Out of Harm`s Way: Sport Injuries
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Out of Harm’s Way: Sport Injuries Chapter 8 Sport Books Publisher 1 Outline: Biomechanical principles of injury Injury treatment and rehabilitation Pain: nature’s warning system Soft tissues injuries Dislocations Fractures Concussions Overuse injuries Injury prevention Sport Books Publisher 2 Biomechanical Principles of Injury Sport Books Publisher 3 Tissue Types Epithelial Muscle Connective Nervous Each type of tissue possesses unique mechanical characteristics Sport Books Publisher 4 Loading To best understand the biomechanical characteristics of tissue we examine its behaviour under physical load Under load a tissue experiences deformation Deformation can be visualized through deformation curve Sport Books Publisher 5 High Ultimate Failure Elastic Limit C Load B Plastic Region Elastic Region Low A Small Deformation Sport Books Publisher Large 6 High Ultimate Failure Elastic Limit C Load B Elasticity: capacity of a tissue to return to its original shape after removal of load Plastic Region Elastic Region Low A Small Deformation Sport Books Publisher Large 7 High Ultimate Failure Elastic Limit C Load B Plastic Region Plastic region begins Tissue no longer posesses elastic properties Elastic Region Low A Small Deformation Sport Books Publisher Large 8 Permanent tissue deformation (does not return Ultimate Failure to original shape) High Elastic Limit Resulting in micro-failure or injury (e.g. sprains) Load B C Plastic Region Elastic Region Low A Small Deformation Sport Books Publisher Large 9 High Ultimate Failure C Elastic Limit Load B Macro- or completes failure (e.g. torn ligament) Plastic Region Tissue becomes completely unresponsive to loads Elastic Region Low A Small Deformation Sport Books Publisher Large 10 Area = strength of the material High Ultimate Failure C Elastic Limit Load B Plastic Region Elastic Region Low A Small Deformation Sport Books Publisher Large 11 High Slope = stiffness (or resistance to deformation) of the material Ultimate Failure Elastic Limit C Load B Plastic Region Elastic Region Low A Small Deformation Sport Books Publisher Large 12 Tissues Response to Training Loads 1. Training load =/ elastic limit – Micro-failure making of new tissue – Positive training effect 2. Training load > elastic limit – Permanent failure – Injury Sport Books Publisher 13 Forces Acting on Tissue TENSION COMPRESSION BENDING Sport Books Publisher SHEAR TORSION 14 Injury treatment and rehabilitation Sport Books Publisher 15 Treatment – Received by patient from a health care professional – Promotes healing – Improves quality of injured tissue – Allows quicker return to activity Rehabilitation – Therapist’s restoration of injured tissue +patient's participation – Individualized for each athlete Sport Books Publisher 16 Healing Phases Sport Books Publisher 17 Inflammatory Response Phase 2 – 4 days Inflammatory Response Phase hrs – 6 wks Inflammatory Response Phase Sport Books Publisher 3 wks - yrs 18 Inflammatory Response Phase Inflammation begins at the time of injury Signs – – – – – Redness Swelling Pain Increased temperature Loss of function Protect Rest Cryotherapy – Decreases swelling, bleeding, pain and spasms Compression – Decreases swelling Elevation – Decreases swelling Sport Books Publisher 19 Fibroplastic Repair Phase Repair and scar formation Granulation tissue fills the gap Collagen fibres are deposited by fibroblasts Signs seen in the phase1 subside Rehab-specific exercises – Restore range of motion and strength Manual massage therapy and ultrasound – Help break down scar Protective taping and bracing Sport Books Publisher 20 Maturation-Remodeling Phase Remodeling or realigning of the scar tissue More aggressive stretching and strengthening – To organize the scar tissue along the lines of tensile stress Include sport-specific skills and activities Sport Books Publisher 21 Pain: nature’s warning system Sport Books Publisher 22 Pain Nature’s way of telling us something is wrong One of the best indicator of when it is best to resume play Sport Books Publisher 23 Problem with Ignoring Pain Pain Masking with medications Pushing injured tissue closer to yield-level point Continued participation Addiction Sport Books Publisher Gastrointestinal complications 24 Soft tissues injuries Sport Books Publisher 25 Contusions Sport Books Publisher 26 Bruise Compressing force crushes tissue E.g. “charleyhorse” – quadriceps Discoloration and swelling Myositis ossification – abnormal bone formation in a severe contusion Life-threatening if the tissue involved is a vital organ P-R-I-C-E Sport Books Publisher 27 Strains and Sprains Sport Books Publisher 28 STRAIN Tendon or muscle tissue is stretched or torn SPRAIN Ligament or the joint capsule is stretched pr torn Sport Books Publisher 29 Grades of sprains and strains GRADE 1 – Slightly stretched or torn; few muscle fibres GRADE 2 – Moderately stretched or torn, more muscle fibres GRADE3 – Complete rupture – Surgery required – E.g. ACL tear Sport Books Publisher 30 Common Strains Quadriceps Adductors Hip flexors Hamstrings Sport Books Publisher Rotator cuffs 31 Hamstring Strains Most frequently strained muscles Mechanism: – Rapid contraction in a lengthened position – E.g. sprinting and running Due to strength imbalance – Hamstring strength >>> quadriceps strength Emphasize hamstrings and quadriceps equally Sport Books Publisher 32 Ankle Sprains During running, walking, dancing or stepping off a curb Most common = lateral ankle sprain – Inversion Common reoccurrence – Decreased proprioception Symptoms – Rapid swelling – Point tenderness Rehabilitation – Decreases reoccurrence – Incorporation of balance exercises Sport Books Publisher 33 Dislocations Sport Books Publisher 34 Great enough forces push the joint beyond its normal anatomical limits Joint surfaces come apart Subluxation – When supporting structures (e.g. ligaments) are stretched or torn enough – Bony surfaces partially separate Most common = fingers Can become chronic Sport Books Publisher 35 Dislocation of the Shoulder Sport Books Publisher 36 Most mobile most unstable joint Categories of dislocation: – Partial (subluxation) – Complete Most common – Head of humerus slips anteriorly – Falling backwards on extended arm Symptoms – Swelling, numbness, pain, weakness, bruising – Capsule and/or rotator cuff tears – Brachial plexus injury Require medical treatment to relocate head of humerus back to glenoid fossa Sport Books Publisher 37 Fractures Sport Books Publisher 38 Simple fracture – Stays within the surrounding soft tissue Compound fracture – Protrudes from the skin Stress fracture – Results from repeated low magnitude loads Avulsion fracture – Involves tendon or ligament pulling small chip of bone Sport Books Publisher 39 Concussions Sport Books Publisher 40 Injury to the brain Mechanism: – Violent shaking or jarring action of the head – Brain bounces against the inside of the skull Symptoms – Confusion – Temporary loss of normal brain function REST No such thing as “minor concussion and “shaking off” Sport Books Publisher 41 Overuse injuries Sport Books Publisher 42 Due to – Repeated and accumulated microtrauma – Non-sufficient recovery Results from – Poor technique – Poor equipment – Too much training – Type of training Sport Books Publisher 43 Tendonitis Sport Books Publisher 44 Inflammation of tendon as a result of a small tear in the tendon Age (loss in elasticity) Excessive , repetitive motion Improper technique Tendonitis Symptoms – Pain (aggravated by movement) – Tenderness – Stiffness near joint Sport Books Publisher 45 Tennis Elbow Lateral epicondylitis Affect forearm extensors – Attach to lateral epicondyle – Extend wrist and fingers Contributing factors – Excessive forearm pronation and wrist flexion – Gripping racquet too tightly – Improper size3 grip – Excessive string tension – Excessive racquet weight – Topspins – Hitting ball off-centre Sport Books Publisher 46 Gofer’s and Little League Elbow Medial epicondylitis Affects tendons of forearm flexors – Attach to medial epicondyle – Flex wrist and fingers May result in collateral ligament and ulnar nerve injury May affect medial humeral growth plate in young children (little league elbow) Sport Books Publisher 47 Jumper’s Knee Patellar tendonitis Affects infrapatellar ligament Caused by: – Repetitive eccentric knee actions – Eccentric load during jump preparation >>> body weight Sport Books Publisher 48 Bursitis Sport Books Publisher 49 Inflammation of the bursae – Tiny fluid-filled sacs – Lubricate and cushion pressure points between bone and tendons Results from overuse and stress – Age is also a factor Most common – Shoulder, elbow and hip Inflammation and pain aggravated by movement and direct pressure Sport Books Publisher 50 Shoulder Impingement Sport Books Publisher 51 Excess movement of the humeral head + lack of space Inflammation of bursae or rotator cuff tendon Result of muscle imbalances in shoulder muscles – Weak shoulder depressors – Strong shoulder elevators Balanced strength training Sport Books Publisher 52 Stress Fractures Sport Books Publisher 53 Stress fracture Results from repeated low-magnitude forces 3. Small disruption of the outer bone layer Weakened bone Cortical bone fracture NOT a shin splint 1. 2. Shin splints Pain along inside tibial surface Involve pain and inflammation NO disruption of cortical bone Sport Books Publisher 54 Injury prevention Sport Books Publisher 55 Protective Equipment Sport Books Publisher 56 Warm Up and Cool Down Sport Books Publisher 57 Keeping Fit and Flexible “Use it or lose it” Especially important during the offseason Preparing the muscle for placing demands Sport Books Publisher 58 Eating and Resting In order to function effectively body must receive – Proper nutrient – Adequate rest Avoid over-training and lack of sleeping Sport Books Publisher 59
