Preventing Athletic Injuries
Tony Milian, ATC, LAT
Manager, Sports Medicine
[U18] Sports Medicine
Cooper City Optimist Lecture
February 16th, 2010
Parents’, Coaches’, Trainers’, Physicians’
Everybody’s Goals
Make the game as safe as possible for the
players
Protect the athlete from further injury
Accurate evaluation
Early recognition and treatment
Definitive injury care
Return to play
Prevention
Representative Areas For Today:
Head Injury
Heat Injury
Supplement Injury
Lightning Injury
Stretching Dynamic / Static
Head Injury: Concussion
Definition - Immediate
and transient
impairment of neurologic
function due to traumatic
injury to the head
May or may not involve
loss of consciousness
(LOC)
Early Signs of Concussion
Impaired attention
Slurred, incoherent
speech
Disorientation
Impaired Coordination
Emotional reaction out of
proportion
Memory deficits
Any loss of
consciousness
Late Signs of Concussion
Persistent headache
Dizziness
Poor Attention
Memory Dysfunction
Nausea or Vomiting
Irritability
Photophobia
AAN Concussion Grading
Scale
Grade I
Abnormal symptoms resolve in less than 15 minutes
Grade II
Abnormal symptoms resolve in greater than 15
minutes
Grade III
A: Brief LOC (seconds)
B: Prolonged LOC (minutes)
Assessment
Cervical Spine (LOC)
Facial Expression
Pupil size and reactivity
Upper and Lower extremity
Orientation
Immediate Memory
Delayed Recall
AAN Concussion Management
Grade I (<15 minutes, no LOC)
Remove from contest
Immediate exam and at 5 minute intervals
Out for Remainder of Game
AAN Concussion Management
Grade II (>15 minutes, no LOC)
Remove from contest; no return
Immediate exam and at 5 minute intervals
Re-exam the next day
MD exam and clearance after 1 asymptomatic
week
AAN Concussion Management
Grade III (Any LOC)
EMS transport to nearest ER
MD evaluation and +/- brain
imaging
Possible Admit
AAN Concussion Management
Grade III - Return to play
Brief LOC : 1 week
Prolonged LOC : 2 weeks
2nd Injury: 1 month
Abnormal Brain Scan : season terminated
Heat Injury
When “walk it off” is not the right thing to say
What three types exist
What are the risk factors
Prevention strategies
Treatment strategies
Heat cramps
Heat exhaustion
Heat stroke
Heat Related Injury
Heat production increases
15X with exercise
Two mechanisms to dissipate
head
Radiation (65%) – Clothing
Evaporation (30%) –
Humidity
Heat Related Injury
Heat Cramps
Painful muscle spasms that most
commonly occur in the calf and abdomen
but can occur anywhere.
Treatment involves drinking water, mild
stretching and ice massage of the affected
area.
Heat Related Injury
Heat Exhaustion
Headache
Dizziness
Weakness
Fatigue
Muscle cramps
Vomiting
Excessive thirst dry tongue and mouth
In-coordination, mental dullness,
Elevated body temperature & reduced sweating.
Heat Related Injury
Heat Exhaustion
Treatment
Rest
Remove from hot environment
Fluid replacement over several hours
Likely requiring IV fluid
Ice packs to neck, groin, armpits
Heat Related Injury
Heat Stroke
Sudden collapse usually with a loss of consciousness
Flushed, hot skin; Rapid, strong pulse
Sweating is often absent
Body has lost the ability to cool itself
Treatment - Immediate call to 911 and
Cool the body
Strip all the clothing off the athlete
Sponge with cool water, and fan with a towel
Ice water immersion is controversial
No alcohol sponge baths
Heat Related Injury
Prevention Strategies
Education
Hydration
Prior to activity (1/2 liter starting 2 hours prior to activity)
Every 15-20 minutes during activity
If Child = 5oz
If Adolescent = 9oz
Rest
More frequently during hot and humid days
Schedule adjustment
Equipment removal
Heat Related Injury
Hydration
Sports Beverages
Recommended
Carbohydrate
(glucose and
sucrose)
Sodium
Potassium
Heat Related Injury
WARNING!!!
Heat Illness
Heat illness may
be hard to detect
Fluids before /
during / after
EMS activation
Treatment on
scene
Prevention is key
Supplement Illness
Caffeine
Steroids
GNC
Amphetamine
s
Red Bull
Caffeine Content
Standard 4 ounce cup = 50 mg caffeine
8 oz Red Bull
16 oz Rockstar
16 oz Arizona
8 oz Cocaine Energy Drink
OR
2 oz Extreme Energy
Lightning Injury
Florida ranks as # 1 in the US for lightning
related injury and death
One out of every 9 lightning strikes end in a
fatality
Common misconceptions
Lightning Illness
Lightning
Lightning strikes up to 25 miles away
Be Proactive!
Plan Ahead
Monitor the weather
Postpone the activity
Get to a safe place
Lightning
Use the 30/30 rule…
If time between lightning and thunder is LESS than 30 seconds…get to a safe place!!!
WAIT 30 seconds after hearing last thunder before leaving safe location
Retreat to an enclosed building
Vehicle with closed window adequate
OK to touch victim
AVOID…
Dugout
Picnic pavilion
Rain shelter
Lightning
Move victim ONLY if necessary, with particular attention to any
possible brain or spinal cord injury
Examine for burns, broken bones, cuts, loss of hearing or eyesight
Emergency Plan Activation
Activate your plan
Notify EMS
AED if available
Log roll
Initiate effective CPR
Some Emergencies on the field
Obviously need 911
Dislocations
Open Fractures
Gross Deformities
LOC
Injury Prevention
3.5 million injuries each
year
– Most common are
strains and sprains
Prevention
– Dynamic warm up
– Static stretching
– Proper biomechanical
training
33
Stretching
Stretching: the act of performing a particular
exercise to improve joint range of motion. European
College of Sports Sciences 2006.
Static Stretching: when a body part is taken to a
point of mild discomfort and held for an amount of
time.
Dynamic Stretching/Movements: movements that
maximize active range of motion and elevate core
body temperature.
•
Journal of Strength and Conditioning 2005
34
Static vs. Dynamic
Does static stretching prior to activity
achieve the goals of injury prevention and
performance enhancement?
NO
Research has shown that static stretching
can be detrimental to performance and does
not lead to a decrease in injury
35
Static vs. Dynamic
•
Study from the Journal of Strength and Conditioning, 2008
24 Division I wrestlers were randomly assigned to
complete a 4 week Dynamic or Static warm up
routine prior to their preseason practices
11 performed the static warm up
13 performed the dynamic warm up
They were tested on med ball underhand throw,
300 yard shuttle, pull ups, push ups, sit ups, broad
jump, 600 m run, sit to stand reach, trunk
extension, quad and hamstring peak torque tests.
36
Static vs. Dynamic
• Results Dynamic Group
Increase in quadriceps peak torque by 11%
Increase in broad jump by 4%
Increase in underhand med ball throw by 4%
Increase in sit ups by 11%
Increase in push ups by 3%
Static group posted no improvements to tests
performed.
37
Static vs. Dynamic
•
Study from the Journal of Strength and Conditioning, 2006
United States military academy took 30 cadets to do a
study on static vs. dynamic warm up routines to see
which one would better prepare their cadets for power
and agility activities
Tested on the 5 step jump to determine functional leg
power
Medicine ball throw was chosen to measure total
body power
T-drill was chosen to measure agility
38
Static vs. Dynamic
For 3 days one group of cadets performed
static stretches for 10 minutes prior to data
collection
Other group performed dynamic stretches
for 10 minutes
All routines were done at 6AM each day
There was a 2 minute period between
finishing the warm up and beginning the
performance test
39
Static vs. Dynamic
• Results
T –drill static warm up = 9.69 sec vs. dynamic’s
9.56 sec
Medicine ball throw = 9.34 meters with static vs.
9.79 meters with dynamic
5 step jump = 9.78 meters with static vs. 10.06
meters with dynamic
For task requiring power and agility, the results
suggest that dynamic warm up will offer
performance benefits not found with static warm
ups.
40
Times have changed!
41
Thank You
Tony Milian, ATC, LAT
Manager, [U18] Sports Center
954-538-5501
amilian@mhs.net
www.u18sportsmedicine.com