Injuries and the Healing ProcessInjuries and the Healing Process

Olympic High School Sports Olympic High School Sports MedicineMedicine

Chapter 12,13Chapter 12,13

Vocabulary Chapter 13Vocabulary Chapter 13

RICERICE MuscleMuscle TendonTendon DOMSDOMS MyositisMyositis FasciitisFasciitis Ectopic calcificationEctopic calcification CreptitationCreptitation SynoviaSynovia ArticulationArticulation OsteochondrosisOsteochondrosis ApophysisApophysis

OsteoblastsOsteoblasts OsteoclastsOsteoclasts Wolff’s lawWolff’s law CallusCallus MechanoreceptorsMechanoreceptors Muscle guardingMuscle guarding Trigger pointTrigger point Open fractureOpen fracture Closed FractureClosed Fracture

Types of InjuriesTypes of Injuries Strains/SprainsStrains/Sprains Grade 1Grade 1- - slight stretch but no deformity, slight stretch but no deformity,

mild to mod. Pain, localized swellingmild to mod. Pain, localized swelling Grade 2Grade 2- some tearing of fibers, mod. - some tearing of fibers, mod.

Instability, mod. Severe pain, swelling Instability, mod. Severe pain, swelling Grade 3Grade 3- total rupture, major instability, - total rupture, major instability,

severe pain at first then little or no pain, severe pain at first then little or no pain, swelling is greatswelling is great

ContusionContusion Bruise, hematoma, ecchymosisBruise, hematoma, ecchymosis TendinitisTendinitis: inflammation of tendon: inflammation of tendon Overuse injury, pain, swelling, crepitusOveruse injury, pain, swelling, crepitus BursitisBursitis: inflam. Of bursa: inflam. Of bursa Swelling, pain, increased pressureSwelling, pain, increased pressure Wound Injuries:Wound Injuries:blister, abrasion, blister, abrasion,

laceration, skin avulsion, incision, puncturelaceration, skin avulsion, incision, puncture

Tenosynovitis:same as tendonitis but inflamed tendon/synovial sheath.

Types of Injuries continued: fracturesTypes of Injuries continued: fractures

Types of Injuries continuedTypes of Injuries continued Muscle Cramps/spasmMuscle Cramps/spasm: muscle contraction/tightness due to fatigue : muscle contraction/tightness due to fatigue

or injuryor injury Myositis Ossificans:Myositis Ossificans: calcification of muscle due to excessive calcification of muscle due to excessive

bleeding.bleeding. Dislocation:Dislocation: complete displacement of bone with the joint complete displacement of bone with the joint Subluxation:Subluxation: partial displacement of bone with the joint partial displacement of bone with the joint Epiphyseal Injuries:Epiphyseal Injuries: growth plate injuries. Salter fractures for growth plate injuries. Salter fractures for

epiphyseal fracturesepiphyseal fractures Nerve Injuries:Nerve Injuries:

– Hypoesthesia:Hypoesthesia: a diminished sense of feeling a diminished sense of feeling– Hyperesthesia:Hyperesthesia: an increased sense of feeling such as pain or touch an increased sense of feeling such as pain or touch– Paraesthesia:Paraesthesia: numbness, prickling, or tingling, which may occur from a numbness, prickling, or tingling, which may occur from a

direct blow or stretch to an areadirect blow or stretch to an area Kyphosis:Kyphosis: round back, forward-thrust head, winged scapulae, flat round back, forward-thrust head, winged scapulae, flat

chest. Tight pectoral muscleschest. Tight pectoral muscles Lordosis:Lordosis: sway back or hollow back. Tight lower back muscles with sway back or hollow back. Tight lower back muscles with

weak abdominal muscles. Lineman or gymnasts most susceptible. weak abdominal muscles. Lineman or gymnasts most susceptible. Scoliosis:Scoliosis: lateral curvature of the spine lateral curvature of the spine Genu Valgum:Genu Valgum: knock knee knock knee Genu VarumGenu Varum: bowleg: bowleg

How do injuries happen?How do injuries happen?

What are the What are the possible possible injuries that injuries that can happen can happen in this slide?in this slide?

Mechanical Forces and StrengthsMechanical Forces and Strengths

Compression Force: Compression Force: A A force that with enough energy force that with enough energy crushes tissue. A contusion crushes tissue. A contusion occurs if too much force is occurs if too much force is appliedapplied

Tension ForceTension Force: a force that : a force that pulls and stretches tissue. pulls and stretches tissue. Sprains/strains, avulsions, Sprains/strains, avulsions, rupturesruptures

Shearing Force:Shearing Force: a force a force that is transverse to fibers. that is transverse to fibers. sprainssprains

Example of injuriesExample of injuries

PainPain

– Two types of sorenessTwo types of soreness» Acute-onset muscle soreness - accompanies fatigue, and is Acute-onset muscle soreness - accompanies fatigue, and is

transient muscle pain experienced immediately after transient muscle pain experienced immediately after exerciseexercise

» Delayed-onset muscle soreness (DOMS) - pain that occurs Delayed-onset muscle soreness (DOMS) - pain that occurs 24-48 hours following activity that gradually subsides (pain 24-48 hours following activity that gradually subsides (pain free 3-4 days later)free 3-4 days later)

Potentially caused by slight microtrauma to muscle or Potentially caused by slight microtrauma to muscle or connective tissue structuresconnective tissue structures

– Prevent soreness through gradual build-up of Prevent soreness through gradual build-up of intensityintensity

– Treat with static or PNF stretching and ice Treat with static or PNF stretching and ice application within 48-72 hours of insultapplication within 48-72 hours of insult

Muscle StiffnessMuscle Stiffness– Does not produce painDoes not produce pain– Result of extended period of workResult of extended period of work– Fluid accumulation in muscles, with slow Fluid accumulation in muscles, with slow

reabsorbtion back into bloodstream, resulting in reabsorbtion back into bloodstream, resulting in swollen, shorter, thicker muscles --resistant to swollen, shorter, thicker muscles --resistant to stretching.stretching.

– Light activity, motion, massage and passive Light activity, motion, massage and passive mobilization assists in reducing stiffnessmobilization assists in reducing stiffness

VocabularyVocabulary

VasoconstrictionVasoconstriction VasodilationVasodilation RegenerationRegeneration PhagocytosisPhagocytosis SerumSerum Synthesis/lysisSynthesis/lysis CryokineticsCryokinetics ModalityModality ConductionConduction ConvectionConvection ConversionConversion

Inflammatory ResponseInflammatory Response

Occurs first for 3-4 daysOccurs first for 3-4 days Swelling, redness, pain, heat, loss of function.Swelling, redness, pain, heat, loss of function. This occurs to protect the bodyThis occurs to protect the body

Acute InflammationAcute Inflammation-- Before inflammation begins intact blood vessels Before inflammation begins intact blood vessels

vasoconstriction up to 10 minutesvasoconstriction up to 10 minutes Then blood coagulation begins to seal broken Then blood coagulation begins to seal broken

vesselsvessels Then vasodilatation- blood viscosity increases Then vasodilatation- blood viscosity increases

slowing blood flow and swelling then serum slowing blood flow and swelling then serum seepage 15-30 min.seepage 15-30 min.

Phagocytosis starts to clean out debrisPhagocytosis starts to clean out debris Internal swelling: 1. Throboplastin is sent 2. Internal swelling: 1. Throboplastin is sent 2.

Thromboplastin and calcium is sent. 3. Thrombin Thromboplastin and calcium is sent. 3. Thrombin to fibrinogen into final fibrin clotto fibrinogen into final fibrin clot

Inflammatory ResponseInflammatory Response Repair Phase- Repair Phase-

Fibroplastic(Fibroplastic(scar formation)scar formation) RegenerationRegeneration Regrowth of lost cellsRegrowth of lost cells Last up to 3 weeks following Last up to 3 weeks following

injuryinjury Primary healing- heal around Primary healing- heal around

edgesedges Secondary healing – gaps Secondary healing – gaps

heal toward each otherheal toward each other RemodelingRemodeling Increase scar tissue first 3 Increase scar tissue first 3

weeksweeks Last 3 months to a yearLast 3 months to a year

Factors that impede Factors that impede healinghealing

1. Extent of the injury1. Extent of the injury 2. Edema/hemorrhage2. Edema/hemorrhage 3. Poor vascular supply3. Poor vascular supply 4. Separation of tissue4. Separation of tissue 5. Muscle spasm5. Muscle spasm 6. Atrophy6. Atrophy 7. Infection7. Infection 8. age8. age

Pain PerceptionPain Perception

PainPain-- Is described by: burning, sharp, dull, aching, tinglingIs described by: burning, sharp, dull, aching, tingling Deep pain is different than superficial painDeep pain is different than superficial pain

– HowHow

Psychological aspects of PainPsychological aspects of Pain Must treat the whole athleteMust treat the whole athlete Personality differences plays a role in pain perceptionPersonality differences plays a role in pain perception

Referred PainReferred Pain-- Visceral pain has a tendency to radiate and give rise to pain that Visceral pain has a tendency to radiate and give rise to pain that

becomes referred to skin’s surfacebecomes referred to skin’s surface

COLD AND HEATCOLD AND HEAT

Types of cold:Types of cold: Ice bag, ice massage, ice boot, cold whirlpool, ice bucket, chemical Ice bag, ice massage, ice boot, cold whirlpool, ice bucket, chemical

sprayspray

Physiological effects of coldPhysiological effects of cold Decrease in local temperature up to 4”Decrease in local temperature up to 4” Vasoconstriction of capillaries w/in first 15-20 min., vasodilation 5 Vasoconstriction of capillaries w/in first 15-20 min., vasodilation 5

min., vasoconstriction 20 min. (Hunting effect)min., vasoconstriction 20 min. (Hunting effect) Decrease local cell metabolismDecrease local cell metabolism Decrease blood flowDecrease blood flow Decrease nerve velocityDecrease nerve velocity Decrease excitability of muscleDecrease excitability of muscle Analgesic effect (numb) which will decrease spasmAnalgesic effect (numb) which will decrease spasm

Cold and Heat cont.Cold and Heat cont.

Types of heatTypes of heat Conduction-transmission of heat between two objectsConduction-transmission of heat between two objects Convection-heat produced by a moving mass(gas or liquid)Convection-heat produced by a moving mass(gas or liquid) Conversion-heat by electrical currentConversion-heat by electrical current Radiation- ultraviolet lightRadiation- ultraviolet light Physiological effects of heatPhysiological effects of heat Increase elasticity of muscles & tendons Increase blood flow- vasodilation Decrease spasm Increase local cell metabolism Increase excitability of muscle Increase temp. to 3mm depth

Indications of coldIndications of cold Acute traumaAcute trauma Anti-inflammatoryAnti-inflammatory Decrease painDecrease pain Decrease spasmDecrease spasm Post exercisePost exercise Prior to therapyPrior to therapy

ContraindicationsContraindications Before or during activitiesBefore or during activities Hyper/hypo sensitive to coldHyper/hypo sensitive to cold Circulatory inefficiencyCirculatory inefficiency

Indications of heatIndications of heat Post acute phasePost acute phase Decrease spasmDecrease spasm Decrease painDecrease pain Help wound healingHelp wound healing Prior to exercisePrior to exercise

ContraindicationsContraindications Acute injuriesAcute injuries Hyper/hypo sensitive to heatHyper/hypo sensitive to heat Circulatory problemsCirculatory problems

Different ModalitiesDifferent Modalities Heat TherapiesHeat Therapies

Short-wave diathermy:Short-wave diathermy: High frequency electrical current.High frequency electrical current.Used for: bursitis, capsulitis, osteoarthritis, spasm, strainsUsed for: bursitis, capsulitis, osteoarthritis, spasm, strainsHeat depth= up to 2 inchesHeat depth= up to 2 inches

Ultrasound:Ultrasound:High frequency sound waves causes molecules to vibrate and warmHigh frequency sound waves causes molecules to vibrate and warmUsed for: joint contractures, scar tissue, tendonitis, bursitis, skeletal Used for: joint contractures, scar tissue, tendonitis, bursitis, skeletal

muscle spasm, and painmuscle spasm, and pain Paraffin bath:Paraffin bath:

Hot wax used for extremities especially the hand.Hot wax used for extremities especially the hand. Massage Techniques:Massage Techniques: Effleurage- stroking, Petrissage- kneading, friction-heat, tapotement- Effleurage- stroking, Petrissage- kneading, friction-heat, tapotement-

percussion, vibration-rapid shakingpercussion, vibration-rapid shaking

Contrast Baths and other Contrast Baths and other ModalitiesModalities Hot and cold modalityHot and cold modality Physiological effects:Physiological effects: Same as heat/coldSame as heat/cold Flushing affect. Brings in new material for repair and flushes out Flushing affect. Brings in new material for repair and flushes out

edemaedema When should you use contrast bath?When should you use contrast bath?

– When swelling has subsided (48-72 hours)When swelling has subsided (48-72 hours)

Time interval for treatmentsTime interval for treatments 4 min. cold then 1 min hot 4 times end in cold= 24 min.4 min. cold then 1 min hot 4 times end in cold= 24 min. 3 min. cold then 2 min hot 4 times end in cold= 23 min3 min. cold then 2 min hot 4 times end in cold= 23 min 2 min. cold then 3 min hot 4 times end in hot= 20 min2 min. cold then 3 min hot 4 times end in hot= 20 min 1 min. cold then 4 min hot 4 times end in hot= 20 min1 min. cold then 4 min hot 4 times end in hot= 20 min Or 5 min. cold/ 5 min. hotOr 5 min. cold/ 5 min. hot

Treatment times and TemperaturesTreatment times and Temperatures

Ice bag, ice boot, ice whirlpool (Ice bag, ice boot, ice whirlpool (55-65 55-65 degreesdegrees) - ) - 20 min.20 min.

Ice massage Ice massage 5-10 min.5-10 min. Warm whirlpool (Warm whirlpool (97-102 degrees97-102 degrees), moist ), moist

heat pack –heat pack –10 min.10 min. Ultrasound- Ultrasound- 5-7 min.5-7 min. Muscle stim- Muscle stim- 10-20 min.10-20 min.