Injuries and the Healing Process

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Injuries and the Healing Process

• Olympic High School Sports Medicine
• Chapter 12,13

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Vocabulary Chapter 13

• RICE
• Muscle
• Tendon
• DOMS
• Myositis
• Fasciitis
• Ectopic calcification
• Creptitation
• Synovia
• Articulation
• Osteochondrosis
• Apophysis

• Osteoblasts
• Osteoclasts
• Wolffs law
• Callus
• Mechanoreceptors
• Muscle guarding
• Trigger point
• Open fracture
• Closed Fracture

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Types of Injuries

• Strains/Sprains
• Grade 1- slight stretch but no deformity, mild to
  mod. Pain, localized swelling
• Grade 2- some tearing of fibers, mod.
  Instability, mod. Severe pain, swelling
• Grade 3- total rupture, major instability, severe
  pain at first then little or no pain, swelling is
  great
• Contusion
• Bruise, hematoma, ecchymosis
• Tendinitis inflammation of tendon
• Overuse injury, pain, swelling, crepitus
• Bursitis inflam. Of bursa
• Swelling, pain, increased pressure
• Wound Injuriesblister, abrasion, laceration,
  skin avulsion, incision, puncture

Tenosynovitissame as tendonitis but inflamed
tendon/synovial sheath.
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Types of Injuries continued fractures
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Types of Injuries continued

• Muscle Cramps/spasm muscle contraction/tightness
  due to fatigue or injury
• Myositis Ossificans calcification of muscle due
  to excessive bleeding.
• Dislocation complete displacement of bone with
  the joint
• Subluxation partial displacement of bone with
  the joint
• Epiphyseal Injuries growth plate injuries.
  Salter fractures for epiphyseal fractures
• Nerve Injuries
• Hypoesthesia a diminished sense of feeling
• Hyperesthesia an increased sense of feeling
  such as pain or touch
• Paraesthesia numbness, prickling, or tingling,
  which may occur from a direct blow or stretch to
  an area
• Kyphosis round back, forward-thrust head,
  winged scapulae, flat chest. Tight pectoral
  muscles
• Lordosis sway back or hollow back. Tight lower
  back muscles with weak abdominal muscles.
  Lineman or gymnasts most susceptible.
• Scoliosis lateral curvature of the spine
• Genu Valgum knock knee
• Genu Varum bowleg

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How do injuries happen?

• What are the possible injuries that can happen in
  this slide?

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Mechanical Forces and Strengths

• Compression Force A force that with enough
  energy crushes tissue. A contusion occurs if too
  much force is applied
• Tension Force a force that pulls and stretches
  tissue. Sprains/strains, avulsions, ruptures
• Shearing Force a force that is transverse to
  fibers. sprains

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Example of injuries
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Pain

• Two types of soreness
• Acute-onset muscle soreness - accompanies
  fatigue, and is transient muscle pain experienced
  immediately after exercise
• Delayed-onset muscle soreness (DOMS) - pain that
  occurs 24-48 hours following activity that
  gradually subsides (pain free 3-4 days later)
• Potentially caused by slight microtrauma to
  muscle or connective tissue structures
• Prevent soreness through gradual build-up of
  intensity
• Treat with static or PNF stretching and ice
  application within 48-72 hours of insult

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• Muscle Stiffness
• Does not produce pain
• Result of extended period of work
• Fluid accumulation in muscles, with slow
  reabsorbtion back into bloodstream, resulting in
  swollen, shorter, thicker muscles --resistant to
  stretching.
• Light activity, motion, massage and passive
  mobilization assists in reducing stiffness

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Vocabulary

• Vasoconstriction
• Vasodilation
• Regeneration
• Phagocytosis
• Serum
• Synthesis/lysis
• Cryokinetics
• Modality
• Conduction
• Convection
• Conversion

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Inflammatory Response
Inflammatory Phase

• Occurs first for 3-4 days
• Swelling, redness, pain, heat, loss of function.
• This occurs to protect the body
• Acute Inflammation-
• Before inflammation begins intact blood vessels
  vasoconstriction up to 10 minutes
• Then blood coagulation begins to seal broken
  vessels
• Then vasodilatation- blood viscosity increases
  slowing blood flow and swelling then serum
  seepage 15-30 min.
• Phagocytosis starts to clean out debris
• Internal swelling 1. Throboplastin is sent 2.
  Thromboplastin and calcium is sent. 3. Thrombin
  to fibrinogen into final fibrin clot

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Inflammatory Response

• Repair Phase- Fibroplastic(scar formation)
• Regeneration
• Regrowth of lost cells
• Last up to 3 weeks following injury
• Primary healing- heal around edges
• Secondary healing gaps heal toward each other
• Remodeling
• Increase scar tissue first 3 weeks
• Last 3 months to a year

• Factors that impede healing
• 1. Extent of the injury
• 2. Edema/hemorrhage
• 3. Poor vascular supply
• 4. Separation of tissue
• 5. Muscle spasm
• 6. Atrophy
• 7. Infection
• 8. age

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Pain Perception

• Pain-
• Is described by burning, sharp, dull, aching,
  tingling
• Deep pain is different than superficial pain
• How
• Psychological aspects of Pain
• Must treat the whole athlete
• Personality differences plays a role in pain
  perception
• Referred Pain-
• Visceral pain has a tendency to radiate and give
  rise to pain that becomes referred to skins
  surface

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COLD AND HEAT

• Types of cold
• Ice bag, ice massage, ice boot, cold whirlpool,
  ice bucket, chemical spray
• Physiological effects of cold
• Decrease in local temperature up to 4
• Vasoconstriction of capillaries w/in first 15-20
  min., vasodilation 5 min., vasoconstriction 20
  min. (Hunting effect)
• Decrease local cell metabolism
• Decrease blood flow
• Decrease nerve velocity
• Decrease excitability of muscle
• Analgesic effect (numb) which will decrease spasm

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Cold and Heat cont.

• Types of heat
• Conduction-transmission of heat between two
  objects
• Convection-heat produced by a moving mass(gas or
  liquid)
• Conversion-heat by electrical current
• Radiation- ultraviolet light
• Physiological effects of heat
• Increase elasticity of muscles tendons
• Increase blood flow- vasodilation
• Decrease spasm
• Increase local cell metabolism
• Increase excitability of muscle
• Increase temp. to 3mm depth

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• Indications of heat
• Post acute phase
• Decrease spasm
• Decrease pain
• Help wound healing
• Prior to exercise
• Contraindications
• Acute injuries
• Hyper/hypo sensitive to heat
• Circulatory problems

• Indications of cold
• Acute trauma
• Anti-inflammatory
• Decrease pain
• Decrease spasm
• Post exercise
• Prior to therapy
• Contraindications
• Before or during activities
• Hyper/hypo sensitive to cold
• Circulatory inefficiency

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Different Modalities

• Heat Therapies
• Short-wave diathermy
• High frequency electrical current.
• Used for bursitis, capsulitis, osteoarthritis,
  spasm, strains
• Heat depth up to 2 inches
• Ultrasound
• High frequency sound waves causes molecules to
  vibrate and warm
• Used for joint contractures, scar tissue,
  tendonitis, bursitis, skeletal muscle spasm, and
  pain
• Paraffin bath
• Hot wax used for extremities especially the hand.
• Massage Techniques
• Effleurage- stroking, Petrissage- kneading,
  friction-heat, tapotement- percussion,
  vibration-rapid shaking

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Contrast Baths and other Modalities

• Hot and cold modality
• Physiological effects
• Same as heat/cold
• Flushing affect. Brings in new material for
  repair and flushes out edema
• When should you use contrast bath?
• When swelling has subsided (48-72 hours)
• Time interval for treatments
• 4 min. cold then 1 min hot 4 times end in cold
  24 min.
• 3 min. cold then 2 min hot 4 times end in cold
  23 min
• 2 min. cold then 3 min hot 4 times end in hot 20
  min
• 1 min. cold then 4 min hot 4 times end in hot 20
  min
• Or 5 min. cold/ 5 min. hot

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Treatment times and Temperatures

• Ice bag, ice boot, ice whirlpool (55-65 degrees)
  - 20 min.
• Ice massage 5-10 min.
• Warm whirlpool (97-102 degrees), moist heat pack
  10 min.
• Ultrasound- 5-7 min.
• Muscle stim- 10-20 min.