1. Athletic Therapy Presented by Tara Sutherland CAT(C)

2. PIER PIER Pressure, Ice, Elevation, Rest Pressure, Ice, Elevation, Rest this entire process should be repeated for 24 to 72 hours this entire process should be repeated for 24 to 72 hours

3. Pressure Pressure stops or limits swelling space available and decreases blood flow to the area, thus decreasing the amount of blood available to swell stops or limits swelling space available and decreases blood flow to the area, thus decreasing the amount of blood available to swell eg. eg. Tensor wraps, tape Tensor wraps, tape pressure pads pressure pads Maintain pressure constantly.. Except at night Maintain pressure constantly.. Except at night

4. ICE ICE decreases the metabolic rate of the cells, this decreases the effect of the toxins in the area decreases the metabolic rate of the cells, this decreases the effect of the toxins in the area decreases the need for oxygen, thus decreasing the secondary tissue death decreases the need for oxygen, thus decreasing the secondary tissue death decreases nerve conduction rate, thus decreasing the pain decreases nerve conduction rate, thus decreasing the pain decreases blood flow to area, thus decreasing swelling decreases blood flow to area, thus decreasing swelling

5. ICE ( con’t) ICE ( con’t) eg. eg. Ice bags, cubed..crushed Ice bags, cubed..crushed frozen vegetables frozen vegetables gel packs gel packs cold tubs etc. cold tubs etc. Apply 15 to 20 minutes every hour for first 24- 48 hours Apply 15 to 20 minutes every hour for first 24- 48 hours

6. ELEVATION ELEVATION decreases blood flow to the area decreases blood flow to the area assists venous and lymphatic return, aiding in the decreasing of swelling assists venous and lymphatic return, aiding in the decreasing of swelling elevation means to elevate above the heart as often as possible. elevation means to elevate above the heart as often as possible.

7. Rest or restricted activity Rest or restricted activity decreases blood flow to the area decreases blood flow to the area decreases chance of further injury or re- injury decreases chance of further injury or re- injury e.g.. e.g.. Bed rest Bed rest sling sling crutches crutches braces, splints braces, splints

8. NEVERHEATANACUTEINJURY

9. Primary Injury- directly from an external force Primary Injury- directly from an external force Secondary injury - arises from an injury not properly treated Secondary injury - arises from an injury not properly treated Injuries

10. Injury classifications Injury classifications contusions - blows to soft tissue as well as boney areas contusions - blows to soft tissue as well as boney areas sprains - stretching or tearing of ligaments (connects bone to bone) sprains - stretching or tearing of ligaments (connects bone to bone) strains- stretching or tearing of muscle tissue strains- stretching or tearing of muscle tissue tendonitis - inflammation of a tendon (connects muscle to bone) tendonitis - inflammation of a tendon (connects muscle to bone) bursitis - inflammation of a bursa (balloon like protests areas) bursitis - inflammation of a bursa (balloon like protests areas)

11. Typical Sports Injuries Ankle sprains ( ATF) Ankle sprains ( ATF) Medial Tibial Stress Syndromes ( shin splints) Medial Tibial Stress Syndromes ( shin splints) Knee MCL or ACL Knee MCL or ACL Quad Contusions Quad Contusions Fractures Fractures Head Injuries Head Injuries

12. Ankle ATF Sprains Inversion Ankle Sprains Inversion Ankle Sprains more common than eversion because of ligament and bony support more common than eversion because of ligament and bony support stress is applied to the lateral side of the foot during plantar flexion and inversion stress is applied to the lateral side of the foot during plantar flexion and inversion individual will report cracking or tearing sound at time of injury individual will report cracking or tearing sound at time of injury swelling and ecchymosis will be rapid and diffuse swelling and ecchymosis will be rapid and diffuse point tenderness over ATF may extend over CF point tenderness over ATF may extend over CF

13. Rx - PIER, modalities -horseshoe pad Rx - PIER, modalities -horseshoe pad Should probably xray to rule out any possible fractures Should probably xray to rule out any possible fractures

14. Medial Tibial Stress Syndrome shin splints shin splints pain along the posteriormedial tibial border pain along the posteriormedial tibial border usually in the distal third usually in the distal third Possible factors - excessive pronation, prolonged pronation, recent training changes (speed, form, running surface, distance) Possible factors - excessive pronation, prolonged pronation, recent training changes (speed, form, running surface, distance) pain usually present at start of activity,but decreases with activity only to return after activity, later stages pain present at all times - may restrict activity pain usually present at start of activity,but decreases with activity only to return after activity, later stages pain present at all times - may restrict activity

15. RX - PIER, NSAIDS, ( modalities) activity modification (rest) - low impact - non impact - stretching and strengthening of intrinsic muscle of the foot RX - PIER, NSAIDS, ( modalities) activity modification (rest) - low impact - non impact - stretching and strengthening of intrinsic muscle of the foot

16. Medial Collateral Ligament provide valgus, external rot support ( note ACL is also very imp in this function) provide valgus, external rot support ( note ACL is also very imp in this function) basically a thickening of the medial capsule basically a thickening of the medial capsule superficial layer and a deep layer superficial layer and a deep layer

17. Anterior Cruciate Ligament ACL most common and serious injury to the knee ACL most common and serious injury to the knee susceptible to injury with a valgus force, external rotation strong quad contraction of knee hyperextension susceptible to injury with a valgus force, external rotation strong quad contraction of knee hyperextension ACL is subject to deceleration injuries, internal tibial torque is the most dangerous loading mechanism, particularly when combined with an anterior tibial force ACL is subject to deceleration injuries, internal tibial torque is the most dangerous loading mechanism, particularly when combined with an anterior tibial force

18. damage to the ACL usually results from a cutting or turning maneuver, landing off balance or a sudden deceleration damage to the ACL usually results from a cutting or turning maneuver, landing off balance or a sudden deceleration pain described as being felt deep in the knee or on either side of the patellar tendon pain described as being felt deep in the knee or on either side of the patellar tendon joint effusion is usually bloody and fairly rapid onset joint effusion is usually bloody and fairly rapid onset

19. Rx - PIER, –tensor wrap Rx - PIER, –tensor wrap Send to Physician / Therapist Send to Physician / Therapist Should probably xray to rule out any possible fractures Should probably xray to rule out any possible fractures

20. Quad Contusion AKA Charlie horse AKA Charlie horse most common site for contusion is the anterolateral thigh, which almost always damages muscle tissue most common site for contusion is the anterolateral thigh, which almost always damages muscle tissue severity of injury is almost always underestimated and under treated severity of injury is almost always underestimated and under treated

21. s/s - immediately after impact pain and swelling may be extensive, ROM will be limited due to severity s/s - immediately after impact pain and swelling may be extensive, ROM will be limited due to severity if severe the individual may not be able to bear weight and not able to fully flex the knee if severe the individual may not be able to bear weight and not able to fully flex the knee there may be a palpable firm hematoma with in 24 hours – resulting in the inability to contact the quads there may be a palpable firm hematoma with in 24 hours – resulting in the inability to contact the quads

22. Rx – PIER – do not heat – should be iced in a flexed position Rx – PIER – do not heat – should be iced in a flexed position Myositis ossificans is an abnormal ossification involving bone deposites within muscle tissue Myositis ossificans is an abnormal ossification involving bone deposites within muscle tissue

23. Muscle strains muscular strains to the thigh and hip are frequent in sports, Rectus Femoris, Adductors and hamstrings muscular strains to the thigh and hip are frequent in sports, Rectus Femoris, Adductors and hamstrings hamstrings are the most commonly strained muscle in the body hamstrings are the most commonly strained muscle in the body

24. individual may report a snapping or tearing during an explosive action, followed by immediate pain and loss of function, with local tenderness and possibly a palpable defect individual may report a snapping or tearing during an explosive action, followed by immediate pain and loss of function, with local tenderness and possibly a palpable defect usually caused by rapid contraction or a violent stretch usually caused by rapid contraction or a violent stretch hamstring strain has the reputation of being a chronic and reoccurring problem hamstring strain has the reputation of being a chronic and reoccurring problem

25. Risk factors Risk factors Poor flexibility Poor flexibility Poor posture Poor posture Muscle imbalance Muscle imbalance Improper warm up Improper warm up Muscle fatigue Muscle fatigue Previous injury Previous injury Overuse Overuse Improper technique Improper technique

26. Fractures Can range from stress fractures, hairline fractures to displace open fractures Can range from stress fractures, hairline fractures to displace open fractures When in doubt send for an xray When in doubt send for an xray If open or displaced call 911, do not try to re align or move the limb in question If open or displaced call 911, do not try to re align or move the limb in question If closed, splint and transport to hospital If closed, splint and transport to hospital

31. Head Injuries Prevention of Injuries Prevention of Injuries the most important protective measure for the head is the use of helmets the most important protective measure for the head is the use of helmets the proper use of protective equipment can protect the head from accidental or routine injuries the proper use of protective equipment can protect the head from accidental or routine injuries

32. A concussion literally means: A concussion literally means: a violent shaking or jarring action of the brain, resulting in immediate or transient impairment of neurologic function a violent shaking or jarring action of the brain, resulting in immediate or transient impairment of neurologic function this condition does not always involve the loss of consciousness this condition does not always involve the loss of consciousness when shaken or jarred brain function can be disrupted temporarily with out causing injury or damage to the brain when shaken or jarred brain function can be disrupted temporarily with out causing injury or damage to the brain S/S range from mild to moderate and are transient and reversible since damage to soft tissue is minimal S/S range from mild to moderate and are transient and reversible since damage to soft tissue is minimal

34. Loss of consciousness Loss of consciousness unresponsive, confused, disoriented unresponsive, confused, disoriented Amnesia - confusion Amnesia - confusion loss of memory of events after injury (posttraumatic amnesia) loss of memory of events after injury (posttraumatic amnesia) loss of memory prior to injury ( retrograde amnesia) loss of memory prior to injury ( retrograde amnesia)

35. Pupil abnormalities- note pupil size and accomodation to light - both should be equal Pupil abnormalities- note pupil size and accomodation to light - both should be equal vision problems - blurred, double, seeing stars vision problems - blurred, double, seeing stars Headache Headache Nausea or Vomiting Nausea or Vomiting

36. SCAT Sport Concussion Assessment Tool Sport Concussion Assessment Tool Most uptodate assessment and treatment tool for concussions Most uptodate assessment and treatment tool for concussions When in doubt be safe When in doubt be safe

37. Thank you for your time. Thank you for your time. Tara Tara