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Questions and Answers
A sports physiotherapist is called onto the field to assess an injured athlete. What is the maximum time they typically have to make a clinical decision during an on-field assessment?
A sports physiotherapist is called onto the field to assess an injured athlete. What is the maximum time they typically have to make a clinical decision during an on-field assessment?
- 5 minutes (correct)
- 10 minutes
- 15 minutes
- 20 minutes
During the primary survey of an unconscious athlete on the field, what is the first priority?
During the primary survey of an unconscious athlete on the field, what is the first priority?
- Protecting the cervical spine (correct)
- Assessing circulation
- Checking for neurological disability
- Ensuring clear breathing
Which of the following symptoms would be the MOST concerning to a sports physiotherapist when assessing a potentially serious spinal injury on the field?
Which of the following symptoms would be the MOST concerning to a sports physiotherapist when assessing a potentially serious spinal injury on the field?
- Reports of heavy arms and legs (correct)
- Localized pain in the lower back
- Slight tingling in the fingers
- Mild headache
An athlete has sustained an injury on the field and is not in immediate danger. What is the next critical step for the sports physiotherapist?
An athlete has sustained an injury on the field and is not in immediate danger. What is the next critical step for the sports physiotherapist?
On the field, why is understanding the mechanism of injury so important to the sports physio?
On the field, why is understanding the mechanism of injury so important to the sports physio?
During an on-field assessment, what type of questions are MOST appropriate for gathering information quickly from an injured athlete?
During an on-field assessment, what type of questions are MOST appropriate for gathering information quickly from an injured athlete?
An athlete reports that their symptoms are easing up a few minutes after a soft tissue injury on the field. What is the MOST likely cause of this?
An athlete reports that their symptoms are easing up a few minutes after a soft tissue injury on the field. What is the MOST likely cause of this?
Following an on-field assessment, an athlete is allowed to continue playing. What action MUST the sports physiotherapist take?
Following an on-field assessment, an athlete is allowed to continue playing. What action MUST the sports physiotherapist take?
What is the primary purpose of a sports physiotherapist performing a quick physical assessment of an injured athlete on the field?
What is the primary purpose of a sports physiotherapist performing a quick physical assessment of an injured athlete on the field?
During a sideline assessment, what is the PRIMARY question a sports physiotherapist aims to answer?
During a sideline assessment, what is the PRIMARY question a sports physiotherapist aims to answer?
What is the PRIMARY benefit of moving an injured player to the change rooms or away from the field during a sideline assessment?
What is the PRIMARY benefit of moving an injured player to the change rooms or away from the field during a sideline assessment?
During a sideline assessment, which aspect of the player's injury history is MOST relevant to determining their ability to return to play?
During a sideline assessment, which aspect of the player's injury history is MOST relevant to determining their ability to return to play?
What consideration regarding re-injury is MOST important when determining return-to-play during a sideline assessment?
What consideration regarding re-injury is MOST important when determining return-to-play during a sideline assessment?
In addition to the subjective and physical examinations, what assessment MUST be performed before clearing an athlete for return to play during a sideline assessment?
In addition to the subjective and physical examinations, what assessment MUST be performed before clearing an athlete for return to play during a sideline assessment?
Why you should monitor an athlete closely, if they return to play?
Why you should monitor an athlete closely, if they return to play?
According to research, how might immediate return to play after cryotherapy treatments affect athletic performance?
According to research, how might immediate return to play after cryotherapy treatments affect athletic performance?
To avoid the negative impacts of cryotherapy what action should the sports physio take?
To avoid the negative impacts of cryotherapy what action should the sports physio take?
What is a key distinction of a standard clinical assessment, compared to on-field and sideline assessments?
What is a key distinction of a standard clinical assessment, compared to on-field and sideline assessments?
Why is it difficult to diagnose the injured structure in the first few days post injury?
Why is it difficult to diagnose the injured structure in the first few days post injury?
What physiological process contributes to increased pain and tenderness in the days immediately following an injury, making it difficult to accurately assess the extent of structural damage?
What physiological process contributes to increased pain and tenderness in the days immediately following an injury, making it difficult to accurately assess the extent of structural damage?
In the first 3 days post-injury, what type of assessment findings should a clinician place the MOST emphasis on?
In the first 3 days post-injury, what type of assessment findings should a clinician place the MOST emphasis on?
An athlete who took a mark and landed on his head seemed okay initially but started walking in the wrong direction. What is the MOST likely cause?
An athlete who took a mark and landed on his head seemed okay initially but started walking in the wrong direction. What is the MOST likely cause?
Which statement is MOST accurate?
Which statement is MOST accurate?
Which of the following is LEAST important for influencing the decision on whether to return an athlete to play?
Which of the following is LEAST important for influencing the decision on whether to return an athlete to play?
What must always be done before clearing a player for return to play
What must always be done before clearing a player for return to play
What is the maximum amount of time you could have an ice pack on an injured athlete on the sidelines?
What is the maximum amount of time you could have an ice pack on an injured athlete on the sidelines?
What nerve transmission is reduced when an ice pack touches a joint?
What nerve transmission is reduced when an ice pack touches a joint?
Which immune cell moves in to start cleaning up after 3 days of a soft tissue injury?
Which immune cell moves in to start cleaning up after 3 days of a soft tissue injury?
What best describes secondary hypoxia?
What best describes secondary hypoxia?
Which form of questioning is most appropriate on field?
Which form of questioning is most appropriate on field?
Which scenario best warrants calling a stretcher
Which scenario best warrants calling a stretcher
What is the sports physio's main priority during an on-field assessment?
What is the sports physio's main priority during an on-field assessment?
After cryotherapy, athletes should do what?
After cryotherapy, athletes should do what?
Which of the following must be protected when running out to help an injured player?
Which of the following must be protected when running out to help an injured player?
What did the 2012 review show?
What did the 2012 review show?
When doing the warm up after ice has been applied what is being restored by increasing the temperature?
When doing the warm up after ice has been applied what is being restored by increasing the temperature?
What should the sports physio look at if they think it is an avulsion fracture?
What should the sports physio look at if they think it is an avulsion fracture?
How long should a sideline assessment typically be?
How long should a sideline assessment typically be?
What does substance P do?
What does substance P do?
What is the most relevant structure to palpate if the player reports that their symptoms are clearly in the muscle belly?
What is the most relevant structure to palpate if the player reports that their symptoms are clearly in the muscle belly?
What is a key factor when assessing the spinal cord using the AC and D system
What is a key factor when assessing the spinal cord using the AC and D system
During a sideline assessment, if a sports physiotherapist is considering the potential use of a local anesthetic to allow an athlete to return to play, what prerequisite condition MUST be met?
During a sideline assessment, if a sports physiotherapist is considering the potential use of a local anesthetic to allow an athlete to return to play, what prerequisite condition MUST be met?
A sports physiotherapist is performing a sideline assessment on an injured player. Besides subjective and physical examinations, what other assessment MUST be completed before the player can be cleared for return to play?
A sports physiotherapist is performing a sideline assessment on an injured player. Besides subjective and physical examinations, what other assessment MUST be completed before the player can be cleared for return to play?
Within the first three days post-injury, why might a sports physiotherapist be cautious about making definitive diagnoses based solely on palpation and range of motion assessments?
Within the first three days post-injury, why might a sports physiotherapist be cautious about making definitive diagnoses based solely on palpation and range of motion assessments?
During an on-field assessment of an athlete who is not in immediate danger, what is the MOST important reason for asking directed, closed questions rather than open-ended questions?
During an on-field assessment of an athlete who is not in immediate danger, what is the MOST important reason for asking directed, closed questions rather than open-ended questions?
What is the PRIMARY reason a sports physiotherapist should closely monitor an athlete who returns to play after an injury, even if the athlete appears to be functioning well?
What is the PRIMARY reason a sports physiotherapist should closely monitor an athlete who returns to play after an injury, even if the athlete appears to be functioning well?
Flashcards
On-Field Assessment
On-Field Assessment
Assessment of an injured athlete that occurs directly on the playing field, requiring quick decisions under time constraints.
Primary Survey (ABC-D)
Primary Survey (ABC-D)
Involves checking the Airway, Breathing, Circulation, and Disability with cervical spine protection.
Signs of Spinal Damage
Signs of Spinal Damage
Pain/tenderness, numbness/paresthesia, weakness, paradoxical respiration, or spinal deformity.
Importance of Mechanism of Injury
Importance of Mechanism of Injury
Observe the mechanism of injury, ask the athlete and/or trainer what happened.
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Directed Questions On-Field
Directed Questions On-Field
What happened? What do you feel now? What did you feel when it happened? Are symptoms changing?
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On-Field Physical Assessment
On-Field Physical Assessment
Brief assessment involving muscle strength tests, ligament tests, and bone palpation.
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Monitoring After On-Field Assessment
Monitoring After On-Field Assessment
Athlete must be watched for the remainder of the game. Re-assess during the next break.
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Sideline Assessment
Sideline Assessment
A more detailed assessment done on the sidelines, typically within 10 minutes, to determine return-to-play.
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Key History Questions (Sideline)
Key History Questions (Sideline)
Mechanism of injury, symptoms at the time, injury history, and functional loss.
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Factors for Return-to-Play
Factors for Return-to-Play
Pathophysiology, potential for re-injury, and protection via bracing/taping.
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Non-Medical Factors
Non-Medical Factors
Game, training, preseason, winning/losing, coach's perspective, player reliability, age, and financial considerations.
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Functional Sport-Specific Assessment
Functional Sport-Specific Assessment
Mimicking sport-specific movements to assess readiness.
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Cryotherapy Impact
Cryotherapy Impact
Athletic performance may be adversely affected when athletes return to play immediately after cryotherapy treatments.
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Standard Clinical Assessment
Standard Clinical Assessment
Standard assessment done a few days post-injury, allowing inflammation to subside.
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Day 3 Advantage
Day 3 Advantage
Hyperalgesia reduces significantly, leading to fewer false positives.
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Objective Testing (Early Assessment)
Objective Testing (Early Assessment)
Examine ligament testing, range of movement, and end-feel.
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Taking Players to Change Rooms
Taking Players to Change Rooms
Taking athletes to the change rooms helps to take the player away from prying eyes.
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Clinical Reasoning in Sports Physiotherapy
- Sports physiotherapy uniquely involves assessing injured athletes through three specific scenarios: on-field, sideline, and standard clinical assessments.
On-Field Assessment
- This assessment occurs when an athlete is injured during play and the sports physiotherapist must quickly evaluate them on the field.
- There is approximately a five-minute window to decide if the athlete is in danger and/or can continue playing safely.
- The initial step involves determining if the athlete is unconscious, potentially indicating spinal damage.
- Airway, breathing, circulation, and any neurological disabilities are checked with cervical spine protection as a priority.
- Suspect spinal damage if there's unconsciousness or injury to the head, face, or neck.
- Signs and symptoms of potential spinal damage include cervical spine pain/tenderness, numbness/paresthesia, limb weakness, paradoxical respiration, or spinal deformity.
- If the athlete is in danger, first aid is administered, an ambulance is called, and the athlete is stabilized, play is halted.
- If the athlete is not in danger, a quick provisional diagnosis is made to assess if they can safely continue playing.
- Base decisions on evidence such as the injury mechanism.
- Quickly ask the athlete what happened, what they're feeling currently + immediately post-injury, and whether their symptoms are improving or worsening.
- Soft tissue injuries might ease up with movement.
- If uncertain, a brief physical assessment is performed, focusing on primary areas of pain.
- Muscle injuries are assessed by resisting muscle contraction, stretching, and palpating the muscle.
- Joint injuries are assessed via quick ligament tests and movement checks.
- Bone injuries are assessed via active movement, palpation and potentially stress tests.
- Athletes who continue playing must be monitored for the rest of the game.
- Assign sideline personnel to monitor the player and verbally check on them during breaks, removing them for reassessment if their condition declines.
Sideline Assessment
- This assessment takes approximately 10 minutes.
- Key decisions revolve around the athlete's ability to return to play, necessary actions for return, and guidance for injury management if they cannot return.
- Conduct the assessment away from prying eyes with a slightly more in-depth history.
- Gather details about the injury mechanism, the sensations at the time of injury, and subsequent developments.
- Ask the player about previous injuries or symptoms in the affected area and any functional loss.
- Conduct a more thorough physical assessment of the local structure and potentially referring structures.
- Assess the injury's pathophysiology and the risk of re-injury.
- Consider whether bracing or taping can adequately protect the injured structure; grade 1 sprains/strains can be taped, but more severe injuries cannot.
- Local anesthetics may be considered with medical personnel to manage symptoms if the structure is intact, but that decision falls to the medical practitioner.
- External factors, such as whether it is a game , training, or preseason, winning or losing situations, and the coach's perspective, need considering.
- Player reliability in reporting injuries should also be factored in.
- Remember that decisions have medical-legal implications.
- Conclude with a functional sport-specific assessment to mimic the demands of the sport.
- Assess running, change of direction, and other relevant movements to ensure satisfactory performance, free movement, and minimal discomfort.
- If the athlete returns to play, continue monitoring them and apply tape or other support as necessary.
- Cryotherapy before return to play may negatively affect athletic performance as it reduces proprioception
- If using ice, ensure the athlete warms up to restore normal nerve transmission and proprioception.
Standard Clinical Assessment
- This assessment can occur from the day of injury up to days later.
- It involves a standard physiotherapy evaluation process.
- Accurate diagnosis within the first three days post-injury can be challenging due to hyperalgesia from inflammation.
- Inflammatory mediators contribute to tenderness and pain, leading to potential false positives during assessment.
- Secondary hypoxia and swelling can further complicate assessment by affecting blood supply to cells, leading to inflammation.
- Objective tests like ligament testing and range of motion are more reliable in the first three days as positive results will remain consistent.
- Be cautious in interpreting negative results due to potential inflammation or muscle tension.
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