This was a conference powerpoint presentation for Nurse Practitioners A&E, Practice nurses and relevant staff in Sussex trusts about Minor injury care. This gives an overview of possible treatments and not an in depth lecture

Harmsworth, Mark

English

Bournemouth University Research Online

Rehabilitation and Treatments of Sports InjuriesbyMark HarmsworthPrinciples of Rehabilitationz Prevention is better than curez Needs a whole body approach and is aimed towards the individualz Aim is to return to sport with full function. There is constant pressure to facilitate the safe return to competition / activity in the shortest time possiblez Effective planningz Commences immediately following injury and post return to activityz Must integrate a range of therapeutic activitiesz Stages – initial, intermediate, advanced and return to sportz Look for and correct any found biomechanicalabnormalitiesPrinciples of Rehabilitation / Treatmentsz Musculoskeletal injuries can have immediate and significant detrimental effects on functionz Must integrate a range of therapeutic activitiesz Soft tissue response, muscle conditioning, flexibility, neuromuscular control and functional exercisesz Psychology targetz Return to sport skillsz Maintenance is often required to prevent reoccurrenceProprioceptionz Sensorimotor controls all activities and enables an individual to maintain a position (neuromuscular)z Is a sensory feedback mechanism for balance and controlz Body reacts to incoming information and the feedback mechanism adjusts balance and movement controlz When proprioception is poor, so will be biomechanical controlz There is a real needto restore early proprioceptive input to the injured areaz Is not stressful to healing tissuez Exercises varies to achieve aimsRehabilitationz Motor control stability training, addresses altered patterns of muscle recruitment and seeks to improve fine tune muscle coordination and improve the efficiency of movementz Example – trained using slow sustained contractions at low loadsz Strength training – in relation to functional performancez ROM enhancement -small limitations can have a profound effect – best use static stretching exercisesz Fitness / endurance Treatmentsz Clients should benefit from the appropriate element of the available treatmentsz The most important time of acute STI is the first 24 – 48 hoursz RICEz PRICEz MICEz Immobilization first and early mobilizationz Protected mobilizationz Continuous passive motion mobilization and exercise therapyz Heat used on longer term injuries can be helpful in selected conditions, but NOT on new injuriesSoft Tissue Massage / Therapyz Sports massage therapy involves manipulation of soft tissuez Designed to assist in correcting problems and imbalances in soft tissue, that are caused from repetitive and strenuous physical activity / traumaz Very underestimated to the general sports personz Aims to enhance performance, aid recovery and prevent injuryz Sports massage practitioners need qualificationz Can self massageSoft Tissue Techniquesz Palpationz Stroking (effleurage)z Kneading (petrissage)z Squeezingz Frictionz Rocking and shakingz Percussion (tapotement)z Neuromuscular technique (NMT)z Muscle energy technique (MET)z Soft tissue release (STR) – trigger pointsz Connective tissue manipulation (CTM) –myofacial techniquesEffects of Sports Massage Techniquesz Stretches soft tissuez Relieves muscle tensionz Improves flexibilityz Reduces muscle spasmz Improves formation of scar tissue, adhesions and fibrous tissue, created by scar tissuez Reduces swelling z Relieves painz Increases general / micro blood circulation and lymph flowz Increases oxygen and nutrients to soft tissuez Helps tissue flexibility andinterstitial permeabilityz Removes waste productsz Stimulates the nervous systemz Relieves tension / anxietySoft Tissue Therapy Contraindicationsz Acute soft tissue inflammation (within 48 hours)z Wounds / recent surgeryz # / dislocations and joint injuriesz DVT / Varicose veinsz Infectious skin conditionsz Skin, tumours and other cancersz Bleeding disordersz Myositis ossificansz Caution in diabeticsz Caution in pregnant womenz Cardiovascular type conditionsDiagnostic Musculoskeletal Ultrasound Scanz Imaging tendons, ligaments, muscles and other soft tissue e.g. achilles, patella, rotator cuff tendons, muscles thigh / calf, hamatoma formation, calcification, localizing foreign bodiesz Real and short time, biofeedback advantagez Has less graphic images than other methods thoughz Larger structures good but not deep tissuesz MRI scan alternativeUltrasound Therapy / Electro Muscle Stimulationz Can help to speed up the repair process of soft tissuez Therapeutic U/S of 1MHz = 1 million cycles per secondz Power in Wattsz Continuous (chronic) or pulsed (acute or close to bone) as it reduces heatz Effects – heat and oscillation of particlesTherapeutic uses :-z Helps absorption of intercellular tissue fluidz Increased blood supplyz Analgesia effectsz Softens fibrous tissuez Other types – Tens, interferential stimulation, and low level laserCorticosteroids Injection Therapyz Treatment of some musculoskeletal disorders, usually given with a local anaestheticz Suppresses inflammationz Breaks up inflammation damage – repair – damage cycle (bridge)z Kenalog / adcortyl corticosteroid are normally usedz Lidocaine local anaesthetic normally usedz Most feared complication is joint sepsisTaping / Strappingz Used for prevention, treatment, rehab and proprioceptionz The application of tape to injured soft tissue / joints provides support and protectionz Minimizes pain and swelling in the acute stagez Tape should reinforce the normal supportive structures in their relaxed positionz Should protect the injured tissues from further damagez Functional fascial tapingz Only has limited use during active sport, as it loses support quicklyOther Treatmentsz Glucosamine (500 mg +)z Used in the body to form new connective molecules (help repair)z It stimulates growth of cartilage and hydrates tendons and ligaments (protection)z Chondroitin (300 mg +)z Keeps cartilage filled with fluid, nourishing and hydrating itz A combination of both will help restore synovial fluid and all the other effectsz May take 2 months for benefits to be feltz May reduce muscle sorenessz Topical analgesics usually acts as a skin counter-irritantz Topical anti -inflammatory agentsDevelop Active Lumbar Stabilityz 3 overlapping stagesz Phase 1 (muscle re-education)z Voluntary control over stabilizing muscle (deep abdominals, gluteals, intersegmental muscle spine and multifidusz kneeling (four point) / prone lying abdo hollowing exercisez Phase 2 (building core stability control)z Heelside (hollowing), plank (bridge) - lateral and pronez Phase 3 (reduced attention) impose spine alignment and muscle stabilise to realignz Resistance training in gym, balance board and swiss gym ballTypes of Muscle Contractionz Isometric – muscle works without movement happening i.e. muscle does not change length (stretching exercises)z Isotonic – muscle force is constant but muscle length changes. Commonly used by strength exercises (WT machine / free weights)z Isokinetic muscle contraction at a constant speed over the full ROM (special machines)z Eccentric - muscle is stretched as it tries to resist a force pulling the bones of attachment away from each other. Lengthening while contractingz Concentric - muscle shortens to move the attachments closer (contracts to move a weight)Stretchingz Tight muscles can cause problems, while poor flexibility is associated with increased injury riskz Muscles work in pairs, so it effects more than 1 musclez Logical to increase and maintain flexibilityz Frequent daily stretches will help lengthen musclesz Held for 15 – 30 seconds & repeated 3 – 5 timesz Static stretching - hold a position, that is the farthest point and hold. Using prior to running type exercise, is now questioned, if it increases injury risk. z Dynamic stretch, simulates the muscles for the activity you are warming up forz Stretching post exercise is very importantReferencesz Alter, M., 1998. Sports Stretch. 2nd ed. USA : Human Kinetics. z Anderson, M, Parr, G, Hall, S., 2008. Foundation of athletics training. USA : Lippincotte, Williams and Wilkins.z Beil, Andrew., 2005. Trail Guide to the body. 3rd ed. USA : Books of Discovery.z Brukner, P and Kham, K., 2007. Clinical sports medicine. 3rded. London : McGraw-Hill.z Cash, M., 1996. Sports & Remedial massage therapy. London : Ebury Press. z Field, D and Hutchinson, J., 2006. Anatomy palpation and surface marking. 4th ed. London : Elsevier.z Fox, S and Pritchard, D., 2003. Anatomy, physiology and pathology for the massage therapist. 2 ed. Gloucestershire : Corpus.z Kendall, F, McCreary, E, Provance, P., 2005. Muscle testing and function with posture and pain. USA : Lippincotte, Williams and Wilkins.Referencesz Macdonald, R., 2004. Taping Techniques. 2nd ed. London : Butterworth – Heinemann.z Moore, K and Dalley, A., 2006. Clinical oriented anatomy. 5thed. London : Lippincotte, Williams and Wilkins.z Norris, C., 2004. Sports Injuries. 3rd ed. London :  Butterworth  - Heinemann.z Paine, T., 2007. Sports Massage. 2nd ed. London :  A&C Black publishers.z Palmer, L and Epler, M., 1998. Musculoskeletal Assessment techniques. USA : Lippincotte, Williams and Wilkins.z Peterson, L and Renstrom, P., 2005. Sports injuries. 3rd ed. London : Taylor & Francis.z Sanderson , M., 2002. Soft tissue release. Gloucestershire : Corpus publishing.z Saunders, S and Longworth, S., 2006. Injection techniques in ortho’s and sports medicine. 3rd ed. London : Elsevier.Journals - Sportex Dynamics and Sportex Medicine

Rehabilitation / treatments of sports injuries

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