Transcript Out of Harm`s Way: Sport Injuries

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