DR.NORLELAWATI BINTI MOHAMAD SPORTS PHYSICIAN HOSPITAL SULTAN ISMAIL Pre SEA Games Training : Management of Sports Injury Conference 2016 Any physical complaint sustained by a patient that results from sports/exercise participation irrespective of time loss from sports/exercise activities. * Various way to classify the sports injury, based on: * Mechanism/Causes of injury -Direct -Indirect -Overuse * Onset of symptoms -Acute -Chronic * Structural involved -Bone -Ligament -Tendons -Muscles Causes of injury Direct Overuse Indirect Direct injury -caused by an external blow or force -i.e :- a collision with another person -being struck with an object (for example, a cricket ball or hockey stick). Indirect injury can occur in 2 ways: - The actual injury can occur some distance from the impact site.( i.e falling on an outstretched hand can result in a dislocated shoulder) - The injury does not result from physical contact with an object or person • But from internal forces built up by the actions of the performer, (i.e over-stretching, poor technique)
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DR.NORLELAWATI BINTI MOHAMAD
SPORTS PHYSICIAN
HOSPITAL SULTAN ISMAIL
Pre SEA Games Training : Management of Sports Injury Conference
2016
Any physical complaint sustained by a
patient that results from
sports/exercise participation
irrespective of time loss from
sports/exercise activities.
*Various way to classify the sports injury, based on:
*Mechanism/Causes of injury
-Direct
-Indirect
-Overuse
*Onset of symptoms
-Acute
-Chronic
*Structural involved
-Bone
-Ligament
-Tendons
-Muscles
Causes of
injury
Direct OveruseIndirect
Direct injury-caused by an external blow or force
-i.e :- a collision with another person
-being struck with an object (for example, a
cricket ball or hockey stick).
Indirect injury can occur in 2 ways:
- The actual injury can occur some distance from the
impact site.( i.e falling on an outstretched hand can result
in a dislocated shoulder)
- The injury does not result from physical contact
with an object or person
• But from internal forces built up by the actions of
the performer, (i.e over-stretching, poor technique)
Overuse injury-when excessive and repetitive force is placed on
the bones and other connective tissues of the body
-symptoms begin when there is a change in training
practices (↑ traning,poor technique and equipment) Onset of
injury
ACUTE CHRONIC
*An acute injury is an injury
that occurred recently as a
result of a traumatic event
*i.e; fractures, dislocations,
ligaments sprain,
contusions, muscle strain
*is the result of
overuse or a long-
standing condition
*i.e: overuse
syndrome,
tendonitis, bursitis
and arthritis
-Total 83 injuries & 64 illnesses were recorded (276 athletes)
-Muscles strains and tears (most common injury),
then ligamentous and soft tissues contusions/bruises
-injury highest among badminton, hockey and rugby
‘Patterns of Injuries and Illnessess among Malaysian athletes at the ASEAN Games 2014’
(Mohamad Shariff et al.Sains Malaysiana. 2016)
-Study period (January 2005 –June 2007), badminton player
-469 musculoskeletal injuries recorded
-majority were overuse injury and involved knee
‘Musculoskeletal injuries among Malaysian
badminton players’
(Shariff et al.Singapore Med J.2009)
-Total 86 injuries were reported (141 matches)
-injuries mostly involved the lower extremity(44%), trunk(14%) and upper limb (13%)
‘Incidence and characteristics of injuries during the 2010 FELDA/FAM National Futsal League in Malaysia’
(Shariff AH, Azril MA et al.PLOS ONE.2014)
1. Anterior Cruciate ligament(ACL)
2. Meniscus injury
3. Patellofemoral pain syndrome
4. Hamstring tear
5. Achilles tendinopathy
6. Shoulder impingement
-ACL is one of four
stabilizing ligaments
-Protects integrity of
menisci and articular
cartilage
-ACL prevents excessive
anterior translation of the
tibia and internal or
external rotation of the
tibia on the femur
Mechanism of Injury:
-Usually a history of non-
contact injury (70%)
-Common in any physical
activity that requires quick
change in direction(pivoting)
or a contact sport
- involves sudden
deceleration,
hyperextension and tibial
torsion
*Signs & Symptoms:
*Acute
-Marked pain and pop
-Significant knee swelling
-Difficulty bearing weight on the affected knee
-unstable feeling knee
*Chronic
-The knee feels loose
-Feeling of “buckling”, “giving way” or instability
-Pain and swelling
-can associated with other injuries to knee structures:
-Ligaments
*Medial Collateral Ligament (MCL)
*Posterior Cruciate Ligament (PCL)
*Posterolateral Corner
-Meniscus-(cushions in the knee)
*Medial
*Lateral
-Articular cartilage (gliding cartilage on the ends of bones)
*Diagnosis:
-History
-Know the mechanism of ACL injuries!
-Appropriate mechanism accompanied by what
athlete describes as a “pop” and excruciating pain
-PE
-Excessive swelling with knee effusion
-Decreased range of motion (ROM)
-inability to contract quadriceps
-Special test (ADT , Lachman’s test, Pivot shift)
-X-rays� usually normal
but should be obtained to
ensure that there is no
fracture
-MRI-excellent for
evaluating not only the
ACL but also the
meniscus, articular
cartilage and other knee
ligaments
*Risk Factors
-Individuals participating in high risk sports
-Playing surface
-High shoe-surface friction that increase performance
(artificial turf)
-Neuromuscular deficits of the female sex
-Females tend to activate their quadriceps near full
knee extension, thus landing with smaller angles of
knee flexion than their male counterpart
-Females show earlier neuromuscular fatigue
*Treatment
-Rest
-Ice
-Elevation
-Compression
-Protected Weight Bearing
-Brace
-Surgery
(arthroscopic ACLR)
*Rehabilitation
-Prerehab (Gold-standard)
*Implemented immediately after diagnosis
*Decrease pain and swelling
*Increase ROM, quad strength, and proprioception >90% of
contralateral leg
*Prerehab allows for quicker post-operative return to ADLs
and physical activity
-Rehab Progression varies depending on graft choice
*Also focuses on decreasing pain and swelling, while
increasing ROM, strength, and proprioception
*Prevention
-ACL injury prevention programs
-Programs focus on modifying neuromuscular and biomechanical risk factors
*Agility drills and plyometric exercises
*Recognition of injury associated actions and positions
*Educate athletes in proper jumping techniques, softer landings, instant recoil, and correct posture and alignment