1. The Lecture Series in Athletic Training and Sports Medicine
Jim Berry, MEd, ATC, SCAT/NREMT
Director of Sports Medicine
Head Athletic Trainer
Myrtle Beach High School
Myrtle Beach, South Carolina
© 2003

2. Author’s Note
The information contained within this lecture series is based upon over 17 years professional experience in the athletic training, sports medicine, and emergency medical fields, and numerous athletic training and sports medicine references and resources. A list of those references and resources is located at the end of this presentation.
The purpose of this series is to provide instructors in athletic training and sports medicine, primarily in the secondary schools, another educational resource that they may use to enhance the educational studies of their students.

3. Musculoskeletal Injuries
SPORTS MEDICINE
Unit 9, Part D
Emergency Care for
Musculoskeletal Injuries
and Bleeding

4. Musculoskeletal Injuries
Of major importance in musculoskeletal injury is the initial control of hemorrhage (bleeding), early inflammation, muscle spasm, and pain.
The easiest way to do this is through the use of REST, ICE, COMPRESSION, and ELEVATION or R.I.C.E.

5. ICE (Cold Application)
An effective first aid agent that reduces pain and spasm in the first 4-6 hours after an injury.
There is much debate about how cold works physiologically.
It is the subject of on-going research.
It does constrict blood vessels, thicken the blood, and reduce blood flow.
Also reduces tissue demand for O2 & reduces HYPOXIA (lack of O2 in blood).

6. ICE (Cold Application)
The benefit of ice to an area extends to surrounding tissues, that were not injured, by preventing injury-related tissue death from spreading to healthy tissue.
For best results, ice should be applied directly to the skin for a period of minutes, 3-4 times per day during the acute stage of an injury (first hours).

7. ICE (Cold Application)
Prolonged application of ice can cause tissue damage, so ATCs should always caution athletes to only use ice for the aforementioned treatment periods.

8. COMPRESSION
An important adjunct to cold application with acute injury.
External pressure on an injury decreases hemorrhage, swelling, and hematoma formation.
There are many types of compression.
The most commonly used are elastic wraps, or a combination of wraps and felt/foam pads.

9. COMPRESSION
While cold is placed on the injury intermittently, compression should be maintained throughout the day.
The wrap should be applied distally to proximally, which prevents swelling from moving into more distant parts of an extremity.
This is usually the result of gravity.
Care should be taken to not wrap too tightly.
It is important to caution athletes and also advise them that, if they start to experience numbness or tingling in the extremity, they should loosen or remove the wrap immediately.

10. ELEVATION
Along with ice and compression, it is important that the injured body part be elevated above the level of the heart for the first hours after injury.
This elevation will help reduce swelling and internal bleeding.
It also enhances venous return, by making it easier for blood to get back to the heart.

11. REST Essential for musculoskeletal injuries.
This can be achieved by telling the person not to move the body part, or by applying tape, wraps, splints, casts, or putting the person on crutches.
Immobilization helps to insure proper healing without complications.

12. HEMORRHAGE
Defined as an abnormal external or internal discharge of blood.
May be venous, capillary, or arterial and the bleeding may by on the inside or outside of the body.

13. HEMORRHAGE
Arterial bleeding is exhibited with the forceful spurting of bright, red blood.

14. HEMORRHAGE
Venous bleeding is usually dark and flows continuously

15. HEMORRHAGE
Capillary bleeding is usually exhibited by an oozing of bright, red blood.

16. External Bleeding
Stems from an open skin wound such as abrasions, lacerations, incisions, punctures, avulsions, etc.
There are several methods that can be used to control external bleeding, including…

17. External Bleeding
Direct Pressure - applying direct pressure over the wound with your hand and sterile gauze. The pressure is firmly applied against the resistance of the bone.
Elevation - in combination with direct pressure, you should elevate the body part above the heart. This reduces blood pressure to the area and slows bleeding.

18. External Bleeding
Pressure Points - can be used when pressure and elevation do not work. There are 11 major pressure points on each side of the body. These are areas that have superficial arteries and veins that can be compressed. Most common are the brachial and femoral arteries.

19. External Bleeding
Tourniquet - if all other attempts to stop bleeding fail, then your last resort is to apply a tourniquet. This is a method seldom used in sports. If you apply a tourniquet you must…
Note the time you put the tourniquet on on the forehead of the patient.
DO NOT release the tourniquet at any time unless told to do so by a doctor.
Remember you are cutting off all circulation to that body part. Athlete may lose it because of this.
14:30

20. Internal Bleeding
Invisible to the eye unless seen by x-ray or other means.
The danger with internal bleeding is that it’s difficult to detect and can be overlooked.
Can be as simple as a contusion under the skin to filling a body cavity like the thorax or skull.
If you suspect severe internal bleeding, refer to the hospital immediately.

21. End Unit 9

22. References & Resources
American Academy of Orthopedic Surgeons, Emergency Care and Transportation of the Sick and Injured – 8th Edition, Jones & Bartlett Publishers, 2002.
Anderson, Marcia, & Susan J. Hall, Fundamentals of Sports Injury Management
Arnheim, Daniel D., & William E. Prentice, Essentials of Athletic Training – 5th Edition, McGraw-Hill, 2002.
Arnheim, Daniel D., & William E. Prentice, Modern Principles of Athletic Training, McGraw-Hill, 2000.
Cartwright, Lorin A., & William A. Pitney, Athletic Training for Student Assistants, Human Kinetics, 1999.
Kapit, Wynn, & Lawrence M. Elson, The Anatomy Coloring Book, Harper-Collins Publishers, 1977.
Mistovich, Joseph J., Brent Q. Hafen, Keith J. Karren, & Howard A. Werman, Pre-hospital Emergency Care, 1999.
Pfeiffer, Ronald P., & Brent C. Mangus, Concepts of Athletic Training – 2nd Edition, Times Mirror/Mosby College Publishing, 1989.
Roy, Steven, Richard Irvin, & Duane Iverson, Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation of Athletic Injuries – 2nd Edition, Prentice-Hall, Inc., 1998.
American Academy of Orthopedic Surgeons (
American College of Sports Medicine (
National Athletic Trainers’ Association (