Transcript What Are Sports Injuries?

‫بسم هللا الرحمن الرحیم‬
Sport Physiotherapy
principles
SHIRIN KAMALGHARIBI
MASTER DEGREE OF PHYSIOTHERAPY
 Sports physiotherapy is the specialized branch of physiotherapy which
deals with injuries and issues related to athletics.
 Experts in sports physiotherapy may do research, help athletes recover
from injuries, and provide education and resources to prevent
problems.
 Therapists help athletes overcome their injuries and return to their
previous levels of activity by offering rehabilitation services and advice
on preventing future issues.
 Depending on the type and severity of an injury, successful
rehabilitation physiotherapy may take anywhere from a couple hours in
light sessions to months or years of intensive training
 Sport physiotherapy include:
 examining and diagnosing injuries
 planning treatment programmes
 using methods such as manipulation, massage, heat
treatment, electrotherapy and hydrotherapy
 keeping records of patient's treatment and progress.
Sport physiotherapy
 1. Injury Prevention
Sports physiotherapists assess the risks of injury
associated with an athlete’s participation in a specific
sport or physical activity context; they inform and
train athletes and other professionals in a way that
reduces the occurrence and recurrence of injuries.
 2. Acute Intervention:
 Sports physiotherapists respond appropriately to
acute injury .
 3. Rehabilitation:
 Sports physiotherapists use clinical reasoning and
therapeutic skills to assess and diagnose sportsrelated injuries, and to design, implement, evaluate
and modify evidence-based interventions that aim
for a safe return to the athlete’s optimal level of
performance in their specific sport or physical
activity.
 Performance Enhancement:
 Sports physiotherapists contribute to the
enhancement of an athlete’s performance by
evaluating their physical and performance related
profile and advising or intervening to optimize
conditions for maximal performance in a specific
sport, within a multidisciplinary team approach
 5. Promotion of a Safe, Active Lifestyle:
 Sports physiotherapists collaborate with other
professionals to promote safe participation in sports
and activity for individuals of all abilities; they
provide evidence-based advice regarding the optimal
activity or sport for specific individuals and the ways
in which they can minimize risk of injury and
promote health
Sport injury
 The term “sports injury,, refers to the kinds of
injuries that most commonly occur during sports or
exercise.
 Some sports injuries result from accidents; others
are due to poor training practices, improper
equipment, lack of conditioning, or insufficient
warm-up and stretching.
Sport injury
 Although virtually any part of your body can be
injured during sports or exercise, the term is
typically reserved for injuries that involve the
musculoskeletal system, which includes the muscles,
bones, and associated tissues like cartilage.
Traumatic brain and spinal cord injuries (relatively
rare during sports or exercise)
 Most sports injuries result from:
 Doing too much too quickly.
 Overestimating your fitness and ability.
 Lack of preparation/poor technique.
 Pushing your body too hard (over-training).
 Poor equipment
 accidents.
What are the types of sports injury?
 Stress fractures:
 Stress fractures are common sports injuries.
 Stress fractures are overuse injuries. They occur
when muscles are fatigued, weakened or injured, and
cannot absorb added shock.
 Stress fractures tend to result from a sudden increase
in training intensity or quantity, a change of sports
surface or change of running shoes.
 Most stress fractures occur in the lower leg, but they
can also occur in the thigh and hip.The sports where
they are most seen are track and field events, tennis
and basketball. They are slightly more common in
women.
What are the types of sports injury?
 Foot and heel pain
 One common condition is plantar fasciitis: the
plantar fascia is a thick band of tissues stretching
under the foot.
 Heel pain may also be due to bruised heel, which is a
bruise in the heel pad.
 Broken bones (fractures) can occur in the long bones
of the feet or in the toes
 Ankle pain
 Achilles tendonitis
 Achilles tendon rupture
 Ankle sprain and ankle fracture
 Lower leg pain
 Muscle strains or cramps
 Shin splints
 A torn calf can occur when excess strain is put on the
calf
 Knee and thigh pain
 Knee cartilage injuries
 Knee ligament injuries
 Pattello femoral pain syndrome
 Osgood schlatter disease
 Hamestring injury
 Popliteus tendonitis
 Shoulder pain
The most common causes of shoulder pain in sports
are swelling (inflammation): rot cuff tendonitis
 Injuries, strains and tears to the biceps and triceps
muscles can occur in those who use their arms in
sport.
 Elbow pain
 Tennis elbow
 Golfer elbow
 Wrist and hand pain:
 Wrist tendonitis
 Carpal tunnel syndrome
 Finger dislocation and fracture
 Lower back pain
 Pain in the lower back is often due to underlying
back problems which are made worse by sport.
However, strain on the lower back is severe in those
lifting weights, particularly if the technique is not
excellent.
What Are Sports Injuries?
 Sprains and Strains
 Knee injuries
 Shin Splints
 Achilles Tendon Injuries
 Rotator cuff injuries
 Fractures
 Dislocations
Chronic Injuries?
 Acute Injuries
 Acute injuries, such as a sprained ankle, strained
back, or fractured hand, occur suddenly during
activity.
 Signs of an acute injury include the following:
 sudden, severe pain
 swelling
 inability to place weight on a lower limb
 extreme tenderness in an upper limb
 inability to move a joint through its full range of
motion
 extreme limb weakness
 visible dislocation or break of a bone
 Chronic Injuries
 Chronic injuries usually result from overusing one
area of the body while playing a sport or exercising
over a long period.
 The following are signs of a chronic injury:
 pain when performing an activity
 a dull ache when at rest
 swelling.
 When you have pain from a particular movement or
activity, STOP! Continuing the activity only causes
further harm.
Components of a rehabilitation program include:
1. minimizing swelling
2. controlling pain
3. restoring full range of motion
4. restoring muscular strength and endurance
5. re-establishing neuromuscular control
6. regaining balance
7. maintaining cardiorespiratory fitness
8. incorporating functional progression
 Phase acute - Acute Inflammatory Response Phase
 May last up to 4 days
 Immobility for the first 2 days is necessary to control
inflammation
 Primary focus is to control swelling and modulate pain w/ RICE
 Early mobility during rehab is critical, however, being overly
aggressive during the first 48 hours may not allow
inflammatory process to accomplish its purpose
 Rest should be active - avoid aggravating injury, but working to
maintain other areas
 Acute Inflammation ( 24-48 hours )
 Chronic Inflammation ( 3-7 days )
Acute Phase
4. Goals:
a. Reduced Swelling
b. Decrease Pain
c. Tissue Healing
d. Improved ROM
 Minimizing Initial Swelling
 Swelling is caused by many factors and must be controlled
immediately after injury
 Minimizing swelling significantly speeds the healing process
 Controlling Pain
 Some degree of pain will be experienced
 Pain will be dependent on the severity of the injury, athlete’s
response, perception of pain and the circumstances
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RICE, analgesics and medication can be used to modify pain
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Pain can interfere w/ rehab and therefore must be addressed
throughout the rehab proces
 It’s important that during the first three days of a
sports injury you don’t apply heat to the area, as
heat can increase circulation and worsen swelling.
 Once the swelling has gone down, you can begin to
alternate heat packs with ice
 Electrotherapy comes in many forms, but in sport
the three most common ones are ultrasound,
interferential therapy and transcutaneous electrical
nerve stimulation (TENS).
 Goal is to control the pain and inflammation
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PRICE
Protection
 Rest
 Ice
 Compression
 Elevation

Improved ROM

By day 3 or 4 swelling begins to subside mobility exercises
may be started (pain free ROM)
 If
it is the lower extremity, patient should be
encouraged to bear weight gradually
 History
 Find out exactly how the injury occurred. This is
essential to understand the mechanism of injury.
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Ask whether there was direct trauma.
If so, ask where, how and in what direction.
Try to assess the force of the impact.
Establish the position of the joints when it happened.
Especially if you are not familiar with the sport, ask the athlete to
explain exactly what was happening.
 Ask whether the athlete was able to continue the game.
 Ask how long ago the injury took place.
 Ask whether there been a similar injury before
examination
 Look at the area. Note where there is bruising or
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swelling. Note if there is any distortion.
Put the joint through its full range of passive
movements in all directions.
Ask the patient to perform that range of movement
actively.
Test active movement against resistance.
Stress the joint to detect instability of ligaments.
Palpate the joint and also around it for local
tenderness, swelling or effusion and muscle spasm.
 Alternative training
Athletes can continue to train even when they are injured. It
means adopting different types of training or training methods
that do not stress the injury. One of the major goals of the
rehabilitation process is to maintain aerobic fitness levels by
using alternative training methods. For instance, instead of
running, athletes can try water running with a flotation belt, or
cycling. As the coach, you should implement this alternative
aerobic training programme as soon as possible. It is vital that
athletes believe that even though they are injured, they can
stay in shape.
 Restoring or Increasing Muscular Strength &
Endurance
 Once the pain has subsided and the athlete has started to
meet the flexibility and strengthening goals.
 Isometrics Performed in early part of rehab following
period of immobilization
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Used when resistance through full range could make injury worse
Increase static strength, work to decrease/limit atrophy, create a
muscle pump to decrease swelling
Strength gains are limited primarily to angle at which joint is
exercised, no functional force or eccentric work developed
Progressive overload
One of the key principles of training is progressive overload. The exercises are set at a specific intensity and volume to start with. Given appropriate recover
 One of the key principles of training is progressive
overload. The exercises are set at a specific intensity
and volume to start with. Given appropriate recovery
time between sessions, this initial training dosage
will produce a training response. After a certain time
the athlete adapts and the dosage will have to be
increased for there to be further increases in fitness.
If there is no progression then the athlete’s fitness
level will plateau.
Progressive Resistance Exercise (PRE)
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Can be performed using a variety of equipment
Utilizes isotonic contractions to generate force while muscle
changes length
Traditionally focus on concentric exercises
 Eccentric contractions facilitate concentric contractions for
plyometrics .
 Both forms of contraction can be created using a variety of
equipment

Table 1 below, for example, gives an eight-week hamstring strengthening
programme, using the eccentric hamstring exercise illustrated. Note how the
‘repetitions and sets’ of the exercise change over time.
Week
1 and 2
3 and 4
5 and 6
7 and 8
Reps and sets
2 sets x 5 reps
3 sets x 5 reps
3 sets x 8 reps 3 sets x 10 reps
Frequency
2 x per week
2 x per week
2 x per week
2 x per week
 Strength endurance training
 Strength endurance is a common goal for many
rehabilitation programmes. The aim is to increase a
muscle’s ability to withstand repetitive forces or be
able to maintain its function for sustained periods.
Guidelines for developing strength endurance
Repetitions
10 to 20
Sets
2 to 4 or 10 to 90 sec holds per set (static
positions)
Intensity
At a resistance (weight) that results in fatigue
during last few reps of each set
Rest
30 to 60 secs between sets
Frequency
2 to 5 x per week
Phase duration
4 to 8 weeks
Strength training
 For strength training the resistance must be at a level
that allows the athlete to perform no more than 10
repetitions per set. Rest periods between sets should
be longer: 2 to 3 minutes to allow for the necessary
recovery, and the weights progressively increased
rather than upping the number of repetitions
Guidelines for developing strength
Repetitions
3 to 10
Sets
2 to 5
Intensity
Heavy weights to produce fatigue
within each set
Rest
2 to 3 min between sets
Frequency
2 to 3 x per week
Phase duration
4 to 8 weeks
Neuromuscular Control
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Neuromuscular control is the mind’s attempt to
teach the body conscious control of a specific
movement.
Re-establishing neuromuscular control requires
many repetitions of the same movement through a
step-by-step progression from simple to more
complex movements.
Strengthening exercises, particularly those that
tend to be more functional, are essential for reestablishing neuromuscular control.
Neuromuscular Control
 Neuromuscular control, on the other hand, is the
ability of muscle to respond to afferent
proprioceptive information to maintain joint stability
.For example, when running on an uneven surface,
cross-country runners require their lower
extremities-especially their ankles-to adjust to the
ground to prevent falls and injuries; that ability to
adjust is neuromuscular control
Neuromuscular Control
 After an injury, neuromuscular control, like strength and
flexibility, is usually impaired .
 Specific types of exercises exist to improve neuromuscular
control following injury and can be manipulated through
alterations in surface stability, vision, and speed.
 Mini-trampolines, balance boards, and stability balls can be
used to create unstable surfaces for upper and lower extremity
training. Athletes can perform common activities such as
squats and push-ups on uneven surfaces to improve
neuromuscular control.
Neuromuscular Control
 Exercises may also be performed with eyes closed,
thus removing visual input, to further challenge
balance.
 Finally, increasing the speed at which exercises are
performed provides additional challenges to the
system. Specifically controlling these variables
within a controlled environment will allow the
athlete to progress to more challenging exercises in
the next stage of healing.
© 2011 McGraw-Hill Higher Education. All rights
reserved.
Regaining Balance
 Involves complex integration of muscular forces,
neurological sensory information from
mechanoreceptors and biomechanical information
Regaining Balance
 If a patient lacks balance or postural stability
following injury, they may also lack proprioceptive
and kinesthetic information or muscular strength
which may limit their ability to generate an adequate
response to disequilibrium
Regaining Balance
 A rehabilitation plan must incorporate functional
activities that incorporate balance and
proprioceptive training
 exercises such as hopping on a trampette,
unilateral balance drills, wobble-board exercises
and jumping drills are important to retrain any lost
proprioception
Balance Equipment
Maintaining Cardiorespiratory Fitness
 When injury occurs an athlete is forced to miss
training time which results in decreased
cardiorespiratory endurance unless training occurs
to help maintain it.
 Alternative activities must be substituted that allow
athlete to maintain fitness
Step Return to Play Progression
 Involves a series of gradually progressive activities
designed to prepare the individual for return to a specific
sport/activity
 Should be incorporated into treatment as early as possible
 Progression moves from simple to complex, slow to fast,
short to long, light to heavy
Step Return to Play Progression
 Step 1: Light aerobic activity
Begin with light aerobic exercise only to increase an
athlete’s heart rate. This means about 5 to 10 minutes on
an exercise bike, walking, or light jogging. No weight
lifting at this point.
 Step 2: Moderate activity
Continue with activities to increase an athlete’s heart rate
with body or head movement. This includes moderate
jogging, brief running, moderate-intensity stationary
biking, moderate-intensity weightlifting (less time
and/or less weight from their typical routine).
Step Return to Play Progression
 Step 3: Heavy, non-contact activity
Add heavy non-contact physical activity, such as
sprinting/running, high-intensity stationary biking,
regular weightlifting routine, non-contact sportspecific drills (in 3 planes of movement)
 Step 4: Practice & full contact
Young athlete may return to practice and full contact
(if appropriate for the sport) in controlled practice.
 Step 5: Competition
Young athlete may return to competition