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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
CONTENTS
  • Roles of on-field physiotherapist
  • Basic assessment procedures
  • Prevention and assessment of heat & cold injuries
  • Management of acute soft tissue injuries
on field physiotherapist
ON FIELD PHYSIOTHERAPIST
  • Roles
  • On-field services in Hong Kong
  • Team Physiotherapist
  • Domestic, National and International Level
on field physiotherapy services
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
slide6
Swire Group Tsing Ma Bridge 10 km and Marathon
  • Hong Kong - Beijing Relay
  • Standard Chartered International Marathon (1997-2002)
sports physiotherapy in elite level
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
slide12

KNOW THE

SPORT

ON FIELD

SERVICES

KNOW THE

VENUE

preparation
PREPARATION
  • Deployment of manpower
  • Equipment
slide15

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

slide16

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

on field management
ON-FIELD MANAGEMENT
  • ASSESSMENT PROCEDURES
  • VENUE
  • PERSON
systematic approach
SYSTEMATIC APPROACH
  • Scene Survey
  • Is the scene safe?
slide20
It is frequently better to remain uncertain about a diagnosis and feel mildly folish than to be constantly certain and confirm that you are an absolute fool.
primary survey of the patient

PRIMARY SURVEY OF 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

airway c spine control

AIRWAY + C-SPINE CONTROL

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

breathing

BREATHING

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

breathing24
BREATHING
  • Auscultate the chest for unequal air entry
  • Check if the trachea is central
circulation

CIRCULATION

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

circulation26
CIRCULATION

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

decision point send for the ambulance immediately

DECISION POINT : SEND FOR THE AMBULANCE IMMEDIATELY

Impaired conscious state

Airway obstruction

Breathing difficulties

Significant external bleeding especially when control by external pressure is ineffective

decision point send for the ambulance immediately28
DECISION POINT : SEND FOR THE AMBULANCE IMMEDIATELY
  • feature of shock: thready pulse, cold clammy hands, delayed capillary refill
  • unstable pelvis
  • major fracture of limb bones
cardiopulmonary arrest
CARDIOPULMONARY ARREST
  • PROBABLE CAUSES:
  • HEAD TRAUMA
  • Cx INJURY
  • MAXILOFACIAL OR THORACIC TRAUMA
  • CVA
  • MYOCARDIAL INFARCTION
haemorrhage
HAEMORRHAGE
  • INTERNAL:-
  • COLD
  • RAPID PULSE AND RESPIRATION
  • PALPABLE PAIN AND TENDERNESS
  • RESTLESSNESS
  • EXCESSIVE THIRST
  • BLOOD IN THE URINE OR STOOL
  • OBSERVE FOR SHOCK OR ARREST
haemorrhage31
HAEMORRHAGE

External

  • Direct Pressure
  • Arterial Pressure Pt. Compression
  • Area should be elevated
secondary assessment
SECONDARY ASSESSMENT
  • Chief Complaints
  • Behaviour of symptoms
  • Location & radiation of the symptoms
  • Mode of onset
  • Mechanism of injury
  • Functional alterations
  • Related symptoms
  • Past injuries
look and palpation
LOOK AND PALPATION
  • Location of Pain
  • Degree & type of swelling
  • Temperature & texture of the area
  • Muscle spasm
  • Tissue continuity & deformity
  • Neuromuscular function
  • Abnormal Motion or sensation
movement
MOVEMENT
  • Active & Functional Motions
  • Resistive Motion
  • Specific Stress Test
  • Sport Specific Function
  • Return to activity
slide36

Exercise 20-25x

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

convection
CONVECTION
  • 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
conduction
CONDUCTION
  • Minimal effect on body heat transfer
  • Direct contact between skin and an object
radiation
RADIATION
  • Solar radiation and radiation from tracks, roads, and surrounding structures
  • Can be a major contributor to heat load
evaporation
EVAPORATION
  • 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)
slide41
WBGT
  • 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
slide43

Without adaptive mechanisms, moderate exercise

could elevate temp by 1C every 5-6’

heat injury44
HEAT INJURY

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

prevention
PREVENTION
  • 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’

children and heat injury
CHILDREN AND HEAT INJURY
  • Sweat less effectively;
  • produce  metabolic heat for given workload;
  • acclimatize more slowly than adults;
  • larger M/A;
  •  renal tubular filtration rate;
  • self perceive;
but how about cold injury
BUT HOW ABOUT COLD INJURY?
  • Heat loss also depends on air movement, humidity, evaporation (sweating) and ambient temperature
  • Wind velocity exacerbates heat losses
slide48

Shivering, cold, hunger

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

slide49

Acute Sports Injuries

Treatment that comes with

PRICE!