WAYS TO CLASSIFY SPORTS INJURIES
Injuries are generally classified according to the cause of the injury or the way it occurred.
e.g. Direct/Indirect
Other classifications can be used such as the type of tissue damaged in the injury.
e.g. Hard Tissue/Soft Tissue

DIRECT
Caused by external forces to the body
Injury occurs at the site of the force
Can result in fractures, dislocations, sprains and bruises.
Examples include:
– A cricketer catching the ball and getting a dislocated finger
– A footballer hit high and gets a broken cheekbone
INDIRECT
Can be caused by internal or external forces and usually results in an injury occurring at a site away from the intial force
Can occur as a result of poor preparation or excessive movement.
Can occur because of undue strain on muscles, tendons or ligaments and can cause irritation and possible structure damage.
Examples include.:
– Cyclist falls, puts out his hand and dislocates shoulder
– Netballer tears ligaments from twisting

SOFT TISSUE
This includes:
– Muscles
– Tendons
– Ligaments
– Joint tissue
– Fatty tissue
Any injury to these are classified as soft tissue injuries
Types of soft tissue injuries include:
– Bruises (haematoma)
– Sprains (ligaments)
– Strains (tendons)
– Lacerations (skin)
– Dislocations (joints)
– Tendonitis (tendons)
HARD TISSUE
Hard tissue includes:
– Teeth
– Bones
Any injuries to these are classified as hard tissue injuries.

OVERUSE
• Caused by excessive use over a long period of time.
• Brought on by repetitive low impact exercise such as jogging or swimming.
• Causes include poor training techniques, high intensity too soon, poor surfaces, inappropriate equipment and physical characteristics (flat feet, etc).
• Injuries characterized by pain and inflammation.
Common overuse injuries include:
Shin splints
Tendonitis
Stress fractures
Commonly called Repetitive Strain Injuries (RSI

Tears (Strains): a disruption of the fibres of muscle or tendon. Occurs when the muscle/tendon is overstretched or the muscle contracted too quickly
Sprains: a stretching or tearing of the ligament fibres, muscles or tendons supporting a joint. Occurs when a joint is extended beyond its range of movement.
Strains and Sprains can be classified according to severity
Grade 1 being the least serious up to Grade 3 being the most serious
Contusions: a bruise (bleeding) into the soft tissue.
Generally caused by contact with a solid (usually blunt) object.

Skin abrasions: occur when the outer layer of the skin is removed, usually a scraping action.
Lacerations: a cut, which will usually require stitches, depending on the depth of the cut. This is usually caused by a sharp object.
Blisters: occur because of friction, which causes a pocket of fluid to form under the skin
Calluses: when a build-up of dead skin forms at a site where constant friction has occurred.

This is the initial stage of repair involving the first 48-72 hrs after the injury as the body increases blood flow to the injured site.

Phase 1 –
Inflammatory stage:
Phase 2 – Repair stage (3 days to six weeks)
Redness
Heat
Swelling
Pain
Loss of function
Eliminate debris
Form new fibres
Produce scar tissue
Phase 3 –
Remodelling stage
(6 weeks to months) development of scar tissue tissue needs to strengthen in the direction force is applied dependant on amount of exercise and rehab routine aim to regain full function

RICER (Rest, Ice, Compression, Elevation, Referral)
Rest: minimal movement for the first 48-72 hrs
Ice: causes blood vessels to constrict to decrease blood flow. Apply for 20-30 mins every 2 hrs for 48-72 hrs.
Compression: ice should be firmly applied in a wide elastic bandage. This reduces swelling and provides support.
Elevation: ensure the injury site is elevated above the heart. This reduces the volume and pressure of blood flow to the injury and reduces swelling.
Referral: a medical assessment should be sought ASAP to as ascertain the full extent of the injury.
See Table 11.1 pg 410 of outcomes

MUSCLES/TENDONS/LIGAMENTS
ALWAYS THINK
RECOGNITION OF INJURY AND
APPROPRIATE MANAGEMENT- ACUTE –
CHRONIC?
USE:
R - REST
I – ICE
C – COMPRESSION
E – ELEVATION
R – REFERRAL
STRAINS/SPRAINS

DEFINITELY NO:
H – HEAT
A – ALCOHOL / ASPIRIN
R – RUNNING (exercise)
M – MASSAGE
IN THE FIRST 24 – 72 HOURS OR
LONGER

The knee.
A minefield to diagnose.
Leave it to the experts!

Where would you not apply ice to a soft tissue injury?

The immediate response aims to:
– Prevent further damage and reduce the risk of infection
– Reduce swelling
– Erase or minimise pain
– Restore flexibility
– Regain full function
– Prevent reoccurrence.
For abrasions/lacerations:
– Stop bleeding if necessary and clean the wound where possible
– Apply non stick sterile dressing
– Seek stitches if necessary
For burns:
– Immediately apply cold running water
– No ice or creams
– Keep clean and sterile
– Seek medical advice

It is a break in a bone, which can be as simple as a small crack with no visible deformity, or complex, in that it may affect vital organs close to the fracture site.

Common causes include:
Direct contact with:
Others
Objects
The ground
Indirect force on another body part (falling and landing on arm; fractured clavicle)
Inappropriate muscular action (jumping from a height, landing on feet; fractured patella)
Overuse, repeated trauma (running; stress fracture in foot)

Simple/Closed: the bone is fractured but there is no wound at the site.
Open/compound: the jagged end of a fractured bone protrudes through the skin.
Complicated: the fractured bone damages local tissues, i.e. organs

Pain
Reduced/no movement
Local tenderness
Deformity
Irregular alignment
Swelling

It is where one bone is displaced from another
Signs and symptoms may include:
Loss of movement at the joint
Obvious deformity
Swelling and tenderness
Pain at the injury site
Subluxation: a partial dislocation where the joint dislocates and then relocates.

DAMAGE TO
ALWAYS THINK
DAMAGE
SOFT TISSUES
NERVES
BLOOD VESSELS
MINIMAL MOVEMENT - IMMOBILISE.
TRANSPORT - AMBULANCE IN ALL
CASES OF MAJOR FRACTURE OR
DISLOCATION.

IS

GREAT CARE!

IMMOBILISATION?

ICE - SUPPORT - TRANSPORT

IMMOBILISATION
To another limb
To another part of the body
To a firm, smooth, straight object
Splint above the joint above the fracture and below the joint below the fracture

MEDICAL TREATMENT
Support the site with a sling or splint
Check for impaired circulation
Arrange for transport
Implement RICER if it does not cause pain.
NEVER ATTEMPT TO REDUCE/RELOCATE A
DISLOCATION!
DO NOT ATTEMPT TO RE-ALIGN FRACTURED
LIMBS!
SEEK MEDICAL ATTENTION!
Complete application pg 413

!
D.R.A.B.C.D.
T.O.T.A.P.S.

TOTAPS (Talk, Observe, Touch, Active movement, Passive movement, Skills)
Talk: talk and find out exactly what happened. This will provide valuable info about the nature of the injury.
Observe: look at the injury site and see if there are any signs of obvious deformity. Compare opposite sides of the body.
Touch: gently feel the areas for any sign of deformity or swelling and try to pinpoint the area of pain.
Active movement: ask the player to perform a range of movements such as flexion, extension and rotation. If these can be done without pain, proceed.
Passive movement: physically mobilize the joint as far or further than the patient did actively, aiming to identify painful areas and any instability
Skills test: ask the player to perform a range of skills necessary for participation in the game, i.e. sidestep.
CLICK FOR ROLE PLAY ACTIVITY SCENERIOS

ALWAYS THINK
DO NOT ATTEMPT TO REMOVE A
PLAYER FROM THE FIELD WHO:
IS UNCONSCIOUS.
HAS A SUSPECTED SPINAL INJURY.
HAS A MAJOR DISLOCATION/FRACTURE.
HAS A SUSPECTED INTERNAL INJURY.
HAS AN INJURY OR CONDITION THAT
COULD BE SERIOUSLY WORSENED BY
MOVEMENT.

ALWAYS ENSURE AN AMBULANCE IS CALLED IN
THE ABOVE SITUATIONS – OR IF IN DOUBT –
PROTOCOL?
CONSIDER: ALL CONDITIONS MUST BE
MANAGED BY THE FIRST AID OFFICER UNTIL THE
AMBULANCE RESPONDS.
THIS WILL DEPEND UPON LOCATION.
ISOLATED AREAS – DISTANCE.
AVAILABILITY OF AN AMBULANCE.
TIME IS AN IMPORTANT FACTOR!
– YOU WILL BE OF GREAT ASSISTANCE TO THE FAO!!

Assessment can be stopped at any stage if the player cannot proceed or if danger is apparent.
If the player can perform to the satisfaction of the assessor, the player can return to the game.
If there is risk of further damage through continued play, remove the player from the game

MEDICAL CONDITIONS (ASTHMA,
DIABETES, EPILEPSY)
People with asthma have extrasensitive airways.
Triggers like dust, pollens, animals, smoke and exercise may cause the airways to swell and narrow.
This leads to wheezing, coughing and difficulty breathing.

Steps to follow in case of asthma attack:
Sit the person comfortably upright. Stay calm and reassuring.
Give 4 puffs of a blue reliever puffer/inhaler. These are best given through a spacer. Give one puff every 4 breaths for 4 puffs, holding the breath for 2-4 seconds after a puff.
Wait 4 minutes. If there is no improvement, give another 4 puffs.
If little or no improvement, call an ambulance (000)

Some activities provoke an asthma attack more than others – there is significant risk with running, some risk with cycling and little risk with swimming. There is far less risk swimming in warm water.

It is generally agreed that exercise is of more benefit than no exercise at all, even if it leads to an attack.

It is a complex hereditary or developmental disease where the supply of insulin is reduced or eliminated.

Type 1 diabetes is usually hereditary and the pancreas does NOT produce insulin at all. It is treated with injected insulin.
Type 2 diabetes is usually developmental and is usually the result of a sedentary lifestyle and poor nutrition. Obesity is a significant determinant for type 2. It is treated with a managed diet and lifestyle adjustments.

Hypo-glycemia
Low glucose levels.
Mild cases cause:
– Dizziness
– Weakness
– Disorientation
Severe cases can lead to:
– Convulsions
– Unconsciousness
– Brain damage
A hypo is generally a blood sugar level below 3.0
Hypo food:
– Cordial/fizzy drink
– Jelly beans
– Juice
Hyper-glycemia
High glucose levels
Sufferers will be:
– Lethargic
– Thirsty
– Strong thirst
Can result in damage to:
– Eyes
– Kidney
– Nerves
If left untraced, can cause a coma or death.
Occurs as a result of too little insulin.
Requires an injection of insulin and a doctor’s visit.
A hyper is generally a blood sugar level of over
10.0

Exercise is seen as an important part of the management of diabetes.
It is important that insulin levels are balanced by either injection, food intake or exercise. Diet needs to be well balanced, with complex carbohydrates forming a significant portion
Because exercise utilizes sugar, diabetics need a pre-game meal to raise blood sugar levels and hourly glucose supplements if exercise is prolonged.

Increase intensity and duration gradually
Undertake exercise regularly
Allow for adequate warm-up and cool-down
Always have a supply of hypo food
Constantly maintain blood sugar levels

Epilepsy is a brain disorder characterized by recurring seizures and fits. Seizures are caused by sudden flurries of electrochemical activity in the brain, which disrupts the conversation between neurons.

Some people falsely believe that exercise will trigger a seizure, but this is not the case.
Some anti-epileptic drugs (AED’s) cause fatigue, or problems with concentration, vision or coordination.

Extreme fatigue
Lack of sleep
Dehydration
Electrolyte loss
Hyperthermia
Hypo-glycaemia

Consult with doctor/specialist regularly
Avoid known seizure triggers
Ensure you keep an adequate supply of medication
Alert your teammates to your condition
Wear a medical bracelet
Wear protective equipment
Avoid contact sports, scuba diving, bungee jumping and boxing
Avoid high altitudes
Let people know of your walking routes

Overuse injuries in children are created by the same factors as for adults.
– excessive training
– repetitive movements
– incorrect training techniques
Most overuse injuries in children occur in the lower limbs.

Achilles tendonitis: the tendons that connect the heel bone to the calf muscle become inflamed.
Plantar fasciitis: the tissue that runs along the arch of the foot becomes inflamed.
Stress fractures: repetitive pounding on foot and anklebone causes hairline fractures.
Tendo-achilles bursitis: the fluid-filled sac between the Achilles tendon and the heel bone becomes inflames.

Be knowledgeable about overuse injuries
Use the right shoes
Manage training and competition loads
Avoid repetitive movements
Be sure the level of competition is within the child’s range.

IMMEDIATE REST 4-8WEEKS
FREQUENT USE OF ICE
POSSIBLE USE OF ANTI-INFLAMATORY
MEDICATION
MAINTAIN PHYSICAL CONDITIONparticipate in activities that don’t involve the injured part in pounding movementse.g.swimming
Use exercises & corrective devices that improve body mechanics if caused by biomechanical factors

A young athlete’s temp. regulation system is not as developed as adults.
They:
– Produce more heat when exercising
– Have less perception of the need for rest and hydration
– Have less blood volume
– Have smaller sweat glands
– Lower hemoglobin concentration
– Lower cardiac output
– Acclimatize slower.

Consider weather conditions when scheduling training and games
Encourage appropriate clothing
Incorporate water breaks and encourage around-the-clock hydration
Be aware of warning signs of heat stress

Most sporting codes match young athletes according to age, and sometimes skill level, strength, size, etc.

Advantages of matching by age
-Equal experience
-Mental maturity
-Equal skill
-Playing with peers
-Convenience
-Avoids health risks
Disadvantages of matching by age
-Differences in:
-Size
-Weight strength
-Self-esteem issues

Resistance training for adolescents usually focuses on their own body weight. There are safe and widely known exercises that can be used.
(push ups, bridges, sit ups).

This depends on:
The child’s training base
Ability to learn new techniques
Their stage of growth
Equipment available
Quality of supervision
What type of training best suits

Correct breathing and safe lifting techniques
Appropriate warm up and cool down
Progressive overload, but progress should be conservative
Balance between muscle groups
Low resistance with high reps; no max lifts
Supervision
Should not be competitive & strength specialisation should be avoided

As people age:
Blood vessels lose elasticity
Blood pressure rises
The heart may weaken
Maximum stroke volume decreases.

Some aged athletes may have heart attacks or heart-related problems
Pre-screening is essential and work intensity needs to be lower
Regular aerobic exercise can maintain or lower the loss of cardiovascular functioning
Progress must be gradual
Activity needs to be of moderate intensity

Loss of bone density begins around 35 yrs of age.
Regular aerobic and weight-bearing activities can reduce this loss.
Osteoporosis sufferers should avoid activities, which involve a risk of falling, with focus on aerobic, low impact and safety with pain-free movement.
Resistance training helps bone density

Joint pain, arthritis and tight muscles make flexibility training difficult.
Regular, gentle flexibility exercises are essential.
Stretch to strain, not pain.
An increase in flexibility reduces injuries, reduces likelihood of falls and increases mobility

The following issues affect women and girls participation in sport.
Sports trainers and coaches needs to be aware of how these issues impact on the females they coach.
SPECIAL DIETARY NEEDS-increased iron & calcium requirements

Anorexia Nervosa
– Lack of nutrients in the blood
– Degeneration of muscle mass
– Characterized by selfstarvation and is potentially lifethreatening
– Mainly affects teen females
– They may exercises excessively
Bulimia Nervosa
– Binge eating and throwing up
– Sufferers tend to use laxatives
– Exercise excessively
– Deprives body of nutrients
– Leads to excessive weight loss
– Damages the digestive tract

Iron is an essential mineral for haemoglobin
Deficiency leads to lethargy
Affects performance and involvement
Affects women more than men due to blood loss through menstruation
If haemoglobin bellow 11g per 100mL = anaemic

Quantity of calcium in the bones
Can lead to fractures which result in poor mobility and pain
Women need to be aware of osteoporosis after menopause.
There is a need for adequate calcium intake and participation in regular weightbearing activities.

Exercise is not only safe, but is recommended.
Low impact, moderate exercise that includes adequate warm up and cool down can be beneficial in maintaining fitness levels, muscle tone, etc

Its affect on performance varies from person to person.
Moderate exercise can help relieve menstrual stress.
Heavy exercise may cause the absence of periods.

Pre-screening of participants prior to exercise is an important preventative measure. It involves assessing current fitness levels, medical history and conditions and previous injuries related to exercise.

Injuries can often result from poor skill and technique
E.g. incorrect head positioning in a tackle

Being physically ready for sport reduces the chance of being injured. General fitness should be achieved before participating in most sports.
For more specificity, physical fitness should be related to the sport, e.g. cardiovascular fitness for cross country runners, muscular strength and power for weightlifters, flexibility and muscular endurance for gymnastics.
A lack of physical fitness places the athlete at risk of injury, e.g. participating in gymnastics with a lack of flexibility would increase the likelihood of a muscle tear, participating in a marathon with no cardiovascular fitness may result in a calf strain or a rolled ankle.

An appropriate warm up should prepare the body for physical activity. Warm up routines need to be specific to the nature of the sport. For example, a warm up for a game of touch needs to include running with changes of direction, forwards and backwards running and ball passing. A good warm up gradually prepares the body for the demands that will be faced during participation in the sport.

A cool down eases the body into recovery and reduces the severity of soreness. A cool down should not be as intense as a warm up.

Stretching is an essential part of any warm up and cool down. For warm ups, generally dynamic stretching is more effective. It gradually prepares the muscles and joints for activity and ranges of motion they may experience in the sport. Failure to stretch in a warm up may result in a muscular tear or joint sprain by forcing a joint beyond its range of motion. For cool downs, generally static stretching is most effective. Failure to stretch as part of a cool down will increase the incidence of soreness and affect further participation.

Rules assist the flow of play, create a safe environment for participation and protect from injury.
Where a dangerous practice is identified a rule change may be able to reduce this risk. E.g. Spear tackle in Rugby League
Appropriately accredited referees, umpires, etc should enforce rules.

Such modifications protect children from injury and ensure safety.
They make allowances for the size and strength of young children.
They often remove elements of the adult game that place participants at risk of injury.
Examples include: Rugby leagues, mini footy and mod league. Minky Hockey, Roo Ball etc.

Changes in size of playing field
Changes in size or weight of playing equipment
Changes in timing of games
Changes in rules regarding numbers of players or inter change
Others you can think of ???

This means that sport can be equitable for all participants and provisions may include divisions such as:
– Weight
– Age
– Skill divisions
Or as per Rugby Union smaller players may be able to weigh down a division

In most sports some form of protective equipment is used by players to ensure their safety during the game.
Ground surrounds and equipment must also be made safe. Sometimes this involves use of protective equipment as well. E.g. Goalpost pads

APPAREL AND PROTECTIVE
EQUIPMENT FOR HEAD AND NECK,
EYES, BODY, TEETH AND FEET
Some examples of these may include:
– Neck braces
– Goggles
– Glasses
– Arm guards
– Gloves
– Mouth guards
– Sport-specific shoes
– Headgear
– Shoulder pads

Surfaces must be level and free from any protruding objects that may cause harm or injury
Barriers must be in place to maintain spectators and separate the game from the crowd.
If playing at night adequate lighting should be provided
Any hard objects (goal posts, etc) should be padded.
Others you can think of????

Any equipment used must be safe and not pose any hazard to any participants
All individual equipment must be kept in good condition and checked before each game.

Most sports make provisions for the use of protective equipment. All protective equipment must:
Adequately protect the wearer and others
Allow freedom of movement
Allow airflow
Be comfortable
Be of acceptable quality

Core body temp should be maintained at 37.5 degrees Celsius.
It is controlled by hypothalamus in the brain.

44 Upper limit of survival
42 Heat stroke – brain damage
40 Fever
37 Normal
36
Shivering and Co ordination
34
32
Violent Shivering
30
Semi – Consciousness
28
Body unable to regulate
26
Temperature
IT IS INTERESTING TO NOTE THAT OUR THERMAL DEATH POINT IS ONLY 7 DEGREES
EITHER SIDE OF OUR REFERENCE TEMPERATURE – 37 DEGREES C

Convection: the transfer of heat away from the body by moving air currents.
Radiation: the transfer of heat away from the body to a cooler environment.
Conduction: the transfer of heat away from the body to something else (e.g. ice).
Evaporation: heat loss through sweat.

Climatic conditions including temperature, humidity, wind, rain, altitude and pollution need to be considered prior to performance. The combination of high temperature and high humidity increase the level of risk of hyperthermia, particularly in relation to endurance performances. The combination of cold weather and wind increase the likelihood of hypothermia.
Think about wind chill factor, effect of different climates, (dry heat vs humid) etc.

Appropriate hydration is one of the main issues regarding temperature regulation and maintaining athletic performance. Fluid replacement before, during and after exercise is extremely important as even a small loss of fluid can affect an athlete's performance.

Drink water …. cool to cold.
Drink before … during … after training and playing.
Special care in hot/hot humid conditions.
DEHYDRATION
ALWAYS THINK
PREVENTABLE
Thirst is a poor indicator of the need for fluid replacement
What type of drink is the best ?
Alcohol - NO
High sugar/caffeine - NO
Sports Drinks - YES
WATER - YES, YES
WEIGH PLAYERS

SAFE HYGIENIC PRACTICES ARE
ESSENTIAL WITH WATER
CONTAINERS AND THE DELIVERY OF
WATER TO PLAYERS – PROTOCOL?
DRINKS HIGH IN CAFFEINE AND
SUGAR?
(DISCUSS)

Acclimatisation involves preparing the body to perform in the climatic conditions that will be experienced during an event, e.g. heat, altitude, cold. It is an important factor in preparing for any event and contributes to preventing injury.

Refers to the application of adhesive or non-adhesive strapping or bandages to a joint area to protect, support or strengthen the joint during movement.
In some sports that require high amounts of explosive movements there is considerable potential for injury.
Taping in this situation is called
PREVENTATIVE or PROPHYLACTIC taping

Taping is often required after an injury and may be necessary during the rehab process.
Injuries may be taped when returning to play for physical and psychological support.
A player may use this until their body is fully accustomed to activity again.

Bandaging is more commonly used for the treatment of soft tissue injuries. Bandaging can help reduce swelling, support a joint or muscle and restrict movement. Generally, elastic bandages or slings are used.
To be effective, the correct technique and firmness need to be applied to the injured area.

Non-elastic taped for support
Begin with anchors
Ensure evenness of tension
Overlap each application
Maintain even pressure
Reapply if circulation is cut
Avoid creases

Avoid continuous taping
Always tape in the direction to tighten
Completely cover skin with no gaps
Finish with locks
Remove with blunt scissors

ALWAYS THINK
EFFECTIVENESS
Give support without limiting function.
Does the player really need taping?
IF SO
Decide why.
Know the anatomy involved.
Decide how.
Know materials to use.
REMEMBER
Rehabilitation first – consult physiotherapist.
TAPING SHOULD ONLY BE APPLIED BY PERSONS
TRAINED TO USE TAPING TECHNIQUES!

Explore the following links for demonstrations on taping an ankle, wrist and thumb.
Ankle http://emedicine.medscape.com/article/86495-overview http://www.elastoplastsport.com.au/Injury/TapingTechniqu es.aspx http://www.physioadvisor.com.au/11244150/ankle-tapingankle-strapping-physioadvisor.htm
Wrist http://www.physioadvisor.com.au/11376450/wrist-tapingwrist-strapping-strap-wrist-phy.htm
Thumb http://www.physioadvisor.com.au/12460050/thumbtaping-thumb-strapping-strap-thumb-phy.htm

After treatment it is essential for movement to be restored ASAP.
It involves gradually extending the range of movement
May initially be passive until active movement can be restored

• STRETCHING
• CONDITIONING
• ACHIEVING TOTAL BODY FITNESS

To reduce scarring, stretching is important.
The most appropriate are proprioceptive neuromuscular facilitation (PNF).
Initially, movement should be within pain barriers and gradually increased as strength increases

It involves adapting the body to a range of strength, agility and power skills to ensure full function
This is followed by exposure to noncompetitive situations where full movement is required.

It is regaining pre-injury fitness
Must involve all principles of training, particularly progressive overload.
Programs should involve all muscle groups and energy systems.
Adaptations should include:
– Hypertrophy of muscles (increased size)
– Increased capillarisation and blood flow
– Strengthening of ligaments and tendons
– Increased elasticity of fibres
– Increased joint mobility
– Absence of pain
– Full confidence in the injury
– Fully restored balance and coordination

With total body fitness restored, full training can commence.
The athlete will be expected to train fully with no pain.
This involves warm up, conditioning, drills, skills, development exercises, tactics and cool down.

The application of heat and cold to an injured site is important in the healing process. Cold is used for the immediate treatment of injury as it prevents swelling due to internal bleeding. It can be applied by using ice packs, ice contained in plastic and wrapped in a towel or cool water/ice baths and immersion for short periods. Cold will also be useful after exercise and training when the injured area has been through a workout.
Heat should not be used in the early stages of injury while bleeding at the injured site is still occurring. It may help in promoting movement and blood flow and relaxing the muscles through rehabilitation.

ELASTICITY: flexibility returned
STRENGTH: new tissue is strong and able to support body in stressful movements
PAIN FREE: if there is no visible or communicated pain, the athlete has passed this condition of readiness to return to play
MOBILITY: the joint where the injury was sustained must have a suitable range of movement and mobility to suit the playing conditions
BALANCE: able to balance on injured limb

Pre test and post-test: the progress of the athlete must be monitored before and after a fitness test to ensure that there is no damage or harm done during the test which may delay the return to play.

After an injury, an athlete may feel quite anxious about returning to play. Even if the athlete is physically recovered from an injury, they may not be psychologically ready to return to elite competition. In this case, a coach may play them in a lower division until they are back to their best

After injuries, it is sometimes necessary to have a specific warm up where the focus is on preparing the injury site for the proceeding impacts of play.
A specific warm up may include:
– Extra or varied stretches
– Strength work
– A more concentrated warm up

Individual sports will have their own specific return to play policies and procedures. The athlete's wellbeing should be central to any return to play policy. Contact sports usually have a policy about returning to play after a head injury.

Many coaches will put pressure on valuable players to return early so that their playing roster is bolstered.
The more professional the sport, the more intense the pressure becomes.
This also carries risks, such as:
– Long term health problems
– Arthritis
– Early retirement

Some elite players have injuries heavily strapped or painkillers injected so that they can return ASAP.
Irrespective of financial gain, it is unwise to return early
Pain indicates tissue damage and is a warning that rehab is necessary.
Painkillers de-sensitize the area and leave it susceptible to further injury, prolonging the healing process and may lead to permanent damage.