Injury

Acute + Chronic Injuries

Acute injuries:

  • a sudden injury associated with a traumatic event
  • e.g. netballer spraining ankle or footballer breaking fibula

Chronic injuries:

  • those which develop over time due to repeated continued stress on the body
  • associated with overuse
  • e.g. shin splints in long distance runners
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Acute Hard Tissue Injuries

Hard tissue injury involves damage to the bone, joint + cartilage

Fracture:

  • partial or complete break in the bone
  • in closed fractures skin remains unbroken + in compound fractures bone breaks through skin
  • signs of fracture - deformity, swelling + discolouration
  • symptoms of fracture - pain + inability to move injured area

Dislocation:

  • occurs from a direct force (collision or object) or an indirect force (a fall) pushing the joint past its extreme range of motion
  • subluxation (partial dislocation) causes damage to ligaments + increases the likelihood of recurrent dislocations which can compromise an athlete's career
  • sign of dislocation - deformity, swilling + discolouration
  • symptoms of a dislocation - may feel a 'pop', severe pain + loss of movement
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Acute Soft Tissue Injuries

Soft tissue injury involves damage to the skin, muscle, tendons or ligaments

Contusions + haematoma - a contusion is a bruise from localised congealed bleeding from ruptured blood vessels + severe can be haematoma which involves internal bleeding from minor bruises under skin to deep tissue bleeding shown by swelling, discolouration + pain

Sprains - overstretch or tear in ligament that connects bone to bone caused by sudden twist, impact or fall forcing joint past extreme range of motion shown by swelling, bruising + inability to bear weight

Strains - overstretch or tear in muscle or tendon that connects bone to bone + common in dynamic lunging movement with serious sprain resulting in a rupture (complete tear) + shown by swelling/discolouration, bruising + pain on movement

Abrasion - superficial damage to skin caused by scraping against a surface caused by falling, slipping or clothing rubbing on body with worst needing stitches

Blister - seperation of layers of skin where pocket of fluid formed, caused by friction + can be painful but preventable with correct footwear, equipment + training load

Concussion - traumatic brain injury resulting in a disturbance of brain function causing swelling + possible disruption to electrical processes in brain shown by loss of consciousness, disorientation, vomiting + headaches

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Chronic Injuries

Stress fractures:

  • hard tissue injury
  • tiny crack in the surface of a bone caused by overuse
  • common with distance running events, tennis + cricket as repetitive stress of the foot on the ground cause trauma
  • overtraining can cause this + usually stops with rest

Shin splints:

  • soft tissue injury
  • chronic pain due to inflammation of muscles + stress on tendon attachments to the surface of the tibia
  • common with distance runners, dancers + football players
  • caused by being overweight, wearing inadequate footwear or poor leg biomechanics

Tendinosis:

  • soft tissue injury
  • the deterioration of a tendon in response to chronic overuse + repetitive stran
  • tendons are tough fibrous connective tissues designed to transmit force
  • e.g. achilles tendonisis
  • shown by limited movement/stiffness, burning, stinging + aching
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Risk Factors

Intrinsic risk factors (from inside body):

  • previous injury
  • posture + alignment issues
  • age
  • nutrition
  • poor preparation
  • inadequate fitness levels
  • inappropriate flexibility level

Extrinsic risk factors (from outside body):

  • poor technique + training
  • incorrect equipment + clothing
  • inappropriate intensity, duration or frequency of activity
  • warm-up + cool-down effectiveness
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Warm-up

Warm-ups used for:

  • raising body temperature - rise of 2-3 degrees increases enzyme activity, diffusion gradients + metabolic activity, improving efficiency of muscular contraction
  • preparing the body physiologically - the elasticity of tendons + ligaments improves, antagonistic co-ordination improves
  • preparing body physiologically - mentally performers are ready for task ahead
  • minimising the risk of injury - e.g. performer less likely to suffer strains + sprains

Key features:

  • lasts 20-45 minutes
  • gradually increases intensity
  • three stages - pulse raising, stretching + mobility + sport-specific drills
  • stretching + mobility should be dynamic in sport-specific patterns
  • static stretches should be avoided
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Cool Down

Used for:

  • maintaining heart rate - to maintain blood flow + metabolic activity, flushing muscle tissue with oxygenated blood
  • aiding removal of lactic acid - enhancing future performances, delaying fatigue + injuries
  • aiding the healing process

Key features:

  • lasts 20-30 minutes
  • gradually decreasing in intensity
  • has several stages:
    • moderate intensity - to maintain HR, aid venous return + remove waste
    • stretching - reduce muscle tension + lower temperature
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Warm-up + Cool Down Debate

Static stretches historically large part of warm up but research suggests:

  • has no effect on injury prevention
  • may reduce peak force produced by Achilles tendon by 8%
  • deteriorates atagonistic co-ordination, hampering explosive movements
  • reduces eccentric strength by 9%, decreasing the ability to change directions at speed
  • reduces muscles' ability to consume O2 by 50%

Aa a result, static stretches should be avoided as part of a warm up unless advised by physio

Injury prevetion researchers believe dynamic stretching such as high knee skips + walking lunges should be used as part of a warm-up instead

Historically, an active cool down was thought to benefit all athletes but after low-intensity activity such as jogging, a passive recovery can be more beneficial

Little evidence to suggest an active-cool down can prevent or limit DOMS

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Assessment Using SALTAPS

SALTAPS - protocol for the assessment of a sporting injury

Stop - stop the game + observe the injury

Ask - ask the questions of the player/participant: how did the injury happen? + where does it hurt?

Look - at the injury site, check for swelling, bruising, deformity + discolouration

Touch - at the injury site, check for swelling, deformity, bumps or heat

Active movement - ask for active movements from the participant

Passive movement - assesor moves the injured limb/body part

Strength testing - ask the player to stand, lift + put pressure on injured area, asking if they can continue

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Acute Injury Management Using PRICE

PRICE - protocol for treatment of of acute injuries

First two or three days after injury

Protect - protect your injury from further damage e.g. using support or splint

Rest - rest your injury for first two or three day e.g. use crutches + reintroduce movement gradually to prevent loss of muscle strength

Ice - ice the painful area with a cold compress e.g. ice or frozen peas wrapped in towel which will reduce swelling + bruising + should be done for 15-20 minutes every 2-3 hours

Compress - compress injured area with an elastic bandage or elasticated tubular bandage to limit swelling + movemement

Elevate - Rest injury above level of heart to keep it supported

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Six Rs to Recognise Concussion

Six Rs - protocol for recognition of concussion

Recognise - learn the signs + symptoms of concussion to help identify when an athlete may have a suspected concussion

Remove - any athlete who has suspected concussion must be removed from play immediately

Refer - once removed, the athlete should be immediately referred to a qualified healthcare professional who is trained in evaluating + treating concussion

Rest - athletes must rest from exercise until symptom-free + not be left alone for the first 24 hours following injury

Recover - athletes must be fully recovered + symptom free from the concussion before returning to play with adults taking a minimum 1 week and under-18s a minimum of weeks before seeking approval from healthcare professional

Return - in order for safe return the athlete must be symptom free + cleared by healthcare professional before completing 'Graduated Return To Play' protocol

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Rehabilitation

Rehabilitation - the process of restoring full function after an injury has occured

Stages of rehabilitation:

  • early stage - gentle exercise encouraging damaged tissue to heal
  • mid stage - progressive loading of connective tissues + bones to develop strength
  • late stage - functional exercises + drills to ensure body is ready to return to training
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Treatment of Simple Fractures

Medical attention ASAP

PRICE

Immobilisation (plaster cast, sling + crutches)

Anti-inflammatory + pain medication e.g. Non-steroid anti-inflammatory drugs (NSAIDS)

Severe fractures may require surgery to realign bones or fix pins + wires

Physiotherapy may be needed

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Treatment of Stress Fractures

Medical ttention required for diagnosis + advice

PRICE

Rest for two weeks, avoid activity for 8 weeks

Immobilisation may be needed

Gently return to exercise

Strengthening exercises for surrounding connective tissue

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Treatment of Dislocation

Medical attention ASAP

Immobilisation + no attempt to reposition bones unless a medical professional

PRICE

Anti-inflammatory + pain medication

Severe dislocations may require surgery to realign bones + pin them into original position

Physiotherapy will strengthen surrounding connective tissue + improve mobility

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Treatment of Sprain

Medical attention may be required in severe cases

PRICE

Immobilisation or support using strapping, brace + crutches

Anti-inflammatory + pain medication

Exercise to strengthen surrounding connective tissue + improve mobility + balance

Severe sprains may need reconstructive surgery

Heat therapy - applying heat to an area before trainng for a therapeutic effect e.g. increasing blood flow

Contract therapy - use of alternate cold + heat for therapeutic effect e.g. increasing blood flow

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Treatment of Torn Cartilage

Medical attention

PRICE

Support using strapping e.g. knee brace

Anti-inflammatory + pain medication

Physiotherapy to strengthen surrounding connective tissue + restore ROM

Hydrotherapy to maintain fitness without bearing weight

Arthroscopy - a minimally invasive procedure to examine + repair damage within a joint to reshape + resurface a torn cartilage

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Treatment of Exercise Induced Muscle Damage

In most cases, medical attention not required + symptoms should improve within 5 days

Cold therapy such as ice packs + ice baths post-exercise

Massage + stretching techniques

Anti-inflammatory + pain medication

Medical attention may be required if heavy swelling or dark urine

Heat therapy + contrast therapy for pain relief

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