Sports Injuries

1. Sports Injuries BED SES UNIT 15

2. A little something to get you started • http://www.youtube.com/watch?v=I3SrLubLKAo • http://www.youtube.com/watch?v=fJ_6QqLP_pw&feature=related

3. Learning outcomes • Know and describe the classification of injuries in relation to time • Describe the initial physiological responses to injury and relate them to specific injuries (these were covered in the previous lessons such as sprains, strains, etc) • Describe the importance of scar tissue.

4. Classification of injuries • Stage of healing • Injuries are usually described in relation to their stage of healing, i.e. acute, sub-acute, or chronic. Put simply this means severe, moderate or mild. • Acute Stage (Severe) 0-72 hours after injury • Sub-Acute Injury (Moderate) 72 hours to 21 days after injury • Chronic Continuum (Mild) 21 days after injury. • The severity of the injury will dictate sub-acute and chronic. For example, less severe injuries will meet the chronic stage sometimes before day 21, more severe may take longer than 21 days.

5. Acute injury • Acute injury is defined by the early onset and short duration of the particular signs and symptoms following the trauma. The injury could involve any one or more of the bodies' tissues. • Typically, the athlete is aware of how the injury occurred, and with an acute sporting injury the common signs and symptoms can include immediate pain, tenderness, swelling, contour deformity or bleeding. • An injury is normally described as being acute until the initial signs of inflammation have reduced, and the healing process has begun, which is normally after 0-72 hours.

6. Sub-Acute • Sub-Acute is sometimes referred to as post-acute injury. This classification is related to the time-scale of repair, and typically, a sub-acute injury is the state of injury 72 hours to 21days. • Obviously, the severity of the injury and the acute treatment provided affect the rate of healing and the quality of repair, but the sub-acute injury is where the inflammation has begun to reduce, and there are gradual improvements in symptoms and function. • The rehabilitation process begins at the sub-acute stage.

7. Chronic injury • Chronic Injuries usually have a gradual onset of pain, resulting most commonly from repetitive minor injuries. Chronic problems often develop when minor injuries are poorly managed. • Unfortunately, with more severe injuries (whether from one traumatic incident or from overuse) the athlete is often left with a chronic problem. Chronic problems usually demand management and rehabilitation that may involve adaptations to normal daily activities in addition to physical therapy.

8. Physiological responses to injury • The physiological responses to injury are how the body reacts to an injury immediately after its occurrence and how it adapts over a period of time. • The repair of injured soft tissue, such as a muscle, usually commences within 24 hours following an injury. One of the first signs that soft tissue is injured is the appearance of swelling. When the injured area starts to swell, it will feel painful. This is due to the swelling creating pressure on the nerves surrounding the damaged tissue. • The swelling occurs because the surrounding blood vessels are ruptured, allowing blood to bleed into the areas and the tissue fluid to gather around the injury site. The injured area will usually look red because the blood vessels surrounding the site dilate, which also has the effect of making the injured area feel hot. • The injured area will show a reduced function or a total inability function because of the pain and swelling. The level of the signs and symptoms will be directly related to the degree of the injury - the greater the degree, the greater the effects of inflammation. It is over a period of between 48 and 72 hours and up to 21 days that the repair is carried out with vigour by the body.

9. The body's clotting mechanism seals the end of the torn blood vessels so that further blood plasma cannot escape into the surrounding tissues. As the immediate effects of injury subside the healing/repair process begins. This consists of: • Absorption of swelling • Removal of debris and blood clot • Growth of new blood capillaries • Development of initial fibrous scar tissue. • After 12 hours, and for the first four days, the cells soon become active and new capillary blood vessels form and gradually grow to establish a new circulation in the area.

10. Scar tissue • The damaged tissue is repaired by scar tissue. It is important to remember that scar tissue has 'plastic' properties. Scar tissue is not elastic in composition like muscle. It will form in a haphazard pattern of kinks and curls and will contract or shorten if not carefully stretched daily for many months after the injury. • There is a great need for the new scar tissue to form in parallel lines to give it strength. Correct stretching causes the scar tissue to line up along the line of stress of the injured structure. Therefore, injured muscles or ligaments should be carefully mobilised and stretched daily (beginning five days after the initial injury). • The stretching will ensure that the scar is moulded to the desired length and improve the strength of the healed area (scar), and thus reduce a recurrence of damage to the scarred area and injured structure.

11. Remodelling and maturation phase • The repairing (scar) tissue contains relatively unrecognised collagen fibres and the union between damaged structures is still moderately fragile. The fibres of collagen are initially randomly arranged, but over time and with careful rehabilitation, they become aligned along the lines of the external stress that are placed upon them during both normal activities and rehabilitation exercises. • This is the consolidation or remodelling phase, and as the scar tissue matures, it gradually becomes more avascular with poor elasticity. The rehabilitation at this stage normally, becomes gradually more aggressive, in terms of mobility, flexibility, strength, proprioception and power. All of which are crucial to the long-tem functionality of the repaired tissue.

12. Finally • Questions (student led)