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Injuries and the Healing Process Olympic High School Sports Medicine Chapter 12,13 Vocabulary Chapter 13 RICE Muscle Tendon DOMS Myositis Fasciitis Ectopic calcification Creptitation Synovia Articulation Osteochondrosis Apophysis Osteoblasts Osteoclasts Wolff’s law Callus Mechanoreceptors Muscle guarding Trigger point Open fracture Closed Fracture Types of Injuries Strains/Sprains Grade 1- slight stretch but no deformity, mild to mod. Pain, localized swelling Grade 2- some tearing of fibers, mod. Instability, mod. Severe pain, swelling Grade 3- total rupture, major instability, severe pain at first then little or no pain, swelling is great Contusion Bruise, hematoma, ecchymosis Tendinitis: inflammation of tendon Overuse injury, pain, swelling, crepitus Bursitis: inflam. Of bursa Swelling, pain, increased pressure Tenosynovitis:same as tendonitis but Wound Injuries:blister, abrasion, inflamed laceration, skin avulsion, incision, puncture tendon/synovial sheath. Types of Injuries continued: fractures Types of Injuries continued Muscle Cramps/spasm: muscle contraction/tightness due to fatigue or injury Myositis Ossificans: calcification of muscle due to excessive bleeding. Dislocation: complete displacement of bone with the joint Subluxation: partial displacement of bone with the joint Epiphyseal Injuries: growth plate injuries. Salter fractures for epiphyseal fractures Nerve Injuries: – Hypoesthesia: a diminished sense of feeling – Hyperesthesia: an increased sense of feeling such as pain or touch – Paraesthesia: numbness, prickling, or tingling, which may occur from a direct blow or stretch to an area Kyphosis: round back, forward-thrust head, winged scapulae, flat chest. Tight pectoral muscles Lordosis: sway back or hollow back. Tight lower back muscles with weak abdominal muscles. Lineman or gymnasts most susceptible. Scoliosis: lateral curvature of the spine Genu Valgum: knock knee Genu Varum: bowleg How do injuries happen? What are the possible injuries that can happen in this slide? Mechanical Forces and Strengths Compression Force: A force that with enough energy crushes tissue. A contusion occurs if too much force is applied Tension Force: a force that pulls and stretches tissue. Sprains/strains, avulsions, ruptures Shearing Force: a force that is transverse to fibers. sprains Example of injuries Pain – Two types of soreness » Acute-onset muscle soreness - accompanies fatigue, and is transient muscle pain experienced immediately after exercise » Delayed-onset muscle soreness (DOMS) - pain that occurs 24-48 hours following activity that gradually subsides (pain free 3-4 days later) Potentially caused by slight microtrauma to muscle or connective tissue structures – Prevent soreness through gradual build-up of intensity – Treat with static or PNF stretching and ice application within 48-72 hours of insult Muscle Stiffness – Does not produce pain – Result of extended period of work – Fluid accumulation in muscles, with slow reabsorbtion back into bloodstream, resulting in swollen, shorter, thicker muscles --resistant to stretching. – Light activity, motion, massage and passive mobilization assists in reducing stiffness Vocabulary Vasoconstriction Vasodilation Regeneration Phagocytosis Serum Synthesis/lysis Cryokinetics Modality Conduction Convection Conversion Inflammatory Response Occurs first for 3-4 days Swelling, redness, pain, heat, loss of function. This occurs to protect the body Acute Inflammation- Before inflammation begins intact blood vessels vasoconstriction up to 10 minutes Then blood coagulation begins to seal broken vessels Then vasodilatation- blood viscosity increases slowing blood flow and swelling then serum seepage 15-30 min. Phagocytosis starts to clean out debris Internal swelling: 1. Throboplastin is sent 2. Thromboplastin and calcium is sent. 3. Thrombin to fibrinogen into final fibrin clot Inflammatory Response Repair PhaseFibroplastic(scar formation) Regeneration Regrowth of lost cells Last up to 3 weeks following injury Primary healing- heal around edges Secondary healing – gaps heal toward each other Remodeling Increase scar tissue first 3 weeks Last 3 months to a year Factors that impede healing 1. Extent of the injury 2. Edema/hemorrhage 3. Poor vascular supply 4. Separation of tissue 5. Muscle spasm 6. Atrophy 7. Infection 8. age Pain Perception Pain- Is described by: burning, sharp, dull, aching, tingling Deep pain is different than superficial pain – How Psychological aspects of Pain Must treat the whole athlete Personality differences plays a role in pain perception Referred Pain- Visceral pain has a tendency to radiate and give rise to pain that becomes referred to skin’s surface COLD AND HEAT Types of cold: Ice bag, ice massage, ice boot, cold whirlpool, ice bucket, chemical spray Physiological effects of cold Decrease in local temperature up to 4” Vasoconstriction of capillaries w/in first 15-20 min., vasodilation 5 min., vasoconstriction 20 min. (Hunting effect) Decrease local cell metabolism Decrease blood flow Decrease nerve velocity Decrease excitability of muscle Analgesic effect (numb) which will decrease spasm Cold and Heat cont. Types of heat Conduction-transmission of heat between two objects Convection-heat produced by a moving mass(gas or liquid) Conversion-heat by electrical current Radiation- ultraviolet light Physiological effects of heat Increase elasticity of muscles & tendons Increase blood flow- vasodilation Decrease spasm Increase local cell metabolism Increase excitability of muscle Increase temp. to 3mm depth Indications of heat Post acute phase Decrease spasm Decrease pain Help wound healing Prior to exercise Contraindications Acute injuries Hyper/hypo sensitive to heat Circulatory problems Indications of cold Acute trauma Anti-inflammatory Decrease pain Decrease spasm Post exercise Prior to therapy Contraindications Before or during activities Hyper/hypo sensitive to cold Circulatory inefficiency Different Modalities Heat Therapies Short-wave diathermy: High frequency electrical current. Used for: bursitis, capsulitis, osteoarthritis, spasm, strains Heat depth= up to 2 inches Ultrasound: High frequency sound waves causes molecules to vibrate and warm Used for: joint contractures, scar tissue, tendonitis, bursitis, skeletal muscle spasm, and pain Paraffin bath: Hot wax used for extremities especially the hand. Massage Techniques: Effleurage- stroking, Petrissage- kneading, friction-heat, tapotementpercussion, vibration-rapid shaking Contrast Baths and other Modalities Hot and cold modality Physiological effects: Same as heat/cold Flushing affect. Brings in new material for repair and flushes out edema When should you use contrast bath? – When swelling has subsided (48-72 hours) Time interval for treatments 4 min. cold then 1 min hot 4 times end in cold= 24 min. 3 min. cold then 2 min hot 4 times end in cold= 23 min 2 min. cold then 3 min hot 4 times end in hot= 20 min 1 min. cold then 4 min hot 4 times end in hot= 20 min Or 5 min. cold/ 5 min. hot Treatment times and Temperatures Ice bag, ice boot, ice whirlpool (55-65 degrees) - 20 min. Ice massage 5-10 min. Warm whirlpool (97-102 degrees), moist heat pack –10 min. Ultrasound- 5-7 min. Muscle stim- 10-20 min.