Key Info

Define aetiology

The cause of an injury

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Define injury

Injury occurs when the load applied to a tissue exceeds its failure tolerance. Injury is the medical term of cellular damage. Injured soft tissue consists of: dead cells, extracellular substance and extravasated blood

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What are the three stages of inflammation?

1. Vasodilation. 2. Phagocyte migration. 3. Repair

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What is calor?

Symptom of inflammation

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What is rubor?

Symptom of inflammation

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What is dolor?

Symptom of inflammation. Paingate theory. Caused my chemicals released by dying and damaged cells acting on the bare nerve ending of pain fibres.

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What is tumor?

Symptom of inflammation. Takes a few hours. Histamine, kinines and serotonin released from damaged cells. Increases local blood vessel permeability. Increas osmolarity. Large net outflow of fluid from blood.

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Briefly outline the healing and repair process.

12 hours after injury. New capillaries grow towards site. Canalise and fill with blood. Fibroblasts move towards injury. By day 5, fibrils of collagen are laid down.

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What is an acute injury?

Also known as traumatic injury. Usually easy to diagnose. Rapid onset of pain/symptoms. For example: compound fracture, ligament tear in rugby

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What is a chronic injury?

Gradual onset. Cause is usually repetitive overloading. Difficult to diagnose. Varies greatly between individuals. For example: stress fracture, patella tendonitis in volleyball

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What do ligaments attach?

Bone to bone

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What do tendons attach?

Muscle to bone

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List examples of injury to bone.

Fractures. Acute or chronic. Transverse, oblique, spiral, comminuted. Compound/open. Simple/closed. Articular surface. Avulsion

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List examples of injury to ligaments.

Partial tear (grade I - minor grade II). Complete tear (major grade II - major grad III)

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List examples of injury to muscles.

Ruptures or tears. Subdivided into sprain or compression. Complete or partial. Haematoma. Inter or intra muscular.

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List examples of injury to tendons.

Peritenosis. Tendinosis. Tendinitis. Insertionitis. Complete/partial tears.

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Briefly describe the sequence for prevention of sports injuries.

1. Establish the extent of the problem: incidence and severity. 2. Establish the aetiology and mechanism of injury. 3. Introduce a preventative measure. 4. Assess its effectiveness by repeating step 1.

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Define load.

The forces acting on a body.

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Define stress.

Stress is defined as the average force per unit area that some particles of a body exert on an adjacent particle.

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Define strain.

Strain is the level of deformation caused by the load.

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What is the formula for mechanical stress?

Stress (σ) = Force (N) / Cross Sectional Area (m2)

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What is the formula for mechanical strain?

Strain (ε) = Change In Length (m) / Original Length (m)

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What are the three types of loading?

Tension, compression and shear.

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What causes biological tissue strength to vary under loading?

Direction and rate of loading.

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Biological tissues are said to be anisotropic. What does this mean?

It means the strength depends on the direction of forces.

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What are some characteristics of biological tissue?

Anisotropic, viscoelastic (viscose, elastic)

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With regards to viscoelasticity, describe hysteresis.

Stress strain response is not consistent for loading and unloading. Inelastic behaviour/viscose property.

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With regards to viscoelasticity, describe creep.

Under constant stress, strain increases.

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With regards to viscoelasticity, describe stress-relaxation.

Under constant strain, stress decreases.

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What is Wolffe's Law (1870)?

'Bones remodel themselves depending on the magnitude and direction of the stresses which they experience.'

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Give examples of acute bone injury/failure.

Fracture, periosteal contusion.

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Give examples of chronic bone injury/failure.

Stress fracture, bone strain, stress reaction, osteitis, periostitis, apophysitis

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What are the functions of cartilage? (With regards to force transfer and distribution)

Anisotropic, compressive properties and viscoelasticity.

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What are the functions of cartilage? (With regards to friction between joints)

Smooth surface, bonds synovial fluid, fluid is exuded from cartilage when loaded, shape creates 'wedges' of synovial fluid

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Give examples of acute cartilage injury/failure.

Osteochondral/chondral fractures, minor osteochondral injury

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Give examples of chronic injury/failure.

Chrondropathy, lack of lubrication.

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Give examples of acute ligament injury/failure.

Sprain/tear (grades I - III)

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Give examples of chronic ligament injury/failure.

Inflammation.

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Give examples of acute tendon injury/failure.

Tear (complete or partial)

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Give examples of chronic tendon injury/failure.

Tendinopathy

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Give examples of acute muscle injury/failure.

Strain/tear (grads I - III). Contusion. Cramp. Acute compartment syndrome.

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Give examples of chronic muscle injury/failure.

Chronic compartment syndrome. DOMS. Focal tissue thickening/fibrosis.

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Define rehabilitation.

Restoration to a former capacity or standing or to rank, rights and privileges lost or forfeited

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What is the main aim of rehabilitation?

To return patient to full functional fitness in the shortest, safest possible time.

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What are the key aspects of rehabilitation?

SAID principle (Specific adaptation to imposed demands). Setting therapeutic goals. Continual evaluation. Functional progression. Early exercise. Rate of reconditioning. Pain free. Biofeedback. Athletes health comes first.

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What are the stages of rehabilitation?

Early, intermediate and late (also pre-discharge)

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Describe the early stage of rehabilitation.

Injured limb is non-weight bearing. Mobilization and flexibility. Pain free. Increases range of movement. Cardiovascular fitness is maintained.

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When can patients progress from the early stage into the intermediate stage of rehabilitation?

Weight-bearing forces can be applied through the limb. For knees, no effusion, flexion to 90 degrees. Other joints, 2/3 of normal function and movement. No pain or swelling.

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Describe the intermediate stage of rehabilitation.

Progression from non-weight bearing to partial weight bearing through to full weight bearing exercises. Lower limb; introduction to gait re-education. Regain full range of movement. Increase strength. Maintain CV. No competitive/dynamic/rotation work

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When can patients progress from the intermediate stage into the late stage of rehabilitation?

Lower limb; full pain free range of movement and ready to commence running. Upper limb; bilateral and symmetrical movements.

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Describe the late stage of rehabilitation.

More dynamic and agressive stage. Re-educate normal functional activities. Increase general fitness and include sports specific activities. Prepare for return to sport. There should be no measurable difference between the injured and non-injured limb

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When can the patient progress from the late stage of rehabilitation?

Full, normal ROM. Unaffected by exercise. Pain free movements. No swelling. Good proprioception. CV fitness maintained. Necessary skills regained.

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What questions need to be asked at the pre-discharge stage of rehabilitation?

Is the patient fit to return to unrestricted activity? Has the injury recovered fully? Necessary fitness or skills to perform the tasks? Has the patient recovered psychologically?

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What are the types of exercise used in muscle conditinioning?

Main three: isometric, isotonic, isokinetic. Remedial exercises. Open/closed kinetic chain exercises.

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When are open kinetic chain exercises performed?

When the limb is not fixed and is allowed to move freely through space.

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When are closed kinetic chain exercises performed?

When the limb is fixed or maintains contact with a ground reactive force.

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What is SCI?

Spinal cord injury. It is caused by disease or trauma that results in a loss or impaired function resulting in reduced mobility or feeling.

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What are the barriers to sport, related to SCI?

Disabled person. Acceptance. Facilities. Financial.

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What affects the choice of sport for a person who has suffered SCI?

Personal preference. Characteristics of the sport. Medical condition of the individual. Cognitive ability and social skills. Facilities. Availability of coaching and support staff. Availability of equipment.

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What is tetraplegia?

Lesion superior (above) to C7 (quadriplegia). Loss of function in arms and legs.

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What is paraplegia?

Lesion inferior (below) to C7. Loss of function of legs and abdomen.

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What are some associated problems with spinal injury?

Motor loss. Sensory loss. Loss of autonomic control. Respiratory function. Effects of cardiac function.

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Explain sensory loss with relation to SCI.

Loss of light touch/proprioception/pain sensation and pressure sores

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What bones is the knee made up of?

Femur, tibia and patella

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What do the medial cruciate ligament (MCL) and lateral cruciate ligament (LCL) stabilise?

Side to side movement

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What do the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) stabilise?

Front to back movement

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What movement can occur at the knee?

Flexion and extension (pivotal hinge joint). Slight medial and lateral rotation in the flexed position.

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Where does the ACL attach and pass through?

The knee end of the femur at the back of the joint and passes down through the knee joint to the front of the flat upper surface of the tibia. It prevents forward movement of the tibia from underneath the femur.

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How do ACL injuries occur?

Twisting force applied to the knee whilst the foot is firmly planted on the ground or upon landing. Direct blow to the knee.

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Give examples of acute knee injuries.

Anteior cruciate ligament (ACL) injuries

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Give examples of chronic knee injuries.

Patella tendonopathy (Jumper's knee). Patellofemoral syndrome.

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What are the symptoms of ACL injuries?

An audible pop or crack. Initial instability. Extreme pain immediately following. Swelling, usually immediate and extensive but can be - minimal or delayed & widespread mild tenderness. Restricted movement, inability to straighten leg.

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What are the options for ACL injury, surgery?

Patella tendon graft with bone plugs. Hamstring tendon graft. Donor tendons. Artificial tendons.

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Why are donor tendons better than artificial tendons?

Artificial tendons often break. Donor tendons can be used to reinforce a graft.

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What are the pros and cons of the patella tendon graft with bone plugs?

Pros - very strong. Cons - can have pain on kneeling on post surgery, less flexibility.

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What are the pros and cons of the hamstring tendon graft?

Pros - more flexibility than the patella tendon graft. Cons - may weaken hamstring, numbness, graft may pull out, not as strong.

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Briefly outline ACL injury rehabilitation.

RICE (Rest Ice Compression Elevation). Stage 1: Pre-operative stage. Stage 2: Week one following surgery. Stage 3: Concentrated rehab (weeks 1-12). Stage 4: Late rehab (weeks 13-20). Stage 5: Functional rehab (week 20+)

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What is tendonopathy?

Degeneration of the tendon.

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What is tendonitis?

Inflammation.

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Describe patella tendinopathy (Jumper's knee).

Knee pain comes on gradually if running, jumping and landing activities are practiced too much. Strain on the patella tendon becomes too great and microscopic damag develops in the tissue.

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What are the signs and symptoms of patella tendinopathy (Jumper's knee)?

Knee pain comes on gradually below knee cap. Activity makes the pain worse. Patella tendon is painful to touch and feels very stiff first thing in the morning.

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What is the suitable treatment for patella tendinopathy (Jumper's knee)?

NSAIDs (not appropriate). Ice for 20 mins every 2 hours. 3 months rest from sport (collagn tissue). Heat treatment. Pool running. Aprotinin injection. Eccentric strengthening exercises (e.g. single legged squats and double leg squats)

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What is the medical name for Runner's knee?

Patellofemoral syndrome (a.k.a. anterior knee pain)

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What are the symptoms of Runner's knee (patellofemoral syndrome)?

Generalised pain around the kneecap. History of dull, aching pain in the knee. Flexing the knee completely is painful. Slight swelling may exist. Decreased kneecap motion but full ROM.

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How does patellofemoral syndrome (Runner's knee) occur?

Patellofemoral maltracking and produces abnormal stresses on the under-surface of the patella that can cause knee cap pain.

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What is the appropriate treatment for Runner's knee?

Physical activities should be decreased by 30%. NSAIDS. Ice. Specific exercises to strengthen and rebalance the muscles about the knee. A knee sleeve, splint or taping. Special footwear or orthotics.

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Give examples of acute and chronic shoulder injuries.

Acute- dislocation. Chronic- rotator cuff injury/tendonitis.

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What are the major muscles of the shoulder?

Trapezius, deltoid, pectoralis, biceps and triceps.

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What are the bones in the shoulder?

Clavicle, scapula and humerus.

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What are the joints in the shoulder?

Glenohumeral, acromioclavicular and sternoclavicular.

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What are the four rotator cuff muscles?

Supraspinatus, infraspinatus, teres minor and subscapularis.

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How can glenohumeral joint dislocation occur?

Direct blow to the shoulder. Transmission of force up the arm (e.g. falling on out stretched hand)

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What is the proportion of shoulder dislocation injuries?

Anterior (external rotation and abduction, 90-95%). Posterior (internal rotation, convulsive or electro-shock, 5-10%). Inferior (abducted and internally rotated above head,

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What is shoulder reduction and briefly describe the process for shoulder reduction.

Shoulder reduction is the relocation of the shoulder after dislocation back into it's original place. For shoulder reduction: cease exercise, support arm, ice and go to A & E.

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What are the two phases of rehabilitation for shoulder dislocation?

Phase 1: Protective Phase (0-6 weeks). Phase 2: Functional Phase (6+ weeks)

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Explain the protective phase of shoulder dislocation rehabilitation.

0-6 weeks. Immobilised in a sling for 3-4 weeks. No overhead arm movement or sport for 6 weeks. Immobilising device worn in bed. Some active exercises in the pain-free range.

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What are the active exercises that should be used in the protective phase of rehabilitation for shoulder dislocation?

Grip strengthener (10 mins every couple of hours). Wrist and elbow bending and straightening (twice daily). The arm can be raised forward to 90 degrees and out to the side to 60 degrees. Isometric exercises used once out of sling.

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Explain the functional phase of shoulder dislocation rehabilitation.

6+ weeks. Continue strengthening and increasing ROM. Use resistance cord/band to strengthen internal/external rotator muscles. Self-assisted ROM exercises for the shoulder.

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Describe the chronic shoulder injury, rotator cuff tendonpathy/tendonitis.

Inflammation in 1 or more of the rotator cuff tendons. Most common in supraspinatus muscle. Overuse injury. Impingement syndrome (Primary, 75%). Shoulder instability (Secondary, 15%). Over-straining. Can lead to microscopic tears.

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What are the signs and symptoms of rotator cuff tendonpathy/tendonitis?

Shoulder pain, which increases during overhead activities. Shoulder weakness due to a loss of shoulder movement. Pain develops gradually and often disappears quickly (with heat or use of arm).

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What are the possible treatments for rotator cuff tendonpathy/tendonitis?

Ice (cryotherapy). NSAIDS and/or corticosteroid injection. Tears are best treated by surgical repair. Physiotherapy is often effective in treating acute inflammation and chronic degeneration of the cuff where a tear is not present.

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Describe the appropriate rehabilitation for rotator cuff tendonpathy/tendonitis?

Exercises to regain full movement. Carefully-graded strengthening and stabilising programme (resistance bands). Faults in sporting technique that may have caused the problem in the first place must also be rectified.

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Define doping.

(IOC) : The use of an expedient (substance or method) which is potentially harmful to athlete's health and/or capable of enhancing their performance or the presence in the athlete's body of a prohibited substance or evidence doping methods.

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Why do athletes take drugs? (Part 1)

Knowledge/belief that competitors are taking drugs. Determination to do anything possible to succeed. Direct/indirect pressure from coaches, parents and peers. Pressure from government and/or authorities themselves (Eastern block countries, 60s-90s)

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Why do athletes take drugs? (Part 2)

Lack of access to legal and natural methods to enhance performance (e.g. nutrition, psychology and recovery). Pressure and expectation from community and media to succeed and performance. Financial rewards.

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What does WADA stand for?

World Anti-Doping Agency

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Give examples of anabolic agents.

Androgens and testosterone.

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What are androgens?

Androgens are steroid hormones that are secreted primarily by the testes. (Including testosterone)

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What is testosterone responsible for?

The development of primary sexual characteristics.

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What are the effects of androgens on the person?

Contributes to increased height and skeletal muscle mass. Promotes agressive behaviour.

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In what sports are anabolic androgenic steroid (AAS) hormones more commonly used?

Weight lifting, power lifting, sprinting & throwing

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What is the outline of the procedure for drug testing in athletes?

1. Selection. 2. Notification. 3. Presenting for a drug test. 4. Sample collection. 5. Splitting, sealing and labelling of the sample. 6. Checking pH and concentration of sample. 7. Final paperwork.

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What is the medical ethics goal?

'To improve the quality of patient care by identifying, analysing and attempting to resolve the ethical problems that arise in the practices of clinical medicine.'

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What are contentious areas in medical ethics?

1. Conflict of interest. 2. Confidentiality. 3. Performance-enhancing drugs. 4. Infectious diseases. 5. Ethics in sport.

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