1. BTEC Level 5 Sport & Remedial Massage Therapy LSSM 25 A Weekend 3 Types of Injury

2. Therapist Basics Anatomy Pathomechanics of inflammation and scar tissue formation Biomechanics of activity Case History –mechanism of injury previous injury, predisposing factors Clinical assessment & treatment plan

3. Bone Injuries Fracture Stress Fracture Avulsion Fracture Periostitis

4. Joint Injuries Dislocation Internal Derangement Adhesive Capsulitis (referred pain = neural pathways)

5. Ligament Injuries - Sprain Limited or no direct blood supply Always associated with joint injuries High velocity trauma

6. Muscle Injuries - Strain Overload Direct Trauma Partial / complete rupture Grades 1, 2 & 3

7. Muscle Injuries - Strain Graded 1 st, 2 nd, 3 rd Degree 1 st Mild; –No great loss of strength –stabbing/pulling sensation –Active/passive stretching = pain, but can still participate *but perhaps shouldnt!!

8. Muscle Injuries - Strain 2 nd degree – Moderate ~5-50% of muscle fibres involved Pain on contraction Loss of power Searing pain and limits participation

9. Muscle Injuries 3 rd degree –Severe –Up to complete rupture –Muscle deficit (gap/hollow)/bunched up –Felt a snapping sensation –PAIN! –Contraction not possible, complete loss of power

10. Tendon Injuries - Strain Strain (tear, rupture) Mild, Moderate and severe Mild, Moderate and severe Overuse – tendonosis / tendinopathy –Achilles –Patellar Tendon (ligament) –Supraspinatus –Lateral/Medial Epicondylosis

11. Tendon Injuries - Strain Mild Mild Pain on or after activity that disappears after activity Pain on or after activity that disappears after activity Moderate Moderate Pain with sporting activity but not with activities of daily living (ADLs) Pain with sporting activity but not with activities of daily living (ADLs) Severe Severe Pain during ADLs Pain during ADLs

12. Ligament Injuries - Sprain 1 st degree – Mild –Few fibres, stable, no loss of function, no bleeding or swelling 2 nd degree – Moderate 2 nd degree – Moderate Less than 50% of fibres, some loss of function, pain when limb is loaded, some bruising and swelling, limits participation 3 rd degree – Severe 3 rd degree – Severe Complete rupture, unstable joint, loss of function

13. Inflammatory Response Inflammation is the reaction of tissues to any injury Blacks Medical Dictionary Inflammation is the reaction of tissues to any injury Blacks Medical Dictionary 5 Cardinal signs of inflammation; Redness Redness Swelling Swelling Heat Heat Pain Pain Loss of function Loss of function

14. Acute Inflammatory Phase 0 – 72 hours Tissue damage Blood, cells, debris leak out – exudate (pus) = toxic Immune response – Inflammatory Cascade –Vasoconstriction – vasodilation = Redness +swelling + heat + pain + loss of function –Circulating neutrophils + macrophages = phagocytosis of dead cells occurs within 24 hours –Treatment (TTT) = PRICE - POLICE

15. Proliferation / Repair Phase 2 days – 6 weeks Fibroblasts – scar collagen with lots of cross links – scar tissue formation indiscriminate patchwork scar formation indiscriminate patchwork scar formation Stress applied to healing tissue decreases number of cross links and increases tensile strength of tissue.

16. Maturation / Remodelling Phase 4 weeks – 12 months (+) Collagen content slowly reduced and scar tissue tends to return to that of pre-injury tissue. The initial severity of the injury will largely determine the time for complete remodelling to occur.

17. Clinical Assessment Case History – 80% clue Clinical Assessment – confirmatory Observation – cardinal signs of inflammation - look for pain (face, movement)

18. Clinical Assessment Palpation Active movements – look for abnormal movement & decrease in range of motion (ROM) Active Resisted Passive movements Joint assessment. When appropriate?