1. Unit 3 Chapter 1: Definition of Sports Injury Chapter 8: The Injury Process

2. Acute vs. Chronic Injury Acute Injury –Rapid onset –Resulting from traumatic event Chronic Injury –Slow, insidious onset –Gradual structural damage Critical Force –Magnitude of a single force for which the anatomical structure of interest was damaged

3. Overuse Injuries In the tendons it occurs when the work load from exercise exceeds the ability of the musculotendonous tissue to recover Common sites –Achilles tendon –Patellar tendon –Rotator cuff tendon Most injuries occur during an eccentric contraction – during deceleration

4. Catastrophic Injuries Damage to the brain and or the spinal cord Potentially life threatening or permanent

5. Injury Classification

6. Sprain Injury to a ligament Ligament connects bone to bone 1 st degree –Mild swelling, mild pain and discomfort 2 nd degree –Swelling present, slight tear of the ligament 3 rd degree –Complete rupture of the ligament, noticeable pain and swelling, extensive tissue damage

7. Grade 1 Ankle Sprain

8. Grade 2 Ankle Sprain

9. Grade 3 Ankle Sprain

10. Types of Swelling Edema –Swelling outside the joint –Extracellular Effusion –Swelling inside the joint –intracellular

11. Strain Injury to muscle or tendon Tendon connects muscle to bone 1 st degree –Mild spasm and swelling 2 nd degree –Pain, swelling, muscle spasm, loss of function 3 rd degree –Defect noticed, complete rupture of the soft tissue

12. Muscle Strains

13. Grade 2 & Grade 3 Hamstring Strain

14. Contusion “bruise” Results from direct blow to body surface Characteristics –Pain –Stiffness –Swelling –Ecchymosis (discoloration) –Hematoma Myositis ossificans –Can develop if bruise is not treated properly –Development of bone like formation in the muscle

16. Fracture A break or crack in the bone Closed –Does not break the skin Open –Breaks through the skin Stress fracture –Bone is subjected to repeated episodes of overloading

20. Salter-Harris Fractures Happens mostly in adolescents Fracture to the epiphyseal growth plate Classification –I – complete separation –II – Break of epiphysis from metaphysis –III – through epiphysis –IV – break epiphysis and metaphysis –V – crushing without displacement

21. Dislocation Displacement of bones at a joint Subluxation –Partial displacement Luxation –Full displacement Most common sites –Glenohumeral (GH) joint –Acromioclavicular (AC) joint

24. http://www.cuw.edu/Academics/progr ams/athletic_training/injury_episodes. html

25. Chapter 8 – The Injury Process

26. Connective Tissue –Ligaments –Retinaculum –Joint capsule –Bone –Cartilage –Fascia –Tendons Eccentric contraction –Simultaneous processes of muscle contraction and stretch of muscle-tendon unit by extrinsic force A tendon can withstand stress of 8700-18000 lb/in 2

27. Mechanical forces of injury Types – Tensile – Compressive – Shear Ligaments and tendons resist tensile force Bone absorbs compressive force Critical force – the limit to how much stress a tissue can withstand

28. Inflammatory process Normal signs & symptoms – Swelling – Pain – Reddening of the skin – Increase in temperature

29. Acute Inflammatory Phase Initially when an injury occurs you have vasodilatation (blood vessel gets larger) A few minutes after injury you have vasoconstriction (blood vessel gets smaller) Sudden increase of blood flow in interstitial space – hematoma Chemical Mediators present – Histamine – short term vasodilatation – Hageman factor (XIIa) – carried in blood and becomes active when tissue is damaged – Bradykinin – affects vasculature by increasing vascular permeability – Chemotaxis - process of attracting leukocytes (WBCs) – Neutrophils (WBC) – arrive quickly, release chemical to attract macrophage – By the way of phagocytosis, leukocytes dispose damaged cells – Macrophage (WBC) – consumes cellular debris through phagocytosis – Arachidonic acid – product of interaction between leukocytes and phospholipids Acute inflammatory phase lasts 3-4 days

30. Healing Phase

31. Regeneration Phase Fibroblast –produce collagen fibers –Must have balance between synthesis & lysis Angiogenesis – formation of new capillaries Scar tissue…….. good or bad?????

32. Pain & Injury Pain – result of sensory input received through the nervous system that indicates the location of damage Pain response is triggered because of altered homeostasis – results in sensory nerve receptors sending impulse to CNS –Sclerotome – bone –Dermatome – skin –Myotome – muscle Pain due to external force – impulse is slow because it travels on the nociceptive C fibers Nociceptive C fibers – labeled slow b/c conductivity is slower than A-delta (touch) and Beta (temp.) fibers –Slower because the diameter is smaller and have little myelination –Myelination – insulator, fat that surrounds the nerve

33. Afferent messages are “ranked” when sent to CNS –Those with highest velocity are 1 st –This is based on the Gate Control Theory of Pain Pain – “perception of an uncomfortable stimulus” –Cutaneous – sharp, bright, burning –Deep somatic – tendon, muscle, joint –Visceral – internal organ –Psychogenic – emotional

34. Interventions Cryotherapy –Acute inflammatory phase –If done initially, may reduce vasodilatation therefore reducing swelling –RICE Rest Ice Compression Elevation Use an elastic wrap for compression, moving distal to proximal Use for 48-120 hours after injury THEN begin heat

35. Thermotherapy – moist heat pack – ultrasound –Can increase metabolic activity –Why not use heat initially? Pharmacologic agents –Steroids – most common is cortisone Oral Injected Transdermal –phonophoresis –iontophoresis (-) effects – decrease collagen formation therefore decreasing overall strength –NSAIDs – prevent swelling –Analgesics – prevent pain –Antipyretic – decrease fever

36. Why do rehab? Increases circulation – increases oxygen supply Stress healing tissue – “guides” proper alignment if collagen cells

37. 4 Phases Phase 1 –PROM –to reestablish normal ROM –Decrease muscle spasm & pain Phase 2 –AAROM –Begin increasing muscle strength Phase 3 –AROM –Move through full ROM –Use gravity as weight –Therapist gives assistance in exercises Phase 4 –RROM –Resistance added to continue to increase strength –Use manual resistance, weights, machines