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ON-FIELD PHYSIOTHERAPY CONTENTS Roles of on-field physiotherapist Basic assessment procedures Prevention and assessment of heat & cold injuries Management of acute soft tissue injuries Why we need on field physiotherapy? ON FIELD PHYSIOTHERAPIST Roles On-field services in Hong Kong

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CONTENTS

  • Roles of on-field physiotherapist

  • Basic assessment procedures

  • Prevention and assessment of heat & cold injuries

  • Management of acute soft tissue injuries



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ON FIELD PHYSIOTHERAPIST

  • Roles

  • On-field services in Hong Kong

  • Team Physiotherapist

  • Domestic, National and International Level


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ON-FIELD PHYSIOTHERAPY SERVICES

  • 1996 International Masters Hockey Tournament

  • 1996 Seoul International Women’s Road relay

  • Hong Kong Cricket team - Bangladesh Cricket Tournament

  • Standard Chartered Shenzen - Hong Kong Marathon


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Sports Physiotherapy in Elite level

  • SDB, 5 full time physiotherapists

  • Hong Kong Team physiotherapists

  • 1987 Asian Athletic Championship

  • 1992 Barcelona Olympics, 1994 Commonwealth and Asian Games, 1996 Altanta Olympics (3)

  • 2002 Busan Asian Games: 8 physiotherapists


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KNOW THE

SPORT

ON FIELD

SERVICES

KNOW THE

VENUE


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PREPARATION

  • Deployment of manpower

  • Equipment


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Types of injury

Cases

Muscle soreness/strain

175

Ligamentous sprain

112

Tendonitis

44

Joint problems

41

Contusion

42

Laceration

7

Haematoma

3

Concussion

1

Others

6


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Types of services

Number

IFT

44

US

158

TENS

34

HVG

7

ICE

98

Manual technique

210

Massage

211

Strapping and taping

70

Dressing

13

Education and advice

85


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ON-FIELD MANAGEMENT

  • ASSESSMENT PROCEDURES

  • VENUE

  • PERSON


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SYSTEMATIC APPROACH

  • Scene Survey

  • Is the scene safe?


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PRIMARY SURVEY diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute foolOF THE PATIENT

LOC Talk to the patient and assess his level of consciousness

A Alert

V Response to vocal stimuli

P Response to pain

U Unresponsive


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AIRWAY + C-SPINE CONTROL diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

Is the victim able to maintain his airway

If he can talk, the airway is OK

Open airway by jaw thrust if necessary

Do not use head tilt as this may affect the C-spine


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BREATHING diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

Assess if victim is breathing adequately. Is it too fast? too slow? too shallow?

Oxygen, if available, should be given if breathing is laboured.

Feel for any tenderness


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BREATHING diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Auscultate the chest for unequal air entry

  • Check if the trachea is central


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CIRCULATION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

Arrest any visible haemorrhage using direct pressureCheck both carotid and radial pulseIf radial pulse is weak or not palpable, the patient is probably in shockCapillary refill is less than 2 secondnormally


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CIRCULATION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

If the patient is unresponsive and with no carotid pulse==> this is cardiac arrest. you should start cardiopulmonary resuscitation immediately


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DECISION POINT : diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute foolSEND FOR THE AMBULANCE IMMEDIATELY

Impaired conscious state

Airway obstruction

Breathing difficulties

Significant external bleeding especially when control by external pressure is ineffective


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DECISION POINT : diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute foolSEND FOR THE AMBULANCE IMMEDIATELY

  • feature of shock: thready pulse, cold clammy hands, delayed capillary refill

  • unstable pelvis

  • major fracture of limb bones


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CARDIOPULMONARY ARREST diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • PROBABLE CAUSES:

  • HEAD TRAUMA

  • Cx INJURY

  • MAXILOFACIAL OR THORACIC TRAUMA

  • CVA

  • MYOCARDIAL INFARCTION


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HAEMORRHAGE diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • INTERNAL:-

  • COLD

  • RAPID PULSE AND RESPIRATION

  • PALPABLE PAIN AND TENDERNESS

  • RESTLESSNESS

  • EXCESSIVE THIRST

  • BLOOD IN THE URINE OR STOOL

  • OBSERVE FOR SHOCK OR ARREST


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HAEMORRHAGE diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

External

  • Direct Pressure

  • Arterial Pressure Pt. Compression

  • Area should be elevated


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SECONDARY ASSESSMENT diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Chief Complaints

  • Behaviour of symptoms

  • Location & radiation of the symptoms

  • Mode of onset

  • Mechanism of injury

  • Functional alterations

  • Related symptoms

  • Past injuries


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LOOK AND PALPATION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Location of Pain

  • Degree & type of swelling

  • Temperature & texture of the area

  • Muscle spasm

  • Tissue continuity & deformity

  • Neuromuscular function

  • Abnormal Motion or sensation


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MOVEMENT diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Active & Functional Motions

  • Resistive Motion

  • Specific Stress Test

  • Sport Specific Function

  • Return to activity


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HEAT INJURY diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool


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Exercise 20-25x diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

Metabolic Heat Stress

25% efficiency

Metabolic heat production

Exercise

Shivering

Thryoxine

Sympathetic stimulation

Heat Production

Heat Balance

Radiation

Conduction

Convection

Evaporation

Climatic Heat Stress

Temp. rad. Eng. Wind vel. Humdity

Heat loss

WBGT

0.1: 0.7: 0.2


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CONVECTION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Responsible for transferring heat from working muscles and the skin surface

  • Temp differential between skin and environment

  • Heat transfer coefficient, body surface area and wind velocity

  • Minimal body fat and loose-fitting clothing


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CONDUCTION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Minimal effect on body heat transfer

  • Direct contact between skin and an object


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RADIATION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Solar radiation and radiation from tracks, roads, and surrounding structures

  • Can be a major contributor to heat load


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EVAPORATION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Most important heat dissipation mechanism in warm environments

  • Sweating – a fit athlete can produce up to 30 ml of sweat per min

  • Evaporation depends evaporative heat transfer coefficient – air velocity and water vapor pressure gradient (relative humidity)


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WBGT diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Wet Bulb Globe Temperature

  • Three monitors:

  • Dry bulb (Tdb)  air temperature

  • Wet bulb (Twb)  relative humidity

  • Black globe (Tg)  solar radiation

  • WBGT = 0.1Tdb + 0.7Twb + 0.2Tg


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Without adaptive mechanisms, moderate exercise diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

could elevate temp by 1C every 5-6’


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HEAT INJURY diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

Warm, humid conditions, inadequate fluid replacement

Fluid/electrolyte solutions

Prevention: added salt to food, high K+ diet

Loss of Sodium and Potassium

Cool fluids

pre-hydrate

Heat Cramp

Dehydration

Profuse Sweating

Clammy & Cool Skin

Headache & Weakness

Nausea & Weakness

Rapid Pulse & Disorientation

Red, Hot and Dry skin

Strong & Rapid pulse

Lack of sweating, CNS symptoms unsteady gait

confusion, combative behaviour, coma

Heat exhaustion

Shading

remove excess cloth

cooling with ice, sponges

hydration

monitor vital sign

hospital

Medical Emergency !!

Heat Stroke


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PREVENTION diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Conditioning

  • Acclimatization

  • Fluid replacement

  • Venue and schedule

 sweat rate

 core temperature

 plasma volume

 heat storage

3-4 hrs/day, 60-70% load

5-10 days

  • Thirst: poor indicator

  • 2-3%;

    intense exercise 3L/hr

  • Every L loss,  0.3 C

  • Q  1L/min

  • HR  8

Intake: 400-600 ml 15-20’

200-300 ml every 15-20’


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CHILDREN AND HEAT INJURY diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Sweat less effectively;

  • produce  metabolic heat for given workload;

  • acclimatize more slowly than adults;

  • larger M/A;

  •  renal tubular filtration rate;

  • self perceive;


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BUT HOW ABOUT COLD INJURY? diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • Heat loss also depends on air movement, humidity, evaporation (sweating) and ambient temperature

  • Wind velocity exacerbates heat losses


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Shivering, cold, hunger diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

Confusion muscle spasm

Slow pace

Adequate clothing

High energy bar

Avoid wind exposure

Mild

Hypothermina

Semi-conscious confused actions

Extremely tired

Poor coordination

Muscle stiffness

Slurred speech Disorientation

Loss of consciousness

Faint heartbeat

Moderate

Hypothermia

Medical Emergency !!

Severe

Hypothermia


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Acute Sports Injuries diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

Treatment that comes with

PRICE!


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MANAGEMENT OF ACUTE SOFT TISSUE INJURIES diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool

  • PRICE

  • HARM


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