Chapter 22 shit

Question 1

Who is on the sports medicine team?

Answer 1

-Team Physician
-Athletic Trainer
-Physical therapist/physiotherapist
-S+C pro
-Exercise Physiologist
-Nutritionist
-Counselor, psychologist, or psychiatrist

Question 2

What is a team physician’s role?

Answer 2

-Team physician
+Medical doctor (MD) or doctor of osteopathy (DO) typically proficient in musculoskeletal and sports injuries and sport-related medical conditions
+Responsibilities include:
++Preparticipation examinations
++On-field emergency care
++Injury and illness evaluation and diagnosis
++Referral to other professionals as needed
++Prescriptions of any medications needed by the athlete
++Typically makes final determination of athlete readiness to return to competition

Question 3

What is the athletic trainer’s role?

Answer 3

-Individual responsible for the day-to-day physical health of the athlete
-Certified by the national athletic trainer’s association (ATC) as a “Certified Athletic Trainer”
-Works under the supervision of the team physician
-Responsibilities include:
+Management, prevention, and rehabilitation of injuries through sport-specific exercises and prophylactic equipment (i.e. tape or braces)
+Administrator for the sports medicine team
+Key role in communicating between the sports medicine team, the coach, and the athlete

Question 4

What is the physical therapist role?

Answer 4

-Licensed physical therapist
-Typically certified through the American Board of Physical Therapy Specialties as a “Sports Certified Specialist”
-May be employed directly by the sports team or work at an outpatient facility
-Participate in the evaluation, treatment, and rehabilitation of acutely injured athletes
-Often serve dual capacity as team athletic trainer and sports physical therapist

Question 5

What is the strength and conditioning professional’s role?

Answer 5

-Focuses on strength, power, and performance enhancement
-Typically certified through the National Strength and Conditioning Association as a Certified Strength and Conditioning Specialist (CSCS)
-Works in consultation with athletic trainer and sports physical therapist
-Applies knowledge of proper technique and application of exercise to develop reconditioning programs for returning the athlete to competition

Question 6

What is the exercise physiologist’s role?

Answer 6

-Formal background in exercise science
-Assists with designing conditioning programs that consider metabolic responses to exercise and the ways in which that reaction aids the healing process

Question 7

What is the nutritionist’s role?

Answer 7

-Registered dietician with a background in sport nutrition who can provide guidelines to athletes regarding proper nutrition to optimize healing tissues
-Ideally received formal training in nutrition and dietary sciences and recognized by the Academy of Nutrition and Dietetics Commission on Dietic Registration

Question 8

What is the counselor/team psychologist/psychiatrist’s role?

Answer 8

A licensed mental health professional who can help the injured athlete better cope with the mental stress accompanying an injury

Question 9

How is communication important for the sports medicine team?

Answer 9

-Communication is essential between members of the sports medicine team
-Athlete typically has the most communication with the coaches, athletic trainer, and strength and conditioning professional
-Recommended to have a weekly meeting with entire sports medicine team to discuss training requirements and restrictions for each athlete
-Strength and conditioning professional must understand indications and contraindications from the athletic trainer regarding the recommended exercises and exercises to avoid
+Athletic trainer typically provides the indications and contraindications
+Athletic trainer provides a form that specifies the indications and contraindications

Question 10

What is macrotrauma?

Answer 10

-A specific sudden episode of overload injury to a given tissue
-Results in disrupted tissue integrity
-Bone macrotrauma - can lead to contusion or fracture
-Joint macrotrauma:
+Dislocation - complete displacement of joint surfaces
+Subluxation - partial displacement of joint surfaces
+Sprain - ligamentous trauma
++First degree - partial tear of ligament without increased joint instability
++Second degree - partial tear with minor joint instability
++Third degree - complete tear with full joint instability

Question 11

What is musculotendinous trauma classified as?

Answer 11

-Contusion - direct trauma
+Area of excess accumulation of blood and fluid in tissues surrounding the injured muscle
-Strain - indirect trauma
+Tears of muscle fibers assigned grades or degree
++First degree - partial tear of individual fibers characterized by strong but painful muscle activity
++Second degree - partial tear with weak, painful muscle activity
++Third degree - complete tear manifested by very weak, painless muscle activity
+Tendons can also rupture if tensile load exceeds its limit
++Collagen typically stronger than muscle fibers
+++Failure most likely to occur in:
++++Musculotendinous joint
++++Muscle belly
++++Tendon attachment to the bone

Question 12

What is microtrauma?

Answer 12

-Overuse injury resulting from repeated abnormal stress applied to a tissue by continuous training or training with too little recovery time
-Can be due to:
+Training errors - i.e. poor program design, excessive volume
+Suboptimal training surfaces - i.e. too hard or uneven
+Faulty biomechanics or technique during performance
+Insufficient motor control
+Decreased flexibility
+Skeletal malalignment or predisposition
-Common overuse injuries involve bone and tendon:
+Bone- stress fracture - often the result of rapid increase in training volume or excessive training volume on hard surfaces
+Tendinitis - inflammation of a tendon - can become tendinopathy if left uncorrected

Question 13

What are the phases of tissue healing?

Answer 13

Inflammatory response phase
Fibroblastic repair phase
Maturation-remodeling phase

Question 14

What happens during the inflammatory phase?

Answer 14

-Inflammation - the initial reaction to the injury necessary for normal tissue healing to occur
+Inflammation is both local and systemic during the inflammatory repsonse phase
+Allows eventual healing of damaged tissue
-Events during inflammatory phase:
+Injured area becomes red and swollen due to changes in vascularity, bloodflow, and capillary permeability
+Locally hypoxic environment causes a certain amount of tissue death
++Causes release of chemical mediators such as histamine and bradykinin
+++Further increases blood flow and permeability in the local area
+++Allows edema - the fluid surrounding the injured area that inhibits contractile tissues and limits function - to escape into nearby tissues
+++Tissue debris and pathogens are removed from the injured area via phacytosis
++Inflammatory substances stimulate pain fibers
-Typically lasts 2-3 days and up to a week depending on blood supply and degree of structural damage

Question 15

What happens during the fibroblastic repair phase?

Answer 15

-Involves the breakdown and replacement of tissue that is no longer viable following an injury
-New capillaries and connective scar tissue form in the area to improve tissue integrity
-Type 3 collagen is randomly deposited along the injured structure to serve as a framework for tissue regeneration
-Strength of new tissue is less than original tissue
+Collagen fibers are strongest when they are longitudinal to the line of stress
+New collagen lies mostly transverse to stress line
-Phase begins as early as two days after injury and can last for several months

Question 16

What happens during the maturation-remodeling phase?

Answer 16

-Type 1 collagen produced that allows new tissue to improve structure, strength and function
-With increased loading, collagen and scar tissue begin hypertrophy and align themselves along the lines of stress - still not as strong as original tissue
-Maturation-remodeling can last months to years

Question 17

What should treatment goals be during the inflammatory response phase?

Answer 17

-Prevent disruption of new tissue
-Rest and physical agents are often applied to minimize tissue damage and reduce acute pain - results are mixed - i.e.:
+Ice
+Compression
+Elevation
+Electrical stimulation
-Other systems of the body must be maintained in terms of power, strength, and endurance of musculoskeletal tissue
+Strength and conditioning professional should consult with the athletic trainer regarding indicated and contraindicated exercises
+Can include general resistance, aerobic, and anaerobic training of uninjured extremities
+Isolated exercises targeting proximal and distal areas to the injuries can be used if they do not stress the injured area
+Maximal protection of injured area remains the primary goal during this phase

Question 18

What are exercise strategies during the inflammatory response phase?

Answer 18

-Passive rest of the injured area is necessary to protect tissue from additional injury
-Exercise that directly involves injured areas are not recommended

Question 19

What are treatment goals during the fibroblastic repair phase?

Answer 19

-Prevent excessive muscle atrophy and joint deterioration in injured area
-Balance must be maintained between avoiding disruption of newly formed collagen fibers and adding low-load stress to allow increased collagen synthesis and prevent loss of motion in the joint
-Athlete should perform active resistive exercise in damage tissue
-Protected motion exercises will hasten optimal alignment of collagen fibers and promote improved tissue mobility (avoid adhesions)

Question 20

What are exercise strategies during the fibroblastic repair phase?

Answer 20

-Physical therapist, athletic trainer, or team physician must be consulted before beginning exercises
-Isometric exercises can be performed provided they do not cause pain and are not contraindicated
+Since isometric strength is joint-angle specific, may require isometrics at different joint angles
-Isotonic exercises can be included
-Neuromuscular control should be focused on:
+The ability of muscles to respond to sensory information to maintain joint stability
+Involves proprioception:
++Afferent sensory information that occurs in response to stimulation of sensory receptors in skin, muscles, tendons, ligaments, and the joint capsule
++Contributes to conscious and unconscious efferent control of posture, balance, stability, and sense of position
+Modalities include balance boards, exercise balls, and other balance exercises - in addition to standard exercises (squats, pushups) performed on uneven surfaces
+Exercise must be controlled to allow progression to more challenging exercises

Question 21

What are treatment goals during the maturation-remodeling phase?

Answer 21

-Optimize tissue function while transitioning to return to play or activity
-Improve function by continuing and progressing the exercises performed during the repair phase
-Addition of more advanced, sport-specific exercises that allow progressive stress to the injured tissue
-Injured tissues still not fully healed and require further attention for complete recovery
+Progressive tissue loading allows improved collagen fiber alignment and hypertrophy
-Return to play decisions should be based on an understanding of normal tissue healing time frames as well as criteria-based progression with predetermined objectives
+Usually include measures of ROM and strength, functional testing, and patient-reported function - must follow return-to-play metrics to ensure safe return to activity

Question 22

What are exercise strategies for the maturation-remodeling phase?

Answer 22

-Exercises must be functional and must mimic activity demands (specificity)
+Joint angle specific strengthening
+Velocity-specific muscle activity
+Closed kinetic chain exercises
+Exercises designed to further enhance neuromuscular control
-Transition from general exercises to sport-specific exercises designed to replicate movements common in sports
+I.e. basketball guard with sprained ankle - progress from single joint to specific sport position activities
+Strengthening exercises should mimic sport-speed requirements

Question 23

What is a progression for a sprinter coming back from a hamstring strain?

Answer 23

-Recovery flexibility and strength in injured muscles
-Eccentric strength
-Concentric strength
-Dynamic stretching
-Rapid isotonic strengthening
-Manually resisted strengthening
-Plyometric and speed training

Question 24

What is the difference between open and closed chain exercises?

Answer 24

-Closed chain - distal joint is stationary, terminal joint meets considerable resistance
+Considered more functional
+I.e. squats, pushups, deadlifts
-Open chain
+Terminal joint is free to move - allow greater concentration on isolated joint or muscle
+I.e. knee extension
+Most sports movements involve both closed and open chain exercises

Question 25

What are program design considerations for resistance training?

Answer 25

-Should include resistance and aerobic training
-Similar design principles as those used for training uninjured athletes
-Resistance training:
+Delorme and oxford method:
++3 sets of 10 with pyramid design
++Delorme you work up
++Oxford you start heavy and work down
+Knights Daily adjustable progressive resistive exercise (DAPRE)
++4 sets - 10 @50%, 6 @75%, max reps @100% estimated 1rm
+Delorme, Oxford and Dapre have been shown to increase strength but may be too strict to be followed specifically
++Programs should include more sport-specific movements and training structure
+++I.e. higher reps when rehabbing endurance athletes, lower for strength/power athletes

Question 26

What are program design considerations for aerobic and anaerobic training?

Answer 26

-Optimal program unknown
-Should generally mimic sport and metabolic demands as closely as possible
-S+c professional is the ideal team member to prescribe and supervise the aerobic training program
-Must consider the demands the specific sport places on the injured athlete