Lecture 4 sports injury and healing process

Question 1

Sport injury

Answer 1

• Tissue damage/derangemetn of normal physical function
• Generally due to external forces (transfer of kinetic energy)
• sport injury can to all tissues: vessels, muscle, ligament, cartilage, nerve, etc.

Question 2

Mode of onset

Answer 2

• Injury may result from a clear acute mechanism (acute injury), clear repetitive mechanism (overuse injury), or from a combination of both mechanism.
• Acute injury → Sudden onset (single event)
• Overuse injury → Gradual onset (repetitive)
• Overuse injury → Sudden onset (single event / repetitive)

Question 3

Direct contact injury

Answer 3

Contact with another player/object

Question 4

Indirect contact injury

Answer 4

Through another athlete/ an object

Question 5

Noncontact injury

Answer 5

Without any contact from another external source

Question 6

Soft-tissue injuries

Answer 6

cartilage injuries, muscle injuries, tendon injuries, and ligament injuries

Question 7

Skeletal injuries

Answer 7

bone fractures, other bone injuries

Question 8

Acute injuries

Answer 8

bleeding(hematoma)

Question 9

Articular cartilage

Answer 9

flexible cartilage, provides smooth surface for joint movement (end of bones)

Question 10

fibrocartilage

Answer 10

a tough cartilage, able to absorb loads (e.g., discs of the spine, meniscus)

Question 11

tendon

Answer 11

muscle -> bone

Question 12

enthesis

Answer 12

Junction between a tendon/ligament and a bone

Question 13

Ligament

Answer 13

Bone -> Bone

Question 14

Sprain

Answer 14

ligament and joint injuries

Question 15

strain

Answer 15

Muscle injury

Question 16

fracture

Answer 16

Bone injury

Question 17

Rupture

Answer 17

organ, muscle, tendon injuries

Question 18

Stiffness

Answer 18

Ability of a tissue to resist a load

Question 19

Yield point

Answer 19

indicates the limit of elastic behaviour and the beginning of plastic behaviour

Question 20

Creep

Answer 20

Deformation in the shape/properties of a tissue that occurs under the influence of persistent mechanical stresses

Question 21

Four stages of wound healing

Answer 21

Hemostasis, inflammation, proliferation, remodelling

Question 22

Hemostasis

Answer 22

-Stop the leak!
* Process to prevent and stop bleeding
when injury occurs → Results in formation of a clot

• Steps:
• Vascular spasm
• Formation of platelet plug
• Blood clotting (coagulation cascade)
• Formation of the final clot
• Platelet release growth factors

Question 23

Inflammation

Answer 23

• Clean up!
• Defensive response of tissues to a physical or chemical injury, or bacterial infection
• Recruitment of cells to destroy debris and bacteria:
• Neutrophils – for the first 48 hours
• Macrophages – peak around 48–72 hours
• Lymphocytes – appear after 72 hours
• Indicated by redness, warmth, swelling, pain, and dysfunction

Question 24

Proliferation

Answer 24

• Rebuild!
• Healing over, rebuilding new tissue
• angiogenesis, fibroblast migration, epithelialization, wound retraction

Question 25

Angiogenesis

Answer 25

Formation of new blood vessels, restore blood flow

Question 26

Fibroblast migration

Answer 26

- Fibroblasts produce collagen fibres and elastin - Results= granulation tissue which replaces the clot

Question 27

Epithelialization

Answer 27

Epithelial cells cover denuded epithelial surface

Question 28

Wound retraction

Answer 28

Contraction of the wound

Question 29

Remodelling

Answer 29

- Increase tissue strength! - Granulation tissue matures into scar - This stage may last several months-years -- important implication for return to sport - Form and functions of the scar tissue depend on loading during this stage - Never achieve the same level of tissue strength than before injury!

Question 30

Rehabilitation

Answer 30

- Bone and soft tissue respond to loading -> remodel accordingly - healing structures need to be exposed to progressive loads.

Question 31

Wound healing

Answer 31

- Hemostasis: minutes/hours - Inflammation: days - Proliferation: weeks - Remodelling: months/years

Question 32

Important factors in wound healing

Answer 32

* Nutrition * Hypoxia * Infection * Immunosuppression * Chronic disease * Wound management * Age * Genetics * Surgical technique

Question 33

Early treatment of acute soft tissue injuries

Answer 33

Too much bleeding slows healing * Goals: * Limit bleeding * Limit swelling * Relieve pain * Improve conditions for subsequent treatment and healing

Question 34

Acute injury management

Answer 34

PEACE/LOVE

Question 35

PEACE

Answer 35

- Protect: unload or restrict movement for 1-3 days - Elevate: elevate the limb higher than the heart - Avoid: NSAID's and ice - Compress: helps limit deem and hematoma - Educate: educate patients on the benefits of active approach to recovery

Question 36

LOVE

Answer 36

- Load: active approach with movement and exercise benefits most patients - Optimism: optimistic patient expectations are associated with better outcomes - Vascularization: cardiovascular activity is a cornerstone in the management of injuries - Exercise: exercises help to restore mobility, strength and proprioception early after injury

Question 37

Old acronyms

Answer 37

PRICE and POLICE (Protect,rest,ice,compression,elevation) - also used for acute management

Question 38

Stages of tissue healing

Answer 38

acute stage, subacute stage, chronic stage

Question 39

Acute stage

Answer 39

Days - PEACE - (POLICE, PRICE)

Question 40

Subacute stage

Answer 40

(rehabilitation stage) weeks - LOVE

Question 41

Chronic stage

Answer 41

(training stage) Months - LOVE

Question 42

Acute stage- 2

Answer 42

* DO NO HARM! * ESSENTIAL that treatment begins as soon as possible! * In the 3 days following acute injury, avoid: * Heat – hot baths, hot showers, saunas, heat packs * Moderate-Vigorous-strenuous activity – e.g., walking briskly, running * Massage