Lectures 2-5 on Legal Concerns, Injury Prevention, and Pain

**Lecture \#2 Legal Concerns and Insurance Issues** Athletic Therapist cannot override a physicians instruction making the call to clear a player if they have not completed physical exam to participate in team activity. This can be due to underlying conditions that can be present. Liability: State...

**Lecture \#2 Legal Concerns and Insurance Issues** Athletic Therapist cannot override a physicians instruction making the call to clear a player if they have not completed physical exam to participate in team activity. This can be due to underlying conditions that can be present. Liability: State of being legally responsible for the harm one causes to another person. **Scope of Practice:** Duties & responsibilities that you are allowed to perform. - Injured athlete has laceration; allowed to close wound with sterilized strips. - Not allowed to stitch; pierce skin Minimum Standard of Care: Minimum reasonable care that is owed to an athlete. - Head to head collision: assume spinal injury, rule out concussion. Failure to do so would be negligence. Negligence: - Failure to use ordinary reasonable care. - Failure to perform legal duties. - Therapist would be tried in Tort Law Tort Law: **Torts:** Legal wrong committed against / to another person. - affected individual would seek damages under Tort Law. Can start from: - Nonfeasance: Fail to perform legal duty of care. - Failure to refer client to another professional. - Ex. Monitoring concussed client, you allow them to go to change room alone and they pass out. Your responsible to monitor until cleared. - Malfeasance: Performs action that is not his / hers to legally perform (i.e., perform advanced treatment leading to complications) - Ex. You stitch an athlete who's cut their chin instead of going to hospital out of country. Cut is then infected. Stitching it outside of scope of practice. - Misfeasance: Performs an action incorrectly that he / she has legal right to do so. - Making a mistake essentially - Gross Negligence: Total disregard for safety of others. - Vicarious Negligence: - Ex. Owner of clinic that therapist performs ***Misfeasance*** Proof of Negligence Plaintiff would need to prove: 1. Duty of care was owed to athlete 2. Breach of standard of care 3. Injury resulted 4. injury was a direct result of breach of standard of care - **All 4 need to be proven** Defense against Negligence 1. Proper standard of care was taken, no breach of duty 2. Injury was unavoidable 3. Injured party involved in contributory negligence 4. Athlete was aware of assumption of risk 1. Ex. signing up for boxing knowing there's risk of head injury What is Assumption of Risk? - Athlete is aware of inherent risks but decides to continue participating - Written waiver or implied from conduct of athlete - Can be used as a defense against an individuals negligence However... - Doesn't excuse AT from giving reasonable care and conduct - Varied interpretations (w minors) - Waiver will stand in court except with fraud, misrepresentation or duress. Other Defenses against negligence - Sovereign Immunity - Statute of Limitations - specific time limit to sue a person for negligence. - Contributory Negligence - involved parties - Good Samaritan Law - Law that helps Canadians who - Voluntarily help someone during an emergency - Act in good faith - Act without expected compensation - Are not guilty of misconduct or gross negligence - Varies from province to province; don't have to have proper training to help someone in emergency situation and you are protected if you do so. - Other Legal Factors 1. Informed Consent: Injured party has been reasonably informed of needed treatment, possible alternatives, and advantages and disadvantages of actions. \*Must include all steps or it is not informed consent. - Exclusionary clause - identify conditions not treated by the AT - Waiver excluding responsibility / care for condition not related main area of treatment - Obtain before any treatment - Potential for battery - People have the right to refuse care - Unless individual is unconscious; you're permitted to help 1. Refusing Help - Individuals have the right to refuse treatment - Except - increased risk for further injury 1. Confidentiality - Right to privacy - Disclosure without consent (HIV, pregnant) 1. Product Liability - Manufacturer has the duty to create equipment that will not cause injury - Express Warranty: Manufacturers written guarantee of products safety - Equipment Warning Labels: - Informs of dangers with product use - CSA (Canadian standard association) NOCSAE meets minimum safety standards - altering equipment voids safety guarantee from company - Equipment defect = subject to liability Preventing Litigation 1. Understand and complete your duty of care 2. Understand the law in the province and country 3. Act in an ethical manner 4. Take steps to reduce risk of litigation Other Steps - Establish good relationships - Keep good records - Obtain informed consent - Insurance - Covers against claims of negligence - Professionals must be fully protected - Should carry and understand limits of coverage - Knowing scope of practice **Lecture \#4 Intro to Psychological Aspects of Pain** Pain: a subjective and multi-dimensional, unpleasant sensory and emotional experience associated with actual or potential tissue damage. Purpose: - If we didn't feel pain, injury can progress Types: - Acute: immediate in nature. - Chronic: lasts longer than 3 months Categories of Pain - Somatic Pain - originating from skin or musculoskeletal system (muscles, joints, tissue) - Localized to problem site - Client can easily identify when initial pain was felt - Visceral Pain - Originates from internal organs - Diffused / to general area - Can cause pain elsewhere in body - Harder to pinpoint - Associated symptoms: Nausea - Ex. Heart attack = sign from pain in arm or shoulder instead of chest - Referral patterns can help identify condition - Psychological Pain - Pain sensation felt but no apparent physical cause or damage. - Emotionally based - Can be felt by thinking about or anticipating Nociceptor: Sensory or afferent nerve endings that when stimulating will produce a pain sensation. It's what starts that impulse / message sent to the brain. - Mechanosensitive nociceptors - Respond to touch or pressure - Ex. Pressing or stretching tissue; stepping on toe. - Thermosensitive nociceptors - Respond to extremes of temperature - Ex. Touch a stove - Chemosensitive nociceptors - Respond to chemicals - Ex. Serotonin Categories of Pain - A discrepancy can exist between where the pain is felt and the true site of the disorder. - Referred Pain: - Pain felt in areas away from injured tissue. - Too many afferent signals / messages can disrupt nerve signals, it can send down wrong passage resulting in pain felt in different area. - Radiating Pain: - Pain felt along the involved structure - Ex. Sciatica Pain Descriptions: - Shooting - Nerve - Throbbing - Vascular, Congestion of Fluid - Stabbing - Acute (Sprain or Strain) - Deep - Bone, Arthritic - Stiff / Achy - Chronic Inflammation Why do we ask to describe pain? - Gives us an idea what we may be dealing with, narrowing down what may be going Pain Characteristics - AM pain / stiffness / better with activity = chronic inflammation with swelling - Pain increasing as day progresses = increased congestion in a joint - weight bearing joints - Sharp, stabbing pain during activity = acute ligament sprain or muscular strain - Dull, aching pain aggravated by muscle contraction = chronic muscle strain - Pain subsides during activity = chronic inflammation - Night pain = compression of a nerve or bursa - can indicate cancer - Deep / nagging / very localized = bone pain, degradation - Sharp / burning / numbness = nerve pain - General aching / referred to another area = vascular pain Questions to ask? - Where does it hurt most? - Can you point to a specific spot? - Is the pain limited to that area, or does it radiate? - How bad is the pain on a scale of 0-10? - Can you describe the pain? - What aggravates the pain? - How long does it last? - Does it wake you up at night? - What alleviates the pain? - OPQRST - Onset: Sudden or Gradual - Provoke or Palliative - Better or Worse - Quality: Describe - Radiate or Referred - Severity: Pain Scale 1-10 - Time: When did this occur? Physiology of Pain Noxious Stimulus: Any stimulus that elicits a pain response. **Coping in General** **Coping:** Ability to identify, manage and overcome issues that stress us in any sort of capacity. - reduces threat value of any sort of stimulus and the associated emotions or change of tissues with it. - Knowledge can help reduce threat value, allowing coping to be easier. - Factors like knowledge of situation, or absence / inclusion of those around you, or serious of situation. - E.g., knowledge of the injury, no one is there during injury or - May be less pain felt, if brain feels like there's no threat - Low threat value = low pain - High threat value = high pain - Other facts that affect Pain Response - Fatigue, Emotion, Depression, Medication (drugs, alcohol) - Pain Management Techniques - Hypnosis - Faith & Belief systems - Distraction, Emotion (*laughter*) - Past experiences - Peer pressure ("*suck it up*") - Cultural (*how did you see those around you cope*) - Sport - In the heat of the moment **Kids Coping with Pain** - Reaction may be overreactive to the actual pain; once parental figure o consoles then injury is small. - Fat **Pain Control Mechanisms** **1. The Gate Control Theory** - Use stimulation of A Beta (large diameter) fibers to help block the other types of pain carrying fibers (A delta and C carrying fibers) - Substantia Gelatinosia acts as a gate keeper - Allows pain response or afferent sensation to 2nd order neuron - Let's pain feeling through or other sensation like touch - First come first serve; whoever gets their first and the other gets block - A Beta fibers are fast, thick diameter, and can inhibit transmission of slower pain carrying fibers. - E.g., Stubbing your toe - Reaction is to hold foot in pain; by rubbing it may block pain fibers. - E.g., Applying Ice - Cold can get to gate; - Key Takeway - Non-painful stimuli can block painful stimuli **2. Descending Control (Central Biasing Theory of Pain Control)** - Quality of knowing how you perceiving pain or mental state you're in respect to the pain may influence overall pain tolerance - Emotional influencing, previous experiences, sensory perception, other coping mechanisms can affect overall pain tolerance. - "Can consciously override pain tolerance" - E.g., In the heat of the moment during an intense pain, deciding to play through it. - E.g., Depression amplifying painful experience. - E.g., Player - Placebo Effect of Pain Relief: Psychological belief that something is working in order to relieve our pain. - E.g., Rubbing some type of ointment in belief it'll remedy our pain. - Brain power alone controls 60% of our pain experience. 40% physical tissue. - Pain Descending Diagram - Travel to dorsal horn along the first order neuron - Synapse with 2nd order neuron at the level of spinal cord - Then travels to Brain - Cellular level: Synapse with the Pariaqueductal Gray Area (in the Raphe Nucleus) - Efferent nerve impulse that descends through the Dorsal Lateral Tract - When this happens it releases Serotonin as a response to incoming pain message - Serotonin release Enkephalins, which blocks Substance P (Neurotransmitter that carries pain message across synaptic cleft **3. Beta-Endorphin** - Noxious (painful) stimulation of nociceptors resulting in transmission of pain information along A-Beta and C Afferents can stimulate the release of an endogenous opiate like chemical called Beta-Endorphin (released from hypothalamus and anterior pituitary) - Beta-Endorphins produces these potent analgesic effects are unclear - E.g., Acupuncture, Runners High **Coping with Pain** - Gaining a sense of control over pain is the most important factor in learning to cope. - Passive Coping - Avoid activity, waiting for someone to treat them. Don't feel the need to be apart that process. - Active Coping - Those who want to learn and work with you to explore ways to move. - Explore their own limits. Usually positive. **Pain Perception** Psychological Factors: - Previous pain experience (Good or Bad experience; can be unpleasant or mild) - Pain expectations - Pain tolerance levels - Effect of Modalities (Placebo?, - Body part / what injury looks like - Situation / Time of season / Winning / Losing - Status of Player **Acute Situations** Handling Pain: - ATC must establish control - Stop delay game - Helping / collaborative relationship between you and athlete - Alter concentration / Attention - Distraction from pain - Provide information - To ease fears - ***Caveat! Adrenaline may mask PAIN*** Psychological Techniques - Maintaining sense of humor - Patient / pain education - Visualizations - Goal setting - Reduce swelling to reduce pain - Relaxation skills Coping with Chronic Pain - Long-term pain (chronic situations) - Dependency on pain medication - Caution - Depression can result from long term pain medication and chronic pain. - Longer than 3 month period - Emotions and Situations affecting - Lack of enjoyment - Worries **Lecture \#3 Injury Prevention** **Epidemiologist:** Professional use research methods to investigate the rates and determinants of injury and disease. **Epidemiology:** study of distribution of determinants of the varying rates of disease, injuries, or other health states in human populations. - Basic assumption = epidemiologist believe in causes, not bad luck Epidemiological Factors: - Rates of injury With respect to... - Person (age, race, sex) - Place (environments, playing surface, population density) - Time (Time of year / season, 2nd half of game, beginning of season) Uses of Epidemiology - To identify risk factors or causes of Disease/Injury - Determine assessment or intervention stratagies - Proper Equipment use - **Injury Prevention & Wellness Promotion** 1. Pre-Participation Exam (PPE) - Purpose: Pick up potential problems that may pre-dispose an athlete to injury - Timing: 4-6 weeks before season start - Frequency: Annually - Content: Musculoskeletal Evaluation: Flexibility, Strength & mobility testing, neurological, skin 2. Nutritional Carbs, Protein, Fats = Macronutrients (Energy production, growth / repair tissue, muscle maintenance Vitamins, Minerals, Water = Micronutrients (regulation of body processes) - Simple Carbs = Simple sugars - Complex Carbs - Starches - broken down into simple sugars - unused starches stored as glycogen - Fibers = structural part of plants not digestible, reduces colon cancer, diabetes - structural parts of plants not digestible - reduces risk of colon cancer - reduces incidents of obesity, constipation, colitis, and diabetes - Too much leads to intestinal discomfort, constipation - Protein - Growth, maintenance, repair of body - Needed for: increased physical activity, anabolism, hormones, collagen, excess converted into fat, enzyme and hormone production. - Amino acids - Basic unit that compose protein - most produced by the body - essential must be consumed - found in animal rpidcts - plants do not contain all essential amino acids Proteins - Anabolism - Building cell membranes - Carries heredity information - Structural proteins - Plasma proteins - Oxygen carrying -- hemoglobin - Maintain acid-base balance - Actin / myosin - Hormones - Fats - Most concentrated source of energy - Saturated Fats: - Animal products - Solid at room temperature - Increases risk of heart disease - Unsaturated Fats: Plant derivatives - Plant derivatives - Liquid at room temperature - Decreases heart disease, stroke, and hypertension - Trans Fat: Resembles saturated (junk Food) - Resembles saturated fat - Junk foods, fast foods - Omega 3: Unsaturated (fish) - Unsaturated fat - Cold water fish - Vitamins - A,D,E,K - found in fat portion of foods and oils (fat soluble) - C,B - regulate metabolism, cannot be stored (water-soluble) - A,E,E - prevent aging, cancers, heart disease (anti-oxidants) Deficiencies: Iron, B12 - Anemia C - Scruvy Calcium - clotting, muscle contraction, nerve induction B - Beriberi B complex - cellular integrity, enzymatic function D - Rickets K - Collagen A - Epithelial, Skin Minerals - Stored in liver and bones - Ex. Iron - Energy, Magnesium - Energy, Calcium - Bone, Sodium / Potassium - Nerve Conduction Water - Most essential nutrient of all chemical processes - Dehydration can lead to illness and death - Electrolytes can maintain levels of hydration - 3. Energy Systems - ATP = Energy source - Glucose form blood or glycogen - Fat is utilized when glycogen stores depleted - Anaerobic = Short burst, Aerobic= Long burst **[Principles of Conditioning & Training:]** - Safety - Warm-Up - Prevent Musculoskeletal injuries & soreness - enhance performance - Physiological preparation for physical work (Best activity is dynamic warm-up, not static stretching) - Should last 5-20 minutes - Increases metabolic processes, core temperature and muscle elasticity - Cooldown - Decreased muscle soreness if stretching - Often ignored, but essential component of workout - Brings body back to resting state - Motivation - Overload & SAID Principle - To gain more - one must increase or upgrade activity - Work at or near maximum capacity - Applicable to conditioning and training - Consistency / Routine - Progression - Intensity - Specificity - **Specificity Principle:** Training should be relevant and appropriate to the sport for optimal performance. - Individuality - Relaxation / Minimize Stress **[Techniques for Resistance Training]** - Progressive resistance - Overload principles must apply - Increase intensities to enhance strength overtime - Same intensity sustains muscle strength **[Overtraining]** - Can result in psychological and physiological breaking down causing injury, fatigue and illness - Training appropriately, eating right, and appropriate rest are critical for overtraining prevention Under-training **[Muscle Atrophy]** - Gains in muscular strength reversed - Declines in training or stopping altogether will result in rapid decreases in strength **[Flexibility Limits]** - Bony structures - Excessive Fat - Muscle and tendons lengths - Connective tissue - Skin - Neural tissue tightness Improve Flexibility - ROM may increase due to stress reflex **Lecture \#5 Biomechanics & Pathology of Sport Injuries:** **Factors that Predispose Athletes to Injury?** **Intrinsic Factors (within the individual):** - Age - Sex - Neuromuscular, Structural, or Performance Factors - Mental Psychological Factors - E.g., Risk Takers - Postural Deviations **Extrinsic Factors** - Exposure - Potential hazards and unique risks of the sport - Position played - Amount of training and playing time - Competitive level - Low level isn't as physical; competitive more skilled and conditioned may be less likely however it tends to be more physical - Environment - Type and condition of playing surface - Weather conditions - Time of day, season - Crowd Control - Laxity of officials - Equipment - Protective equipment - Footwear Mechanical Injury - External force impairs anatomical tissue structure - Injury will cause inflammatory response - Injury is dependent on tissue properties and force - Tissue Properties - Load: An external force acting on the body causing internal reaction within the tissues. - Stiffness: Ability of a tissue to resist a load. - Greater stiffness = Greater magnitude load can resist. - Stress: Internal resistance to load. - Strain: Internal change in tissue (ie. length) resulting in deformation. Tissue Force: - Compression: Force that squeezes the tissue. - Tension: Force that pulls and stretches tissue. - Shearing: Force that moves across the parallel organization of tissue. - Bending: - Two force pairs act as opposite ends of a structure (4 Points) - Three forces cause bending point (3 points) - Already bowed structures encounter axial loading (top down) - Torsion - Loads caused by twisting in opposite directions from opposite ends. - Shear stress encountered will be perpendicular and parallel to the loads. - E.g., Golf swing **Positive Stress vs. Adverse Stress** Amount of Stress: - Stress = force divided by the area over which the force acts. - A given force over a large area versus a small concentrated area can have very different results. - Positive Stress = Resilience, Negative = Injury - SAID principle **Stress/Strain Curve** - Elasticity of tissue changes at Yield Point - Before yield point, tissue can return to regular state - When changes set in = Creep - Tissue Failure = Past Yield and Creep Order of Elasticity 1. Skin 2. Tendon 3. Ligament 4. Bones **Mechanism of Injury** Traumatic: - Physical injury or wound, produced by internal or external single force - Macrotrauma - Acute -- something has initiated the injury process - Example = a direct blow, contact sports Overuse: - Nature of physical activity dictates that over time injury will occur - Microtrauma - Chronic -- when it doesn't properly heal - Example = *repetitive* loading over time **Types of Tissue Injuries** Soft Tissue Properties: - Collagen - Primary constituent of skin, tendon, ligaments. - Protein substance strong in resisting tensile forces. - Wavy configuration, which allows for an elastic-type deformation or stretch but otherwise is inelastic. - Unloaded / No tension = like hair strands - Loaded / Tension = Straightened hair strands - Breaking Point = 6-8% of its length resulting in tear - Triple helix strand that creates one collagen strand fiber - Why do we feel stiff when waking up? - Cross link formation of collagen creating stiffness in collagen tissue, by stretching were breaking up adhesions formed. - By not moving, being active regularly, - Elastin - Protein substance - Adds elasticity - Elastin Unloaded / No tension = curling, relaxed - Loaded / Tension = straightened, cross link - Recoils when load is lifted, back to its original state - Elastin and Collagen provide strength and resiliency of our tissue. Part 2 Muscle Strains - Stretch, tear, or rip to muscle or adjacent tissue - Can be mild tear to complete muscle rupture - Usually involves large force producing muscle, also can be micro tears over time. - Healing time? - 6-8 weeks in General - Grade I or II can be short, Grade III can be longer. **Muscle Strain Grades** Grade I : - **Some muscle fiber tearing** - Tenderness and painful movement but full range present Grade II : - **Many torn muscle fibers** - Active contraction is painful, usually a depression or divot is palpable, some swelling and discoloration result. Grade III : - **Complete rupture of fibers** - Significant impairment initially with a great deal of pain that diminishes due to nerve damage. - Usually require surgical intervention or long term immobilization. Hamstring tear Example - Usually sports with short quick bursts - **Muscle Spasm** - A reflexive reaction caused by trauma - Muscles Splint/Stiffen the area in an effort to guard the area to minimize pain through limitation of motion **Two types:** - **Clonic** = alternating involuntary muscular contractions and relaxations in quick succession (quivering) - **Tonic** = Rigid contraction that lasts a period of time - During field play. - Ice or deep massage usually remedy. **Muscle Soreness** - Overexertion in exercise resulting in muscular pain - Result of an unaccustomed activity **Two types of soreness** **Acute-onset muscle soreness (AOMS)** - Transient muscle pain and fatigue immediately after exercise **Delayed-onset muscle soreness (DOMS)** - Pain that occurs 24-48 hours following activity that gradually subsides (pain free 3-4 days later) - Slight microtrauma to muscle or connective tissue - Prevent soreness through gradual buildup of intensity - Making smaller increases in our physical activity or doing a proper cooldown will prevent soress **Tendon Injuries** - Collagen re-absorption occurs with repeated microtrauma - Results in weakening tendons - Collagen re-absorption also occurs with immobilization (not using tissue for long period of time) - Weakens the tissue - Requires gradual loading and conditioning **Tendonitis** - Tendon acute inflammation - Due to gradual onset with repeated microtrauma - Signs & Symptoms: - Swelling and pain - Crepitus = sticking of tendon due to accumulation of inflammatory by-products on irritated tissue - Treatment - Rest and modify activity. - *itis* = inflammation **Tendinosus** - Poor healing of tendinitis -- degenerates and results in tendinosis - Chronic Tendonitis, ON and OFF pain from a longer period of time. - Signs & Symptoms: - Less inflammation and more visibly swollen with stiffness and restricted motion - Sometimes a tender lump will appear - Common in middle or old age - Treatment - stretching and strength - *osis* = breakdown **Tenosynovitis** - Inflammation of synovial sheath - Signs & Symptoms - Acute cases -- rapid onset, crepitus, and diffuse swelling - Chronic cases -- thickening of tendon with pain and crepitus - Often occurs in long flexor tendon of the digits and the biceps tendon - Treatment - Due to nature of injury, anti-inflammatory agents may be helpful **Myofascial Trigger Points** - Hypersensitive nodule within tight band of muscle or fascia (knot) - Due to mechanical stress on muscle fiber from overuse - Active or latent trigger points - Active = pain at rest (aching, throbbing sensation) - Latent = pain with pressure (tenderness) - Usually show up in postural muscles (traps, etc) **Contusions (Bruise)** - Sudden blow to body - Can be both deep and superficial - Hematoma from blood and lymph into surrounding tissue - Chronically contused tissue may result in generation of calcium deposits (*myositis ossificans*) **Atrophy** - Wasting away muscle due to - Immobilization - Inactivity - Loss of Nerve functioning (nerve severe, pinch) **Ligaments Sprain** - Result of trauma (twisting, tearing of tissue) - See joint effusions (swelling); may have joint bleeding - Pain point tenderness; increase in area temperature - Bruising (ecchymosis) - Ankle typical area Grade I : - Some pain, minimal loss of function, no abnormal motion and mild point tenderness - Walk can't run, bit of limp - Rehab - Difficult as it wont get back to functioning as it was before. Focus on balance and strengthening. Stretch of tissue. Grade II : - Pain, moderate loss of function, swelling, and instability with tearing and separation of ligament fibers - laxity - Rehab - Difficult as it wont get back to functioning as it was before. Focus on balance and strengthening. Stretch of tissue. Grade III : - Extremely painful, clear inevitable loss of function, severe instability and swelling immediately, and may also represent subluxation. - Rehab - Complete tear so would realign tissue; which makes it easier to get back to normal function. **Bursitis** - Bursa are fluid-filled sacs that develop in areas of friction - **Acute Bursitis** = sudden irritation - **Chronic Bursitis** = overuse and constant external compression - Swelling, pain, and some loss of function - Repeated trauma can lead to calcification (crystals) **Bone Structure** - Diaphysis - Shaft is hollow and cylindrical - Covered by compact bone. Medullary cavity that contains bone marrow. - Epiphysis - Composed of cancellous (porous, spongy) bone and has hyaline cartilage covering - Blood supply - Covered by hyaline cartilage - Periosteum - Dense, white fibrous covering that penetrates bone via Sharpey's fibers - Contains blood vessels and osteoblasts - When bone is broken, periosteum helps redevleop bone **Bone Fractures** - Closed Fractures - Little movement or displacement - Skin does not break - Open Fractures - Displacement of the fractured ends - Breaking through the surrounding tissue - Requiring surgery - Signs & Symptoms - Deformity, pain, point tenderness, swelling, and pain on active and passive movements - Possible crepitus - X-ray will be necessary for definitive diagnosis **Fracture Types** 1. Greenstick - Usually with Kids due to higher collagen content from immaturity of bone. 2. Comminuted - Bone shattering - Harder to heal 3. Linear - Rehabs well 4. Transverse - Bone has not displaced but align. 5. Oblique Non-displaced - Angled not displaced - Heals well 6. Spiral - Displaced not align - Require surgery for realignment Healing Time - 6 weeks in cast + 6 weeks rehab - Usually 3 months, can be season ending **Neuropraxia** - When the Nerve conduction interrupted - Due to compression, tension or trauma - Impacts motor more than sensory function - Signs and symptoms - Radiating pain, pinch, burn, tingle, muscle weakness Minor or Major