Chapter 8
The Injury Process
The Physics of Sports Injury
Connective Tissue
• Connective tissues are the most common
type of tissue in the body.
• Connective tissues include ____________
__________________________________
__________________________________
• In some sports, nearly 50% of acute
injuries involve either tendon or muscle.
The Physics of Sports Injury
(cont.)
Muscle/fascia are thought to be injured by
excessive tension during contractions.
• Tendons are extremely strong structures;
strains occur most often at the distal
____________________________(MTJ).
• These strains are the ____ _________soft
tissue injuries related to sports.
Mechanical Forces of Injury
Types of Force
•
•
•
Mechanical Forces of Injury
(cont.)
• Tendons resist ________ forces.
• Bones resist ___________ forces.
• Ligaments resist _________ forces.
Each type of tissue has a limit for how much
force it can withstand (critical force).
The Physiology of Sports
Injury
The ________________ _____________:
• Is a predictable sequence of physiologic
actions that occur when the body reacts in a
manner to repair damaged tissues.
• Begins during the first few minutes following
an injury.
The body’s initial response to trauma is
commonly called _________________.
The Inflammatory Process
(cont.)
Normal signs and symptoms of inflammation
include:
• .
• .
•
• .
Acute Inflammatory Phase
• Initial trauma destroys millions of cells.
• _________________ is followed by vasodilation.
• Damage to blood vessels results in blood flow
into ___________ ______causing a hematoma.
• A _________ is the “localized collection of
extravasted blood.”
• ___________ _________injury results in
additional cellular destruction.
Acute Inflammatory Phase
(cont.)
In response to injury, chemicals are released
that affect nearby cells. The effects of these
chemicals are:
• _______________ (cellular breakdown).
• ________________ (vasodilators).
• ________________ (attract scavenger
cells).
Acute Inflammatory Phase
(cont.)
_____________ __________is responsible for
the manufacture of bradykinin.
• ____________ increases vascular
permeability and triggers the release of
prostaglandins resulting in:
• Vasodilation.
• Increased vascular permeability.
• Pain.
• Blood clotting.
Acute Inflammatory Phase
(cont.)
• Plasma proteins, platelets, and leukocytes
move out of capillaries and into damaged
tissue.
•
• Macrophages migrate into the damaged area.
Arachidonic acid is formed by a combination of
leukocyte enzymes and phospholipids derived
from cell membranes.
•
Acute Inflammatory Phase
(cont.)
The acute inflammatory process results in a
walling off of the damaged area from the rest
of the body.
The acute phase lasts up to 3 or 4 days, unless
aggravated by additional trauma.
Resolution (Healing) Phase
During this phase, special leukocytes
(polymorphs and monocytes) and a type of
macrophage (histocytes) migrate into the
area of injury.
•
Regeneration and Repair
Except for bone, connective tissues heal by
forming scar tissue that begins to develop 3–
4 days after the injury.
•
• Fibroblasts are immature connective tissue
fibers that can mature into several different
types of cells.
Regeneration and Repair
(cont.)
• ______________is the formation of new
capillaries.
• ________ _______may take up to four
months.
• Scar tissue can be 95% as strong as
the original tissue. Stress on the tissue
is helpful for rehabilitation; exercises
are critical to this process.
• Bone tissue heals by way of specialized
cells (__________________________).
Pain and Acute Injury
• Everyone copes with pain differently.
•
.
• Pain results from sensory input received
through the nervous system and indicates
location of tissue damage.
• Messages concerning sensory information
that travel quickly through the nervous system
are given higher priority than pain messages
that travel more slowly.
• .
Intervention Procedures
• Sports medicine community has no clear set
of criteria for first aid treatment of acute softtissue injury.
_____________ includes bags of crushed
ice, aerosol coolants, ice cups, ice water
immersion, and commercial cold packs.
After the acute phase,___________is
appropriate (i.e., hydrocollator packs, moist
warm towels, and ultrasound diathermy).
Intervention Procedures
(cont.)
• Modalities such as ultrasound should ONLY be
used under the supervision of trained allied
health personnel.
•
.
• If they must be prescribed by a physician,
these agents represent treatments that are
beyond the scope of the coach.
• OTC drugs should also be used with caution.
(Consult parents when athlete is under 18 years
of age.)
Cryotherapy
• Direct application of
cold may reduce
vasodilation in the first
few minutes after
injury.
• .
Courtesy of Ron Pfeiffer
Cryotherapy (cont.)
• In extremities, elevation and compression are
also helpful in treatment.
•
• Elastic wrap secures the ice bag to the body.
• Cold application has analgesic effect and
reduces muscle spasm.
•
• Risk of frostbite is minimal with crushed ice.
Thermotherapy
Thermotherapeutic agents:
•
• Increase vasodilation.
• Are useful in the final phases
of injury repair.
Pharmacologic Agents
Steroidal and NSAIDs
• Both affect aspects of the inflammatory process.
• Steroidal drugs resemble gluococorticoids, but
the exact mechanism of their action is unknown.
Steroids may:
•
•
•
•
Pharmacologic Agents
(cont.)
Steroids must be used with care.
•
.
Steroids may be injected or taken orally and
include drugs such as:
• Cortisone, hydrocortisone, prednisone,
prednisolone, triamcinolone, and
dexamethasone.
NSAIDs
NSAIDs do not have the negative effects of
steroids.
• NSAIDs are very popular drugs.
• .
NSAIDs (cont.)
• NSAIDs block the conversion of arachidonic
acid to prostaglandin.
•
• Research is inconclusive regarding NSAIDs’
effect on tissue healing and strength.
RICE
Best approach to the care of soft tissue injury is
_______ along with prescribed
pharmacologic agents and supervised
rehabilitative exercise.
R=
I=
C=
E=
The Role of Exercise
Rehabilitation
• Properly supervised
physical activity is
very effective for
many injuries.
• .
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Exercise Rehabilitation
•
• Rehabilitation must be supervised by
professionals with appropriate training, such
as a BOC-certified Athletic Trainer or a
Physical Therapist with sports medicine
training.
Exercise Rehabilitation
(cont.)
Rehabilitative exercise is a four-phase
process.
•
•
•
•
Injury Rehabilitation
• Injury rehab should be considered an ongoing
process.
•
• Without this approach, the likelihood of
reinjury is high.