Recognizing Different Sports Injuries

Mechanisms and Characteristics of Sports Trauma Sports Trauma: A physical injury or wound sustained in sports caused by an internal or external force. Mechanical injury results from a force causing a harmful disturbance in function and/or structure of a body part. This is not the same as a repetitive strain or overuse condition. Load = a singular or group of internal or external forces acting on the body. Mechanical stress is a resistance to this load - results in tissue deformation A yield point is reached when tissue is deformed to the maximum of its elastic properties. Mechanical failure occurs when the yield point is exceeded = tissue damage.

Mechanisms and Characteristics of Sports Trauma Mechanisms of sports injuries Tension force that pulls or stretches tissue Stretching force beyond yield point = sprain, strain, avulsion fracture Compression crushing force - the force can no longer be absorbed Shearingforce that moves across the parallel organization of tissue eg. blisters, abrasions, vertebral disk injuries Bendingforce on a horizontal beam of bone that places stress within the structure causing it to bend. This occurs with other forces to create several types of fractures and torsion injuries.

Soft tissue Classification Contractile Muscle Tendon, or bony insertion

Soft tissue Classification Non-contractile Skin Joint capsule Ligament Fascia Cartilage Nerve Dura

Skin Injuries Blister - collection of fluid in or below epidermal layer caused by continuous rubbing. Abrasion - epidermis and dermis are worn away due to scrape on rough surface Skin bruise - blow compresses or crushes skin surface causing bleeding under the skin Laceration - flesh is irregularly torn Skin Avulsion - tissue is ripped from its source Incision - skin has been sharply cut Puncture - penetration of skin by sharp object

Acute Traumatic Injuries w Bone Trauma Closed fracture Open fracture TYPES Contrecoup Depressed Greenstick Comminuted Longitudinal Oblique Serrated Spiral Transverse Impacted

Other Acute Injuries w Stress Fracture/ Avulsion Fracture w Dislocations and Subluxation w Ligament Sprain w Contusion w Muscle Cramps

Contusion Crushing of soft tissue causing a bruise of the skin, muscle, deep or superficial tissues, or bone, resulting from a direct blow. Treatment of contusions PIER Restricted movement Treat as strain after acute phase

Contusion First DegreeSecond DegreeThird Degree Mild blow causing tissue compression Moderate blow causing haematoma Sever blow Little bleeding and minimal damage Significant bleedingMay look like a fracture- severe bleeding Little loss of f unction20% - 80% loss ROMComplete loss of function May have slight spasmSpasm may last hoursExtreme spasm present Little/no swellingModerate swellingGross swelling No DiscolourationModerate DiscolourationSevere Discolouration No palpable indentationMay have indentation and palpable tenderness Extreme palpable tenderness and indentation Increased skin temp.Warm to touch Mild discomfortSignificant painExtreme pain

Strains Strains pertain to contractile tissue. Caused by excessive forcible contraction or overstretch or chronic overuse resulting in local tissue trauma to the muscle, musculotendinous unit or the muscle tendon.

Strains Predisposing factors w lack of or poor flexibility w lack of or poor warm up w muscle fatigue w poor muscle strength w poor skill level w antagonistic muscle imbalance w poor playing/workout conditions or surfaces w existing minor inflammation Prevention w lack of or poor flexibility w Equipment w Environment w increase flexibility w proper warm up and cool down w skill improvement w increase muscle endurance w increase muscle strength and power w muscle balance

Strain First DegreeSecond DegreeThird Degree ClassificationMild micro tearingModerate strainSevere with palpable rut SwellingSlightMeasurableVisibly apparent –gross PainLocalizedIndefinablesever StrengthSlight loss35% - 83% lossComplete loss FunctionPartial to non weight bearing Abnormal gait to non weight bearing Non weight bearing RangeSlight lossModerate lossComplete loss DiscolourationLittle to noneObviousObvious – severe Healing1 –2 weeks3 – 12 weeks3 months onward

Sprain SprainsFirst DegreeSecond DegreeThird Degree Classification mild micro tearing at cellular level moderate - partial tearing severe- complete rupture Function 95% functional with partial weight bearing for 1-3 minutes and then able to return to activity loss of function - partial weight bearing to non weight bearing Non - weight bearing due to pain and swelling Swelling none at time of injury with minimal visible swelling after several hours or the next day moderate to severe intra capsular swelling- usually not immediately visible moderate to severe swelling - may be immediate - will be visible and measurable

SprainsFirst DegreeSecond DegreeThird Degree Discolouration usually nonemoderate localized discolouration - not immediate initially some mild discolouration and then will turn very dark (almost black) around the injury site Range of Motion near full20% to 80% lossunable to move joint due to pain - on passive tests there is no tension in the joint - bone on bone contact will usually stop the range of motion at the extreme end of range

Sprain SprainsFirst DegreeSecond DegreeThird Degree Joint instability none - no laxity on stress tests 5 to 10 degrees laxity on stress test and will feel unstable using joint complete laxity of joint - gross instability Strength minimal to no weakness 20% to 80% loss - may not do resisted test pain will cause unwillingness to resist or move limb Point Tenderness size of dime size of quarterdefuse palpable tenderness - all over area

Sprain SprainsFirst DegreeSecond DegreeThird Degree Pain minimal discomfort at time of injury and minimal pain on stress test - able to continue moderate local pain at time of injury and on stress test - unable to continue may have no pain due to nerve involvement - usually extreme pain at time of injury - pain in large area near injured structure

Chronic Overuse Injuries w Tendinitis w Muscle Soreness w Tenosynovitis w Osteoarthritis

Tendonitis Inflammation and degenerative changes in the tendon or musculotendinous junction caused by; excessive overuse (too much too soon), excessive friction over the tendon, direct or repeated trauma to the area.

Signs and Symptoms of Tendonitis Local thickening of the tendon. Point tenderness. Possible crepitus. Usually becomes self limiting.

Phases of Tendonitis Phase 1symptoms following activity, no performance disability, Phase 2symptoms during and after activity, progresses from no significant performance disability to some performance disability to episodes of significant performance disability, Phase 3symptoms during and after activity, persistent performance disability, Phase 4symptoms all the time.

Preventing Tendonitis Slow gradual warm - up prior to all activity (increases blood flow to tendons). Slow gradual increase in level of activity. Increase the flexibility of the muscles. Proper equipment. Recognize early S&S of tendonitis.

Bursitis Inflammation of the bursal sac leading to pain and swelling which, if not allowed to resolve, will progress to a chronic condition with secondary thickening in the bursal walls and a tendency to recur. Caused by direct trauma, chronic irritation (over use), infection, calcium deposits.

Signs and Symptoms of Bursitis onset may be slow or gradual, pain in region of bursa, pain may increase when bursa is squeezes, (abduction), varying disability, swelling, tenderness, crepitus, limited range of motion, often increased pain in morning, usually subsides in six weeks but may remain for several years.

Inflammatory Response Phase w Inflammatory Response Phase most critical stage phagocytosis w Fibroblastic Repair Phase scar formation w Maturation-Remodeling Phase new fibers

Acute Inflammatory Phase The function of the inflammation response is to: Localize the extent of the injured area Remove waste products or foreign material resulting from the initial trauma and secondary response Set the stage for healing to take place Protect site or joint The reaction is always the same. This phase is present for as long as the signs and symptoms are present Do not get hung up on time factors - Acute inflammation is different for everyone and every condition.

Acute Inflammatory Phase Causes of inflammation: Physical trauma Chemical irritation Bacterial invasion Extremes of temperature

Characteristics of Inflammation Swelling, Heat, Altered function, Redness, Pain Swelling caused by the accumulation of blood and inflammatory exudate. Heat caused by increased biochemical activity and the increase of blood flow to the area. Altered function caused by the resulting pain and swelling or the actual destruction of an anatomical structure. Redness caused by the dilation of vessels and increased blood flow to the area. Pain caused by the direct injury to the nerve fibres, pressure from swelling, chemical irritants, as well as protective muscle spasm around the injury site.

The Affects of the P.I.E.R. principle on the Acute Inflammatory Response. PPressure IIce EElevation RRest

P.I.E.R. PRESSURE 1.Decrease the amount of space for swelling to occur, 2.Direct pressure on vessels decreases blood flow around injury site ( thus decreasing blood swelling), 3.Decreases plasma fluid leakage. 4.Decreases lymph leakage.

ICE 1.Decreases metabolic rate, which decreases: The affects of the toxins in the area; The need for oxygen, therefore decreases secondary cell death; The conduction of the nerve cells in the area which helps to decrease the pain and minimize the amount of muscle spasm, 1.Decreases blood flow to the site 2.Decreases tissue elasticity in surrounding injury area. 3.Decreases hydrostatic pressure.

ELEVATION 1.Assists venous and lymphatic return. 2.Decreases blood flow to area.

RESTRICTED FUNCTION 1.Decreases chance of re-injury. 1.Decreases blood flow to area.