Paper 1 - Injury

Question 1

Define sports injury

Answer 1

Any kind of injury, pain or physical damage that occurs as a result of sport, exercise or physical activity. Most commonly associated with the musculo-skeletal system: muscles; bones; ligaments; tendons; cartilage.

Question 2

Define acute injury and chronic injury with examples

Answer 2

Acute injury - Sports injuries that occur in an instant. Examples = fracture, dislocation, strain, sprain.
Chronic injury - Sports injuries that occur over an extended period of time - sometimes called overuse injuries. Examples = tendinitis, stress fracture.

Question 3

Define hard tissue injury and soft tissue injury with examples

Answer 3

Hard tissue injury - Injury, pain or physical damage to the solid structures of the musculo- skeletal system: bone; cartilage. Examples = fracture, stress fracture, dislocation, meniscus tear.
Soft tissue injury - Injury, pain or physical damage to the soft structures of the musculo- skeletal system: muscles, tendons, ligaments. Examples = tear, strain, sprain.

Question 4

Define concussion

Answer 4

Concussion - A violent acceleration/deceleration force of the brain, resulting in impairment of neurological function. Can cause a contusion of the brain tissue or a haemorrhage inside the skull.

Question 5

What’s the difference between a strain and a sprain

Answer 5

Both are acute injuries and both are soft tissue injuries.
A sprain refers to an injury of the ligament. A strain refers to an injury of the muscle or tendon. (Strain = over stretch and tear a muscle, Sprain = over stretch and tear a ligament).

Question 6

What is the most frequently injured joint in the body? (Extra info)

Answer 6

The knee because it is the least stable joint in the body relying on 4 ligaments and 2 meniscus to increase its stability.

Question 7

Common acute sports injuries : name the 6

Answer 7

Concussion
Dislocation
Fracture
Sprain
Strain
Cartilage tear

Question 8

Common acute sports injuries : concussion (area of musculoskeletal system / hard or soft issue injury / brief outline / possible causes)

Answer 8

Head

Soft tissue but also Hard tissue (if skull gets fractured)

• when the brain is injured by contacting the inside of skull.
• either a contusion or bruise of the brain tissue occurs.
• …or a haemorrhage or bleeding inside the skull occurs.

any forceful collision with an object or athlete during contact sports
e.g. football, rugby, hockey.
a serious fall e.g. horse racing, skiing. a blow to the head e.g. boxing.

Question 9

Common acute sports injuries : dislocation (area of musculoskeletal system / hard or soft tissue injury / brief outline / possible causes)

Answer 9

any joint; shoulder most common.

Hard tissue

• a joint injury where the ends of the bones are forced out of their original position.

violent contact with another athlete or solid object.
e.g. tackle in rugby.
falling on an outstretched hand
e.g. tripping in netball.

Question 10

Common acute sports injuries : fracture (area of musculoskeletal system / hard or soft tissue injury / brief outline / possible causes)

Answer 10

Any bone

Hard tissue

• a broken bone which may be completely or partially fractured.
• there are many different types of fracture including: compound, simple, transverse.

high impact force to a bone.
e.g. aggressive tackle in football. e.g. bad landing from the vault in gymnastics

Question 11

Common acute sports injuries : sprain (area of musculoskeletal system / hard or soft tissue injury / brief outline / possible causes)

Answer 11

any ligament - those in knee and ankle most common.

Soft tissue

• a stretch or tear in the ligament.
• a violent wrench or twist to the ligament.
• causing a grade 1, 2 or 3 tear.
Symptoms – pain, swelling, bruising, limited movement

high impact sports involving jumping, sprinting and changing direction.
e.g. basketball, hockey, netball commonly associated with ankle sprains.

Question 12

Common acute sports injuries : strain (area of musculoskeletal system / hard or soft tissue injury / brief outline / possible causes)

Answer 12

any muscle or tendon.

Soft tissue

• a stretching injury to the muscle or tendon.
• also known as a ‘pulled muscle’.
• Symptoms – pain, swelling and bruising

explosive movements involving dynamic flexibility.
e.g. lower back strain in fast bowlers. e.g. groin strain in football and hockey players that requires fast pivoting.

Question 13

Common acute sports injuries : cartilage tear (area of musculoskeletal system / hard or soft issue injury / brief outline / possible causes)

Answer 13

Any cartilage

Hard tissue

• commonly associated with the discs of fibrocartilage that cushion the knee joint - called the medial and lateral meniscus
• may accompany other injuries such as ligament sprains

forceful twisting of the knee, especially when the knee is bent. e.g. landing and changing direction in netball.

Question 14

What are the 5 clear indications of concussion and 6 symptoms that may indicate concussion

Answer 14

Clear :
Seizures, loss of consciousness, balance problems, confusion, blank expression

May :
Slow to get up, headache, dizziness, visual problems, vomiting, light sensitivity

Question 15

Define contusion, abrasion and blisters

Answer 15

Abrasion – damage to the skin caused by friction when the athlete’s skin rubs against another surface, e.g. after falling off a bike, marathon runner
Contusion – damage to the blood vessels following a direct impact which results in the release of blood (bruising) within a confined area
Blister – the development of a fluid-filled sac & separation of layers of skin. Pocket of fluid forms due to friction. Preventable through correct equipment and footwear.

Question 16

Common chronic sports injuries : tennis elbow golfer’s elbow thrower’s elbow (area of musculoskeletal system / hard or soft issue injury / brief outline / possible causes)

Answer 16

Elbow joint

Soft but also Hard (thrower’s elbow only)

• all are forms of tendinitis, which is an inflammation or irritation of a tendon.
• tennis elbow = tenderness in outer or lateral elbow.
• golfer’s elbow = tenderness in inner or medial elbow.
• thrower’s elbow = tiny fractures in bones of elbow as well as tendinitis.

tennis elbow = tennis, badminton, osteoarthritis.
golfer’s elbow = golf, cricket, osteoarthritis.
thrower’s elbow = tennis, shot put, javelin & cricket.

Question 17

Common chronic sports injuries : rotator cuff & patella tendonitis (area of musculoskeletal system / hard or soft issue injury / brief outline / possible causes)

Answer 17

Shoulder joint / knee joint

Soft tissue

• both are forms of tendinitis.
• rotator cuff tendonitis = inflammation of tendons in the shoulder.
• patella tendonitis (jumpers knee) = inflammation of the tendon that contains the patella and attaches the rectus femoris to the tibia.

rotator cuff tendinitis = sports requiring repetitive overhead movements e.g. tennis, swimming, bowling in cricket.
patella tendinitis = sports requiring repetitive jumping e.g. basketball, netball, long jump.

Question 18

Common chronic sports injuries : osgood schlatter syndrome (area of musculoskeletal system / hard or soft issue injury / brief outline / possible causes)

Answer 18

Knee joint

Soft tissue

• a condition where the patella tendon pulls on the front of the tibia where it attaches just below the knee.
• it affects active young teenagers.
• it is more common in boys than girls.

the condition is not specific to any particular sport as all young teenagers repeatedly contract their quadriceps in all sports. it flairs up during growth spurts as the quadriceps become tighter.

Question 19

Common chronic sports injuries : medial tibial pain - shin splints (area of musculoskeletal system / hard or soft issue injury / brief outline / possible causes)

Answer 19

Lower leg

Soft tissue

• a term used to cover all pain at the front of the tibia.
• a form of tendinitis.
• pain felt due to inflammation of the tendons that attach the tibialis anterior to the tibia.

repetitive stress on the tibialis anterior muscle. e.g. running, jumping. changes to the frequency, intensity and duration of running.

Question 20

Common chronic sports injuries : stress fractures (area of musculoskeletal system / hard or soft issue injury / brief outline / possible causes)

Answer 20

Any bone

Hard tissue

• small cracks appear in the bone.
• common in children while their bones are still growing.
• common in weight bearing bones e.g. tibia.

repetitive impact activities e.g. in the tibia of runners or the radius & ulna in tennis players or gymnasts or ankle in jumpers.
osteoporosis sufferers or athletes with low bone density.

Question 21

List 6 intrinsic risk factors

Answer 21

Flexibility
Age
Body mass
Injury history
Underprepared
Fitness levels

Question 22

Explain the intrisnic risk factors (Flexibility Age Body mass Injury history Underprepared Fitness levels)

Answer 22

Flexibility : The more flexible an individual is, the less likely they are to become injured. This is because they can stretch their muscles, ligaments and tendons to a greater degree before overstretching occurs.
Age : As an individual gets older, their risk of injury becomes greater. The strength of their tissues is also reduced which increases the risk of an acute injury occurring.
Body mass : The higher an individual’s body mass, the more stress is being placed on their weight- bearing bones and connective tissue.
Injury history : Suffering an injury in the past increases an athlete’s risk of suffering from the same injury in the future. e.g. those who suffer from ACL tears are far more likely to suffer another ACL tear in the future.
Underprepared : The body needs to be accustomed to the demands being placed upon it. Therefore it is important that the body gradually builds up the amount of stress being placed upon it so that it can adapt.
Fitness levels : Low levels of fitness can result in poor technique being displayed when the athlete becomes fatigued, which can increase the risk of an injury occurring.

Question 23

List 7 extrinsic risk factors

Answer 23

Poor technique
Incorrect equipment
Inappropriate intensity
Inappropriate duration
Inappropriate frequency
Warm up
Cool down

Question 24

Explain the extrinsic risk factors (Poor technique Incorrect equipment Inappropriate intensity Inappropriate duration Inappropriate frequency Warm up Cool down)

Answer 24

Poor technique : Having a poor technique can place limbs in vulnerable positions and increase the risk of acute injuries. Greater strain on the muscles and tendons and, therefore, increase the risk of chronic injuries occurring.
Incorrect equipment : By not wearing the necessary safety equipment, an athlete is placing themselves at risk of acute contact injuries. Risk of chronic injuries occurring if they are wearing inappropriate clothing, e.g. running shoes without enough cushioning.
Inappropriate intensity : Exercising at an intensity which the athlete is not prepared for will increase their risk of injury. This is because the body has not had time to adapt to this exercise load.
Inappropriate duration : An inappropriate length of exercise can increase the risk of chronic injuries as the tissues are repeatedly loaded and my not be able to handle the stress that they are put under. Overuse injuries.
Inappropriate frequency : Exercising too often can prevent the tissues from adequately recovering and adapting to the exercise load, which increases the risk of an injury occurring. Overuse injuries.
Warm up : Performing a warm-up reduces the risk of injury by allowing the muscles and tendons to gradually become accustomed to contracting.
Cool down : A cool-down allows the body to effectively recover from exercise. This speeds up the recovery process and, therefore, ensures that the body is fully recovered before the next exercise session.

Question 25

Responding to Injury : what method is used to respond to any injury

Answer 25

SALTAPS

Question 26

Responding to Injury : what do each part of SALTAPS stand for and explain them

Answer 26

See/stop – observe the injury and stop the game Ask – question the injured athlete to see how they did it and where it hurts Look – for specific signs of bruising, broken skin, swelling, etc. Touch – gently press the site of injury and assess the source of pain Active – can the athlete actively move the injured limb, without pain? Passive – if they can move it, try to move the injured limb through the full range of motion to assess further Strength – assess strength of the injury by asking the athlete to apply pressure by standing or lifting

Question 27

Responding to Injury : what method is used to respond to acute soft tissue injuries

Answer 27

PRICE

Question 28

Responding to Injury : what do each part of PRICE stand for and explain them

Answer 28

Protect – Protect from further injury Rest – no activity for 2–3 days; use crutches or a sling if needed. Ice – Ice the injury for 15 minutes every two hours to reduce swelling. Compress – Compress the area with a bandage to prevent swelling from spreading. Elevate – Elevate the injury above the heart to reduce swelling. Prevent blood pooling

Question 29

Responding to Injury : what method is used to respond to head injury / concussion

Answer 29

The 6 Rs

Question 30

Responding to Injury : what do each part of the 6 Rs stand for and explain them

Answer 30

Recognise - This requires an understanding of the symptoms of concussion so that they can be spotted as soon as an athlete is displaying them. Remove - Take the player off the field of play so that they are not in danger of further aggravating the injury. Refer - Take the athlete to a trained medical professional so that they can receive the treatment that they require. Rest - The athlete should not return to the field of play and should have an appropriate time off training until they recover. Recover - The player should be assessed by a medical professional during their rest to determine how well they are recovering. Return - Only when the medical professional is happy that the athlete has fully recovered should they return to training. In order to do so, they will need written confirmation.

Question 31

Rehabilitation of injury : define rehabilitation, what it involves and what happens without it

Answer 31

Rehabilitation = A programme devised to enable the athlete to return to sport with full function in the shortest possible time. It involves restoring: strength, flexibility, endurance and power. Without effective rehabilitation, the athlete is: • prone to reinjury of the affected area. • incapable of performing at pre-injury standard. • predisposed to injury in another part of the body.

Question 32

Rehabilitation of injury : what are the 4 stages of rehabilitation (describe, functional level of injured site, sport they can do)

Answer 32

Initial (Early) - considered to be from the time of injury to the point of almost full, pain-free range of motion. - Poor - Nil sport Intermediate (mid) - resumption of daily activities and some sporting activity, with activity mainly skill related. Progressive loading of connective tissue and bones to develop strength - good - Isolated skills (e.g. basketball – shooting only) Advanced (late) - resumption of functional activities related to the sport. - good - commence sport specific agility work, skills, game drills Return to sport - return to sport including full participation in training and competition. - good - full sport

Question 33

Rehabilitation of injury : monitoring the rehab programme

Answer 33

The therapist should continually monitor the athlete’s progress by assessing: • pain • range of motion • swelling • heat • redness • ability to perform exercises and functional activities

Question 34

What are the different treatments for rehabilitation of injury

Answer 34

- stretching - massage - heat, cold and contrast therapies - anti inflammatory drugs - physiotherapy - surgery

Question 35

Rehabilitation of injury : treatments (stretching) why, benefits, recommendations & good treatment for

Answer 35

Range of movement around a joint is restricted by injury due to: • pain. • swelling. • shortened muscles. Stretching will restore the normal flexibility of the joint. • increases flexibility. • increases muscle relaxation. • decreases muscle soreness. • improves circulation. • Speeds up recovery process • precede stretching with an adequate warm up. • heat can be applied to the area before stretching • No stretching in early stage (first 3 days). Use PRICE. • Gentle static and passive stretching in mid stage • Late stage add PNF to static/ passive stretching to develop ROM Soft tissue injuries

Question 36

Define static stretching, dynamic stretching, PNF stretching in relation to rehabilitation of injury

Answer 36

static stretching - taking a joint just beyond its point of resistance and holding the position for up to 30 seconds. dynamic stretching - using a controlled movement, bounce or swinging motion to take a joint to the limit of its range of motion. PNF stretching - the most effective form of stretching involves taking a joint just beyond its point of resistance and performing an isometric contraction for 10 seconds. Relax the muscle and repeat 3 times.

Question 37

Rehabilitation of injury : treatments (massage) why, benefits, recommendations & good treatment for

Answer 37

• help treat soft tissue injuries. • reduce tension in the musculoskeletal system. • form part of an injury prevention programme. • realigns deeper layers of connective tissue. • reduces muscle pain. • breaks down scar tissue. • improves circulation and blood supply to area. • improves lymphatic draining to reduce swelling. • increases the rate of removal of harmful bi-products. • increases range of motion and flexibility. • not advisable in first 48 hours due to the risk of further damage or restarting bleeding. • can be used once inflammation has subsided. . • use firm pressure and massage across the line of the tissue as well as along it. • Do not use massage on bruising, ligament or tendon ruptures Soft tissue injuries

Question 38

Define massage and lymphatic drainage in relation to rehabilitation of injury + foam rollers

Answer 38

Massage - a manual therapy used in the assessment, treatment and management of soft tissue injury and pain. Also known as: soft tissue therapy. Lymphatic drainage - the carrying of waste products away from the tissues towards the heart. Foam rollers provide an opportunity for self treatment of soft tissue therapy or massage. A combination of foam rolling and stretching can improve flexibility and range of motion.

Question 39

Rehabilitation of injury : treatments (heat, cold, contrast therapies) benefits, risks, examples & good treatment for

Answer 39

HEAT - reduces muscle tension - provides pain relief - vasodilation of blood vessels - increases blood flow to injuries site - increases bleeding and swelling if applied in first 24 hours of acute injury - burns - warm shower or bath, heat packs, apply for 15 mins COLD (CRYOTHERAPY) • provides pain relief. • vasoconstriction of blood vessels. • decreases swelling. • ice burns. • superficial nerve damage. • PRICE • ice packs • ice wraps • Ice baths – for muscle soreness • Cryokinetics–Iceplusrehab exercises – good for ligament strains • Cryostretching ice plus stretching to decrease pain from muscle soreness CONTRAST • deceases swelling by alternating heat and cold. • provides pain relief. • increases blood flow to injured site. • increases bleeding and swelling if used in first 24 hours of acute injury due to heat phase. • burns. • hot bath to cold bath. • 4 minutes hot/1 minute cold. • repeat 3-7 times. • always finish with cold to encourage vasoconstriction. OVERALL GOOD TREATMENT FOR: • stress fractures. • dislocation. • sprain. • torn cartilage. • exercise induced muscle damage.

Question 40

Rehabilitation of injury : treatments (anti inflammatory drugs) benefits, risks, side effects, examples & good treatment for

Answer 40

Inflammation occurs at the site of an acute or chronic injury due to the release of chemicals and enzymes that initiate an inflammatory response. NSAIDs block these reactions and help inhibit the inflammatory response to reduce swelling. • can be detrimental to tissue repair as they can inhibit the natural healing process. Short term use: • rashes. • headache. • nausea. Long term use: • increased risk of cardiovascular complications. (e.g. heart attack.) • gastro-intestinal bleeding. Trade name Aspirin Ibuprofen Usual dose 650mg 400mg Daily dose 3-4 for both Good for all injuries

Question 41

What are NSAIDs in relation to rehabilitation of injury

Answer 41

medication widely used in the treatment in sports injuries that have analgesic and anti- inflammatory properties. Non Steroidal Anti Inflammatory Drugs

Question 42

Acute and chronic injury : what are the types of fracture

Answer 42

Simple (closed) fractures = skin is unbroken Compound (open) fractures = bone breaks through skin Transverse, spiral, comminuted, impacted, green stick, oblique

Question 43

Rehabilitation of injury : what is physiotherapy and what does it consist of + prehabilitation + Physiotherapy treatments for sporting injuries

Answer 43

Physiotherapy is the treatment of injury using practical methods, rather than drugs or surgery, and may consist of: ü Mobilisation of joints ü Electrotherapy to repair and stimulate tissue ü Exercise to strengthen muscles ü Massage to stretch and relax tissues, relieve pain and increase circulation Prehabilitation ü Posture and alignment training to release tension, minimise injury and maximise power output (performance) Physiotherapy treatments for sporting injuries: • PRICE • manual therapy including massage • heat, cold and contrast therapies • acupuncture • transcutaneous electrical nerve stimulation (TENS) • ultra-sound All these treatments will reduce pain and promote recovery. The chartered society of physiotherapy (regulatory board for physiotherapists)

Question 44

Rehabilitation of injury : extra knowledge about physio (what are physiotherapy, price, manual therapy, acupuncture, TENS, ultra sound

Answer 44

Physiotherapy - the use of manual therapy, education and advice to help people affected by injury, illness or disability. PRICE - the recommended response for managing acute soft tissue injuries during the first 24- 72 hours. Manual therapy - a broad group of treatments including massage where the physiotherapist applies force directly to the joint or muscle to restore pain-free full range of motion. Acupuncture - fine needles are inserted into specific points of the body. TENS - a small electrical device is used on the injured site that delivers a low electrical current, reducing pain messages to brain. Ultra sound - high frequency sound waves are used to treat deep tissue injuries by stimulating blood flow.

Question 45

Rehabilitation of injury : what are Arthroscopic surgery and Open surgery

Answer 45

Arthroscopic surgery - a type of keyhole surgery used both to diagnose and treat joint injuries. Also called an arthroscopy. An arthroscope is a thin metal tube that contains a light source and camera that sends images to a screen. Tiny surgical instruments can be used alongside an arthroscope to allow surgeon to treat joint injuries. Open surgery - A traditional type of surgery where a long incision is made in the skin for the surgeon to see the structures underneath and teat the injury by inserting the instruments.

Question 46

Rehabilitation of injury : treatments (surgery) why, types of, good treatment for

Answer 46

Despite many advances in the non-operative management of sports injuries, surgery has a major role to play in both acute and chronic injuries. It is used to: • remove damaged tissue. (e.g. removal of the damaged flap of tissue after a meniscus tear.) • reconstruct damaged tissue. (e.g. reconstruction of the anterior cruciate ligament (ACL) using the patellar tendon or a tendon from the hamstring.) • realign damaged tissue. (e.g. reduction of the shoulder joint following a dislocation to realign the bones.) Sports surgery can be classified as arthroscopic surgery or open surgery. Arthroscopic surgery has some potential benefits over open surgery: • only involves minor cuts to the skin. • less pain after operation. • faster healing time. • lower risk of infection. • athlete can go home the same day as the surgery. • athlete may be able to advance through the 4 stages of rehabilitation more quickly. Arthroscopic surgery is mainly used to view and treat joint injuries. The surgeon will look at: • the articular surfaces of the bones. • the surrounding ligaments and tendons. • the meniscus. The surgeon can treat: • torn cartilage by removal of the torn part. • sprained ligaments • by repairing the damage in a grade 1 or grade 2 tear. • by reconstructing the ligaments in a grade 3 tear Open surgery is used to treat bone fractures and joint injuries. The surgeon will aim to recreate the pre- injury anatomy by repairing the damaged tissue. The surgeon can treat: • an unstable fracture by placing a metal plate, rod or pins in the bone. sprained ligaments • by repairing the damage in a grade 1 or grade 2 tear. • by reconstructing the ligaments in a grade 3 tear Good for Stress fractures Dislocation Serious sprain Serious torn cartilage

Question 47

Rehabilitation of injury : common sporting injuries (define Exercise induced muscle damage and eccentric exercise)

Answer 47

Exercise induced muscle damage (also known as delayed onset of muscle soreness (DOMS).) - Pain experienced after intense exercise due to microscopic tears in the muscle fibres that cause swelling and pain. It peaks between 24-72 hours post event.. Eccentric exercise - Exercise that involves eccentric contraction of the muscle where it lengthens under tension. e.g. running downhill, plyometric work.

Question 48

Rehabilitation of injury : exercise induced muscle damage (what, symptoms, treatment, factors to reduce it) and 6 treatments of sports injuries

Answer 48

• the mildest type of muscle damage. • causes muscle soreness 1-3 days after exercise. • more severe after eccentric exercise. • usually disappears without treatment by 5-7 days. • Stiffness. • soreness. • usually disappears without treatment by 5-7 days. • relatively mild inflammation so does not need anti-inflammatory drugs. • cool-down. • massage. • active non-weight-bearing exercise. • hydrotherapy. • heat, cold, contrast therapies. 1. stretching. 2. massage. 3. heat, cold and contrast therapies. 4. anti-inflammatory drugs. 5. physiotherapy. 6. surgery.

Question 49

Rehabilitation of injury : complete the table on the injuries (describe, sign/symptoms, potential causes, treatment)

Answer 49

On Showbie (rehab of injury)