Athletic TherapyAthletic TherapyPresented byPresented by

Tara Sutherland CAT(C)Tara Sutherland CAT(C)

PIERPIER

Pressure, Ice, Elevation, Pressure, Ice, Elevation, RestRest

this entire process should be this entire process should be repeated for repeated for 24 to 72 hours24 to 72 hours

PressurePressure stops or limits swelling space stops or limits swelling space

available and decreases blood flow available and decreases blood flow to the area, thus decreasing the to the area, thus decreasing the amount of blood available to swellamount of blood available to swell

eg. eg. Tensor wraps, tapeTensor wraps, tape pressure padspressure pads Maintain Maintain pressure constantlypressure constantly .. ..

Except at nightExcept at night

ICEICE decreases the metabolic rate of the decreases the metabolic rate of the

cells , this decreases the effect of the cells , this decreases the effect of the toxins in the area toxins in the area

decreases the need for oxygen , thus decreases the need for oxygen , thus decreasing the secondary tissue decreasing the secondary tissue deathdeath

decreases nerve conduction rate , decreases nerve conduction rate , thus decreasing the pain thus decreasing the pain

decreases blood flow to area , thus decreases blood flow to area , thus decreasing swellingdecreasing swelling

ICEICE ( con’t) ( con’t) eg.eg. Ice bags , cubed ..crushed Ice bags , cubed ..crushed frozen vegetablesfrozen vegetables gel packsgel packs cold tubs etc.cold tubs etc.

Apply Apply 15 to 20 minutes15 to 20 minutes every hour every hour for first 24- 48 hoursfor first 24- 48 hours

ELEVATIONELEVATION decreases blood flow to the areadecreases blood flow to the area assists venous and lymphatic return , assists venous and lymphatic return ,

aiding in the decreasing of swellingaiding in the decreasing of swelling

elevation means to elevate above elevation means to elevate above the heart as often as possible.the heart as often as possible.

Rest or restricted activityRest or restricted activity decreases blood flow to the area decreases blood flow to the area decreases chance of further injury or decreases chance of further injury or

re-injuryre-injury e.g..e.g.. Bed restBed rest slingsling crutchescrutches braces, splintsbraces, splints

NEVER NEVER

HEAT HEAT

AN AN

ACUTE ACUTE

INJURYINJURY

Primary Injury- directly from an Primary Injury- directly from an external forceexternal force

Secondary injury - arises from an Secondary injury - arises from an injury not properly treatedinjury not properly treated

InjuriesInjuries

Injury classificationsInjury classifications contusionscontusions - blows to soft tissue as - blows to soft tissue as

well as boney areaswell as boney areas sprainssprains - stretching or tearing of - stretching or tearing of

ligaments (connects bone to bone) ligaments (connects bone to bone) strainsstrains- stretching or tearing of - stretching or tearing of

muscle tissuemuscle tissue tendonitistendonitis - inflammation of a - inflammation of a

tendon (connects muscle to bone) tendon (connects muscle to bone) bursitisbursitis - inflammation of a bursa - inflammation of a bursa

(balloon like protests areas) (balloon like protests areas)

Typical Sports InjuriesTypical Sports Injuries Ankle sprains ( ATF)Ankle sprains ( ATF) Medial Tibial Stress Syndromes ( shin Medial Tibial Stress Syndromes ( shin

splints)splints) Knee MCL or ACLKnee MCL or ACL Quad ContusionsQuad Contusions FracturesFractures Head InjuriesHead Injuries

Ankle ATF SprainsAnkle ATF Sprains

Inversion Ankle SprainsInversion Ankle Sprains more common than eversion because of more common than eversion because of

ligament and bony support ligament and bony support stress is applied to the lateral side of the foot stress is applied to the lateral side of the foot

during plantar flexion and inversion during plantar flexion and inversion individual will report cracking or tearing sound individual will report cracking or tearing sound

at time of injury at time of injury swelling and ecchymosis will be rapid and swelling and ecchymosis will be rapid and

diffusediffuse point tenderness over ATF may extend over CFpoint tenderness over ATF may extend over CF

Rx - PIER, modalities -horseshoe padRx - PIER, modalities -horseshoe pad Should probably xray to rule out any Should probably xray to rule out any

possible fracturespossible fractures

Medial Tibial Stress Medial Tibial Stress SyndromeSyndrome

shin splintsshin splints pain along the posteriormedial tibial border pain along the posteriormedial tibial border usually in the distal third usually in the distal third Possible factorsPossible factors - excessive pronation , - excessive pronation ,

prolonged pronation , recent training prolonged pronation , recent training changes (speed, form , running surface , changes (speed, form , running surface , distance) distance)

pain usually present at start of activity ,but pain usually present at start of activity ,but decreases with activity only to return after decreases with activity only to return after activity, later stages pain present at all activity, later stages pain present at all times - may restrict activitytimes - may restrict activity

RX - PIER, NSAIDS, ( modalities) RX - PIER, NSAIDS, ( modalities) activity modification (rest) - low activity modification (rest) - low impact - non impact - stretching and impact - non impact - stretching and strengthening of intrinsic muscle of strengthening of intrinsic muscle of the footthe foot

Medial Collateral Medial Collateral LigamentLigament

provide valgus, external rot provide valgus, external rot support ( note ACL is also very support ( note ACL is also very imp in this function)imp in this function)

basically a thickening of the basically a thickening of the medial capsulemedial capsule

superficial layer and a deep layersuperficial layer and a deep layer

Anterior Cruciate Anterior Cruciate LigamentLigament

ACL most common and serious injury to ACL most common and serious injury to the knee the knee

susceptible to injury with a valgus force, susceptible to injury with a valgus force, external rotation strong quad contraction external rotation strong quad contraction of knee hyperextensionof knee hyperextension

ACL is subject to deceleration injuries , ACL is subject to deceleration injuries , internal tibial torque is the most dangerous internal tibial torque is the most dangerous loading mechanism, particularly when loading mechanism, particularly when combined with an anterior tibial forcecombined with an anterior tibial force

damage to the ACL usually results damage to the ACL usually results from a cutting or turning maneuver, from a cutting or turning maneuver, landing off balance or a sudden landing off balance or a sudden deceleration deceleration

pain described as being felt deep in pain described as being felt deep in the knee or on either side of the the knee or on either side of the patellar tendonpatellar tendon

joint effusion is usually bloody and joint effusion is usually bloody and fairly rapid onsetfairly rapid onset

Rx - PIER, –tensor wrapRx - PIER, –tensor wrap Send to Physician / TherapistSend to Physician / Therapist Should probably xray to rule out any Should probably xray to rule out any

possible fracturespossible fractures

Quad ContusionQuad Contusion

AKA Charlie horseAKA Charlie horse most common site for contusion is most common site for contusion is

the anterolateral thigh, which almost the anterolateral thigh, which almost always damages muscle tissuealways damages muscle tissue

severity of injury is almost always severity of injury is almost always underestimated and under treated underestimated and under treated

s/s - immediately after impact pain s/s - immediately after impact pain and swelling may be extensive, ROM and swelling may be extensive, ROM will be limited due to severitywill be limited due to severity

if severe the individual may not be if severe the individual may not be able to bear weight and not able to able to bear weight and not able to fully flex the kneefully flex the knee

there may be a palpable firm there may be a palpable firm hematoma with in 24 hours – hematoma with in 24 hours – resulting in the inability to contact resulting in the inability to contact the quadsthe quads

Rx – PIER – do not heat – should be Rx – PIER – do not heat – should be iced in a flexed positioniced in a flexed position

Myositis ossificans is an abnormal Myositis ossificans is an abnormal ossification involving bone deposites ossification involving bone deposites within muscle tissue within muscle tissue

Muscle strainsMuscle strains

muscular strains to the thigh and hip muscular strains to the thigh and hip are frequent in sports, Rectus are frequent in sports, Rectus Femoris, Adductors and hamstrings Femoris, Adductors and hamstrings

hamstrings are the most commonly hamstrings are the most commonly strained muscle in the bodystrained muscle in the body

individual may report a snapping or individual may report a snapping or tearing during an explosive action , tearing during an explosive action , followed by immediate pain and loss followed by immediate pain and loss of function , with local tenderness of function , with local tenderness and possibly a palpable defectand possibly a palpable defect

usually caused by rapid contraction usually caused by rapid contraction or a violent stretchor a violent stretch

hamstring strain has the reputation hamstring strain has the reputation of being a chronic and reoccurring of being a chronic and reoccurring problemproblem

Risk factorsRisk factors Poor flexibilityPoor flexibility Poor posturePoor posture Muscle imbalanceMuscle imbalance Improper warm up Improper warm up Muscle fatigueMuscle fatigue Previous injuryPrevious injury Overuse Overuse Improper techniqueImproper technique

FracturesFractures

Can range from stress fractures , hairline Can range from stress fractures , hairline fractures to displace open fracturesfractures to displace open fractures

When in doubt send for an xrayWhen in doubt send for an xray If open or displaced call 911, do not try to If open or displaced call 911, do not try to

re align or move the limb in questionre align or move the limb in question If closed , splint and transport to hospitalIf closed , splint and transport to hospital

Head InjuriesHead Injuries

Prevention of InjuriesPrevention of Injuries the most important protective the most important protective

measure for the head is the use of measure for the head is the use of helmetshelmets

the proper use of protective the proper use of protective equipment can protect the head from equipment can protect the head from accidental or routine injuriesaccidental or routine injuries

A concussion literally meansA concussion literally means:: a violent shaking or jarring action of the a violent shaking or jarring action of the

brain, resulting in immediate or transient brain, resulting in immediate or transient impairment of neurologic function impairment of neurologic function

this condition does not always involve the this condition does not always involve the loss of consciousnessloss of consciousness

when shaken or jarred brain function can when shaken or jarred brain function can be disrupted temporarily with out causing be disrupted temporarily with out causing injury or damage to the braininjury or damage to the brain

S/S range from mild to moderate and are S/S range from mild to moderate and are transient and reversible since damage to transient and reversible since damage to soft tissue is minimalsoft tissue is minimal

Loss of consciousnessLoss of consciousness unresponsive, confused , disorientedunresponsive, confused , disoriented Amnesia - confusion Amnesia - confusion loss of memory of events after injury loss of memory of events after injury

(posttraumatic amnesia)(posttraumatic amnesia) loss of memory prior to injury loss of memory prior to injury

( retrograde amnesia) ( retrograde amnesia)

Pupil abnormalitiesPupil abnormalities - note pupil - note pupil size and accomodation to light - both size and accomodation to light - both should be equalshould be equal

vision problems - blurred, double , vision problems - blurred, double , seeing starsseeing stars

Headache Headache Nausea or VomitingNausea or Vomiting

SCATSCAT

Sport Concussion Assessment Tool Sport Concussion Assessment Tool

Most uptodate assessment and Most uptodate assessment and treatment tool for concussionstreatment tool for concussions

When in doubt be safe When in doubt be safe

Thank you for your time .Thank you for your time .

Tara Tara