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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


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.

40



Thank YouTony Milian, ATC, LATManager, [U18] Sports [email protected]


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