How do you prevent injuries?

• Warm up and cool down throughly .
• Wear appropriate footwear. 
• Tape or strap vulnerable joints, if neccessary. 
• Drink plenty of fluids, before, during and after game. 
• Try to avoid exercising in the hottest part of the day between 11am and 3pm.
• Maintain a good level of overall fitness. 

Classification of injuries: Direct

•  Caused by forces generated outside the body.
• Most common in contact sports.
• Consist of contusions, fractures, dislocations and concussions.
• Example: A hockey player receiving a bruise from being struck on the leg by a stick during a game. 

Classification of injuries: Indirect

•  Caused by forces within the body
• Involves the athlete damaging the soft tissues (ligaments, tendons or muscles) of the body through internal or external forces.
•  Example: a beach volleyball player overstretching to reach a ball straining a hamstring. 

Types of indirect injuries?

Acute

• Strain
• Sprain
• Bruise

Chronic

• Overuse

Recurrent 

What is a strain? 

Tearing of the fibres of a muscle or tendon when that muscle is overstretched or contracts too quickly. 

Example: Torn hamstring when starting a 100m race. 

What is a sprain? 

Tearing of the fibres of a ligament surrounding a joint. It usually occurs when the joint is forced beyond its normal range of motion. 

Example: the patella being pushed to the side in a rough tackle. 

What is a bruise? 

What is an overuse injury? 

Excessive and repetitive force over extended periods of time, incorrect technique, equipment or too much training. 

Example: Tendonitis in the shoulder of a swimmer from excessive amounts of training. 

What is a recurrent injury? 

What is a tendon? 

What is a ligament?

What are intrinsic injuries? 

What are extrinsic injuries?

Created by forces outside the control of an individual. 

Example: implement or vehicle. 

Management of a soft tissue injury? 

REST (48-72 hours), ICE, COMPRESSION, ELEVATE, REFER.

No HEAT, ALCOHOL, RUN, MASSAGE

What is a grade 1 soft tissue injury?

Minor tear, mild pain, tenderness, some swelling, 15% damage to muscle, ligament or tendon. 

What is a grade 2 soft tissue injury? 

What is a grade 3 soft tissue injury? 

What is a hard tissue injury? 

What is a simple fracture? 

• Bone that breaks underneath the skin. 
• bleeding remains concealed beneath the skin. 
• Can be difficult to detect. 

What is a compound fracture? 

• A jagged end of the fractured bone protrudes through the skin.
• Visible external bleeding. 
• Infection may enter the body through the bone of cut because of improper care of injury. 

What is a complicated fracture?

• Fracture bone damages local tissues. Example: rib punctures the lung.
• Seeking medical assistance as soon as possible will benefit patient as it may cause internal bleeding. 

What are the signs and symptoms of a fracture? 

•  Pain at site of the injury.
•  Inability to move the injured part.
• Unnatural movement of the injured part.
• Deformity of the injured part.
• Swelling and discolouration.
• Grafting of bones.
• Irregular limb alignment. 

What is the treatment for a fracture? 

• Place a splint to imobilise. 
• Check for impaired circulation and other possible implications.
• Arrange for transport to hospital and professional medical assessment.
• Implement the RICER- of it does not cause pain. 

What is the correct way to place a splint?

1. Above the joint above the fracture.
2.  Below the joint below the fracture.
3. At the joint above the fracture.
4. At the joint below the fracture.
5. Just above the fracture.
6. Just below the fracture. 

What is a dislocation? 

What are the signs and symptoms of a dislocation? 

• Loss of movement at the joint.
• Obvious deformity.
• Swelling and tenderness.
• Pain at the injured site.
• Tenderness.
• Muscle spasm. 

How do you manage a dislocation? 

•  Immobilisation. 
• Immobilise joints above and below injury site. If the injury site is the shaft of a long bone the injury can be supported with a sling and or splint. 

A small group is out abseiling a 20 metre cliff. During one of the descents an abseiled falls in the last 5 metres onto the ground dislodging rocks from the cliff in the process. The person is unconscious and has a visibly broken arm. You are in the group and have first aid training. What do you do? How do you manage it?

Assessment:

• D.R.A.B.C.
• The falling rocks pose a danger and should be addressed when making the first general assessment.
• Treatment of the broken arm and shock would come next followed by monitoring the person until medical help arrives.

Management

• Stabilising of the neck is important in this situation and monitoring of the person's vital signs of breathing and circulation.
•  Next: management of the broken arm by restricting movement within the person's comfort level.
• Keeping the person warm to prevent shock until medical help arrives.

What is the acute stage of healing? 

• From the initial time of injury and while the pain, bleeding and swelling is at its worst.
• The body’s aim is to protect the injury from further damage.
• Treatment of injury will depend on how long the injury takes time to settle down but this will usually take between 2-4 days. 

What is the proliferation stage of healing?

• Turns into proliferation phase when it makes a transition to repairing the injured tissues.
• Lasts up to 6 weeks post-injury.
• The body is laying down new soft tissue and reducing the need to protect the injury as new scar tissue has begun to mature and strengthen. 

What is the remodelling stage of healing?

• At six weeks post injury, the healing tissue is reasonably mature but usually the new scar tissue is not strong enough to cope with the increase physical activity.
•  The body will detect that the repaired structure is still weaker than necessary and will stimulate additional new tissue to help strengthen and support the healing tissue. 

What are the advantages of taping? 

• Mechanical reinforcement of an area susceptible to injury. Example: ligaments prone to damage or a knee prone to dislocation.
• Gives the athlete confidence that the injury will behave itself.
• Allows natural movement rather than compensate for an injury that might happen. 

What are the disadvatages of taping? 

• An athlete’s mind can become too dependent on tape and can cause the muscle to become weak and dependent on it too.
•  Continued taping can become an excuse for performance.
• Some people may react to tape.
• Tape is expensive. 

What are the types of tape used?

• Rigid tape: for large joint treatment such as injured ankle, elbow, and fingers.
• Elastic adhesive bandage tape: greater flexibility, offers compression.
• Kinesio tape: designed to act and aid as a weak muscle, tendon or ligament.  

What is the first step to strapping an ankle? 

1.       Anchor

·         Apply 1 or 2 anchors just below the belly of the calf muscle to provide a firm base to attach the other tapes.

·         Strap with some under wrap to protect the skin. 

What is the second step to strapping an ankle? 

1.       Stirrup

•  A vertical “U” piece of tape, supporting either side of the ankle.
• Apply 2 or 3 stirrups, starting from the anchor on the medial side of the leg.
• Medially passing under the foot, pulling up with some tension on the lateral side and finishing on the anchor.
• The stirrup should be parallel to one another, overlapping by half the width of the tape and centred on the malleoli medially and laterally. 

What is the third step to strapping an ankle? 

1.       Figure of six

·         Used to support and reinforce one side of the ankle.

·         1 or 2 “6s” on lateral side.

·         Start parallel to the stirrup, then cross the front of the foot. 

What is the fourth step to strapping an ankle? 

1.       Half a heel lock

•  Provided to further support the posterior ankle region.
•  Begin on the anterolateral aspect of the lower leg and move inferiorly across the medial aspect of the ankle towards the front of the heel.
• Pass the tape under the foot and across the later aspect of the heel at a 45 degree angle. The tape then passes back to the medial side of the ankle to finish the later aspect of the lower leg where it originally started. 

What is the emergency care of an unconscious patient? 

1.       D- danger

·         Check for danger.

2.       R- response

·         Ask patient for their name.

3.       S- send

·         Send for help.

4.       A- airway

·         Open and clear airway.

5.       B- breathing

·         Check breathing

·         If patient is breathing, put in recovery position.

6.       C- CPR

·         Cardiopulmonary resuscitation.

·         30 chest compressions with 2 breaths.

7.       D- defibrillator

·         Apply defibrillator if available. 

Why is the recovery position used? 

• It prevents the casualty's tongue from blocking their airway.
• It promotes drainage of fluids, such as blood or vomit, from their mouth.
• It keeps the casualty in a safe position if they have to be left alone

What is the on field injury assessment protocol? 

S- See the initial injury.

A- Ask for the history.

L- Look for signs of inflammation or deformities.

T- Touch for tenderness, pain or pins and needles.

A- Active. Ask for active movement from the patient.

P- Passive. Ask the coach/parent to move the part passively.

S- Strength. The therapist resists movement of the injured part by the player. 

What is the S.A.I.D principle? 

• Specific Adaptation to Imposed Demands.
• This explains that a certain exercise or type of training produces adaptations specific to the activity performed and only in the muscles that are stressed by the activity.
• Example: running produces favourable adaptations in the leg muscles. However, the muscles not stressed show no adaptation; so even heroic amounts of running will produce no favourable changes in, say, the arms.

What are common injuries to the ankle? 

• Plantar fasciitis (rupture of the fascia under the foot)
• Hallus rigidus (strain of big toe)
• Achilles tendon ruptures
• Achilles tendonitis
• Heel spur

What is the rehabilitation plan for a mild 2nd degree sprain of the later ankle ligaments: 

1.  Isometric eversion exercises (getting physiotherapist to push ankle in and out) progressing to isotonic eversion (using a big rubber band and forcing against the appliance); stretching of Achilles tendon.
2. Lead up to proprioception exercises (e.g. wobble boards, standing on leg on a mini tramp), progressing to hopping exercises and then to jogging in a figure of 8 pattern.
3. Additional work on the entire extremity; specific return to sport exercises and activities.

What are the common injuries to a knee? 

• Fractures
• Dislocations
• Anterior cruciate ligament tears
• Posterior cruciate ligament tears
• Collateral ligament tears
• Meniscus tears

Tendon tears

What is a rehabilitation plan for a mild sprain of the medial collateral ligament of the knee? 

1. Initially perform quadriceps and hamstring isometric exercises, Followed by isotonic exercises and stationary cycling.
2. Hamstring stretching exercises and strengthening of other muscle groups.
3. Internal tibial rotation, abduction toe raises, work on hip stabilizers.
4. Hopping and stationary running followed by stair climbing eventually jogging figures of eight, sideways shuffling, etc.

What is concussion? 

Concussion is an altered state of consciousness usually caused by a blow to the head. The person may become unconscious.  When knocked unconscious there is a possibility of a serious brain injury. 

What are the causes of concussion? 

• Car accidents 
• Falls
• Sporting injuries

What are the signs and symptoms of concussion? 

•  Headache
• Loss of consciousness which can last from seconds to minutes
• Loss of memory
• Confusion
• Wounds to the scalp or face
• Unco-ordination
• Loss of balance
• Blurred vision
• Nausea & Vomiting

What is the management of a concussion? 

• If conscious: SALTAPS and if spinal injury is suspected do not move and seek medical attention.
• If unconscious: DRSABCD

What is cerebral compression? 

This is a condition where pressure inside the skull increases, due to either bleeding or damaged tissues.  This can cause a fatal amount of pressure on the brain.

What are the symptoms of a cerebral compression? 

• Diminishing conscious state, irregular breathing, slow but full pulse, weakness on one side of the body, unequal pupils, flushed appearance, fever
• The only action is to call medical attention immediately and monitor DRSABCD until it arrives.

What is the management of a skull fracture? 

• Call an ambulance
• Support the head and shoulders - minimize movement
• If they are bleeding from an ear lean them towards that ear to drain away the fluid. 

What are the signs and symptoms of a spinal injury?

• Pain at or below the site of injury. Example: back pain
• Tenderness over site of injury
• Absent or altered sensation. Example: tingling in hands or feet.
• Loss of movement or impaired movement below site of injury. 

What is the management of a spinal injury? 

• Do not move anyone with a spinal injury unless they are in a life threatening situation.
• Tell the person not to move
• Ensure a clear airway. If the patient is unconscious you can turn the person on their side keeping head, neck and trunk in alignment.
• Common sense prevails.
• Clear the area and call an ambulance immediately. 

What is a full arm sling used for? 

What is a St John sling used for? 

What is a collar and cuff sling used for? 

What is the reef knot used for? 

To tie bandages because it does not slip, can be untied quite easilt, lies flat and does not dig into the wound. 

How do you apply ice to a soft tissue injury? 

1. Get the ice on quickly.
2. Perform an "ice massage."
3. Don't forget to elevate.
4. Watch the clock (15-20 minutes).
5. Allow time between treatments (allow area to warm for 20-45 minutes before continuing)
6. Repeat as desired.

What does ice therapy help with?

• Pain relief
• Reduces bleeding and swelling
• Reduces muscle spasm
• Decreases metabolic rate

When is a player allowed to return to play?