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Chapter 8: Sports InjuriesOutline:

• Biomechanical principles of injury• Injury treatment and rehabilitation• Pain: nature’s warning system• Soft tissues injuries• Dislocations• Fractures• Concussions• Overuse injuries• Injury prevention

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4 Tissue Types:

Each type of tissue possesses unique mechanical Each type of tissue possesses unique mechanical characteristicscharacteristics

Epithelial Muscle Connective Nervous

BIOMECHANICAL PRINCIPLES OF INJURY

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Loading

• To best understand the biomechanical characteristics of tissue we examine its behaviour under ______________________

• Under load a ____________________________

• This change in shape (deformation) can be visualized through in the _________________________

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A

C

B

Deformation LargeSmall

Loa

dHigh

Low

Load Deformation Curve

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A

C

B

Elastic Region

Plastic Region

Ultimate Failure

Elastic Limit

Deformation LargeSmall

Loa

dHigh

Low

6

A

C

B

Elastic Region

Plastic Region

Ultimate Failure

Elastic Limit

Deformation LargeSmall

Loa

dHigh

Low

7

A

C

B

Elastic Region

Plastic Region

Ultimate Failure

Elastic Limit

Deformation LargeSmall

Loa

dHigh

Low

8

A

C

B

Elastic Region

Plastic Region

Ultimate Failure

Elastic Limit

Deformation LargeSmall

Loa

dHigh

Low

If load continues to increase to ‘C’Macro- or complete failure

(e.g. torn ligament)

Tissue becomes completelyunresponsive to loads

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A

C

B

Elastic Region

Plastic Region

Ultimate Failure

Elastic Limit

Deformation LargeSmall

Loa

dHigh

Low

Area under the curve =

Slope =

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Tissues Response to Training Loads

1. Training load ____ elastic limit (B)– Positive training effect– Micro-failure

– the microscopic injuries cause temporary muscle soreness and weakness therefore need a rest period (e.g. a day off)

2. Training load ___ elastic limit– Negative training effect – More severe

*related to principles of training: overload (FITT), stress-rest intervals, overtraining

*optimal training occurs when tissue is stressed________________________

________________________________

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Forces Acting on Tissue

(pull) (squeeze) (twist)

Other terms: Valgus: outward angulation (of distal part away from midline)

Varus: inward angulation (..toward midline)

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• Injury Treatment– Received by patient from a health care

professional------

versus

• Injury Rehabilitation– Therapist’s restoration of injured tissue– patient's __________________– ______________________________– E.g. Athletic therapist (AT), Physiotherapist

(PT), Occupational Therapist (OT), Massage Therapist (MT), Chiropractor, etc.

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Inflammatory Response Phase (hours - 2 to 4 days)

• Inflammation begins at the time of injury

• Signs-----

• Treatment (PRICE) - Protect - Rest - Ice (Cryotherapy-Decreases

swelling, bleeding, pain, spasms)

- Compression (decreases swelling)

- Elevation (above level of the heart to return blood to heart and decrease swelling etc)

Healing PhasesHealing Phases::

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Fibroblastic Repair Phase (hours – 6 weeks)

• Injured tissue repair and scar formation

• Granulation ______________________

• _________ fibres are deposited by fibroblasts

• Signs seen in the phase1 subside

Treatment• Rehab-specific

exercises– Restore range of motion

and strength

• Manual massage (friction)

therapy and ultrasound– Help _____________

• Protective _________ _______________

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Maturation-Remodeling Phase

• Remodeling or ________________________ • Treatment:• More aggressive ______________________

– To organize the scar tissue along the lines of tensile stress

• Include sport-specific skills and activities

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PainPainPainPain

Pushing injured Pushing injured tissue closer to tissue closer to yield-level pointyield-level point

Pushing injured Pushing injured tissue closer to tissue closer to yield-level pointyield-level point

GastrointestinalGastrointestinalcomplicationscomplications

GastrointestinalGastrointestinalcomplicationscomplications

Pain•Nature’s way of telling us something is wrong•One of the best indicators of when the athlete is ready to resume activity

Inability to participate at optimal level or at all

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Injury Types:Overuse: • Progressive _____________________________________• Heals slowly (months)

_________:• Caused by abrupt force• Heals quickly

__________:• Repeated damage & inflammation due to neglected or

mistreated overuse or acute injuries• Accumulation of chronic _______________• Painful for tissue, pain-sensitive nerve endings• Heals slowly (years if un/mistreated)

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A: Soft Tissue Injuries:

1._____________ (a.k.a. Bruise)• Compressing force crushes tissue• E.g. “charleyhorse” – quadriceps• _____________________________• ______________ = severe pooling of

blood in bruise• Can be life-threatening if in vital organs

• Signs:______________________• Treatment: P-R-I-C-E• Myositis ossification – ____________

_______________________________

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____________

Tendon or muscle tissue is stretched

or torn

____________

_________or the joint capsule is stretched or

torn

2.Sprains and Strains

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Grades of sprains and strains

GRADE 1 (1st degree, mild) • Slightly stretched or torn; few muscle fibres (< ____% of fibres)• Signs:_______________________, no limitation of muscle mobility

or joint range of motion (ROM)

GRADE 2 (2nd degree, moderate)• Stretch or tear more muscle fibres (___________% of fibres)• Signs: tenderness,____________________, some limitation of

muscle mobility or joint ROM

GRADE3 (3rd degree, severe)• Stretch or tear ____________% of fibres (complete rupture)• Signs: severe tenderness, swelling, bruising, __________________

of muscle mobility/ROM, gap in tissue can sometimes be felt in complete rupture

• ______________________*See page 176 in text

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Common Strains

_____________ Adductors _____________ Hamstrings ________________

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• Occurs when great enough forces push the joint beyond its normal anatomical limits

a) _____________________: Joint surfaces come completely apart

e.g. ball of joint is forced out of socket as in a shoulder

b) ______________________(subluxation): When supporting structures (e.g. ligaments) are

stretched or torn causing bony structures to partially separate (i.e. pops out then pops in)

• Most common in finger, shoulder• Can become chronic

B: Dislocations:

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1. _____________________– Stays within the surrounding soft tissue

2. Compound (open) fracture– _____________________

3. ____________ fracture– Results from repeated low magnitude

loads (e.g. runners who overtrain)– Begins as a _________________

___________________________ – With continued use=weakened bone,

complete cortical bone fracture4. Avulsion fracture

– Involves tendon or ligament __________ _________________________________

C: Fractures: A crack, break or complete shattering of a bone

elbow

Compound fracture

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E: Overuse Injuries• Due to

– Repeated and accumulated microtrauma– Non-sufficient recovery

• Results from– _________________– __________________– ___________________– ___________________

*Note: words that end in “itis” = inflammationof the body part due to repetitive microtrauma (overuse)

e.g. stress fractures, tendonitis, bursitis

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• Symptoms– Pain (aggravated by movement)– Tenderness– Stiffness near joint

1. Tendonitis:1. Tendonitis: Inflammation of _____________________________________________________________

TendonitisTendonitis

))

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Injury Prevention: Injury Prevention:

1.

2.

- sport-specific activities

3.

-especially during off-season

-include flexibility activities

4.

5.

- Avoid overtraining

-Get proper sleep

-Cross-train in off-season