Sports conditions,injuries and prevention

Kate Logan & Claire PrenterFinal year physio students

Sports Injuries and Conditions:• Commonly encountered sports injuries and conditions

include:• Fractures• Concussion• Bleeding• Joint injuries• Soft tissue injuries

– Muscle injuries– Tendon and ligament injuries

• Skin damage• Dehydration• Hyperthermia (heat stroke) and hypothermia

Who has had a fracture?.....

What is a Fracture?

• A fracture is a break in the continuity of a bone or a loss of continuity in the substance of a bone

Clinical signs of a fracture

• A deformity that can be seen or felt

• Pain on stressing the limb

• Abnormal movt in a limb due to movt at # site

• Crepitus or grating between bone ends

• Impaired function

• Swelling at the fracture site

• Tenderness at # site

Fractures

Causes of fractures• Direct trauma

– caused by external forces which exceed the strength of the bone.

– direct violence e.g. RTA, a blow

or

• Indirect trauma– Fracture results from twisting or rotational

forces being applied to the bone

– e.g football studs planted, rotation force applied to the limb resulting in spiral # of the tibia

or

• Pathological fracture– bone is already weakened or diseased

– fracture because the bone’s internal structure is weakened

• Stress fracture– Caused by repeated excessive loading of a bone, the

cumulative forces result in a break

Types of fracture:

• Classified by skin damage• Or shape of fracture • Or displacement

Classified by skin damage:

• Open: skin’s broken either by external force or internal one

• Closed: simple fracture

Fractures

Fractures

Classified by shape

• Shape of the fracture– Transverse or Horizontal – Oblique / Spiral– Comminuted (many small parts)– Crush– Greenstick -

• children, bend in immature bone with a break in cortices

Eg transverse fracture of tibia and oblique fracture of tibia:

Classification by displacement:

– Undisplaced

– Displaced

– Impacted

– Stable

Comminuted displaced fracture of a femur

Stable undisplaced fracture of a radius:

Stages of fracture healing:

• Stage 1: Haematoma (0–2 wks)

• Stage 2: Cellular proliferation (2-6 wks)

• Stage 3: Callus formation• Stage 4: Consolidation stage (6-12 wks)

Ossification occurs 12 -26 wk callus matures

• Stage 5: Stage of remodelling (1-2 yrs)

Why do physios treat fractures?

• Aim to restore the patient to optimal functional state

• Prevent fracture and soft-tissue complications

• Get the fracture to heal, and in a position which will produce optimal functional recovery

• Rehabilitate the patient as early as possible

Who has had concussion?

Sports Concussion:

• Head injuries in sport are common in all contact sports, the vast majority are minor

• Common sports for these are:– football– Boxing– Gymnastics– Horse riding – Martial arts

...impact from camogie stick

Causes:

• Direct blow to head, face, neck, or elsewhere on the body with force transmitted to the head

• Typically results in rapid onset of short-lived impairment of neurological function that resolves spontaneously

• May or may not involve loss of consciousness

Symptoms:

• Headache• dizziness• Unsteadiness• Feeling stunned or dazed• Seeing stars or flashing lights• Tinnitus• Double vision

• Sleepiness, sleep disturbance, • Poor concentration• Nausea/vomiting• Slurred speech• Personality change• Impaired playing ability

Which 2 sports have the highest incidence of concussion?

1. Professional horse jumping jockeys2. Australian footballers

Physio role?

• Remove player from field of play!• Exclude the presence of serious head injury or

spinal injury• If athlete’s unconscious assume presence of

head injury and spinal injury and manage accordingly – hospital...for assessment and observation...

Bleeding

• Open and closed wounds– Incised: a cut from a sharp edge– Laceration: rough tear or crush to the skin– Abrasion: graze or superficial wound from a

rough surface

– Contusion: bruise or internal bleeding– Puncture: an object entering the body– Velocity injury: a puncture wound at

velocity will cause extensive damage, there may be an entry and exit wound

Physio role:

• From first aid perspective, dress wound to maintain sterile state and remove to hospital for treatment if required

• Sports medic on pitch side can stitch wounds as required

Joint Injuries:

Joint injuries:• High energy impact• Damage to:

– Menisci – Ligaments– Joint capsule– Bony structures

• Knee “big three” – Anterior cruciate ligament (ACL), medial

meniscus, medial collateral ligament (MCL)– Traumatic knee, shoulder, elbow, wrist,

ankle injuries eg dislocations

What are the Soft Tissues?

• Muscles & Tendons• Ligaments, Joint Capsules, Bursa• Cartilage• Nervous Tissue

Types of soft tissue injuries

• TRAUMATIC:

• Specific cause is identified

• Cause of injury easily identified

• OVERUSE:

• Develop slowly not attributed to one incident

• Specific injuries assoc with a particular sport

Injury Classification

• ACUTE: rapid onset, traumatic event with a clearly identifiable cause.

• CHRONIC: slow insidious onset, gradual development of structural damage.

• SUB-ACUTE: period between acute and chronic, usually 4-6 weeks post-injury.

Causes of Soft Tissue Injuries

• Intrinsic causes of injury

–factors within the sports person

• Extrinsic causes of injury

–factors outside the sports person

Muscle Injuries

• Muscle strain= tear in muscle fibres beyond its limit

• Causes: (i) forceful contraction of the muscle (ii) Overstretching the muscle

Muscle Injuries

• Classification of muscle strains

Grade Extent of damage SymptomsGrade 1 5% or less muscle

fibresMinimal pain

Grade 2 5% - 99%Some muscle fibres still present

Moderate / severe pain on contractionLimited ROM

Grade 3 Complete rupture No contractionLess pain / no pain

Muscle InjuriesAssessing a Muscle strain:

1. PAIN on mvt / resistance2. PAIN on contraction3. PAIN on palpation

Muscle most susceptible to injury?Rectus femoris (quad) HamstringsGastrocnemius (calf)

Tendon Injuries

• Tendon properties:– Connects muscle to bone– Low blood supply

• Tendonitis –inflammation???• Tendinopathy – Degeneration of tendon• Healing tendon:

– HEAT (increase blood supply)– DTFM– Strengthen– Stretch

Ligament Injuries

• Ligament Properties:– Connects bone to bone

Grade 1 –minimal swelling, bruising, painGrade 2 – Moderate to severe swelling, bruising,

painGrade 3 – A lot of swelling, agony, may or may not

bruise

Management of soft tissue injuries

• Acute Injury• PRICE:

– Protect– Rest– Ice– Compression– Elevation

Icing• Limits Inflammatory process• First 48-72 hours• Methods: - Crushed ice in a towel, frozen veg, Ice

bath, Chemical ice packs (pitch-side), Freeze spray / cryogel

• Application: - 10 mins every 2 hours

• Dangers of leaving ice on too long - Ice burn - Never damage - Increase in blood flow

The aims of early management

The management of STI in the first 72 hours: • to reduce pain • to reduce local tissue temperature • to limit and reduce inflammatory fluid• to reduce metabolic demands of the tissues • to protect the damaged tissue from further injury • to protect the newly-formed fibrin bonds from

disruption • to promote collagen fibre growth and realignment • to maintain general levels of cardio-respiratory and

musculoskeletal fitness / activity

Management of medical problems• HYPOTHERMIA• ‘Hypo’ = Below / under ‘Thermia’= heat

- Condition in which a person’s body temperature is sufficiently below normal to cause distress and disorder of normal bodily functions.– Mental deterioration– Loss of coordination– Unconsciousness– Failure of breathing and circulation– Death

Hypothermia• Causes:

- Cold- Wind- Wet clothing- Perspiration- Water immersion

• Stages:Peripheral (core 37-36)Moderate (core 34)Severe (core 32 or lower)

Hypothermia• Signs / Symptoms:

-Tiredness / exhaustion - Shivering - White / purplish appearance (bluish tinge to lips / fingers) - Clumsiness / falling/ tumbling - Weak grip and slowness in muscle contraction - Cold rigid arms and legs - Poor concentration, loss of interest, lethargy - Slurred speech

Hypothermia• Treatment:• Removal from cold, wet, windy conditions

(shelter)• Insulation to prevent further heat loss• Passive or active re-warming• Gentle and minimal handling• Provision of nutritional and fluid support• Transport to medical facility

Hypothermia

• Hypothermia hits stumbling Lebanese

Gloucester30th Oct 2000New Zealand Vs Lebanon Rugby LeagueGroup2

Hyperthermia

• Hypertherma = overheating of body• Hyper = ‘ high’, therma = ‘heat’• Body can not effectively regulate excess heat /

elevated temperatures• Temperature > 37.5–39.9 °C• Causes:

– Exposure to excessive heat– Exposure to high humidity– High physical exertion– Dehydration

Hyperthermia• Signs and Symptoms

- Hot, dry skin - Dizziness / Fainting - Nausea / Vomiting - Headaches - Gastrointestinal problems e.g. Diarrhoea - Multi-organ dysfunction

Treatment: - Cool / tepid water immersion - Rehydration - Sponging head, neck, trunk with cold water - Sit in shade

Dehydration

• Fluid Loss exceeds Fluid Intake• Causes:

- Excessive Sweating - insufficient fluid intake - Hot & humid conditions - High intensity exercise

Dehydration

• Consequences:– Increase in perceived effort– Reduced performance– Impaired reaction times, judgement,

concentration and decision-making

• Electrolyte Drinks - Sodium (speeds fluid absorption)- Carbohydrate (provides fuel) - Small amounts frequently (500-800ml/Hr)

Quick overview of........• Fractures• Concussion• Bleeding• Joint injuries• Soft tissue injuries

– Muscle injuries– Tendon and ligament injuries

• Skin damage• Dehydration• Hyperthermia (heat stroke) and hypothermia

Questions: