#4 Sports Medicine How is injury rehabilitation managed PDF

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#4 Sports Medicine How is injury rehabilitation managed...

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SPORTS MEDICINE: INQUIRY QUESTION: How is injury rehabilitation managed?

Students learn about: Students learn to: ● Rehabilitation procedures ● Examine and justify rehabilitation procedures used - Progressive mobilisation for a range of specific injuries, - Graduated exercise eg. hamstring tear, shoulder - Gradual exercise dislocation (stretching, conditioning, total body fitness) - Training - Use of heat and cold ➔ When an athlete is recovering from an injury, there are 4 specific procedures that need to be followed. They are : ➔ Progressive Mobilisation ➔ Graduated Exercise ➔ Training ➔ Use of Heat and Cold You will need to have specific examples of and justifications relating to a Hamstring Tear & a Shoulder Dislocation ➔ Progressive mobilisation: ➔ This refers to slowly mobilising an injured joint back from little or no movement gradually to full movement and complete recovery. ➔ This can be done by Active Exercises (Performed by the athlete) and Passive Exercises (performed by another person eg physio) ➔ You will need to have specific examples for progressive mobilisation for a hamstring tear and a shoulder dislocation. ➔ Graduated exercise: ➔ This involves stretching, conditioning and total body fitness and follows similar principles to progressive mobilisation. ➔ Stretching : will progress from static gentle, to PNF, to dynamic. ➔ Conditioning : is gradually done to return the injured area to pre injury levels of strength / flexibility. ➔ Total Body Fitness : is maintaining as good a level of fitness for the rest of the body so that the principle of reversibility does not impact too heavily on rehabilitation. ➔ You will need to have specific examples for graduated exercise for a hamstring tear and a shoulder dislocation. ➔ Training: ➔ When an athlete has recovered from an injury, they are not yet ready to return to play. ➔ They need to complete a structured training program that progressively mobilises the injured part and involves the athlete in game like situations whilst protecting the athlete as much as possible. ➔ You will need to have specific examples for training drills/tests for a hamstring tear and a shoulder dislocation.

➔ Use of heat and cold: ➔ When recovering from an injury, both heat and cold treatments are used. ➔ They are used for different reasons and generally at different times of the rehabilitation process. ➔ Cold is used exclusively in the first 3 – 4 days and also after training sessions. ➔ Heat is used once the initial period of injury has passed and the athlete is progressively mobilising the injured part. ➔ You will need to have specific examples for the use of heat and cold for a hamstring tear and a shoulder dislocation.

Students learn about: ● Return to play: - Indicators of readiness for return to play (pain free, degree of mobility) - Monitoring progress (pre-test and post-test) - Psychological readiness - Specific warm-up procedures - Return to play policies and procedures - Ethical considerations, eg pressure to participate, use of painkillers

Students learn to: ● Research and evaluate skill and other physical tests that could be used to indicate readiness to return to play ● Critically examine policies and procedures that regulate the timing of return to play, considering questions such as: ● Why aren’t such policies applied to all sports? ● Who should have ultimate responsibility for deciding if an athlete returns to competition ● Should athletes be allowed to use painkillers in order to compete when injured?

➔ Monitoring progress ➔ The athlete’s progress during rehabilitation should be continually monitored in order to ensure proper rehabilitation is taking place. ➔ Clinical tests may need to be administered to ensure that progression is undertaken at an optimal rate. ➔ Pre- and post-testing is promoted to gauge the progress of the injury. ➔ A severe ankle injury test will initially involve measuring the range of movement at the joint, its strength and mobility without pain. ➔ Progress should be monitored during all training sessions. ➔ Prior to returning to competition sport, the athlete should be put through a series of tests that involve sport-specific movements associated with the sport.

➔ Psychological readiness ➔ The psychological readiness of the athlete to return to play can be measured using discussion and observation of behaviour.

➔ Anxiety levels can also be monitored to ensure the athlete is not feeling pressure to return to play before being fully ready to do so. ➔ The athlete, coach and medical staff should all feel confident in the physical and psychological readiness of the athlete to return to play. ➔ Taping the injured area might also act as a psychological form of treatment long after the injury is recovered.

➔ Specific warm-up procedures ➔ Specific warm-up programs are often developed by the staff in collaboration with the athlete. ➔ The aims of these procedures are to achieve maximum recovery and minimise further or re-injury. ➔ Consideration to the injury site may include : ➔ a longer, and more specific stretch combined with a longer warm-up routine to ensure adequate blood flow to the site and increased flexibility of the site.

➔ Return to play policies and procedures ➔ The decision to return to activity and playing sport after an injury depends on the type of injury and its severity. ➔ Recommended procedures for returning to play include: ◆ Establishing a chain of command regarding decisions to return an injured athlete to training or competition. ◆ Communicating the return-to-play process to athlete, family, certified trainers, coaches and administrators. ◆ Establishing a system for documentation. ◆ Establishing protocols to release information regarding an athlete’s ability to return to training or competition following an injury. ➔ It is essential that return-to-play policies address the: ➔ safety of the athlete ➔ potential risk to the safety of other participants ➔ functional capabilities of the athlete ➔ functional requirements of the athlete’s sport ➔ federal, state, local, school and governing body regulations related to returning an injured athlete to training or competition.

➔ Ethical considerations, eg pressure to participate, use of painkillers Pressure to Participate ➔ Ethical considerations can play a significant role in determining when an athlete returns to play. ➔ Athletes who do not allow for an appropriate recovery period after injury place themselves at risk of further complications. ➔ There is a temptation for some athletes to return to competition before they are ready. Various internal and external pressures push them towards such a decision. Ethical Considerations eg pressure to participate, use of painkillers Internal Pressure

External Pressures

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Boredom A drive for success A fear of losing place in them A sense of letting down the team

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Financial Pressures Pressure from the media Pressure from sponsors Expectations of other players, family or the coach Pressure from spectator

If an athlete returns to play prematurely after injury it might cause the injury to become further established. In which will lengthen the necessary recovery time and cause the athlete to lose more time than would have been the case if the appropriate time had been spent in recovery initially.

Use of Painkillers: - The pressures on athletes to return to performance increase the use of pain killing medications - With the financial and various other pressures increasing, and with advances in drug technology, the use of medications to allow athletes to return to play before full recovery is an increasingly important issue - Sporting clubs and athletes are often presented with an ethical dilemma regarding the use of painkillers - The driving question for an athlete are “Do I use this drug now to get me back on the field, and risk further (and potentially long term) injury ?” or “Do I not use the drug, miss out on selection, maybe get dropped from the team, and potentially lose my contract bonus and not be able to support my family?” SCAT 2 is Sport Concussion Assessment Tool 2 - use to assess concussion...