File - Coach blackwell`s Sports Medicine

Chapter 8 The Injury Process

The Physics of Sports Injury Connective Tissue • Connective tissues are the most common type of tissue in the body. • Connective tissues include ____________ __________________________________ __________________________________ • In some sports, nearly 50% of acute injuries involve either tendon or muscle.

The Physics of Sports Injury (cont.) Muscle/fascia are thought to be injured by excessive tension during contractions.

• Tendons are extremely strong structures; strains occur most often at the distal ____________________________(MTJ). • These strains are the ____ _________soft tissue injuries related to sports.

Mechanical Forces of Injury Types of Force • •

•

Mechanical Forces of Injury (cont.) • Tendons resist ________ forces. • Bones resist ___________ forces. • Ligaments resist _________ forces. Each type of tissue has a limit for how much force it can withstand (critical force).

The Physiology of Sports Injury The ________________ _____________: • Is a predictable sequence of physiologic actions that occur when the body reacts in a manner to repair damaged tissues. • Begins during the first few minutes following an injury. The body’s initial response to trauma is commonly called _________________.

The Inflammatory Process (cont.) Normal signs and symptoms of inflammation include:

• . • .

• • .

Acute Inflammatory Phase • Initial trauma destroys millions of cells. • _________________ is followed by vasodilation. • Damage to blood vessels results in blood flow into ___________ ______causing a hematoma. • A _________ is the “localized collection of extravasted blood.” • ___________ _________injury results in additional cellular destruction.

Acute Inflammatory Phase (cont.) In response to injury, chemicals are released that affect nearby cells. The effects of these chemicals are: • _______________ (cellular breakdown). • ________________ (vasodilators). • ________________ (attract scavenger cells).

Acute Inflammatory Phase (cont.) _____________ __________is responsible for the manufacture of bradykinin. • ____________ increases vascular permeability and triggers the release of prostaglandins resulting in: • Vasodilation. • Increased vascular permeability. • Pain. • Blood clotting.

Acute Inflammatory Phase (cont.) • Plasma proteins, platelets, and leukocytes move out of capillaries and into damaged tissue. • • Macrophages migrate into the damaged area. Arachidonic acid is formed by a combination of leukocyte enzymes and phospholipids derived from cell membranes. •

Acute Inflammatory Phase (cont.) The acute inflammatory process results in a walling off of the damaged area from the rest of the body.

The acute phase lasts up to 3 or 4 days, unless aggravated by additional trauma.

Resolution (Healing) Phase During this phase, special leukocytes (polymorphs and monocytes) and a type of macrophage (histocytes) migrate into the area of injury. •

Regeneration and Repair Except for bone, connective tissues heal by forming scar tissue that begins to develop 3– 4 days after the injury. •

• Fibroblasts are immature connective tissue fibers that can mature into several different types of cells.

Regeneration and Repair (cont.) • ______________is the formation of new capillaries.

• ________ _______may take up to four months. • Scar tissue can be 95% as strong as the original tissue. Stress on the tissue is helpful for rehabilitation; exercises are critical to this process. • Bone tissue heals by way of specialized cells (__________________________).

Pain and Acute Injury • Everyone copes with pain differently. • . • Pain results from sensory input received through the nervous system and indicates location of tissue damage. • Messages concerning sensory information that travel quickly through the nervous system are given higher priority than pain messages that travel more slowly. • .

Intervention Procedures • Sports medicine community has no clear set of criteria for first aid treatment of acute softtissue injury. _____________ includes bags of crushed ice, aerosol coolants, ice cups, ice water immersion, and commercial cold packs. After the acute phase,___________is appropriate (i.e., hydrocollator packs, moist warm towels, and ultrasound diathermy).

Intervention Procedures (cont.) • Modalities such as ultrasound should ONLY be used under the supervision of trained allied health personnel. • . • If they must be prescribed by a physician, these agents represent treatments that are beyond the scope of the coach. • OTC drugs should also be used with caution. (Consult parents when athlete is under 18 years of age.)

Cryotherapy • Direct application of cold may reduce vasodilation in the first few minutes after injury. • .

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Cryotherapy (cont.) • In extremities, elevation and compression are also helpful in treatment. • • Elastic wrap secures the ice bag to the body. • Cold application has analgesic effect and reduces muscle spasm. • • Risk of frostbite is minimal with crushed ice.

Thermotherapy Thermotherapeutic agents: • • Increase vasodilation.

• Are useful in the final phases of injury repair.

Pharmacologic Agents Steroidal and NSAIDs • Both affect aspects of the inflammatory process. • Steroidal drugs resemble gluococorticoids, but the exact mechanism of their action is unknown. Steroids may: • • • •

Pharmacologic Agents (cont.) Steroids must be used with care. • . Steroids may be injected or taken orally and include drugs such as: • Cortisone, hydrocortisone, prednisone, prednisolone, triamcinolone, and dexamethasone.

NSAIDs NSAIDs do not have the negative effects of steroids.

• NSAIDs are very popular drugs. • .

NSAIDs (cont.) • NSAIDs block the conversion of arachidonic acid to prostaglandin. • • Research is inconclusive regarding NSAIDs’ effect on tissue healing and strength.

RICE Best approach to the care of soft tissue injury is _______ along with prescribed pharmacologic agents and supervised rehabilitative exercise. R= I= C= E=

The Role of Exercise Rehabilitation • Properly supervised physical activity is very effective for many injuries. • .

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Exercise Rehabilitation • • Rehabilitation must be supervised by professionals with appropriate training, such as a BOC-certified Athletic Trainer or a Physical Therapist with sports medicine training.

Exercise Rehabilitation (cont.) Rehabilitative exercise is a four-phase process. • • • •

Injury Rehabilitation • Injury rehab should be considered an ongoing process. •

• Without this approach, the likelihood of reinjury is high.