1. Chapter 8
The Injury Process

2. The Physics of Sports Injury
Connective Tissue
most common type of tissue in the body.
Includes - ligaments, retinaculum, joint capsules, bone, cartilage, fascia, and tendons.
In some sports, nearly ___% of acute injuries involve either tendon or muscle.

3. Connective Tissue __________ – connect bone to bone
__________ – a connecting or retaining band especially of fibrous tissue
_____ ________- ligamentous sac that surrounds the articular cavity of a freely movable joint
________ – Gives structure and shape

4. Connective Tissue
__________ - translucent somewhat elastic tissue that composes most of the skeleton of vertebrate embryos and except for a small number of structures (as some joints, respiratory passages, and the external ear) is replaced by bone during ossification in the higher vertebrates

5. Connective Tissue
__________ - a sheet of connective tissue (as an aponeurosis – attach or cover various muscles) covering or binding together body structures. tissue occurring in such a sheet
__________ – Connects muscle to bone

6. The Physics of Sports Injury (cont.)
Muscle/fascia are thought to be injured by excessive tension during contractions.
Tendons are extremely ________ structures; strains occur most often at the distal musculotendinous junction (MTJ).
These strains are the most common ________ tissue injuries related to sports.

7. Mechanical Forces of Injury
Types of Force
Compressive –
Tensile –
Shear -

8. Mechanical Forces of Injury
__________ – a force that, w/enough NRG, crushes tissue. Ex: fx, contusions
________ – force that pulls or stretches tissue. Ex: strains, sprains
________ – force that moves across the parallel organization of tissue. Ex: skin injuries, vertebral disk injuries

9. Mechanical Forces of Injury (cont.)
Tendons resist ________ forces.
Bones resist ____________ forces.
Ligaments resist ________ forces.
Each type of tissue has a limit for how much force it can withstand (critical force).

10. The Physiology of Sports Injury
The inflammatory process: (__-__Days)
physiological actions that occur when the body reacts to repair damaged tissues.
Begins during the first few minutes following an injury.
The body’s ________ response to trauma is ________.

11. The Inflammatory Process (cont.)
Normal signs and symptoms of inflammation include:
__________.
__________ of skin (erythema).
__________ temperature in the affected area.

12. Acute Inflammatory Phase
Initial trauma destroys millions of cells.
__________ is followed by __________.
Damage to blood vessels causes a hematoma.
Secondary hypoxic ( O2) injury results in additional cellular destruction.

13. Acute Inflammatory Phase (cont.)
In response to injury, chemicals are released that affect nearby cells. The effects of these chemicals are:
____________ (cellular breakdown).
____________ (vasodilators).
____________ (attract scavenger cells).

14. Acute Inflammatory Phase (cont.)
Hageman Factor is responsible for the manufacture of bradykinin.
____________ increases vascular permeability and triggers the release of prostaglandins resulting in:
____________
Increased vascular permeability.
Pain.
________ clotting.

15. Acute Inflammatory Phase (cont.)
Plasma proteins, platelets, and leukocytes move out of capillaries and into damaged tissue.
Leukocytes engage in ____________ (damaged cell absorption).
Macrophages migrate into the damaged area. Arachidonic acid is formed by a combination of leukocyte enzymes and phospholipids derived from cell membranes.
Arachidonic acid catalyzes the production of leukotrienes.

16. Acute Inflammatory Phase (cont.)
The acute inflammatory process results in a walling off of the damaged area from the rest of the body. The process acts to clean up the debris and provide components for healing. The acute phase lasts up to __ or __ days, unless aggravated by additional trauma.

17. Fibroblastic Repair Phase
4 Days – 6 Weeks
During this phase, special leukocytes (polymorphs and monocytes) and a type of __________ (histocytes) migrate into the area of injury.
These cells break down cellular debris and set the stage for __________ and __________

18. Maturation and Remodel
Weeks – up to 2 to 3 Years
Except for ______, connective tissues heal by forming scar tissue that begins to develop __-__ days after the injury.
__________ (proteoglycan- and collagen-producing cells) migrate into the damaged area.

19. Maturation and Remodel
Angiogenesis is the formation of new capillaries.
Scar formation may take up to ______ months.
Scar tissue can be 95% as strong as the original tissue. ________ on the tissue is helpful for ____________; exercises are critical to this process.
Bone tissue heals by way of specialized cells (osteoclasts and osteoblasts).

20. Maturation and Remodel
____________ – migrate to the region of injury and remove destroyed cells as well as other debris.
____________ – specialized fibroblast that migrate to the injured area from adjacent periosteum and bone. Also develops a zone of collagen that is known as a callus

21. Pain and Acute Injury as much psychological as physiological.
results from sensory input received through the nervous system and indicates location of tissue damage.
Messages concerning sensory information that travel quickly through the nervous system are given higher priority than pain messages that travel more slowly.
not a useful indicator of injury severity.

22. Pharmacologic Agents Steroidal and NSAIDs
Both affect aspects of the ____________ process.
Steroidal drugs resemble gluococorticoids, but the exact mechanism of their action is unknown.
Steroids may:
__________ amount of chemicals released by lysosomes.
__________ permeability of capillaries.
__________ WBC phagocytosis.
__________ local fever.

23. Pharmacologic Agents (cont.)
Steroids must be used with care.
They can interfere with __________ formation, __________ connective tissue strength in injured area.
Steroids may be __________ or taken __________ and include drugs such as:
Cortisone, hydrocortisone, prednisone, prednisolone, triamcinolone, and dexamethasone.

24. NSAIDs NSAIDs do not have the negative effects of steroids.
NSAIDs are very popular drugs.
Common NSAIDs include aspirin, ibuprofen, naproxen, indomethacin,
and naproxen sodium.

25. NSAIDs (cont.)
NSAIDs block the conversion of arachidonic acid to prostaglandin.
Aspirin has anti-inflammatory, analgesic, and antipyretic effects.
Research is inconclusive regarding NSAIDs’ effect on tissue healing and strength.

26. RICE
Best approach to the care of soft tissue injury is RICE along with prescribed pharmacologic agents and supervised rehabilitative exercise.
R = ________
I = ______
C = ____________
E = __________

27. The Role of Exercise Rehabilitation
Properly supervised physical activity is very effective for many injuries.
Such exercise can have a positive effect on collagen formation.
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28. Exercise Rehabilitation
Collagen formation and tissue regeneration require 2 to 3 weeks.
Rehabilitation must be supervised by professionals with appropriate training, such as a BOC-certified Athletic Trainer or a __________ Therapist with ________ medicine training.

29. Exercise Rehabilitation (cont.)
Rehabilitative exercise is a four-phase process.
________ exercise
________ assisted
________

30. Injury Rehabilitation
Injury rehab should be considered an ongoing process.
Injury-specific exercise should be a __________ component in training and __________.
Without this approach, the likelihood of reinjury is ________.