1. Bell Ringer
Think about the “coolest” injury you have ever seen. What was it and why did you think it was “cool” or interesting?

2. Pathology of Sports Injury
Unit 3
Pathology of Sports Injury

3. Mechanisms and Characteristics of Musculoskeletal Trauma

4. Trauma
Physical injury or wound that is produced by an external or internal force
Mechanical injury- when a force applied to any part of the body results in harmful disturbance in function and/or structure

5. Tissue Loading Tension Compression Shearing
Force that pulls or stretches a tissue
Pulls tissue apart
Compression
External loads applied towards one another on opposite surfaces in opposite directions
Shearing
Equal but not directly opposite loads are applied to opposing surfaces forcing those surfaces to move in parallel directions relative to one another

6. Tissue loading cont’d Bending Torsion
When two force pairs act at opposite ends of a structure
When an already bowed structure is axially loaded
Torsion
Twisting in opposite directions from the opposite ends of a structure cause shear stress over the entire cross section of that structure

7. Tissue Loading

8. Acute vs. Overuse injuries
Acute- sudden traumatic onset of injury
Example: ankle sprain
Overuse- gradually develops due to repetitive forces
Example: stress fracture

9. Types of wounds
Blister- fluid filled wound due to rubbing and/or friction
Abrasion- top layer of skin is rubbed away
“Strawberry” or “carpet burn”
Incision- smooth edged cut
Laceration- jagged edged cut
Puncture- object penetrates body
Contusion- bruise

10. Blister

11. Abrasion

12. Incision

13. Laceration

14. Puncture

15. Contusion

16. Muscle strains
Strain- a stretch, tear, or rip in the muscle or its tendon
Grades
Grade 1- some muscle fibers have been stretched or actually torn.
Some tenderness and pain with active motion
Movement painful
Full ROM

17. Muscle strains cont’d
Grade 2- a number of muscle fibers have been torn
Active contraction of muscle extremely painful
Depression or divot present
Some discoloration due to capillary bleeding
ROM decreased
Grade 3- complete rupture of a muscle
Significant impairment or loss of movement
Pain is intense but diminishes after rupture

18. Grades of strains

19. Additional muscular injuries
Muscle cramps- painful, involuntary muscle contractions
Due to fluid and electrolyte loss
Muscle guarding- involuntary muscle contractions in response to pain from a musculoskeletal injury
Muscle soreness- pain caused by overexertion in exercise
DOMS = delayed onset muscle soreness
Occurs hours after rest
May occur to small tears in muscle fibers or disruption in connective tissue

20. Tendon injuries Tendon- attaches muscle to bone
Example – Achilles tendon, patellar tendon
Tendinitis- inflammation of the tendon
Key is REST to heal

21. Ligaments Ligaments- connective tissue that connects bone to bone
Helps provide stability to the joint
Example: Anterior Cruciate ligament (ACL)
Ligament Sprain grades
Grade 1- stretching and separation the ligament fibers
Minimal instability
Mild to moderate pain
Swelling and joint stiffness

22. Ligaments cont’d
Grade 2- some tearing and separation of the ligament fibers
Moderate instability
Moderate to severe pain
Swelling and joint stiffness
Grade 3- total tearing of the ligament
Initial severe pain that subsides
Swelling may be great
Joint become stiff
Typically results in surgery

24. Dislocations and subluxations
Dislocation- a bone is forced out of alignment and stays out until surgically or manually replaced or reduced
Subluxation- a bone is forced out of alignment but goes back into place

25. Elbow dislocation

26. Bone Functions: Classification: Body support Organ protection Movement
Calcium storage
Formation of blood cells
Classification:
Flat
Skull, ribs, scapula
Irregular
Vertebrae and skull
Short
Wrist and ankle bones
Long
Humerus, ulna, femur, tibia, fibula, phalanges

27. Bone injuries
Injuries caused by tension, compression, bending, twisting, shearing
Periositis- inflammation of the periosteum (lining on the bone)
Fractures
Open- bone protrudes through skin
Closed- fracture does not penetrate superficial tissue

28. Fracture classifications
Greenstick-incomplete breaks in bones that have not completely ossified
Comminuted- three or more fragments at the fracture site
Linear- bone splits along its length
Transverse- straight line, more or less at right angle to bone shaft
Oblique- one end of the bone receives sudden torsion or twisting while the other end is fixed or stabilized
Spiral- “S-shaped” separation

29. Fracture classification

30. Fractured leg video

31. Stress fractures Causes: Overload caused by muscular contraction
Altered stress distribution in the bone accompanying muscle fatigue
A change in the ground reaction force
Overtraining
Starting initial training too quickly
Changing habits or environment

32. Turn and talk
What kind of changes in your habits and environment may lead to a stress fracture? Also, what kind of sports have a lot of stress fractures? Why?

33. Stress fracture cont’d
Signs and symptoms:
Swelling
Focal tenderness
Pain
Occurs with rest and at night
Common sites- tibia, fibula, metatarsal shaft, calcaneus, femur

34. Tissue Response to injury

35. Phases of healing Healing process is a continuum 3 phases:
Phases overlap
3 phases:
Inflammatory
Fibroblastic/proliferation phase
Maturation/remodeling phase

36. Inflammatory phase Begins right after injury occurs Characterized by:
Redness
swelling,
Tenderness
Pain
loss of function
increase temperature

37. Platelets and leukocytes adhere to vascular wall
Clot formation
Phagocytosis
Platelets and leukocytes adhere to vascular wall
Vascular reaction (vasoconstrictionvasodilationexudate creates statsis)
Chemical mediators liberated (histamine, leukotrienes, cytokines)
Injury to cell

39. Fibroblastic Repair phase

40. Maturation-Remodeling phase
Realignment or remodeling of the collagen fibers that make up scar tissue according to the tensile force to which scar tissue is subjected

41. Psychosocial effects of injury

42. Post It Up Activity
In small groups, discuss the psychological and social effects an injury may have on an athlete? Write your ideas down on the post its you have and we will put them up on the chart.

43. Psychological effects
EVERY RESPONDS DIFFERENTLY TO INJURY- no two people will react the same
Factors that may effect athletes reaction to injury:
Severity of injury
Length of recovery
Reactive phases:
Reaction to injury
Reaction to rehab
Reaction to return

44. Reactions to injury Length of rehab Reaction to injury
Reaction to rehab
Reaction to return
Short (<4 wks)
Shock
Relief
Impatience
Optimism
Eagerness
Anticipation
Long (>4 wks)
Fear
Anger
Loss of vigor
Irrational thoughts
Alienation
Acknowledgment
Chronic (recurring)
Frustration
Dependence or independence
Apprehension
Confident or skeptical
Termination (career-ending)
Isolation
Grief process
Loss of athletic identity
Closure and renewal

45. Social Challenges
Athletes may have difficulty socially following injury
May feel alienated if they are unable to participate
May feel a lack of support from coaches and teammates

46. Changes ATC’s see (w/ rehab)
Depression or grief
Anxiety
Anger, agitiation, or aggression
Denial
Sleep Disturbance
Psychosocial isolation
Substance abuse

47. Turn and talk
What can you do as an Athletic Trainer to help your athletes? How can you help?

48. Athletic Trainer’s Role
Be a good listener
Find out what the problem is
Be aware of body language
Project a caring image
Explain the injury to the patient
Manage the stress of the injury
Help the Athlete return to competition

49. Talk it out activity
You have a senior football athlete who recently tore his ACL during preseason of football. The college scouts were supposed to be coming to watch him this coming week. He has been distant and his teammates approached you saying he has been keeping to himself or been getting angry with them. What do you do as his Athletic Trainer?