Tip of the month
"
Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If you Quit, however, it lasts Forever"
Injury Process
Acute stage (inflammatory phase) 24 to 48 hours (PRICE)
1. Injury occurs
2. Blood vessels get damaged, causing bleeding
3. Cells die due to lack of nutrients and O2
4. Chemicals are released causing a chain reaction
5. Initial Vasoconstriction occurs, (lasting from a few seconds to a few minutes)
6. Lymphatic vessels constrict to limit fluid loss
7. Coagulation factors are released, causing platelet aggregation at the site of injury
8. Platelets release the enzyme Thrombin which in turn changes Fibrinogen to Fibrin
9. Fibrin lays down a sticky mesh to trap dead cells causing a blood clot
10. Within hours, Histamines are released from Mast cells causing vasodilation swelling
11. Plasma flows into damaged area causing erythema, oedema and the production of Exudate
12. Phagocytes then clear away debris by ingesting the particles and breaking them down
13. Sticky matrix formed (scab)
Sub Acute stage (repair phase) 72 hours to 21 days
1. New blood vessels begin to form (3 days post injury)
2. Fibroblasts migrate to the area of revascularisation laying down collagen fibres haphazardly
3. Collagen fibre starts to re-align
4. New Lymphatic vessels are formed, assisting with drainage of excessive tissue fluid/debris
5. Collagen fibres contract and begin to form scars
Regeneration stage (remodelling phase) 21 days to 3 years
1. Collagen fibres continue to contract
2. Scar tissue begins to mature and shrink, (this may take up to 3 years following injury)
3. Collagen fibres continue to align with tensile stress
Initial Management of Soft Tissue Injury (PRICE)
P - Protection - Refrain from all painful positions or activities, injured part should be immobilised and non-weight bearing (NWB).
R - Rest - Rest should be 24/48 hours or longer depending on severity of injury, this is essential in the Inflammatory Phase of an injury.
I - Ice - Ice will reduce bleeding, swelling and pain (analgesic effect). It slows down the bodies metabolism, decreasing cell death, limiting the area of damage. Ice should be applied immediately or within the first 20 min of injury and for 10 - 20 min every 2 hours during the day for 24/48 hours or longer.
C - Compression - This reduces the amount of space available for swelling and offers counter pressure to the injured site reducing blood flow.
E - Elevation - Enables gravity to assist in the return of blood and tissue fluid back into general circulation.
Common Injuries
Fractures
Tibia, Fibula and ankle are the most common (immobilisation in plaster).
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Meniscus
Common in contact sport, often combined with ligament injuries (arthroscopy) surgery
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Problems relate mostly to soft tissue injuries
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Fractures
The Clavicle and upper part of the Humerus are most prone to fracture (immobilisation in plaster).
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Shin splints
Stress fractures, Periostitis inflammation of the periosteum, Compartment syndromes (rest)
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Chondromalacia patella CMP
Softening of the articular surface of the patella, (avoid activity that causes the problem)
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Quadriceps
An extrinsic blow to the quads could lead to the formation of Myositis Ossificans,calcification in the muscle (rest)
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Shoulder joint
Types of dislocations:- Anterior, Acromioclavicular (AC), Sternoclavicular (SC),(Manipulation, Rehab)
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Tennis leg
Strain in the calf muscle, will have difficulty in contracting the muscle (RICE)
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Osteochondritis dissecans
Loose bodies in the knee joint, pain and a locking sensation, limited ROM (arthroscopy) surgery
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Rectus femoris
More common as this is a bi-axial muscle, caused by kicking or explosive movements
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Frozen shoulder
(Adhesive capsulitis)
Affects females more than males, ROM will be poor
(massage, METs and ice)
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Achilles Tendon ruptures
The most common tendon injury, total or partial, total requiring surgery (gunshot sound) partial (RICE)
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Osgood-Shlatters disease
Traction of the patella tendon where it inserts into the Tibial Tuberosity (rest, massage)
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Hamstrings
Caused by eccentric loading mainly by slowing down from running speed
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Impingement syndrome
Trapping of soft tissue under the Acromium process, leading to painful inflammation caused by excessive overuse (RICE)
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Achilles Tendinitis
Inflammation of the Achilles tendon as a result of prolonged and repeated loading (RICE)
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Jumpers Knee
Anterior knee pain, junction of Quads tendon where it attaches to the superior pole of patella (RICE)
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Adductors
Simply a groin strain caused by an explosive movement
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Ruptures of
supraspinatus tendon, long head, Biceps tendons
partial (rest, followed by strength exercises)
Complete (surgery)
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Achilles bursitis
Inflamed bursa (fat pad) of the Calcanus, caused by prolonged pressure against tendon (RICE)
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Runners Knee
Pain on the lateral Femoral condyle, where the iliotibial band starts to create friction, tight ITB (RICE, massage)
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Piriformis syndrome
When weakened, the Piriformis can become tight, it can impinge on the Sciatic nerve creating pain (massage, stretching)
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Inflammation of soft tissue around shoulder
Muscles repeatedly overloaded will start to become inflamed, causing tendinitis in and around the insertion (RICE)
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Osteochondritis dissecans
Loose bodies in the ankle joint, pain and a locking sensation, limited ROM (arthroscopy) surgery
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Bursitis
Common in areas of excessive friction, inflammation around knee joint (RICE)
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Overuse injuries
Soft tissue around the hip can also become prone to overuse injuries due to prolonged periods of exercise (RICE)
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Plantar Fasciitis
Ligaments become inflamed in the foot from Calcanus to the 1st metatarsal inside of arch (ultrasound, ice, massage, taping and strapping)
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Ligaments
Cruciate and Collateral ligaments, are the most common cause of injury in the knee (RICE, strength exercises) surgery may be required
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Ligaments
Talofibular
Calcaneofibular ligaments, test for laxity, (RICE, immobilisation)
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