ON-FIELD PHYSIOTHERAPY

ON-FIELD PHYSIOTHERAPY

CONTENTS  Roles

of on-field physiotherapist  Basic assessment procedures  Prevention and assessment of heat & cold injuries  Management of acute soft tissue injuries

Why we need on field physiotherapy?

ON FIELD PHYSIOTHERAPIST  Roles

On-field services in Hong Kong  Team Physiotherapist  Domestic, National and International Level 

ON-FIELD PHYSIOTHERAPY SERVICES  1996

International Masters Hockey Tournament  1996 Seoul International Women’s Road relay  Hong Kong Cricket team - Bangladesh Cricket Tournament  Standard Chartered Shenzen - Hong Kong Marathon

 Swire

Group Tsing Ma Bridge 10 km and Marathon  Hong Kong - Beijing Relay  Standard Chartered International Marathon (1997-2002)

Sports Physiotherapy in Elite level  SDB,

5 full time physiotherapists  Hong Kong Team physiotherapists  1987 Asian Athletic Championship  1992 Barcelona Olympics, 1994 Commonwealth and Asian Games, 1996 Altanta Olympics (3)  2002 Busan Asian Games: 8 physiotherapists

KNOW THE SPORT

ON FIELD SERVICES KNOW THE VENUE

PREPARATION  Deployment  Equipment

of manpower

Types of injury

Cases

Muscle soreness/strain

175

Ligamentous sprain

112

Tendonitis

44

Joint problems

41

Contusion

42

Laceration

7

Haematoma

3

Concussion

1

Others

6

Types of services

Number

IFT

44

US

158

TENS

34

HVG

7

ICE

98

Manual technique

210

Massage

211

Strapping and taping

70

Dressing

13

Education and advice

85

ON-FIELD MANAGEMENT ASSESSMENT

VENUE

PERSON

PROCEDURES

SYSTEMATIC APPROACH



Scene Survey



Is the scene safe?

It

is frequently better to remain uncertain about a diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool.

PRIMARY SURVEY OF THE PATIENT LOC

Talk to the patient and assess his level of consciousness A Alert V Response to vocal stimuli P Response to pain U Unresponsive

AIRWAY + C-SPINE CONTROL 

 



Is the victim able to maintain his airway If he can talk, the airway is OK Open airway by jaw thrust if necessary Do not use head tilt as this may affect the C-spine

BREATHING 

Assess if victim is breathing adequately. Is it too fast? too slow? too shallow?



Oxygen, if available, should be given if breathing is laboured.



Feel for any tenderness

BREATHING 

Auscultate the chest for unequal air entry



Check if the trachea is central

CIRCULATION Arrest any visible haemorrhage using direct pressure Check both carotid and radial pulse If radial pulse is weak or not palpable, the patient is probably in shock Capillary refill is less than 2 second normally

CIRCULATION If the patient is unresponsive and with

no carotid pulse==> this is cardiac arrest. you should start cardiopulmonary resuscitation immediately

DECISION POINT : SEND FOR THE AMBULANCE IMMEDIATELY Impaired

conscious state Airway obstruction Breathing difficulties Significant external bleeding especially when control by external pressure is ineffective

DECISION POINT : SEND FOR THE AMBULANCE IMMEDIATELY feature

of shock: thready pulse, cold clammy hands, delayed capillary refill unstable pelvis major fracture of limb bones

CARDIOPULMONARY ARREST PROBABLE

CAUSES: HEAD TRAUMA Cx INJURY MAXILOFACIAL OR THORACIC TRAUMA CVA MYOCARDIAL INFARCTION

HAEMORRHAGE  INTERNAL: COLD  RAPID

PULSE AND RESPIRATION  PALPABLE PAIN AND TENDERNESS  RESTLESSNESS  EXCESSIVE THIRST  BLOOD IN THE URINE OR STOOL  OBSERVE FOR SHOCK OR ARREST

HAEMORRHAGE External  Direct Pressure  Arterial Pressure Pt. Compression  Area should be elevated

SECONDARY ASSESSMENT  Chief

Complaints  Behaviour of symptoms  Location & radiation of the symptoms  Mode of onset  Mechanism of injury  Functional alterations  Related symptoms  Past injuries

LOOK AND PALPATION  Location

of Pain  Degree & type of swelling  Temperature & texture of the area  Muscle spasm  Tissue continuity & deformity  Neuromuscular function  Abnormal Motion or sensation

MOVEMENT  Active

& Functional Motions  Resistive Motion  Specific Stress Test  Sport Specific Function  Return to activity

HEAT INJURY

Metabolic Heat Stress Metabolic heat production Exercise Shivering Thryoxine Sympathetic stimulation

Exercise 20-25x 25% efficiency

Heat Production

Heat Balance Radiation Conduction Convection Evaporation

Heat loss

WBGT 0.1: 0.7: 0.2

CONVECTION  Responsible

for transferring heat from working muscles and the skin surface  Temp differential between skin and environment  Heat transfer coefficient, body surface area and wind velocity  Minimal body fat and loose-fitting clothing

CONDUCTION Minimal

effect on body heat transfer Direct contact between skin and an object

RADIATION Solar

radiation and radiation from tracks, roads, and surrounding structures Can be a major contributor to heat load

EVAPORATION Most

important heat dissipation mechanism in warm environments Sweating – a fit athlete can produce up to 30 ml of sweat per min Evaporation depends evaporative heat transfer coefficient – air velocity and water vapor pressure gradient (relative humidity)

WBGT Wet

Bulb Globe Temperature Three monitors: Dry bulb (Tdb)  air temperature Wet bulb (Twb)  relative humidity Black globe (Tg)  solar radiation WBGT = 0.1Tdb + 0.7Twb + 0.2Tg

Without adaptive mechanisms, moderate exercise could elevate temp by 1C every 5-6’

Fluid/electrolyte Loss of solutions Sodium andadded Prevention: Potassium salt to food, high K+ diet

HEAT INJURY

Heat Cramp

Warm, humid conditions, inadequate Cool fluids fluid pre-hydrate replacement

Dehydration

Red, Hot and Dry skin Heat exhaustion Strong & Rapid pulse LackMedical of sweating, CNS symptoms unsteady Emergency !! gait Heat Stroke confusion, combative behaviour, coma

Profuse Sweating Clammy & Cool Shading Skin remove excess Headache &cloth cooling with ice, Weakness sponges Nausea & hydration Weakness monitor Rapid vital Pulsesign & hospital Disorientation

PREVENTION  Conditioning

 sweat rate  Acclimatization 3-4 Thirst: hrs/day, poor indicator 60-70% load  core temperature Intake: 400-600 ml 15-20’ 5-10 days volume  Fluid replacement 2-3%;  plasma 200-300 ml every 15-20’ exercise heat storage  Venue and schedule intense 3L/hr Every L loss,  0.3 C Q  1L/min HR  8

CHILDREN AND HEAT INJURY      

Sweat less effectively; produce  metabolic heat for given workload; acclimatize more slowly than adults; larger M/A;  renal tubular filtration rate; self perceive;

BUT HOW ABOUT COLD INJURY?  Heat

loss also depends on air movement, humidity, evaporation (sweating) and ambient temperature  Wind velocity exacerbates heat losses

Adequate clothing High energy bar Avoid wind exposure

Medical Emergency !!

Mild Hypothermina

Moderate Hypothermia

Severe Hypothermia

Shivering, cold, hunger Confusion muscle spasm Slow pace Semi-conscious confused actions Extremely tired Poor coordination Muscle stiffness Slurred speech Disorientation Loss of consciousness Faint heartbeat

Acute Sports Injuries Treatment that comes with PRICE!

MANAGEMENT OF ACUTE SOFT TISSUE INJURIES PRICE

HARM