Sleepiness, sleep disturbance,

1

• Sleepiness, sleep disturbance,
• Poor concentration
• Nausea/vomiting
• Slurred speech
• Personality change
• Impaired playing ability

2
Which 2 sports have the highest incidence of
concussion?

1. Professional horse jumping jockeys
2. Australian footballers

3
Physio role?

• Remove player from field of play!
• Exclude the presence of serious head injury or
  spinal injury
• If athletes unconscious assume presence of head
  injury and spinal injury and manage accordingly
  hospital...for assessment and observation...

4
Bleeding

• Open and closed wounds
• Incised a cut from a sharp edge
• Laceration rough tear or crush to the skin
• Abrasion graze or superficial wound from a rough
  surface

5

• Contusion bruise or internal bleeding
• Puncture an object entering the body
• Velocity injury a puncture wound at velocity
  will cause extensive damage, there may be an
  entry and exit wound

6
Physio role

• From first aid perspective, dress wound to
  maintain sterile state and remove to hospital for
  treatment if required
• Sports medic on pitch side can stitch wounds as
  required

7
Joint Injuries
8
Joint injuries

• High energy impact
• Damage to
• Menisci like cartilage, prevents friction.
• Ligaments
• Joint capsule contains the synovial fluid.
• Bony structures

9

• Knee big three
• Anterior cruciate ligament (ACL), medial
  meniscus, medial collateral ligament (MCL)
• Traumatic knee, shoulder, elbow, wrist, ankle
  injuries eg dislocations

10
What are the Soft Tissues?

• Muscles Tendons
• Ligaments, Joint Capsules, Bursa
• Bursa Small fluid filled sacs.
• Provides cushioning between bones tendons.
• Helps to reduce friction.
• Cartilage
• Nervous Tissue

11
Types of soft tissue injuries

• TRAUMATIC
• Specific cause is identified
• Cause of injury easily identified
• OVERUSE
• Develop slowly not attributed to one incident
• Specific injuries assoc with a particular sport

12
Injury Classification

• ACUTE rapid onset, traumatic event with a
  clearly identifiable cause.
• CHRONIC slow insidious onset,
  gradual development of structural damage.
• SUB-ACUTE period between acute and chronic,
  usually 4-6 weeks post-injury.

13
Causes of Soft Tissue Injuries

• Intrinsic causes of injury
• factors within the sports person
• Extrinsic causes of injury
• factors outside the sports person

14
Muscle Injuries

• Muscle strain tear in muscle fibres beyond its
  limit
• Causes (i) forceful contraction of the muscle
• (ii) Overstretching the muscle

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Muscle Injuries

• Classification of muscle strains

Grade Extent of damage Symptoms
Grade 1 5 or less muscle fibres Minimal pain
Grade 2 5 - 99 Some muscle fibres still present Moderate / severe pain on contraction Limited ROM
Grade 3 Complete rupture No contraction Less pain / no pain
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Muscle Injuries

• Assessing a Muscle strain
• PAIN on movement / resistance
• PAIN on contraction
• PAIN on palpation
• Muscle most susceptible to injury?
• Rectus femoris (quad)
• Hamstrings
• Gastrocnemius (calf)

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Tendon Injuries

• Tendon properties
• Connects muscle to bone
• Low blood supply
• Tendonitis inflammation???
• Tendinopathy Degeneration of tendon
• Healing tendon
• HEAT (increase blood supply)
• DTFM - massage
• Strengthen
• Stretch

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Ligament Injuries

• Ligament Properties
• Connects bone to bone
• Grade 1 minimal swelling, bruising, pain
• Grade 2 Moderate to severe swelling, bruising,
  pain
• Grade 3 A lot of swelling, agony, may or may
  not bruise

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Management of soft tissue injuries

• Acute Injury
• PRICE
• Protect
• Rest
• Ice
• Compression
• Elevation

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Icing

• Limits Inflammatory process
• First 48-72 hours
• Methods - Crushed ice in a towel, frozen veg,
  Ice bath, Chemical ice packs (pitch-side), Freeze
  spray / cryogel
• Application
• - 10 mins every 2 hours
• Dangers of leaving ice on too long
• - Ice burn
• - Nerve damage
• - Increase in blood flow

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The aims of early management

• The management of STI in the first 72 hours
• to reduce pain
• to reduce local tissue temperature
• to limit and reduce inflammatory fluid
• to reduce metabolic demands of the tissues
• to protect the damaged tissue from further injury
  
• to protect the newly-formed fibrin bonds from
  disruption
• to promote collagen fibre growth and realignment
• to maintain general levels of cardio-respiratory
  and musculoskeletal fitness / activity

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Management of medical problems

• HYPOTHERMIA
• Hypo Below / under Thermia heat
• - Condition in which a persons body
  temperature is sufficiently below normal to cause
  distress and disorder of normal bodily functions.
• Mental deterioration
• Loss of coordination
• Unconsciousness
• Failure of breathing and circulation
• Death

23
Hypothermia

• Causes
• Cold
• Wind
• Wet clothing
• Perspiration
• Water immersion
• Stages
• Peripheral (core 37-36)
• Moderate (core 34)
• Severe (core 32 or lower)

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Hypothermia

• Signs / Symptoms
• -Tiredness / exhaustion
• - Shivering
• - White / purplish appearance
• (bluish tinge to lips / fingers)
• - Clumsiness / falling/ tumbling
• - Weak grip and slowness in muscle contraction
• - Cold rigid arms and legs
• - Poor concentration, loss of interest,
  lethargy
• - Slurred speech

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Hypothermia

• Treatment
• Removal from cold, wet, windy conditions
  (shelter)
• Insulation to prevent further heat loss
• Passive or active re-warming
• Gentle and minimal handling
• Provision of nutritional and fluid support
• Transport to medical facility

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Hypothermia

• Hypothermia hits stumbling Lebanese

Gloucester 30th Oct 2000 New Zealand Vs Lebanon
Rugby League Group2
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Hyperthermia

• Hypertherma overheating of body
• Hyper high, therma heat
• Body can not effectively regulate excess heat /
  elevated temperatures
• Temperature gt 37.539.9 C
• Causes
• Exposure to excessive heat
• Exposure to high humidity
• High physical exertion
• Dehydration

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Hyperthermia

• Signs and Symptoms
• - Hot, dry skin
• - Dizziness / Fainting
• - Nausea / Vomiting
• - Headaches
• - Gastrointestinal  problems e.g. Diarrhoea
• - Multi-organ dysfunction
• Treatment
• - Cool / tepid water immersion
• - Rehydration
• - Sponging head, neck, trunk with cold water
• - Sit in shade

29
Dehydration

• Fluid Loss exceeds Fluid Intake
• Causes
• - Excessive Sweating
• - Insufficient fluid intake
• - Hot humid conditions
• - High intensity exercise

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Dehydration

• Consequences
• Increase in perceived effort
• Reduced performance
• Impaired reaction times, judgement,
  concentration and decision-making
• Electrolyte Drinks
• - Sodium (speeds fluid absorption)
• Carbohydrate (provides fuel)
• - Small amounts frequently (500-800ml/Hr)

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Quick overview of........

• Fractures
• Concussion
• Bleeding
• Joint injuries
• Soft tissue injuries
• Muscle injuries
• Tendon and ligament injuries
• Skin damage
• Dehydration
• Hyperthermia (heat stroke) and hypothermia

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Questions