Injury Prevention
Injury Prevention
The best method of managing and caring for athletic
injuries is to PREVENT them from occurring
Many factors are important in the prevention process
Equipment
Bracing
Taping
Coaching Techniques
Body Mechanics
Universal Precautions
Protective Equipment
Proper selection and fit are essential in prevention of
injuries
Should be designed to prevent injury and protect
injured parts against further injury
Minimal functional interference
Cause no harm to other participants
Simple to fit and maintain
Durable and reliable
Not expensive
Protective Equipment
The hazard demonstrated in each individual sport
dictate the need for specific types of protection
Contact Sports
Padding must protect primary contact points
Vital areas such as head, neck, kidneys, genitalia have priority
for protection
High velocity hazards (ball/puck sports)
Helmets, face masks, eye protection needed
Dental protection
Protective Equipment
Modifications and improvements in sport
equipment are continually being made
Protective equipment can be abused
By using equipment as a weapon against their
opponent
Players who take dangerous risks and rely on
equipment to protect them
Legal Concerns
Manufacturers and purchasers of sports
equipment must foresee all possible uses
and misuses of equipment
Must warn the user of any potential risks in
the use or misuse of the equipment
Legal Concerns
To decrease possibilities of injuries and litigation:
Buy protective equipment from reputable manufactures
Buy the safest equipment resources permit
Ensure equipment is assembled correctly-follow all
instructions to the letter
Maintain all equipment properly
Use equipment only for purpose designed
Warn athletes who use equipment of all risks
Use great caution when customizing any equipment or
don’t do it at all
Use no defective equipment
Selection and Fitting of
Equipment
Correctly fitting equipment is very important for
injury prevention
To fit athlete these factors should be
considered:
Size
Sport Position
Strength
Age and Physical Development
Skill Level
Design of Protective
Equipment
Channeling
Forces are channeled away from anatomical
structures
Dispersion
Forces are dispersed over a large area
Mechanical Structuring
Forces are reduced through the use of a
mechanical structure
Restriction
Anatomical ranges of motion are reduced to
prevent forces that cause injury
Head Protection
Nothing can eliminate the possibility of head
injury
Helmets do help to significantly lessen head
injury severity
Head protection is advised/mandated in
football, ice hockey, lacrosse, boxing etc..
Helmets must fit correctly to function properly
Helmets
Helmets should be able to absorb force
levels high enough to fracture the skull
Helmets should be monitored often because
fit can be altered by:
Temperature, hair length, internal padding
Loss of air from cells, spread of facemask
National Operating Committee on Standards
for Athletic Equipment has had a major
influence
NOCSAE
All helmets must have NOCSAE certification
To be NOCSAE approved:
Helmet must be able to tolerate forces to many
different areas
Withstand repeated blows
Withstand high mass low velocity impacts
Even though helmet is certified does not mean
it is fail-safe
NOCSAE Warning
Warning placed on all football helmets
“Do not use this helmet to butt, ram or spear an
opposing player. This is a violation of football
rules, and can result in severe head, brain, neck
injury, paralysis, or death to you and possible
injury to your opponent. There is a risk these
injuries may also occur as a result of accidental
contact without intention to butt, ram or spear.
No helmet can prevent all such injuries”
Face Protection
Four categories
Full face guards
Protect against flying or carried objects
Mouth guards
Majority of dental injuries can be prevented
Absorbs shock of chin blows, helps prevent concussions
Ear guards
Wrestling and boxing
Eye protection devices
Corrective lenses, glasses, headgear
Trunk and Thorax Protection
Shoulder, ribs, spine and genitalia have
insufficient soft tissue protection
Shoulder Pads and Restraints
Flat-quarterback or receiver
Cantilevered-blocking and tackling athletes
Flak jackets protect ribs and thoracic area
Breast Support- Sports Bra
Groin and Genitalia-Cup
Other Padding and Braces
Shoulder Braces
Restraining devices for chronic dislocated shoulder
Restricts upper arm from being abducted and
externally rotated
Hip pads
Collision and high velocity sports to protect vulnerable
areas such as iliac crest
Abdominal and low back supports
Designed to give relief and permits movement
Limb Protection
Footwear
Socks and Shoes
Shin and Lower Leg
Hard shelled, molded shin guards
Thigh and Upper Leg
Pads slip into ready-made pockets in the uniform
Knee Supports
Knee pads, Elastic sleeve, Bracing
Ankle Supports
Commercial bracing and ankle taping
Hand, Wrist, Arm and Elbow Protection
Padded gloves, mitts and boxing gloves
Footwear
Can mean the difference between success, failure
and injury
Socks
Poor fitted socks can cause abnormal stresses and cause
irritations
Socks should be clean, dry and without holes
Shoes
Chronic abnormal pressure to foot can cause permanent
structural deformities, calluses, blisters
Can cause mechanical disturbances that affect total postural
balances, effecting joints and muscles The bare human foot
was designed to function on uneven surfaces
Shoes cont...
Shoes were created to protect against harmful
surfaces
Left foot generally varies in size and shape from the
right foot
It is important to measure both feet and simulate
the conditions under which they will perform with
shoes on
Fit shoes at the end of the day
Toes can be fully extended without being cramped
When dealing with cleats- cleats should be
positioned under two weight bearing joints
Foot pads
Can be helpful in treating a variety of foot
problems as well as hip and knee
Commercial or Custom-made orthotics
Corns, bunions, fallen arches, pronated feet
Foam, Felt, Plaster or aluminum and heel
cups
Prophylactic Knee Braces
Prophylactic
To prevent or avoid
Effectiveness is controversial
Players at greatest risk- Offensive and
Defensive Lineman, Linebackers, Tight Ends
Designed to provide protection against
lateral and medial, but not rotary forces
Knee Braces cont…
Studies are divided
Decrease, No difference and Increase in
knee injuries
More studies need to be conducted
concerning:
Relative strength of braces
Weather they pre-stress the knee joint and
produce injuries
Functional Knee Braces
Customized orthopedic knee brace
prescribed for the athlete
Following serious knee joint injury that
produces chronic instability/surgery
Designed to prevent re-injury to the cruciate
ligaments
Effectiveness better documented
Taping
Used for the care and protection of the athlete
Adhesive tape offers a number of possibilities
Retention of wound dressings
Stabilization of compression-type bandages that
are used to control bleeding
Support of recent injuries to prevent additional
injuries
Protect against acute injuries- by limiting ROM
Taping Guidelines
Be sure the area is dry, clean and free of body
hair
Use some form of tape adherent to ensure
bonding of the tape to the skin
Apply one layer of prewrap over adherent
Apply lubricated pad
Prevents cuts, blisters and rashes
Overlap each strip of tape to the previous strip by
half
Taping Guidelines Cont.…
Avoid spaces between tape segments
Spaces may result in blistering
Smooth and mold the tape to the natural
contour of the area
Try to make athlete comfortable, but
maintain dorsiflexion
After wrapping/taping is complete check for
comfort and impaired circulation
Taping Usage
Tape is available in variety of widths, strength
and elasticity
Tape should adhere readily when applied
Stretch and elastic should be used for
smaller, more angular body parts
Tape should be stored in a cool place
Temperatures greater than 75 degrees may alter
the adhesive ability
Taping Usage Cont...
To tear tape, hold firmly on each side of the
proposed tear line, and pull the free end away at
an angle so that the forces crosses the lines of
the fabric at a sharp angle
Edges should be straight, no loose threads
Special cutters are made for tape removal
Avoid cutting over bony prominences
Look for blisters and skin irritations as the tape is
removed
Effectiveness of Taping
Controversy
Taping only should be used in conjunction
with proper exercise
Improperly applied wrap/tape can compound
an injury and create postural imbalances
Arguments for and against
Taping
For
Most studies agree
that taping does
contribute to a lower
incidence of injury/reinjury
Prophylactic taping is
superior to lace on
braces for the first 20
minutes, after that
they are equal
Against
Tape usually becomes
loose with wear
The skin is mobile, thus
taping can not be
effective
Taping weakens the leg
muscles
Moisture develops
between skin/tape, thus
affecting tape adherence
Tape tears under stress
Complications of Taping
Skin allergies
Skin irritations
Blisters
Lacerations
Reactions to tape adherent
Common Taping Procedure
Routine Non-Injury Ankle Taping
Have athlete sit on table with leg extended,
the lower part of the calf past the edge of the
table
Have athlete hold foot at a 90 degree angle
in dorsiflexion
Apply a coat of tape adherent to protect the
skin
Ankle Taping
Apply a foam pad over the instep and back
of the heel
Apply a layer of prewrap to the ankle
Using 11/2 inch tape, apply an anchor
around the ankle about 5-6 inches above
the malleolus
Apply another anchor at the distal third of
the longitudinal arch, making sure not to
constrict the base of the fifth metatarsal
Ankle Taping
Apply 2-3 stirrups in consecutive order
Begin on the medial part of the calf
Pull up on the lateral aspect of the leg with moderate
tension
This places the foot into slight eversion
Apply circular strips form the point of the proximal
anchor, moving downward until the malleolus is
completely covered
Ankle Taping
Apply arch strips down to the distal anchor
Apply a heel lock
Start high on the instep, bring the tape along the ankle
at a slight ankle
Hook the heel
Lead the tape under the arch
Finish by coming up on the opposite side by the
starting point
Cover the ankle again with a second layer of tape
(optional)
Prophylactic Thumb Taping
Protects the joints and surrounding muscles
Have athlete fully extend and adduct the
fingers, by keeping the thumb in a relaxed,
neutral position
Stand in front in the athlete
Apply rewrap to the forearm, wrist and thumb
Thumb Taping
Using 1 inch tape place an anchor strip around
the wrist and another around the distal end of
the thumb
From the anchor at the tip of the thumb to the
anchor around the wrist, apply 4 strips in a
series on the dorsal side of the thumb
Hold these strips in place by applying one
locking strip around the wrist and one encircling
the tip of the thumb
Thumb Taping
Add a series of three “spica” strips
The first spica is started on the radial side at the base
of the thumb and carried under the thumb, completely
encircling it and then crossing the starting point
The strip should continue around the wrist and finish at
the starting point
The following 2 spica strips should overlap the
preceding strip by at least 2/3 inch and move
downward on the thumb
Place a final locking strip around the wrist
Elbow Hyperextension Taping
Have athlete stand with the elbow flexed at least
30-45 degrees, and the forearm in neutral
position
Taper should stand facing the arm
Apply adhesive spray to the area
Apply prewrap from mid-humerus to the midforearm
Apply two anchor strips loosely around the arm,
approximately 2-3 inches above and below the
elbow joint
Elbow Hyperextension Taping
Construct a checkrein
Place a 4 inch strip of tape against the center of
a 10 inch strip of tape, thereby “blanking out’
the center portion of the longer strip
Place the checkrein so that is spans the two
anchor strips with the blanked out side facing
down
Elbow Hyperextension Taping
Place 5 additional 10 inch strip of tape over
the first checkrein (tape fan)
Finish by securing the checkrein with three
locking strips both above and below the
elbow joint
A figure-8 elastic wrap can be added over
the taping to prevent the tape from slipping
because of perspiration
Sports Medicine Professional
Obligations
Ethical and Legal responsibility to each athlete
they work with
Athletes welfare should be placed above all
other considerations-coaches, parents etc...
Do not allow non-medical considerations
influence judgement
If pressure is exerted an question of judgement
arises a Physician’s opinion should be called
for- Physician has final call
Sports Medicine Obligations
If find unsafe coaching practices of facilities:
Notify appropriate person
If advice is ignored report the findings and
recommendations should be made to the highest
authority
Use careful judgement to ensure frivolous remarks
are not made
Same situation applies for use of illegal or banned
drugs
Treat every athlete equally
Be loyal to the coaches, team, physicians, etc.
Coaching Techniques
Coach is responsible for teaching playing skills
Coaches should impart a proper game
philosophy and an overall safety awareness
“Win at all costs” syndrome is dangerous and
shows little regard for the safety of the athletes
Coaches can show concern by meeting with
team members and parents to inform about
potential injuries and means of prevention
Coaching Obligations
Warn athletes of potential for head and neck injuries
Insist on blocking and tackling techniques that reduce the
chance of injury
Must provide or delegate appropriate person to give
emergency care and first aid in absence of a sports med
professional
At least one member of any coaching staff should have
training in CPR and first aid
Safety and well being of athlete must always have highest
priority
Body Mechanics
Center of Gravity
More than half the total body weight is located
in the upper part of the body, which is supported
by thin bones
Center of gravity increases stability as it is
lowered- for example widening the stance
Musculature serves as a shock absorber by
absorbing impact and distributing it over a
larger area
Body Mechanics
Posture
Spine has 3 curves that help maintain
balance
The head weighs close to 14 pounds and is
balanced on top of 7small cervical vertebrae
Particular vulnerable to injury
Strengthening the neck muscles is an important
protective measure
Body Mechanics
Musculoskeletal System Factors
Heredity, congenital or acquired defects may
predispose athlete to a specific type of injury
Postural deviations are often major
underlying cause of sport injuries
For example a consistent pattern of knee injury
may be related to asymmetries within the pelvis
and the legs
Knee Disorders
Genu Valgum
Knock Kneed
Weight bearing line passes to the lateral
side of the center of the knee joint
Results of the inward angling of the thigh
and lower leg
Causes the body weight to be borne on
medial aspect
More prone to medial knee injuries
Knee Disorder
Genu Varum
Bow Legged
Opposite of Genu Valgum
The extra stress is placed on the lateral aspects
Athlete more prone to lateral knee injuries
If severe should be directed into non-contact
activity (same for Genu Valgum)
Spinal Abnormalities
Kyphosis
Round Back
Abnormal curvature of thoracic spine
Forward Head and Flat chest
Basketball players, gymnasts, weight lifters
common to have this deviation
Susceptible to anterior dislocations of arm
Spinal Abnormalities
Lordosis
Abnormal curvature of lumbar spine
Sway back
Football linemen and gymnasts are prone
Scoliosis
Lateral curvature of the spine
Can be attributed to unequal leg length
Universal Safety Precautions
Universal body substance precautions with all body
fluids, blood being most common
When a wound is oozing or bleeding, sporting
activity should be stopped ASAP
Wear gloves for all routine procedures
Wash hands with germicide soap before and after
using latex gloves
Change gloves after each treatment
Discard gloves that are torn, cut or punctured into a
biohazard container
Universal Safety Precautions
Wear a protective face mask/eyewear if a procedure
may drop or spry into eyes, nose or mouth
Dispose used needles, scalpel blades and other
sharp items into a biohazard container
Any needle pricks should be reported to a physician
Clean all tables and counters regularly with a bleach
solution
Use an approved pocket mask shield when giving
artificial respiration
Universal Safety Precautions
Educate staff, coaches, athletes, etc. about the
risks for contacting and spreading contagious
diseases
If athlete has blood on their uniform
They must be brought out of play until blood can be
cleaned up
A solution of bleach and water is used to remove the
blood from the uniform
Precautions serve to protect not only the sports
medicine professional, but also the athlete
The End
Any Questions???