CXA402: Injury Prevention and Management Lecture summary ... · cxa402: injury prevention and management ... tendonitis 8 week 2 – principles of injury management (treatment) 8

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CXA402: Injury Prevention and Management Lecture summary and exam preparation

Table of Contents

WEEK 1 – INTRODUCTION TO INJURIES 4

BONE FRACTURES 5

JOINT INJURIES 6

LIGAMENT INJURIES 6

MUSCLE INJURIES 7

OVERUSE INJURIES 7

STRESS FRACTURES 8

OSTEITIS AND PERIOSTITIS 8

TENDONITIS 8

WEEK 2 – PRINCIPLES OF INJURY MANAGEMENT (TREATMENT) 8

TUTORIAL/PRACTICAL 8

TREATMENT OF COMMON ACUTE INJURIES 10

ASSESSMENT OF EXERCISE CAPACITY IN CLIENTS WITH MUSCULOSKELETAL CONDITIONS 10

PAIN 10

WEEK 3 – PRINCIPLES OF INJURY TREATMENT (RICE) 11

EMERGENCY AND FIRST AID PROCEDURES 11

ACUTE HEMOSTATIC AND INFLAMMATORY RESPONSES TO INJURY. 11

COMMON TREATMENTS FOR ACUTE INJURIES 12

WEEK 4 – PRINCIPLES OF REHAB 12

MUSCLE CONDITIONING 13

PRINCIPLES 13

MUSCULAR STRENGTH 14

MOTOR RE-EDUCATION 15

FLEXIBILITY 15

FUNCTIONAL EXERCISES 16

HYDROTHERAPY 16

STAGES OF REHABILITATION 17

WEEK 5 – INTRODUCTORY EXERCISES 18

INTRODUCTORY EXERCISES- 18

INTERMEDIATE AND ADVANCED EXERCISE 19

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SHOULDER INJURIES 19

LOWER BACK AND PELVIS 19

LOWER LIMB INJURIES 20

ELBOW, WRIST AND FOREARM 20

CONCLUSION 21

WEEK 6: BIOMECHANICS AND ERGONOMICS 21

BIOMECHANICS 21

STANCE POSITION: LOWER LIMB 21

NORMAL ROM: LOWER LIMB 21

PRINCIPLES OF GAIT 22

POSTURE 22

ABNORMAL BIOMECHANICS: FOOT 22

ABNORMAL BIOMECHANICS: PELVIS 23

ABNORMAL BIOMECHANICS: EXCESSIVE TILT OF PELVIS 23

LOWER LIMB ASSESSMENT 24

BIOMECHANICAL CORRECTION 24

25

ERGONOMICS 25

BENCH SPACE 25

CHAIR 25

DESK 26

COMPUTER SCREEN 26

KEY BOARD AND MOUSE 26

OTHER 26

WEEK 7 STRETCHING TBC 26

DEFINITIONS 26

BENEFITS OF FLEXIBILITY 27

STATIC STRETCHING 27

PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) 28

DYNAMIC / BALLISTIC 28

THE BIOMECHANICS OF STRETCHING 28

ASSESSMENT: POSTURAL AND PHASIC 29

COMMON IMBALANCE PATTERNS 29

CONTRAINDICATIONS: 31

APPLICATION OF STRETCHING 31

PRESCRIBING STRETCHES 31

WEEK 8 NEUROMUSCULAR DISORDERS, STROKE AND CHRONIC FATIGUE 32

NEUROMUSCULAR DISEASES 32

MYASTHENIA GRAVIS (NMJ DISORDER) 33

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BECKER’S MUSCULAR DYSTROPHY 33

DUCHENNE MUSCULAR DYSTROPHY 33

STROKE 33

DIABETES 34

CHRONIC FATIGUE SYNDROME 35

WEEK 9 - SHOULDER PAIN 36

FUNCTIONAL ANATOMY OF THE SHOULDER 36

IMPORTANT MUSCLES OF THE SHOULDER 37

SHOULDER GIRDLE INJURIES 38

ROTATOR CUFF INJURIES 38

SHOULDER IMPINGEMENT 39

ADHESIVE CAPSULITIS 39

SHOULDER DISLOCATIONS 40

ACROMIOCLAVICULAR JOINT INJURIES (AC JOINT) 40

EXAMINATION OF SHOULDER INJURIES 42

LOWER BACK OVERVIEW 42

WEEK 10: ELBOW WRIST AND HAND 44

LATERAL ELBOW PAIN 44

POSTERIOR ELBOW PAIN 45

FOREARM PAIN 46

WRIST AND HAND 47

HOOK OF HAMATE 49

DISLOCATIONS 49

GRADUAL ONSET PAIN 49

WRIST: 49

CARPAL TUNNEL: 49

WEEK 11 - HIP AND GROIN INJURIES 51

OVERVIEW 51

ADDUCTOR MUSCLE STRAINS 51

TROCHANTERIC BURSITIS 52

GLUTEUS MEDIUS TENDINOPATHY 52

WEEK 12 - HEAD INJURIES/ SPINAL CORD INJURIES/ ABI 53

SCI (SPINAL CORD INJURIES) 53

PRECAUTIONS: 53

ABI (ACQUIRED BRAIN INJURY) 54

HEAD INJURIES 54

MANAGEMENT 54

CONCUSSION 55

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WEEK 13 – INFECTIONS/OVERTRAINING/ETHICS 55

HEPATITIS A 55

HEPATITIS B 56

HEPATITIS C 56

MENINGOCOCCAL MENINGITIS 56

HUMAN IMMUNODEFICIENCY VIRUS (HIV) 57

INFECTIOUS MONONUCLEOSIS – 57

SKIN INFECTIONS 57

HERPES SIMPLEX VIRUS (HSV-1) 57

FUNGAL SKIN INFECTIONS 58

ETHICS 58

OVERTRAINING 59

LIKELY QUESTIONS 59

WEEK 1 – 59

WEEK 4 – STAGES OF REHABILITATION 62

WEEK 9 62

WEEK 10 – WRIST/ELBOW 67

WEEK 12 – KNEE JOINT/SPINAL CORD 68

WEEK 13 – INFECTIONS/ETHICS/OVERTRAINING 70

Week 1 – Introduction to Injuries Describe how various intrinsic and extrinsic factors interact and contribute to injuries. Intrinsic Muscle asymmetry, osteoporosis, disease Extrinsic External blow, impact, landing Understand and explain common injuries sustained during physical activity.

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Bone Fractures

Clinical features of fractures Very common injury Closed- doesn’t pierce the skin Open- outside of the skin Pain, tenderness, localised bruising and swelling Deformity and restriction of movement Comminuted Fracture More than one fracture, often a shatter or 2 or 3 breaks due to old age or motor vehicle accident Avulsion Fracture

Common in young women due to the tendon pulling some of the bone away Common in hamstring injuries due to high tension or early onset of weight training and lifting too early and due to growth

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Joint Injuries

Dislocation Complete dislocation of the articulating surfaces, no contact with the glenoid fossa. They cause damage to the joint capsule, ligaments, nerves and blood vessels. Subluxation Occurs when the articulating surface remain partially in contact with each other. Talk about the AC joint or SC The longer it is dislocated the worse the stretching and tearing is.

Ligament Injuries Range from mild to complete tears and can lead to joint instability Categorised into 3 grades according to severity, just the ligament not the joint injury Grade 1 Strain and represents some stretched fibres and normal ROM when stressing the ligament, not joint laxity. Notice that there is an end point, cannot slide it backwards and forwards Important to test to guide practice and treatment and assess improvements Grade 2 Considerable amount of fibres have been torn, increased laxity but still a definite end point. Considerable amount of pain and discomfort and longer rehab Grade 3 Complete rupture of the ligament with excessive joint laxity and huge amounts of movement in the knee. There can be no pain due to the nerve fibres being damaged as well There can be a surgical intervention but is normal based on lifestyle, as it is only really necessary for pivoting or changing direction quickly Management 1 & 2 First aid, soft tissue management

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Muscle strengthen Functional training 3 Surgery Protective bracing Muscle strengthen Functional training

Muscle Injuries Straining, tears, contusions and cramps Classed into grades 1,2 & 3 Most common- hamstring, quads and gastrocnemius Grade 1 7-10 days, not strength loss Grade 2 Tear significant amount of fibres Pain and swelling and pain on contraction, strength and movement decreased Will need to test through movement, harder than ligament Grade 3 Complete tear don’t occur very often Complete tear of the muscle Most common at the musculotendinous junction Involves a significant amount of force or muscle asymmetry Management Minimise bleeding, swelling and inflammation through minimise blood flow Progressive strengthening and flexibility should be conducted due to connective tissue replacing the muscle. Improving this will minimise ROM loss Quicker than ligaments because of the increased blood flow

Overuse Injuries Can be hard to diagnose Need to get a large amount of history from the individual and how the injury came about, nature of the individual and their history Don’t stop when you think you know what it is Understand lifestyle, previous sporting history and current situation Treatment Involves active rest, resting the injured area but remaining relative active Lots of overuse are soft tissue injuries

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Types

Stress fractures

Micro fracture in the bone due to repeated physical loading Most common are tibia, fibula, femur and pelvis Understand what has changed Need to understand their stance, running gait and walking gait Some people just have abnormal scan results naturally Diagnosed by an X-ray, bone scan, MRI and CT scan Usually have one for diagnosis but not one during recovery Heal between 6-12 weeks Must follow the general training load and have relative rest Monitor tenderness and ability to perform task

Osteitis and Periostitis

Osteitis is inflammation of the bone and force should be dissipated before it gets to the groin

Tendonitis

Treatments include mimicking movements that caused the injury One of the most common overuse injuries Regularly happens in tennis elbow, knee Traditional way that we train these is what causes the issues Therefore, compound exercises are prioritised The collagen bundles are damaged and may include separation of collagen bundles Tendon pain can decrease during the exercise due to increased blood flow

Week 2 – Principles of injury management (Treatment)

Tutorial/Practical 8 Steps - Initial Injury, - Capillary bleeding, - Clot formation, - Tissue swelling, - Secondary tissue damage, - Removal of clot and swelling, - Healing of tissue and regain function

Capillary bleeding

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This causes the redness and the heat from the tissues, with the amount of bleeding dependent on the degree and type of injury sustained. Muscles bleed more than tendons, with elevation and icing at the same time the most effective method. Clot formation Bleeding will eventually clot with ice and elevation speeding up this process. This will cause due to a combination of tissue damage and a clot hematoma. It is best to ice and stretch simultaneously throughout ROM, allowing the joint to still move whilst being iced. Tissue Swelling This is caused by damaged tissue, tissue build up, bleeding from capillaries and inflammatory response. This tissue can build up and decrease the ROM of movement around the joints, causing more bleeding to occur. At 72 hours the tissues will need more movement to increase blood flow to the area to consume the clot and quicken the rehab time. Secondary Tissue Damage Caused by increased movement, damaged capillaries and tissue swelling with the distance from the injury cells to the bloody supply greater and therefore there will be no movement or healing agent and inflammatory molecules cannot get to the injured site to assist with healing Removal of clot and tissue swelling Involves the body breaking down and removing the initial clot, with this process continuing until the full removal occurs. The length of time this takes depends on the: Size of the clot amount of tissue fluid and the management of the injury This demonstrates that the initial processes to decrease these variables is very important This can occur within 72 hours of the injury and begins the process of regaining muscle, tendon and ROM. Healing of tissues Beings in stage 6 with fibrous scar tissue lay down to replace damaged tissue, with this scar tissue potentially causing a decrease in muscle length. To avoid this, stretching must begin as soon as possible to maintain muscle length, within reason, with overstretching increasing injury recovery time. Therefore, need to educate the patient on their healthy limb and what is a natural and unnatural feeling to ensure they do not damage their limb further Regain Function Occurs during stages 6-7 The aim is to regain full post injury function, with the absence of pain with appropriate, graded rehab being optimal. This will be dependent on the injury and the individual you are dealing with, as motivation and outside factors being different in many cases. This will lead to a strength and conditioning program that will assist in regaining strength.

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Treatment of common acute injuries Head Injuries Always assess their injury by asking questions that they cannot get from their surroundings such as can you remember the last thing you did? They are likely to have issues with memory, co-ordination and reaction time and therefore they should not be left alone. Repeat the same questions to assess improvement. Refer them to a doctor Neck Injuries Obviously very serious as they can lead to spinal cord injuries, try to keep them calm and avoid mentioning their neck injury. Ask/assess any sensory changes and address any pains in regions of organs Will have to move them if the danger to you or them becomes too great, with jumpers, splints or other sturdy objects good for bracing. Chest Injuries Very common and can cause lung issues, with punctured lungs quite common. Assess their respiratory function Limb Injuries Rest, ice, compression, elevation and referral are the best option. Always stay within your scope of practice and whether they need immediate help from a GP or Physio.

Assessment of exercise capacity in clients with musculoskeletal conditions Go through DRSABCD Dangers, response, send for help, airway, breathing, CPR and defibrillator Managing the incident Stop, talk, observe and prevent further injury Go through TOTAPS Talk, observe, touch, active/passive movements and skills

Pain Location- where does it hurt when it was injured and where is it now? Decreases the scope of the injury and understand where it hurts and when it hurts doing specific activities

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Onset- how fast was the pain Severity- mild, moderate, serve did it continue or dissipate determines the level of injury. On a daily basis how is the pain, what makes it worse or better? Do you do anything about it? Understand what they are doing with their day and understand motivation Irritability: don’t answer their question and ask open questions what hurts the injury Nature: where the pain comes from, does it come up or down Behaviour: Constant or intermittent, when does it affect you? Above a certain point or when doing activity Radiation: where it travels Aggravating factors: what makes it worse Relieving factors: what helps, sitting, medication Associated features: something else that has occurred, pins and needles Previous treatments: what they have done before and what was successful or not

Week 3 – Principles of injury Treatment (RICE)

Emergency and First Aid procedures

1. Minimise the extend of the initial damage 2. Reduce associated pain and inflammation 3. Promote healing of damaged tissue 4. Maintain, restore flexibility, strength, proprioception and overall conditioning during the

healing phase 5. Functionally rehabilitate athlete opt return to sport 6. Assess and correct and predisposing factors

Acute hemostatic and inflammatory responses to injury. Blood vessels are also damaged, leading the accumulation and swelling, compressing adjoining tissues and causing further damage. Swelling, increase pressure, inhibiting healing, and mobilization and increases pain levels There is a formation of a hematoma and bruising and swelling so there will be the application of ice with the benefits being decreased temperature, decrease blood flow, decrease pain, cheap and decrease metabolic rate with the nutrients required decreasing with this lasting for 40-45 minutes.