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Wardle

OPTION 3 Sports Medicine CQ1 - How are sports injuries classified and managed? ● Ways to classify sports injuries

❏ Direct and indirect - Direct injuries: injuries caused by forces generated from outside the body. For example, a punch from boxing. 

- The injury is caused by another competitor. 

- Indirect injuries: injuries caused by forces from within the body. For example, rolling an ankle. 

- Typically involve damage to soft tissues like tendons and muscles. 

❏ Soft and hard tissue 

- Soft tissue: damage to all tissue other than bones and teeth. For example, a sprained ankle is a direct soft tissue injury, or a black eye from a punch is a direct soft tissue injury. 

- Includes: muscles, tendons, ligaments, fascia, nerves, fibrous tissues, blood vessels and synovial membranes. 

- Soft tissue injuries can be: ➔ Acute (sudden) ➔ Chronic (prolonged).  

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- Hard tissue injuries: damage to bone, teeth and cartilage. For example, hockey player breaking their wrist is an indirect hard tissue injury, and a dislocated shoulder from a tackle in rugby is a direct hard tissue injury. ❏ Overuse - Overuse injuries: develop due to overly repetitive or continuous tasks, incorrect techniques/equipment or overtraining.

Wardle - The loaded tissue can’t withstand repetitive loads being placed upon it, so injury develops. 

● Soft tissue injuries ❏

Tears, sprains, contusions Tears - Tears AKA strains, is damage to a muscle or tendon caused by overstretching of the muscle fibres. 

- Has 3 classifications; ➔ 1st – small tear ➔ 2nd – partial tear 

➔ 3rd – complete tear - E.g. a torn pectoral muscle. - Signs and symptoms: swelling, discoloration, bruising and pain. 

Sprains  

- Sprain: a tear that occurs in the ligament (joining bone to bone around joints). Also has the 3 classifications. - Caused when the joint is forced beyond its normal range of motion (ROM).

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- Sprains occur in ligaments, whereas tears are in the muscle. 

- Signs and symptoms: swelling, loss of power, bruising and pain.

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Contusion - Contusion (cork/bruise): damage to muscle (ruptured capillaries) caused by a direct blow, resulting in internal bleeding and bruising.

Wardle ❏ Skin abrasions, lacerations, blisters - These require cleaning and possibly bandaging to prevent infection or aggravation. 

- Skin Abrasion: is damage to the superficial surface of the skin from scraping the ground or other hard surfaces, E.g. a grazed knee from a slide tackle in soccer. 

- A Laceration: is a deep cut or tear to the skin of resulting from contact with a sharp device. E.g. an ice-hockey player who gets hit with a stick cutting his skin open. ➔ Larger than 1 cm should be referred to a medical practitioner. 

- A Blister: is damage to the skin caused by excessive friction, with fluid accumulation as a result beneath the skin. E.g. blister from the wrong sized shoe. 

❏ Inflammatory response 

- Inflammatory response: the body’s natural response to tissue damage. 

- The body’s initial response to the damage of soft-tissue is to increase blood flow to the area. 

- This new blood is enriched with inflammatory mediators, designed to initiate healing. 

- The response of the body is often excessive which actually slows the healing process, causing a temporary increase in swelling and discomfort. 

- For this, RICER is used to manage soft-tissue injuries. 

Phases of the inflammatory response - Acute inflammatory phase: ➔ 48–72 hours ➔ Pain, swelling, redness, heat (from blood pooling) ➔ Loss of function. 

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- Repair phase: ➔ 72 hours–6 weeks ➔ Inflammation decreases ➔ Collagen replaces the damaged tissue ➔ The structure is unorganised ➔ Production of scar tissue. - Remodelling phase: ➔ 3 weeks–12 months (even 2 years) ➔

Wardle Organising and uniformity of collagen takes place ➔ Increased production of scar tissue. ➢ Learn to: RICER & no HARM 

RICER -

Rest: A comfortable position with injured area supported. Avoid usage for 4872 hours. Ice: apply for 20 minutes every 2 hours (first 48-72 hours). Reduces swelling, pain and bleeding. Compression: applying a bandage will reduce bleeding and swelling, and provide support. Elevate: raise the injured area above the level of the heart at all times. Referral: ASAP after the injury, see a qualified health care professional, e.g. physiotherapist. This will determine the extent of the injury, etc.

no HARM -

No Heat: heat applied increases bleeding. No Alcohol: alcohol increases bleeding and swelling which delays healing and can mask pain and severity. No Running: running or exercise increases blood flow to the injured site, which can aggravate it and delay healing. No Massage: massage or the use of heat rubs increases swelling and bleeding.

● Hard tissue injuries

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- Hard tissue injuries: injury to bone and teeth. - For hard tissue, management is initial attention to DRSABCD, then immobilisation and ice etc. However, assessment is just TOTAPS. - Types of fractures: spiral, greenstick, comminuted, transverse, compound, vertebral, compression.

Wardle ❏ Fractures 

- A Fracture: is a broken bone. 

- Can be a result of high-force impact, repeated stress or direct impact to the bone. Primary classifications of fractures

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- Closed:  

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➔ Where the bone is broken but doesn’t break the skin surface ➔ Can be further categorised into displaced or nondisplaced (i.e. moved/displaced from original position or not). ➔ Should be immobilised and need medical assessment & treatment. - Open: ➔ Where a bone is broken and breaks the surface (open wound) ➔ Requires urgent medical attention ➔ Immobilise and gently bandage to minimise risk of infection.

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- Complicated: 

➔ Where a bone is broken and causes internal damage to a major nerve, organ or blood vessel. ➔ Urgent medical intervention required. ➔ Rest the injured area in the position of most comfort. - Others

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➔ Complete Fracture: clean break. ➔ Comminuted Fracture: multiple fractures in the one bone. ➔ Incomplete / Greenstick Fracture: does not break the whole

Wardle way (bone intact). ❏ Dislocation 

- Dislocation (laxation): an abnormal separation in a joint between two bones. E.g. a dislocated shoulder (humorous separates from scapula). 

- They typically cause damage to the surrounding tissue such as ligaments and cartilage. 

- Subluxation: the ‘popping in and out’ of a joint, where it dislocates and immediately returns to normal alignment. Damage to surrounding tissue can still occur. 

● Assessment of injuries – Initial assessment should involve DRSABCD then TOTAPS ➔ Danger ➔ Response ➔ Send ➔ Airway ➔ Breathing ➔ CPR ➔ Defibrillation - TOTAPS: the method for assessing injuries - provides information about the extent of the injury and whether the athlete should continue with activity or seek medical attention. ❏ TOTAPS (Talk, Observe, Touch, Active and Passive movement, Skills test) 

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- If one level produces significant pain or obviously rules out the athlete from returning, you should: ➔ Stop assessment immediately ➔ Remove the athlete from the playing field ➔ Progress to initial treatment of the injury. - Talk: talk to the injured athlete to determine what happened, site of injury, abnormal sounds and type of pain. - Observe: observe the athlete for any obvious deformities or irregularities. Note mental state, consciousness, position of the body and facial expression. - Touch: touch the suspected injury area to determine the exact site and severity of the injury. Note any swelling, immediate bruising or deformity. - Active movement: active movement by the athlete. Note willingness to move, ROM, etc.

Wardle - Passive movement: performed by the trainer. Gently move the joint through the ROM noting any pain. Check for instability of any affected joints. 

- Skills test: skills test after prior steps that are specific to the sport. 

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CQ2 - How does sports medicine address the demands of specific athletes?

● Children and young athletes

- Young athletes and children have unique physical needs and capabilities that require specialised care when they participate in sport. ❏ Medical conditions (asthma, diabetes, epilepsy) - Medical conditions impact the ability of some children to participate fully in sport. 

- Individualised strategies can often be implemented to ensure that young athletes with health conditions are able to remain safe and active. 

Asthma 

- Asthma: a respiratory condition that is characterised by inflammation and contraction of the bronchioles, increasing the difficulty to breathe. 

- It’s important to identify what is likely to trigger an individual's asthma so that appropriate preventative measures may be put in place. 

- An up-to-date asthma management plan should be maintained for each child and treatment: 1 puff, four breathes 4 times – no improvement = call ambulance. 

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Diabetes

Wardle - Diabetes: is a condition of poor insulin efficiency, or lack of insulin production to control blood sugar levels. Implications, timing and use of insulin will vary with physical activity. It should not limit engagement when properly managed. - Young athletes with type 1 or 2 diabetes must constantly regulate their blood glucose levels for safety. - A management plan should be in place for each child to appropriately rectify high and low blood glucose levels. 

- Low blood sugar is characterised by fatigue, poor reaction times and anxiety. 

- High blood sugar is characterised by frequent urination, thirst and drowsiness. 

- Low blood sugar: immediate ingestion of high GI foods, e.g. jelly beans. 

- High blood sugar: insulin and/or medical attention. 

Epilepsy 

- Epilepsy: caused by excessive neuron activity in the brain causing seizures or in some cases a loss of awareness for a period of time. 

- Implications should not affect participation in general, although water sports, horse riding and motor sports may not be safe if seizure is likely. 

- Children and young athletes suffering from epilepsy use medication to control their seizures. - All coaches and trainers in contact with these athletes must be aware of

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it. 

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- An appropriate management plan for the child is needed, consulted with the child's parents, coaches and doctor. - If the seizure lasts longer than 5 minutes, an ambulance must be called, ending the following of the management plan. ❏ Overuse injuries

Wardle - Overuse injuries: result from repetitive movements placing repetitive stress upon the body parts involved. E.g. stress fracture, shin splints, tendonitis. 

- Implications varied sports participation, adequate rest and recovery. Management includes stopping the activity until fully recovered, and in done in conjunction with health professionals. Other considerations are medication and modifying the training procedure. - E.g. a child with a stress fracture in their shin needs to rest from running until cleared by a GP. - Measures to avoid them: ➔ Breaks for repetitive movements ➔ Gradually building up training intensity ➔ Safe equipment. 

❏ Thermoregulation 

- Thermoregulation: is maintaining normal body temperature (approx. 37 degrees Celsius) 

- Physical activity produces heat as a by-product of ATP production. 

- Children typically have a higher core temperature in hot conditions as they have less-developed sweat glands & overall reduced volume of fluid in their bodies. - Children also have less muscular development than adults, often lower body fat. - This means they are less able to generate and conserve body heat when they are cold.

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- Implications include: appropriate clothing, time of day the sport is played, availability of shade, and access to fluid. Management: hyperthermia cool down using fans, removing clothing, in shade, etc. Hypothermia, warm up using blankets, remove wet clothing. Call ambulance in emergencies. 

❏ Appropriateness of resistance training  

- Resistance training is recommended for children and young athletes. It is no more dangerous than other forms of physical activity and does not stunt growth.

Wardle - It is vital that coaches of juniors have a clear understanding of the procedures ofstrength training for children/young athletes. - Implications and management for children and young athletes should be properly supervised, and be taught techniques as 1 st priority. - Key guidelines for strength training for young athletes:  

➔ Use body weight & progress to light free weights when able. ➔ Train large muscle groups.

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➔ Never ‘lift heavy’ until they have reached physical maturity 

(damages growth plates). ● Adult and aged athletes

❏ Heart conditions - Heart conditions such as hypertension, CVD, etc. can lead to problems for the older competingin higher intensity exercise if not accounted for. They will need a medical clearance before beginning physical activity, which is significantly beneficial for them. 

- Participation options include appropriate exercise (lower intensity sport) over a prolonged period of time. This can improve heart function and reduce blood pressure. 

- A general consensus is that exercise should be low resistance, low impact, and gradually increase as tolerance improves. 

❏ Fractures / bone density 

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- A fracture is a broken bone and poor bone density (i.e. osteoporosis) leads to bones breaking more easily. - Bone density decreases after 35-40, making the older athlete susceptible to broken bones.

Wardle - Thus, participation options are limited, contact sports and other sports with high impact or frequency of injury should be avoided to prevent fractures. - Measures: participating in appropriate weight bearing exercises and recommended daily calcium intake. E.g. swimming is a low impact sport and beneficial for people with low bone density. 

❏ Flexibility / joint mobility 

- Flexibility generally decreases with age (primarily due to osteoarthritis and progressive muscle tightening). 

- Flexibility is joint specific and refers to the joint ROM. Elderly and aged athletes with poor flexibility should develop their flexibility before participating in sports that require flexibility (i.e. gymnastics, dance). - A medical practitioner or physiotherapist can provide advice for participation options. E.g. Yoga for beginners, then progress to intermediate, etc. 

● Female athletes - Women often suffer from the female triad. 

- Female triad includes low energy availability, menstrual irregularities, and weak bones. 

- Tips for female athletes: ➔ Keeping track of their periods ➔ Not skipping meals ➔ Visiting a dietician. 

❏ Eating disorders - Eating disorders are common among many female athletes and the general female population. 

- Anorexia (lack of food intake) and bulimia (purging / throwing up of food following meals) are the most common forms of eating disorders. 

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- Restrictive eating disorders impair physical performance, reducing the energy available for active muscle contractions. - Dehydration can impact the body’s capacity to function at optimum performance due to inhibiting thermoregulation and side effects, e.g. dizziness.

Wardle ❏ Iron deficiency 

- During menstruation, females lose increased levels of iron from their 

body. - This means they must ingest an adequate level of iron to maintain normal levels of it. 

- Iron is vital to the production of haemoglobin, responsible for oxygen transportation, which allows the body’s muscular and energy-producing systems to function. 

- Iron deficiency generally leads to anaemia (lack of RBC), which causes fatigue, reduced energy production and diminished lactate clearance. 

❏ Bone density 

- Low bone density is more common among female athletes, and increases with age. 

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- Low bone density decreases bone strength, thus the risk of fractures. - Recommended that female athletes:

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➔ Consume a high-calcium diet. 

➔ Participate in regular weight-bearing exercise to diminish the incidence ofosteoporosis. 

❏ Pregnancy 

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- Falling pregnant doesn’t mean that the female athlete has the cease participation in sport. - Physical changes experienced during pregnancy: ➔ Weight gain of 10-15kg ➔ Loosening of ligaments ➔ Increased resting heart rate ➔ Decreased blood pressure and volume.

Wardle - An exercise program of light-moderate intensity exercises with low impact tasks should be appropriate. 

- Pregnant athletes should ensure they aren’t getting too hot or short of breath. 

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- Consulting a doctor for a program is recommended. 

- E.g. hydrotherapy, swimming, walking and yoga.

CQ3 – What role do preventative actions play in enhancing the well-being of the athlete? ● Physical preparation

- Physical preparation: in designing sessions, coaches must identify the necessary physical skills, fitness requirements and knowledge of the game that will ensure athletes physical readiness for participation. ❏ Pre-screening - Pre-screening: prior to commencement of a program, athletes should undergo pre-exercise questionnaires and assessment. 

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- Includes: previous injuries & medical conditions, personal goals, previous experience. - Specific concerns: ➔ Age of 40+ w/ sedentary lifestyle ➔ Hypertension, smoking or being overweight ➔ Family history of CVD - E.g. a 40-year-old with CVD fails pre-screening because it is not safe to begin exercise without medical clearance.

Wardle ❏ Skill and technique - High skill and good technique helps prevent injury and enhance the wellbeing of the athlete. 

- Having an inefficient or potentially dangerous technique increases the risk of acute and overuse injuries. 

- E.g. a cricket bowler twists wrong when bowling and injuries his back. - It’s the coach’s responsibility to ensure they have the necessary education, qualifications and current knowledge, so they can teach and develop these skills and techniques. 

❏ Physical fitness - Sport-specific components of fitness are necessary for success as well as ensuring safety by the athlete’s physical readiness for the sport. 

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- Having sufficient fitness levels reduces fatigue and improves performance. If an athlete is lacking in fitness levels, it is often the cause of acute and overuse injuries, as technique and concentration decrease. - E.g. a netball player with poor muscular endurance will fatigue faster and becomes more likely to ...