ways to classify sports

injuries

direct
/ indirect

soft /
hard

overu
se

Q1: How are sports injuries classified and managed?

Ways to classify injuries:

Direct:
caused by external forces
applied to the body
results in hard (fractures,
dislocations) or soft (sprains, bruises)
tissue injuries
e.g. collision during a hockey
game resulting in a broken bone and
bruising
Indirect:
Can happen in two ways:

Intrinsic force (force within

the body)

Actual injury occur some

distance from the impact site

results in soft tissue

injuries (excessive strain on muscles,
tendons, ligaments)

e.g. sprinter tearing a

hamstring when running
Overuse:

caused by repeated use of

body regions over a prolonged period
of time

results in pain and

inflammation, causing either soft or
hard tissue injury

e.g. soft tissue overuse tennis elbow

e.g. hard tissue injury stress fracture

caused by:
Incorrect technique - A
strain is an injury of a muscle and/or
tendon.
Doing too much too soon insufficient rest and recovery time
Tendonitis (inflammation of
the tendon) - repeated low intensity
activity causing small tears in the
tendon.e.g. tennis elbow

Soft / Hard tissue injuries:

Soft: damage to the organs of the body
acute: occurs suddenly

Skin tissue damage

abrasions, burns, blisters

Muscle injury tears,

sprain to muscle fibres

Tendon injury tears,

strain, inflammation (tendonitis)

Ligament injury sprain,

tear to ligament fibres
e.g. kick in AFL over stretching the hamstring
muscle resulting in a strain

Hard tissue injuries: injuries Involving

damage to the bones if the skeleton

Range from severe

fractures and joint dislocations to
bruising of the bone.
Fractures:
Simple (Closed): broken bone but remains
within the body doesnt penetrate the skin
Compound (open): broken bone, penetrate
through the skin, expose bone
Comminuted: severe, shattering of the bone
Greenstick: breaks along side of the bone,
caused by a force perpendicular to the bones
axis
e.g.

Fracture in the bone: e.g.

stress fracture in the foot of long
distance runners

Dislocations are the

displacement of a bone in a joint: e.g.
impact to the shoulder socket in a
football tackle

Bruising of the bone or

periostitis: e.g. impact to the shin
which only has a thin layer of muscle

REMEMBER:

A tear is a disruption of the fibres of a muscle or tendon.

 A sprain is a tear of the ligament fibres, muscles or tendons that support a joint. Sprains
usually occur when a joint is extended beyond its normal range of motion.
A contusion or bruise is a bleeding into any soft tissue structure. It is usually caused by
the direct impact of an object or person.
A sprain is a stretch and/or tear of a ligament
A strain is an injury of a muscle and/or tendon

soft tissue injuries:

tears,
sprains,
contusions

skin
abrasions,
lacerations,
blisters

inflam
matory
response

soft tissue injuries:

tears

sprain: occurs when a ligament is stretched beyond its normal ROM

and the tearing of fibres occur
strain: occurs when a muscle or tendon is stretched beyond its ROM,
a partial or complete tear of the muscle or tendon may occur
partial tear: disrupt enough to interfere with normal function
complete tear: involved total loss of muscle function

contusions

occurs when a player collides with another player, the

ground or an object
the skin is not broken and no injury may be present
swelling / bruising may occur in the next 48 hours

inflammatory
response

when soft tissue is injured in becomes inflamed, the

body activates a self healing process called the inflammatory
response
length of response will determine the severity of the
injury and management strategies used by the athlete
3 phases:
1. Inflammatory stage: this is initial inflammation,
including pain and swelling
2. repair and regenerative stage: production of scar
tissue, elimination of debris, formation of new fibres
3. remodelling stage: increased production of scar tissue
and replacement of tissue to strengthen and develop injury

manage of soft
tissue injuries
(RICER)

to ensure there is no further damage apply NO HARM procedure:

NO:
Heat: dont apply heat for at least 48 hours as this increases bleeding
Alcohol: dont consume alcohol, this increases swelling
Running: although some movement is encouraged do not run, as the
weight and impact will cause further injury
Massage: direct massage is discouraged, causes bleeding to increase

RICER procedure:
Rest: return heart rate to resting levels, reducing the blood flow

around the body

How: place in comfortable position with the injury elevated and
supported
- avoids further injury
- reducing bleeding
Ice: compresses blood vessels
How: crushed ice in a wet towel wrapped around the injury, frozen gel
pack in a towel
- reducing pain, swelling, blood flow
- dont apply directly to the skin
- 20 mins every hour for up 48 hours
Compression: compresses blood vessels
How: wrap elastic bandage over the injured area, covering below /
above the sight
- decreases bleeding
- reduces swelling
- reduces ROM, prevents further injury
- apply at the time of injury and periodically for at least
24 hours
Elevation: above heart level
How: raised injured area above the level of the heart by placing a
support e.g. pillow, under the injury
- decreases bleeding, swelling, throbbing
- restricts blood flow
Referral: medical practitioners for full diagnosis
How: appointment with doctor or physio
- understand the nature and extent of the injury
- seek advice for rehabilitation

Immediate treatment of skin injuries:

Danger: to yourself and the patient
Bleeding: managed
Assess: injury and decide what it is (bruise/laceration) and whether its a simple or complex injury
Clean: the injured area
dra
Dress: the wound
Referral: medical practitioner
Hard tissue Injuries:
Fractures

Stress: small fracture in the bone

Simple (Closed): broken bone but doesnt penetrate the skin
Compound (open): broken bone, penetrate through the skin,
expose bone
Comminuted: severe, shattering of the bone
Greenstick: breaks along side of the bone, caused by a force
perpendicular to the bones axis

symptoms:

intense pain
swelling, deformity, bruising, discolouration
loss of function/movement
grinding sound if moved

stop participation in activity

seek immediate medial assistance
immobilise player

treatment:

Dislocations

where thw two bones at a joint completely displace

from each other
majority of damage is done to ligaments
surrounding the joint
symptoms:

swelling and deformity

pain and tenderness
loss of function/movement

never attempt to relocate

seek medical attention immediatly

treatment:

Manage hard
tissue injuries

Management of Fractures:
DRSABCD
control bleeding
treat for shock
immobilise using splint / bandage
seek immediate medical assistance
Management of Dislocations:
DRSABCD
secure with splint to immobilise injury
Ice, support using bandage
seek immediate medical assistance
Immobilisation:
Splint:
must extend beyond the nearest joints of the
injured sit
can be another limb, part of the body, or a firm
straight object
Sling:
never relocate the dislocation as this will further
damage
slings help immobilise limb
bandage the injured limb to another limb

Talk:

What happened?
What did / do you feel?
Where does it hurt?
Has it happened before?

Observe:

watch behaviour - indicator of pain level

observe injury - swelling, deformity

if obviously a hard tissue injury STOP assessment and management steps

immediately
Touch:

Is the injury tender to touch?

is the injury hotter than other body parts?

if obviously a hard tissue injury STOP assessment and management steps

immediately
Active Movement:

ask the athlete to move injured part as much as possible until they feel pain

if movement is hindered management steps should be taken immediately

Passive Movement:

SPORTS FIRST AIDER moves injured body part through its full range of motion until
athlete feels pain

if pain / change in range of motion management steps should be taken immediately

Skills test:

ask the athlete to run through basic movement skills suitable to their sport if they are
capable to retake the field

MANAGEMENT OF INJURY FLOW CHART:

INJURY OCCURS TO ATHLETE

assessment of injuries
TOTAPS:

talk

obser
ve

touch

active
movement

passi
ve movement

skills

DRABCD - First step for all injuries

FAST ON FIELD ASSESSMENT

THOROUGH ASSESSMENT - TOTAPS

RELEVANT MANAGEMENT PLAN (RICER, FRACTURE, DISLOCATION)

Q3. How does sports medicine address the demands of specific athletes?

text

Children and Young Athletes:

Condition:

Factors to consider:

Asthma:
narrowing of
airways resulting in
breathing difficulties

- awaren
ess of triggers
- prevent
ative steps
including a
management
plan
- should
exercise
preferably
swimming (low
risk of asthma
attack)

Diabetes
inability of the
pancreas to make
sufficient insulin

- awaren
ess of signs
and symptoms
- prevent
ative measures
including a
management
plan
- particip
ate in physical
activity,
although
nothing with
strenuous

Signs and Symptoms

-

wheezin

g
- difficulty
in breathing
- tightnes
s in chest
- panic

Hypo: (low blood

glucose levels)
- tired,
pale, slow
movements
Hyper (high blood
glucose levels)
- high
levels of energy

First aid procedures /

management
- administ
or medication
(preventer
inhaler)
- avoid
environmental
triggers such as
outdoor air
pollution
- sufficien
t warm up and
cool down
- exercise
at a steady
intensity
- drink
water
- coachin
g staff/ officials
should be aware
and
understanding place sufferer in
upright position 4 puffs ambulance if no
improvements
after a few
minutes monitor vital
signs
Balance insulin by:
- medicati
on (injections)
- diet
(complex carbs)
- exercise
- pre
exercise meal
and hourly
glucose
supplementation

children and young

athletes
medic
al conditions
(asthma,
diabetes,
epilepsy)

analyse the implications of

each of these
considerations for the
ways young people
engage in sport and how
each is managed.

activity may
cause exercise
induced
hyperglycemia
(low levels)
Epilepsy:
central nervous
system disorder
(neurological
disorder) causing
unusual electrical
activity in the brain,
causing seizures or
periods of unusual
behavior

Issue:

- collisio
n sports should
be avoided if
epilepsy is
daily / weekly
(may cause
head trauma
which can
worsen
disorder)
- avoid
swimming
alone (in case
of seizure)
- aware
of triggers and
extent of
seizures

Implications:

Overuse
injuries:
s
ustai
ned
from
repeti
tive
use
of
body
parts
over
a
long
perio
d of
time
A
stres
s

A
void
use
of
injure
d
body
part
espe
cially
high
inten
sity
activit
ies
(may
wors
en)
e
.g.
stres

Management:
s
horte
r
perio
ds of
exerc
ise
c
orrect
techn
ique
a
void
overtr
ainin
g the
worki
ng
musc
les /

Petit mal:
-

stare
memory

loss
- odd
movements
Grand Mal:
- falling to
the ground
- body is
rigid with jerking
movements
- seizure

- medicati
on (reduce the
incidence of
seizures
- avoid
fatigue and
extremes of
body
temperatures
(can trigger
epilepsy)
- supervis
ion (people who
know
management
plan if seizure
occurs
e.g.remove
hazards, dont
restrain)

fractu
re is
a
small
crack
in a
bone,
or
sever
e
bruisi
ng
within
a
bone
caus
ed by
repeti
tive
activit
y or
overu
se of
the
bone
or
musc
le

s
fractu
re of
the
tibia
shoul
d not
run
p
artici
pate
in low
impa
ct
exerc
ise to
maint
ain
fitnes
s

overu
se injuries
(stress
fractures)
therm
oregulation
appro
priateness of
resistance
training

Thermoregul
ation:
t
he
proce

children are
less
developed
ess

bone
s
s
uffici
ent
warm
up
and
cool
down
to
reduc
e
injury
h
ave
rest
days
u
se
ice or
antiinfla
mmat
ory
medi
catio
n to
reduc
e
symp
toms
/ pain
R
EST
(4-8
week
s
depe
nding
on
sever
ity)
w

ater
intak
e
-

ss of
regul
ating
and
contr
olling
our
body
temp
eratu
re

deve
lope
d
swea
t
glan
ds
prod
uce
less
swea
t
less
evap
orati
on
less
cooli
ng
C
hildre
n
have
small
er
limbs
in
relati
on to
the
size
of
their
torso.
This
mean
s that
childr
en
have
a
relati
vely
large
skin
surfa
ce
area.
They
have
less
fluid
in

a
pprop
riate
clothi
ng
that
enabl
es
regul
ation
of
body
heat
a
pprop
riate
warm
up
and
cool
down
(help
the
body
regul
ation
proce
ss)

adult and aged athletes

heart
conditions
fractu
res / bone
density
flexibi
lity / joint
mobility

explain the sports

participation options
available for aged people
with medical conditions

their
bodie
s and
more
oppor
tunity
to
lose
that
fluid
throu
gh
the
large
skin
surfa
ce
area.
Child
ren
are
theref
ore
more
likely
to
lose
fluid
and
dehy
drate
durin
g
exerc
ise.
d
ue to
this
childr
en
shoul
d
avoid
for
exerc
ising
for
over
30
minut
es in

extre
me
temp
eratu
res
due
to
their
inabili
ty to
regul
ate
body
temp
eratu
re
throu
gh
swea
t
gland
s
Resistance
training:

implications
c

is the
use
of
resist
ance
throu
gh
musc
ular
contr
actio
n to
build
the
stren
gth,
anaer
obic
endur
ance
and
size
of
skele
tal
musc
les.

an
stunt
growt
h
in
juries
can
occur
due
to
level
of
resist
ance
or
incorr
ect
techn
ique
Can cause
growth
imbalances:
I
njurie
s in

resistance
training can
be highly
beneficial if
followed by
correct
guidelines
li
ght
resist
ance,
high
repeti
tion,
full
ROM
b
ody
weig
ht
exerc
ises
b
alanc
e
with
other
exerc

female athletes:
- iron deficiency
- eating disorders
- bone density
- pregnancy

assess the degree to

which iron deficiency and
bone density affect
participation in sport.

both
preadole
scent
s and
adole
scent
s are
usual
ly
relate
d to
growt
h
imbal
ance
s
amon
g
bone
s,
musc
les
and
tendo
ns.
The
growt
h
plate
s of
bone
s are
espe
cially
affect
ed.
B
ones
can
grow
faster
than
musc
les or
tendo
ns,
and
painf
ul
infla
mmat
ory

ise
st
retch,
appro
priate
warm
up
and
cool
down
e
nsure
super
vision
a
pprop
riate
techn
ique

condi
tions
can
result

espe
cially
from
overu
se
durin
g
exerc
ise.

Heart Conditions:
As people age their
blood vessels lose
elasticity, blood
pressure rises, their
heart may weaken
and maximum stroke
volume decreases.
e.g. myocardial
infarction (heart
attack), angina,
arrhythmia.
Training programs
must reflect individual
ability and slowly
progress to avoid
stress upon the heart.

Options for sports

participation:
Key principles:
- medi
cal clearance
- gradu
al exercise
- aerob
ic - moderate
intensity
Considerations:
A
light to
moderate
exercise
program 3-4
times per
week is
recommende
d as a
starting point
for adults or
the aged.
- Exerc
ise is
beneficial as
it reduces
blood
pressure and
helps
strengthen

the heart
muscle
Suitable exercises for
rehab:
- long
warm ups
and cool
downs (no
sudden
changes)
- avoid
holding
breath
- suffici
ent rest
breaks
- train
at 60-75%
max heart
rate
recommended:
e.g. walking, jogging,
low impact aerobics
such as pilates, water
aerobics
- gradu
al increase;
5-10 minutes
then progress
to 30-60mins
maximum

physical preparation:

prescreening

skill
and technique

physi
cal fitness

warm
up, cool down,
stretch

Fractures / Bone
Density:
Physical activity
increases bone mass
and makes bones
stronger. Inactivity
promotes calcium
discharge, weakening
bones
- Exerc
ise is
particularly
important to
older women
because it
contributes to
delaying
postmenopausal
bone loss.

Options for sports

participations:
Regular exercise is
an important part of
treatment for patients
with osteoporosis, or
as a preventative
measure against
reduced bone density.
Recommended
activities include:
- Walki
ng
- Supe
rvised
resistance
training

e.g. osteoporosis,
thinning of the bone
tissue and loss of
bone density mostly
common in the spine,
hip and wrists

Bone density must

be monitored and
programs should
include low weightbearing exercises if
required to decrease
the risk of fracture
e.g. gardening, lawn
bowls, walking,
swimming

Joint Mobility /
Flexibility

Options for sports

participation

Aging can cause loss

in elasticity of
tendons, ligaments,
muscles.
Physical inactivity can
also increase
stiffness of the joints
reducing flexibility
and ROM

The programs need

to be of low impact,
be specific to a
persons limitation
and regular.
Efforts should be
made to keep the
joints supple and
flexible so that a full
range of movement is
possible.
Regular, gentle, and
slow stretching can
achieve this.

e.g.
Arthritis: inflammation
(pain and swelling of

the joints)
Osteo-arthritis:
degenerative joint
disease - cartilage
within the joint breaks
down, causing pain
and stiffness. commonly the knee
and hip

Recommended
activities include:
- Nonweight
bearing
activity
swimming,
cycling
- Yoga

Focus needs to be
placed on adequate
warm up and gradual
increase in range of
movement and
intensity to avoid
injury.

Female athletes:
Eating disorders:
characterised by abnormal eating behaviours
e.g. bulimia, anorexia
common in sports where low body fat percentage or an ideal body shape or size is
expected or can be of advantage e.g. gymnastics or diving
Female athletes are more likely to develop and eating disorder due to:
weight loss pressure from media portrayal of women e.g. magazines
social expectations to have an ideal body
self esteem
Effects on performance:
damages the digestive tract
malnutrition - particularly deficiencies of energy, protein, vitamins and minerals which
can increase the risk of respiratory infections, kidney failure, heart attack
Dehydration - can cause heart failure, kidney failure
electrolyte imbalance - can affect the teeth, joints and bones, nerve and muscle
impulses, blood sugar levels and delivery of oxygen to the cells
muscle atrophy - wasting away of muscle and a decline in muscle mass
Prevention:
Recognition and attention by loved ones and treatment by professionals, such as psychologists and

nutritionists, is the best way to help female athletes who have eating disorders. Awareness of signs and
symptoms is essential, and a multidisciplinary approach is necessary to treat the condition.
Focus should be placed upon correct technique rather than appearance of the body as
well as healthy eating instead of low body weight to avoid eating disorders.

Iron Deficiency:
condition in which blood lacks adequate healthy red blood cells. Red blood cells carry
oxygen to the body's tissues
deficiency is common in women due to loss of blood through menstruation, reduced
consumption of red meat (high in iron)
Iron deficiency can cause anaemia oxygen delivered to the working muscles fatigue / loss
of energy
sports policy and the
environment:

rules
of sports and
activities

modifi
ed rules for
children

matc
hing opponents

use
of protective
equipment

safe
grounds,
facilities,
equipment

Effects on performance:
lethargy, weakness,
reduced capacity to produce energy fatigue
Prevention:
consume high iron foods e.g. meat, seafood, poultry
recommended 12-16mg

Bone Density:
Bone density is the amount of bone tissue in a certain volume of bone.
Factors that contribute to low bone density in women:
Inactivity
poor nutrition
the onset of menopause
can result in low bone density and osteoporosis.
Osteoporosis is a condition characterised by brittle bones, largely caused by insufficient calcium.
Effects on performance:
weaker performance due to weakness of bones
increase risk of fractures and breaks
reduced mobility and ROM
Prevention:
Weight bearing exercise and a calcium rich diet to increase bone density and decrease injury
good sources of calcium are:
milk and cheese

Q3: What preventative strategies play in enhancing the wellbeing of the athlete?

PHYSICAL PREPARATION:

Conduct pre-screening:

Prevents injury determines and assesses predisposing factors, injuries, medical

conditions

Reveal risk factors, current injuries or muscular injuries personalised intervention

Design prevention programs based on results

Review previous experience in the sport technical and tactical skills

Discuss goals and aspirations

e.g. Sports Medicine Australia use an individually based questionnaire on age, gender, health status,
previous experience to determine a variety of lifestyle and health factors
temperature regulation:

conve
ction

radiat
ion

cond
uction

evap
oration

SKILL AND TECHNIQUE:

Promoting skills and developing correct techniques

Modifying skills into small manageable components e.g. teaching a handspring vault
flat backs matting

Prevents ankle injuries for gymnasts

Temporal patterning (smaller parts of the movement are executed in a sequence e.g.
forward walkover

Safe sporting movement is controlled movement confidence

e.g. spotting in gymnastics
May need to reevaluate technique if:

Recurring soreness particular technique

Poor execution injury to self or others

PHYSICAL FITNESS:

Emphasis on specific requirements of the sport or position and concentrate on

technique

E.g. netball centre position vs. goal shooter

Health Related Components:
Sophie Carters Family Milks Cows

Muscular Strength: force that can be produced by a single contraction of a muscle

Cardiovascular: ability of circulatory system to supply oxygen to the muscles
Flexibility: range of movement at various joints
Decrease ligament damage, muscle tension
Increased chance of dislocation
Muscular Endurance: ability of muscle group to continue muscle over a length of time
Delays fatigue
Body Composition: percentage of body fat compared to lean body mass (muscle,

bone, water)

Skill Related Components:

Peter Cowman Sails at Reck Bay

climatic conditions

temp
erature,
humidity, wind,
rain, pollution,
altitude

Power: ability to do strength work at a explosive pace

Coordination: integration of hand/food movement input of the senses
Speed: ability to move quickly from one point to another
Agility: ability of the body to change directions quickly
Reaction time: amount of time it takes to response to a stimulus
Balance: the ability to remain upright while still or moving
Warm up, stretching, cool down
The use of a warm up incorporating gross motor movements and specific stretching followed by skillspecific movements prepare an athlete both physically and mentally for physical activity. (WIISAA)

Warm up:
Increase blood flow and oxygen to the active muscles
Increased body and muscle temperature
Stretches ligaments and muscles to reduce chances of injury
Assist mental preparation
Allows athlete to comments at physical and mental peak

Followed by:
1. Easy exercise: 5 minutes
- general body warm up jogging raise body temperature and sweat
2. Stretching:
- static stretching 10 30 seconds gradually stretching the muscle to a position of mild tension,
during this time the muscle lessens (stretch and hold)
- PNF stretching 6 10 seconds muscle is stretched by applying force to an immoveable object
e.g. PNF hamstring and gluteal stretch against a person applying force
3. Vigorous exercise: 10-15 minutes
- specific to activity development of skill and technique drills
- e.g. short sharp sprints, agility movement runners
- e.g. crunches, pushups gymnasts
Short recover 5 minutes before performance
4. Cool Down: reversed to warm up

guidel
ines for fluid
intake:

A cool down after physical activity will enhance the removal of lactic acid, speeding up the recovery
process.
-

Reduce muscle soreness, tightness

e.g. intense activity that is gradually reduce
e.g. 2 minutes of jogging followed by 3-5 minutes of walking
Followed by stretching

PREVENTATIVE STRATEGIES EXAMPLE:

e.g. Gymnastics:
The ankle and foot are the most common site of injury in both males and females.

 Result from poor landings

accli
mitisation:

Preventative strategies:
Conduct physical preparation pre-screening, warm up, stretching, cool down
Preventative taping/guards
Strength training of muscles around calves
Practice skills landing with spotters
Perform drills, improve technique and reduce injury
Sports Policy and the Environment:
Rules of Sport:

taping and bandaging:

preve
ntative taping

taping
for isolation of
injury

band
aging for
immediate
treatment of
injury

Enforce explicit rules, regulations, policies

Risk management, preventative measures, safe participation

e.g. qualification, police safety checks, banning spear tackles in football

Spectator Behaviour Policy

Discrimination, racism, verbal/physical behaviour

Increase flow of game no interruptions

Modified rules for children:

minor adjustments, simplifying

accommodates: growth, development, understanding

functional, practical, motor skills

fundamental safe participation, motor skills, social skills
e.g. modified AFL juniour game
Protective equipment:

minimise risk/injury increase health and safety

mandatory/ compulsory in relation to the sport

e.g. cricket helmets

Reduced injury such as embedded objects to the eye

Increases participation, protection of major organs

Safe ground, facilities, equipment:

Management, maintenance mandatory for safe participation

Clubs and associations responsible

Focused based on:

spectators and participants

provision and maintenance of equipment

facility design and layout

provision of first aid facilities and qualified personnel

facility maintenance
Reduced indirect injury pot holes, glass, unmaintained equipment
Increase safety hygiene, first aid, access to emergency services

Increases public use

Decreases indirect injuries

Environmental Considerations:
Temperature regulation

The body loses heat through four processes:

rehabilitation procedures
progr
essive
mobilisation
gradu
ated exercise
(stretching,
conditioning,
total body
fitness)
trainin
g
use of
heat and cold

examine and justify

rehabilitation procedures
used for a range of
specific injuries, eg
hamstring tear, shoulder
dislocation

Radiation
Heat is lost in the form of infra-red rays greater the difference between
bodys heat and environment greater the heat loss

Heat given off the body

At rest radiation accounts for 60% of heat loss
Strategies to support mechanism:

Going out at cooler times of the day

Light clothing
Conduction
Transfer of heat from the body to an object by contact
3% of heat loss
Strategies to support mechanism:

Ice vests

Wet clothing
Convection
Transfer of heat by a moving fluid/gas
12% of heat loss
Strategies to support mechanism:

Fans

Training on days with a breeze

Evaporation (sweating)
Only effectives if water evaporates
25% of heat loss (more when exercising/hot days)
Strategies to support mechanism:

Training on dry days

Exposing skin to the air

Heat is gained through metabolism and physical exercise.
Body temperature is controlled by the hypothalamus in the brain.

Climatic Conditions

Heat and humidity

The risk of heat injury is highest in conditions of high temperature and
high humidity.
Heat injury includes: heat exhaustion, heat stroke, dehydration and
hyperthermia.
Symptoms of hyperthermia include:

Confusion, dry skin, headache, nausea and can lead

to death.

Cold and wind

In cold and windy conditions vasoconstriction occurs decreased blood
flow to the skin slows the heat loss.
Shivering also occurs to produce heat through muscle contraction.
As wind flows past the body, this causes it to lose heat through
convection known as wind chill
The athlete is at risk of hypothermia in cold and windy conditions.

Rain
Can lower body temp contribute to hypothermia
Causes slippery playing surface increases risk of injury (e.g. falls,
collisions)
Reduces visibility

Altitude
Reduces aerobic capacity impaired performance in endurance events
Less air resistance increased performance in high/long jump; increased
distance of kicks in soccer/rugby

Pollution

 Irritates airways > increases their resistance > less oxygen into lungs
Hazard for people with asthma/respiratory problems and for those who
train in large cities
Guidelines for fluid intake

The most important cooling system during physical activity is the evaporation of body
sweat from the body

Hydration is vital as it improves concentration and co-ordination, prevents fatigue, and

aids in the recovery process

It is important to:
Drink plenty of water 24 hours before strenuous exercise in order to
prevent dehydration
2 hours before hand drink 0.5-1 litre of water
500 ml fluid in the hour before
Drink 200-300ml every 20 mins during exercise
Minimum post exercise: consume 1L water for every 1kg lost in sweat
Acclimatisation

Technique where athletes train in expected climatic conditions before competition, e.g.
heat, altitude, cold

Benefits:
Allows body to adapt improves performance
Promotes safety, e.g. reduced chance of heat illness

Example: heat tents train in hot conditions; improved sweating response > more
effective evaporation > enhanced cooling
Taping and Bandaging
Preventative Taping

Athletes which play sports that demand explosive movements and frequent changes
of direction, are more prone to injury occurring which is why they use preventative taping.

E.g.: Ankle taping aims to prevent the inversion and eversion of the foot, yet it allows
plantar flexion and dorsiflexion.
Taping for Isolation of Injury

Taping is often required after an injury and may be necessary during the rehabilitation
process.

Uses:
Physical support

Taping aims to limit movement. When an injury has

occurred taping can be done to isolate and immobilize the joint. If it is done
properly it can prevent further damage and decrease recovery time.

When done correctly, taping can isolate the joint and

prevent any extreme movements that might impact upon the healing process.
Psychological support increase athletes confidence
Bandaging for Immediate Treatment of Injury

Immediately after an injury is sustained taping is essential as it is a part of the RICER

management.

The compression of the bandages restricts bleeding to the injured area and limits the
motion of the body part, reducing swelling

Bandaging has a role in the immediate treatment of various injuries including:

Compression bandaging in the initial treatment of soft tissue injuries (as
part of the RICER regime).
Controlling bleeding and preventing infection in the case of various skin

injuries.
To immobilise and support a hard tissue injury, e.g. a fracture

Q4: How is injury rehabilitation managed?

Progressive Mobilisation
- The range of movement should gradually be extended until the part is fully functional
again.
- It helps prevent the joint from becoming stiff and helps scar tissue to heal.
Example - after a knee reconstruction surgery, a skier regained mobility by walking without crutches at
first and then was able to walk up and down the stairs
Safe mobilization involves:
- Slow and progressive movements (rather than sharp and rapid)
- Movements should remain within a pain free range
- Circulation to the injured area should be increased before beginning mobilisation
movements
- Mobilization should not be commenced during the Acute Inflammatory Phase.
Graduated exercise:
Stretching
- Stretching is important to ensure that the injury heals without scarring.
- Scarring will shorten the muscle and make it prone to further injury
- Initially, movement should be within pain barriers and gradually increased as strength
increases.
Types:
- PNF stretching is recommended as the muscle is stretched and strengthened using safe
movements.
- Physiotherapy helps to strengthen the muscles and joints.

return to play
indica
tors of
readiness for
return to play
(pain free,
degree of
mobility)

Conditioning
- involves numerous exercises aimed to prepare the body for the demands of the sport. It
may include adapting the body to a rrange of agility, strength and power skills to restore the full
range of motion
- It is critical that strength endurance and control be developed around the injury as soon
as possible
- Maintains cardiovascular and muscle endurance as well as flexibility.
E.g. Swimming, aquarobics, running or cycling
Means:
- Rehabilitation exercises commence with low demand around the injury and progress
towards more demanding exercises that resemble the actual requirements of the sports activity
- This should be followed by exposure to game skills in noncompetitive situations where
increased strength and a full range of movement is required.

Total Body Fitness

- is the regained fitness through progressively overloading the muscle groups and energy
systems so that required adaptations are regained before commencement of activity
Means:
- Exercises must not compromise the injury
- Progressively overload the muscle groups and energy systems so that required
adaptations are regained before competition recommences.
Adaptations include:
- Hypertrophy of muscles (increased size),
- Increased capillarisation and blood flow,
- Increased elasticity of fibres, Increased joint mobility,
- Absence of pain, Full confidence in the injury and
- Fully restored balance and coordination.
Training:
Training may be incorporated into the injury management procedure in a safe manner which involves
activity for the injured person which is relatively risk and pain free.
- The athlete will be expected to train fully with no pain.
- This involves warm up, conditioning, drills, skills, development exercises, tactics and cool
down.
- Progressively increase the demand on the injured tissue.
- Training during rehabilitation needs to cover all requirements of the athletes sport as
they continue to progress.

monit
oring progress
(pre-test and
post-test)

Use of heat and cold:

Generally, cold treatments should be administered to an injury in the first 72 hours. This may include ice
massages, ice baths, or vapo-coolant spray. After this period, heat treatments should be applied. This
may include heat packs, massage and contrast baths (heat and cold).
Heat:
-

psych

Heat can be applied after 3 days following injury to:

o Increase elasticity
o Reduce pain
o Reduce stiffness
o Increase blood flow
o Reduce inflammation
o Stimulate blood flow and will improve healing
Heat relaxes muscles and eases pain, but heat can make swelling worse. It is for this reason that
the use of cold is recommended immediately after an injury and heat is recommended for later on when
the swelling decreases.
Commonly used methods of thermotherapy include:
Heat packs
Whirlpool baths -Immersion in a hot bath, with the injury being massaged by the moving

ological
readiness

fluid.
-

Ultrasound therapy -Uses high frequency sound waves to produce heat energy.

Positive:
-

increases blood flow, elasticity

decreases stiffness

increases blood flow and swelling

Negative:

Cold:
-

Can be applied for up to 3 days following an injury to reduce inflammation

Cold applications include:
o Ice massage
o Ice water immersion
o Vapocoolant sprays
Positive:
-

specif
ic warm-up
procedures

constricts blood vessels to reduce blood flow and swelling

Return to play:
indicators of
readiness for
return to play
(pain free, degree
of mobility)

five indicators of readiness include:

- elasticity
- strength
- mobility
- pain free movement
- balance
no visible or communicated pain

use active and passive movements to test the level of readiness of the player
which will indicate the degree of mobility:
degree of mobility:
- the joint where the injury was sustained must have a suitable
rainge of movement and mobility to suit the playing conditions
- moves without any restriction
- move with equal control and alignment on injured and non injured
sight
additional:
return
to play policies
and procedures

monitoring
progress (pre-test
and post-test)

full involvement in training

psychologically ready to return

pre test and post test

- pre test taken before the injury occurred could be compared to a
post-test taken after the injury was sustained
- the test needs to be specific to the injury
- this will establish if an athlete has lost fitness components

- monitoring process occurs in consolation with medial and fitness

personnel
- this might involve:
- visual observations of the athletes performance
- interviews and informal discussions with the
athlete in regards to fitness, injury etc.
- ongoing testing
- videotaping
The athlete will benefit from feedback about performances. Appropriate visits to
medical professionals to monitor the injury are also advisable, to prevent re-injury
to the area and to provide medical assistance if needed eg. massage. Ongoing
therapy is advisable until the athlete returns to pre-injury levels.
psychological
readiness

Psychological barriers may prohibit an athlete from returning to play, including:

- anxiety
- trauma from injury
- the longer an athlete is away from the sport, their confidence will
lower
- these barriers can hinder performance
- these barriers can be avoided through the application of
progressive involvement: returning to play in a lower grade, reducing
participation time
The psychological readiness of the athlete can be measure by
- discussion and observation of behaviour
Anxiety levels can also be monitored to ensure the athlete is not
feeling pressure (internal or external) to return to play before being fully
ready to do so.
Taping the injured area can provide support and proprioceptive
awareness to the athlete; it can be a physiological form of treatment long
after the injury is recovered.

ethica
l considerations,
eg pressure to
participate, use
of painkillers.

specific warm-upprocedures

return to play

Injured athletes may benefit from a longer, harder or more specific warm up and
stretch routines than other athletes. Time and care is needed at the injured site
and surrounding tissue area to ensure adequate flexibility, blood flow and
readiness to perform. Warm ups can be specifically designed by the athlete,
coach or physio to minimise the chance of injury.
- Specific warm up focused on preparing the injury site for the
proceeding impacts of play.
May include:
Extra or varied stretches
Strength work
Concentrated warm up.
Warm-ups should move from general movements to specific movements
and be at least 15 minutes in duration
For example
A sprinter who has torn a hamstring should perform additional
stretches for the hamstring and quadricep muscle groups
Due to the varying nature of all sports, each sport had its own return to play

policies and
procedures

policies and procedures. This is a result of the different risk factors involved in
each sport. Examples include:
- Rugby union: concussion- cannot return to play for 3 weeks
Q
- Blood rule: in netball and other sports
Q
- Injury report
Q
- E.g. netball NSW return to play policy:
Q
NSW Netball INJURY PROTOCOL:
If you injure yourself at either Association, State Team, ANL, gym or home training
follow the procedure below:
1. Rest, Ice, Compression, Elevation
2. Inform your state league and representative coach/es and the NNSW high
performance manager straight away
3. diagnosis from practitioner e.g. doctor or physio to complete notice of
treatment form
4. copies must be given to your managers / coach/es to have an awareness of
your rehabilitation
A clearance from your sports physiotherapist or sports physician must state you
are cleared to train or play.

critically examine policies

and procedures that
regulate the timing of
return to play, considering
questions such as:
why
arent such
policies applied
to all sports?
who
should have
ultimate
responsibility for
deciding if an
athlete returns
to competition?
shoul
d athletes be
allowed to use
painkillers in
order to
compete when
injured?

ethical
considerations,
eg pressure to
participate, use of
painkillers.

Pressure to Participate
The decision to return to play has short term and long-term considerations. If the
athlete does not allow for an appropriate recovery period after injury they place
themselves at further risk of complications to the area of injury. Various internal
and external pressures push athletes to make the decision to return to play.
Internal Pressures include:
Boredom
A drive for success
A fear of loosing ones position in the team
A sense of letting down the team
External Pressures include:
Financial pressures
Pressure from the media
Pressure from sponsors
Expectations of other players, family or the coach
Pressure from spectators
If an athlete returns prematurely after injury it might cause the injury to become
further established. This will extend necessary recovery time, and the athlete ends
up losing more time than needed if they had appropriate recovery time initially.

Pain killers:

Athletes experiencing pain but wishing to return to sport may use painkillers.
However, painkillers may result in more extensive injuries as they mask the bodys
natural response to the injury.
Q
Pain-killing injections - desensitise the damaged area:
Make athlete unaware they are doing further damage
Prolong the healing process
May lead to permanent damage
Becoming more common in sports
The pressures on athletes to return to performance increase through the use of
these medications
- Pain-killing drugs are attractive to athletes and for clubs who rely financially on
their athletes taking the field
- With financial and various other pressures increasing, and with advances in drug
technology, the use of medications to allow athletes to return to play before full
recovery is an increasingly important issue.

research and evaluate skill and other physical tests that could be used to indicate readiness to return to play