INTRODUCTION:
Participation in exercise and sport is on the increase today. The "science" of sport has developed from man's desire to perform at increasingly higher levels. Even at grass-roots level athletes are more aware of training strategies and the need to achieve fitness levels specific to their particular sport.
In their efforts to reach "perfection" many athletes many athletes push themselves beyond their safe limits. Although the primary outcome of organised physical activity should be positive in terms of health and fitness benefits, it is true to say that injury does occur when exercising, or during sport. There can be many reasons for this, some of which fall outside the control of the athlete or coach.
Although many injuries cannot be predicted, a greater number can be prevented. Indeed in most cases prevention is better than cure.
Creating a well thought out practical sports medicine strategy within the sports club is fundamental to giving the athletes the care and respect they deserve.
THE TEAM APPROACH
The players in the sports medicine team can be many or few depending on such factors as levels of participation, severity of injury, or indeed financial assistance available to the club. At the centre of any care programme is the athlete.
Members of the sports medicine team involved may include first-aiders, sports therapists, chartered physiotherapists, doctors, podiatrists club coaches, family friends and team members. It is crucial, however, from youth level to professional sport that an integrated approach to sports first aid is established within the club.
SPORTS MEDICINE PRINCIPLES
Injury Prevention
How to manage the on-field injury
Common First-Aid Principles
Section 2
Prevention Of Injury
Whenever possible, measures should be taken to ensure the possibility of injury is kept to a minimum. This applies to athletes at every level of competition. This session of the course will look at some of the main ways in which injuries can be prevented.
N.B. Not every athlete will necessarily benefit from, nor indeed require such attentions. Very often it is a question of finance, lack of knowledge and/or poor coaching. This further raises the question: "Whose responsibility is it?"
TASK: Look at the following sub-sections and decide which preventative measures you have already put into place and decide which of them you could introduce for the care of your own athletes. Write them down, then, being critical, analyse your role.
2.1 Screening
• Those beginning to exercise for the first time, or perhaps returning after an extended period of ill health should have a Medical Check-up to ensure they are healthy enough. This can be done by your own local G.P or Club Doctor.
• Fitness Testing is a very useful method of determining whether an athlete is ready to return to training and competition. It can be used to measure how effective your training programmes have been.
A good test will include the following elements:
• Anthropometric Analysis
• Lung Function
• Strength/Power Tests
• Aerobic and Anaerobic Endurance Test
• Health Monitoring
• Blood Lactate Analysis
• A Detailed Questionnaire (lifestyle, medical history, activity levels etc.)
These tests are usually Laboratory based and are consequently quite expensive. That does not mean they are beyond the reach of the "grass-roots" competitor.
An alternative to these are Sports Specific Field Tests. These usually involve specific measurements of the physical components of fitness, which an athlete requires for his/her chosen sport. They are normally carried out by the coaching staff at the training ground.
2.2 Fitness
The term "fitness" means different things to different individuals and will vary depending on factors such as level of health, age, training level, motivation, nutritional awareness etc.
Athletes tend to be "creatures of habit". Fitness should be considered in more than just physical performance. Mental, social and even spiritual fitness can all play a significant role in determining how the individual performs.
REMEMBER:
• Fitness is an individual thing.
• Levels of fitness vary more amongst athletes who compete at lower levels. This should not be accepted as the norm however.
• Sports-specific fitness. This is important when designing rehabilitation programmes.
• Design appropriate training programmes to suit the athletes within your club. These will probably include general team and individual fitness.
• Following injury, ensure the athlete can continue with some general conditioning work. This should maintain general aerobic fitness but at the same time should not interfere with the actual injury.
When designing fitness programmes, the following Physical Components should be considered:
• Endurance – Aerobic & Anaerobic
• Strength
• Flexibility
• Speed
• Co-ordination & Balance
• Skill Acquisition
• Power
• Agility
2.3 Coaching
As a coach you may feel that sometimes everything is left to you. By attending this course it shows you have a genuine interest in learning more about the overall care of your athletes. Here are a few things to think about:
• Make sure your safety measures are in place and that all concerned are aware of them.
• Educated your athletes, fellow coaches, parents etc.
• Delegate to others to take care of some of the important preventative measures e.g. equipment and venue checks. Athletes should take more responsibility for their own injury prevention.
• Remember, match your training loads to the abilities and fitness levels of your charges.
• Be aware of the signs of over-training
• Consider the requirements of young children / pre-pubescent athletes.
• Attempt at all times to maintain discipline and have good control over every situation.
REMEMBER – "Failing to Plan means Planning to Fail!"
• Be aware of Controversial or Contraindicated exercises. This is crucial, particularly with younger athletes, when joints can be lax, muscles tight and strength not yet matured.
• Make sure everyone involved understands fully the Rules governing your particular sport. Many rules have been introduced in recent years in an attempt to minimise the risk of injury. These should be enforced at all times.
2.4 Selection Procedures
Choosing the right form of physical activity can be a difficult task for many people. Below are some of the factor that should be taken into account to reduce the chance of injury.
• The individual’s Somatotype
• Anatomical/biomechanical abnormalities e.g. Hyperpronation (flat feet)
• Individual personality traits, levels of interest, competitive pressure
• Parental influence
• All children develop physically at different rates. Not every 13 year old is the same size nor necessarily possess the same skill levels. Mis-matching may produce injury, particularly in the more dangerous contact sports.
• Fitness Levels: Choose an activity that matches the individual’s level of fitness. Many beginners drop out of sport because they have had a ‘bad experience’ first time around. Too often this results in unnecessary injury from doing either too much exercise and / or incorrect exercises. (A perfect example is weight-lifting).
• Do not match beginners with more experienced individuals!!
2.5 Warm-Up and Cool-Down
Both "warm-up" and "cool-down" play important roles in injury prevention. So why are they so neglected amongst athletes? The purpose of each our outlined below:
WARM-UP
• To increase body temperature
• To increase circulation to working muscles
• To increase heart rate slowly and safely
• To stretch muscles, tendons and ligaments
• To increase general mobility
• To practice specific skills in order to complete both physical and mental preparation
HINTS
• Your warm-up should contain both general and specific exercises
• It should be varied and at the correct intensity. Avoid undue fatigue
• Make it interesting. A good warm-up will gradually give way to actual skin practice
• Allow individuals to express their own specific needs
• Timing is important
• Be aware of climatic conditions e.g. heat, cold, rain etc. Ensure adequate clothing is available during the warm-up, at half time and after the competition
TASK: Analyse the "warm-up" you use within your own club setting. How could it be improved and/or changed?
COOL-DOWN
Done at the end of the session this is designed to:
• Slowly decrease the heart rate.
• Prevent ‘pooling’ in the primary muscles which can give rise to muscle stiffness or soreness.
• Activities should be rhythmically continuous and gentle in intensity.
• Slowly stretch muscles which have become shortened by the physical activity.
HINTS
• Cool down does not last as long as the warm-up.
• It can be used as a period of personal reflection and analysis or just simply to help the athlete to ‘calm down’.
• Massage will help, but will not replace the effects of a good cool-down.
2.6 Equipment, Facilities and Clothing
Nowadays the market for sports equipment and clothing results in an ever increasing array of companies promoting their products. Very often the athlete ends up paying for the name, the corporate sponsor which raises the question: "Do you get what you pay for?"
Good quality equipment will prevent injury in most situations. Check the following:
• It has clear instructions.
• It passes both International safety guidelines and your governing body’s guidelines.
• It is checked regularly.
• It is serviced regularly by a professional.
• Any protective equipment should be checked to ensure it fits individual athletes. Can it be adjusted to allow for growth?
• It does what it says it does. If you are not sure get it tested!
• Make sure you know how to use it.
FOOTWEAR
• Should be appropriate for the chosen sport, the individual and the type of playing surface.
• Shop around when buying shoes. The most expensive is not necessarily the best.
• Running shoe design is ever changing. It can be a daunting task trying to choose the right shoe. Consider the following:
o Miles per week
o Foot mechanics
o Type of surface(s)
o Running style
o Body weight
o Previous injury
N.B. DO NOT RUN IN CROSS-TRAINING SHOES!
Most good shoe outlets should be able to tell you the right type of shoe that you require. If you are in any doubt, don’t purchase!
FACILITIES
• Different playing surfaces can present the athlete with problems that could result in injury e.g. changing from a soft running surface to a hard one; playing your sport on consecutively different surfaces i.e. grass, wood, concrete, shale and synthetic carpet.
• Ensure the playing area is regularly checked and is safe for play.
• Indoors, consider things such as temperature, lighting etc. make sure your athletes are wearing the correct footwear for the chosen surface.
2.7 Other Considerations
2.7.1 Treatment And Rehabilitation
• Prevention of re-injury begins as soon as the athlete begins a proper treatment and subsequent rehabilitation programme. Ensure you give the correct advice immediately following the injury and that quick referral to a Doctor and / or Chartered Sports Physiotherapist is carried out.
• Once the athlete has begun their rehabilitation make sure they receive adequate supervision and support. Keep communication lines open with any other members of the ‘team’ involved in their care.
2.7.2 Psychological Factors
• The ‘injury-prone’ athlete is not necessarily just a physical problem.
• With so much pressure on athletes today the role of the sports psychologist is becoming more evident.
• Athletes suffering from Stress could be at risk of injury. This is particularly evident in children and young athletes who may be ‘victims’ of their own talent.
2.7.3 Nutritional Requirements, Ergongenic Aids and Performance Enhancing Drugs
• The amount of scientific research and conflicting ideas about the perfect diet for athletes could fill this booklet over and over again. Unless you have a particular desire to become an expert nutritionalist here are a few guidelines:
• Ensure your athletes receive a sufficient calorie intake to match their training loads.
• Be careful when training occurs in the evenings.
• Pre-competition eating should be carefully monitored.
• Fluid replacement is essential. Athletes on the whole do not drink enough. But beware if the so-called miraculous sports drinks. Take advice on the electrolyte and carbohydrate content of any rehydration product you intend using.
• Some dietary supplements that claim to enhance performance may be placebos. Nevertheless because of the amount of conflicting ideas about nutrition they remain very popular with athletes at all levels who strive for that magical ‘quick cure’. They should not replace a well balanced diet.
Besides that, consider this: the famous athletes who endorse the products are paid a lot of money to do so. Even they don’t all compete at the same level within a particular sport.
• Injury is more likely in athletes who are overweight. This places more stress on the musculo-skeletal system and makes the individual slower.
• You have a responsibility to ensure that the athletes in your care are aware of the rules concerning banned drugs and doping. Guidelines and lists of drugs can be obtained from the Sports Council. Athletes should carry the list of drugs with them at all times in case they require medical treatment or prescription medicine for example.
Section 3
Classification of Sports Injury
3.1 Soft Tissues
• Most frequently injured during sport are the Soft-Tissues: Muscle, Ligament, Cartilage, Tendon, Skin and Blood
• Injury to bones and joints are also frequently involved.
• The common soft-tissues like muscle, tendon and ligament are made up of the same basic proteins Elastin and Collagen which, depending on its amount, confers its common properties upon the tissue e.g. strength, elasticity, support etc.
• Injury to the internal organs is less common but invariably more serious.
Injuries will often take place in sport despite precaution being taken. Sometimes they are impossible to predict or prevent, e.g. contact sports, extreme sports, adrenaline-pumping high-risk sports.
• Sport is actually statistically extremely safe.
• A large majority of sports injuries admitted to Accident & Emergency Units do not require admission. They are in the most minor in severity and are discharged forthwith. Most commonly these injuries are to joints, muscles, ligaments and tendons.
• Unfortunately, follow-up advice on sub-acute care, treatment and rehabilitation for the athlete, who attends a busy Accident and Emergency Department, is often absent.
3.2 Basic Categories
• Acute Injury: This is a sudden injury when the athlete is immediately aware something has happened. The effects are felt very quickly e.g. pain, (sharp, burning, severe), swelling, bruising (Haematoma, Local Haemorrhage) and open wound, fracture etc.
• Overuse Injury: Sometimes known as the Chronic injury, this has a much slower onset and is often much more difficult to assess as the causes can be very subtle. Consequently they are very often mis-diagnosed / treated incorrectly. They are directly associated with some type of repetitive activity, e.g. most injuries sustained by runners are of the overuse type.
3.3 Extrinsic and Intrinsic Injury
Both acute and chronic injuries can be further classified by considering the 2 main Causes i.e. Extrinsic (direct) and Intrinsic (indirect).
ACUTE
E I
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T T
R R
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S S
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C C
CHRONIC
Section 4
How to Deal with Injury
At some stage you will probably be faced with the situation whereby an injury occurs and it is your responsibility to deal with it. Here are a few guidelines which will make things much easier for you:
• PLAN beforehand – it is better to be prepared in the event of injury. Check your first-aid kit / facilities, equipment, evacuation procedures etc.
• Be VIGILANT – many injuries occur quickly. DO NOT ‘follow the ball’. If you can remember that exact incident leading up to the injury this information could be of great help to the paramedical professionals, physiotherapists etc.
• DON’T PANIC – take control and be decisive. If you remain calm it will reassure the injured athlete and those around you.
IF IN DOUBT – DO NOTHING!
In the event of a more serious injury where the casualty cannot be moved, it is better to wait until the ‘professionals’ arrive.
REMEMBER: it is not your job to Diagnose the injury. You will ‘have a go’ if you suspect the injury is life threatening.
Thankfully the incidence of sudden death and / or potentially fatal injury in sport is relatively minor. More often than not the coach or trainer is faced with the dilemma of having to decide whether or not an athlete who is in pain should continue to play or be brought off. The following regime may help you to decide.
4.1 The S.A.L.T.A.P.S. Regime
Remember the mnemonic - S.A.L.T.A.P.S.
S: STOP play. If the player has gone down injured get there as quickly as you can. (Check with the referee beforehand the rules regarding access).
A: ASK the player (unless unconscious) what happened. Remember, as detailed a history as possible will be important. Be aware of facial expression, posture adopted etc as this may indicate the degree of pain (and hence the severity of injury). Is the player talking sensibly?
L: LOOK at the specific limb. Be vigilant for obvious signs e.g. bleeding, discolouration / bruising, immediate swelling, bone / joint deformity, muscle spasm.
T: TOUCH the injury site only if the athlete will let you. (Again this can indicate just how serious the injury may be.) Palpate gently to find the site of pain – note the athlete’s response. Do not be sadistic in your handling.
A: ACTIVE movement: can the athlete move the limb painlessly through the full range of movement?
P: PASSIVE movement: Only if ‘A’ above applies attempt to move the joint to the end of its range and note the response. (Techniques for these movements will be dealt with in practical sessions.)
S: STAND-UP and Play-on: Can the player resume immediately or are they trying to ‘run-it-off’. In both instances keep a close eye on them to make sure they recover fully and quickly. Be prepared to replace them.
REMEMBER:
• If you follow the basic steps above you will not do any harm.
• If you have sole responsibility for the athletes in your care, then do not be afraid to make the decision that a player must ‘come off’. It is better to be safe now than sorry later.
• Do not forget to |
