Injury Prevention

Injury Prevention

The best method of managing and caring for athletic injuries is to PREVENT them from occurring

Many factors are important in the prevention processEquipment

Bracing

Taping

Coaching Techniques

Body Mechanics

Universal Precautions

Protective Equipment

Proper selection and fit are essential in prevention of injuries

Should be designed to prevent injury and protect injured parts against further injury

Minimal functional interference

Cause no harm to other participants

Simple to fit and maintain

Durable and reliable

Not expensive

Protective Equipment

The hazard demonstrated in each individual sport dictate the need for specific types of protection

Contact SportsPadding must protect primary contact points

Vital areas such as head, neck, kidneys, genitalia have priority for protection

High velocity hazards (ball/puck sports)Helmets, face masks, eye protection needed

Dental protection

Protective Equipment

Modifications and improvements in sport equipment are continually being made

Protective equipment can be abusedBy using equipment as a weapon against their opponent

Players who take dangerous risks and rely on equipment to protect them

Legal Concerns

Manufacturers and purchasers of sports equipment must foresee all possible uses and misuses of equipment

Must warn the user of any potential risks in the use or misuse of the equipment

Legal Concerns

To decrease possibilities of injuries and litigation:Buy protective equipment from reputable manufactures

Buy the safest equipment resources permit

Ensure equipment is assembled correctly-follow all instructions to the letter

Maintain all equipment properly

Use equipment only for purpose designed

Warn athletes who use equipment of all risks

Use great caution when customizing any equipment or don’t do it at all

Use no defective equipment

Selection and Fitting of Equipment

Correctly fitting equipment is very important for injury prevention

To fit athlete these factors should be considered:

Size

Sport Position

Strength

Age and Physical Development

Skill Level

Design of Protective Equipment

ChannelingForces are channeled away from anatomical structures

DispersionForces are dispersed over a large area

Mechanical StructuringForces are reduced through the use of a mechanical structure

RestrictionAnatomical ranges of motion are reduced to prevent forces that cause injury

Head Protection

Nothing can eliminate the possibility of head injury

Helmets do help to significantly lessen head injury severity

Head protection is advised/mandated in football, ice hockey, lacrosse, boxing etc..

Helmets must fit correctly to function properly

Helmets

Helmets should be able to absorb force levels high enough to fracture the skullHelmets should be monitored often because fit can be altered by:

Temperature, hair length, internal paddingLoss of air from cells, spread of facemask

National Operating Committee on Standards for Athletic Equipment has had a major influence

NOCSAE

All helmets must have NOCSAE certification

To be NOCSAE approved:Helmet must be able to tolerate forces to many different areas

Withstand repeated blows

Withstand high mass low velocity impacts

Even though helmet is certified does not mean it is fail-safe

NOCSAE Warning

Warning placed on all football helmets“Do not use this helmet to butt, ram or spear an opposing player. This is a violation of football rules, and can result in severe head, brain, neck injury, paralysis, or death to you and possible injury to your opponent. There is a risk these injuries may also occur as a result of accidental contact without intention to butt, ram or spear. No helmet can prevent all such injuries”

Face Protection

Four categoriesFull face guards

Protect against flying or carried objects

Mouth guardsMajority of dental injuries can be prevented

Absorbs shock of chin blows, helps prevent concussions

Ear guardsWrestling and boxing

Eye protection devicesCorrective lenses, glasses, headgear

Trunk and Thorax Protection

Shoulder, ribs, spine and genitalia have insufficient soft tissue protectionShoulder Pads and Restraints

Flat-quarterback or receiverCantilevered-blocking and tackling athletesFlak jackets protect ribs and thoracic area

Breast Support- Sports BraGroin and Genitalia-Cup

Other Padding and Braces

Shoulder BracesRestraining devices for chronic dislocated shoulder

Restricts upper arm from being abducted and externally rotated

Hip padsCollision and high velocity sports to protect vulnerable areas such as iliac crest

Abdominal and low back supportsDesigned to give relief and permits movement

Limb Protection

FootwearSocks and Shoes

Shin and Lower LegHard shelled, molded shin guards

Thigh and Upper LegPads slip into ready-made pockets in the uniform

Knee SupportsKnee pads, Elastic sleeve, Bracing

Ankle SupportsCommercial bracing and ankle taping

Hand, Wrist, Arm and Elbow ProtectionPadded gloves, mitts and boxing gloves

Footwear

Can mean the difference between success, failure and injury

SocksPoor fitted socks can cause abnormal stresses and cause irritations

Socks should be clean, dry and without holes

ShoesChronic abnormal pressure to foot can cause permanent structural deformities, calluses, blisters

Can cause mechanical disturbances that affect total postural balances, effecting joints and muscles The bare human foot was designed to function on uneven surfaces

Shoes cont...

Shoes were created to protect against harmful surfacesLeft foot generally varies in size and shape from the right footIt is important to measure both feet and simulate the conditions under which they will perform with shoes onFit shoes at the end of the dayToes can be fully extended without being crampedWhen dealing with cleats- cleats should be positioned under two weight bearing joints

Foot pads

Can be helpful in treating a variety of foot problems as well as hip and knee

Commercial or Custom-made orthotics

Corns, bunions, fallen arches, pronated feet

Foam, Felt, Plaster or aluminum and heel cups

Prophylactic Knee Braces

ProphylacticTo prevent or avoid

Effectiveness is controversial

Players at greatest risk- Offensive and Defensive Lineman, Linebackers, Tight Ends

Designed to provide protection against lateral and medial, but not rotary forces

Knee Braces cont…

Studies are divided

Decrease, No difference and Increase in knee injuries

More studies need to be conducted concerning:

Relative strength of braces

Weather they pre-stress the knee joint and produce injuries

Functional Knee Braces

Customized orthopedic knee brace prescribed for the athlete

Following serious knee joint injury that produces chronic instability/surgery

Designed to prevent re-injury to the cruciate ligaments

Effectiveness better documented

Taping

Used for the care and protection of the athlete

Adhesive tape offers a number of possibilitiesRetention of wound dressings

Stabilization of compression-type bandages that are used to control bleeding

Support of recent injuries to prevent additional injuries

Protect against acute injuries- by limiting ROM

Taping Guidelines

Be sure the area is dry, clean and free of body hair

Use some form of tape adherent to ensure bonding of the tape to the skin

Apply one layer of prewrap over adherent

Apply lubricated padPrevents cuts, blisters and rashes

Overlap each strip of tape to the previous strip by half

Taping Guidelines Cont.…

Avoid spaces between tape segmentsSpaces may result in blistering

Smooth and mold the tape to the natural contour of the area

Try to make athlete comfortable, but maintain dorsiflexion

After wrapping/taping is complete check for comfort and impaired circulation

Taping Usage

Tape is available in variety of widths, strength and elasticity

Tape should adhere readily when applied

Stretch and elastic should be used for smaller, more angular body parts

Tape should be stored in a cool placeTemperatures greater than 75 degrees may alter the adhesive ability

Taping Usage Cont...

To tear tape, hold firmly on each side of the proposed tear line, and pull the free end away at an angle so that the forces crosses the lines of the fabric at a sharp angleEdges should be straight, no loose threadsSpecial cutters are made for tape removalAvoid cutting over bony prominencesLook for blisters and skin irritations as the tape is removed

Effectiveness of Taping

Controversy

Taping only should be used in conjunction with proper exercise

Improperly applied wrap/tape can compound an injury and create postural imbalances

Arguments for and against Taping

ForMost studies agree that taping does contribute to a lower incidence of injury/re-injuryProphylactic taping is superior to lace on braces for the first 20 minutes, after that they are equal

AgainstTape usually becomes loose with wear

The skin is mobile, thus taping can not be effective

Taping weakens the leg muscles

Moisture develops between skin/tape, thus affecting tape adherence

Tape tears under stress

Complications of Taping

Skin allergies

Skin irritations

Blisters

Lacerations

Reactions to tape adherent

Common Taping Procedure

Routine Non-Injury Ankle Taping

Have athlete sit on table with leg extended, the lower part of the calf past the edge of the table

Have athlete hold foot at a 90 degree angle in dorsiflexion

Apply a coat of tape adherent to protect the skin

Ankle Taping

Apply a foam pad over the instep and back of the heel

Apply a layer of prewrap to the ankle

Using 11/2 inch tape, apply an anchor around the ankle about 5-6 inches above the malleolus

Apply another anchor at the distal third of the longitudinal arch, making sure not to constrict the base of the fifth metatarsal

Ankle Taping

Apply 2-3 stirrups in consecutive orderBegin on the medial part of the calf

Pull up on the lateral aspect of the leg with moderate tension

This places the foot into slight eversion

Apply circular strips form the point of the proximal anchor, moving downward until the malleolus is completely covered

Ankle Taping

Apply arch strips down to the distal anchor

Apply a heel lockStart high on the instep, bring the tape along the ankle at a slight ankle

Hook the heel

Lead the tape under the arch

Finish by coming up on the opposite side by the starting point

Cover the ankle again with a second layer of tape (optional)

Prophylactic Thumb Taping

Protects the joints and surrounding muscles

Have athlete fully extend and adduct the fingers, by keeping the thumb in a relaxed, neutral position

Stand in front in the athlete

Apply rewrap to the forearm, wrist and thumb

Thumb Taping

Using 1 inch tape place an anchor strip around the wrist and another around the distal end of the thumb

From the anchor at the tip of the thumb to the anchor around the wrist, apply 4 strips in a series on the dorsal side of the thumb

Hold these strips in place by applying one locking strip around the wrist and one encircling the tip of the thumb

Thumb Taping

Add a series of three “spica” stripsThe first spica is started on the radial side at the base of the thumb and carried under the thumb, completely encircling it and then crossing the starting point

The strip should continue around the wrist and finish at the starting point

The following 2 spica strips should overlap the preceding strip by at least 2/3 inch and move downward on the thumb

Place a final locking strip around the wrist

Elbow Hyperextension Taping

Have athlete stand with the elbow flexed at least 30-45 degrees, and the forearm in neutral positionTaper should stand facing the armApply adhesive spray to the areaApply prewrap from mid-humerus to the mid-forearmApply two anchor strips loosely around the arm, approximately 2-3 inches above and below the elbow joint

Elbow Hyperextension Taping

Construct a checkreinPlace a 4 inch strip of tape against the center of a 10 inch strip of tape, thereby “blanking out’ the center portion of the longer strip

Place the checkrein so that is spans the two anchor strips with the blanked out side facing down

Elbow Hyperextension Taping

Place 5 additional 10 inch strip of tape over the first checkrein (tape fan)

Finish by securing the checkrein with three locking strips both above and below the elbow joint

A figure-8 elastic wrap can be added over the taping to prevent the tape from slipping because of perspiration

Sports Medicine Professional Obligations

Ethical and Legal responsibility to each athlete they work with

Athletes welfare should be placed above all other considerations-coaches, parents etc...

Do not allow non-medical considerations influence judgement

If pressure is exerted an question of judgement arises a Physician’s opinion should be called for- Physician has final call

Sports Medicine Obligations

If find unsafe coaching practices of facilities:Notify appropriate person

If advice is ignored report the findings and recommendations should be made to the highest authority

Use careful judgement to ensure frivolous remarks are not made

Same situation applies for use of illegal or banned drugs

Treat every athlete equally

Be loyal to the coaches, team, physicians, etc.

Coaching Techniques

Coach is responsible for teaching playing skills

Coaches should impart a proper game philosophy and an overall safety awareness

“Win at all costs” syndrome is dangerous and shows little regard for the safety of the athletes

Coaches can show concern by meeting with team members and parents to inform about potential injuries and means of prevention

Coaching Obligations

Warn athletes of potential for head and neck injuries

Insist on blocking and tackling techniques that reduce the chance of injury

Must provide or delegate appropriate person to give emergency care and first aid in absence of a sports med professional

At least one member of any coaching staff should have training in CPR and first aid

Safety and well being of athlete must always have highest priority

Body Mechanics

Center of GravityMore than half the total body weight is located in the upper part of the body, which is supported by thin bones

Center of gravity increases stability as it is lowered- for example widening the stance

Musculature serves as a shock absorber by absorbing impact and distributing it over a larger area

Body Mechanics

PostureSpine has 3 curves that help maintain balance

The head weighs close to 14 pounds and is balanced on top of 7small cervical vertebrae

Particular vulnerable to injury

Strengthening the neck muscles is an important protective measure

Body Mechanics

Musculoskeletal System FactorsHeredity, congenital or acquired defects may predispose athlete to a specific type of injury

Postural deviations are often major underlying cause of sport injuries

For example a consistent pattern of knee injury may be related to asymmetries within the pelvis and the legs

Knee Disorders

Genu ValgumKnock Kneed

Weight bearing line passes to the lateral side of the center of the knee joint

Results of the inward angling of the thigh and lower leg

Causes the body weight to be borne on medial aspect

More prone to medial knee injuries

Knee Disorder

Genu VarumBow Legged

Opposite of Genu Valgum

The extra stress is placed on the lateral aspects

Athlete more prone to lateral knee injuries

If severe should be directed into non-contact activity (same for Genu Valgum)

Spinal Abnormalities

KyphosisRound Back

Abnormal curvature of thoracic spine

Forward Head and Flat chest

Basketball players, gymnasts, weight lifters common to have this deviation

Susceptible to anterior dislocations of arm

Spinal Abnormalities

LordosisAbnormal curvature of lumbar spine

Sway back

Football linemen and gymnasts are prone

ScoliosisLateral curvature of the spine

Can be attributed to unequal leg length

Universal Safety Precautions

Universal body substance precautions with all body fluids, blood being most commonWhen a wound is oozing or bleeding, sporting activity should be stopped ASAPWear gloves for all routine proceduresWash hands with germicide soap before and after using latex glovesChange gloves after each treatmentDiscard gloves that are torn, cut or punctured into a biohazard container

Universal Safety Precautions

Wear a protective face mask/eyewear if a procedure may drop or spry into eyes, nose or mouth

Dispose used needles, scalpel blades and other sharp items into a biohazard container

Any needle pricks should be reported to a physician

Clean all tables and counters regularly with a bleach solution

Use an approved pocket mask shield when giving artificial respiration

Universal Safety Precautions

Educate staff, coaches, athletes, etc. about the risks for contacting and spreading contagious diseases

If athlete has blood on their uniformThey must be brought out of play until blood can be cleaned up

A solution of bleach and water is used to remove the blood from the uniform

Precautions serve to protect not only the sports medicine professional, but also the athlete

The End

Any Questions???