Recognizing Different Sports Injuries

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Recognizing Different Sports Injuries
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Mechanisms and Characteristics of Sports Trauma
Sports Trauma A physical injury or wound
sustained in sports caused by an internal or
external force. Mechanical injury results from a
force causing a harmful disturbance in function
and/or structure of a body part. This is not the
same as a repetitive strain or overuse
condition. Load a singular or group of internal
or external forces acting on the body.
Mechanical stress is a resistance to this load -
results in tissue deformation A yield point is
reached when tissue is deformed to the maximum of
its elastic properties. Mechanical failure occurs
when the yield point is exceeded tissue damage.
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Mechanisms and Characteristics of Sports Trauma

• Mechanisms of sports injuries
• Tension force that pulls or stretches tissue
• Stretching force beyond yield point sprain,
  strain, avulsion fracture
• Compression crushing force - the force can no
  longer be absorbed
• Shearing force that moves across the parallel
  organization of tissue eg. blisters,
  abrasions, vertebral disk injuries
• Bending force on a horizontal beam of bone that
  places stress within the structure causing it
  to bend. This occurs with other forces to
  create several types of fractures and torsion
  injuries.

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Soft tissue Classification

• Contractile
• Muscle
• Tendon, or bony insertion

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Soft tissue Classification

• Non-contractile
• Skin
• Joint capsule
• Ligament
• Fascia
• Cartilage
• Nerve
• Dura

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Skin Injuries
Blister - collection of fluid in or below
epidermal layer caused by continuous
rubbing. Abrasion - epidermis and dermis are worn
away due to scrape on rough surface Skin bruise
- blow compresses or crushes skin surface causing
bleeding under the skin Laceration - flesh is
irregularly torn Skin Avulsion - tissue is ripped
from its source Incision - skin has been sharply
cut Puncture - penetration of skin by sharp
object
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Acute Traumatic Injuries

• Bone Trauma
• Closed fracture
• Open fracture
• TYPES
• Contrecoup
• Depressed
• Greenstick
• Comminuted

• Longitudinal
• Oblique
• Serrated
• Spiral
• Transverse
• Impacted

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Other Acute Injuries

• Stress Fracture/ Avulsion Fracture
• Dislocations and Subluxation
• Ligament Sprain
• Contusion
• Muscle Cramps

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Contusion

• Crushing of soft tissue causing a bruise of the
  skin, muscle, deep or superficial tissues, or
  bone, resulting from a direct blow.
• Treatment of contusions
• PIER
• Restricted movement
• Treat as strain after acute phase

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Contusion
First Degree Second Degree Third Degree
Mild blow causing tissue compression Moderate blow causing haematoma Sever blow
Little bleeding and minimal damage Significant bleeding May look like a fracture- severe bleeding
Little loss of f unction 20 - 80 loss ROM Complete loss of function
May have slight spasm Spasm may last hours Extreme spasm present
Little/no swelling Moderate swelling Gross swelling
No Discolouration Moderate Discolouration Severe Discolouration
No palpable indentation May have indentation and palpable tenderness Extreme palpable tenderness and indentation
Increased skin temp. Warm to touch
Mild discomfort Significant pain Extreme pain
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Strains
Strains pertain to contractile tissue. Caused by
excessive forcible contraction or overstretch or
chronic overuse resulting in local tissue trauma
to the muscle, musculotendinous unit or the
muscle tendon.    
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Strains

• Prevention
• lack of or poor flexibility
• Equipment
• Environment
• increase flexibility
• proper warm up and cool down
• skill improvement
• increase muscle endurance
• increase muscle strength and power
• muscle balance

• Predisposing factors
• lack of or poor flexibility
• lack of or poor warm up
• muscle fatigue
• poor muscle strength
• poor skill level
• antagonistic muscle imbalance
• poor playing/workout conditions or surfaces
• existing minor inflammation

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Strain
First Degree Second Degree Third Degree
Classification Mild micro tearing Moderate strain Severe with palpable rut
Swelling Slight Measurable Visibly apparent gross
Pain Localized Indefinable sever
Strength Slight loss 35 - 83 loss Complete loss
Function Partial to non weight bearing Abnormal gait to non weight bearing Non weight bearing
Range Slight loss Moderate loss Complete loss
Discolouration Little to none Obvious Obvious severe
Healing 1 2 weeks 3 12 weeks 3 months onward
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Sprain
Sprains First Degree Second Degree Third Degree
Classification mild micro tearing at cellular level moderate - partial tearing severe- complete rupture
Function 95 functional with partial weight bearing for 1-3 minutes and then able to return to activity loss of function - partial weight bearing to non weight bearing Non - weight bearing due to pain and swelling
Swelling none at time of injury with minimal visible swelling after several hours or the next day  moderate to severe intra capsular swelling- usually not immediately visible moderate to severe swelling - may be immediate - will be visible and measurable
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Sprains First Degree Second Degree Third Degree
Discolouration  usually none moderate localized discolouration - not immediate initially some mild discolouration and then will turn very dark (almost black) around the injury site
Range of Motion  near full 20 to 80 loss unable to move joint due to pain - on passive tests there is no tension in the joint - bone on bone contact will usually stop the range of motion at the extreme end of range
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Sprain
Sprains First Degree Second Degree Third Degree
Joint instability none - no laxity on stress tests 5 to 10 degrees laxity on stress test and will feel unstable using joint complete laxity of joint - gross instability
Strength  minimal to no weakness   20 to 80 loss - may not do resisted test pain will cause unwillingness to resist or move limb
Point Tenderness size of dime  size of quarter defuse palpable tenderness - all over area
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Sprain
Sprains First Degree Second Degree Third Degree
Pain  minimal discomfort at time of injury and minimal pain on stress test - able to continue moderate local pain at time of injury and on stress test - unable to continue may have no pain due to nerve involvement - usually extreme pain at time of injury - pain in large area near injured structure
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Chronic Overuse Injuries

• Tendinitis
• Muscle Soreness
• Tenosynovitis
• Osteoarthritis

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Tendonitis
Inflammation and degenerative changes in the
tendon or musculotendinous junction caused by
excessive overuse (too much too soon), excessive
friction over the tendon, direct or repeated
trauma to the area.    
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Signs and Symptoms of Tendonitis

• Local thickening of the tendon.
• Point tenderness.
• Possible crepitus.
• Usually becomes self limiting.

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Phases of Tendonitis
Phase 1 symptoms following activity, no
performance disability, Phase 2 symptoms during
and after activity, progresses from no
significant performance disability to some
performance disability to episodes of significant
performance disability, Phase 3 symptoms during
and after activity, persistent performance
disability, Phase 4 symptoms all the time.
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Preventing Tendonitis

• Slow gradual warm - up prior to all activity
  (increases blood flow to tendons).
• Slow gradual increase in level of activity.
• Increase the flexibility of the muscles.
• Proper equipment.
• Recognize early SS of tendonitis.

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Bursitis

• Inflammation of the bursal sac leading to pain
  and swelling which, if not allowed to resolve,
  will progress to a chronic condition with
  secondary thickening in the bursal walls and a
  tendency to recur.
• Caused by direct trauma, chronic irritation
  (over use), infection, calcium deposits.

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Signs and Symptoms of Bursitis

• onset may be slow or gradual,
• pain in region of bursa,
• pain may increase when bursa is squeezes,
  (abduction),
• varying disability,
• swelling,
• tenderness,
• crepitus,
• limited range of motion,
• often increased pain in morning,
• usually subsides in six weeks but may remain
  for several years.

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Inflammatory Response Phase

• Inflammatory Response Phase
• most critical stage
• phagocytosis
• Fibroblastic Repair Phase
• scar formation
• Maturation-Remodeling Phase
• new fibers

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Acute Inflammatory Phase

• The function of the inflammation response is to
• Localize the extent of the injured area
• Remove waste products or foreign material
  resulting from the initial trauma and secondary
  response
• Set the stage for healing to take place
• Protect site or joint
• The reaction is always the same.
• This phase is present for as long as the signs
  and symptoms are present Do not get hung up on
  time factors - Acute inflammation is different
  for everyone and every condition.

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Acute Inflammatory Phase

• Causes of inflammation
• Physical trauma
• Chemical irritation
• Bacterial invasion
• Extremes of temperature

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Characteristics of Inflammation
Swelling, Heat, Altered function, Redness,
Pain Swelling caused by the accumulation of blood
and inflammatory exudate. Heat caused by
increased biochemical activity and the increase
of blood flow to the area. Altered function
caused by the resulting pain and swelling or the
actual destruction of an anatomical
structure. Redness caused by the dilation of
vessels and increased blood flow to the area.
Pain caused by the direct injury to the nerve
fibres, pressure from swelling, chemical
irritants, as well as protective muscle spasm
around the injury site.
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The Affects of the P.I.E.R. principle on the
Acute Inflammatory Response.
P Pressure I Ice E Elevation R Rest
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P.I.E.R.

• PRESSURE
• Decrease the amount of space for swelling to
  occur,
• Direct pressure on vessels decreases blood flow
  around injury site ( thus decreasing blood
  swelling),
• Decreases plasma fluid leakage.
• Decreases lymph leakage.

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• ICE
• Decreases metabolic rate, which decreases
• The affects of the toxins in the area
• The need for oxygen, therefore decreases
  secondary cell death
• The conduction of the nerve cells in the area
  which helps to decrease the pain and minimize the
  amount of muscle spasm,
• Decreases blood flow to the site
• Decreases tissue elasticity in surrounding injury
  area.
• Decreases hydrostatic pressure.

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ELEVATION

• Assists venous and lymphatic return.
• Decreases blood flow to area.

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• RESTRICTED FUNCTION
• Decreases chance of re-injury.
• Decreases blood flow to area.