BTEC Level 5 Sport & Remedial Massage Therapy

1. BTEC Level 5 Sport & Remedial Massage Therapy LSSM 25 A Weekend 3 Types of Injury

2. Therapist Basics • Anatomy • Pathomechanicsof inflammation and scar tissue formation • Biomechanics of activity • Case History –mechanism of injury previous injury, predisposing factors • Clinical assessment & treatment plan

3. Bone Injuries • Fracture Stress Fracture Avulsion Fracture • Periostitis

4. Joint Injuries • Dislocation • Internal Derangement • Adhesive Capsulitis (referred pain = neural pathways)

5. Ligament Injuries - Sprain • Limited or no direct blood supply • Alwaysassociated with joint injuries • High velocity trauma

6. Muscle Injuries - Strain • Overload • Direct Trauma • Partial / complete rupture Grades 1, 2 & 3

7. Muscle Injuries • 3rd degree –Severe • Up to complete rupture • Muscle deficit (gap/hollow)/bunched up • Felt a ‘snapping’ sensation • PAIN! • Contraction not possible, complete loss of power

8. Tendon Injuries - Strain • Strain (tear, rupture) Mild, Moderate and severe • Overuse – tendonosis/ tendinopathy • Achilles • Patellar Tendon (ligament) • Supraspinatus • Lateral/Medial Epicondylosis

9. Tendon Injuries - Strain • Mild • Pain on or after activity that disappears after activity • Moderate • Pain with sporting activity but not with activities of daily living (ADL’s) • Severe • Pain during ADL’s

10. Ligament Injuries - Sprain • 1st degree – Mild • Few fibres, stable, no loss of function, ‘no’ bleeding or swelling • 2nd degree – Moderate Less than 50% of fibres, some loss of function, pain when limb is loaded, some bruising and swelling, limits participation • 3rd degree – Severe Complete rupture, unstable joint, loss of function

11. Inflammatory Response ‘Inflammation is the reaction of tissues to any injury’ Black’s Medical Dictionary 5 Cardinal signs of inflammation; • Redness • Swelling • Heat • Pain • Loss of function

12. Acute Inflammatory Phase0 – 72 hours • Tissue damage • Blood, cells, debris leak out – exudate (pus) = toxic • Immune response – Inflammatory Cascade • Vasoconstriction – vasodilation = Redness +swelling + heat + pain + loss of function • Circulating neutrophils + macrophages = phagocytosis of dead cells occurs within 24 hours • Treatment (TTT) = PRICE - POLICE

13. Proliferation / Repair Phase2 days – 6 weeks • Fibroblasts – scar collagen with lots of cross links – scar tissue formation • ‘ indiscriminate’ ‘patchwork’ scar formation • Stress applied to healing tissue decreases number of cross links and increases tensile strength of tissue.

14. Maturation / Remodelling Phase4 weeks – 12 months (+) • Collagen content slowly reduced and scar tissue ‘tends’ to return to that of pre-injury tissue. • The initial severity of the injury will largely determine the time for complete remodelling to occur.

15. Clinical Assessment • Case History – 80% clue • Clinical Assessment – confirmatory • Observation – cardinal signs of inflammation - ‘look’ for pain (face, movement)

16. Clinical Assessment • Palpation • Active movements – look for abnormal movement & decrease in range of motion (ROM) • Active Resisted • Passive movements • Joint assessment. When appropriate?