Sports Medicine PDF

SPORTS MEDICINE How are sports injuries classified and managed? ways to classify sports injuries - identify specific examples and injuries that reflect each of the classifications direct and - Direct injuries - injury sustained at the site of external force eg fractures, i...

SPORTS MEDICINE How are sports injuries classified and managed? ways to classify sports injuries - identify specific examples and injuries that reflect each of the classifications direct and - Direct injuries - injury sustained at the site of external force eg fractures, indirect dislocations, sprains and bruises → shoulder dislocation due to tackle in rugby - Indirect injuries - caused by an intrinsic force resulting from excessive strain placed on the muscles, tendons and ligaments causing irritation and damage to body structures → Usually caused by an inadequate warm up, ballistic movements excessive movements or fault in execution of skill eg hamstring tear in race soft and - Soft tissue - damage to muscles, tendons, ligaments, cartilage, skin, blood hard tissue vessels, organs and nerves - May be acute (occurring suddenly) eg sprains, strains, dislocation, subluxation, torn cartilage, contusions and abrasions or chronic (prolonged) eg severity necessitates a long rehabilitation - Hard tissue - damage to bones and teeth eg fracturing a bone overuse - Injuries caused by tissue damage/trauma over a period of time - Provoked by repetitive, low-impact exercise eg jogging, causing pain and inflammation at the site of injury - Examples include anterior shin splints and tendonitis - Overuse contributes to stress features, indicated by local swelling and tenderness soft tissue injuries - manage soft tissue injuries (RICER, immediate treatment of skin injuries) tears, - Tear - the ripping of fibrous tissue that can occur in the ligaments, muscles sprains, or tendons. The severity of a tear can range from a microscopic to full contusions rupture of all the connecting soft tissue to a bone or muscle. - Sprains eg ACL rupture in knee - Stretching or tearing of ligaments - resulting in pain, swelling and inability to perform normal joint movement - Ligaments and strong inelastic tissue, which connects bone to bone and provide stability therefore should not be stretched - Ligaments have relatively poor blood supply, causing slow healing process - Strains eg torn hamstring - Injury to muscle or tendon - causing bleeding or discolouration around the injury → 1st degree, 2nd degree or 3rd degree - Stretching or pressure at the site of injury will cause sharp pain - Contusion ie deep bruise - Caused by the rupture/bursting of capillaries, leading to internal bleeding - the crushing of soft tissue interrupts blood flow to surrounding tissue skin Skin trauma caused by the application of external force eg scraping or friction on abrasions, outer layer of skin lacerations, - Skin abrasions - shallow scraping of the epidermal layer of skin causing blisters pain and mild bleeding. Treatment: 1. Cleanse and sterilise wound using disinfectant to prevent further infection 2. Cover with non-stick dressing - Lacerations - deep cut or tear of the skin from contact with a sharp object eg cut of hand with kitchen knife. Treatment: 1. Manage bleeding by applying pressure to area with a dry and sterile gauze pad 2. Thoroughly cleans wound with antiseptic 3. Apply non-stick dressing or seek serious medical attention if stitches or surgery may be required - Blisters - collection of fluid below or within the epidermal (surface) layers of the skin. May include liquid or blood if a blood vessel has been ruptured. Can occur when new equipment is being worn or used for a long time, sudden changes of direction or friction at the site of blister. Treatment: 1. Cover blister with padding eg Band-Aid 2. Remove the object causing friction 3. Do not pop the blister but allow it to heal inflammatory The body’s natural reaction to injury and infection response - Phase 1 - acute inflammatory stage (2 - 3 days) - Inflammation is fast and painful, consisting of vasodilation (widening) of blood vessels to increase the blood flow and transfer of fluid to the area → this increases white blood cells, leukocytes, which enter the area to remove debris and fight possible infection - Characterised by redness, swelling, loss of mobility and heat - Phase 2 - repair and regeneration stage (3 days - 6 weeks) - Body begins to heal the injured/damaged site as leukocytes remove debris from the injury and new tissue forms - Characterised by the production of scar tissue, which should be minimised for proper healing to occur as scar tissue is weaker than normal tissue - Phase 3 - remodelling stage (6 weeks - many months) - Continues to rebuild the injured area, characterised by increased production of scar tissue and development/strengthening of new functional body tissue - Balance of exercise and rest is important - over-exercise may lead to further injury, yet excessive rest may weaken scar tissue RICER ensures injury heals correctly and quickly. In the long term, RICER aims to restore flexibility, regain function, prevent recurrence and return players to game as soon as possible. For maximum results, it should be applied for at least 48 hours after sustaining injury. Rest - minimise movement to prevent further damage and ensure inflammatory response is not stimulated again Ice - necessary within the first 48 hours, through methods such as 1 hour off, 1 hour on or 10 mins off 10 mins on. Aids in reducing pain, decreasing recovery time and reducing inflammation. Ice causes vasoconstriction, narrowing the arteries in the surrounding area. When ice is removed, there is a brief increase in inflammatory response by allowing vasodilation to aid in the removal of waste and delivery of new nutrients for repair. Compression - acts as support to stabilise the joint and prevent movement beyond normal range of motion to prevent further injury. Involves application of bandage around the injured area. The pressure applied helps force fluid away from the area to reduce inflammation. Elevation - elevation above the heart allows gravity to assist in the removal of inflammatory fluid. Gravity helps move the blood and other fluid back towards the heart to reduce/control the inflammatory response. Referral - allows for proper diagnosis and rehabilitation is needed. GPs will often provide anti-inflammatory drugs to reduce pain and assist recovery. After completing RICER and to ensure the quickest recovery, an injured person should also follow the No HARM principle. For the first 48–72 hours from sustaining the injury, the person should not use: Heat - increases blood flow to the site and causes more bleeding eg heat packs, hot showers and heat creams. Alcohol - may contribute to an increase in swelling and decrease in movement. It may also lead to numbness or decreased pain in the affected area, leading to further damage. Running - Any vigorous activity will increase blood flow and further damage Massage - contributes to an increase in swelling and bleeding. hard tissue injuries - manage hard tissue injuries (assessment for medical attention, immobilisation) fractures - Simple (closed) fractures - bone breaks but remains underneath the skin - Compound (open) fractures - fractures the bone which breaks and protrudes through skin - Greenstick (partial break), comminuted (more than 1 break), depressed (skull) - Management: - DRSABCD - Control bleeding and cover wounds - Treat shock - Use of splint and bandage to immobilise movement - Seek medical attention, especially if there is obvious deformity, uncontrolled bleeding, unable to use the TOTAPS regime dislocation - Dislocation - displacement of a bone at a joint - Subluxation - when the bone momentarily ‘pops out’ and quickly returns to place - Although the bone is displaced, it is not damaged (technically not a hard-tissue injury) - Concerning damage is to ligaments which may be stretched or ruptures - Signs and symptoms include deformity, swelling, pain, tenderness and loss of function - Management: - Securing with splint to fully immobilise injury - Apply ice and elevation - Immediate medical attention - Never attempt to relocate the displaced bone, as this may increase damage assessment of injuries - perform assessment procedures to determine the nature and extent of injury in simulated scenarios TOTAPS Talk - talk to the athlete to gather information about injury, including symptoms (pain, grating or cracking sensation) location of pain or pain scale out of 10. Observe - compare both limbs/sides of the body to determine if there is an obvious abnormality and whether there are any signs of injury eg redness, swelling, blood etc. Touch - touch the casualty to compare the other limb/side of the body. During this step, attempt to see where the pain begins moving along the limb or injured side towards the site of injury. Feel for abnormalities, heat and swelling. Active movement - ask the casualty to move the injured area to see if the athlete has full range of motion around the injured site and that this movement is pain  free. You may also place a hand on the injured area to feel for grating as the athlete moves. Passive movement - move the injured area for the athlete. This often involves applying force to the area eg pulling or pushing the joint to test range of motion. Moving the joint is to test ligaments, tendons and joint stability. Skill test - at this point, if there is an injury it is likely not serious. A skills test is used to assess the injury to determine if the injured area can undergo the forces often found in the sport being played eg applying weight on the injured limb, walking or jogging → to faster, more powerful and forceful activities eg jumping and changing direction at speed. How does sports medicine address the demands of specific athletes? children and young athletes - analyse the implications of each of these considerations for the ways young people engage in sport and how each is managed medical ASTHMA - over 10% of the population suffer from asthma. conditions Implications: - Characterised by inflammation of the airways leading to contraction of the bronchioles (airway branches) limiting the air flow both in and out of the lungs - Asthma begins with coughing and wheezing, leading to fatigue - Possible triggers includes dust, pollen, pollution and exercise - Exercise-induced asthma (EIA) = airways are dilated during physical activity but constrict immediately when activity ceases leading to an asthma attack Management: - Activity should be preceded by controlled breathing and relaxation exercises - Use a gradual warm up and cool down - Exercise intensity must be steady - asthma more likely triggered in longer duration activity than short and intense bursts of activity eg more likely to occur in a marathon run that a 100m sprint - More likely provoked by running over swimming as cooling process of nerve endings in air passageways is more extreme in passageways compared to warm moist environment of swimming - Essential to use medication before exercise if required (bring asthma puffer to training sessions) - Consume adequate water - Remove athlete from environment that triggers attack - Follow directions from National Asthma Council chart ‘First Aid for Asthma’ → sitting the person comfortable upright, give 4 puffs (1 puff per 4 breaths), wait 4 minutes, if not breathing normally another 4 puffs and call 000 DIABETES - body does not produce or properly utilise insulin (Type 1 - body’s inability to produce insulin, caused by an autoimmune disease leading to build up of glucose in blood. Type 2 - body’s inability to produce sufficient insulin or use it effectively) Implications: - Diabetes is a medical condition that relates to the glucose levels in blood, which affects sports engagement because glucose is also an important energy source for ATP production during sport participation.  - If glucose levels during exercise or physical activity are too low it can lead to a hypoglycaemic episode, but if they are too high it can cause a hyperglycaemic episode. Both of these can lead to loss of consciousness and death. - Important to monitor blood glucose levels closely during exercise, not using an insulin injection before/after, eating meals before/after to balance levels Management: - Insulin managed by injection, food intake and exercise (well balanced diet with complex carbohydrates) - Participation in regular physical activity to prevent hyperglycemia - Important to supervise children/young athletes and know first aid procedures to manage hypoglycaemic or hyperglycaemic episodes - Hypoglycaemic episodes - sudden onset and cause - rapid heart rate, sweating, shaking, anxiety, dizziness and unconsciousness. Manage by providing sugary food or drink eg juice or jelly beans followed by a meal. - Hyperglycaemic episodes - occurs slowly - thirst, vomiting, weak rapid pulse, rapid breathing, drowsiness. Medical assistance should be sought EPILEPSY - medical condition relating to disruption of normal brain activity resulting in seizures (when the brain's nerve cells misfire and generate sudden, uncontrolled burst of electrical activity in the brain) Implications: - Medications can be used to reduce the likelihood of seizures occurring - Type and possible triggers should be considered as sports are selected - Ensure others are present as they participate in sports particularly water sports, bike riding and horse riding Management: - Medication - Supervising adult should be aware of how to manage seizures if they occur - Time the seizure, protect from injury by removing surrounding objects and protect the head - Do not attempt to restrain the person - Roll into the recovery position and remove triggering environment - Calmly talk to the person until they regain consciousness, let them know they are safe and that you will stay with them while they recover Overuse Overuse injuries occur because of repeated use of a body part. Most common injuries examples in children include: stress fractures, tennis elbow, Achilles tendonitis, swimmer’s shoulder and runner’s knee. Commonly experienced by children due to different rates of growth between bone and muscle. Implications: - Causes tissue damage and considerable discomfort - Risk of further injury prevents participation Management: - Children should have days of non-training and monitor their volume and intensity of exercise - To prevent overuse injuries, training program/physical activity must address high training volume, frequency and intensity, inadequate warm-ups, lack of general fitness, unsuitable equipment (lacking support), poor technique (joint stress), strength and flexibility imbalance (poor body alignment) - Application or RICER, up to 8 weeks rest, icing to reduce inflammation Stress fractures - common form of overuse injury - Implications - gradual onset of localised pain, local swelling and tenderness eg shin splints  - Management - frequence ice to reduce swelling, anti inflammatory medication, rehabilitation exercise that doesn’t use injured site eg swimming, rest for 4-8 weeks Thermo- Maintenance of a stable internal temperature independent of the temperature of regulation the environment (balancing heat loss with heat gain) Implications: - Children at increased risk of environmental strength as they do not have the same ability to lose heat through evaporation at the same rate as adults - Children’s sweat glands release fluid more slowly and are less responsive to temperature changes - Children rely more on radiation and convection to lose heat - Acclimatisation to heat is also slower, putting them at greater risk on hot, humid days - Shorter tolerance time in extreme heat, increasing possibly of dehydration - Higher chance of developing hypothermia from exposure to cold Management: - Poor thermoregulation means children and young athletes need to have their body temperature monitored closely when in heat or cold - Must consider appropriate clothing, time of day sport is played, availability of shade, access to fluid - If suffering from heat stroke or heat exhaustion; DRSABCD, remove unnecessary clothing, sponge with cool water/cover with wet blanket, give cool water, seek medical aid - If suffering from hypothermia: DRSABCD, lie in warm dry place, avoid wind/rain/sleet/cold/wet grounds, remove wet clothing,w arm with a blanket, warm drinks, call 000 Appropriaten Strength training programs for children are an integral part for improving overall ess of skill and fitness resistance Implications: training - Resistance training can be beneficial for young athletes, reducing body fat percentage and increasing lean muscle mass. However, precautions should be put in place. - Young athletes must be fully supervised at all times by qualified instructors and heavy lifting should be avoided until the athlete has finished growing. - It is important to perfect technique first, rather than lifting for absolute strength, as the growth plates can be easily damaged. - Low resistance with high repetition through full range of motion - Strength specialisation should be avoided as it can lead to imbalances between muscle groups and contribute to injury Management: - If injury occurs seek first aid immediately - RICER adult and aged - explain the sports participation options available for aged people with medical conditions Heart - Heart condition include hypertension, CVD, people who have had heart conditions attacks or bypass surgery - Exercise reduces blood pressure in moderately hypertesnive patients by an average of 11 systolic and 9 diastolic points - Maximum benefit of exercise is agined in conjunction with a diet low in fat and salt - Medical clearance should be obtained for those with existing heart  conditions, including a stress test determining the level of intensity their circulatory system will tolerate - The intensity of exercise should be 10+ bpm lower than levels that trigger abnormal signs/symptoms, including nausea and chest pain as determined by stress test (ie do not work past point of angina chest pain) - Aerobic exercise eg walking, jogging, cycling is the most suitable, performed gradually and slowly after a warm up eg 30 mins a day 2-3 times a week - Steady state activity eg cycling, jogging and swimming provide cardiovascular training without placing excess stress of the heart muscle and surrounding arteries - Programs should be tailored to individuals for sustainable benefits - Modified strength training programs should target major muscle groups and include a light load, avoiding isometrics which can raise blood pressure - Alternate sports include golf, brisk walking, aerobics, tennis fractures/ - Osteoporosis - musculoskeletal condition caused by the deterioration of bone density bone structure - Bones become thin and weak leading to increased risk of bone fractures - Exercise should aim to reduce the risk of falls and fractures - Physical acitvity increases bone mass and makes bones stronger (particularly for older women delaying post menopausal bone density loss) - Inactivity encourages calcium discharge, weakening the bones - Activity should focus on improved fitness, balance, strength, coordination, aerobic capacity and flexibility - Activities include: endurance (walking, cycling, swimming), low impact (aerobics), low range strengthening (focus on limbs, core and back) - High loads in resistance training must be guided by a physician to develop postural retraining - Osteoporosis foundation (prevention, facts, statistics) - Local physios offering classes eg hydrotherapy flexibility/ - Exercise assists in improving flexibility and joint mobility in older people joint through safe stretching and improving range of motion of joints, especially mobility beneficial for people with arthritis, aching joints and tight muscles - Programs increase balance and stability to help reduce fractures cause by falls - Programs must be low impact, cater for individual limitations and consider existing medical conditions that may limit movement - Activities may include walking, cycling, aqua aerobics, Tai Chi or yoga - Sports Medicine Australia - policies and guidelines for active older Australians It is important for adults and aged athletes to be able to continue their participation in their chosen sport. Many sporting organisations are recognising this and now provide modified competition arrangements for such athletes, eg ‘Golden Oldies’ use modified equipment, rules and reduced physical contact female athletes - assess the degree to which iron deficiency and bone density affect participation in sport Eating - Characterised by behaviour such as purging, binge eating and purposeful disorders starving (commonly anorexia nervosa and bulimia nervosa) - Affects more than half of female athletes, as low body fat and idealised body shapes are expected in sports such as gymnastics, diving, dance (diving - thinness an advantage to artistic and technical merit, considered when arriving at score)  - Females at 2x risk due to - Exposure to peer influence/media pressures - Exposure to social expectations within athletic subculture - Conform to ideal sporting image that values ideal body shape, size, weight and low body fat 1980s and 90s saw an acceleration of ideal body shapes 1976 → average gymnast 1.6m 47.7kg 1992 → average gymnast 1.4m 40kg - To prevent, coaches and trainers need to: - Encourage effort not solely on winning - Be educated to detect signs and use nutrition experts eg fainting, dizziness, lethargy - National Eating Disorder Collaboration - Observe training and social practices, taking action at unusual behaviour Iron - Iron deficiency causes anaemia (condition of abnormally low level of deficiency haemoglobin, making less oxygen available to tissues) - If haemoglobin levels drop below 11 grams per 100mL of blood, the person is considered anaemic - Without sufficient rion, the number of red blood cells is reduced, limiting the oxygen carrying capacity of the blood - If a female athlete has low iron levels, they cannot deliver enough oxygen to their mustly to sustain sports performance, relying too heavily on the anaerobic energy system - Ultimately, iron deficiency contributes to fatigue and loss of energy leading to limiting motivation and early onset of lethargic sensations - High iron = more haemologin to bind with oxygen and transport it around the body, speeding up recovery from lactic acid energy system - Many women suffer from iron deficiency losing around 5-40mg during menstruation, and failing to meet recommended red meat intake (18mg/day) - Exercise induced anaemia (sports anaemia) is common in female athletes due to intense training where iron reserves are heavily drained - Caused by a loss of iron in sweat, destruction of red blood cells from body temp. - Heart Foundation Sydney walking groups - Iron levels must be constantly monitored and increased only as required through supplementation ie iron tablets - Supplementation only beneficial for athletes below the recommended intake as indiscriminate use can cause iron levels to reach toxic amounts, contributing to liver disease, diabetes, heat problems and joint damage Bone density - Bone density is related to the quantity of calcium in the bones - Bones lacking calcium are at risk of fractures and structural weakening (should not engage in high intensity of contact sports/sports requiring agility as this increases pressure on joints eg sudden changes in direction in netball) - Calcium is regulated by the parathyroid glands, controlling how much calcium is stored in the bones and how much will be released into the body - If the parathyroid glands become overactive, calcium from bone tissue is release to the bloodstream, causing bones to become brittle and contributing to osteoporosis - Bone deterioration begins in mid thirties and post menopause women lose calcium faster than men - Women beginning sports programs should focus on safety in activity and chose aerobic sports such as swimming, cycling, running and aerobics  - Female athletes must be aware of how their bones are affected by age - A well-balanced diet with adequate calcium-enriched foods, such as milk and cheese, is recommended - Activity must include a warm up, progress to stretching and ice should be used on inflamed or arthritic joints to prevent swelling and soreness - Women must be aware of the effect of ageing and menopause on bone density Pregnancy - Exercise regularly performed improves cardiovascular fitness - Intensity must be moderate as excessively intense activities could place the foetus at risk as their is restricted placental blood flow - Pregnant women should exercise in cool conditions and consume adequate water to avoid thermal stress, which can affect foetal development - It is easier to control these factors in self-regulated exercise programs than in competitive sports - Benefits of exercise in uncomplicated pregnancies: maintenance of fitness and general well being, weight control in later stages of pregnancy, improved muscle tone What role do preventative actions play in enhancing the wellbeing of the athlete? physical preparation - analyse different sports in order to determine priority preventative strategies and how adequate preparation may prevent injuries Pre- - Assesses the health status of a person before they become involved in a screening training program - Age, gender, health status and previous experience are important - Eg 30 year old, history of activity will not have as much risk as an older, unfit, obese person - Especially important for: - Males over 40 - Females over 50 - Asthmatics - Smokers, obese, high blood pressure - Heart condition family history - Promoted by Sports Medicine Australia - Example questions – have you had a heart attack? Do you ever feel faint? Do you have diabetes? - Can be used to tailor a program for individual needs - Knowing limitations helps avoid soreness and losing motivation - Assesses appropriate frequency, intensity, time/duration, type - It also ensures those who are at high risk of suffering a heart attack or stroke during exercise are first cleared by their medical practitioner, and have correct supervision and prescription of exercise to avoid harm skill and - Skill and technique relates to the efficiency of movement technique - Someone with good technique is efficient, protecting against injury as they do not get easily fatigued and thus resort to poor technique - It is essential to injury prevention eg a basketball player still in the cognitive stage of skill acquisition may be constantly looking down at the ball while dribbling and can easily collide with a defender - Skilful players:  - Perform difficult movements with ease, precision and control - High degree of temporal patterning - This allows the athlete to perform the skill safely without being injured as they can simultaneously focus on surroundings and the action eg dodge players - Poor technique leads to higher injury rates, especially overuse injuries - Examples: a tennis player with good technique for their serve is more consistent with their first serves, but also suffers less injury because they are putting less strain on their body. This prevents injury to the back or shoulder. A rugby player unsure of how to correctly tackle is at risk of severely hurting their back - Eg Netball Knee program physical - Before full competition begins, an individual should attain an appropriate fitness level of physical fitness to prevent injury - Eg rugby – strength, power, speed, endurance, agility, gymnastics – flexibility, coordination, balance - For most sports a degree of cardiorespiratory fitness is required to ensure the athlete does not fatigue, which may cause them to compromise their technique and hence increase injury risk - Appropriate fitness levels ensure energy supplies are adequate and body systems are able to meet the demands of the activity warm up, - Most important injury prevention features of any training program stretching - Warm up - must be specific towards demands of the sport should be and cool approx. 20-25 mins down - Sports that require explosive movements (sprinting, discus) require longer warm up than endurance events (cycling) - Warm ups cause redistribution of the blood flow from internal organs to assist circulation to the skeletal muscles, where oxygen and nutrients are required by cells for muscle contraction - Higher muscle temperature increases elasticity to decrease risk of tearing, and improves muscle reflex time - Warm ups can include stretching, skill rehearsal (drills/routines) jogging etc - Stretching - all individuals should participate in a general stretching program at least 4-5 times per week - Sports people require additional flexibility according to the demands of their particular sport to stretch their muscles beyond their ROM - This is achieved safely through: static stretched (gradually stretch muscle groups beyond normal ROM eg quad stretch) and Proprioceptive Neuromuscular Facilitation (PNF) stretching (static stretched followed by isometric contraction and relaxation phase in lengthened position) - Cool down - recovery period post exercise where body temperature, circulatory and respiratory rates return to pre exercise states - Cool downs are essential to: maintain the stretch in the muscle groups that may be shortened in the exercise eg leg muscles in cycling if not extended fully to reach pedal, disperse lactic acid that has built up during exercise and prevent blood pooling (through gradual reduction of heart rate) - Involves stretching for about 10 minutes, performing callisthenics and light a gross motor activity eg light jog - PEP program (prevent injury and enhance performance) jog line to line of soccer field (cone to cone), shuttle run (side to side), backwards running sports policy and the sports environment - critically analyse sports policies, rules and equipment to determine the degree to which they promote safe participation, eg heat rules, rugby union scrum rules rules of - Assist flow, prevent injury, promote safety sports and - Enforced by referee or umpire activities - Rules must be made to state what constitutes dangerous with penalties HIA assessment - Trainers assess symptoms eg loss of consciousness, dizziness, unsteadiness, memory loss - Removed from field of play if symptoms are seen - free interchange - External doctor reviews footage and conducts a concussion assessment and neck examination - Questions include “which half is it?”, “what venue are we at?” - Tested for long and short term memory and concentration techniques eg repeating numbers in reversed order - Balance testing - Importance: can lead to brain bleeding or skull fracture Heat rules - Sports Med Australia has hot weather guidelines - ‘Heat and beat fact sheet’ - prevention of dehydration, heat stroke - About 36˚ and 30% humidity has extreme health risks - advice to cancel Rugby union scrum tackle rules - High possibility of injury especially in illegal movements - Medical journey of Australia - research which led to changes - Law 20: from “crouch touch pause engage” to “crouch bind set” - Reduces movement in scrum to prevent it from collapsing and injuring players - Limits number of resets to decrease the number of spinal injuries modified - Modified rules for children allows the sports environment to accommodate rules for for the specific needs of younger athletes eg lowering basketball hoop and children netball ring - By tailoring rules for children, their potential to learn new skills and willingness to participate increases - Eg little athletics utilises lighter equipment and shorter distances, Milo cricket uses plastic bats and rubber balls - Other changes may be seen in equipment size, court dimensions and playing environment matching of Growth and development, and skill level opponents - It is desirable to match children with others of comparable size to promote safety - There are vast differences in physical maturity between individuals of the same age, difficult to address because often grouped by age - Consideration should be given to: size, age, gender, strength, psychological development and skill level of competitors - Eg makes considerable difference in hockey – can hit harder - Heightens interest and makes sports more competitive and fair - Players are able to match their skills against opponents of similar ability and enjoy competition for its own sake, not solely to win use of - Equipment must protect the wearer and other players, allow freedom of protective movement, air flow and be comfortable equipment - Eg mouthguards, helmets, padding, wetsuit, hates, gloves - Higher risk activities mean safe equipment is more important - Equipment needs to be rigid, supportive and reliable eg cricket helmet - Footwear needs to be supportive and protective - if not, can lead to blisters  and structural deformities - Unique to sports due to different stresses - Eg dance shoes to allow for turning without too much grip, but not enough to slip - Comfort, reduce cramping, flexible, high heel, midsole capable of absorbing impact, suppostive heel safe - Responsibility of organising group to ensure every effort is made to meet grounds, safety expectations equipment - Safety guideline for children in sport and recreation (Sports Med Aus) and - Playing surface without holes or hard patches facilities - Clear rubbish – glass, stones, cans - Check corner posts cannot injure - Ensure goal posts padded - Perimeter fences away from playing area - Spectators, equipment, vehicles away from sidelines - Matting eg gymnastics - Equipment: suited to age, checked and maintained, padded, stable or movable when necessary, properly constructed - Eg sponsor signs should not interfere with player movements on or off the field - Appropriate lighting – may extend time period that ground can be used, wearing down the field environmental considerations - evaluate strategies an athlete could employ to support the body’s temperature regulation mechanisms - analyse the impact of climatic conditions on safe sports participation temperature - Normal temperature is 37˚ – balance exists between heat produced by regulation body (muscle action and metabolism) and heat being dispersed (convection, (convection, radiation, conduction, evaporation) radiation, - Thermostat of the brain = hypothalamus: controls reactions when above or conduction, below temp eg shiver when too cold evaporation) - 4 ways to lose heat to balance heat rise in activity: 1. Convection - occurs when fluid, in the water or air, draws heat away from the skin as it passes over. Eg, when an athlete is running, the air that they move through draws heat away from the skin and cools the body (12% heat loss) On cold days, athletes will wear tight clothing to trap heat in Placing the athlete in front of a fan, and pouring water over the skin supports convection as a temperature regulation mechanism. 2. Radiation: heat from the body is lost via infra-red rays radiated to the atmosphere (60% heat loss) If the athlete is cold, exposing the athlete to the sun or a warm fire will help to heat the body causing body temperature to rise. If the athlete is hot and needs to lose heat, exposing more skin to the environment can help to lose more heat by radiation. However, radiation is one of our bodies least effective mechanisms for temperature regulation. 3. Conduction: transfer of heat through objects in contact eg tennis runner’s feet on hot road (3% heat loss) The heat transfer is always from the hotter object to the cooler one. During exercise, our bodies heat up due to the creation of heat when ATP is turned to ADP and P. If the body is warmer than the bike being ridden, some heat will be lost through conduction. Ice-vests work as heat is conducted from the body into the ice, warming the ice and removing heat from the body. 4. Evaporation: Evaporation is affected by the humidity of the air. The more humid the air the less effective evaporation is at removing heat. It affects heat loss through sweating (25% at rest, up to 80% in endurance events). Many athletes sweat between 1 and 2 L/h. Trained athletes will even begin to sweat before it is needed because their body knows it will be needed as the athlete continues to move and produce more heat. If an athlete is hot, evaporation can be increased, by adding water to the surface of the body. Actions such as pouring water over the body will leave more water on the body to evaporate off, taking the heat with it. Drinking plenty of fluid will also assist the evaporation process as it allows the body to continue to produce sweat without causing dehydration to the athlete. Removing sweat with towel for cold athletes or wearing a jumper as soon as a swimmer exits a pool climatic TEMPERATURE conditions - High temperature and humidity: (temperature, - May lead to heat stroke as increasing amounts of blood become humidity, devoted to transporting heat rather than oxygen, placing the athlete wind, rain, at higher risk of hyperthermia. altitude, pollution) - Increased heat through breakdown of ADP and P, and radiation from the environment - Pouring water over the body, wearing light loose clothing, doing physical activity in cooler times of the day and in the shade if possible - Low temperature: - When the internal body temperature decreases more than 1°C (eg skiing), the body’s heat conservation mechanisms activate ie shivering and peripheral vasoconstriction - Excess clothing in cold environments stimulates sweating and  bulkiness which can inhibit performance - The heat loss process in cold water is more rapid than when surrounded by air (4x faster in liquid than same air temperature) - Wearing long sleeves or warm clothes such as snow jackets and pants, ensuring the athlete does not stand around in the cold waiting, using longer warm ups to prevent injury HUMIDITY - High amounts of moisture in the air leads to slower evaporation, and sweating does not efficiently lower body temperature - Limits the body’s ability to dissipate heat and prevents evaporation - Using an ice-vest, adequate fluid consumption to prevent dehydration WIND - Combined effect of convection and conduction contributes to wind chill, producing burning sensation on the skin - Light clothing that covers most surface areas during running and cycling can prevent wind chill - The combination of cold and wind increases the likelihood of hypothermia - Wearing appropriate warm clothing, longer warm up, continuing movement, having warm water available to drink, ensuring athlete removes sweat and water to reduce heat loss through convection and evaporation RAIN - Rain may assist body temperature control during performances in warm to hot conditions, but may impact visibility, safety and humidity - Rain increases the heat lost through convection as water moves the skin’s surface. This can be dangerous if it occurs in cold and/or windly climatic conditions - In many sports such as netball, games will be cancelled if courts are wet as injury risk is very high - ******** ALTITUDE - As altitude increases, our ability to perform physical work is affected, particularly in endurance type events - There are different oxygen concentrations in the air at varying altitudes. The higher the altitude the lower the oxygen concentration, and the lower the altitude the greater concentration. - For example, there is greater radiation from the sun at higher altitudes, placing the athlete at greater risk of UV burn. Sunscreen should be worn - With less molecules on your shoulder, there is less resistance to vertical movement, allowing athletes to jump higher - If an athlete has been doing physical activity at a low altitude and is then required to perform at a high altitude, their performance will decrease as there is less oxygen moving into their blood and being transported to the muscles - If going from a lower altitude to a higher altitude, there is an increase in haemoglobin, whicher increases the amount of oxygen in the blood at the higher altitude, thereby improving performance - If an athlete does not acclimatise to the higher altitude, they may experience hypoxia, which means they do not have enough oxygen and will get dizzy, light headed and lose balance. Hypoxia can be life threatening. - “Live high train low” = this is where the athlete lives at high altitude (real or simulated) to increase haemoglobin levels, but train at low altitude, where training can still be performed at high intensities. The results in greater  oxygen transportation to maintain higher intensities for longer - Many athletes will try and acclimatise to the location of their competition 2-4 weeks before competition. POLLUTION - Pollution is the presence of contaminants - Pollution increases airway resistance, causing irritation to the upper respiratory tract and redacted oxygen transport capacity in the blood - The most dangerous pollutant is carbon monoxide, which binds to haemoglobin in preference to oxygen, which inhibits oxygen delivery to muscles - Ozone might also create a health risk as it can cause respiratory discomfort, nausea, eye irritations, cancer, bronchitis or asbestosis - Pollution mosts affects people living in cities or suffering from asthma and cardiorespiratory problems - There are limited strategies to use other than not participating or wearing a mask guidelines - Over half the total body weight of the average person is water (57%) for fluid - Water is critical for temperature regulation as blood plasma is 90% water intake - Reduction in water lowers plasma levels and causes blood pressure to decrease meaning less blood is available to the muscles - Reduced plasma negatively affects circulatory system from delivering cells, nutrients, carbon dioxide waste and hormones - The effect of exercise on the body’s fluid supply accelerates water loss through sweating, causing body temperature to rise - Symptoms: - 1% loss - thirst - 5% loss - discomfort and decline in aerobic effort - 10% lost - breakdown in coordination - difficult to move - 20% loss - upper limit before death - Before exercise: - 480-600mL water or sports drink at least 4 hours before exercise - 240-360mL more 10-15 mins prior to performance - Small amounts of salt may also be beneficial for reducing fluid loss - During exercise: - 90-240mL water every 15-20 mins if exercise is under 60 mins - 90-240mL sports drink every 15-20 mins if exercise is over 60 mins - DO NOT consume more than 1L per hour of exercise - Post exercise: - Fluid lost should be replaced within 2 hours after exercise - 1.3-1.6L of fluid should be consumed for every kg of weight lost - DO NOT consume more than 1L per hour of exercise acclimatisation - Acclimatisation is a training technique where athletes experience different climatic stressors, causing physiological adaptations to occur - It assists performance competitions in a range of climates eg footballers from Northern Queensland may find difficulty with breathing and skill execution on cold evenings in Canberra, while Sydney footballers find the humidity of far north Queensland energy sapping - About developing tolerance to expected performance conditions - Acclimatisation is enhanced through exposure and training in the environment or a prefabricated environment providing a similar effect - It takes about 5-7 days for heat and 2-3 weeks for altitude acclimatisation - Acclimatisation to heat leads to: increased sweat rate, increased sweat gland distribution, decreased heart rate, increased plasma volume, increased oxygen consumption, earlier onset of sweating at a lower core  body temperature - Acclimatisation to cold leads to: shivering begins at a lower skin temperature, increased metabolic rate, improved intermittent blood flow to the hands and feet taping and bandaging - demonstrate taping and bandaging techniques, including taping the ankle, wrist and thumb - evaluate the role taping plays in both the prevention and treatment of injury preventative - Taping = application of adhesive or non-adhesive strapping or bandages to taping a joint area to protect, support or strengthen the joint during movement - Protects, strengthens, supports - Good for sports which employ explosive movements with fast changes of direction eg agility, power, speed and strength to periodically sustain high levels of stress on the joints - Preventative taping also works as a placebo by allowing the athlete to be confident in their movements, which helps in skilled athletes biomechanically efficient, making them likely to suffer injury - Preventative taping pulls on the athlete’s skin when the tape is stretched providing a sensation to provide feedback to the athlete to stimulate the muscles around the joint and to reduce movement to prevent injury - A systematic review publish in The Journal of Science and Medicine in Sport found that ankle sprains decreased by approx. 70% when preventative taping was used and that taping can reduce the injury rate by almost 50% - Long term taping can lead the athlete to become reliant upon the tape to provide the support for the joint, which decreases stabilising muscle strength and weakens the joint → taping should be used as a short term prophylactic (preventative) measure - Completely cover skin around area with tape and always finish with locks Method (example to prevent inversion sprain of ankle – rolling to side) 1. Positioning: stabilise the ankle on bench/table and shave area to be taped. Set ankle in dorsiflexed position (achilles tendon fully stretched) slightly evert foot 2. Anchors: attach the first anchor 15 cm above the ankle. This should begin at the front of the foot and run obliquely around lower leg 3. Stirrups: each stirrup begins with attachment to the anchor on the medial side of leg and joints to the anchor on the lateral side 4. Extra anchors: apply extra anchor strips to secure stirrups 5. Heel locks: begin on the inside of the heel and apply tape across the top of the foot and underneath the heel. Continue coming up the medial side of the foot and extend around behind the heel, across the lateral ankle bone and the top of the foot (apply another heel lock) 6. Close down: begin on the lateral side of the leg and on the lower side of anchors. Wind tape around leg, overlapping slightly. Continue spiralling once at the ankle but in a figure 8 pattern that goes under the foot and around the ankle. This ensures all skin is covered and tape underneath is securely attached. taping for - Taping is often required after sustaining an injury during the rehabilitation isolation of process injury - Support should be provided while the injured area becomes accustomed to the demands of full activity - Taping ensures the athlete can participate in body conditioning exercises to maintain fitness as much as possible during recovery - The goals of taping in the treatment of injury include - Limiting range of motion - Providing proprioceptive feedback to stimulate muscles for stability - Increase stability of the joint - Shift anatomic parts into the correct position eg patella  - Compress soft tissue to reduce inflammation bandaging - Using RICER regime uses compression bandages to restrict bleeding into for the injured area immediate - Compression bandages apply pressure to the injured area and helps force treatment fluid away from the area, or restricts fluid coming to the area, reducing of injury inflammation - This helps prevent damage from too much inflammation, which can damage tissue and avoids the bui;ld up of debris as it can be cleaned up by the immune system and ultimately speeds up recovery allowing a faster return to play - The bandage type varies with the type and location of injury - Bandaging at this point serves to limit the motion of the body part, usually by securing it to another body part eg strapping sprained thumb to wrist for support Positive Negative - Strengthens, supports, - Athlete may become dependent on it, tape acts in stabilises, prevents replacement of weakening muscle injury - If too tight, tape may cause swelling and circulation issues - Athlete may be allergic - need to spay or have underlying white tape How is injury rehabilitation managed? rehabilitation procedures - examine and justify rehabilitation procedures used for a range of specific injuries, eg hamstring tear, shoulder dislocation progressive - After injury, the joints become stiff as muscles around the joint tighten mobilisation because they were not used for an extended period of time - This involves gradually extending the range of movement through which the injured part can be manipulated until it is fully functional - The athlete must avoid any aggravation of the injury during rehabilitation as this will extend the healing period - Progressive mobilisation should begin as early as possible to prevent scar tissue and reduce recovery time - Progressive mobilisation should involve passive movement first (especially if injury to muscle is across the joint) and then followed by active movement, where all movements should be as pain free as possible eg static, dynamic and PNF stretching - Shoulder dislocation - The immediate treatment for a shoulder dislocation is immobilisation of the shoulder and its arm, and to apply ice packs if it does not cause further pain - After relocation (by a professional) a sling is usually worn for 5-7 days. If the athlete requires surgery then this should also be done before rehabilitation begins graduated STRETCHING exercise - Stretching ensures healing without scarring, which may shorten the muscle (stretching, and make it more prone to further injury conditioning - The most beneficial and commonly used form of stretching is PNF, where , total body the muscle is stretched and strengthened during safe movements to prevent fitness) joint stiffness - Dynamic stretching is usually used towards the end as it requires more control, indicating that the athlete is in the ‘conditioning’ phase - Hamstring tear - There should be no stretching of the hamstring during the initial acute period of injury. This will allow the injury to begin to heal before it is pulled at, which will cause further injury - Once a professional has declared this to be over, stretching becomes the first rehabilitation procedure for a hamstring tear - Stretching will help to increase and restore the range of motion/movement at the knee and hip as the hamstring goes across both joints - Shoulder dislocation - Often the shoulder is stiff and tight after the sling being worn and the arm being immobilised for so long. Range of motion exercises includes a range of stretches that are isometric, PNF and dynamic CONDITIONING - Conditioning involves a build up in fitness as a result of adaptations to gradual increases in physical stress ie progressive overload principle - Conditioning is the process of strengthening muscles and getting them back to their pre-injury levels eg muscular strength, endurance, speed and power - Speed and power are the last to be redeveloped as they cause more stress to the muscles and joints, requiring a greater level of recovery - Specificity is already important as it needs to target the general cardiorespiratory fitness increasing the need for strength, power and local muscular endurance around the injured area - Hamstring tear - Athletes should begin with isometric contractions of the hamstring that are a low intensity to begin with. Isometric exercise should be conducted throughout the pain free range of movement. - The progress through a range of dynamic activities as recovery continues. Movements will then become functional, before sport specific exercises are given. During these exercises it is important to minimise pain, and often cold therapy is used if pain occurs. - Shoulder dislocation - Strengthening the rotator cuff muscles as soon as it is possible (pain free). - Strengthening exercises begin with isometric contractions. Actions such as: extension, adduction, external and internal rotations and abduction when possible are all done as isometric contractions. Internal and external rotations particularly target the rotator cuff muscles, strengthening the stability of the shoulder joint. - Once the shoulder is strong, and more importantly stable, general conditioning exercises may be added TOTAL BODY FITNESS - This refers to regaining the level of mental and physical fitness of the athlete before the injury occurred - During injury the principle of reversibility means body fitness is lost as signs of this fitness loss are seen from 2-3 weeks → training helps slow down reversibility - Gradually overloading the muscle groups and energy systems ensure the  required adaptations are regained before competition is commenced - Such adaptations include: muscle hypertrophy, strengthening of tendons and ligaments, increased joint mobility, absence of all pain, fully restored balance and coordination, increased capillarisation and subsequent blood flow to injured area, increased elasticity of fibres - Pre and post injury tests are vital to compare results and determine if the athlete has fully recovered and can return to the level of play - Hamstring tear - Stationary equipment is used to maintain and/or enhance total body fitness - Arm ergometers can be used to help maintain cardiovascular fitness - From low impact machines eg rowing erg the athlete will progress to light jogging and before agility runs. Finally the athlete will progress to full sprints - Shoulder dislocation - Athletes will need to resume training as soon as possible (to counteract reversibility) - During rehabilitation a stationary bike could be used to help maintain some levels of total body fitness training - During rehabilitation… - Training aims to limit loss of fitness and continue to train the rest of body by using non injured side/limb/part - Eg athlete recovering from a shoulder dislocation should engage in lower body training eg incline walking - After rehabilitation… - The athlete may have regained strength, power, flexibility etc, but a lack of engagement means sports specific components eg coordination and agility may be diminished - The athlete may also have lost their ability to “read the game” and may not be psychologically prepared/confident enough to return to play - Training should thys aim to develop sport specific fitness components and skills, increase confidence and safety return the athlete to play - Requires a performance assessment, whereby an athlete should exhibit the characteristics of a skilled performer - Hamstring tear - Once the athlete has been given the clear from a professional, they may return to training - It will take a while for muscular endurance and power produced by the hamstring to return - The athlete will also become more confident to use the hamstring to their full potential through training drills use of heat - Benefits and aims of using heat application and cold - Increased blood flow (delivering nutrients and white blood cells while removing waste) - Decreased pain - Increased flexibility (increases the elasticity of fibres) - Decreased joint stiffness - Increased tissue repair (by increasing blood flow) - Examples of heat application - Heat packs eg microwavable wheat bags - Hydrotherapy eg heated pool using buoyancy to limit the force/weight on injured area during exercise - Infra-red lamps: proceed heat via radiation  - Contrast water therapy - athlete moves injured area between ice bath and warm bath - Ultrasound - applies heat using sound waves on dense tissue eg bone or ligaments - Microwaves - heat deeper tissue that has high water content eg muscles and blood vessels and the area is heated for less than 30 mins at 40 degrees - Heat should not be applied to acute injuries - Cold/cryotherapy - Reduces pain and inflammation - Reduces blood flow and bleeding - Ice for 48-72 hours, then heat - Ice packs, ice massages, cold water immersion, ice bath, contrast water therapy, vapocoolant sprays, cryotherapy machines return to play - research and evaluate skill and other physical tests that could be used to indicate readiness to return to play - critically examine policies and procedures that regulate the timing of return to play, considering questions such as: - why aren’t such policies applied to all sports? - who should have ultimate responsibility for deciding if an athlete returns to competition? - should athletes be allowed to use painkillers in order to compete when injured? indicators of - Pain free readiness - Injured area must be pain free during both light and strenuous for return to exercise play (pain - Eg football player with sprained ankle should not just be pain free free, degree when doing fitness activities, but also during agility runs, drills, mini of mobility) games and competition simulations - Degree of mobility - Degree of mobility = amount of movement around injured area eg if torn hamstring must have restored range of movement and both hip and knee - Movements must be smooth and show confidence through speed, power and agility - Strength - New tissue should be strong and able support the body in stressful movements eg high impact jumps - Elasticity - Aids in flexibility and the prevention of further injury - Balance - Questions to ask (from American Academy of Paediatrics (AAP)) - What is the diagnosis? How does the condition affect performance? What is the risk of the condition getting worse from playing? What has been the effect of treatment? What is the risk of secondary injury? Can the sport of level of participation be modified? Are there published guidelines that address the return to play decision? Does the athlete want to play? monitoring - Compare pre-testing results to post test to determine if injury has affected progress fitness components eg speed or agility (pre-test - These tests must be sport specific ie if knee ligaments damaged an agility and post- test eg illinois test is appropriate vs grip strength inappropriate test)  - Once an athlete has reached the pre-test levels again they are fit to return to play (granted they are pain free, mobile and are psychologically ready) psychological - Athletes may be too overconfident and eager to return to play before readiness rehabilitation is complete, or they may be pressured to return, which leads to an overestimate of ability and re-injury - Contrairily, other athletes easily lose confidence in their ability as they may be hesitant the injured area can withstand the pressure of full competition - This lacking confidence diminishes their performance eg in contact sports they will be reluctant to engage in a tackle and may hold back - Athletes suffering from long term injuries eg ACL will be particularly anxious and vulnerable and shield the injured site to protect it, which leads to poor technique and injury elsewhere - Balance of motivation, self assurance and common sense is required - This confidence and psychological readiness can be enhanced through frequent positive feedback from trainers specific - Athletes may be given specific warm up procedures as they return to play warm-up on top of normal warm up procedures to protect the athlete from re-injury procedures by ensuring the area has an adequate blood supply and that the specific muscle groups are properly stretched before training or playing a game - Specific warm up targets the injured area eg hamstring strain will result in more dynamic stretching and strength based activities around the hip and knee - Agility runs may be added to prepare the hamstring for application and absorption of forces (especially for sports such as tennis and football) - Other procedures such as sports massage may be added return to - The decision regarding when a player can return to play varies between play policies ports and if competing at an amateur or professional level and - At a professional level policies usually exist to suggest a set of procedures to procedures be followed to prove a player is free of injury - These include - Consultation, review of x-rays, discussion regarding the use of strapping/bracing, fitness assessment and participation in a range of sport specific movements (skills test) - Sports Medicine Australia: Position statement - concussion - Head Injury Assessment (HIA): athlete suffering head knock is met by professional sports trainer who observes athlete and looks for symptoms eg dizziness, and should be removed from field immediately is symptoms are seen - Athlete is then escorted to a doctor in the dressing room who reviews television footage of head knock and constructs a Sports Concussion Assessment Tool (SCAT), which tests different parts of the brain including orientation questions such as which half is it? What venue are we at? Did you win last week? - Return-to-participation after concussion should only occur once all symptoms are resolved, and with medical clearance - Any sports participation diagnosed with or suspected of having a concussion should not be allowed to return to participation on day of injury - Anyone evaluating concussion on the field or sideline should err on the side of safety: “when in doubt, sit them out” - NRL policy return to play - Formulated by the NRL Sports Trainer Accreditation Scheme - States the conditions where a medical clearance is required such as  ny form of cardidation cognition, concussion or unconsciousness, broken bones, eye injury, asthma, diabetes, epilepsy, cervical neck injury, hypertension - Australian National Boxing Federation Rules and Regulations - The athlete is banned from competition and sparing for a minimum of 28 days the first time they are knocked out and 3 months the second time - Not all sports policies and procedures are applied equally to every sport ie they are individualised to the specific demands of the sport - Eg effect of a wrist sprain on swimmer vs soccer player - The athlete’s decision to return to play is made in conjunction with medical and professional staff and the sport’s procedures and policies - This ensures the athlete makes properly informed decisions, as they are not trained to understand injury and injury rehabilitation, and cannot calculate if the risk of reinjury is high or low ethical - Pressure to participate considerations, - At a professional level many players are perceived by athletes as eg pressure commodities who need to be on the field of play to gain value for to cost participate, - This financial pressure to return to play is dangerous if insisting the use of painkillers player to return prematurely, before injuries have healed - This pressure may also come from fans who want to see their side winning and teammates who need the athlete as they are a vital player - Use of painkillers - Prescription painkillers eg through injection are taken to mask pain that would normally be present during the activity - Pain, as the body’s response to tissue or organ damage, lets the body know that what is happening is causing harm and must be stopped - However, through injections they desensitise the injured tissue and set an environment for further damage without the athlete being aware of what is happening - Overall, this prolongs the healing process and produces further rupturing and permanent mutilation of fibres - There is greater pressure during an individual sport to administer painkillers than in a team sport, because often a substitution can be made in a team sport, but to pull out as an individual guarantees the loss