preventing athletic injuries tony milian, atc, lat manager, sports medicine [u18] sports medicine...

Preventing Athletic Preventing Athletic InjuriesInjuries

Preventing Athletic Preventing Athletic InjuriesInjuries

Tony Milian, ATC, LATTony Milian, ATC, LATManager, Sports MedicineManager, Sports Medicine

[U18] Sports Medicine[U18] Sports MedicineCooper City Optimist LectureCooper City Optimist Lecture

February 16th, 2010February 16th, 2010

Tony Milian, ATC, LATTony Milian, ATC, LATManager, Sports MedicineManager, Sports Medicine

[U18] Sports Medicine[U18] Sports MedicineCooper City Optimist LectureCooper City Optimist Lecture

February 16th, 2010February 16th, 2010

Parents’, Coaches’, Trainers’, Physicians’Parents’, Coaches’, Trainers’, Physicians’ Everybody’sEverybody’s Goals Goals

Parents’, Coaches’, Trainers’, Physicians’Parents’, Coaches’, Trainers’, Physicians’ Everybody’sEverybody’s Goals Goals

Make the game as safe as possible for the players

Protect the athlete from further injury

Accurate evaluation

Early recognition and treatment

Definitive injury care

Return to play

Make the game as safe as possible for the players

Protect the athlete from further injury

Accurate evaluation

Early recognition and treatment

Definitive injury care

Return to play

PreventionPreventionPreventionPrevention

Representative Areas For Today:

Head Injury

Heat Injury

Supplement Injury

Lightning Injury

Stretching Dynamic / Static

Representative Areas For Today:

Head Injury

Heat Injury

Supplement Injury

Lightning Injury

Stretching Dynamic / Static

Head Injury: ConcussionHead Injury: ConcussionHead Injury: ConcussionHead Injury: Concussion

Definition - Immediate and transient impairment of neurologic function due to traumatic injury to the head

May or may not involve loss of consciousness (LOC)

Definition - Immediate and transient impairment of neurologic function due to traumatic injury to the head

May or may not involve loss of consciousness (LOC)

Early Signs of ConcussionEarly Signs of ConcussionEarly Signs of ConcussionEarly Signs of Concussion

Impaired attention

Slurred, incoherent speech

Disorientation

Impaired Coordination

Emotional reaction out of proportion

Memory deficits

Any loss of consciousness

Impaired attention

Slurred, incoherent speech

Disorientation

Impaired Coordination

Emotional reaction out of proportion

Memory deficits

Any loss of consciousness

Late Signs of ConcussionLate Signs of ConcussionLate Signs of ConcussionLate Signs of Concussion

Persistent headache

Dizziness

Poor Attention

Memory Dysfunction

Nausea or Vomiting

Irritability

Photophobia

Persistent headache

Dizziness

Poor Attention

Memory Dysfunction

Nausea or Vomiting

Irritability

Photophobia

AAN Concussion Grading AAN Concussion Grading ScaleScale

AAN Concussion Grading AAN Concussion Grading ScaleScale

Grade I

Abnormal symptoms resolve in less than 15 minutes

Grade II

Abnormal symptoms resolve in greater than 15 minutes

Grade III

A: Brief LOC (seconds)

B: Prolonged LOC (minutes)

Grade I

Abnormal symptoms resolve in less than 15 minutes

Grade II

Abnormal symptoms resolve in greater than 15 minutes

Grade III

A: Brief LOC (seconds)

B: Prolonged LOC (minutes)

AssessmentAssessmentAssessmentAssessment

Cervical Spine (LOC)

Facial Expression

Pupil size and reactivity

Upper and Lower extremity

Orientation

Immediate Memory

Delayed Recall

Cervical Spine (LOC)

Facial Expression

Pupil size and reactivity

Upper and Lower extremity

Orientation

Immediate Memory

Delayed Recall

AAN Concussion AAN Concussion ManagementManagement


Grade I (<15 minutes, no LOC)

Remove from contest

Immediate exam and at 5 minute intervals

Out for Remainder of Game

Grade I (<15 minutes, no LOC)

Remove from contest


Out for Remainder of Game



Grade II (>15 minutes, no LOC)

Remove from contest; no return


Re-exam the next day

MD exam and clearance after 1 asymptomatic week

Grade II (>15 minutes, no LOC)

Remove from contest; no return


Re-exam the next day

MD exam and clearance after 1 asymptomatic week



Grade III (Any LOC)

EMS transport to nearest ER

MD evaluation and +/- brain imaging

Possible Admit

Grade III (Any LOC)

EMS transport to nearest ER

MD evaluation and +/- brain imaging

Possible Admit



Grade III - Return to play

Brief LOC : 1 week

Prolonged LOC : 2 weeks

2nd Injury: 1 month

Abnormal Brain Scan : season terminated

Grade III - Return to play

Brief LOC : 1 week

Prolonged LOC : 2 weeks

2nd Injury: 1 month

Abnormal Brain Scan : season terminated

Heat InjuryHeat InjuryHeat InjuryHeat Injury

When “walk it off” is not the right thing to say

What three types exist

What are the risk factors

Prevention strategies

Treatment strategies

Heat cramps

Heat exhaustion

Heat stroke

When “walk it off” is not the right thing to say

What three types exist

What are the risk factors

Prevention strategies

Treatment strategies

Heat cramps

Heat exhaustion

Heat stroke

Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related Injury

Heat production increases 15X with exercise

Two mechanisms to dissipate head

Radiation (65%) – Clothing

Evaporation (30%) – Humidity

Heat production increases 15X with exercise

Two mechanisms to dissipate head

Radiation (65%) – Clothing

Evaporation (30%) – Humidity


Heat Cramps

Painful muscle spasms that most commonly occur in the calf and abdomen but can occur anywhere.

Treatment involves drinking water, mild stretching and ice massage of the affected area.

Heat Cramps

Painful muscle spasms that most commonly occur in the calf and abdomen but can occur anywhere.

Treatment involves drinking water, mild stretching and ice massage of the affected area.


Heat Exhaustion

Headache

Dizziness

Weakness

Fatigue

Muscle cramps

Vomiting

Excessive thirst dry tongue and mouth

In-coordination, mental dullness,

Elevated body temperature & reduced sweating.

Heat Exhaustion

Headache

Dizziness

Weakness

Fatigue

Muscle cramps

Vomiting

Excessive thirst dry tongue and mouth

In-coordination, mental dullness,

Elevated body temperature & reduced sweating.

Looks Like a

Viral Illness


Heat Exhaustion

Treatment

Rest

Remove from hot environment

Fluid replacement over several hours

Likely requiring IV fluid

Ice packs to neck, groin, armpits

Heat Exhaustion

Treatment

Rest

Remove from hot environment

Fluid replacement over several hours

Likely requiring IV fluid

Ice packs to neck, groin, armpits

Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related InjuryHeat Stroke

Sudden collapse usually with a loss of consciousness

Flushed, hot skin; Rapid, strong pulse

Sweating is often absent

Body has lost the ability to cool itself

Treatment - Immediate call to 911 and

Cool the body

Strip all the clothing off the athlete

Sponge with cool water, and fan with a towel

Ice water immersion is controversial

No alcohol sponge baths

Heat Stroke

Sudden collapse usually with a loss of consciousness

Flushed, hot skin; Rapid, strong pulse

Sweating is often absent

Body has lost the ability to cool itself

Treatment - Immediate call to 911 and

Cool the body

Strip all the clothing off the athlete

Sponge with cool water, and fan with a towel

Ice water immersion is controversial

No alcohol sponge baths

Heat Related InjuryHeat Related InjuryHeat Related InjuryHeat Related InjuryPrevention Strategies

Education

Hydration

Prior to activity (1/2 liter starting 2 hours prior to activity)

Every 15-20 minutes during activity

If Child = 5oz

If Adolescent = 9oz

Rest

More frequently during hot and humid days

Schedule adjustment

Equipment removal

Prevention Strategies

Education

Hydration

Prior to activity (1/2 liter starting 2 hours prior to activity)

Every 15-20 minutes during activity

If Child = 5oz

If Adolescent = 9oz

Rest

More frequently during hot and humid days

Schedule adjustment

Equipment removal


Hydration

Sports Beverages Recommended

Carbohydrate (glucose and sucrose)

Sodium

Potassium

Hydration

Sports Beverages Recommended

Carbohydrate (glucose and sucrose)

Sodium

Potassium


WARNING!!!WARNING!!!

Heat IllnessHeat IllnessHeat IllnessHeat Illness

Heat illness may be hard to detect

Fluids before / during / after

EMS activation

Treatment on scene

Prevention is key

Heat illness may be hard to detect

Fluids before / during / after

EMS activation

Treatment on scene

Prevention is key

Supplement IllnessSupplement IllnessSupplement IllnessSupplement Illness

Caffeine

Steroids

GNC

Amphetamines

Red Bull

Caffeine

Steroids

GNC

Amphetamines

Red Bull

Caffeine ContentStandard 4 ounce cup = 50 mg caffeine

8 oz Red Bull

16 oz Rockstar

16 oz Arizona

8 oz Cocaine Energy Drink

2 oz Extreme Energy

OR

Lightning InjuryLightning InjuryLightning InjuryLightning Injury

Florida ranks as # 1 in the US for lightning related injury and death

One out of every 9 lightning strikes end in a fatality

Common misconceptions

Florida ranks as # 1 in the US for lightning related injury and death

One out of every 9 lightning strikes end in a fatality

Common misconceptions

Lightning IllnessLightning IllnessLightning IllnessLightning Illness

Lightning strikes up to 25 miles away

Be Proactive!

Plan Ahead

Monitor the weather

Postpone the activity

Get to a safe place

Lightning strikes up to 25 miles away

Be Proactive!

Plan Ahead

Monitor the weather

Postpone the activity

Get to a safe place

LightningLightningLightningLightning


Use the 30/30 rule…

If time between lightning and thunder is LESS than 30 seconds…get to a safe place!!!

WAIT 30 seconds after hearing last thunder before leaving safe location

Retreat to an enclosed building

Vehicle with closed window adequate

OK to touch victim

AVOID…

Dugout

Picnic pavilion

Rain shelter

Use the 30/30 rule…

If time between lightning and thunder is LESS than 30 seconds…get to a safe place!!!

WAIT 30 seconds after hearing last thunder before leaving safe location

Retreat to an enclosed building

Vehicle with closed window adequate

OK to touch victim

AVOID…

Dugout

Picnic pavilion

Rain shelter


Move victim ONLY if necessary, with particular attention to any possible brain or spinal cord injury

Examine for burns, broken bones, cuts, loss of hearing or eyesight

Emergency Plan Activation

Activate your plan

Notify EMS

AED if available

Log roll

Initiate effective CPR

Move victim ONLY if necessary, with particular attention to any possible brain or spinal cord injury

Examine for burns, broken bones, cuts, loss of hearing or eyesight

Emergency Plan Activation

Activate your plan

Notify EMS

AED if available

Log roll

Initiate effective CPR

Some Emergencies on the field Obviously need 911

Dislocations

Open Fractures

Gross Deformities

LOC

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Injury PreventionInjury Prevention

3.5 million injuries each 3.5 million injuries each yearyear– Most common are Most common are

strains and sprainsstrains and sprains

PreventionPrevention– Dynamic warm upDynamic warm up

– Static stretchingStatic stretching

– Proper biomechanical Proper biomechanical trainingtraining

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StretchingStretching

Stretching:Stretching: the act of performing a particular the act of performing a particular exercise to improve joint range of motion. exercise to improve joint range of motion. European European College of Sports Sciences 2006.College of Sports Sciences 2006.

Static StretchingStatic Stretching: when a body part is taken to a : when a body part is taken to a point of mild discomfort and held for an amount of point of mild discomfort and held for an amount of time.time.

Dynamic Stretching/MovementsDynamic Stretching/Movements: movements that : movements that maximize active range of motion and elevate core maximize active range of motion and elevate core body temperature.body temperature.

• Journal of Strength and Conditioning 2005Journal of Strength and Conditioning 2005

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Static vs. DynamicStatic vs. Dynamic

Does static stretching prior to activity Does static stretching prior to activity achieve the goals of injury prevention and achieve the goals of injury prevention and performance enhancement?performance enhancement?

NONOResearch has shown that static stretching Research has shown that static stretching can be detrimental to performance and does can be detrimental to performance and does not lead to a decrease in injurynot lead to a decrease in injury

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Static vs. DynamicStatic vs. Dynamic• Study from the Journal of Strength and Conditioning, 2008Study from the Journal of Strength and Conditioning, 2008

24 Division I wrestlers were randomly assigned to 24 Division I wrestlers were randomly assigned to complete a 4 week Dynamic or Static warm up complete a 4 week Dynamic or Static warm up routine prior to their preseason practicesroutine prior to their preseason practices

11 performed the static warm up 11 performed the static warm up

13 performed the dynamic warm up13 performed the dynamic warm up

They were tested on med ball underhand throw, They were tested on med ball underhand throw, 300 yard shuttle, pull ups, push ups, sit ups, broad 300 yard shuttle, pull ups, push ups, sit ups, broad jump, 600 m run, sit to stand reach, trunk jump, 600 m run, sit to stand reach, trunk extension, quad and hamstring peak torque tests.extension, quad and hamstring peak torque tests.

3377


• Results Dynamic GroupResults Dynamic GroupIncrease in quadriceps peak torque by 11%Increase in quadriceps peak torque by 11%

Increase in broad jump by 4%Increase in broad jump by 4%

Increase in underhand med ball throw by 4%Increase in underhand med ball throw by 4%

Increase in sit ups by 11%Increase in sit ups by 11%

Increase in push ups by 3%Increase in push ups by 3%

Static group posted no improvements to tests Static group posted no improvements to tests performed.performed.

3388

Static vs. DynamicStatic vs. Dynamic• Study from the Journal of Strength and Conditioning, 2006Study from the Journal of Strength and Conditioning, 2006

United States military academy took 30 cadets to do a United States military academy took 30 cadets to do a study on static vs. dynamic warm up routines to see study on static vs. dynamic warm up routines to see which one would better prepare their cadets for power which one would better prepare their cadets for power and agility activitiesand agility activities

Tested on the 5 step jump to determine functional leg Tested on the 5 step jump to determine functional leg powerpower

Medicine ball throw was chosen to measure total Medicine ball throw was chosen to measure total body powerbody power

T-drill was chosen to measure agilityT-drill was chosen to measure agility

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For 3 days one group of cadets performed For 3 days one group of cadets performed static stretches for 10 minutes prior to data static stretches for 10 minutes prior to data collectioncollectionOther group performed dynamic stretches Other group performed dynamic stretches for 10 minutesfor 10 minutesAll routines were done at 6AM each dayAll routines were done at 6AM each dayThere was a 2 minute period between There was a 2 minute period between finishing the warm up and beginning the finishing the warm up and beginning the performance testperformance test

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• ResultsResultsT –drill static warm up = 9.69 sec vs. dynamic’s T –drill static warm up = 9.69 sec vs. dynamic’s 9.56 sec9.56 sec

Medicine ball throw = 9.34 meters with static vs. Medicine ball throw = 9.34 meters with static vs. 9.79 meters with dynamic9.79 meters with dynamic

5 step jump = 9.78 meters with static vs. 10.06 5 step jump = 9.78 meters with static vs. 10.06 meters with dynamicmeters with dynamic

For task requiring power and agility, the results For task requiring power and agility, the results suggest that dynamic warm up will offer suggest that dynamic warm up will offer performance benefits not found with static warm performance benefits not found with static warm ups.ups.

4411

Times have changed!Times have changed!

Thank YouTony Milian, ATC, LATManager, [U18] Sports Center

[email protected]

mailto:[email protected]

preventing athletic injuries tony milian, atc, lat manager, sports medicine [u18] sports medicine...

Documents

traumatic injury

prolonged loc minutes

prolonged loc minutes

play slide

loss of consciousness

loc ems transport

return immediate exam

asymptomatic week grade