1
Q
Mechanism of injury (MOI)
A
How an injury happened
2
Q
Sources of MOI
A
Trauma
Overuse
3
Q
Trauma
A
From an external force on the body
4
Q
Overuse
A
Repetitive strain on a tissue
5
Q
Onset of MOI
A
Acute/traumatic
Insidious
6
Q
Acute/traumatic
A
Sudden onset
7
Q
Insidious
A
Gradual and often of unknown origin
8
Q
Signs
A
Something you see
9
Q
Symptoms
A
Something the athlete feels/describes
10
Q
Examples of signs
A
- bruising
- swelling
- heat/cold
- spasm/guarding
- sweating
- shivering
- vomiting
11
Q
Examples of symptoms
A
- pain
- tingling
- numbness
- burning
- tight
- pressure
- nausea
12
Q
Pain
A
- not every experience is the same
- comes with fear and shock
- imp to reassure
13
Q
Psychological affects of injuries
A
- anger
- fear
- denial
- sadness
- catastrophizing
- regret
14
Q
Things to consider for psychology of injuries and performance
A
- coping strategies
- support at home
- access to care
- professional support
- team/coach support
15
Q
How can we help with the psychology of injuries?
A
- listen
- reassure
- know when to refer
- educate
- coach/player/family/friend support
- mindful and sequential return to play
- keep them part of the team
16
Q
Types of skin wounds
A
- lacerations
- abrasions
- punctures
- contusions
- blisters
17
Q
Laceration
A
Slice in tissues
18
Q
Management of lacerations
A
- Control bleeding
- Clean the wound
- Steri-strips
19
Q
Step 1: Control the bleeding
A
- PPE (gloves)
- Pressure
- Elevation
20
Q
Pressure to control bleeding
A
- “all gauze sponges” ie. non-sterile loose gauze
- add extra layer of gauze as needed (don’t remove previous layer)
- conforming stretch gauze bandage
21
Q
Step 2: Clean the wound
A
- soap and water
- cinder suds (lifts dirt and debris)
22
Q
Step 3: Steri-strips field coverage considerations
A
- dry the area around the laceration
- adhesive spray via Q-tip
- rub Q-tip on either side of laceration where steri-strips will be applied
23
Q
When do we send for stitches?
A
- only done effectively within 24hrs of injury
- deep wounds affecting more then just skin
- unable to stop the bleeding
- wound is to the face
- wound is across the joint
24
Q
Minor cuts and abrasions
A
- superficial layers of skin
- for return to play: non-stick gauze and cover roll
25
Punctures
- if object is still in, leave it in
- pad around it with gauze rolls
- send for medical attention
26
Contusions
- bleeding under skin from blunt trauma
27
Deep contusions
- need proper management to avoid myositis ossificans
- no deep tissue massage
- effleurage or lymph drainage
- ice
- protective padding (donut pad)
28
How can contusions be supervised in clinic?
- ultrasound (pulsed setting)
- interferential current (IFC)
29
Blister prevention
- skin lube over areas of friction
30
Blister treatment
- if broken, clean well
- second-skin
- coverroll/hypafix
31
When do we seek medical attention?
- unable to control bleeding
- wound is dirty and unable to be cleaned
- deep wound or puncture
- object is still impaled
- changes in sensation
- wound is from human/animal bite
- wound is from rusty object
32
Cartilage and meniscus healing
- limited capacity to heal
- little or no direct blood supply
33
Ligament healing
- during repair phase, collagen or connective tissue fibres lay down randomly
- gradually scar is formed
- over following months collagen fibres align in response to joint stress/strain
34
Skeletal muscle healing
- regeneration of new myofibers is minimal
- healing and repair follows the same process of random collagen alignment and develops tensile strength in response to stress/strain
35
Healing of nerves
- regeneration can take place very slowly (3-4mm/day)
- peripheral nerves regenerate better than central nervous system
36
Phases of wound healing
1. Hemostasis
2. Inflammation
3. Repair and regeneration
4. Remodelling
37
Hemostasis
Process leading to cessation of bleeding
38
What is inflammation?
Essential vascular and cellular response for proper tissue healing
39
Repair and regeneration- what is formed?
Formulation of granulation tissues
40
Timeline of stages of wound healing
1. Inflammation: 4-6 days
2. Proliferation: 4-24 days
3. Remodelling: 21 days -2 years
41
Tissue response to injury (acute)
Acute musculoskeletal injuries fall into 3 phases:
1.Inflammation
2. Repair and regeneration
3. Remodelling
42
Phase 1: Inflammatory response (acute)
- vasodilation of blood vessels
- white blood cells (neutrophils and macrophages) fight infection, break down and clean up damaged tissue
43
Signs and symptoms of inflammation
- redness
- swelling
- heat
- pain
- loss of function
44
Phase 2: Repair and regeneration (acute)
- collagen laid down in disorganized mix
- revascularization bring oxygen and nutrients
- edges of wounds draw closer
45
Phase 3: Remodelling (acute)
- collagen reorganizes along lines of stress (Wolff's law)
- tissues increase in tensile strength
46
Tissue healing phases (table)
1. Inflammatory response phase
2. Fibroblastic repair phase
3. Maturation-remodelling phase
47
Inflammatory response phase (table)
- pain, swelling, redness
- decreased collagen synthesis
- increased inflammatory cells
48
Fibroblastic repair phase (table)
- collagen fiber production
- decreased collagen fiber organization
- decreased inflammatory cells
49
Maturation-remodelling phase (table)
- proper collagen fiber alignment
- increased tissue strength
50
Bone healing 5 stages
1. Hematoma formation
2. Cellular proliferation (cells grow and divide)
3. Callus formation (soft callus)
4. Ossification (hard callus)
5. Remodelling
51
How long does bone healing take?
6-8 weeks
52
Inflammatory phase aims of treatment
- decrease inflammation
- decrease pain
- decrease swelling
- decrease activity
- protect
- educate
53
Inflammatory phase time
days 1-5
54
Demolition phase aims of treatment
- decrease residual swelling
- decrease residual pain
- increase ROM
- increase flexibility
- increase strength
- increase proprioception
- prevent second degree complications
- increase CV fitness
- educate
55
Demolition phase time
days 3-15
56
Healing phase aims of treatment
- increase circulation
- decrease pain or muscle spasm
- increase ROM
- increase flexibility
- increase strength
- increase CV (sports specific)
- increase proprioception
57
Healing phase time
10 days to 8 weeks
58
Long term goals aims of treatment
- maintain/restore skin and connective tissue
- ensure full ROM, strength of lesion side, restore flexibility, psychological readiness
- optimal biomechanics
- correct training habits/equipment
- maintain/increase proprioception
- protect injury site
- educate
59
Guidelines for return to play
- full ROM, 80% strength
- able to perform the demands of the sport
- psychological readiness
60
What tools do student trainers have?
- heat and cold
- massage
- educate
- exercise
- taping and wrapping
- wound care
61
Heat indications- when do we use it?
- healing phase and beyond
- relaxation
- promote flexibility
62
Tissue response to heat
- increased circulation
- increased inflammation
- increased metabolism
- increased edema/swelling
- decreased pain
- decreased spasm
63
Types of heat
- most heat application (hydrocollator packs)
- electric heating pads
- hot tub
- microwaveable bean bag
- infrared sauna
- ultrasound (continuous setting)
64
Infrared vs traditional saunas
- infrared: heat skin/body
- traditional: heat air around you
65
Temp of infrared sauna
- 37 degrees C
66
Temp of traditional sauna
- 60-80 degrees C
67
Which conditions do saunas benefit?
- high BP
- heart failure
- dementia and alzheimer's
- headaches
- T2D
- arthritis
- relaxation
- improved circulation
- detox
68
Contraindications to heat
- inflamed tissues
- bleeding disorders
- blood clots
- impaired sensation
- metal implants
- infection
- open wounds
- additional contras for whole body ie. sauns, hot tub
69
Additional contraindications for whole body
- pregnancy or trying to conceive
- multiple sclerosis due to heat intolerance
- illness
70
Tissue response to cold (cryotherapy)
- decreased inflammatory response
- decreased edema/swelling
- decreased pain
- decreased circulation
- decreased hematoma formation
- decreased muscle spasm
- decreased tissue metabolism
- decreased enzymatic activity
- decreased extensibility
71
Cryotherapy types
- crushed ice or ice cubes
- gel packs or frozen peas
- frozen beanbag
- ice cup massage
- cold immersion
- hyperbaric gaseous cryotherapy (neurocryostimulation)
- cryochamber
72
Cryotherapy consideration: Ice bag
- flatten ice and remove air pockets by sucking air out of bag
- apply a barrier btwn ice and skin
- time: 15-20 min
73
Cryotherapy consideration: frozen beanbag
- already has soft covering
- time: 10-15 min
74
Cryotherapy consideration: ice cup massage
- fill styrofoam cup 1/2 way and freeze it
- apply to skin in circular continuous motion
- time: 5-10 min
75
Cryotherapy consideration: cold immersion
- 10 degrees for CBAN (cold, burning, achy, numb)
76
Cryotherapy consideration: Neurocryostimulation
- sprays micro crystals of liquid CO2 at -78 degrees C
77
Cryotherapy consideration: cryochamber types
1. Electric (cools the air)
2. Liquid nitrogen
78
Cryotherapy consideration: electric cryochamber
- temps as low as -160 degrees C for at least 3 min and until skin gets to desired temp
- settings: 7, 9, 11 degrees
79
Cryotherapy consideration: liquid nitrogen cryochamber
- temp as low as -130 degrees
- timing 2-4 min
80
Contraindications of electric cryochamber
- pregnancy
- high BP
- blood clots
- heart conditions
- infection
81
Contraindications to cold
- raynaud's phenomenon
- urticaria (hives/rash)
- clotting disorders
- over superficial nerves
- altered skin sensation
- complex regional pain syndrome
82
Raynaud's phenomenon
- caused by decreased blood flow to fingers/toes due to vasospasm
83
Indications for massage- when to use it
- tight muscles
- injured muscles
84
How does massage help tight muscles?
- increase extensibility
- decrease pain
85
What type of massage should be used for an injured muscle in the inflammatory phase?
- effleurage/lymph drainage only
- decrease pain and swelling
86
What type of massage should be used for an injured muscle in the healing phase?
- deeper forms
- increase circulation
87
Massage protocols
- educate on why you're massaging
- clear contraindications
- always obtain consent
- expose the are to be treated
- be professional
88
Contraindications to massage therapy
- acute inflammation (except for lymph drainage)
- contusions (lymph drainage only)
- acute spasm around another injury
- over open wounds or skin reactions
- altered sensation
- possible blood clot
- bleeding disorders
- over varicose veins
- deep vein thrombosis
- some medical conditions
89
Medical conditions that are contraindications to massage therapy
- cancer
- diabetes
90
Four main principles of massage therapy
1. General - specific - general
2. Superficial - deep - superficial
3. Proximal - distal - proximal
4. Peripheral - central - peripheral
91
What should you always do when applying any modality or form of treatment?
- clear contraindications
- expose the area to be treated
- ask permission
92
Open terminus lymphatic drainage massage
- in hollow above clavicles
- gentle pumping C motions
93
Pre-event massage
- indications: general tissue warm up
- short duration, energetic (not relaxation)
- local & general (not whole body)
94
Pre-event massage techniques
- petrissage
- shaking/rocking
- vibration
95
Petrissage
- spreading the muscle belly perpendicular to muscle fibres
- avoid stripping the muscle mass and ends of tendons
96
Shaking/Rocking
- pre event: faster, shorter
- post event: slower, longer
97
Vibration
- engage tissue, hand-over-hand, vibrate
98
Sterile gauze
Used once wound has been cleaned or to help clean the wound
99
Non-stick gauze
Used to dress the wound for long term application (doesnt stick to wound as it dries)
100
Hypafix/coverroll
Used to secure the non-stick gauze
101
When to ice vs heat
- ice: inflammatory phase
- heat: healing phase
KNPE331
flashcards
Decks in class (12)
# Cards
