KINE 2495 Lecture Notes - Sports Medicine Team PDF

KINE 2495 Lecture Notes **Topic \#1; Introduction to the Sports Medicine Team** **Sports Medicine and Athletic Training: Broad field of medical practices related to athletic therapy and sport. Involves number of specialties, performance enhancement or injury care and prevention** **Primary Care...

KINE 2495 Lecture Notes **Topic \#1; Introduction to the Sports Medicine Team** **Sports Medicine and Athletic Training: Broad field of medical practices related to athletic therapy and sport. Involves number of specialties, performance enhancement or injury care and prevention** **Primary Care Team: Athlete, Team Doctor, Coach, Athletic Therapist** **Role Of the Athletic Therapist; Highly educated skilled professional specializing in health care for the physically active. Experts in preventing, recognizing, managing, and rehabilitating injuries** - **[Injury Prevention]** - **Clinical evaluating and differential diagnosis** - **Immediate and emergency care/on field** - **Treatment and rehabilitation** - **Organizational and professional health and well-being** **Must act as an educator, counsellor, researcher, and continuing education (Staying on current up to date content and information)** **PICO (Patient Intervention Comparison Outcome): A specialized framework used by most researching to formulate a research question and to facilitate literature review** **Topic \#2 - Legal Concerns and Insurance Issues\ Chapter 3** **[Legal Concerns for Athletic Therapists]** - **Athletic Therapists are accountable for client care** - **Techniques/procedures used by AT's can result in legal action** **[Athletic Therapists are bound by their profession to do a max and a min]** - **Scope of Practice** - **Your duties and responsibilities that you are allowed to perform** - **Minimum Standard of Care** - **Minimum reasonable care that is owed to an athlete** - **Ex. You can you sticky paper stitches to stitch a wound but cannot pierce skin and literally stitch the skin together** **[Going beyond / negligence of Scop of Practice looks like]** - **Failure to use ordinary or reasonable care** - **Failure to perform Legal duties** - **AT practice would normally be tried under tort law** - **Tort Law; A legal wrong committed to or against another person** - **Issues within Tort can come from the following;** - **Nonfeasance -- Fail to perform legal duty** - **Malfeasance -- Performs action that is not his/hers to legally perform** - **Misfeasance -- Performs an action incorrectly that he/she has the legal right to do** **Proving Negligence** **Must show;** **A duty of care was owed to the athlete A breach of the standard of care was committed An injury resulted The injury was a direct result of the break of standard of care** **Informed Consent** **Injured party has been reasonably informed of needed treatment, possible alternative treatment, and advantages and disadvantages of each course of action** **Product Liability** **Manufacturer has duty to create equipment that will not cause injury. Guarantee of equipment safety, Meets CSA, NOCSAE, / minimum safety standards.** **MAIN MESSAGE** **[Athletic Therapists]** **Are accountable for their client's care** **Must carry liability insurance** **Understand the limits of coverage** **Topic \#3 -- Injury Prevention\ ** **Epidemiology** The study of the determinant of the carrying rates of disease, injuries, or other health states in human population **Epidemiologist**- Uses research methods to investigate the rates and determinants of injury and disease **Factors**: Rates of injuries/illness with respect with **Person Place Time** **Benefits of Epidemiology** - Identify risk factors or causes - Determine assessment or intervention strategies - Proper equipment use - Safe Scheduling - Rule changes - Monitor health of a team/community - Injury prevention and wellness promotion **Injury Prevention & Wellness Promotion** - Conduct pre-participation examination - Explain important diet and lifestyle changes - Develop training and conditioning programs - Select and fit protective equipment properly - Ensure appropriate medication use and discourage substance abuse - Ensure safe environment **Vitamins** - Fat Soluble - Vitamin A, D, E, and K - Found in fatty portion of foods and oils - Water Soluble - Vitamin C and B - Help to regulate metabolism - Antioxidants - May prevent aging, cancers, heart diseases - Includes Vitamins A and E - Dark deep coloured fruits and vegetables **Topic \#4 -- Introduction to the Physiological & Psychological Aspects of Pain** **Pain**: A subjective and multidimensional, unpleasant, sensory and emotional experience associated with actual or potential tissue damage **Acute**: immediate feeling from injury **Chronic**: 3 Months+ **Categories** [Somatic Pain] -- Originates from skin and musculoskeletal system; Bones, muscles, tendons, ligaments [Visceral Pain] -- Internal organs, general area hard to pinpoint, feeling uneasy and nauseous [Psychological Pain] -- Feeling sensation, but no physical cause or damage **Nociceptors --** It recognizes the issue or damage; it is what sends signals to the brain that there is an injury [Mechanosensitive Nociceptors] -- It is direct physical pain; when you stretch or compress tissue [Thermosensitive Nociceptors] -- React to extreme heat or cold, touching a stove [Chemosensitive Nociceptors] -- Responds to chemicals **Referred Pain --** Pain where the issue may not lie in the same area as the sensation, feeling sensation in the arm but having a heart attack **Radiating Pain --** Feeling along the involved structure, pinching a nerve in the leg and feeling sensation on that same spot **Group II A-beta:** Myelinated, sensation moves through these afferent nerves at 35-75 m/sec. Carries touch, pain, temperature, sensation. **Group III A-delta:** Thinly Myelinated, 5-30 m/sec. Carries pain, sharp more localized pain **Group IV C:** No myelin, 0.5-2 m/sec. Carries lower levels of pain, slow, throbbing, lasting, dull pain **Coping with Pain** **Coping:** The ability to identify, manage, and overcome issues that stress us in any sort of capacity **Gate Controlling Theory:** A-beta nerves will tend to block out the slower A-delta and C pains because A-beta is quicker. The control gate works on a first come first served basis - Stubbing your toe and then grabbing it will lower the pain. Touching the toe allows for your touch receptors that run along the A-beta fibers to run the signals quicker rather than the slower pain signals of group III and IV **Descending Brain Control:** If you think you will get better then you will. Pain goes up towards your brain, your brain will then send down endorphins and other substances that will mute the pain signals as much as possible **Beta-Endorphin Theory:** Pain stimulation of nociceptors resulting in transmission of pain information along a-delta and c afferents can stimulate a opiate-like chemical called **Beta-Endorphins**. Our bodies natural painkillers. **Topic \#5 -- Biomechanics & Pathology of Sports Injury\ ** **What Factors Predispose Athletes to Injury?** **Intrinsic Factors** - Age - Sex - Neuromuscular, Structural, or Performance Factors - Mental & Psychological Factors - Postural Deviations **Extrinsic Factors** Exposure to an injury situation - Potential hazards and unique risks of the sport - Position Played - Amount of Training and Playing Time - Competitive Level Environment - Type and Condition of playing surface - Weather conditions - Time of Day - Time of Season - Crowd Control - Laxity of officials Equipment - Protective Equipment - Footwear **Mechanical Injury** 1. External Force impairs anatomical tissue structure or function causing injury 2. Injury will cause the inflammatory response 3. Injury is dependent on tissue properties and force **Tissue Properties** **Load\ **An external force acting on the body causing internal reactions within the tissue **Stiffness\ **Ability of a tissue to resist a load **Stress\ **Internal resistance to a load **Strain\ **Internal change in tissue resulting in deformation **Tissue Force** Compression: Squeeze Tension: Stretch Shearing: Shear Sliding Bending: 3 Loads -- Axial, Tension, & Compression Torsion: Twisting force, Shear force with Compression **Positive Stress Vs. Adverse Stress** **Positive Stress:** Gradual Stress results in Gradual Response from the body to positively affect the body **Adverse/Negative Stress:** Too much too soon, and Harsh delays healing or cause injury **Amount of Stress:** Force divided by the area over which the force acts **Yield Point of Skin:** The skin cannot stretch anymore **Creep:** Past the Yield point where changes are permanent **Mechanism of Injury** **Traumatic** **Overuse** ------------------------------------------------------------------------- ----------------------------------------------------------------------- Physical Injury or wound, produced by internal or external single force Nature of physical activity dictates that over time injury will occur Microtrauma Microtrauma Acute, Something has initiated the injury process Chronic, When it doesn't properly heal **Example:** A direct Blow **Example:** Repetitive loading over time **Soft Tissue Properties** Collagen: Primary Constituent of skin, tendon, ligaments. Its wavy formation allows for elastin elasticity even though inelastic Elastin: Adds Elasticity **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 - Healing Time? **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 discolouration result **Grade III -- Complete rupture of Fibers**: Significant impairment initially with a great deal or pain that diminishes due to nerve damage **Muscle Spasm / Guarding** A Reflex Reaction caused by trauma **Clonic:** Alternating involuntary muscular contractions and relaxations in quick succession **Tonic:** Rigid contraction that lasts a period of time **Muscle Soreness** Overexertion in exercise resulting in muscular pain, Unaccustomed activity **2 Types** **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 **Tendon Injuries** Collagen re-absorption occurs with repeated microtrauma\ - Resulting in weakening tendons Collagen re-absorption also occurs with immobilization\ - Weakens the tissue\ - Requires gradual loading and conditions **Tendinitis** - Tendon Inflammation - Gradual onset with repeated microtrauma - Swelling and pain - Crepitus = Sticking of tendon due to accumulation of inflammatory by-products or irritated tissue - Rest and modify activity **Tendinosis** - Poor healing of tendinitis - Less inflammation and more visibly swollen with stiffness and restricted motion - Sometimes a tender lump - Treatment involves stretching and strengthening **Tenosynovitis** - Inflammation of synovial sheath - Acute Cases; Rapid onset, crepitus, diffuse swelling - Chronic Cases; Thickening of tendon with pain and crepitus - Often occurs in long flexor tendon of the digits and the bicep tendons - Due to nature of injury, anti-inflammatory agents may be helpful **Myofascial Trigger Points** - Hypersensitive nodule withing tight band of muscle fascia - Due to mechanical stress on muscle fiber - Active = pain at rest - Latent = Pain with pressure **Contusions** - 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 function **Ligament Sprain Grades** Result of traumatic joint twist that causes stretching or tearing of connective tissue, Swelling or even bleeding at joint **Grade I:** Some pain, min loss of function. Good range of motion **Grade II:** Pain, moderate loss of pain, Swelling, Minor tearing **Grade II:** Extremely painful, inevitable loss of function, severe instability and swelling, subluxation **NOTE** It is easier to get a Grade III tear back to regular function than Grades I and II **Bursitis** Bursa are fluid-filled sacs that develop in areas of friction, usually swelling and some loss of function. Repeated trauma can lead to calcification **Acute Bursitis:** Sudden irritation **Chronic Bursitis:** Overuse and constant external compression **Bone Fractures** **Closed Fractures:** Little movement or displacement **Open Fractures:** Displacement of the fractured ends breaking through the surrounding tissue **Signs & Symptoms** X-Ray is necessary for definitive diagnosis **Fracture Types** **Greenstick**: Part of the bone breaks off like a healthy stick from a tree **Comminuted**: ggs **Linear:** Straight linear line **Transverse:** Straight horizontal fracture **Oblique nondisplaced:** Cooked lowkey **Spiral:** Cooked fsfs **Neuropraxia** Nerve conduction interrupted, compression, tensions or trauma. Impacts more motor than sensory function. Radiating Pain, pinch, burn, tingle. **Tissue Response to Injury** **Tissues of the Body:** Bone Soft Tissue - Epithelial tissue = skin, and vessel and organ linings - Connective tissue= Tendons, ligaments, cartilage, fat, and blood - Muscle tissue= Skeletal, smooth, cardiac muscle - Nerve tissue= Brain, Spinal cord, and Nerves **Healing** 1. **Inflammatory Phase** 48-72 hrs a. Phagocytes digest macro-organisms and any debris 2. **Fibroblastic Repair Phase** 1-6 Weeks b. Scar Formation. Resolution -- Little tissue damage restores itself, Regeneration -- Replacing Tissue 3. **Maturation-Remodeling** **Phase** Months-Several Years c. Collagen needs to be applied related to tensile forces, Stress needs to synthesize and breakdown to increase strength **Cardinal Signs of Inflammation** **S**welling\ **H**eat\ **A**ltered Function\ **R**edness\ **P**ain and Tenderness **Healing Factors** - Immobilize inflammation - Bracing and Taping - More aggressive ROM and Strength training exercises - Any signs from patient **Impeding Healing Factors** - Extent of injury - Too much swelling and inflammation - Tissue separation **Cartilage Healing** - Variable of healing due to poor blood supply - Closer to bones receive more nutrition **Ligament Healing** - Random laying down - Appropriate stress and strengthening will result in normal healing usually - Can tale up to 12 months **Skeletal Muscle Healing** - Initial bleeding - Myoblastic cells form - Collagen will mature and orient along lines of tensile force - 6-8 Weeks **Tendon Healing** - Requires union of separated ends - A lot of collagen needed for good tensile strength - Week 2 Injured tendon adheres to surrounding tissues - Week 3 Tendon will gradually separate and become its own - Week 4 Tensile strength increases **Never Healing** - Regeneration can take place withing a nerve fiber - Proximity of injury to nerve cells make regeneration more difficult - Optimal environment needed - Injured central NS do no heal as quickly and peripheral NS nerves **Bone Healing** 1. Hematoma - blood clot 2. Soft Callus 3. Hard Callus -- Starting of ossification 4. Ossification bone **Topic \#6 -- Conditions in Specific Populations Young Athletes** **Bone Growth** - Primary ossification centre at diaphysis - Secondary ossification centre at epiphyses - Early childhood= Epiphysis ossification, followed by diaphyseal and metaphyseal growth - When the seal is closed, growth has stopped **Growth Related Problems** Mismatched Growth: - Muscle-tendon tightness due to longitudinal bone growth out pacing softer tissue growth - Creates susceptibility to overuse injuries Ligaments and Tendons - Insertions into fibrous and fibrocartilaginous periosteal perichondral regions of metaphysis - Typically, stronger than physis or apophysis **Common Problems** 1. Epiphyseal Fractures 2. Apophyseal Injuries (Strain or Fracture ligament attachment to bone) 3. Various Osteochondroses (Degenerative Changes) 4. Stress Fractures (Spondylolytis, Spondylolisthesis) 5. Patellofemoral Pain Syndrome (PFPS) **1: Epiphyseal Injuries** **Salter-Harris Classifications** Type I -- Separation of Physis Type II -- Fracture Separation of growth plate and small part of metaphysis Type III -- Fracture part of physis Type IV -- Fracture physis an Metaphysis Type V -- Crushing of physis with no displacement **2: Apophyseal Injuries** Young Physically active individuals are susceptible - Apophyses are traction epiphyses in contrast to pressure epiphyses - Serve as sites of origin and insertion for muscles **3: Osteochondrosis\ **Degenerative changes to epiphyses of bone during rapid child growth Possible Cause includes 1. Aseptic necrosis (disrupted circulation to epiphyses) 2. Cartilage fractures cause fissures to subchondral bone 3. Trauma to a joint that results in cartilage fragmentation - Friction between Patella and Patellofemoral joint **The Female Athlete** **Biomechanical Predisposition** - Increased Q-angle - Small intercondylar notch - Quadriceps/hamstrings ratio - Hormonal Effects **Males** **Females** ------------------------------------------------ -------------------------------------------------- 13 Degrees Q-angle 18 Degrees Q-angle Increased Medial Tibiofemoral Contact Pressure Highly Increased Lateral Patellofemoral Pressure Genu Varum (Bow out) Genu Valgum (Bow in) **Anterior Cruciate Ligament (ACL)** Controls the anterior movement of the Tibia off the Femur, A Valgus force that pulls "into" the body - 2-6x the injuries with the ACL in women compared to men **Patellar Subluxation and PFPS Often occur more often in Women than Men** Patellar Subluxation: Displacement of kneecap/Patella **Stress Fractures** Biomechanical Predisposition due to - Overuse - Poor biomechanics - Low Bone Density - Poor nutrition - Menstrual cycle -- missed cycles can result in lower bone density **Societal Effects** **Pressure of Society:** - **Thin Body Build** - **Working Mom** **Effects of Fashion:** - **Shortened Achillies tendon** - **Potential for Hallux valgus** **Hormonal Effects** Amenorrhea: The female is not has not started to menstruation, Decrease of estrogen now means lower bone density Primary: Females who have not had their periods at the age of 16 Secondary: When menstruation has stopped Oligomenorrhea: irregular period cycle Anovulation: Not ovulating because low level of estrogen Short Luteal Phase: Can lead to decrease in Progesterone Dysmenorrhea: Pain during period **RED-S Relative Energy Deficiency in Sport** The cause of this syndrome is energy deficiency relative to the balance of dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities **Menopause:** - Means cessation of menstruation - Typically occurring anytime from age 40 onwards - Typically gradual changes rather than one specific event **Bone Health** Decrease in bone mineral density is seen commonly in older women and is linked to declines in FSH, LH, Progesterone and, Estrogen **The Male Athlete** **Main Actions of Testosterone** 1. Induce differentiation of the male genital tract during fetal development 2. Induce development o primary and secondary sex characteristics 3. Create anabolic effects 4. Promote spermatogenesis and maturation of sperm **Spermatogenesis:** The generation of sperm - Begins at an average age of 13 years old and continues throughout the reproductive years of a man's life - Occurs in the seminiferous tubules of the testes **What type of Sport Injuries are more common in Men** Not predisposed to injury **Penile Injuries**: - Superficial wounds, contusions, abrasions, lacerations, avulsions, penetrating wounds, and frost bite - Fracture of Penis - Pudenda nerve irritations- can lead to transient paresthesia or priapism - Priapism -- Overstimulated - Primary: Trauma or Infection - Secondary: different blood and neurological traumas **Testicular Trauma** **Haematocele**: swelling caused by blood collecting in a body cavity - The cavity of the tunica vaginalis is the most likely space for blood to accumulate and cause a haematocele to develop following trauma to the testicle **Hydrocele**: Swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle - Common in newborns - Older boys and adults develop this due to inflammation **Varicocele**: An enlargement of the veins withing the loose bag of skin that hold your testicle - Common cause of low sperm production and decreased sperm quality **Spermatocele**: A cystic swelling either or the epididymis or of the testes that contains spermatozoa - Often posterior of the left testicle **Testicular Torsion**: Spermatic cord, which provides blood flow to testicle, rotates and becomes twisted - Swelling, Nausea or Vomiting, Abdominal pain, One testicle appears to be higher than the other **Hernias** Protrusion of abdominal viscera through a portion of the abdominal wall - may be congenital or acquired **Direct/Umbilical:** Common in men over 40, Weakness is fascia bounded by rectus abdominus, inguinal ligament, and epigastric vessels **Inguinal:** Most common type, Weakness in peritoneum around deep inguinal rung, protrusion into inguinal canal and sometimes scrotum **Femoral:** Primarily women, Protrusion through femoral ring into femoral canal, Presents itself as a mass inferolateral to the pubic tubercle and medial femoral artery and vein **Testicular Cancer** Most common cancer in young men in Canada - Most curable - In one or both testicles - Diagnosed with pain or heaviness **The Mature Athlete** **Defining Aging** The process of growing old - Physiological change and altered behaviour - Decreased cardiovascular fitness, strength, flexibility - Hypertension, Osteoporosis - Cardiovasuclar disease is the leading cause of death in older adults