SPORT INJURY MANAGEMENT FOR COACHES / PE INSTRUCTORS (THE CONCEPT)

BY : NUR IZURA BT. MOHD SAAD

What is Sport Injuries??

Caused by participation in a sporting event; may be overuse injuries or caused by a hard contact with something

Objective
The participants will have a knowledge of: Injury prevention Injury cycle The participants will be able to: Systematically approach an injury situation Provide appropriate initial management Able to reduce the likelihood of further damage Referral if necessary

TYPE OF INJURY ACUTE CHRONIC CAUSES INTRINSIC EXTRINSIC

Body Composition Age Muscle Weakness Poor Flexibility Injury

Training Method Surface Equipment Environment

Causes of injury

Overload High intensity Improper safety Impropriate warm up & cooling down Others

Injury occurs- Hard & soft tissue (due to intrinsic & extrinsic factors)

COMMON SPORT INJURIES

Nerve Joint

Muscle
Bone Ligament

Soft tissue
Refers to injuries to muscles, tendon, ligament, fascia & skin Common / type of injuries 1. Sprain 2. Strain 3. Open wound 4. Deep bruising (haematoma) 5. Muscle soreness 6. Muscle cramp

Management of soft tissue injury

Why need early management? To facilitate rapid healing To prevent edema To reduce risk of recurrent

Factors to be consider within To reduce local temperature (48-72 hours)

To manage pain Minimize inflammation Protect damage tissue from further injury Aid collagen fiber growth (realignment) Maintain cardiorespiratory & muscular fitness

Injury Cycle
Prevention Of Recurrence Prevention

Rehabilitation

Incident phase

Definitive care

Acute phase

INJURY PHASE PREVENTION

DESCRIPTION To stop injury occurring The first few seconds

APPROACH USED Prevention strategies Ensure no danger or no life-threatening (DRABC)

INCIDENT PHASE ACUTE PHASE

48 72 hours after STOP, TOTAPS, injury RICER, NO HARMS Fracture Management

INJURY ASSESSMENT
Primary Survey (DRABC)
Secondary Survey (TOTAPS)

 DRABC Danger, Response, Airway, Breathing, Circulation (could this incident have been prevented?) STOP a fast on-field assessment.

3 Steps in the management of an incident

Stop, talk, observe, prevent further injury

Determine - is there an injury - can the athlete continue to play - is the injury major/ minor - should the athlete be removed TOTAPS to make a full assessment on or off the field Use it to: specifically assess the injury outline the basis of your management plan

WHAT IS PRIMARY SURVEY ?

When an athlete goes down with an injury, you should do as follow : Determine whether the athlete is conscious/ unconscious
If unconscious, check the athletes ABCs : * airway used head tilt/chin lift/chin lift only * breathing look, listen & feel for breathing - if none, give 2 full breaths * circulation check carotid (neck) pulse

 If the athlete is conscious & able to talk, check these

function : * breathing for irregularities * pulse for heart / circulation problems

If both breathing & pulse are normal, begin the

secondary survey to locate & check the extent of the injury

Performed after life threatening injuries have been ruled out

 TALK ask the player what happen ?

TOTAPS

- where does it hurt ? - what kind of pain ? OBSERVE look at the offered area for REDNESS/SWELLING - is the injured side different from other side ? TOUCH touch will indicate warmth for inflammation - touch also assesses pain

 ACTIVE MOVEMENT

- ask the injured athlete to move the injured part without any help
PASSIVE MOVEMENT

- if the player can move the injured part, carefully try to move it yourself through its full range of motion

 SKILL TEST

- did the active & passive movement produce pain?

- If no, can the player stand & demonstrate some of

the skills from the game carefully? - If an injury is identified, remove the player from the activity immediately.

 STOP stop the athlete from participating /

STOP

- stop the game if necessary TALK talk to the injured athlete : * what happened? * how did it happen? * what did you feel? * where does it hurt? * can you play on? * if no, arrange appropriate transport

 OBSERVE observe whilst talking to the athlete:

* GENERAL : is the athlete distressed? : is the athlete lying in an unusual position/posture? * INJURED SITE : is there any swelling, deformity / discoloration? : can the athlete remove the injured part?

 PREVENT FURTHER INJURY by:

- ensuring a detailed assessment using TOTAPS

IMMEDIATE ASSESSMENT (on the field)

R : Rest I : Ice C : Compression E : Elevation R : Referral

Further Management?
Rehabilitation NO H - HEAT A - ALCOHOL R - RUNNING M -MASSAGE

Rest - stop using injured limb

How - should lying down, immobised & supported Why - activity will promote bleeding

Ice - crushed ice in wet towel/ plastic bag, cold water

immersion in ice water, commercial cold packs Why - ice reduces swelling, pain, muscle spasm

Compression - apply a firm wide

compression bandage (not to rigid) Why - it reduces swelling, bleeding & provide support

Elevation - Raise the injured area above the level of Heart

Why - reduce bleeding, swelling & pain

The RICER regime must be continued & NO HARM factors for the first 48 72 hours after the injury to reduce :
The severity of further injury, haematoma & tissue

swelling The amount of tissue damage The recovery time

RICER

REST rest reduces further damage

essential elements for a quick recovery from injury

- avoid such as movement as possible to limit further damage - dont put any weight on the injured part of the body
ICE apply a hot/cold pack to the injury for

20 minutes every 2 hours

 COMPRESSION

- apply Elastoplasts Sport Elastic Adhesive bandage or a non-elastic compression covering the injured area as well as the areas above & below - compression reduces bleeding & swelling - check bandage is not too tight

 ELEVATION elevate the injured area to stop

bleeding & swelling - place the injured area on a pillow for support
REFERRAL refer the injured person to a

qualified professional such as a doctor for definitive diagnosis & continuing management

NO HARM
HEAT - such as sauna, spa hot water bottle,

hot shower, rubs - increase bleeding ALCOHOL increase swelling RUNNING or exercise too soon can make injury worse MASSAGE in the first 48-72 hours increase bleeding & swelling

INJURY PREVENTION Conditioning Nutrition - Warming Down Skills & Knowledge - Warming Up Others Environment Protective Equipment

Handling Minor Injuries

1. Evaluate the injury 2. Administer first aid 3. Remove from game (if necessary)

4. Contact the coaches or parents

5. Suggest to see the doctor 6. Injury report

Handling Serious Injury

1. Check level of consciousness (AVPU) 2. Activate Emergency Medical (ERP) 3. Wait for rescue team 4. Assess the injury

5. Administer the first aid

6. Assist for transportation 7. Accompany to hospital

8. Complete injury report

Cares for bleeding

Could be open wound Could lead to shock

1. 2. 3. 4. 5. 6. 7. 8.

Alert EMS system Provide an open airways (monitor pulse) Keep at rest (emotional support) Treat for shock Loosen restrictive clothing Nothing to the mouth Splint (for fractures) Constantly monitor vital signs

Moving an injured athlete

Moving critical injured
- keep the athlete still unless you cannot establish airway or CPR

Non critically injured

- can be more readily move

Management of soft tissue injuries

(strain, sprain, soreness, contusion)
Early, aggressive & proper use of RICER regime and NO HARM factors is very essential. (usually within 72 hours)

Summary managing injured athlete

Once it happened. .

Step 1 Danger control danger then assess

Step 2 Life threat Use DRABC Step 3 Initial injury assessment Use STOP Step 4 Detailed injury assessment Use TOTAPS Step 5 Initial management Manage appropriate Referral

Stages of managing injury

1. First Aid measures 2. RICE

3. Early management make a diagnosis with appropriate investigation

4. Formulate a treatment plan 5. Maintain cardiorespiratory fitness 6. Stretching & strengthening exercise 7. Sport specific fitness 8. Attention to technique & equipment 9. Competition staged return

Other therapy
Corticosteroid injection Inflammatory gels

Vitamins
Dietary supplementation

- Glucosamine - Chondroitin sulphate? Traction Electrotherapy Sports massage Surgery

 The use of special exercises and modified

training methods to help an athlete recovery from an injury

Is required to return the athlete to the

previous level & enable the athlete to return to sport will function in the shortest possible time

OBJECTIVE OF REHAB :
Is enable the athlete to return to sport with full

function in the possible time Also minimize the undesirable effects of immobilization on the injured area; encourage proper healing, maintain all around conditioning (allowing for restrictions because of the injury) * restore sport specific function Also can break an athletes injury or re-injury cycle

Future of sports medicine

The risk of injury will never be entirely eliminated but modifications in training techniques, equipments, sports venue and rules based on meaningful research have shown that risks can be lowered.

(The Director of Institute of Preventive Medicine - Michigan)

Further Reading
1. Flegel, Melinda J (2004) Sport First Aid, Human Kinetic 2. Griffith H. W. (1999) Complete guide to Sports Injuries Mc Graw Hill

3. Prentice, William E. (1999) Rehabilitation techniques in Sports Medicine Mc Graw Hill 4. BMJ, 1994, 308: 1356-9 ABC of Sports Medicine Nature, Prevention & Management of Injury in Sport 5. http://www.merck.com

Conclusion
1. Injuries in sport usually either acute traumatic or chronic (overuse) injuries

2. History to establish causes(s) of injury and thus make correct diagnosis and prevent recurrence 3. Diagnosis for correct treatment
4. Treatment appropriate to injury
- Rest - DRUGS - PHYSIOTHERAPY - SURGERY

(cont.) Conclusion. .

5. Maintenance of general Fitness 6. Correction of poor training programmed 7. Rehabilitation gradual, structured regimen 8. Emphasis of importance of warm up, stretching and exercise 9. Lets think common sense, dont panic and approach with professional manner

THANK YOU