Injury

Question 1

Factors that can cause an injury

Answer 1

Overtraining - E.g. shin splints in a runner
Lack of preparation - grassroots player doing minimal warm up
Poor technique - Weightlifter
Impact from collision or fall - falling off a horse in horse riding

Question 2

Hard tissue injuries

Answer 2

Involves damage to the bone, joint or cartilage, including fractures and dislocations
These can result in – internal bleeding, circulatory problems, joint stability and they usually require hospital treatment

Question 3

Soft tissue injuries

Answer 3

Involves damage to the skin, muscle, tendon or ligament
Includes – sprains, strains and tears
Result in – inflammation, bruising (internal bleeding) and require immediate attention to minimize recovery times.

Question 4

Acute injuries

Answer 4

These injuries are a sudden injury associated with a traumatic event
Examples of these injuries are: a fracture, a collision, a dislocation, a sprain and a strain

Question 5

Chronic injuries

Answer 5

These injuries are slowly developed overtime and are associated with overuse. They can occur from repeated or continuous stress
These usually occur from a sudden increase in frequency/ intensity/ duration of activity or reduction in recovery
These can occur from inadequate equipment, technique, a poor ROM or an inadequate warm-up/ cool- down
Examples of these include: tennis elbow, shin splints and Osgood Schlatter’s disease

Question 6

What is a fracture

Answer 6

A fracture is a partial or complete break in a bone due to an excessive force that overcomes the bone’s potential to flex.
Fractures usually occur from a direct force (collision or object) or an indirect force (unintended)

Question 7

4 types of force that can cause fractures with E.g.

Answer 7

Direct force: Fractured nose/ jaw from a jab/ uppercut in boxing
Collision: Fractured ribs when tackling in rugby
Object: Fracturing a finger when catching a ball (in netball/ basketball)
Indirect force: A fall where an athlete lands on their feet may result in a pelvic fracture OR a fall from a horse in horse riding

Question 8

Common indicators of a fracture

Answer 8

Pain at the area of the fracture site
Inability to move the affected area or unnatural movement
Deformity
Swelling
Discoloration
(Depends on the type of fracture which is diagnosed)

Question 9

Difference between simple and complex fractures

Answer 9

Simple: The skin remains unbroken as the fracture causes little movement of the bone. This minimises the damage to the soft tissue surrounding it
Complex: The fractured bones break through the skin creating an open wound. This has a high risk of infection

Question 10

What is a dislocation and what is a subluxation

Answer 10

A dislocation occurs when one bone is displaced from another, moving them out of their original position
A subluxation is an incomplete or partial dislocation

Question 11

Issues with subluxation and dislocations

Answer 11

Dislocation: It is easier to dislocate joints that have dislocated before as the surrounding tissue e.g. ligaments are overstretched. If the joint is injured and pulled apart, the structures of the joint, plus the bones, can be torn or fractured as a result.
Subluxation: Causes damage to the ligaments – when overstretched, ligaments can permanently lengthen which, decreases joint stability and increases the likelihood of recurrent dislocations. These may require surgeries

Question 12

Common sites of dislocations and subluxations

Answer 12

Dislocations: Shoulder, hip (ball and socket), knee, ankle, elbow, fingers and toes.
Subluxations: Shoulder, elbow and knee.

Question 13

Causes of dislocations and subluxations

Answer 13

Dislocation: Occurs from a direct force (from a collision or object/ impact to the joint) or an indirect force (a fall). This pushes the joint past its extreme ROM.
Subluxation: Joint hyperextension (when the joint is pushed past its extreme ROM) Overuse injuries e.g. golfer’s elbow Force injuries e.g. a severe fall

Question 14

Signs and symptoms of dislocations and subluxations

Answer 14

Dislocation: Severe pain at the injury site, loss of movement, deformity, swelling and a ‘pop feeling’.
Subluxation: Pain and swelling around the joint, a sensation of joint instability, limited ROM, loss of feeling/ numbness and bruising

Question 15

What is a contusion

Answer 15

A bruise is also known as a contusion
It is an area of skin or tissue in which the blood vessel have been ruptured (torn)
The raised area of a bump or contusion results from blood leaking from these injured vessels into the tissues as well as the body’s response to the injury where fluid is drawn to the muscle.
Most contusions are minor and heal rapidly without a break in play or training

Question 16

What is a Haematoma

Answer 16

Localised congealed bleeding from the ruptured blood vessels.
They can range from superficial small bruises to deep bleeds that seep into the surrounding tissue.
Congealed is a change of state from liquid to solid – to form a clot underneath the skin
E.g. ‘Cauliflower ears’ – rugby players can be a result of consistent damage and blood clots within the ear lobe
Signs and symptoms: Swelling, Discoloration, inability to move the limb/ affected area

Question 17

What is a sprain

Answer 17

A overstretch or a tear in the ligament that connects bone to bone and support a joint.
It is usually cause by a sudden twist, impact or fall that force the joint beyond its extreme range of motion.
It is common in the knees of footballers (when the studs dig into the ground, the ankle is stabilised and the twist occurs
Signs and symptoms include: Pain, Swelling, Bruising, Inability to bear weight, Possible dislocation

Question 18

Degree of sprains

Answer 18

First-degree sprain - Overstretch of a few ligament fibres
Second-degree sprain - A partial tear of ligament fibres
Third-degree sprain - A total rupture (tear) of a ligament from the bone
A total rupture could require complete surgical reconstruction

Question 19

What is a strain

Answer 19

A strain is an overstretch or tear in the muscle or tendon that connects muscle to bone
It usually occurs from overstretching a particular area or contracting fibres too quickly and without enough preparation
Again this can result in an overstretch, partial rupture or complete rupture of the muscle fibres/ tendon
Grade 1 – minor damage
Grade 2 – extensive damage but not completely ruptured
Grade 3 – complete rupture (requires surgery/rehabilitation)
Signs and symptoms include: Pain on movement of the affected area, Discoloration, Bruising

Question 20

What is an abrasion

Answer 20

Superficial damage to the skin caused by a scraping action against a playing surface: athletics track, netball court, Cycling – track or road
It can also occur from chafing during a marathon (when the thighs rub together)
The abrasion may cause an open wound, where there is a high risk of infection.
If there is a laceration (cut) medical attention may be required in the form of suturing (stitching)

Question 21

What are blisters

Answer 21

Blisters are separation of layers of skin where a pocket of fluid forms due to friction.
Although painful, they may not stop participation with treatment and are preventable with the correct equipment especially footwear and being mindful of training load and progressive overload.
Signs and symptoms include: Swelling, Fluid under the skin, Pain

Question 22

What is a concussion

Answer 22

Traumatic brain injury resulting in a disturbance of brain function such as; headaches, dizziness, balance problems, nausea
Concussion can occur from a direct blow to the head or other parts of the body which cause rapid movement of the head.
A concussion can also occur from whiplash, impact with the ground or a direct impact.
Most common in sports such as boxing, rugby, football and horse
raising where a collision is most likely to occur.

Question 23

Symptoms of concussion

Answer 23

Symptoms that clearly indicate concussion: post-traumatic seizure, loss of consciousness, balance problems, disorientation and confusion, dazed or blank expression
Symptoms that may indicate concussion: lying motionless, slow to get up, grabbing / clutching head, headache, dizziness, visual problems, nausea or vomiting, fatigue, light sensitivity

Question 24

Rugby World cup 6 R’s

Answer 24

1. Recognise
2. Remove
3. Refer
4. Rest
5. Recover
6. Return

Question 25

Recognise, remove, refer

Answer 25

Recognise - parents, players, coaches and officials should all be aware of the signs and symptoms of concussion Remove - If a player has a concussion or a suspected concussion, they must be removed from the field of play immediately Refer - If removed from the field, the player should be referred immediately to a qualified healthcare professional who is trained in evaluating and treating concussion

Question 26

Rest, recover, return

Answer 26

Rest - Players must rest from exercise until symptom free and not be left alone for the first 24 hours Recover - Players must fully recover and be symptom free before considering a return to play. Adults must take a minimum of one week and under-18’s two weeks before seeking an authorised return from a healthcare professional. Rest and specific treatment through recovery are essential for the health of the injured participant Return - To complete a safe return to the field the player must be symptom free, have written authorisation and complete the ‘graduated return to play’ protocol

Question 27

What is SALTAPS

Answer 27

When you see an injury that is not a concussion how you respond See Ask Look Touch Active Passive Strength

Question 28

See, ask, look

Answer 28

See: Acknowledge the injury has occurred and ensure no further damage can take place by stopping game Ask: Question about nature and location of injury Look: look for signs of injury based on info given, bruising and swelling should be considered

Question 29

Touch, Active, passive, strength

Answer 29

Touch: touch injury to assess pain level Active: can the player move area unaided Passive: If active successful try move area through full ROM Strength: Assess strength with resistance from assessor or bearing weight

Question 30

PRICE

Answer 30

Protect: protect area from further damage by removing player from site and isolating the injury Rest: area for at least 2-3 days allowing initial healing process to take place Ice: the injury every 15 mins for 2 hours to reduce swelling Compress: area with bandage to limit spread of swelling Elevate injury above heart to further limit swelling of area

Question 31

Describe the use of surgery to treat acute hard tissue injuries

Answer 31

1.(Open surgery) Incision made to open a joint to access injury 2.(Realign bones) Realign fractured/dislocated bones 3.(Stabilise) Use of plates /pins /rods /wires to stabilise fractures /dislocation 4.(Arthroscopy) Arthroscopy/keyhole surgery to access injury/small incisions/camera to access injury/be less invasive 5.(Knee/Meniscus) Repair/trim/resurface meniscus/cartilage in (knee) joint 6.(Shoulder/Labrum) Used to repair Bankart lesion/damaged labrum/cartilage in shoulder/treat repeated shoulder dislocations

Question 32

What is a stress fracture

Answer 32

A tiny crack in the surface of a bone cause by overuse. This is usually when fatiguing muscles transfer the stress overload to the bone tissue A regular X-Ray cannot often pick up on stress fractures – they are usually hard to spot

Question 33

How can FMRI scans be used for stress fractures

Answer 33

Uses radio waves and a strong magnetic field to produce detailed images of internal structure. Can visualise stress fractures within the first week of injury Can visualise lower grade stress fractures Better able to distinguish between stress fractures and soft tissue injuries

Question 34

3 soft tissue injuries

Answer 34

Shin splints Tendinosis Bursitis

Question 35

Shin splints

Answer 35

Repeated overuse of the tibialis anterior (anterior shin splints) And the tibialis posterior (posterior shin splints) These can become injured when repetitive actions occur which cause stress In nearly all cases of shin splints the tendon and periosteum become inflamed, leading to pain

Question 36

Tendinosis

Answer 36

Caused by chronic overuse of a tendon where the collagen deteriorates It can occur in any tendon but most often occurs in the tendons of the heel (Achilles tendon), wrist, elbows, knees (patella tendon) and shoulder (in the rotator cuff) Repetitive strain causes small-scale injuries that are not given the time to heal and so accumulate, resulting in a chronic injury. Inflammation does not occur with tendinosis only with tendonitis

Question 37

Tendinosis signs and symptoms and diagnosis

Answer 37

Signs and symptoms: Pain in the affected tendons when moved or touched Stiffness and restricted movement In some cases the appearance of a tender lump Stinging and burning sensation Diagnosis: Diagnosed by a physical examination, MRI or ultra-sound

Question 38

Bursitis

Answer 38

Inflammation/irritation of the Bursa Bursa – sac filled with lubricating fluid found between tissues such as bone, muscle and tendons that decreases rubbing and friction It occurs in joints performing repetitive motions and is only relieved by rest and recuperation Usually affects: Elbows, Shoulders, Hips, Achilles tendon

Question 39

Tennis elbow

Answer 39

Strenuous overuse of the tendons in the forearm during repeated twisting actions This can lead to microscopic tears, pain and tightness that limits movement These are common in racket sports/ throwing activities Javelin athletes often now wear support strapping surrounding their elbow within competition

Question 40

Treatment of compound fractures

Answer 40

Immediate medical attention required and sometimes ambulance may be required. Wounds will be required to be washed. Immobilise the joint if possible and anti-inflammatory and pain medication may be required. Surgery will be required including the use of pins, rods, plates and screws followed by a cast to immobilise the limb

Question 41

Treatment of simple fractures

Answer 41

Medical attention is required and in severe cases an ambulance will be required. PRICE to reduce swelling if it doesn’t cause pain. Immobilisation using a splint, sling, crutches or plaster cast to assist the healing process. Anti-inflammatory and pain medication. More severe injuries may require surgery to re-align the bones with the assistance of pins, wires or nails to fix the bones in their original position

Question 42

Treatment of stress fractures

Answer 42

Medical attention required for diagnosis and advice. Rest for around two weeks and no activity for a further eight weeks to prevent larger more complex injury. Immobilisation may be used to limit activity. A gentle return to exercise accompanied by posture and alignment re-training. PRICE to reduce swelling. Strengthening exercises for surrounding connective tissue

Question 43

Treatment of dislocation

Answer 43

PRICE to reduce swelling and pain. Anti- inflammatory and pain medication. If this injury occurs again, this may require surgery to realign and pin bones into their original position. Physiotherapy will strengthen the connective tissues around the joint and improve flexibility and mobility. Immediate medical attention is required and in severe cases an ambulance. Immobilisation (where possible) using a splint or sling. No attempt to reposition bones unless by a medical professional.

Question 44

Treatment of sprains

Answer 44

Immobilisation or support using strapping, a brace or crutches to assist the healing process. Severe injuries such as a complete rupture may require reconstructive surgery. Recovery can take from several weeks to several months depending on the severity of the injury. Medical attention may be required in severe cases.

Question 45

Exercise induced muscle damage

Answer 45

Eccentric exercises, strength training, downhill running and plyometric exercises can cause microscopic injury to the muscle fibres Usually occurs at the start of a programme The greater the intensity and duration, the greater the exercise induced muscle damage Peaks 24-72 hours post exercise Commonly referred to as DOMS Warm-up, progressive overload and a stretching routine will lessen the impact of DOMS

Question 46

Signs and symptoms of exercise induced muscle damage

Answer 46

Signs and symptoms pain and tenderness Swelling Stiffness decreased range of motion and strength (peaking 24-72 hrs post exercise)

Question 47

Treatment of exercise induced muscle damage

Answer 47

Medical attention is not required (in most cases) – symptoms should stop within 5 days Treatment is often ineffective however, the pain associated can be reduced by: Cold therapy – ice packs/ice bath Massage and stretching techniques – consider how foam rollers have recently impacted/ increased use by athletes/ individuals Anti-inflammatory and pain medication. Medical attention should be sought if there is heavy swelling or dark urine as this may indicate the level of muscle damage has affected the kidneys

Question 48

Process of rehabilitation

Answer 48

The process of regaining full function of the injured area. This is essential for full recovery and to prevent further injuries Early Stage – gentle exercise – encourage healing Mid Stage – progressive overloading of the affected area to develop strength Late Stage – functional exercises and drills to enable player to return to full time training

Question 49

Massage

Answer 49

A physical therapy used for injury prevention by increasing flexibility and joint mobility) and treatment of soft tissue injuries Deep muscle therapy used to realign damaged muscle fibres and removing toxins from the affected areas

Question 50

Positive effects of sports massages

Answer 50

Move fluid and nutrients through damaged tissues to encourage healing and accelerate the removal of waste products (this can aid recovery in between training sessions) Stretch tissues – releasing tension and pressure and improving elasticity Break down scar tissue from previous injuries that can lead to inflexible tissues, injury and pain Reduce pain, generate heat, circulation and relaxation

Question 51

Negative effects of sports massage

Answer 51

It cannot be used on certain soft tissue injuries such as ligament of tendon rupture (complete tear) It cannot be used on contusions or open wounds as bleeding will be increased and the injury may be complicated It can be expensive It is a long term solution (it takes time)

Question 52

Cold therapy (cryotherapy)

Answer 52

Use of ice or ice baths to reduce tissue temperature and metabolic activity and reduce blood flow from vasoconstriction of blood vessels – used on acute injuries early in recovery process The vasoconstriction of blood vessels decreases blood flow and reduces inflammation, swelling and pain Risks associated with cold therapy - Ice burns/ tissue damage - Nerve damage (if in contact too long) - Uncomfortable - Not suitable for people with Rynaulds

Question 53

Types of cold theraoy

Answer 53

PRICE, applied as early as possible and continued for 24-48 hours is the best treatment for acute, soft tissue injuries. Cold water immersion (ice baths) for ten minutes at around 10degrees has been shown to reduce the pain and drop in performance associated with exercise-induced muscle damage, post-exercise Cryokinetics involves ice application followed by rehabilitation exercises proven successful in treating ligament sprains Cryostretching combines cold application and stretching to reduce muscle tension and increase flexibility, useful to decrease the pain associated with exercise-induced muscle damage

Question 54

Cryostretching

Answer 54

Apply cold pack is used to reduce muscle spasms and so increase flexibility. It involves three phases, cold application, static stretching, and then contract-relax technique. First, the body part is cooled for up to 20 minutes at which time it should become numb. Following these, two sets of 65-second stretches are applied with a 20-second rest between sets. Each period of 65 seconds consists mainly of static stretching, with three 5 second isometric contractions interspersed throughout the stretch. Ice reduces muscle spasms allowing the muscle to relax more and so increasing the stretch. Static stretches overcome the stretch reflex to reduce muscle spasms.

Question 55

Heat therapy

Answer 55

Use of hot pads to reduce muscle tension, pain, stiffness and increase blood flow from vasodilation of the blood vessels – used on chronic or latter stage acute injuries. This can include heat packs, hot towels, heat rubs and warm water immersions May be combined with stretching techniques to increase the elasticity of connective tissue during rehabilitation and before exercise. Some risks of heat include – swelling if applied too early and if too hot, there is a risk of burns and scalding

Question 56

Contrast therapy

Answer 56

Use of heat and cold treatments 3-5 days after injury occurs After swelling/inflammation has reduced Immerse injury in cold water bath/ice Followed by warm water/heat pack/hot towels Use in conjunction with mobilising exercises Cold:warm ratio of 1:3 or 1:4 minutes Cold vasoconstricts blood vessels Heat vasodilates blood vessels Causing pumping action Increasing blood flow/oxygen/nutrients to damaged tissue

Question 57

Strengths of contrast therapy

Answer 57

More effective than heat therapy on its own Reduces swelling/ inflammation Reduces pain Speeds up recovery/ repair/ healing

Question 58

Weaknesses of contrast therapy

Answer 58

Use of incorrect timing can limit effectiveness Applying the heat for too long can cause an increase in swelling Ice burns can occur if ice is in contact for too long If the ice is on for too long it can cause nerve damage Not suitable for hard tissue injuries Not suitable for those who have negative reactions to cold treatments e.g. Raynaud's

Question 59

Surgery

Answer 59

As a last resort when all other rehabilitation has been attempted or for fast recovery of elite performers surgery can be used. The type of surgery depends on the severity of the injury. Common surgical procedures include: relocation of dislocated joints, repairing meniscal tears or ligament ruptures

Question 60

Arthroscopy and its positives

Answer 60

Arthroscopy where a small incision is made and a camera used to help mend the damaged tissue or open surgery where the whole injured area is opened up to allow complete repair + It is minimally invasive + It reduces the risk of infection + It has a quicker recovery time + The damage to surrounding tissues is minimised. + Less painful

Question 61

Negatives of surgery

Answer 61

Risk of infection Further complications Long recovery time Soreness and pain Swelling at the site of incision Scar tissue can develop

Question 62

Anti-inflammatory drugs

Answer 62

Medication taken to reduce inflammation, temperature and pain following injury e.g. Ibuprofen and aspirin These are mainly used to treat acute sporting injuries Help reduce the inflammatory response to injury by inhibiting the natural chemical releases in the cells following injury interfering with the pain receptors. This also reduces pain, reduces swelling, reduces the temperature at the site of injury and speeds up the recovery and healing process

Question 63

Evaluate anti inflammatory drugs

Answer 63

+ It can be used for acute and chronic injuries + Prescription is not needed + Easily accessible and cheap - Can have limited effectiveness - Can mask pain/injury - Long term Side effects like gastrointestinal bleeding and heart conditions - Short term side effects like heartburn, headaches

Question 64

If in doubt treatments of injury

Answer 64

PRICE P - Pain at the site I - inflammation D - deformity S - swelling D - discoloration