1. Sports Injury and Types Lecture 2

2. Definition of Sports Injury
Occurs as a result of participation in an organized practice or game
Requires medical attention by a therapist or physician
Results in restriction of the athlete’s participation or performance for one or more days.

3. Mechanism or Injury MOI
What happened , how was the athlete injured, main cause
Provide clues as to acute or chronic

4. Importance of MOI Details how injury occurred
Determines when it occurred
Guides evaluation
Determines levels of severity
Leads to s differential diagnosis
Guides treatment plans

5. Questions to Determine MOI
What is your primary complaint
What happened how did it happen where do you hurt
What makes it feel better
Wha makes it feel worse
When did it happen
What can you do , what can’t you do
Was the pain sudden or did it gradually appear

6. Acute injury a single force ( macrotrauma )
definite moment of onset ( usually rapid onset) followed by a relatively predictable pattern of events
Usually a single traumatic event

7. Critical Force
tissues are said to have a limit that it is able to withstand a force , this limit is the critical force
the critical force value varies for each type of tissue
The critical force may depend upon age, temperature, skeletal maturity , sex, and body weight

8. Chronic Injury repeated loading or stress ( microtrauma)
develops and worsens over a period of time, slow or insidious onset
pain and inflammation - worsen with time
may persist for months – years
Often occur in activities with repeated,
continuous movements
Often called overuse injuries

9. Catastrophic Injuries
Involve damage to the brain and or spinal cord and are potentially life threatening or permanent

10. Soft tissue
Includes muscle , fascia ,tendons, joint capsules, ligaments , blood vessels and nerves .
Soft tissue injuries
Contusions, sprains, strains,

11. Injury Classification
Sprains stretch or tear of stabilizing connective tissue , ligaments
History of acute onset
MOI may be due to overstretch or overload
Pain is localized over the injury site
Discolouration in severe cases ( caused by blood pooling distally to site of trauma)

12. Sprains
lst degree: mildest form of sprain , mild pain, mild dysfunction , point tenderness, little to no swelling
2nd degree: more severe, imply more damage to ligament involved, increased amount pain and dysfunction , swelling more pronounced with abnormal movement

13. Sprains
3rd degree: most severe and imply a complete rupture, severe pain, major loss function, major instability, severe swelling

14. Sprain ankle

15. Strains
Injuries to muscles. Tendons or muscle tendon junctions ( MTJ).
Most common location for a strain is MTJ
There is a tremendous variability in the severity of strains

16. Strains
1st degree: mildest form of strain with little associated damage to muscle and tendon structures, pain noticeable during use , with mild swelling
2nd degree:more extensive damage to soft tissue, pain , swelling are more pronounced and functional loss is moderate

17. Strains
3 rd degree: most severe and imply a complete tear or rupture of structure involved
Significant swelling and loss of function
A defect may be apparent through the skin

18. Hamstring strain

19. Contusions
a result of compressive force or a direct blow to the body surface.
Characterized with pain, stifness and swelling as well as
Ecchymosis - tissue discolouration if haemorrhage is superficial
Haematoma – pooling of blood

22. Fractures is a disruption in the continuity of a bone a) simple
bone ends remain intact within surrounding soft tissues
b) compound
one or both ends protrude from the skin
Associated with swelling , deformity , pain, tenderness loss of use, grating sensation

23. Types of fractures
transverse - break occurs in straight line across the bone
oblique - break occurs diagonally across the bone
spiral - jagged bone ends are S- shaped
avulsion - bony fragment is pulled off by attached tendon
stress - repeated low magnitude forces over time

24. Types of fractures comminuted - bone fragments into several pieces
greenstick - bone breaks incompletely
as with a green stick
impacted - a bone impacts or is driven into another bone

25. Fracture dislocation

27. Dislocations Luxation
A temporary separation b/w articulating ends & remains that way for extended period.
results in extreme damage to connective tissue.
common: fingers, G-H jt.
S/S --dysfunction , deformity, athlete will often report a snapping or popping sound

30. Subluxation incomplete separation b/w articulating ends.
less severe damage than luxation.
common: patellafemoral jt.

31. Tissue Response to Injury
tendons, ligaments , muscle , bones with progressive training all structures gradually get stronger and larger
injuries occur as a result of the bodies inability to adapt to an increased load of training ( rapid changes )
“Healing is a matter of time but sometimes also a matter of opportunity” Hippocrates

32. Force Directions
Compressive - an axial loading that produces a squeezing or crushing effect on a structure ( bruises)
Tensile - axial force that is opposite to compressive force ( longitudinal force) (muscle stretch)
a pulling force that tends to stretch the structure
Bending –results in tension on one side and compression on the other ( ankle sprains damage to both sides)

33. Shear - a force that acts perpendicular to the tissues involved (structures slide or displace) (ligament tears , blisters)
Rotational- combination of tension and shears ( spiral fractures , acl tears)

35. Soft Tissues Skin - tendons - ligaments all made up of collagen
Collagen - is a protein strong in resisting tension but stretches slightly under tensile loading as fibres straighten
thus collagen provides both strength and flexibility to tissues ( but are relatively inelastic)
Elastin another protein provides added elasticity to some connective tissue structures.

36. Skin 3 layers largest organ of the human body
loose multidirectional arrangement of collagen fibres - enables the resistance of multidirectional loads, including compression, tension and shear

38. Epidermis outer sheath of the body acts as a barrier.
Contains pigments
hair, nail and glands

39. Dermis 1 st layer under the epidermis blood vessels nerve endings
glands ( sweat, sebaceous)

40. Subcutis subcutaneous fat primary area for fat storage
producing internal temperature regulation
mobility of skin over internal body core

41. Skin Injury Classification

42. Blister Repeated application of a shear in multiple directions
excessive friction on skin
results in a pocket of fluid accumulation below epidermis.
hot spot.
open vs closed

44. do not aspirate if blood filled … otherwise
aspirate after 24 hours ,
with a sterile needle ,
clean and dress the wound ..
leave the top layer of skin on …
cover with donut pad and or second skin.

45. Skin Bruise Ecceymosis
a direct compressive force , from a blow or trauma
damage to underlying bloods vessels causing accumulation of blood within the skin
ice and pad if necessary

47. Abrasion result of scraping or shear of skin on rough surface.
results in loss of epidermis or worse depending on amount of force
clean and remove any debris
flush with saline solution
dress with non stick adherent pad and secure

48. Punctures
direct penetration of skin by sharp object - eg: T&F spike, javelin.
CAUTION!! Tetanus Bacillis
lockjaw - acute disease -
booster shots if not had one in five years

49. Lacerations sharp object (skate blade) direct blow (squash racquet)
stitches vs steri-strips
1/2" length, 1/8" deep, need to be done with in 10 hours

52. Ligaments and Tendons Injury Classification

53. Tendons connect muscles to bones dense connective tissue
fibers parallel - enable resistance of high unidirectional tensile loads

55. Ligaments connect bone to bone dense connective tissue
fibers parallel and interwoven
resistance along long axis and also small resistance to loads of other directions
more elastin in ligaments than tendons thus more elastic in nature

56. Tendon Injuries
stronger than muscle, so usually damage to muscle belly or musculotendinous junction.
however, tendons can be weakened by collagen re-absorption with:
early conditioning.
post - immobilization.
repeated micro trauma.
Note: also weakened with steroid use

57. Tendonitis S/S History of chronic onset
MOI due to overuse, or repeated overstretch or overload
Pain exists through out the length of tendon and increases with palpation
Swelling may be minor to major and thickening of tendon may be present

58. Crepitus may be present
Pain usually at the extremes of motion
Pain increases during stretching and resisted actions
Strength decreases with pain

59. Tenosynovitis inflammation of synovial sheath around tendon.
occurs quickly
crepitus - snapping sound
acute or chronic
if chronic a nodule is often formed

60. Fascitis inflammation of fascia which separates muscle layers
eg. - plantarfascia.

61. Bursitis may be acute or chronic direct trauma or repetitive forces
fluid filled sac
found in areas where friction might occur

62. Joints Types

63. Fibrous lack of synovial cavity.
articulation held together by fibrous connective tissue.
little to no movement.
eg.: distal tib fib joint.

64. Cartilaginous no synovial cavity.
articulation held together by cartilage.
little to slight movement.
eg.: symphasis pubis, intervertebral discs.

65. Synovial -freely movable joints. -must process following criteria:
space/potential b/w articulating ends.
articular cartilage (hyaline cartilage).
Articular Capsule:
i) Fibrous (outer).
ii) Synovial membrane (inner).
secretes synovial fluid to lubricate joint and provide nutrition.

66. Types of Synovial Joints
Ball & Socket
Hinge
Pivot
Saddle
Gliding

68. Bone like lig. & tendon connective tissue, except:
calcium carbonate , calcium phosphate, collagen and water
some degree of flexibility and strength
progressive loss of collagen with age - which increases the bones brittleness
Periosteum - contains blood supply to bone