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15 Sports injury and assessment


While participation in sport and exercise activity has a lot of positive aspects, such as improving fitness levels, being involved in a social group who share common interests, etc., it also has a negative aspect in the form of potentially getting injured. This unit will identify different types of sports injuries and how they can occur. It will consider both physiological and psychological responses to injury and rehabilitation and then go on to explore the possible cause of the injury, which is called the aetiology of the injury. Once a cause has been diagnosed, ways to prevent future injuries will be examined. Finally, the unit will explore a range of treatment and rehabilitation procedures that can be considered for people who have suffered from a sport or exercise-related injury.

Learning aimsThe aims of this unit are to:

A Understand acute and overuse injuries, their associated signs and symptoms and mechanism of injury

B Examine the physiological and psychological responses to injury and rehabilitation

C Investigate aetiology of sports injuries and their associated prevention strategies

D Explore common treatment and rehabilitation methods.

How will I be assessed?The sports injury and assessment unit will be assessed by assignments that have been designed internally by your tutors. It is likely that there will be three assignments for you to complete where you will be able to apply the knowledge you have learnt to a range of sport and exercise activities.

About this unit

Aetiology is the cause or set of causes that results in an injury or condition.

Key term

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Level 3 Sport and Exercise Science

Table 15.1 shows the grading criteria for this unit. To achieve a pass grade you must meet all the P criteria; to achieve a merit grade you must achieve all the P and all the M criteria; to achieve a distinction grade you must achieve all the P, M and D criteria.

Table 15.1 Assessment criteria

Pass Merit Distinction

Learning aim A: Understand acute and overuse injuries, their associated signs and symptoms and mechanism of injury

D1A B Evaluate injury mechanisms and the associated physiological and psychological responses to injury and rehabilitation, using specific examples.

P1A Discuss acute and overuse injuries, including signs and symptoms.

M1A Assess acute and overuse injuries, including signs, symptoms and examples of mechanisms of injury.

Learning aim B: Examine the physiological and psychological responses to injury and rehabilitation

P2B Explain how the body responds physiologically and the mind psychologically to sports injuries.

M2B Assess the physiological and psychological responses to sports injuries, with regards to stages of injury including rehabilitation, using specific examples.

Learning aim C: Investigate aetiology of sports injuries and their associated prevention strategies

P3C Explain how extrinsic and intrinsic risk factors including gait analysis contribute to sports injuries, and identify how they can be prevented, using specific examples.

M3C Assess gait analysis and injury, considering preventative measures for intrinsic and extrinsic risk factors, using specific examples.

D2C Evaluate the sequence of prevention model, justifying the different stages, using specific examples.

Learning aim D: Explore common treatment and rehabilitation methods

P4D Apply appropriate protocols when performing a range of treatment methods to four contrasting scenarios.

P5D Design an appropriate rehabilitation programme for a specific sports injury, identifying factors that may affect rehabilitation.

M4D Apply appropriate protocols in a confident and effective manner when performing a range of common treatment methods to four contrasting scenarios.

M5D Design a detailed safe and appropriate rehabilitation programme for a specific sports injury, including adaptations and alterations.

D3D Justify the rehabilitation programme design, including consideration of factors that may affect rehabilitation, future recommendations and considerations.

How will I be graded?

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A Understand acute and overuse injuries, their associated signs and symptoms and mechanism of injury ( P1A , M1A , D1A B )

For this learning aim you will need to be able to discuss each injury with regards to mechanisms of injury and signs and symptoms and be able to make reference to specific sporting examples.

A1 Acute injuriesAn acute injury is an injury that occurs from taking part in one exercise or sporting session.

Bone fractures

A fracture is the technical term for a broken bone. The sign of a fracture is swelling or bruising over the bone, or deformity in the area around the fracture. The injured person will feel pain in the area of the fracture and will have loss of function around the injured area. Fractures happen whenever a bone is hit with enough force to make it break, creating either a small crack or, in a serious fracture, a complete break. There are a number of different types of fracture.

TransverseTransverse fractures are usually the result of a direct blow or force being applied at a sideways angle to the bone. The resultant shape of the bone ends helps transverse fractures stay in alignment more easily than those of other fractures, where the resultant ends do not line up so readily.

Figure 15.1 A transverse fracture

SpiralSpiral fractures are also known as oblique fractures. They usually occur as a result of a twisting movement being applied about the long axis of the bone, for example, the foot being held trapped by football boot studs while the leg twists around it.

Figure 15.2 A spiral fracture

ComminutedA comminuted fracture is where there is splintering of the bone so that the bone is broken into a number of pieces. This type of fracture can take longer than others to heal, and is usually caused by direct trauma.

Skin

Bone

Figure 15.3 A comminuted fracture

OpenAn open fracture is also called a compound fracture. It is generally a more serious type of injury because the bone breaks through the skin. The break causes considerable damage to surrounding tissue and can cause serious bleeding if a large artery is ruptured. It also exposes the broken bone to the possibility of infection, which can interfere with healing.

Figure 15.4 An open fracture

Articular cartilage

Normal synovial joint function requires a smooth-gliding cartilage surface on the ends of the bones. This cartilage also acts to distribute force during repetitive pounding movements, such as running or jumping. Cartilage injury can result in locking, localised pain and swelling around the affected area. It appears as a hole in the cartilage surface. As cartilage has minimal ability to repair itself, it needs treatment in order to minimise the deterioration to the joint surface.

OsteochondralThis type of injury is where the cartilage covering the end of the bone is torn. It can occur when a person twists their joint badly or from direct impact to the inner or outer part of the joint.

Meniscal tearA meniscus is a piece of cartilage that acts to protect, cushion and stabilise a joint. The meniscus can be torn from a bad twist of the joint which can leave the meniscus loose in the joint causing it to lock.

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Grade IGrade I sprains commonly exhibit the following symptoms:

� few ligament �bres are torn

� mild pain

� little swelling

� some joint stiffness.

Grade IIGrade II sprains commonly exhibit the following symptoms:

� minimal to moderate tearing of the ligament �bres

� moderate to severe pain

� swelling and stiffness.

Grade IIIGrade III sprains commonly exhibit the following symptoms:

� total rupture of the ligament

� severe pain

� severe swelling.

With a Grade III sprain, shortly after the injury, most of the localised pain will disappear. This is a result of the nerve endings being severed, which causes a lack of feeling at the injury site.

From the explanations above you can see that pain and swelling are the two most common symptoms associated with a ligament sprain. You can also expect some bruising to occur at the injury site. The associated swelling and bruising is the result of ruptured blood vessels and this in turn will produce heat – or inflammation.

Muscle strain/tear

A strain is a twist, pull and/or tear to a muscle or tendon, and is often caused by overuse, force or over-stretching. If a tear in the muscle occurs, surgical repair may be necessary. A person suffering from muscle strain may have bruising and swelling around the area, and there will be restricted movement around the affected area. Muscle strains can be classified into three categories: first degree strain, second degree strain and third degree strain.

Joint

DislocationDislocation is the displacement of a joint from its normal location. The dislocated joint will look deformed and the injured person will feel a great deal of pain around the injury. A dislocation occurs when a joint is over-stressed, which makes the bones that meet at that joint disconnect. This usually causes the joint capsule to tear, together with the ligaments holding the joint in place. Most dislocations are caused by a blow or a fall. If a person has dislocated a joint then it will usually look out of place, discoloured and/or misshapen. Movement is limited, and there is usually swelling and intense pain.

SubluxationA subluxation is when one or more of the bones of the spine moves out of position and creates pressure on, or irritates, the spinal nerves. A person with a subluxation will feel a great deal of pain around the affected region and will have very limited movement in their spine. This interferes with the signals travelling along these spinal nerves, which means some parts of the body will not be working properly.

Figure 15.5 A subluxation

Ligament sprain/tear

A sprain is a stretch and/or tear to a ligament and is often caused by a trauma that knocks a joint out of position, and over-stretches or ruptures the supporting ligaments. Sprains often affect the ankles, knees or wrists. A person suffering from a sprain will have swelling around the affected area and restricted movement around the affected joint. There are three degrees of ligament sprain:

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whether the haemotoma is inter muscular or intra muscular.

Inter means between.

Intra means within.

Key terms

An intermuscular haemotoma is less severe than an intramuscular haemotoma. An intermuscular haemotoma is when the blood loss from the torn muscle fibres can escape from the damaged muscle and flow around the surrounding tissues. However, an intramuscular haematoma is where the blood cannot flow out of the muscle fascia which causes increased pressure in the muscle, resulting in more pain and reduced mobility with a longer recovery time.

Intermuscular haematoma

Epimysium

Intramuscular haematoma

Perimysium

Intermuscular haematoma

Epimysium

Intramuscular haematoma

Perimysium

Figure 15.6a–b An intramuscular haematoma and an intermuscular haematoma

Cramps

A muscle cramp is when the muscle contracts involuntarily, remains contracted and feels painful. There are a number of reasons why people are thought to get muscle cramps including dehydration, fatigue and low calcium or potassium levels in the body. A person suffering from cramp will be in a great deal of pain in the affected area, which may well stop them from taking part in sport for a short period of time. The person will usually be holding the affected area, however, there are no obvious signs that a person has cramp.

Grade IGrade I strains commonly exhibit the following symptoms:

� few muscle �bres are torn

� mild pain

� little swelling

� some muscle stiffness.

Grade IIGrade II strains commonly exhibit the following symptoms:

� minimal to moderate tearing of the muscle �bres

� moderate to severe pain

� swelling and stiffness.

Grade IIIGrade III strains commonly exhibit the following symptoms:

� total rupture of the muscle

� severe pain

� severe swelling.

From the explanations above you can see that pain and swelling are the two most common symptoms associated with a muscle strain. You can also expect some bruising to occur at the injury site. The associated swelling and bruising is the result of ruptured blood vessels and this in turn will produce heat – or inflammation.

Haematoma

A muscle haematoma is bruising of the muscle tissue and occurs due to direct trauma, commonly a blow to the outer part of the thigh or back of the calf. A person with this type of injury will feel pain in the affected area, and swelling and bruising may be present.

This injury is commonly referred to as a ‘dead leg’ – it is a bruising of muscle tissue caused by the muscle being squashed between the object causing the impact and the underlying bone. The muscle fibres are squashed and associated capillaries are torn. This results in bleeding into the area with resultant haematoma formation. Usually the haematoma formed is fairly small. But in some circumstances the bleeding may be extensive and can cause a ‘pressure problem’ depending on

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LacerationThis is a tearing of the skin and layers of tissue beneath it. There is often a lot of bleeding with this type of injury and it will often require stitches. This type of injury can occur in sport from an impact with an external object, such as a hockey stick.

Puncture woundThis type of wound is from an object piercing the skin which creates a small hole in the skin. Depending on how deep the puncture wound is will determine how severe it is – the deeper the wound goes the more tissue will be damaged and the more severe the injury.

ContusionA contusion is the technical term for a bruise. Contusions are often produced by a blunt force, such as a kick, fall or blow. The result will be pain, swelling and discoloration.

Figure 15.7 Contusion (bruising)

A2 Overuse injuries Overuse injuries occur as a result of repeated participation in a particular sporting or exercise movement which places stress on specific areas of the body. The injuries can occur due to the fact the body part has not had sufficient time to heal between training sessions.

Acute compartment syndrome

This often occurs in response to other injuries such as a fracture. The condition is where the injured tissue swells and blocks the blood flow and nerve impulses that lead to that tissue. This condition must be treated quickly otherwise it will lead to the tissue in that area dying (necrosis) which can lead to loss of function of the affected area. A person suffering from this syndrome will be in a great deal of pain and have restricted movement in the affected areas, however, there may not be any visible signs of this condition.

Tendon

Tendons attach muscle to bone.

Partial and complete tear A damaged tendon can be partially or completely torn. A partial tear means that the muscle that is attached to the tendon will still function but to a limited degree; a complete tear means that the tendon is no longer joined to the muscle so the muscle will not function.

Tendonitis This is inflammation of a tendon and can occur from overuse. A person suffering from tendonitis may have swelling in the affected area and pain on movement of the affected area.

Bursa – traumatic bursitis

Bursas are synovial fluid filled sacs located in synovial joints to reduce friction in the joint. Bursitis is where the bursas are inflamed which results in pain and restricted movement around the joint where the bursa is located.

Traumatic bursitis occurs from a direct impact, such as a kick to the knee in football.

Skin

The skin covers the whole of the body providing protection to the internal structures of the body. As this organ is continually in contact with the outside world, it is the most injured of all the human organs.

AbrasionAn abrasion is when the surface of the skin is grazed so that the top layer is scraped off, leaving a raw, tender area. This type of injury often occurs as a result of a sliding fall.

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OsteoarthritisOsteoarthritis is where there is break down of the cartilage in the joint and the bone underneath that cartilage. The joints with osteoarthritis will feel stiff and can ache. The affected joint with osteoarthritis can also make a crunching noise when it is moved which is called crepitus.

Ligament

Overuse of a specific body part can lead to inflammation of the ligaments that are crossing over the joints involved. Inflammation leads to pain and swelling in that area.

Muscle

Chronic compartment syndrome This condition can also occur as an overuse injury from repeated stress to a muscle or group of muscles.

Muscle focal thickeningRepeated trauma to a muscle is thought to lead to muscle adhesions in the muscle tissue itself, which leads to specific areas of the muscle becoming thicker. This may lead to localised pain in the area of the thickening and may be felt by a sports therapist.

Tendon – tendonitis, tendinosis and tendinopathy

Tendinopathy is the term used for a tendon injury or disease.

Many injuries will cause some inflammation so when you see the term itis added to an area of the body this means the area is inflamed, e.g. tendonitis means that a tendon is inflamed.

Itis means inflammation.

Key term

Tendonitis is usually an overuse injury which leads to an inflammation of the tendon as a result of micro tears to the tendon itself. However, many people who are diagnosed with tendonitis actually have tendinosis. Tendinosis is degeneration of the

Bone

Stress fracture A stress fracture is an overuse injury. It occurs when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone, causing a tiny crack called a stress fracture. Stress fractures usually occur because of a rapid increase in the amount or intensity of training. The impact of an unfamiliar surface or incorrect trainers can also cause stress fractures.

Figure 15.8 A stress fracture

Osteitis This is a condition where there is inflammation of the bone making it ache and feel painful.

ApophysitisThis condition can occur as an overuse injury in younger athletes. The apophysis is the site on a bone where a tendon inserts. Repetitive stress to the area can injure the area which leads to pain and inflammation of the area called apophysisis. Osgood-Schlatter disease is an example of an apophysitis occurring at the tibia where the patella tendon attaches at the knee.

Articular cartilage

Chondropathy is the term given to cartilage that is diseased and is no longer able to perform its function. This means the ends of the bones where the articular cartilage is located will be painful when performing certain movements and some swelling around the joint may occur, leading to restricted movement in the area.

Joint

Synovitis This condition is from inflammation of the synovial membrane within a joint which produces swelling and pain within the joint. There may be swelling around the affected area and restricted movement around the affected joint.

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1 Timing of the movement – This is how long the force takes place when performing the movement which produces the sports injury. This is often a very short space of time.

2 Position or location – This is how the body or the body part is positioned when the person gets injured. For example, the person may have a �exed elbow and abducted shoulder as in playing a tennis and preparing to hit the ball.

3 Displacement – This describes how something has moved away from its starting position.

4 Velocity – This is different from speed as it focuses on the change in position, or displacement, that a body or object has undergone. It is calculated by dividing displacement by the time taken in seconds:

Velocity = displacement in metres (m) time taken in seconds (s)

5 Acceleration – An increase in the magnitude of rate of change of velocity.

The greater the velocity, acceleration and displacement involved in sustaining a sports injury, the greater the severity of injury. For example, if a football player is tackled by an opposing team member who runs at them at full sprint and attempts to make contact with the ball but actually kicks the player in the knee, the injury sustained is going to be much more severe than if the opposing team member tackled them from a standing start as they would have less velocity and acceleration compared to the sprinting tackle.

Kinetics and forces

This is the assessment of movement with respect to forces involved. A force is something that can start or stop a movement, speed up or slow down a movement or change the direction of the movement. Force is measured in newtons (N) and is a product of mass and acceleration.

Force = mass × acceleration

The force on the body is what actually causes the sports injury; kinematics examines how the force is applied. However, kinetics explores the different types of forces that can produce sports injuries. There are a number of different forces involved in kinetics which include:

tendon’s collagen as a result of overuse. This means that the tendon has not had adequate time to heal after an exercise session so that there is reduced amounts of collagen in the tendon. The collagen is also made up of immature fibres and the collagen that is there is not aligned. The blood vessels in a person suffering from tendinosis are also not aligned properly leading to reduced blood flow to that area. All of this leads to reduced strength and reduced healing properties of the tendon.

Paratenonitis can also occur from overuse and is an injury to the Achilles tendon involving pain over the Achilles tendon area. The paratenon is the outer sheath of the Achilles tendon which can become inflamed from overuse.

Tenosynovitis is where the fluid filled sheath that surrounds all other tendons except the Achilles tendon becomes inflamed.

Bursa

Bursitis can also occur as an overuse injury when a joint is used frequently without time to repair itself.

Skin

Blister A blister is a fluid filled sac that is a result of friction or a burn. The feet are usually most susceptible to getting blisters from footwear repetitively rubbing on an area of the skin on the foot. A person with a blister will have a bubble of clear fluid under their skin around the affected area and the area will usually feel painful.

CallusA callus is a thickened area of skin that has been exposed to repetitive friction or pressure. A callus can occur on the hands of weight lifters who lift weights repetitively with calluses occurring around the area that grips the weight.

A3 Mechanisms of injury Kinematics

Kinematics are a description of movement that resulted in the sports injury without reference to the forces that produced the injury. Within kinematics, there are five primary variables:

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� Ligament forces acting on joints – The ligaments attach bone to bone and keep the joints in place. If the force acting on the joints from the ligaments is too large it can result in injury to the bones or ligaments in that joint.

� Musculotendinous forces – Tendons attach muscle to bone. If the force from the tendon is greater than the muscle tissue is able to withstand, it can result in muscle or tendon injuries.

Newton’s laws

Newton’s first lawNewton’s first law, the law of inertia, states that:

A body will maintain a state of rest or constant velocity unless acted on by an external force that changes its state.

Once a body or object is in motion it is resistant to change its direction and velocity. It will only do so if it comes into contact with a second body or object and it will then be accelerated, decelerated or diverted. If you think about when you kick a football it will continue in a straight line until it comes into contact with another player’s foot that either stops it, deflects it or increases its velocity in the direction that you kicked it.

Newton’s second law Newton’s second law examines the relationships between force, mass and acceleration. The size of a force is measured in newtons (N) while the mass of an object is a measure of how much matter it contains in kilograms (kg). The law of reaction states:

A force applied to a body causes an acceleration of that body of a magnitude:

Proportional to the force, in the direction of the force, and inversely;

Proportional to the body’s mass.

This means that if a ball is struck it will travel in the direction that the force has been applied in. When you serve in badminton, the shuttlecock will travel towards your opponent in the direction that you hit it at a velocity dependent on how much force you applied to the shuttlecock. If you applied twice as

� Gravity – This is the force that pulls us to the ground and is often a cause of injury when people lose their balance, trip, etc. and fall downwards towards the ground. The impact of hitting the ground can then result in sports injury.

� Ground action forces – When we are standing still we will be applying a force on the ground or surface underneath our feet. The force is produced by our mass and gravity acting on our mass. A person of a greater mass will apply a greater force on the ground. The forces produced by the athlete on the ground will produce forces that are equal and opposite. This force will be upwards into the athlete’s body and is described as a reaction force, or in this case a ground reaction force, as it is produced by the surface the athlete is standing on. When the athlete starts to move two things will happen. Firstly, the direction of the force will change as the athlete’s foot will push downwards at a different angle. Secondly, the size of the force will increase as their foot is being accelerated towards the ground by muscular contractions and the effect of gravity. This means that the size of the reaction forces will increase as well. The human body is designed to deal with reaction forces as our bones can bend slightly and our joints are cushioned by cartilage; however, if the reaction forces do become too great then damage can be done to the structures of our body.

� Impact of objects – When an object makes contact with the body, the impact force of this object can result in an injury. For example, if a hockey ball hits a person’s face, the impact of this ball will result in injury to that person’s face.

� Compression forces exerted on long bones in lower extremities – The body undergoes compressive loads frequently in sport; when running the body can experience two and a half times its own body weight which can increase to up to �ve times body weight during landing, say from a volleyball smash or a basketball lay-up.

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3 Direction – from which direction did the load come from that caused the injury?

4 Time period for application

5 How often – was it a single force or a repetitive force?

6 Constant or varied – was the amount of force the same or did it vary in intensity?

7 How quickly applied – how long was the force applied for?

Tissue deformationWhen a force is applied to a body part, the body tissue in and around that area will undergo deformation. This means that the tissue will become damaged as it gets bruised or it may even break as in a fracture or ligament tear. The degree of tissue deformation will determine the severity of the injury.

Rotation injuriesThese sorts of injures can be quite common in sports. They can occur in such instances where a sports performer with studded boots plants their foot on the ground, the studs hold the foot in place. However, if the player then starts to turn, there is a turning force experienced by the lower leg as the foot is resisting the movement from being fixed to the ground by the studs. This can result in a twisting force acting on the lower limb called torsion which can result in injury. The factors that will determine the severity of this injury include:

� Mass – Mass is the amount of matter that makes up an object; the greater the mass, the more severe the injury.

� Inertia – This is an object’s resistance to movement, usually the greater the mass of an object the greater the inertia will be.

� Torque – The turning effect produced by a force is called the torque. This is equal to the product of the force and the distance between this force and the axis of rotation. This distance is referred to as a moment arm because a torque is sometimes called a moment of force. Torque is measured in Nm.

much force to the shuttlecock it would accelerate twice as quickly as the slower shuttlecock and have twice as much velocity. This is because its acceleration is proportional to the size of the force applied on the shuttlecock.

However, if the shuttlecock was twice as heavy and an equal force was applied to the shuttlecock during the serve, it would only accelerate at half the velocity of the lighter shuttlecock. This is an example of an inverse relationship. The relationship between force, mass and acceleration can be expressed as:

Force = mass × acceleration

Newton’s third lawNewton’s third law of motion states that for every action there will be an equal and opposite reaction. When this is used in the context of forces it states that:

When one body exerts a force on a second body, the second body exerts a reaction force that is equal in magnitude and opposite in direction on the first body.

This means that if a force is applied by the body on another object or surface then that object or surface will apply an equal force that pushes back on the athlete. If you think about when you are running, every time your foot strikes the ground a force of equal size is sent back up your leg – the force is equal and opposite to the force created by your body weight landing on the ground through your foot. This force is called a ground reaction force (see page 9) and can cause damage if you are wearing inappropriate footwear or have poor running technique.

Consideration of external force (load)

When a person is injured in sport from an external force, there are seven aspects of how the force was applied in order to understand what sort of injury the person may have sustained.

1 How – what happened and what caused the injury?

2 Where – which area of the body is affected?

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There are three general stages of injury which can be applied to most sports injuries:

1 Phase 1 – The in�ammatory phase (0 to 72 hours after injury)

2 Phase 2 – The proliferative phase (tissue formation) (72 hours to 21 days after injury)

3 Phase 3 – The maturation (remodeling) phase (21 days after injury).

The severity of the injury will dictate stages 2 and 3 of the above model; this means that less severe injuries will reach stage 3 sometimes before day 21, and more severe may take longer than 21 days.

Phase 1 – the inflammatory phase

One of the first signs that soft tissue is injured is the sign of swelling. When the injured area starts to swell, it will feel painful. This is due to swelling creating pressure on the nerves surrounding the damaged tissue. The swelling occurs because the surrounding blood vessels are ruptured allowing blood to bleed into the area and tissue fluid to gather around the injury site. The injured area will usually look red because the blood vessels surrounding the injury site dilate, which also has the effect of making the injured area feel hot. The injured area will show a reduced function or a total inability to function because of the pain and swelling. This is the body’s way of preventing further movement from occurring, which could result in more damage to the injured area. The level of the above signs and symptoms will be directly related to the degree of the injury – the greater the degree of damage, the greater the effects of inflammation will be.

Phase 2 – the proliferative phase (tissue formation)

During this phase, 48 to 72 hours after injury and even up to 21 days after injury, the repair is carried out with vigour by the body. The body’s clotting mechanism seals the ends of the torn blood vessels so that further blood plasma cannot escape into the surrounding tissues. During this phase, the swelling starts to reduce in size and the injured area no longer feels warm to the touch.

As the immediate effects of injury subside the healing/repair process begins.

1 Select and name five acute injuries and two overuse injuries.

2 Explain each injury, including the signs and symptoms of each injury and the different aspects of acute and overuse injuries, differentiating between the two. You should also identify the common signs and symptoms of the two specific injuries selected. Common signs and symptoms could include general signs of acute or overuse, as well as signs specific to the chosen injury.

3 Provide an assessment of each injury by including the signs and symptoms and examples of mechanisms of injury for each injury. Mechanisms of injury should be considered with regards to the role of biomechanics and sports injuries. From these examinations, you should arrive at a conclusion for each chosen injury. Support your conclusions with examples of annotated diagrams and pictures.

Activity ( P1A , M1A , D1A B )

1 Describe four different types of fracture.

2 Explain the difference between a grade I and a grade III ligament tear.

3 Describe five different acute or overuse injuries.

4 Identify the five primary variables in the mechanisms of injury.

5 Describe Newton’s laws of motion, providing sporting examples of each.

6 Explain why a football player may experience rotational injuries in their lower leg.

7 Analyse a sports injury of your choice providing details of the signs, symptoms and mechanisms of the injury.

A Check your understanding

B Examine the physiological and psychological responses to injury and rehabilitation ( P2B , M2B ,

D1A B )

B1 Physiological response to injuryThe repair of injured soft tissue such as muscle actually commences within the first 24 hours following the injury.

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Other tissues that are frequently damaged during sport are ligaments and tendons. These are also soft tissue and are primarily made of collagen. Ligaments connect bone to bone and tendons connect muscles to bone. Ligaments and tendons can adapt to changes in their mechanical environment due to injury, disease or exercise. A ligament or tendon is made up of fascicles.

Each fascicle contains the basic fibril of the ligament or tendon, and the fibroblasts, which are the cells that make the ligament or tendon.

Unlike normal ligaments, healed ligaments are partly made up of a different type of collagen, which has fibrils with a smaller diameter and is therefore a mechanically inferior structure. As a result, the healed ligament often fails to provide adequate joint stability, which can then lead to re-injury or a chronically lax (permanently slightly unstable) joint.

B2 Psychological response to injuryThe psychological responses to injury should be considered, as these will have an impact on the person’s overall response to getting injured and how they cope with their treatment and rehabilitation.

The response to injury varies from individual to individual. It may vary within an individual alone dependent on when the injury occurs – at the start of a training session, middle of a season or during a major competition.

The reaction initially is negative in the main but positive attitudes can be formed. For example, it may give an individual more personal time to spend with family and friends, or time to develop new skills such as coaching, or to work on other aspects of their performance. Generally, though, the reaction is negative.

In reality, while some individuals struggle with the negative feelings that they experience, most cope without great difficulty, particularly if the injury is not too severe.

Grief response model

The typical grief response model shows that people react to injury with the following emotions:

This consists of:

� ABSORPTION of swelling

� REMOVAL of debris and blood clot

� GROWTH of new blood capillaries

� DEVELOPMENT of initial �brous scar tissue.

After 12 hours and for the first 4 days, the cells soon become active and new capillary blood vessel buds form and gradually grow to establish a new circulation in the area.

With the new blood supply, the debris of dead cell tissues and the initial blood clot that was formed is cleared.

Phase 3 – the maturation (remodeling) phase

The damaged tissue is repaired by scar tissue. It is important to remember that scar tissue has ‘plastic’ properties.

Plastic properties means it can be stretched and moulded.

Key term

Scar tissue is not elastic like muscle. It will form in a haphazard formation of ‘kinks and curls’ and will contract or shorten if not carefully stretched daily for many months after the injury.

Figure 15.9 Scar tissue

There is a great need for the new scar tissue to form in parallel ‘lines’ to give it strength.

Correct ‘stretching’ causes the scar tissue to line up along the line of stress of the injured structure.

Therefore, injured muscles or ligaments should be carefully mobilised and stretched daily (beginning 5 days after the initial injury).

The ‘stretching’ will ensure that the scar is ‘moulded’ to the desired length and improve the strength of the healed area (scar) and thus reduce a recurrence of damage to the scarred area and injured structure.

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injury, an individual can become depressed at the uncertainty of the future. An injured individual who belongs to a team may start to feel isolated from the ‘group’ and this in turn can lead to depression. It must be noted, however, that depression is not inevitable and has not always been observed during the grief reaction in research studies. Tension and helplessness are then generated as the individual becomes frustrated at not being able to continue as normal with training or playing. Again, the isolation that injury causes, from a normal routine or from being with ‘the team’, can be difficult for some people to accept.

Acceptance – Finally, the individual starts to move towards an acceptance of the injury and adaptation of lifestyle while injured. The focus is then turned to rehabilitation and a return to sports activity. This stage tends to mark the transition from an emotional stage to a problem-coping stage as the individual realises what needs to be done to aid recovery.

The timescale for progression through these stages can vary considerably depending on the individual and the severity of the injury, and setbacks during rehabilitation can lead to further emotional disturbance. In cases of very serious

1 denial

2 anger

3 bargaining

4 depression

5 acceptance.

Denial – After the initial shock is over, many athletes tend to play down the significance of the injury and think that it is not very severe and that everything will be fine.

Anger – However, as the injury becomes more apparent, denial is often replaced by anger directed towards themselves or towards other people. The responses can vary in intensity depending on situational and personal factors but can be especially strong in individuals whose self-concept and personal identity are based on being ‘an athlete/a player/a competitor’. The loss of this identity due to the inability to perform can cause much distress.

Bargaining – Following anger, the injured athlete might try bargaining or rationalising to avoid the reality of the situation. A runner may promise to train extra hard on return to training.

Depression – By confronting reality, and realising and understanding the consequences of the

Read the case study and then answer the questions that follow.

Carla is a talented 17-year-old long jumper who has just competed in the school’s county championships. However, during her second jump, she felt a sharp pain down the back of her left hamstring. She thinks she may have heard a small ‘pop’ as well. She had to pull out of the jump and hobbled through the sand. She was not able to take any further part in the competition. When she goes to see a physiotherapist the next day, she feels pain and tenderness as he presses on the back of her left hamstring; there is also some bruising around the site of the injury. She finds that it is very painful when she bends her knee and also her hip. She is still a bit shaken up by the injury and feels very upset about getting injured, particularly as she has a national event coming up in a month’s time in which she is desperate to compete. She asks the physiotherapist if she will be fit in time and he says he cannot answer that. She starts to get very worried and secretly thinks that she will rest for a couple of days and then start training again. But when she starts to think about jumping again, it makes her feel anxious.

Think about it1 From your reading of the case study and knowledge of muscle injuries, what physiological responses

will Carla be experiencing?

2 From your reading of the case study, describe the psychological responses Carla is experiencing.

3 Explain the physiological and psychological responses that Carla will be experiencing.

4 Analyse the physiological and psychological responses that Carla will be experiencing.

Case study

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Behavioural response(adherence

to rehab programmes)

Emotional response(e.g. anger, depression)

Cognitive appraisal(interpretation of injury)

Personal factors(psychological

and/or historicalcharacteristics)

Situational factors (injuryrelated and social/environment

characteristics such asstressful life events)

Figure 15.10 The cognitive appraisal model

Three categories of response

Three categories of how a sports performer reacts to sustaining a sports injury have been suggested by Udry et al. (1997). How the performer progresses through each stage will vary significantly depending on the severity of the injury and the mental and emotional state of the athlete.

First response category – injury relevant information processing stage In this stage the sports performer is keen to find out as much as possible about their injury in relation to what it is, how it can be treated, what needs to be done to treat it, how long will it take to recover, etc. The sports performer will usually be in a negative state of mind as they have gone from being injury free and able to participate in their sport to being injured which is preventing them doing something that they love, and for professional athletes, it could have an impact on their income.

Second response category – emotional upheaval and reactive behaviour stage During this stage the sports performer will become emotionally upset or agitated. They may want to remove themselves from the company of other people while they try to deal with what has happened to them. They may also be in denial

injury and ones in which the emotional reactions are prolonged, the skills of a clinical psychologist might be required.

It must be stressed that this process may not be a linear one for all individuals who experience some of these feelings.

Motivations and goal-setting strategies have been shown to help some people. This is possible if a coach, trainer or parent can help an injured individual recover sensibly, effectively and more positively by encouraging them to follow professional advice relating to physical rehabilitation. You can also reassure them that the feelings they are experiencing are not uncommon.

The channelling of a positive attitude can ease the rehabilitation for not just the injured player but also those around them!

Cognitive appraisal model

This model was devised by Brewer (1994) and provides an outline of a sports performer’s response to getting injured and suggests that the sports performer sees their injury as a stressor. The sports performer then evaluates how the injury will affect them in relation to:

1 Situational factors which include:

� Sports-related factors, such as if the injury is going to prevent them from competing in a big game that is coming up in the next few months.

� Environmental factors, such as if they are going to be able to get the support they need to rehabilitate after the injury.

2 Personal factors, such as the sports performer’s ability to withstand pain.

3 Cognitive appraisal which includes how a sports performer evaluates the injury in relation to how it will affect their life and goals.

4 Emotional response which is how the performer feels about the injury, their future and how it affects their mood.

5 Behavioural response which is what the performer does in response to the injury, such as following the rehabilitation without missing a session.

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their rehabilitation programme (personal factors). If they are then not meeting their expected results in the time frame they have given themselves, they will become frustrated and then depressed, as they will start to feel that they will not be ready to compete in a significant upcoming event (situational factors). This can then lead to them not taking part in the rehabilitation sessions and so delay their recovery time.

Stress response

Physiological changes When a person is stressed, their body responds by releasing adrenaline. This is a hormone released during times of stress which gets the body ready for action (known as the ‘fight or flight response’), so that if a person is in danger, they are able to fight in response to the dangerous situation, or are ready to run away quickly from the danger. The effects of adrenaline include making the heart beat faster, increasing the blood pressure, increasing the breathing rate, increasing the sweating rate, increasing the muscle tension, and decreasing the digestive activity.

Attention changesWhen a person is stressed there are changes to their ability to pay attention in the normal way, and they cannot concentrate on the activity or sport, as they are worrying about something else. Their field of vision is narrowed, which means they are not able to see in their peripheral vision.

B3 Psychological factors associated with sport injury rehabilitation adherencePsychological/social factors affecting rehabilitation:� Personal factors, e.g. pain tolerance, mental

toughness, self-motivation, independence.

� Situational factors, e.g. belief, process and procedures, environment, social support.

Psychological techniques used to enhance rehabilitation adherence

A number of methods can be used to speed up the rehabilitation process and ensure the athlete follows the rehabilitation programme fully.

about how severe the injury is and how long it will take them to recover.

Third response category – positive outlook and coping stageAt this point the sports performer has accepted their injury and the fact that they will need treatment and rehabilitation to get back to participating in their sport. They will be more positive at this stage and be more focused on their recovery.

Stress injury model – Williams and Anderson 1998

This model suggests that how a sports performer will deal with a stressful event will be affected by:

� Personality factors which includes their attitude to risk taking, competitive trait anxiety, resilience, achievement and motivation.

� The available coping resources and behaviours which is how a person deals with the stressors and how they cope with them. The coping resources include social support from friends, team mates, family, coach and medical professions. These people can offer emotional support to listen to the performer and provide comfort; informational support by their coach or therapist telling them that they are doing well, and tangible support which provides materials support in the shape of help with injury treatment and rehabilitation.

Integrated model – Wiese-Bjornstal 1998

This model takes into account a number of factors, including:

� Pre-injury factors such as personality, coping resources and history of stressors

� Personal factors

� Situational factors.

Each of these factors will influence the emotional and behavioural response to the recovery and rehabilitation process.

To demonstrate the interrelationship of these factors, if a javelin thrower that has injured their shoulder for the third time is a perfectionist (pre-injury factor), then they would set themselves a goal be ready to go back into competition in a short time frame, and as such, would put a lot of effort into

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their motivation to adhere to their rehabilitation programme and help to reduce their stress levels. The team mates should be made aware that the injured athlete may feel isolated so it is important for them to maintain contact. Support from other athletes that have been injured is also beneficial to the athlete in their recovery process.

EducationThe athlete should be made fully aware of what to expect while they are injured and what is involved in the rehabilitation programme. This is even more important if it is the first time the athlete has been injured, as they will have very little or no knowledge of what to expect. When an athlete is educated in what the whole process involves, they are more likely to commit to the rehabilitation programme and understand the emotions and difficulties that they may experience during the rehabilitation period.

Imagery This can be used to aid the healing process and helps the athlete to carry out sports-related practices while they are injured. There are different types of imagery that can be used, including:

� Healing injury, where the athlete uses images of the physiological healing process in their mind, such as increased blood �ow to the injured area.

� Pain injury, where the athlete creates images of factors that are causing pain and then creates pain-reducing images to help them to deal with the pain.

� Relaxation imagery, where the athlete creates calming images in their mind, such as lying on a beach by the sea.

� Performance imagery, where the athlete creates images of them performing a speci�c sporting skill correctly.

Self-talkAn injured athlete may have negative thoughts about themselves and their injury. This may have the effect of reducing their pain threshold and feeling the pain of the injury to a greater degree than if they had positive thoughts. These increased feelings of pain can then lead to a decrease in

Goal settingThis plays a key role in rehabilitation as it can increase the amount of effort an athlete puts into their rehabilitation programme. They will have a number of goals to focus on, including:

� A performance goal – which is a goal to achieve speci�c performance objectives and is not related to other athletes’ abilities.

� A process goal – this is where the athlete focuses on what actions they must carry out in order to perform well; this may be to do with working hard during rehabilitation sessions.

� An outcome goal – this is a goal that focuses on being able to perform a speci�c outcome, such as being able to run with a football.

For each of these goals the principles are the same, the goals must be SMART:

Specific – the goal has to state exactly what needs to be done

Measureable – you must be able to measure if the goal has been reached

Achievable – the goal has to be something that the athlete is able to do within the time frame given

Relevant – the goal has to be important to the athlete and their recovery process

Time-bound – a specific time frame needs to be given for completion of the set goal.

Motivational interviewingThis is where a sports therapist talks with the athlete in a form of interview. This focuses on helping to support the athlete to gain their own intrinsic motivation to adhere to the rehabilitation programme and change behaviour, so that they feel confident that they can work through their injury and get back to playing their sport within a specific time frame. The process is goal-oriented to support the athlete to return to play.

Social supportA sports therapist provides social support to an injured athlete; however, friends and family, team mates and the athlete’s coach are also vital in providing social support to the athlete. These people can all influence the athlete in

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injury, they may feel isolated from the team, which could affect the team dynamics when they return to playing with their team mates. They may also feel that there is pressure from family or friends for them to return to sport, as these people know that the athlete loves their sport and was upset when they were not able to play through the injury. This may result in them putting undue pressure on the athlete to return to play sooner than they are physically or psychologically ready. An athlete may also experience being beaten in their sport by competitors that they could beat before they were injured, which places negative social comparisons on the athlete so affecting their self-con�dence.

� Performance stressors – This is where the athlete does not have the same ability in their sport as they did before they were injured and they have fallen behind in terms of progress compared to other athletes in the same programme. It may result in them not being picked for the team or squad which negatively affects the athlete’s ability to return to their sport after injury.

A sports therapist should be aware of each of these psychological factors that can affect an athlete on their return to sport and help the athlete to come to terms with these stressors, as well as supporting them in dealing with each potential stressor. A sports therapist can do this through a number of methods:

� help the athlete to have realistic expectations about what they can expect to achieve during speci�c time frames

� use goal setting techniques to help the athlete see that they are progressing in a positive way

� ensure the athlete returns to sport when they feel they are ready, rather than listening to what other people think is best for them

� encourage the athlete to talk and spend time with other athletes that have been injured

� try to ensure the athlete maintains contact with their team mates while they are not able to participate in the sport.

activity levels and reduced motivation to work hard or not at all during rehabilitation sessions, which will have the effect of increasing the rehabilitation period. An athlete should learn to carry out positive self-talk to help them to deal with their emotional response to injury, which in turn will help to increase their motivation in their rehabilitation programme and help to reduce the rehabilitation period.

Coping resources

There are three main types of coping resources that an athlete can use to try to deal with their sports injury:

� Avoidance coping – this is where the athlete is not able to acknowledge that there is a problem and they are in denial about the fact that they are injured. This is sometimes known as wishful thinking.

� Emotion-focused coping – this is where the athlete uses different forms of support using emotion to help them to cope, such as using imagery or social support.

� Problem-focused coping – this is where the athlete considers ways to deal with the problem in order to cope with their injury, such as goal setting or gathering information about their injury in order to help them to understand their injury better.

Psychological factors associated with the return to sport

When an athlete is ready to return to sport, they may feel a number of stressors act on them, making them uneasy about returning to sport. These include:

� Physical stressors – This is the main concern of many athletes returning to sport as many may feel worried that when they play the sport again they will get injured. They may worry about increasing their �tness so that they are match-�t. Athletes may also �nd that they make adjustments to their sporting techniques in order to take off any excess pressure from their injured body part.

� Social stressors – When an athlete has had time off from playing with their team due to

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Provide an evaluation of how two sports performers of your choice have each responded to different injuries. You should include in your answer an evaluation of:

• the mechanisms of the injury

• the associated physiological responses to the injury and rehabilitation

• the associated psychological response to the injury and rehabilitation.

Distinction activity

C Investigate aetiology of sports injuries and their associated prevention strategies ( P3C ,

M3C , D2C )

C1 Aetiology and prevention Intrinsic risk factors

An intrinsic risk factor is a physical aspect of the athlete’s body that can cause an injury. There are many different types of intrinsic risk factors.

MuscularMuscle imbalanceA muscle imbalance means that one muscle in an antagonistic pair is stronger than the other. This is often seen in footballers who have strong quadriceps muscles from extending their knee to kick the ball, but their hamstring muscles are not as strong. This can result in knee injuries because the hamstring muscles are not strong enough to put a brake on the kicking action of the knee. As a result, when a striker goes to score a goal they can over-kick, so that their knee hyperextends and gets injured.

Muscle weaknessWhere muscles are weakened from not being given sufficient time to rest to adapt to training they are more prone to injury as the muscle is not able to withstand as much force when it is in a weakened state.

Leg length discrepancy A number of people are born with one leg slightly longer than the other. If there is a large difference

1 Explain the three phases of the physiological response to an injury of your choice.

2 Describe the grief response model.

3 Describe the cognitive appraisal model.

4 Describe how personal factors affect rehabilitation.

5 Explain three different psychological techniques that can be used to enhance rehabilitation adherence.

B Check your understanding

1 Write a report that provides an explanation, assessment and evaluation of how:

a) the body responds physiologically to sports injuries

b) a person’s mind responds psychologically to sports injuries.

Your explanation should include the three phases: inflammatory, proliferative and maturation. Stages should all be clearly addressed, with a sound explanation of what occurs in each phase. Your assessment could address different aspects of the responses, how they interrelate and the extent of importance.

Activity

To achieve the AB.D1 criterion, you will need to carefully consider the injury mechanisms and the physiological and psychological responses to them. You will need to make a judgement as to the relevance and/or significance of the mechanisms of the injuries and the associated physiological and psychological responses. You will need to include in your evidence both the injury and rehabilitation phases. You should clearly break down the theory related to the physiological and psychological subject areas and from these draw conclusions that are supported with well-considered examples. The information presented will need to be factually correct and you should ensure you use concise written language and correct terminology.

Meeting distinction criteria

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that the person has taken part in so it is able to withstand the stresses encountered rather than getting injured.

� Growth and development – Children who take part in strength-training can damage their growth plates at the end of their bones which could result in growth problems, so it is important that the child has the correct lifting techniques and should aim to lift lighter weights with a high number of repetitions rather than try to increase muscle bulk.

� Gender – Research suggests that males and females should not take on the same volume of training as elite female athletes perform optimally at a training volume that is around 10% to 15% lower than that observed in elite male athletes. If the volume of training is increased for a female it often does not improve performance and can lead to over-training. This is due to the hormone testosterone which is responsible for aiding muscle growth and tissue repair. As training results in the breakdown of tissues, males are able to recover much more quickly from training than females because of this hormone.

� Size – The size of a person can help to determine which sports they may or may not be more suited to. A person who is quite small with low muscle mass would not be suited to a sport such as rugby which requires physical contact to tackle other players; a smaller person would be more likely to get injured during these tackles if they are playing against larger players.

� Body composition – A person with a high muscle mass will weigh more than a person of a similar height with less muscle mass. This means high impact sports such as running may cause more damage to their body from the impact. Similarly, if a person is overweight with high levels of body fat then the excess weight can increase the impact on the body from high impact sports.

� Previous injury history – Where a person has been injured before can often be a site for further injury as the injured area can remain weakened and therefore more prone to further injury.

between the two legs, this can affect the person’s running technique, which may then place more strain on one side of the body, which would make the person more likely to sustain injuries after long periods of exercising.

Lack of flexibilityGeneralised muscle tightness and restricted range of movementReduced flexibility can result from muscle tightness after having not stretched after exercise. After taking part in sport and exercise the muscles remain in a slightly contracted state. If the muscles are not stretched out they will gradually get shorter which will result in a person becoming less flexible as their range of motion will be reduced. This means that if a person tries to reach out and stretch to a greater degree than they are able to, the muscle tissue will likely tear and the person will suffer from a muscle strain. Ligaments and tendons can also have reduced flexibility if a person does not stretch regularly after taking part in sport and exercise, which can lead to ligament or tendon injuries if a person overstretches while playing or during participation in sport or exercise.

Focal areas of muscle thickeningRepeated trauma to a muscle is thought to lead to muscle adhesions in the muscle tissue itself, which leads to specific areas of the muscle becoming thicker. This may lead to localised pain in the area of the thickening and may be felt by a sports therapist.

Restricted range of movement When a person has reduced flexibility the range of movement in their joints can be reduced which means they more be more likely to injure the muscles, tendons or ligaments around the joint when taking part in sport or exercise.

Individual variablesA variety of individual variables will affect the potential for intrinsic risk of getting injured.

� Age – As a person gets older, their joints and muscles become stiffer and therefore more prone to injury.

� Fitness level – The �tter a person is the less likely they are to get injured as their body has gradually adapted to the sport and exercise

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� Tibial torsion – This is inward twisting of the tibia and can cause the feet to turn inwards.

Psychological factors According to Williams and Anderson’s (1998) stress injury model, sports performers are more likely to get sports injuries if they exhibit the following factors:

� History of stressors – A stressor is something that causes a person stress; getting injured while playing sport would be a stressor as well as everyday life, such as arguments with a friend or family member, workload, etc.

� Personality characteristics – How a person views situations can determine how at risk they are of getting a sports injury. If the performer views a particular game or event as threatening then they may be more at risk of getting injured. Locus of control, competitive trait anxiety, resilience and risk taking are also factors to take into account, and these are explored in more detail in Unit 3.

� Poor coping resources – This is how a person deals with a stressor. A person that is able to cope more readily with stressful situations is less likely to get injured.

� Personal factors – These include a variety of different things, such as pain tolerance, mental toughness, self-motivation and independence.

If a sports performer has a history of stressors, views the games as threatening and has poor coping resources they will view participating in

Postural defectsThe shape of the spine can produce postural defects which can leave some people more prone to injury.

� Lordosis – excessive inwards curvature of the lower spine.

� Kyphosis – excessive inward curvature of the upper spine.

� Scoliosis – excessive sideways curvature of the spine.

Malalignment Malalignment means bad alignment and this can occur in different parts of the body.

� Pes planus – This causes �at feet from the loss of the medial longitudinal arch of the foot.

� Pes cavus – This is a high arch of the foot.

� Rearfoot varus – This is where the whole foot is inverted in relation to the ground.

� Tibia vara – This condition is a growth disorder which leads to the lower leg angling inwards which makes the leg look bowlegged.

� Genu valgum – This is where the knees turn inwards, also known as ‘knock-kneed’.

� Genu varum – This is outward turning of the knees which is also more commonly known as bowlegged.

� Patella alta – This condition is where the person’s patella is located high on the knee joint and is more likely to get dislocated.

� Femoral neck anteversion – This is where the neck of the femur is rotated inwards to a greater degree than normal.

Normal Scoliosis Kyphosis Lordosis

Figure 15.11 Postural defects

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CommunicationIt is important for sports performers to communicate well with their team mates and coach so that these are aware of any concerns, weaknesses or injuries before playing.

Ensuring adherence to rules (foul play) and governing body guidelines It is important for sports performers to follow the rules of the sport in which they are participating as some of these rules are there to help to prevent injuries. For example, in football, a player should only aim to kick the football when going in for a tackle so that they try to avoid kicking the other player’s legs.

Incorrect technique – lifting and handling equipment The technique of performing an action or specific sport skill is usually dictated by the guidance that the sports participant has received from the PE teacher, coach, trainer or instructor. But it is very easy for individuals to start to slip from these standards if they are not reinforced at the right time. If correction does not occur the participant can soon start to adopt bad habits in terms of skill level and performance. This can in turn lead to injury problems. An obvious example is weightlifting, where back injuries particularly occur due to incorrect and bad or poor technique.

Environmental factors ConditionsThe environment in which we perform sports can also have a big impact on the likelihood of sustaining an injury. The environment encompasses the area in which a sport is played, so if you are playing basketball the environment would consist of the sports hall, and include the playing surface, the lighting and the temperature. If the lighting was poor, a player may be more likely to misjudge attacking or defensive moves and injure themselves or another player.

Other environmental conditions include the climate, such as if it is hot or cold, as these can have an impact on the risks of injury. For example, in cold conditions, muscle tissue is less pliable, so a person is more likely to have a muscle strain in

that sport as more stressful than other players. This will produce physiological and psychological reactions from the performer. They may tense their muscles and find it difficult to relax, they may also find it hard to concentrate on the game as they are more concerned with their own safety. This can then affect the performer’s technique and focus on the game which makes them more at risk of getting injured.

Extrinsic risk factors

An extrinsic risk factor is something external to the body that can cause an injury.

Training errors If a sport performer’s training programme is not appropriate it can lead to sports injuries, in particular overuse injuries. The following are ways that the training programme may be inappropriate for a sports performer:

� excessive volume

� excessive intensity

� rapid increase

� sudden change in type

� training when still experiencing excessive fatigue

� having inadequate rest time or recovery between each training session

� using a faulty technique when training.

Coaching Poor coaching/leadershipInappropriate instruction given by a coach or a trainer is an obvious way in which sports participants can easily become injured. It is vital that all instruction given is done so by someone who has an up-to-date depth of knowledge about the sport and is able also to communicate this appropriately and effectively. It is essential that the rules and regulations for the sport, as given by the specific governing body, have been correctly interpreted and are appropriately enforced. Likewise, during training activities it is important that the information given by the coach/trainer is reliable, therefore many governing bodies have coaching schemes that are constantly reviewed so that coaching qualifications can be maintained at the highest and safest of standards.

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playing areas and there are specialised shoes and boots for each surface. However, although a sports person may be wearing the correct footwear, certain types of footwear make a person more susceptible to injury. For instance, the studs on a footballer’s or rugby player’s boot can make the wearer more susceptible to leg injuries because the studs plant the foot in the ground, so if the person is turning on a planted foot they are more likely to twist their knee.

Incorrect footwear can also be a factor in causing a person to injure themselves while playing sport. For example, a marathon runner needs a lot of cushioning in their trainers to absorb the repeated impact of running. If they were to wear trainers with little padding they would be much more likely to sustain an overuse sport injury.

Safety hazards It is very important that regular safety checks are carried out by sports performers and/or coaches to ensure everything is in working order. Before participation in sport, equipment checks and pitch inspections should be carried out as well as risk assessments. Safety checklists and records should be completed as proof that these safety checks have been carried out.

Misuse of equipment If equipment is not used appropriately it can lead to injury. This is evidenced in gyms where every person that uses the gym has to take part in an induction process to show them how to use the equipment to prevent incorrect use which could lead to injury.

Inadequate nutrition and hydration If a sports performer has not had appropriate nutrition or is dehydrated they may become fatigued more easily and are therefore more prone to getting injured when taking part in sport.

Social factorsThe attitudes and influences of coaches and team managers can affect sports performers’ attitudes to safety. If sports leaders are very safety conscious and aware and make the performers aware of potential risks then the performers are more likely to follow safety guidelines to reduce the risk of injury.

these conditions. Humid weather means that heat loss from sweating is reduced, which can lead to overheating, as well as more slippery conditions underfoot if the surface is damp.

Wet weather can lead to slippery surfaces outside, which increase the risk of slipping and falling over.

Surfaces The surface on which a sports performer plays can result in an increased risk of injury; for example, a person who runs on hard surfaces may be at more risk of getting an overuse injury such as shin splints compared to if they ran on a softer surface which resulted in less pressure forces being exerted on the body. A cambered ground is where there is an arched surface, such as in an indoor athletics track, which arches upwards on the bends. This can be a risk as it can lead to imbalances on the foot, which can lead to ligament sprain or muscle sprain.

Weather effects on surfacesIf the surface of a playing area is wet, a sports performer would be more likely to slip over because the surface becomes much more dangerous when it is wet.

Clothing and footwear The use of appropriate clothing can also be an issue. Certain sports require, as stipulated by the respective governing body of the sport, certain pieces of protective clothing, such as shin pads for football, and pads, gloves and helmets for cricket and hockey.

Other sports, by their very nature, need to have clothing which is very flexible and allows a full range of movement. For example, gymnasts wear clothing which allows them to perform complex movements on the floor and on specialised equipment. If restrictive clothing was worn this could greatly reduce the range of movement allowed and therefore cause injury.

Correct footwear for the correct surface that the sport is to be played on is a must. There is a phenomenal array of specialised footwear for all sports, including running, basketball, tennis, squash, gymnastics, football and rugby. All these specialised pieces of footwear are made to be supportive to the player and totally suitable for the surface required for the sport. Football has grass, artificial turf and sports hall floors as its main

23


body continues to move forwards and the foot flattens on the floor which is known as the mid stance phase. The heel then lifts off the floor and then the toes push off the floor to propel the body forwards.

Swing phaseDuring this phase the leg accelerates forwards during the follow-through phase up to a point and then remains at a constant speed as it passes the other leg and then starts to decelerate as it is lowered to the ground during the foot descent phase.

Double support phaseDuring this phase there is a very short period of time when both feet are in contact with the ground before one foot starts to leave the ground and enter the swing phase.

Running gait

The running gait also includes three phases:

1 Stance phase

2 Flight phase

3 Swing phase.

C2 Gait analysisA person’s gait is their method of walking or running. Abnormal biomechanics associated with gait are often not from injury but can be from a variety of other factors. However, an abnormal gait can lead to chronic injuries. Therefore, an understanding of normal gait and abnormal gait helps to prevent injuries from occurring.

Walking gait

The walking gait includes three phases:

1. The stance phase – within this phase there is contact with the ground, mid stance and propulsive.

2. The swing phase – this includes follow-through, forward swing and foot descent.

3. The double support phase.

During the stance phase the foot is always in contact with the floor; however, during the swing phase, the foot has left the floor.

Stance phaseDuring this phase the heel makes contact with the floor which is also known as heel strike. The

Contact withthe ground

Propulsive Follow-through Forward swing Foot descent DoubleSupport phase

Figure 15.12 The complete walking gait cycle

Stance phase Flight phase Swing phase

Figure 15.13 The complete running gait cycle

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The main aim is to have as little upward and downward movement as possible from the centre of mass as this is unwanted movement – the main aim of walking and running is to move in a horizontal direction so any vertical movement is wasted energy.

� How change in speed affects change in gait – the faster a person walks or runs the more this will affect their gait.

� Footwear – the choice of footwear can have an impact on a person’s gait as the footwear can control how the foot lands on the ground. This, therefore, affects how the rest of the body reacts to the way the foot is placed on the ground.

Gait abnormalities

Any forces placed on the body from issues with a person’s gait can lead to injury.

Some of the most common concerns with gait abnormalities are to do with the feet.

� Pronation – there may be some pronation in a person’s foot, however, too much pronation can lead to injuries. This is where the foot rolls inwards due to some collapse in the arch on the inside.

� Supination – there may be some supination in a person’s foot, however, too much supination can lead to injuries. This is where the foot rolls outwards due to some collapse in the arch of the foot to the outside.

Stance phaseDuring this phase the foot is in contact with the ground.

Flight phaseDuring this phase both feet have left the ground.

Swing phaseDuring this phase the leg accelerates forwards.

The main difference therefore between walking and running is the fact that during running, both feet have left the ground for a period of time, whereas in walking, there is always one foot in contact with the ground and there is also a point in the cycle when both feet are in contact with the ground.

Factors to consider

In gait analysis, a number of factors are examined to try to determine if the person has any concerns with their gait which may lead to or have produced injuries.

� Duration – the length of time the foot is in contact with the �oor, the stride length (distance travelled) and stride rate (number of strides taken in a speci�c distance). The longer the stride length and the faster the stride rate, the faster an athlete will travel.

� Motion and position – this is how the body moves and is usually tracked by the centre of mass. The centre of mass of a person’s body is usually just below waist height. Cameras will be used to track how the centre of mass travels when a person is walking and running.

Unsafe range

Over-pronation Pronation Neutral(right foot)

Supination Over-supination

Unsafe rangeSafe range

Figure 15.14 Over-pronation to over-supination

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(b)

(f)

(d)

(a)

(e)

(c)

Figures 15.17–15.22 Structural abnormalities: a) forefoot varus; b) forefoot valgus; c) rearfoot varus; d) rearfoot valgus; e) bowed legs; f) knock knees

Pelvic tiltsThe position of the pelvis can also affect a person’s gait.

Anterior pelvic tilt – the pelvis can be angled so that the front of the pelvis drops forwards and the back of the pelvis tilts upwards.

Posterior pelvic tilt – the pelvis can tilt in the other direction with the front of the pelvis tilted upwards and the back of the pelvis tilted downwards.

Figures 15.15 and 15.16 Anterior pelvic tilt and posterior pelvic tilt

Structural abnormalities

The way the skeleton is held together in relation to ligaments and bone growth can result in some structural abnormalities in the body which can affect a person’s gait.

� Forefoot varus – this is where the bones at the front of the foot are in an inverted position in relation to the heel.

� Forefoot valgus – this is where the bones of the front of the foot are in an everted position in relation to the heel.

� Rearfoot varus – this is where the entire foot is inverted in relation to the ground.

� Rearfoot valgus – this is where the entire foot is in the everted position in relation to the ground.

� Bowed legs – this is where the legs form a bow shape moving away from each other at the knees.

� Knock knees – this is where the knees move inwards to each other.

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are in�amed resulting in pain and restricted movement around the joint where the bursa is located. In this incidence, the bursas are located in the heel which results in restricted movement of the foot.

� Blisters – a blister is a �uid-�lled sac that is a result of friction or a burn. The feet are usually most susceptible to getting blisters from footwear repetitively rubbing on an area of the skin on the foot.

� Bruising – this occurs from direct trauma caused by the muscle being squashed between the object causing an impact and the underlying bone. The muscle �bres are squashed and associated capillaries are torn. This results in bleeding into the area with resultant haematoma formation.

Footwear

The footwear a person chooses can have a significant impact in reducing the risk of them getting injured due to the structural abnormalities in their body.

Referral for orthosesOrthoses are devices that can be fitted to a person to correct a biomechanical alignment concern or correct a structural abnormality. They are designed to meet the person’s specific needs and are custom made for that person. The person will then wear these orthoses in their footwear to correct the area of concern. These can usually be worn in most footwear and are used for walking, running and playing sport.

Common footwear considerationsWhen selecting footwear, a person should consider their own requirements in relation to gait concerns or any structural abnormalities, as well as the sport that they are going to be wearing the footwear for, as these will all affect the selection of footwear for that person.

If the person has over-pronation or over-supination, most modern trainers will be able to provide some support for either of these concerns and help to balance the inward or outward roll of the foot by the trainer and lining inside the trainer.

Associated lower limb injuries

These structural abnormities can lead to specific lower limb injuries due to issues with the person’s gait.

� Plantar fasciitis – this results in pain in the person’s heel and at the bottom of their foot and is thought to occur from inwards rotation of the foot from over-pronation of the foot or other structural abnormalities that lead to this inward rotation.

� Achilles tendinopathy – this causes stiffness and pain in the Achilles tendon and can occur from repeated injury to the Achilles tendon.

� Medial shin pain – this is pain towards the inside of the shins and can occur from overuse of shin splints as a result of increasing the duration or frequency of running in a training programme or repeated running on hard surfaces.

� Patellar tendinopathy – the tendon that holds the patella in place can become over used and start to wear away from repeated jumping movements.

� Patellafemoral pain – this is a pain at the front of the knee that can result from wearing down of the cartilage under the patella, which can be due to the fact the patellar is not properly aligned.

� Stress fracture – this is a small break in a bone due to repeated use so the bone is not able to take the stress any longer.

� Hamstring strain – when the hamstrings are tight due to reduced �exibility; they are more likely to get torn when a person overstretches.

� Iliotibial Band Syndrome (ITBS) – this produces pain on the outside of a person’s knee as a result of friction on the iliotibial band on the side of the knee. This can occur from overuse, especially from extended running.

� Calcaneal bursitis – bursas are synovial �uid-�lled sacs located in synovial joints to reduce friction in the joint. Bursitis is where the bursas

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1. Carefully place your foot in a bowl of water.

2. Step onto a piece of paper so that you can see your footprint.

3. Look at the footprint that is left on the piece of paper – repeat this process with your other foot.

If your footprint shows:

• All of the sole of your foot with little to no curve on the inside – this means that you have low arches and your feet will tend to over-pronate. You can also check your shoes – if there is extra wear of the outside of the heel of your shoe this will confirm that there is some over-pronation in your foot. This means that you will need a trainer that helps to support over-pronation with a motion-control feature and maximum support.

• Only a portion of the front of your foot and heel, with a very narrow connection between the two – this shows that you have high arches and you tend to supinate. You can also check this by looking at your shoes and seeing if they are worn mainly on the outside edge of the shoe. The type of trainer you will need will be designed to help to prevent supination and be cushioned, with a soft midsole.

• The front of your foot and heel with a distinct curve joining the two – this shows that you have a neutral arch, and the inside and outside of your shoes will not show any difference in wear. You will need a stability trainer, which will have the right mix of cushioning and support.

Normal archneutral pronation

Flat archover-pronation

High archunder-pronation

(supination)

Figure 15.23 Footprints showing neutral pronation, over-pronation and under-pronation (supination)

Activity: Do your feet pronate or supinate?

C3 Preventative measures Principles of injury prevention

The sequence of prevention model for sports injuries was developed by Van Mechelen et al. (1992) and Van Tiggelen et al. (2008). These are used as a framework to reduce the incident of injury.

The sequence prevention model includes the following steps:

1. Establishing theextent of the injuryproblem (incidence,

severity)

2. Establishing theaeitology and

mechansims ofsports injury

3. Introducingpreventative

measures

4. Assessing itseffeciveness by

repeating step 1

Figure 15.24 Sequence prevention model

The first two steps:

1. Establishing the extent of the injury problem and

2. Establishing the cause, origin and mechanisms of the sports injury

Should be carried out via a research-based approach to fulfilling information requirements for each step. Initially, the risk factors involved should be investigated in line with intrinsic and extrinsic risk factors. Gait analysis should also be considered as a potential mechanism for sports injury. This has all been covered in sections C1 and C2 in this unit. Step 3 introduces preventative measures which are covered in this section of the chapter. You will need to understand the limitations of the actual implementation of preventative measures in step 3, and be able to assess the effectiveness of the introduction of any preventative measures in step 4, as methods of assessment cannot be addressed.

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should be checked to make sure they are appropriate for the planned activity, i.e. that it is not too hot or too cold.

Performer preparationThe sports performer has a responsibility to ensure they can help to reduce the chance of sustaining a sports injury.

� Warm-up/cool-down – Before taking part in sport it is important to warm the body up to reduce the risk of injury. The warm-up should increase the blood �ow to the muscles and increase the range of movement permitted at joints. After taking part in sport it is important to gradually return the body to resting levels by carrying out a cool-down which helps with venous return and removal of lactate.

� Stretching – This helps to reduce the risk of muscle strains from overstretching while playing sport. Stretching before participation helps to increase the pliability of muscles meaning that there is less chance of straining a muscle. After taking part in exercise, it is important to stretch to try to maintain a person’s �exibility.

� Sports massage – Where possible, sports performers should have sports massage to help to keep muscles relaxed and reduce the tension in muscles.

Appropriate training� Principles of training – The coach and sports

performer should ensure that when training they follow the principles of training including the FITT principles, as well as the additional principles of training including rest and recovery and variation in order to help to reduce the risk of overuse injuries.

� Training methods – Different training methods can be used to help to add variation to the training programme and reduce the risk of overtraining related injuries.

� Strength and conditioning – Many sports performers would also bene�t from taking part in this to help their body to withstand the demands of training and increase the strength of body structures, to allow them to withstand greater stress and therefore be less likely to get injured.

Preventative measures (Step 3 principle)

Role of the coachThe coach should have up-to-date knowledge of the sport/performer so that they are fully aware of the performer’s ability and fitness levels. This will ensure they don’t push them too hard and concentrate training on specific components of fitness, skills, techniques or specific body areas.

� Quali�cations – The coach should have appropriate quali�cations to coach at the level that they are coaching as well as regular CPD to keep up to date with latest research on coaching practice.

� Adapt coaching style to performer’s ability/age/�tness level – A coach should take into account all of these factors to ensure that the coaching they are providing is personalised and appropriate to each sports performer they are working with.

� Communication – They should have good communication skills so that the sports performer knows exactly what is expected from them, what they are to do and how they should do it.

Equipment and environmentPrior to any sporting activity the following should be carried out:

� Equipment should be checked to make sure it is full working order. The equipment should also be appropriate to the sport, such as correct footwear.

� Risk assessments should be carried out to make sure the activity is appropriate for the participants and the environment.

� Appropriate surfaces – These should be checked to make sure they are free from hazards and appropriate for the activity.

� Protective equipment – This should be worn by sports performers to help to reduce injury, such as gum shields in rugby.

� Sport-speci�c equipment – Equipment required for speci�c sports, such as shin pads for football, should be in place.

� Assessment of environment conditions – The playing surface should be checked to ensure it is �t for purpose and the weather conditions

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and during a game as well as to help them to cope with winning or losing, help them to relax and prepare themselves for future events.

1 Identify what is meant by aetiology.

2 Choose a sport that you take part in or enjoy watching.

Linked to this sport:

a) describe fi ve intrinsic risk factors that could result in sports injury

b) describe fi ve extrinsic risk factors that could result in sports injury.

3 Describe how the role of the coach should help to prevent injuries.

4 Explain how water on

a) a football pitch

b) a sports fl oor

may result in sports injuries.

5 Describe factors that should be included in a risk assessment.

6 Explain why a sports performer should warm-up and cool-down when taking part in sport.

C Check your understanding

Write a report that can be given to sports performers that take part in a sport of your choice that:

1 Explains, assesses and evaluates how extrinsic and intrinsic risk factors can contribute to sports injuries.

2 Assesses and evaluates how preventative measures can be used to help to prevent sports injuries in your selected sport.

You should use specific examples in your response and show that you understand the interrelationship of risk factors and preventative strategies.

Activity

� Core stability – This helps with posture and helps a person to carry out sporting techniques appropriately.

Correction of biomechanical abnormalitiesThere are a variety of ways biomechanical abnormalities can be corrected, such as:

� Referral to strength and conditioning coach – they can concentrate on the areas of the body that require an increase in strength and provide exercises to work on these areas.

� Core stability – increased core stability will help to correct posture.

� Stretching – this will help to increase �exibility in areas of the body that have reduced �exibility.

� Referral to podiatrist for shoe modi�cation – this can help to correct any biomechanical issues with the foot.

� Leg length – it is not unusual to have legs that are slightly different lengths, however, the larger the difference between the lengths of the legs the greater the chance of injury. Orthoses can be used to help to correct this issue.

Other measuresOther factors can be brought in to help prevent injury which include:

� Taping and bracing to any area of weakness (see learning aim D1 on page 33 for more information on other treatments).

� Nutrition to help with recovery after exercise such as ensure glycogen stores are full and also ensuring the sports performer is appropriately hydrated.

� Adequate recovery to allow the body to adapt to the training.

� Psychological intervention to support the mental state of a sports performer and help them to maintain optimal measures of arousal before

To meet the C.D2 criterion, you will need to present a careful consideration of the sequence of sports injury prevention model. Within your evidence you will need to examine the strengths, weaknesses and relative significance of each stage, providing justification of each place in the model. You will need to explore the risk factors which may contribute to sports injuries and their associated prevention strategies. You should also make judgements about all aspects of the prevention model for sports injuries, drawing conclusions from it and supporting these conclusions with a range of specific, well-considered examples. The information will need to be factually correct and you should use concise written language and correct terminology.


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After this, the secondary survey is carried out which requires the first aider to talk to the injured person to find out what happened and work out what sort of injury they have sustained.

Emergency/immediate treatment It is necessary to establish what is wrong with the person. If they are lying on the ground you should follow the guidelines below.

1 Assess the situation – Identify any risks to yourself and to the casualty.

2 Make the area safe – such as turning off an electric switch.

3 Assess the casualty – Talk to them �rst to see if they respond – they may just be asleep.

If they do not respond, speak to them with a louder voice, asking them if they are all right. If you still receive no response, gently shake them. If the person is not injured but is unconscious, then they should be placed in the recovery position.

Treatment of an unconscious casualty

Figure 15.25 The recovery position

This position helps a semiconscious or unconscious person breathe and allows fluids to drain from the nose and throat so that they do not choke. The casualty should not be moved into the recovery position if you suspect that they have a major injury, such as a back or neck injury and give first aid if appropriate. Establish if the person is conscious and then check their ABC; this would be thoroughly covered in a first aid course:

To avoid sports injuries there are a number of methods a sports person can include in their training programme, such as ways to minimise intrinsic and extrinsic risk factors. They should also analyse their walking and running gait in order to help prevent injuries occurring due to structural abnormalities.

Provide an evaluation of the sequence of prevention model which includes the methods outlined earlier, which can be used by athletes to avoid getting injured. You should provide justification of the four different stages of the prevention model, using specific examples.


D Explore common treatment and rehabilitation methods ( P4D ,

P5D , M4D , M5D , D3D )

D1 Treatment methods and the need for medical referralFirst aid

First aid is the immediate treatment given to an injured person. When a suitably qualified person arrives on the scene they then take over the care of the person. Anyone with some knowledge of first aid can have a huge impact on the health of an injured person, so it is always useful to know some basics. By completing a recognised first aid qualification you will gain a very good basic knowledge of what to do in an emergency situation. It is not in the scope of this book to cover all aspects of first aid because practical work is required to complement the theoretical principles of first aid. Therefore, this section will only cover some very basic aspects of first aid.

Primary and secondary survey The primary survey is the first thing a first aider does to find out if someone has a life threatening injury or condition.

If there are any life threatening conditions these need be dealt with first and are outlined in the emergency/immediate treatment section.

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BleedingA person may suffer from external bleeding, which is usually obvious to the first aider as blood flows out from the site of injury. Internal bleeding, however, is not so obvious – it is not visible as the blood is flowing out of the injury site into the body. The first aider should ensure they are adequately protected when dealing with a casualty who is bleeding, in order to ensure they do not expose themselves to any blood-borne viruses such as HIV.

External bleeding should be treated in the following manner:

� lay casualty down

� apply direct pressure with a gloved hand or �nger to the site of bleeding; as soon as possible, place a clean dressing over the wound

� elevate and rest the injured part when possible

� seek medical assistance.

Internal bleeding is difficult to diagnose, but some of the potential signs and symptoms are:

� coughing up red frothy blood

� vomiting blood

� faintness or dizziness

� weak, rapid pulse

� cold, clammy skin

� rapid, gasping breathing.

The treatment for a person you suspect has internal bleeding is as follows:

1 lay the casualty down

2 raise the legs or bend the knees

3 loosen tight clothing

4 urgently seek medical assistance

5 give nothing by mouth

6 reassure the casualty.

Risk assessment These should be carried out before participation in any sport by the sports coach or leader to help to ensure the safety of participants. A risk assessment is about identifying hazards and assessing the risks associated with them.

A hazard is something that is dangerous, and therefore has the potential to affect someone’s safety or cause an injury.

� Airway – they have an open airway

� Breathing – they are breathing

� Circulation – check their circulation by assessing if they have a pulse.

1 Summon quali�ed assistance – try to get help as soon as possible.

2 Deal with the aftermath – complete accident/incident report.

If you follow a first aid course you will be taught how to:

� check the ABC

� open a person’s airway

� deal with them if they are not breathing by giving them arti�cial resuscitation

� check if a person has a pulse and how to administer cardiac compressions if they do not.

Prevention of infectionIf the person has an open wound, then it is important to try to prevent any infection from getting into the wound. Using sterile bandages and dressings is the best course of action to treat an open wound, but if these are not to hand, then clean clothing may be the only option available to help to stop the bleeding of an injured person.

ShockWhen a person is suffering from shock, there is not enough blood going to the major organs of the body. Shock can be caused by number of things, including burns, electric shock, allergic shock or severe injuries. A person suffering from shock will usually have cool, moist skin, a weak, rapid pulse and shallow breathing. Other symptoms may include nausea, vomiting or trembling. The treatment for a conscious casualty suffering from shock is to reassure them, then try to find and treat the cause of shock, e.g. control any bleeding. Keep the casualty lying down and check for neck, spine, head or abdomen injuries. If there are none of these injuries then the feet should be raised so that they are higher than the casualty’s head.

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2 Injury requiring medical assistance

3 Major injury or fatality

For example, broken glass on a park football pitch.

Likelihood of happening: 2. Quite likely

Severity: 2. Injury requiring medical assistance.

By multiplying the likelihood against the severity you will be able to set a chart that looks at the potential problems and make a decision on whether you want to take the risk or whether it is too much of a hazard.

2 x 2 = 4

Table 15.2 provides an example of such a chart.

Control measuresControl measures help reduce the likelihood of an accident happening. These could include having safety goggles, where a person is at risk of getting something in their eye. Having eye wash solution close could also help somebody if they were to get something in their eye. Cleaners often put up warning signs when they are mopping floors. This is a control measure to alert people that the floor may be wet and helps reduce the risk of injury, by bringing attention to the hazard. Control measures can also be known as precautions.

Safety equipmentSpecialist equipment is also used in sport to help minimise the risk of injury. This can include protective clothing, accessories and equipment.

Cyclists will wear helmets in case they fall off, while a batsman would wear protective equipment such as a box and helmet to prevent

Most sport and outdoor pursuit activities contain many hazard factors that could affect a person’s general health. Therefore, the participants must ensure that they remain safe and avoid the possibility of injury or even death. This is normally the responsibility of the person leading the session.

An example of a hazard could include:

� broken glass on a football pitch

� a strong current in the sea (kayaking).

Risk is the possibility of something bad happening.

Key term

A risk is linked to the chance of somebody being harmed by the potential hazard. Risks are often categorised into how likely they are to happen. Something that is a low risk means that the likelihood of it happening are low, whereas something that is high risk means that it is likely to happen.

After you have highlighted the hazard the easiest way is to use the following formula to assess the potential problems that may arise.

LIKELIHOOD × SEVERITY

LIKELIHOOD – Is it likely to happen?

1 Unlikely

2 Quite likely

3 Very likely.

SEVERITY – How badly someone could be injured.

1 No injury/Minor incident

Table 15.2 Risk assessment chart

Likelihood × Severity Is the risk worth taking?What measures should be considered/taken prior to activity?

1 Yes, with caution

2 Yes possibly, with caution

3 Yes possibly, with extreme caution

4 Yes possibly, with extreme caution

6 No

9 No

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the injury, which will further help to minimise swelling and bruising at the injury site.

� Diagnosis by professional – The injured person should then be referred to a medical professional to give a full diagnosis and refer for appropriate treatment if required.

SALTAPS

The sooner an injury is treated then the greater the chances of a complete recovery and the faster the rehabilitation. The immediate treatment can be summarised by the acronym SALTAPS.

SALTAPS is a set procedure for examining an injured person and attempting to diagnose the type and the degree of injury. It stands for: see, ask, look, touch, active movement, passive movement, strength testing.

� See – the injury occur and the mechanism of injury.

� Ask – the casualty what is wrong and where they have pain.

� Look – for signs of bleeding, deformity of limbs, in�ammation, swelling and redness.

� Touch – the injury or close to the injury for signs of heat, tenderness, loss or change of sensation and pain.

� Active movement – ask the casualty to move the injured area. If they are able to, ask them to move it through its full range of movements.

� Passive movement – try to move the injured site only if a good range of movement is available.

� Strength – if the casualty has been taken through the steps above with no pain, use resisted movements to assess loss of function. For example, with an injured ankle you would assist the casualty to their feet, then ask them to stand unaided, then progress the test to walking and running.

Other treatments

Bandaging and tapingThese are carried out in order to prevent injury, or to treat or rehabilitate an injured joint. Both are performed in order to increase the stability of a joint

injury from the ball. Safety ropes are often used in climbing and abseiling to minimise the risk of potential danger.

Accident reporting procedures/formHealth and safety is the responsibility of everyone. In the workplace, everyone should be responsible, however, in sports activities it is often the responsibility of the instructor, coach or leader. If an accident happens or there is a near miss, it needs to be reported and documented, so that it can be looked at, dealt with accordingly and hopefully stopped from happening again.

PRICED

If a person has suffered from a soft tissue injury such as a strain or a sprain, then ensuring that they follow the PRICED (protect, rest, ice, compression, elevation, diagnosis by professional) regime will help to limit the severity of their injury.

� Protect – the injured body part from further injury.

� Rest – As soon as a person has injured themselves they should be told to discontinue their activity. Further activity could cause further injury, delay healing, increase pain and stimulate bleeding.

� Ice – An ice pack or cold compress should be applied to the injured area. This will help to reduce the swelling and pain of the injury.

� Compression – Gentle pressure should be applied to the injury site by surrounding the area with padding, a compressive bandage or a cloth. Compressing the injured area will reduce blood �owing to the injury site and also help to control swelling by decreasing �uid seeping into the injured area from adjacent tissue. After applying a compression bandage, the casualty’s circulation should be checked by squeezing the nail beds of the injured limb. If blood is seen to return to the nail bed on release, the compression bandage is not too tight. The compression bandage should be reapplied after 24 hours in order to maintain compression over the injury site.

� Elevation – The injured area should be supported in a raised position above the level of the heart in order to reduce the blood �ow to

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Splints A fracture should be immobilised in order to prevent the sharp edges of the bone from moving and cutting tissue, muscle, blood vessels and nerves. The injured body part can be immobilised using splints or slings. If a casualty has an open fracture, the first aider should never attempt to push the bones back under the skin. A dressing should be applied to the injury site to protect the area and pressure should be applied in order to try to limit the external bleeding. A splint can be applied, but should not be placed over the protruding bone.

Cryotherapy (use of ice) Cooling an injured body part to minimise the swelling and bruising of an injured area and to reduce pain is essential. When a person sustains a soft tissue injury, blood vessels are torn and blood cells and fluid escape into the spaces among the muscle fibres. By cooling the injury site, the local blood vessels are constricted, so blood flow to the area is reduced. The application of something that is cold to the injured area not only has the effect of decreasing the flow of this fluid into the tissues but also helps to slow the release of chemicals that cause pain and inflammation. Cold also decreases the feeling of pain by reducing the ability of the nerve endings to conduct impulses.

Because cold reduces bleeding and swelling within injured tissue, it is best used immediately after injury has occurred for up to 48–72 hours.

Ice bags (plastic bags with ice cubes in, a bag of frozen vegetables or chemical cold packs) can be used. Never apply ice directly onto the skin. The injured area should be covered with a cloth towel in order to prevent direct contact of the ice with the skin, which could cause a blister or ‘ice burn’. The cold application should be applied to the injured area for no more than 10 minutes. During this time the person’s skin will pass through four stages of sensation, which are:

1 cold

2 burning

3 aching

4 numbness – as soon as the skin feels numb the cold therapy should be stopped.

when there has been an injury to the ligaments that normally support the joint. They limit unwanted joint movement, support the injury site during strengthening exercises and protect the injury site from further damage.

Taping involves the use of adhesive tape (e.g. zinc oxide tape), whereas bandaging uses strips of cotton and/or specialised pressure bandages. Their purpose is to restrict the joint movement to within safe limits. Taping should not be carried out if the joint is swollen or painful, or if there are any lesions around the taping area. The person who applies the taping/bandaging should be careful to ensure that they do not bind the injury site too tightly so that circulation is affected.

It should also be noted that some individuals have an allergic reaction to some types of tape, such as zinc oxide. Ideally, they should be asked about this possibility before application of the tape. For any uncertainty, an underwrap can be applied to provide a protective barrier between the skin and the tape. Unfortunately this can impair the tape’s performance as tape also provides a proprioceptive response mechanism by having its contact directly with the skin. It reminds the individual that it is there to protect and maintain a joint within a range of movement.

The use of tape may well provide support and comfort for a sports person, however the benefits of use over approximately 20 minutes are diminished due to the material properties. This said, it is often used for time periods well beyond the 20 minute mark and its proprioceptive response declines after this amount of time. The psychological value of tape is valuable for a lot of players at all levels of competition, to the extent that it may even be applied to an injury that has fully recovered so the player still feels ‘comforted’ by the application of the tape!

Bandaging can be used to create pressure around the injury site in order to restrict swelling.

Sling A sling is used with an injury to the arm, hand or shoulder. It is used to immobilise the joint and to elevate the area to promote healing.

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the injured person to the qualified first aider who will decide the next steps for injury treatment.

St John AmbulanceSt John Ambulance first aiders are volunteers who are qualified to administer immediate first aid. These people are often present on site at large events and are there to help people at the event should they need first aid assistance.

Emergency services If a person is injured and you believe the injury requires professional attention, you must ensure that someone calls for an ambulance. If you are dealing with a casualty by yourself, minimise the risk to them by taking any vital action first (check their airway, breathing and circulation), then make a short but accurate call.

1 Dial 999 and ask for an ambulance.

2 Give your exact location.

3 Give clear details of the accident and the severity of the injuries your casualty has sustained.

4 Give the number, sex and approximate age of the casualty.

If you ask someone else to make the call, always ask them to report back to you to confirm that the call has been made.

When the paramedics arrive, tell them as much as possible about how the casualty has behaved, such as if they were unconscious, if they needed artificial resuscitation, and so on.

Local accident and emergency departments can also be used, and in some cases, such as non-life-threating injuries (and if the person is able to move), it may be quicker to drive the injured person to the local A and E department rather than wait for an ambulance. Some doctor’s surgeries have a minor injuries clinic which could also be the better option to go to if the person has only a minor injury to deal with.

General practitioner A doctor can assess an injury and provide some treatment, however, they will also need to make a judgement on if a specialist therapist needs to be seen and if they believe that the injury requires specialist attention they can refer the sports person to a specialist therapist.

The cooling procedure should be repeated every two waking hours.

There are a number of methods of cold treatments (cryotherapy) on the market, including ice and gel packs, ice bath immersion and cans of spray.

Thermal therapy (use of heat) The application of heat to an injury site will act to dilate the local blood vessels, thus increasing the blood flow to the area. This type of treatment should only be given in the sub-acute stage in order to aid in the healing process. The increased blood supply will have the effect of absorbing the swelling and removing the dead cells from the injury site. It will also help to increase the growth of new blood vessels in the area and help scar tissue to form. The application of heat to muscles allows them to relax and aid in pain relief.

Heat treatment would not be suitable during the early stages of injury, on an open wound or where tissues are very sensitive, such as the genital region.

The Lewis Hunting reaction (also known as contrast bathing or hot/cold therapy)This is the process by which alternating treatments of both hot and cold therapy are applied to the injury site and should be applied during the sub-acute phase. The application of a hot treatment will increase the blood flow to the area then, when this is followed by a cold treatment, the blood flow to the area will decrease and take with it the debris from the injury site. The injured site should be immersed in alternating hot and cold water for periods ranging from one to four minutes, with increased time initially in the cold water.

Medical referral

Where an unqualified person treats someone with a sports injury, the casualty should always be referred to a medical professional. The nature of the injury and access to medical professionals will determine who the most appropriate person will be.

Qualified first aiderSome sporting events have qualified first aiders on site, and most workplaces have to have a qualified first aider. Where this is the case, you should refer

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Table 15.3 The five identifiable phases of post-injury management

PHASE 1 Acute phase (up to 72 hours post-injury)

PHASE 2 Sub-acute phase (3–10 days)

PHASE 3 Early rehabilitation stage

Active rehabilitation stage

Mobilising exercises for joint range

Strengthening exercises

PHASE 4 Late rehabilitation stage

PHASE 5 Functional rehabilitation/training stage

Phase 1: Acute The aim of treatment at this stage is to:

� Control any bleeding and swelling (maintain sterile cover and cold compress, elevate)

� Relieve pain (cold compress and elevation)

� Protect from further damage (advise that they avoid using the injured part as much as possible)

� Give advice for home treatment (do not wear compression bandages throughout the night, correct use of ice, PRICED, etc.).

Phase 2: Sub-acuteDuring this stage the injury should be in the early stages of recovering:

� Absorption of swelling

� Removal of debris/dead cells from the area

� Growth of new blood vessels

� Development of scar tissue.

The use of treatments such as contrast bathing, elevation and massage and passive exercises, e.g. non-weight bearing exercises, will help to disperse the products of inflammation. The joint should be moved through its pain-free range in order to increase the range of movement of the joint, help to strengthen and lengthen the muscles around the injury and also to help the scar tissue to form in alignment. Throughout these exercise the person should feel no pain.

Contrast bathing as well as the use of heat packs may also aid the healing process. It may be necessary to use walking aids, etc. to protect from further injury or the use of bandages for added support. The use of strengthening exercises

Specialist therapist, e.g. physiotherapist, sports therapist The type of injury will determine which specialist therapist will be able to help. A physiotherapist is a person who supports the rehabilitation process after an injury and is available on the NHS. A sports therapist will also be able to rehabilitate a person after an injury, but they usually only take private appointments. A doctor can advise which specialist would be most appropriate based on the nature of the injury.

A radiologist deals with fractures and will be responsible for taking an x-ray of the area where there is a suspected facture to confirm if this is indeed the case.

D2 Principles of rehabilitation Treatment and rehabilitation will be based on accurate assessment diagnosis by a qualified person.

For rehabilitation to occur we must first ensure an accurate and immediate diagnosis is gained in order to help establish effective treatment and rehabilitation management of an injury. Therefore it is essential that an appropriately qualified person diagnoses the injury as early as possible after it occurs. This may include a sports therapist, a physiotherapist, a doctor or some other suitably qualified person.

The diagnosis relies on accurate information given by either the injured person or someone who saw the injury happen. The smallest of details can make a difference to how accurate a diagnosis can be. So all information, including information regarding the environment, previous injury history, as well as the actual injury event is very important to communicate.

The five stages of rehabilitation

There are numerous ways in which to classify injury and its management. The following is a commonly accepted role model for injury treatment and management.

There are five identifiable phases of post-injury management, which is sometimes called the stepladder approach to rehabilitation.

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Phase 4: Late rehabilitation phase This is similar to the early rehabilitation phase, but with a greater emphasis on the strengthening activities.

Phase 5: Functional rehabilitation The aim of treatment at this stage is to:

� improve balance and movement co-ordination

� restore speci�c skills and movement patterns to pre-injury level

� provide psychological reassurance of function.

Progression to this phase is dependent on the ability to repeatedly be able to perform the exercises set at phase 4 in the rehabilitation programme.

Aim and goals of rehabilitation

Rehabilitation is the restoration of the ability to function in a normal or near-normal manner following an injury. It usually involves reducing pain and swelling, restoring range of motion and increasing strength with the use of manual therapy (massage and manipulation), therapeutic methods such as ultrasound and an exercise programme.

If a sports person does not rehabilitate their injury effectively, they are much more likely to sustain another injury to the same area.

It should be taken into consideration that as well as the physical rehabilitation of the player, the psychological rehabilitation may also need to be considered. The trauma of the injury itself and the resulting exclusion from training/coaching sessions, competitions, matches, after competition social aspects can be very difficult for some individuals to come to terms with. This alone can force injured players to try to start playing again much too soon in some cases.

Rationale

A rationale for treatment has to be in place, based on the formulated hypothesis by the qualified professional working with the patient as to why the injury occurred.

Principles of rehabilitation

ATCISITThere are a number of principles of rehabilitation and one of these is ATCISIT.

specific to the injured area will help the tone of muscle and for joint injuries it will encourage stability around a joint. Attention to scar tissue development is essential during this stage.

Phase 3: Early rehabilitation phase Before starting active rehabilitation it is important to make sure that the following applies to the injured part:

� There is no signi�cant in�ammation

� There is no signi�cant swelling

� While there may be some joint stiffness, there is some range of movement free from pain

� There is the ability to undertake some weight-bearing.

Initially, the range of movement needs to be improved as there may have been some weakening of muscles through injury. For every week of immobilisation, a person may lose up to 20% of their muscle strength. Therefore it is important to start to encourage movement first through non-weight-bearing exercises and then to progress to weight-bearing activities.

The use of supports may still be necessary in the early part of this stage.

Prolonged immobilisation will lead to stiffness of the joints in the injury area and a decrease in ligament strength. However, if the injured area is mobilised early on in the rehabilitation process, re-growth of the damaged tissues is encouraged and sports ability and skills are maintained.

A selection of exercises used for the injured part should be encouraged on a regular basis as well as continuing to exercise the rest of the body without undue pressure on the injury.

Care should be taken to avoid over exercising which may result in more damage and therefore a delay in rehabilitation.

The two main types of exercises that should be utilised throughout this stage are:

1 Mobilisation activities – to improve the range of movement and reduce joint stiffness.

2 Strengthening activities – to help stability of joints and strengthen the weakened muscles.

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experiencing pain, there is the possibility that the injured area is getting aggravated and creating a greater degree of injury rather than recovery.

Progression of rehabilitation

Each rehabilitation phase that involves taking part in exercises and activities should be planned in line with the following considerations:

� Type of activity – how strenuous the activity is.

� Duration of activity – an appropriate length of time should be given so that the activity promotes appropriate stress to performer to produce a rehabilitation effect.

� Frequency of activity/rest – appropriate rest periods should be built into the activity or exercise to ensure that the performer is physically ready to carry out the process again.

� Intensity of activity – the activity or exercise has to be of an appropriate intensity; too high an intensity could damage the injured area, too low an intensity could have no rehabilitation effect.

� Complexity of activity – if the activity is dif�cult the sports performer may need time to learn what needs to be done and how to do it.

Acute – Phase 1 Play/exercise should cease as soon as injury occurs. ‘Playing on through the pain’ is not the best advice. Immediate treatment should be given as specified earlier.

Very little exercise should be performed during this stage as the aim of the treatment is to control the bleeding and swelling and protect the injured body part from further damage. PRICED is recommended at this stage for up to 72 hours.

Sub-acute – Phase 2 Contrast bathing and massage are used during this phase along with stretching. Stretching the injured body part is very important during this stage in order to help ensure that the new tissue is laid down in the correct orientation. If there are any signs that the injured body part is not ready to commence this stage, such as heat or swelling around the injury, then stretching should not be started. When stretching, the person should have their injured body part made as warm as possible.

This stands for:

Avoid aggravation – which means the process should avoid causing any further injury to the affected area.

Timing – this has to take into account the different phases of injury repair and the fact that the rehabilitation programme should take place as soon as possible after injury.

Compliance – the injured person must be compliant with the rehabilitation programme or it will not be successful.

Individualisation – this has to take into account the fact that each person will respond differently to an injury, so what works for one person may not work for another.

Specific sequencing – the rehabilitation programme should follow a specific sequence of events which is determined by how quickly the body is able to respond to the injury with the healing process.

Intensity – the intensity of the rehabilitation programme should be sufficient to challenge the injured person but not cause further injury.

Total patient – the injured person as a whole should be considered, not just their injured area; the rest of their body and mind must be factored into the rehabilitation process.

SAIDSAID is a principle that stands for Specific Adaptation to Imposed Demand. This means that the body will respond in relation to the type of stresses placed on it and adapt accordingly. Therefore, if a person takes part in weight training, their muscles will respond by adapting to grow in size to meet the requirements of the demand put on them.

Therefore, the rehabilitation programme has to be specific to the needs of the individual in order to recover from the injury and also prevent the chances of the person suffering from the same injury in the future.

Pain-freeThe rehabilitation programme should be as pain-free as possible, as when the injured person is

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During the process of rehabilitation the following factors are taken into account at each stage:

� The type of activity – this will vary at different stages in the programme.

� Duration of activity – this will increase as the programme progresses.

� Frequency of activity and rest – activity periods will increase and rest periods will decrease as the programme progresses.

� Intensity of activity – this will increase as the programme progresses.

� Complexity of activity – the complexity of the activity will increase as the programme progresses.

� Regain full range of motion – this will happen towards the end of the programme.

� Restore muscle strength – this will gradually happen as the programme progresses.

� Normalise biomechanics – this will happen towards the end of the programme.

� Restore high speed – this will happen towards the end of the programme.

� Restore full power – this will happen towards the end of the programme.

� Restore proprioception and agility – this will happen towards the end of the programme.

At the end of the programme the athlete should be ready to return to sport fully fit and able to play the sport.

Monitoring the rehabilitation programmeDuring the rehabilitation programme a number of factors should be monitored to see how the sports performer is progressing and to determine when they are ready to move on to the next part of the stage or the next stage of the programme.

Factors to be monitored – these include:

� Making sure the sports performer is carrying out the exercises/activities correctly.

� Pain levels should be assessed so that the performer is not in undue pain when carrying out the rehabilitation programme.

This can be done through use of a thermal heat pack or a soaking in a hot bath. Stretches should be held (static stretches) to the onset of discomfort for 15 to 20 seconds. However, a person should never stretch to the extent that they are in pain.

Stretching should be performed for short periods of time and frequently throughout the day.

Early rehabilitation – Phase 3 Strengthening exercises that can be used during this stage start with isometric exercises. This is where the muscle contracts but no joint movement occurs. Once these have been carried out and no pain has been felt, concentric muscle contractions can be carried out. This is where the muscle shortens, for example the biceps shortening in a biceps curl.

If the person has injured their leg(s), initially all the strength-training exercises should be carried out in a non-weight-bearing position, so the injured body part should not take the weight of the body. Instead, the person should be sitting down, lying down or standing on their good leg.

Late rehabilitation – Phase 4 Once this type of muscle contraction can be carried out with no pain, eccentric muscle contractions can be performed. This involves the muscle lengthening under tension. An example of this is the quadriceps muscle lengthening as the knee flexes into the sitting position.

This stage involves partial weight bearing if the performer has injured their leg, where the arms are used to help support the body weight. Lastly, the exercises can be carried out with the full body weight on the injured body part.

Functional rehabilitation – Phase 5 Initially this stage should involve the very basic elements of the sports person’s usual sport. For example, a footballer would start with running on the spot or in a straight line. Then they would progress to running up and down hills, then on a diagonal and changing direction. This would then progress to skill training and involve training the various ball skills required. Once they are able to complete these exercises with no problems, they can commence full training and eventually be ready for competitive play.

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Figure 15.26 A CPM device

Passive mobilations – this is where the sports therapist moves the body part and starts to mobilise the joint, moving through ranges of motion that are causing minimum pain to the sports performer.

Passive exercises – the sports therapist moves the body part(s) to carry out different exercises, such as moving the knees from side to side, or holding them up for a period of time. Again, the sports performer is not responsible for moving the body part as the therapist moves the body part, causing as little pain to the sports performer as possible.

Active exercises – the sports performer is now responsible for moving their body part(s) and uses their muscles to carry out set exercises to help to rehabilitate the injured area.

Active assisted exercises – the sports therapist will now be involved in assisting the active exercises by offering resistance to make the muscles work harder or helping to increase the range of movement that the body part moves in.

Methods to improve musculotendinous flexibility

There are a range of different methods of flexibility training: active stretching, passive stretching and PNF (proprioceptive – pronounced ‘prope-rio-ceptive’ – neuromuscular facilitation) training.

Active stretching involves holding a stretch for around 30 to 60 seconds, e.g. sitting down with your legs out straight in front of you and reaching to touch your toes.

� The posture of the sports performer should be monitored when carrying out exercises and activities and also when they are at rest to make sure their posture is not being affected by the injury.

� Mood state should be monitored to ensure the sports performer is focused and motivated to complete the rehabilitation programme.

� Consideration of adverse effects – this is where the injury is not healing as quickly as anticipated or the rehabilitation is not going as well as planned due to physiological or psychological factors.

� Documentation and recording of information – all aspects of the rehabilitation programme should be monitored and recorded so that both the sports therapist and sports performer can see the progress that is being made. This will motivate the sports performer and also inform the sports therapist of how quickly the performer is responding to the treatment, to inform what exercises and activities should be carried out and at what intensity for each stage of the programme.

D3 Methods of rehabilitation Methods to improve joint range of motion

A range of different exercises can be used for rehabilitation to improve the range of movement of a joint. It is important to try to get the joint moving as soon as possible – if it is left immobile it can become stiff and harder to move, prolonging the rehabilitation process.

Each activity is carried out in the following stages:

1 continuous passive motion

2 passive mobilisation

3 passive exercises

4 active exercises

5 active assisted exercises.

Continuous passive motion (CPM) – this is where a CPM device is used which moves the body part through a controlled range of movement. The sports performer does not put any effort into moving the body part themselves; the CPM device is responsible for moving the body part.

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Power exercisesThese types of exercise should be performed gradually and at the later stage of the rehabilitation programme as they may cause further injury if performed at too high an intensity or too soon.

Plyometric training will develop power which is producing strength at speed. It usually involves moving your body weight very quickly through jumping or bounding, such as jumping onto boxes and over hurdles. Some other examples are:

� Depth jumping

� Vertical jumps and standing long jump

� Medicine ball throws

� Hopping

� Bounding

� Squat and jump

� Press-up and clap.

It is a very strenuous type of training and the sports performer much have developed their strength before performing plyometrics. The sports performer should be fully warmed up before taking part in these exercises and ideally a sprung floor or a soft surface should be used to help to cushion the impact on landing. As the person progresses through their rehabilitation programme, the speed of these plyometric exercises can be increased.

Endurance exerciseMuscular endurance is the ability of a muscle, or a group of muscles, to continue performing contractions. In order to improve muscular endurance, it is necessary to exercise the specific muscle groups for periods of time. If the sports performer is ready to use resistance equipment to increase their muscular endurance, they should use low weights and high repetitions (12 or more) for two or three sets.

Methods to improve neuromuscular control

Proprioception and balanceProprioception is how the body works out where each body part is in relation to each other. To help to improve proprioception, exercises that require balance can be used, such as balance boards or stability trainers.

Passive stretching involves relaxing the body and having a partner gently push or pull the body or limb into a stretched position.

Proprioceptive neuromuscular facilitation (PNF) stretching is an advanced type of stretching in order to develop the length of the muscle:

� The muscle is stretched to the point of bind by the sports therapist.

� At this point, the therapist asks the sports performer to contract the muscle and push against them at about 40–50% effort.

� This contraction is held for 10 seconds.

� When the muscle is relaxed the sports therapist will stretch the muscle further.

� Again a contraction is applied and then the muscle is re-stretched.

� This is done three times.

This is a more effective way of developing the length of the muscle as the contraction will actually cause the muscle to relax more quickly and more deeply which helps to increase the rate at which flexibility can be increased.

Methods to improve muscle conditioning

Strength exercises Strength needs to be built up gradually using resistance to increase muscle strength. Initially resistance can be in the form of the therapist using their body to oppose the movement of the sports performer. The sports performer can also perform isometric contractions which are where the muscle doesn’t change length but is contracting.

Isotonic contractions are where the muscle changes length and include concentric contraction where the muscle gets shorter and eccentric contraction where the muscle gets longer while contracting.

Isokinetic contractions are where the muscle changes length but maintains the same speed; to perform this type of contraction it requires a specialised piece of equipment.

Isometric contractions are where the muscle does not change in length so no movement is created, but the muscle still creates tension.

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challenge the sports performer to ensure that they have appropriate levels of each component of fitness required for their selected sport which will reduce the risk of re-injury.

1 Describe the emergency treatment that should be carried out if a person is found lying on the ground.

2 Explain what PRICED stands for.

3 Explain what SALTAPS stands for.

4 Assess when a casualty would require:

• Bandaging

• Taping

• A sling

• A splint.

5 Explain when hot and cold therapy is used as a form of treatment.

6 Explain the five stages of rehabilitation.

D Check your understanding

1 With a partner, demonstrate that you are able to carry out the correct protocols to treat four different sports injuries.

2 For a sports injury of your choice, design a rehabilitation programme including factors that may affect rehabilitation, adaptations and alterations and justification of the programme with recommendations and considerations for the future.

Your programme should have a clear aim and rationale, show logical progression through the five stages of injury, applying methods, principles and progressions and address all areas including: joint range of motion, flexibility, muscle conditioning, neuromuscular control and skill acquisition/functional exercises.

All aspects of methods of rehabilitation should be included and detailed, including a statement regarding the consequences of inadequate rehabilitation. Adaptations and alternative exercises should be included and documented where possible. The programme that you produce should be safe and show progression.

Activity Figure 15.27 A balance board

Co-ordinationThis is the ability to use different parts of the body so they can complete a movement smoothly and efficiently. In order to complete a range of sporting skills and techniques good co-ordination is required. The sport that the sports performer usually takes part in will determine the types of method used to help to improve co-ordination but examples include running while throwing, passing, heading or catching a ball.

Methods to improve skill acquisition/functionality

ExercisesLastly, to help the sports performer to return to full functionality so that they are ready to take part and compete in their selected sport, the final part of the rehabilitation programme includes exercises that combine strength, power, endurance, flexibility and neuromuscular control and which use muscle groups that are specific for that particular sport.

This will include skills practices such as passing and shooting drills. Other exercises will be set to

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Anderson, M.K., Hall, S.J. and Parr, G.P. (2008). Foundations of Athletic Training: Prevention, Assessment and Management. U.S., Lippincott Williams & Wilkins.

Brukner, P. and Khan, K. (2007). Clinical Sports Medicine (Third Edition). Australia, McGraw Hill.

Cartwright, L.A. and Pitney, W.A. (2005). Fundamentals of Athletic Training (Second Edition). Champaign, Human Kinetics.

Oxford, U.K., Kolt, G.S. and Snyder-Mackler, L. (2005). Physical Therapies in Sport and Exercise (Second Edition). Australia, Elsevier Limited.

Norris, C. (2004). Sports Injuries: Diagnosis and Management (Third Edition). London, Butterworth and Heinemann.

Shultz, S.J., Houglum, P.A. and Perrin, D.H. (2005). Examination of Musculoskeletal Injuries (Second Edition). Champaign, Human Kinetics.

Further Reading

nsmi.org.uk

Sports Medicine Information – provides information with regards to sports injury, classification, signs and symptoms, mechanisms and injury prevention.

PhysioRoom.com

PhysioRoom – provides sports injury information including signs and symptoms and prevention.

sportsinjuryclinic.net

Sports Injury Clinic – provides extensive information with regards to sports injures, prevention and rehabilitation.

stopsportsinjuries.org

The American Orthopaedic Society for Sports Medicine – provides sport-specific injury and sport-related information on injuries including coach, athlete, parent and healthcare provider’s resources.

Useful websites

Gledhill, A., Mackay, N., Forsdyke, D. and Randerson, K. (2011). Foundations in Sports Therapy. London, Heinemann.

Brukner, P. and Khan, K. (2007). Clinical Sports Medicine (Third Edition). Australia, McGraw Hill.

References

To meet the D.D3 criteria, you will need to give reasons to justify your rehabilitation programme design, as well as future recommendations and considerations. You will need to address the appropriateness of the scenario that you select and why the programme is appropriate for meeting the aims and goals. You will need to apply theoretical knowledge of principles and methods of rehabilitation to the practical design of the programme. The information that you present will need to be factually correct and you should use concise written language and correct terminology. The importance of sports injury management will need to be considered with regard to its role in helping sports performers prevent or overcome common sports injuries. The importance of many factors in the management process will also need to be considered, including aetiology, mechanism of injury, gait analysis, injury prevention, immediate treatment and rehabilitation. You will need to provide judgements and conclusions will need to be drawn about the role of sports injury management in preventing or overcoming sports injuries. You will also need to use research evidence to support carefully considered reasoning in your assignment.


ScenarioA football player who plays for their college team and is hoping to be signed up for a semi-professional team has sustained a sports injury. They were playing football and turned to kick the ball, but their football boot studs kept their foot planted on the ground. This resulted in their leg turning but their foot remaining still. The football player heard a crack before they fell to the ground. They have severe pain in their lower leg and have, in fact, fractured their tibia and fibula.

You will need to design a rehabilitation programme for this sports performer. Include in your programme justification for each part of it, including consideration of factors that may affect the sport performer’s rehabilitation. You should also provide future recommendations for the sports performer and considerations to help them to prevent future sports injuries.


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