managing sports injuries

MANAGING SPORTS MANAGING SPORTS INJURIESINJURIES

PREVENTION OF PREVENTION OF INJURY IS BETTER INJURY IS BETTER

THAN CURETHAN CURE

potentially between 30 – 50% of potentially between 30 – 50% of sports injuries are preventablesports injuries are preventable

Sporting injuries come Sporting injuries come from three main areas:from three main areas:

Human (54%)Human (54%) Muscle weaknessMuscle weakness and imbalanceand imbalance Inadequate warm up and cool downInadequate warm up and cool down SpectatorsSpectators CollisionCollision Improper techniqueImproper technique

Terrain (31%)Terrain (31%) Uneven groundUneven ground Obstructions on groundsObstructions on grounds Wet and/or slippery groundsWet and/or slippery grounds

Equipment (15%)Equipment (15%) Unsafe protective equipmentUnsafe protective equipment Inadequate, ill fitting protective equipmentInadequate, ill fitting protective equipment Unpadded fixturesUnpadded fixtures

PRINCIPLES OF PREVENTION 1.

Prevent the incident

occurring in the first place

2.

Prevent complications

arising from the incident

6.

Prevent your intervention

being harmful to the athlete

3. Prevent death

5.Prevent delay in

the athlete’s recovery

4.Prevent the

athlete becoming worse

ELEMENTS IN THE ELEMENTS IN THE PREVENTION OF INJURYPREVENTION OF INJURY

Warm UpWarm UpAthletes should warm up before Athletes should warm up before allall trainings and competitions as trainings and competitions as close to the commencement as close to the commencement as possible. They should warm up possible. They should warm up with 5 – 10 minutes of light with 5 – 10 minutes of light activity, stretching and specific activity, stretching and specific skills of the sport – until they skills of the sport – until they have a light sweat.have a light sweat.

Warm up:Warm up: Helps prepare the mind and body Helps prepare the mind and body

for exercisefor exercise Increases body and muscle Increases body and muscle

temperaturetemperature Increases the blood and oxygen Increases the blood and oxygen

to the working musclesto the working muscles Increases flexibilityIncreases flexibility

StretchingStretchingStretching should be performed Stretching should be performed during warm up and cool down during warm up and cool down and should follow ‘Guidelines for and should follow ‘Guidelines for safe stretching’.safe stretching’.

Stretching:Stretching: Lengthens muscles so there is Lengthens muscles so there is

minimal strain during exerciseminimal strain during exercise Reduces the risk of injuryReduces the risk of injury Maintains flexibility so muscles Maintains flexibility so muscles

can respond effectively during can respond effectively during sporting activitysporting activity

Elements in the prevention of injury Elements in the prevention of injury continued……continued……

Cool DownCool DownAthletes should gradually Athletes should gradually reduce activity for 5 – 10 reduce activity for 5 – 10 minutes following training or minutes following training or competition, followed by static competition, followed by static stretching.stretching.

Cool down:Cool down: Prevents pooling of the blood Prevents pooling of the blood

in the limbs, which can lead in the limbs, which can lead to dizziness and faintingto dizziness and fainting

Aids the removal of waste Aids the removal of waste products from the muscles eg products from the muscles eg lactic acidlactic acid

Helps maintain flexibilityHelps maintain flexibility Enhances recoveryEnhances recovery Reduces muscle soreness Reduces muscle soreness

and stiffnessand stiffness

Skill DevelopmentSkill DevelopmentThe higher the skill level the The higher the skill level the lower the rate of injury, lower the rate of injury, therefore skill development therefore skill development and technique is crucial.and technique is crucial.


FitnessFitnessFitness is important because it allows Fitness is important because it allows the athlete to perform at their best the athlete to perform at their best and assists in injury prevention. and assists in injury prevention. While injuries can occur at any time While injuries can occur at any time they are more likely to occur at the they are more likely to occur at the end of the sporting activity because end of the sporting activity because the athlete is tire, less able to cope the athlete is tire, less able to cope with physical demand and less with physical demand and less capable of performing skills to an capable of performing skills to an adequate level due to fatigue.adequate level due to fatigue.

Components of fitness include:Components of fitness include: Cardiovascular endurance (heart and Cardiovascular endurance (heart and

lungs delivering oxygen to the lungs delivering oxygen to the muscles over time)muscles over time)

Muscular endurance (muscles Muscular endurance (muscles continuing work over an extended continuing work over an extended period of time)period of time)

Strength (muscles producing force Strength (muscles producing force against resistance)against resistance)

Speed (to move as fast as possible)Speed (to move as fast as possible) Power (producing maximum force in Power (producing maximum force in

the shortest time)the shortest time) Flexibility (range of movement around Flexibility (range of movement around

a joint)a joint)

Improving fitness:Improving fitness:Involves the principle of overload, the Involves the principle of overload, the body must work harder than it is used body must work harder than it is used to, adapt to this higher level and then to, adapt to this higher level and then improve. This must be done improve. This must be done gradually; therefore only one FITT gradually; therefore only one FITT factor should be increased at a time.factor should be increased at a time.

FF Frequency Frequency (number of (number of session per day/week)session per day/week)

II Intensity Intensity (how hard the (how hard the exercise is performed)exercise is performed)

TT TimeTime (length of time at the (length of time at the intensity required)intensity required)

TT TypeType (exercise must be (exercise must be specific to fitness component)specific to fitness component)


Rules of the gameRules of the gameMany rules are written for the safety Many rules are written for the safety of the game, therefore athletes of the game, therefore athletes should learn both the written and should learn both the written and unwritten rules of the game. unwritten rules of the game. Coaches should emphasise good Coaches should emphasise good sportsmanship and fair play and sportsmanship and fair play and discourage violence or dangerous discourage violence or dangerous techniques.techniques.

Sporting grounds/areasSporting grounds/areasEnvironments should be safe, be Environments should be safe, be sure of the following:sure of the following: Level and firmLevel and firm Free from obstructions eg sprinkler Free from obstructions eg sprinkler

headsheads Permanent fixtures should be Permanent fixtures should be

padded, flexible and highly visiblepadded, flexible and highly visible Spectators should be well away from Spectators should be well away from

the playing areasthe playing areas Adequate matting is provided where Adequate matting is provided where

necessarynecessary Have safe ground markingsHave safe ground markings

EquipmentEquipmentCheck equipment for:Check equipment for: Properly erected/constructedProperly erected/constructed Stable or movable if necessaryStable or movable if necessary Properly anchoredProperly anchored Padded as appropriatePadded as appropriate Checked before being used, especially if Checked before being used, especially if

supporting body weightsupporting body weight

Change roomsChange roomsShould be:Should be: Clean and tidyClean and tidy Adequate size for the number of athletes Adequate size for the number of athletes

using themusing them Have adequate soap, paper towel, rubbish Have adequate soap, paper towel, rubbish

bins, brooms, disinfectant available at all bins, brooms, disinfectant available at all times.times.


Protective equipmentProtective equipmentShould be:Should be: Designed to protect against Designed to protect against

injuryinjury Light and comfortable to wearLight and comfortable to wear In good conditionIn good condition Correctly assembledCorrectly assembled Correctly worn by the athleteCorrectly worn by the athlete An appropriate size and fit and An appropriate size and fit and

not interfere with functionnot interfere with function Appropriate for the sport and Appropriate for the sport and

conditions encounteredconditions encountered

Taping and BracingTaping and BracingTaping and bracing can help to Taping and bracing can help to reduce injury or the chance of reduce injury or the chance of injury by restricting the injury by restricting the movement of the joint. It is movement of the joint. It is effective in prevention and effective in prevention and reducing the severity of injuries.reducing the severity of injuries.

Fluid replacementFluid replacementWhen exercising it is important to When exercising it is important to replace lost fluids, especially in replace lost fluids, especially in the heat, otherwise it can lead to the heat, otherwise it can lead to dehydration, fatigue, reduced dehydration, fatigue, reduced performance, heat illness and performance, heat illness and even death.even death.When exercising in heat or humid When exercising in heat or humid conditions: take it easy, wear conditions: take it easy, wear loose, light coloured clothing that loose, light coloured clothing that permits air flow and drink before, permits air flow and drink before, during and after activity.during and after activity. Note: It is possible to become Note: It is possible to become

dehydrated in cooler conditionsdehydrated in cooler conditions Children and elderly are more Children and elderly are more

susceptible to heat illness so susceptible to heat illness so must be closely monitored in hot must be closely monitored in hot and humid conditions.and humid conditions.


SunshineSunshineAustralia’s harsh conditions, Australia’s harsh conditions, especially between 11 am and 3 pm especially between 11 am and 3 pm can be harmful. The Australian can be harmful. The Australian Cancer Society recommends:Cancer Society recommends:

Slip on a shirtSlip on a shirtSlop on some sunscreenSlop on some sunscreen

Slap on a hatSlap on a hatWrap on a pair on sunglassesWrap on a pair on sunglasses

ColdColdWhen exercising in the cold consider When exercising in the cold consider the following:the following: Plan properly and avoid long breaksPlan properly and avoid long breaks If long breaks occur re warm upIf long breaks occur re warm up Wear warm clothingWear warm clothing Dress in layers to trap heatDress in layers to trap heat The layer closest to the body should The layer closest to the body should

be a natural fibre (wool or cotton)be a natural fibre (wool or cotton) Cover heads, face and hands to Cover heads, face and hands to

reduce heat lossreduce heat loss Wear wind and waterproof outer Wear wind and waterproof outer

clothingclothing

Appropriate management of existing Appropriate management of existing illness/injuryillness/injury

When ill or injured an athlete should When ill or injured an athlete should not train as it can cause tissue and not train as it can cause tissue and organ damage and further damage to organ damage and further damage to the injury.the injury.

Before returning to sports, athletes Before returning to sports, athletes should ensure:should ensure: The doctor or physio has given them The doctor or physio has given them

clearanceclearance The injured part has full range of The injured part has full range of

movementmovement Injured area has full strengthInjured area has full strength The injured area is pain freeThe injured area is pain free There is no inflammation of the There is no inflammation of the

injured areainjured area

Personal HygienePersonal HygieneBathing reduces body odour, keeps Bathing reduces body odour, keeps skin healthy, is soothing to the skin, skin healthy, is soothing to the skin, prevents chafing and prevents prevents chafing and prevents blocked pores. Hand washing blocked pores. Hand washing reduces the risk of spreading reduces the risk of spreading infection or illness. This is important infection or illness. This is important for the health of the athlete.for the health of the athlete.


Group hygieneGroup hygieneGolden RuleGolden Rule

DO NOTDO NOTSHARESHARE

DO NOT share towels, razors, DO NOT share towels, razors, sponges, face washers, water sponges, face washers, water bottles or any other equipment that bottles or any other equipment that may contain body fluidsmay contain body fluids

Discourage communal bathing Discourage communal bathing areas such as spasareas such as spas

Ban spitting or urinating in team Ban spitting or urinating in team areasareas

Do not put hands in water bucketsDo not put hands in water buckets Proper use of water bottles, nozzle Proper use of water bottles, nozzle

should not touch the lipsshould not touch the lips All clothes, equipment and surface All clothes, equipment and surface

areas contaminated by blood must areas contaminated by blood must be treated as potentially infectious be treated as potentially infectious and treated accordinglyand treated accordingly

All athletes should be vaccinated All athletes should be vaccinated against Hep Bagainst Hep B

All group areas should be dry and All group areas should be dry and clean with adequate supplies of clean with adequate supplies of cleaning products.cleaning products.

Balanced competitionBalanced competitionCompetitions should not simply by Competitions should not simply by age groups, try to balance through:age groups, try to balance through: AgeAge SizeSize StrengthStrength SkillSkill GenderGender DisabilityDisability HeightHeight WeightWeight

Common SenseCommon Sense

Tells you it is far better to prevent Tells you it is far better to prevent than manage!!!!than manage!!!!

QUICK ON FIELD APPROACH TO QUICK ON FIELD APPROACH TO THE INJURED ATHLETETHE INJURED ATHLETE

SS STOPSTOPTT TALKTALKOO OBSERVEOBSERVEPP PREVENT FURTHER INJURYPREVENT FURTHER INJURY

Severe injury – get helpSevere injury – get helpLess severe – RICER regimeLess severe – RICER regimeMinor injury – play onMinor injury – play on

A DETAILED ASSESSMENT A DETAILED ASSESSMENT OF THE INJURED ATHLETEOF THE INJURED ATHLETE

TT TALKTALK OO OBSERVEOBSERVE TT TOUCHTOUCH AA ACTIVE MOVEMENTACTIVE MOVEMENT PP PASSIVE MOVEMENTPASSIVE MOVEMENT SS SKILL TESTSKILL TEST

A SUMMARY OF THE APPROACH TO AN A SUMMARY OF THE APPROACH TO AN INJURED ATHLETEINJURED ATHLETE

If it is preventable – prevent it!!!If it is preventable – prevent it!!!

Once it has happened – Once it has happened – DANGERDANGER Control dangers then Control dangers then

assess assess injured athleteinjured athlete

LIFE THREATLIFE THREAT Use DRABCUse DRABC

INITIAL INJURY INITIAL INJURY Use STOPUse STOP

ASSESSMENTASSESSMENT

DETAILED INJURYDETAILED INJURY Use TOTAPSUse TOTAPS

ASSESSMENTASSESSMENT

INITIAL INITIAL Manage appropriatelyManage appropriately

MANAGEMENTMANAGEMENT REFERREFER

STEP1

STEP2

STEP3

STEP4

STEP5

ASSESSING THE ASSESSING THE MANAGEMENT OF INJURIESMANAGEMENT OF INJURIES

One is the most important with five being the least important.One is the most important with five being the least important.

1.1. Life EssentialLife Essential – such as unconscious, airway obstruction, – such as unconscious, airway obstruction, breathing difficulty or haemorrhage. breathing difficulty or haemorrhage. To be covered in ‘Dealing To be covered in ‘Dealing with Serious Injuries’.with Serious Injuries’.

2.2. Protected non-life essential internal organsProtected non-life essential internal organs – such as spinal – such as spinal cord, gastro-intestinal organs, kidney and external genetalia. cord, gastro-intestinal organs, kidney and external genetalia. To be covered in ‘Dealing with Serious Injuries’.To be covered in ‘Dealing with Serious Injuries’.

3.3. Hard tissue injuriesHard tissue injuries – such as fractures and dislocations – such as fractures and dislocations4.4. Soft tissue injuriesSoft tissue injuries – such as muscle strains and ligament – such as muscle strains and ligament

sprainssprains5.5. Body surface damageBody surface damage – such as skin abrasions, lacerations, – such as skin abrasions, lacerations,

or infections.or infections.

INJURY INJURY

CYCLECYCLE Prevention

Incident Phase

Prevention of Recurrence

Acute Phase

Rehabilitation

Definitive Care

HARD TISSUE INJURIES - fracturesHARD TISSUE INJURIES - fracturesA fracture is a break in the bone, which can be as simple as a small A fracture is a break in the bone, which can be as simple as a small crack with no visible deformity, or complex, in that it may affect life crack with no visible deformity, or complex, in that it may affect life

support close to the site of the fracture.support close to the site of the fracture.

Common causes of fractures:Common causes of fractures:

CAUSE DEFINITION EXAMPLE

Direct contact withOthersImplementsThe ground

The bone is struck directly, breaking at the point of impact

Forearm is hit by a hockey stick, resulted in a fractured ulna

Indirect force on a body part Force is indirectly applied to the bone causing a fracture away from the point of impact.

Landing on an out stretched arm, resulting in a fracture of the clavicle.

Inappropriate muscular action, for example forceful contraction

Muscles contract forcefully and strongly pull on bones causing a fracture

An athlete jumping from a height, landing on their feet and fracturing their patella.

Overuse, repeated trauma The repeated use (overuse) of a joint causes small fractures in the bone called stress fractures

A runner who trains long distances may develop a stress fracture of a bone in the foot.

FRACTURESFRACTURES Types of fractures include:Types of fractures include: Closed Closed – the bone is fractured but there is no cut or – the bone is fractured but there is no cut or

wound at the fracture sitewound at the fracture site Open Open – a jagged end of the fractured bone protrudes – a jagged end of the fractured bone protrudes

through the skin OR there is a cut near the fracture sight, through the skin OR there is a cut near the fracture sight, though the bone does not penetrate the skinthough the bone does not penetrate the skin

ComplicatedComplicated – the fractured bone damages the local – the fractured bone damages the local tissues or organs that it protects eg a lung punctured by tissues or organs that it protects eg a lung punctured by a fractured rib.a fractured rib.

Signs and symptoms of a fracture:Signs and symptoms of a fracture: PainPain Reduced movement or inability to move the injured partReduced movement or inability to move the injured part Local bony tenderness at the injury siteLocal bony tenderness at the injury site DeformityDeformity Irregular alignment of the limbIrregular alignment of the limb Swelling Swelling

MANAGEMENT OF A FRACTUREMANAGEMENT OF A FRACTUREThe major objective is – The major objective is –

Minimise movement of the injured body part by:Minimise movement of the injured body part by: Immobilising the joint Immobilising the joint aboveabove the fracture the fracture Immobilising the joint Immobilising the joint belowbelow the fracture the fracture Support the injured area using a splint or slingSupport the injured area using a splint or sling

1.1. Immobilise and support the injured area using a splint or slingImmobilise and support the injured area using a splint or sling2.2. Where an ambulance is close at hand (less than 45 minutes), it is Where an ambulance is close at hand (less than 45 minutes), it is

recommended that fractures be managed in the position found to recommended that fractures be managed in the position found to prevent further damage. This can be achieved with padding rather prevent further damage. This can be achieved with padding rather than splinting.than splinting.

3.3. Check for signs of impaired circulationCheck for signs of impaired circulation4.4. Seek qualified helpSeek qualified help5.5. Arrange transport to the hospitalArrange transport to the hospital6.6. ‘‘RICER’ regime and NO ‘HARM’ if appropriate for the injury and if it RICER’ regime and NO ‘HARM’ if appropriate for the injury and if it

does not aggravate the pain.does not aggravate the pain.

MANAGEMENT OF A FRACTUREMANAGEMENT OF A FRACTURESplinting:Splinting:

Choose an appropriate splint – the body, the other limb, a smooth, firm object long Choose an appropriate splint – the body, the other limb, a smooth, firm object long enough to extend beyond the joint above and below the fractureenough to extend beyond the joint above and below the fracture

Pad the splint at the sites of contact and any hollowsPad the splint at the sites of contact and any hollows Tie the splint to the injured limb above and below the fractureTie the splint to the injured limb above and below the fracture Immobilise the joints above and below the fracture by tying the splint at those jointsImmobilise the joints above and below the fracture by tying the splint at those joints Immobilise the fracture site and provide further support by bandaging above and below Immobilise the fracture site and provide further support by bandaging above and below

the fracturethe fracture Check for signs of impaired circulationCheck for signs of impaired circulation

Air splint:Air splint:An air splint is easy to apply, provides support and is comfortable. However, they can An air splint is easy to apply, provides support and is comfortable. However, they can leak, are often not returned to medical clinics, are difficult to re-clean and sterilise, can leak, are often not returned to medical clinics, are difficult to re-clean and sterilise, can impair circulation if inflated too much and do not support upper arm or upper leg impair circulation if inflated too much and do not support upper arm or upper leg injuries.injuries.If they are used carefully place the injured limb in the splint, do up the zipper, inflate If they are used carefully place the injured limb in the splint, do up the zipper, inflate until firm (ensuring you can touch the limb through the splint) and check circulation and until firm (ensuring you can touch the limb through the splint) and check circulation and sensation.sensation.

Slings:Slings: Low arm sling – provides support for the forearm and maintains it in a horizontal Low arm sling – provides support for the forearm and maintains it in a horizontal

positionposition High arm sling – provides support for the arm and elevates the forearmHigh arm sling – provides support for the arm and elevates the forearm Improvisation – proper slings are best but improvising is an alternativeImprovisation – proper slings are best but improvising is an alternative Knots – when bandages and slings are being used, use reef knots as they do not Knots – when bandages and slings are being used, use reef knots as they do not

tighten and can be quickly released.tighten and can be quickly released.

HARD TISSUE INJURIES – HARD TISSUE INJURIES –

dislocationsdislocations A joint is the place where two bones meet, allowing A joint is the place where two bones meet, allowing movement and consists of the bones, joint capsule, movement and consists of the bones, joint capsule, ligaments, fluid and cartilage. A dislocation is when the ligaments, fluid and cartilage. A dislocation is when the bones are forced out of position and may result in bones are forced out of position and may result in tissue damage and/or fractures. A subluxation is a tissue damage and/or fractures. A subluxation is a partial dislocation where the bones or parts of the bone partial dislocation where the bones or parts of the bone surfaces are still in contact.surfaces are still in contact.

Signs and symptoms: Signs and symptoms: PainPain Inability to move the joint / loss of functionInability to move the joint / loss of function SwellingSwelling DeformityDeformity Muscle spasmMuscle spasm Tenderness over the injured jointTenderness over the injured joint The athlete holding their limb in a preferred positionThe athlete holding their limb in a preferred position

MANAGEMENT OF A DISLOCATIONMANAGEMENT OF A DISLOCATIONThe management of a dislocation is the same as that of The management of a dislocation is the same as that of a fracture.a fracture.The management of a dislocation involves the The management of a dislocation involves the following steps:following steps:

1.1. Immobilise and support the injured area using a splint or slingImmobilise and support the injured area using a splint or sling2.2. Check for signs of impaired circulationCheck for signs of impaired circulation3.3. Seek qualified helpSeek qualified help4.4. Arrange transport to the hospitalArrange transport to the hospital5.5. ‘‘RICER’ regime and NO ‘HARM’ if appropriate for the injury and if it RICER’ regime and NO ‘HARM’ if appropriate for the injury and if it

does not aggravate the pain.does not aggravate the pain.

Due to the deformity associated with dislocations:Due to the deformity associated with dislocations: pad the injury to the body, other limb or splint before being tied pad the injury to the body, other limb or splint before being tied

for immobilisationfor immobilisation It may not be possible to effectively immobilise some It may not be possible to effectively immobilise some

dislocations, therefore allow the athlete or support person to dislocations, therefore allow the athlete or support person to keep the injured area in the position of most comfort, and then keep the injured area in the position of most comfort, and then pad appropriately.pad appropriately.

DISLOCATIONSDISLOCATIONSCommon dislocations:Common dislocations: Shoulder – are common because of the structure of the joint, first Shoulder – are common because of the structure of the joint, first

time dislocations may have fractures and nerve damage. Refer time dislocations may have fractures and nerve damage. Refer to a doctor for relocation – DO NOT ATTEMPT THE to a doctor for relocation – DO NOT ATTEMPT THE RELOCATION.RELOCATION.

Fingers – may be associated with fractures, refer to a doctor for Fingers – may be associated with fractures, refer to a doctor for relocation.relocation.

Patella – are not overly common but occur more often in teenage Patella – are not overly common but occur more often in teenage athletes, some relocate spontaneously as the muscle spasm athletes, some relocate spontaneously as the muscle spasm relaxes, however they still require medical attention.relaxes, however they still require medical attention.

Why not to relocate a dislocation:Why not to relocate a dislocation: The potential for fractures to existThe potential for fractures to exist The muscles that cross the joint usually go into very forceful The muscles that cross the joint usually go into very forceful

spasm, thus anaesthetic is often needed for relocationspasm, thus anaesthetic is often needed for relocation The damage to ligaments or impingement of nervesThe damage to ligaments or impingement of nerves

DISLOCATIONSDISLOCATIONSCommon complications associated with Common complications associated with

dislocations:dislocations:The potential complications are the same as a The potential complications are the same as a fracture and also include:fracture and also include: Bleeding – there may be bleeding in the jointBleeding – there may be bleeding in the joint Possible fractures – sometimes the inability to move Possible fractures – sometimes the inability to move

the joint is due to a fracture not the dislocation. Hence the joint is due to a fracture not the dislocation. Hence all dislocations should be immobilised, supported and all dislocations should be immobilised, supported and not moved/relocated without x-ray.not moved/relocated without x-ray.

Ligament damage – dislocation usually results in torn Ligament damage – dislocation usually results in torn or ruptured ligaments around the joint and/or reduced or ruptured ligaments around the joint and/or reduced stability at the joint, which may cause the joint to be stability at the joint, which may cause the joint to be more prone to further dislocations.more prone to further dislocations.

ALL DISLOCATIONS MUST BE REFERRED FOR ALL DISLOCATIONS MUST BE REFERRED FOR PROPER ASSESSMENT AND FOLLOW UP.PROPER ASSESSMENT AND FOLLOW UP.

SOFT TISSUE INJURIESSOFT TISSUE INJURIESTYPE CAUSE INJURY

ACUTE INJURIES

Injuries that occur from a known,or sometimes unknown incident.Symptoms and signs develop rapidly.

(i) Bruise (haematoma)

Direct force applied to the body, such as being hit or kicked, or making contact with player, implement etc.

Compression of soft tissue, resulting in damage to soft tissue and bleeding into the tissue eg bruise (haematoma)May bruise any soft tissue (muscle, skin & fat, periosteum)

(ii) Sprain Joint is forced beyond its normal range of motion

Ligament fibres are tornCategorised according to severityFirst degree (mild) – very few fibres are tornSecond degree (moderate) large number of fibres are tornThird degree (severe) –a complete rupture of the ligament

(iii) Strain Muscle is overstretched or contracts too quickly

The muscle and/or tendon fibres are torn.Categorised according to severity First degreeSecond degreeThird degree

OVERUSE INJURIES

Injuries that develop over a period of time. Symptoms and signs develop slowly

i. continual, repetitive movements Inflammation and pain eg bursitis

ii. Repeating the movement following a minor acute injury which was not noted and which is then aggravated by the repeated action.

Repeated stress and microtrauma to soft tissue eg shin splints, tennis elbow

AIMS OF MANAGEMENT OF SOFT AIMS OF MANAGEMENT OF SOFT TISSUE INJURIESTISSUE INJURIES

Minimise tissue damageMinimise tissue damage Minimise inflammationMinimise inflammation Prevent further tissue damagePrevent further tissue damage Early and efficient removal of blood clot and tissue Early and efficient removal of blood clot and tissue

swellingswelling Minimise scarring of damaged tissueMinimise scarring of damaged tissue Regain full function before returning to playRegain full function before returning to play Enable the doctor or physiotherapist to make an early Enable the doctor or physiotherapist to make an early

diagnosis because the swelling will be lessdiagnosis because the swelling will be less Reduce rehabilitation timeReduce rehabilitation time Minimise the seriousness of the injuryMinimise the seriousness of the injury Allow rehabilitation to begin soonerAllow rehabilitation to begin sooner Allow early and complete return to sportAllow early and complete return to sport

INITIAL MANAGEMENT TO SOFT INITIAL MANAGEMENT TO SOFT TISSUE INJURIES TISSUE INJURIES

(first 48 – 72 hours)(first 48 – 72 hours)

RR RESTREST II ICEICECC COMPRESSIONCOMPRESSIONEE ELEVATIONELEVATIONRR REFER AND RECORDREFER AND RECORD

RICERRICERR – Rest the athleteR – Rest the athlete

How – remove athlete from the field without further damaging and How – remove athlete from the field without further damaging and rest from the activity causing the injuryrest from the activity causing the injury

Why – movement will increase blood flow to the injured site, may Why – movement will increase blood flow to the injured site, may cause blood clots to dislodge & begin bleeding again and may cause cause blood clots to dislodge & begin bleeding again and may cause further damagefurther damage

I – Ice applied to the injuryI – Ice applied to the injury Apply ice directly over the injured site and surrounding tissue for 20 Apply ice directly over the injured site and surrounding tissue for 20

– 30 minutes every 2 hours,– 30 minutes every 2 hours, How – in a wet towel or plastic bag, in a frozen cup of water How – in a wet towel or plastic bag, in a frozen cup of water

continuously moving over the site (ice massage) or a freezer gel bag continuously moving over the site (ice massage) or a freezer gel bag with a wet towel between the pack and the skinwith a wet towel between the pack and the skin

Why – Ice decreases swelling and painWhy – Ice decreases swelling and pain Remember – check the athlete and move the ice around to avoid; Remember – check the athlete and move the ice around to avoid;

cooling too fast, superficial tissues cooling and not deeper areas and cooling too fast, superficial tissues cooling and not deeper areas and oversensitivity to ice. Reassure that the initial cold pain will subside oversensitivity to ice. Reassure that the initial cold pain will subside and do not apply ice direct to the skin to avoid ice burns.and do not apply ice direct to the skin to avoid ice burns.

Do not apply ice to – diabetics, persons with cardiovascular or Do not apply ice to – diabetics, persons with cardiovascular or circulation problems, persons with Raynaud’s phenomenon and circulation problems, persons with Raynaud’s phenomenon and other diseases, special body area eg eyes.other diseases, special body area eg eyes.

RICERRICERC – Compression applied to the injuryC – Compression applied to the injury

How – apply a firm, elastic, non-adhesive bandage over the ice pack How – apply a firm, elastic, non-adhesive bandage over the ice pack to hold it in place and provide compressionto hold it in place and provide compression

Why – reduces swelling and bleeding at the injury siteWhy – reduces swelling and bleeding at the injury site Remember – look for numbness, tingling, coldness and pale blue Remember – look for numbness, tingling, coldness and pale blue

skin when compressing as these are signs that the bandaging is too skin when compressing as these are signs that the bandaging is too tight. Reapply not as tight and once ice is completed reapply a dry tight. Reapply not as tight and once ice is completed reapply a dry bandage.bandage.

E – Elevate the injured areaE – Elevate the injured area How – raise the injured area above the level of the heart wherever How – raise the injured area above the level of the heart wherever

possible (when applying ice, when at home, between rehabilitation possible (when applying ice, when at home, between rehabilitation exercises) exercises)

Why – elevation decreases bleeding, swelling and painWhy – elevation decreases bleeding, swelling and painR – Refer and recordR – Refer and record

How – refer to a health care professional for diagnosis and How – refer to a health care professional for diagnosis and management, record observations, assessment and initial management, record observations, assessment and initial managementmanagement

Why – to obtain an accurate and definitive diagnosis and for Why – to obtain an accurate and definitive diagnosis and for continuing management and rehabilitation.continuing management and rehabilitation.

INITIAL MANAGEMENT TO SOFT INITIAL MANAGEMENT TO SOFT

TISSUE INJURIES cont…TISSUE INJURIES cont… HH HEATHEAT

AA ALCOHOLALCOHOL

RR RUNNING OR EXERCISINGRUNNING OR EXERCISING

MM MASSAGEMASSAGE

In the first 48 – 72 hours the In the first 48 – 72 hours the following factors should be following factors should be

avoided:avoided: H – HeatH – HeatSuch as sauna spa, hot water bottle, hot shower Such as sauna spa, hot water bottle, hot shower and baths, hot liniment rubs as it increases the and baths, hot liniment rubs as it increases the bleeding to the area. bleeding to the area.

A – AlcoholA – AlcoholAs it increases swellingAs it increases swelling

R – RunningR – RunningAny exercise too soon can make the injury worseAny exercise too soon can make the injury worse

M – MassageM – MassageAny use of massage and heat rubs in the first 48 Any use of massage and heat rubs in the first 48 – 72 hours increases swelling and bleeding and – 72 hours increases swelling and bleeding and disrupts the healing process.disrupts the healing process.

REHABILITATIONREHABILITATIONRehabilitation of an athlete is to ‘return the athlete to the previous level Rehabilitation of an athlete is to ‘return the athlete to the previous level of fitness, skill and competition’.of fitness, skill and competition’.Rehabilitation:Rehabilitation: Begins during the definitive care of an injuryBegins during the definitive care of an injury Continues through to prevention of further injuriesContinues through to prevention of further injuries Is based on the ‘SAID’ principleIs based on the ‘SAID’ principle

SS SpecificSpecificAA Adaptation toAdaptation toII ImposedImposedDD DemandsDemands

The more you do something the easier it becomes, provided there is no The more you do something the easier it becomes, provided there is no painpain

Practice must be perfect and specific to the requirements of the athlete to Practice must be perfect and specific to the requirements of the athlete to achieve progressachieve progress

As the skills become easier, progress to a more difficult task, until it As the skills become easier, progress to a more difficult task, until it becomes easy, and then progress again.becomes easy, and then progress again.

Rehabilitation programs are generally set by a doctor or physiotherapist.Rehabilitation programs are generally set by a doctor or physiotherapist.

managing sports injuries

Education

injury prevention

rate of injury

chance of injury

safe stretching

timemuscular endurance

adequate level

skill level

humid conditions