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8/2/2019 CH 8 Sport Injuries
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Sport Books Publisher 1
Out of Harms Way:
Sport Injuries
Chapter 8
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Outline:
Biomechanical principles of injury
Injury treatment and rehabilitation
Pain: natures warning system Soft tissues injuries
Dislocations
Fractures
Concussions
Overuse injuries
Injury prevention
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Biomechanical Principles ofInjury
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Tissue Types
Each type of tissue possesses uniquemechanical characteristics
Epithelial Muscle Connective Nervous
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Loading
To best understand the biomechanicalcharacteristics of tissue we examine its
behaviour under physical load
Under load a tissue experiences deformation
Deformation can be visualized throughdeformation curve
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
d
High
Low
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
d
High
Low
Elasticity:
capacity of a tissue
to return to its original shapeafter removal of load
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
d
High
Low
Plastic region begins
Tissue no longer posesses
elastic properties
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
d
High
Low
Permanent tissue deformation
(does not return
to original shape)
Resulting in micro-failure
or injury (e.g. sprains)
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
d
High
Low
Macro- or completes failure(e.g. torn ligament)
Tissue becomes completely
unresponsive to loads
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Loa
d
High
Low
Area = strength of the material
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A
C
B
Elastic Region
Plastic Region
Ultimate Failure
Elastic Limit
Deformation LargeSmall
Load
High
Low
Slope = stiffness (or resistance to
deformation) of the material
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Tissues Response to Training
Loads
1. Training load =/ elastic limit
Micro-failure making of new tissue Positive training effect
2. Training load > elastic limit Permanent failure
Injury
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Forces Acting on Tissue
TENSION TORSIONBENDINGCOMPRESSION SHEAR
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Injury treatment andrehabilitation
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Treatment
Received by patient from a health
care professional Promotes healing
Improves quality of injured tissue
Allows quicker return to activity
Rehabilitation
Therapists restoration of injured
tissue +patient's participation
Individualized for each athlete
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Healing Phases
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Inflammatory
ResponsePhase
2 4 days
Inflammatory
ResponsePhase
hrs 6 wks
InflammatoryResponse
Phase
3 wks - yrs
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Inflammatory Response Phase
Inflammation begins atthe time of injury
Signs
Redness
Swelling
Pain
Increased temperature
Loss of function
Protect
Rest
Cryotherapy Decreases swelling,
bleeding, pain and
spasms Compression
Decreases swelling
Elevation Decreases swelling
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Fibroplastic Repair Phase
Repair and scarformation
Granulation tissue fillsthe gap
Collagen fibres aredeposited by fibroblasts
Signs seen in thephase1 subside
Rehab-specificexercises
Restore range of motionand strength
Manual massagetherapy and ultrasound
Help break down scar Protective taping and
bracing
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Maturation-Remodeling Phase
Remodeling or realigning of the scar tissue
More aggressive stretching and strengthening
To organize the scar tissue along the lines oftensile stress
Include sport-specific skills and activities
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Pain: natures warning system
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Pain
Natures way of telling us something is
wrong
One of the best indicator of when it is bestto resume play
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Problem with Ignoring Pain
Pain
Masking with
medications
Continued
participation
Pushing injured
tissue closer to
yield-level point
Gastrointestinal
complicationsAddiction
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Soft tissues injuries
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Contusions
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Bruise
Compressing force crushes
tissue E.g. charleyhorse quadriceps
Discoloration and swelling
Myositis ossificationabnormal bone formation in asevere contusion
Life-threatening if the tissueinvolved is a vital organ
P-R-I-C-E
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Strains and Sprains
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STRAIN
Tendon or muscletissue is stretched
or torn
SPRAIN
Ligament or the joint
capsule is stretched pr
torn
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Grades of sprains and strains
GRADE 1 Slightly stretched or torn; few muscle fibres
GRADE 2 Moderately stretched or torn, more muscle fibres
GRADE3 Complete rupture
Surgery required
E.g. ACL tear
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Common Strains
Quadriceps Adductors Hip flexors Hamstrings Rotator cuffs
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Hamstring Strains
Most frequently strained muscles
Mechanism:
Rapid contraction in a lengthened position E.g. sprinting and running
Due to strength imbalance Hamstring strength >>> quadriceps strength
Emphasize hamstrings and quadricepsequally
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Ankle Sprains
During running, walking, dancing or stepping off acurb
Most common = lateral ankle sprain Inversion
Common reoccurrence Decreased proprioception
Symptoms Rapid swelling
Point tenderness Rehabilitation
Decreases reoccurrence
Incorporation of balance exercises
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Dislocations
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Great enough forces push the joint beyond itsnormal anatomical limits
Joint surfaces come apart
Subluxation When supporting structures (e.g. ligaments) are
stretched or torn enough
Bony surfaces partially separate
Most common = fingers
Can become chronic
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Dislocation of the Shoulder
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Most mobile most unstable joint
Categories of dislocation: Partial (subluxation)
Complete
Most common Head of humerus slips anteriorly
Falling backwards on extended arm
Symptoms Swelling, numbness, pain, weakness,
bruising
Capsule and/or rotator cuff tears
Brachial plexus injury
Require medical treatment to relocatehead of humerus back to glenoidfossa
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Fractures
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Simple fracture
Stays within the surrounding
soft tissue Compound fracture
Protrudes from the skin
Stress fracture Results from repeated low
magnitude loads
Avulsion fracture Involves tendon or ligament
pulling small chip of bone
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Concussions
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Injury to the brain
Mechanism: Violent shaking or jarring action of
the head
Brain bounces against the inside ofthe skull
Symptoms Confusion
Temporary loss of normal brainfunction
REST
No such thing as minorconcussion and shaking off
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Overuse injuries
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Due to
Repeated and accumulated microtrauma
Non-sufficient recovery
Results from
Poor technique
Poor equipment
Too much training
Type of training
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Tendonitis
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Symptoms Pain (aggravated by movement) Tenderness
Stiffness near joint
Inflammation of tendon as a result of a small tearin the tendon
Tendonitis
Excessive ,
repetitive
motion
Improper
technique
Age(loss in
elasticity)
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Tennis Elbow
Lateral epicondylitis
Affect forearm extensors Attach to lateral epicondyle
Extend wrist and fingers
Contributing factors Excessive forearm pronation and wrist
flexion
Gripping racquet too tightly
Improper size3 grip Excessive string tension
Excessive racquet weight
Topspins
Hitting ball off-centre
G f d
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Gofers and
Little League Elbow
Medial epicondylitis
Affects tendons of forearm flexors Attach to medial epicondyle
Flex wrist and fingers
May result in collateral ligament andulnar nerve injury
May affect medial humeral growthplate in young children (little leagueelbow)
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Jumpers Knee
Patellar tendonitis
Affects infrapatellar ligament
Caused by:
Repetitive eccentric kneeactions
Eccentric load during jumppreparation >>> body weight
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Bursitis
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Inflammation of the bursae
Tiny fluid-filled sacs
Lubricate and cushionpressure points between boneand tendons
Results from overuse and
stress Age is also a factor
Most common
Shoulder, elbow and hip
Inflammation and painaggravated by movementand direct pressure
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Shoulder Impingement
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Excess movement of thehumeral head + lack of space
Inflammation of bursae orrotator cuff tendon
Result of muscle imbalancesin shoulder muscles Weak shoulder depressors
Strong shoulder elevators
Balanced strength training
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Stress Fractures
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Stress fracture
Results from repeated
low-magnitude forces
1. Small disruption of theouter bone layer
2. Weakened bone3. Cortical bone fracture
NOT a shin splint
Shin splints
Pain along inside tibial
surface
Involve pain andinflammation
NO disruption of cortical
bone
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Injury prevention
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Protective Equipment
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Warm Up and Cool Down
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Keeping Fit and Flexible
Use it or lose it
Especially important during the off-season
Preparing the muscle for placingdemands
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Eating and Resting
In order to function effectively bodymust receive
Proper nutrient Adequate rest
Avoid over-training and lack of sleeping