Transcript Treatment of Sports Medicine Injuries

Treatment of Sports Medicine
Injuries
Introduction
Immediate care of an injury athlete or person
engaging in physical activities
Rehabilitation of the injured part of body using
conservative methods
The applications of new technologies
Treatment and prevention of environmental
injuries
Immediate Care
Athletic injuries may life-threatening
– Asphyxia
Water inhalation
Strangulation by external means
– External bleeding
Cutting a blood vessel on a sharp object
Initial management of theses involves
– ABC (airway, breathing, circulation)
– CPR (Life-saving technique)
– If bleeding is a problem, it needs to be controlled
Cardiopulmonary Resuscitation (CPR)
Most musculoskeletal injuries are not lifethreatening, but immediate care should
initiated quickly
– Control bleeding and edema
– Management early inflammation, pain, and muscle
spasm
– Acronym of these procedures is
P= protection
R= rest
I = ice
C= compression
E= elevation
S= stable
Cryotherapy for
immediate and longterm treatment
– Cold causes a
vasoconstriction of blood
vessel and reduces limb
temperature and help
reduces swelling
– Slowing the tissue
metabolic rate and pain
and in control of muscle
spasm
– Application about 20
min per hour for 1.5 to
1.5 hours or cold may
lead to tissue damage
Applying pressure to an injury helps reduce
hemorrhaging and the creation of a hematoma
– Reduction of fluid seepage into surrounding area and
facilitation of the absorption rate
– Decreasing the possibility of secondary injury
Elevation of a body part is another strategy to reduce
swelling
– Extremity above the level of the heart facilitates the return
of fluid through the vein back to the heart and reduces
edema
Immobilizing the limb may be accomplished through
taping, casting, splinting or aids (crutch, cane)
– Certain amount of rest is vital for the healing process
– Too much rest of immobilizing can lead to loss of motion
in a joint and muscular atrophy
Rehabilitation Treatment for Sports
Medicine Injuries
Exercise
– Various types of exercise in conjunction with
therapeutic procedure are used to rehab. patient
Isometric Exercise
– A type of strength
training in which the
joint angle and muscle
length do not change
during contraction
– Use during early stage of
rehab. process
– When extremity is
immobilized it helps to
reduce muscle atrophy
Dynamic Exercise
– Is used to strengthen a group of muscles through a
range of motion
– Can be perform either concentric or eccentric
exercise
– More muscle force can be developed during
eccentric exercise than isometrics or concentric
exercise
– Eccentric contractions, although important, it may
produce post exercise muscle soreness (DOMS)
– There are may be a compromise between rehab.
and training and the amount that would produce
soreness
Isokinetic Exercise
– Produces more force at some
joint angles than others and
therefore can present more
stress on a joint t that might
be appropriate for
rehabilitation
– A type of dynamic exercise
– Use dynamometer that
provide an accommodation
in resistance at each set
velocity
– Use in assess muscle
strength and to increase
muscular strength
Treatment Modalities
Cryotherapy
– Clod has been used in immediate care and first
aids
– Is appropriate for sprains, strains, hematoma,
contusions, and problems such as fasciitis,
tenosynovitis, tendonitis
– Cold therapy
Increases pain threshold
Decreases velocity of impulses (desensitized nerve
endings)
Decreases muscle spindle firing
Decreases muscle’s reaction to stretch; helps relax
Reduces spam
– Shunting reaction by cryotherapy
Cryokinetics
– Combination of cold and exercise (passive or
active movement)
– An approach results in less disuse atrophy and
reduces the possibility of developing adhesions
Thermotherapy
– is the application of heat to the body for pain relief
and health
– It can be beneficial to those with arthritis and stiff
muscles and injuries to the deep tissue of the skin
– The therapeutic effects of heat include
increasing the extensibility of collagen tissues;
decreasing joint stiffness;
reducing pain;
relieving muscle spasms;
reducing inflammation, edema, and aids in the post acute
phase of healing;
increasing blood flow-the increased blood flow to the
affected area provides proteins, nutrients, and oxygen for
better healing
Four methods of thermotherapy
– Conduction: direct contact with a heat source
(whirlpool, paraffin baths, analgesic balms)
– Convection: indirect heat such as heated water or air
(whirlpool: heat and hydro-massage)
– Radiation: transfer of heat or energy through space
by electromagnetic waves (infrared lamp)
– Conversion: heat by other forms of energy
(diatherapy, ultrasound, phonophoresis)
Ultrasound is one of the most frequently used
modalities of penetrating heat in sports
medicines (to rehab. bursitis, tendinitis, fasciitis,
and soft tissue injury)
Electrical Stimulation
– Is used to control swelling, reduce atrophy, increase blood
flow, reeducate muscles, and control of pain
– By regulating the characteristics of electric current (type of
current, current pulse width, frequency, and intensity) the
desired outcomes in the rehab. process may be obtained
– Iontophoresis (Electromotive Drug Administration (EMDA))
is a technique using a small electric charge to deliver a medicine or
other chemical through the skin
To anesthesia, fight infection, and plantar warts
– Transcutaneous electrical stimulation (TENS)
Become a treatment to diminish acute and chronic pain
This type of direct , low-intensity current produces “gating”
mechanism in dorsal horn of the spinal cord that turns off the pain
signal
Surgery
More invasive measures are sometime required
– Orthopedic surgeon
– Graft from neighboring tissue of torn muscle or
tendons
– Realignment of patella
Surgical Materials
Various plastic materials have been used in
artificial joints, and these need to be designed
to be biocompatible with neighboring tissues
– Gore-Tex polyester
– Teflon
– Dacron
Arthroscopy
is a minimally invasive
surgical procedure in
which an examination
and sometimes
treatment of damage of
the interior of a joint is
performed using an
arthroscope, a type of
endoscope that is
inserted into the joint
through a small incision.
Arthroscopic procedures can be performed either to
evaluate or to treat many orthopedic conditions
including torn floating cartilage, torn surface cartilage,
ACL reconstruction, and trimming damaged cartilage.
The advantage of arthroscopy over traditional open
surgery is that the joint does not have to be opened up
fully. Instead, for knee arthroscopy for example, only
two small incisions are made — one for the
arthroscope and one for the surgical instruments to be
used in the knee cavity.
This reduces recovery time and may increase the rate
of surgical success due to less trauma to the
connective tissue.
Micro-fracture is used to put
small holes in bone and
promote healing by blood
clotting and production of
fibrocartilage
Autologous chondrocyte
transplantation (ACT)damaged knee cartilage can
be repaired by patient’s own
healthy tissue is used to
grow new cells
New Technology
The computer in
rehabilitation
– Physical therapists used to
conduct range of motion
exercise for a brief of time
– Continue passive motion
(CPM) is a postoperative
treatment method that is
designed to aid recovery
after joint surgery
– Computer control a
machine that provides
extended periods of
continual flexion and
extension at a joint
Radiography
– Injury Detection
Osgood-Schlatter’s
condition
– Bone Imaging
Radioisotope (technetium) bone imaging is
often used when a stress fracture is suspected
As certain types of fractures, hot spots are
sometimes evident a day earlier than when the
fracture shows up on a radiograph
Cold spots may indicate a decrease
radionuclide uptake found in the early stage of
a disorder called vascular necrosis
– Arthrography
Radiology technique that permits inspection of joint
surface and surrounding structure
Air introduced into the articular cavity as a thin layer of
radiological contrast medium coats articular surface
This detection technique is often used for suspected
knee, shoulder, and ankle injuries
Examination of the radiographs helps determine
whether a ligament teat exists
– Computerized Tomography
Tomography in which computer analysis of a series of
cross-sectional scans made along a single axis of a
bodily structure or tissue is used to construct a threedimensional (horizontal, sagittal, and frontal) image of
that structure.
Some advanced systems provide a greater acuity to
detect various types of lesions, plus the patient is
subjected to less radiation than conventional CAT scan
– Ultrasound
Is a safe and noninvasive
technique used to assess
numerous physical
activity problems
Sound wave are bounced
off different structures and
reflected back to the
transducer and these
reflected sound wave are
received and integrate
into an electron system
that constructs a twodimensional picture (real
time image)
– Cystoscopy
Urologists have inspected the urinary bladder
Orthopedic surgeons use a similar device to inspect
joints of the body
Both arthroscopy and arthroscopic surgery may be
conducted under local or general anesthesia and are
done as an outpatient procedure
– Magnetic Resonance Imaging (MRI)
The technique is based on the effect of a magnetic field
has upon proton excitation
Tissue protons in a magnetic field absorb energy, causing
the to wobble
Radio-wave are used to create this magnetic field
After the waves are turned off, the protons return to their
original state and emit energy, which is magnetic
resonance signal
This bears no known side effects or risks
Sport Diving Injuries
Barotrauma
– Frequent occur during descent, when a diver is unable to
equalize pressure in the internal anatomic air spaces as the
ambient pressure increases
Nitrogen Narcosis
– As partial pressure increases, more nitrogen is forced into
solution with the body
– This condition affects the central nervous system with
sequential symptoms of dizziness, impairment of mental
processing etc…
Air Embolism
– Is a condition associated with the ascent of the
diver
– Air or other gas bubbles enter the blood stream and
cause obstruction in small arterial vessels and
cause hypoxia, and tissue ischemia
Decompression Sickness
– Condition arising from dissolved gases coming out
of solution into bubbles inside the body on
depressurization
– Two types of decompression illnesses
Type I is called musculoskeletal bends
Type II is called central nervous system bends
Treatment of Environmental Injuries
Heat-related Disorders
– Heat Cramps
are muscle spasms that result from loss of large amount
of salt and water through exercise.
Heat cramps are associated with cramping in the
abdomen, arms and calves.
This can be caused by inadequate consumption of fluids
or electrolytes
– Heat Exhaustion
Can be a precursor of heatstroke; the symptoms include
heavy sweating, rapid breathing and a fast, weak pulse
– Heat Stroke
Defined by a body temperature of greater than 40.6 °C
(105.1 °F) due to environmental heat exposure with lack
of thermoregulation. Symptoms include dry skin, rapid,
strong pulse and dizziness
Preventing Heat Disorders
Ample fluid replacement must be done
Heat acclimatization (cardiovascular and
hormonal adjustment) to environment
Appropriate uniforms, equipment and length of
activity sessions
Cold Injuries
Exposure to cold can produce a variety of injuries that occur as
a result of man's inability to adapt to cold.
These injuries can be divided into localized injury to a body
part, systemic hypothermia, or a combination of both
Hypothermia or systemic cold injury occurs when the core
body temperature has decreased to 35 degrees C (95 degrees F)
or less.
The general principals of pre-hospital management are to (1)
prevent further heat loss, (2) rewarm the body core
temperature in advance of the shell, and (3) avoid precipitating
ventricular fibrillation
There are two general techniques of rewarming--passive and
active
The freezing of the corneas has been reported to occur in
individuals who keep their eyes open in high wind-chill
situations without protective goggles (e.g., snowmobilers,
cross-country skiers).
Frostbite
– is the medical condition where localized damage is
caused to skin and other tissues due to extreme
cold.
– Frostbite is most likely to happen in body parts
farthest from the heart and those with large
exposed areas.
– The initial stages of frostbite are sometimes called
"frostnip".
Chilblains
– are acral ulcers (that is, ulcers affecting the
extremities) that occur when a predisposed
individual is exposed to cold and humidity.
– The cold exposure damages capillary beds in the
skin, which in turn can cause redness, itching,
blisters, and inflammation
Discussion
Do you know other measures which runners
suffering chronic bone injury are
therapeutically beneficial.
In case of extreme cold environment, should
you still implement cryotherapy to relieve an
acute injury?
Could you design a various types of exercise in
conjunction with therapeutic procedure are
used to rehab a young adult whose locomotion
impairment has brought his life a great
inconvenient.