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Injury and the Healing Process Unit 6 Introduction to Injury When an injury takes place some responses are ________________, but others are_____________ It is not clear if the stages are the same in acute and chronic injuries An athletes point of view of an injury Painful problem that prevents or hampers sport performance Tissue Damage ______________________ Involves damage to a structure at a microscopic level ______________________ Is obvious, visible damage to a structure Individual cell holds the key to the regulation of the body’s trauma response Sports Medicine Goals When an injury occurs the sports med team Minimize the adverse effects of traumatic __________ response ______________tissue repair Expediting a safe return to performance Challenged to understand and anticipate the cellular response in predicting the recovery from injury Injury Mechanisms Human movement during sport and exercise is typically faster and or_____________________ As a result, the potential for injury is also heightened Understanding the different forces that act upon the body- you can understand how to prevent injuries Force Defined as a_____________________________ When a force is sustained by body tissue, two factors help determine if injury occurs The _____________________of the force The material properties of the involved tissues Magnitude of Force ____________forces The response of the loaded structure is elastic When the load is removed the material will return to its original size and shape ___________forces Exceeds the materials elastic limits- the structure is unable to elastically rebound to its original shape Some amount of deformation results Magnitude of Force Larger forces Exceed the material’s ultimate failure limit Produces mechanical failure of the structure Translates to a _________________________of a soft tissue Direction The __________________is applied has important implications for injury potential Many tissues are stronger in resisting force from some directions than from others Lateral ankle sprains are much more common than medial ankle sprains, because ligament support of the ankle is much stronger on the medial side Categories of Force Force acting along the long axis of a structure is an axial Load. 4 categories of force Compression Tension Shear Torque Compressive Force __________that produces a squeezing or crushing effect is a compressive force Weight of the human body constantly produces compression on the bones When a football player is sandwiched between two tacklers, the force upon the player is compressive Often result in_______________________ Tensile Force Axial loading in the direction opposite of that of compression in called tension ________________that stretches the object to which it is applied Muscle contraction produces a tensile force on the attached bone, enabling movement When the ankle is inverted, the tensile force results in an ankle sprain Shear Force Force that acts ---------------------tangent to a plane passing through an object Tends to cause one part of the object to slide, displace, or shear with respect to another part of the object Torque A _____________force is termed torque or torsion Excessive torque's can produce injury Usually generated by forces external to the body rather than by the muscles Torsion results in the creation of shear stress throughout a structure Causing such injuries as a spiral fracture Stress When a given force is distributed over a larger area, the resulting stress is less than if the force where distributed over a smaller area If a force is concentrated over a small area, the mechanical stress is relatively high Football and hockey pads- distribute any force sustained across the entire pad, thereby reducing the stress acting on the player Strain The amount of __________an object undergoes in response to an applied force Application of a ________________to an object produces shortening and widening of a structure __________________produces lengthening and narrowing of a structure _____________results in internal changes in the structure acted upon Acute vs. Chronic ________Injury Caused by a single traumatic force Force is of large magnitude Definitive moment of onset Predictable process of healing Macrotrauma Ruptured ACL Fractured Humerus ____________Injury Cased by repeated forces Force is of small magnitude Over a period of time Stress injury Microtrauma Starts when pain and inflammation become evident May persist for months or even years Body’s Response to Force Tendon, ligament, muscle and bone respond to _________________stress by becoming larger and stronger Overuse syndromes and stress fractures result from the body’s _______________to an increased training regimen Soft Tissue Injuries Behave in characteristic ways when subjected to different forms of loading Skin Tendon Ligament Muscle Collagen Major ________________of soft tissue __________that is strong in resisting tension Allows tissues to stretch slightly under tensile loading, providing flexibility Skin Injuries Skin is the body’s first layer of defense against injury _____________________injured body tissue Different Types of Skin Injuries Abrasions Blisters Skin Bruises Incision Laceration Puncture Wound Abrasions Minor skin injuries Caused by a shear force ______________with sufficient force, usually in one direction, against a rough surface The greater the applied force, the more layers of skin that are scraped away Blisters Minor skin injuries Caused by repeated application of shear in one or more directions Occurs when a shoe rubs back and forth against foot Result is the formation of a ____________between the multiple layers of skin Skin Bruises Contusion Injuries resulting from _______________sustained during a blow Damage of the underlying capillaries Causes the accumulation of blood within the skin Incision and Laceration I____________ Clean cut Produced by the application of a tensile force to the skin as it is stretched along a sharp edge L________________ Irregular tear in the skin Typically results from a combination of tension and shear Puncture Wound Formed when a _____________________the skin and underlying tissues with tensile loading Puncture wound can come from: Shoe spike Nail Categories of Injury ________________________________ Result from compression sustained from heavier blows Injuries vary in severity according to the area and depth over which blood vessels are ruptured Rated according to the extent to which associated joint range of motion is impaired Categories of Injuries Strain and Sprains Caused by an abnormally high tensile force that produces rupturing of the ________________ ___________________________________ Categorized as first, second, and third degree injuries First Degree Injuries Some pain Only involve micro-tearing of the fibers No readily observable symptoms Mild discomfort Local tenderness Mild swelling Ecchymosis NO loss of function Second Degree Injury More severe pain More extensive rupturing of the tissue Detectable joint instability Muscle weakness Limited joint range of motion Third Degree Injury Produce severe pain Major loss of tissue continuity Loss of range of motion Complete instability of the joint Tendonitis Chronic condition Characterized by ____________________ ___________________________ Prolonged chronic inflammation of muscle or tendon can result in the accumulation of mineral deposits, known as calcification Bursitis Involves irritation of one or more bursa, the fluid filled sacs Serve to reduce friction in the tissues surrounding joints Can be______________________ Soft Tissue Healing Normal healing process takes place in a regular and predictable fashion Three Phases Acute Response Repair and Regeneration Remodeling Acute Phase Also known as the____________________ Lasts for the first several days following an injury ______________is major reaction in this phase Characteristics of the inflammatory process: Redness, ___________________ Pain and_________________ Vasoconstriction Vasoconstriction occurs in the________________ Curtails the loss of blood Enables initiation of clotting Hypoxia and Necrosis occur due to lack of oxygen and blood in the area Hypoxia Reduced _________________ Necrosis ______________ Vasodilatation Vasodilatation also occurs in the acute phase Occurs after vasoconstriction Brought on by ____________released by the body Increased blood flow causes swelling in area of injury Broken blood vessels and damaged cells form a__________________ Speeds the arrival of specialized cells that will ingest dead cells and any foreign material or infectious agents The resulting swelling also stimulates nerve endings to cause pain Repair and Regeneration Phase Takes place from about 2 days following the injury through the next 6-8 weeks Begins when hematoma has diminished in size allowing room for____________________ Except for skin, all other soft tissues replace damaged cells with_______________ Healing begins with the accumulation of fibroblasts to produce scar tissue Repair and Regeneration Phase Cont… Fibroblasts begin to produce immature collagen The scar tissue that is formed is less strong and less functional than the original tissue Development of the scar also causes the wound to shrink in size, ____________________________ the affected tissue Remodeling Phase Begins about_________________, overlapping the repair and regeneration phase and continues for a year or more Maturation of the newly formed tissue Decreased fibroblast activity Organization of the tissues increases and normal chemical activity resumes Severe Muscle Injuries Severe muscle injuries can result in scarring or the formation of________________ After severe injury, muscle may regain only about _________of its pre-injury strength Adhesions Tissues that bind the healing tissue to adjacent structures Happens within the muscle Inhibits muscle fiber regeneration Tendon and ligament injuries Have few reparative cells Healing may take more than a year If these tissues undergo abnormally high tensile stress before scar formation is complete, the newly formed tissues can be elongated This may result in__________________________ Bone Injury Healing Three Phases Process Acute Phase Repair and Regeneration Remodeling Phase Acute Phase Last __________________ Hematoma is formed Vasodilatation occurs Edema Tissue chemical changes Repair and Regeneration Phase Osteoclasts come to the area of injury to reabsorb damaged bone tissue Osteoblasts____________________ A callus is forms between the fractured bone ends A callus is a fibrous vascularized tissue containing immature bone Strengthens with time through remodeling phase ________________are only implanted when it appears unlikely that the fracture will not heal properly Remodeling Phase Osteoblasts and Osteoclasts activity continues until normal shape and strength has restored ___________largest requirement for proper none union to take place Complete remodeling may take many years Nerve Injuries Most commonly injured by ________________ forces When a nerve is loaded with tension, the nerve fibers tend to rupture prior to the rupturing of the surrounding tissue The nerve roots on the spinal cord are not protected by connective tissue and are particularly susceptible to tensile injury, especially stretching of the brachial and cervical plexus Compression Injury to Nerves More complex Severity depends on the -___________________ of the loading force Nerve function is highly dependent on oxygen provided by blood vessels Damage to the blood supply caused by a compressive injury results in damage to the nerve Nerve Injuries Symptoms can range Pain Discomfort Complete loss of sensation Chronic irritation/inflammation Lead to chronic pain along the nerve’s path P__________________ of a nerve Results in a sharp wave of pain that is transmitted through a body segment Nerve Healing Completely severed nerve Healing_________________ Loss of function is typically ________________ Incomplete nerve injury Sometimes possible for______________ Regeneration is relatively slow Pain Universal Symptom common to most injuries Individual’s perception of pain is influenced by four factors: Physical Chemical Social Psychological Neurological Basis of Pain _______________, slow transmission nerves carry pain impulses ________________nerves carry other sensations: touch, temperature, proprioception Located in superficial skin layers Can be stimulated by mechanical stresses such as trauma, swelling, and muscle spasm Other pain receptors are chemo-sensitive Pain threshold can become progressively lower Gate Control Theory __________is organized in such a way that pain or other sensations may be experienced An area or “gate” within the spinal cord organizes input stimulus and transmits stimulus to the brain Therefore, stimulation from the larger, faster nerves can selectively “close the gate” to the smaller, slower pain fibers Concept explains why cold can numb the pain as well as why acupuncture, acupressure and skin irritants provide some relief against pain Factors That Mediate Pain Body produces natural “pain killers” that are chemicals similar to morphine called___________ Endorphins __________nerve receptors sites that transmit pain Pain is a mixture of physiological and psychological factors Individuals vary in their pain thresholds Referred Pain Pain that is perceived at a location remote from the injury site Pain is thought of as an error in perception on the part of the brain and body Some referred pain is predictable __________________shoulder and arm Spleen-_____________________ Nutrition and Healing Proper nutrition _____________________the necessary nutrients for wound healing Proteins Vital role in repair, ____________________of body tissue Carbohydrates Main __________for the body and important for repair and healing Nutrition and Healing Vitamins Important role in________________ Vitamin B, C, A,E, and K are all important Supplements Are ____________for healing as long as athlete diet is nutritionally balanced The End Any Questions??
