Unit 10 Sport Medicine l3

SAINS SUKANTOPIK 10

SPORT MEDICINE

OBJECTIVES:

• To understand the important components and stages of rehabilitation

• To understand the criteria for return to play

• To be aware of medical conditions affecting athletes

• To plan and institute measures for medical preparedness during competition and travel

SPORTS MEDICINE LEVEL III

1. Rehabilitation of sports injury

2. Medical conditions in athletes

3. Medical preparedness for competition and travel

• Definition

• Components of Rehabilitation

• Stages of rehabilitation

REHABILITATION OF SPORTS INJURY

• Rehabilitation is defined as the process of restoration of the injured athlete to full function as required by the sport.

Components of Rehabilitation

• a) Muscle Conditioning

• b) Flexibility

• c) Neuromuscular Control

• d) Functional Exercises

• e) Sports Skills

• f) Correction of Abnormal Biomechanics

• g) Maintenance of Cardiovascular Fitness

• h) Psychology

• *Integration of Individual Components into a progressive rehabilitation program

Stages of rehabilitation

a) Initial Stage

b) Intermediate Stage

c) Advance Stage

d) Return to play

Initial Stage

• RICE Treatment & Electrotherapy – for pain relief and minimising swelling

• Isometric Exercises, followed by AROM & PROM exercises – to improve ROM, activate & strengthen muscles;

* Type of activity, duration, Frequency, Intensity and complexity depends on pain-free ROM.

INITIAL STAGE (CONTINUED)

• Start with non-weight bearing (NWB) exercises & progress to partial WB & full WB (FWB) – for stability & improves strength

• Resistance exercises with theraband / light weights – helpful in strengthening & endurance training

INTERMEDIATE STAGE

• Prerequisites: Able to resume activities of daily living, improved ROM & strength.

• ↑ frequency of AROM & PROM, • Start stretching exercises & joint mobilisation – to

promote flexibility (realignment of scar tissue)• ↑ the load & repetitions using free-weights, pulleys,

theraband, tubing, exercise devices - to ↑ strength, power & endurance;

• ↑functional, closed kinetic chain exercises – to promote WB exercises

INTERMEDIATE STAGE (CONTINUED)

• Introduce more difficult proprioceptive & balance exercises progressively;

• Start sports specific activities without using affected limb: e.g. stationary shooting (basketballer with lower limb injury), footwork for badminton athlete with shoulder injury.

INTERMEDIATE STAGE (CONTINUED)

• Lower limb exercises: supervised walking, jogging, striding and agility

• Upper limb exercises: supervised wiping exercises, ball balance exercises, wobble board exercises;

* Other treatment modalities e.g. joint mobilisation, RICE, electrotherapy & massage therapy may be utilised to promote progress.

ADVANCE STAGE

• Prerequisite: Good strength & endurance with full flexibility & ROM; improved proprioceptive, agility & functional exercises without adverse effects;

• Muscle conditioning specific to activity of sports: power for sprinters & weight lifters (high load, low repetitions); endurance for distance runners or swimmers (low load, high repetitions);

ADVANCE STAGE (CONTINUED)

• Fast-speed isotonic exercises & functional plyometric exercises; Progressive through a sequence of functional activities required for the sport: jogging, striding, bounding, agility skills of increasing complexity intensity & volume. Ball & racquet skills: stroke, lob, jab, smash;

• Identify biomechanical abnormality & technique faults (video analysis).

• Participate in between 70-90% normal training load. Introduce more sports specific skills progressively

RETURN TO PLAY

• If an injured athlete returns to play (RTP) prematurely– injury may be recurrent or chronic – injury may worsen– May predispose to other injuries

RETURN TO PLAY

• An injured athlete may RTP if he fulfills these criteria –

a)completed specified duration of healing & supervised rehabilitation program;

b)no persistent swelling and pain-free ROM;

c)adequate strength & endurance, good flexibility, proprioception & balance; adequate cardiovascular fitness; regained skills, psychological mindset & training form for sports, corrected biomechanical anomaly (if any).

MEDICAL CONDITIONS IN ATHLETES

• Asthma & Exercise Induced Asthma (EIA)

• Gastrointestinal Problems

• Athlete’s Hematuria

• Menstrual Problems

• Skin Infections

• Contraindications to sports

• Prevention of Infectious Diseases

ASTHMA & EIA

• Bronchial Asthma: An attack of shortness of breath, persistent cough, wheezing (high pitched breathing), chest tightness; may worsen with physical exercise;

• Athletes with “Exercise induced asthma” has an asthma attack during or after physical exercise.

• May be triggered especially in the cold; during URTI (Colds or flu), exposure to allergens and irritants

ASTHMA & EIA (CONTINUED)

• Require physical assessment & spirometry to determine severity & treatment options for good control.

• Rx with Inhalers (require TUE Exemption), but oral corticosteroids & bronchodilators are not allowed.

• Oral Leukotriene Antagonists (Singulair) does not require TUE.

• Rx of upper airway disease (e.g. Allergic Rhinitis and Chronic Sinusitis) is beneficial.

• Return to play: when athlete is asymptomatic

GASTROINTESTINAL PROBLEMS

• Endurance runners often suffer from abdominal cramps & diarrhoea during prolonged moderate intensity exercise.

• May be due to delayed gastric emptying time, diminished blood flow to the large intestine, reduced absorption of fluid during exercise.

• Other symptoms are heartburn, nausea, bloating, flatulence, rectal bleeding.

• Treatment: Reduce training load & anti-diarrhoeal medication.

ATHLETE’S HEMATURIA

• Prolonged running may also predispose to hematuria due to reduced blood supply to the kidneys and increased renal parenchymal permeation.

• Symptoms usually resolves itself with reduced training load or rest. However, the athlete will need to be examined by a doctor to rule out other medical conditions.

MENSTRUAL PROBLEMS

• Female athletes who suffer from dysmenorrhoea (period pain) may be offered options of timing of menses before or after a competition event. The athlete should consult a doctor at least 1 month before the event to ensure that intervention with oral contraceptive pills could be attempted.

MENSTRUAL PROBLEMS (CONTINUED)

• Endurance athletes may occasionally suffer from amenorrhoea (delayed period) due to hormonal changes associated with increased ‘mileage’ (duration of training).

• Prolonged periods of amenorrhoea (>6 months) should be treated to prevent osteoporosis.

• Refer to the doctor & nutritionist if Female Athlete’s Triad (amenorrhoea, anorexia, osteoporosis) is suspected.

SKIN INFECTIONS• Skin infections (e.g. tinea infection, impetigo,

viral warts, herpes simplex) are common amongst athletes in contact sports (e.g. rugby, soccer, wrestling).

• Athletes with such conditions should be adequately treated and symptom free before return to play.

SUDDEN CARDIAC DEATH

• Sudden cardiac death is an uncommon occurrence causing an athlete to collapse & die during exercise .

– Athletes who are < 35 yrs old may have structural congenital heart lesion (hypertrophic cardiomyopathy).

– Athletes > 35 yrs old may collapse due to Coronary Arterial Disease.

• Other causes are heart valve structural problems or disease or arrhythmia.

CONTRAINDICATIONS TO SPORTS

• In certain medical conditions, participation in sports may predispose the athlete to further harm and danger. It is the responsibility of the coach to identify situations that may put the athlete at risk and act accordingly. The coach must consult the Medical Officer if the athlete has the following contraindications:

CONTRAINDICATIONS TO SPORTS (CONTINUED)

• Absolute Contraindications• Sensory: Detached Retina, Severe hearing

loss (tympanic perforation), severe myopia, Seizure disorder (depends on sport), Concussion; Brachial Plexus Injury;

• Spine: Spondylosis, Spondylolisthesis, Cervical Spine Instability, Cervical Stenosis, Herniated Disc with Cord Compression;

• Abdominal: Enlarged liver or spleen, Active hepatitis, Inguinal hernia;

• General Illnesses: Acute Febrile Illness, Uncontrolled Diabetes, Severe and Moderate Hypertension,

• Cardiovascular: Coronary Arterial Disease, Valvular Heart Disorders, Cardiac Arrhythmias;

• Pulmonary: Pneumothorax, Hemothorax, Tuberculosis,

• Blood disorder: Hemophilia & bleeding tendencies; severe anaemia;

• Skin: Herpes Simplex, Measles, Chicken Pox, viral warts, tinea infection (fungal);

• Single Organ: Eye, Ear, Kidney, testicle (for contact sports)

• Relative Contraindications

• Hypertension, Diabetes Mellitus, hyperthyroidism, anaemia;

• Delayed Onset Muscle Soreness, Cramps,

• Overuse injuries: tendinopathy, mild osteoarthritis;

PREVENTION OF INFECTIOUS DISEASES

• Infectious diseases can be transmitted during sporting activity. Modes of transmission in athletic settings include

a.Person-to-person contact,

b.Food & Water Borne

c.Airborne/droplet spread

d.Vector Bourne

PERSON-TO-PERSON CONTACT: • HIV, Hepatitis B, Herpes Simplex, Gonorrhoea,

Syphilis, Candidal infection may be transmitted sexually

• Preventive measures:

a.Vaccination (Hepatitis B)

b.Safe sex: single partner, barrier methods (condom), avoid unnatural practices

c. precautions of contamination from wounds (gloves, wound dressing)

d.personal hygiene

PERSON-TO-PERSON CONTACT (CONTINUED)

• Viral warts; Taenia Infection; Onychomycosis; Impetigo; may be transmitted by skin contact

• Preventive measures:

a.Isolation and treatment of infective athlete

b.Closing affected area of skin

c.Hand washing

d.Personal Hygiene

FOOD & WATER BORNE: • Acute Gastroenteritis; Typhoid, Hepatitis A,

Cholera;

• Preventive measures:

a)Hand washing

b)Drinking boiled water

c)Hygienic food preparation & food handling

d)Vaccination (Typhoid, Hepatitis A)

AIRBORNE / DROPLET SPREAD:

• Haemophilus Influenza A and B (flu), Coxsackie Virus;

• Preventive measures:

a)Vaccination (if available)

b)Avoid contact with ill athlete

c)Hand washing

d)Personal Hygiene

VECTOR BOURNE:

• Dengue fever, Chikungunya, Malaria, Yellow Fever;

• Preventive measures:

a)Insect repellent and larvicide (e.g. Abate)

b)Long-sleeve attire and mosquito netting

c)Malaria prophylaxis: Malarone or Mephaquin tablets

d)Vaccination: Yellow fever

MEDICAL PREPAREDNESS: COMPETITION & TRAVEL

• Pre-event preparation

• Event Coverage

• Preparation for travel

PRE-EVENT PREPARATION

• Sports injuries & medical emergencies can be prevented with adequate preparation before the sporting event.

• The role of a coach is essential in ensuring that the risk of such injuries & emergencies are minimised.

ROLE OF COACH:• Ensure athlete undergoes pre-participation medical

examination• Identify athlete’s medical conditions & injury• Identify nutritional supplements & medication used by

athletes. Inform Medical Officer & notify Anti-Doping Agency (MASDOC)

• Appoint Medical Personnel responsible for the team• Inform injury risk & medical conditions• Prepare first-aid box, taping kit & coolman (Ice box)• Identify medical facilities & support (include referral)

available at the event• Identify time for food intake, warm-up, cool-down &

rest

EVENT COVERAGE

• a) Identify medical facility & person-in-charge at the venue

• b) Ensure that Medical Personnel is present during warm-up & cool-down

• c) Ensure that athletes are well-hydrated• d) Ensure that open wounds are covered with wound

dressing• e) Tape injured parts before warm up and ensure

tape is removed after cool-down• f) Ensure that protective devices are properly applied

by athletes• g) Accompany injured athlete to hospital (if medical

personnel is not available)

PREPARATION FOR TRAVEL• a) Pre-participation medical examination to certify fitness

of participation & to identify risk of injury & medical

conditions

• b) Vaccination of team members (at least 2 weeks prior to

travel)

• c) Briefing of team members

• d) Planning of duration of stay before competition to

prevent jet-lag

• e) Sleep hygiene during travel: adjust to time of

destination, avoid alcohol intake, carbonated drinks &

fatty foods

• f) Prepare medical first-aid kit, taping kit & coolman (ice box)

• g) Arrange for Insurance Coverage during travel & competition

• *NB: Some insurance policies do not cover for participation in competitive sports