OPTION 3 – SPORTS MEDICINE

1. OPTION 3 – SPORTS MEDICINE Overview • How are sports injuries classified and managed? (Classifying Injuries, soft/hard tissue injuries, totaps) • How does sports medicine address the demands of specific athletes?(child/aged/female athletes) • What role do preventative actions play in enhancing the wellbeing of the athlete? (prescreening, sports policies, environmental considerations, fluid intake, acclimatisation) • How is injury rehabilitation managed? (rehab procedures, return to play policies)

3. How are Sport Injuries classified and managed?!?

4. How Are Sports Injuries Classified? • Direct injuriesare caused by an external force applied to the body e.g. injury caused by tackle/collision • Examples of injuries that result from external forces: • Haematomas (corks) • Contusions (bruise) • Joint and ligament damage • Dislocations and bone fracture • Indirect injuriesare caused by an intrinsic force e.g. hamstring tear while sprinting • http://www.youtube.com/watch?v=sPZEntyFzdk&feature=related • Actual injury can occur away from the impact site. EG falling with an outstretched arm can result in dislocated shoulder • http://www.youtube.com/watch?v=xPxR1p9DvK8 • Activity – Explain why it is necessary to classify injuries

5. How Are Sports Injuries Classified? • Overuse injuriesare caused by the overuseof specific body parts e.g. • tennis elbow • shin splints • heel and knee pain • Caused by excessive and repetitive force is placed on the bones • Little or no pain may be experienced initially, so can go undetected • Large amount of overuse injuries result from poor training plans • Poor technique also leads to overuse. Poor tennis backhands - tennis elbow • Many endurance based sports need to be particularly careful of overuse injuries. • http://www.youtube.com/watch?v=l8TZLIVDxXM

6. How Are Sports Injuries Classified? • Soft tissue injuries -Damage that only occurs skin deepe.g. Lacerations, tears • These are the most common forms of injury • Includes: • Skin injuries – blisters, cuts • Muscle injuries – tears or strains of muscle fibres and contusions (bruise • Tendon injuries – tears or strains of tendon fibres (tendonitis) – Nadal had this in knees • Ligament injuries- tears or strains of ligament fibres • A Strain is a partial or complete tear of a muscle or tendon (bone to muscle) • A Sprain is a partial or complete tear of a ligament (bone to bone)

7. Types of Soft Tissue injuries • Abrasionscaused as a result of the skin being scraped. The wound needs to be cleansed and sterilised in order to prevent infection. • Lacerationsare when the skin has incurred an irregular tear. It may require stitches depending on the depth of the cut. • Blistersare caused by a collection of fluid below or within the epidermal layer of the skin ,they occur because of friction. • Callusesis when a build up of dead skin forms at a site where friction has occurred

8. Immediate Treatment of skin Injuries • Danger - play continuing around the injury • Blood and bodily fluids increase the risk of infectious diseases • Bleeding – needs to be controlled immediately to slow down blood flow • Pressure should be applied to the wound with elevation being applied • After dressing is applied, place ice so that it will decrease bleeding • Assessment - see if it is a simple or complex injury • E.g. Is it just a blister or a deep cut requiring stitches • Cleansing – Clean using clean water or saline solution • Take out foreign material (grass/dirt), though leave in deep material • Make sure clothes are also clean before athlete returns • Antiseptic – should be applied to the skin injury • Dressing – should be adhesive (band aid) or non adhesive (allow large wounds which may weep. • Dressing should not get damp as this encourages infection • Referral - should be made for complex injuries, such as head injuries or deep wounds

9. Soft tissue scenarios • What would you do in the following situations: • During a ruck, a football player gets stomped on the thigh by another player • When attempting a rebound, a basketball player lands on somebody else’s foot and rolls over on her ankle • A tennis player reaching out for a shot falls and skids across the bitumen court, grazing their entire right side • A soccer player falls over during training onto a broken piece of glass that embeds deeply into their hand • A gymnast falls heavily off the beam onto their wrist. Their wrist bends back sharply on impact

10. How Are Sports Injuries Classified? • Hard Tissue injuries occur when the damage is done to the bonee.g. Fractures • They range from severe fractures and dislocations to bruising of the bone • http://www.youtube.com/watch?v=QnnPhc_ZjWk • Perform practical activity: • Application of arm slings/leg splints

11. Inflammatory response • Phase one, the inflammatory stageis characterised by pain, increase blood flow to the area (which cause pain because of excess fluid to the area) redness, heat, swelling, loss of function and mobility • Phase two, the repair and regenerative stage is characterised by formation of new fibres and the production of scar tissue. The longer the inflammation occurs, the worse the scar tissue will be • Phase three, the remodelling stageis characterised by increased production of scar tissue and replace of tissue that needs to be strengthened

12. Types of Hard Tissue Injuries • Classifications of Fractures: • simple/closed- bone broken but the skin over it is intact. • Complicated/open–the skin over fracture is not intact and bone is breaking through • Compound – The bone is broken inmore than oneplace • Stress fractures are bone fractures that develop slowly and are caused by overuse • Dislocations aredisplacementof a bone at a joint

13. How are sport injuries Analyzed ? TOTAPS • T- Talk • O- Observe • T- Touch • A –Active movement • P –Passive movement • S- Skills test • ACTIVITY - research in depth this principle

14. How are sport injuries managed? • R -REST - prevent further injury. Remain inactive for 48-72hrsI -ICE –reduces pain ,blood flow, swelling. The application of ice causes blood vessels to constrict, thus reducing circulation and resulting in less inflammation. This also reduces scar tissue.C - Compression- decreases bleeding and bruising through applying pressure with a elastic bandage. This helps reduce swelling by reducing fluid build up. It also provides support for the injured site.E - Elevation- raise above heart level to decrease bleeding. The elevation reduces the volume and pressure of blood flow to the area.R - Referral –seek guidance for rehab • Most of what RICE does is reduces the blood flow, and speeds up rehab • For soft tissue injuries and to stop bleeding, abrasions, calluses, blisters , lacerations

15. How are sport injuries managed? • Things to avoid • Application of heat (old school). Heat packs, spas etc • Drinking alcohol • Activity • Massage • All these activities stimulates blood flow to the area and therefore swelling and inflammation reduces rehab

16. Sports Injury Flow Chart

17. Revision • Sports injuries that are caused by agents from within the body are called? • Sports injuries that are caused by factors outside the body, such as another player or a piece of equipment are called? • Tennis elbow is an example of what type of injury? • The structure that joins a bone to another one is what? • Soft tissue injuries that continue over a long period of time are called? • Another term for a bruise • A strain occurs when this is stretched beyond its range of movement • Soft tissue undergo this response when damage occurs • Damage to these structures within soft tissue causes bleeding to occur • Bruising occurs following soft tissue injury due to the tissue damage and the? • This process whereby an athlete will regain their function of the injured area • Gravel rash is an example of? • Blisters occur due to the process of what? • The management routine followed for soft tissue injuries is what? • This action reduces pain and swelling of the injured area • Bleeding of a skin injury can be decreased by applying what? • When two bones at a joint are displaced from each other, what is this called? • The routine followed for a thorough assessment of injury is called what?

18. Revision • Exam-style questions 1 Explain how sporting injuries can be classified. (8 marks) 2 Contrast the management of soft-tissue injury and hard-tissue injury. (8 marks) 3 Describe the inflammatory response and the role it plays in injury rehabilitation. (8 marks) 4 Assess each step of the TOTAPS procedure and the role it plays in the assessment of a sporting injury. (12 marks)

19. Sports Medicine: How does sports medicine address the demands of specific athletes? Students learn about: • children and young athletes - medical conditions (asthma, diabetes, epilepsy) overuse injuries (stress fractures) thermoregulation appropriateness of resistance training adult and aged athletes heart conditions fractures/bone density flexibility/joint mobility •female athletes: eating disorders iron deficiency. bone density pregnancy.

20. Children and Young Athletes. • Exercise and play are important parts of a child’s physical, mental and social development. Children and young people obtain the following benefits from participating in physical activity: • enjoyment • social interaction • improved motor and communication skills • greater aerobic fitness • improved coordination • increased strength • development of self-esteem • promotion of physical activity into adulthood

21. Children and Young Athletes. • Children are not little adults. • They have specific physical capabilities, and special care should be taken when they are involved in sport. • Young athletes cannot cope with the same level of training as adults. • Intensive training can often be boring, restrictive and socially isolating for maturing young performers.

22. What the syllabus asks you to know children and young athletes - medical conditions (asthma, diabetes, epilepsy) • overuse injuries (stress fractures) • thermoregulation • appropriateness of resistance training

23. Children and Young Athletes.

24. Asthma • Asthma is a narrowing of the airways that makes breathing difficult. Strenuous physical activity can trigger an asthma attack in some sufferers. • This is called ‘exercise-induced asthma’ and is very common among asthmatics. • Factors that make the condition worse include cold, dry air and exercise of significant intensity and duration. • The following points should be noted when training asthmatics: • Ensure the person has an adequate warm-up. • Don’t ask the person to perform if he or she has had an asthma attack recently. • Provide opportunity for rest. • Have the person use preventative medication, if necessary, and ensure it is with the person at all times. • Take extra care in cold or dry weather, or if the person is suffering from a respiratory infection. • Know the athlete’s limits. • Be aware of asthma management techniques and familiar with the individual person’s asthma management plan.

25. Diabetes • Diabetic athletes should prepare themselves for the demands of training or participation by adhering to specific dietary requirements and by monitoring their blood glucose levels. • If diabetics engage in over strenuous activity they can develop hypoglycaemia. This can cause collapse, and even unconsciousness. • If the person develops hypoglycaemia and is still conscious, a glucose substance should be given

26. Epilepsy • Epilepsy is a condition characterised by seizures that make individuals unable to control their movements • When participating in physical activity it is important to know that fatigue and extremes of body temperature can trigger an epileptic seizure. • If an epileptic episode occurs: • Allow the seizure to occur unrestrained. • Ensure there is a safe space around the affected person. • Allow the person to rest after the seizure has ceased.

27. Overuse Injuries • Children should not overtrain, particularly on hard surfaces. • To avoid overuse of particular muscles and joints: • children should be allowed • to play a number of sport and exercise in a variety of positions. • Coaches and parents should help to avoid overuse injuries by ensuring appropriate conditioning and stretching programs are undertaken • Stress fractures – repeated trauma on a bone which leads to small cracks in the bones. • Mostly occur around the growth plates on the hips and knees.

28. Children and Young Athletes: Thermoregulation. • The process to control the body's core temperature. • Young athletes take longer to become acclimatise to heat. They cannot loose as much heat through evaporation for their sweating mechanism does not fully develop until they are older. • Children are more prone to dehydration and extremes of temperature (both hot and cold) than are adults. • Therefore, children should not exercise for long periods of time (more than 30 minutes) in any extremes of weather conditions. • They should be encouraged to drink small amounts of water frequently to replace any lost fluids, and to wear appropriate clothing

29. Children and Young Athletes: Matching of opponents. • Ensure athletes are matched in size, maturity and skill level. • This does not only decrease injury but also increases enjoyment. • Contact sports especially benefit from this.

30. Children and Young Athletes: Resistance training. • The best exercises for developing strength in children are those where they lift their own body weight. • It is acceptable to use resistance training (using light weights and large numbers of repetitions), as long as it is closely supervised and correct technique is taught. • Generally though, there is no need for young athletes to be in resistance training. • Activity - Discuss the appropriateness of resistance training for children http://www.youtube.com/watch?v=esrqV8IVorQ

31. What the syllabus asks you to know • adult and aged athletes • Heart conditions • Fractures/bone density • Flexibility/joint mobility

32. Adult and aged athletes: Heart conditions • As we age, our cardiovascular system becomes less efficient and this leads to a decreased ability to carry oxygen. • Problems associated with this process can include a weaker heart, narrowed and less elastic blood vessels, and high blood pressure. • The lungs are also less elastic, which makes breathing harder. • Participants in aerobic events are therefore those most affected by heart problems. • Older athletes should avoid strenuous exercise and should exercise at approximately 60–75 per cent of their maximum heart rate. • A wide variety of physical activities are suitable as they do not place excessive stress on the cardiovascular system. They include walking, cycling, golf and bowls.

33. Adult and aged athletes: fractures/bone density. • Bones that are more brittle and less dense will fracture more easily as a result of falls, impact from other people or objects or even sudden muscle contractions. • Stress fractures are also common among athletes with reduced calcium, especially those women who are amenorrhoeic or have low oestrogen levels. • Particular care should be taken with older females in avoiding contact sports and situations that involve sudden changes in direction. • Bone development relies on physical activity, thus strength training (resistance training) should be an important consideration.

34. Adult and aged athletes:Flexibility and joint mobility • Flexibility decreases with age because of a loss in elasticity of tendons, ligaments and muscles. • Regular, gentle and slow stretching is recommended. • Participation in activities such as yoga and tai chi can also assist in maintaining flexibility. • Swimming or exercise in an aquatic environment, such as aqua aerobics, is ideal for maintaining joint mobility. • It also allows light stretching to be done in a non-weight-bearing environment. It is important for older athletes to maintain flexibility to assist with being mobile.

35. Adult and aged athletes: trainers should consider Flexibility. Medications. Past injuries AGED ATHLETES Medical conditions Lifestyle. Lower intensity program Bone density.

36. What the syllabus asks you to know •female athletes: • Eating disorders • Iron deficiency. • Bone density • Pregnancy

37. Female Athletes: eating disorders. • Approximately 5 per cent of women can be expected to develop an eating disorder at some stage in their lives. • It appears that high-level physical activity can be a risk factor for eating disorders only if other predisposing factors exist; for example, poor self-esteem. • For some women, extreme exercise is a way of dealing with conscious or unconscious emotional conflicts, just as others may engage in extreme gambling or excessive alcohol consumption for the same reason.

38. Female Athletes: eating disorders. • Anorexia nervosa is common among elite female athletes, particularly in those involved with ‘appearance’ sports (such as gymnastics, diving, ice skating and body building) and endurance sports (such as long-distance swimming, running and triathlon). • Women are 2 times more likely to have eating disorders due to pressure from sport. • http://www.youtube.com/watch?v=RRzdzcP3Aug&feature=related • Disordered eating leads to starvation and dehydration, both of which impair performance.

39. Female Athletes: iron deficiency • Females need twice as much iron as males. This difference is mainly due to blood loss during menstruation; iron is a major constituent of blood. • Female athletes also need more iron during training. • Iron is also lost from the mother to her foetus during pregnancy. • Iron is needed in the blood to carry oxygen and carbon dioxide, and in important muscular and energy-producing chemical reactions. • Low iron can lead to anaemia. • Loss of iron in menstruation and high sporting activity. • To avoid this diets high in red meats and leafy vegetables should be consumed.

40. Female Athletes: pregnancy • Pregnant women should participate in PA to enable healthy development of the baby. • Mild to moderate exercise is safe and beneficial for pregnant women. Many elite athletes have trained and performed at various stages throughout and after pregnancy with no apparent problems. • Benefits of exercising during pregnancy: • Controlled maternal weight • Decrease risk of gestational diabetes • Increase of baby weight

41. Female Athletes: Bone Density • Bone density refers to the thickness and strength of bones. Calcium deficiency is associated with osteoporosis and bone fractures in older females. • This is particularly dangerous for women going through and after menopause. • Calcium is necessary for bone strength, and is also required in the blood to allow muscles and nerves to function correctly.

42. Revision • Discuss the implications for a coach of training a young athlete with asthma. (4marks) • Account for the considerations that need to be made when coaching aged athletes. (5marks) • Discuss why it is important to assess the physical, psychological and social needs of all athletes. (6marks) • Discuss the impact that medical conditions such as heart conditions, poor bone density and joint immobility may have on exercise options for the adult and aged athlete. (6marks) • Analyse the impact of thermoregulation for children and young athletes participating in sport. (4 marks) • Describe the sport participation options that are available for aged people with medical conditions. (5marks)

43. What role does preventative action play in enhancing the wellbeing of the athlete?

45. Physical preparation • Pre – screening: • Provides information of the athletes history, capability or any pre existing injuries. • This is usually completed as a questionnaire and provides a starting point for exercise programs to be tailored to their needs. • Effective pre-screening will consider: • Age, • Gender • Health status • Previous experience of PA. • Risk factors for exercise related complications include: • Being over 40 • Being overweight • Having HBP or cholesterol levels • Having diabetes • Smokers • Being pregnant • Being physically inactive

46. Physical preparation • Skill and Technique • Many injuries result due to bad technique and skill • This places extra responsibility on coaches to teach proper technique • EG tackling in rugby needs proper technique • When coaching, coaches can break the skill down into parts, promoting safety.

47. Physical preparation • Physical fitness • Physical fitness is important in any sport, but they all need to work on components specific to their sport. • EG. Netballers work on speed and agility, hand eye co-ordination as well as cardiovascular endurance. • It would be pointless for them to train for strength • Even within netball, different positions need to focus more on different components. EG. Mid court do more running so more endurance, shooters speed bursts.

48. Physical preparation • Warm up/Cool Down • Warm up prepares the body for activity, lasting around 15mins • Purpose of warm up: • Increase blood flow and oxygen to muscles • Increase body temperature • Stretch muscles, ligaments • Mental preparation • Usually involves some general activity, stretching and then specific activity for the chosen sport • Cool down assists body to return to normal state after exercise • They reduce muscle soreness and tightness and reduce DOMS • A gentle activity followed by stretching generally occurs • Activity - research some preventative measures put in place by clubs and sports to decrease injuries

49. Sports policy and the sport environment • Rules of sports and activities • When playing sport, players must respect the rules and those who enforce the (officials) • The more dangerous the game, the more strict the rules need to be. EG. Rugby league say no high tackles • Players are penalised on (and off – judiciary) the field • Some rules are also for players safety – • Heat rule (roof close) • Rugby Union scrum • http://www.youtube.com/watch?v=1PJOdeMPDio

50. Sports policy and the sport environment • Modified rules for children • Introduced to reduce the risk of injuries to players • This can be completely new games or new versions of old ones • EG: • Kanga Cricket – no fielder allowed 10m of batting wicket, everyone bats and bowls equal amounts to encourage participation • Walla Rugby – no pushing in scrum, contact reduced