Download Queensland Senior Physical Education

Sports injuries
Chapter overview
Classifying and managing injuries
• Classifying sports injuries
• Soft-tissue injuries
• Hard-tissue injuries
• First aid
page 259
page 263
page 267
page 270
Injury rehabilitation
• Rehabilitation
• Returning to play
page 276
page 282
Now that you’ve finished … answers
Classifying and managing injuries
Page 259
Classifying sports injuries
Page 259
If injuries are classified according to their cause, the three
categories are:
 direct injury
 indirect injury
 overuse injury.
If injuries are classified according to the type of body tissue
damaged, the two categories are:
 soft-tissue injury
 hard-tissue injury.
Direct injury
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Caused by an external blow or force.
Examples of injuries that result from external forces include
haematomas (corks) and bruises, joint and ligament damage,
dislocations and bone fractures.
Indirect injury

Can occur due to a collision, but
differs from direct injuries because
the actual injury is some distance
from the impact site. E.g. falling on
outstretched hand and dislocating
shoulder
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Can occur from the actions of the
athlete. Often the result of
overstretching, poor technique,
fatigue or lack of fitness; e.g.,
muscle strains and tears, and
ligament sprains
Overuse injury
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Occur when excessive and repetitive force is placed on the
bones and connective tissues of the body.
Often occur when there is a change in training practices
Examples of injuries that result from repetitive forces are stress
fractures (small cracks in the bone) and tendonitis (inflammation
of a tendon).
Personal reflection
Have you ever had an
overuse injury? What
caused it?
Table 7.1 Overuse injuries
Injury
Shin soreness
Knee pain
Heel pain
Symptoms and
signs
Tenderness
Pain in shins
Pain increases by
running and jumping
Swelling
Pain around knee
Pain increased by
sport, stairs, sitting,
hills
Swelling
Discolouration
Tenderness over heel
Pain increased by
running, jumping
Possible causes
Management
Increased activity
Poor footwear
Posture imbalance
Muscle imbalance
Decrease painful activity
RICER
Physiotherapy
Correct footwear
Orthotic control
Decrease activity
RICER
Physiotherapy
Tape
Correct footwear
Orthotic control
Decrease activity
RICER
Physiotherapy
Stretching program
Correct footwear
Orthotic control
Increased activity
Posture imbalance
Poor footwear
Muscle imbalance
Growth spurt
Tight calf muscles
Growth spurt
Poor footwear
Table 7.1 Overuse injuries (cont.)
Injury
Shoulder pain
Elbow pain
Symptoms and
signs
Pain on certain
movements
Reduced movement
Local tenderness
Possible causes
Management
Increased activity, e.g.
swimming
Poor technique, e.g.
swimming, pitching, serving
Pain in and around
elbow
Pain increased by
certain activities, e.g.
shaking, lifting,
gripping
Jarring
Increased activity e.g. golf,
tennis
Muscle imbalance
Poor technique
Change of grip
Lack of control
Decrease activity
RICER
Physiotherapy
Stretching program
Exercises
Modify activity
Decrease activity
RICER
Physiotherapy
Stretching program
Elbow brace
Modify technique
Source: Australian Coaching Council Inc.
Soft-tissue injury
Soft-tissue injuries are the most common sports injuries. They
include:
• skin injuries—abrasions, lacerations and blisters
• muscle injuries—bruises (contusions), and tears or strains of
muscle fibres
• tendon injuries—tears or strains of tendon fibres and
inflammation (tendonitis)
• ligament injuries—sprains and tears of ligament fibres.
Hard-tissue injury


Those involving damage to the bones.
Range from severe fractures and joint dislocations to bruising of
the bone
Secondary injury

Occurs as a result of a previous injury being poorly treated or not
being fully healed.
Table 7.2 Injury incidence in AFL (2009 season)
Body area
Injury type
Head/neck
Concussion
Facial fractures
Neck sprains
Other head/neck injuries
Shoulder sprains and dislocations
Acromio-clavicular joint injuries
Fractured clavicles
Elbow sprains or joint injuries
Other shoulder/arm/elbow injuries
Forearm/wrist/hand fractures
Other forearm/wrist/hand injuries
Rib and chest wall injuries
Lumbar and thoracic spine injuries
Other buttock/back/trunk injuries
Groin strains/osteitis pubis
Hamstring strains
Quadriceps strains
Thigh and hip haematomas
Other hip/groin/thigh injuries, including hip joint
Shoulder/arm/elbow
Forearm/wrist/hand
Trunk/back
Hip/groin/thigh
New injuries per
club per season
0.5
0.5
0.1
0.1
1.3
0.5
0.2
0.2
0.1
1.1
0.4
0.3
1.4
0.5
3.2
7.1
2.2
1.0
1.0
Table 7.2 Injury incidence in AFL (cont.)
Body area
Injury type
Knee
Knee anterior cruciate ligament
Knee medial cruciate ligament
Knee posterior cruciate ligament
Knee cartilage
Patella injuries
Knee tendon injuries
Other knee injuries
Ankle joint sprains
Calf strains
Achilles tendon injuries
Leg and foot fractures
Leg and foot stress fractures
Other leg/foot/ankle injuries
Medical illnesses
Non-football injuries
Shin/ankle/foot
Other
New
injuries/club/season
New injuries per
club per season
0.6
0.7
0.3
1.9
0.2
0.5
1.0
2.6
1.3
0.6
1.0
0.9
1.5
2.9
0.1
37.6
Source: J Orchard and H Seward 2010, 2009 Injury Report, Australian Football League, Melbourne
Soft-tissue injuries
Page 263
Types of soft-tissue injuries


Tears, sprains and contusions
Skin abrasions, lacerations and
blisters
Managing soft-tissue injuries
1. RICER: rest, ice, compression, elevation and referral
Personal reflection
Have you used RICER
to successfully manage
a soft-tissue injury?
2. Treating skin injuries
For most skin injuries, such as abrasions, lacerations and blisters, seven
management steps should be followed:
1. Reduce the dangers of infection (for example, by wearing gloves).
2. Control bleeding with rest, pressure and elevation.
3. Assess the severity of the wound.
4. Clean the wound using clean water, saline solution or a diluted
antiseptic.
5. Apply an antiseptic to the wound (for example, Savlon or Betadine)
after ensuring that the person is not allergic to the antiseptic to be
used.
6. Dress the wound with a sterile pad and bandage.
7. If necessary, refer the person to medical attention.
Hard-tissue injuries
Page 267
Types of hard-tissue injuries
1.
2.
Fracture: a break in a bone
Dislocations: injuries to joints where one bone is displaced
from another.
Fractures are classified into three types: simple
(left), compound (centre) and complicated (right).
Managing hard-tissue injuries
1. Medical treatment: hard-tissue injuries can be accompanied by
significant damage to muscle, blood vessels, surrounding organs
and nerves.
2. Immobilisation: minimising the movement of the joints above
and below the site of the injury
First aid
Page 270
Table 7.3
Approaching injured athletes—a summary
Step
Action
1. Danger
•
Control dangers, then assess injured athlete
2. Life threat
•
Use DRABCD
3. Initial injury assessment
•
Use STOP
4. Detailed injury
•
Use TOTAPS
•
Manage appropriately
•
Refer to health professional
assessment
5. Initial management
Source: J Orchard and H Seward 2010, 2009 Injury Report, Australian Football League, Melbourne
DRABCD
The six letters of the abbreviation stand for:
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danger
response
airway
breathing
compressions
defibrillation (if
available).
A critical step in
assessing injury is
determining
consciousness.
STOP
A fast method for assessing injuries on a field.
STOP stands for:
 Stop
 Talk
 Observe
 Prevent
TOTAPS
Used to provide information about the extent of the injury.
TOTAPS stands for:
• talk
• observe
• touch
• active movement
• passive movement
• skills test
Touch the injured site to help determine the
seriousness of the injury.
Injury rehabilitation
Page 276
Rehabilitation
Page 276
Progressive mobilisation
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The freeing of hindered joints to allow improved motion.
Can be achieved by the athlete carefully exercising the injured
joint or by another person manipulating the injured part.
The range of movement is gradually increased over time until the
full range of movement is restored.
Should begin soon after the injury because inactivity can
increase the formation of scar tissue.
Graduated exercise
1. Stretching improves rehabilitation by:

reducing muscle tension

increasing circulation

increasing muscle and tendon length

increasing the range of motion.
2. Muscle conditioning: Even if the injured area is immobilised (for
example, in a cast or brace) a program should be designed to
prevent muscle atrophy (wasting of muscle tissue).
3. Total body fitness: The choice of exercises to maintain total body
fitness will depend on the type and severity of injury and the athlete’s
sport.
Retraining for skills

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Timing, speed and coordination are affected by rest.
Returning to competition too early would risk re-injury because
their movement skills, game skills and confidence have not been
re-established.
Retraining must be aimed at re-establishing all skills in an
environment that is as close as possible to competition
conditions.
Heat treatment


Heat is applied to increase circulation, either in the body generally or in
a particular area.
The body’s general physiological responses to heat are:
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decreased pain
increased ability to stretch
relaxation
increased blood flow
reduced joint stiffness
decreased muscle spasm
increased inflammatory
response (more blood and
fluid flows to the area)
increased tissue healing.
Heat should not be applied
to acute injuries.
Cold treatment
Cold is commonly applied to an injury:
• during the initial phase of injury
treatment
• after therapeutic exercise of injured
sites.
Cold applied to an injury has the
physiological effects of decreasing:
• swelling
• circulation to the injured site
• acute inflammation
• pain and discomfort
• muscle spasm
• tissue metabolism.
Returning to play
Page 282
Assessing readiness to return to play
Must avoid pressure to participate and first assess:
1.
Physical readiness: being pain free and having mobility
restored to the injured area.
2.
Psychological readiness: monitoring anxiety levels and
assessing behaviour of athlete
Monitoring progress
Athletes’ physical and psychological
condition should be monitored when
they return to play. This might
involve:
• observing the athlete’s
performance
• discussing progress with the
athlete
• conducting ongoing testing
(comparing test results pre-injury
with current results)
• using performance-evaluation
techniques.
Warm-ups after injury
Athletes returning to play may require:


Longer, harder or more specific warm-up and stretching routine
than other athletes.
Extra care the injury site and surrounding tissues to ensure
adequate flexibility, blood flow and readiness to perform.
Return-to-play policies

Return-to-play policies, procedures and guidelines vary
depending on the sport.

Decisions about readiness to play may be determined by a
particular sport’s governing organisation or be left to the
discretion of individual sporting clubs.
Now that you’ve finished…
Answers
1. Describe practices that should be avoided after a soft-tissue
injury.
During the first two to three days after a soft-tissue injury, certain
actions must be avoided. These include applying heat (for
example, hot liniments, spas, saunas and hot baths), drinking
alcohol, physical activity and massage. These actions all increase
blood flow and therefore swelling.
2. Outline the procedure for the immediate management of skin
injuries.
For most skin injuries, such as abrasions, lacerations and blisters, seven
management steps should be followed:
1. Reduce the dangers of infection (for example, by wearing gloves).
2. Control bleeding with rest, pressure and elevation.
3. Assess the severity of the wound.
4. Clean the wound using clean water, saline solution or a diluted
antiseptic.
5. Apply an antiseptic to the wound (for example, Savlon or Betadine)
after ensuring that the person is not allergic to the antiseptic to be
used.
6. Dress the wound with a sterile pad and bandage.
7. If necessary, refer the person to medical attention.
3. Explain the difference between the first aid assessment of
sporting injuries and their long-term management.
First aid aims to:
•
treat unconscious casualties
•
provide information about the extent of an injury.
•
provide initial pain relief and treatment
•
helps to indicate whether the person should be permitted to
continue a game
Finally, first aid determines if the person should be given
professional medical help. It is a professional medical practitioner
who determines what long-term management is required. The
initial stages of assessment and first aid can play a large part in
the long-term successful recovery of an injury.
4. Do some research to discover the most common injuries that occur in your
chosen sport. Create an informative brochure for athletes and coaches.
In your brochure, you should summarise the:
a latest injury statistics
b classification of injuries sustained
c primary causes of injury
d preventative methods.
Your brochure should include diagrams and graphs to represent the statistics you
find.
Answers will vary.
5. Compile a media file of articles about injuries sustained by elite
athletes.
For each injury:
a classify it by cause and tissue type
b outline relevant management procedures.
Answers will vary.
6. Create a short film of the management procedure for soft-tissue
injuries and hard-issue injuries.
Answers will vary.
7. Contrast the management methods used to treat soft-tissue
injuries and hard-tissue injuries.
Soft-tissue injuries are managed using the RICER procedure,
which recommends rest, ice, compression, elevation and referral
(also see answer to question 2). Hard-tissue injuries are managed
by immobilising the injured site.
8. Describe the inflammatory response and the role it plays in
injury rehabilitation.
The acute inflammatory phase, during the first 24 to 72 hours after
injury, is the initial stage of repair of body tissue. The body’s
immediate response to injury is to increase the flow of blood and
other fluids to the injured site. If blood vessels at the site are
damaged, there will also be direct bleeding into the surrounding
tissue. The accumulation of fluid in the area causes an increase in
pressure, which produces pain.
9. Discuss each step of the TOTAPS procedure and the role it
plays in assessing a sporting injury.
1. Talk—ask questions to gather information about the cause, nature and site of
injury
2. Observe—examine the site of the injury to look for deformity, swelling and
redness
3. Touch—feel the site of the injury (if there is no obvious deformity or the
athlete is not especially distressed) and compare with the corresponding site
on the other side of the body. Note any differences in bone shape and skin
temperature.
4. Active movement—If there is no evidence of a fracture or dislocation, ask the
athlete to try to move the injured part and observe the degree of pain.
5. Passive movement—First aider moves the athlete’s injured body part to
determine how much pain-free movement is possible
6. Skills test—decide if the athlete can return to play by having them perform
movements similar to those required in the activity to be resumed.
10. Justify the four rehabilitation procedures commonly used after
sporting injuries.
Progressive mobilisation—necessary because the range of movement is
gradually increased over time until the full range of movement is restored.
Mobilisation of the injured part should begin soon after the injury because
inactivity can increase the formation of scar tissue.
Graduated exercise—necessary to reduce muscle tension, increase circulation,
increase muscle and tendon length and increase the range of motion.
Retraining for skills—even though they might have a full range of movement
and flexibility, strength and fitness, if athletes were to return to competition at this
stage they would risk re-injury because their movement skills, game skills and
confidence have not been re-established. Timing, speed and coordination are
affected by rest. To prepare for the physical and psychological demands of
competition, the athlete must \ undertake active retraining.
Heat and cold are used to break down the body’s responses to an injury and
increase the body’s healing responses.
11. Outline what may determine whether a player is
psychologically ready to return to play.
There is no formal model in place to determine an athlete’s
psychological readiness. However, coaches, teachers and medical
professionals should discuss with athletes their readiness and
observe their behaviour in order to make a decision.
12. Discuss the possible consequences for an athlete who returns
to play prematurely.
If an athlete returns prematurely after injury it might cause the
injury to become worse. This will extend the recovery time, and the
athlete ends up spending more time out of action.
Image credits
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Slide 1, Getty Images / Stuart Franklin
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