1. Basic Injury Management Mike Robinson R.Kin CAT(C) ATC MS Certified Athletic Therapist Certified Athletic Trainer Precision Fitness & Performance Centre 1510 Woodcock Street, London, Ontario T: (226) 289-2070 C: (519)-636-8285 mike@robinsonmike.com http://www.robinsonsportsmedicine.com mike@robinsonmike.com http://www.robinsonsportsmedicine.com

2. About Me Bachelor of Applied Health Science in Athletic Therapy (Sheridan) Certified Athletic Therapist Masters in Athletic Training (Ohio University) Licensed Athletic Trainer (Ohio) Registered Athletic Trainer (WV) PhD Student (Western) Psychometric Properties of Concussion Assessment Tools Sports Medicine Experience Soccer (CSL, League One, CCAA/OCAA), Rugby (club and national level), Hockey (provincial level), High School (WV), Wrestling (Olympic qualifying camp), Karate Canada, Skate Canada…

3. Agenda Fifa 11+ Emergency Action Plan Basic Injury Management Concussions Sprains, strains PIER Medications Ice vs Heat Questions

4. Fifa 11+ Injury prevention program developed by FIFA’s Medical Assessment and Research Centre (F-MARC), the Oslo Sports Trauma Research Center and the Santa Monica Orthopedic and Sports Medicine Research Foundation Scientifically validated via a randomized control trial Requires no extra equipment or specialized knowledge Before each training session and before matches Athletes of all ages and skill levels should participate Canadian Soccer Association is rolling out Fifa 11+ coaching programs over the next 3 years to all CSA clubs across Canada

5. Fifa 11+ - Impact Completing the Fifa 11+ program 1.5 times a week reduces knee and ankle injury rates by up to 43% over one season

6. Fifa 11+ - More Information http://www.f-marc.com/ http://www.robinsonsportsmedicine.com/11-injury-prevention- program/ http://www.robinsonsportsmedicine.com/11-injury-prevention- program/ http://www.canorth.org

7. Emergency Action Plan “Medical Time Out” Pre-game meeting between both team’s medical staff/staff and match officials to discuss the emergency action plan Emergency Action Plan Formal written document or informal verbal plan Defines individual’s roles during an emergency Charge Person Typically a member of the team’s medical staff or designated team “trainer” Call Person Designated individual to contact 911 and direct them to the field Control Person The Control Person is responsible for controlling the crowd and other participants to ensure that the EAP is executed effectively.

8. Basic Injury Management - Concussions The appropriate response for a layperson when they suspect a player has suffered a concussion is permanent removal from that game “When in doubt sit them out” Medical imaging (CT, MRI) cannot diagnose or clear a concussion A player can suffer a concussion WITHOUT hitting their head Any player with concussion or suspected concussion should be immediately and permanently removed from training or play. Appropriate emergency management procedures must be followed especially if a neck injury is suspected.

9. Basic Injury Management - Concussions Potential Immediate Symptoms Seizure (fits) Loss of consciousness – confirmed or suspected Unsteady on feet or balance problems or falling over or poor coordination Confused Disorientated – not aware of where they are or who they are or the time of day Dazed, blank or vacant look Behavioral changes e.g. more emotional or more irritable Lying motionless on ground Slow to get up off the ground Grabbing or clutching of head Injury event that could possibly cause concussion

10. Basic Injury Management - Concussions Patient Reported Symptoms Headache Dizziness Mental clouding, confusion, or feeling slowed down Visual problems Nausea or vomiting Fatigue Drowsiness/feeling like “in a fog“/difficulty concentrating “Pressure in head” Sensitivity to light or noise

11. Basic Injury Management - Concussions Management Rest They do not need to be woken up every hour! Instead, a responsible adult should check on them visually. Activity Refrain from strenuous physical activity Refrain from any activity that causes symptoms Medical Care They do not need to go to the ER unless Have a headache that gets worse Are very drowsy or can’t be awakened Can’t recognize people or places Have repeated vomiting Behave unusually or seem confused; are very irritable Have seizures(arms and legs jerk uncontrollably) Have weakness or numbness in their arms or legs Are unsteady on their feet; have slurred speech Should be seen by a HCP trained in concussion management (MD, AT, PT)

12. Resources http://playerwelfare.worldrugby.org/content/getfile.php?h=d66f98b9815023 fbf00e8ef28b20cdb6&p=pdfs/World_Rugby_Concussion_Guidance_EN.pdf http://playerwelfare.worldrugby.org/content/getfile.php?h=d66f98b9815023 fbf00e8ef28b20cdb6&p=pdfs/World_Rugby_Concussion_Guidance_EN.pdf http://concussionsontario.org/

13. Basic Injury Management – Sprains/Strains Sprain A sprain is a stretching or tearing of ligaments (the tough bands of fibrous tissue that connect two bones together in your joints) Strain A strain is a stretching or tearing of muscle or tendon (the fibrous cord of tissue that connects muscles to bones)

14. Basic Injury Management – PIER Pressure Tensor bandage Helps control swelling Ice Crushed ice, damp towel between ice and skin Commercial ice packs can cause injury as they are below 0 o C Helps relieve pain and lower cellular metabolism (preventing cell death due to a lack of oxygen) Elevation (above the level of the heart) Aids with lymphatic drainage Pillow under the mattress at the end of the bed Rest

15. Basic Injury Management – Medications Day 0 – 7 Tylenol No NSAID, Advil, Naproxen etc. Day 7+ NSAID, Advil, Naproxen etc.

16. Basic Injury Management – Ice vs. Heat Day 0 – 7 Ice Day 7+ Heat Once the inflammatory process has run its course ice is no longer beneficial, heat will accomplish the same goals as ice