1 Krysten Sinclair YR 12 PD/H/PE- Sports Medicine When classified according to the cause of the injury or mechanism involved, the

following groupings are generally used: Direct or indirect injuries Overuse injuries Soft or hard tissue injuries

Direct Injuries- Any new injury is referred to as a primary injury. The most common are caused
by an external force applied to the body are known as direct injuries. Can be caused by a collision with another person or being struck with an object. Eg. Haematomas (corks) and bruises, joint and ligament damage, dislocations and bone fractures. Indirect Injuries- are caused by intrinsic forces within the individual sportsperson. Intrinsic force applied (without external force). These occur due to internal forces which occur without physical contact as the body builds up excess forces within the muscles, tendons and joints caused by overstretching a muscle beyond its flexibility range, poor technique, fatigue and lack of fitness. Its fair to say that these injuries could be avoided if individuals were fitter. The result involves: A muscle and tendon strains or tears when a muscle is stretched and/or contracted with excessive force Joint injuries and ligament sprains when motion is poorly controlled often in twisting and turning movements Overuse Injuries- Can result from Incorrect Technique- could put over excessive stress on a muscle, causing it to tear Poor equipment or footwear- heightens the risk of injury to eg. Ankles, knees Postural abnormality- may cause a muscle to overcompensate for another Surface- An uneven surface can lead to injury because of the body having to compensate for the lack of consistency with the surface Overtraining- muscles not having the time to recover leads to a greater risk of an acute injury. Also, if there is a change in the frequency or intensity of training. Can result in muscular injuries and tendonitis, wear and tear injuries, joint injuries, stress injuries, chronic fatigue. Little or no pain might be experienced in the early stages and the athlete might continue to place pressure on the injured site- thus not allowing it the necessary time to heal. This damage accumulates, and the injured site becomes inflamed, and therefore painful. Overuse injuries in children may occur at the part of the bone where growth occurs. This growth area, called the epiphysial plate, represents a region of cartilage lodged between the shaft and ends of the bone. Bone growth depends on its blood supply. If blood supply is affected, then growth can be hampered. Injuries to this plate are accompanied by initial pain during and after exercise. There needs to be sufficient time for the recovery of muscular and skeletal systems in training programs. All new schedules, techniques or equipment should be introduced gradually to allow adaptation. Eat a balanced diet to sustain energy and rest.

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Injury Shin soreness

Knee Pain

Shoulder pain

Signs/Symptoms Tenderness Pain in shins that increases by running Swelling Pain around knee that increases by sport, stairs, sitting Swelling Discolouration Pain on certain moves Reduced movement Local tenderness

Possible Causes Poor footwear Postural imbalance Muscle imbalance Increased activity Postural imbalance Poor footwear Muscle imbalance Increased activity Poor technique

Management Decrease painful activity RICER Physio Correct footwear Decrease activity RICER Physio Tape Correct footwear Decrease activity RICER Physio Stretching program Exercises Modify activity

CLASSIFICATION ACCORDING TO TISSUE TYPE

Injuries to the soft tissues (muscles, tendons, ligaments, skin) and hard tissue injuries (fractures and dislocations) are an inherent problem when participating in sport. Soft Tissue Injuries- The skin, muscles, ligaments and tendons are the soft tissues most commonly injured in sport/performance activities. Other soft tissues, such as those contained within the abdomen, brain, lungs and genitals are also vulnerable in certain activities, but are less frequent. They include: Skin injuries- lacerations, abrasions, contusions, burns and blisters Muscle injuries- tears or strains of muscle fibres and contusions Tendon injuries- tears or strains of tendon fibres and inflammation (tendonitis) and Ligament injuries- sprains and tears of ligament fibres Soft tissue injuries may result in internal bleeding and swelling around the injured site. The longer and greater this bleeding and swelling is the longer it will take to recover from the injury. There are three types of soft tissue injuries: Acute- these injuries occur suddenly from a known or unknown incident. E.g. a black eye from an elbow to the eye socket Overuse- these occur due to repeated activities over a period of time. They take a number of weeks or months to develop. E.g. a sore elbow following an extensive tennis practice and play. Chronic- these injuries continue to be a pain for an extended period of time (6 months or longer). It may be due to the fact that rehabilitation was not complete and there is still a weakness in the area. E.g. a chronic ankle sprain which is evident in ankle weakness. Internal soft tissue injuries Sprains- an injury to issues (ligaments) that hold bones together at a joint. This occurs when a ligament is stretched beyond its normal movement. There is usually swelling and the athlete feels pain. The joint is difficult to move due to discomfort and bruising follows. It is important for a first aider to try and determine if a fracture or dislocation has occurred. Strains- an injury to a muscle or tendon caused by movement, resulting due to the tendon or muscle being stretched beyond its normal range of motion. It could be a partial or complete tear. Bruises (contusions)- Damage to the blood vessels below the skin. Caused by a blow or impact. The skin is not broken and no injury may be immediately apparent. Swelling and

Krysten Sinclair

3 Krysten Sinclair YR 12 bruising may appear within 24-28 hours and pain increases. The contusion can damage any soft tissue injuries- muscles, skin or fat and may also damage the outer layer of bones (severe contusions). Sprains, strains and contusions are examples of acute soft tissue injuries. Ligaments (a fibrous band joining one bone to another) and tendons (attaches a muscle to a bone) function to stabilise muscles and bones around joints. Muscle injuries- direct blows or forces generated within the muscle can result in injury. More often than not, fibres are torn along with connective tissue and blood vessels. Strains are the most common muscle injury. Depending on severity, the signs and symptoms include: Pain on contraction and swelling Decreased function Tenderness Swelling Spasms Bruising Loss of continuity (if muscle is completely ruptured) Tendons join muscles to bone. They consist of parallel bundles of fibres. Tears in tendons occur when coordination is impaired by fatigue or poor skill. Tendons that are subjected to violent and repetitive stresses are more likely to tear. Most common are Achilles tendon, tendons in the shoulder and forearm, tendons in the thigh muscles. Ligament injuries- when stresses are applied to the joint beyond its normal range of movement, the ligament may be abnormally extended resulting in tears to some of the fibres. The damage is referred to as a sprain. Skin abrasions- occur when a player falls and scrapes skin across rough ground/surface of another object. The skin is grazed and broken, but there is not a tear to its full depth. Lacerations- are much deeper injuries than skin abrasions. They involve a deep tear of skin that exposes underlying skin tissue. The shape of the tear will be determined by what type of cut (straight, jagged or a puncture wound). The depth and location will determine whether suturing is required. Medical attention is required if the laceration is deep enough to expose fat, tendons or bone. Sometimes a superficial laceration will require suturing, in the case of: The laceration is located over a joint because flexion will continually open the wound. The laceration is located in a cosmetically sensitive position (the face) Callus- forms in areas that undergo continual friction. The skin around the callus becomes tough and inflexible, which causes further discomfort. It is important to try and stop callus formation using a pumice stone so that they do not contribute to further skin damage.

Inflammatory response- This is the bodys natural response that occurs immediately
following tissue damage. The immediate response of the body is to increase the flow of blood and other fluids to the site. Its main functions are to defend the body against harmful substances, dispose of dead or dying tissue and to promote the renewal of normal tissue. If blood vessels at the injured site are damaged there will also be direct bleeding into the surrounding tissue. The accumulation of fluid into the area causes an increase in tissue pressure which provides pain. This acute inflammatory phase goes for 24-72 hours after injury. The inflammatory reaction is normally characterised by 5 distinct signs, each of which is due to a physiological response to issue injury: 1. Pain (due to chemicals released by damaged cells) 2. Swelling or edema (due to an influx of fluid into the damaged region) 3. Reddness (due to vasodilatation- the widening of blood vessels) 4. Heat (due to an increase in blood flow to the area)

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4 Krysten Sinclair YR 12 5. Loss of function (due to increased swelling and pain)

MANAGEMENT OF SOFT TISSUE INJURIES

This is largely concerned with decreasing the area of tissue damage, keeping rehabilitation short and enabling the athlete to make a complete recovery so that they can return to sport.

Immediate treatment of skin injuries- The aim is to:

Prevent infection for both victim and first aider Minimise the blood loss and tissue damage Promote healing in order to reduce recovery time Danger- reduce the dangers of infection- wear gloves, clean hands. Also, stop play. Bleeding- control bleeding by sitting patient down, making them comfortable and remember REST, PRESSURE, ELEVATION. This will reduce the amount of bleeding. Elevation of the wound above the heart. Asses- the severity of the wound Clean- the wound using clean water, saline solution, diluted antiseptic. Anything embedded in the wound should be cleaned out. Do not remove any objects deeply embedded. Padding should be placed around these until the patient can be seen by a doctor. Apply- an antiseptic to the wound (salvon, betadine) Dress- the wound with a sterile pad and bandage. Put ice on the wound to decrease blood flow. Refer- to medical attention if necessary Skin injuries that should be referred to medical attention include wounds that require stitching, that show signs of infection that cannot be properly cleaned and head wounds. Treatment of Blisters No pressure should be applied because there is already a build-up of pressure under the skin of the blister. The blister and the area around it should be cleaned and the blister should be pierced with a sterile needle. Draining the fluid relieves the pressure inside the area. Do not remove the skin, but apply a dressing.

RICER- The most important aspect of soft tissue injury management

R- Rest the athlete. Continued activity will increase circulation of blood to the injured site and we want to reduce the flow of blood. I- Ice the area with a cold pack so that the blood vessels in the area will be constricted. This will reduce the flow of blood. This will reduce the bleeding and swelling. Do not apply the ice directly to the skin C- Compression will constrict the blood vessels in the injured area. This is usually done by applying a bandage. Reduces bleeding and swelling. E- Elevation will result in reduced blood flow to the injured area. We do this by lifting it above the level of the heart if possible. Again this will help bleeding and swelling in that area R- Refer an injury that requires this management because it will be serious enough to need some supervision during recovery. Should be referred to a suitable professional. During the first 48-72 hours, application of heat (hot liniments, spa, sauna, hot bath), drinking alcohol, physical activity and massage should be avoided as they all increase blood flow- and therefore swelling.

HARD TISSUE INJURIES

Hard tissue injuries are injuries to the bones eg. Bruises to the bone, displacement or dislocation. Bruising to bone (periostitis) tissue results from a lack of padding and blood accumulates between the outer lining of the bone and the underlying compact bone.

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Fractures are break/s in the bone resulting from a direct (from a play or piece of equipment) or
indirect (landing from a great height) force or repetitive smaller impacts (as occurs in a stress fracture). If the skin over the fracture is intact, it is described as simple or closed. If the skin is open, the fracture is open or compound. A complicated fracture is if nearby tissues and organs are damaged Signs and symptoms of a fracture: Pain at the site Inability to move the injured part or unnatural movement Deformity Swelling and discolouration Grating of bones Dislocations are injuries to joints where one bone is displaced from another, also causing considerable damage to the surrounding connective tissue. When the bones are only partially displaced it is called a sublaxation. They occur as a result of the joint being pushed past its normal range of movement. Signs and symptoms include: Loss of movement at the joint Obvious deformity Swelling and tenderness Pain at injured site

S-T-O-P Procedure (quick injury assessment)

Assessing quickly on-field whether or not an injury is a fracture requires the following: S-STOP- Stop play, clear the area and give space to victim and first aider T-TALK- Ask the victim where the pain is, keep them alert to stop from going into shock and talk in a calming voice O-OBSERVE- Observe their behaviour (vitals): breathing, heartbeat, colouring P-PREVENT- Prevent further damage to the limb by ceasing any unnecessary movement and clean any open wounds to prevent infection. (Insert summary from school here) Part Injured Head/Neck How it happened Blow to head Collision or fall Signs & Symptoms (H)Unconsciousness, drowsiness, double vision (N)Pain/tenderness, inability to move limbs Pain and swelling Deformity Bleeding, loose or separated tooth Pain, swelling, deformity, inability to perform movements Pain, swelling, deformity, inability to perform natural movements Pain, swelling, What to do Get medical assistance Try not to move the athlete if possible

Face Teeth

Direct hit or force Direct hit or force

Shoulder

Direct or indirect force

Arm

Direct or indirect force

RICER Get medical assistance Cleanse broken tooth in milk and replace if possible. Dentist RICER, Support injured arm in a sling, get medical assistance Apply splints, support forearm, RICER, get medical assistance Budding taping, RICER,

Fingers

Direct hit or force Krysten Sinclair

6 Krysten Sinclair YR 12 deformity, cannot bend finger Pain, restricted movements Pain, bruising, deformity, cannot perform natural movements Pain, bruising, loss of movement, swelling get medical assistance Remove from play, get medical assistance Apply splints, RICER, crutches, get medical assistance (LL)Apply splints, (BOTH) RICER, Crutches, medical help

Back Thigh

Direct trauma Direct or indirect force

Knee/Lower leg

Direct or indirect force

ASSESSMENT OF INJURIES
If an athlete is unconscious, use DRABC. If athlete is conscious, use TOTAPS, which will give you information about the extent of the injury, and will indicate whether the person should be allowed to continue playing or given to professional help. T-Talk- Talk and ask the player to gather information about the cause, nature and site of the injury: How did the injury happen? Where does it hurt? Did you hear any snaps or cracks? Is pain sharp or dull For concussion, questions should be direct at discovering the players alertness and level of consciousness. If shown signs of serious spinal injury, the person should be immobilised and seek professional help. Also ask for previous injury history and talk to witnesses. O-Observe- Visually examine the injury. Look for deformity, swelling and redness. If the injury is a limb, compare it to the other. If there are any obvious signs of deformity, there is likely to be a fracture or serious ligament/tendon damage, and medical help is needed. If there is no deformity, move to the next stage. T-Touch- Feel the site of the injury without moving it. Compare both limbs by touch. Note any differences in bone shape and skin temperature. If touching the injury causes the player intense, the injury could be more serious. If it only causes slight pain, move to next stage. If there is evidence of a fracture if dislocation, the procedure stops here. A-Active Movement- Ask to move the injured part. Observe the degree of pain and the extent of movement that is achieved. Compare with other limb. As the person moves, feel the injured site for any clicking or grating. If injured site cannot be moved or only has a minimal range of movement, use RICER. If casualty can move without intense discomfort, proceed to next stage. P-Passive Movement- If this stage is reached, the injury might not be serious. The first aider moves the athletes injured part and determines how much pain-free movement is possible. If this cannot be done, use RICER. If range of movement is normal, ask to stand. S- Skills Test- If the player can stand, have the person put pressure on the injured site by performing movements similar to what is required in their game. If this can be done, athlete can return to play.

Krysten Sinclair