Recognizing Different Sports Injuries

Mechanisms and Characteristics of Sports Trauma

Sports Trauma: A physical injury or wound sustained in sports caused by an internal or external force.

Mechanical injury results from a force causing a harmful disturbance in function and/or structure of a body part.

This is not the same as a repetitive strain or overuse condition.

Load = a singular or group of internal or external forces acting on the body.

Mechanical stress is a resistance to this load - results in tissue deformation

A yield point is reached when tissue is deformed to the maximum of its elastic properties.

Mechanical failure occurs when the yield point is exceeded = tissue damage.

Mechanisms and Characteristics of Sports Trauma

Mechanisms of sports injuries

• Tension force that pulls or stretches tissue

• Stretching force beyond yield point = sprain, strain, avulsion fracture

• Compression crushing force - the force can no longer be absorbed

• Shearing force that moves across the parallel organization of tissue eg. blisters, abrasions, vertebral disk injuries

• Bending force on a horizontal beam of bone that places stress within the structure causing it to bend. This occurs with other forces to create several types of fractures and torsion injuries.

Soft tissue Classification

Contractile

• Muscle

• Tendon, or bony insertion

Soft tissue Classification

Non-contractile

• Skin

• Joint capsule

• Ligament

• Fascia

• Cartilage

• Nerve

• Dura

Skin Injuries

Blister - collection of fluid in or below epidermal layer caused by continuous rubbing.

Abrasion - epidermis and dermis are worn away due to scrape on rough surface

Skin bruise - blow compresses or crushes skin surface causing bleeding under the skin

Laceration - flesh is irregularly torn

Skin Avulsion - tissue is ripped from its source

Incision - skin has been sharply cut

Puncture - penetration of skin by sharp object

Acute Traumatic Injuries Bone Trauma

• Closed fracture

• Open fracture

• TYPES• Contrecoup• Depressed• Greenstick• Comminuted

• Longitudinal• Oblique• Serrated• Spiral• Transverse• Impacted

Other Acute Injuries

Stress Fracture/ Avulsion Fracture Dislocations and Subluxation Ligament Sprain Contusion Muscle Cramps

ContusionCrushing of soft tissue causing a bruise of the skin, muscle, deep or superficial tissues, or bone, resulting from a direct blow.

Treatment of contusions

•PIER

•Restricted movement

•Treat as strain after acute phase

Contusion

First Degree Second Degree Third DegreeMild blow causing tissue compression

Moderate blow causing haematoma

Sever blow

Little bleeding and minimal damage

Significant bleeding May look like a fracture- severe bleeding

Little loss of f unction 20% - 80% loss ROM Complete loss of function

May have slight spasm Spasm may last hours Extreme spasm present

Little/no swelling Moderate swelling Gross swelling

No Discolouration Moderate Discolouration Severe Discolouration

No palpable indentation May have indentation and palpable tenderness

Extreme palpable tenderness and indentation

Increased skin temp. Warm to touch

Mild discomfort Significant pain Extreme pain

Strains

Strains pertain to contractile tissue.

Caused by excessive forcible contraction or overstretch or chronic overuse resulting in local tissue trauma to the muscle, musculotendinous unit or the muscle tendon.

 

 

Strains

Predisposing factors lack of or poor flexibility lack of or poor warm up muscle fatigue poor muscle strength poor skill level antagonistic muscle imbalance poor playing/workout

conditions or surfaces existing minor inflammation

Prevention lack of or poor flexibility Equipment Environment increase flexibility proper warm up and cool down skill improvement increase muscle endurance increase muscle strength and

power muscle balance

Strain

First Degree Second Degree Third Degree

Classification Mild micro tearing Moderate strain Severe with palpable rut

Swelling Slight Measurable Visibly apparent –gross

Pain Localized Indefinable sever

Strength Slight loss 35% - 83% loss Complete loss

Function Partial to non weight bearing

Abnormal gait to non weight bearing

Non weight bearing

Range Slight loss Moderate loss Complete loss

Discolouration Little to none Obvious Obvious – severe

Healing 1 –2 weeks 3 – 12 weeks 3 months onward

SprainSprains First Degree Second Degree Third Degree

Classification mild micro tearing at cellular level

moderate - partial tearing

severe- complete rupture

Function 95% functional with partial weight bearing for 1-3 minutes and then able to return to activity

loss of function - partial weight bearing to non weight bearing

Non - weight bearing due to pain and swelling

Swelling none at time of injury with minimal visible swelling after several hours or the next day

 moderate to severe intra capsular swelling- usually not immediately visible

moderate to severe swelling - may be immediate - will be visible and measurable

Sprains First Degree Second Degree Third DegreeDiscolouration  usually none moderate localized

discolouration - not immediate

initially some mild discolouration and then will turn very dark (almost black) around the injury site

Range of Motion  near full 20% to 80% loss unable to move joint due to pain - on passive tests there is no tension in the joint - bone on bone contact will usually stop the range of motion at the extreme end of range

Sprain

Sprains First Degree Second Degree Third Degree

Joint instability none - no laxity on stress tests

5 to 10 degrees laxity on stress test and will feel unstable using joint

complete laxity of joint - gross instability

Strength  minimal to no weakness

 

20% to 80% loss - may not do resisted test

pain will cause unwillingness to resist or move limb

Point Tenderness

size of dime  size of quarter defuse palpable tenderness - all over area

Sprain

Sprains First Degree Second Degree Third DegreePain  minimal

discomfort at time of injury and minimal pain on stress test - able to continue

moderate local pain at time of injury and on stress test - unable to continue

may have no pain due to nerve involvement - usually extreme pain at time of injury - pain in large area near injured structure

Chronic Overuse Injuries

Tendinitis Muscle Soreness Tenosynovitis Osteoarthritis

Tendonitis

Inflammation and degenerative changes in the tendon or musculotendinous junction caused by; excessive overuse (too much too soon), excessive friction over the tendon, direct or repeated trauma to the area.

 

 

Signs and Symptoms of Tendonitis

• Local thickening of the tendon.

• Point tenderness.

• Possible crepitus.

• Usually becomes self limiting.

Phases of Tendonitis

Phase 1 symptoms following activity, no performance disability,

Phase 2 symptoms during and after activity, progresses from no significant performance disability to some performance disability to episodes of significant performance disability,

Phase 3 symptoms during and after activity, persistent performance disability,

Phase 4 symptoms all the time.

Preventing Tendonitis

• Slow gradual warm - up prior to all activity (increases blood flow to tendons).

• Slow gradual increase in level of activity.

• Increase the flexibility of the muscles.

• Proper equipment.

• Recognize early S&S of tendonitis.

Bursitis

• Inflammation of the bursal sac leading to pain and swelling which, if not allowed to resolve, will progress to a chronic condition with secondary thickening in the bursal walls and a tendency to recur.

• Caused by direct trauma, chronic irritation (over use), infection, calcium deposits.

Signs and Symptoms of Bursitis

• onset may be slow or gradual,

• pain in region of bursa,

• pain may increase when bursa is squeezes, (abduction),

• varying disability,

• swelling,

• tenderness,

• crepitus,

• limited range of motion,

• often increased pain in morning,

• usually subsides in six weeks but may remain for several years.

Inflammatory Response Phase

Inflammatory Response Phase• most critical stage• phagocytosis

Fibroblastic Repair Phase• scar formation

Maturation-Remodeling Phase• new fibers

Acute Inflammatory Phase

The function of the inflammation response is to:

• Localize the extent of the injured area

• Remove waste products or foreign material resulting from the initial trauma and secondary response

• Set the stage for healing to take place

• Protect site or joint

The reaction is always the same.

This phase is present for as long as the signs and symptoms are present Do not get hung up on time factors - Acute inflammation is different for everyone and every condition.

Acute Inflammatory Phase

Causes of inflammation:

• Physical trauma

• Chemical irritation

• Bacterial invasion

• Extremes of temperature

Characteristics of Inflammation

Swelling, Heat, Altered function, Redness, Pain

Swelling caused by the accumulation of blood and inflammatory exudate.

Heat caused by increased biochemical activity and the increase of blood flow to the area.

Altered function caused by the resulting pain and swelling or the actual destruction of an anatomical structure.

Redness caused by the dilation of vessels and increased blood flow to the area.

Pain caused by the direct injury to the nerve fibres, pressure from swelling, chemical irritants, as well as protective muscle spasm around the injury site.

The Affects of the P.I.E.R. principle on the Acute

Inflammatory Response.

P Pressure

I Ice

E Elevation

R Rest

P.I.E.R.

PRESSURE

1. Decrease the amount of space for swelling to occur,

2. Direct pressure on vessels decreases blood flow around injury site ( thus decreasing blood swelling),

3. Decreases plasma fluid leakage.

4. Decreases lymph leakage.

ICE1. Decreases metabolic rate, which decreases:

• The affects of the toxins in the area;

• The need for oxygen, therefore decreases secondary cell death;

• The conduction of the nerve cells in the area which helps to decrease the pain and minimize the amount of muscle spasm,

1. Decreases blood flow to the site

2. Decreases tissue elasticity in surrounding injury area.

3. Decreases hydrostatic pressure.

ELEVATION

1. Assists venous and lymphatic return.

2. Decreases blood flow to area.

RESTRICTED FUNCTION

1. Decreases chance of re-injury.

1. Decreases blood flow to area.