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Preventing Athletic Injuries. Tony Milian, ATC, LAT Manager, Sports Medicine [U18] Sports Medicine Cooper City Optimist Lecture February 16th, 2010. Parents’, Coaches’, Trainers’, Physicians’ Everybody’s Goals. Make the game as safe as possible for the players

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preventing athletic injuries
Preventing Athletic Injuries
  • Tony Milian, ATC, LAT
  • Manager, Sports Medicine
  • [U18] Sports Medicine
  • Cooper City Optimist Lecture
  • February 16th, 2010
parents coaches trainers physicians everybody s goals
Parents’, Coaches’, Trainers’, Physicians’Everybody’s 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
prevention
Prevention
  • Representative Areas For Today:
    • Head Injury
    • Heat Injury
    • Supplement Injury
    • Lightning Injury
    • Stretching Dynamic / Static
head injury concussion
Head 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)
early signs of concussion
Early Signs of Concussion
  • Impaired attention
  • Slurred, incoherent speech
  • Disorientation
  • Impaired Coordination
  • Emotional reaction out of proportion
  • Memory deficits
  • Any loss of consciousness
late signs of concussion
Late Signs of Concussion
  • Persistent headache
  • Dizziness
  • Poor Attention
  • Memory Dysfunction
  • Nausea or Vomiting
  • Irritability
  • Photophobia
aan concussion grading scale
AAN Concussion Grading Scale
  • 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)
assessment
Assessment
  • Cervical Spine (LOC)
  • Facial Expression
  • Pupil size and reactivity
  • Upper and Lower extremity
  • Orientation
  • Immediate Memory
  • Delayed Recall
aan concussion management
AAN Concussion Management
  • Grade I (<15 minutes, no LOC)
    • Remove from contest
    • Immediate exam and at 5 minute intervals
    • Out for Remainder of Game
aan concussion management1
AAN Concussion Management
  • Grade II (>15 minutes, no LOC)
      • Remove from contest; no return
      • Immediate exam and at 5 minute intervals
      • Re-exam the next day
      • MD exam and clearance after 1 asymptomatic week
aan concussion management2
AAN Concussion Management
  • Grade III (Any LOC)
    • EMS transport to nearest ER
    • MD evaluation and +/- brain imaging
    • Possible Admit
aan concussion management3
AAN Concussion Management
  • Grade III - Return to play
    • Brief LOC : 1 week
    • Prolonged LOC : 2 weeks
    • 2nd Injury: 1 month
    • Abnormal Brain Scan : season terminated
heat injury
Heat 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
heat related injury
Heat Related Injury
  • Heat production increases 15X with exercise
  • Two mechanisms to dissipate head
    • Radiation (65%) – Clothing
    • Evaporation (30%) – Humidity
heat related injury1
Heat Related Injury
  • 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 related injury2
Heat Related Injury
  • 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 related injury3
Heat Related Injury
  • 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 injury4
Heat Related Injury
  • 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 injury5
Heat Related Injury
  • 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
heat related injury6
Heat Related Injury
  • Hydration
  • Sports Beverages Recommended
  • Carbohydrate (glucose and sucrose)
  • Sodium
  • Potassium
heat illness
Heat Illness
  • Heat illness may be hard to detect
  • Fluids before / during / after
  • EMS activation
  • Treatment on scene
  • Prevention is key
supplement illness
Supplement Illness
  • Caffeine
  • Steroids
  • GNC
  • Amphetamines
  • Red Bull
caffeine content
Caffeine Content

Standard 4 ounce cup = 50 mg caffeine

8 oz Red Bull

16 oz Rockstar

16 oz Arizona

8 oz Cocaine Energy Drink

OR

2 oz Extreme Energy

lightning injury
Lightning 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
lightning
Lightning
  • Lightning strikes up to 25 miles away
  • Be Proactive!
  • Plan Ahead
  • Monitor the weather
  • Postpone the activity
  • Get to a safe place
lightning1
Lightning
  • 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
lightning2
Lightning
  • 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
slide31

Some Emergencies on the field Obviously need 911

  • Dislocations
  • Open Fractures
  • Gross Deformities
  • LOC
injury prevention
Injury Prevention
  • 3.5 million injuries each year
    • Most common are strains and sprains
  • Prevention
    • Dynamic warm up
    • Static stretching
    • Proper biomechanical training

33

stretching
Stretching
  • Stretching: the act of performing a particular exercise to improve joint range of motion. European College of Sports Sciences 2006.
  • Static Stretching: when a body part is taken to a point of mild discomfort and held for an amount of time.
  • Dynamic Stretching/Movements: movements that maximize active range of motion and elevate core body temperature.
  • Journal of Strength and Conditioning 2005

34

static vs dynamic
Static vs. Dynamic
  • Does static stretching prior to activity achieve the goals of injury prevention and performance enhancement?
  • NO
  • Research has shown that static stretching can be detrimental to performance and does not lead to a decrease in injury

35

static vs dynamic1
Static vs. Dynamic
  • Study from the Journal of Strength and Conditioning, 2008
  • 24 Division I wrestlers were randomly assigned to complete a 4 week Dynamic or Static warm up routine prior to their preseason practices
  • 11 performed the static warm up
  • 13 performed the dynamic warm up
  • They were tested on med ball underhand throw, 300 yard shuttle, pull ups, push ups, sit ups, broad jump, 600 m run, sit to stand reach, trunk extension, quad and hamstring peak torque tests.

36

static vs dynamic2
Static vs. Dynamic
  • Results Dynamic Group
  • Increase in quadriceps peak torque by 11%
  • Increase in broad jump by 4%
  • Increase in underhand med ball throw by 4%
  • Increase in sit ups by 11%
  • Increase in push ups by 3%
  • Static group posted no improvements to tests performed.

37

static vs dynamic3
Static vs. Dynamic
  • Study from the Journal of Strength and Conditioning, 2006
  • United States military academy took 30 cadets to do a study on static vs. dynamic warm up routines to see which one would better prepare their cadets for power and agility activities
  • Tested on the 5 step jump to determine functional leg power
  • Medicine ball throw was chosen to measure total body power
  • T-drill was chosen to measure agility

38

static vs dynamic4
Static vs. Dynamic
  • For 3 days one group of cadets performed static stretches for 10 minutes prior to data collection
  • Other group performed dynamic stretches for 10 minutes
  • All routines were done at 6AM each day
  • There was a 2 minute period between finishing the warm up and beginning the performance test

39

static vs dynamic5
Static vs. Dynamic
  • Results
  • T –drill static warm up = 9.69 sec vs. dynamic’s 9.56 sec
  • Medicine ball throw = 9.34 meters with static vs. 9.79 meters with dynamic
  • 5 step jump = 9.78 meters with static vs. 10.06 meters with dynamic
  • For task requiring power and agility, the results suggest that dynamic warm up will offer performance benefits not found with static warm ups.

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