1
Q
vasovagal response
A
may be triggered by pain or emotional upset
- results in drop in blood pressure and therefore loss of consciousness
2
Q
what to do if athlete is experiencing or may experience vasovagal response
A
- avoid looking/listening
- block athletes view
- have others block the scene
3
Q
primary injury prevention
A
reducing the incident of injury before they occur
4
Q
secondary injury prevention
A
addressing injuries in their early stage to prevent recurrence, severity and/or secondary complications
5
Q
examples of primary injury prevention
A
- safe field/court conditions
- protective equipment
- proper warm-up
- nutrition/hydration
- scanning for unsafe technique
- collab with coaches, S&C
- recognize injury patterns in a team
6
Q
examples of secondary injury prevention
A
- early identification of injuries
- bracing/taping/wrapping
- sufficient rehab of injuries
- education of re-risk
- sufficient reconditioning post-injury (including psych readiness)
7
Q
bracing vs taping
A
brace:
1. ongoing conditions
2. larger joints requiring complex tape jobs
3. maintains integrity longer than tape
tape:
1. feels tighter and more secure
***feel the tape so they are more aware of the injury
8
Q
footwear and orthotics
A
- wearing proper shoe/orthotics can achieve more optimal biomechanics
- performing with optimal biomechanics can prevent injuries
9
Q
orthotics
A
- not recommended until over 12 years old
- should be prescribed with supportive rehab to retrain intrinsic and extrinsic foot muscles and movement patterns
- can result in a noticeable difference in biomechanics up the chain
- made from casting foot in subtalar neutral (NWB)
10
Q
types of sports injuries
A
- urgent vs. non-urgent
- traumatic vs. overuse
- acute vs. chronic
11
Q
how do muscles/tendons get injured
A
- strain
2.tendonitis/osis - contusion
12
Q
how do ligaments get injured
A
- sprain
- overstretch, dislocations, subluxations
13
Q
how do bones get injured
A
- fracture/break - different types
- bruise
14
Q
how do nerves get injuries
A
- burner/stringer (head and shouder brought away from each other)
- contusion/crush injury
15
Q
how does the brain get injured
A
- concussion, acquired brain injury (ABI)
- direct trauma, indirect
16
Q
how does the skin get injured
A
- lacerations, abrasions
- contusions
17
Q
strain vs. sprain
A
strain: muscle or tendon
sprain: ligament
18
Q
grade 1 or 1st degree
A
tissues stretch/some fibres disrupted
19
Q
grade 1 sprain
A
integrity of the joint maintained
20
Q
grade 1 strain
A
contractions are strong but painful
21
Q
grade 2 or 2nd degree
A
partial tear/many fibres disrupted
22
Q
grade 2 sprain
A
results some instability/laxity in joint
23
Q
grade 2 strain
A
contraction are weak and very painful
24
Q
grade 3 or 3rd degree
A
complete tear (nerved are severed)
25
grade 3 sprain
results in significant instability/laxity in the joint
26
grade 3 strain
unable to contract and often pain-free (nerves were severed)
27
types of bone fractures
1. transverse
2. linear
3. oblique, non-displaced
4. oblique, displaced
5. spiral (from rotation)
6. greenstick (bend in bones)
7. comminuted
28
contusions
crush injury to the muscle and connective tissue from blunt trauma
29
muscle response to contusion
1. pain
2. discolouration
3. swelling
4. spasm/guarding
5. reflex inhibition
- pain and/or swelling can stop voluntary muscle contraction
- results in weakness/giving out
30
itis vs otis
itis: inflammation (acute)
otis: tissue breakdown (chronic)
31
overuse injuries
1. tendonitis
2. bursitis
3. shin splits
4. stress fractures
32
emergency action plan (EAP)
1. predetermined, organized system of managing severe injury
2. allows for quick and efficient injury management
3. decreases chaos/panic, and creates trust and reassurance
33
what should be included in EAP
1. charge person
2. call person
3. control person
4. important numbers
5. address of sports facility (map)
6. address of nearest hospital
7. address of urgent care/x-rays
8. location of player medicals, AED and spinal board if available
34
charge person
person in charge of delivering medical care
35
call person
provides medical information, meets, and directs ambulance
36
control person
manages team/crowd/surrounding/locates supplies
37
normal/ideal gait pattern
1. heel strike in slight supination
2. arch absorbs forces as it rolls into pronation
3. supinate back into neutral through mid-forefoot for a neutral toe off
38
foot types
1. overpronators (valgus foot) - collapse through arch (pronate)
2. supinators (varus foot) - weight stays through outside of foot (supinate)
3. normal - ideal gait
39
contraindications - when NOT to tape
1. allergies to adhesives
2. immediately after injury (tissues bleed and swell)
3. injury hasn't been fully assessed
4. RTP criteria hasn't been fully met
5. areas of altered skin sensation
6. overnight - swelling
7. check sport governing body allows tape
40
mechanism of injury
what position did the structure/joint/limb/athlete go into?
41
sources of MOI
1. trauma: from an external force on the body
2. overuse: repetitive strain on a tissue
42
onset of MOI
1. acute/traumatic: sudden onset
2. insidious: gradual onset and often of unknown origin
43
signs vs. symptoms
signs: something you see
symptoms: something the athlete feels/describes
44
signs
1. bruising
2. swelling
3. heat/cold
4. spasm/guarding
5. sweating
6. shivering
7. vomiting
45
symptoms
1. pain
2. tingling
3. numbness
4. burning
5. tight
6. pressure
7. nausea
46
pain
1. everyone experiences it differently
2. measure on a scale of 1-10
3. shock and fear comes with pain so need to keep athletes calm and reassure them
47
psychological aspect of injuries
anger, fear, denial, sadness, catastrophizing, regret
- repeat injury leads to fears
48
how to help athletes with psychology of injuries
1. listen
2. reassure with a plan supporting their concerns
3. know when to refer to a specialist
4. educate on injury/prevention and next steps
5. coach/player/family/friend support
6. mindful and sequential RTP
7. keep them part of the team
49
types of skin wounds
1. laceration (deep wounds)
2. abrasions
3. punctures
4. contusions
5. blisters
50
management of lacerations
step 1: control bleeding with pressure
step 2: clean the wound to rid infection
step 3: steri-strips
51
step 1: control bleeding of lacerations
1. PPE
2. pressure: all-gauze sponges, extra layers as needed, conforming stretch gauze
3. elevation: above heart to decrease blood flow to area
52
step 2: clean the wound
1. soap and water
2. cinder suds - directly to wound to lift dirt and debris
***try to not send anyone to hospital with a dirty wound
53
step 3: steri-strips
1. dry the area
2. adhesive spray with q-tip
54
when to send for stitches
1. only done effectively within 24 hours
2. deep wounds affecting more than just skin
3. unable to stop bleeding
4. wound is to the face
5. wound is across a joint
55
minor cuts and abrasions
1. superficial layers of skin
2. non-stick gauze and cover roll for RTP
56
punctures
1. common in feet and hands
2. can penetrate multiple levels
57
why should you leave the object in the limb if it punctures deep
to prevent further bleeding - the object may ben providing pressure on artery which is helping the bleeding
1. pad around it with gauze
2. send them for medical attention
58
treating contusions
1. avoid a deep tissue massage
2. effleurage or lymph drainage
3. ice and protective padding (donut)
***if deep contusions are not treated properly there is risk of myositis ossificans
59
contusions in the clinic
1. ultrasound on the pulsed setting (for inflammation) not continuous
2. interferential current (IFC)
60
blisters
fluid-filled bubble caused by friction
61
prevention of blisters
skin lube over areas of friction
62
treatment of blisters
1. if broken, clean well
2. second-skin (gives buffer and absorbs the friction)
3. coverroll
63
when do we seek medical attention for wounds?
1. unable to control bleeding
2. would is dirty and unable to be throughly cleaned
3. deep wound or puncture
4. object is still impaled (do not remove)
5. changes in sensation (nerve affected)
6. wound is from a human/animal bite
7. wound is from a rusty object
64
cartilage and meniscus healing
limited capacity to heal due to little or no direct blood supply
65
ligament healing
1. during repair phase, collagen or CT fibres lay down randomly
2. gradually a scar is formed
3. over following months collagen fibres align in response to joint stress/strain
66
skeletal muscle healing
1. regeneration of new myofibres is minimal
2. healing and repair follows the same process of random collagen alignment and develops tensile strength in response to stress/strain
67
nerves healing
1. regeneration can take place very slowly (3-4mm/day)
2. peripheral nerves regenerate better than central nerves
68
wound healing phases
1. hemostasis
2. inflammation
3. repair and regeneration
4. remodeling
69
hemostasis phase
process leading to cessation of bleeding
70
inflammation phase
1. essential vascular and cellular response for proper tissue healing (fight infection)
2. can be prolonged if people don't rest
(4-6 days)
71
repair and regeneration phase
1. formation of granulation tissues (a type of new CT)
2. repair injured tissues
3. lay down collagen
(4-24 days)
72
remodeling
1. strengthening of tissues along lines of tension
2. collagen straightens up and remodels the muscle
(21days-2years)
73
phase 1: inflammatory response
1. vasodilation of blood vessels
2. white blood cells (neutrophils and macrophages) fight infection, breakdown and clean up damaged tissues to start healing
74
S&S of inflammation
1. redness
2. swelling
3. heat (big indicator)
4. pain
5. loss of function
75
phase 2: repair and regeneration (proliferation)
1. collagen laid down in disorganized matrix
2. revascularization (blood vessels grow) brings O2 and nutrients
3. edges of wound draw closer (feels tighter)
***could easily re-injure at this phase
76
phase 3: remodeling
1. collagen reorganizes along lines of stress (wolffs law)
2. tissues increase in tensile strength
77
bone healing
follows the same 3 phases but more complex
(6-8 weeks)
78
5 stages of bone healing
1. hematoma formation
2. cellular proliferation (cells grow and divide)
3. callus formation (soft callus)
4. ossification (hard callus)
5. remodeling
79
goals of treatment in inflammatory phase (day 1-5)
decrease
1. inflammation
2. pain
3. swelling
4. activity
- protect
- educate
80
goals of treatment in demolition phase (day 3-15)
decrease
1. residual swelling
2. residual pain
increase
1. ROM
2. flexibility (surrounding tissues)
3. strength
4. proprioception
5. CVF
- prevent second degree complication
- educate
81
goals of treatment in healing phase (day10-8weeks)
decrease
1. pain or muscle spasm
increase
1. circulation
2. ROM
3. flexibility
4. strength (to support lesion)
5. sports specific CVF
6. proprioception
82
long term goals of treatment
1. maintain/restore skin and CT
2. optimal biomechanics
3. increase proprioception
4. protect injury site
5. educate
6. ensure full ROM, strength of lesion site, flexibility, psychological readiness
83
guidelines for RTP
1. full ROM, 80% strength
2. able to perform the demands of sport
3. psychological readiness
84
when do we use heat therapy?
1. healing phase and beyond
2. relaxation
3. promote flexibility in the tissues
85
tissue response to heat
decrease
1. pain
2. spasm
increase
1. circulation
2. inflammation
3. metabolism
4. edema/swelling
86
types of heat
1. moist heat application (hot wet towel)
2. electric heating pads
3. hot shower/tub/bacl
4. microwaveable bean bag
5. infrared sauna
6. ultrasound - continuous setting
87
infrared vs traditional saunas
infrared: heats your skin/body
traditional: air around you
88
what conditions do infrared saunas benefit
1. high blood pressure
2. heart failure
3. dementia
4. headaches
5. type 2 diabetes
6. arthritis and chronic pain
7. relaxation
8. improved circulation
9. sweating = detox
89
contraindications to heat
1. inflamed tissues/post-injury
2. bleeding disorders
3. blood clots (heat moves it)
4. impaired sensation (could burn skin)
5. metal implants
6. infection (heat spreads it)
7. open wounds
8. pregnancy, illness, multiple sclerosis
90
tissue response to cold (cryotherapy)
decrease
1. inflammation
2. edema/swelling
3. pain
4. circulation
5. hematoma formation
6. muscle spasm
7. tissue metabolism
8. enzymatic activity
9. extensibility
91
types of cold therapy
1. crushed ice or ice cubes (remove air pockets, 15-20min)
2. gel packs or frozen peas (15-20min)
3. frozen beanbag (10-15min)
4. ice cup massage (5-10min)
5. cold immersion
6. hyperbaric gaseous cryotherapy (spray crystals)
7. cryochamber (cools full body - not head)
8. liquid nitrogen (2-4 min)
92
cold immersion
1. cold tub - no neck only to shoulders
2. ice bucket - for foot, ankle. hand and tricky contours
***10 degrees for CBAN
93
CBAN
stages of the cold therapy
C- cold
B- burn
A- achy
N- numb
94
contraindications to cryochamber
1. pregnancy
2. high BP
3. blood clots
4. heart conditions
5. infection
95
contraindications to cold
1. raynauds phenomenon
2. urticaria - hives/rash from cold
3. clotting disorders
4. over superficial nerves
5. altered skin sensation
6. complex regional pain syndrome (body is not responding properly)
96
raynauds phenomenon
caused by decreased blood flow to fingers/toes due to vasospasm in those areas
- turn white, blue or red
97
when to massage
1. tight muscles (decrease pain, increase extensibility)
2. injured muscles
3. increase circulation
98
when to massage injured muscles
1. inflammatory phase only do lymph drainage (light)
- decrease pain and swelling
2. in healing phase, deeper massage
- increase circulation to promote healing
99
contraindications to the massage therapy
1. acute inflam (only effleurage)
2. contusions (only effleurage)
3. acute spasm around other injury
4. over open wounds
5. altered sensation
6. possible blood clot
7. bleeding disorders
8. over varicose vein
9. deep vein thrombosis (DVT) - calf pain
10. cancer
100
four main principles of massage therapy
1. general - specific - general
2. superficial - deep - superficial
3. proximal - distal - proximal
4. peripheral - central - peripheral
101
3 techniques for massage
1. petrissage
2. shaking/rocking
3. vibration
102
what massage techniques can you do before a game
1. petrissage
2. shaking
3. vibration
103
what massage techniques can you do after a game
1. stripping
2. pressure point
3. petrissage
4. shaking
5. vibration
104
wound dressings
1. sterile gauze: once wound has been cleaned or to help clean wound
2. non-stick gauze: to dress the wound for long term application
3. hypafix/coverroll: to secure to non-stick gauze
4. gauze roll: conforming stretch gauze bandage
105
when should you ice vs. heat
ice: inflammatory phase
heat: in healing phase
106
lymphatic drainage
1. superficial draws from deep
2. can see effect immediately
3. can be used for post-op, facial drainage and in a cast to decrease swelling
107
player medical records
keep these with you because knowing ahead of time will help manage injuries
108
what is in medical records
1. medical conditions (epi-pen? know where its kept)
2. allergies
3. previous injuries (watch how athletes move)
4. emergency contact info
5. level of experience/# years playing
109
what are the keys goals during emergency conditions
1. provide care to manage conditions
2. minimize secondary complications
3. determine safe removal
110
if you're unsure about what to do in an emergency condition what can you do?
1. ask more questions to see if anyone saw what happened
2. ask for help (another AT, certified, other team)
3. err on the side of caution, if unsure what to do, call ambulance
111
general hierachy of conditions
1. ABCs, major bleeds (get rid of immediately)
2. acquired brain injury/concussion
3. spinal
4. fracture/dislocation (can cause shock and be bigger prob)
5. sprains/strains
6. abrasions
***also assess for shock too
112
emergency on-field assessment
1. survey the scene (it is safe?)
2. control the c-spine (block head)
3. assess LOC (how alert - AVPU)
4. assess vitals (ABCs)
5. secondary survey (history, SAMPLE, PQRST)
6. head-to-toe (other injuries)
113
scene survey
1. any safety concerns in the immediate environment
2. any clues to indicate what happened?
3. did anyone see anything happen - ask questions
4. how many athletes or bystanders are injured
114
what do you do if multiple athletes are injured?
determine who is the most injured and help them first
115
control the cervical spine (c-spine)
1. block the head (hand on forearm, and make them remain still (no yes and no) - DO NOT COVER EARS (CSF)
2. once rule c-spine out get someone else to hold head so you can finish assessment
3. if unaligned and do not have ABC you need to re-align them and watch expressions
4. if unaligned and have ABCs do not move them
116
level of consciousness
1. remove mouth guard or anything in mouth (helps airway)
2. rate athletes LOC using AVPU scale
117
AVPU scale
1. Alert: eyes open; able to verbalize
2. Verbal: responds to commands or questions
3. Painful: facial grimace, flexion, extension, or withdrawal of body part; moan or groan
4. Unresponsive: no response
***as soon as you see they're unresponsive don't go on with further assessment
118
ABCs
A: airways
B: breathing
C: circulation
119
A-airway
1. is it open?
2. position of head - is it in alignment?
3. speaking or crying - if so we know airway is opened
4. unconscious? do a jaw thrust
120
airway management
1. oropharyngeal airway - keeps tongue out of back of throat (only for unconscious)
2. nasopharyngeal airway - use anytime
121
B-breathing
1. look (chest rise)
2. listen (breathing)
3. feel breathe on the cheek
122
C-circulation
1. do they have a carotid pulse? (check side that you are on)
2. obvious major bleed? - put pressure
123
secondary survey summary
1. rapid body scan
2. history
3. decision on next steps
124
rapid body scan
1. major bleeds
2. deformities
3. anything indicating a life-threatening emergency
125
history
1. what happened?
2. pain in neck, head, back? (ask one at a time)
3. any tingling in limbs?
4. can you wiggle fingers and toes?
5. does anything hurt?
***if yes to pain in neck/back - check for pain on palpation of spinous processes
126
call EMS if what signs are occuring
any 2 out of 4 red flags (or unsure)
1. central pain on palpation (spinous processes)
2. tingling/numbness/unable to move extremities
3. MOI
4. unwillingness to move (cannot move them if they say no)
127
head injury
1. trauma to head
2. pain in head
***head injury assessment
128
head injury assessment
1. clear cervical spine first
2. check active ROM - flexion, extension, side bending, rotation
3. if clear, then check symptoms
129
head injury assessment - symptom check
1. any pain or pressure in head?
2. any ringing in your ears?
3. feel dizzy?
4. feel nauseous?
5. anything blurry or seeing double?
***one symptom is considered a concussion = no RTP
130
head injury assessment - observable signs
1. check ears/nose for blood or CSF
2. look/feel for any deformities in head
3. bruising behind ears (battles sign)
4. black eyes (raccoon eyes)
5. aggressive/emotional behaviour
6. not making sense
7. altered speech
8. unable to focus
9. seizure
131
head injury assessment - ocular/motor screen
1. PEARL - pupils equal and reacting to light
- cover one eye and see what happens to the other
2. tracking - follow my finger
3. peripheral vision
4. ability to focus: 'how many fingers'
- near and far
132
head injury assessment - cognitive screening
1. orientation - todays date, which team playing
2. immediate memory - ask them to remember unrelated 3 words
3. delayed recall - ask what those 3 words are a few minutes later
4. concentration - ask to count backwards by 3, starting at 100
133
decision making for emergency conditions
1. c-spine clear
2. on-field assessment complete
3. continue with head-to-toe exam and decide how to safely remove them from field
4. complet SCAT6 on sidelines
134
what are you looking for in the head--to-toe assessment
1. pain (watch facials)
2. bleeding
3. spasm
4. deformities
5. bruising/wounds
6. distal circulation in ankle/foot
7. distal circulation in fingers
135
major fractures and dislocations
1. large bone
2. unstable or displaced
3. compounded fracture (open fracture)
136
what to do when someone has a major fracture or dislocation
1. stabilize
2. treat for shock
3. call 911
137
emergency medical conditions
1. diabetic emergency
2. epilepsy/seizures
3. asthma
4. anaphylactic shock - food or bee
5. heat/cold emergencies
6. abdominal injuries
138
shock
1. circulatory system fails to adequately circulate blood
2. life threatening - medical emergency
139
symptoms of shock
1. pale, cool, clammy akin
2. rapid breathing
3. rapid and weak pulse
4. changes in LOC/confused
5. naseau
6. decreasing blood pressure
140
care for shock
1. blanket to maintain body temperature
2. rest in comfy position that minimizes pain
3. have athlete lie down if necessary = increase blood to organs/brain
4. reassure
5. oxygen if available
141
what do you do if someone has a helmet on when you are checking c-spine
keep it on to avoid further injury
142
when do you do a non-urgent assessment
when emergency condition is ruled out, they are
1. alert
2. ABCs
3. no concerning head/spine MOI
4. c-spine and head assessment clear
143
non-urgent conditions
1. sprains
2. strains
3. simple fractures
4. contusion
5. abrasions/minor lacerations
144
HOPS on field-assessment
History: what happened
Observation: what you see
Palpation: what do you feel? where is pain? - start gently just to identify injury
Special Test: put injury under stress to confirm suspicion
145
history taking
1. SAMPLE
2. PQRST
146
SAMPLE assessment
S- signs and symptoms
A- allergies
M- medication
P- past medical history
L- last oral intake
E- events leading up to injury
147
PQRST pain assessment
P-provoke - what makes it worse?
Q- quality - sharp, dull, achy, burning?
R- region/radiate - does pain shoot anywhere?
S- severity (1-10) - 10 is worst possible pain (everyone different)
T- time - when did it start? is it intermittent or constant?
148
history - symptoms
1. what happened
2. where does it hurt - broad or specific
3. did you hear or feel anything (snap, crack, pop)
4. did it give out?
149
history - medications
1. ask if they are on any medication and if no as what they are
2. could the medication be dampening symptoms?
150
history - past medical history
1. any medical conditions
2. have you been feeling sick lately?
3. any previous injuries?
4. have you hurt this area before?
151
history - last oral intake
food
1. low blood sugar?
2. need to know if eaten if they need surgery
drink
1. dehydrated?
***what did they consume and when?
152
history - events leading up to injury
1. what happened
2. did they collide with someone (gives clue that there could be another injured athlete)
3. piece together what happened
4. looking for MOI to indicate possible injuries
152
HOPS - observations
1. what do you see?
2. whats around the athlete
3. what position are they in (may indicate MOI)
4. expose the injury site to check for
- bruising/discolouration
- swelling
- deformity
- bleeding
- rashes/hives
153
HOPS - palpations
1. have athlete show location
2. check distal circulation - cap refill
3. is location warm vs the other side?
4. do you feel a divot or deformity vs other side?
5. check above and below injury to be sure you're not missing anything
154
index of suspicion
based on HOP you create an index of suspicion and confirm it with special tests
- what structure do you suspect is injured?
1. muscle
2. ligament
3. bone
155
HOPS - special tests
what test can you do to confirm suspected injury and rate severity?
156
special test for muscle/tendon
have the tissue contract (resisted testing 1-5)
157
special test for ligament
1. test to open the joint it stabilizes
2. testing for level of stability
3. what motion should the ligament limit?
158
special test for bone
fracture testing
159
kendalls resisted muscle testing
1. rate quality of strength out of 5
2. mark with an * if triggers pain
160
kendals resisted muscle testing scale
0- no visible or palpable contraction
1- visible or palpable contraction
2- full ROM, gravity eliminated
3- full ROM, against gravity
4- full ROM against gravity, moderate resistance
5. full ROM against gravity, maximal resistance
161
fracture test 1: tap testing
1. gentle tap at location on the bone AWAY from suspected fracture site
2. vibration may cause pain at suspected fracture site
3. don't test if there is a deformity
162
fracture test 2: compression test
1. compress the two ends of the bone together
- direct: either end of long bone
- indirect: compress bone around the small bone with suspected fracture (carpals/tarsals)
163
fracture test 3: tuning fork
1. bang the end on TF off shoe/hard surface
2. place base of TF on bone with suspected fracture, AWAY from fracture site
3. resulting vibration may cause pain at suspected fracture site
164
tuning fork
1. is able to rule out a fracture
2. not the best technique
3. good for out of clinic
165
fracture testing inconclusive
1. err on the side of caution - get an x-ray
2. prevent secondary complications
- further muscle/ligament injury surrounding fracture
- nerve/vessel damage
- major bleeds - emergency
166
sideline assessment
more detailed than on-field HOPS assessment
1. rule out joint above and below (for muscles crossing 2 joints mostly)
2. full physiological ROM for joint
3. 3 special tests to rule out/confirm
4. more extensive palpation
167
physiological ROM
1. flexion
2. extension
3. abduction
4. adduction
5. internal rotation
6. external rotation
7. dorsiflexion
8. plantarflexion
9. cross-flexion
10. cross-extension
11. pronation
12. supination
13. ulnar deviation
14. radial deviation
168
accessory movements (intra-articular)
will not be able to get full physiological movement without the accessory movements
1. roll
2. spin
3. glide
169
roll, spin, glide
roll: rotating across a stretch
spin: rotating in one spot
glide: non-rotating slide
170
eg of the intra-articular movements
glenohumeral joint
- must roll upwards and slide downwards for abduction to happen in shoulder
171
sideline assessment: ROM and strength
1. Active ROM
- overpressure if the end of range if full and pain-free
- ROM must be 100% for RTP
2. resisted testing - must be 80% for RTP
172
what does it mean if they dont have full ROM
body is telling them something happened
173
impressions
we cannot diagnose, so we only have an impression and must include a documentation
174
what do you include in your impression documentation
1. severity
2. structure
3. injury
4. assessment done
5. treatment provided
6. plan
175
plan included in the impression documentation
1. RTP decision
2. immediate care
3. educate (reassure)
4. communicate
5. transport (urgent or no)
6. referral (where to send)
176
sideline management for sprains
1. ice and elevation
2. wrap (pressure pad) to support, approximate tissues, provide compression
3. crutches for WB extremities
177
sideline management for strains
1. ice and elevation
2. wrap for compression
3. pressure pad over strained tissues to approximate ends and provide compression
4. crutches for WB extremities
178
sideline management for contusion
1. ice
2. donut pad with cover pad to protect from 2nd insult
3. wrap padding on to area with herringbone technique
4. NO MASSAGE (only effleurage)
5. RTP?
179
sideline management for fractures (non-urgent)
1. splint (SAM - more comfy or speed)
2. split above and below
3. monitor for shock
4. refer for imaging
180
sideline management for abrasions
tefla/non-stick pad and cover-roll
181
sideline management for minor lacerations
1. tefla/non-stick pad and cover-roll
2. steri-strips if it needs more support
182
steri-strips
put them according to what your goal is RTP or clinic
183
keys structures of the foot and ankle to consider following injury
1. talus position - anterior
2. cuboid position - rotated
3. navicular position - rotated or dropped
4. base of the 5th - tender on palpation (TOP)
5. sesamoid bones
184
plantar fascia (aponeurosis)
O: medial process of calcaneal tuberosity
I: proximal aspect of digits
***medial attachment is where people experience symptoms
185
lateral ligaments of the ankle
1. anterior talofibular lig (ATFL) - most commonly injured
2. calcaneofibular lig (CFL)
3. posterior talofibular lig (PTFL) - harder to injure
4. anterior inferior tibiofibular lig (AITFL)
5. posterior inferior tibiofibular lig (PITFL)
186
what two lateral ligaments are commonly sprained together
ATFL and CFL
187
ligaments of the medial ankle
1. deltoid ligament (MCL)
2. spring ligament (plantar calcaneonavicular lig)
188
deltoid ligament (MCL)
4 ligs make a triangle (deltoid lig)
1. tibionavicular
2. tibiocalcaneal
3. tibiospring
4. tibiotalar
189
3 layers of tibiotalar
1. anterior tibiotalar
2. posterior superficial tibiotalar
3. posterior deep tibiotalar
190
key structures to consider in the foot and ankle
1. tib post (PF and INV)
2. flexor digitorum longus (PF and toe flex)
3. flexor hallicus longus (PF and hallicus flex)
4. tib ant (DF and INV)
5. peroneal (fibularis) tendons
- peroneus longus (EV)
- peroneus brevis (PF and EV)
6. achilles tendon (PF)
191
functional anatomy tibialis anterior
eccentrically lowers the longitudinal arch
192
functional anatomy tibialis posterior
stabilizer of longitudinal arch
193
functional anatomy plantar fascia
important for dynamic longitudinal arch support
- absorbs the forces when WB
194
functional anatomy anterior talus
what happens up the chain?
- injury to anterior talus could cause pain up the chain
195
ROM of the toes
1. flexion
2. extension
3. abduction
4. adduction
*** if cannot abduct toes it'll cause lack of base of support
196
ROM of tibiotalar joint
1. dorsiflexion (extension)
2. plantarflexion (flexion)
197
ROM of subtalar joint
1. pronation
2. supination
198
turf toe
MOI: hyperextension of big toe
1. 1st MTP sprain of plantar ligs/capsule
S&S: swelling, bruising, pain, loss of toe DF ROM, weak hallux flexion
- can result in instability of 1st MTP with Gr 3 sprain
199
runners toe (subungual hematoma)
MOI: repeat trauma to end of toes
S&S: pain and pressure under nail, discolouration of nail
1. most common in big toe
2. nail falls off
3. excessive pressure may need to be relieved
4. results from foot sliding in toe, tight or loose toe box, running downhill, toes rubbing against shoe
200
prevention of runners toe
proper shoe fitting, varied course/terrain
201
sesamoiditis
caused by jumping in plantarflexion repeatedly
- sesamoids act like pulleys
202
MOI of sesamoiditis
repeat trauma to ball of foot
203
S&S of sesamoiditis
1. pain over sesamoids
2. swelling (to FHB)
3. limited big toe extension
4. weak/painful flexion
***usually no bruising
204
treatment of sesamoiditis
1. rest
2. treat inflammation
3. padded insoles
205
plantar fasciitis
role of PF: absorber, support long arch
- often present with association tight achilles (or further up chain)
206
MOI of plantar fasciitis
poor biomechanics/overuse stress
207
S&S of plantar fasciitis
TOP medial calcaneus or along longitudinal arch, pain with 1st steps in morning, ankle/toe DF stretch pain
208
treatment of plantar fasciitis
find the cause
1. retrain biomechanics
2. night splints
3. orthotics
209
S&S of bunions (hallux valgus)
1. big toe aligns towards 2nd toe
2. tender bump medial MTP joint
3. inflammation
210
cause of bunions
1. genetics
2. poor foot mechanics
3. tight/narrow footwear
211
when are bunions painful
1. when weightbearing
2. plantarflexion
3. inflammation
212
how can bunions be used as a red flag
tells us
1. footwear must be adjusted
2. improper biomechanics
***can prevent all foot mechanics by fixing foot mechanics
213
how do we retrain foot biomechanics
1. toe spreaders
2. do exercises that create a stable base
214
MOI for tendonitis and shin splints
1. poor mechanics
2. poor playing field
3. overuse
***potential for stress fractures at muscle origin due to traction on bone
215
common structures affected in tendonitis and shin splints
1. peroneal tendons
2. tibialis anterior
3. Tib post
4. flexor digitorum longus
5. flexor hallicus longus
216
S&S of tendonitis and shin splints
1. TOP over inflamed tissues
2. pain with running/walking
3. pain with resisted muscle testing or stretch of affected structure
217
treatment of tendonitis and shin splints
1. correct foot/lower extremity mechanics
2. taping (shin, arch)
3. proper footwear
4. insoles/orthotics
5. heel lift for achilles to take tension out (both sides)
***combining shin and arch tape is more effective
218
MOI of lateral ankle sprains
ankle inversion (in neutral or DF or PF)
219
possible structures affected in a lateral ankle sprain
1. ATFL
2. CFL
3.PTFL
4.AITFL
5. PITFL
6. peroneals
7. cuboid (can be pulled out by peroneals)
8. base of 5th MT
220
S&S of lateral ankle sprain
1. "pop"
2. giving out
3. swelling (immediate)
4. brusing
5. limping (antalgic gait)
221
sideline management for lateral ankle sprain
1.HOPS
2. educate
3. WB or NWB
4. support them so they can properly WB
222
inflammation management for lateral ankle sprain
1. limit swelling with ice/compression
2. support with taping
3. lymph drainage
4. prevent second degree injuries
5. ensure team involvement
6. work on proprioception
223
healing phase for lateral ankle sprain
1. restore proper mechanics
2. increase circulation through heat
3. massage
4. increase ROM
5. shock wave therapy and ultrasound (continous)
6. dynamic support to muscles and injured structure through exercise
224
RTP for lateral ankle sprain
1. psychological readiness
2. 100% ROM, and 80% strength
3. tape ankle and get them to do figure 8 (challenges ankle)
225
MOI for medial ankle sprains
ankle eversion
*** doesn't happen as often due bone structure of talus and fibula
226
possible structures affected in medial ankle sprain
1. deltoid lig
2. spring lig
3. TDH
4. navicular (fib fracture)
227
S&S of medial ankle sprain
1. "pop"
2. giving out
3. swelling
4. bruising
5. limping (antalgis gait)
228
treatment for medial ankle sprain
would be the same as lateral ankle sprain but would challenge it differently with exercise to change specific movement pattern
229
fractures in the foot/ankle
1. jones fracture
2. metatarsal fracture
3. talus
4. calcaneus
5. fibula
6. tib-fib (with dislocation = urgent)
230
surgical management for fractures
1. unstable fracture is either
1. redued = put back to proper spot
2. fixated = weights and screws to stabilize it
2. stable fracture is immobilized (not as secure)
231
jones fracture
peroneus brevis avulsion of base of 5th MT
- ankle sprain symptoms may distract from these
232
MOI of a jones fracture
inversion sprain (lateral ankle sprain)
233
S&S of a jones fracture
1. tender on palpation (TOP) base of 5th MT
2. pain in WB
234
MOI of a talus fractures
1. severe ankle sprains
2. land from height
3. forced DF
235
S&S of a talus fracture
1. vary with severity
2. pain with WB (or unable to)
3. loss of ROM
236
MOI of a calcaneus fracture
fall/jump from a height
237
S&S of a calcaneus fracture
1. extreme pain
2. unable to WB
238
MOI of a fibula fracture
1. direct blow to side of the leg
2. ankle sprain mechanism
***sometimes people can walk with this fracture because the fibula is not a WB bone
239
S&S of a fibula fracture
vary with severity
240
when to tape
1. chronic ankle instability from previous sprains
2. RTP following treatment of recent ankle sprain
3. when ankle bracing doesn't fit athletic shoe properly or a sport does not permit bracing
241
ankle testing
1. anterior drawer - ATFL
2. talar tilt - CFL
3. eversion talar tilt - deltoid lig
4. wedge test - AITFL
242
supination of foot
1. talocrural
2. sole of foot faces medially
3. combination of PF, INV and adduction
243
pronation of foot
1. talocrural
2. sole of foot faces laterally
3. combination of DF, EV, and abduction
244
knee joint
1. tibiofemoral joint
2. patellofemoral joint
3. superior tibiofibular joint
245
compartments of the lower leg
1. lateral: peroneal
2. anterior: extensor (DF) group
3. posterior: flexor group
- deep and superficial
246
anterior compartment of the lower leg
1. tib anterior
2. extensor hallicus longus
3. extensor digitorum longus
4. fibularis (peroneus) tertius
247
lateral compartment of the lower leg
1. peroneus longus
2. peroneus brevis
248
deep posterior compartment of the lower leg
Tom, Dick and Harry
1. tib posterior
2. flexor digitorum longus
3. flexor hallicus longus
***dynamically stabilize the medial ankle together
249
superficial posterior compartment of the lower leg
1. gastrocnemius
2. soleus
3. achilles tendon
250
intracapsular structures of the knee
1. ACL
2. PCL
3. meniscus (medial and lateral)
4. cartilage
5. joint surface
251
wipe test for intracapsular swelling
1. helps identify if one of the intracapsular structures are affected
2. if intracapsular structure is affected it will be full of fluid
252
medial vs lateral meniscus
medial: c-shaped oval
lateral: round o shaped
253
meniscus
shock absorber
254
quadriceps muscle
muscles with lateral pull on patella
1. rectus femoris
2. vastus lateralis
3. vastus intermedius
muscles with medial pull on patella
1. vastus medialis (most injured due a natural imbalance)
255
medial hamstrings
1. semimembranosus
2. semitendinosus
256
lateral hamstrings
biceps femoris
257
pes anserine group (goose's foots)
adduction and to add dynamic stability on the medial side
1. semitendinosus
2. gracilis
3. sartorius
258
function of the gluteus medius
1. hip abduction
2. prevents pelvis on stance side from dropping during gait (trendelenburg gait)
259
anterior fibres of gluteus medius
internally rotate hip and assists with hip flexion
- eccentrically controls IR of femur in WB
260
posterior fibres of gluteus medius
extend and externally rotate the hip
261
what happens if glute medius is weak
it'll cause pressure on knee and foot affecting things down the chain
262
quads to hammy ratio
1. ideally 3:2
2. post ACL injury 1:1
263
medial tibial stress syndrome (MTSS) - shin splints
1. exercise-induced pain over the anterior tibia and is an early stress injury
2. excess pull though tendons and muscles
3. could cause stress fracture if not caught early
4. often due to foot pattern that there is tension and traction
- tape arches
264
compartment syndrome
1. excessive pressure within a muscle/fascial compartment
2. often overlooked as shinsplints - overuse
2. trauma following bone fracture (acute)
265
S&S of the compartment syndrome
1. red or pale
2. hot
3. shiny
4. very painful
5. numb
6. weak
7. faint pulse distal to site
266
acute management for the compartment syndrome
1. no pressure (need it gone)
2. reduce inflammation
3. no RTP
4. NWB
5. refer to sports med Dr.
6. occasional need for fasciotomy to release pressure
267
gastroc/soleus strains
overstretch in DF with knee extension especially with forceful contraction
268
S&S of gastroc/soleus strain
1. "pop" or "pull"
2. sharp pain
3. swelling and bruising
269
special tests for gastroc/soleus strain
1. muscle tests for gastrocs, soleus, deep flexors
2. thompson test to rule out achilles rupture
3. toe raises
270
acute management of gastroc/soleus strain
1. PIER
2. pressure pad with wrap over injured tissues (reduce swelling and bring ends together)
3. NWB
4. avoid stretch
5. avoid contraction
271
can an athlete RTP with a gastroc/soleus strain
NO, usually self-limiting
- once rehabbed can tape with heel lift for initital RTP (both sides)
272
MOI of an achilles rupture
sudden forceful contraction
273
achilles rupture
common in stop and go sports - basketball, tennis, squash
274
S&S of an achilles rupture
1. sudden sharp pain (partial rupture)
2. feeling of being kicked in back of leg
3. unable to PF
4. swelling
5. delayed onset bruising (becomes extensive)
275
special tests of an achilles rupture
thompson test on both sides
276
acute management of an achilles rupture
1. PIER
2. NWB
3. pressure pad over injured tissues with tensor
4. educate
5. refer to consult with sports med Dr.
277
patellofemoral pain syndrome (PFPS)
most often overuse condition; occasional acute onset
278
MOI of PFPS
poor tracking of patella in femoral condyle
279
S&S of PFPS
TOP posterior aspect of patella
280
what to check with PFPS
1. mechanics from bottom up and top down
2. stable base
3. quad imbalance
4. 1 leg squat
281
MOI of a patellar dislocation
valgus force with foot planted causing internal rotation of femur
282
patellar dislocation
most common in active children ages 10-17
283
S&S of a patellar dislocation
1. patella positioned on lateral side of knee
2. significant pain
3. usually in knee flexion
284
special tests of a patellar dislocation
none if dislocated
- if subluxed do an apprehension test
285
what do you need to do if its a 1st time dislocation
1. rule out osteochondral fracture
- can affect patella or femoral condyle
-very common and requires surgery
286
acute management of a patellar dislocation
1. rule out fracture
2. PIER if reduced
3.refer
4. braced in full extension for 3 weeks, then ROM and strengthening
287
MOI of patellar tendonitis
excessive traction on patellar tendon
288
S&S of patellar tendonitis
1. pain
2. swelling and heat over patellar tendon
3. pain with jumping, running, quick change in direction or quad contraction
4. pain with flexion and extension
5. can often train/compete through the pains
289
special tests for patellar tendonitis
thomas test; resisted quads
290
acute management for patellar tendonitis
1. PIER
2. roll/soft tissue mobility for quads
3. lower extremity mechanics - how are they moving for their sport
4. train hamstrings to prevent anterior translation of tibia
RTP: patellar tendonitis tape
291
bursas
fluid-filled sacs that lay between areas of friction
292
MOI of knee bursitis
1. direct trauma
2. friction from tight muscles/tendons
293
S&S of knee bursitis
1. rebound pain
2. often painless
3. visible fluid-filled sacs
294
acute management of knee bursitis
1. protect with padding to avoid repeat insult
2. soft tissue mobility of tight muscles
295
chronic bursitis
can develop granular rice-like texture
296
MOI of stress fractures - MTSS/shin splints
overuse/poor mechanics
297
MOI of patellar fracture
1. direct blow
2. patellar dislocation
298
MOI of tibial plateau fracture
1. varus or valgus load
2. direct blow
299
meniscus function
1. poor blood supply
2. cushion the joint during loading
300
types of meniscus tears
1. vertical
2. transverse
3. peripheral
4. bucket-handle (surgical)
5. parrot-beak
6. flap
301
MOI of a meniscus tear
1. plant and twist
2. contact
3. wear and tear/degeneration
302
S&S of a meniscus tear
1. sharp pain at specific ROM - loaded rotation and deep squat
2. catching/clicking/locking
3. swelling (24 hours later)
303
meniscus tear
commonly associated with ACL injuries
- bracing doesn't work because you can't stop rotation in a brace
304
special tests for a meniscus tear
1. McMurrays
2. Apleys
3. duck walk
305
acute management for a meniscus tear
1. PIER
2. NWB
3. educate
306
ligament sprains
1. MCL
2. LCL
3. ACL
4. PCL
307
anterior cruciate ligament (ACL)
1. antero-medial aspect of intercondylar area of tibial plateau
2. passes up and back to postero-medial aspect of lateral femoral condyle
3. prevents anterior translation of tibia on femur and limits IR of tibia
4. major stabilizer of the knees
308
2 bundles of the ACL
1. posterolateral: taught in extension with less than 30 degree rotation
2. anterolateral: taught going into flexion and rotation
309
MOI of an ACL tear
1. sudden cut or pivot (rotational force)
2. sometimes from added external force from a tackle/collision (valgus, hyperextension)
310
S&S of an ACL tear
1. swelling
2. extreme pain throughout the knee
3. difficulty/unable to WB
4. delayed-onset bruising
311
incidence of an ACL tear
1. higher incidence in females vs males
2. 30% from direct contact
3. 70% from wrong movement
312
special test of an ACL tear
1. anterior drawer
2. lachmans
3. pivot shift (hard for the hammies to kick in)
313
acute management of an ACL tear
1. PIER
2. NWB
3. educate
COMPRESSION - swells a lot
NO RTP
314
ACL surgery
depends on how unstable joints are
1. autograft (person's tissue's) vs allograft (cadaver)
2. bone-tendon-bone graft
3. hamstring graft (re-create ACL)
4. unilateral vs contralateral (graft from other side)
5. BEAR - new
315
what is the dynamic protection of the ACL
the hamstrings
- need proper reconstruction of the hamstrings for ACL recovery
316
BEAR
bridge enhanced ACL repair
317
posterior cruciate ligament (PCL)
1. antero-lateral aspect of medial femoral condyle within the notch inserts along posterior aspect of tibial plateau
2. can do without, ACL is the primary stabilizer
318
MOI of a PCL tear
1. hyperflexion
2. forced posterior translation of tibia on the femur
319
S&S of a PCL tear
1. swelling
2. extreme pain throughout the knees
3. difficulty/unable to WB
4. delayed-onset of bruising
320
special tests of a PCL tear
1. posterior drawer
2. sag sign (does the tibia drop with gravity)
321
acute management of a PCL tear
1. PIER
2. NWB
3. educate
322
medical collateral ligament (MCL)
1. superficial and deep fibres
2. commonly associated with ACL injuries
3. doesn't usually need a surgery
323
MOI of a MCL tear
1. valgus stress on the knees (direct blow to the outside of the knee)
2. plant and twist (with lateral rotation of femur on tibia)
324
special tests of a MCL tear
valgus stress (0 then 30 degrees)
325
acute management of a MCL tear
1. PIER
2. NWB
3. pressure pad to approx ends
326
lateral collateral ligament (LCL)
1. only superficial fibres
2. doesn't usually need a surgery
327
MOI of a LCL tear
varus stress to the knees
328
S&S of a LCL tear
1. lateral knee pain
2. swelling
3. TOP LCL
4. stiffness
329
S&S of a MCL tear
1. medial knee pain
2. swelling
3. TOP MCL
4. stiffness
330
special test of a LCL tear
varus stress
331
acute management of a LCL tear
1. PIER
2. NWB
3. pressure pad to approx ends
332
importance of strengthening dynamic stabilizers
1. these are not usually reconstructed
2. proprioception
333
knee special tests
1. wipe test - intracapsular swelling
2. valgus at 0 degrees (superficial fibres) and at 30 degrees (deep fibres) - MCL
3. varus at 0 degrees - LCL
4. lachmans - ACL
5. anterior drawer - ACL
6. posterior drawer - PCL
7. sag sign - PCL
8. mcmurrays - meniscus
9. apleys - meniscus
334
what is vibration massage technique used for
over particularly tight areas or "knots"
335
sensitivity of a tuning fork
75-92%
336
specificity of a tuning fork
18-94%
337
is tuning fork good?
some value it for ruling out a fracture, but not for ruling in a fracture
***false positives
338
what ligaments are involved in high ankle sprains?
AITFL and PITFL - they keep the tibia and fibula together
339
common structures affected with shin splints
1. peroneal tendons
2. tib ant
3. TDH
340
talar tilt
plantarflexion and inversion
341
what do you do for resisted muscle testing?
put the structure into its opposite motion for then to resist
ex. tib ant, put them into PF and EV so they resist
342
KNPE 331
flashcards
Decks in class (3)
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