Treatment of Sports Medicine Treatment of Sports Medicine InjuriesInjuries

IntroductionIntroduction

Immediate care of an injury athlete or person Immediate care of an injury athlete or person engaging in physical activitiesengaging in physical activities

Rehabilitation of the injured part of body using Rehabilitation of the injured part of body using conservative methodsconservative methods

The applications of new technologies The applications of new technologies

Treatment and prevention of environmental Treatment and prevention of environmental injuries injuries

Immediate CareImmediate Care

Athletic injuries may life-threatening Athletic injuries may life-threatening – Asphyxia Asphyxia

Water inhalationWater inhalation

Strangulation by external meansStrangulation by external means

– External bleedingExternal bleedingCutting a blood vessel on a sharp objectCutting a blood vessel on a sharp object

Initial management of theses involves Initial management of theses involves – ABC (airway, breathing, circulation)ABC (airway, breathing, circulation)

– CPR (Life-saving technique)CPR (Life-saving technique)

– If bleeding is a problem, it needs to be controlledIf bleeding is a problem, it needs to be controlled

Cardiopulmonary Resuscitation (CPR)Cardiopulmonary Resuscitation (CPR)

Most musculoskeletal injuries are not life-Most musculoskeletal injuries are not life-threatening, but immediate care should threatening, but immediate care should initiated quicklyinitiated quickly– Control bleeding and edemaControl bleeding and edema– Management early inflammation, pain, and muscle Management early inflammation, pain, and muscle

spasmspasm– Acronym of these procedures is Acronym of these procedures is

P= protectionP= protectionR= restR= restI = iceI = iceC= compressionC= compressionE= elevationE= elevationS= stableS= stable

Cryotherapy for Cryotherapy for immediate and long-immediate and long-term treatmentterm treatment– Cold causes a Cold causes a

vasoconstriction of blood vasoconstriction of blood vessel and reduces limb vessel and reduces limb temperature and help temperature and help reduces swellingreduces swelling

– Slowing the tissue Slowing the tissue metabolic rate and pain metabolic rate and pain and in control of muscle and in control of muscle spasmspasm

– Application about 20 Application about 20 min per hour for 1.5 to min per hour for 1.5 to 1.5 hours or cold may 1.5 hours or cold may lead to tissue damagelead to tissue damage

Applying pressure to an injury helps reduce Applying pressure to an injury helps reduce hemorrhaging and the creation of a hematomahemorrhaging and the creation of a hematoma– Reduction of fluid seepage into surrounding area and Reduction of fluid seepage into surrounding area and

facilitation of the absorption ratefacilitation of the absorption rate– Decreasing the possibility of secondary injuryDecreasing the possibility of secondary injury

Elevation of a body part is another strategy to reduce Elevation of a body part is another strategy to reduce swellingswelling– Extremity above the level of the heart facilitates the return Extremity above the level of the heart facilitates the return

of fluid through the vein back to the heart and reduces of fluid through the vein back to the heart and reduces edemaedema

Immobilizing the limb may be accomplished through Immobilizing the limb may be accomplished through taping, casting, splinting or aids (crutch, cane)taping, casting, splinting or aids (crutch, cane)– Certain amount of rest is vital for the healing processCertain amount of rest is vital for the healing process– Too much rest of immobilizing can lead to loss of motion Too much rest of immobilizing can lead to loss of motion

in a joint and muscular atrophyin a joint and muscular atrophy

Rehabilitation Treatment for Sports Rehabilitation Treatment for Sports Medicine InjuriesMedicine Injuries

ExerciseExercise– Various types of exercise in conjunction with Various types of exercise in conjunction with

therapeutic procedure are used to rehab. patienttherapeutic procedure are used to rehab. patient

Isometric ExerciseIsometric Exercise– A type of strength A type of strength

training in which the training in which the joint angle and muscle joint angle and muscle length do not change length do not change during contractionduring contraction

– Use during early stage of Use during early stage of rehab. processrehab. process

– When extremity is When extremity is immobilized it helps to immobilized it helps to reduce muscle atrophyreduce muscle atrophy

Dynamic ExerciseDynamic Exercise– Is used to strengthen a group of muscles through a Is used to strengthen a group of muscles through a

range of motionrange of motion– Can be perform either concentric or eccentric Can be perform either concentric or eccentric

exerciseexercise– More muscle force can be developed during More muscle force can be developed during

eccentric exercise than isometrics or concentric eccentric exercise than isometrics or concentric exerciseexercise

– Eccentric contractions, although important, it may Eccentric contractions, although important, it may produce post exercise muscle soreness (DOMS)produce post exercise muscle soreness (DOMS)

– There are may be a compromise between rehab. There are may be a compromise between rehab. and training and the amount that would produce and training and the amount that would produce sorenesssoreness

Isokinetic ExerciseIsokinetic Exercise– Produces more force at some Produces more force at some

joint angles than others and joint angles than others and therefore can present more therefore can present more stress on a joint t that might stress on a joint t that might be appropriate for be appropriate for rehabilitationrehabilitation

– A type of dynamic exerciseA type of dynamic exercise

– Use dynamometer that Use dynamometer that provide an accommodation provide an accommodation in resistance at each set in resistance at each set velocityvelocity

– Use in assess muscle Use in assess muscle strength and to increase strength and to increase muscular strengthmuscular strength

Treatment ModalitiesTreatment Modalities

CryotherapyCryotherapy– Clod has been used in immediate care and first Clod has been used in immediate care and first

aidsaids– Is appropriate for sprains, strains, hematoma, Is appropriate for sprains, strains, hematoma,

contusions, and problems such as fasciitis, contusions, and problems such as fasciitis, tenosynovitis, tendonitistenosynovitis, tendonitis

– Cold therapyCold therapyIncreases pain thresholdIncreases pain thresholdDecreases velocity of impulses (desensitized nerve Decreases velocity of impulses (desensitized nerve endings)endings)Decreases muscle spindle firingDecreases muscle spindle firingDecreases muscle’s reaction to stretch; helps relaxDecreases muscle’s reaction to stretch; helps relaxReduces spamReduces spam

– Shunting reaction by cryotherapyShunting reaction by cryotherapy

CryokineticsCryokinetics– Combination of cold and exercise (passive or Combination of cold and exercise (passive or

active movement)active movement)– An approach results in less disuse atrophy and An approach results in less disuse atrophy and

reduces the possibility of developing adhesionsreduces the possibility of developing adhesions

ThermotherapyThermotherapy– is the application of heat to the body for pain relief is the application of heat to the body for pain relief

and healthand health– It can be beneficial to those with arthritis and stiff It can be beneficial to those with arthritis and stiff

muscles and injuries to the deep tissue of the skinmuscles and injuries to the deep tissue of the skin– The therapeutic effects of heat include The therapeutic effects of heat include

increasing the extensibility of collagen tissues; increasing the extensibility of collagen tissues; decreasing joint stiffness; decreasing joint stiffness; reducing pain; reducing pain; relieving muscle spasms; relieving muscle spasms; reducing inflammation, edema, and aids in the post acute reducing inflammation, edema, and aids in the post acute phase of healing; phase of healing; increasing blood flow-the increased blood flow to the increasing blood flow-the increased blood flow to the affected area provides proteins, nutrients, and oxygen for affected area provides proteins, nutrients, and oxygen for better healingbetter healing

Four methods of thermotherapyFour methods of thermotherapy– Conduction: direct contact with a heat source Conduction: direct contact with a heat source

(whirlpool, paraffin baths, analgesic balms)(whirlpool, paraffin baths, analgesic balms)– Convection: indirect heat such as heated water or air Convection: indirect heat such as heated water or air

(whirlpool: heat and hydro-massage)(whirlpool: heat and hydro-massage)– Radiation: transfer of heat or energy through space Radiation: transfer of heat or energy through space

by electromagnetic waves (infrared lamp)by electromagnetic waves (infrared lamp)– Conversion: heat by other forms of energy Conversion: heat by other forms of energy

(diatherapy, ultrasound, phonophoresis)(diatherapy, ultrasound, phonophoresis)

Ultrasound is one of the most frequently used Ultrasound is one of the most frequently used modalities of penetrating heat in sports modalities of penetrating heat in sports medicines (to rehab. bursitis, tendinitis, medicines (to rehab. bursitis, tendinitis, fasciitis, and soft tissue injury) fasciitis, and soft tissue injury)

Electrical StimulationElectrical Stimulation– Is used to control swelling, reduce atrophy, increase blood Is used to control swelling, reduce atrophy, increase blood

flow, reeducate muscles, and control of painflow, reeducate muscles, and control of pain

– By regulating the characteristics of electric current (type of By regulating the characteristics of electric current (type of current, current pulse width, frequency, and intensity) the current, current pulse width, frequency, and intensity) the desired outcomes in the rehab. process may be obtaineddesired outcomes in the rehab. process may be obtained

– Iontophoresis (Electromotive Drug Administration (EMDA)) Iontophoresis (Electromotive Drug Administration (EMDA)) is a technique using a small electric charge to deliver a medicine or is a technique using a small electric charge to deliver a medicine or other chemical through the skinother chemical through the skin

To anesthesia, fight infection, and plantar wartsTo anesthesia, fight infection, and plantar warts

– Transcutaneous electrical stimulation (TENS)Transcutaneous electrical stimulation (TENS)Become a treatment to diminish acute and chronic painBecome a treatment to diminish acute and chronic pain

This type of direct , low-intensity current produces “gating” This type of direct , low-intensity current produces “gating” mechanism in dorsal horn of the spinal cord that turns off the pain mechanism in dorsal horn of the spinal cord that turns off the pain signalsignal

SurgerySurgery

More invasive measures are sometime More invasive measures are sometime requiredrequired– Orthopedic surgeonOrthopedic surgeon– Graft from neighboring tissue of torn muscle or Graft from neighboring tissue of torn muscle or

tendonstendons– Realignment of patellaRealignment of patella

Surgical MaterialsSurgical Materials

Various plastic materials have been used in Various plastic materials have been used in artificial joints, and these need to be designed artificial joints, and these need to be designed to be biocompatible with neighboring tissuesto be biocompatible with neighboring tissues– Gore-Tex polyesterGore-Tex polyester– TeflonTeflon– DacronDacron

ArthroscopyArthroscopy

is a minimally invasive is a minimally invasive surgical procedure in surgical procedure in which an examination which an examination and sometimes and sometimes treatment of damage of treatment of damage of the interior of a joint is the interior of a joint is performed using an performed using an arthroscope, a type of arthroscope, a type of endoscope that is endoscope that is inserted into the joint inserted into the joint through a small through a small incision.incision.

Arthroscopic procedures can be performed either to Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions evaluate or to treat many orthopedic conditions including torn floating cartilage, torn surface including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming cartilage, ACL reconstruction, and trimming damaged cartilage.damaged cartilage.

The advantage of arthroscopy over traditional open The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up surgery is that the joint does not have to be opened up fully. Instead, for knee arthroscopy for example, only fully. Instead, for knee arthroscopy for example, only two small incisions are made — one for the two small incisions are made — one for the arthroscope and one for the surgical instruments to be arthroscope and one for the surgical instruments to be used in the knee cavity. used in the knee cavity.

This reduces recovery time and may increase the rate This reduces recovery time and may increase the rate of surgical success due to less trauma to the of surgical success due to less trauma to the connective tissue.connective tissue.

Micro-fracture is used to put Micro-fracture is used to put small holes in bone and small holes in bone and promote healing by blood promote healing by blood clotting and production of clotting and production of fibrocartilagefibrocartilage

Autologous chondrocyte Autologous chondrocyte transplantation (ACT)- transplantation (ACT)- damaged knee cartilage can damaged knee cartilage can be repaired by patient’s own be repaired by patient’s own healthy tissue is used to healthy tissue is used to grow new cellsgrow new cells

New TechnologyNew TechnologyThe computer in The computer in rehabilitationrehabilitation– Physical therapists used to Physical therapists used to

conduct range of motion conduct range of motion exercise for a brief of timeexercise for a brief of time

– Continue passive motion Continue passive motion (CPM) is a postoperative (CPM) is a postoperative treatment method that is treatment method that is designed to aid recovery designed to aid recovery after joint surgeryafter joint surgery

– Computer control a Computer control a machine that provides machine that provides extended periods of extended periods of continual flexion and continual flexion and extension at a jointextension at a joint

RadiographyRadiography– Injury DetectionInjury Detection

Osgood-Schlatter’s Osgood-Schlatter’s conditioncondition

– Bone ImagingBone ImagingRadioisotope (technetium) bone imaging is Radioisotope (technetium) bone imaging is often used when a stress fracture is suspectedoften used when a stress fracture is suspected

As certain types of fractures, hot spots are As certain types of fractures, hot spots are sometimes evident a day earlier than when the sometimes evident a day earlier than when the fracture shows up on a radiographfracture shows up on a radiograph

Cold spots may indicate a decrease Cold spots may indicate a decrease radionuclide uptake found in the early stage of radionuclide uptake found in the early stage of a disorder called vascular necrosisa disorder called vascular necrosis

– ArthrographyArthrographyRadiology technique that permits inspection of joint Radiology technique that permits inspection of joint surface and surrounding structuresurface and surrounding structure

Air introduced into the articular cavity as a thin layer of Air introduced into the articular cavity as a thin layer of radiological contrast medium coats articular surfaceradiological contrast medium coats articular surface

This detection technique is often used for suspected This detection technique is often used for suspected knee, shoulder, and ankle injuriesknee, shoulder, and ankle injuries

Examination of the radiographs helps determine Examination of the radiographs helps determine whether a ligament teat existswhether a ligament teat exists

– Computerized TomographyComputerized TomographyTomography in which computer analysis of a series of Tomography in which computer analysis of a series of cross-sectional scans made along a single axis of a cross-sectional scans made along a single axis of a bodily structure or tissue is used to construct a three-bodily structure or tissue is used to construct a three-dimensional (horizontal, sagittal, and frontal) image of dimensional (horizontal, sagittal, and frontal) image of that structure. that structure.

Some advanced systems provide a greater acuity to Some advanced systems provide a greater acuity to detect various types of lesions, plus the patient is detect various types of lesions, plus the patient is subjected to less radiation than conventional CAT scan subjected to less radiation than conventional CAT scan

– UltrasoundUltrasoundIs a safe and noninvasive Is a safe and noninvasive technique used to assess technique used to assess numerous physical numerous physical activity problemsactivity problems

Sound wave are bounced Sound wave are bounced off different structures off different structures and reflected back to the and reflected back to the transducer and these transducer and these reflected sound wave are reflected sound wave are received and integrate received and integrate into an electron system into an electron system that constructs a two-that constructs a two-dimensional picture (real dimensional picture (real time image)time image)

– CystoscopyCystoscopyUrologists have inspected the urinary bladderUrologists have inspected the urinary bladder

Orthopedic surgeons use a similar device to inspect Orthopedic surgeons use a similar device to inspect joints of the bodyjoints of the body

Both arthroscopy and arthroscopic surgery may be Both arthroscopy and arthroscopic surgery may be conducted under local or general anesthesia and are conducted under local or general anesthesia and are done as an outpatient proceduredone as an outpatient procedure

– Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)

The technique is based on the effect of a magnetic field The technique is based on the effect of a magnetic field has upon proton excitationhas upon proton excitation

Tissue protons in a magnetic field absorb energy, Tissue protons in a magnetic field absorb energy, causing the to wobblecausing the to wobble

Radio-wave are used to create this magnetic fieldRadio-wave are used to create this magnetic field

After the waves are turned off, the protons return to their After the waves are turned off, the protons return to their original state and emit energy, which is magnetic original state and emit energy, which is magnetic resonance signalresonance signal

This bears no known side effects or risksThis bears no known side effects or risks

Sport Diving InjuriesSport Diving Injuries

BarotraumaBarotrauma– Frequent occur during descent, when a diver is unable to Frequent occur during descent, when a diver is unable to

equalize pressure in the internal anatomic air spaces as the equalize pressure in the internal anatomic air spaces as the ambient pressure increasesambient pressure increases

Nitrogen NarcosisNitrogen Narcosis– As partial pressure increases, more nitrogen is forced into As partial pressure increases, more nitrogen is forced into

solution with the bodysolution with the body

– This condition affects the central nervous system with This condition affects the central nervous system with sequential symptoms of dizziness, impairment of mental sequential symptoms of dizziness, impairment of mental processing etc…processing etc…

Air EmbolismAir Embolism– Is a condition associated with the ascent of the Is a condition associated with the ascent of the

diverdiver– Air or other gas bubbles enter the blood stream and Air or other gas bubbles enter the blood stream and

cause obstruction in small arterial vessels and cause obstruction in small arterial vessels and cause hypoxia, and tissue ischemiacause hypoxia, and tissue ischemia

Decompression SicknessDecompression Sickness– Condition arising from dissolved gases coming out Condition arising from dissolved gases coming out

of solution into bubbles inside the body on of solution into bubbles inside the body on depressurizationdepressurization

– Two types of decompression illnessesTwo types of decompression illnessesType I is called musculoskeletal bendsType I is called musculoskeletal bendsType II is called central nervous system bendsType II is called central nervous system bends

Treatment of Environmental InjuriesTreatment of Environmental Injuries

Heat-related DisordersHeat-related Disorders– Heat CrampsHeat Cramps

are muscle spasms that result from loss of large amount are muscle spasms that result from loss of large amount of salt and water through exercise. of salt and water through exercise. Heat cramps are associated with cramping in the Heat cramps are associated with cramping in the abdomen, arms and calves. abdomen, arms and calves. This can be caused by inadequate consumption of fluids This can be caused by inadequate consumption of fluids or electrolytesor electrolytes

– Heat ExhaustionHeat ExhaustionCan be a precursor of heatstroke; the symptoms include Can be a precursor of heatstroke; the symptoms include heavy sweating, rapid breathing and a fast, weak pulseheavy sweating, rapid breathing and a fast, weak pulse

– Heat StrokeHeat Stroke Defined by a body temperature of greater than 40.6 °C Defined by a body temperature of greater than 40.6 °C (105.1 °F) due to environmental heat exposure with lack (105.1 °F) due to environmental heat exposure with lack of thermoregulation. Symptoms include dry skin, rapid, of thermoregulation. Symptoms include dry skin, rapid, strong pulse and dizzinessstrong pulse and dizziness

Preventing Heat DisordersPreventing Heat Disorders

Ample fluid replacement must be doneAmple fluid replacement must be done

Heat acclimatization (cardiovascular and Heat acclimatization (cardiovascular and hormonal adjustment) to environmenthormonal adjustment) to environment

Appropriate uniforms, equipment and length Appropriate uniforms, equipment and length of activity sessions of activity sessions

Cold InjuriesCold InjuriesExposure to cold can produce a variety of injuries that occur Exposure to cold can produce a variety of injuries that occur as a result of man's inability to adapt to cold.as a result of man's inability to adapt to cold.These injuries can be divided into localized injury to a body These injuries can be divided into localized injury to a body part, systemic hypothermia, or a combination of bothpart, systemic hypothermia, or a combination of bothHypothermia or systemic cold injury occurs when the core Hypothermia or systemic cold injury occurs when the core body temperature has decreased to 35 degrees C (95 degrees body temperature has decreased to 35 degrees C (95 degrees F) or less.F) or less.The general principals of pre-hospital management are to (1) The general principals of pre-hospital management are to (1) prevent further heat loss, (2) rewarm the body core prevent further heat loss, (2) rewarm the body core temperature in advance of the shell, and (3) avoid precipitating temperature in advance of the shell, and (3) avoid precipitating ventricular fibrillationventricular fibrillationThere are two general techniques of rewarming--passive and There are two general techniques of rewarming--passive and activeactiveThe freezing of the corneas has been reported to occur in The freezing of the corneas has been reported to occur in individuals who keep their eyes open in high wind-chill individuals who keep their eyes open in high wind-chill situations without protective goggles (e.g., snowmobilers, situations without protective goggles (e.g., snowmobilers, cross-country skiers). cross-country skiers).

FrostbiteFrostbite– is the medical condition where localized damage is is the medical condition where localized damage is

caused to skin and other tissues due to extreme caused to skin and other tissues due to extreme cold.cold.

– Frostbite is most likely to happen in body parts Frostbite is most likely to happen in body parts farthest from the heart and those with large farthest from the heart and those with large exposed areas. exposed areas.

– The initial stages of frostbite are sometimes called The initial stages of frostbite are sometimes called "frostnip"."frostnip".

ChilblainsChilblains– are acral ulcers (that is, ulcers affecting the are acral ulcers (that is, ulcers affecting the

extremities) that occur when a predisposed extremities) that occur when a predisposed individual is exposed to cold and humidity. individual is exposed to cold and humidity.

– The cold exposure damages capillary beds in the The cold exposure damages capillary beds in the skin, which in turn can cause redness, itching, skin, which in turn can cause redness, itching, blisters, and inflammationblisters, and inflammation

DiscussionDiscussionDo you know other measures which runners Do you know other measures which runners suffering chronic bone injury are suffering chronic bone injury are therapeutically beneficial.therapeutically beneficial.

In case of extreme cold environment, should In case of extreme cold environment, should you still implement cryotherapy to relieve an you still implement cryotherapy to relieve an acute injury? acute injury?

Could you design a various types of exercise Could you design a various types of exercise in conjunction with therapeutic procedure are in conjunction with therapeutic procedure are used to rehab a young adult whose locomotion used to rehab a young adult whose locomotion impairment has brought his life a great impairment has brought his life a great inconvenient.inconvenient.