 3) This ankle injury is less common due to the strength and size of the deltoid ligament 4) This knee injury is often followed by severe swelling and little to no pain after the immediate trauma 5) Most injuries originate from structural imbalance of this joint dislocations, AC separations, not impingement which requires relaxation of the major muscles of the shoulder girdle Lateral epicondylitis or tennis elbow Eversion sprains ACL or PLC complete tears The Hip joint