 By the end of this lesson you will be able to: ◦ Recap previous session ◦ Identify and describe methods of treatment ◦ Identify and describe stages of rehabilitation ◦ Identify and describe how to plan a safe and appropriate rehabilitation treatment programme with tutor support  By the end of this lesson you may be able to:  Identify and describe how to plan a safe and appropriate rehabilitation treatment programme with NO tutor support  By the end of this lesson you could be able to: ◦ Justify choices for treatment programme and offering alternative exercises

 What should you do when you come across an injured person?

 Priorities  Resuscitation  Shock  Bleeding  Fractures  Unconscious casualty  Preventing infection  Summon assistance  Accident report forms

1. Assess the situation 2. Make the area safe 3. Assess the casualty- SALTAPS 4. Treat the casualty

 Plasters (range of sizes)  Disposable gloves  Face shield for resuscitation  Triangular bandages  Sterile eye pads  Wound dressings

 This is for task 1 of assignment 3.

Common treatments PRICED SALTAPS Support mechanisms Hot/ Cold treatments Medical referral

 See- Stopand observe the injury  Ask-ask questions about the injury  Look- look for specific signs e.g. swelling  Touch-palpate to identify painful areas  Active-active movement- can they move injured part without assistance  Passive- passive movement- can you move the part through full ROM  Strength- strength testing- can the injured person put pressure/ weight on the injury NOTE- Use needs to be appropriate to the injury and you should stop treatment at the appropriate stage!!!!

 P – protect the person and injured part  R – rest promotes healing & prevents further damage  I – ice reduces swelling  C – compression acts to support & reduce swelling  E – elevation reduces blood flow and swelling to the area with the help of gravity  D- diagnosis- needs to be done by a professional

 This dilates blood vessels  By dilating the blood vessels, more blood goes to the injured area  This absorbs swelling and dead cells  Encourage growth of new vessels  Not to be used on an open wound

 Taping – limits unwanted movement  Tubi-grip – limits unwanted movement  Bandaging – increase joint stability  Limb support – increase stability

 Cold compress – these are so that the blood vessels vasoconstrict, causing a reduction in the flow of blood to the injured area.  This is to reduce swelling and also the pain felt by stopping the nerve endings form conducting impulses  It is best used directly after an injury but also for hours afterwards.

1. Cold 2. Burning 3. Aching 4. Numb This is the feelings that the skin will go through during cold treatments. Once stage 4 is reached the application should be stopped. Ice should never be applied directly to the skin!!

 Why refer?  Who? ◦ GP ◦ Physiotherapist ◦ Consultant ◦ Surgeon ◦ Strength and Conditioning Coach ◦ Nutritionist

 What is rehabilitation?  This, in simple terms, is restoring normal function to a normal or near normal level, after an injury takes place.  Rehabilitation is not restricted to physical characteristics. We need to consider the psychological rehabilitation of an athlete also.  Treatment is based upon an accurate diagnosis

Which treatments could you use after an injury??? Write a list of the possible treatments you could use as a ‘therapist’. Ext Task: Which other treatments could a chiropractor / osteopath use alongside the standard treatment protocols?

How do you know how to rehabilitate an injury? It depends on what stage the injury is at. There are 5 rehab stages. Rehab must be done in progressive stages. The client / athlete must complete one stage prior to moving onto the next one.

 Prevent as much initial swelling  Protect the injured area  Control bleeding  Relieve pain  SALTAPS  PRICED

 You come across someone with a fractured tibia.  You do not know for sure it is fractured but you must assume the worst and commence phase 1.  Prevent – excessive swelling. Keep footwear on for now.  Protect – remove the person from the pitch or situation. If this is not possible halt the game immediately.  Control – if the leg is also bleeding, cover this up.  Relieve – pain. Move in to comfortable position and raise the leg.

Aims  Control bleeding and swelling  Relieve pain  Protect from further damage  Advice for home treatment Compression bandages (day) Ice PRICED ROM (active in a pain free range)

 For a grade 2 sprained ankle  Swelling should be stopped by using cold compress and elevation  Cold compress will relieve the pain (remember to advise the stages of cold compress; when the ankle is numb, stop!  Advise the injured person e.g. PRICE

Aims  Absorption of swelling  Removal of debris/dead cells  Growth of new blood vessels  Develop scar tissue  Elevation  Light Massage (effleurage)  Passive exercises (Non WB)  Contrast bathing  Cold/ Heat

 Sprained ankle tennis player  Consistent contrast bathing during painful moments of the day  This should be coupled with keeping the joint moving  This is for ensuring correct formation of scar tissue  Massage and physiotherapy is also used to help with inflammation of the joint

 Prior to commencing this stage the athlete MUST ensure there is: ◦ NO significant inflammation ◦ NO swelling ◦ Range of movement in a pain free range. ◦ Ability to undertake some weight bearing exercise

 It is essential to improve the range of movement.  Muscles can lose up to 20% of their strength, for every week it is not active or if it is not mobile.  Non-weight bearing is essential first  Lack of mobilisation early on leads to severe joint stiffness  Skills and exercises should be done early on  Be careful not to overtrain

 Non WB exercises  Progress to WB exercises  Use supports – tubigrip, compression bandage, taping, neoprene support  Mobilisation exercises – increase joint ROM  Strengthening exercises – isometric, concentric, eccentric  Heat  Sports Massage

Aims  Improve balance and movement co-ordination  Restore specific skills and movement patterns  Psychological reassurance of function  PROGRESSION TO A FUNCTIONAL STAGE REQUIRES THE LEVEL BELOW IT TO BE COMPLETED REPEATEDLY WITH NO PROBLEMS.

 Involve the basic sports elements  Sport specific drills  Proprioception exercises RETURN TO SPORT!!!!

 E.g. recovering from gaestrocnemius level 2 strain in tennis.  The person would not go straight in to practicing.  Instead start with basic movements ◦ Running in a straight line ◦ Running diagonally ◦ Then the person can put these in to a skill based situation

Treatments for Injuries- plan

 SALTAPS!!!!!!  Remember…… You cannot treat an injury until you have a diagnosis!!

 Administer first aid treatment  Reduce pain and swelling  Minimise pain in subsequent days/ weeks  Re-establish neuromuscular control of injured area  Restore ROM to affected joints  Restore muscular strength, power, endurance  Develop core stability, posture and balance  Maintain CV fitness

 When writing your treatment plan you should include the following: ◦ Area to be treated- type of injury ◦ Timing of treatment ◦ Special precautions ◦ Reasoning for your treatment

Inflammatory Response Repair Phase Remodelling Phase Soon after injury Start of healing process Ensures healing properties in blood can access affected areas and removes by- products Occurs a few hours after injury Can last up top 6 weeks Symptoms similar to inflammatory phase Rebuilding damaged structure Development of scar tissue Scar tissue imitates original structures prior to injury Appropriate Rx = decreased scarring and increase ROM and strength

 This is essential and should run alongside a physiological programme.  Psychological rehab is essential to monitor emotions of the athlete, to support the athlete, to motivate the athlete and to enable the athlete to set goals and targets for the future.

 Why? Remove uncertainty Develop an understanding Prevent further injury Prevent anxiety Control of the recovery process

 What is this? This is not blaming themselves or others This is taking responsibility for the recovery process Without this feeling of control athletes could be more susceptible to psychological issues

 Why? An athlete may at first relax and be very positive about the injury. However this is not something, which will necessarily, stay consistent.

 Why? What might this prevent? If an athlete can use support from players, friends, family and coaches they can have a more bearable recovery period. If the person does not use support e.g. attending training sessions to score or collect stats, they can feel isolated.

 Why? SMART Most athlete set themselves goals even if they are not injured. This should not stop during injury, these goals should just change

 Why? Depending on the injury an athlete can still train. E.g. a broken arm will rarely stop a runner from running. They may not be able to do so to the best of their ability but it will make it easier when they come back to full training.

 Most importantly it is important to track the injury progress ◦ Keeping a record of progress is essential ◦ Without this we do not know if the person is making progress or not. ◦ You must also record:  Medical conditions  Injury history  Treatment  Timescales  Review dates  Objectives

Treatment and Rehab Notes

Stage 2Stage 4 Tx Notes: Applied ice to the ® anterior knee for 10 mins. Applied a compression bandage to the knee. Tx Notes: Completed a sports massage to the ® quadriceps. Taped the ® knee for medial ligament support.

Stage 2Stage 4 Rehab Notes: Isometric contraction to the ® quadriceps and hamstrings. 2 sets of 10 reps. Rehab Notes: Client to perform 10 squats.(2 sets) Progress to 10 squats (2 sets) with dumbbells. 2 sets of 10 lunges, progress to diagonal lunges.

Stage 2Stage 4 Measurable Objectives: Current pain scale – 7/10. Aim is to reduce this to 5/10 for the next session. Measurable Objectives: Current pain scale = 2/10. Aim is to reduce this to 1/10 for the next session. Review date & Timescales: To be reviewed next session (1 week). Review date & Timescales: To be reviewed next session (2 weeks).

 Make them specific!!!!  1 page (A4) per injury.  Specifiy the muscles / area being treated or rehabilitated.  Provide timings of treatments.  Provide sets and reps for rehab.  Measurable Objectives: either pain scale / goniometer readings.

◦ Recap previous session ◦ Identify and describe methods of treatment ◦ Identify and describe stages of rehabilitation ◦ Identify and describe how to plan a safe and appropriate rehabilitation treatment programme with tutor support  Identify and describe how to plan a safe and appropriate rehabilitation treatment programme with NO tutor support ◦ Justify choices for treatment programme and offering alternative exercises