ON-FIELD PHYSIOTHERAPY
CONTENTS
 Roles
of on-field physiotherapist
 Basic assessment procedures
 Prevention and assessment of heat & cold
injuries
 Management of acute soft tissue injuries
Why we need
on field
physiotherapy?
ON FIELD
PHYSIOTHERAPIST
 Roles
On-field services in
Hong Kong
 Team Physiotherapist
 Domestic, National
and International
Level

ON-FIELD PHYSIOTHERAPY
SERVICES
 1996
International Masters Hockey
Tournament
 1996 Seoul International Women’s Road
relay
 Hong Kong Cricket team - Bangladesh
Cricket Tournament
 Standard Chartered Shenzen - Hong Kong
Marathon
 Swire
Group Tsing Ma Bridge 10 km and
Marathon
 Hong Kong - Beijing Relay
 Standard Chartered International
Marathon (1997-2002)
Sports Physiotherapy in Elite level
 SDB,
5 full time physiotherapists
 Hong Kong Team physiotherapists
 1987 Asian Athletic Championship
 1992 Barcelona Olympics, 1994
Commonwealth and Asian Games, 1996
Altanta Olympics (3)
 2002 Busan Asian Games: 8
physiotherapists
KNOW THE
SPORT
ON FIELD
SERVICES
KNOW THE
VENUE
PREPARATION
 Deployment
 Equipment
of manpower
Types of injury
Cases
Muscle soreness/strain
175
Ligamentous sprain
112
Tendonitis
44
Joint problems
41
Contusion
42
Laceration
7
Haematoma
3
Concussion
1
Others
6
Types of services
Number
IFT
44
US
158
TENS
34
HVG
7
ICE
98
Manual technique
210
Massage
211
Strapping and taping
70
Dressing
13
Education and advice
85
ON-FIELD MANAGEMENT
ASSESSMENT
VENUE
PERSON
PROCEDURES
SYSTEMATIC APPROACH

Scene Survey

Is the scene safe?
It
is frequently better to
remain uncertain about a
diagnosis and feel mildly
folish than to be constantly
certain and confirm that you
are an absolute fool.
PRIMARY SURVEY
OF THE PATIENT
LOC
Talk to the patient and assess
his level of consciousness
A Alert
V Response to vocal stimuli
P Response to pain
U Unresponsive
AIRWAY + C-SPINE CONTROL




Is the victim able to maintain his
airway
If he can talk, the airway is OK
Open airway by jaw thrust if
necessary
Do not use head tilt as this may
affect the C-spine
BREATHING

Assess if victim is breathing
adequately. Is it too fast? too slow?
too shallow?

Oxygen, if available, should be given
if breathing is laboured.

Feel for any tenderness
BREATHING

Auscultate the chest for unequal
air entry

Check if the trachea is central
CIRCULATION
Arrest any visible haemorrhage using direct
pressure
Check both carotid and radial pulse
If radial pulse is weak or not palpable, the
patient is probably in shock
Capillary refill is less than 2 second normally
CIRCULATION
If the patient is unresponsive and with
no carotid pulse==> this is cardiac
arrest. you should start
cardiopulmonary resuscitation
immediately
DECISION POINT :
SEND FOR THE AMBULANCE
IMMEDIATELY
Impaired
conscious state
Airway obstruction
Breathing difficulties
Significant external bleeding especially
when control by external pressure is
ineffective
DECISION POINT :
SEND FOR THE AMBULANCE
IMMEDIATELY
feature
of shock: thready pulse, cold
clammy hands, delayed capillary refill
unstable pelvis
major fracture of limb bones
CARDIOPULMONARY
ARREST
PROBABLE
CAUSES:
HEAD TRAUMA
Cx INJURY
MAXILOFACIAL OR THORACIC
TRAUMA
CVA
MYOCARDIAL INFARCTION
HAEMORRHAGE
 INTERNAL: COLD
 RAPID
PULSE AND RESPIRATION
 PALPABLE PAIN AND TENDERNESS
 RESTLESSNESS
 EXCESSIVE THIRST
 BLOOD IN THE URINE OR STOOL
 OBSERVE FOR SHOCK OR ARREST
HAEMORRHAGE
External
 Direct Pressure
 Arterial Pressure Pt. Compression
 Area should be elevated
SECONDARY ASSESSMENT
 Chief
Complaints
 Behaviour of symptoms
 Location & radiation of the symptoms
 Mode of onset
 Mechanism of injury
 Functional alterations
 Related symptoms
 Past injuries
LOOK AND PALPATION
 Location
of Pain
 Degree & type of swelling
 Temperature & texture of the area
 Muscle spasm
 Tissue continuity & deformity
 Neuromuscular function
 Abnormal Motion or sensation
MOVEMENT
 Active
& Functional Motions
 Resistive Motion
 Specific Stress Test
 Sport Specific Function
 Return to activity
HEAT INJURY
Metabolic Heat Stress
Metabolic heat production
Exercise
Shivering
Thryoxine
Sympathetic stimulation
Exercise 20-25x
25% efficiency
Heat Production
Heat Balance
Radiation
Conduction
Convection
Evaporation
Heat loss
WBGT
0.1: 0.7: 0.2
CONVECTION
 Responsible
for transferring heat from
working muscles and the skin surface
 Temp differential between skin and
environment
 Heat transfer coefficient, body surface
area and wind velocity
 Minimal body fat and loose-fitting clothing
CONDUCTION
Minimal
effect on body heat transfer
Direct contact between skin and an
object
RADIATION
Solar
radiation and radiation from
tracks, roads, and surrounding
structures
Can be a major contributor to heat
load
EVAPORATION
Most
important heat dissipation
mechanism in warm environments
Sweating – a fit athlete can produce
up to 30 ml of sweat per min
Evaporation depends evaporative heat
transfer coefficient – air velocity and
water vapor pressure gradient
(relative humidity)
WBGT
Wet
Bulb Globe Temperature
Three monitors:
Dry bulb (Tdb)  air temperature
Wet bulb (Twb)  relative humidity
Black globe (Tg)  solar radiation
WBGT = 0.1Tdb + 0.7Twb + 0.2Tg
Without adaptive mechanisms, moderate exercise
could elevate temp by 1C every 5-6’
Fluid/electrolyte
Loss of
solutions
Sodium andadded
Prevention:
Potassium
salt
to food, high
K+ diet
HEAT INJURY
Heat Cramp
Warm, humid
conditions,
inadequate
Cool fluids
fluid
pre-hydrate
replacement
Dehydration
Red, Hot and Dry skin
Heat exhaustion
Strong & Rapid pulse
LackMedical
of sweating, CNS
symptoms
unsteady
Emergency
!! gait
Heat Stroke
confusion, combative
behaviour, coma
Profuse Sweating
Clammy & Cool
Shading
Skin
remove
excess
Headache
&cloth
cooling
with ice,
Weakness
sponges
Nausea &
hydration
Weakness
monitor
Rapid vital
Pulsesign
&
hospital
Disorientation
PREVENTION
 Conditioning
 sweat rate
 Acclimatization
3-4
Thirst:
hrs/day,
poor
indicator
60-70% load

core
temperature
Intake: 400-600 ml 15-20’
5-10
days volume
 Fluid replacement 2-3%;

plasma
200-300 ml every 15-20’
exercise
heat storage
 Venue and schedule intense
3L/hr
Every L loss,  0.3 C
Q  1L/min
HR  8
CHILDREN AND HEAT
INJURY






Sweat less effectively;
produce  metabolic heat
for given workload;
acclimatize more slowly
than adults;
larger M/A;
 renal tubular filtration
rate;
self perceive;
BUT HOW ABOUT COLD
INJURY?
 Heat
loss also depends on air movement,
humidity, evaporation (sweating) and
ambient temperature
 Wind velocity exacerbates heat losses
Adequate clothing
High energy bar
Avoid wind
exposure
Medical
Emergency !!
Mild
Hypothermina
Moderate
Hypothermia
Severe
Hypothermia
Shivering, cold,
hunger
Confusion
muscle spasm
Slow pace
Semi-conscious
confused actions
Extremely tired
Poor coordination
Muscle stiffness
Slurred speech
Disorientation
Loss of consciousness
Faint heartbeat
Acute Sports Injuries
Treatment that comes with
PRICE!
MANAGEMENT OF ACUTE
SOFT TISSUE INJURIES
PRICE
HARM