SPORTS MEDICINE OPTION 3 HOW ARE SPORTS INJURIES CLASSIFIED AND MANAGED?

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1 SPORTS MEDICINE OPTION 3 HOW ARE SPORTS INJURIES CLASSIFIED AND MANAGED? WAYS TO CLASSIFY SPORTS INJURIES DIRECT AND INDIRECT: Direct: Injury is caused by an external blow or force generated outside the body Causes of direct injuries: collisions (e.g. a tackle), being struck (e.g. a cricketball) Injuries that could result include: haematomas, bruises, joint damage, ligament damage, dislocations, fractures. Indirect: Injury caused by an intrinsic force within the body Injury can occur distance from impact site e.g. fall on outstretched arm and dislocate shoulder Injury occurs as a result of internal forces, built up by actions of performer e.g. overstretching due to fatigue, poor technique, lack of fitness. HARD AND SOFT TISSUE: Soft: Includes all injuries apart from bones and teeth. Includes damage to muscles, tendons, ligaments, cartilage, skin, nerves, organs. Most common type sports injury Treated through RICER --> in order to limit scar tissue build up, very stiff and rigid and therefore hard to get rid of/ go back to how it was. Examples include: skin injuries (abrasions and lacerations), muscle injuries (tears, strains, contusions), tendon injuries (tears, strains, inflammation), Ligament injuries (tears and strains). Hard: injuries that involve damage to bones of skeleton and teeth. Includes fractures, dislocations, bruising. Internal bleeding can result. Secondary Injuries: Injuries that occur as a result of a previous injury. Return to play before fully recovered Full ROM and strength gained prior to returning to play. OVERUSE: Injury is a result of intense or unreasonable use of joints or body areas. Change in training practices (increased intensity) and body unable to deal with the increased stress. Due to incorrect technique Repetitive force e.g. shin splints, tennis elbow, stress fractures. SOFT TISSUE INJURIES TEARS, SPRAINS, CONTUSIONS TEARS: Disruption of the fibres of a muscle or a tendon.

2 Tiny tears are known as strains or sprains. A tear can be classified as mild to severe Strains occur when muscles or tendons are overstretched or contract too quickly SPRAINS: A tear of the ligament, supporting the joint. A sprain results when a joint is extended beyond its normal range of movement. Limited blood supply healing slow. CONTUSIONS: Caused by bleeding into the soft tissue. Also known as a bruise Often caused by direct blows or collisions. Severe can form a haematoma blood clot. SKIN ABRASIONS, LACERATIONS, BLISTERS SKIN ABRASIONS: involves skin being scraped and shallow bleeding occurring needs to be cleared with warm soapy water. LACERATIONS: A wound where the flesh is irregularly torn or cut. BLISTERS: Caused by a collection of fluid below or within the epidermal layer of the skin. May contain clear fluid or blood Occur due to new equipment, old equipment, friction. Calluses are increased thickness of the skin caused by constant pressure e.g. gripping a bat. INFLAMMATORY RESPONSE Without RICER the inflammatory response is much worse resulting in a longer time injured.

3 3 phases to the Inflammatory response: 1. The Inflammatory Stage: Pain, redness, swelling Loss of movement and function Damage to cells and surrounding tissue Increased blood flow to the area Leakage of fluid causing swelling (oedema) excess of watery fluid collecting in cavities or tissue protective mechanism Formation of blood cells to promote healing. 2. Repair and Regenerative Stage (3-6 days) Elimination of debris Formation of new fibres Production of scar tissue sticky substance almost like glue collagen type of protein in the body. 3. Remodelling Stage (6 weeks many months) Increased production of scar tissue Replacement tissue that needs to strengthen and develop in the direction that the force is applied. Type of remodelling varies according to the time and degree of mobilisation of the injury Excessive exercise too early will cause further damage Too little = large amounts scar tissue build up, lack strength and flexibility Immediate treatment of soft tissue injuries: Reduce swelling Prevent further damage Ease pain Long term treatment aims to: Restore flexibility Regain full function Prevent recurrence Return to play ASAP No HARM principle: First hours to ensure quickest recovery HEAT: avoid any type of heat to injured area increase blood flow to the site and increase bleeding and swelling ALCOHOL: alcohol will dilate blood vessels and increases blood flow to injured site increased swelling. Can also numb the area and may make person believe not as bad as it is distorts pain response. RUNNING: Any vigorous form of physical activity will increase blood flow to the injured site and further damage the injured part MASSAGE: An increase in blood flow occurs when the body part is massaged and therefore will contribute to increased swelling and bleeding.

4 MANAGING SOFT TISSUE INJURIES: Ricer: REST: depends on severity. Remain inactive for hours. Used to reduce bleeding and prevent further damage. ICE: used to reduce pain, blood flow, swelling enzyme activity, spasm and tissue demand for oxygen. Ice causes blood vessels to constrict and thus decrease circulation. Apply crushed ice in a wet towel to injury and surrounding area for 20-30mins every 2hours for the first hours. COMPRESSION: reduces swelling by limiting the fluid build up. Uses an elastic bandage around the injury and surrounding site. Compression needs to be applied for a minimum of 24 hours. ELEVATION: helps to decrease bleeding, reduce swelling and throbbing. Elevate the injured site above heart level (or pressure point) for the next hours. REFERRAL: Seeking medical advice will help to understand the nature and extent of the injury and can help provide a rehabilitation program. HARD TISSUE INJURIES FRACTURES: Result of a simple break in the bone Direct, indirect or repetitive impact Simple/ closed: bone is fractured but skin is intact Compound/ open: a jaggered end of the bone cuts through the skin and protrudes, or there is a cut at the site of the fracture. Visible bleeding and risk of infection is high. Complicated: fractured bone damages the local tissues (e.g organ) Stress fractures: small incomplete bone breaks caused by repeated pounding. Signs and symptoms: Pain at site Inability to move injured part/ unnatural Deformity Swelling/ bruising Grating sound from bones when moving Management:

5 Minimise movement Immobilisation of joints above and below useful Should be supported by a splint 1. DRSABCD 2. Control bleeding, treat shock 3. Immobilise area/ use splint and bandage 4. Obtain medical help 5. Serious help needed if obvious deformity, uncontrolled bleeding, can t complete TOTAPS DISLOCATION: displacement of the bone at the joint Never attempt to relocate displaced bone medical professional Apply ice and seek medical aid Finger dislocations common Subluxation: occurs when bone pops out and then back in again ligament damage rehab ASSESSMENT OF INJURIES TOTAPS (TALK, OBSERVE, TOUCH, ACTIVE AND PASSIVE MOVEMENT, SKILLS TEST) T TALK Questions: How did injury happen Where does it hurt Hear snaps/ cracks Pins and needles Sharp or dull pain If you cannot obtain information or a concussion is possible seek immediate medical aid. O OBSERVE Visually examine the injure and compare to non-injured side if possible. Deformity Swelling Redness If there is an obvious deformity seek immediate medical assistance T TOUCH Gently feel the injured area for sign of deformity. Determine the area of tenderness/ pain. Compare with opposite side of body and determine if there is: Temperature change Change in bone shape Observe the players response to determine the extent of pain. If there is evidence of a fracture or dislocation stop and seek immediate medical aid and immobilise the injured area. A ACTIVE MOVEMENT Ask the player to attempt to move the injured part. Observe degree of pain and ROM. Check for clicking or grating when moving. If there is minimal or non-existent movement apply RICER and seek immediate medical assistance. P PASSIVE MOVEMENT At this stage unlikely to be serious. Move injured limb to determine how much movement is pain free and possibility of returning to play.

6 If movement causes pain apply RICER S SKILLS TEST Once standing have the player place pressure on the injured site by performing movements similar to the game. Only when these actions can be completed can the player return to the game.

7 HOW DOES SPORTS MEDICINE ADDRESS THE DEMANDS OF SPECIFIC ATHLETES? CHILDREN AND YOUNG ATHLETES MEDICAL CONDITIONS: Nature of condition How can exercise affect this condition? ASTHMA EPILEPSY DIABETES Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. A condition characterized by breathing difficulty where there is a reduction in the width of the airways leading to the lungs, resulting in less air being available to them. 1/10 people have asthma. Symptoms are breathlessness, wheezing, chest tightness and coughing. Causes are genetics, eczema, hay fever and external chemicals/smoke. Should not be an excuse to avoid participation Exercise-induced bronchospasm or EIB: When you exercise air that comes through your mouth has not been filtered air that gets to your airways is cooler and drier than usual. If you have asthma, your extra-sensitive airways don't like cool dry air. airways react Tighter airways mean there is less space for the air to pass through. It is extremely rare for a person to have a seizure while exercising. Rather than triggering seizures, your epilepsy may improve with exercise. abnormalities on EEG (a test that measures the electrical activity of the brain) decrease during exercise. Overall fitness and a feeling of wellbeing help reduce seizure frequency. Most sports activities are safe as long as people avoid overexertion, dehydration and hypoglycaemia (low blood sugar). If a seizure occurs, it is most likely to be after the exercise (15 minutes to three hours later). Type 1 diabetes is an auto-immune condition occurs when the pancreas does not produce insulin. The most common type is type 2 diabetes Caused by bodies inability to produce sufficient insulin or use it efficiently This condition leads to high blood glucose levels Physical activity causes blood glucose to drop and if the child s blood glucose level falls too low this can cause hypoglycemia

8 Precautions in engaging in exercise How is this condition managed? Keep asthma medications with you when exercising Check your asthma is under control before partaking, Make sure you understand how to use a puffer Warm up and cool down properly Protect yourself from asthma triggers, e.g. air quality, allergies, temperature, humidity Know steps to take when asthma triggers occur take medication according to your doctor s directions Drink plenty of water before, during and after exercise Don t push yourself to the point of physical exhaustion If you are feeling very hot and tired, slow down or stop Make sure you have at least two rest days every week Make sure your diet is nutritionally adequate Get plenty of rest and good quality sleep Limit or abstain from alcohol Collision sports avoided. supervisors present and know what to do if a seizure occurs. swimming alone, scuba diving and rock climbing completely avoided Therefore extra carbohydrates e.g. Gatorade before activity, check blood glucose before, during and after and have a prepared kit of snacks, glucose tablets, fruit juice, water and any medication Good meal beforehand - pregame meal to raise blood sugar levels and hourly glucose supplementation Type 1 diabetes managed with insulin injections/ insulin pump Diabetes check ups OVERUSE INJURIES: until age 11/12 boys and girls similar levels of strength and body proportions during period of growth bones grow significantly, muscle mass increases injuries in adolescents related to growth imbalances bones can grow quicker than muscles and tendons (painful) growth plate never damaged can cause severe growth problems later on How to prevent: o Do not overtrain o Play a number of sports o Exercise in variety of positions o Appropriate conditioning o Appropriate stretching E.g. stress fractures, runners knee, Achilles tendonitis, and shin splints.

9 THERMOREGULATION: the process that allows the body to maintain temperature. Action of the hypothalamus in the brain in responding to changes in body temperature and initiating appropriate mechanisms (ie sweating). Children less metabolically efficient than adults. Children have larger surface area to body sixe Less fluid Sweat glands less developed Less muscular development than adults Do not have mental alertness just don t think about it 3-5x more likely to suffer overheat/ heat exhaustion more prone to dehydration and extremes in temperatures Hyperthermia- too cold. Hypothermia too hot. How to avoid: o Not exercise for long periods of time in extreme weather conditions o Encouraged to drink water frequently o Wear appropriate clothing APPROPRIATENESS OF RESISTANCE TRAINING: Can participate in some Strength is an important component if all sports, the growth plate is an important consideration so as to not damage this area. Maximum lifting avoided Must be supervised Correct technique Overall muscle groups Using own body weight e.g. pull ups, push ups Light weight, high reps, correct technique. ADULTS AND AGED ATHLETES: Exercise programs should aim to develop strength, flexibility, aerobic capacity and coordination all can improve functional capacity HEART CONDITIONS Can include high BP, weak heart, narrow arteries, heart disease, heart attack Lungs also affected Decreasing Decreased ability to carry oxygen breathing harder during exercise Exercise benefit if implemented correctly reduce BP by average 11 systolic and 9 diastolic points Needs to be combined with low fat and low salt diet Need to get medical clearance prior stress test Supervision at an early stage

10 60-75% max Adequate time and rest older fatigued more quickly Aerobic exercise best e.g. swim, walk, cycle Modified strength programs no heavy weights, more reps, light loads, major muscle groups. Key considerations: medical clearance, progress gradual, mod intensity only, tailored individual tastes, sustainable program, never exercise to point of pain, don t exercise when too hot. FRACTURES/ BONE DENSITY Bones that are more brittle and less dense fracture more easily as a result of falls, impact from other players, or sudden muscle contractions. Stress fractures reduced calcium Osteoporosis females (loss of minerals during menopause) Osteoporosis- deterioration of bones due to lack of mineral content Exercise will increase bone mass and make bones stronger Inactivity encourages depletion of calcium from the bone, making it weaker. Focus on physical fitness, balance, strength, coordination, aerobic capacity, flexibility, postural retraining. Risk of fall assessed and avoided. High loads avoided and resistance decreased FLEXIBILITY/ JOINT MOBILITY Decreases with age because of loss of elasticity in tendons, ligaments, and muscles. Effort needs to be made to keep joints supple so full ROM is possible and tasks performed efficiently Regular gentle and slow stretching Swimming Can get arthritis, tight muscles, aching as a result of lack of Programs need to be low impact, specific to person s limitations, consider existing medical conditions that may limit movement. Goals to improve QOL by increasing aerobic endurance, increasing strength, increasing energy levels, increasing balance and coordination, increasing flexibility, maintaining weight. FEMALE ATHLETES Special dietary needs: increased iron (periods), increased calcium (due to loss of bone density as age increases) Menstruation (not on syllabus but still important to note) Affect will differ for some athletes Some will have trouble performing at best Exercise often causes disruptions LINKS TO IRON DEFICIENCY menstruating athletes need 18mg iron/ day to replace (normal 12-16) Some athletes stop menstruating (amenorrhoea- usually reversible) caused by intense training, nutritional problems, and psychological factors. Osteoporosis EATING DISORDERS: characterised by behaviours such as purging, binge eating and starving.

11 Most common anorexia and bulimia Often linked to sport weight control, food intake, physical inactivity Affect more than half athletes in events which require low body fat Female athletes 2x risk eating disorders due to exposure to peer influence, exposure to social expectations, pressures within athletic subculture Risks include: o Loss of energy o Irregular periods o Weak bones o Abnormal heart rhythm o Dehydration o Starvation Prevented by a multi disciplinary approach o Participation focus > winning o Nutritional education + counselors o Able to detect signs o Educate parents on reasonable pressure o Observe training and eating and take action when behaviour is suspicious BONE DENSITY Quantity of calcium in bones Needed for bone strength and muscle and nerve functions Calcium deficiency associated wit osteoporosis and bone fractures Required for bone strength and in the blood to allow muscles and bones to function correctly Bones that lack calcium susceptible to fractures and weakening Causes: hormonal changes in menopause, decreased exercise, inadequate amounts of calcium RDI 14-18y/o 1300mg/day 3-4 serves /day sources: milk, cheese, yoghurt, vegetables, fruit, tofu, salmon mod exercise recommended to reduce chance of osteoporosis calcium regulated by parathyroid glands control how much is stored and released IRON DEFICIENCY Common in female athletes Anaemia: where there is a low level of haemoglobin resulting in less oxygen being available to tissues Exercise induced anaemia is common in athletes and is believed to be the result of intense training when iron reserves are low Causes breathlessness = impact on performance Females need 2x much iron as males period Females eat less red meat Female athletes need more during traiing Sources: red meat, legumes, dark veggies, eggs Iron needed to carry oxygen and CO2 and is needed in muscular and energy producing chemical reactions. Symptoms: lethargy, weakness, fatigue, breathlessness.

12 Need to monitor Supplementation benefits people below recommended levels Indiscriminate use of iron tablets can cause iron levels to reach toxic amounts and contribute to liver disease, diabetes, heart problems, and joint damage. PREGNANCY Mild moderate exercise Dangerous in high risk pregnancies Don t start new program Avoid vigorous activity No contact sports/ scuba No heat stress/ saunas Good warm up/ cool down Advise doctor of intention to exercise Be aware of signs to stop Adequate hydration Self regulated rather than competitive sports Benefits: o Maintain fitness and general well being o Weight control in later stages o Improved muscle tone o Reduce risk f CVD o Reduce risk of gestational diabetes o Improve self esteem and wellbeing. ASSESS THE DEGREE TO WHICH IRON DEFICIENCY AND BONE DENSITY AFFECT PARTICIPATION IN SPORT: IRON DEFICIENCY: Tired, weak fatigues hard to train at required intensity Performance will suffer so will concentration E.g. female hockey player Poorer performance and limited participation due to a lack of haemoglobin lack of O2 to working muscles Affect aerobic BONE DENSITY: Bones more at risk of fracture/ stress fractures No high impact sports Athletes with no periods at risk and may have to consider ceasing or changing intensity of periods.

13 HOW ARE SPORTS INJURIES CLASSIFIED AND MANAGED? PHYSICAL PREPARATION: Helps body cope with demands of sport Reduces rate of injuries Improve overall performance PRE SCREENING: To assess the health status of a person before they become involved in a training program Subjects at risk must be screened e.g. males 40+, females 50+, asthmatics, smokers, obese, family history heart conditions Age, gender, health status, previous experience must be considered Promoted sports med Australia tool for identifying people risk of acute CVD, identifying low/ mod risk. Encourage people through exercise prescription specifies what to do to achieve desired level of fitness FITT principle Athletes pre screened at start of season SKILL AND TECHNIQUE Efficiency in which we perform required activities Skillful players high degree temporal patterning, pacing, and control Essential to prevent injury Improved performance E.g. soccer player unsure about correct tackling technique at risk every time go in to tackle. PHYSICAL FITNESS Ensure level of physical fitness required by sport attained before full competition begins Dependent on sport/ activity Lack of is major contributor to injury Level of physical fitness fitting to the sport ensures that energy supplies are adequate and body systems are able to meet demands of what is required in activity. WARM UP, STRETCHING, AND COOL DOWN WARM UP: Geared to demands of sport Explosive events warm up longer increased stress on muscle. Redistribution of blood flow Higher muscle temp allows ability of muscle to stretch without tearing and improve time muscle takes to respond to stimulus. Positive psychological feelings General body warm up increases blood flow and raises muscle temp Stretching increases elasticity and increased muscle extensibility

14 Calisthenics strengthens muscle and draws blood from internal organs to skeletal muscle Skill rehearsal increases agility, promotes game readiness, and maintains body temp. STRETCHING General stretching 4/5 times per week Stretching program Specific to needs Muscle groups placed on demands require specific attention COOL DOWN Maintain stretch in muscle groups that may have been shortened during activity Disperse lactic acid that has built up -- active recovery Prevent blood pooling Not as intense of as long as warm up SPORTS POLICY AND SPORTS ENVIRONMENT: RULES OF SPORTS AND ACTIVITIES Assist flow of play Protect from injuries Break rules put themselves and others at risk rules enforced by referee and punishment decided by referee and possibly official panel (rugby league) responsibility on officials and coaches to ensure players under control do not intentionally break the rules e.g. hockey goal keeper must wear set equip heat rules aus open will stop playing outdoor courts/ give more breaks when too hot. MODIFIED RULES FOR CHILDREN Rules modified for children to reduce risk of injury and accommodate their needs Include design of modified games e.g. walla rugby/ netta Changed rules within competition e.g. u19 bowlers in cricket restricted to amount of overs they are allowed to bowl Rules to address specific needs e.g. lowering of ring in basketball/ netball, modifying equipment/ distances in little athletics Field dimensions, rules, equipment adjusted to promote enjoyment and safety to avoid failure MATCHING OF OPPONENTS Promote safety match children/ players with those of the same size, gender, age, strength, skill level and physiological development When competitions are even skills are matched and interest is heightened Risk of mismatched opponents in some sports is height e.g. rugby league/ union Hard to match skill level in younger ages When comp is even, interest is high

15 USE OF PROTECTIVE EQUIPMENT Purpose: o Absorb energy from direct blow o Deflect blow and protect o Limit excessive movement Equipment must allow freedom of movement, air flow as requires, and be comfortable. Helmets: worn when rules dictate, must protect but continue to allow full movement and vision Mouthguards: can prevent most dental injuries, absorbs force and protects teeth and jaw, absorbs shock of blows to chin and decreases chance of concussion. Shoulder/ shin pads: protect against bruising and soft tissue injuries by absorbing impact of direct blow Footwear: supportive and protective, adequate support and traction to minimize injury, sport shoes specific to each individual sport, studs to prevent foot from losing traction Joint harnesses and braces: prevent joints extending past normal range EXPENSIVE EQUIPMENT TESTED THOROUGHLY. SAFE GROUNDS, EQUIPMENT, FACILITIES Must always ensure grounds meet safety standards Risk assessment Ensure playing surface is in reasonable condition Clear away all rubbish Check corner posts Pad all goal posts Ensure perimeter fences well back from sideline Adequate lighting at night Matting where needed Equipment must be checked each time before being used Equipment must be suited to size and ability of child, sufficient in number, padded appropriately Properly erected and constructed Actual field/ court design must contribute to player safety e.g. enough room on sidelines of courts/ fields to avoid contact with walls/ fences. ENVIRONMENTAL CONSIDERATIONS TEMPERATURE REGULATION (CONVECTION, RADIATION, CONDUCTION, EVAPORATION) Thermoregulation: the ability of body to regulate temperature and maintenance of core temp within 1 degree of 37 degrees Body temp controlled through hypothalamus in brain Reacts to changes in atmospheric temp by triggering devices such as sweat mechanism Involuntary CONVECTION Refers to flow of air across skin

16 If air cool body will lose heat and visa versa 12% heat lost at rest WIND OR WATER RADIATION Heat gain or loss to the surrounding atmosphere Accounts for 60% heat lost Temp and humidity CONDUCTION Involves skin contact with an object of a different temperature Rest accounts for only 3% heat loss EVAPORATION Sweat evaporates from the skin and a cooling effect is achieved, thus heat is released Accounts for 25% heat loss CLIMATIC CONDITIONS (TEMPERATURE, HUMIDITY, WIND, RAIN, ALTITUDE, POLLUTION) Air temp and humidity vital factors in thermoregulation Sweat does not evaporate in humid climates cooling effect reduced TEMPERATURE: Normal temp not present problem if fluid intake is adequate Steps must be taken to avoid hypo/ hyperthermia Hyperthermia: excessively high body temperature, usually experienced in hot, humid conditions Hypothermia: heat loss that far exceeds body heat gain In water heat is lost 4x quicket Dehydration: where fluid is lost at a greater rate than it is replaced Weight lost most accurate measurement of fluid loss Replace 1L water for every kg lost Signs: confusion, dizzy, nausea, collapse Special care with children HUMIDITY Water concentration in atmosphere Limits ability of body to lose heat Prevents evaporation Exercise avoided Strategies to avoid dehydration: o Drink every 15 mins o Drink stations at sporting events o Compulsory shade and hats

17 o Ice on hand to cool down athletes o Avoid scheduling competition for hottest part of the day o CHO mix to allow athletes to rehydrate o Cooling vests when available o Loose clothing Performing in cold also hazardous shivering and vasoconstriction Vasoconstriction: decrease in blood vessel size causing less blood to be supplied to area serviced by blood vessel decreases blood flow, slows heat loss Shivering: increases heat production WIND: RAIN Convection Hypothermia avoid by using light windproof layer Cyclists using wind jackets Assist with heat loss Use rain/ waterproof clothing Impact safety Hypothermia ALTITUDE: Not enough O2 = altitude sickness Altitude increases = ability to perform is impacted Reduction in aerobic capacity by -3.5% for every 300m above 1500m High jump benefits less resistance Altitude training Live high train low POLLUTION Increases airway resistance Safety hazard asthma/ cardiorespiratory problems Carbon monoxide bings to haemoglobin in preference to oxygen Ozone can be a health risk In cities avoid: smoking areas, exercising in peak hour and training outside with high levels of pollution GUIDELINES FOR FLUID INTAKE Effective functioning body needs to be hydrated 57% body is water Loss of small amounts can reduce athletic performance Role of water in temp regulation crucial blood plasma is 90% water Replacing fluid essential to allow core temp maintained 1% loss = thirst

18 5% loss = discomfort/ decline aerobic performance 10% loss = breakdown in coordination 20% loss = upper limit of dehydration before death 1 hour exercise Water 1-2 hours Diluted CHO, non carbonated Before exercise 500ml water 30 mins prior. Cold water empty stomach faster During competition/ training 200ml every 15 mins, more in hot conditions, water and CHO mix, electrolytes to replace salts and prevent cramping After competition Water and CHO drinks, drink till weight returns to normal and urine is clear, 1L water p/kg of weight lost. ACCLIMATISATION HEAT: method of training where body is forced to compensate for the stresses of a new or different climate training technique allows body to adapt to different environmental conditions athletes undergo acclimatization when preparing for specific environmental condition climatic stressors cause physiological adaptions to occur developing tolerance to expected performance conditions altitude training to prepare for comp overseas acclimatization applies to heat, cold, humidity, wind, altitude. E.g. teams train NT/ Queensland for hot and humid conditions Processed by which an athlete becomes accustomed to increased heat over 4-14 days Common marathon running Improved ability to tolerate heat and humidity will improve performance Linked to dehydration and ability to replenish fluids Most adjustments made days Most will reach acclimatization of 75% within 5 days Most successful follow progression: 1. Training volume and intensity reduced on atlete s first exposure 2. Volume and intensity increased as athlete adapts 3. Weight hydration rates, BP monitored 4. Extreme care to ensure proper hydration ALTITUDE: Only a few athletic competitions held at altitude Most athletes don t train at altitude to acclimatize for competition there hypoxic training purpose Sea level 20.93% oxygen decreases as gets higher Body compensates for decrease in oxygen by increasing its production of erythrocytes (RBC) Develop greater physical ability to utilse oxygen for performance in thinner less oxydgen rich air

19 Once trained capacity to produce greater number of red blood will remain a factor for a number of weeks. Altitude training is further broken into 3 types: o Live high train high (not as popular because cannot train at high intensity) o Live high train low (12 hours to take affect) o Sea level training (altitude tents expensive but have same effect) Increase oxygen carrying capacity by 2-3% within 3 months Benefit lost 3 months post training.

20 HOW IS RECOVERY FROM INJURY MANAGED? REHABILITATION PROCEDURES Rehabilitation: the process of restoring the athlete to the pre-injury level of fitness. Aims: restore optimal function full movement of joint, return to competition quickly and safely, prevent re-injury. Time taken will depend on severity of injury PROGRESSIVE MOBILISATION Passive movement: you move it for the patient Takes place after RICER Asap (depends on injury) Movement will reduce formation of scar tissue can limit movement Freeing of hindered joints to improve ROM Moving of joint/ injured area Gradually extending ROM of injured area Continues until area is fully functional E.g. ankle: slight planti and dorsi flexion movements after the initial injury will reduce the risk of surrounding muscles seizing up. Make sure no fracture is present/ do not do in inflammatory stage. GRADUATED EXERCISE Must be gradual STRETCHING: Injury will decrease flexibility of a joint formation of scar tissue shortens muscle and makes further prone to injury. Benefits: reduces muscle tension, increases circulation, muscle tendon length and ROM, slow static stretching and PNF, PNF best for rehab Static used first, then PNF (most beneficial), then dynamic towards end more control Pain free always CONDITIONING: Restoring muscular length, ROM and ability to perform skills with injured area Must be progressive too much too soon will reinjure area and increase recovery time Individualized to athlete depending on injury, age, previous conditions e.g. older athlete longer recovery time Restoring muscular strength essential to prevent atrophy (muscle loss) Passive muscles lose size Cast = isometric strength exercises As swelling and pain lessen introduce pain free movement Can still do a number of exercise when injured, power and speed last.

21 TOTAL BODY FITNESS: Maintain overall fitness during rehab Maintain flexibility, strength, and endurance specific to sport and that don t hinder recovery Exercise depend on type and severity of injury E.g. Injury to chest of rower = stationary bike. Still using legs and cardio. Hypertrophy of muscles Strengthening of tendons and ligaments Increased blood flow to the injured area Increased joint mobility Increased confidence that injured area can handle stress. When pain-free, start to overload injured area slowly with sport/skills. TRAINING After rehab Must return to training first timing speed and coordination affected by rest from competition Redevelop muscle, speed and coordination to full capacity, mentally prpare Return gradually modified sessions to start Start at low intensity Longer warm up and cool down Muscle, coordination and speed and skills to pre-injury state Able to perform skills under pressure and delay fatigue Complete full competitive training session Testing of injured site USE OF HEAT AND COLD COLD: HOT: Cryotherapy vasoconstriction Immediately on all injuries to reduce pain and swelling Stops blood flow and prevents from getting worse Use after rehab sessions, conditioning, stretching, training Ice packs used 8-12 weeks after injury or in chronic injuries indefinitely E.g. ice pack, ice massage, ice bath, cooling sprays 20 mins every 2 hours. Thermotherapy Increased circulation of whole body or local area After 48hours when internal bleeding has stopped Decreases pain, increases ability to stretch, relaxation, promote blood flow, reduce stiffness, decrease muscle spasm, increase tissue healing. EXAMINE AND JUSTIFY REHABILITATION PROCEDURES USED FOR A RANGE OF SPECIFIC INJURIES

22 Shoulder dislocation rugby Progressive Rotation, adduction, abduction, mobilisation elevation, depression of shoulder Pain free and slow No arm used first After a while introduce arms to extend ROM and use tendons and ligaments. Graduated exercise Light static stretching only initially then introduce dynamic movement and PNF Elastic bands to help with conditioning, very light weights Cardio fitness maintained throughout injury spin bike Intensity gradually get harder and introduce skills and game like movement. Training Return slowly, low volume and no intensity Build volume and intensity slowly Maintain fitness through other training methods Use of heat and cold Cold: Before and after sessions throughout day 20mins on 2 hours off Heat: after HARM reduce scar tissue. Hamstring tear runner Improve movement of hip Flexion and extension of knee Flexion and extension hip joint Walking Gradually extend ROM Static stretching: hamstring and quad Dynamic movement of leg Move to PNF when able Conditioning: continue walking, elastic band, avoid excess pressure Swimming, upper body, bike treadmill after 4-6 weeks Return slowly Less distance no intensity No directional change Increase distance/ intensity slowly Extra warm up RETURN TO PLAY Should not return to play until completely healed Medical clearance fro doctor INDICATORS OF READINESS TO RETURN TO PLAY (PAIN FREE, DEGREE OF MOBILITY) Performing without pain Elasticity: muscle stretched and flexible Strength: new tissue strong and can support stressful movements Mobility: full ROM Pain free ALWAYS Balance: complete Psychologically ready confident

23 Sports specific fitness test completed Discussed with coach and physio. MONITORING PROGRESS (PRE TEST AND POST TEST) Pre test: athlete not injured Post test after athlete come back from injury When ready to return should be very similar. Injury specific e.g. knee ligaments = agility test/ shuttle run. Monitor progress Visually observe coach Interviews athletes honest Videotape filming can be compared Performance evaluation sheets measure how performance is improving PSYCHOLOGICAL READINESS Physical readiness not enough must be ready for comp mentally True and honest level psychological readiness hard to gauge Some athletes over confident, others under- confident scared Both scenarios can re-injure e.g. worried = hesitant = poor tackling = re injure Balance between complete physical readiness, common sense, self-assurance required SPECIFIC WARM UP PROCEDURES Full warm up needed Helps to prevent injury, ensures adequate blood supply Injured longer and harder wwith greater stretch adequate flexibility, blood flow, and readiness to perform Specific to injured area Coach and physio help RETURN TO PLAY POLICIES AND PROCEDURES Professional level policies and preocedures exist when athletes can t return to play Valuable commodity re injury can cost them/ club/ sponsors Amateur sports advice from DR and physio Typical procedure: 1. Consultation with dr, surgeon, physio 2. X rays 3. Strapping, bracing discussion 4. Treatment 5. Rehab 6. Fitness tests 7. Return to play

24 EXAMPLE: boxing established regulations governing the return of athletes who have been knocked out, or have had their bouts stopped by the ref. 1 st loss of consciousness = next match at least 1 month after 2 nd loss of consciousness = next match at least 3 months after 3 rd loss of consciousness = next match at least 12 months after LOOK AT NETBALL, AFL, RUGBY LEAGUE PROTOCOLS TOO ETHICAL CONSIDERATIONS (PRESSURE TO PARTICIPATE, USE OF PAINKILLERS) PRESSURE TO PARTICIPATE: more for elite athlete issue is complex long term and short term consequences health vs money temptation for some athletes to return before they are ready internal pressures: boredom, drive for success, fear of losing position, sense of letting team down. External pressures: financial, media, sponsors, other players and coach, spectators. Before playing should make sure area free of pain, full ROM and regained full strength Pain = damage still present = further rehab required USE OF PAIN KILLERS: Allows athletes to play when they have not fully recovered Nurofen, injections of pain killers (cortisone, codine?!?) Drugs mask pain present Issue as pain is an indicator from the body that the activity should be stopped Injections desensitise whole area additional damage caused without being aware Prolongs healing process, as well as causing damage to fibres Some athletes higher pain threshold any pain that causes athlete to change or modify movement needs to be addressed If pain is dominant thought that interferes with tactics movement should be stopped Issue: when players inject a damaged joint prior to big matches decision made with dr, coach, athlete but long term athlete only one impacted.