1. Out of Harm’s Way: Sport Injuries
Chapter 8
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2. Outline: Biomechanical principles of injury
Injury treatment and rehabilitation
Pain: nature’s warning system
Soft tissues injuries
Dislocations
Fractures
Concussions
Overuse injuries
Injury prevention
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3. Biomechanical Principles of Injury
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4. Each type of tissue possesses unique mechanical characteristics
Tissue Types
Epithelial Muscle Connective Nervous
Each type of tissue possesses unique mechanical characteristics
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5. Loading
To best understand the biomechanical characteristics of tissue we examine its behaviour under physical load
Under load a tissue experiences deformation
Deformation can be visualized through deformation curve
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6. C B A High Load Low Small Large Deformation Ultimate Failure
Elastic Limit B
Load
Plastic Region
Elastic Region
Low A
Small
Large
Deformation
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7. to return to its original shape
High
Ultimate Failure C
Elastic Limit B
Elasticity:
capacity of a tissue
to return to its original shape
after removal of load
Load
Plastic Region
Elastic Region
Low A
Small
Large
Deformation
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8. Tissue no longer posesses
High
Ultimate Failure C
Elastic Limit B
Plastic region begins
Tissue no longer posesses
elastic properties
Load
Plastic Region
Elastic Region
Low A
Small
Large
Deformation
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9. C B A High Load Low Small Large Deformation
Permanent tissue deformation
(does not return
to original shape)
Resulting in micro-failure
or injury (e.g. sprains)
High
Ultimate Failure C
Elastic Limit B
Load
Plastic Region
Elastic Region
Low A
Small
Large
Deformation
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10. C B A High Load Low Small Large Deformation
Ultimate Failure C
Elastic Limit
Macro- or completes failure
(e.g. torn ligament)
Tissue becomes completely
unresponsive to loads B
Load
Plastic Region
Elastic Region
Low A
Small
Large
Deformation
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11. Area = strength of the material
High
Ultimate Failure C
Elastic Limit B
Load
Plastic Region
Elastic Region
Low A
Small
Large
Deformation
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12. Slope = stiffness (or resistance to deformation) of the material
High
Ultimate Failure C
Elastic Limit B
Load
Plastic Region
Elastic Region
Low A
Small
Large
Deformation
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13. Tissues Response to Training Loads
Training load =/ elastic limit
Micro-failure  making of new tissue
Positive training effect
Training load > elastic limit
Permanent failure
Injury
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14. Forces Acting on Tissue
TENSION
COMPRESSION
BENDING
TORSION
SHEAR
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15. Injury treatment and rehabilitation
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16. Treatment Rehabilitation
Received by patient from a health care professional
Promotes healing
Improves quality of injured tissue
Allows quicker return to activity
Rehabilitation
Therapist’s restoration of injured tissue +patient's participation
Individualized for each athlete
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17. Healing Phases
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18. Inflammatory Response Phase Inflammatory Response Phase Inflammatory
2 – 4 days
Inflammatory
Response
Phase
hrs – 6 wks
Inflammatory
Response
Phase
3 wks - yrs
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19. Inflammatory Response Phase
Inflammation begins at the time of injury
Signs
Redness
Swelling
Pain
Increased temperature
Loss of function
Protect
Rest
Cryotherapy
Decreases swelling, bleeding, pain and spasms
Compression
Decreases swelling
Elevation
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20. Fibroplastic Repair Phase
Rehab-specific exercises
Restore range of motion and strength
Manual massage therapy and ultrasound
Help break down scar
Protective taping and bracing
Repair and scar formation
Granulation tissue fills the gap
Collagen fibres are deposited by fibroblasts
Signs seen in the phase1 subside
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21. Maturation-Remodeling Phase
Remodeling or realigning of the scar tissue
More aggressive stretching and strengthening
To organize the scar tissue along the lines of tensile stress
Include sport-specific skills and activities
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22. Pain: nature’s warning system
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23. Pain Nature’s way of telling us something is wrong
One of the best indicator of when it is best to resume play
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24. Problem with Ignoring Pain
Masking with
medications
Continued
participation
Pushing injured
tissue closer to
yield-level point
Gastrointestinal
complications
Addiction
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25. Soft tissues injuries
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26. Contusions
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27. Compressing force crushes tissue E.g. “charleyhorse” – quadriceps
Bruise
Compressing force crushes tissue
E.g. “charleyhorse” – quadriceps
Discoloration and swelling
Myositis ossification – abnormal bone formation in a severe contusion
Life-threatening if the tissue involved is a vital organ
P-R-I-C-E
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28. Strains and Sprains
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29. Tendon or muscle tissue is stretched or torn
STRAIN
Tendon or muscle tissue is stretched or torn
SPRAIN
Ligament or the joint capsule is stretched pr torn
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30. Grades of sprains and strains
Slightly stretched or torn; few muscle fibres
GRADE 2
Moderately stretched or torn, more muscle fibres
GRADE3
Complete rupture
Surgery required
E.g. ACL tear
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31. Common Strains Adductors Hamstrings Quadriceps Hip flexors
Rotator cuffs
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32. Emphasize hamstrings and quadriceps equally
Hamstring Strains
Most frequently strained muscles
Mechanism:
Rapid contraction in a lengthened position
E.g. sprinting and running
Due to strength imbalance
Hamstring strength >>> quadriceps strength
Emphasize hamstrings and quadriceps equally
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33. Ankle Sprains During running, walking, dancing or stepping off a curb
Most common = lateral ankle sprain
Inversion
Common reoccurrence
Decreased proprioception
Symptoms
Rapid swelling
Point tenderness
Rehabilitation
Decreases reoccurrence
Incorporation of balance exercises
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34. Dislocations
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35. Great enough forces push the joint beyond its normal anatomical limits
Joint surfaces come apart
Subluxation
When supporting structures (e.g. ligaments) are stretched or torn enough
Bony surfaces partially separate
Most common = fingers
Can become chronic
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36. Dislocation of the Shoulder
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37. Most mobile  most unstable joint Categories of dislocation:
Partial (subluxation)
Complete
Most common
Head of humerus slips anteriorly
Falling backwards on extended arm
Symptoms
Swelling, numbness, pain, weakness, bruising
Capsule and/or rotator cuff tears
Brachial plexus injury
Require medical treatment to relocate head of humerus back to glenoid fossa
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38. Fractures
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39. Simple fracture Compound fracture Stress fracture Avulsion fracture
Stays within the surrounding soft tissue
Compound fracture
Protrudes from the skin
Stress fracture
Results from repeated low magnitude loads
Avulsion fracture
Involves tendon or ligament pulling small chip of bone
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40. Concussions
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41. No such thing as “minor concussion and “shaking off”
Injury to the brain
Mechanism:
Violent shaking or jarring action of the head
Brain bounces against the inside of the skull
Symptoms
Confusion
Temporary loss of normal brain function
REST
No such thing as “minor concussion and “shaking off”
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42. Overuse injuries
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43. Due to Results from Repeated and accumulated microtrauma
Non-sufficient recovery
Results from
Poor technique
Poor equipment
Too much training
Type of training
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44. Tendonitis
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45. Inflammation of tendon as a result of a small tear in the tendon
Tendonitis
Excessive ,
repetitive
motion
Improper
technique
Age
(loss in
elasticity)
Symptoms
Pain (aggravated by movement)
Tenderness
Stiffness near joint
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46. Tennis Elbow Lateral epicondylitis Affect forearm extensors
Attach to lateral epicondyle
Extend wrist and fingers
Contributing factors
Excessive forearm pronation and wrist flexion
Gripping racquet too tightly
Improper size3 grip
Excessive string tension
Excessive racquet weight
Topspins
Hitting ball off-centre
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47. Gofer’s and Little League Elbow
Medial epicondylitis
Affects tendons of forearm flexors
Attach to medial epicondyle
Flex wrist and fingers
May result in collateral ligament and ulnar nerve injury
May affect medial humeral growth plate in young children (little league elbow)
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48. Jumper’s Knee Patellar tendonitis Affects infrapatellar ligament
Caused by:
Repetitive eccentric knee actions
Eccentric load during jump preparation >>> body weight
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49. Bursitis
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50. Inflammation of the bursae
Tiny fluid-filled sacs
Lubricate and cushion pressure points between bone and tendons
Results from overuse and stress
Age is also a factor
Most common
Shoulder, elbow and hip
Inflammation and pain aggravated by movement and direct pressure
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51. Shoulder Impingement
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52. Excess movement of the humeral head + lack of space
Inflammation of bursae or rotator cuff tendon
Result of muscle imbalances in shoulder muscles
Weak shoulder depressors
Strong shoulder elevators
Balanced strength training
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53. Stress Fractures
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54. Pain along inside tibial surface Involve pain and inflammation
Shin splints
Pain along inside tibial surface
Involve pain and inflammation
NO disruption of cortical bone
Stress fracture
Results from repeated low-magnitude forces
Small disruption of the outer bone layer
Weakened bone
Cortical bone fracture
NOT a shin splint
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55. Injury prevention
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56. Protective Equipment
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57. Warm Up and Cool Down
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58. Keeping Fit and Flexible
“Use it or lose it”
Especially important during the off-season
Preparing the muscle for placing demands
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59. In order to function effectively body must receive
Eating and Resting
In order to function effectively body must receive
Proper nutrient
Adequate rest
Avoid over-training and lack of sleeping
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