Focus Question 1 How are sports injuries classified and managed?

1. Focus Question 1How are sports injuries classified and managed?

2. WAYS TO CLASSIFY SPORTS INJURIES Injuries are generally classified according to the cause of the injury or the way it occurred. e.g. Direct/Indirect Other classifications can be used such as the type of tissue damaged in the injury. e.g. Hard Tissue/Soft Tissue

3. DIRECT Caused by external forces to the body Injury occurs at the site of the force Can result in fractures, dislocations, sprains and bruises. Examples include: A cricketer catching the ball and getting a dislocated finger A footballer hit high and gets a broken cheekbone INDIRECT Can be caused by internal or external forces and usually results in an injury occurring at a site away from the intial force Can occur as a result of poor preparation or excessive movement. Can occur because of undue strain on muscles, tendons or ligaments and can cause irritation and possible structure damage. Examples include.: Cyclist falls, puts out his hand and dislocates shoulder Netballer tears ligaments from twisting

4. SOFT TISSUE This includes: Muscles Tendons Ligaments Joint tissue Fatty tissue Any injury to these are classified as soft tissue injuries Types of soft tissue injuries include: Bruises (haematoma) Sprains (ligaments) Strains (tendons) Lacerations (skin) Dislocations (joints) Tendonitis (tendons) HARD TISSUE Hard tissue includes: Teeth Bones Any injuries to these are classified as hard tissue injuries.

5. OVERUSE • Caused by excessive use over a long period of time. • Brought on by repetitive low impact exercise such as jogging or swimming. • Causes include poor training techniques, high intensity too soon, poor surfaces, inappropriate equipment and physical characteristics (flat feet, etc). • Injuries characterized by pain and inflammation. • Common overuse injuries include: • Shin splints • Tendonitis • Stress fractures • Commonly called Repetitive Strain Injuries (RSI

6. SOFT TISSUE INJURIES

7. TEARS, SPRAINS, CONTUSIONS • Tears (Strains): a disruption of the fibres of muscle or tendon. Occurs when the muscle/tendon is overstretched or the muscle contracted too quickly • Sprains: a stretching or tearing of the ligament fibres, muscles or tendons supporting a joint. Occurs when a joint is extended beyond its range of movement. • Strains and Sprains can be classified according to severity Grade 1 being the least serious up to Grade 3 being the most serious • Contusions: a bruise (bleeding) into the soft tissue. Generally caused by contact with a solid (usually blunt) object.

8. SKIN ABRASION, LACERATION, BLISTERS, CALLUSES Skin abrasions: occur when the outer layer of the skin is removed, usually a scraping action. Lacerations: a cut, which will usually require stitches, depending on the depth of the cut. This is usually caused by a sharp object. Blisters: occur because of friction, which causes a pocket of fluid to form under the skin Calluses: when a build-up of dead skin forms at a site where constant friction has occurred.

9. INFLAMMATORY RESPONSE This is the initial stage of repair involving the first 48-72 hrs after the injury as the body increases blood flow to the injured site.

10. Redness Heat Swelling Pain Loss of function Eliminate debris Form new fibres Produce scar tissue Phase 1 – Inflammatory stage: Phase 2 – Repair stage (3 days to six weeks) Phase 3 – Remodelling stage (6 weeks to months) development of scar tissue tissue needs to strengthen in the direction force is applied dependant on amount of exercise and rehab routine aim to regain full function

11. MANAGING SOFT TISSUE INJURIES

12. RICER (Rest, Ice, Compression, Elevation, Referral) • Rest: minimal movement for the first 48-72 hrs • Ice: causes blood vessels to constrict to decrease blood flow. Apply for 20-30 mins every 2 hrs for 48-72 hrs. • Compression: ice should be firmly applied in a wide elastic bandage. This reduces swelling and provides support. • Elevation: ensure the injury site is elevated above the heart. This reduces the volume and pressure of blood flow to the injury and reduces swelling. • Referral: a medical assessment should be sought ASAP to as ascertain the full extent of the injury. • See Table 11.1 pg 410 of outcomes

13. SOFT TISSUE INJURIES –MUSCLES/TENDONS/LIGAMENTS • ALWAYS THINK RECOGNITION OF INJURY AND APPROPRIATE MANAGEMENT- ACUTE – CHRONIC? USE: R - REST I – ICE C – COMPRESSION E – ELEVATION R – REFERRAL STRAINS/SPRAINS

14. SOFT TISSUE INJURIES • DEFINITELY NO: • H – HEAT • A – ALCOHOL / ASPIRIN • R – RUNNING (exercise) • M – MASSAGE • IN THE FIRST 24 – 72 HOURS OR LONGER

15. KNOW SOME BASIC ANATOMY • The knee. A minefield to diagnose. Leave it to the experts!

16. LATERAL/MEDIAL ANKLE

17. ICE SHOULD BE AVAILABLE AT ALL TRAINING AND GAMES • Where would you not apply ice to a soft tissue injury?

18. IMMEDIATE TREATMENT OF SKIN INJURIES The immediate response aims to: • Prevent further damage and reduce the risk of infection • Reduce swelling • Erase or minimise pain • Restore flexibility • Regain full function • Prevent reoccurrence. For abrasions/lacerations: • Stop bleeding if necessary and clean the wound where possible • Apply non stick sterile dressing • Seek stitches if necessary For burns: • Immediately apply cold running water • No ice or creams • Keep clean and sterile • Seek medical advice

19. HARD TISSUE INJURIES

20. FRACTURES It is a break in a bone, which can be as simple as a small crack with no visible deformity, or complex, in that it may affect vital organs close to the fracture site.

21. Common causes include: • Direct contact with: • Others • Objects • The ground • Indirect force on another body part (falling and landing on arm; fractured clavicle) • Inappropriate muscular action (jumping from a height, landing on feet; fractured patella) • Overuse, repeated trauma (running; stress fracture in foot)

22. Types of fractures include • Simple/Closed: the bone is fractured but there is no wound at the site. • Open/compound: the jagged end of a fractured bone protrudes through the skin. • Complicated: the fractured bone damages local tissues, i.e. organs

24. Signs and symptoms include: • Pain • Reduced/no movement • Local tenderness • Deformity • Irregular alignment • Swelling

25. DISLOCATIONS It is where one bone is displaced from another Signs and symptoms may include: • Loss of movement at the joint • Obvious deformity • Swelling and tenderness • Pain at the injury site Subluxation: a partial dislocation where the joint dislocates and then relocates.

26. FRACTURE - DISLOCATION • ALWAYS THINK • DAMAGE • DAMAGE TO • SOFT TISSUES • NERVES • BLOOD VESSELS • MINIMAL MOVEMENT - IMMOBILISE. • TRANSPORT - AMBULANCE IN ALL CASES OF MAJOR FRACTURE OR DISLOCATION.

27. A DISLOCATION IS A FRACTURE UNTIL PROVEN OTHERWISE

28. FRACTURE - DISLOCATION • GREAT CARE!

29. FRACTURE - DISLOCATION • IMMOBILISATION?

30. DO NOT REDUCE! • ICE - SUPPORT - TRANSPORT

31. MANAGING HARD TISSUE INJURIES IMMOBILISATION • To another limb • To another part of the body • To a firm, smooth, straight object • Splint above the joint above the fracture and below the joint below the fracture

32. MEDICAL TREATMENT • Support the site with a sling or splint • Check for impaired circulation • Arrange for transport • Implement RICER if it does not cause pain. • NEVER ATTEMPT TO REDUCE/RELOCATE A DISLOCATION! • DO NOT ATTEMPT TO RE-ALIGN FRACTURED LIMBS! • SEEK MEDICAL ATTENTION! • Complete application pg 413

33. ASSESSMENT OF INJURIES

34. PROTOCOL WHEN INJURY/ILLNESS OCCURS – VITAL! D.R.A.B.C.D.T.O.T.A.P.S.

35. TOTAPS (Talk, Observe, Touch, Active movement, Passive movement, Skills) • Talk: talk and find out exactly what happened. This will provide valuable info about the nature of the injury. • Observe: look at the injury site and see if there are any signs of obvious deformity. Compare opposite sides of the body. • Touch: gently feel the areas for any sign of deformity or swelling and try to pinpoint the area of pain. • Active movement: ask the player to perform a range of movements such as flexion, extension and rotation. If these can be done without pain, proceed. • Passive movement: physically mobilize the joint as far or further than the patient did actively, aiming to identify painful areas and any instability • Skills test: ask the player to perform a range of skills necessary for participation in the game, i.e. sidestep. • CLICK FOR ROLE PLAY ACTIVITY SCENERIOS

38. REMOVAL FROM THE FIELD OF PLAY • ALWAYS THINK • DO NOT ATTEMPT TO REMOVE A PLAYER FROM THE FIELD WHO: • IS UNCONSCIOUS. • HAS A SUSPECTED SPINAL INJURY. • HAS A MAJOR DISLOCATION/FRACTURE. • HAS A SUSPECTED INTERNAL INJURY. • HAS AN INJURY OR CONDITION THAT COULD BE SERIOUSLY WORSENED BY MOVEMENT.

39. REMOVAL FROM THE FIELD OF PLAY • ALWAYS ENSURE AN AMBULANCE IS CALLED IN THE ABOVE SITUATIONS – OR IF IN DOUBT – PROTOCOL? • CONSIDER: ALL CONDITIONS MUST BE MANAGED BY THE FIRST AID OFFICER UNTIL THE AMBULANCE RESPONDS. • THIS WILL DEPEND UPON LOCATION. • ISOLATED AREAS – DISTANCE. • AVAILABILITY OF AN AMBULANCE. • TIME IS AN IMPORTANT FACTOR! • YOU WILL BE OF GREAT ASSISTANCE TO THE FAO!!

40. Assessment can be stopped at any stage if the player cannot proceed or if danger is apparent. • If the player can perform to the satisfaction of the assessor, the player can return to the game. • If there is risk of further damage through continued play, remove the player from the game

41. HOW WOULD YOU MANAGE THIS?

42. Focus Question 2How does sports medicine address the demands of specific athletes?

43. CHILDREN AND YOUNG ATHLETES

44. MEDICAL CONDITIONS (ASTHMA, DIABETES, EPILEPSY) • People with asthma have extra-sensitive airways. • Triggers like dust, pollens, animals, smoke and exercise may cause the airways to swell and narrow. • This leads to wheezing, coughing and difficulty breathing.

45. Management of an Asthma Attack • Steps to follow in case of asthma attack: • Sit the person comfortably upright. Stay calm and reassuring. • Give 4 puffs of a blue reliever puffer/inhaler. These are best given through a spacer. Give one puff every 4 breaths for 4 puffs, holding the breath for 2-4 seconds after a puff. • Wait 4 minutes. If there is no improvement, give another 4 puffs. • If little or no improvement, call an ambulance (000)

46. Some activities provoke an asthma attack more than others – there is significant risk with running, some risk with cycling and little risk with swimming. There is far less risk swimming in warm water.

47. It is generally agreed that exercise is of more benefit than no exercise at all, even if it leads to an attack.

48. Diabetes It is a complex hereditary or developmental disease where the supply of insulin is reduced or eliminated.

49. Type 1 diabetes is usually hereditary and the pancreas does NOT produce insulin at all. It is treated with injected insulin. • Type 2 diabetes is usually developmental and is usually the result of a sedentary lifestyle and poor nutrition. Obesity is a significant determinant for type 2. It is treated with a managed diet and lifestyle adjustments.

50. Hypo-glycemia Low glucose levels. Mild cases cause: Dizziness Weakness Disorientation Severe cases can lead to: Convulsions Unconsciousness Brain damage A hypo is generally a blood sugar level below 3.0 Hypo food: Cordial/fizzy drink Jelly beans Juice Hyper-glycemia High glucose levels Sufferers will be: Lethargic Thirsty Strong thirst Can result in damage to: Eyes Kidney Nerves If left untraced, can cause a coma or death. Occurs as a result of too little insulin. Requires an injection of insulin and a doctor’s visit. A hyper is generally a blood sugar level of over 10.0