1. The Physiological and Psychological responses to sports injuries
P3 & P4/ M2/ D1

2. Physiological Responses to Injury

3. Inflammation Damaged Tissue and primary response: Pain Redness
Inflammation is a protective attempt by the body to remove harm and to initiate the healing process
It occurs within a few minutes to hours of injury
The 5 key characteristics of inflammation are:
Pain
Redness
Swelling
Heat
Immobility (loss of function)

4. Injury causes tissue damage The damaged tissue releases chemicals
The Inflammatory Response
Injury causes tissue damage
The damaged tissue releases chemicals
Blood vessels dilate (widen) allowing increased blood flow to the injured area.
This causes;
LOSS OF
FUNCTION
BLEEDING
SWELLING
HEAT
PAIN
REDNESS

5. The clotting Mechanism (Coagulation)
Clotting, also known as “coagulation”, occurs almost immediately after injury to a blood vessel. It is the process of blood changing from its usual liquid state to a solid form.
There are 3 stages:
Formation of Prothrombinase
When liquid blood comes into contact with certain molecules (or foreign objects) it stimulates the formation of an enzyme called Prothrombinase.
Prothrombin is then converted to Thrombin
The enzyme Prothrominase converts Prothrombin into Thrombin (another enzyme)
Fibrinogen is converted into Fibrin
Thrombin converts Fibrinogen into Fibrin which forms the tread-like scaffolding structures that form a clot/ and eventual SCAB.

6. Here is a links to a video animation of inflammation & coagulation which may help your understanding!
A cartoon animation of the full Clotting process in detail including all the info you need

7. Scar Tissue and Remodelling process:
A scar is a result of the body's repair mechanism after injury on many tissues. Scar tissue replaces normal tissue after it is damaged.
Scar tissue is the formation and laying down of a protein called “collagen”. This is a fibrous tissue that replaces the tissue that has been damaged.
It is not as elastic and pliable as skin and muscular tissue which makes it a lower quality tissue and less effective and efficient at doing its job.

8. Sprains and Strains: sprain strain
Sprains and Strains are overstretching or tearing of tissue. Sprains involve ligamentous tissue and strains involve muscular tissue. Both involve pain and discomfort , deformity, swelling, bruising, impaired movement and loss of function.
strain
A stretching or tearing of muscle/tendon
sprain
A stretching, or tearing, of one or more ligaments.
Sprains and Strains can be classified as first, second and third degree, depending on the amount of fibers involved.

9. GRADES OF INJURY: LIGAMENT SPRAIN MUSCLE STRAIN Degree / Severity
Fibre Damage
Signs and Symptoms
Grade I (mild)
few fibres
Minimal discomfort swelling / tenderness movement slightly impaired / functional.
Grade II (moderate)
many fibres
Significant pain / discomfort / noticeable swelling / tenderness / impaired movement / function impaired.
Grade III (severe)
total rupture
Pain / significant swelling / bruising / tenderness / impaired movement / joint unstable / loss of function.

10. Haematomas (inter/intra):
A haematoma, is a localized collection of blood outside the blood vessels, usually caused by trauma (in this case a muscle). It is different from a bruise, which is the spread of blood under the skin in a thin layer.
There are 2 types of haematoma:
Intramuscular
This injury only effects the muscle fibre tissue and therefore bleeding is contained within the sheath that surrounds the muscle. Pressure within the muscle builds up which can become very painful. The fluid is unable to escape as the muscle sheath prevents it, acting like a balloon. Healing takes longer as bleeding stays in one area and has to be broken down.
You are less likely to see visible bruising.
Intermuscular
This type of injury includes the muscle and also the muscle sheath and therefore bleeding is not contained and can spread (for example with gravity). Initial bleeding can last longer, however recovery is often faster than intra muscular as the blood and fluids can flow away from the site of injury.
You are more likely to see bruising.

11. grading criterion M2 and D1 (analysis) may also be achieved.
Criteria P3 and P4 aim to address the issue of occurrence of sports injuries and the resulting symptoms, both physiologically and psychologically
Damaged tissue:
Primary damage response, healing response, the clotting mechanism
Scar tissue:
The importance of scar tissue control in the re-modelling process
Specific to injury:
Sprain/strain (signs and symptoms of first, second and third degree), haematomas (inter/intra)
If the explanation is sufficient enough and related to the concept of sports injury, then it is possible that
grading criterion M2 and D1 (analysis) may also be achieved.
To push for the Distinction go into further detail and analyse what might happen if a player ignored the physiological and psychological signs and symptoms of injury. Use examples of professional athletes, with news reports or newspaper articles if possible.
Response to injury
Anger, anxiety, depression, frustration, isolated from team mates
Response to treatment and rehabilitation
Anxiety, frustration, need for motivation, use of goal setting

12. What you guys can do…
Design a leaflet that describes in a informative manner the following points:
· Damaged tissue- primary response (inflammation)
· The Clotting Mechanism
· Scar Tissue/ Re-modeling process
Signs and Symptoms a coach should look out for to identify;
o A sprain
o A strain
Grading system (1st/ 2nd
Haematoma
(Including severity and types of haematoma

13. Psychological Responses to Injury

14. Aaron Ramsey
In February, 2010, during an Arsenal v Stoke match Aaron Ramsey fractured both his right tibia and fibula which required surgery. He experienced one of the worst possible injuries and faced months of gruelling physio and rehab.
Put yourself in his shoes….
How do you think he felt?....

15. How would you as the Physio combat these negative emotions?
Psychological Responses to Injury: Anger, Anxiety, Depression & Frustration
After the initial shock and denial of receiving the injury, Aaron would experience emotions of;
Anger – Aaron would have been very angry, maybe asking
“Why me?”
Anxiety – Feelings of anxiety would be present with Aaron asking himself questions such as
“Will I recover from this?”
“Do I need surgery?”
“Will I ever get back to full fitness & play at the same level?”
Depression – Aaron will no longer be experiencing the adrenalin rush and the feel good hormones of when playing football. This may cause feelings of depression.
Frustration – Aaron may feel this out of boredom of rehab & being restricted to a timescales e.g. wanting to progress to running but his Physio/Surgeon not letting him until 3 months post injury
How would you as the Physio combat these negative emotions?
These emotions will vary depending on the individuals personality, playing status & degree of injury

16. Isolation from team mates…
Psychological Responses to Injury:
Isolation from team mates…
Whilst completing physio sessions and rehab you are removed from the normal training group. This can result in you feeling isolated from the group.
Having social interaction with team mates and a support network from within the club can help reduce the stress of an injury and maintain group cohesion.

17. Psychological Responses to Treatment & Rehab:
Once the initial recovery from surgery was over Aaron faced the gruelling task of physio. He had the prospect of long days, weeks and months in rehab. He would have experienced emotions such as…
Anxiety – fear of re-injury, fear of future prognosis e.g. arthritis in the future in he continue to play. Feelings of anxiety will be heightened if he has Trait Anxiety is a Type A personality
Frustration – uncertainty of the timescale of return e.g. if his return to training date keeps getting put back, watching his team mates play in important games your missing out on
Drop in Motivation – this may be caused by the return date to training seems so far away, he can’t see the light at the end of the tunnel. It would be the responsibility of the Physio and back room staff to raise his moral levels and keep him motivated. This could be helped by goal setting.

18. Psychological Responses to Treatment & Rehab:
The Use of Goal Setting
Being told on day 1 that he wouldn’t play a competitive game for 8 months, would have been devastating for Aaron. His motivation for Physio and regaining his strength would have started high but would more than likely have dropped after the initial phase of physio.
A way to improve motivation and enthusiasm would be to set Aaron goals & SMART targets.
For example, rather than being told;
“lets work towards getting match fit in 8 months”
He may have been told;
“lets work towards weight bearing in 6 weeks”
Then, following that;
“lets work towards running in 3 months”
Having smaller, realistic and achievable goals would help boost motivation. Achieving a goal every few weeks would give Aaron a sense of accomplishment and boost his self confidence, giving him more motivation to work hard in the next phase of rehab.

19. grading criterion M2 and D1 (analysis) may also be achieved.
Criteria P3 and P4 aim to address the issue of occurrence of sports injuries and the resulting symptoms, both physiologically and psychologically
Damaged tissue:
Primary damage response, healing response, the clotting mechanism
Scar tissue:
The importance of scar tissue control in the re-modelling process
Specific to injury:
Sprain/strain (signs and symptoms of first, second and third degree), haematomas (inter/intra)
If the explanation is sufficient enough and related to the concept of sports injury, then it is possible that
grading criterion M2 and D1 (analysis) may also be achieved.
To push for the Distinction go into further detail and analyse what might happen if a player ignored the physiological and psychological signs and symptoms of injury. Use examples of professional athletes, with news reports or newspaper articles if possible.
Response to injury
Anger, anxiety, depression, frustration, isolated from team mates
Response to treatment and rehabilitation
Anxiety, frustration, need for motivation, use of goal setting

20. What you guys can do…
Think back to your last serious injury, if you have had one. If not, try to imagine a career threatening injury; think about all the emotions you would experience.
Write a diary for an injured player identifying all the psychological responses that may occur. You could write multiple daily entries or create one weekly entry. To make sure you cover the grading criteria, ensure you include the following points:
Emotions experienced
o Anger
o Anxiety
o Depression
o Frustration
Isolation from team mates
o Response to treatment:
Drop in motivation
Frustration
Goal setting