Transcript Injuries and the Healing Process

Injuries and the Healing Process
Olympic High School Sports
Medicine
Chapter 12,13
Vocabulary Chapter 13
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RICE
Muscle
Tendon
DOMS
Myositis
Fasciitis
Ectopic calcification
Creptitation
Synovia
Articulation
Osteochondrosis
Apophysis
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Osteoblasts
Osteoclasts
Wolff’s law
Callus
Mechanoreceptors
Muscle guarding
Trigger point
Open fracture
Closed Fracture
Types of Injuries
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Strains/Sprains
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Grade 1- slight stretch but no deformity,
mild to mod. Pain, localized swelling
Grade 2- some tearing of fibers, mod.
Instability, mod. Severe pain, swelling
Grade 3- total rupture, major instability,
severe pain at first then little or no pain,
swelling is great
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Contusion
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Bruise, hematoma, ecchymosis
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Tendinitis: inflammation of tendon
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Overuse injury, pain, swelling, crepitus
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Bursitis: inflam. Of bursa
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Swelling, pain, increased pressure
Tenosynovitis:same
as tendonitis but
 Wound Injuries:blister, abrasion,
inflamed
laceration, skin avulsion, incision, puncture tendon/synovial sheath.
Types of Injuries continued: fractures
Types of Injuries continued
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Muscle Cramps/spasm: muscle contraction/tightness due to fatigue
or injury
Myositis Ossificans: calcification of muscle due to excessive
bleeding.
Dislocation: complete displacement of bone with the joint
Subluxation: partial displacement of bone with the joint
Epiphyseal Injuries: growth plate injuries. Salter fractures for
epiphyseal fractures
Nerve Injuries:
– Hypoesthesia: a diminished sense of feeling
– Hyperesthesia: an increased sense of feeling such as pain or touch
– Paraesthesia: numbness, prickling, or tingling, which may occur from a
direct blow or stretch to an area
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Kyphosis: round back, forward-thrust head, winged scapulae, flat
chest. Tight pectoral muscles
Lordosis: sway back or hollow back. Tight lower back muscles with
weak abdominal muscles. Lineman or gymnasts most susceptible.
Scoliosis: lateral curvature of the spine
Genu Valgum: knock knee
Genu Varum: bowleg
How do injuries happen?
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What are the
possible
injuries that
can happen
in this slide?
Mechanical Forces and Strengths
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Compression Force: A
force that with enough energy
crushes tissue. A contusion
occurs if too much force is
applied
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Tension Force: a force that
pulls and stretches tissue.
Sprains/strains, avulsions,
ruptures
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Shearing Force: a force
that is transverse to fibers.
sprains
Example of injuries
Pain
– Two types of soreness
» Acute-onset muscle soreness - accompanies fatigue, and is
transient muscle pain experienced immediately after
exercise
» Delayed-onset muscle soreness (DOMS) - pain that occurs
24-48 hours following activity that gradually subsides (pain
free 3-4 days later)
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Potentially caused by slight microtrauma to muscle or
connective tissue structures
– Prevent soreness through gradual build-up of
intensity
– Treat with static or PNF stretching and ice
application within 48-72 hours of insult
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Muscle Stiffness
– Does not produce pain
– Result of extended period of work
– Fluid accumulation in muscles, with slow
reabsorbtion back into bloodstream, resulting in
swollen, shorter, thicker muscles --resistant to
stretching.
– Light activity, motion, massage and passive
mobilization assists in reducing stiffness
Vocabulary
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Vasoconstriction
Vasodilation
Regeneration
Phagocytosis
Serum
Synthesis/lysis
Cryokinetics
Modality
Conduction
Convection
Conversion
Inflammatory Response
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Occurs first for 3-4 days
Swelling, redness, pain, heat, loss of function.
This occurs to protect the body
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Acute Inflammation-
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Before inflammation begins intact blood vessels
vasoconstriction up to 10 minutes
Then blood coagulation begins to seal broken
vessels
Then vasodilatation- blood viscosity increases
slowing blood flow and swelling then serum
seepage 15-30 min.
Phagocytosis starts to clean out debris
Internal swelling: 1. Throboplastin is sent 2.
Thromboplastin and calcium is sent. 3. Thrombin
to fibrinogen into final fibrin clot
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Inflammatory Response
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Repair PhaseFibroplastic(scar formation)
Regeneration
Regrowth of lost cells
Last up to 3 weeks following
injury
Primary healing- heal around
edges
Secondary healing – gaps
heal toward each other
Remodeling
Increase scar tissue first 3
weeks
Last 3 months to a year
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Factors that impede
healing
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1. Extent of the injury
2. Edema/hemorrhage
3. Poor vascular supply
4. Separation of tissue
5. Muscle spasm
6. Atrophy
7. Infection
8. age
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Pain Perception
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Pain-
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Is described by: burning, sharp, dull, aching, tingling
Deep pain is different than superficial pain
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– How
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Psychological aspects of Pain
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Must treat the whole athlete
Personality differences plays a role in pain perception
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Referred Pain-
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Visceral pain has a tendency to radiate and give rise to pain that
becomes referred to skin’s surface
COLD AND HEAT
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Types of cold:
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Ice bag, ice massage, ice boot, cold whirlpool, ice bucket, chemical
spray
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Physiological effects of cold
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Decrease in local temperature up to 4”
Vasoconstriction of capillaries w/in first 15-20 min., vasodilation 5
min., vasoconstriction 20 min. (Hunting effect)
Decrease local cell metabolism
Decrease blood flow
Decrease nerve velocity
Decrease excitability of muscle
Analgesic effect (numb) which will decrease spasm
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Cold and Heat cont.
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Types of heat
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Conduction-transmission of heat between two objects
Convection-heat produced by a moving mass(gas or liquid)
Conversion-heat by electrical current
Radiation- ultraviolet light
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Physiological effects of heat
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Increase elasticity of muscles & tendons
Increase blood flow- vasodilation
Decrease spasm
Increase local cell metabolism
Increase excitability of muscle
Increase temp. to 3mm depth
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Indications of heat
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Post acute phase
Decrease spasm
Decrease pain
Help wound healing
Prior to exercise
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Contraindications
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Acute injuries
Hyper/hypo sensitive to heat
Circulatory problems
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Indications of cold
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Acute trauma
Anti-inflammatory
Decrease pain
Decrease spasm
Post exercise
Prior to therapy
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Contraindications
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Before or during activities
Hyper/hypo sensitive to cold
Circulatory inefficiency
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Different Modalities
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Heat Therapies
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Short-wave diathermy:
High frequency electrical current.
Used for: bursitis, capsulitis, osteoarthritis, spasm, strains
Heat depth= up to 2 inches
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Ultrasound:
High frequency sound waves causes molecules to vibrate and warm
Used for: joint contractures, scar tissue, tendonitis, bursitis, skeletal
muscle spasm, and pain
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Paraffin bath:
Hot wax used for extremities especially the hand.
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Massage Techniques:
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Effleurage- stroking, Petrissage- kneading, friction-heat, tapotementpercussion, vibration-rapid shaking
Contrast Baths and other
Modalities
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Hot and cold modality
Physiological effects:
Same as heat/cold
Flushing affect. Brings in new material for repair and flushes out
edema
When should you use contrast bath?
– When swelling has subsided (48-72 hours)
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Time interval for treatments
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4 min. cold then 1 min hot 4 times end in cold= 24 min.
3 min. cold then 2 min hot 4 times end in cold= 23 min
2 min. cold then 3 min hot 4 times end in hot= 20 min
1 min. cold then 4 min hot 4 times end in hot= 20 min
Or 5 min. cold/ 5 min. hot
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Treatment times and Temperatures
Ice bag, ice boot, ice whirlpool (55-65
degrees) - 20 min.
 Ice massage 5-10 min.
 Warm whirlpool (97-102 degrees), moist
heat pack –10 min.
 Ultrasound- 5-7 min.
 Muscle stim- 10-20 min.
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